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Supplements

bromelain

What is It?
Health Benefits
Forms

Dosage Information

Guidelines for Use

General Interaction

Possible Side Effects

Cautions

References
Evidence Based Rating Scale

What Is It?

Bromelain is the name of a group of powerful protein-digesting, or proteolytic, enzymes that are found in the pineapple plant (Ananas comosus). Discovered in 1957, and widely studied since then, bromelain is particularly useful for reducing muscle and tissue inflammation and as a digestive aid. (1) Supplements are made from enzymes found in the pineapple stem.

Health Benefits

Bromelain is a natural blood thinner and anti-inflammatory. It works by breaking down fibrin, a blood-clotting protein that can impede good circulation and prevent tissues from draining properly. Bromelain also blocks the production of compounds that can cause swelling and pain. When inflammation is reduced, blood can move more easily to a traumatized area, easing pain and speeding healing. Bromelain has also been shown to have anti-tumor properties in a study done on mouse skin cells, but it’s too soon to know whether there will be any benefit in humans. (2)

Specifically, bromelain may help to:

  • Treat mild sprains, strains, and muscle aches and pains. Bromelain reduces mild swelling, bruising, redness, and tenderness that can result from tissue injuries, from muscle aches and pains, or from surgery. In 2002, a British university led an open study using volunteers who had mild acute knee pain for less than three months but were otherwise healthy.  Seventy-seven people were randomly given 200mg or 400mg of bromelain each day for one month.  In both treatment groups, symptoms were significantly reduced compared to baseline with the higher dosage (400mg) group showing significantly greater improvements in total symptoms. Bromelain appeared to be effective in improving symptoms of mild knee pain. (3) Bromelain also has an anti-inflammatory effect on the muscles and can help excess fluid drain from the site of a muscle injury.

  • Alleviate back pain and chronic joint pain associated with arthritis. In addition to easing the aching and stiffness of back muscles, bromelain also seems to relieve pain associated with arthritis in chronically inflamed joints.  Most of the studies assessing bromelain's effectiveness on arthritis have been either open studies or equivalence studies comparing bromelain to non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin.  A review of these studies indicates that while bromelain shows effectiveness, more studies are needed to determine optimum dosage and efficacy. (4) In moderate to severe knee arthritis, a randomized placebo-controlled study indicated bromelain showed no efficacy versus placebo. (5) 

  • Aid digestion and reduce heartburn. Bromelain can enhance the effect of such digestive enzymes as trypsin or pepsin (especially when the pancreas is producing insufficient amounts of them). Bromelain can also ease the pain of heartburn and lessen the effects of diarrhea when these conditions are caused by a shortage of digestive enzymes. Bromelain also appears to be promising in the treatment of inflammatory bowel disease (IBD). (6) A pilot laboratory study led by Duke University researchers assessed the effectiveness of bromelain on tissues from the colon biopsies of 51 patients. The biopsies were divided into three groups: 8 from controls, 20 from patients with ulcerative colitis (UC) and 23 from patients with Crohn's disease (CD). The biopsies were treated with bromelain in the lab and the production of the enzymes that fuel IBD were measured. Bromelain reduced the production of these enzymes and could potentially do the same in the body. (7)

  • Reduce the swelling and pain of gout. In some studies, bromelain relieved the joint and tissue swelling and severe pain related to an attack of gout, joint pain caused by deposition of uric acid crystals that most often occurs in the big toe. If taken regularly, bromelain may also prevent recurrent gout attacks.

  • Ease chronic bronchitis, sinusitis, and respiratory allergies. In individuals with chronic bronchitis, bromelain has been shown to suppress cough and ease congestion. Patients with sinusitis and allergies that affect the sinuses have also responded to bromelain therapy; it helps reduce inflammation and fluid retention in the nasal membranes. (8-10)
  • Relieve carpal syndrome tunnel. Bromelain reduces tissue swelling that causes the finger numbness, shooting pains, and weakness in the hand associated with this repetitive stress injury; however no specific studies have been done for this condition. (14)

  • Lessen the swelling and accelerate the healing of cuts and scrapes, and insect bites and stings. The enzymes in bromelain reduce the inflammation of skin wounds, insect bites, and stings, and also promote healing.

  • Speed up the healing of burns.  Debridement is the removal of damaged skin so that healthy skin can heal. Bromelain has shown promise in this area. (11) A non-comparative study design described the effectiveness of a topical agent made from bromelain on 130 patients with second and third degree burns.  The patients were treated between 1984 and 1999 with varying numbers of applications of the agent, which was found to be effective in accelerating debridement. (12)

Note: Bromelain has been found to be useful for a number of other disorders. For information on these additional ailments, see our Dosage Recommendations Chart for Bromelain.

Forms

  • tablet
  • powder
  • capsule

Dosage Information

Special tip:

--Bromelain's activity is measured in GDUs (gelatin digesting units) or MCUs (milk clotting units). (13) One GDU equals roughly 1.5 MCUs. To calculate your bromelain dosage, use a product's GDUs or MCUs as a guideline. Although milligram (mg) dosages are listed below, be aware that these amounts can vary greatly from brand to brand.

  • For inflammation, muscle and joint pain, and injuries: Take 500 mg three times a day between meals; this 1,500 mg should supply 6,000 GDU or 9,000 MCU daily.

  • For indigestion and heartburn: Take 500 mg three times a day with meals; this 1,500 mg should supply 6,000 GDU or 9,000 MCU daily.

  • For gout: During acute flare-ups, take 500 mg every three hours until the attack subsides. To prevent further gout attacks, decrease the bromelain to 500 mg twice a day (this 1,000 mg should supply 4,000 GDU or 6,000 MCU daily) and add 500 mg of quercetin twice a day. Quercetin reduces the high uric acid levels that can cause the inflammation and pain of gout; this flavonoid is more readily absorbed in combination with bromelain.

  • For upper respiratory infections, sinusitis, and allergies: Take 500 mg twice a day between meals; this 1,000 mg should supply 4,000 GDU or 6,000 MCU daily.

  • For carpal tunnel syndrome: During the acute phase, take 1,000 mg twice a day between meals until symptoms ease; this 2,000 mg should supply 8,000 GDU or 12,000 MCU daily. (During the acute phase, bromelain is most effective if combined with 50 mg of Vitamin B6 in 100 mg pills taken three times a day. Once symptoms subside, reduce the bromelain to 500 mg twice a day; this 1,000 mg should supply 4,000 GDU or 6,000 MCU daily.

  • For cuts and scrapes: Take 500 mg three times a day between meals for five days; this 1,500 mg should supply 6,000 GDU or 9,000 MCU daily.

  • For insect bites and stings: Take 500 mg three times a day between meals until symptoms decrease; this 1,500 mg should supply 6,000 GDU or 9,000 MCU daily.

 Be sure to check out our Dosage Recommendations Chart for Bromelain, which lists therapeutic dosages for specific ailments at a glance.

Guidelines for Use

  • Take bromelain on an empty stomach (between meals), unless you're using it as a digestive aid, in which case you should take it just before eating.

  • Check labels carefully. Products that list only weight (mg) but not activity units (GDUs or MCUs) may lack potency.

  • Consider combination products. Because bromelain enhances the effect of different compounds, for convenience they are sometimes sold together. Common pairings include bromelain and quercetin and bromelain and turmeric.

General Interaction

Use caution when combining bromelain with anticoagulants (blood thinners), such as enoxaparin or warfarin. This enzyme is a natural blood thinner and may increase the medication's effect.

Note: For information on interactions with specific generic drugs, see our WholeHealthMD Drug/Nutrient Interactions Chart.

Possible Side Effects

  • Bromelain is generally considered safe, even at high doses.

  • Avoid taking if you have a active gastric or duodenal ulcer.

  • Some people have occasionally reported nausea, vomiting, diarrhea, excess menstrual bleeding, or skin rash when taking medicinal doses of bromelain.

  • Bromelain can cause an allergic reaction (red or itchy eyes, sneezing, running nose, irritated throat) in people who are sensitive to it or to pineapple.

Cautions

--Check with your doctor before taking bromelain if you're on prescription anti-inflammatory medication and/or if you have hypertension.

 

References

 1.  Hale LP, Greer PK, Sempowski GD. Bromelain treatment alters leukocyte expression of cell surface molecules involved in cellular adhesion and activation. Clin Immunol 2002;104:183-90
2. Kalra N, Bhui K, Roy P, Srivastava S, George J, Prasad S, Shukla Y. Regulation of p53, nuclear factor kappaB and cyclooxygenase-2 expression by bromelain through targeting mitogen-activated protein kinase pathway in mouse skin. Toxicol Appl Pharmacol. 2008 Jan 1;226(1):30-7.
3.  Walker, A.F; Bundy, R.; Hicks, S.M; Middleton, R.W.  Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults.Phytomedicine.  2002 Dec;9(8):681-6
4.  Brien, S.; Lewith, G.; Walker, A.; Hicks, S.M; Middleton, D.  Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evidence Based Complementary Alternative Medicine. 2004 December; 1(3): 251–257.
5.  Brien, S.; Lewith, G.; Walker, A.; 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.  Quarterly Journal of Medicine 2006; 99: 841-850.
6.  Hale LP, Greer PK, Trinh CT, Gottfried MR.  Treatment with oral bromelain decreases colonic inflammation in the IL-10-deficient murine model of inflammatory bowel disease.  Clin Immunol. 2005 Aug; 116(2):135-42.
7.  Onken JE, Greer PK, Calingaert B, et al. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clinical Immunology (2008) 126, 345–352.
8.  Helms, S.; Miller, A.  Natural treatment of chronic rhinosinusitis.  Alternative Medicine Review. 2006 Sep;11(3):196-207
9.  Braum, J.M.; Schneider, B.; Beuth, H.J.  Therapeutic use, efficiency and safety of the proteolytic pineapple enzyme Bromelain-POS in children with acute sinusitis in Germany.   In Vivo.  2005 Mar-Apr; 19(2):417-21.
10.  Guo, R.; Canter, P.H.; /Ernst, E.  Herbal medicines for the treatment of rhinosinusitis: a systematic review.  Otolaryngoly Head  Neck Surgery 2006 Oct;135(4):496-506.
11.  Taussig, S.J and Batkin, S.  Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application:  An update.  J Ethnopharmacol.  1988 Feb-Mar;22(2):191-203.
12.  Rosenberg L, Lapid O, Bogdanov-Berezovsky A, Glesinger R, Krieger Y, Silberstein E, Sagi A, Judkins K, Singer AJ.  Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report.  Burns.  2004 Dec;30(8):843-50.
13. Bromelain.  Alternative Medicine Review 1998; 3(4): 302-305.
14. Hoernecke, R and Doenicke, A.  Perioperative enzyme therapy. A significant supplement to postoperative pain therapy?  Anaesthesist.1993 Dec;42(12):856-61.

15.  Braum, J.M.; Schneider, B.; Beuth, H.J.  Therapeutic use, efficiency and safety of the proteolytic pineapple enzyme Bromelain-POS in children with acute sinusitis in Germany.   In Vivo.  2005 Mar-Apr; 19(2):417-21

16. Helms, S.; Miller, A.  Natural treatment of chronic rhinosinusitis.  Alternative Medicine Review. 2006 Sep;11(3):196-20727.  Guo, R.; Canter, P.H.; /Ernst, E.  Herbal medicines for the treatment of rhinosinusitis: a systematic review.  Otolaryngoly Head  Neck Surgery 2006 Oct;135(4):496-506.\
17.  Guo, R.; Canter, P.H.; /Ernst, E.  Herbal medicines for the treatment of rhinosinusitis: a systematic review.  Otolaryngoly Head  Neck Surgery 2006 Oct;135(4):496-506.\

Evidence Based Rating Scale    

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.


Date Published: 04/18/2005
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