6 Best Digestive Enzymes

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

If you go to a pharmacy and ask for some kind of enzyme preparation, you will definitely need to clarify for what purpose you need it. After all, an enzyme, or enzyme, is a special protein that is not absorbed by the body itself and has no nutritional value. Its task is to significantly speed up chemical reactions hundreds and thousands of times.

Therefore, the pharmacist can clarify exactly what you need. After all, enzymes can be used in wounds and purulent-necrotic processes, such as trypsin and ribonuclease. Enzymes can thin viscous secretions if the patient has lung disease. There is a group of enzymes that thin the blood, dissolve blood clots, and are used in myocardial infarction. These are urokinase, streptokinase, fibrinolysin.

And finally, the group of enzymes that we need are drugs that improve digestion. They are numerous. These are gastric juice and abomin, pancreatin and pepsin, and many others. They are prescribed in the case when the own enzyme systems of the gastrointestinal tract are defective due to birth defects, or temporarily suffer from any disease.

Enzyme preparations that improve digestion: what is it?

All enzyme preparations described in the article are needed for only one thing: for replacement therapy. Substitution therapy is an attempt to supplement the lack of physiological function with the help of some compounds artificially introduced into the body, a kind of “prosthesis” of the digestive system. Enzymes are highly active, and can improve not only intestinal, but also gastric digestion.

In large numbers, all enzymes for improving digestion began to arrive in clinical practice and in pharmacies back in the 1970s. They are produced in the form of tablet preparations, all are well stored, and can be used both individually and in complex therapy for diseases of the pancreas, mild and severe diseases of the intestines, biliary tract, stomach and liver.

Modern enzyme preparations can be used in newborns, and in babies, and in adults. But still, the elderly and old people will most often consume enzymes, because for well-known reasons for the general weakening of vital activity, both the digestive function of the stomach and the enzyme-excreting function of the pancreas are weakened in them. They also suffer from intestinal peristalsis. What is included in modern enzyme preparations?

The composition of enzyme preparations

The vast majority of enzyme preparations contain digestive enzymes of animal origin, and almost always it is pancreatin, which is obtained from the pancreas of cattle, which are taken from slaughterhouses and sent to pharmaceutical factories. There is a second, more humane approach, not related to the destruction of animals. These are artificially synthesized enzymes that are obtained as a result of synthesis using industrial microorganisms.

Most preparations with bacterial enzymes are required to work with food masses in the stomach. Much less often, yeast enzymes, and even mold fungi, can be used in prescription drugs. Such a variety is required if it is necessary to help a patient with a certain disease, or to choose an enzyme that acts on a specific substrate, to choose the temperature regime of the enzyme.

These preparations may contain pepsin, bile, chymotrypsin, and they may differ in the amount of enzymes, for example, pancreatin. The well-known Creon, which is one of the best enzyme preparations, and which will be discussed later, can often be sold in several varieties. For example, Creon 10000, 25000, 40000. The number shows the specific strength, or the amount of enzyme in one tablet, and the larger the number, the greater the activity of the drug, the more severe the gastrointestinal tract it must be used.

In practice, preparations that contain several bovine enzymes are most often used, for example, dried pancreas tissue, pounded and cleaned. Of course, it would be possible theoretically to create a drug from a single high-purity enzyme without any additives, but the effort will be too expensive, and therefore, from the point of view of pharmacoeconomics, this is unprofitable. But if we are talking about enzymes artificially created by microbes, then this can be completely done, and even composed, like perfumery, a multi-enzyme composition.

European companies most often produce dragees or tablets; capsules are used in Asia. Children are recommended granules and powder to be added to milk formulas for newborns. Currently, there are enzyme preparations from 13 countries on the pharmacy market of the Russian Federation, ranging from Germany and France to Pakistan and even San Marino. However, the main supplier is Germany, which produces Creon, Pankreoflat, a complex drug that combines a drug that improves digestion and a remedy for bloating.

The market for enzyme preparations is a rather profitable business, because diseases of the digestive system account for 8% of all diseases, and the annual increase is about 2%. in absolute terms. This is about 20 million people. The reasons for the alarming increase can be called illiterate nutrition of schoolchildren and students, passion for fast food, and all kinds of hot dogs. Needless to say, the urban population has problems with digestion, and even those with an income above the average, allowing them to eat in fast food restaurants.

Criteria for a good drug

A high-quality, balanced preparation for improving digestion should have:

1. Data on enzyme activity, such as the amount of pancreatic lipase.

2. Creon has such data, and they were cited above. The instruction for each enzyme preparation should have information about the activity. So, if the patient does not have any chronic disease of the digestive system, and discomfort, bloating and heaviness are caused by an error in the diet, eating a large amount of fatty foods, then a small dosage of lipase, no more than 3500 units, will be enough. But in the event that there is an organic pathology, and the exocrine function of the pancreas suffers, for example, during an exacerbation of chronic pancreatitis, then drugs with a higher content of enzymes are needed, the same Creon, starting from 10000 units. The dose is always selected individually, depending on complaints and clinical symptoms.

3. A good drug should always be protected from the action of gastric juice, that is, have an acid-resistant shell. After all, it works in the duodenum.

4. Standardized content of enzymes among themselves. In addition to lipase, the active ingredient can be a protease that breaks down proteins, and an amylase that lyses carbohydrates.

5. The enzyme preparation should mix very well with food in the stomach, and simultaneously with the food bolus enter the duodenum, not earlier and not later.

6. After entering the duodenum, the enzyme must be released and begin to work.

If at least one of these stages fails, then the medicine will be ineffective. If it does not evenly mix with the food lump in the stomach, then the enzymes will not be able to work in the full volume of the lump, chyme. If the medicine remains in the stomach after the food has entered the duodenum, then there will also be no effect. Finally, if the enzymes are not activated in the duodenum, then the remedy will also have no effect.

Thus, the creation of a modern enzyme preparation is not an easy task. Anyone who thinks that it is enough to “roll” dried and powdered pancreatic tissue into a capsule is mistaken.

And now, before proceeding with the description of modern effective and popular drugs, let us recall those signs and symptoms of pancreatic insufficiency that most often force the use of enzymes that improve digestion.

How does pancreatic insufficiency manifest itself?

People with insufficiency of external secretion of pancreatic enzymes develop digestive insufficiency. They cannot digest proteins, fats and carbohydrates fully. As a result, for example, the phenomenon of creatorrhea and steatorrhea occurs. In the first case, undigested muscle fibers can be found in the feces after eating meat, and in the second case, there is neutral, undigested fat in the feces due to a lack of pancreatic lipase.

As a result, there are complaints about the instability of digestion, bloating, intolerance to certain types of food, alternating constipation and diarrhea. This leads to chronic damage to the intestines – secondary dysbacteriosis develops, beriberi (after all, many vitamins are produced by microbes living inside us), immunity decreases. It is for the correction of these disorders that enzymatic preparations are intended.

The Best Enzymes for Digestion

Modern enzyme preparations

The following is a list of various digestive preparations containing highly active enzymes, their combinations, or other ingredients. We tried to compile the list in such a way that it does not include products containing the same components in the same concentrations. For example, a lot of preparations contain only pancreatin, and they contain nothing but pancreatin. These are drugs such as Panzinorm, Mezim, Pangrol, Creon and others.

It is enough to describe only one Creon, and mark the rest as its synonyms and commercial counterparts from various manufacturers. This list includes drugs containing an extract from the gastric mucosa, such as acidin-pepsin, some combined enzymes, when Pancreatin is combined with bile and hemicellulose components. These are Festal, Enzistal, Panzinorm Forte. There are also plant enzymes plus pancreatin, such as Wobenzym.

For each drug, the price range, dosage, and number of capsules per package are given. The price is relevant for the spring of 2020, for pharmacies of all forms of ownership in the Russian Federation. The criterion for inclusion in this list is the national clinical recommendations of nutritionists and gastroenterologists, specialists in the treatment of chronic diseases of the pancreas. And opens the list of one of the undisputed leaders of enzyme preparations, namely Creon. Therefore, we will describe it in more detail than others.

Pancreatin (Creon Panzinorm, Enzistal-P, Mezim, Mezim-Forte, Micrasim, Pangrol, Penzital, Pancitrate, Panzikam)

Rating: 4.9

The following enzymes are isolated from the tissues of the pancreas of slaughtered animals:

1. pancreatin (a mixture of enzymes representing a gray – yellow powder);

2. amylase (for the breakdown of carbohydrates);

3. lipase (for fats);

4. protease (for proteins).

The drug is available in an enteric coating. After all, normally these enzymes work in the duodenum, where the environment is much more alkaline than in the stomach.

“Creon” and its analogues are used in all situations where primary or secondary insufficiency in the synthesis of pancreatic enzymes develops, or there is a mechanical obstacle to their entry into the intestine. These are chronic pancreatitis, cystic fibrosis, pancreatic resection, malignant neoplasms of the pancreatoduodenal region, obstruction and narrowing of the excretory ducts of the pancreas. These are pathological formations of the common bile duct, taken in the elderly and senile age. Creon is prescribed after operations on the stomach and gallbladder, in the complex therapy of chronic cholecystitis, hepatitis and cirrhosis (due to insufficient secretion of bile).

The following dosages of the drug are currently available: 10000 units (capsule 0,15 g, or 150 mg, in a package of 20 capsules), 25000 units (capsule 0,3 g, or 300 mg, in a package of 20 capsules), 40000 units (in vial of 50 capsules).

They take enzymes for a long time, at least several weeks, if these are not errors in eating in a healthy person. The most important thing is that the remedy is taken with food, and the food is washed down with a sufficient amount of liquid. After all, all enzymes work in the liquid phase.

Advantages and disadvantages

There are very few contraindications to taking enzyme preparations: this is acute inflammation, and exacerbation of chronic pancreatitis. The use of Creon tablets is prohibited for two reasons: firstly, in acute pancreatitis and exacerbation, “hunger, cold and rest” is prescribed. Since food does not enter the intestines, then the enzymes that help break it down have nothing to do there either. And secondly, in acute pancreatitis, enzymes are not friends, but the worst enemies, because they cause autolysis, or self-digestion of gland tissues. And to help the disease destroy a vital organ, right, is not worth it. In addition, the drug is contraindicated in case of allergy to its components. Although rare, it happens: although the enzymes of all mammals are very similar, they are still foreign protein molecules, and an allergic reaction can develop to them.

As usual, the side effects are “an extension of the virtues.” If you overdo it with the reception, then there may be a feeling of discomfort, diarrhea (diarrhea), or nausea with heartburn may develop. Therefore, you need to take “Creon”, gradually increasing the dose to an acceptable state of health. It must be said that in the treatment of chronic pancreatitis, Creon must be taken while adhering to a diet. In that case, you can get by with the minimum dosage of the drug, and at the same time not have any side effects.

Of all the above drugs, Creon is the most expensive. So, a package of 20 Creon 25000 capsules costs from 500 rubles, and domestic pancreatin (60 tablets) at the same dosage costs from 32 rubles. At the same time, the cleaning, the level of activity and the severity of the effect of Creon are very good. It is manufactured by Abbott Laboratories LLC.

Pancreatin + Dimethicone (Pancreoflat)

Rating: 4.8

We have seen how well pancreatin works, which itself is a mixture of 3 enzymes that help digest proteins, fats and carbohydrates. What will happen if dimethicone is additionally added to pancreatin, which is separately used as a remedy for bloating, but does not have any enzymatic activity? Then you get a wonderful complex drug called Pankreoflat. It contains 170 mg of Pancreatin and 80 mg of Dimethicone in one oblong white tablet.

The enzyme part of the drug is a powder of the pancreas of pigs, and it contains the necessary enzymes in excess: alpha-amylase, lipase, chymotrypsin and trypsin. Lipase breaks down fats, trypsin breaks down proteins into short-chain amino acid residues, and alpha-amylase breaks down polysaccharides that contain glucose. Dimethicone itself is chemically inert, does not enter into any reactions, and once in the intestine, it eliminates excess gas formation, which is characteristic of chronic pancreatitis and dyspeptic intestinal syndrome. How does dimethicone work? it simply changes the surface tension of the gas bubbles in the intestines, they burst, and the gas is no longer held by the bubble, but freely escapes or is absorbed by the intestinal wall. Pancreatin itself and dimethicone itself are not absorbed in any way, and also leave the intestines.

Indications for use – all dysfunction of the external secretion of the pancreas without exacerbation. This is pancreatitis, chronic. Achilia, that is, lack of gastric juice. This is a different dysfunction of the biliary tract, chronic liver pathology, as well as the period after surgery on the digestive organs, and Pancreoflat is especially indicated if there is excessive gas formation. For adults, you need to take 1 or 2 tablets with food, the course of treatment can be long, but in any case it is determined by the doctor.

The drug is produced by Solway Pharma, from Germany, and on sale you can buy coated tablets in the amount of 50 pieces. This is a rather expensive drug, and it costs about 2500 rubles for this package. But you can completely replace it with the usual Creon, which you will take along with the usual dimethicone. If you can’t find dimethicone in pharmacies, it is quite possible to replace it with activated dimethicone, which is called simethicone. This is already quite an affordable drug, and you can buy it, for example, in the form of Bobotik or Espumizan. You will save quite a large amount, and the effect will be exactly the same. Only instead of one drug will have to take two.

Advantages and disadvantages

Pancreoflat is fairly well tolerated, but there are contraindications. It cannot be used in the early stages of acute pancreatitis, or during an exacerbation of chronic pancreatitis, then a strict diet is necessary, and it can be prescribed only in the interictal period, for planned therapy. Side effects may include allergic reactions, abdominal pain, discomfort, or a tendency to constipation in case of an overdose. But usually the drug is well tolerated, and there are no problems. The only thing is that you can’t crack the pill, since active enzymes, once on the oral mucosa, can lead to ulceration. Tablets should be swallowed whole. This remark applies to all enzyme active preparations without exception.

Acidin-pepsin

Rating: 4.7

The next drug already helps not only with the pathology of the pancreas, but also with insufficiency of gastric juice. It contains the gastric enzyme pepsin and betaine hydrochloride. Under the influence of hydrolyzed betaine, hydrochloric acid is formed, it increases the acidity of gastric juice. And the added pepsin, an enzyme that hydrolyzes proteins, improves digestive function in the stomach. From here, indications can also be called: these are hypoacid and antacid gastritis, achilia, and symptoms of gastric dyspepsia. Acidin-pepsin is desirable to take two tablets, that is, 500 mg with meals, that is, 3-4 times a day. Children with the same diagnoses are prescribed half the dosage. Produces Acidin-pepsin Belarusian pharmaceutical plant Belmedpreparaty, and this drug is inexpensive: from 85 to 200 rubles per pack of 50 tablets.

Advantages and disadvantages

Despite the fact that there is no pancreatin, no amylase, no lipase in Acidin-pepsin, it does not break down carbohydrates, does not hydrolyze fats, and does not help the pancreas, it contains the main enzyme that breaks down proteins, namely pepsin . And since digestion begins in the stomach, this medicine can be fully considered an enzyme preparation.

This enzyme medicine also has contraindications. Naturally, this is an increased concentration of hydrochloric acid, hyperacid gastritis, heartburn, stomach ulcers, or erosive processes of the gastric mucosa and duodenum. If Acidine-Pepsin is accidentally taken with these symptoms and diagnoses, it will aggravate all these symptoms. Of the adverse reactions, naturally, there may be heartburn, discomfort or pain in the epigastrium, as well as allergic reactions. By and large, acidin-pepsin can be considered hydrochloric acid and a means for digesting proteins in a “dry form”. All patients with insufficiency of gastric digestion are grateful to this inexpensive drug. It allows you to compensate for errors in the diet, and digest the stomach what nature has denied it.

Hemicellulase + bile components + pancreatin (Festal, Enzistal)

Rating: 4.6

Let’s add a third component! Now we will add bile components (extract and bile acids) and hemicellulase to pancreatin. These are enteric dragees Festal. A package of 20 such dragees will cost from 130 to 160 rubles. They are produced by the Republic of India, the Indian representative office of Sanofi, sometimes Turkey may be indicated as the manufacturer.

Why is Festal so interesting? It contains bile acids. And if a person has chronic pancreatitis, then he most often has a bile deficiency, and their presence in the duodenum compensates for biliary, that is, bile insufficiency. There is still pancreatin, three enzymes for the breakdown of proteins, fats and carbohydrates. This facilitates the work of the pancreas and absorption in the small intestine. In this regard, Festal works in exactly the same way as other drugs, such as Creon. In addition, Festal contains bile extract, it stimulates the excretion of its own bile, emulsifies fats, facilitates their absorption and simplifies the work of the lipase enzyme, which can only break down fats in emulsified form. In addition, bile extract helps the absorption of fat-soluble vitamins, these are vitamins A, E, K, D.

What is hemicellulase? This is an enzyme. Hemicellulase breaks down cellulose, or fiber. We cannot digest fiber ourselves, because we are not bark beetles, the larvae of which are excellent at chewing through wood. But on the other hand, fiber improves peristalsis, absorbs toxins from a healthy person. And if there is a lack of digestion, then it, accumulating in the intestines, increases gas formation. And hemicellulase reduces the symptoms of bloating, and works in exactly the same way as dimethicone is ultimately contained in Pankreoflat.

Festal is indicated for all disorders of the pancreas (without exacerbation), in the presence of chronic pancreatitis, cirrhosis of the liver, flatulence, alcoholic liver damage. It is prescribed after cholecystectomy, due to the loss of bile acids, and even to improve digestion in patients with normal gastrointestinal function, but due to overeating and a sedentary lifestyle. It is necessary to take Festal one or two tablets 3 times a day with meals, a higher dosage is possible, but it is prescribed only by a doctor. The duration of treatment can be different: from several days, and even up to several years, if long-term replacement therapy is necessary.

Advantages and disadvantages

The dignity of Festal is in the fullness of action. It provides not only “enzymatic services”, but also improves the functioning of the hepatobiliary zone, bile secretion, provides the same bile, improves intestinal motility, and reduces gas formation. At the same time, the drug is inexpensive. There are contraindications to it, but not much. These are acute pancreatitis, severe liver failure, hepatitis, obstructive jaundice, when bile cannot physically drain, intestinal obstruction, which, of course, requires surgery, a tendency to intestinal hypermotility, diarrhea and children under 3 years of age. But if used moderately, and according to indications, then he can compete with Creon, and as for the price, it is extremely low.

Lactazar

Rating: 4.5

We need to talk a little about children’s enzyme preparations. Such an enzyme remedy for babies is Lactazar, which is produced by the domestic company Pharmstandard-Leksredstva. A package of 50 capsules of 150 mg will cost from 250 to 460 rubles. This drug is even indicated for children who are breastfed. The composition contains an enzyme for the breakdown of milk sugar, namely lactose – the enzyme lactase. The drug is available in capsules, 150 mg each, and in one capsule 700 units of the active lactase enzyme. It is used for lactase deficiency.

It is prescribed for babies up to a year at the rate of one capsule per feeding. The capsule must be opened and poured into expressed breast milk. If we are talking about artificial feeding, then you need to add one capsule per 100 ml of milk formula. If we are talking about older children, from a year to 5 years, then you can add one capsule for each year of life, and pour them into non-hot food containing milk. For example, a 5-year-old boy can pour 5 capsules into warm milk soup. If the food temperature exceeds 55 degrees, then the enzyme is inactivated. It should be remembered that this supplement, which facilitates the absorption of milk sugar, that is, lactose, is not a medicine.

However, not only children can experience a deficiency of the lactase enzyme. Therefore, Lactazar is also produced for adults, as well as for children over 7 years old. Here, the capsules already have a large dosage of 550 mg each, and a package of 100 such capsules will already cost from 700 to 1300 rubles. Why so many capsules? But because adults need more enzyme, because they consume more milk. Yes, the price is quite high, but if a patient has a congenital lack of lactase, he will experience certain symptoms of lactase deficiency all his life. This means that he needs to categorically avoid any dairy products, and this is not so easy. Taking lactase will make such a patient a healthy person for a while, who can fully digest dairy products. Lactazar is a means of improving the quality of life.

Advantages and disadvantages

Since the remedy is monocomponent, and contains only one enzyme, there are practically no contraindications to it, just as there are no side effects. This is a tool aimed at correcting the deficiency of just one single enzyme. Therefore, this drug can be considered very important, convenient, and even the price of this remedy is not a hindrance.

Wobenzym

Rating: 4.4

Wobenzym, which we consider at the end of the list, rises as a separate “cliff” among all enzyme preparations. If all the above remedies were used only to correct digestion, with a lack of enzymes, then Wobenzym managed to have indications for almost any branch of medicine. It contains the well-known pancreatin, lipase and amylase, then the enzymes trypsin, bromelain and papain, and also chymotrypsin.

Such a combination of very strong natural enzymes, not only of plant but also of animal origin, produces a complex of effects – improves local immunity, fights inflammation, improves the resorption of blood clots, fights edema, prevents platelet aggregation, and even relieves some pain. Wobenzym reduces the number of circulating immune complexes, improves the activity of macrophages, lymphocytes and phagocytic activity of neutrophils. It improves the permeability of the vascular wall, promotes the resorption of hematomas and bruises. It affects lipid metabolism, reduces the synthesis of cholesterol in the liver, and reduces the level of atherogenic fractions.

Naturally, it also affects digestion. It is taken in capsules and its powerful enzyme composition enhances the breakdown of proteins, fats and carbohydrates in the duodenum. Therefore, it can be used for chronic pancreatitis in remission, chronic hepatitis, duodenitis, accompanied by a deficiency of digestive juices, in case of hypoacid gastritis, and errors in the diet.

Wobenzym is a fairly expensive enzyme preparation. It is produced by the German company Mucos Pharma, and one pack of 40 enteric tablets will cost from 400 to 530 rubles. It should be taken 30 minutes before meals with a glass of water.

The dosage is determined by the doctor, but depending on the activity and severity of the disease, it is prescribed from 3 to 10 tablets three times a day. Therefore, even with a minimum layout of 9 tablets per day, I am only four and a half days of taking. That is why Wobenzym is available in packages with a huge number of tablets. The largest jar contains 800 tablets, and its cost is from 6000 to 8500 rubles. If you prescribe Wobenzym in a huge dosage of 30 tablets per day, which is the maximum allowable, then such a huge package will be enough for almost a month of treatment.

Advantages and disadvantages

Wobenzym is indeed an active drug, but the big disadvantage is poor compliance, since taking five, six, seven or ten tablets three times a day is simply not always convenient. In addition, this drug is never used in a single variant as a monotherapy, but always only in complex therapy. In our case, we are talking about a lack of digestive function. And naturally, trypsin, chymotrypsin, alpha-amylase, lipase are the enzymes that we need to maintain the function of the stomach and pancreas. But why a patient with indigestion should additionally take papain and bromelain, which are plant enzymes, is not entirely clear. We get excess alien activity, which, roughly speaking, can go sideways. Otherwise, the drug is well tolerated, contraindications to it are small, but it must be prescribed by a doctor.

Conclusion

Here, perhaps, are all the main enzyme preparations, which represent different groups. It does not make sense to repeat those drugs that contain the same active substances, but under different commercial names. One could also include Motilium, aka domperidone, Metoclopramide, aka Cerucal, in the list. Yes, these drugs are anti-nausea, anti-emetic, and may even affect peristalsis. But at the same time, they do not affect the gastrointestinal tract at all, but act on the brain, on its dopamine receptors. At the same time, neither Motilium nor Cerucal is an enzymatic agent, and is not used for replacement therapy. A classic example of the correct prescription of Cerucal is the relief of nausea and vomiting in patients who are on chemotherapy for oncological neoplasms and they are forced to take toxic drugs, which causes nausea. Therefore, if someone tells you that Motilium or Cerucal helps digestion, then this is a big mistake.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.