What is Bromelain?
Bromelain is a mixture of enzymes found naturally in the juice and stems of pineapples. Called a proteolytic enzyme, bromelain is believed to help with the digestion of protein.
Some bromelain appears to be absorbed by the body intact, so it's also thought to have effects outside the digestive tract. In fact, bromelain is often marketed as a natural anti-inflammatory for conditions such as arthritis. It's one of the most popular supplements in Germany, where it is approved by the Commission E for the treatment of inflammation and swelling of the nose and sinuses due to surgery or injury.
Bromelain is typically extracted from pineapples and made into capsule or tablet form. Because it's able to digest protein, bromelain is available in some grocery stores as a meat tenderizer. A topical form of bromelain is also being explored experimentally for burns.
When used for as a digestive aid, bromelain is usually taken with meals. When used for inflammatory conditions, practitioners typically recommend taking bromelain between meals on an empty stomach to maximize absorption.
Why Do People Use Bromelain?
1) Surgery and Injuries
There is some evidence that bromelain supplements may reduce swelling, bruising, inflammation and pain after surgery and injury. In Germany, bromelain has been approved for these uses by the Commission E since 1993. Large, well-designed studies are needed, because not all studies have confirmed these results.
Bromelain has been suggested as a complementary treatment for sinusitis. Preliminary studies suggest that it may help reduce congestion, improve breathing and suppress coughing. It's approved by the Commission E as a complementary treatment for nasal and sinus swelling and inflammation after ear, nose and throat surgery. A review of three small but well-designed previously published studies found that bromelain may help relieve sinusitis symptoms.
Bromelain is a popular natural digestive aid due to it's ability to digest proteins. It's used for bloating, gas and other digestive symptoms and for conditions such as irritable bowel syndrome. Bromelain is often used alone or in combination with other enzymes such as lipase, which digests fats, and amylase, which digests starch. There is little research, however, on the safety or effectiveness of bromelain for digestion.
Bromelain may help with mild pain associated with osteoarthritis. It's a common ingredient in nutritional supplements marketed as a natural pain remedy for arthritis. Large, well-designed studies are needed to see if it is effective and to find out about possible side effects.
Bromelain and other proteolytic enzymes have been explored as a complementary treatment for cancer. Although there is some preliminary research, there isn't enough evidence at this time on the safety or effectiveness of bromelain for cancer. It should never be used in place of conventional treatment.
Side Effects and Safety Concerns
Some of the more common side effects of bromelain include indigestion, nausea and diarrhea. Other side effects may include vomiting, increased heart rate, drowsiness and abnormal uterine bleeding or heavy menstruation.
Bromelain has resulted in allergic reactions and asthma symptoms, including breathing problems, tightness in the throat, skin hives, rash or itchy skin. People with allergies to pineapples should avoid bromelain. Allergic reactions may also occur in people with allergies to latex, carrot, celery, fennel, rye, wheat, papain, bee venom or grass, birch or cypress pollens.
People with peptic ulcers should not use bromelain. People with other digestive disorders should consult a qualified healthcare professional before using bromelain.
Theoretically, bromelain may increase the risk of bleeding, so people with bleeding disorders and those taking medication that can increase the risk of bleeding should only use bromelain under the supervision of their physician. It should not be taken two weeks before or after dental procedures or surgery.
The safety of bromelain in pregnant or nursing women, children or people with liver or kidney disease isn't known.
Possible Drug and Herb Interactions
People taking "blood-thinners" (anticoagulant or anti-platelet medication), such as aspirin, warfarin (Coumadin), heparin, clopidogrel (Plavix), non-steroidal anti-inflammatory medications such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve) should only use bromelain under a physician's supervision. It should also be used with caution by people taking herbs and supplements that are thought to increase the risk of bleeding, such as ginkgo biloba and garlic.
Studies suggest bromelain may also increase the absorption of other medications, such as:
- amoxicillin, tetracycline and other antibiotics
- chemotherapy drugs such as 5-fluorouracil and vincristine
- "ACE inhibitor" blood pressure medications such as captopril (Capoten) and lisinopril (Zestril)
- medications that cause drowsiness, such as benzodiazepines lorazepam (Ativan) or diazepam (Valium), some antidepressants, narcotics such as codeine, and barbituates such as phenobarbitol.
Brien S, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. (2006) 99.12: 841-850.
Brien S, Lewith G, Walker A, Hicks SM, Middleton D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. (2004) 1.3: 251-257.