Q. I have benefited greatly from taking a pancreatic enzyme product. It has dramatically reduced my symptoms of indigestion. I noticed on the label that the product is 10X USP. What does this designation mean?

A. Pancreatic enzyme products are quite popular nutritional supplements. Most commercial preparations are prepared from fresh hog pancreas (pancreatin). The United States Pharmacopeia (USP) has set strict definitions for levels of digestive activity. A 1X pancreatic enzyme product has in each milligram not less than 25 USP units of starch-digesting activity, not less than 2.0 USP units of fat-digesting activity, and not less than 25 USP units for protein-digesting activity. Pancreatin of higher potency is given a whole-number multiple indicating its strength. For example, a full-strength pancreatic extract that is 10 times stronger than the USP standard is referred to as 10X USP. Full-strength products are preferred to lower potency pancreatin products because lower potency products are often diluted with salt, lactose, or galactose to achieve their desired strength (e.g., 4X or 1X).

Enzyme products are often enteric-coated; that is, the pills are coated to prevent digestion in the stomach, so that the enzymes will be liberated in the small intestine. However, non-enteric-coated enzyme preparations actually outperform enteric-coated products if they are given prior to a meal (for digestive purposes) or on an empty stomach (for anti-inflammatory effects).