Bromelain Overview

Bromelain is not actually a single substance, but rather a collection of protein-digesting enzymes (also called proteolytic enzymes) found in pineapple juice and in the stem of pineapple plants. 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, and, by 1995, bromelain had become the thirteenth most common individual herbal product sold in Germany.

While most large enzymes are broken down in the digestive tract, those found in bromelain appear to be absorbed whole to a certain extent. ^{1 2} 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. ³ These influences may be responsible for some of bromelain's therapeutic effects.

See also Proteolytic Enzymes for a discussion of combination products that often contain bromelain.

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. ⁴ Participants given 40 mg of bromelain 4 times daily for 3 days, beginning 4 hours after delivery, showed a statistically significant decrease in edema, inflammation, and pain. Ninety percent of patients taking bromelain demonstrated excellent or good responses compared to 44% in the placebo group. However, another double-blind study of 158 women who received episiotomies failed to find significant benefit. ⁵ In a double-blind controlled trial, 95 patients undergoing treatment for cataracts were given 40 mg of bromelain or placebo (along with other treatments) 4 times daily for 2 days prior to surgery and 5 days post-operatively. ⁶ Overall, less inflammation was noted in the bromelain-treated group compared to the placebo group.

Benefits were also seen in double-blind, placebo-controlled studies of dental, ⁷ nasal, ⁸ or foot surgery. ⁹ However, a study of 154 people undergoing facial plastic surgery found no benefit. ¹⁰ A somewhat informal controlled study of 146 boxers suggested that bromelain helps bruises to heal more quickly. ¹¹ Another study—this one without any type of control group—found that bromelain reduced swelling, pain at rest, and tenderness among 59 patients with blunt trauma injuries, including bruising. ¹² 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. ¹³

Sinusitis

In a double-blind trial, 48 patients with moderately severe to severe sinusitis received bromelain or placebo for 6 days. ¹⁴ 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% of those taking bromelain compared to 52% of the placebo group. Breathing difficulty was relieved in 78% of the bromelain group and 68% of the placebo group. Overall, good to excellent results were observed in 87% of patients treated with bromelain compared to 68% on placebo.

Benefits were also seen in two other studies enrolling a total of more than 100 individuals with sinusitis. ¹⁵

Recommended dosages of bromelain vary with the form used. Due to the wide variation, we suggest following label instructions.

1. SMYTH RD, BRENNAN R, MARTIN GJ. STUDIES ESTABLISHING THE ABSORPTION OF THE BROMELAINS (PROTEOLYTIC ENZYMES)FROM THE GASTROINTESTINAL TRACT. Exp Med Surg. 22():46-59.
2. Miller JM, Ginseberg M, McElfatrick GC, et al. The administration of bromelain orally in the treatment of inflammation and edema. Exp Med Surg. 1964;22:293-299.
3. Izaka KI, Yamada M, Kawano T, Suyama T. Gastrointestinal absorption and antiinflammatory effect of bromelain. Jpn J Pharmacol. 22(4):519-34.
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5. Howat RC, Lewis GD. The effect of bromelain therapy on episiotomy wounds--a double blind controlled clinical trial. J Obstet Gynaecol Br Commonw. 79(10):951-3.
6. Spaeth GL. The effect of bromelains on the inflammatory response caused by cataract extraction: a double-blind study. Eye Ear Nose Throat Mon. 47(12):634-9.
7. Tassman GC, Zafran JN, Zayon GM. Evaluation of a plant proteolytic enzyme for the control of imflammation and pain. J Dent Med. 1964;19:73-77.
8. SELTZER AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain). A controlled study of 53 rhinoplasty cases. Eye Ear Nose Throat Mon. 41():813-7.
9. Frank SC. Use of chymoral as an anti-inflammatory agent following surgical trauma. J Am Podiatr Assoc. 1965;55:706-709.
10. Gylling U, Rintala A, Taipale S, Tammisto T. The effect of a proteolytic enzyme combinate (bromelain) on the postoperative oedema by oral application. A clinical and experimental study. Acta Chir Scand. 131(3):193-6.
11. Blonstein JL. Control of swelling in boxing injuries. Practitioner. 1969;203:206.
12. Masson M. Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice [in German; English abstract]. Fortschr Med. 1995;113:303-306.
13. Stone MB, Merrick MA, Ingersoll CD, Edwards JE. Preliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness management. Clin J Sport Med. 12(6):373-8.
14. Ryan RE. A double-blind clinical evaluation of bromelains in the treatment of acute sinusitis. Headache. 7(1):13-7.
15. Taub SJ. The use of Ananase in sinusitis. A study of 60 patients. Eye Ear Nose Throat Mon. 45(6):96 passim.