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Bromelain
Overview
Bromelain is a mixture of protein-digesting (proteolytic) enzymes found in pineapples (Ananas comosus). Pineapple has been used for centuries in Central and South America to treat indigestion and reduce inflammation. Bromelain, which is derived from the stem and juice of the pineapple, was first isolated from the pineapple plant in the late 1800s. The German Commission E approved bromelain to treat swelling and inflammation following surgery, particularly sinus surgery.
Bromelain can be useful in treating a wide range of conditions, but it is particularly effective in reducing inflammation associated with infection and injuries.

What is Bromelain ?
Bromelain is a protein-digesting enzyme found in the pineapple plant (Ananas comosus). Pineapple has a long tradition as a medicinal plant among the native peoples of South America and Central America. Extracts from the flesh and stem of the pineapple plant were made into dressings and were applied to wounds and skin injuries to reduce inflammation. Drinking the juice of the plant was known to ease stomachaches and indigestion by drinking.

The people of Guadeloupe introduced pineapple as a dessert and a medicinal plant to Christopher Columbus when he came ashore there in 1493. Bromelain, the bioactive ingredient of the pineapple was first isolated in 1891 and was introduced as a therapeutic supplement in 1957. Today, bromelain is used by arthritis patients to help reduce the swelling that causes joint pain. Bromelain has also shown promise in the treatment of pain, numbness, tingling, aching, and loss of motor and sensory function in the fingers resulting from carpal tunnel syndrome. Bromelain contains a protease enzyme that may be beneficial to the heart. Studies have shown that bromelain can reduce the clumping of platelets (small plate like bodies in the blood), the formation of plaques in the arteries, and the formation of blood clots. All these effects help to prevent and treat cardiovascular disease. Bromelain has also been discovered to have anti-tumor action, as well as helping the body absorb medications.

The health benefits of bromelain also include help for colds, asthma, and excessive mucus production in the respiratory system. Patients who suffer from hay fever and other seasonal allergies may also benefit from bromelain's anti-inflammatory activity. Other recognized benefits of bromelain include reducing the painful symptoms of varicose veins, including dull aches, tired legs and feet, and itchy skin.

Pineapple is a mouth-watering fruit, but eating more pineapple won't necessarily increase the bromelain levels in your body. The active ingredients are found in the juice and stem of the plant, and the stem contains more natural bromelain than the fruit. The pineapple stem, while edible, tends to be much less tasty than the succulent berry from the plant. An easier way to add bromelain to your diet is to take a nutritional supplement that contains bromelain. The pills and capsules allow you to get the necessary bromelain content, and the powder inside is guaranteed not to drip down your chin.

In summary, bromelain is an all-natural extract of the stem and juice of the pineapple plant. Medically, bromelain appears to have anti-inflammatory properties similar to other anti-inflammatory medications, such as ibuprofen.

How it is made
Bromelain is typically extracted from pineapples and made into capsule or tablet form.

Where it is found
Bromelain is present in all parts of the pineapple plant (Ananas sp.), but the stem is the most common commercial source, presumably because it is readily available after the fruit has been harvested.
Product related PDF file
Bromelain

Benefits / uses
Surgical Procedures and Sports Injuries
Bromelain reduces swelling, bruising, healing time, and pain following surgery and physical injuries. It is often used to reduce inflammation associated with tendinitis, sprains and strains, and other minor muscle injuries.

Wounds and Burns
Bromelain (applied to the surface of the skin) is may be useful in removing dead tissue (debridement) from third-degree burns. In addition, a preliminary study using a debridement agent that is derived from bromelain to treat people with second- and third-degree burns showed a benefit. Bromelain may also be applied topically to reduce swelling from insect bites and stings.

Sinusitis (Sinus inflammation)
Bromelain may help reduce cough and nasal mucus associated with sinusitis, and relieve the swelling and inflammation caused by hay fever. The German Commission E approved bromelain for the treatment of sinus and nasal swelling following ear, nose, and throat surgery or trauma.

Indigestion
Bromelain can digest proteins and may help relieve stomach upset or heartburn, particularly when used in conjunction with other enzymes such as amylase (which digests starch) and lipase (which digests fat). One animal study suggests that the antibacterial effects of bromelain may help control diarrhea caused by bacteria. Another study suggests bromelain may be a novel therapy for inflammatory bowel disease. However, human studies are needed.

Arthritis and other Inflammatory Conditions
A combination of bromelain, rutosid, and trypsin was as effective as some commonly used nonsteroidal anti-inflammatory (NSAID) medications for reducing pain associated with osteoarthritis. NSAIDs include ibuprofen (Advil or Motrin), naproxen (Aleve), and diclofenac (Voltaren), among others. Studies suggest that bromelain may also help reduce pain associated with rheumatoid arthritis, but the results.

Infection
Bromelain can kill some viruses and bacteria. That could make it a useful addition to conventional treatment of bronchitis, pneumonia, and urinary tract infections.

When To Take/Types To Take
arw Take on an empty stomach to aid absorption unless taking it as a digestive aid.
arw Take after a meal if the meal has created an upset stomach.
 
Doses
Pediatric
Because there are no known scientific studies on the pediatric use of bromelain, do not give it to children.

Adults
The German Commission E recommends 80 - 320 mg 2 - 3 times per day. For specific conditions, higher doses may be prescribed:
Digestive aid: 500 mg per day in divided doses with meals
Injuries: 500 mg 4 times a day on an empty stomach
Arthritis: 500 - 2,000 mg a day in two divided doses

Possible Side effects / Precautions / Possible Interactions:
Some of the more common side effects of bromelain include indigestion, nausea and diarrhea. Other side effects may include vomiting, increased heart rate, drowsiness and abnormal uterine bleeding or heavy menstruation.

Bromelain has resulted in allergic reactions and asthma symptoms, including breathing problems, tightness in the throat, skin hives, rash or itchy skin. People with allergies to pineapples should avoid bromelain. Allergic reactions may also occur in people with allergies to latex, carrot, celery, fennel, rye, wheat, papain, bee venom or grass, birch or cypress pollens.

People with peptic ulcers should not use bromelain. People with other digestive disorders should consult a qualified healthcare professional before using bromelain.

Theoretically, bromelain may increase the risk of bleeding, so people with bleeding disorders and those taking medication that can increase the risk of bleeding should only use bromelain under the supervision of their physician. It should not be taken two weeks before or after dental procedures or surgery.
Pregnant women and people with bleeding disorders, high blood pressure, and liver or kidney disease should not take bromelain.

Interactions:
If you are currently being treated with any of the following medications, you should not use bromelain without talking to your health care provider.
Antibiotics -- Bromelain may increase the amount of antibiotics absorbed by the body. In one clinical study, the combination of bromelain and amoxicillin increased the levels of amoxicillin in the blood. Also, some studies suggest that bromelain may increase the body's absorption of tetracycline, but results of other studies have been conflicting.

Anticoagulants and antiplatelet drugs (blood-thinners) -- Bromelain may affect the blood's ability to clot, and could interfere with any blood-thinning drugs you are taking, including:

arw Warfarin (Coumadin)
arw Clopidogrel (Plavix)
arw Aspirin
Sedatives -- Some experts believe bromelain may increase the effect of drugs that have a sedating effect, including:
arw Anticonvulsants, such as phenytoin (Dilantin) and valproic acid (Depakote)
arw Barbiturates
arw Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
arw Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)
arw Tricyclic antidepressants, such as amitriptyline (Elavil)
arw Alcohol
 

The same is true of herbs with a sedating effect, such as valerian, kava, and catnip.

Research studies / References

arw Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
arw Hotz G, Frank T, Zoller J, Wiebelt H. [Antiphlogistic effect of bromelaine following third molar removal]. [Article in German]. Dtsch Zahnarztl Z 1989;44:830-2.
arw Valueva TA, Revina TA, Mosolov VV. Potato tuber protein proteinase inhibitors belonging to the Kunitz soybean inhibitor family. Biochemistry (Mosc) 1997;62:1367-74.
arw Tanabe S, Tesaki S, Watanabe M, Yanagihara Y. [Cross-reactivity between bromelain and soluble fraction from wheat flour]. [Article in Japanese]. Arerugi 1997;46:1170-3.
arw Masson M. [Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice]. [Article in German]. Fortschr Med 1995;113:303-6.
arw Gaby AR. The story of bromelain. Nutr Healing May 1995:3, 4, 11.
arw Gutfreund AE, Taussig SJ, Morris AK. Effect of oral bromelain on blood pressure and heart rate of hypertensive patients. Hawaii Med J 1978;37:143-6.
arw Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8.
arw Walker AF, Bundy R, Hicks SM, Middleton RW. "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.
arw Tilwe GH, Beria S, Turakhia NH, Daftary GV, Schiess W. "Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthrosis of knee joint: an open randomized controlled clinical trial." J Assoc Physicians India. 2001 Jun;49:617-21.
arw Metzig C, Grabowska E, Eckert K, Rehse K, Maurer HR. "Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo." In Vivo. 1999 Jan-Feb;13(1):7-12.
arw Engwerda CR, Andrew D, Murphy M, Mynott TL. "Bromelain activates murine macrophages and natural killer cells in vitro." Cell Immunol. 2001 May 25;210(1):5-10.
arw Leipner J, Iten F, Saller R. " Therapy with proteolytic enzymes in rheumatic disorders " BioDrugs. 2001;15(12):779-89.
arw Wittenborg A, Bock PR, Hanisch J, Saller R, Schneider B. "Comparative epidemiological study in patients with rheumatic diseases illustrated in a example of a treatment with non-steroidal anti- inflammatory drugs versus an oral enzyme combination preparation." Arzneimittelforschung. 2000 Aug;50(8):728-38.
arw Snowden HM, Renfrew MJ, Woolridge MW. "Treatments for breast engorgement during lactation." Cochrane Database Syst Rev. 2001;(2):CD000046.
arw Graf J."Herbal anti-inflammatory agents for skin disease." Skin Therapy Lett. 2000;5(4):3-5.
arw Eckert K, Grabowska E, Stange R, Schneider U, Eschmann K, Maurer HR. "Effects of oral bromelain administration on the impaired immunocytotoxicity of mononuclear cells from mammary tumor patients." Oncol Rep. 1999 Nov-Dec;6(6):1191-9.
arw Shahid SK, Turakhia NH, Kundra M, Shanbag P, Daftary GV, Schiess W."Efficacy and safety of phlogenzym--a protease formulation, in sepsis in children.J Assoc Physicians India. 2002 Apr;50:527-31.
arw Roep BO, van den Engel NK, van Halteren AG, Duinkerken G, Martin S. "Modulation of autoimmunity to beta-cell antigens by proteases." Diabetologia. 2002 May;45(5):686-92. Epub 2002 Mar 28.
arw Glade MJ, Kendra D, Kaminski MV Jr. "Improvement in protein utilization in nursing-home patients on tube feeding supplemented with an enzyme product derived from Aspergillus niger and bromelain." Nutrition. 2001 Apr;17(4):348-50.
arw Kumakura S, Yamashita M, Tsurufuji S. "Effect of bromelain on kaolin-induced inflammation in rats." Eur J Pharmacol. 1988 Jun 10;150(3):295-301.
arw Rosenbaum, M. and Bosco, D. Super Supplements. 1987, p.106 & 236. Signet books, New York.
arw Rathgeber WF. The use of proteolytic enzymes (Chymoral) in sporting injuries. S Afr Med J 1971;45:1813.
arw Seligman B. Bromelain: An Anti-inflammatory Agent. Angiology 1962;13:50810.
arw Cirelli MG. Five years experience with bromelain in therapy of edema and inflammation in postoperative tissue reaction, skin infections and trauma. Clin Med 1967;74:559.
arw Miller, JM. The absorption of proteolytic enzymes from the gastrointestinal tract. Clin Med 1968;75:3542 [review].
arw Pearson, D. and Shaw, S. Life Extension. 1982. p.237. Warner Books, New York.
arw Castell JV, Friedrich G, Kuhn CS, et al. Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol 1997;273:G13946.
arw Boyne PS, Medhurst H. Oral anti-inflammatory enzyme therapy in injuries in professional footballers. Practitioner 1967;198:5436.
arw Murray, M. and Pizzorno, J. Encyclopedia of Natural Medicine. 1991, p. 513. Prima Publishing, Rocklin, Ca.
arw Holt HT. Carica papaya as ancillary therapy for athletic injuries. Curr Ther Res 1969;11:6214.
arw Taussig, S., Yokoyama, M., Chinen, A. et al. "Bromelain, a proteolytic enzyme and its clinical application: A review." Hiroshima Journal of Medical Science. 1975, 24:185.
arw Taussig, S. "The mechanism of the physiological action of bromelain." Medical Hypothesis. 1960, 6:99.
arw Buck JE, Phillips N. Trial of Chymoral in professional footballers. Br J Clin Pract 1970;24:3757.
arw Trickett P. Proteolytic enzymes in treatment of athletic injuries. Appl Ther 1964;6:64752.
arw Sweeny FJ. Treatment of athletic injuries with an oral proteolytic enzyme. Med Times 1963:91:765.
arw Deitrick RE. Oral proteolytic enzymes in the treatment of athletic injuries: A double-blind study. Pennsylvania Med J 1965;Oct:357.
arw Cirelli MG. Treatment of inflammation and edema with bromelain. Delaware Med J 1962;34:15967.
arw Masson M. Bromelain in the treatment of blunt injuries to the musculoskeletal system. A case observation study by an orthopedic surgeon in private practice. Fortschr Med 1995;113:3036.