Your Nutrients

Glucosamine is an important building block needed by the body to manufacture specialized molecules called glycosaminoglycans, found in cartilage.

Glucosamine is not present in significant amounts in most diets. Supplemental sources are derived from the shells of shrimp, lobster, and crab, or may be synthesized.

A glucosamine deficiency in humans has not been reported.

Osteoarthritis (glucosamine sulfate) Autism Knee pain (glucosamine HCI) Minor injuries Osteoarthritis (glucosamine HCl) Sprains and strains Wound healing (oral)

At the amount most frequently taken by adults 500 mg three times per day of GS adverse effects have been limited to mild reversible gastrointestinal side effects. In one trial, people with peptic ulcers and those taking diuretic drugs were more likely to experience side effects. Animal research has raised the possibility that glucosamine could contribute to insulin resistance. This effect might theoretically result from the ability of glucosamine to interfere with an enzyme needed to regulate blood sugar levels. However, available evidence does not suggest that taking glucosamine supplements will trigger or aggravate insulin resistance or high blood sugar. Two large, 3-year controlled trials found that people taking GS had either slightly lower blood glucose levels or no change in blood sugar levels, compared with people taking placebo. Until more is known, people taking glucosamine supplements for long periods may wish to have their blood sugar levels checked; people with diabetes should consult with a doctor before taking glucosamine and should have blood sugar levels monitored if they are taking glucosamine. In 1999 the first case of an allergic reaction to oral GS was reported. Allergic reactions to this supplement appear to be rare. Some GS is processed with sodium chloride (table salt), which is restricted in some diets (particularly for people with high blood pressure). The theory that GS and chondroitin sulfate work synergistically in the treatment of osteoarthritis remains unproven. At the time of writing, there were no well-known drug interactions with glucosamine.

Healthy people do not need to routinely supplement with glucosamine. Most research with people who have osteoarthritis, uses 500 mg three times per day of GS. Appropriate amounts for other conditions are not known.

Digestive enzymes are complex proteins involved in digestion that stimulate chemical changes in other substances. They work optimally at specific temperature and pH. Digestive enzymes include pancreatic enzymes, plant-derived enzymes, and fungal-derived enzymes. There are three classes of digestive enzymes: proteolytic enzymes needed to digest protein, lipases needed to digest fat, and amylases needed to digest carbohydrates.

Only small amounts of the animal-based proteolytic enzymes, trypsin and chymotrypsin, are found in the diet; however, the pancreas can synthesize these enzymes. The plant-based proteolytic enzyme bromelain comes from the stems of pineapples and is useful in many conditions. Papain comes from unripe papayas. All of these enzymes are available as supplements.

People with pancreatic insufficiency and cystic fibrosis frequently require supplemental pancreatic enzymes (which include proteolytic enzymes, lipases, and amylases). In addition, those with celiac disease or Crohn’s disease and perhaps some people suffering from indigestion may be deficient in pancreatic enzymes. As bromelain and papain are not essential, deficiencies do not exist.

Low back pain (chymotrypsin, trypsin) Pancreatic insufficiency (including pancreatitis) Sprains and strains (chymotrypsin, trypsin) Celiac disease Indigestion (Lipase) Osteoarthritis (bromelain, trypsin, rutosid combination) Tendinitis (proteolytic enzymes) Acne Rosacea Chronic candidiasis Crohn’s disease Food allergies Gastroesophageal reflux disease (GERD) Low back pain (papain) Sprains and strains (papain)

The most important digestive enzymes in malabsorption diseases are usually fat-digesting enzymes called lipases. Proteolytic enzymes can digest, as well as destroy, lipases. Therefore, people with enzyme deficiencies may want to avoid proteolytic enzymes in order to spare lipases. If this is not possible (as most enzyme products contain both), people with malabsorption syndromes should talk with their doctor to see if their condition warrants finding products that contain the most lipase and the least protease. In theory, too much enzyme activity could be irritating because it could start to “digest” parts of the body as the enzymes travel through the digestive system. Fortunately, that does not happen with supplemental amounts. Research has not determined the level at which such problems might arise. A serious condition involving damage to the large intestines called fibrosing colonopathy has resulted from the use of pancreatic enzymes in children with cystic fibrosis. In some cases, the problem was linked to the use of high supplemental amounts of enzymes. However, the amount of enzymes used has not been linked to the problem in all reports. In some cases, lower amounts of enzymes have caused fibrosing colonopathy if the enzymes are enteric-coated. Some researchers now believe that some unknown interaction between the enteric coating and the enzymes themselves may cause damage to the intestines of children with cystic fibrosis. Until more is known, children with cystic fibrosis needing to take pancreatic enzymes should only do so under the careful supervision of a knowledgeable healthcare professional. Certain medicines may interact with digestive enzymes. Refer to drug interactions for a list of those medicines.

The digestive enzymes—proteolytic enzymes, lipases, and amylases—are generally taken together. Pancreatin, which contains all three digestive enzymes, is rated against a standard established by the U.S. Pharmacopeia (USP). For example, “4X pancreatin” is four times stronger than the USP standard. Each “X” contains 25 USP units of amylase, 2 USP units of lipase, and 25 USP units of protease (or proteolytic enzymes). Three to four grams of 4X pancreatin (or a lower amount at higher potency) with each meal is likely to help digest food in some people with pancreatic insufficiency. Those with chronic pancreatitis need to discuss enzyme intakes with their physician. Under medical supervision, seriously ill people with pancreatic insufficiency caused by pancreatitis are given very high levels of enzymes to improve fat digestion. In one successful trial, enough pancreatin was used with each meal to supply slightly over 1,000,000 USP units of lipase. Because pancreatin is rapidly emptied from the stomach during digestion, people taking these enzymes may obtain better results by spreading out supplementation throughout the meal. Supplemental enzymes that state only product weight, but not activity units, may lack potency.

Bromelain, derived from the pineapple plant, is one of a group of proteolytic enzymes (enzymes capable of digesting protein).

Bromelain is found mostly in the stems of pineapples and is available as a dietary supplement.

Since bromelain is not essential, deficiencies of this plant-based enzyme do not exist.

Sinusitis Wound healing Post-surgical healing Prostatitis (NBP, PD) Sprains and strains Tendinitis Urinary tract infection Angina Asthma Low back pain Rheumatoid arthritis Thrombophlebitis

Bromelain is generally safe and free of side effects when taken in moderate amounts. However, one preliminary report indicates increased heart rate with the use of bromelain. In addition, some people are allergic to bromelain. One woman reportedly developed a hives and severe swelling after taking bromelain, even though she had tolerated bromelain on two other occasions previously. Because bromelain acts as a blood thinner and little is known about how bromelain interacts with blood-thinning drugs, people should avoid combining such drugs with bromelain in order to reduce the theoretical risk of excessive bleeding. Certain medicines may interact with bromelain. Refer to drug interactions for a list of those medicines.

Assessing the right amount of bromelain to take is complicated. Most bromelain research was conducted years ago, when amounts used were listed in units of activity that no longer exist. These old units do not precisely convert to new ones. Today, bromelain is measured in MCUs (milk clotting units) or GDUs (gelatin dissolving units). One GDU equals approximately 1.5 MCU. Strong products contain at least 2,000 MCU (1,200–1,333 GDU) per gram (1,000 mg). A supplement containing 500 mg labeled “2,000 MCU per gram” would have 1,000 MCU of activity. Some doctors recommend as much as 3,000 MCU taken three times per day for several days, followed by 2,000 MCU three times per day. Much of the research uses smaller amounts, more like the equivalent of approximately 500 MCU taken four times per day. However, most of the bromelain used in the studies was enteric-coated in order to prevent it from being destroyed by gastric juice. It is likely, therefore, that currently available bromelain preparations (which typically are not enteric-coated) are of lower potency than the bromelain used in most studies.

Digestive enzymes are complex proteins involved in digestion that stimulate chemical changes in other substances. They work optimally at specific temperature and pH. Digestive enzymes include pancreatic enzymes, plant-derived enzymes, and fungal-derived enzymes. There are three classes of digestive enzymes: proteolytic enzymes needed to digest protein, lipases needed to digest fat, and amylases needed to digest carbohydrates.

Only small amounts of the animal-based proteolytic enzymes, trypsin and chymotrypsin, are found in the diet; however, the pancreas can synthesize these enzymes. The plant-based proteolytic enzyme bromelain comes from the stems of pineapples and is useful in many conditions. Papain comes from unripe papayas. All of these enzymes are available as supplements.

People with pancreatic insufficiency and cystic fibrosis frequently require supplemental pancreatic enzymes (which include proteolytic enzymes, lipases, and amylases). In addition, those with celiac disease or Crohn’s disease and perhaps some people suffering from indigestion may be deficient in pancreatic enzymes. As bromelain and papain are not essential, deficiencies do not exist.

Low back pain (chymotrypsin, trypsin) Pancreatic insufficiency (including pancreatitis) Sprains and strains (chymotrypsin, trypsin) Celiac disease Indigestion (Lipase) Osteoarthritis (bromelain, trypsin, rutosid combination) Tendinitis (proteolytic enzymes) Acne Rosacea Chronic candidiasis Crohn’s disease Food allergies Gastroesophageal reflux disease (GERD) Low back pain (papain) Sprains and strains (papain)

The most important digestive enzymes in malabsorption diseases are usually fat-digesting enzymes called lipases. Proteolytic enzymes can digest, as well as destroy, lipases. Therefore, people with enzyme deficiencies may want to avoid proteolytic enzymes in order to spare lipases. If this is not possible (as most enzyme products contain both), people with malabsorption syndromes should talk with their doctor to see if their condition warrants finding products that contain the most lipase and the least protease. In theory, too much enzyme activity could be irritating because it could start to “digest” parts of the body as the enzymes travel through the digestive system. Fortunately, that does not happen with supplemental amounts. Research has not determined the level at which such problems might arise. A serious condition involving damage to the large intestines called fibrosing colonopathy has resulted from the use of pancreatic enzymes in children with cystic fibrosis. In some cases, the problem was linked to the use of high supplemental amounts of enzymes. However, the amount of enzymes used has not been linked to the problem in all reports. In some cases, lower amounts of enzymes have caused fibrosing colonopathy if the enzymes are enteric-coated. Some researchers now believe that some unknown interaction between the enteric coating and the enzymes themselves may cause damage to the intestines of children with cystic fibrosis. Until more is known, children with cystic fibrosis needing to take pancreatic enzymes should only do so under the careful supervision of a knowledgeable healthcare professional. Certain medicines may interact with digestive enzymes. Refer to drug interactions for a list of those medicines.

The digestive enzymes—proteolytic enzymes, lipases, and amylases—are generally taken together. Pancreatin, which contains all three digestive enzymes, is rated against a standard established by the U.S. Pharmacopeia (USP). For example, “4X pancreatin” is four times stronger than the USP standard. Each “X” contains 25 USP units of amylase, 2 USP units of lipase, and 25 USP units of protease (or proteolytic enzymes). Three to four grams of 4X pancreatin (or a lower amount at higher potency) with each meal is likely to help digest food in some people with pancreatic insufficiency. Those with chronic pancreatitis need to discuss enzyme intakes with their physician. Under medical supervision, seriously ill people with pancreatic insufficiency caused by pancreatitis are given very high levels of enzymes to improve fat digestion. In one successful trial, enough pancreatin was used with each meal to supply slightly over 1,000,000 USP units of lipase. Because pancreatin is rapidly emptied from the stomach during digestion, people taking these enzymes may obtain better results by spreading out supplementation throughout the meal. Supplemental enzymes that state only product weight, but not activity units, may lack potency.