What Is Bromelain?

Bromelain is a mixture of enzymes found naturally in the juice and stems of the pineapple plant (Ananas comosus). Available in dietary supplement form, bromelain is considered a proteolytic enzyme, a class of enzymes that aid in the digestion of protein. It should be noted that bromelain does not work the same way as other proteolytic enzymes, such as papain, trypsin, or chymotrypsin.

Bromelain supplements are marketed for a variety of health conditions, especially those associated with chronic inflammation, such as allergies, osteoarthritis, sinusitis, and ulcerative colitis.

Bromelain has also been looked at for postsurgical use for third-molar (wisdom tooth) removal and topically for removing dead skin from burns. However, there is not enough evidence to support the use of bromelain for most conditions.

This article will review the uses of bromelain and what to look for if bromelain is recommended for you.

Uses of Bromelain

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Research regarding the benefits of bromelain is limited. Here's a look at several findings from the available research on the potential uses of bromelain.

Sinusitis

A few studies have documented some benefits of bromelain supplementation for sinusitis, including:

• A review of 10 randomized control trials reported that, when used with standard medications, bromelain may help relieve sinus inflammation.
• Another review of studies reported that bromelain may shorten the duration of acute sinusitis symptoms in children, improve breathing, and reduce nasal inflammation.
• The most recent systematic review of alternative therapies for sinusitis concluded that bromelain showed some promise but that studies are still needed to compare bromelain to standard therapy.

Still, the research overall is limited and is not enough to recommend bromelain's use for sinusitis.

Pain Relief

Laboratory studies show that bromelain reduces the levels of some substances that cause inflammation from arthritis, but results from clinical trials are mixed.

Knee Pain

So far, studies testing bromelain's effects on knee pain have yielded mixed results.

In one small study, for example, bromelain supplements appeared to be no more effective than a placebo in alleviating symptoms such as pain and stiffness in people with knee osteoarthritis.

Another review analyzed nine clinical trials on the use of bromelain for the treatment of osteoarthritis pain. Seven of those trials found bromelain was at least as effective as diclofenac (a nonsteroidal anti-inflammatory drug often prescribed for osteoarthritis). However, the other two trials found bromelain to be no more effective than placebo (a dummy pill with no therapeutic value).

Other research shows that bromelain may ease knee pain in people without arthritis, but these findings are limited to small studies. In one study analyzing the data of 77 otherwise healthy adults with mild acute knee pain, the researchers found that one month of treatment with bromelain significantly relieved symptoms and improved physical function.

Surgical Pain

Research has looked at whether oral bromelain is effective in reducing pain, swelling, and healing time following oral surgery. However, its effectiveness has been found to vary from person to person and in different tissues in the body.

Four different systematic reviews (detailed reviews of articles focusing on answering a single question) evaluated bromelain for use after third-molar surgeries. The studies indicated that bromelain appeared to offer moderate pain relief after surgery. However, the results on whether it controlled swelling were mixed.

Wound Healing

The topical use of bromelain has been investigated for its effects on burn wounds. Surgical excision remains the standard of care for burn wound debridement (removal of burned tissue), but there is some evidence that topical bromelain may reduce the amount of excision needed.

It should be noted that this treatment is done under medical supervision and only for burn wounds that require hospitalization. This does not apply to oral supplementation of bromelain.

What Are the Side Effects of Bromelain?

Side effects commonly associated with bromelain include diarrhea and upset stomach.

In certain people, bromelain may trigger allergic reactions and asthma symptoms, such as breathing problems, tightness in the throat, hives, rash, and itchy skin. You should avoid bromelain supplementation if you are sensitive or allergic to pineapples. You may also be susceptible to an allergic reaction if you have an allergy to:

• Carrots
• Celery
• Fennel
• Rye
• Papaya
• Birch
• Cypress pollen
• Certain grasses
• Latex

If you experience any of these symptoms, stop taking bromelain.

Precautions

Bromelain supplements are not recommended for use:

• If you are sensitive or allergic to pineapples
• If you are pregnant or breastfeeding
• If you have peptic ulcers or other digestive problems
• Prior to undergoing surgery, as it may increase the risk of bleeding.
• If you are taking blood thinners, such as Jantoven (warfarin), Lovenox (heparin), or aspirin, or supplements like ginkgo biloba
• If you have liver or kidney disorders

Dosage: How Much Bromelain Should I Take?

Eating large amounts of pineapple will not give the same effect as taking a bromelain supplement. Bromelain is primarily found in the stem of the pineapple, which is not normally eaten.

When used as a digestive aid, bromelain is typically taken with meals. When used for inflammatory conditions, it's often taken between meals on an empty stomach to maximize absorption.

There is no standardized dose of bromelain. Doses are discussed in milligrams or enzyme activity units, known as milk clotting units (MCU) or gelatin dissolving units (GDU). Before starting bromelain, ask your healthcare provider or pharmacist about the right dosage for you. Make sure to read the product label for instructions on its use.

It should also be noted that avoiding or delaying standard care and self-treating a chronic condition with bromelain supplements may have serious consequences. Talk to your healthcare provider if you are considering using bromelain for any condition.

What Happens If I Take Too Much Bromelain?

Based on animal studies, bromelain is thought to have low toxicity. However, taking more bromelain than recommended may increase the likelihood of experiencing side effects, such as:

• Nausea
• Vomiting
• Diarrhea
• Indigestion
• Rapid heartbeat
• Uterine bleeding
• Heavy menstruation

To prevent toxicity, follow your healthcare provider's advice on how to take bromelain safely.

Interactions

Since bromelain may slow blood clotting, using it in combination with prescribed blood thinners could increase the risk of bleeding and bruising. These can include:

• Jantoven (warfarin)
• Plavix (clopidogrel)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Naprosyn (naproxen)
• Aspirin

Similarly, use caution with supplements that also have a bleeding risk, such as garlic and ginkgo biloba.

Bromelain may also increase the absorption of certain antibiotics, such as tetracycline and amoxicillin, which can increase their side effects.

Before starting bromelain, tell your healthcare provider about any medicines you are taking or plan to take, including prescription and over-the-counter (OTC) drugs, vitamins, and herbal supplements.

It is essential to carefully read the ingredient list and nutrition facts panel of a supplement to know which ingredients and how much of each ingredient is included. Please review this supplement label with your healthcare provider to discuss any potential interactions with foods, other supplements, and medications.

How to Store Bromelain

Store Bromelain supplements in a cool and dry place. Supplements and medications should always be kept out of reach of children.

Sources of Bromelain & What to Look For

Bromelain supplements are sold as powders, creams, tablets, or capsules, either alone or in combination with other ingredients. Bromelain may also be found as a single ingredient or in combined products marketed for digestive health that provide multiple types of enzymes.

Since bromelain is an enzyme, the label should list the amount of enzyme activity in units, as well as its quantity in mass.

When choosing a supplement, look for products that have been certified by third-party authorities like ConsumerLab, USP, or NSF International. These certifying bodies ensure that supplements are pure and contain just the ingredients listed on the product label.

Summary

Bromelain is an enzyme found naturally in the juice and stems of pineapples that plays a role in protein breakdown. As a supplement, some research shows that it may help reduce pain and inflammation in some conditions. However, there is not enough high-quality evidence to recommend it for these uses.

Taken alone, it is not likely to help with digestive problems. Although marketed for several other health conditions, there is not enough evidence to support these claims.

Before starting to take any new supplements, talk to your healthcare provider to be sure the supplement is appropriate and safe for you to take.