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Bromelain


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Bromelain

Background

Bromelain is a digestive enzyme that is extracted from the stem and fruit of pineapple.

Synonyms

Ananas sativus , Ananase®, bromeline (pleural), Bromelainum, Bromeliaceae (family) , Bromelin, Bromelins, plant protease concentrate, pineapple extract, Traumanase®.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Inflammation
Several preliminary studies suggest that when taken by mouth, bromelain can reduce inflammation or pain caused by inflammation. Better quality studies are needed to confirm these results.

B

Sinusitis
It is proposed that bromelain may be a useful addition to other therapies used for sinusitis (such as antibiotics) due to its ability to reduce inflammation/swelling. Studies report mixed results, although overall bromelain appears to be beneficial for reducing swelling and improving breathing. Better studies are needed before a strong recommendation can be made.

B

Chronic obstructive pulmonary disease (COPD)
There is not enough information to recommend for or against the use of bromelain in COPD.

C

Urinary tract infection (UTI)
There is not enough information to recommend for or against the use of bromelain in urinary tract infections.

C

Rheumatoid arthritis (RA)
There is not enough information to recommend for or against the use of bromelain in rheumatoid arthritis (RA). Notably, most studies and case reports in this area have been published by the same authors.

C

Steatorrhea (fatty stools due to poor digestion)
There is not enough information to recommend for or against the use of bromelain in the treatment of steatorrhea.

C

Digestive enzyme/pancreatic insufficiency
Bromelain is an enzyme with the ability to digest proteins. However, there is little reliable scientific research on whether bromelain is helpful as a digestive aid. Better study is needed before a firm conclusion can be made.

C

Cancer
There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies.

C

Nutrition supplementation
There is not enough information to recommend for or against the use of bromelain as a nutritional supplement.

C

* Key to grades
A:
Strong scientific evidence for this use;
B:
Good scientific evidence for this use;
C:
Unclear scientific evidence for this use;
D:
Fair scientific evidence against this use (it may not work);
F:
Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acquired immune deficiency syndrome (AIDS), allergic rhinitis (hay fever), amyloidosis, angina, appetite suppressant, atherosclerosis ("hardening" of the arteries), autoimmune disorders, back pain, blood clot treatment, bronchitis, bruises, burn and wound care, bursitis, cancer prevention, carpal tunnel syndrome, cellulitis/skin infections, colitis, common cold, cough, diarrhea, epididymitis, episiotomy pain (after childbirth), food allergies, food lodged in the esophagus, frostbite, gout, heart disease, hemorrhoids, immune system regulation, antibiotic absorption problems in the gut, infections, indigestion, injuries, joint disease, "leaky gut" syndrome, menstrual pain, pain (general), pancreatic problems with food digestion, Peyronie's disease (abnormal curvature, pain, and scar tissue in the penis), platelet inhibition (blood thinner), pneumonia, poor absorption of digested food, poor blood circulation in the legs, upper respiratory tract infection, sciatica, scleroderma, shingles pain/post-herpetic neuralgia, shortening of labor, smooth muscle relaxation, sports or other physical injuries, staphylococcal bacterial infections, stimulation of muscle contractions, stomach ulcer/stomach ulcer prevention, swelling (after surgery or injury), tendonitis, thick mucus, thrombophlebitis, treatment of scar tissue, ulcerative colitis, varicose veins, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Bromelain may be standardized to milk clotting units (MCU), gelatin digesting units (GDU), FIP units, or Rorer units (RU) per gram. The milk clotting unit of measurement is officially recognized by the Food Chemistry Codex. Some experts recommend using bromelain standardized to contain at least 2000 MCU in each gram, although other sources recommend a range between 1200 to 1800 MCU per gram.

Adults (18 years and older)

Tablets (by mouth) : A variety of doses have been used and studied. Research in the 1960s and 1970s used 120 to 240 milligrams of bromelain concentrate tablets daily (Traumanase® or Ananase®; 2500 Rorer units per milligram) in three to four divided doses for up to one week to treat inflammation. The German expert panel, the Commission E, has recommended 80 to 320 milligrams (200 to 800 FIP units) taken two to three times per day. Some authors recommend 500 to 1000 milligrams of bromelain to be taken three times daily, and many manufacturers sell products standardized to 2000 GDU in 500mg tablets. Effects of bromelain may occur at lower doses, and treatment may be started at a low dose and increased as needed.

Cream (applied to the skin) : Cream containing a 35% bromelain in an oil-containing base has been used to clean wounds.

Children (younger than 18 years)

There is not enough scientific research to recommend safe use of bromelain in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

There are multiple reports of allergic and asthmatic reactions to bromelain products, including throat swelling and difficulty breathing. Allergic reactions to bromelain may occur in individuals allergic to pineapples or other members of the Bromeliacea e family, and in people who are sensitive/allergic to honeybee venom, latex, birch pollen, carrot, celery, fennel, cypress pollen, grass pollen, papain, rye flour, or wheat flour.

Side Effects and Warnings

Few serious side effects have been reported with the use of bromelain at daily doses up to 10 grams for each kilogram (2.2 pounds) of body weight. The most common side effects reported are stomach upset and diarrhea. Other reported reactions include increased heart rate, nausea, vomiting, irritation of mucus membranes, and menstrual problems.

In theory, bromelain may increase the risk of bleeding. Caution is advised in people who have bleeding disorders or who are taking drugs that increase the risk of bleeding. Dosing adjustments may be necessary. Bromelain should be used with caution in people with stomach ulcers, active bleeding, a history of bleeding, taking medications that thin the blood, or prior to some dental or surgical procedures.

Bromelain may increase heart rate at higher doses, and should be used cautiously in people with heart disease. Some experts warn against bromelain use by people with liver or kidney disease, although there is limited scientific information in these areas. Bromelain may cause abnormal uterine bleeding or heavy/prolonged menstruation.

Pregnancy and Breastfeeding

Bromelain is not recommended during pregnancy or breastfeeding, as little safety information is available. Bromelain may cause abnormal uterine bleeding.

References

1. Balakrishnan V, Hareendran A, Nair CS. Double-blind cross-over trial of an enzyme preparation in pancreatic steatorrhoea. J Assoc Phys India 1981; 29(3):207-209.

2. Cirelli MG. Five years of clinical experience with bromelains in therapy of edema and inflammation in postoperative tissue reaction, skin infections and trauma. Clin Med 1967;74(6):55-59.

3. Cohen A, Goldman J. Bromelains therapy in rheumatoid arthritis. Penn Med J 1964;67:27-30.

4. Cowie DH, Fairweather DV, Newell DJ. A double-blind trial of bromelains as an adjunct to vaginal plastic repair operations. J Obstet Gynaecol Br Commonw 1970;77(4):365-368.

5. Gerard G. [Anticancer treatment and bromelains]. Agressologie 1972;13(4):261-274.

6. Glade MJ, Kendra D, Kaminski MV. Improvement in protein utilization in nursing-home patients on tube feeding supplemented with an enzyme product derived from Aspergillus niger and Bromelain. Nutrition 2001;17(4):348-350.

7. Gylling U, Rintala A, Taipale S, et al. The effect of a proteolytic enzyme combinate (bromelain) on the postoperative oedema by oral application. A clinical and experimental study. Acta Chir Scand 1966;131(3):193-196.

8. Hotz G, Frank T, Zoller J, et al. [Antiphlogistic effect of bromelaine following third molar removal]. Dtsch Zahnarztl Z 1989;44 (11) :830-832.

9. Howat RC, Lewis GD. The effect of bromelain therapy on episiotomy wounds--a double blind controlled clinical trial. J Obstet Gynaecol Br Commonw 1972;79(10):951-953.

10. Hunter RG, Henry GW, Civin WH. The action of papain and bromelain on the uterus. Part III. The physiologically incompetent internal cervical os. Am J Obst Gynec 1957;73(4):875-880.

11. Korlof B, Ponten B, Ugland O. Bromelain--a proteolytic enzyme. Scand J Plast Reconstr Surg 1969;3(1):27-29.

12. Kugener H, Bergmann D, Beck K. [Efficacy of bromelain in pancreatogenic digestive insufficiency]. Zeitschrift fur Gastroenterologie 1968;6:430-433.

13. Mader H. [Comparative studies on the effect of bromelin and oxyphenbutazone in episiotomy pains]. Schweiz Rundsch Med Prax 1973;62(35):1064-1068.

14. Masson M. [Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice]. Fortschr Med 1995;113(19):303-306.

15. Miller JM, Ginsberg M, McElfatrick GC, et al. The administration of bromelain orally in the treatment of inflammation and edema. Exper Med Surg 1964;22:293-299.

16. Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19(3):147-153.

17. Morrison AW, Morrison MC. Bromelain - a clinical assessment in the post-operative treatment of arthrotomies of the knee and facial injuries. Brit J Clin Pract 1965;19(4):207-210.

18. Mudrak J, Bobak L, Sebova I. Adjuvant therapy with hydrolytic enzymes in recurrent laryngeal papillomatosis. Acta Otolaryngol Suppl 1997; 527:128-130.

19. Ryan RE. A double-blind clinical evaluation of bromelains in the treatment of acute sinusitis. Headache 1967;7(1):13-17.

20. Seligman B. Bromelain: an anti-inflammatory agent. Angiology 1962;13:508-510.

21. Seligman B. Oral bromelains as adjuncts in the treatment of acute thrombophlebitis. Angiology 1969;20(1):22-26.

22. Seltzer AP. Adjunctive use of bromelains in sinusitis: a controlled study. Eye Ear Nose Throat Mon 1967;46(10):1281, 1284, 1286-1288.

23. Spaeth GL. The effect of bromelains on the inflammatory response caused by cataract extraction: a double-blind study. Eye Ear Nose Throat Mon 1968;47(12):634-639.

24. Stange R, Schneider R, Maurer R et al. Proteolytic enzyme bromelaine enhances zytotoxicity in patients with breast cancer [abstract]. Nat Scien Conf Compl Altern Integ Med Res, Boston, MA, April 12-14, 2002.

25. Tassman GC, Zafran JN, Zayon GM. A double-blind crossover study of a plant proteolytic enzyme in oral surgery. J Dent Med 1965;20(2):51-54.

26. Tassman GC, Zafran JN, Zayon GM. Evaluation of a plant proteolytic enzyme for the control of inflammation and pain. J Dental Med 1964;19(2):73-77.

27. Taub SJ. The use of bromelains in sinusitis: a double-blind clinical evaluation. Eye Ear Nose Throat Mon 1967;46(3):361.

28. Weiss S, Scherrer M. [Crossed double-blind trial of potassium iodide and bromelain (Traumanase) in chronic bronchitis]. Schweiz Rundsch Med Prax 1972;61(43):1331-1333.

29. Zatuchni GI, Colombi DJ. Bromelains therapy for the prevention of episiotomy pain. Obstet Gynecol 1967; 29(2):275-278.

January 01, 2004

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