Can eating pineapple help arthritis?

Arthritis and pineapple: the bromelain connection

Pineapple contains a group of enzymes called bromelain, which has promising anti-inflammatory and pain relief effects. It is found in the fruit but is extracted from the core and stem where it is most highly concentrated. Bromelain was first extracted from pineapple in 1891. A study in 1964 looked at effects in people with Rheumatoid arthritis, but studies since then looked at osteoarthritis and the effects of bromelain. Although there is a potential for bromelain to be used as a non-steroidal anti-inflammatory, there is not enough evidence to make any recommendations on this supplement.

Indigenous peoples of Central and South America have long been drinking pineapple juice to calm sore throats and queasy stomachs at sea, induce labour, ease digestion and fluid retention, and as an anti-inflammatory.

How does it work?

It’s interesting to know how something works in our bodies to produce an effect, but the exact mechanism of bromelain is not fully understood. It appears to work on anti-inflammatory and pro-inflammatory signalling molecules through three main metabolic pathways to produce an overall anti-inflammatory effect in the body.

There are other potentially beneficial ways bromelain may work in our body, but for people with arthritis, bromelain has the potential to act as a non-steroidal anti-inflammatory pain killer (NSAID).

The research – osteoarthritis

Osteoarthritis is the most prevalent form of arthritis in Aotearoa. Bromelain as a treatment for osteoarthritis has primarily been for its analgesic (pain-relief) effects and has been studied in people with hip, knee, shoulder, and lumbar spine osteoarthritis.

A 2021 review of bromelain processing, pharmacokinetics and therapeutic uses notes that for rheumatoid and osteoarthritis, bromelain has the potential to act as an NSAID treatment. But the poor quality of studies means there is not enough evidence for recommendations.

A 2016 randomised control pilot study among 40 patients with knee osteoarthritis found that after 16 weeks of Bromelain supplementation, patients had improved pain, stiffness, and physical function compared with baseline (the start of the study). At week 4, there was no difference in relief of symptoms and quality of life scores between those taking bromelain and those taking diclofenac, an anti-inflammatory medicine.

A 2004 review of clinical studies on bromelain as a treatment for osteoarthritis found that there wasn’t enough evidence to make recommendations on the dosage and use of bromelain as a treatment for osteoarthritis.

The research – rheumatoid arthritis

Rheumatoid arthritis is an auto-immune, inflammatory condition for which the use of NSAIDs is fairly common. So it makes sense that bromelain as an alternative or adjunct pain relief treatment may be considered.

One study found that 72% of the rheumatoid arthritis patients involved had promising results at low dosages of 20 to 40mg 3-4 times daily. There was no control group in the study, making it too low quality to reach any significant conclusions. There’s been a lot less research on rheumatoid arthritis compared with osteoarthritis and the use of bromelain.

Is it safe?

There seems to be good tolerability and safety in the lower doses that have been studied, around 500mg/day and comparable in symptom relief to standard pain medication. It also appears safe and well tolerated with no relevant side effects with higher doses of up to 2000mg/kg body weight. Remember that it is up to your health provider to work out the dosage for you.

Care should be taken in;

long-term supplementation
People with kidney issues
People taking anticoagulants and antibiotics.

Make sure you talk to your doctor before starting supplementation with bromelain.

Food or supplement?

Fresh, raw pineapple will have the highest amounts of bromelain as cooking inactivates the enzyme. But there’s more to it than eating pineapple everyday, generally the amounts in the fruit, frozen, canned, or fresh, will not be enough to give you any kind of symptom relief. Like many supplements, therapeutic doses that can’t be achieved by eating food are used in studies. So for pain relief, a higher concentration of bromelain in the form of a supplement will provide a better chance at results.

Should I try this for my arthritis?

If you are currently taking NSAIDs for your arthritis or haven’t been able to tolerate these medications well in the past, bromelain could potentially be an add-on treatment for you. Supplements do not replace any medication your clinician has prescribed.

A 2021 review concludes that the main limitations for therapeutical recommendations is a lack of high quality evidence and long term clinical trials for safety and efficacy as well as the high cost of bromelain extraction and purification and no standard guidelines for these processes. There also needs to be further studies to establish the mechanism of action.

If you want to know if bromelain as a supplement is right for you, consult both your GP or rheumatologist and dietitian or naturopath before commencing.