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8 Effects and Side Effects of Bromelain (5 Contraindications To Be Noted)

Bromelain, also known as bromelain or bromelain, is a popular health food recently, for indigestion and inflammation symptoms have a soothing effect, in the clinic is also used as a drug, has many therapeutic effects, such as the treatment of angina, bronchitis, sinusitis, surgical trauma, thrombophlebitis, wound debridement, enhance drug absorption, especially antibiotics.

In empirical medicine, does bromelain really have benefits? Are there any side effects of bromelain? See text analysis for details.

What is bromelain?

Bromelain refers to plants of the pineapple family (skin, stems and leaves) and other parts of various thiol endopeptidases and other components, such as phosphatase, glucosidase, cellulase, peroxidase, glycoprotein, carbohydrate, a mixture of various protease inhibitors, proteases are considered the most active part.

Since 1875, the chemical properties of bromelain have been known, due to its ability to promote protein digestion, soften flesh quality, promote blood clotting. Among other various biological activities, bromelain enzyme is thus used in beauty, food industry, textiles and pharmaceuticals: and other aspects have important economic value.

Bromelain is quite absorbable, does not lose its proteolytic activity after ingestion into the human intestine, its half-life is about 6 to 9 hours, and about 1 hour after ingestion, the highest concentration of bromelain can be detected in the blood.

Where is bromelain source?

Bromelain/bromelain is one of the few proteases that can be extracted from plants (including pulp, stem, peel and leaves), and because it is concentrated in the stem and the fruit part is less abundant, both in composition and concentration, it is won by the stem.

For commercial use, bromelain is typically extracted from pineapple stems by ultrafiltration, centrifugation, lyophilization, and two-step rapid protein liquid chromatography (FPLC).

After extraction, crude compounds containing bromelain are purified, as impurities (e.g., phosphatase, glucosidase, peroxidase, cellulase, glycoprotein) can react with bromelain and hinder its mechanism of action.

What are the recommended benefits of bromelain?

1. Beneficial for the management after tooth extraction surgery

In dental terms, impacted teeth refer to teeth that do not erupt as expected, or fail to erupt due to lack of space or the wrong direction or position of the growth, the most common impacted teeth are third molars/third molar (98%), followed by maxillary canines (1.3%).

Removal of impacted teeth requires surgery, in which the soft tissue flap is lifted leading to tissue damage, and common postoperative complications such as pain, bacterial infection, closed teeth (mouth that cannot be opened due to muscle spasms), etc., cause great pain to the patient.

To reduce surgical complications, in addition to improving surgical technique, laser light and cryotherapy are used in combination with proteolytic enzymes such as trypsin, chymotrypsin, papain, sera peptidase, and bromelain, as well as conventional antibiotics, analgesics, and corticosteroids.

A meta-analysis (6 randomized controlled trials of 312 patients with impacted third molars removed from the lower jaw) noted that oral bromelain/bromelain helped reduce postoperative pain, improve quality of life (diet, appearance, social isolation, and sleep quality), and reduce the average amount of medication required per patient (but facial swelling and closed teeth were not significantly helpful). Note 1

*Conclusion: For patients undergoing third molars extraction, bromelain may be helpful in reducing postoperative pain and have a positive impact on postoperative quality of life, but limited by small sample sizes, more studies are needed for further validation

2. Assist in burn debridement

Proper management of burn wounds is the primary goal of burn patient care. It is essential to achieve good functionality and aesthetics, and it is essential in severe burns.

With prolonged wound closure, the risk of infectious complications may affect mortality; Timely and effective burn wound debridement is necessary prior to prognosis-related safe and rapid wound closure.

One randomized controlled trial (182 patients with deep hand burns) noted that bromelain (NexoBrid)-induced debridement significantly reduced burn wound resection and autografting, and reduced the need for urgent eschartomy, compared with standard care. Note 2

*Conclusion: For deep hand burns, bromelain debridement may be beneficial in removing eschar and preserving dermal living tissue

3. Beneficial for chronic lichenoid pityriasis

Pityriasis lichenous is a rare disease of pityriasis that occurs in adolescents, usually before the age of 30, especially in men, and is rarer in infants and older people.

The chronic form is characterized by the gradual development of small, flat, red to brown papules that spontaneously flatten and recover over a period of time and are called chronic pityriasis lichenoides chronica.

Acute morphology, characterized by a sudden eruption of a large number of papules, the development of small vesicles and pustules, which eventually form ulcers and crusts. Also known as acute pityriasis lichenoides et varioliformis acuta.

The pathogenesis is unknown and non-contagious, but may be associated with allergic reactions caused by bacteria or drugs, viral or protozoan infections, and immune dysfunction.

One study (3 months, 8 patients with chronic pityriasis lichenoides) showed that oral bromelain helped achieve full symptomatic recovery without side effects during treatment. Note 1

The mechanism behind it may be related to anti-inflammatory, immunomodulatory or antiviral properties.

*Conclusion: Bromelain may be considered as a new and effective treatment in patients with chronic pityriasis lichenoides, but further confirmation from larger randomized controlled trials is needed

4. Beneficial for cardiovascular disease

Cardiovascular disease is the leading cause of death in diabetic patients (about 70%), so how to manage the causative factors has become the focus of improving prognosis. Note 1

About 80% of diabetic patients have hypertension and hyperlipidemia, coupled with chronic hyperglycemia damage to blood vessels, resulting in more than 3 times the risk of cardiovascular disease.

One randomized, double-blind controlled study (12 weeks, 68 people with diabetes) showed that bromelain was no better than placebo on fibrinogen and other cardiovascular risk factors (eg, lipids, blood pressure, blood sugar, C-reactive protein). Note 2

*Summary: Bromelain has no significant effect on improving cardiovascular disease-related risk factors, and more large-scale experiments are needed

5. Good for Osteoarthritis

Joints are important parts of daily activities, weight-bearing, bending, stretching and other actions, and osteoarthritis is because of the cartilage in the joint cavity, which is destroyed and worn for various reasons, and leads to persistent inflammation, because it tends to occur in the elderly, so it is also called degenerative arthritis.

It is estimated that 25% of people aged 65 to 14 are affected by the disease, while 65% are over 34 years old, almost one in three people, and in severe cases, it can even cause mobility problems and greatly reduce quality of life.

In a controlled study of 40 patients with osteoarthritis, patients were divided into two groups, one with bromelain (500 mg daily) and the other with an anti-inflammatory drug (diclofenac).

Results At 4 weeks after use, it was found that the osteoarthritis index (WOMAC) and pain subscales of both groups decreased significantly, and there was no significant difference between the two groups. This shows that bromelain can reduce oxidative stress (MDA) and the inflammatory hormone PGE2 for mild to moderate osteoarthritis, and can also exert an improvement effect that is not inferior to drugs.Note 3

*Conclusion: For osteoarthritis, oral bromelain can help improve discomfort, but due to the limited sample size, more large studies are needed to support it

6. Aids digestive function

The food we eat every day will be digested and broken down in the stomach and intestines, forming a variety of different small molecule nutrients that can be used by the body’s cells.

The main credit of this huge digestion project is attributed to a molecule called enzyme, which can be divided into lipase, protease, amylase according to different functions and structures, and is responsible for the digestion of different foods in different pH environments.

Unlike other enzymes,Bromelain adapts to various pH extremes in the digestive tract and maintains an active state, assisting in the digestion of a variety of protein-containing foods both in the stomach and intestines.Note 4

Therefore, bromelain can be used as a digestive enzyme supplement (as a substitute for pepsin and trypsin deficiencies).

7. Improve delayed muscle damage after exercise?

Post-exercise delayed muscle pain often occurs during unfamiliar training (especially high-intensity eccentric exercise), resulting in localized damage to muscle fibers.

Usually delayed onset muscle pain peaks 24 to 48 hours after exercise, causing a lot of discomfort in the exerciser

A small controlled study found that taking protease supplements, including bromelain, helped reduce blood inflammation, reduce muscle damage, and maintain strength output.Note 5

Another study has also pointed out that proteases help reduce delayed-onset muscle soreness after intense exercise and help restore muscle function.Note 6

To date, there have been no large studies demonstrating the soothing effect of bromelain alone in soothing muscle damage, so more reports are needed.

*Conclusion: To date, there are no large studies demonstrating the effectiveness of bromelain alone in relieving muscle damage, so more reports are needed

8. Beneficial for sinusitis

Sinuses are cavities in the bones of the face (near the nose and eyes) that are densely packed with mucous membranes and communicate with the nasal cavity.

Generally referred to as chronic sinusitis, it is a long-term chronic inflammation caused by infection of the nasal mucosa, often causing annoying symptoms such as runny nose, nasal congestion, headache, and facial pain.Note 9

It is estimated that 2900 million people (about 14.2% of the population) are affected by the disease every year in the United States alone, and the related medical costs are tens of millions of dollars.

An epidemiological study from Germany (in 116 patients with acute acute sinusitis under 11 years of age) found that bromelain alone was associated with shorter duration and faster recovery from the disease (compared to patients treated with drugs alone).Note 7

Preliminary observations also indicate that for patients with chronic sinusitis (with or without nasal polyps), taking bromelain can help improve the total symptom scores, total rhinoscopy scores and quality of life before surgery.Note 8

*Conclusion: The use of bromelain has a positive effect on the improvement of sinusitis symptoms, but it is limited by the sample size and needs more large studies to support it

What are the side effects of bromelain (bromelain)?

Bromelain has been found to be highly safe in animal studies, but occasional side effects in humans include nausea, vomiting, diarrhea, palpitations, indigestion, loss of appetite, headache, muscle pain, dizziness, drowsiness, uterine bleeding and menorrhagia, especially in cases of overdose.

Safety precautions (5 contraindications to use)

1. Do not use if you are pregnant, lactating or have poor liver and kidney function (due to unknown safety)

2. Do not use if you have been allergic to pineapple, natural latex, wheat, celery, papain, carrot, fennel, pollen or grass (may induce allergic reactions, common allergic symptoms are: cough, dyspnea, strong itching, constipation, nasal congestion, sinus blockage, angioedema, anaphylactic shock etc. Note 1

3. Bromelain has anticoagulant effect, if combined with anticoagulant drugs may increase the chance of bruising and bleeding, related drug names are: warfarin, aspirin, clopidogrel, diclofenac, ibuprofen, naproxen, dalteparin sodium (dalteparin), Enoxaparin, heparin and ginkgo.

4. May increase the risk of bleeding during and after surgery, so please refrain from using it for 1 month before surgery

5. Avoid taking with antibiotics or drugs or health ingredients with sedative effects (which may interfere with the action of the drug and cause unknown risks), related drugs are: amoxicillin, demeclocycline, minocycline, tetracycline

How to eat bromelain? When to eat? What is the dose?

The recommended dosage of bromelain depends mainly on the situation you are dealing with.

For indigestion, the standard dose taken after meals is 200 to 2000 mg.

For other uses, the following are common dosages

Arthritis: 400 mg 1-2 times a day

Allergies: 1000 mg of bromelain and quercetin per day

Surgical recovery: 2 mg 1000 times a day

Although bromelain is generally considered safe, it is important to seek the advice of a healthcare practitioner before use to determine the dosage your body needs.



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