Bromelain's therapeutic uses
Bromelain is a collection of protein-digesting enzymes sourced primarily from pineapple juice and the stems of pineapple plants, recognized for its various therapeutic applications. These include aiding recovery from athletic injuries and surgeries, as well as addressing conditions like sinusitis and phlebitis. In European medicine, bromelain is frequently combined with other enzymes to enhance its effectiveness in treating these ailments. Additionally, it has been proposed for a range of other health concerns, such as arthritis, chronic venous insufficiency, and even digestive issues, though scientific evidence supporting these uses varies.
Bromelain's ability to function effectively in both acidic and alkaline environments makes it a unique digestive aid, potentially enhancing the absorption of certain medications, particularly antibiotics. While bromelain is generally considered safe and nontoxic, it can interact with blood-thinning medications and sedatives, necessitating caution. Research into bromelain's benefits continues, particularly in areas like cancer support and inflammation reduction following dental procedures. Overall, while there is promising evidence for some applications, further studies are needed to fully establish its efficacy across various health conditions.
Bromelain's therapeutic uses
PRINCIPAL PROPOSED USES: Athletic injuries, digestive problems, phlebitis, sinusitis, surgery recovery
OTHER PROPOSED USES: Arthritis, chronic venous insufficiency, easy bruising, gout, hemorrhoids, dysmenorrhea, ulcerative colitis, anti-inflammatory, asthma, cancer, support, cardiovascular disease, dental procedures
Overview
Bromelain is not a single substance, but it is a collection of protein-digesting enzymes (also called proteolytic enzymes) found in pineapple juice and pineapple plants' stems. It is primarily produced in Japan, Hawaii, and Taiwan, and much of the original research was performed in the first two of those locations. Subsequently, European researchers developed an interest in bromelain, and by 1995, it had become the thirteenth most common individual herbal product sold in Germany.
Therapeutic Dosages
Recommended dosages of bromelain vary with the form used. Because of the wide variation, one should follow the label’s instructions.
Therapeutic Uses
Bromelain (often in combination with other proteolytic enzymes) is used in Europe to aid in recovery from surgery and athletic injuries and to treat sinusitis and phlebitis. Other proposed uses of bromelain include chronic venous insufficiency (closely related to varicose veins), hemorrhoids, other diseases of the veins, bruising, rheumatoid arthritis, gout, ulcerative colitis, and dysmenorrhea (menstrual pain). However, scientific evidence is lacking that bromelain is effective for these conditions. One study failed to find bromelain effective for osteoarthritis.
Bromelain is useful as a digestive enzyme. Unlike most digestive enzymes, bromelain is active in both the stomach's acid environment and the small intestine's alkaline environment. This may make it particularly effective as an oral digestive aid for those who do not digest food properly.
Bromelain may also increase the absorption of various drugs, particularly antibiotics such as amoxicillin and tetracycline. This could offer both risks and benefits. Bromelain is widely available in grocery stores as a meat tenderizer.
Bromelain has several other proposed therapeutic uses. The anti-inflammatory effects that make it valuable for sinusitis and arthritis may also allow bromelain to promote recovery from injuries and post-surgery recovery. Bromelain is also being investigated for its efficacy in providing cancer prevention and support and helping to manage chronic conditions such as asthma and cardiovascular disease. Recent studies have looked into bromelain's use for dental procedures.
Scientific Evidence
While most large enzymes are broken down in the digestive tract, those found in bromelain appear to be absorbed whole to a certain extent. This finding makes it reasonable to suppose that bromelain can actually produce systemic (whole-body) effects. Once in the blood, bromelain appears to reduce inflammation, “thin” the blood, and affect the immune system. These influences may be responsible for some of bromelain’s therapeutic effects.
Injury and surgery. The evidence for bromelain as a treatment for injuries and surgeries is mixed. A double-blind, placebo-controlled study evaluated 160 women who received episiotomies (surgical cuts in the perineum) during childbirth. Participants given 40 milligrams (mg) of bromelain four times daily for three days, beginning four hours after delivery, showed a statistically significant decrease in edema, inflammation, and pain. Ninety percent of persons taking bromelain demonstrated excellent or good responses, compared with 44 percent in the placebo group. However, another double-blind study of 158 women who received episiotomies failed to find significant benefit.
In a double-blind controlled trial, ninety-five patients undergoing treatment for cataracts were given 40 mg of bromelain or a placebo (along with other treatments) four times daily for two days prior to surgery and five days postoperatively. Overall, less inflammation was noted in the bromelain-treated group compared with the placebo group.
Benefits were also seen in double-blind, placebo-controlled studies of dental, nasal, or foot surgery. However, a study of 154 people undergoing facial plastic surgery found no benefit.
A somewhat informal controlled study of 146 boxers suggested that bromelain helps bruises to heal more quickly. Another study–this one without any type of control group–found that bromelain reduced swelling, pain at rest, and tenderness among fifty-nine patients with blunt trauma injuries, including bruising.
People who engage in intense exercise to which they are not accustomed may experience a set of symptoms called delayed onset muscle soreness (DOMS), consisting of pain, reduced flexibility, and weakness of the muscles involved. Bromelain has been proposed for this condition, but a small double-blind, placebo-controlled study failed to find it effective.
Sinusitis. In a double-blind trial, forty-eight patients with moderately severe to severe sinusitis received bromelain or a placebo for six days. All patients were placed on standard therapy for sinusitis, which included antihistamines, analgesics, and antibiotics. Upon completion of the study, inflammation was reduced in 83 percent of those taking bromelain, compared with 52 percent of the placebo group. Breathing difficulty was relieved in 78 percent of the bromelain group and 68 percent of the placebo group. Overall, good to excellent results were observed in 87 percent of patients treated with bromelain, compared with 68 percent on placebo. Benefits were also seen in two other studies enrolling a total of more than one hundred individuals with sinusitis.
Dental Procedures. A 2023 study looked into the use of bromelain to promote recovery from periodontal surgery. The study found that supplementation with bromelain reduced bleeding compared to the placebo group. A study the same year in patients undergoing third molar extraction found that supplementation with bromelain reduced inflammation post-surgery.
Other applications of bromelain include general inflammation, infection, and cancer. Further studies are required to understand these benefits fully.
Safety Issues
Bromelain appears to be essentially nontoxic, and it seldom causes side effects other than occasional mild gastrointestinal distress or allergic reactions. However, because bromelain “thins” the blood to some extent, it should not be combined with drugs such as warfarin (Coumadin) without a doctor’s supervision.
According to one small animal study, bromelain might interact with sedative medications, increasing their effect. As noted above, it might also increase blood levels of various antibiotics, which could present risks in some cases. In addition, one trial suggests that doses of bromelain eight times higher than standard recommendations might increase heart rate (but not blood pressure). Safety in young children, pregnant or nursing women, and those with liver or kidney disease has not been established.
Important Interactions
Bromelain might amplify the effect of medications that thin the blood, such as warfarin (Coumadin) or heparin, sedative drugs such as benzodiazepines, or antibiotics.
Bibliography
Babazade, Hossein, Arad Mirzaagha, and Shokoofeh Konarizadeh. "The Effect of Bromelain in Periodontal Surgery: A Double-Blind Randomized Placebo-Controlled Trial." BMC Oral Health, vol. 23, 2023, p. 286, doi.org/10.1186/s12903-023-02971-7. Accessed 14 Sept. 2024.
"Bromelain." Icahn School of Medicine at Mount Sinai, www.mountsinai.org/health-library/supplement/bromelain. Accessed 14 Sept. 2024.
"Bromelain - LiverTox." NCBI, 10 Feb. 2024, www.ncbi.nlm.nih.gov/books/NBK600584. Accessed 14 Sept. 2024.
Brien, S., et al. Bromelain as an Adjunctive Treatment for Moderate-to-Severe Osteoarthritis of the Knee." QJM: An International Journal of Medicine, vol. 99, 2006, pp. 841-850.
Colletti, Alessandro, et al. "An Evaluation of the Effects of Pineapple-Extract and Bromelain-Based Treatment after Mandibular Third Molar Surgery: A Randomized Three-Arm Clinical Study." Nutrients, vol. 16, no. 6, 2024, p. 784, doi:10.3390/nu16060784. Accessed 14 Sept. 2024.
Stone, M. B., et al. "Preliminary Comparison of Bromelain and Ibuprofen for Delayed Onset Muscle Soreness Management." Clinical Journal of Sports Medicine, vol. 12, 2002, pp. 373-378.