Bromelain for Arthritis: Will It Help?

PUBLISHED 07/26/19 BY KIMBERLY HISS

This pineapple-derived compound has anti-inflammatory and pain-relieving properties, but it’s not a magic remedy for arthritis.

If you’ve ever Googled “natural arthritis remedies” you’ve likely run into something called bromelain, which is a group of enzymes found in the fruit and stem of the pineapple plant. In addition to treating ailments like digestive issues, sinusitis, bronchitis, and muscle soreness, bromelain is used as a home remedy for arthritis.

“I’ve had scores of osteoarthritis patients who rely on their bromelain,” says Amy Rothenberg, ND, a licensed naturopathic doctor in Northampton, Massachusetts, who has been prescribing bromelain for all the 34 years she’s been in practice. “People are less aware of bromelain than better-known supplements like turmeric. But most are happy to learn it’s derived from a simple pineapple, and they’re surprised by how well it can work.”

Exactly how bromelain may help to relieve osteoarthritis joint pain has been the subject of multiple research studies, with findings identifying both anti-inflammatory and analgesic (pain-relieving) properties.

“Pineapple has been used as part of traditional folk medicine since ancient times and it continues to be present in various herbal preparations,” says a 2016 review paper in the journal Biomedical Reports.

Does Bromelain Works to Help Arthritis? What the Research Says

While the exact mechanisms of how bromelain works aren’t well-known, it’s believed that bromelain has anti-inflammatory chemicals that fight pain and inflammation. Study findings are generally positive, but mixed.

One 2006 review in the journal Arthritis Research in Therapy analyzed studies on a number of alternative remedies for arthritis, including bromelain. It found that bromelain was more effective than the pain reliever diclofenac at relieving osteoarthritis knee pain (according to patient reports of symptom improvement) in seven randomized trials; however, in two trials, researchers found that bromelain was no more effective than a placebo.

A 2004 review study in the journal Evidence-Based Complimentary and Alternative Medicine said that bromelain may have the potential to “provide a safer alternative or adjunctive treatment for osteoarthritis.”

The 2016 Biomedical Reports paper concluded that “bromelain has been recognized as a safe and successful type of therapeutic agent, and is being used by individuals worldwide for a number of ailments, such as bronchitis, sinusitis, arthritis, and inflammation.”

Such papers recommend more research to better understand bromelain’s effectiveness for arthritis. But in the meantime, a number of arthritis patients — like those who see Dr. Rothenberg — say bromelain is helping their daily lives.

“I have a woman in her fifties who is into golf but has arthritis in her knees,” says Dr. Rothenberg. “If she takes bromelain right before and right after, she says she has a much better time on the course.” Dr. Rothenberg has similarly seen bromelain help ease symptoms in osteoarthritis patients ranging from a 30-something training for a triathlon to employees who have developed wrist and finger issues from regular computer use.

There is more research about bromelain and osteoarthritis than there is on bromelain for inflammatory arthritis like rheumatoid arthritis.

How Bromelain is Taken

In order to get any clinical benefits from bromelain, you’ll need to do more than just pile extra pineapple on your Hawaiian pizza. As a supplement, bromelain is sold in a number of forms, from capsules and tablets to creams and powders. A clinician can help you understand how best to take it.

“When treating a specific, targeted condition, supplements are often given in therapeutic doses,” says Ginger Hultin, a Seattle-based registered dietitian, spokesperson for the Academy of Nutrition and Dietetics and owner of ChampagneNutrition. “A supplement may yield the most potent effects but those often come with side effects or potential drug/nutrient interactions. Food sources are always safest, but may not always be the most effective.”

As for how much bromelain to take, it’s your provider’s job to figure out the correct dosage for your complaint and weight so that you can see efficacy, says Rothenberg.

“I’ll usually tell patients to use 500 mg tablets two to three times per day,” she says, adding that bromelain works best when taken between meals so it competes less with other foods you may be consuming.

There is some evidence that both potatoes and soybeans could inhibit bromelain’s activity in the body, Hultin adds.

Is Bromelain Safe?

While it’s crucial to consider possible side effects, drug interactions, allergic reactions, and other concerns with any medication or supplement, part of bromelain’s appeal as an arthritis remedy is its relative safety.

Potential side effects of bromelain include stomach upset and diarrhea. Stick to the recommended dosages on the packaging of bromelain supplements, because as an enzyme it can be hard on the stomach if taken in too high of a dose, Rothenberg points out.

“Bromelain tends to play nicely in the sandbox, so it works well in people who are on other anti-inflammatories, either natural or pharmaceutical,” Rothenberg says. However, there are certain foods, medications, and supplements that shouldn’t be mixed with bromelain.

• Patients who are allergic to pineapple should avoid bromelain, even in supplement form.

• Bromelain may interact with certain medications and supplments. “There are potential moderate drug interactions with [the antibiotic] amoxicillin and blood-thinning medications or supplements,” says Hultin. “Because bromelain is a potential blood thinner, use caution if you’re having any type of surgery and discuss its use with your medical team.”

Any time you take a new supplement or medication, you need to make sure it’s safe to take with the other medications and supplements you’re already using. Bring a complete list of all your medications, vitamins, and supplements to your health care provider to review.

Keep in mind that supplements like bromelain aren’t tested for safety and regulated by the FDA the same way that prescription drugs are. Products can have additional ingredients or different dosages than what’s listed on the packaging.

Should You Consider Taking Bromelain for Arthritis?

While bromelain has reported benefits for arthritis symptoms, clinicians are quick to point out that it shouldn’t replace the medication or treatment that your doctor has recommended.

Talk to your health care provider about any alternative remedies you want to add to your arthritis treatment plan to make sure they’re safe and may be effective for you.

Any supplements you use should also be part of general lifestyle changes known to help relieve arthritis, including diet, exercise, and stress management.

“Bromelain can be part of an overall treatment plan for arthritis that also includes making dietary changes, reducing alcohol, and promoting mindfulness,” says Dr. Rothenberg.

As a dietitian, Hultin’s focus is overhauling the diet and making it generally more anti-inflammatory. “The food we eat can be either pro-inflammatory — think trans fats often added in shelf-stable processed foods — or it can be anti-inflammatory, which calms the irritation in the body. Think omega-3 fatty acids [cold water fish, hemp and chia seeds, and walnuts] and fruits and veggies that contain a variety of vitamins, minerals, and antioxidants.”