Natural Products

Bromelain

Ananas comosus, Pineapple

Efficacy

• Indications with proven efficacy:
  None
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Post-operative/post-traumatic inflammation (especially of the nasal and paranasal sinuses)
• Also used for these other indications, but with no proof of efficacy:
  Anti-inflammatory action
  Burn debridement
  Cancer prevention
  Digestive aid
  Enhancement of fat excretion in weight loss diet
  Inhibition of platelet aggregation
  Osteoarthritis
  Shortening of labor
  Smooth muscle relaxation
  Stimulation of muscle contraction

Security

• Risk of Drug Interactions: Low
• Adverse Effects: Not Frequent

What is it?

The pineapple plant, which is 60 to 120cm tall, produces a very characteristic fruit, which is in fact a very complex flowerhead that wraps around the stem. Thus, the pineapple is the only cultivated fruit that has its main stem going completely through it. The plant is indigenous to South America and was spread around the world by Europeans settlers. It has been used in traditional tropical medicine for quite some time. It is now mostly cultivated for its fruit, which is used to make juice, candy and syrup.

Pineapple fruits are rich in citric acid (up to 8% in some varieties). The entire plant, fruit and juice are used commercially as a source of bromelain, a proteolytic enzyme. In the food industry, bromelain is used as a meat tenderizer. The plant's medicinal properties are attributed to bromelain, which has a 40% absorption rate when taken orally. Bromelain has been used for burn debridement, to reduce skin and mucosal irritation and inflammation. Some have claimed that bromelain could prevent ulcers and promote fat elimination in some "miracle" diets, but these effects have never been proven. In certain animals, topical application of enzymes obtained from the pineapple have promoted wound healing. In addition, bromelain increases the elimination of coagulation factors (fibrin and fibrinogen). It also appears to reduce inflammatory processes.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

There is no evidence that bromelain is effective in any indication. However it is used to reduce post-operative or post-traumatic inflammation, especially when the sinuses are involved in which it may be of some benefit:

• Post-operative/post-traumatic inflammation :
  A typical oral dose is 80 to 1000 mg daily, in 2 to 3 divided doses, for 10 days. Treatment may be prolonged over 10 days if necessary.

There is insufficient reliable information to conclude that bromelain is effective in any other indication.

Is it safe?

• Bromelain is not associated with any severe toxicity. When taken orally, bromelain may cause gastro-intestinal disturbances and diarrhea. There are reports of allergic reactions to this product. There may be a cross-allergenicity between wheat flour and bromelain.
• Since there is no safety data available concerning its use during pregnancy and breast-feeding, pregnant and lactating women should not use bromelain. There are reports that ingestion of large quantities of pineapple juice may induce uterine contractions.
• Apparently, zinc, an oxidizing agent, inhibits bromelain activity while magnesium, a reducing agent, increases its activity. In addition, bromelain may increase the effects of anticoagulants. Concomitant tetracycline therapy (an antibiotic) increases tetracycline levels.

Clinical notes

• Pineapple, a source of bromelain, is still used for its medicinal properties today, especially for the treatment of soft tissue inflammation or, topically, for burn debridement.

References

1. Blumethal M et al. The Complete German Commission E monographs, 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Facts and Comparisons, The review of Natural Products, 2000
4. Passeportsanté.net. Broméline. http://www.passeportsante.net
5. Taylor J. CE: Phytomedicinals: Uses, precautions, and drug interactions. Drug Topics 2003;1:79
6. Herbal Companion to AHFS DI, American Society of Health-System Pharmacists, 2001