Inflammation is not a disease and it should not be suppressed by the use of anti-inflammatory medications. This seemed like sage advice from "Boyd's Pathology" and my clinical instructors when I graduated from Logan College, and it has not been contradicted over the years. In fact, the side effects of NSAID use are now well understood and are a strong endorsement for the advice I received almost 30 years ago.

But, I soon found that putting that advice into practice was difficult. The chiropractic adjustment was not always enough to combat the four cardinal signs of inflammation. It is true that fever, redness, swelling, and pain herald a defensive action by the body, but it is also true that they signal an increased need for nutrients during the crisis, be it infection, allergic reaction, or traumatic incident.

The majority of chiropractors believe that nutritional supplementation is an important adjunct to their practice. There is arguably no greater need for additional nutrients than during an inflammatory reaction.

For example, acute trauma results in a rapid loss of body protein, the amount depends on the extent of tissue damage. Tissue protein must be replaced and that presents problems in patients with compromised protein digestion -- geriatric patients, for example.

During an inflammatory reaction our bodies require increased amounts of fibrin, plasmin, thrombin and kinins. However, the primary response to inflammation is by the immune system and its increased use of enzymes. Localized deficiencies of enzymes can prolong inflammation and delay healing. It has been reported that oral use of proteolytic enzymes can reduce healing times by up to 50 percent.

In addition to use by the immune system, enzymes breakdown micro-thrombi and fibrin clots in the injured area. This increased blood flow and the debris and waste products are removed more quickly. Therefore, supplementation of enzymes is warranted in these cases. All of this is fairly common knowledge within the profession. What is uncommon knowledge is which enzymes should be supplemented and in what form.

Amylases and lipases also play a role in the inflammatory response, not just proteases. Each contributes specific functions to assist the inflammatory response. These enzymes can be gathered from several sources and concentrated for supplemental use. I use fungal enzymes because they work in broader pH ranges than those taken from beef and pork (so-called pancreatin).

This is an important consideration since there are specific pH changes in tissue during inflammation, the affected tissue becoming either more alkaline or more acid than normal. But perhaps even more important is that plant enzymes have a broader range of substrates they can be employed against. Digestive enzymes from the pancreas are very selective in the bonds they can hydrolyze (digest).

The use of plant enzymes is sometimes confusing. The term means the enzymes were grown on and separated from plants, not animals. But, not all plant enzymes have identical properties.

For example, bromelain from pineapples and papain from papaya are frequently used by supplement manufacturers. This is because they are commonly used for purposes other than dietary supplements and are therefore relatively inexpensive. Papain is used to tan leather, and like bromelain it is used as a meat tenderizer in restaurants.

Both of these enzymes enjoy their peak rate of activity in temperatures above that of body temperature. Bromelain works best in a temperature range of 120 to 160 degrees Fahrenheit! That is why it can be used as a meat tenderizer. Papain has a similar action in temperature ranges above those of the body.

Both of these enzymes will work in the human body, but not anywhere near their peak capacity. The question is why are they used in supplements? Fungal enzymes have their peak activity range between 95 and 105 degrees Fahrenheit. Fortunately, most of our patients are in that temperature range.

There is a great deal of misinformation concerning the destruction of supplemental enzymes by hydrochloric acid (HC1) in the stomach. I speak with practitioners every week who are under the impression that HC1 is constantly present in the stomach. This, of course, is not true. It takes 30 to 60 minutes for the body to concentrate the amount of acid in the stomach, if it can do it at all. Acid production occurs in response to stretching of the stomach wall by the presence of food.

When we supplement enzymes because of an inflammatory reaction, we should do so on an empty stomach and there is no need to worry about acid production in the stomach. If we supplement with meals, the enzymes will be used in the digestion of food and are not available to the immune system.

This means that using enteric coated enzyme tablets between meals to protect the enzymes from HC1 is a waste of time and money. Besides enzymes lose from 40% to 60% of their potency by being compressed into tablet form!