How bromelain works
According to research, the enzyme mixture bromelain has various effects. It inhibits swelling (edema) after injury or surgery and influences blood clotting by, among other things, prolonging bleeding time and preventing platelets from clumping together.
In addition, bromelain exhibits anti-inflammatory properties and, due to its protein-splitting abilities, can aid digestion (such as in diseases of the pancreas, which normally produces digestive enzymes).
In addition, the bromelain effect on various types of cancer and inflammatory rectal changes, which are possible precancerous lesions, has been studied. A positive effect was found. However, the pineapple active ingredient cannot be considered as the sole therapy for cancer.
Absorption, degradation and excretion
After absorption into the bloodstream, bromelain can be distributed throughout the body. Its degradation occurs in the liver – how quickly is unclear. A person’s individual constitution and state of health probably have an influence on the rate of degradation.
When is bromelain used?
Bromelain is used in Germany and Austria as an adjunctive therapy for swelling conditions after operations and injuries, especially of the nose and sinuses.
In combination with other enzymes, bromelain is also used to treat superficial phlebitis, rheumatic diseases, and inflammation of the urinary and genital tracts.
In addition, it is used in special burn clinics for severe burns in the form of a gel to remove the burn scab on the wounds.
Sometimes bromelain is also given to aid digestion (as a dietary supplement).
Without medical consultation (as self-medication), bromelain should only be taken for a few days. Under medical supervision, the active ingredient can be used for a longer period of time.
How bromelain is used
The most common use of bromelain is as an enteric-coated tablet at least half an hour to an hour before a meal. The enteric coating is necessary to prevent the protein from being digested in the stomach. The tablet therefore only dissolves in the intestine, and the released bromelain can be absorbed into the blood from there.
The absorption of proteins through the intestinal mucosa is rather unusual and rarely occurs, but has been proven for the active ingredient bromelain in studies. It can reach its sites of action, such as the sinuses, via the blood.
The dosage of the various preparations varies. Therefore, follow the dosing instructions of the package insert or your doctor.
What are the side effects of bromelain?
Skin rashes, asthma-like symptoms and allergic reactions occur in every tenth to hundredth person treated. If this occurs, the therapy must be interrupted immediately and a doctor must be notified.
Occasionally (i.e., in one in one hundred to one in one thousand patients), digestive disorders, stomach discomfort, and diarrhea occur as side effects.
What should be considered when taking bromelain?
Contraindications
Bromelain should not be taken by:
- hypersensitivity to the active substance or to any of the other components of the drug
Special care should be taken if anticoagulant or antiplatelet drugs are taken at the same time (e.g. phenprocoumon, warfarin, acetylsalicylic acid = ASS, prasugrel).
Drug interactions
Due to its effect on blood clotting, bromelain may increase the bleeding tendency. This is even more true if anticoagulants (such as warfarin) or antiplatelet agents (such as ASA, prasugrel) are also taken.
Age restriction
The age restriction depends on the preparation. In some cases it is not recommended for children under 12 years of age, in others for children and adolescents under 18 years of age.
If in doubt, check with your doctor or pharmacist.
Pregnancy and lactation
Evidence of adverse effects of bromelain in pregnant women and nursing mothers is not known. However, since there are insufficient data for the use of bromelain during pregnancy and lactation, its use is not recommended.
When using the gel to remove burn scabs, nursing mothers should discontinue breastfeeding for at least four days from the first day of use.
How to obtain medication with bromelain
The enteric-coated tablets suitable for self-medication are available only in pharmacies in Germany and Austria, but not on prescription. In Switzerland, no medicines containing bromelain are currently registered.
In addition, there are dietary supplements containing bromelain in all three countries.
How long has bromelain been known?
The pineapple was used in folk medicine several hundred years before the age of modern medicine. The ingredient bromelain was discovered in the pineapple plant in 1891 and identified as a protein-cleaving enzyme. In 1957, the active ingredient was used therapeutically for the first time.