July 30, 2021
Jenina Anne S. Ignacio, MD
Pineapple has been used as a medicinal plant in several native cultures and one of its substances, bromelain, has been known chemically since 1876. Bromelain was introduced in 1957 as a therapeutic compound when Heinicke found it in high concentrations in pineapple stems. Bromelain is a general name for a family of sulfhydryl proteolytic enzymes obtained from Ananas comosus, the pineapple plant.
Bromelain is usually differentiated depending on its source either fruit bromelain or stem bromelain, with all obtainable bromelain being derived from the stem.7 Bromelain’s primary component is a sulfhydryl proteolytic fraction. It also contains a peroxidase, acid phosphatase, several protease inhibitors, and organically bound calcium. When the proteolytic fraction of bromelain is purified and extracted, the result is a potent proteolytic enzyme.9
Studies have shown eight basic proteolytically active components detected in the stem. The two main components have been labeled F4 and F5. The proteinase considered to be the most active fraction has been designated as F9, which comprises about 2% of the total proteins.
Most studies demonstrated that the majority of the physiological activity of bromelain may not be due to single proteolytic fraction, and the beneficial effects of bromelain can be attributed to multiple factors.5 Bromelain has not only been used to treat various health problems, it is also popular as a nutritional supplement to promote health.
In vitro and in vivo studies revealed that bromelain exhibits various fibrinolytic, antiedematous, antithrombotic, and anti-inflammatory activities.6 It is considerably absorbable in the body in a functionally intact form without losing its proteolytic activity and without producing any major side effects. Approximately 40% of labeled bromelain is absorbed from the intestine in high molecular form.8
The proteolytic activity accounts for many therapeutic benefits like the treatment of angina pectoris, bronchitis, sinusitis, surgical trauma, thrombophlebitis as well as debridement of wounds. Furthermore, it can enhance the absorption of drugs, particularly antibiotics, thus interactions with some medications must be noted. It also relieves osteoarthritis, diarrhea, and various cardiovascular disorders and also possesses some anti-cancer activities by promoting apoptotic cell death.
A 2009 pilot study by Pelicano, R. et al. showed the potential role of bromelain in alleviating dyspeptic symptoms. The combination of sodium bicarbonate, sodium alginate, bromelain, and essential oils has improved the visual analog scale (VAS) scores of patients suffering from functional dyspepsia after 3 months of treatment. 11
Bromelain can inhibit blood platelet aggregation by modulating prostaglandin formation subsequently minimizing risk of coronary atherosclerotic disease.6 It continues to provide a desired physiological action for as long as it is administered, with no evidence indicating that a tolerance develops.
Bromelain is relatively safe since it is a protein and seems to be as easily metabolized as other dietary proteins. It is well absorbed and seems to have greater therapeutic impact when administered orally rather than intravenously. It is considered to be non-toxic and lacking in side effects, so it can be used without concern in doses from 200 to 2000 mg for prolonged periods of time.
While effective for inflammation and injury, bromelain is even more effective if administered prior to a traumatic event, i.e. surgery or athletic competition. It seems to enhance the absorption of and improve the action of other substances when they are administered in combination. Because of its impact on the cytokine system, particularly IL-1 and TNF, which stimulate fever and the acute phase response and its demonstrated ability to increase the heart rate, bromelain may assist in generating an acute-stage healing response.
Currently, bromelain is considered as a food supplement and is available to the general public in health food stores and pharmacies in the USA and Europe.4 Notably, there are the several compelling reasons for supplementation with oral bromelain.3 It has been shown to be an effective supplement for various conditions and has a potential to be further developed in the future.