digestive enzymes, such as lipase, improves the absorption of fatty acids
(Valerio et al. 1981). Scientific evidence has suggested lipase is effective in
Cellulase (Trichoderma reesei) 250 CU
Cellulase is a plant-derived enzyme involved in the catabolism of cellulose.
Cellulose is a key component in plant physiology. The fibrous compound
gives structural stability to plant cellular walls. Consequently, cellulase is
endogenous to plant cells only. Ingestion of cellulose results in increased
gastric motility since there is no natural mechanism for the digestion of fibre
within the human digestive tract (Campbell, 1996). Supplementation with
dietary cellulase would promote the digestion of foods high in cellulose
yielding glucose monomers upon complete breakdown of the polymer.
Betaine HCl (betaine hydrochloride) .200mg
Glucose, in its monomeric form, readily undergoes absorption into the gastric
mucosal cell. Subsequently, the simple sugar can diffuse through the
Non-medicinal ingredients: Hydroxypropyl Methylcellulose, water
cytoplasm be transported across the baso-lateral membrane into the bloodstream (Ganong, 2009). Therefore, supplementation with a daily supplement
Recommended dose: Adults: 1-2 capsules with each meal, to a maximum of
of cellulase may help to increase digestion of usually indigestible foods, such
as cellulase, and facilitate glucose absorption.
Duration of use: For prolonged use please consult a health care practitioner. Malt Diastase (Hordeum vulgare- grain) 125 DP
Complex carbohydrates, such as starches are not readily absorbed in their
parent structure. They require digestive enzymes to provide nutritional value
• This product will aid in the process of digestion, and support intestinal
following ingestion. Physiologically, diastase is important for digestion of
starches in the upper intestinal lumen (Ganong, 2009). Currently, the term
Contraindications: Do not use if pregnant, breast feeding, or after recent
diastase means an enzyme mixture consisting of α-amylase, β-amylase and/or
surgery. Do not use if you have gastritis, peptic ulcer, duodenal ulcer or bowel
γ-amylase which function as hydrolases to mediate the breakdown of starches
obstruction. Do not exceed recommended dose.
(Gibbons, 1979). Classically, diastase was isolated from barley andconsidered to be one of the first discovered enzymes, and a first step towards
Warnings: Keep out of reach of children.
the development of modern enzyme kinetics (Schultz, 1994). The breakdown
of starch yields disaccharides or trisaccharides which may be transported intothe intestinal mucosa cells and across the baso-lateral membrane to be
Adverse Effects: Discontinue use should abdominal pain, nausea, or vomiting
absorbed into the bloodstream. In the human digestive tract, there are various
enzymes which work in harmony to catabolise macromolecules and facilitate
Overdose: For management of suspected product overdose it is
the absorption of nutrients (Ganong, 2009). Diastase one of these enzyme
recommended to contact your physician.
which when taken as a daily supplement may aid digestion to enhancenutrient absorption.
Symptoms of Overdose: Has not been investigated nor any reports have beenfiled. Amylase (Aspergillus oryzae) 9,000 DU Amylase is an enzyme which facilitates the breakdown of complex
Supporting Research and Traditional Evidence
carbohydrates into maltose and maltriose (Whitcomb and Lowe, 2007;
Protease (Aspergillus oryzae) 20, 000 HUT
Ganong, 2009). There are various forms of amylase, including α-amylase,
The function of the gastrointestinal tract is to secrete digestive enzymes to
β-amylase and γ-amylase. α-amylase is present in the saliva as the first
promote the breakdown of food stuffs and facilitate the absorption of
mechanism of carbohydrate catabolism. α-amylase can also be secreted by
nutrients in the upper digestive tract. One type of digestive enzyme, protease,
other organs, such as the pancreas (Whitcomb and Lowe, 2007). A small-
facilitates the breakdown of proteins. There are 6 types of proteases, aspartic,
scale study by Layer et al. (1986) used an amylase inhibitor to assess the
cysteine, glutamic, metallo, serine, and threonine, all which contribute to
effects of digestive enzyme inhibition on gastric motility. Fasting participants
protein catabolism (Shen and Chou, 2009). Following catabolism, absorption
were given 50 g of rice starch with either an α-amylase inhibitor or placebo.
occurs in 3 locations: the intestinal lumen, the brush border and/or the
The results suggest that amylase inhibition reduced starch digestion and
cytoplasm of the mucosa cells. Approximately 50% of digested protein
consequently nutrient absorption in the small intestine. Furthermore, in a
comes from diet (Ganong, 2009). Clinical evidence suggests that a
randomized, placebo-controlled study, a supplement containing lipase,
combination enzyme therapy improved digestion and nutrient absorption in
protease and amylase was administered with meals for 14 days. Only patients
patients suffering from chronic pancreatitis. In a parallel-armed, randomized,
demonstrating pancreatic insufficiency, as determined by a fat excretion
placebo-controlled study, a supplement containing lipase, protease and
amount of less than 10 g/day, were included in the trial. The results of the
amylase was administered with meals for 14 days. Only patients
study suggest that treatment with the enzyme mixture was associated with
demonstrating pancreatic insufficiency, as determined by a fat excretion
increased nutrient absorption when compared with placebo control
amount of less than 10 g/day, were included in the trial. Treatment with the
(O’Keefe et al. 2001). Clinical evidence suggests that amylase aids digestion
enzyme mixture was associated with increased nutrient absorption when
by degrading starch which may potentially facilitate nutrient absorption
compared with placebo control (O’Keefe et al. 2001). Overall, scientific
evidence suggests that proteases, as part of a combination enzyme
Lactase (Aspergillus oryzae) 250 LacU
supplement, may enhance digestion and nutrient absorption.
Lactase, a β-galactosidase, is responsible for the hydrolysis of lactose into
Lipase (Aspergillus niger) 900 LU
its monomers, galactose and glucose (Ganong, 2009). Lactase is present in
In the digestive tract, lipase is essential for the breakdown and absorption of
the brush border of the upper intestine and indirectly plays a role in the
fatty acids and triglycerides. In vivo studies have been conducted to assess
absorption of simple sugars. Inactivity of the enzyme is common in society
the effects of enzyme supplementation on nutrient absorption rates in broiler
and the condition is generally known as lactose intolerance (as reviewed by
chickens. A combination enzyme supplement containing xylanase, amylase
Lomer et al. 2007). Associated with lactose intolerance is gastrointestinal
and protease was fed to the chickens daily for 3 weeks. Body weights and
discomfort which occurs when lactose is not degraded in the intestine.
fecal nutrient levels were recorded weekly. The results indicate that enzymes
Typical side effects include abdominal pain, bloating, flatus, diarrhea, nausea
as a dietary supplement improved nutrient absorption (Cowieson and
and vomiting (Lomer et al. 2007). Since lactase is an enzyme involved in
Ravindran, 2008). Furthermore, clinical evidence suggests that lipase
the digestion of milk sugar supplementation with the enzyme may increase
improves the digestive absorption rate in humans. In a double-blind,
the digestion of lactose which could potentially increase nutrient absorption
randomized, crossover, pilot study, healthy participants were given 3 capsules
containing pancrelipase, or sucrose as a control, and then fed a fatty meal. Invertase (Sucrase) (Saccharomyces cerevisiae) 50 SU
The researchers recorded the amount of gastrointestinal discomfort
Physiologically, invertase (also known as sucrase) is found in the brush
associated with the high fat meal, in the form of abdominal symptom scores
border of the small intestine and facilitates the breakdown of sucrose into
and methane production. Treatment with digestive enzymes was associated
glucose and fructose (Ganong, 2009). Sucrose is commonly known as table
with a significant reduction of abdominal symptoms which suggests that
sugar and is ingested in our daily diets in desserts and sweets. In the intestinal
treatment with enzymes improved digestion and absorption of the fatty acids
lumen, both glucose and fructose can be transported across the apical cell
(Suarez et al. 1999). A second single-blind analysis was performed to
membrane. Fructose readily passes across the cellular plasma membrane,
evaluate the use of lipases to increase digestion and absorption of fatty acids.
whereas glucose typically undergoes active diffusion to be absorbed
Patients suffering from pancreatic insufficiency were treated with a
(Gray, 1971). Increased digestion of the sugar would result in increased
supplement of lipase, or placebo, and digestive parameters were assessed for
nutrient absorption within the small intestine. In a double-blind placebo-
an average of 54 weeks. The results of the study suggest that treatment with
controlled clinical trial, a yeast-derived sucrase enzyme was administrated
suggesting that butyric acid levels positively correlate with rate of gastric
to patients suffering from sucrase-isomaltase deficiency and the prevalence
motility (Lewis and Heaton, 1997). Overall, scientific evidence suggests that
of digestive disturbances was evaluated. Patients received enzyme
supplementation with butyric acids may increase gastric motility and
replacement therapy at various doses in addition to ingesting sucrose in their
daily diets. The findings of the study suggest that supplementation withyeast-derived sucrase replacement therapy improved sucrose digestion as
indicated by the reduction of gastrointestinal disturbances (Treem et al.Digestive enzyme blend consisting of:
1993). Clinical evidence suggests that daily supplementation with sucrase
Protease (Aspergillus oryzae) 20, 000 HUT
may help digestion and potentially contribute to the increased absorption of
glucose and fructose within the intestine. Lipase (Aspergillus niger) 900 LU Pectinase (Aspergillus niger) 150 ADJU Cellulase (Trichoderma reesei) 250 CU
In plant physiology, pectinase is important since it facilitates the extension
of plant cell walls and the softening of plant tissues for storage and fruit
Malt Diastase (Hordeum vulgare- grain) 125 DP
ripining. Pectinases catalyze the breakdown of various pectic substances,
such as pectin, pectinic acids, pectic acids and protopectin (as reviewed by
Amylase (Aspergillus oryzae) 9,000 DU
Jayani et al. 2005). Pectin itself is soluble, but is not readily absorbed from
the intestinal lumen. If unabsorbed, pectin passes into the colon where it is
Lactase (Aspergillus oryzae) 250 LacU
undergoes bacterial fermentation. A small-scale clinical trial was conducted
to assess the digestion of pectin healthy subjects. Twenty-two participants
Invertase (sucrase) (Saccharomyces cerevisiae) 50 SU
were fed a meal containing 5 g of pectin and their fecal matter was collected
• Helps with the digestion of table sugar
following pectin administration. The study suggested that approximately
Pectinase (Aspergillus niger) 150 ADJU
90% of the pectin was not degraded and that only a small amount was
fermented. This study suggests that pectin is not naturally cleaved and/or
Phytase (Aspergillus niger) 2 U
absorbed in the human gastrointestinal tract (Chinda et al. 2003), such that
supplementation with an enzyme such as pectinase may improve the
Betaine HCl (betaine hydrochloride)
degradation of pectin and facilitate the absorption of nutrients in the human
• Contributes hydrochloric acid to aid digestion
Butyric Acid (calcium/magnesium butyrate) Phytase (Aspergillus niger) 2 U
• Contributes to gastrointestinal health
Phytate is a compound present in plant materials such as grains and oil seeds. The enzyme is responsible for the digestion of phytate, but unfortunately isnot present in the human digestive system. The breakdown of phytate yieldscarbohydrate moieties and phosphorus (Schlemmer et al. 2009). The effectsof dietary phytase on the breakdown of phytate in the human small intestinewere assessed in a small scale-clinical study. Nine patients who hadpreviously undergone proctocolectomy for ulcerative colitis were given alow-fibre diet for a week and then supplemented with 16 g of phytase-deactivated grain products, grain products containing active phytase or a lowfibre diet the following week. The phytase-active grains and low-fibre diettreatment groups demonstrated increased phytate degradation whencompared to the phytase-deactivated treatment groups (Sandberg andAndersson, 1988). Since phytase is not present endogenously in the humangastrointestinal tract, daily supplementation with the enzyme may enhancethe natural digestion processes and indirectly increase nutrient absorption. Betaine HCl (betaine hydrochloride)
Betaine. Monograph. Altern Med Rev. 2003 May;8(2):193-6.
Betaine hydrochloride has been implicated in promoting gastrointestinal
Campbell NA. Biology. 4th Edition. The Benjamin/Cummings Publishing Company. Don Mills,Canada. 1996.
health through its delivery of hydrochloric acid into the digestive tract
Chinda D, Nakali S, Fukuda S, Sakamoto J, Shimoyama T, Danjo K, Saito D, Nakamura T, Muuakata
(Alternate Medicine Review, 2003). Betaine HCL works in accordance with
A, Sugawara K. Evaluation of Pectin Digestion and Absorption in the Small Intestine and of
proteases, enzymes also present in this formulation of DigestMAX HCL, to
Fermentation in the Large Intestine in the Same Subject. Gastroenterology. 2003.124(4): S1:A434-5. Cowieson AJ, Ravindran V. Effect of exogenous enzymes in maize-based diets varying in nutrient
increase the hydrolysis of polypeptides and increase the potential for the
density for young broilers: growth performance and digestibility of energy, minerals and amino acids.
absorption of protein moieties. The combination has also been implicated in
the treatment of the symptoms associated with dyspepsia and other
Ganong WF. Review of Medical Physiology. Lange Medical Publicaqtions. Los Altos, USA. 2009. Gibbons. On the Localisation and transport of α-amylase during germination and early seedling growth
gastrointestinal disorders (Sweetman, 2007). A clinical trial by Pereira (2006)
of Hordeum vulgare. 1979. Carlsberg Res. Commun. 44:353-366.
evaluated the effects of betaine as part of a combination therapy on the
Gray GM. Intestinal digestion and maldigestion of dietary carbohydrates. Annu Rev Med. 1971;22:391-404. Jayani RS, Saxena S, Gupta R. Microbial pectinolytic enzymes: A review. Process Biochemistry 40
suppression of symptoms associated with gastroesophageal reflux disease.
In a 40 day randomized, single-blind study, a dietary supplement containing
Layer P, Rizza RA, Zinsmeister AR, Carlson GL, DiMagno EP. Effect of a purified amylase inhibitor
melatonin (6 mg), tryptophan (200 mg), vitamin B12 (50 µg), methionine
on carbohydrate tolerance in normal subjects and patients with diabetes mellitus. Mayo Clin Proc. 1986Jun;61(6):442-7.
(100 mg), vitamin B6 (25 mg), betaine (100 mg) and folic acid (10 mg) was
Lewis SJ, Heaton KW. Increasing butyrate concentration in the distal colon by accelerating intestinal
administered to 176 patients suffering from moderate to very-severe
transit. Gut. 1997 Aug;41(2):245-51.
heartburn. Omeprazole (20 mg) was administered to an additional
Lomer MC, Parkes GC, Sanderson JD. Review article: lactose intolerance in clinical practice--mythsand realities. Aliment Pharmacol Ther. 2008 Jan 15;27(2):93-103.
175 patients suffering from severe heartburn as a positive control for heart
O'Keefe SJ, Cariem AK, Levy M. The exacerbation of pancreatic endocrine dysfunction by potent
burn relief. Upon comparison, the results suggested that betaine was as
pancreatic exocrine supplements in patients with chronic pancreatitis. J Clin Gastroenterol. 2001
effective as omeprazole in reducing the symptoms associated with
Apr;32(4):319-23. Oz HS, Ebersole JL. Application of prodrugs to inflammatory diseases of the gut. Molecules. 2008 Feb
gastroesophageal reflux disease. Scientific evidence suggests that a daily
27;13(2):452-74. Review. Erratum in: Molecules. 2008;13(4):771.
supplement containing betaine HCL may enhance digestion and potentially
Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation
stimulate nutrient absorption in the intestine.
with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006Oct;41(3):195-200. Butyric Acid (calcium/magnesium butyrate)
Sandberg AS, Andersson H. Effect of dietary phytase on the digestion of phytate in the stomach andsmall intestine of humans. J Nutr. 1988 Apr;118(4):469-73.
Butyrate, acetate and proprionate are short chain fatty acids which play a
Schlemmer U, Frølich W, Prieto RM, Grases F. Phytate in foods and significance for humans: food
role in maintaining gastrointestinal health (Topping and Clifton, 2001). In
sources, intake, processing, bioavailability, protective role and analysis. Mol Nutr Food Res. 2009
the lower bowel, butyric acid is produced via fermentation by enteric
Sep;53 Suppl 2:S330-75. Schultz AR. Enzyme kinetics: from diastase to multi-enzyme systems. Cambridge University Press.
bacteria. These short chain fatty acids function to modulate of colonic
New York. USA. 1994. [Available Online: http://books.google.ca/books?hl=en&lr=&id=R-
muscular activity, enhance blood flow to the tissue and stimulate electrolyte
and fluid uptake (Oz and Ebersole, 2008). In vitro studies have suggested
=iIRd6vJX7JyiSJrOUkTepmd4naY#v=onepage&q&f=false]. Shen HB, Chou KC. Identification of proteases and their types. Anal Biochem. 2009 Feb 1;385(1):153-60.
that butyric acids contributes to gastrointestinal health by repairing DNA
Suarez F, Levitt MD, Adshead J, Barkin JS. Pancreatic supplements reduce symptomatic response of
damage in colonocyes (reviewed by Oz and Ebersole, 2008; Topping and
healthy subjects to a high fat meal. Dig Dis Sci. 1999 Jul;44(7):1317-21.
Clifton, 2001). Clinical trials have been conducted to assess the correlation
Sweetman SC. Martindale, The Complete Drug Reference. Thirty-fifth Edition. Pharmacetuical Press,London, 2007. p.2056.
between gastrointestinal health and butyrate levels in the human colon over
Topping DL, Clifton PM. Short-chain fatty acids and human colonic function: roles of resistant starch
a 9 day span. Gastric motility was controlled using raw wheat bran plus senna
and nonstarch polysaccharides. Physiol Rev. 2001 Jul;81(3):1031-64. Review. Treem WR, Ahsan N, Sullivan B, Rossi T, Holmes R, Fitzgerald J, Proujansky R, Hyams J. Evaluation
tablets and loperamide to increase and decrease motility, respectively.
of liquid yeast-derived sucrase enzyme replacement in patients with sucrase-isomaltase deficiency.
Following dosing with the described supplements, levels of short chain fatty
Gastroenterology. 1993 Oct;105(4):1061-8.
acids, rate of stool output and whole gut transit time were measured. The
Valerio D, Whyte EH, Schlamm HT, Ruggiero JA, Blackburn GL. Clinical effectiveness of a pancreaticenzyme supplement. JPEN J Parenter Enteral Nutr. 1981 Mar-Apr;5(2):110-4.
results of the study suggest that butyric acid levels increased following
Whitcomb DC, Lowe ME. Human pancreatic digestive enzymes. Dig Dis Sci. 2007 Jan;52(1):1-17.
treatment with senna and decreased following treatment with loperamide
Ro s e m a r y M e d i c a l C e n t r e 2 Rosemary Gardens, Parkstone, Poole BH12 3HF Tel: 0844 477 3101 www.rosemarymedicalcentre.co.uk Our website has been designed with you in mind and is packed with lots of useful information and helpful tips, including surgery opening times, how to make an appointment and what to do when the surgery is closed. In addition, you can also find out a
MC3709 SM2963 Clinical Booklet 8/16/06 8:06 AM Page 1 CLINICAL STUDIES IN SUPPORT OF DISPOSABLE BLOOD PRESSURE CUFFS MC3709 SM2963 Clinical Booklet 8/16/06 8:06 AM Page 2 LONGITUDINAL EVALUATION OF NEONATAL NOSOCOMIAL INFECTIONS: ASSOCIATION OF INFECTION WITH BLOOD PRESSURE CUFF. Author: Martin G. Myers, M.D. Objective: The purpose of this study as documented by the author and a pediatr