Systemic Enzyme therapy: what you need to know

Posted By Braverman IVF & Reproductive Immunology || 9-Feb-2017

Systemic enzyme therapy has recently drawn your attention as noted by an increased number of questions on the topic.

All the blogs, forums, websites claiming its revolutionary effects on pregnancy are based on one single study, presented 17 years ago, at a meeting.
The study never got published in a scientific journal.
In the following blog, we will explain you why many flaws in the study design may prevent us from conclude on any beneficial effects of its use during pregnancy.

  1. What is a systemic enzyme therapy?

This approach consists to deliver a mix of enzymes (protein that catalyses all metabolic reactions in your body) to support immune function.

There are scientific based evidences showing a potential benefit to use enzyme therapy to reduce inflammation.
Different components of the enzyme therapy such as rutin (flavonoid) have antioxidant, anti- inflammatory, and anti-microbial properties (1)

Bromelain (found in pineapple) has the potential to decrease neutrophil migration and secretion of pro-inflammatory cytokines (1-2)

Trypsin has antioxidant effects and decreases the inflammatory response in animal models and in studies with allergic respiratory disease (3)

Nevertheless, scientific studies showed that wobenzym alleviates musculoskeletal symptoms but to the same extent as nonsteroidal anti-inflammatory drugs (4) which was later confirmed in another study in osteoarthritis patients (5).

  1. Systemic enzymatic therapy use during pregnancy

The authors selected N=144 patients with a history of recurrent pregnancy losses (3 or more losses) and characterized these patients with immunological losses although no immune testing was ever done to confirm the potential causes of the losses.

To be able to determine a therapy efficiency, you must compare two groups: one using the therapy and the other group using a placebo (referred as the control group).
These two groups should be similar in term of their demographic characteristics (age, BMI etc..) and obstetrical history (similar number of loss, at similar stage etc..)

In Dittmar’s study, all patients were treated with systemic enzyme therapy (no control group).

Out of N=144:

- 71 received wobenzym containing a cocktail of enzymes with trypsin (porcine pancreas), bromelain (pineapple), rutin, papain (papaya), pancreatin, chymotrypsin

- 73 received phlogenzym containing a cocktail of enzymes with trypsin (porcine pancreas), bromelain (pineapple), rutin.

No details were given on the dosage, time of administration (before conception, after conception, after a positive pregnancy test), duration of administration (up to 15 weeks or through the end of the pregnancy) in the wobenzyme treated group or the phlogenzym treated group.

Results showed that 114/144=79% had a successful pregnancy with a healthy baby.
Were the successful women on wobenzyme or phlogenzym? Were the unsuccessful women the ones who stopped taking it at 15 weeks?

Further, the time of delivery for the successful patients ranged from 34th week to 40th week, so there were clearly some obstetrical complications leading to these preterm births.

This study is very poorly designed and no details were given on the subgroup of patients:

  • What is the outcome in patients treated with wobenzym?
  • What is the outcome in patients treated with phlogenzym?
  • What is the outcome in patients who started the therapy before conception versus those who started after?
  • What is the outcome in patients who stopped at 15 weeks (why did they stop?) versus those who continue until the end of the pregnancy?

Altogether hydrolytic enzyme and flavonoid therapy may be beneficial to reduce inflammation but based on this single study, we do not recommend its use as there is no valid, scientific study with methodologic rigor showing its benefits to date.


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