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Bromelain

Bromelain is an anti inflammatory enzyme derived from the pineapple plant and is one of a group of enzymes capable of digesting protein (proteolytic enzymes).

Numerous studies, mostly on animals, have demonstrated its effectiveness in conditions ranging from sinusitis to cardiovascular disease. In humans, double-blind, placebo-controlled trials have shown bromelain to be very useful in treating facial bruising (in boxers) as well as in the treatment of symptoms associated with sinusitis. The German E Commission acknowledges the use of bromelain for acute postoperative and post-traumatic conditions of swelling, especially of the nasal and paranasal sinuses.

In addition to the anti-inflammatory properties, bromelain is often used as a digestive aid for breaking down proteins. It is widely believed that most orally ingested enzymes are destroyed by the digestive juices prior to being absorbed. However, there is evidence that significant amounts of bromelain can be absorbed intact.
 
Browse Sections:
 Summary
 Other Names
 Description
 Traditional Internal Uses
 Indications
 Actions
 Pharmacological Summary
 Scientific Research / Actions
 Research
 Precautions / Contraindications
 Interaction with Medications
 Possible Side Effects
 Dosage
 References

Common Name
Bromelain
 
Botanical Latin Name / Classification
Ananus comosus
 
Parts Used
Pineapple Stem
 
Other Names
Bromelainum, Bromelin, Pineapple Stem, Pineapple Enzyme, Ananas comosus.

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Description
The protease enzymes that are extracted from the stem and fruit of pineapples are called Bromelain. The commercial supplement is usually obtained only from the stem of the pineapple, which contains a higher concentration of the enzymes than the fruit.

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Traditional Internal Uses
The German E Commission acknowledges the use of bromelain for acute postoperative and post-traumatic conditions of swelling, especially of the nasal and paranasal sinuses. Traditional use of bromelain as a digestive aid is more common as enzymatic and anti-inflammatory actions are cited as reasons for efficacy.

Bromelain is a mixture of protein processing enzymes that aids in digestion while enhancing the absorption of nutrients from food and supplements. Enzymes are the key in digestion which causes the chemical breakdown of foods. This enzymatic action occurs in four areas of the body: the salivary glands, the stomach, the pancreas and the wall of the small intestines.

Bromelain, a proteolytic enzyme, breaks down and digests foods. Specifically, it has the ability to digest fat, thereby making it an excellent supplement to aid in weight loss. Bromelain seems to travel to any place in the body with excess fat and digest the fatty cells. In addition to breaking down fats, bromelain dissolves damaged protein (scar tissue) and speeds the healing rate of bruises.

There are various products available which can help relieve gastric juices, including glutamic acid which supplies hydrochloric acid, lactobacillus acidophilus which provides friendly bacteria to help restore the intestinal flora, and various digestive enzyme formulations required for proper digestive functions.

It has been researched that Bromelain exerts a wide variety of benefic effects on sports injuries, including reducing inflammation in cases of injury or trauma and prevention of swelling after trauma. Studies show that in boxers who have used bromelain all signs of bruising cleared completely within four days.

Bromelain can prevent abnormal high levels of fibrinogen that can cause blood clots to form spontaneously and lead to heart attack.

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Indications
Other Indications: Angina Pectoris (Chest Pain)

Other Indications: Arthritis Support, Asthma

Bloating

Primary Indications: Bruising

Primary Indications: Burns

Other Indications: Cardiovascular Disorders

Secondary Indications: Colitis

Other Indications: Cystitis

Secondary Indications: Dyspepsia

Flatulence

Other Indications: Food Allergies / Sensitivities

Indigestion

Secondary Indications: Liver Disorders, Malabsorption Syndrome, Metabolism

Primary Indications: Muscle Sprains and Strains, Musculoskeletal Injuries, Osteoarthritis Support

Rheumatoid Arthritis Support

Primary Indications: Sinusitis / Sinus Infection Support, Skin Health

Primary Indications: Swelling / Inflammation

Primary Indications: Tendonitis

Secondary Indications: Ulcers Support, Weight Control / Obesity Support

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Actions
Anti-Carcinogenic, Anti-Diarrheal, Anti-Inflammatory, Antibacterial

Hepatoprotective, Immunoactive / Immunomodulatory / Immunostimulative

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Pharmacological Summary
Bromelain is a mixture of protein digesting enzymes from pineapple. The effectiveness of bromelain is evaluated on its ability to clot milk. For most indications, the recommended MCU's range is 1200 to 1800.(15) Bromelain is absorbed orally and experiments with dogs resulted in peak levels at 10 hours, while detectable levels were still found after 48 hours. There is good evidence that in animals and humans up to 40% of an oral dose of bromelain is absorbed in tact.(15)

The most commonly associated use of bromelain is for assisted protein digestion due to pancreatic insufficiency. This condition can lead to poor protein digestion, malabsorption of dietary protein, and intestinal putrefaction of undigested protein with disturbed intestinal effects. In the older person, poor protein absorption may contribute to immune shortfalls in antibodies, since maintaining optimal amounts of plasma amino acids is required for timely antibody production. Furthermore, chronic putrefaction by-products may also overload the immune system. It may be possible for some food allergies to stem from undigested protein particles that are able to gain systemic distribution.

Bromelain is a safe supplement that can be used at meal times to evaluate its usefulness in enhanced protein digestion, and continued if there are beneficial effects. Pancreatic insufficiency may present greater digestion challenges than can be corrected by bromelain alone, thus in some cases lipase and amylase enzymes may also be required. Beyond a digestive role, bromelain is a natural agent for safely modulating key factors that drive local inflammation, and is used in cases of work and sport injury, sprains, strains, arthritis, and other inflammatory conditions.(15) Tissue injury results in elevated kinin levels and formation of fibrin. Fibrin is able to promote local inflammation by forming a matrix barrier that isolates the affected tissue area, limiting site drainage and contributing to edema.

Bromelain enhances plasmin's fibrinolytic action for modulating exaggerated fibrin effects, thus helping to manage the degree of inflammation discomfort. Kinin also contributes to the discomfort of inflammation by increasing vascular permeability, also contributing to edema. Furthermore, kinins magnify pain. By decreasing kinin levels, bromelain exerts a significant modulating effect over the pain and the course of local inflammation. Other inflammatory regulatory agents like prostaglandins are favorably modulated by bromelain.(15)

In arthritis, its anti-inflammatory effects are often enhanced with curcumin.(15,16) Compared against phenylbutazone, curcumin demonstrates its own ability for managing the morning stiffness, walking time, and joint swelling of rheumatoid arthritis.(18) Bromelain is especially effective in combination with curcumin in reducing the need for corticosteroids in RA.(15) Bromelain has been successfully used to manage thrombophlebitis and deep vein thrombosis, as well as cellulites, bruises, and edema.(15) Double blinded clinical investigations have demonstrated that bromelain is able to reduce all of the inflammatory symptoms of thrombophlebitis, including pain, edema, redness, tenderness, elevated skin temperature, and disability.(15, 19, 20)

Better management of varicose veins may also be afforded by bromelain, which enhances plasmin's fibrinolytic action. In part, varicose veins are associated with fibrin deposits, due to insufficient plasminogen activator from the vein endothelial wall. When plasmin levels are inadequate, a balanced fibrinolytic action fails to effectively modulate fibrin homeostasis, contributing to the appearance of the varicose hard lumpy look.(15, 16)

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Scientific Research and Pharmacologicial Actions
Various claims are made for the value of bromelain supplementation, but much of the research underpinning these claims was carried out in the 1960s and 1970s, and there are almost no well-controlled human studies. Bromelain has been associated with improvement in symptoms of sinusitis, acceleration of wound healing, potentiation of antibiotic action, healing of gastric ulcers, treatment of inflammation and soft tissue injuries, reduction in severity of angina, reduction in sputum production in patients with chronic bronchitis and pneumonia and decrease in symptoms of thrombophlebitis.(1)

Sinusitis

Two double-blind, placebo-controlled studies showed that bromelain 160 mg (400 000 units) could reduce some symptoms of sinusitis.(2,3) However, headache was not improved in either study.

Musculoskeletal Injuries

In a double-blind, placebo-controlled trial,(4) 146 boxers with bruises to the face and haematomas to the eyes, lips, ears, arms and chest received either 160 mg bromelain daily or placebo for 14 days. At day 4, 78% of the bromelain treated group were completely cured of their bruises compared with 15% of the placebo group. However, this result was not tested for statistical significance.

Surgical Procedures

Bromelain has been reported in at least two studies(5,6) to reduce the degree and duration of swelling and oral pain with oral surgery. However, one study was not controlled and the other had no statistical analysis.

Antibacterial

Bromelain could be useful an antidiarrhoeal agent. In an in vitro study(7) bromelain was shown to prevent intestinal fluid secretion mediated by Escherichia coli and Vibrio cholera, and in other studies(8,9) to protect piglets from diarrhoea. However, there are no human studies to date.

Cardiovascular Disease

Bromelain has been reported to reduce the severity of angina(10) and several in vitro studies(11,12) have demonstrated that bromelain reduces platelet aggregation.

Ulcerative Colitis

A letter from two US consultants(13) stated that two patients with ulcerative colitis achieved complete clinical and endoscopic remission after initiation of therapy with bromelain.

Cystitis

One double-blind study in humans revealed that bromelain was effective in treating non-infectious cystitis.(14)

Conclusion

Many claims have been made for bromelain, based largely on studies conducted during the 1960s and 1970s. Many of the published trials are uncontrolled human studies or animal or in vitro studies, and well-controlled clinical trials are required to establish the role of bromelain as a potential supplement.

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Research
"Bromelain: Health Food for Bossie, Too"


"Coping With A New Joint?"


"Pineapple Stem May Combat Cancer"

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Precautions / Contraindications
No problems have been reported, but based on the potential pharmacological activity of bromelain, i.e. that it may inhibit platelet aggregation, bromelain should be used with caution in patients with a history of bleeding or haemostatic disorders.

Hypersensitivity to bromelain.

Those allergic to pineapple should use with caution.

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Interaction with Medications
Bromelain is inhibited by oxidizing agents like hydrogen peroxide, methyl bromide, and iodoacetate, and by metal ions of lead, mercury, cadmium, copper, and iron.(15) Magnesium and cysteine activate bromelain.(15)

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Possible Side Effects
Doses of bromelain as high as nearly 2000 mg have been given with no adverse side effects, and there is no established LD50, even when using up to10 grams per kilogram of body weight.(15)

Chronic use appears to be well tolerated, but idiosyncratic allergy may be possible.

Possible but unconfirmed reactions may include nausea, vomiting, diarrhea, metrorrhagia, and menorrhagia.(15,17)

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Dosage
Unless otherwise prescribed: 80-320 mg, two to three times daily for oral ingestion for 8 to 10 days. If necessary, administration may be prolonged.

Solid dosage forms: 80-320 mg of bromelain (200-800 FIP units) in 2 or 3 doses.

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References
1. Anonymous. Bromelain. Altern Med Rev 1998; 3: 302-308.
2. Ryan RE. A double-blind clinical evaluation of bromelains in the treatment of acute sinusitis. Headache 1967; 7: 13-17.
3. Seltzer AP. Adjunctive use of bromelains in sinusitis: A controlled study. Eye Ear Nose Throat Mon 1967; 46: 1281-1288.
4. Blonstein JL. Control of swelling in boxing injuries. Practitioner 1960; 185: 78.
5. Tassman GC, Zafran JN, Zayon GM. Evaluation of a plant proteolytic enzyme for the control of inflammation and pain. J Dent Med 1964; 19: 73-77.
6. Tassman GC, Zafran JN, Zayon GM. A double blind crossover study of a plant proteolytic enzyme in oral surgery. J Dent Med 1965; 20: 51-54.
7. Mynott TL, Guandalini S, Raimondi F, et al. Bromelain prevents secretion caused by Vibrio cholera and Escherichia coli enterotoxins in rabbit ileum in vitro. Gastroenterology 1997; 113: 175-184.
8. Mynott TL, Luke RKJ, Chandler DS. Oral administration of protease inhibits enterotoxigenic Escherichia coli (ETEC) activity in piglet small intestine. Gut 1996; 38: 28-32.
9. Chandler DS, Mynott TL. Bromelain protects piglets from diarrhoea caused by oral challenge with K88-positive enterotoxigenic Escherichia coli. Gut 1998; 43: 196-202.
10. Nieper HA. Effect of bromelain on coronary heart disease and angina pectoris. Acta Med Empirica 1978; 5: 274-278.
11. Heinicke RM, Van der Wal M, Yokoyama MM. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972; 28: 844-845.
12. Metzig C, Grabowska E, Eckert K, et al. Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells, and thrombus formation in rat vessels in vivo. In Vivo 1999; 13: 7-12.
13. Kane S, Goldberg MJ. Use of bromelain for mild ulcerative colitis [letter]. Ann Intern Med 2000; 132: 680.
14. Lotti T, Mirone V, Imbimbo C, et al. Controlled clinical studies of nimesulide in the treatment of urogenital inflammation. Drugs 1993; 46 (suppl. 1): 144-146.
15. Murray, Michael T., The Healing Power of Herbs, Prima Publishing, Rocklin, CA, 1995
16. Whitaker, Julian, Dr. Whitaker's Guide to Natural Healing, Prima Publishing, Rocklin, CA, 1995
17. Ananase (Rorer), In: Physicians Desk Reference, Medical Economics Company, Oradell, NJ, 1982, p. 1645
18. Deodhar, S.D., et al, Preliminary studies on antirheumatic activity of curcumin (diferuloyl methane), Indian Journal of Medical Research, 71:632-634, 1980
19. Seligman, B., Bromelain: An anti-inflammatory agent, Angiology, 13, 508-510, 1962
20. Seligman, B., Oral bromelains as adjuncts in the treatment of acute thrombophlebitis, Angiology, 20, 22-26, 1969

Our thanks to the following information resources: WholeheatlthMD.com, Medicinescomplete.com, American Botanical Council (Herbalgram.org), VitaminsDiary.com, Vitacost.com.

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