Nutrient malabsorption is a negative prognostic factor in acquired immunodeficiency syndrome (AIDS). Recent
studies have shown that pancreatic insuf iciency is a co-determining factor of malabsorption in these cases. As
such, a study was performed to test the ef icacy of pancreatic enzyme supplementation in AIDS patients with
known fat malabsorption problems. The study showed that the use of the digestive enzyme product Creon, at a
dose of 1000 units of lipase enzyme per gram of ingested dietary fat, was highly ef ective in reducing fecal fat loss.
The researchers indicate that if other double-blind studies reveal similar findings, then pancreatic enzyme
supplementation can be added to the weapons in the fight against HIV/AIDS-associated malabsorption.14
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Meschino Health Comprehensive Guide to Accessory Nutrients and Essential Oils
Accessory Nutrients and Essential Oils
Dosage and Standardized Grade
Digestive Enzymes are available in two forms, those derived from the glands of animals (usually hog pancreas), and
those derived from non-animal sources (e.g., the fermentation of wheat bran by Asperigillus oryzae to yield
carbohydrases such as alpha and beta amylase, cellulase, lactase, sucrase and maltase, as well as protease I and
protease I Digestive Enzymes). Bromelain and papain enzymes are also available from the pineapple stem and the
papaya, respectively.
Potency of Digestive Enzymes is often listed as U/gm, where U equals activity units, and 1 unit (U) is defined as the
amount, which catalyzes the transformation of one micromole of substrate per minute under defined conditions (e.g.,
25 degrees C and optimal pH conditions). Each commercial digestive enzyme product has a different composition and
U/g potency, making it very difficult to decide which of these is ef ective for certain applications. For improvement of
digestion and general health support, the following minimum requirements would define a respectable digestive
enzyme product on a per dosage basis:
Amylase - 24,000 U/g
Proteases - 6,000 U/g
Cellulase - 200 U/g
Lactase - 4,000 U/g
Lipase - 1,000 U/g 15,16
1. General Health Support and Improved Digestion (see above minimum requirements)
2. Celiac Disease - a proven intervention has used a pancreatic enzyme source yielding 5,000 IU of lipase, 2,900 IU
of amylase, and 330 IU of protease. Patients took six to ten capsules per day17
3. Multiple Sclerosis and Cystic Fibrosis - a product known as Pancreatin (10X) has been used in these cases, at 350-
700 mg, three times per day between meals, where IX potency indicates that the preparation of hog pancreatic
enzymes has in each milligram not less that 25 USP units of amylase activity, not less than 2 USP units of lipase
activity, and not less than 25 USP units of protease activity (USP represents United States Pharmacopoeia). A ful
strength product usually provides 10 times the 1X dosage or is listed as 10X potency.18
4. Cancer Treatment - the study by Gonzalez used 25-40 gms per day of porcine lyophilized pancreas product in the
treatment of pancreatic cancer.9
5. HIV/AIDS - researchers used a product known as Creon at 1,000 units of lipase enzyme per gram of ingested fat.14
6. Severe Pancreatic Insufficiency - doses as high as 1,000,000 USP units of Pancreatin were successful in managing
severe pancreatic insufficiency in a clinical trial.19
Adverse Side Effects, Toxicity and Contraindications
At supplemental doses used to improve digestion and health optimization, Digestive Enzymes are not associated with
any adverse side ef ects or toxicity. Studies using significantly higher doses for the treatment of cancer, allergies and
pancreatic insuf iciency etc., have also reported very few side ef ects and/or cases of
intolerance.2,3,4,5,6,7,8,9,10,11,12,13,14,17,19
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Meschino Health Comprehensive Guide to Accessory Nutrients and Essential Oils
Accessory Nutrients and Essential Oils
Drug-Nutrient Interactions
There are no well-known drug-nutrient interactions for Digestive Enzymes, although the inclusion of high dose
bromelain may potentially enhance the anti-clot ing effects of warfarin. It is best not to take betaine hydrochloride at
the same time as Digestive Enzymes to improve digestion, as the acidity from betaine hydrochloride will denature the
Digestive Enzymes, rendering them inactive. Experts suggest taking betaine hydrochloride at the beginning of a meal
and Digestive Enzymes at the end of a meal, when these supplements are being used to improve digestion and
absorption.20
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insuf icient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the at ending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Standard Textbooks of Nutritional Science: A. Shils M, Shike M, Olson J and Ross C. Modern nutrition in health and disease. 9th ed.
Lippincott Williams & Wilkins 1993. B. Escott-Stump S and Mahan LK, editors. Food, nutrition and diet therapy. 10th ed. W.B. Saunders
Company 2000. C. Bowman B and Russell RM, editors. Present knowledge in nutrition, 8th ed. ILSI Press 2001. D. Kreutler PA and
Czajka-Narins DM, editors. Nutrition in perspective, 2nd ed. Prentice Hall Inc. 1987.
2. Hendler S. The Doctor’s Vitamin and Mineral Encyclopedia. Simon and Schuster 1990:347-8
3. Ramirez FC, Lee K, Graham DY. All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial.
Am J Gastroenterol. Apr1994;89(4):566-70
4. Layer P, Keller J. Pancreatic enzymes: secretion and luminal nutrient digestion in health and disease. J Clin Gastroenterol
Jan1999;28(1):3-10
5. Patel RS, Johlin FC Jr., Murray JA. Celiac disease and recurrent pancreatitis. Gastrointest Endosc 1999;50:823-7
6. Gullo L. Indication for pancreatic enzyme treatment in non-pancreatic digestive diseases. Digestion 1993;54(suppl 2):43-7
7. Bitonsky, Marilyn. Digestive Enzymes: The Missing Link. Life Extension, Feb2000;6(2):p16
8. Oelgoetz AW, Oelgoetz PA, Wittenkind J. The treatment of food allergy and indigestion of pancreatic origin with pancreatic enzymes. Am
J Dig Dis Nutr 1935;2:422-6
9. Gonzalez NJ, Issacs, LL. Evaluation of pancreatic proteolytic enzyme treatment of adenocarcinoma of the pancreas, with… Nutrition &
Cancer 1999;33(2):p117
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Accessory Nutrients and Essential Oils
10. Gaby, AR. Literature review & commentary: Pancreatic enzymes improve digestion. Townsend letter for Doctors & Patients, Apr
2000(210):p40
11. Cichoke AJ. The effect of systemic enzyme therapy on cancer cells and the immune system. Townsend Letter for Doctors and Patients.
1995;Nov:30-2
12. Wolf M, Ransberger K. Enzyme Therapy. New york: Vantage Press 1972:135-220
13. Gonzalez, N. Preliminary results of Pancreatic Cancer Study. Innovation: The health Letter of FAIM, Sep97(3):p13
14. Carroccio A, Guarino A, Zuin G, Verghi F, Berni Canani R, et al. Efficacy of oral pancreatic enzyme therapy for the treatment of fat
malabsorption in HIV-infected patients. Aliment Pharmacol Ther 2001 Oct;15(10):1619-25
15. Specialty Enzymes and Biochemicals Co. (Product Brochure) www.4enzymes.com
16. Sabinsa Corporation Product Manual; Digesyme. www.sabinsa.com
17. Murray M, Pizzorno J. Encyclopedia of Natural Medicine 2nd ed. Prima publishing 1997:327-8
18. Murray M, Pizzorno J. Encyclopedia of Natural Medicine 2nd ed. Prima publishing 1997:138-9
19. Nakamura T, Tandoh Y, Terada A et al. Effects of high-lipase pancreatin on fecal fat, neutral sterol, bile acid, and short-chain fatty acid
excretion in patients with pancreatic insufficiency resulting from chronic pancreatitis. Int j Pancreatol 1998;23:63-70
20. Healthnotes, Inc. 2001; Healthnotes Online. www.puritan.com/healthnotes
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Accessory Nutrients and Essential Oils
Dimethylaminoethanol (DMAE)
( Deanol)
General Features
Dimethylaminoethanol (DMAE), also known as Deanol, is a naturally occurring substance that is structurally similar to
choline, a nutrient used by the brain to make the memory chemical acetylcholine. Studies on DMAE date back to the
1950’s and indicate that DMAE may be of value in the treatment of autism and for children with hyperkinetic behavior
and learning disorders. Initially, it was claimed that DMAE could increase brain levels of acetylcholine based upon
animal experimentation, but concrete evidence is lacking to support this effect in humans.1,2,3,7
Principle Active Constituents
2-Dimethylaminoethanol (DMAE) is the active ingredient and was marketed as a prescription drug in the 1960’s and
1970’s under the name Deanol.4,5 DMAE is now a natural health product and is no longer categorized as an over-the-
counter or prescription drug.9
Clinical Application and Mechanism of Action