Bromelain, found in pineapple extracts, is an anti-inflammatory enzyme. It may help reduce pain from osteoarthritis and surgery, promote deep burn healing, and improve sinusitis. Read this post to learn more about bromelain’s potential benefits and side effects.
What Is Bromelain?
Bromelain is an enzyme extract from the fruit or stem of pineapples (Ananas comosus). It is rich in proteolytic enzymes, or proteases, which digest proteins into amino acids [1, 2].
Stem- and fruit-derived bromelain are prepared differently and contain varying amounts of these enzymes. Bromelain extracted from stems is more commonly used in studies because it has a higher protease content [1, 3].
Bromelain is used in the form of a dietary supplement, powder, or cream. It is important to note that eating pineapple does not produce the same health benefits as bromelain supplementation [4].
Enzymes and Components
The composition of bromelain depends on the method of purification and the source of the pineapple extract [3].
Fruit bromelain is prepared using cooled pineapple juice, which undergoes ultra-filtration [5].
Stem bromelain is made when pineapple stems are centrifuged, filtered, lyophilized, and freeze-dried [5].
Bromelain is a mixture of different thiol endopeptidases that break down proteins. It also contains other enzymes such as phosphatase, glucosidase, peroxidase, cellulase, and escharase. Bromelain also contains protease inhibitors, which stop some protease enzymes from breaking down proteins [1].
Bromelain’s anti-inflammatory and anti-blood clotting action are likely due to its protein-digesting activity. Alternatively, it may help heal burns and inhibit tumor growth by other mechanisms [1].
Commercially available bromelain is evaluated according to its proteolytic activity and other effects on health, such as its anti-inflammatory and tumor-inhibiting activity [4].
Snapshot
Proponents
- May improve osteoarthritis
- May help deep burns heal faster
- May improve surgical pain
- May improve sinusitis
Skeptics
- Insufficient evidence for most benefits
- May cause upset digestion and other adverse effects
- Unknown safety profile for pregnant and breastfeeding women
- May increase the absorption of several drugs and supplements
Bromelain Benefits
Possibly Effective
1) Osteoarthritis
Bromelain reduced tissue swelling, pain, and joint stiffness in 2 clinical trials on 117 people with knee osteoarthritis. In one of them, it was as effective as the painkiller drug diclofenac [6, 7].
However, it wasn’t more effective than placebo when used as an add-on to conventional therapy in a clinical trial on 47 people [8].
Phlogenzym is an enzyme combination with bromelain, trypsin, and rutosid. In 4 clinical trials on over ~250 people with knee osteoarthritis, Phlogenzym was safe, well-tolerated, and as effective as diclofenac at reducing pain. Natural care with Phlogenzym, dietary counseling, and acupuncture was more effective than physical exercise in another trial on 85 people with shoulder osteoarthritis [9, 10, 11, 12].
A complex of three natural anti-inflammatories (bromelain, devil’s claw, and turmeric) improved both acute and chronic joint pain in a clinical trial on 42 people with osteoarthritis [13].
Bromelain may also improve rheumatoid arthritis by lowering the production of TGF-β, a major contributor to inflammation in people with this autoimmune disease. However, no clinical research has been carried out [3].
Although limited, the evidence suggests that bromelain (especially as part of the enzyme complex Phlogenzym) may improve osteoarthritis symptoms. You may discuss with your doctor if bromelain may help as an add-on to your treatment regime. Importantly, never use it in place of what your doctor recommends or prescribes.
2) Skin Burns
In addition to protein-degrading enzymes, pineapple extracts contain an enzyme that helps remove dead tissue and accelerate healing (escharase) [14].
In 5 clinical trials on over 350 people with deep burns, enzymatic treatment with bromelain healed the wounds with a similar effectiveness to conventional treatments and reduced the need for surgery [15, 16, 17, 18, 19].
The evidence suggests that bromelain may help speed up the healing of deep burns. You may use it as a complementary approach if your doctor determines that it may be helpful in your case.
Insufficient Evidence
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of bromelain for any of the below-listed uses. Remember to speak with a doctor before taking bromelain and never use it as a replacement for approved medical therapies.
1) Pain
In 6 clinical trials on over 250 oral surgery patients, bromelain reduced pain and swelling (although less effectively than painkillers). However, some of the studies lacked a proper placebo control or didn’t observe significant differences between the treatment and the placebo [20, 21, 22, 23, 24, 25].
In a clinical trial on 77 people with mild knee pain, one month of bromelain administration (200 or 400 mg) helped decrease pain and stiffness. However, it’s important to note that the study had a high risk of bias because it was neither properly controlled nor blinded [26].
In a clinical trial of 20 healthy men, protease supplementation (containing bromelain and other enzymes) helped relieve muscle soreness after downhill running. Protease supplementation also helped the muscles heal faster [27].
In contrast, bromelain was ineffective in another trial on 39 people with elbow and muscle pain after exercise. Similarly, an enzyme combination with bromelain, trypsin, and rutosid (Phlogenzym) didn’t improve sprained ankle pain in a clinical trial on over 700 people [28, 29].
The combination of bromelain, N-acetyl cysteine, and alpha lipoic acid improved pelvic pain in a clinical trial on almost 400 women with endometriosis [30].
Another combination with bromelain, alpha lipoic acid, and methylsulfonylmethane reduced nerve pain from chemotherapy in another trial on 25 people [31].
Because the studies were often too small, lacked appropriate placebo controls or blinding, and had mixed results, there is insufficient evidence to claim that bromelain improves pain. Larger, more robust clinical trials are needed to shed some light on this potential use of bromelain.
2) Sinusitis
In an old study on 50 adults and children with acute sinusitis, bromelain reduced symptoms such as nose inflammation, difficulty breathing [32].
In another study on over 100 children, bromelain was efficient at improving acute sinusitis and helped the children recover faster than with conventional therapies [33].
Although the results are promising and bromelain is commonly used for this condition in Germany, two clinical trials are insufficient to support its use in people with sinusitis. Further clinical research is needed to confirm these preliminary results.
3) Immune Balance
In a small trial on 15 healthy men, bromelain altered the circadian profile of both Th1 (IFN-γ) and Th2 (IL-5) cytokines. High doses of bromelain increased IFN-γ release in the afternoon and altered IL-5 levels in the morning without showing a clear pattern [34].
Bromelain activated pro-inflammatory cytokines (IL-1β, IL-6, IFN-γ) in the presence of cellular stress, but reduced their levels when immune cells were already stimulated (such as in case of inflammation) [3].
Bromelain enhanced the T-cell response but also inhibited the production of the pro-inflammatory cytokine IL-2 in mice and cells. These opposed effects may be due to the different kinds of proteases in bromelain and possibly help balance the immune response [35].
A small clinical trial and some cell-based research cannot be considered sufficient to attest to the potential of bromelain to balance the immune system in humans until further clinical research is conducted.
4) Preventing Alzheimer’s Disease
Beta-amyloid plaques are thought to be the main contributors to the onset of Alzheimer’s disease. In a healthy volunteer, the oral administration of a complex with trypsin, alpha-chymotrypsin, and bromelain (Phlogenzym) reduced beta-amyloid levels. The complex helped break down beta-amyloid in test tubes. More clinical trials are needed to validate these early findings [36].
Animal and Cell Research (Lack of Evidence)
No clinical evidence supports the use of bromelain for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies should not be interpreted as supportive of any health benefit.
Protecting the Heart
In rats, bromelain administration reduced the damage caused by insufficient blood supply (ischemia). As a result, bromelain reduced heart cell death and improved recovery after a heart attack or stroke [37].
Incubation with bromelain stopped isolated platelets from clumping together, even after adding drugs that promote platelet aggregation [38, 39].
Bowel Health
In mice and isolated small bowels, bromelain inhibited spasms in the intestine. The effects were stronger in mice with diabetes and inflammation than in healthy mice [40].
In mice with inflammatory bowel disease (IBD), bromelain improved the symptoms of the disease and the production of a protein involved in colon inflammation (CD44) [41].
Bromelain into bowel cells isolated from IBD patients inhibited cytokine production, suggesting it may help reduce inflammation [42].
In rabbit bowel cell cultures, bromelain stopped the activity of various diarrhea-causing bacteria and toxins. It also stopped intestinal fluid secretion, suggesting its potential as an anti-diarrhea drug [43].
Weight Loss
How bromelain may help with weight loss by increasing TNF-alpha. Source: [44]
Bromelain may help with weight loss by inhibiting fat production and promoting fat burning [44].
In rat cell cultures, stem bromelain administration inhibited the development of fat cells [44].
Moreover, it blocked Akt/mTOR signaling and increased TNF-α levels in mature fat cells. This caused fat cells to self-destruct [44].
Additionally, TNF-α induced the breakdown of fats [44].
Inflammation
Bromelain decreased several pro-inflammatory mediators in cell-based studies, making it a powerful anti-inflammatory agent [3].
For instance, it reduced COX-2 and PGE-2 levels in mouse and human cell cultures [3].
In mouse cell cultures, the proteases in bromelain inhibited ERK-2 transmission. This blocked cytokine production and may help prevent inflammation [45].
In conditions when inflammation causes the overproduction of proinflammatory cytokines (such as IL-1β, IL-6, TNF-α, TGF-β), bromelain may reduce their secretion [3].
Side Effects & Precautions
This list does not cover all possible side effects. Contact your doctor or pharmacist if you notice any other side effects.
Call your doctor for medical advice about side effects. In the US, you may report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada, you may report side effects to Health Canada at 1-866-234-2345.
Bromelain may cause allergic reactions in some people. People who are allergic to pineapple should not take bromelain supplements. Allergic reactions to bromelain are more common in those allergic to latex, wheat, celery, papain, carrot, fennel, cypress pollen, or grass pollen [46].
Bromelain is possibly safe when taken at normal doses. The most common side effects are mild and include diarrhea, nausea, flatulence, headache, fatigue, and skin rash [47].
It’s better to take bromelain on an empty stomach away from meals to improve its absorption and activity. However, this may cause stomach discomfort in some people.
Due to the lack of safety data, pregnant or breastfeeding women should avoid bromelain supplements.
Drug and Supplement Interactions
Supplement/Herb/Nutrient-drug interactions can be dangerous and, in rare cases, even life-threatening. Always consult your doctor before supplementing and let them know about all drugs and supplements you are using or considering.
Bromelain may reduce blood clotting, add to the effects of some anticoagulant drugs (such as warfarin), and increased the uptake of other blood thinners (such as heparin). For these reasons, people on blood thinners or with a scheduled surgical procedure should avoid bromelain to prevent bleeding and bruising [48, 49].
Caution is also advised when using it in combination with other supplements that may also thin the blood, such as fish oil.
Bromelain may also help increase the uptake of the following drugs:
Because curcumin and quercetin have low rates of absorption, they are often formulated together with bromelain to increase their uptake and enhance their effects [52, 53].
Supplementation
Dosage
Because bromelain is not approved by the FDA for any condition, there is no official dose. Users and supplement manufacturers have established unofficial doses based on trial and error. Discuss with your doctor if bromelain may be useful as a complementary approach in your case and which dose you should take.
In human osteoarthritis studies, scientists used doses in the range of 540-1890 mg/day [47].
While lower doses were always well tolerated, studies using higher doses had conflicting results. Further long-term studies are needed to assess its safety [47].
User Reviews
The opinions expressed in this section are solely those of bromelain users, who may or may not have medical or scientific training. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.
Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare providers because of something you have read on SelfHacked. We understand that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.
Most users took in bromelain supplements for the relief of surgical and chronic pain. Many of them were satisfied with the results and reported experiencing less pain and swelling and having cut down on painkillers.
Some people used bromelain for sinusitis and digestive issues, normally reporting good results as well.
A user reported taking bromelain to prevent blood clots and considered it a must for anyone over 50 years old.
However, a few users complained that the supplement didn’t work for them.
