Bromelain: a pineapple extract may improve post-surgery healing

Many of my patients ask about supplements that can speed the healing process. One such supplement that I feel is efficacious, decreases bruising and speeds healing is Bromelain. Below is a summary that details some of its potential beneficial qualities.

Pineapple plant. Image: Wikimedia Commons

Bromelain is a type of enzyme found in high concentrations in pineapple plants (and other plants of the plant family Bomeliaceae). Animal studies and anecdotal evidence of the medicinal properties of this pineapple plant extract have brought to light its therapeutic value. Bromelain has also been shown to have low toxicity and produces little to no undesirable side effects.

Evidence from decades of research suggests that bromelain is effective at:

  • reducing pain
  • reducing edema
  • reducing inflammation
  • improving the potency of antibiotics.

All of these properties are related to important aspects of post-operative healing.

The FDA in the United States recognizes bromelain as generally safe, and has categorized it as a food additive. It is commercially available in capsule, tablet, powder, and liquid forms for oral consumption. The recommended dosage varies between 500 to 1,500 milligrams per day.

Evidence from early studies indicate that bromelain may be an effective pain reducer. Healthy adults showed a dose-dependent response to the extract, which reduced acute knee pain and appeared to promote their general well-being. Bromelain reduced pain when applied directly to open blisters in another study.

Bromelain may reduce healing time for soft-tissue wounds. Patients in one controlled clinical trial who took Bromelain had bruising and faster reduction of edema than patients who did not. Analysis of the results, however, showed that the effect fell short of statistical significance. Results from another study showed that patients who took vitamin supplements containing Bromelain had shortened wound-healing time than those who did not.

Bromelain enhances the action of antibiotics. An early study suggested that Bromelain makes tissues more permeable to antibiotics but the results were not statistically significant. Another study, in children, found that Bromelain significantly reduced healing time for sepsis by potentiating the antibiotics.

Studies of Bromelain’s toxicity have found it to be very low. Some reports of “gastrointestinal problems, headache, tiredness, dry mouth, skin rash, and unspecified allergic reactions” have been cited as possible side effects of high doses of Bromelain. Then again, some of these symptoms are seen with placebos. Higher doses have been correlated with stronger side effects. Overall, there have been few reports of adverse effects.

Dr. Larry Nichter

More controlled clinical trials will have to return statistically significant results before Bromelain is accepted for therapeutic purposes. The extent of its efficacy and the mechanisms by which it works must be better understood. However, because of its potential, bromelain has caught the attention of the medical community and will be the object of future research.

I hope you have found this helpful and now understand why I recommend Bromelain to my patients.

—Larry S. Nichter, MD


  • Orsini, Roger A. “Safety & Efficacy Report: Bromelain.” Plastic and Reconstructive Surgery 118.71 Dec. (2006): 1640-44. Print.

Information About Post Operative Nausea and Vomiting (PONV)

Dr. Larry Nichter

Post operative nausea and vomiting (PONV) is a serious problem for patients who are undergoing elective surgery. For facial aesthetic surgery PONV can lead to hematoma, delayed healing times, and other complications not the least of which is patient suffering.

Our focused interest in this problem was motivated by the progressive increase of PONV despite liberal use of antiemetics such as Odansetron (Zofran). At the same time we noted the increasing prevalence of antidepressant medications taken by our patients.

Based on our experience and extensive review of the literature we have established a perioperative treatment protocol that is beneficial to your patients and their well being.

Serotonin Syndrome is a poorly recognized but potentially dangerous condition which in its early stages may include nausea and vomiting (PONV) , hypertension, fever, tachycardia, agitation, restlessness, insomnia, mental status changes, diarrhea, etc. All of these are dangerous in the post operative healing period.

Serotonin Syndrome occurs when two or more drugs are taken together and cause too much available serotonin. Antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin/norepinephrine reuptake inhibitors (SSNRI), and monamine oxidase inhibitors (MAOI); Migriane Triptan medications including Imitrex, Relpax and others. Pain medications: (especially Tramadol), opioids; antiemetics such as odansetron (Zofran); and even cough medicines with dextromethorphan have been implicated in Serotonin Syndrome.

When your patients, who have been appropriately prescribed these medications, are then given certain pain medications or antiemetics they may develop serotonin syndrome and PONV.

We are attaching a table listing some of the multiple drug classes that have been implicated in this syndrome. In order to keep Serotonin Syndrome from occurring in our patients, we use the protocol attached. This includes the use of Cyproheptadine (periactin) as prophylactic when serotonin medications are used.

We your taking note of these guidelines during the postoperative period and contact us directly if you have any concerns or suggestions.

Thank you for reading.

Best wishes,

Larry S. Nichter, MD, MS, FACS