Digestive Enzymes May Be As Effective As NSAIDS For OA Says Study

Digestive enzymes have become a popular topic in recent years and for good reason.  The more research delves into the workings of the human body, the more we learn how everything is truly connected together.  One burning question was recently the focus of a scientific study:  Could digestive enzymes have an impact on the effects of aging which often result in pain and/or loss of function?


Star Trek: Picard leading man Patrick Stewart, B-baller Shaquille O’Neal, and golf pro Kirsty McPherson – one thing these three celebrities have in common is that their lives have been impacted by arthritis.  According to the Centers for Disease Control (CDC), arthritis (a general term for conditions that affect the joints or surrounding tissues) affects about 1 in 4 adult Americans and is expected to increase by 2040.

Interestingly, there is considerable difference from state to state, but Tennessee has consistently ranked among the highest rates for arthritis and is in the top 3 states for:

  • Age-Adjusted Prevalence of Doctor-Diagnosed Arthritis Among Adults (29.4%)
  • Age-Adjusted Arthritis Prevalence in Women             (32.27%)
  • Age-Adjusted Arthritis Prevalence in Men (32.29%)

(Additionally, Tennessee is one of only 4 states that rank in the highest class for both women and men.)

According to the Arthritis Foundation, osteoarthritis (OA) is the most common form of arthritis.  It is a gradual, but progressive disorder that causes pain and limitation of joint movement typically affecting the hands, knees, hips, lower back and neck, but it may occur at any joint.  While it can start at any age, it’s most commonly noticed in adults in their 50s and generally more often in women than men.

OA involves the loss of joint cartilage as well as inflammation.  As the cartilage within the joint deteriorates, the joint loses its “cushion” triggering an inflammatory response.  OA is a chronic, progressive disease for which there is no known cure; however, it can be managed.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to help reduce the inflammation and pain, but can have substantial side effects.  This can be especially concerning since OA patients will likely have long-term care needs.

Research has shown a surprising alternative treatment – digestive enzymes!  A variety of enzymes are involved at every point along the digestive tract from our mouth to our colon.  With each food or beverage we take in, our body secretes the enzyme needed for that food type to be broken down. If there is a lack or imbalance in these enzymes, then our body may not be able to absorb nutrients effectively.

Without the nutritional building blocks from our diet, our body will be hindered in its proper function, including its ability to heal and repair.  This is how digestive enzymes can help some people with chronic pain.

Previous research showed Wobenzym, an oral combination of proteolytic enzymes and bioflavonoid and similar enzyme combinations, to have effects equivalent to a prescription NSAID.  That study did not have a placebo group for comparison.


To more rigorously study this theory, another group of researchers conducted a randomized, double-blind clinical trial.  Subjects were divided into 3 groups: enzyme combination, NSAID and placebo.  They collected information on patient pain levels, improvement of function, as well as type and frequency of any side effects.  Treatments were administered for 12 weeks, with exams at the initial, 4, 8 and 12 week marks.

Subjects were allowed to self-medicate with acetaminophen, 500mg dosage up to a max of 2000mg per day) when necessary and these events were recorded.  No other pain-relieving medications were allowed.  (Those already on a low dose aspirin regimen for cardiovascular health were allowed to continue.)

The measures used in this study included:

  • self-assessment of the affected knee joint by physician interview
  • self-assessments of pain and function, joint stiffness, and physical joint function, as well as the total score after combining all three subscale scores.
  • selected indices of systemic inflammation along with other vitals and blood work

The results confirmed the previous study’s findings.  Subjects treated with either an enzyme combination or the NSAID experienced improvement in their total score that was almost twice that of the subjects who received placebo.  “Absolute and relative reductions in pain did not differ between the [NSAID} and enzyme combination treatment group.”

While there was a small variation in the number of subjects who utilized acetaminophen, there was a significant difference in how much they used.

  • 5% of Placebo group subjects used a median of 10 tablets
  • 5 % of NSAID group subjects used a median of 4 tablets
  • 50% of an enzyme combination group subjects used a median of 0.5 tablets

There was a total of 32 adverse events reported among all 3 subjects which were considered to be potentially a result of the interventions.

  • 7 from an enzyme combination group
  • 9 from placebo group
  • 16 from NSAID group

Most of these were gastrointestinal, (e.g. nausea, reflux, and stomach pain) but none included ulcers or ulcer complications.

Due to the comparatively short time frame for the study and the chronic nature of OA, additional studies will be required to determine if these results would remain the same over a long-term treatment or if they would change.


While the enzyme group had similar improvement to the NSAID group, they required a much smaller amount of additional pain medication (95% less!) and had a side effect rate that was about the same as the placebo group.  This adds to already significant evidence that enzyme combinations are both safe and effective for the management of joint pain.

Because there are a number of types of enzymes that the body utilizes, there are a variety of enzyme supplements available.  Talk to your doctor about any concerns you have with your digestion and ask for help in determining what may be the best one for you to try.  You may have to try more than one to find the one your body needs.

In addition to extensive knowledge of the musculoskeletal system, your doctor of chiropractic has training in nutritional needs of the body and can help you determine where your dietary plan may be improved.  With the necessary nutritional needs met, and the spine in proper alignment, your body will be better prepared to heal itself and keep you moving!


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

Singleton Todd G. Digestive enzymes primer: patient benefits for pain and healing.  ChiroEconomics. 2019 Dec 5.  https://www.chiroeco.com/digestive-enzymes/?fbclid=IwAR1SSukfFDOPnQYWNp5uCs1Shtz4P-sqo-UlIfqycDiiS1gv6JJAdRnKXBA

Arthritis – osteoarthritis.  https://www.arthritis.org/diseases/osteoarthritis

Centers for Disease Control – Arthritis-Related Statistics.  https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm