Ingredients

Advantages of Enteric Coating

Enteric coating microencapsulation protects digestive enzymes from being denatured by HCl, preserving their activity for the higher pH of the duodenum, where pancreatic enzymes are normally released and intended to function.⁸ Enteric coating is the preferred delivery for individuals with stomach irritations due to hyperchlorhydria, Helicobacter pylori, gastritis, stomach ulcer, or esophageal problems caused by acid reflux or excessive alcohol consumption.⁹ For these individuals, microbial enzymes are not recommended if they are acid resistant because they may have undesirable proteolytic action on the lining of the stomach or the esophagus.

Supporting a Healthy Inflammatory Response

Dr. Berne’s Whole Health Pancreatic Enzyme Support may support a proper inflammatory response and balance, especially when taken on an empty stomach because both pancreatic proteases and bromelain are partially absorbed intact in the bloodstream. The mechanistic potential for anti-inflammatory activity is supported by the observed reduction in pain and inflammation by enterically coated pancreatic enzyme therapy and modulation of various inflammatory markers by bromelain in human clinical trials.^12,13 Bromelain has a direct influence on pain mediators like bradykinin, which contributes to its analgesic properties.¹⁴ Specifically, bromelain exhibited anti-inflammatory action in animal studies by inhibiting the generation of bradykinin at the inflammatory site and by the depletion of the plasma kallikrein system.¹⁵ In vitro data shows bromelain has the ability to downregulate cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE-2) expression and reduce interleukin (IL)-1β, IL-6, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α secretion when the immune response is already stimulated and there is an overproduction of inflammatory cytokines.¹¹ Additional in vitro evidence demonstrated bromelain can decrease the activation of CD4+ T cells and can reduce CD25 cell expression.¹⁴ Six weeks of bromelain and proteolytic enzyme supplementation was shown to have a similar reduction as nonsteroidal anti-inflammatory medication for pain and inflammation in individuals with osteoarthritis.¹⁴ In patients with rheumatoid arthritis, oral bromelain therapy had significant anti-inflammatory and analgesic effects.¹⁴ A small, open-label pilot study demonstrated that pancreatic enzyme supplementation for 6 weeks significantly improved atopic dermatitis and gastroduodenal permeability.⁵

Why is this formula free of HCl and pepsin?Considering there are multiple factors unrelated to pancreatic function that may affect stomach acid production and secretion, it is prudent to dose hydrochloric acid (HCl) separately. HCl may be problematic for individuals with stomach and esophageal problems. Pepsin is also excluded from this formula, as it is meant to work in the acidic environment of the stomach; it loses its activity at a higher pH, the condition under which Dr. Berne’s Pancreatic Enzyme Support capsules are formulated to be activated.

• As a digestive aid, 1 to 3 Dr. Berne’s Whole Health Pancreatic Enzyme Support capsules may be taken per meal, distributed in the beginning and throughout meals, or as directed by your health-care practitioner

• To support a healthy inflammatory response, 1 to 3 capsules of Dr. Berne’s Whole Health Pancreatic Enzyme Support may be taken on an empty stomach between meals to maximize the absorption of proteolytic enzymes in the bloodstream

Dr. Berne’s Whole Health Pancreatic Enzyme References

1. ^{USP monograph of pancreatin. U.S. Pharmacopeia. http://www.pharmacopeia.cn/v29240/usp29nf24s0_m60270.html.}
2. ^{Perbtani Y, Forsmark CE. Update on the diagnosis and management of exocrine pancreatic insufficiency. F7000Res. 2019;8:Fl000 Faculty Rev:1991. doi:10.12688/fl000research.20779.1.}
3. ^{Somaraju UR, Solis-Moya A. Pancreatic enzyme replacement therapy for people with cystic fibrosis. Cochrane Database Syst Rev. 2016;11(11):CD008227. doi:10.1002/14651858.CD008227.pub3.}
4. ^{Brady MS, Garson JL, Krug SK, et al. An enteric-coated high-buffered pancrelipase reduces steatorrhea in patients with cystic fibrosis: a prospective, randomized study. J Am Diet Assoc. 2006;106(8):1181-1186. doi:10.1016/j.jada.2006.05.011.}
5. ^{Singer S, Koenekoop J, Meddings J, Powell J, Desroches A, Seidman EG. Pancreatic enzyme supplementation in patients with atopic dermatitis and food allergies: an open-label pilot study. Paediatr Drugs. 2019;21(1):41-45. doi:10.1007/s40272-018-0321-1.}
6. ^{Roxas M. The role of enzyme supplementation in digestive disorders. A/tern Med Rev. 2008;13(4):307-314. https://pubmed. ncbi .nl m.nih.gov/191524 78/.}
7. ^{laniro G, Pecere S, Giorgio V, Gasbarrini A, Cammarota G. Digestive enzyme supplementation in gastrointestinal diseases. Curr Drug Metab. 2016;17(2):187-193. doi:10.2174/138920021702160114150137.}
8. ^{Imrie CW, Connett G, Hall RI, Charnley RM. Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer. Aliment Pharmaco/ Ther. 2010;32(suppl 1):1-25. doi:10.1111/j.1365-2036.2010.04437.x.}
9. ^{de la Iglesia-Garcia D, Huang W, Szatmary P, et al. Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis. Gut. 2017;66(8):1354-1355. doi:10.1136/gutjnl-2016-312529.}
10. ^{Layer P, Kashirskaya N, Gubergrits N. Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency. World J Gastroenterol. 2019;25(20):2430-2441. doi:10.3748/wjg.v25.i20.2430.}
11. ^{Rathnavelu V, Alitheen NB, Sohila S, Kanagesan S, Ramesh R. Potential role of bromelain in clinical and therapeutic applications. Biomed Rep. 2016;5(3):283-288. doi:10.3892/br.2016.720.}
12. ^{Bolten WW, Glade MJ, Raum S, Ritz BW. The safety and efficacy of an enzyme combination in managing knee osteoarthritis pain in adults: a randomized, double-blind, placebo-controlled trial. Arthritis. 2015;2015:251521. doi:10.1155/2015/251521.}
13. ^{Grabs V, Nieman DC, Haller B, Halle M, Scherr J. The effects of oral hydrolytic enzymes and flavonoids on inflammatory markers and coagulation after marathon running: study protocol for a randomized, double-blind, placebo-controlled BMC Sports Sci Med Rehabil. 2014;6(1):8. doi:10.1186/2052-1847-6-8.}
14. ^{Pavan R, Jain S, Shraddha, Kumar A. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:976203. doi:10.1155/2012/976203.}
15. ^{Kumakura S, Yamashita M, Tsurufuji S. Effect of bromelain on kaolin-induced inflammation in rats. Eur J Pharmaco/. 1988;150(3):295-301. doi:10.1016/0014-2999(88)90010-6.}