Bromelain

Bromelain is the Nom de Guerre for a mixture of health promoting compounds that can be extracted from Ananas cosmosus, the pineapple plant. Bromelain is not one single substance, but rather a complex amalgamation of enzymes.

Many investigators have focused on Bromelain’s sulfur containing proteolytic enzymes as the mixtures most health promoting component. Proteolytic enzymes break down proteins into simpler components and aid in digestion. Other components include: escharase, peroxidase, acid phosphatase, and protease inhibitors.

Bromelain is most concentrated in the core and stem of pineapple and to a much lesser extent in the periphery. Sadly, prepackaged pineapple often excludes the core to maximize the sweet chunks of the periphery.

Native to South America, pineapple has been used to treat many illnesses. It is widely used in Hawaiian folk medicine. Considered a natural remedy for a whole range of conditions, pineapple is one of the most plentiful sources of bromelain on Earth. It is also loaded with vitamin C, B1, manganese and potassium.

How Does Bromelain Work?

The immune system is critical for healthy healing. Sometimes, for reasons not entirely understood, the immune system reacts too aggressively to an injury and causes collateral damage to healthy tissue. The immune system’s self inflicted collateral damage further elicits an immune response and fuels a snow balling process that eventually leads to unrestrained inflammation. In this scenario, factors that reduce the immune systems effectiveness are helpful for healing.

In animal studies, bromelain has been associated with both re-balancing the immune system’s response to healing and supporting healthy muscles, tendons, and joints. Research suggests bromelain may reduce production of various immune system signaling molecules. These molecules interact with multiple cells in the immune system. Signaling molecules both direct immune cells to sites of healing and stimulate their activity. White blood cells heavily depend on signaling molecules to orchestrate both their internal processes and external action. If the signaling molecule information is not transmitted properly to the white blood cells brain, their nucleus, than they are less likely to carry out unhealthy healing. That is great news for tendons, muscle, and joints.

Moreover, some research implies bromelain makes it more difficult for white blood cells to attach to blood vessels near the site of healing. Blood vessels are the primary pathway that white blood cells use to enter a site of healing. If the blood vessel pathway is partially blocked, than the entry of white blood cells is significantly restricted. Additionally, bromelain has been shown to decreases synthesis of substances that magnify pain and swelling.

 

3 Musculoskeletal Benefits of Bromelain

1.  Bromelain Boosts Joint Health

 

British researches investigated the effect of Bromelain use on individuals with knee pain. After 4 weeks, study participants reported improvement in knee function scores and general well being. (Walker, A. F., Bundy, R., Hicks, S. M., & Middleton, R. W. (2002). Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults. Phytomedicine, 9(8), 681–686. doi:10.1078/094471102321621269)

2.  Bromelain Promotes Tendon Health 

 

Nigerian researchers evaluated the effect of Bromelain supplementation on rats after inducing an achilles tendon injury. The treatment group demonstrated statistically significant increase in new tendon cells compared to the non treatment group.(Aiyegbusi AI, Olabiyi OO, Duru FI, Noronha CC, Okanlawon AO. A comparative study of the effects of bromelain and fresh pineapple juice on the early phase of healing in acute crush achilles tendon injury. Journal of medicinal food. 2011;14(4): 348-352.)

3.  Bromelain Supports Muscle Health 

 American scientists evaluated the effect of Bromelain when combined with other proteases on muscle recovery and muscle soreness. The treatment group reported less perceived muscle soreness and demonstrated superior recovery when compared to the placebo group. (Miller PC, Bailey SP, Barnes ME, et al. The effects of protease supplementation on skeletal muscle function and DOMS fol- lowing downhill running. J Sports Sci Med. 2004;22:365–72.)

Other Health Benefits

There are other conditions that bromelain may assist, although more research is needed and for some conditions results to date have been mixed. Those include:

  • Supports heart health
  • Promotes GI health
  • Supports lung health

 

 

Precautions

Bromelain is normally well tolerated. Potential side effects include nausea, vomiting, diarrhea, elevated heart rate, and excessive bleeding.

Animal studies have postulated a lethal dose of 10g/kg incredibly high amount. High intake of may increase absorption of antibiotics, risk of bleeding when taken with blood thinners, and strength of prescription sedative drugs.

Any consideration of supplementation should be discussed with a qualified health professional.

References

1. (2009). Pineapple uses, benefits & dosage. Drugs.com Herbal Database. Retrieved from https://www.drugs.com/npp/pineapple.html

2. (2010). Bromelain Monograph. Alternative Medicine Review, 15(4), 361-368.

3. (2017). Pineapple. The World’s Healthiest Foods. Retrieved from http://www.whfoods.com/genpage.php?tname=foodspice&dbid=34

4. (2017). Pineapple. Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Pineapple

5. Aiyegbusi AI, Duru FI, Awelimobor D, Noronha CC, Okanla- won AO. The role of aqueous extract of pineapple fruit parts on the healing of acute crush tendon injury. Nigerian quarterly journal of hospital medicine. 2010;20(4):223-227.

6. Brien, S., Lewith, G., Walker, A. F., Hicks, S. M., & Middleton, R. (2004). Bromelain as a treatment for osteoarthritis: A review of clinical studies. Evid Based Complement Alternat Med, 1(3), 251–257. doi:10.1093/ecam/neh035

7. Brien, S., Lewith, G., Walker, A. F., Middleton, R., Prescott, P., & Bundy, R. (2006). Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: A randomized placebo-controlled pilot study. QJM: An International Journal of Medicine, 99(12), 841-850. doi:10.1093/qjmed/hcl118

8. Buford TW, Cooke MB, Redd LL, et al. Protease supplemen- tation improves muscle function after eccentric exercise. Medci Sports Exerc. 2009;41:1908–14.

9. Ehrlich, S. D. (2014). Bromelain. University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/bromelain

10. Fitzhugh DJ, Shan S, Dewhirst MW, Hale LP. Bromelain treat- ment decreases neutrophil migration to sites of inflammation. Clinical immunology (Orlando, Fla). 2008;128(1):66-74.

11. Ley, C. M., Tsiami, A., Ni, Q., & Robinson, N. (2001). A review of the use of bromelain in cardiovascular diseases. Zhong Xi Yi Jie He Xue Bao, 9(7), 702-10.

12. Maurer, H. R. (2001). Bromelain: Biochemistry, pharmacology and medical use. Cell Mol Life Sci, 58, 1234–1245.

13. Mulyono, N., Rosmeilia, E., Moi, J. G. P., Valentine, B. O., & Suhartono, M. T. (2013). Quantity and quality of bromelain in some Indonesian pineapple fruits. International Journal of Applied Biology and Pharmaceutical Technology, 4(2), 235-240.

14. Miller PC, Bailey SP, Barnes ME, et al. The effects of protease supplementation on skeletal muscle function and DOMS fol- lowing downhill running. J Sports Sci Med. 2004;22:365–72.

15. Nganvongpanit, K., Pradit, W., Pothacharoen, P., Mekchay, S., Chomdej, S. & Ong-Chai, S. (2013). Therapeutic effects of short-term supplementation of 0.5 and 1.0% pineapple shell on rabbits with experimentally induced osteoarthritis. Chiang Mai J Sci, 40(4), 564-576.

16. Siengdee, P. Nganvongpanit, K., Pothacharoen, P., Chomdej, S. Mekchay, S., & Ong-Chai, S. (2010). Effects of bromelain on cellular characteristics and expression of selected genes in canine in vitro chondrocyte culture. Veterinarni Medicina, 55(11): 551–560.

17. Stone MB, Merrick MA, Ingersoll CD, et al. Preliminary com- parison of bromelain and ibuprofen for delayed onset musclesoreness management. Clin J Sport Med. 2002;12:373–8.

18. Shing CM, Chong S, Driller MW, et al. Acute protease supple- mentation effects on muscle damage and recovery across consecutive days of cycle racing. Eur J Sport Sci. 2016;16:206–12. 188.

19. Walker, A. F., Bundy, R., Hicks, S. M., & Middleton, R. W. (2002). Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults. Phytomedicine, 9(8), 681–686. doi:10.1078/094471102321621269

 

 

 

 Lucas J. Bader MD

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