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Bromelain as a Supplement for IBD

Updated June 23, 2009

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What Bromelain Is:

Bromelain is a proteolytic enzyme that is extracted from the stem and juice of pineapple. It was first discovered in the late 1800s, but was not used as a dietary supplement until the 1950s. Bromelain is an anti-inflammatory and has been used as a digestive aid and a blood thinner, as well as to treat sports injuries, sinusitis, arthritis, and swelling. Bromelain is also being studied for use as a supplement for inflammatory bowel disease (IBD), especially ulcerative colitis.

How Bromelain Is Used:

Bromelain digests proteins, which is why it is also used as a meat tenderizer. As a supplement, it is available as capsules or tablets. As a digestive aid, the recommended dosage is generally 500 mg three times per day. It can be taken with food, but is more effective in reducing inflammation when taken on an empty stomach. Bromelain is approved in Germany for use after surgery, where dosages range from 80 to 320 mg per day. The optimal dosage for other uses, such as arthritis, is not known. Bromelain is normally taken for 8 to 10 days.

Bromelain is an anti-inflammatory, but there is not much research to support its use in either Crohn's disease or ulcerative colitis. There is a case report of two patients with ulcerative colitis who responded well to treatment with bromelain. Bromelain has not been studied on humans with IBD, but there is one study that was done on the biopsy tissue taken from the intestine of people with Crohn's disease and ulcerative colitis. The tissue did appear to respond positively to the bromelain, and showed fewer IBD markers than the tissue that was not treated with bromelain.

Eating large amounts of the fruit of the pineapple will not give the same effect as taking a bromelain supplement. Bromelain is primarily found in the stem of the pineapple, which is not normally eaten.

Interactions With Other Drugs and Supplements:

Bromelain may increase the effectiveness of some antibiotics, including amoxicillin. It may have a similar effect on tetracycline, but the current research on this is conflicting.

Bromelain also has an effect on the blood, and may affect the ability of the blood to clot. Therefore, it should not be taken along with any drugs or supplements that also thin the blood or that increase the risk of bleeding, including:

Coumadin (warfarin)
Garlic
Ginkgo biloba
Heparin
Non-steroidal anti-inflammatories (NSAIDs), including aspirin, ibuprofen, and naproxen
Plavix (clopidogrel)
Saw palmetto

Bromelain also may increase the effects that sedatives have on the body. This includes both drugs and supplements that are used as sedatives and those that have a sedating effect. Some examples are:

Alcohol
Anticonvulsants, including Dilantin (phenytoin) or Depakote (valproic acid)
Barbiturates, including phenobarbital
Benzodiazepines, including Ativan (lorazepam), Xanax (alprazolam) and Valium (diazepam)
Catnip
Kava Kava
Narcotics, including codeine
Sleep-inducers, including Ambien (zolpidem), Lunesta (eszopiclone), Rozerem (ramelteon), and Sonata (zaleplon)
Tricyclic antidepressants, including Elavil (amitriptyline)
Valerian

Side Effects:

As with any drug or supplement, there is always a chance of an allergic reaction. Bromelain should be avoided by anyone who has a known allergy to pineapple or other plants in the Bromeliaceae family.

Bromelain may cause adverse effects, including:

Diarrhea
Nausea
Increased menstrual bleeding or abnormal uterine bleeding
Increased heart rate
Stomach upset
Vomiting

Use During Pregnancy:

Bromelain has not been studied extensively in women who are pregnant or breastfeeding. Because bromelain may cause uterine bleeding, is not recommended for use by women who are pregnant or breastfeeding. Tell your doctor if you are pregnant or breastfeeding and have taken or are thinking about taking bromelain.

Overall

Even though bromelain is approved for some uses in Germany, it is not currently approved in the U.S. to treat any condition. The evidence for its use in IBD is mounting, but is currently not robust enough to recommend its widespread use. Tell your doctor if you are considering the use of bromelain, or if you are currently taking bromelain.

_Sources:

_{Kane S, Goldberg MJ. "Use of bromelain for mild ulcerative colitis." Ann Intern Med 18 Apr 2000;132:680. 18 Jun 2009.}

_{Onken JE, Greer PK, Calingaert B, Hale LP. "Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro." Clin Immunol Mar 2008;126:345-352. 18 Jun 2009.}

_{Tinozzi S, Venegoni A. "Effect of bromelain on serum and tissue levels of amoxicillin." Drugs Exptl Clin Res 1978;4:39-44.}

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