Proteolytic Enzymes Improve Injury Healing
excerpt from: Avery's Sprots Nutrition
Almanac
By: Edmund Burke and Daniel Gastelu
Athletic injuries cause setbacks in training and downtime during the season. Because of this, in the 1960s, a number of scientists looked for natural products that can help improve the rate of injury healing. In animal studies, the use of proteolytic enzymes was shown to reduce the inflammation associated with injuries and to shorten healing time. Subsequent studies conducted in hospitals and using injured people, surgery patients, and women who had given birth also demonstrated that proteolytic enzymes can help quicken the healing process.
In 1967, P. S. Boyne and H. Medhurst applied these clinically verified benefits to athletes on the playing field. in a landmark study, they gave a proteolytic-enzyme concentrate (containing trypsin and chymotrypsin) to football (soccer) players from twenty-eight professional teams. The tablets were enterically coated, enabling them to pass through the stomach and not be digested until entering the intestines, since it had been learned in animal studies that the acidic stomach environment decreases the amount of proteolytic enzymes absorbed into the body by altering the enzymes chemically. During the study periods, any athlete who sustained a significant injury was immediately given two proteolytic-enzyme tablets, followed by two tablets at bedtime. The injured athlete then continued to take four tablets daily, in divided dosages, a half hour before meals, until he recovered from his injury and was able to return to training. At the end of the football (soccer) season, Drs. Boyne and Mehurst determined that less playing time had been lost per player when the injured players were given the proteolytic-enzyme product as compared to the previous season, when the proteolytic-enzyme product had not been given. In other words, the proteolytic-enzyme product reduced the amount of time it took to recover from injury and return to training.
Other researchers reported similar results when using proteolytic-enzyme preparations to help quicken injury-recovery time. The benefits to the healing process include improved blood flow to the injured area, reduced inflammation, reduced edema, and improved flexibility and motility. Along with the proteolytic enzymes (trypsin and chymotrypsin), the enzymes papain and bromelain have also been shown to be effective at improving the rate of recovery from injuries. Note that in the aforementioned studies, proper medical attention was also administered, along with drug therapy when indicated, as well as physical therapy, rest, and the application of ice. The oral proteolytic-enzyme products were well tolerated by the subjects, and side effects were rarely reported.
So, the next time you experience a sports-related injury-or any injury, for that matter-include a short course of proteolytic enzymes in your treatment. Try using a bromelain, papain, or trypsin-chymotrypsin product, or one that contains all four of these efficacious enzymes, in enteric-coated tablets or capsules. The effective daily dosages range from 300 to 500 milligrams three to four times a day. These enzymes are best taken on an empty stomach, with juice or water. (Do not take these enzymes if you are sensitive to papaya or pineapple.) Take them until the injury is healed, usually several days; take them longer only under a doctor's supervision. In addition to taking the enzymes, make sure you maintain a healthy diet and take your regular supplements, as well as other supplements known to improve healing-bioflavonoids, 1,000 to 2,000 milligrams a day; curcurnin, 1,000 to 2,000 milligrams a day; glucosamine, 1,500 to 2,500 milligrams a day; and chondroitin sulfate, 1,500 to 2,500 milligrams a day. And don't forget to seek medical attention for the injury!
Article Reference:
E. Burke, D. Gastelu. (Date Unknown) Avery's Sports Nurition Almaac. p.111-112.
What the heck is an Enzyme?
Jack Brown
I know; the image has nothing to do with an enzyme per se - is an image of the result of the comet Shoemaker-Levy 9 fragments slamming into Jupiter - but - certainly allows one to appreciate chemical reactions.
An enzyme is a protein or RNA (yep... some RNA molecules behave in this way - are called ribozymes) which is capable of initiating a chemical reaction which involves the formation and/or breakage of chemical bonds.
OK, let's get started..... Any chemical reaction which results in products of the reaction which exist at a lower energy level relative to the reactants which led to the product, will theoretically occur, with or without an enzyme - but - may take a thousand years, or, may never occur - unless there is a little "zip" added to the mixture.
Enzymes are catalysts - a very special kind of "organically grown" catalyst with a very precise chemical definition. A "true" catalyst in chemical terms substantially reduces the energy barrier which exists between atoms and which prevents the atoms from "getting close" enough to react and form a bond with one another. An enzyme, like all strictly-defined catalysts, is therefore said to lower the energy of activation of a reaction; but, the catalyst is not changed in any way in the process - kind-of like a conduit - a path through which reactions occur. All catalyst-like things, do this. Therefore, when the atoms of molecules are acted upon by enzymes, an identical reaction occurs as would have occurred without the enzyme, but, the energy hill required to overcome the getting-close barrier, is much, much smaller than would have been true without the enzyme's help. The structure of the enzyme is such that atoms of molecules can get close enough to interact, but the energy required to allow this closeness is reatively small - like going into an empty closet with someone relative to going into an empty auditorium with someone. The chances of interaction within the closet are greater than the chances within the auditorium - less energy required to move around to increase the chances of bumping into one another.
Let's look at some analogies to explain all of this energy stuff... You already know that it takes energy to climb a hill. At the bottom of the hill, you possess less potential energy than when you are finally exhausted, but are standing at the top of the hill. This gain in potential energy is partly the result of the effect of gravity, and partly the result of the transfer of energy from your muscles (they lost some to the hill and to the environment) to get you to the top. If you jumped off of the hill, your rate of fall would increase by 32 feet/second, for every second you spent flying through the air (just as it would if you jumped off of a chair) - this means that you will accelerate - and you know that getting hit on the head by a marble dropped from one inch, is not nearly as unpleasant as getting hit on the head by a marble dropped from 100 feet. You know as well as I do, that you could immediately tell the difference in energy released from the two marbles - although, in the latter case you would most likely be unconscious, and couldn't make your knowledge available to anyone.
Now, once you hit the ground, all of the energy you had accumulated at the top of the hill, would be released as heat, friction, and not worth much - no useful work - especially to your prostrate form...However, what if you had tied one end of a rope to yourself, and the other end to a person on the opposite side and at the bottom of the hill? Once you reached the end of your rope during the fall, some of the energy accumulated by you from your arduous trek up the hill and released by your fall, would be transferred to the other person connected to you - this person would probably fly up and over the hill without much effort on their part - unless the person was way bigger than you - would require more energy than you had made available to drag them up and over. Such enzyme-connected reactions are called coupled reactions. Chemical bond breakage or formation by enzymes has some aspects of this analogy. There are other aspects, however.
Now we must talk about personal relationships... you are attracted to someone, and they to you. You and they would each like to move closer to one another and form a bond between you. However, each of you may first need to overcome some barriers (shyness, self-doubt, etc.) Each of you has your own energy level (pretty high - you're out and about, looking to bond), but, your own set of inhibitions as well. So, there must be some impetus required to overcome your individual inhibitions and to push you together (might be a friend who catalyzes the interaction). Chemicals are like this, too. For atoms to get close enough to each other to form bonds between one another, an energy barrier must first be overcome (a hill); however, once this barrier is breached, the resulting reaction then occurs spontaneously, and a product is formed - which is at a lower energy level than the reactants which formed it - the reactants come together and roll down the hill to form a product. Would be similar to you climbing a hill, and when you looked over the other side you find you are standing on the edge of a cliff and there is a canyon beneath you. Would have taken energy to get you to the top, and start you over the edge, but after that, you could parachute to the bottom of the canyon without expending any energy - in fact - you would release energy - and your energy level at the bottom of the canyon would be less than the energy level you possessed prior to climbing the hill, and substantially less than the energy you possessed at the top of the hill. If this difference in energy could somehow be collected, than other useful things could be made to happen.
You know that if you place a piece of wood in an empty fireplace, that you could stare at that wood for a million years and it would never suddenly burst into flames. However, if you place some paper, and maybe a few little sticks in there, and then apply the flame of a match to the paper, there is a strong liklihood that the wood will begin to burn and will continue to burn until the wood is gone. What's happened here? First, the wood, paper and sticks are all made of cellulose - a bunch of sugar molecules (glucose) hooked together into a complex polymer. So, cellulose is nothing but lots of individual carbon, oxygen and hydrogen atoms arranged in a particular way. If more oxygen (O2, the kind that we breathe) reacts with this stuff, chemical bonds can be formed and others broken which results in the release of carbon dioxide and water from the cellulose - that's it, just CO2 and water (you have "tasted" CO2 - it's the stuff in "carbonated" water - that's where the name carbonated, comes from). As I think about it, you have most likely tasted water, as well.
Well, back to the burning wood... there is plenty of oxygen available in the room, or else you would be unconscious again, just after reviving from the marble attack..... so, why doesn't the oxygen in the air just hop onto the cellulose and react with it? Because, there is that energy hill which must first be overcome in order to allow the oxygen atoms to get close enough to the atoms within the cellulose to form a chemical bond. This extra energy is supplied by the flame of the match - increases the rate of movement (is what temperature is) of the oxygen and the atoms in the paper near the flame, accelerates them, and the atoms now have enough energy to slam together. Now, nothing would continue to happen UNLESS the products of this reaction, carbon dioxide and water, were at a lower, final energy level than the energy stored in the bonds of the cellulose. It is because of this difference in energy levels that the reaction continues spontaneously (we call this particular reaction a fire...) There are enzymes in your body and within bacteria which ultimately do exactly the same thing to glucose, e.g., produce CO2 (you exhale it) and water, by allowing glucose (you eat it) and oxygen (you inhale it) to react with one another.
In the fireplace, some of the energy released by the formation of CO2 and water, is taken up by the unburned cellulose and oxygen in the air, which causes more atoms to slam together. Some of the energy remains in the bonds of CO2 and water. Some is lost as heat up the chimney, and the rest goes out into the room. Therefore, we are warmed by the fire. This warmth is useful to us, but really doesn't perform any work. However, if we used some of this heat to boil water, to drive the liquid water molecules into a gas (steam), we could let the steam bang into a turbine blade, turn it, and produce movement... Or, better yet for us and bacteria, this energy is used to provide an ability to move, and to produce other things.
Enzymes are very particular - they won't catalyze just any old reaction, only those which are suited for the enzyme. This selectivity is because of the essentially fixed shape of the place where the molecules must get together within the enzyme's reaction site in order to get close enough to form a bond. This site may comprise only a tiny part (the closet) of the entire enzyme's structure, but all of the structure is necessary in order for the site to be shaped correctly, And, only a select few molecules for any single enzyme will fit into this site. Therefore, there are thousands of different enzymes required in order for the thousands of different molecules within a living cell to engage in reactions. It is for this reason that a change in a gene (mutation) which encodes the enzyme's structure can result in a dysfunctional enzyme and lead to an inability of a cell to properly function.
Some people cannot eat any milk products - milk contains the sugar, lactose (is where the word lactation comes from) which is made of glucose and galactose hooked together. An enzyme is required to digest the lactose and to convert it into glucose and galactose (we use both). However, if there is no enzyme (or a dysfunctional enzyme) which subsequently converts galactose into usable substances, then galactose will build-up and result in severe damage - even mental retardation. The treatment is a diet which is very low in galactose. Another example is the inability of a person to tolerate fructose (in fruits and part of the structure of sucrose - table sugar). The child has only one enzyme missing - the one which works on fructose-phosphate. This child will become severely ill, have very low blood sugar (glucose), and will be malnourished. These children, remarkably, have a natural aversion to sweets and fruits, and also very few dental caries. The treatment is to place the child on a low-fructose diet.
Bacteria too, must have functioning enzymes available. Being only a single cell with only a single chromosome, bacteria are quite astonishing in their ability to make structural and functional components of all of the things necessary for the cell to stay alive. However, not all bacteria have all of the same enzymes - therefore - different habitats and nutritional substances are required for the different species of bacteria, because they can't make all of the component parts necessary to build all of the structures - they need to be near a source of already-made substances for which they have enzymes which can utilize them. Of course, we are like this too. We depend on bacteria, plants and animals for the sources of many of the component parts which we cannot make, and our enzymes which can utilize these substances to initiate chemical reactions and build the structures necessary for life.
Believe it - enzymes are important!
Copyright John C. Brown, 1995
Article Reference:
J. Brown. (1995). University of Kansas. What the Heck is an Enzyme?. http://falcon.cc.ukans.edu/~jbrown/enzyme.html.
The Missing Piece of the Equation
Without enzymes, your digestive system will never add up.
By Robin Westen and Janet Webb
If you're like most Americans, you probably regard digestive problems, such as heartburn and bloating, as inevitable as death or taxes. But common as they are, subjects like gas and diarrhea don't make the talk shows the way cheating spouses or loss of libido do. Let's face it: Tummy troubles are simply not sexy. And our silence means these potential health hazards often go undiagnosed and untreated.
Many of the approximately 90 million digestive problems experienced by Americans every year can be directly linked to poorly digested foods, says Lawrence Cheskin, M.D., director of the gastroenterology division at Johns Hopkins Bayview Medical Center in Baltimore. Chief among the complaints, Cheskin says, are heartburn, constipation, irritable bowel syndrome, gall stones and cancers of the gastrointestinal tract. It's serious stuff to be sure. Some 200,000 people will die this year of problems stemming from their digestive tracts, most notably colon cancer. These disorders will spur 60 million doctor office visits and cost $120 billion in medical expenses and other repercussions like job disability leaves.
It can be difficult to gauge the prevalence of digestive problems because certain ones that are considered commonplace by alternative practitioners, such as toxic bowel syndrome (TBS), aren't recognized by conventional physicians. Characterized by constipation, joint pains and fatigue, TBS can eventually impair the immune system's function The condition is caused by chronically underdigested food that eventually creates a buildup in the colon, says Lucinda Messer, N.D., a naturopathic doctor practicing in Kirkland, Wa.
Poor digestion also can be responsible for a host of more subtle, yet deeply troubling problems, ranging from fatigue, skin rashes and headaches to poor concentration and irritability-symptoms most people wouldn't link to digestive issues. Because of the lack of awareness about both digestive disorders and treatment options (let alone the embarrassment factor) many of these problems are simply tolerated. "There is definitely an epidemic of mild, functional disturbances of the digestive system," confirms Michael Murray, N.D., co-author of Textbook of Natural Medicine (Churchill Livingstone, 1999).
Your digestive system is the keystone to your health and vitality. And most of its everyday disruptions are preventable. While conventional doctors often provide basic (arid sometimes outdated) dietary guidelines and treat digestive disturbances with drugs and surgery, alternative practitioners tend to focus on digestion as if your life depended on it, which it actually does. Their theories sometimes differ, but most agree that the ability to fight illnesses, delay aging and experience positive moods and general well-being are inextricably tied to the process of breaking down foods and assimilating nutrients.
Some experts are frustrated that digestion isn't taken more seriously by health practitioners. "Digestion is the Rodney Dangerfield of the healing arts. It doesn't get any respect-it never has," says Howard Loomis, D.C., an authority in enzymatic therapy, an approach to improving digestion that relies on using enzymes. "Everyone assumes that digestion just normally happens, but it doesn't.
When your digestive system is compromised, even the healthiest diet can't be put to effective use by the body. At first, you may notice only mild symptoms like heartburn, but chronically depriving your body of nutrients over a period of time can cause more serious problems. An inability to absorb calcium, for instance, can eventually lead to osteoporosis. If the body isn't breaking down sugars properly, a yeast buildup up in the intestinal tract can lead to candida, which causes irritability a and bloating. And common discomforts-constipation, diarrhea and gas are often a sign that the body can't thoroughly process one of the basic substances contained in all foods: proteins, carbohydrates, fats and sugars.
All About Enzymes
Enzymes, those essential but often overlooked components of digestion, help process protein, carbs and sugar so the body can reap the benefits of a healthy diet. Despite enzymes' vital role, most Americans don't get enough of them in their diets. But if you learn how to adjust your eating habits, it's possible to maximize the power of enzymes. And it's an easy way to make dramatic changes to your digestive health-changes that will pay off in both the short and long term.
We're all familiar with the word, but most of us are fairly clueless about what enzymes actually are and how they function in the body. No doubt you've seen them at work, though, perhaps after leaving a ripe banana in a warm room for a few hours. Thc browning of the fruit represents enzymes in action, breaking down food. Enzymes are protein substances that function as catalysts for both the digestive system and for many chemical reactions in the body. There are two types: metabolic and digestive. The hundreds of thousands of metabolic enzymes the body produces help you perform basic activities like walking and talking. Digestive enzymes, such as protease, amylase and lipase, break down proteins, carbohydrates and fats, respectively, into usable nutrients. "Enzymes are critical for life," says Anthony J. Cichoke, D.C., author of The Complete Book of Enzyme Therapy (Avery 1999). "It's not only what we eat but also what our bodies absorb that keeps us healthy and energetic."
Enzymes come from two sources: the food we eat and those the body naturally produces, primarily in the pancreas (and, to a lesser extent, in the mouth, stomach and small intestine). Raw foods contain enzymes. Fermented foods, such as yogurt and soy sauce, are also a rich source. Processing food in any way, whether by boiling, baking, microwaving or steaming, kills enzymes. Pasteurization, the process in which dairy products and fruit juices are heated to kill bacteria, also destroys enzymes. When we eat, our pancreas produces 22 different types of digestive enzymes that do most of their work in the small intestine, not the stomach. Without raw food, the body must depend on the enzymes it produces itself Enzymes from raw foods that do their work in the stomach lessen the pancreas' workload. Your body doesn't produce all the enzymes needed to break down fiber, which explains why many people have trouble digesting beans.
Eating a diet of mostly cooked or processed foods devoid of enzymes can lead to the enzyme deficiencies that cause digestive problems. Enzyme therapists are trained to diagnose and treat deficiencies with dietary suggestions and supplements. But it's also possible to learn enough on your own to make lifestyle changes that help prevent digestive discomforts.
Most health educators don't include enzymes in the blackboard diagrams that introduce students to their internal plumbing systems. But enzymes are present at every stage of the process, one that Cichoke compares to a freight train moving along the tracks. If the first "box car," food enters your mouth and encounters enzymes secreted by the salivary glands. These enzymes initiate the digestive process and work best if you chew food thoroughly. In the stomach, food is broken down into even smaller particles and mixed with hydrodchloric acid and pepsin, the main enzyme produced by the stomach. ItÕs in the small intestine that the greatest amount of digestion and absorption takes place, with the help of pancreatic enzymes. Few nutrients remain by the time partially processed food reaches the 1arge intestine where unusable bulk or fiber is processed, water absorbed and waste excreted.
Vegetarian diets are typically more enzyme-rich than the average American's because they're likely to include salads and raw foods. But vegetarians are not immune to digestive problems. For one thing, not all raw foods are good sources of enzymes. Seeds, nuts, grains and beans must be soaked, cooked or sprouted to deactivate natural enzyme inhibitors, says Lita Lee, Ph.D., a chemist who practices enzyme therapy in Lowell, Ore., and Sunnyvale, CA. Compounds in cruciferous vegetables (broccoli, cabbage, cauliflower) can also inhibit thyroid function if eaten raw.
Besides eating the right raw foods, you can enhance your diet with other enzyme-rich sources. Fermented dairy products like yogurt and particularly kefir, a drink made with milk-fermenting enzymes and yeasts, are enzyme storehouses. So are miso, tempeh and soy sauce. Enzyme therapists suggest including some raw food with each meal to enhance digestion. Snacking on yogurt or unpasteurized fruit juice in between meals also helps.
Enzyme Hazards
It's important to make sure your diet contains ample portions of enzymes because deficiencies can easily occur. As we age, many believe that the body's production of enzymes dwindles dramatically. For example, the amount of amylase present in an average 25-year old's saliva is 30 times more abundant than in a 65-year-old's. This is why many people experience digestive woes for the first time in their 40s. "Around age 45, the quantity of our body's enzymes decreases and so does the quality," says Loomis, who also wrote Enzymes "The Key to Health" (Grolee Publishing, 1999). "Our cells just don't have enough energy to maintain production.
To complicate the matter, a number of' environmental factors can also destroy enzymes. Among them are pesticides and food heated above 118 degrees Š a temperature lower than whatÕs required to bake a casserole. Other zappers, Lee says include water flouridation and food irradiation.
Because of these many hazards, enzyme therapists believe most people would benefit from taking multidigestive enzyme supplements containing a full range of enzymes. This is especially true, stresses Loomis, for people who eat a lot of cooked, processed or nonorganic foods that have been sprayed with pesticides. Vegetarians must be careful to avoid supplements derived from animal products, often listed as "pancrean" on the ingredients label. Vegetarian-safe supplements are called "plant-harvested," though Loomis believes some popular plant-derived supplements, like those made from papaya and pineapple, are ineffective. Bromelain, derived from pineapple, and papain, from papaya, work best in environments warmer than normal body temperature. Plant enzymes from aspergillis, a type of mushroom, create some of the highest-quality supplements because they do work at body temperature, says Loomis, who also founded 21st Century Nutrition, a Madison, WI-based company that produces enzyme supplements.
Bite by Bite
There's another school of thought that asks, in essence, Why bother taking supplements when you can get all the enzymes you need from your diet? David Wolfe is a teacher, author and vocal advocate for a small but growing movement that feels the key to optimal health and longevity is eating at least 80 percent raw foods. He says digestive enzymes start breaking down in temperatures above 104 degrees and are destroyed at 118 degrees. "The consequences of eating a predominantly cooked-foods diet are many, from enlargement of the pancreas [pancreatic hypertrophyl to allergies and toxic colon," says Wolfe, author of The Sun Food Diet System (Maul Brothers, 2000). Yet some experts say a diet of mostly taw foods may create different problems. Lee, the enzyme therapist, suggesting taking the middle ground by incorporating more raw foods into your diet and eating enzyme-rich snacks.
As if the raw vs. cooked foods debate werenÕt confusing enough, there are other health practitioners who believe enzyme deficiency isnÕt even a valid health concern in the first place. "Enzyme deficiency is an is an extremely rare condition in -- if It exists at all", asserts Steven Peikin, M.D., chairman of the gastroenterology department in New Jersey's Camden Hospital and author of Intestinal Health (HarperCollins 1999). "Our bodies possess a veritable powerhouse of enzymes which will last until we're dead. In fact, the pancreas makes tenfold in excess of the enzymes we need," he says. Peikin's view is riot unusual among conventional physicians. He does admit, however, that the body doesn't have the enzymes to digest some high-fiber foods like legumes.
A Rising Star
Enzyme therapy is slowly gaining acceptance among the medical community. While still not universally embraced, it has moved in and out of the scientific spotlight in the past 100 years-as the recipient of both praise and skepticism. Mavericks like Nicholas Gonzales, M.D., the New Yolk immunologist who uses pancreatic enzyme therapy and dietary guidelines to treat cancer of pancreas, are still considered controversial. But Gonzales recently received $1.4 million from the National Institutes of Health to further research his method and the patients whose lives he's saved consider him a godsend.
At the turn of the 20th Century, Scottish physician and embryologist John Beard attracted attention when he injected purified enzyme juices into the veins and malignant tumors of cancer patients. In the United States during the 1960's enzyme therapy created a minor flurry when Max Wolf, M.D., treated digestive disorders by having patients reduce animal fat intake, increase raw food consumption and take supplements. But Wolf was no fringe fanatic; his client list included a number of celebrities, like Pablo Picasso and members of the Kennedy family.
Enzyme therapy became more established among the American scientific community when Edward Howell, M.D., published his landmark book, Enzyme Nutrition (Avery, 1985). Today, there are more than 2,000 enzyme therapists in the United States, and the field is expanding every year. These practitioners come from varied medical disciplines: osteopathy, naturopathy, chiropractic and nutrition. And some conventional physicians are beginning to embrace enzyme therapy, says Trent Nichols, M.D., C.N.C., a gastroenterologist and nutritional counselor in Hanover, Pa. "There are a lot of physicians who have been out there for 10, 20 or 30 years who are just not getting results with conventional medicines and surgery," he says. "They're more willing to try something else."
R-E-L-I-E-F
Christine Dubiel, a 48-year-old interior designer living on New York's Long Island, had suffered from ear infections, high fevers, painful stomachaches, incessant coughing and excruciating headaches since she was a child. As an adult, her health problems only worsened. "I had numbness in my face, multiple joint pains, fatigue and bouts with depression," she recalls. Dubiel made the rounds to countless medical experts-from conventional specialists to homeopaths-and spent thousands of dollars on treatments with pharmaceutical drugs, herbs and acupuncture. But nothing seemed to help.
One evening last year, Dubiel happened to hear chiropractor Paul Inselman, D.C., discussing on a local radio show how people with her very symptoms were being successfully treated for digestive disorders. She called Inselman's office the next day and made an appointment. Dubiel's first visit with Inselman included an extensive interview, a complete physical, dietary analysis and urine test to screen for digestive problems and nutrient and enzyme deficiencies. Inselman's diagnosis: Dubiel's body was unable to digest simple carbohydrates and fats due to an enzyme deficiency. That problem had led to a case of toxic bowel syndrome hindering her body's ability to absorb nutrients. "Since Christine was enzyme-deficient, her organs had to work on overdrive to function, which created a disruption of her body's homeostasis or balance," explains Inselman.
Inselman prescribed five plant-based enzyme supplements to aid Dubiel's digestion. He also put her on a low-carbohydrate, high-protein diet because she wasn't eating enough proteins. Six months later Dubiel's condition had improved significantly. The first thing she noticed was an increase in energy. "I went through the winter with only a mild cold-a first for me."
Enzymes, East and West
Practitioners from Eastern traditions concur with their Western peers that enzymes are an important part of the digestive equation. All agree that a healthy digestive system can prevent illnesses and increase vitality. And because enzyme therapy is just one way to improve your digestive health, ultimately the best approach is finding out what works best for you.
Digestion is considered the root of most diseases in traditional Chinese medicine (TCM) and Ayurveda, the classical Indian medical system. But these practitioners depart from enzyme therapists when it comes to raw food.
TCM, for instance, tries to oppose the elements, recommending "warming" foods in winter and "cooling" foods for summer. "Over time, eating too many raw foods can deplete spleen energy, which is what pulls nutrients and chi [life force] out of food," says Higgy Lerner, R.N., L.Ac. an acupucturist and Chinese herbalist in Chico, Calif. But Lerner believes enzymes can energize the digestive system by removing stagnation so chi circulates freely.
Ayurvedic doctors also believe healthy enzyme function is critical for digestive health. But they believe digestion is controlled by another force, agni, (or "Fire") in Sanskrit. In Ayurveda, all matter is composed of five elements: fire, water, earth, air and ether. Agni, the elemental force or "central intelligence controller" of digestion, has no Western equivalent says Sunil Joshi M.D., an Ayurvedic physician practicing in Albuquerque N.M.. "It's the software in the computer that makes it work," he says, adding that enzymes are controlled by agni. "If agni is not functioning properly, enzymes' will not be produced and your pancreas will be overworked."
For a healthy agni, Ayurvedic doctors recommend spices that stoke this digestive fire, such as coriander, turmeric, toasted fennel and asafetida. Raw foods often have the opposite effect on agni says Joshi, who recommends a diet of at least 60 to 70 percent cooked foods. But his actual recommendations vary according to individual constitutions.
Observing how your body reacts to different components in the diet is the key to fine-tuning the digestive system, other alternative practitioners say. "There's no question that enzyme therapy can improve digestion," says Joseph Pizzorno, N.D., the former president of Bastyr University in Kenmore Wash. "But people should try for themselves and see what produces the best results for them" (For a step-by-step guide, see "Tuning Up Your Digestion p. 97.) Pizzorno also explains that enzyme therapy is good protection against increasing amounts of chemicals in the food supply.
Michael Murray says most Americans need to make fundamental changes to their diets before they'll get relief from digestive problems. It's easier to notice how your body responds when you're working with a relatively clean slate, he says. From that point, you can experiment on yourself to see, for instance, how your system responds to adding more raw or fermented foods to your diet. Even though digestive problems have become as common as the cold, they're mostly in your power to prevent.
ROBIN WESTEN, a freelance writer living in Vermont, writes about health and wellness for publications like Self and Glamour. Janet Webb is a senior editor of Vegetarian Times.
Article Reference:
R. Westen, J. Webb. (October 2000) Vegetarian Times. "The Missing Piece
of the Equation
Without enzymes, your digestive system will never add up."
Enzymes
and Digestion
by
Annell St. Charles Ph.D., R.D.
Digestion is the process that enables us to use the nutrients contained within our foods. It begins when the food is placed in our mouth, and continues along a path that is approximately 30 feet long, ending in the disposal of whatever is left at the conclusion. Without proper digestion of our food, good health is impossible. Even the best diet in the world will be useless if we can’t access the available nutrients.
Enzymes are the catalysts that allow digestion to take place. Enzymes are complex proteins produced by living cells that are capable of stimulating chemical changes in other substances without being changed themselves. The cells of the digestive tract regularly produce several different enzymes which function to breakdown ingested foods so that their energy and nutrients can be released. In essence, enzymes allow calories, vitamins, and minerals within foods to become available to the body. They also allow the removal of toxins and other harmful substances from the body.
The food we eat can be classified into three basic groups - proteins, fats, and carbohydrates. Carbohydrates also contain fiber which is mostly indigestible. There is a special category of enzyme which works to break down each of these different food groups. Proteases are enzymes that help us to digest proteins. Lipases work to break down fats. Amylases function in the digestion of carbohydrates. Lactase is an example of an Amylolytic enzyme that works specifically on the breakdown of milk sugar. A fourth category of enzyme, Cellulase, is unique in that it is not produced by the human digestive system but must be obtained from food. Cellulase helps to partially digest fibrous foods.
Enzymes that function in the digestion of our foods can be either produced within our bodies or obtained through the consumption of raw foods. There are several factors which can reduce the availability of enzymes from either source. Clinical conditions, such as phenylketonuria, which results in defective enzyme production, and hypo- or A-clhorhydria, when either too little or no acid is secreted in the stomach, affect enzyme activity. Stress, whether from emotional sources or resulting from injury, surgery, or the introduction of toxins to the system, can reduce enzyme function. Mechanical problems that affect our ability to chew food can compromise digestion by hindering our ability to access the digestible surface areas of the food.
Raw, uncooked foods, especially fruits and vegetables, can be a valuable source of enzymes. Unfortunately, it is more often the tendency in our American culture to cook, and often overcook, our foods prior to eating them. The application of heat to foods has been shownto inactivate the enzymes contained in them. Certain methods of food processing and production can also destroy enzymatic activity. The overuse of salt has also been linked to reduced enzyme function.
The best approach to optimizing digestive enzyme function in the body is to make it a habit to consume some raw fruits or vegetables at every meal. This is particularly critical when ingesting hard-to-digest foods, such as meat. In addition, the inclusion of supplemental enzymes from natural sources has shown promising results. Supplemental enzymes are of benefit, not only with respect to their enhancement of nutrient availability, but also because they enable the body to better tolerate a diet high in fiber. Finally, adequate vitamin and mineral intake, whether from food sources, supplements, or some combination, are critical to enable optimal enzyme activity. Vitamins and minerals serve as co-enzymes to help enzymes do their work.
References:
Prochaska, L.J. and Piekutowski, W.V. (1994) On the Synergistic Effects of Enzymes in Food with Enzymes in the Human Body. A Literature Survey and Analytical Report. Med Hypothesis 42:355-362.
Klatz, R. and Goldman, R. (1996) 7 Anti-Aging Secrets. Elite Sports Medicine Publications, Chicago.
Cichoke, A.J. (1994) Enzymes & Enzyme Therapy. Keats Publishing, New Canaan, CT
Article Reference:
St. Charles, A.(1998) Enzymes and Digestion. http://www.mackstone.com/dev.nutritionals/enzymes_and_digestion.html.
Predicting the supplement best-sellers for 2000. The popularity of alternative medicine has been on the rise in recent years. This interest has prompted scientific studies, which further prompt interest. Throw media, marketing and advertising into the mix and "alternative" is in the mainstream. As we cross this millennial milestone, the most popular supplements will have all or most of these four factors-scientific backing, media attention, marketing andadvertising-paving the mainstream path. And in keeping with tradition through the ages, the "Fountain of Youth" products have all these key elements. Anti-aging products will be hot in 2000. The aging baby boomers are another reason behind their notoriety. Every eight seconds a baby boomer turns 50, and this year, some 75 million Americans will cross this half-century mark. The anti-aging supplements category includes hormones, antioxidants, vitamins, minerals and other nutrients. These products, marketed for a variety of conditions likely to be of concern to an aging populace, promise to whiten teeth, smooth wrinkles, restore hair, increase bust size, reduce the waistline and, overall, add life to one's years. According to Ronald Klatz, M.D., president of the American Academy of Anti-Aging Medicine in Chicago, "Anti-aging medicine is no longer alternative medicine-it's cutting-edge." The organization has grown from 12 physicians in 1993 to 1,300 today. The academy lans to board-certify physicians who want to specialize in anti-aging medicine. While not necessarily new, the products showcased here are backed by science and will very likely be the supplement darlings of 2000.
#1 Growth Hormone Enhancers
One current theory on aging involves the gradual
decline of growth hormone secretion. Human growth
hormone (hGH) is responsible for growth spurts in
teenagers; it also restores lost muscle mass and edistributes
fat cells in the elderly.(1) After age 30, circulating growth hormone
levels decline. Consequently, body composition shifts from muscle
to fat. As a genetically engineered protein derived
from bacteria, hGH was once retrieved from the pituitary
glands of cadavers. Until recently, the only approved
use of prescription hGH was to treat dwarfism in children.
But in 1996, the U.S. Food and Drug Administration (FDA) approved
hGH for long-term replacement therapy in growth hormone-deficient
adults. An estimated 75,000 adult Americans suffer
growth hormone deficiencies, which manifest primarily
as fatigue coupled with a number of the following
symptoms: decreased lean body mass, muscle mass or
physical strength; abdominal obesity and weight
gain; reduced cardiac performance; impaired sense
of well being; and poor sleep.(2) Many of these people
received hGH as growth hormone-deficient children.
Others received it because their pituitary glands were damaged
by cancer, radiation or trauma. However, increasing
numbers of anti-aging enthusiasts are receiving daily
injections for reasons not approved by FDA. One study showed that
21 men aged 61-80 years old who injected 50 mg hGH three times
a week for six months raised their lean mass 8 percent, decreased
fat 14 percent, increased spleen and liver sizes by 18 percent,
and increased bone density by 1.6 percent.(3) Anecdotal reports cite
enhanced libido, improved immunity and wrinkle removal. At $12,000
to $20,000 a year, however, the treatment is out of reach for most
people. Plus, adverse effects are documented in those taking 0.15-5
mg/day of injectable hGH. Side effects run the gamut, from headaches
to cardiovascular and heart diseases.(4-6) Those taking injections
must be monitored by a health care practitioner. Human
growth hormone is also growing in popularity as a performance-enhancing
drug in professional sports. One double-blind, placebo-controlled
study of 35 growth hormone-deficient adults found favorable
changes in body composition after six months. The researchers
concluded that training in addition to supplementing with growth
hormone may be necessary to significantly increase physical performance
in people with hGH deficiencies.(7) Other studies conclude the
ergogenic benefits of growth hormone doping among athletes remain
unproven.(8) Unlike steroids, there is no test for hGH use. Another
approach to increasing hGH levels is amino acid precursor therapy.
A precursor, by definition, converts into another substance along
the biochemical pathway. These amino acids convert to growth hormone,
which in turn increases the burning of fat as well as muscle growth.
•Arginine and ornithine, amino acid precursors for hGH stimulation, first received acclaim in 1987 with Durk Pearson and Sandy Shaw's best-selling book, Life Extension-A Practical, Scientific Approach (Warner Books, 1987). The two growth hormone precursors were touted as body-building and fat-loss products, prompting an increase in sales. However, this is an expensive proposition since rather large doses of the amino acids-at least 6 g arginine or 3 g ornithine-are sometimes required for a detectable increase of hGH in the bloodstream, according to the authors. Plus, those dosage recommendations can cause stomach upset and diarrhea. Finally, no studies indicate this increase translates to increased performance. When the book faded from the best-seller lists, so did consumer interest in hGH precursors. However, new published studies and new products targeting hGH enhancement may swing the pendulum back in favor of these amino acids.
•Glutamine, the most abundant amino acid in the body, is invaluable in influencing hGH. A clinical trial demonstrated that glutamine affects muscular protein synthesis and circulating growth hormone levels.(9) In this study, only 2 g/day oral glutamine caused a significant release (more than 400 percent) of circulating growth hormone in nine healthy adult men. Although growth hormone levels increased, the study did not measure muscle mass changes or exercise enhancement. An in vitro study did show that glutamine increased protein synthesis and inhibited protein breakdown.(10) Physiologically, this could translate to enhanced muscle growth and improved athletic performance. Research on amino acids such as glutamine is still in its infancy; some studies show positive effects of glutamine supplementation on overtraining, others do not.(11)
•Homeopathic growth hormone is another product marketed for hGH enhancement. Three double-blind, placebo-controlled clinical studies published in the December 1999 issue of Alternative and Complementary Therapies found chewable tablets of homeopathic recombinant human growth hormone promoted significant physical, physiological and self-perceived quality-of-life benefits compared toplacebo in 162 healthy adults. The three trials, lasting between 21 and 42 days, found statistically significant decreases in weight and fat storage, lowered blood pressure, relief from fatigue and dry skin, and improvements in sleep quality and libido.(12)
#2 Medicinal Mushrooms
A new category of nutritional supplements is neither vitamin, mineral nor herbal. These are medicinal mushrooms, which fall into the category of mycological products. Although considered part of traditional Chinese medicine (TCM) and Japanese herbology, medicinal mushrooms are not herbs but fungi, a biological kingdom unto themselves. There are about 100,000 different types of fungi, including the penicillin mold. Also in this group are 38,000 species of mushrooms, about 500 of which are thought to possess medicinal properties.
Most of the immune activation provided by medicinal mushrooms is attributed to a complex arbohydrate that enhances white blood cells that destroy harmful microorganisms and tumor cells.
More mainstream practitioners are using medicinal mushrooms to treat a variety of clinical conditions including heart disease, cancer, depressed immunity, hypertension and elevated triglyceride levels. In fact, the all-time, best-selling cancer drug sold in Europe and Japan is a mushroom derivative called PSK. Among the better-known mushrooms used throughout Asia for millennia are reishi, shiitake and maitake.
•Reishi (Ganoderma lucidum), perhaps the most renowned of all medicinal mushrooms, is called the elixir of immortality." In TCM, reishi is considered one of the best longevity tonics. The emperor responsible for the Great Wall of China is said to have dispatched 3,000 soldiers to search for this rare mushroom. Many human clinical trials in China during the last 20 years show reishi to be an effective treatment for a wide range of disorders including coronary heart disease and chronic bronchitis.(13)
•Shiitake (Lentinus edodes) is used as both food and medicine. It is Japan's top agricultural export and the most cultivated exotic mushroom in the world. A shiitake component called lentinan is recognized as an immunostimulant and is an approved drug in Japan for treating gastric cancer.(14)
•Maitake (Grifola frondosa) is the latest mycologic superstar. Used for centuries in Japanese herbal m edicine, recent research seems to confirm maitake's ability to stimulate immunity. At least 30 studies have looked at its anti-tumor action. One study compared maitake D-fraction, an extract of the mushroom that contains a concentration of the immune-stimulating components, with mitomycin-C (MMC), a widely-used chemotherapeutic drug. A small dose of the maitake extract produced an 85 percent tumor shrinkage in mice compared to 30 percent with MMC. When half-doses of MMC and maitake D-fraction were combined, they achieved 99 percent tumor shrinkage in 14 days.(15)
At Georgetown University Medical Center in Washington, Harry Preuss, M.D., is studying the effects of various maitake extracts in different rat breeds. Preuss and colleagues have concluded that both extracts and whole mushroom powder have significant hypotensive and triglyceride-lowering effects when given orally.(16) The fractions are different from D-fraction, and Preuss' work will likely lead to new products. Meanwhile, whole, dried maitake mushroom supplements contain all fractions.
#3 Ribose
Another carbohydrate quickly gaining popularity is D-ribose. Ribose is the sugar backbone of RNA and DNA. Found in all living cells, ribose is the starting point for the energy "currency" called adenosine triphosphate (ATP). Although recognized as an important nutrient since the 1970s, it is only recently that improved and more economical manufacturing procedures have made ribose supplements available. Recent research shows that giving ribose to people suffering from inadequate blood flow to the heart, or myocardial ischemia, greatly increases energy in the heart muscle. In one placebo-controlled study of 20 men with documented severe coronary artery disease, the heart's tolerance to ischemia improved after three days treatment with 60 g ribose daily.(17) Since the body produces ribose from glucose slowly, supplementing can benefit not only heart patients, but also athletes who exercise intensely. Under normal conditions, it takes several days to replace energy lost to ischemia or heavy exercise. In heart patients, low blood flow and ATP deficiency can cause chest pain after light activity such as walking. It is estimated, however, that ribose supplementation could quickly restore energy to muscle cells. A rat study found intravenous administration of ribose fully restored ATP levels in 12 hours vs. 72 hours without supplementation.(18) In athletes, a day off between exercising to exhaustion three or four times per week may not provide enough time for recovery. To keep cellular ATP levels at their highest, 3-5 g of ribose are recommended daily before and/or after exercise.(19) It is conceivable that ribose will become as popular as creatine since the supplements appear to be complementary. Ribose is part of the metabolic pathway leading to ATP production in the presence of oxygen. It is part of adenosine, the "A" in ATP. During exercise, cells generally use creatine phosphate as a source of a phosphate ("P") molecule for reforming ATP. It is theorized that ribose and creatine together may produce a benefit that exceeds that of creatine alone.
#4 Systemic Enzymes
Systemic enzyme supplements are used to instigate various
chemical reactions within cells and not necessarily
for food digestion. The clinical use of enzymes is
most widely practiced in Germany, where they are commonly
used for their anti-inflammatory, immune-supportive
and blood- thinning properties. More than 50 studies
have confirmed their use in treating rheumatoid arthritis and osteoarthritis,
sports injuries and maintaining good heart health and immune
function. One systemic oral enzyme preparation is the No. 1 non-aspirin,
over-the-counter medicine for pain and inflammation and the
ninth-leading natural medicine among all medical drugs in Germany.
In the United States, systemic oral enzymes have been overlooked
by most physicians and consumers, but this trend is changing.
Proteolytic systemic enzymes (proteases), such as
those found in bromelain, papain and pancreatin, are
absorbed from the gastrointestinal tract into the
bloodstream and travel to specific sites where they
break down cell debris, fibrin and toxins. They also stimulate
the immune system and accelerate elimination by way of the lymphatic
system and blood vessels.9200 This translates into improved circulation
and reduced flammation. In contrast to chemical inhibitors
of inflammation such as nonsteroidal anti-inflammatory
drugs
( NSAIDs), enzyme preparations support and accelerate
the natural inflammatory process without contributing to pain,
redness and swelling. This is accomplished by helping degrade and
remove plasma proteins and fibrin that invade the tiny spaces within
tissues at the site of inflammation. Improved microcirculation and
removal of inflammatory products results in pain relief.(21,22) Unlike
digestive enzymes, which are taken with food, systemic enzyme supplements
are taken on an empty stomach, 45 minutes to one hour before
meals, to digest proteinaceous or fibrous waste material including
the outer coating of bacteria, cysts, tumors, necrotic tissue and
immune complexes. The only negative effects are for people with rare
cases of protein allergies.(23) The dawn of the new
year-and millennium-promises to be an exciting one
as more of us turn to natural products for our healthcare needs. When
determining if a supplement is right for you, be sure you understand
how it interacts with other supplements and prescriptions,as
well as how it works on the body . Natural products offer great health
care options, but it's up to you to educate yourself and find out what
it is that your body needs. Ken Babal, C.N., is a
consulting nutritionist and a member of the Society
of Certified Nutritionists. He is staff nutritionist for Erewhon Natural
Foods Market in Los Angeles. Photography by: Peggy
Irelan
References
1. Rudman D. Growth hormone, body composition and aging.
J AmGer Soc 1985;33:800-7. 2. Ho Ky, Veldhuis JD.
Diagnosis of growth hormone deficiency in adults.
Endocrinol Metab 1994;1
(Suppl A):61-3.
3. Rudman D, et al. Effects of human growth hormone in men over sixty years old. New Engl J Med 1990;323:1-6.
4. Toagood AA, Shalet SM. Growth hormone replacement therapy in the elderly with hypothalamic-pituitary disease: a dose-finding study. J Clin Endocrinol Metab 1999;84:131-6.
5. Mason P, et al. Growth hormone as a risk for premature mortality in healthy subjects: data from the Paris prospective study. BMJ 1998;316:1132-3.
6. Lombardi G, et al. Cardiovascular aspects in acromegaly: effects of treatment. Metabolism 1996;45 (Suppl 1):57-60.
7. Rodriguez-Arnao J, et al. Effects of growth hormone replacement on physical performance and body composition in GH deficient adults. Clin Endocrinol 1999 Jul;51(1):53-60.
8. Jenkins PJ. Growth hormone and exercise. Clin Endocrinol 1999 Jun;50(6):683-9.
9. Welbourne TC. Increased plasma bicarbonate and growth hormone after an oral glutamine load. Am J Clin Nutr 1995;61:1058-61.
10. Wu Gy, Thompson JR. The effect of glutamine on protein turnover in chicken skeletal muscle in vitro. Biochem J 1990;265(2):593-8.
11. Williams MH. Facts and fallacies of purported ergogenic amino acid supplements. Clin Sports Med 1999 Jul;18(3):633-49.
12. Brewitt B. Physiological and psychological benefits from homeopathic growth hormone in healthy subjects: three types of double-blind, placebo-controlled studies. Alt Compl Therapies 1999 Dec;5(5). In press.
13. Hobbs C. Medicinal mushrooms: an exploration of tradition, healing and culture. Botanica Press, Santa Cruz, Calif. 1996. P.101.
14. Teguchi T, Kaneko Y. Lentinan: an overview of experimental and clinical studies of its action against cancer. In: Proceedings of the seventh symposium of host defense mechanisms against cancer. Hakone, Japan. Nov. 8-10, 1985.
15. Nanba H. Maitake D-fraction: healing and preventive potential for cancer. J Orthomolecular Med 1997;12(1):43-9.
16. Preuss HG, et al. Effects of maitake mushroom and two extracts on blood pressure (BP) and other CVD parameters in 2 rat strains. J Am Coll Nutr 1998;17:507. 17. Pliml W, et al. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet 1992;340:507-10.
18. Hellsten-Westing Y, et al. Decreased resting levels of adenine nucleotides in human skeletal muscle after high-intensity training. J Appl Physiol 1993;74(5):2523-8.
19. Zimmer HG, Ibel H. Ribose accelerates the repletion of the ATP pool during recovery from reversible ischemia of the rat myocardium. J Mol Cell Cardiol 1984 Sep;16(9):863-6.
20. Klaschka F. Oral enzymes: new approach to cancer treatment. Munich, Germany: Forum-Medizin,(1996) 121.
21. Kleine M, Pabst H. The study of an oral enzyme therapy on an experimental erzeugre hamatome. Forum of practical and general practitioners 1988;27:42.
22. Kleine M et al. Kinetic of proteolytic enzyme activity of serum in a controlled randomized double blind study, Abstr. 2nd International Congress on Biological Response Modifiers, San Diego, California, Jan. (1993), 29-31.
23. Kimber I, et all. Toxicology of protein allergenicity:
prediction and characterization. Toxical Sci 1999
Apr;48(2):157-62.
Article Reference:
Babal, Ken. (January, 2000). Supplements of the Century.
Healthwell.com. http://www.healthwell.com/healthwellmainpage/1_00/supppredict.cfm?path=hw&cond=133&mcat=50
Excerpts from Digestive Wellness
by: Elizabeth Lipski, M.S., C.C.N.
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HEALING OPTIONS Eat in a relaxed manner. Chew your food thoroughly. Limit beverage intake with meals: Drinking liquids at meals dilutes the gastric Juices in the stomach and pancreatic juice in the small intestines. Pancreatic enzyme supplements: Clinical experience shows that pancreatic enzymes work well as a digestive aid. Glandular-based supplements, like pancreatic enzyme preparations, are directed to specific tissues, helping to initiate repair. Pancreatic enzymes also help restore the balance of GI flora. In studies done on monkeys, it was shown that pancreatic enzymes were able to kill Clostridium, Bacteroides, Pseudonionaceae, Enterobacter, E. coli, and Klebsiella. Continued use of pancreatic enzymes can help with repair and maintenance of pancreatic tissue. Pancreatic tissue from pigs has been widely used over the past fifty years to supply missing pancreatic enzymes. You can purchase products from health food stores or ask your physician to prescribe them. The United States Pharmacopoeia (USP) regulates the strength of pancreatic enzymes. For best results use a preparation that is 4x to 10x. Dosage: one to two tablets/capsules at the beginning of meals. Vegetable enzymes: For people who would rather have a vegetarian alternative to pancreatic enzymes, vegetable enzymes are a suitable option. These enzymes are derived from a fungus called Aspergillus oryzae which is used to ferment soy sauce, tamari, and miso. These enzymes work in a much wider range of pH than pancreatic enzymes, enhancing digestion in the stomach as well as in the intestines. Because they are not broken down by stomach acid, the required dosage is much smaller than that for pancreatic enzymes. Vegetable enzymes are also less likely to cause food allergy reactions. Some companies include probiotic bacteria in daily supplements. Dosage: one to two capsules at the beginning of meals. -Elizabeth Lipski Reference: Lipski, E. (2000) Digestive Wellness, Second Edition, p220-221.
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I recommend plant-derived enzymes because they are able to work in the low pH of the stomach and in the neutral environment of the intestines. They provide protease and lipase for the stomach and serve you enzyme needs throughout the digestive tract. Dosage: one to two with meals for a trial period of four weeks. -Elizabeth Lipski Reference: Lipski, E. (2000) Digestive Wellness, Second Edition, p212.
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What is a Dietary Supplement?
by
Marc S. Ullman
Though this subject is not discussed anywhere in the Final Rule, a brief passage in FDA's commentary suggests that the answer to this question may be both very important and not quite as clear as might be expected. According to the Federal Food, Drug and Cosmetic Act as amended by DSHEA, a dietary supplement includes, vitamins, minerals, and other substances intended to supplement the diet. However, DSHEA provided no guidance as to the precise scope of this definition, including what precisely is meant by "other substances intended to supplement the diet."
Some five years following the passage of this law, significant questions still exist concerning exactly what qualifies as a dietary supplement. Are potato chips with ginkgo biloba added a ginkgo supplement with a potato chip delivery system, or are they potato chips with ginkgo sprinkled in them masquerading as a supplement? This issue is of particular note to companies marketing "supplement beverages" (eg., smoothies), that are confronting regulatory action in the state of California which has taken the position that herbs added to these products are unapproved food additives.
In its preliminary discussion of the new rule, FDA states that it views the distinction between dietary supplements and foods as particularly significant, noting: "unlike section 201(g)(1)(C) [the "food exemption" to the definition of "drug"], section 403(r)(6) of the Act [defining "dietary supplement"] does not limit the authorization of structure function claims (without triggering drug approval requirements) to substances that are "food." FDA notes that it is developing an overall strategy and will, when a document incorporating the strategy is released, state how the agency plans to address the requirement that dietary supplements be "intended to supplement the diet."
Later, the agency notes that it views the distinction between foods and supplements as particularly important, explicitly stating that the new rule "applies to claims for dietary supplements only," and that "structure/function claims for conventional foods are limited to effects derived from nutritional value, while structure/function claims for dietary supplements are not."
Depending on exactly where FDA draws the line between "conventional food" and "dietary supplement," there exists the very real possibility that products sold as pills or capsules containing Ginkgo may be able to make the claim "improves absentmindedness" under DSHEA, while potato chips with ginkgo making the claim would be considered unapproved new drugs.
IMPLIED DISEASE CLAIMS
The Final Rule continues to apply FDA's position that any claim that implies treatment for a disease or disease state is not a structure/function claim, but is actually a disease claim. In the context of a claim such as "prevents bone fragility in post-menopausal women" (osteoporosis) or "supports the immune system during the cold and flu season" (cold or flu prevention), this is a difficult proposition to argue. However, a review of some of the claims discussed by FDA suggests that this dividing line is not so clear. Thus, we are left with a situation where FDA has determined that the claims "maintains healthy lung functions," "smoking alternative," "temporarily reduces your desire to smoke" and "mimics the oral sensations of smoking" are acceptable structure/function claims when used individually. FDA has also told LIS that it would consider the claim "maintains healthy lung function in smokers" to be an impermissible disease claim because it "would imply prevention of tobacco related lung cancer and chronic lung disease."
This suggests that the use of the permissible claims "smoking alternative" and "maintains healthy lung function" on the same product or combining them into the single claim "smoking alternative to help maintain healthy lung function" would be considered an implied disease claim, regardless of its veracity, creating a situation where two positives combine to form a negative. Moreover, FDA's basic position fails to address the fundamental question of how to draw the distinction between the maintenance of good health, and the avoidance of good health.
If a product is promoting general well being -- a claim expressly authorized by DSHEA -- what is it doing other than helping to prevent bad health?
The clearly inconsistent, almost random manner in which FDA has attempted to draw a distinction between implied drug claims and acceptable structure/function claims is illustrated by its very different treatment of claims relating to weight loss and cholesterol. In the January 6 Federal Register Notice, the Agency states that it will consider claims that a product is an "appetite suppressant" or is useful as part of a weight loss program to be appropriate structure/function claims, but that claims specifically targeting obesity will be considered disease claims. Thus, a clear distinction is drawn between individuals whose body weights are in a range that it would be considered "a little overweight" and individuals who would be clinically considered "obese."
Yet, FDA has declared that any claim suggesting that a dietary supplement has the ability to lower cholesterol is a disease claim, thus rendering the product an unapproved new drug. The Agency contends that this position is reasonable, even where the claim is directed clearly at individuals whose cholesterol would be considered "high normal" and not suffering from the disease "hypercholesterolemia." When pressed for an explanation , on for this position in response to a "courtesy" letter issued for the claim "helps lower cholesterol," FDA noted that a drug not only "cures" disease, but also "prevents" disease, and that individuals whose cholesterol is within the "high normal" range would be at increased risk of hypercholesterolernia, and thus that all cholesterol lowering claims necessarily imply disease prevention (I raised this question with the Agency on behalf of a client who had received such a letter.)
The very different approaches taken on the issues of weight loss and cholesterol lowering should clearly illustrate the potential difficulties in predicting what FDA will consider an implied disease claim, and what claims it will deign to allow. If individuals with "high normal" cholesterol are at increased risk of hypercholesterolernia, why aren't individuals with "high normal" body weights at increased risk of becoming obese? If all cholesterol-lowering claims necessarily imply prevention of hypercholesterolemia, why don't all weight loss claims necessarily imply prevention of obesity?
FDA CHANGES ITS MIND
How can we explain this very different outcome for weight loss and cholesterol lowering claims? Perhaps it is related to FDA's ongoing effort to classify all cholesterol supplements containing red rice yeast extract as drugs based upon its prior approval of Merck's Mevacor as a cholesterol lowering, drug. Whatever the answer, FDA's treatment of cholesterol raises another very significant concern that arises out of a one page regulation that is implemented based on 50 pages of explanation -- namely that FDA can, and will, change its mind.
When FDA started receiving 30 clay structure /function notices, it took the position that the claim "lowers cholesterol" was an acceptable structure/function claim so long as it was made in conjunction with a statement that the product was useful in the context of a healthy diet and exercise. Under the final rule, however, these claims that FDA had specifically approved will be considered unacceptable disease claims.
In response to a comment suggesting that because it had taken this earlier position, FDA should have come forth with evidence (such as a consumer survey) justifying its new position that any claim involving lowering cholesterol implies treatment or prevention of a disease, the Agency responded: FDA does not agree that it may not change its position on whether particular cholesterol claims imply disease treatment. The record and analysis in this rulemaking, as well as FDA's experience in implementing DSHEA, provide an ample basis for the conclusions that the agency has reached on cholesterol claims.
In as much as FDA has failed to set forth anything beyond its repeated statements that "lowers cholesterol" necessarily implies treatment of a disease, without citing to a single consumer survey, and while rejecting a specific comment from a former Surgeon General of the United States (whose expertise on public health issues should certainly be considered comparable to FDA) urging that such claims be permitted, the only conclusion that can reasonably be drawn is that FDA changed its mind because it wanted to. The problems inherent in this type of "rulemaking" are even more apparent when one considers that FDA has also declared that the claim "helps maintain normal cholesterol" is not permissible, because consumers will understand that it implies cholesterol lowering.
The reality of the problems that can arise from this type of regulatory framework were demonstrated barely one month after publication of the Final Rule. On February 9, 2000 FDA issued an advisory that it was reversing its decision to permit dietary supplements to make structure/function claims associated with pregnancy. After 20 months of what one would expect to be careful deliberation following the publication of its initial structure/function proposal took the opposite decision, FDA determined that "mild conditions commonly associated with particular stages of life or normal physiological processes will not be considered diseases."
The first example listed in the Agency's explanation of this decision was "morning sickness associated with pregnancy." Based upon this express pronouncement, it would not be surprising that a number of supplement companies commenced preparation of a marketing campaign which included claims to this effect.
However, on February 9, FDA issued a statement that: "To ensure that careful consideration is given to concerns recently raised regarding how the structure/function rule relates to pregnancy, FDA today is advising dietary supplement manufacturers not to make any claims related to pregnancy on their products based on the agency's recently issued structure/function rule. FDA will issue a Federal Register notice shortly describing these concerns in more detail, stating the agency's intention to fully review these concerns, hold a public meeting related to potential pregnancy related safety concerns, and then issue further guidance. FDA urges all pregnant women to consult their health care provider before taking any dietary supplements or medication."
While this decision is not necessarily wrong due to the unique circumstances of pregnant women and the concerns relating to the physiology of the fetus, it should serve as a reminder that a claim that FDA has stated is acceptable today, may not be acceptable tomorrow. When operating under a regulatory framework that relies on 50 pages of agency analysis of a one-page rule, there would seem to be no way to be assured that this type of reversal of fortune could not occur at any given time.
OTC DRUG CLAIMS
One of the major reasons the supplement industry has generally received the Final Rule favorably is FDA's determination that the categories of acceptable dietary supplement structure/function claims and over-the-counter (OTC) drug structure/function claims are not mutually exclusive.
In explaining this conclusion, FDA noted that: one kind of valid drug claim is a claim related to the effect of the product on the structure or function of the body, but not related to prevention or treatment. In other words, not all drug claims are disease claims. Congress specifically provided that structure/function claims do not, in themselves, subject a dietary supplement to regulation as a drug. It thus would not be appropriate to exclude from the scope of acceptable structure/function claims OTC monograph claims or other approved claims for products classified as drugs.
Examples of the claims now authorized for dietary supplements under this portion of the Agency's interpretation of the Final Rule include:
- Antacid claims (relief of sour stomach, upset stomach, occasional heartburn and indigestion);
- Nighttime Sleep Aid (relief of occasional sleeplessness);
- Stimulant Claims (helps to restore mental alertness when experiencing drowsiness). Exactly how this fits with efforts to suggest that stimulant claims are inappropriate for ephedra products remains to be seen;
- Stool Softener; and
- Laxative (Relief of occasional constipation.)
While opening the door for these and other claims that had heretofore been reserved for OTC drug products, FDA's commentary also contains an extremely significant caveat: the Agency suggests that where dietary supplements utilize structure/function claims that are also included in an OTC drug monograph, inclusion of any warnings also found in the monograph may be necessary in order for the product's label to be truthful and nonmisleading.
These types of warnings include general statements suggesting that users consult a physician if the condition they are seeking to resolve persists for any period of time, as well as specific statements such as those found on aspirin which warn against use of the product in children under circumstances that may greatly increase the risk of contracting Reyes Syndrome.
Moreover, any supplement manufacturer that does not give careful consideration to the use of these warnings not only runs the risk of running afoul of FDA, but also opens the door to an entire new class of potential product liability litigation for failure to warn, which had not previously been a significant concern for dietary supplement companies. Companies that market products as laxatives, but do not alert the consumer of the need to consult a physician if their constipation problem is not resolved rapidly, place themselves at significant risk of a failure-to-warn lawsuit if a consumer using their product develops a more serious gastrointestinal problem that might have been resolved by a visit to their doctor.
A related question for which the answer may not be apparent anytime soon is whether supplements utilizing structure/function claims found in OTC monographs have a duty to disclose to the consumer that there are alternative products available on the marketplace that have active ingredients that have been specifically indicated by FDA for the identical use. If the answer is that such a duty exists, the door may be open for any number of "consumer rights" litigations seeking compensation for the failure to provide supplement users with material information relevant to their decision to purchase. Any company that has had experience with laws such as California's Unfair Competition statute understand the magnitude of the problem this type of claim can create.
SUBSTANTIATION
No matter how any of these issues are resolved, one universal word of caution applies just because FDA has stated it views of appropriate structure/ function claims for dietary supplements does not mean that it has approved of the use of the claim in conjunction with the marketing of any product.
The one overarching principle that applies to each and every claim made in the marketing of a dietary supplement is that it must be truthful and nonmisleading; if it is not, the product associated with the claim is subject to immediate enforcement action. In order to satisfy this standard, and to comply with DSHEA, companies must possess substantiation supporting each structure/function claim on behalf of their products. Inclusion of a specific claim within FDA's discussion of what it considers appropriate for use in the marketing of supplements does not constitute substantiation of the claim. Indeed, in the very brief discussion of substantiation in the Final Rule, FDA notes that 11clainis ... should be supported by adequate scientific evidence."
Exactly what constitutes substantiation remains an open issue, and perhaps it is best that way. Until such time as either the FDA or the Federal Trade Commission establish a "bright line" standard (which will likely be far more stringent than the supplement industry would desire), the flexibility to argue that some lesser level of substantiation should be required of supplements than is required of drug products may remain an important asset in the ability to assert that many claims that are not proven to a scientific certainty, should never the less be considered truthful and nonmisleading. However, one thing is certain: "adequate scientific evidence" does mean something more than a couple of clippings from a newspaper or magazine, and it certainly does not mean "well, everybody else is doing it."
LOOK BEFORE YOU LEAP
The January 6 Federal Register announcement containing FDA's interpretation of the Final Rules under which it will determine the scope of appropriate structure/function claims for dietary supplements was rightly viewed as a significant accomplishment for the industry. Not only did the Agency retreat from its efforts to impose a new, restrictive, definition of disease, but it also recognized that supplements may legally make a large number of claims that had previously been forbidden. The new regulation and FDA's analysis thereof also contain a number of potential and actual problem areas. It is far to soon to forget FDA's efforts to target ephedra dietary supplements and its campaign against tryptophan to simply accept the Agency's present views as etched in stone.
Additionally, companies utilizing many of the new claims FDA has recognized as acceptable for supplements may now have to confront a variety of new challenges. Supplement companies moving aggressively forward with the marketing of their products under this new regulatory framework would do well to look into and consider all of their potential gains and risks before leaping blindly on to market. SIE
Marc S. Ullman, is partner in Ullman, Shapiro and Ullman, LLP, a law firm based in New York, NY, which specializes in regulatory matters in the nutritional products industry.
Article Reference:
Ullman, M.S., (May 2000). What is a Dietary Supplement?, "Supplement Industry
Executive".
At first bite, the work of the digestive system seems quite straightforward: to break down the food we eat into simpler, more easy-to-digest compounds, and then to absorb these nutrients into the bloodstream. However, digestion is a complex process involving a number of major organs, accessory organs and over a dozen digestive enzymes that break down the food we eat into nutrients the body can use. Adding to the complexity of the digestive system is the fact that it’s so sensitive; poor digestive health is a major problem in the United States today. "Over 80 million Americans suffer from poor digestion," said Tom Bohager, director of Enzymedica, Punta Gorda, FL. Carla Roberts, COO of CX Research, Austin, TX, agrees. "As we get into our mid-thirties, digestive supplements become important because of the cumulative effect of stress, poor eating habits, toxins, and drugs," she said.
The Fluidity of Digestion
Healthy digestion is a fluid and complicated process. Although most of your customers may think of the stomach as the beginning of the digestive tract, digestion actually begins in the mouth, where the action of chewing breaks up food and mixes it with a starch-digesting enzyme, amylase, in the saliva.
After transport through the esophagus, the stomach’s strong acid, rhythmic kneading and a protein-specific enzyme, protease, further prepare food for absorption in the small intestine. There, enzymes supplied by the pancreas, gallbladder and liver further break down food, and nutrients released in the process are absorbed into the bloodstream through the epithelial cells which line the gut. In the large intestine, water and electrolytes are reabsorbed and the solid byproducts of digestion are stored for elimination. Peristaltic movement of smooth muscles in the intestinal walls moves food through the system. Solid waste is then eliminated through the colon.
In such a complex system, much can go awry. Proper movement of food through the digestive tract hinges upon the parasympathetic nervous system’s control of the smooth muscles lining the walls of the stomach and intestines. Stress tends to favor activation of sympathetic "fight or flight" reactions, which often leaves the digestive system in a state of limbo until the body can relax again.
Stress can also cause painful acid reflux by interfering with regulation of the sphincter which separates the vulnerable esophagus from acidic stomach contents. More extreme -- but fortunately a bit less common -- gastric reactions to stress may include nausea and vomiting. The infamous gastric (stomach) ulcer is believed to be caused by a number of factors, including long-term use of irritating non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, and by an overabundance of an unfriendly bacterium, Helicobacter pylori, in the stomach.
Fortunately, the supplement industry has responded to the nation’s distress by providing relief in the form of digestive supplements. "Digestive aids are one of the biggest-selling areas of the market for good reason: people have major problems," said Roberts at CX Research. Help is available for many types of digestive distress, in the form of digestive enzymes, Western herbs and Chinese herbal formulas, as combination and stand-alone products; you can create a substantial digestive care section in your store. Below is an overview of several types of products that either target the upper digestive system (especially the stomach) or which are formulated to support general digestive health.
Digestive Enzymes: Little Helpers
According to Gary Bennett, marketing manager at National Enzyme Co., Forsyth, MO, "Without enzymes, human life would cease to exist…digestive enzymes help break down food into smaller components so that the body can absorb nutrients."
More than a dozen digestive enzymes exist, and each type breaks down a specific type of nutrient. For example, amylase in the saliva breaks down carbohydrates; protease helps break down protein; and lipase aids in digestion of fats. Deficiency in a specific type of enzyme can cause trouble, as in the case of lactose intolerance. The primary sugar in milk, lactose, is broken down by an enzyme called lactase. "Thirty percent of Americans lack an ability to produce lactase, and therefore experience major discomfort due to their inability to digest milk and milk products," said Bennett.
According to Bennett and other sources, everyone can benefit from digestive enzyme supplementation. "People don’t necessarily need to have a digestive problem to need enzymes; if you eat cooked or processed foods, you need them," he said. Bohager of Enzymedica agrees with the distinction. "We emphasize the therapeutic effect of enzymes, as opposed to just alleviating heartburn and other symptoms." Bohager explains the concept of "enzyme potential" and how to preserve it with digestive enzyme supplementation: "Everyone is born with a certain potential for making metabolic enzymes that are crucial to overall health, and that are needed in every cell for a wide variety of functions. Each time you eat food that’s cooked or processed, you’re sacrificing the production of life-giving metabolic enzymes in favor of producing digestive enzymes, and thereby reducing your enzyme potential. This is the only way some researchers have been able to explain why one individual can smoke, drink and eat whatever he wants and live to be 105, while another person can do everything right and only live to 60; it’s because of differences in inborn enzyme potential."
Although researchers have been studying enzymes for a long time, new functions of enzymes are still being discovered. Protease, in particular, is believed to have a strong general therapeutic effect. "We now know that plant-form protease, taken on an empty stomach, combines with alpha-2-hemoglobulin in the blood," said Bohager. "The two together seek pathogenic proteins in the blood and disable them. The alpha-2-hemoglobulin can distinguish the proteins in harmful viruses, and release protease, which exposes those viruses to the immune system." A wide variety of digestive enzyme supplements are available on the market, including Enzymedica’s Digest, which mixes a broad spectrum of enzymes with probiotic bacteria and a pH balancer, and lipase-rich Lipo, which helps people with gallbladder problems to digest fats.
Green Bay, WI-based Enzymatic Therapy’s Protazyme contains pepsin, papain and pancreatin, which assist in the digestion of proteins, and Megazyme blends 10 broad-ranging enzymes that break down fats, proteins and carbohydrates.
The TCM Approach
Chinese herbal combination formulas are perhaps the newest type of digestive supplement to make a splash on the American market. "This is a very fast-growing corner of the market," said Phyllis Tan, product manager at BMK International. "They’re catching on because consumers are recognizing that Traditional Chinese Medicine offers safe and effective formulas as part of an integrated form of medicine with 5000 years of history."
According to Tan, those who take Chinese herbal formulas for digestion avoid the dependency problems that may occur with long-term use of enzyme supplements. "The body is very efficient, so if you continually introduce enzymes into your system, you’ll stop producing them," she said. Tan also emphasized the importance of taking a combined approach to digestive supplementation rather than using stand-alone products. "Chinese herbal therapy never uses single herbs because they could cause an imbalance," she pointed out. "And while single herb supplements may eventually their effectiveness, combined formulas work to improve the whole system, rather than just targeting one issue."
Gastro Ease from BMK is a combination herbal formula targeting upper gastro-intestinal complaints that fall under the Chinese diagnosis of stagnant digestion. Within this formula, a number of herbs work together to improve digestion: ginger helps to dissipate gas, Chinese (deglycyrrhizinated) licorice works to improve the integrity of gastric mucosa, and citrus rind increases metabolism. "Although this formulation can relieve symptoms like gas or reflux within 20 minutes, it really has a dual role. It works quickly for immediate symptoms, but also works long-term to tonify the entire digestive system," said Tan.
Western Herbs and Extracts
A number of Western herbal supplements for digestion are available as well. Iberogast from Enzymatic Therapy contains such ingredients as clown’s mustard, chamomile, angelica and licorice, and has been clinically shown to reduce upper abdominal discomfort, nausea and vomiting. The company also offers GastroSoothe, a remedy that combines calcium carbonate with DGL and the amino acid glycine.
DGL (deglycyrrhizinated licorice), available as a stand-alone chewable supplement from Enzymatic Therapy and a number of other sources, is a substance that helps to protect the innermost mucosal layer of the stomach against damage from irritants that could lead to ulceration. Instead of suppressing or neutralizing gastric acid, it stimulates protective factors in the gut, and also contains flavonoid compounds that have been shown to inhibit the growth of H. pylori.
According to Tan, people with high blood pressure should choose supplements that contain DGL (Chinese) licorice, because regular licorice can raise blood pressure very quickly. Because gastro-intestinal problems and hypertension often go hand-in-hand when stress is a root cause, people with hypertension should be very careful to choose DGL licorice over other varieties.
Combination Products
Other products combine digestive enzymes with Western or Chinese herbs for general digestive system support. "The value of a combination formula is that it gives quick relief from symptoms, but also works on the cause of the problem," said Roberts of CX Nutrition, maker of DigestRC. This product contains the liver enzyme cholic acid, as well as black radish root and artichoke extracts to improve bile production, charcoal to calm the stomach and absorb toxins, and peppermint to regulate smooth muscle activity and relieve gas. "This product can be used to treat acid indigestion, upset stomach, heartburn, constipation, gas, bloating, nausea and cramps," said Roberts. Enzydophilus from Enzymatic Therapy mixes a variety of enzymes with colostrum, probiotic bacteria and fructooligosaccharides (FOS), which promote the growth of friendly bacteria in the body.
Another combination digestive product, Best for Digestion from Doctor’s Best, San Clemente, CA, combines vegetable-derived enzymes with Chinese herbs such as forsythia, citrus, shenchu and ginger. "This formulation relieves immediate problems, and acts as a tonic for the whole digestive tract, especially the stomach," said Richard Conant, L.Ac., C.N., the company’s director of nutrition.
Antacids
Antacids -- most commonly calcium carbonate, calcium citrate, or calcium phosphate -- are common ingredients in digestive supplements, and are also popular stand-alone products. But while they are very effective in the short run, long-term use of antacids can cause trouble in the digestive tract.
The low-pH acid environment of the stomach serves three major purposes: to break down food, to protect the lower gut from invading bacteria, and to activate protein-specific enzymes. Because antacids raise the pH of the stomach, they reduce its ability to do its job. "Not only do antacids actually inhibit the body’s own natural defense system, but it’s not natural to have a higher pH in the stomach; you need a low pH [more acidity] in order to be able to break down your food," said Conant.
Additionally, he stated, "The recent emphasis on the benefits of calcium in antacids is mostly just marketing. Ironically, calcium requires stomach acid in order to be broken down and assimilated." The upshot is that although antacids can be useful, consumers should be aware that they’re not risk-free.
Aiding More Than Just Digestion…
Given the number of supplements offering relief from digestive troubles -- not to mention the broad range of healing philosophies they represent -- the average consumer with a bellyache is bound to find a regimen that can offer both short and long term relief for any particular set of digestive symptoms. But although attaining optimal digestive health is a valuable end in itself, it is also an important means to develop better nutrition, as well as better overall health.
Kate Jones, vice president of Nutrition Now, Vancouver, WA, commented, "No matter how hard you try, you’re not always going to eat what you’re supposed to eat. The reality is that people eat a lot of fast food. It’s really about stacking the odds in your favor. The more educated consumers are about this topic, the better off we’ll all be in the long run."
Conant of Doctor’s Best agrees. "We can’t have good nutrition without good digestion," he said. "You can consume the best diet and all the best supplements, but if you’re not digesting them, they’re not doing you much good." And because of the digestion/nutrition/health connection, the area of digestive supplements is one in which the industry can have a major impact on the health of Americans. Bohager of Enzymedica summed it up cogently: "What’s exciting about the market we’re in is how digestion plays such a key role in overall health. It’s not just about alleviating gas -- it’s about living a more healthful life." VR
Article Reference:
Chisholm, Laura. (May 2000), Supplements For Digestive Health "Vitamin Retailer".
Digestive Symptoms More Common in
US Population Than Assumed
Reuters Health
WESTPORT, Jul 03 (Reuters Health) - Pain, bloating, and diarrhea are more common and frequent in the US than previously recognized, according to the findings of a population based study.
With funding, from Proctor & Gamble, Dr. Robert S. Sandler from the University of North Carolina, in Chapel Hill, and a multicenter team sought to determine whether olestra in potato chips really caused digestive symptoms or whether there was already a background of common frequent symptoms. "People had read the publicity and they expected that they might develop symptoms and when they did they attributed them to the olestracens," Dr. Sandler told Reuters Health.
The group collected data on 2,510 subjects who completed telephone interviews. The subjects were asked to give estimates of the frequency, duration, severity and impact, if any, of digestive symptoms during the month before the survey.
"Among the respondents, 1,017 (40.5%) reported one or more digestive symptoms within the month before the interview," according to the report in the June issue of Digestive Diseases and Sciences. Dr. Sandler's group found that, more than 65% rated their symptoms as moderate or severe-, 21.8% had abdominal pain or discomfort, 15.9% reported bloating or distention and 26.9% had loose stools or diarrhea.
Additionally, more women (24.4%) than men (17.5%) reported abdominal pain or discomfort. Bloating and distention, too, were more common among women (19.2%) than among men (10.5%). However, both men (26.7%) and women (27. 1 %) reported similar Occurrences of diarrhea and loose stool, according to the authors. The team also noted that symptoms were less common among Subjects older than 60 years of a