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Other common
name(s): bromelin, bromeline, pineapple enzyme, pineapple
extract, Ananase®, Traumanase®,
and others
Scientific/medical
name(s): sulphydryl proteolytic enzyme,
cysteine-proteinase, both made from the plant Ananas comosus
Description
Bromelain is a natural enzyme found in the stem and fruit of
the pineapple, a tropical fruit native to Central and South America.
Bromelain supplements are promoted as an alternative remedy for various
health problems including joint inflammation and cancer.
Overview
Some small studies have suggested bromelain may have some
effect on immune function or that it may help reduce the ill effects of
some types of chemotherapy. Early studies have also looked at the
possible use of bromelain for tissues damaged by burns, as a digestive
enzyme, and for the treatment of diarrhea. However, there are no
available scientific studies that have looked at whether bromelain
shrinks tumors, improves comfort, or extends the life of people with
cancer.
How is it promoted for use?
Proponents claim bromelain reduces swelling and inflammation
associated with soft-tissue injuries. Some people also believe that the
enzyme is an effective treatment for a number of digestive problems
because it stimulates the muscles of the intestines. Some practitioners
claim bromelain relieves the pain and inflammation caused by joint
disorders such as arthritis and carpal tunnel syndrome and that it
inhibits cancer cell growth when combined with chemotherapy. There are
some who claim that bromelain can "digest fat" and
that people who take bromelain pills can lose weight without diet or
exercise. Some supporters also state that bromelain fights bacterial
and viral infections.
What does it involve?
Although bromelain can be obtained naturally by eating fresh
pineapple, some people also use supplements. They are available in
capsules, tablets, and ointments in most health food stores and on the
Internet. Bromelain is also a common ingredient in supplements sold for
joint health. Recommended doses vary by manufacturer.
What is the history behind it?
Bromelain has been used for hundreds of years in folk medicine
as a digestive aid and to treat inflammation and other health problems.
Christopher Columbus found pineapples growing on the island of
Guadeloupe in 1493 and brought them back to Spain. By the 1600s, they
were very popular in Europe. In the sixteenth and seventeenth
centuries, the plants were distributed to the Pacific Islands, India,
and Africa. Pineapple was first established as a commercial crop in
Hawaii in 1885. Recently, bromelain has been investigated for medical
uses, including possible anti-cancer activity.
What is the evidence?
There are some suggestions that bromelain may be beneficial
for a number of conditions. However, further research is needed to
learn more about bromleain's possible benefits for humans. A
clinical study of 16 breast cancer patients in Germany found that a
bromelain drug taken by mouth may stimulate one aspect of immune
function. However, this study did not measure actual benefit, such as
improvement or survival, of the treated women. Other studies suggest
that bromelain increases the quantities of immune system hormones,
called cytokines, that are produced by white blood cells. There are
newer studies suggesting that bromelain and other such enzymes may be
used with standard cancer treatment to help reduce some side effects of
therapy and possibly some symptoms of the cancer itself. No scientific
data is available on bromelain's impact on survival or
quality of life in people who have cancer. More well-controlled
research is needed to understand its role, if any, in cancer treatment.
A number of laboratory and animal studies suggest that
bromelain may help treat diarrhea related to E. coli infections. The
health benefits to humans have not been proven. It also appears to help
keep platelets in the blood from sticking together, which in turn may
help prevent blood clots. Although animal and laboratory studies look
promising for some of these uses, further studies are necessary to
determine whether the results apply to humans.
The German Commission E approved bromelain to be used with
other treatments for swelling or inflammation of the nose and sinuses
caused by surgery. Some studies have suggested that bromelain may speed
recovery time, although not all studies have found it helpful. A 2006
review of 3 studies suggested that bromelain may help relieve the
symptoms of sinusitis. However, sinusitis caused by allergies or
different forms of infection may vary in response to bromelain.
Studies on joint injuries and muscle pain have also shown
mixed results. Bromelain may have an anti-inflammatory effect. Some
clinical trials that compared bromelain to standard treatment found it
less effective, while others reported it as a possible alternative.
More research is needed.
Early studies suggest that bromelain may be helpful when used
directly on burns to remove damaged tissue without surgery. A few
clinical studies have used bromelain to clean dead or dying tissue from
burns that were severe enough to injure or kill layers of skin. The
results suggested that bromelain may speed healing and reduce the need
for surgery to remove dead and injured tissues in some patients. More
research is needed to confirm these findings.
Because bromelain is an enzyme that breaks down proteins, it
is a possible alternative to help digestion in people who
don't make enough digestive enzymes on their own. More
research is needed to directly compare bromelain's
effectiveness to that of the enzymes generally used for this purpose.
Are there any possible problems or
complications?
This product is sold as a
dietary supplement in the United
States. Unlike drugs (which must be tested before being allowed to be
sold), the companies that make supplements are not required to prove to
the Food and Drug Administration that their supplements are safe or
effective, as long as they don't claim the supplements can prevent,
treat, or cure any specific disease.
Some such products may not
contain the amount of the herb or
substance that is written on the label, and some may include other
substances (contaminants). Actual amounts per dose may vary between
brands or even between different batches of the same brand.
Most such supplements have
not been tested to find out if they
interact with medicines, foods, or other herbs and supplements. Even
though some reports of interactions and harmful effects may be
published, full studies of interactions and effects are not often
available. Because of these limitations, any information on ill effects
and interactions below should be considered incomplete.
Bromelain is generally considered safe, although it may speed
up the
heart rate. Some people may be allergic to bromelain and pineapple,
especially those with allergies to kiwi fruit, papaya (including
papain), or natural rubber latex, and serious reactions may occur.
Those allergic to honeybee stings, birch or cypress pollen, grass
pollen, carrots, celery, fennel, wheat flour, or rye flour may also
have a higher risk of reacting to bromelain. People who are allergic to
pineapple should not take bromelain.
Upset stomach with nausea, vomiting, and diarrhea have been noted. A
few women have reported increased menstrual bleeding while taking
bromelain. Some practitioners advise caution when giving bromelain to
people with high blood pressure, liver disease, kidney disease, or
bleeding disorders.
When bromelain is taken with blood-thinning medications or aspirin, it
may raise the risk of bleeding. Some antibiotics may reach higher
levels in the body when taken with bromelain. There may be other
potential interactions between bromelain and medicines or herbs, and
some may be dangerous. Always tell your doctor and pharmacist about any
herbs you are taking. Relying on this treatment alone and avoiding or
delaying conventional medical care for cancer may have serious health
consequences.
Additional Resources
More information from your American Cancer
Society
The following information on complementary and alternative
therapies may also be helpful to you. These materials may be found on
our Web site (www.cancer.org)
or ordered from our toll-free number (1-800-ACS-2345).
References
Akhtar NM, Naseer R, Farooqi AZ, Aziz W, Nazir M. Oral enzyme
combination versus diclofenac in the treatment of osteoarthritis of the
knee--a double-blind prospective randomized study. Clin Rheumatol.
2004;23:410-415. Epub 2004 Jul 24.
Barrett S. Bromeline "diet pills".
Quackwatch Web site.
http://www.quackwatch.org/04ConsumerEducation/QA/bromeline.html. Posted
October 18, 1999. Accessed June 4, 2008.
Blumenthal M, ed. The
Complete German Commission E Monographs:
Therapeutic Guide to Herbal Medicines. Austin, TX:
American Botanical
Council; 1998.
Bromelain. Medline Plus Web site.
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-bromelain.html.
Accessed June 4, 2008.
Bromelain. Memorial Sloan-Kettering Cancer Center Web site.
http://www.mskcc.org/mskcc/html/69152.cfm. Accessed June 4, 2008.
Bromelain. PDRhealth Web site.
http://www.pdrhealth.com/drugs/altmed/altmed-mono.aspx?contentFileName=ame0025.xml&contentName=Bromelain.
Accessed June 4, 2008.
Cassileth B. The
Alternative Medicine Handbook: The Complete
Reference Guide to Alternative and Complementary Therapies.
New York,
NY: W.W. Norton; 1998.
Chandler DS, Mynott TL. Bromelain protects piglets from
diarrhea caused by oral challenge with K88 positive enterotoxigenic
Escherichia coli. Gut.
1998;43:196-202.
Desser L, Holomanova D, Zavadova E, Pavelka K, Mohr T,
Herbacek I. Oral therapy with proteolytic enzymes decreases excessive
TGF-beta levels in human blood. Cancer
Chemother Pharmacol. 2001;47
Suppl:S10-S15.
Desser L, Rehberger A, Kokron E, Paukovits W. Cytokine
synthesis in human peripheral blood mononuclear cells after oral
administration of polyenzyme preparations. Oncology.
1993;50:403-407.
Eckert K, Grabowska E, Stange R, Schneider U, Eschmann K,
Maurer HR. Effects of oral bromelain administration on the impaired
immunocytotoxicity of mononuclear cells from mammary tumor patients.
Oncol Rep. 1999;6:1191-1199.
Gruenwald J. PDR
for Herbal Medicines. 3rd ed. Montvale, NJ:
Thomson PDR; 2004.
Guo R, Canter PH, Ernst E. Herbal medicines for the treatment
of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg.
2006;135:496-506.
Kerkhoffs GM, Struijs PA, de Wit C, Rahlfs VW, Zwipp H, van
Dijk CN. A double blind, randomised, parallel group study on the
efficacy and safety of treating acute lateral ankle sprain with oral
hydrolytic enzymes. Br
J Sports Med. 2004;38:431-435.
Metzig C, Grabowska E, Eckert K, Rehse K, Maurer HR. Bromelain
proteases reduce human platelet aggregation in vitro, adhesion to
bovine endothelial cells and thrombus formation in rat vessels in vivo.
In Vivo.
1999;13:7-12.
Pineapple-ananas comosus. University of Georgia Web site.
www.uga.edu/fruit/pinapple.html. Accessed June 4, 2008
Sinusitis. University of Maryland Medical Center Web site.
http://www.umm.edu/ency/article/000647.htm. Accessed June 4, 2008.
Note:
This
information may not cover all possible claims, uses, actions,
precautions, side effects or interactions. It is not intended as
medical advice, and should not be relied upon as a substitute for
consultation with your doctor, who is familiar with your medical
situation.
Last Medical Review: 11/01/2008
Last Revised: 11/01/2008
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