Interview
with Luke Bucci, Part IV -- Proteolytic Enzymes
G.
Douglas Andersen, DC, DACBSP, CCN
Volume
13, number 19, 9/12/95, page 14
Proteolytic enzymes and healing.
Dr. Andersen: Dr. Bucci, in your book Nutrition Applied
to Injury Rehabilitation and Sports Medicine, you mentioned that bromelain
did not have to be enterically coated to be absorbed and demonstrate anti-inflammatory
activity.
Dr. Bucci: I think it should be enteric coated for the
best anti-inflammatory effects, but if you have quick stomach emptying,
then it'll still get out of the stomach acid situation and be absorbed.
That's why an empty stomach is more important than enteric coating.
Dr. Andersen: That really surprises me. When I did extensive
research on proteolytics a few years ago, I found that they had to be
enterically coated to have anti-inflammatory activity.
Dr. Bucci: Well, for bromelain it's not necessarily the
case.
Dr. Andersen: Is there a safe, easy, inexpensive way
for the chiropractor to determine if the patient they are treating has
quick stomach emptying and does not require an enterically coated product?
Dr. Bucci: No, I would stick with the enterically coated
product. I recommend that in the book because you're better to be safe
than sorry.
Dr. Andersen: One of the most confusing and frustrating
aspects of recommending proteolytic enzymes is units of measurement. When
I wrote my series on proteolytic enzymes a few years ago, some of the
units of measurement I came across included caseolytic units, Armour units,
Rohrer units, national formulary units, gelatin-dissolving units, milk-clotting
units, and the United States pharmacopeia units. To make matters worse,
although trypsin, chymotrypsin and papain did have USP ratings, one cannot
compare them. To rate each enzyme a different substrate is used. There
is no common denominator or conversion factor. I know of no rational way
one can recommend any sort of dose other than to instruct a doctor or
a patient to take a handful of pills two to four times a day on an empty
stomach and hope for results.
Dr. Bucci: Unfortunately you're correct. That's how proteases
have been studied since they were discovered way back in the early part
of the century. If you use an assay that shows that, for example, trypsin
is red hot, bromelain doesn't test well, and vice versa. If you use milk-clotting
units, chymotrypsin does not show a lot of activity. You have all these
different assays and then you find enzyme-specific substrates. So, it
is a huge morass. It's just an absolute disaster. I think this more than
anything has allowed proteases to not be given their due concern. It was
a big problem when they were prescription items. That's where you get
Armour units, from the Armour hot dog people and their Chymoral product.
And Rohrer units with their bromelain product, and several others like
that.
Dr. Andersen: I think chiropractors would use a lot more
enzymes if the nutrition companies that serve our industry could pool
their resources and come up with common denominators that doctors could
use for dosing and product comparison. The only common denominator out
there now seems to be weight, and the weight of an enzyme means nothing.
The activity is what is important, and comparing activities between enzymes
and companies is just about impossible.
Dr. Bucci: That's correct. You're absolutely right. Some
people use weights and that gives you an idea of how much of the pure
stuff is there, you hope. Again, there are different grades of pancreatin,
of trypsin, and especially bromelain and papain. There is almost pure
and then there's five percent. And you really don't know if somebody has
put in 100 mg of the five percent stuff or 100 mg of the 90 percent stuff.
They can say it on the label, but even if they do it may not be active
because it sat around too long before the company got hold of it or before
it was bottled. I've assayed products and found no activity. After talking
to one company about it, saying you really need to look at this, they
sent me, in addition to their lawyer's name and number, a certificate
of analysis of that batch showing that it has all this enzyme activity.
I used up-to-date, enzyme-specific methods to show there was no more activity
in the product. Somebody is being fooled, and it isn't me.
Dr. Andersen: The really frustrating thing about proteolytic
enzymes is that when you have an active product that is dosed correctly,
proteolytic enzymes can have a powerful anti-inflammatory effect without
any of the gastrointestinal side effects of nonsteroidal anti-inflammatories.
Dr. Bucci: Yes. Since these things used to be pharmaceutical,
you can't go wrong if you take the pharmaceuticals.
Dr. Andersen: I don't know of any companies that sell
pharmaceutical enzymes.
Dr. Bucci: There are a few out there, but they are prescription
items, like Chymoral, so I think that takes most DCs out of the loop.
I don't even think they're sold much anymore. I've had a hard time finding
them in pharmacies. Every once in a while I'll walk into a pharmacy and
ask, "Do you have Chymoral?" They go, "Huh? Oh, yeah, that
was 20 years ago or something." So even the pharmaceutical companies
have replaced them with NSAIDS.
Dr. Andersen: Maybe as the literature continues to pile
up on the negative effects of nonsteroidal anti-inflammatories, the pharmaceutical
industry will take a second look at proteolytic enzymes. I would have
no problem with sending my patients down the street to the general practitioner
to get a prescription for a good pharmaceutical grade proteolytic enzyme
that would reduce inflammation without comprising the integrity of the
gastrointestinal tract.
Dr. Bucci: If that's the only way to do it, I'm all for
it. There are good products out there right now. Even if you find a good
company, they may have batch-to-batch variations over different years
or different months. You really have to find one that works and stick
with it.
Dr. Andersen: Unfortunately, I wish there was some way
other than doing a trial and error on your own patients. I get calls from
doctors all the time asking me for dosing advice on proteolytic enzymes.
It's impossible to give any specific recommendations for, say, a grade
II sprain over the phone when every product on the market uses a different
unit of measurement. Imagine if everyone who sold vitamin C had a different
unit of measurement for it and there was no common denominator or way
to compare products. It would be a mess and utilization would plummet.
Dr. Bucci: Don't feel bad because the food industry has
the same problem, and they deal with tons of these enzymes every year,
which is really interesting. They have had the same trouble trying to
figure out who has what. They have big bucks and careers riding on single
batches of fermented products. If they don't use the right amount, the
monetary losses can be staggering. It's not just us, it's everyone who
gives or uses proteases. I think there has to be something done with the
manufacturers of these enzymes. I feel they need to stick with just a
few assays, and run all the assays on every product. That way you have
a clear picture of the spectrum of activity and the activity itself. But,
at least for the near future, I don't see it happening.
Dr. Andersen: Dr. Bucci, although it is not a proteolytic
enzyme, before we conclude I would like to ask you about superoxide dismutase
(SOD). Does it have oral activity? Many of the doctors and scientists
in this industry I respect have stated it is not absorbed orally, and
yet there are those who continue to insist otherwise. What is your opinion?
Dr. Bucci: All I can say about SOD is that it gets in
your mouth but not in your hands. It does not get absorbed. I spent six
years looking for oral SOD absorption, and never found it.
Dr. Andersen: This coming from you is impressive considering
the company you used to work for.
Dr. Bucci: Well, yes, and that's why you won't see that
data, because obviously it was not what we all wanted to see. You can't
boost intracellular SOD levels, because if you have too much SOD you end
up with Down's syndrome, basically. One of the primary lesions in Down's
syndrome is too much SOD and not enough of the other antioxidant enzymes
to counteract it.
Dr. Andersen: Dr. Bucci, thank you very much for your
time.
916
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Brea, CA. 92821
(714) 990-0824
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Copyright
2004, G. Douglas Andersen, DC, DACBSP, CCN, 916 E. Imperial Hwy, Brea,
CA 92821, (714) 990-0824
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