Bromelain
Four meta-analyses of wisdom tooth surgery found less pain on oral bromelain. Two found less facial swelling and two found no difference. In knee osteoarthritis, one placebo trial found no difference and another found no difference from diclofenac. No digestion trials were sourced. Reported side effects were flatulence, nausea and headache, and inhaled bromelain sensitized laboratory workers.
Add to Bio HackChecked 2026-11-09
- Status
- Dietary supplement in the US.
- Also called
- pineapple enzyme, Ananas comosus, pineapple stem extract, bromelin, proteolytic enzyme
- Taken for
- swelling after surgery, swelling, edema, bruising, inflammation, joint pain, osteoarthritis, digestion
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help2
Reported risks2
- ModerateReported side effects included flatulence, nausea and headache, with no major health risks across 54 studies.How often is not known
- LimitedCase reports: four laboratory workers developed allergy to bromelain, mostly from breathing it in. No count exists for people taking it by mouth.How often is not known
What people take it for, and what was found
Shown to help2
Pain after wisdom tooth surgery
Shown to lower pain after wisdom tooth surgery in adults, though reviews of the same small trials disagree on when the effect appears.
The numbers and sources
- Effect
- In 6 RCTs against placebo, bromelain lowered pain 7 days after surgery (SMD -0.54, 95% CI -0.87 to -0.20) but not in the first 2 to 3 days [1]. A second meta-analysis of 4 studies found lower pain (MD -0.38, 95% CI -0.66 to -0.09) [2]. A third, of 5 trials (252 patients), found lower pain at 48 to 72 hours (MD -0.89, 95% CI -1.70 to -0.09) [3]. A fourth, of 6 RCTs, found lower pain in the first 24 hours (SMD -0.49, 95% CI -0.82 to -0.17) and at 7 days (SMD -0.52), with better ratings of appearance, social isolation and sleep in the first week [4].
- Population
- Adults having lower third molar surgery [1][2][3][4].
- Sources
- [1], [2], [3], [4]
- Caveats
- The four reviews drew largely on the same small trials. Timing of the pain effect differs between them.
Bruising and swelling after skin procedures
Limited evidence: 5 of 7 small trials reported less bruising or swelling after skin procedures, and the reviewers judged the data insufficient.
The numbers and sources
- Effect
- A systematic review found 7 trials of oral bromelain for bruising or swelling after cosmetic, laser and surgical skin procedures. Five of the 7 reported improvement, and the authors judged the data insufficient [5].
- Population
- People having skin, cosmetic or surgical procedures [5].
- Sources
- [5]
- Caveats
- The abstract does not give effect sizes or pooled results [5].
Mixed results2
Swelling after wisdom tooth surgery
Limited evidence: reviews of overlapping trials disagree, with two finding less swelling after wisdom tooth surgery and two finding no effect.
The numbers and sources
- Effect
- One meta-analysis found less facial swelling early (SMD -0.24, 95% CI -0.46 to -0.02) and late (SMD -0.54, 95% CI -0.84 to -0.24) after surgery [1]. Another found less edema (MD -0.34, 95% CI -0.68 to -0.01) [2]. Two others found no significant effect on swelling [3][4].
- Population
- Adults having lower third molar surgery [1][2][3][4].
- Sources
- [1], [2], [3], [4]
- Caveats
- Reviews of overlapping trials reached opposite results.
Joint pain and osteoarthritis
Limited evidence: one trial found no change in knee osteoarthritis scores against placebo, and pooled studies across conditions found slightly lower pain.
The numbers and sources
- Effect
- In 47 adults with moderate to severe knee osteoarthritis, 800 mg a day for 12 weeks did not change the total WOMAC score against placebo (coefficient 11.16, 95% CI -8.86 to 31.18, p 0.27) [6]. In 40 adults with mild to moderate knee osteoarthritis, 500 mg a day did not differ from diclofenac 100 mg a day at 4 weeks [7]. Across 9 studies of oral bromelain in various conditions, pain scores were slightly lower than in controls (MD -0.27, 95% CI -0.45 to -0.08, I² 29%) [8]. An earlier review found that all trials before 2004 were uncontrolled or comparative [9].
- Population
- Adults with knee osteoarthritis [6][7]. Mixed conditions [8].
- Sources
- [6], [7], [8], [9]
- Caveats
- Only 31 of 47 finished the placebo trial [6]. The diclofenac trial was single-blind with no placebo [7]. The pooled pain estimate mixes conditions [8].
Claimed, not studied in people1
Digestion
Not studied in people. In mice, bromelain raised pancreatic trypsin activity and shifted gut bacteria, and high doses loosened a lab model of human gut lining.
No study in people. This rests on animal studies, lab studies.
The numbers and sources
- Effect
- Healthy young mice fed 1 mg of bromelain a day for 3 days showed higher pancreatic trypsin activity, a thicker ileal lining, fewer Proteobacteria and more Akkermansia muciniphila in the gut. In a reconstructed human intestinal tissue model, the highest dose disrupted the tissue barrier and raised its permeability [12].
- Population
- C57BL/6 mice and a human 3D intestinal tissue model [12].
- Sources
- [12]
- Caveats
- A 3-day mouse study and a tissue model do not show an effect on digestion in people [12]. No trial of bromelain as a digestive aid in people was located. One 8-week trial in 70 people with ulcerative colitis found lower disease activity scores on 400 mg a day than placebo, with no change in quality of life, which is a different question from everyday digestion [13].
Doses studied
The knee osteoarthritis trials used 800 mg a day for 12 weeks [6] and 500 mg a day for 16 weeks [7].
Risks
Reported risks2
Side effects in trials
Reported side effects included flatulence, nausea and headache, with no major health risks across 54 studies.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Across 54 studies, reported adverse events of oral bromelain included flatulence, nausea and headache, and no major health risks were reported [8]. Adverse events in the knee osteoarthritis trial were generally mild [6].
- Population
- People in clinical studies of bromelain [8]. 47 adults with knee osteoarthritis [6].
- Sources
- [8], [6]
- Caveats
- The abstract gives no adverse event rates [8].
Allergy
Case reports: four laboratory workers developed allergy to bromelain, mostly from breathing it in. No count exists for people taking it by mouth.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- Four workers in a blood grouping laboratory developed occupational allergy to bromelain, with mostly respiratory symptoms. Sensitization was more common among exposed workers than unexposed people and usually came from breathing it in, not swallowing it. The authors report that skin testing with bromelain can trigger systemic reactions, even at very high dilutions [10].
- Population
- Laboratory workers and unexposed controls [10].
- Sources
- [10]
- Caveats
- Workplace inhalation, not supplement use. No count of allergy among people taking bromelain by mouth was located.
Checked, no increase found1
Bleeding and clotting
Limited evidence: a bromelain enzyme applied to burns did not change clotting tests against surgery in 26 patients. Oral use was not studied.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In 26 intensive care burn patients treated with a bromelain-based enzyme applied to the wound, prothrombin time, partial thromboplastin time and platelet count did not differ from 26 matched patients given surgical debridement [11].
- Population
- Adults with burns over 15% of body surface or in intensive care [11].
- Sources
- [11]
- Caveats
- This was topical use on burns in a retrospective comparison, not oral supplements. No controlled study of oral bromelain and bleeding was sourced.
Claims tested and not found
- That bromelain relieves moderate to severe knee osteoarthritis. WOMAC scores did not differ from placebo over 12 weeks [6].
Sources
- Liu S, Zhao H, Wang Y, et al. Oral Bromelain for the Control of Facial Swelling, Trismus, and Pain After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis. Journal of Oral and Maxillofacial Surgery. 2019. https://doi.org/10.1016/j.joms.2019.02.044
- de Souza GM, Fernandes IA, Dos Santos CRR, Falci SGM. Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta-analysis. Phytotherapy Research. 2019. https://doi.org/10.1002/ptr.6244
- de A C Almeida R, de Sousa Lima FCM, do E Vasconcelos BC. Is bromelain an effective drug for the control of pain and inflammation associated with impacted third molar surgery? Systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery. 2019. https://doi.org/10.1016/j.ijom.2018.07.028
- Mendes ML, do Nascimento-Júnior EM, Reinheimer DM, Martins-Filho PR. Efficacy of proteolytic enzyme bromelain on health outcomes after third molar surgery. Systematic review and meta-analysis of randomized clinical trials. Medicina Oral, Patología Oral y Cirugía Bucal. 2018. https://doi.org/10.4317/medoral.22731
- Ho D, Jagdeo J, Waldorf HA. Is There a Role for Arnica and Bromelain in Prevention of Post-Procedure Ecchymosis or Edema? A Systematic Review of the Literature. Dermatologic Surgery. 2016. https://doi.org/10.1097/DSS.0000000000000701
- Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. 2006. https://doi.org/10.1093/qjmed/hcl118
- Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clinical Rheumatology. 2016. https://doi.org/10.1007/s10067-016-3363-1
- Leelakanok N, Petchsomrit A, Janurai T, et al. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutrition and Health. 2023. https://doi.org/10.1177/02601060231173732
- Brien S, Lewith G, Walker A, et al. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evidence-Based Complementary and Alternative Medicine. 2004. https://doi.org/10.1093/ecam/neh035
- Gailhofer G, Wilders-Truschnig M, Smolle J, Ludvan M. Asthma caused by bromelain: an occupational allergy. Clinical Allergy. 1988. https://doi.org/10.1111/j.1365-2222.1988.tb02894.x
- Capitelli-McMahon H, McCrossan S, Kershaw J, et al. The use of NexoBrid enzymatic debridement and coagulation abnormalities. Burns. 2024. https://doi.org/10.1016/j.burns.2023.06.012
- Kostiuchenko O, Kravchenko N, Markus J, et al. Effects of proteases from pineapple and papaya on protein digestive capacity and gut microbiota in healthy C57BL/6 mice and dose-manner response on mucosal permeability in human reconstructed intestinal 3D tissue model. Metabolites. 2022. https://doi.org/10.3390/metabo12111027
- Delgarm P, Mokhtare M, Ebrahimi Daryani N, et al. Effects of bromelain supplementation on disease activity and quality of life in patients with ulcerative colitis: a randomized, triple-blind, placebo-controlled study. Scientific Reports. 2025. https://doi.org/10.1038/s41598-025-26975-1