Bromelain

Common Names

How It Works
Bromelain has anti-inflammatory properties but it has not been shown to treat or prevent cancer.
Bromelain, obtained from the stem of the pineapple, is an enzyme that breaks down protein molecules. In laboratory experiments, bromelain prevented several steps of blood clotting and decreased some substances that cause inflammation. Bromelain increases the absorption of antibiotics and when used topically, helps remove dead and damaged tissue from burns. Bromelain can help digestion and absorption in patients with digestive tract cancers. Anticancer activity has not been studied in humans.
Purported Uses
- To treat arthritis
  Laboratory studies show that bromelain reduces the levels of some substances that cause inflammation, but results from clinical trials are mixed.
- To treat burns of the skin
  Studies support this use.
- To prevent and treat cancer
  Laboratory studies suggested bromelain has anticancer activities. But these effects have not been confirmed in humans.
- To treat circulatory disorders
  Laboratory studies show that bromelain can prevent the formation of blood clots, but there is no proof from clinical trials that it can treat circulatory disorders.
- To reduce swelling
  Small clinical studies show that bromelain helps reduce swelling.
Do Not Take If
- You are taking warfarin or other blood thinners (Bromelain may increase the risk of bruising and bleeding).
- You are taking Tetracycline antibiotics (Bromelain may increase blood and urine levels).
Side Effects
Allergic reactions have been reported.
Special Point
Bromelain may increase blood levels of antibiotics by increasing their absorption in the intestine.
Brand Name
Ananase, Dayto Anase, Traumanase
Scientific Name
Sulphydryl proteolytic enzyme, cysteine-proteinase
Clinical Summary
An enzyme obtained from the stem of pineapple, bromelain is a proteolytic enzyme, and has a wide range of applications. Preclinical data show that it has anti-inflammatory ⁽¹⁵⁾ ⁽¹⁶⁾ properties, reduces serum fibrinogen levels, supports fibrinolysis and has also been investigated for its debriding effects on burn wounds ⁽¹⁾. A review of clinical findings reported safety and effectiveness of a bromelain based product for burn debridement ⁽²⁸⁾. Small studies also suggest it may be useful for treating skin conditions such as pityriasis lichenoides chronica (PLC) ⁽²⁾; for reducing mild, acute knee pain ⁽³⁾; and for alleviating post-operative pain and swelling ⁽²⁷⁾ ⁽²⁹⁾ ⁽³⁰⁾. But data on bromelain’s pain relieving effects in arthritic patients are mixed ⁽⁴⁾ ⁽⁵⁾ ⁽⁶⁾. A randomized study did not find any benefit in reducing fibrinogen or in influencing other risk factors of cardiovascular disease ⁽³¹⁾.
Bromelain has been investigated for its anticancer potential as well. It was shown to have chemopreventive ⁽¹⁹⁾ ⁽²⁵⁾ and antitumorigenic effects ⁽²⁰⁾ ⁽²⁶⁾, and increased the survival indices of animals bearing leukemia, sarcoma, lung, breast, and ascetic tumors ⁽¹⁰⁾. It may be useful as an adjuvant in cancer treatments ⁽⁷⁾ ⁽⁸⁾ ⁽⁹⁾.
Food Sources
Pineapple
Purported Uses
- Arthritis
- Bruises
- Burns
- Cancer prevention
- Cancer treatment
- Circulatory disorders
- Edema
- Indigestion
Mechanism of Action
Proteolytic removal of cell surface molecules by bromelain may account for some of its activities. Studies show that it prevents platelet aggregation and adhesion of platelets to blood vessel endothelial cells, as well as improving ischemia-reperfusion injury ⁽¹³⁾. It can act as an anti-inflammatory agent by reducing levels of prostaglandin E2 and thromboxane A2 ⁽⁹⁾. In addition, bromelain inhibits neutrophil migration in response to IL-8 during inflammation ⁽¹⁴⁾ and decreases pro-inflammatory chemokine and cytokine secretion ⁽¹⁵⁾ ⁽¹⁶⁾. Topical application of bromelain may be used for the skin debridement of burns ⁽¹⁾.
Oral enzymes such as bromelain have been proposed as additive agents for cancer therapy ⁽⁸⁾. Proposed mechanisms include down-regulation of the immunosuppressive cytokine, TGF-beta ⁽⁷⁾, direct inhibition of tumor cell growth, modulation of immune cell function, modulation of cell adhesion molecules (CAMs), and the effects on platelet aggregation and thrombosis mentioned above ⁽⁸⁾ ⁽⁹⁾. Experiments with murine models showed that bromelain induced apoptosis-related proteins along with inhibiting NF-kappaB-driven Cox-2 expression by blocking the MAPK and Akt/protein kinase B signaling in DMBA-TPA-induced skin tumors ⁽²⁰⁾. Bromelain also induced the expression of autophagy-related proteins, light chain 3 protein B II (LC3BII), and beclin-1 thereby facilitating apoptosis in mammary carcinoma cells ⁽²⁶⁾.
Adverse Reactions
Allergic reactions have been reported following use of bromelain. ⁽²¹⁾ ⁽²²⁾
Herb-Drug Interactions
Cytochrome P450 2C9: Bromelain inhibits CYP2C9 activity and can affect metabolism of its substrates ⁽¹²⁾.
Antibiotics/Tetracyclines: Bromelain may increase blood and urine levels ⁽²³⁾.
Anticoagulants: Bromelain may increase bleeding risk due to its antithrombotic effects ⁽²⁴⁾.
References
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2. Massimiliano R, Pietro R, Paolo S, et al. Role of bromelain in the treatment of patients with pityriasis lichenoides chronica. J Dermatolog Treat. 2007;18(4):219-222.
3. Walker AF, et al. 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.
4. Klein G, Kullich W, Schnitker J, et al. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol. Jan-Feb 2006;24(1):25-30.
5. Kerkhoffs GM, Struijs PA, de Wit C, et al. A double blind, randomised, parallel group study on the efficacy and safety of treating acute lateral ankle sprain with oral hydrolytic enzymes.Br J Sports Med. Aug 2004;38(4):431-435.
6. Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study.QJM. Dec 2006;99(12):841-850.
7. Desser L,et al. Oral therapy with proteolytic enzyes decreases excessive TGF-beta levels in human blood. Cancer Chemother Pharmacol 2001;47:S10-5.
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14. Fitzhugh DJ, Shan S, Dewhirst MW, et al. Bromelain treatment decreases neutrophil migration to sites of inflammation. Clin Immunol. Jul 2008;128(1):66-74.
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27. Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014 Jun;72(6):1043-8.
28. Rosenberg L, Shoham Y, Krieger Y,et al. Minimally invasive burn care: a review of seven clinical studies of rapid and selective debridement using a bromelain-based debriding enzyme (Nexobrid®). Ann Burns Fire Disasters. 2015 Dec 31;28(4):264-274.
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