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Digestive and systemic enzymes ranked by evidence, with dosing and the goals they support.
Top picks: Bromelain, Lactase, and Digestive Enzymes.
Proteolytic enzyme from pineapple, taken on an empty stomach for swelling after surgery or injury and for sinus symptoms.
A digestive enzyme taken with dairy to break down lactose. Small placebo-controlled challenge trials mostly show less breath hydrogen and, in most, fewer symptoms in people with lactose malabsorption, but responses vary widely between people and products and no pooled analysis in adults exists.
Enzyme blend that helps break down proteins, fats and carbohydrates. Small trials suggest less discomfort in functional dyspepsia, but the evidence for everyday bloating is mixed.
Combinations of protein-cleaving enzymes (trypsin, chymotrypsin, papain, bromelain), often with rutoside, taken between meals for joint pain and swelling. In osteoarthritis they were non-inferior to diclofenac in two 6-week trials designed to test that, and a pooled reanalysis reported fewer adverse events than diclofenac, but placebo-controlled evidence is mixed and a 721-person ankle sprain trial found no benefit.
Proteolytic enzyme made by Serratia bacteria, popular in Europe and Japan for swelling and sinusitis — but human evidence is thin and mixed; a systematic review judged it insufficient to support routine use.
An oral enzyme from the mould Aspergillus niger that breaks down gluten in the stomach. Small trials show it lowers the gluten reaching the small intestine after a meal, but it is not a treatment for coeliac disease. It does not make gluten safe in coeliac disease or wheat allergy, and it must not replace a gluten-free diet.
An oral enzyme, usually from pig kidney or pea sprouts, taken just before meals to break down histamine from food in the gut. Small trials in people with suspected histamine intolerance report fewer symptoms, but the trials in migraine, urticaria, fibromyalgia and insomnia mostly failed to show a clear difference from placebo.
Supplemental bile acids for fat digestion, mainly after gallbladder removal. The honest verdict: the physiology is sound, but direct human evidence is sparse — only a few small studies, no meta-analyses, and most data come from unrelated disease states rather than fat-digestion trials.