EP.366/ Study Spotlight: Dietary Modification and Supplement Use For Endometriosis Pain series - is serrapeptase worth the hype?

Podcast

10 Oct

Today we’re continuing with our Study Spotlight series on the study entitled ‘Dietary Modification and Supplement Use For Endometriosis Pain’. If you’re new to the series and want to understand what this study was about, the strengths and weaknesses and my overall thoughts on the study, go to episode 365, and the link to that is in the show notes.

Today, we’re diving into one of the supplements with the best response rate, and that is serrapeptase.

So, serrapeptase is a type of proteolytic enzyme. Proteolytic enzymes are types of enzymes that break down proteins, there are many types and you may be more familiar with ones like bromelain, which is derived from pineapples and is often used in digestive enzyme formulas, and trypsin, a naturally occurring digestive enzyme made in our bodies and used for digestion.

Whilst used for digestion, proteolytic enzymes are also used commonly as supplements to help to reduce inflammation post surgery and aid in clearing waste products from the wound site, and help to reduce adhesion and scar tissue. This is because they help to break down the protein structures produced during scar tissue formation, and also help lower inflammation.

Serrapeptase is the star of the show for this purpose. It’s been studied and routinely used for sports injuries and recovery from dental surgery, to help reduce pain, swelling, inflammation and to potentially prevent scar tissue formation, due to its ability to break down proteins and fibrin, which forms scar tissue. However, research is limited, sometimes of poor quality and more research needs to be done into its ability to break down scar tissue in general.

For inflammation, it works by blocking key inflammatory messengers that signal to the body to swell and make pain, including prostaglandins and cytokines like interleukins.

It does this by inhibiting the enzyme used to make these inflammatory meditators, the enzyme is called cyclooxygenase. And if you recognise that name, that’s because ibuprofen eases pain by blocking the same enzyme. So, you can already see the potential here for endo pain relief, as many people with endo rely on pain medication and anti-inflammatories that block the same pathway. In fact, researchers are exploring it as a safer anti-inflammatory alternative to NSAIDS.

I’ve linked to two studies in the show notes for those of you who would like to read the science of how serrapeptase blocks these inflammatory pathways.

So, how does this help endometriosis patients exactly? Well, some of the key players in endometriosis pain and inflammation are inflammatory prostaglandins like PgE2 and inflammatory interleukins like interleukin 6.

Research has shown that people with endometriosis and period pain have elevated levels of inflammatory prostaglandins, especially PgE2. PgE2 is one of the major contributors of endo pain, development and progression.

In terms of interleukin 6, a 2024 meta-anaylsis (which is the highest quality form of research) found that people with endo have significantly elevated levels of interleukins, especially interleukin 6, in their blood. And another review found significantly higher levels both in the blood and peritoneal fluid (which is the fluid in the pelvic area), so much so that they proposed that the levels of interleukin 6 could be a diagnostic tool for a predictor of endo related infertility. Interleukin 6, like pgE2, helps endo to grow.

The main way interleukin 6 causes pain is by sensitising our nerves and increasing pain signals to the brain (and again, you can look at the research in the show notes for this).

Prostaglandin E2 also increases pain signalling and nerve sensitivity, and it also causes swelling, heat, fever and causes changes to blood flow, which all affect our experience and severity of pain.

So, given that interleukin 6 and prostaglandin E2 are key to endo pain and development, and serrapeptase can inhibit their production, are there any studies, outside of this one we’re discussing in this series, that look at the use of serrapeptase for endo?

Well, actually, no.

But what we do have is one study which used a proteolytic enzyme formula for surgery recovery in those with mild to minimal endometriosis. This formula, called Wobenzyme Vital, does not include serrapeptase, but does include other enzymes that have the potential to breakdown scar tissue and lower inflammation, such as chymotrypsin and bromelain.

Wobenzyme was shown to reduce pain and inflammation post surgery and reduced inflammatory markers including interleukin 6 and growth factors directly involved in endo development, like TGF-α and VEGF. These specific markers are all elevated in people with endo.

The reduction in these markers could possibly reduce the chances of endo recurrence by inhibiting the factors that help implantation and growth with endo. For example, TGF-α and VEGF are essential to the formation of new blood vessels, and they are directly implicated in endo development and progression, by providing blood flow to endo lesions and increasing proliferation and invasion (basically meaning it helps it to multiply and spread).

Additionally, we know that abdominal surgery significantly increases the risk of adhesion development from the scar tissue itself, and many clients come to me post-surgery with what they think is endo pain, but it’s actually from the scar tissue and adhesions. Because proteolytic enzymes have the potential to break down scar tissue, taking something like Wobenzyme could in theory help reduce the chances of adhesion formation following surgery.

There is also some research on animals with endo showing that proteolytic enzymes (but not serrapeptase) did reduce inflammation and time to conception, but interestingly in this study, interleukin 6 levels actually increased.

Outside of that, we don’t have any studies on serrapeptase directly for endometriosis.

What we do have is what we know so far in terms of its role in lowering inflammation and specific inflammatory messengers that increase endo pain and development, and from this one study, we can see it reduces pain and inflammation post-surgery in endo patients. But we also have a lot of endo patients reporting improvements with serrapeptase online in forums, on Reddit, Instagram, etc.

And now we have this major study showing about 33% of those who tried serrapeptase, reported improvements in pain.

Now remember, there’s a chance that those who didn’t experience improvements, didn’t take it for long enough, consistently enough and also at high enough doses. But there’s also the chance of the placebo effect, that those who did see an improvement, did so because they expected to, based on all the positive online conversations of the supplement.

But as I said in my last episode, I believe people when they say something helped. And whilst we don’t have enough research proving serrapeptase can help with endo management overall, it’s in my opinion, if it’s in your budget, it’s worth giving a go.

In my practice, I actually use proteolytic enzymes pre and post surgery, as they did in the study, which was 40-60 days pre-op and then 60 days post op, to help with recovery in terms of symptoms, but to also possibly reduce the risk of recurrence and adhesion formation.

Now, I have not used it outside of surgery with my clients, but based on this recent study, I actually plan to start trying it with those who want to. I’d be especially interested in seeing if it can help those with scar tissue and adhesions from old surgeries (not just recent), and those with neuropathic pain too, but of course, with endo pain in general.

Now serrapeptase is a natural blood thinner, as are many natural supplements like fish oil, so if you’re on blood thinning medication, you absolutely need to discuss with your doctor first. Additionally, if you’re on a lot of anti-inflammatory supplements like ginger, curcumin or fish oil already, again, check with your doctor in terms of blood thinning safety. Finally, if you have a surgery coming up, because of bleeding risk, check with your surgeon regarding when they would like you to stop with your serrapeptase. Remember that this podcast offers general education, not tailored advice, so you should always discuss with your doctor before adding in any new supplements, and ideally, work with a practitioner to find the right ones for you.

Because we don’t have any specific studies for endometriosis, we don’t have an exact dosage. However, the studies on humans we do have often used 10mg three times a day, or 30m g per day, or even 20mg three times a day. Now, you might see a brand state the dose in units, and just so you know, 10mg is 20,000 units.

Now because it breaks down proteins, it can be used as a digestive enzyme, so it’s best to take an hour before food or two hours after food.

Additionally, look for enteric coated supplements, which help protect the enzyme from being broken down by stomach acid.

If you want to discuss brands, doses and whether serrapeptase or any of the other supplements researched in this study could be right for you, you can now book in for single or two-session 1:1 coaching with me, to create a tailored nutrition and supplement plan for endometriosis. Of course, you can also book in with me for the full six to twelve month 1:1 coaching programme I offer, where we look at all root causes of endo pain and progression, from upregulated nerve signals, poor oestrogen metabolism, to gut health and more. I’ve linked to all of these support options in the show notes.

Show Notes:

Main study

https://www.theendobellycoach.com/podcast/new-endo-survey-study-review

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831953

Serrepeptase overall research

https://pubmed.ncbi.nlm.nih.gov/29618875/

https://pubmed.ncbi.nlm.nih.gov/23380245/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7585045/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8265778/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8624573/#B8-medicines-08-00068

https://www.mdpi.com/2218-273X/12/10/1468

Serrepeptase inflammation research