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So, I saw a random unsourced picture on the internet, which has to true because it used some fancy science words and stuff. The claim summarized that pineapples were extremely important in natural health because they contain bromelain, an enzyme which reduces inflammation, acts as a natural antibiotic, and suppresses cough. It has apparently been used to ease digestion issues by Brazilians for centuries. Guess I better go to the store and buy some pineapples then!  Or, then again, maybe I should stop and think about this.

I did some digging as to the origin of the meme, and I came across an “article” on PreventDisease.com, a typical propaganda site (don’t forget to check out their store!) for natural health proponents. In it, the author mentions (though does not provide a link for) a 2010 study in Der Pharma Chemica (ever heard of it?), which looked at herbal remedies for mycobacterium tuberculosis.[1] I found it though.  Pineapple juice is mentioned on page 4, in a table among dozens of other herbal remedies as being useful in decreasing mucus associated with tuberculosis when combined with honey, pepper, and a dash of salt.[2] Not very convincing, and certainly not evidence of it being “5 times more effective than cough syrup,” as the ad *ahem* article claims. You may notice, this author also writes that with pineapple juice you get all the cold-fighting benefits of cough syrup without the “toxic chemicals”. Sounds like another case of, if I can’t pronounce it, it causes cancer.

bare-necessitiesBesides the fact that it is so inherently wrong to assume a meme on the internet containing health advice is true and accurate, let’s think about what this truly means for the average consumer, and specifically to CF patients. Pineapples are a dietary source of bromelain; that is true. It can be found in all parts of the pineapple, but is most prevalent in the stem. I personally don’t know anybody who eats the stems from pineapples. Regardless, even if you stuffed the whole pineapple down your throat like Baloo the bear from the Jungle Book, the concentration of bromelain is not high enough to be used as a medicine[3].  It takes a level of over 3000 mg/day of bromelain to register in a blood test[4] (spoiler: that’s a lot more than found in a pineapple). A better way would be to buy a Bromelain supplement tablet from a trusted health store.

Keep in mind, many companies lately have been busted for containing little to none of the active ingredient which they present on the label. Also, most supplement companies do not take a lot into account in terms of pharmacokinetics-that is the dose, delivery, absorbtion and elimination of a drug and specifically studying a product’s half-life, whether it’s transformed by the liver, and how changing the dose changes these effects. It’s the kind of thing that makes the difference between herbalism and pharmacognosy. Most supplement bottles will have a dosing structure on the label, but it’s important to know that those directions can range from well-studies to completely arbitrary. It is buyer beware. Currently, it’s not even clear whether bromelain can survive through the intestinal track and remain functionally intact, although an enteric coating on oral capsules may help.[5]

Secondly, let’s look at what bromelain is and what it’s used for. Bromelain is an enzyme which is able to break down the amino acids found in collagen, gelatin and other protein peptides. Collagen is the stuff that holds muscle tissue together, so essentially it can turn meat into mush. In fact, it is used for just this in the culinary world. Sprinkle a little bromelain onto a steak before cooking and voila, you’ve got a nice tender T-bone.[6] Just don’t leave it on too long because it will literally dissolve meat into baby food (It becomes ineffective once cooked).  It is also used externally in hospital settings for severe burns to peel off the dead scorched skin from the victim’s body. Bromelain, however, should not ever be rubbed into healthy tissue.

There have been mixed and contradictory studies showing that it may be effective as an anti-inflammatory when combined with other enzymes, with arthritis pain effects similar to NSAIDs like Aspirin and Tylenol.  Also that it can aid in healing after certain types of surgery because of its anti-inflammatory properties. It should be noted though that, like some other NSAIDs, it is a blood thinner, so shouldn’t be used immediately before or after surgery, especially for people who are on blood thinners, or have trouble clotting after a wound. Some studies, particularly relevant to those of us with chronic sinusitis, have shown it to be helpful with pain and swelling in the nasal passages. Although, it should be mentioned that some of these positive studies were small, or were not of the best quality.[7]

To call bromelain a natural antibiotic may be a little premature. There have been a few test tube and animal studies showing that it may be able to kill certain types of bacteria as well as viruses. However, there have been no human clinical trials that I have found to support the statement that it can be used to treat infections. As I have said before, results in a petri dish are a far cry from results in the human body. However, if it is not an antibiotic itself, it has been confirmed that it messes with them.

One of the most important bits of info one should know regarding bromelain is that it has been shown to increase the effects of antibiotics. It particularly raised the blood levels of amoxicillin and tetracycline when used in conjunction with bromelain.[8]  If you are taking antibiotics, especially in the same family as those listed above, it’s so important to tell your doctor about any bromelain you may be ingesting so as not to reach potentially dangerous levels of antibiotics in the bloodstream.

As far as the claim of suppressing a cough, I think this may be a leap from the conclusions of some positive (but not definitive) studies. Furthermore, suppressing a cough in cystic fibrosis should be done as infrequently as possible. Sure, it can be annoying and sometimes prevent you from sleeping. But coughing keeps all the junk moving so it doesn’t block up our airways inviting infection, and more importantly gets it out. According to WellPilot.com, the relationship between bromelain and cystic fibrosis is not supported by any relevant published research.[9]

When I am researching a supplement, one of my most trusted sources is Examine.com, where they compile all available research on hundreds of different compounds and commercially available supplements. Their page on bromelain included the Human Effect Matrix, which is a feature that looks at only human studies, grades them from A (best) to D (least reliable) and compiles a summary of the effectiveness of the test drug. On all the complaint categories in question, bromelain scored minor (1 out of 3 stars) effects, in only C and D quality studies, with 100% scientific consensus. This being said, it’s not an incredibly impressive treatment, but it’s not worthless either.  For the record, if I may pull a direct quote from the page: “There are many anecdotes that say bromelain supplementation will cause semen to taste like pineapple, but no studies have tested this claim.”[10] Just thought that was worth sharing. 🙂

All in all, bromelain is generally well-tolerated (some have reported nausea, vomiting, and diarrhea in conjunction with taking bromelain), and it does have some evidence to support a potential anti-inflammatory benefit, it appears that there’s no significant reason to add it to your daily regimen.  Like most natural remedies, the picture on the internet over simplifies some very complex medical issues and then offers an equally simple solution. The old adage, if it seems too good to be true, it probably is, applies here.

Of course if you like pineapples, there’s no reason to stop eating them (or carrots, fennel, wheat, and the myriad of other food items that also contain some bromelain) it is afterall, a very healthy food. Just please don’t be fooled by pretty pictures with unsourced health facts. If your first reaction is “it couldn’t hurt!” there’s a dangerous mindset here that not only shows a level of gullibility to the naturalistic fallacy, but could cause greater harm in self-experimentation (like trying to nebulize pineapple juice- please don’t do that).

[1] http://preventdisease.com/news/14/040314_Pineapple-Juice-5-Times-More-Effective-Than-Cough-Syrup.shtml

[2] http://derpharmachemica.com/vol2-iss6/DPC-2010-2-6-311-319.pdf

[3] http://umm.edu/health/medical/altmed/supplement/bromelain

[4] http://www.sciencebasedmedicine.org/systemic-enzyme-therapy/

[5] http://www.drugs.com/npp/pineapple.html

[6] http://science.howstuffworks.com/innovation/edible-innovations/pineapple-enzyme-tenderize-steak1.htm

[7]http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/bromelain

[8] http://www.rxlist.com/bromelain-page3/supplements.htm

[9] http://wellpilot.com/conditionTreatment/12636

[10] http://examine.com/supplements/Bromelain/