by Dr. Tina Marcantel

The use of systemic enzyme therapy can be a good natural alternative to some pharmaceutical drugs for controlling pain, promoting healing, and boosting the immune system. Dr. Tina Marcantel is a naturopathic doctor in Gilbert, Arizona, who also serves the East Valley cities of Scottsdale, Tempe, Chandler, Mesa, Apache Junction, and Queen Creek.

This article originally appeared in the July issue of Naturopathic Doctor News and Review.

Pain is one of the most common and challenging complaints doctors are called upon to treat. Most of our patients present with some type of chronic pain from long-term illnesses such as fibromyalgia, diabetes, rheumatoid arthritis, or back injuries; many may also complain of acute pain from sports injuries or trauma from accidents. In my practice I have found that the use of systemic enzyme therapy can be a good natural alternative to some pharmaceutical drugs for controlling pain, promoting healing, and boosting the immune system.

When referring to enzymatic supplements, it’s important to distinguish between those used as digestive and systemic aids. Digestive enzymes are taken orally with food in order to help break down food for improved digestion. Systemic enzymes are taken orally in between meals. The timing of the medication is a crucial component of its success: the medication must be taken one hour or more before or after eating to obtain its full systemic effectiveness to reduce inflammation and pain. This way the enzymes can be absorbed in substantial quantities into the blood to promote the desired effects.

Research has shown that inflammation is usually a component of pain. By reducing inflammation in the affected area, pain is often alleviated in patients presenting with such complaints as arthritis, sciatica, and chronic back pain. Non-steroidal anti-inflammatory drugs like aspirin and ibuprofen used for this purpose are known to have ill effects on the liver, kidneys, stomach, and intestines, and the use of proteolytic enzymes offers a healthier alternative to these drugs.

In one double-blind clinical trial, 73 patients with painful gonarthritis received three weeks of systemic enzyme therapy with an oral enzyme preparation containing bromelain, trypsin, and rutin, or the NSAID diclofenac. The effects were measured using the Lequesne index measuring pain and function of the affected knee. The researchers found that “the Lequesne index improved continuously in both groups: from 13.56 at baseline to 3.10 after 3 weeks (end of therapy) to 2.05 at 7 weeks (follow-up) in the enzyme group, and from 14.04 to 3.50 to 2.24, respectively, in the diclofenac group. Statistical evaluation showed the treatment groups to be equivalent.” The conclusion of the study states that, “oral enzymes may be considered an effective and safe alternative to NSAIDs such as diclofenac in the treatment of painful gonarthritis.”*systemic enzyme therapy can help control pain

The use of systemic enzyme therapy can break down proteins in the body that can cause scar tissue and inflammation, thus decreasing inflammation, swelling, and pain associated with sports injuries like muscle sprains. This treatment has also been found to be effective in speeding wound healing. A 2004 study tested the use of an oral nutritional supplement containing proteolytic enzymes to determine its effect on soft-tissue healing times. “Twenty-six normal, healthy volunteers…were subjected to a 3-mm forearm biopsy and randomly received a placebo or oral supplement (four capsules per day for 7 days). After a 2-week washout period, a second biopsy was performed to start phase II, with each subject receiving the respective placebo or supplement capsules.” Wound healing was analyzed through digital photographs and measurements. Of the 22 patients who completed the trial, “…17 subjects had improved wound healing and five subjects did not respond or responded only slightly to the supplement treatment.” The resulting 17% acceleration of wound-healing was statistically significant. The authors concluded that the supplement being studied, “modulates the wound-healing process and suggests that many patients with minor soft-tissue wounds may benefit from treatment.”**

Click on this link to read a case study by Dr. Marcantel concerning this therapy.

Some proteolytic enzymes aid the body’s defense mechanisms by modulating the immune system because they exhibit an increased binding of several very important cytokines (hormone-like molecules that have a powerful influence on immune cells).

Another benefit of systemic enzyme therapy is that it can help maintain blood circulation throughout the body by breaking down blood clots and platelet aggregations within blood vessels.

Two important ingredients that may be included in systemic enzyme therapy blends are bromelain and papain. Bromelain is a protease derived from the pineapple plant and its actions help to prevent swelling and edema, to promote smooth muscle relaxation, to inhibit platelet aggregation, and to enhance antibiotic absorption. Papain, derived from the Carica papaya, is effective for the reduction of edema and inflammation and cytotoxin binding. It is also noted for the acceleration of wound healing.

As with any type of medication or supplement, systemic enzyme therapy should be monitored by a physician and assessed regularly for changes in appropriate dosages. The physician and patient should also be aware of any potential interactions among various medications being taken, particularly any type of drugs or botanicals that have anti-coagulant effects (see sidebar). It is also very important to get a thorough history before prescribing enzymes. In my clinical experience I have found that patients with gastrointestinal inflammation or ulcers may experience an adverse reaction to the treatment.


*Klein, G. and Kullich, W. “Short-Term Treatment of Painful Osteoarthritis of the Knee with Oral Enzymes: A Randomized, Double-Blind Study versus Diclofenac.” Original research article. Clinical Drug Investigation. 19(1): 15-23, January 2000.

**Brown, S. A., PhD., etal “Oral Nutritional Supplementation Accelerates Skin Wound Healing: A Randomized, Placebo-Controlled, Double-Arm, Crossover Study.” Plastic & Reconstructive Surgery. 114(1): 237-244, July 2004.