Quick answer

Bromelain, one of the enzymes in our blend, seems well tolerated by mouth; its most frequent side effects are stomach upset and loose stools. Allergic reactions to bromelain, papain and mold-made lactase are rare but documented. Prescription enzymes carry stronger warnings: doses above 6,000 lipase units per kg per meal have been linked to bowel injury in children.^1,2,3

Key facts

LiverTox reports that bromelain has not been linked to raised liver enzymes or to liver injury.⁴
Papain is one of papaya's main allergens, and papaya reactions are linked with latex allergy.^5,6
Little is known about bromelain's safety in pregnancy or while breastfeeding.¹
The supplement trials we found lasted hours or a few days, so long-term daily use is untested.^7,8

Common side effects

Stomach upset and diarrhea are the side effects most often reported with oral bromelain.¹

NCCIH describes oral bromelain as seeming well tolerated. Its advice is to talk with your health care provider before using bromelain if you take any type of medicine, because some herbs and medicines interact in harmful ways.¹

LiverTox reports that bromelain has not been linked to raised liver enzymes or to liver injury.⁴

The trials of lactase, alpha-galactosidase, lipase and protease in healthy people gave the enzyme with one meal, or with meals for a few days. That is too short to show rare effects or problems that build up with daily use over months.^7,8,9,10

Allergic reactions

Allergic reactions are rare but documented, both to bromelain and to lactase tablets made with Aspergillus, including one case of anaphylaxis after a single lactase tablet.^2,11,12

Papain is among papaya's most allergenic proteins, and people with latex allergy can react severely to papaya. Cross-reactions between papaya, latex and kiwi have occurred.^5,6

Pineapple allergy: bromelain is made from the pineapple plant¹
Papaya or latex allergy: papain comes from papaya, and the two allergies are linked^5,6
Mold allergy: many supplement enzymes, lactase included, are made with Aspergillus molds^2,12
Kiwi allergy: cross-reactions with papaya and latex have occurred⁶

One case shows how easily an enzyme allergy can be mistaken for something else. A man had four reactions after eating ice cream and was thought to be allergic to milk, until doctors noticed he took a lactase supplement just before each one. Skin testing confirmed the lactase.¹²

Swelling of the face or throat, wheezing or trouble breathing after a supplement needs emergency care.²

Prescription enzymes carry stronger warnings

The prescription pancrelipase label warns that very high doses, usually taken over long periods, have been linked to scarring and narrowing of the colon (fibrosing colonopathy), mostly in children with cystic fibrosis, and to raised uric acid.³

Crushing or chewing prescription enzyme capsules, or holding them in the mouth, can irritate the mouth and cost enzyme activity.^3,13

These warnings come from the label of pancrelipase, a prescription medicine for people whose pancreas cannot make enough enzymes, as in cystic fibrosis or chronic pancreatitis. It is made from pig pancreas, so people with a known allergy to pork proteins are watched for reactions, and the label notes a theoretical risk of viruses from pigs, although no such infection has been reported.^3,13

Is it safe to take digestive enzymes every day?

We found no trial that followed people taking an over-the-counter enzyme blend daily for months. Prescription pancrelipase is taken with every meal for as long as it is needed, but under a doctor's care, at doses set for a diagnosed condition.¹³

No tolerable upper intake level exists for enzyme supplements, so the label is the limit. Our blend's label says not to exceed the recommended dose of one capsule twice a day.

Who should ask a doctor first

People taking acarbose or miglitol for diabetes: both labels say carbohydrate-splitting enzyme products may weaken the medicine and should not be taken at the same time^14,15
People taking a blood thinner such as warfarin, or any other prescription medicine¹
Anyone pregnant or breastfeeding¹
Anyone with ongoing stomach pain, fatty stools, unexplained weight loss or blood in the stool, which need a diagnosis rather than a supplement¹³
Parents thinking of giving enzymes to a child or a baby

Questions people ask

Are digestive enzymes safe for infants?

Ask your pediatrician first. Prescription pancrelipase is given to infants, but only under a doctor's care and with its own instructions for mixing it into a soft acidic food. Over-the-counter blends are made for adults, and our label says anyone under 18 should consult a physician.¹³

Can digestive enzymes cause diarrhea?

Diarrhea and stomach upset are the side effects most often reported with oral bromelain. If they last, stop and talk to your doctor.¹

Can I take digestive enzymes while breastfeeding?

Little is known about bromelain in pregnancy or breastfeeding, and LactMed found no data on papaya enzymes and breastfeeding. For prescription pancrelipase, LactMed says the enzymes are not appreciably absorbed and expert opinion considers it acceptable. Ask your doctor before using a supplement blend.^1,6,16

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Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.