Pineapple

Pineapple (Ananas comosus): A Comprehensive Reference on Botanical Identity, Constituents, Traditional Use, and Scientific Evidence

1. Identity and Botanical Classification

Botanical name: Ananas comosus (L.) Merrill, commonly known as pineapple, belongs to the Bromeliaceae family, encompassing about 50 genera and 200 species. Pineapple is a perennial herbaceous plant, exhibiting unique physical attributes, with its main parts including the stem, leaves, peduncle, multiple fruit, crown, shoots, and roots.

The name "pineapple" in English (or piña in Spanish) comes from the similarity of the fruit to a pinecone. Ananas comes from anana, the Tupi word for the fruit, meaning "excellent fruit." Comosus means "tufted" and refers to the stem of the fruit.

Geographic origin and cultivation: Originating from the region around the Paraná and Paraguay Rivers (present-day Brazil, Paraguay, and Argentina), the pineapple was an important economic plant in the development of Indigenous civilizations in the Americas. The pineapple is native to South America, where it has been cultivated for many centuries. The introduction of the pineapple plant to Europe in the 17th century made it a significant cultural icon of luxury. Since the 1820s, pineapple has been commercially grown in greenhouses and many tropical plantations.

Plant morphology: Pineapples grow as a small shrub; the individual flowers of the unpollinated plant fuse to form a multiple fruit. The plant normally propagates from the offset produced at the top of the fruit or from a side shoot, and typically matures within a year.

Market standing: Ranked third behind banana and citrus, the demand for pineapple has greatly increased within the international market.

2. Common Forms and Preparations

Pineapple is consumed and applied therapeutically in a range of forms, spanning fresh and processed food products through to concentrated pharmaceutical preparations:

• Fresh fruit: consumed raw, grilled, or as juice.
• Canned and pasteurized products: many commercial pineapple juice products are pasteurized (heat-treated). This may significantly decrease bromelain and vitamin C content. Heat can inactivate bromelain, and studies show that juice pasteurization can lead to vitamin C losses of 2–47%, depending on time and temperature.
• Oral bromelain supplements: available as capsules, tablets, and powders, standardized by enzymatic activity units rather than weight alone.
• Topical pharmaceutical preparations: bromelain is used topically (applied to the skin) as a prescription drug in the treatment of serious burns. The FDA-approved prescription product, cleared in 2022, uses bromelain in a topical form to remove dead tissue from severe burns in adults; the European Union has approved the same product. This takes advantage of bromelain's protein-digesting power to clean wound surfaces without surgical scraping.

3. Traditional and Historical Use

3.1 Indigenous Peoples of the Americas

Prior to the discovery of the pineapple fruit by Cristobal Colón (Christopher Columbus) on 4 November 1493, the fruit was already a stable component of the vegetative-crop complex and in the diet of native Americans in the lowland tropics. The Tupi-Guarani and Carib peoples called the fruit, a staple crop, nanas ("excellent fruit"), and several varieties were grown. As well as food, the pineapple was a source of medicine, fermented to become alcohol, its fibers made into robes, bow strings, and thread for cloth.

Native Americans used pineapple for the preparation of alcoholic beverages (pineapple wine, chicha, and guarapo), for the production of fibre, and for medicinal purposes, as an emmenagogue, abortifacient, antiamoebic, and vermifuge, and for the correction of stomachal disorders, and for the poisoning of arrowheads. Most of these medicinal uses are related to the proteolytic enzyme bromelain of the pineapple.

The medicinal benefits of the pineapple had already been known to various native peoples across a wide geographical area for some time. One of these groups, the Kalinago people, inhabited Guadeloupe at the time of Columbus' arrival. Different indigenous peoples had used the pineapple to assist with fevers and stomach complaints.

In traditional medicine, the cortexes of A. comosus are used as an alexipharmic, antitussive, and antidiarrheal agent, while the leaves are commonly used as a remedy for indigestion.

3.2 Other Cultures and Traditions

Pineapple has been used as part of traditional folk medicine since ancient times and it continues to be present in various herbal preparations. The list of painful and inflammatory conditions that pineapple extracts have been used to treat is extensive and includes strains, sprains, phlebitis, angina, menstrual cramps, connective tissue disease, digestive pain and cramping, infectious diarrhea, neuralgia, hemorrhoids, and many other common inflammatory, vascular, infectious, and autoimmune disorders.

Unripe pineapple and papayas have been traditionally used topically on skin wounds and for cosmetic facials to soften the skin and loosen old, devitalized cells. Bromelain may also have mucolytic effects and has been included in many traditional formulas for cough, bronchitis, allergic rhinitis, and lung congestion.

Bromelain was first identified in 1876, but it was not fully isolated, purified, and characterized until much later. Bromelain was first isolated in the late 19th century and gained medical interest in the 20th century, especially in Germany, where it became widely used for inflammatory and post-surgical conditions.

4. Key Constituents and Active Compounds

4.1 Macronutrients and Vitamins

On a nutritional level, pineapple contains mainly carbohydrates and water, followed by dietary fiber, sugars, organic acids, vitamins (ascorbic acid, niacin, and thiamine), and minerals (mainly magnesium, manganese, and copper).

Pineapple is rich in vitamin C, providing the equivalent of 57.63% of the vitamin C NRV, or 46.10 mg per 100 g. Vitamin B9 is the 2nd most notable vitamin in pineapple, with a content of 19.60 µg per 100 g (or 9.80% of the NRV in vitamin B9).

Pineapple is rich in manganese, providing the equivalent of 42% of the NRV for manganese, or 0.84 mg per 100 g. The mineral most present in pineapple is potassium, with a content equivalent to 7% of the NRVs in potassium, or 140 mg per 100 g.

4.2 Polyphenols and Antioxidant Compounds

The ascorbic acid content of pineapple ranged from 5.08 to 33.57 mg/100 g fresh weight across cultivars, while the total phenolic content varied from 31.48 to 77.55 mg gallic acid equivalents (GAE)/100 g fresh weight. The antioxidant capacity of pineapple was correlated with the contents of phenolics, flavonoids, and ascorbic acid.

Pineapples are rich in flavonoids and phenolic acids, two antioxidants that protect cells from free radicals that can cause chronic disease. Pineapple contains myricetin, a compound of the flavonol family that has strong antioxidant activity.

Phytochemical analysis revealed that A. comosus contains numerous biologically active compounds, including n-hexadecanoic acid, bromelain, n-heptadecanol-1, methyl ester, hexadecanoic acid, squalene, α-tocopherol, tetradecane, 5-hydroxymethylfurfural, dihydroxyacetone, dodecane, DL-α-tocopherol, furan methanol, dodecanoic acid, and 2,4,6-cycloheptatrien-1-one, among others.

The phytochemical screening of leaf extract from Ananas comosus revealed the presence of carbohydrates, alkaloids, saponins, flavonoids, tannins, phenolic compounds, as well as proteins and amino acids. Extraction using seven different solvents yielded saponins, tannins, steroids, flavonoids, terpenoids, naphthoquinone, inulin, alkaloids, phenols, and amino acids as phytochemical compounds.

4.3 Bromelain: Composition and Enzymatic Identity

Bromelain is a complex combination of multiple endopeptidases of thiol and other compounds derived from the pineapple fruit, stem, and/or root. Fruit bromelain and stem bromelain are produced completely distinctly and comprise unique compounds of enzymes, and the descriptor "Bromelain" originally referred in actuality to stem bromelain.

The Enzyme Commission (EC) number 3.4.22.33 was given to bromelain isolated from the pineapple fruit and is referred to as fruit bromelain (FBM), whereas bromelain isolated from the pineapple stem is referred to as stem bromelain (SBM) and was assigned EC number 3.4.22.32. Physiologically, bromelain is present abundantly in both the stem and fruit of pineapple plants, with Heinecke first finding in 1957 that there was considerably more bromelain in the pineapple stem than in the actual fruit.

Bromelain is a mixture of different thiol endopeptidases and other components like phosphatase, glucosidase, peroxidase, cellulase, escharase, and several protease inhibitors. Although the pineapple plant contains a small amount of other proteolytic enzymes, such as ananain and comosain, bromelain remains the primary and most extensively explored among these proteolytic enzymes.

Pineapple also contains various amino acids, including tyrosine and tryptophan, along with bromelain, an enzyme aiding digestion by breaking down proteins.

5. Mechanisms of Action

5.1 Proteolytic and Digestive Action

Bromelain primarily acts as a proteolytic enzyme; this property allows bromelain to aid in protein digestion, facilitating the breakdown and absorption of dietary proteins in the gastrointestinal tract. Significant amounts of orally ingested bromelain have been found to be absorbed into the bloodstream unchanged, thereby increasing the proteolytic and fibrinolytic blood activity for hours.

5.2 Anti-inflammatory Mechanisms

Bromelain exerts its therapeutic effects through a multifaceted mechanism of action, which contributes to anti-inflammatory, analgesic, antiangiogenic, and antioxidant properties, making it a promising candidate for the treatment of various inflammatory and oxidative stress-related disorders; its diverse biological effects depend on multiple mechanisms of action, including proteolytic activity, anti-inflammatory and immunomodulatory effects, fibrinolytic activity, antioxidant properties, and modulation of cell signaling pathways.

This enzyme complex can downregulate PGE-2 (prostaglandin E2) through inhibition of NF-κB (nuclear factor kappa B) and COX-2 (cyclooxygenase-2), and upregulating PGE-1 (prostaglandin E1). Bromelain has been reported to inhibit the expression of COX enzymes, particularly COX-2, which are responsible for the synthesis of prostaglandins from arachidonic acid, thereby reducing the production of PGE2. By inhibiting PGE2 synthesis, bromelain helps mitigate inflammation and alleviate pain.

In murine and human cell lines, bromelain was shown to downregulate the expression levels and functioning of both NF-κB and cyclooxygenase-2 (COX-2), important inflammatory mediators able to convert arachidonic acid into several by-products (e.g., the proinflammatory lipid prostaglandin E2). Moreover, other inflammatory mediators such as interferon gamma (IFNγ) and IFNγ-mediated nitric oxide, tumor necrosis factor alpha (TNF-α), interleukin-1 beta, and interleukin 8 (IL-8) can be modulated by bromelain, demonstrating its ability to decrease the majority of inflammatory mediators.

5.3 Fibrinolytic and Antithrombotic Mechanisms

In both in vitro and in vivo studies, bromelain has been shown to be an effective fibrinolytic agent because it promotes the conversion of plasminogen to plasmin, resulting in increased fibrinolysis due to fibrin degradation. Plasma prekallikrein is a proenzyme that has to be converted into kallikrein, the active form of the enzyme, which plays a role in coagulation, and bradykinin is a compound released into the blood that causes smooth muscle contraction and blood vessel dilation, further increasing coagulation. It has been documented that bromelain reduces prekallikrein synthesis and thus reduces bradykinin growth at the site of infection, relieves pain and inflammation, and improves blood circulation at the damaged tissue in rat studies.

By promoting fibrinolysis, bromelain may help prevent excessive blood clot formation and improve circulation.

5.4 Degradation of Advanced Glycation End Products (AGEs)

Advanced glycation end products (AGEs) are formed through nonenzymatic glycation and oxidation of proteins, lipids, and nucleic acids. Accumulation of AGEs is associated with various pathological conditions, including diabetes, cardiovascular disease, and neurodegenerative disorders. Bromelain has been shown to degrade AGE receptors, such as the receptor for AGEs (RAGE), thereby reducing AGE-induced inflammation and tissue damage.

6. Scientific Evidence by Area of Use

6.1 Sinusitis and Nasal Inflammation

A systematic review of herbal medicines for rhinosinusitis found that across multiple randomized trials, bromelain as an add-on treatment significantly improved some symptoms of acute rhinosinusitis, with a meta-analysis of two trials supporting that benefit. The evidence for chronic sinusitis is weaker, but the acute picture is genuinely encouraging.

A study of 116 children with acute sinusitis found that recovery was significantly faster in children given bromelain compared to those without.

The German Commission E approved bromelain for the treatment of swelling and inflammation of the nose and sinuses caused by injuries and surgery in 1993. The German Commission E has approved bromelain as a treatment for sinus and nasal swelling following ear, nose, or throat surgery.

Evidence assessment: A lot of bromelain's reputation rests on lab studies, animal work, and small trials. The anti-inflammatory mechanism is real and the sinus evidence is solid for an herbal supplement, but most other uses sit at "preliminary."

6.2 Osteoarthritis and Joint Pain

Bromelain, an extract from the pineapple plant, has been demonstrated to show anti-inflammatory and analgesic properties and may provide a safer alternative or adjunctive treatment for osteoarthritis. All previous trials, which have been uncontrolled or comparative studies, indicate its potential use for the treatment of osteoarthritis.

Bromelain administration resulted in significant decrease in pain and stiffness in patients with knee osteoarthritis.

Other human trials on bromelain alone have shown it to be as effective as the nonsteroidal anti-inflammatory (NSAID) diclofenac in patients with osteoarthritis of the hip. Clinical trials that combine bromelain with turmeric show the combination to be an effective and safe anti-inflammatory alternative to NSAIDs in patients suffering from degenerative joint diseases.

Oral bromelain has been evaluated in more than 100 clinical trials for conditions such as sinusitis, osteoarthritis, and rheumatoid arthritis, and is usually described as well tolerated and without significant side effects or adverse events.

Evidence assessment: The data available at present indicate the need for trials to establish the efficacy and optimum dosage for bromelain and the need for adequate prospective adverse event monitoring in such chronic conditions as osteoarthritis. Reviews describe consistent anti-inflammatory effects and some clinical signals for osteoarthritis, but the human trials are smaller and more mixed than the sinus data.

6.3 Post-Surgical and Post-Dental Swelling

A recent meta-analysis involving six RCTs has shown that bromelain effectively reduces postoperative pain seven days after mandibular third molar surgery (p = 0.002) and diminishes facial swelling in both the early and late postoperative stages (p = 0.02 and p = 0.0004, respectively).

The placebo group showed a statistically higher need for ibuprofen (from days 1 to 7) at the study's conclusion (p < 0.0001). Reductions in pain and swelling were significantly higher in both the bromelain and pineapple groups (p < 0.0001 for almost all patients, at all intervals) than in the placebo group.

In a randomized, controlled, double-blind clinical trial of 26 patients undergoing free gingival grafting: bromelain caused a significant reduction in pain at the donor site (2.605 ± 0.509) compared to placebo (4.885 ± 0.519; P < 0.05). The number of donor sites with complete epithelialization was higher in the bromelain group compared to the placebo, but the difference was not statistically significant (P > 0.05). The two groups were the same regarding postoperative bleeding (P > 0.05). Oral bromelain (500 mg/day) was effective in the reduction of pain at the donor site after free gingival grafting and may also enhance wound healing.

Evidence assessment: Evidence for post-surgical and post-dental swelling reduction is among the strongest for bromelain, supported by multiple RCTs and a meta-analysis. However, trial sizes remain relatively small.

6.4 Wound Healing and Burn Debridement

In two separate experiments, two bromelain-based agents, Debriding Gel Dressing and Debrase Gel Dressing, were able to rapidly eliminate the dead tissue layer of the dermis while simultaneously protecting the unburned tissue in a porcine model. As bromelain facilitates the debridement mechanism and provides improved, faster healing and efficient reepithelialization, bromelain has been suggested as a valid approach for treating postoperative wounds and relieving discomfort, swelling, and other side effects.

Some of the anti-inflammatory effects of bromelain are attributed to proteolytic, fibrinolytic, gelatinase, and collagenase activities, all of which contribute to bromelain's wound healing abilities. Bromelain accelerates the recoveries of blood perfusion and oxygen partial pressure in wound tissue; controls the expression of tumor necrosis factor-α; and raises the expression of transforming growth factor-β, all mechanisms that also improve allergic and systemic inflammation and help reduce pain.

The European Medicines Agency granted orphan drug designation in 2002 for a bromelain-based debridement concentrate from pineapple stems, approved in 2012 for treating partial thickness burns.

6.5 Digestive Health

Pineapple contains a group of digestive enzymes called bromelain that breaks down protein molecules, meaning the small intestine can more easily absorb them. Bromelain enhances the effects of the digestive enzymes trypsin and pepsin, which speeds up the breakdown of proteins in food and helps to avoid indigestion and stomach pains.

Evidence has suggested that bromelain counteracts some of the effects of certain intestinal pathogens like Vibrio cholerae and Escherichia coli, whose enterotoxin causes diarrhoea in animals. Bromelain appears to exhibit this effect by interacting with intestinal secretory signaling pathways, including adenosine 3′:5′-cyclic monophosphatase, guanosine 3′:5′-cyclic monophosphatase, and calcium-dependent signaling cascades.

Evidence assessment: The enzyme activity of bromelain on dietary proteins is biochemically well-established, but large-scale human trials specifically on digestive endpoints remain limited. Evidence for anti-diarrheal effects is primarily animal-based.

6.6 Anti-cancer Activity

Stem bromelain (EC 3.4.22.32) is a major cysteine proteinase, isolated from pineapple (Ananas comosus) stem. Its main medicinal use is recognized as digestive, in vaccine formulation, antitumoral, and as a skin debrider for the treatment of burns.

Bromelain's anticancer activity is specifically related to its effect on cancer cells and their microenvironment, and to the manipulation of the immune, inflammatory, and hemostatic systems. NF-κB, COX-2, and PGE2 are boosters of cancer development. COX-2, a multiple target gene of NF-κB, helps in the conversion of arachidonic acid into PGE2 and leads to tumor angiogenesis and progression. Proper inhibition of NF-κB, COX-2, and PGE2 can be a possible treatment for carcinoma.

Various findings from traditional and clinical reports indicate that bromelain may be an effective anticancer therapeutic agent.

Evidence assessment: Anticancer evidence at present is predominantly preclinical — from in vitro cell line studies and animal tumor models. There are no large-scale human clinical trials confirming anticancer efficacy of oral bromelain supplementation in humans. This area remains investigational.

6.7 Cardiovascular and Antithrombotic Effects

A possible mechanism has been suggested to explain how the body can maintain thrombin at a level too low to cause platelet aggregation but adequate to stimulate release of prostaglandins and enzymes for more than 24 hours from a single dose of the pineapple enzymes. Since bromelain therapy leads to formation of platelets with increased resistance to aggregation, the dominant endogenous prostaglandins being produced must be from the group that increases platelet cyclic AMP levels (prostacyclin, PGE1, etc.). The combination of fibrinolytic and antithrombic properties appear to be effective, and two large-scale tests on heart patients showed a practically complete elimination of thrombosis.

At a higher concentration of bromelain, both prothrombin time (PT) and activated partial thromboplastin time (APTT) are markedly prolonged.

Evidence assessment: Cardiovascular and antithrombotic effects have biological plausibility and some early clinical data, but the underlying studies are older, limited in scale, and insufficiently controlled by modern standards. Definitive clinical evidence is lacking.

6.8 Immune Modulation

Various in vivo and in vitro studies have shown that bromelain-derived compounds are anti-edematous, anti-inflammatory, anti-cancerous, anti-thrombotic, fibrinolytic, and facilitate the death of apoptotic cells. It has been shown that bromelain downregulates COX-2 and PGE-2 expression levels in murine microglial cells and human monocytic leukemia cell lines. Bromelain activates the inflammatory mediators, including interleukin (IL)-1β, IL-6, interferon (INF)-γ, and tumor necrosis factor (TNF)-α in mouse macrophage and human peripheral blood mononuclear cells (PBMC).

6.9 Exercise-Induced Muscle Soreness

Bromelain is promoted as a dietary supplement for a variety of purposes including postoperative pain after wisdom tooth extraction, sinusitis, osteoarthritis, and exercise-induced muscle soreness.

Evidence assessment: A small number of studies have been done on the use of bromelain taken orally for reducing symptoms of sinusitis and reducing pain and swelling after wisdom tooth extraction. Evidence for exercise-induced muscle soreness is preliminary and based on small studies; no robust systematic reviews confirm this indication.

7. Body Systems and Health Areas Associated with Pineapple / Bromelain

Bromelain is widely administered for its well-recognized properties, such as its anti-inflammatory, antithrombotic and fibrinolytic effects, anticancer activity, and immunomodulatory effects, in addition to being a wound healing and circulatory improvement agent.

• Gastrointestinal system: protein digestion, anti-diarrheal activity, gut inflammation modulation.
• Musculoskeletal system: osteoarthritis pain and stiffness reduction, management of post-traumatic edema and sprains.
• Respiratory system: sinusitis and nasal inflammation, mucolytic effects, allergic rhinitis support.
• Integumentary system: wound healing, burn debridement, skin softening.
• Cardiovascular system: fibrinolytic and antithrombotic effects, platelet aggregation inhibition.
• Immune system: cytokine modulation, macrophage activation, immunomodulatory effects.
• Oncological research (preclinical): NF-κB, COX-2, and PGE-2 pathway modulation relevant to cancer-associated inflammation.

8. Dosage Forms and Dosages Reported in Studies

8.1 Measurement Units

Bromelain potency is typically measured in Gelatin Dissolving Units (GDU) or Milk Clotting Units (MCU), rather than simply by weight in milligrams, which can sometimes cause confusion when selecting supplements. In Europe, the Fédération Internationale Pharmaceutique (FIP) is a quantification method used.

Because different pineapples grown in different conditions may have different enzyme strengths and profiles, bromelain is often quantified by its strength, rather than purely by milligram weights. A typical therapeutic dose listed in studies uses bromelain standardized to 2,400 GDU per gram.

8.2 Specific Dosages from Published Studies and Official Recommendations

• German Commission E recommendation (general anti-inflammatory use): 80–320 mg (200–800 FIP units) taken two to three times per day.
• Anti-inflammatory / systemic use: bromelain has been delivered at dosages varying from 540 to 1,890 mg/day in clinical trials for osteoarthritis.
• Osteoarthritis (specific trial): some study participants showed improvement when given 400 milligrams of bromelain twice daily, suggesting a meaningful anti-inflammatory effect on joint tissue.
• Post-surgical and wound healing: oral bromelain at 500 mg/day demonstrated effectiveness in pain reduction at the donor site after free gingival grafting.
• Digestive use: when the intended use of bromelain is as a digestive enzyme, 500–1,000 mg is taken with each meal.
• Chronic pain and inflammation: bromelain is taken between meals or 30 minutes before meals and before bed to ensure that the proteolytic enzymes are absorbed into the bloodstream for the best systemic effect, rather than being used in the stomach and intestines for digestive effects. For chronic pain and inflammation, 500–1,000 mg is taken two to three times per day between meals and before bed.
• Pharmacokinetics: oral administration of proteolytically active pineapple extract is absorbed into the intestines and remains biologically active with a half-life of approximately 6–9 hours, and plasma concentration reaching as much as 5,000 pg/mL by 48 hours after oral multidosing of 3 g/day.

9. Safety Considerations and Interactions

9.1 General Safety Profile

Bromelain is a concentrated mixture of proteins and enzymes made from the stems and fruit of the pineapple plant that has anti-inflammatory and digestive properties. Bromelain is generally recognized as safe (GRAS) and has not been linked to serum aminotransferase elevations nor to instances of clinically apparent liver injury.

Although the complete molecular mechanism of action of bromelain has not been completely identified, bromelain gained universal acceptability as a phytotherapeutic agent due to its history of safe use and lack of side effects.

Numerous clinical trials have demonstrated the efficacy and safety of bromelain across various medical conditions, including osteoarthritis, sinusitis, surgical wounds, cardiovascular health, and digestive health. However, larger-scale studies and further research are needed to confirm these findings and establish optimal dosing regimens and treatment protocols for different indications. Long-term safety data and potential drug interactions should be carefully evaluated in future studies. Currently, bromelain is considered to be nontoxic and without side effects.

9.2 Reported Adverse Effects

No severe adverse effects have been identified in a study of clinical trials examining the impact of bromelain on osteoarthritis, although there have been several cases of stomach symptoms, headache, exhaustion, dry mouth, skin rash, and unspecified allergic reactions. Compared with normal care, higher dosages of bromelain appeared to have higher incidences of harmful drug reactions.

Sporadic reports of allergic reactions and symptoms of asthma, related to occupational exposure to bromelain, have been identified. After pineapple peroral challenge, certain patients developed gastrointestinal distress. Respiratory and gastrointestinal effects were discovered to result from bromelain-mediated immunoglobulin E reactions.

Bromelain may cause allergic reactions, especially in people who have other allergies. People with an allergy to papaya or an enzyme found in papaya, called papain, may be more likely to have an allergic reaction to bromelain or pineapple.

9.3 Drug Interactions

Anticoagulants and antiplatelet drugs: Individuals taking antiplatelet or anticoagulant medications, including aspirin, heparin, warfarin (Coumadin), and clopidogrel (Plavix), as well as NSAIDs such as ibuprofen and naproxen, should use bromelain only under the supervision of a practitioner. Bromelain should be used with caution by people taking supplements and herbs that augment bleeding risk, for instance, garlic and Ginkgo biloba.

Antibiotics: Bromelain can reduce or increase the absorption of antibiotics, such as amoxicillin and tetracycline, reducing their efficacy or increasing antibiotic side effects.

Chemotherapy drugs: Experiments have proposed that bromelain may possibly increase the absorption of medications including antibiotics (such as tetracycline and amoxicillin) and chemotherapy drugs (such as 5-fluorouracil and vincristine).

Liver safety: Studies were mostly for short-term use only (3 to 6 days) and included a limited number of subjects. Nevertheless, despite widespread use, there have been no reports of liver injury, jaundice, or hepatotoxicity associated with oral or topical use of bromelain.

9.4 Special Populations

Those who have a pineapple allergy or allergy to grass pollen, latex, celery, fennel, carrots, and wheat should avoid taking bromelain. Pregnant women should also avoid bromelain because of its effect on the uterus (womb) muscles.

Oral bromelain does not increase the risk of postoperative bleeding, based on one controlled clinical trial. However, this finding should be weighed against the theoretical antithrombotic and fibrinolytic properties discussed above, particularly in the context of concurrent anticoagulant drug use.

9.5 Effect of Processing on Active Compounds

Heat treatment may significantly decrease bromelain and vitamin C content. Heat can inactivate bromelain, and studies show that juice pasteurization can lead to vitamin C losses of 2–47%, depending on time and temperature.

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