Bromelain Explained Simply

1. What Is Bromelain?

Bromelain is a mixture of protein-cleaving enzymes. These enzymes occur naturally in the pineapple. For preparations, the stem of the plant is usually used. Bromelain is offered as a powder, tablet or capsule. The enzyme activity is often stated. There are also combination preparations with other enzymes or plant substances. Bromelain is studied, for example, for swelling after operations, for joint wear, for inflammation and for sinusitis.

2. Where Is It Found, and What Is It Made From?

Bromelain is found in the pineapple, both in the fruit and in the stem. The concentration is particularly high in the stem. For preparations, the stem is pressed. The enzyme is filtered out of the juice and purified. The activity is stated in standardized units, not in milligrams. In studies, bromelain was mostly tested as a capsule, sometimes alone, sometimes with other substances.

3. What Does Bromelain Do? What Research Shows

Dental and Maxillofacial Surgery

After wisdom tooth removal, facial swelling was less with bromelain 36, and swelling and jaw locking decreased more than with the painkiller aceclofenac 20. Purified bromelain and a bromelain-enriched pineapple extract lowered pain, swelling and the need for painkillers more than a sham preparation 27. After tooth removal with ridge preservation, pain and initially swelling were less than with sham preparation 37. A mixture of baicalin, bromelain and escin relieved pain more than ibuprofen and a sham preparation 18. Against pain, bromelain alone acted similarly to common painkillers; these acted faster only at individual early time points 202935. The studies were mostly small and used different preparations.

Swelling and Inflammation After Surgery

After operations, bromelain reduced swelling and bruises. After rhinoplasty, bruises and eye hemorrhages were less than with a sham preparation, but swelling was not 32. Capsules with a stated enzyme activity reduced swelling after eyelid surgery, bruises only in the first days 24. The evidence is moderate, as only a few controlled trials tested bromelain alone. Several studies tested mixtures, such as with other enzymes or plant substances 141631; their results cannot be attributed to bromelain alone.

Sinusitis

For bromelain alone in sinusitis, only review articles are available. One review considers bromelain possibly effective 10. Another review describes a study in children with acute sinusitis in which the children recovered faster with bromelain alone than with the usual treatment, with or without bromelain 6. In chronic sinusitis, a combination preparation in addition to the corticosteroid spray improved certain complaints more than the spray alone 38. The evidence is low; dedicated controlled trials (with comparison group) with bromelain alone are still pending.

Inflammation and Inflammatory Markers

After traumatic brain injury, bromelain lowered an inflammation marker more than a sham preparation, other markers did not differ 30. In the same study, the severity of the disease and mortality after two months were lower than with a sham preparation 30. A study with an enzyme combination in knee osteoarthritis found higher levels of two proteins in the blood 25. The evidence is low; most studies tested mixtures.

Osteoarthritis

A review reports that a mixture of the enzymes trypsin and bromelain and the plant substance rutoside together with the painkiller diclofenac relieved temporomandibular joint complaints more than the painkiller alone 8. In knee osteoarthritis, a mixture of bromelain, trypsin and rutoside improved pain and complaints more than a sham preparation, but not the overall score 25. Both results concern mixtures and cannot be attributed to bromelain alone. A study of a mixture of frankincense and bromelain found better quality of life, but had no comparison group 39. The evidence is low; studies with bromelain alone are still pending.

Other Investigations

In deep burns and chronic wounds, a bromelain-based preparation for topical application cleaned the wound faster and more often completely 2510111719. In burns, surgery or skin grafting was less often necessary 234. In venous leg ulcers, the preparation cleaned the wound faster and more often completely than an ointment with another enzyme 34. An enriched pineapple extract relieved pain and swelling in children with orchitis and epididymitis more than a sham preparation 23. After skin cancer surgery, wounds healed faster with oral bromelain than without, and stitches could be removed earlier 21. The later scar quality was not worse than after the usual treatment 23433. A combination preparation led to healing more often than a sham preparation in acute bronchitis 13.

4. How Was Bromelain Taken in the Studies?

For oral use, bromelain was mostly given as a capsule, partly with stated enzyme activity 2428. On wounds, a bromelain-based preparation was used for wound cleaning 1719. In addition, an enriched, freeze-dried pineapple extract was tested 2327. Several investigations tested mixtures, for example with other enzymes or plant substances 1214161825; their results cannot be attributed to bromelain alone.

5. Is Bromelain Safe? Side Effects in the Studies

The studies predominantly report good tolerability. Mentioned were mainly flatulence, nausea and headache 10. When the preparation is applied to wounds, burning, pain, fever and blood poisoning can occur; however, whether these complaints really come from the preparation is unclear. Serious health risks were not reported 10. In controlled trials, adverse events under bromelain did not occur more often than in the comparison groups 51724.

All details with tables and sources: full expert page on Bromelain