Osteoarthritis is the most common form of arthritis occurring in Western countries widely affecting the older age group people. According to National Health and Nutrition Examination survey, it was estimated that 27 million people are affected with osteoarthritis disease in United States.
Although the early symptoms of disease might be mild or barely noticeable, the condition progress in later stages leading to intensive pain, inflammation and joint disability. Fortunately, studies have reported that certain nutrients and foods may help to decrease or prevent the progression of osteoarthritis by reducing the pain and inflammation associated with it.
Among the fruits, pineapple is found to have strong effect in treatment of arthritis condition because of the presence of bromelain enzyme which is as effective as anti-inflammatory drugs when dealing with pain of osteoarthritis.
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Pineapple for osteoarthritis
The pineapple tree (Ananas comosus) is a tropical tree belonging to the family of Bromeliaceae. This tree is native to South America, but was first discovered by Europeans on Caribbean islands. Pineapple fruit is usually cylindrical in shape with scaly green, brown, or yellow skin and a crown of spiny, blue-green leaves. The yellow coloured flesh inside has vibrant flavour of sweet and tart taste.
The fruit is rich source of vitamin C, magnesium, manganese and a vital enzyme known as bromelain. Along with this it also contains copper, potassium, vitamin B1, vitamin B6, dietary fibre, folate and pantothenic acid. The major anti-inflammatory and analgesic properties of pineapple is basically because of the presence of bromelain enzyme. Bromelain belongs to the group of digesting enzymes extracted from the fruit or stem of pineapple tree.
The bromelain enzymes extracted from different parts of the tree (fruit and stem) are different and contain different composition. Bromelain is a set of various thiol endopepeptidases (peptidases containing active thiol –C-SH group) and other enzymes such as phosphatase, glycosidase, peroxidase, cellulose, and escharase. Bromelain has been found to have number of beneficial properties including anti-inflammatory (reduce inflammation), anti- analgesic (pain killer), and anti-oedematous (anti swelling), anti-thrombotic (prevent blood clot) and fibrinolytic (dissolution of fibrin) effects.
Bromelain is found to have number of therapeutics benefits such as in treatment of angina pectoris, bronchitis, sinusitis, osteoarthritis, surgical trauma, thrombophlebitis, debridement of wounds, diarrhoea and in many cardiovascular disorders. It also prevents cancer growth and promotes apoptotic cell death (naturally occurring programmed cell death).
Researchers proved that the traditional medicinal therapies used by man from ancient times involving the plant extracts with high proteolytic enzymes (enzymes those breakdown protein into smaller polypeptides or amino acids) are based on scientific studies. One of such enzyme used in Ayurveda is bromelain enzymes extracted from pineapple fruit or stem. In modern medicine, such therapy is called as enzyme therapy (use of enzymes to treat deficiencies or other medical conditions in patient’s body)
One of such scientific study included preclinical and clinical trials of systemic enzyme therapy on arthritic patients. Set of experiments were carried out using enzyme preparations consisting of combinations of bromelain (from pineapple), papain (from papaya), trypsin and chymotrypsin (secreted from pancreases).
It was shown the ratio of proteinases to antiproteinases which are usually affected by chronic disease like in arthritis (especially rheumatoid arthritis) was found considerably influence by oral administration of proteolytic enzyme extracts. It was indicated that these change in ratio of proteinases to antiproteinases could be due to the induction of antiproteinases synthesis or due to signal transduction of proteinases-antiproteinases complex via specific receptors molecules.
Along with these changes it was also indicated that during this enzyme therapy, there may be also various alternations in cytokine composition resulting from immunomodulatory effects (capable of modifying or regulating one or more functions of immune system) which indicated the effectiveness of the therapy. In same set of experiment, various studies were carried out including placebo-controlled studies in comparison with non-steroidal anti-inflammatory drugs.
Placebo- controlled is a research method in which an inactive substance (placebo) is given to one test group and a drug or vaccine given to other group.
Results showed that study involving oral therapy with proteolytic enzymes produced certain analgesic and anti-inflammatory effects which proved that enzyme therapy including proteolyic enzymes like bromelain could be chosen as an effective treatment therapy in inflammatory diseases like arthritis.
A group of studies were carried out including 28 patients to understand the effect of bromelain on knee joint of osteoarthritis patients. The studies reported that the use of bromelain in different dose amounts and in different duration period showed positive clinical effects in 18 patients as compared to control cases, which was measured by assessment in reduction of swelling of soft tissues, pain and joint stiffness. And no side effects of medication were observed on the patient’s health indicating that the bromelian can be successfully used in treatment of musculoskeletal disorders like that in osteoarthritis.
In vivo studies carried on rat model, indicated the vital role of bromelain enzyme in preventing the symptoms associated with pathogenesis of inflammatory diseases such as in osteoarthritis. It was reported that bromelain enzyme extracted form pineapple act as a powerful proteolytic enzyme which interfere in arachidonic acid metabolism.
Arachidonic act as a precursor for prostaglandins and other eicosanoids prostacyclins, thromboxanes and leukotrienes) which play important role in many physiological effects such as inflammation, pain, fever and blood clotting. Hence inhibition of arachidonic acid cascade leads to further prevention of all the physiological effects which are mainly associated with inflammatory disease like arthritis thus proving the strong anti-inflammatory property of bromelain enzyme.
Another study was carried out where short term oral treatment of bromelain enzyme purified from pineapple stem was administrated to laboratory mice suffering from chronic colitis (inflammation of colon or large intestine) to detect the effect of enzyme on colonic inflammation.
This experiment also showed there was subsequently decrease in production of pro inflammatory molecules such as cytokines and leucocyte at the site of inflammation when bromelain enzyme was given thus reducing the symptoms of inflammation. Same study was repeated where experimental mice was allowed to consume fresh pineapple juice which also contains bromelain enzyme but with different concentration from that of pineapple stem.
Results indicated that this bromelain enzyme extracted from fruit had better proteolytic activity than that from stem which showed lower incidence of inflammation associated with the disease thus concluding that long term dietary supplementation with fresh or unpasteurized pineapple juice with proteolytically active bromelain enzyme is safe to consume and more active in decreasing the severity of inflammatory diseases.
Another open study was carried out for one month where bromelain in two different doses (200mg and 400mg ) was given in otherwise healthy adults (n= 77) with mild knee pain showing no medical symptoms. Data was collected where significant improvement in total symptoms such as joint stiffness, physical fitness and physiological well-being were compared and results were found to be better when adults administrated with higher dose ( 400mg) of bromelain as compared to the low one (200mg).
Overall psychological well- being was also found to be much better after treatment process with bromelain as compared to the baseline which again indicated that bromelain was found to be effective in reducing physical symptoms and improving general health in otherwise healthy adults who were suffering from mild knee pain. Thus proving again bromelain appears to have potential for the treatment of knee osteoarthritis.
Pineapple is also rich in vitamin C and manganese, both of which play important role in reducing symptoms liked with inflammatory diseases like osteoarthritis. The antioxidant vitamin C found in pineapple juice helps in repair of collagen or protein in connective tissues which in turn helps to keep functioning of joints properly in joint related problems.
Drinking of pineapple juice also increases the intake of antioxidant vitamin A in body, which also helps in reducing arthritis pain as antioxidants fight against free radicals (that causes cell destruction and joint damage in arthritis patients). It is also observed another mineral present in fruit, manganese also possess antioxidant properties in removing free radicals from body tissues. Manganese is a key component for antioxidant enzyme called superoxide dismutase, the enzyme which neutralize free radicals preventing cell damage and subsequent death.
Therefore it is found deficiency of vitamins (especially vitamin C) and manganese in diet leads to weakness in joints, fractures in bone and bone malformation that further can lead to disease like arthritis.
How to include pineapple in your diet
Pineapple is a delicious fruit and also healthy to make your everyday meal more exciting. As it is good source of manganese, food containing this fruit provides good source of energy to body.
Eating pineapple is a great way to add color, flavour and variety to everyday dishes. Pineapple can be eaten as fresh fruit, as canned or grilled. Fresh ripe pineapple can be stored at room temperature for 1-2 days and once cut should be stored in fridge under low temperature. Canned pineapple pieces can be substituted for fresh fruits when required.
Dried pineapple is also one option but it is not widely available and used. Pineapple is a versatile fruit can be used in main course or dessert, at breakfast or at dinner. It is mainly used in fruit salad with other fruits which is everyone favourite dessert. Now a day’s fruit salsa is becoming popular where pineapple can be also used. In many Asian countries it is used in curry and fried rice too as a main dish. But it taste best when it is broiled or grilled along with meat steaks or vegetable steaks.
Eating pineapple is generally considered safe when eaten in moderate amount. Generally two slices of pineapple contains approximately 100mg of ascorbic acid (vitamin C) which act as a good source of antioxidant on daily basis. Over eating of this fruit can lead to diarrhoea and other digestive problems.
Pineapple may also show allergic reactions in some people such as temporary swelling on lips and rash. Other major side effect of pineapple fruit is that it may promote menstrual flow and bleeding and hence not advised for pregnant women. Pineapple is safe and healthy when eaten in its ripe form as unripe pineapple juice or fruit can cause irritation in the throat which can lead to drastic purgative action.
Pineapple products (Bromelain) are available commercially in form of liquid, as tablet or as capsule which should be taken only when prescribed by doctors or health experts .Bromelain is generally recommended safe for most people if taken in proper amounts. It is usually taken at the dosage of 40mg for 3 to 4 times a day.
Bromelain is mainly used for reducing swelling (inflammation). It is also used for hay fever, treating bowel problems (ulcerative colitis), preventing accumulation of water in lung (pulmonary edema, stimulating muscles contraction, preventing cancer, relaxing muscles etc.
For osteoarthritis, a product known as Phlogenzym is recommended which contains bromelain (90mg) with trypsin (48mg) and rutin (100mg,substance found in buckwheat) taken as 2 tables three times daily.
Bromelain is generally regarded safe but in some, it may cause some allergy or side effects like diarrhoea, stomach and intestinal problems. Bromelain is not recommended for people having active gastric or duodenal ulcers. It is also believed to cause bleeding during and after surgery and hence should be avoided strictly in people who have undergone surgery.
Pregnant women and breast feeding are also advised not to use bromelaian as this product is found to interact with number of other medicines. It is found to interact with tetracycline antibiotic (declomycin, acromycin), amoxicillin drugs (amoxil, trimox) affecting their overall effect.
They also found to interact strongly with anticoagulant or antiplatelet drug such as aspirin, diclofenac, ibuprofen, heparin, warfarin etc. leading to chances of bruising and bleeding. And therefore, should be taken only after consulting your health professional or doctor.
Many plant extracts containing high content of proteolytic enzymes have always been used from ancient times as a part of traditional medicines in treatment of various illness.
And they were always proved to be effective and safe compared to antibiotics and other chemical drugs used mostly now a days. Therefore use of such plant extracts and herbal medicines are gaining importance recently and are used as a part of modern enzyme therapy.
One of such enzyme therapy uses, the bromelain enzyme extracted from pineapple tree which is demonstrated to have number of anti-inflammatory and analgesic properties and hence proves to be safer alternative or adjective treatment of inflammatory diseases such as osteoarthritis.