Is pineapple the next natural therapy for osteoarthritis?

Pineapple contains bromelain, a group of enzymes (1), which is a potential treatment for osteoarthritis due to its anti-inflammatory and analgesic qualities (2). Bromelain extracts can obtained from pineapples, particularly from the fruit core (3).


Several studies have suggested that bromelain’s anti-inflammatory effect derives from its ability to promote serum fibrinolytic activity as well as decrease plasma fibrinogen and bradykinin; the latter assists in reducing blood vessels’ permeability and thus, pain and oedema (2). Bromelain’s anti-inflammatory effect is further achieved through its ability to mediate prostaglandin, which is involved in the inflammation process (2). Consumption of bromelain extracted from pineapple offers a potential, natural and safe alternative to conventional pharmaceutical therapy for osteoarthritis (4).


Currently, bromelain is available over-the-counter as a health supplement and is commonly used to treat acute inflammation and sports injuries (5). This substance may be used as a stand-alone treatment or in combination with other medications, whether in the topical or oral route (1). If you are currently taking blood-thinning medication such as Warafin or Pradaxa, it is best to avoid bromelain, which has an anti-platelet effect and therefore, can increase the risk of excessive bleeding (6). Bromelain may also enhance the effect of certain drugs such as antibiotics, sedatives and anti-seizure medications (6). Thus, you should consult your doctor about the use of bromelain, especially if you are on these prescription medications (6).


Neither pineapple nor its bromelain derivatives have been linked to any serious adverse events when used to treat osteoarthritis but gastrointestinal discomfort, headache and allergic reactions have been reported (2).

Among the different ways to enhance dietary consumption of bromelain for alleviation of joint pain, eating fresh pineapple or drinking its juice is the most beneficial (7).This is because bromelain’s activity is sensitive to temperature change (8, 9) and at least 50% of bromelain in pineapple may be lost through cooking (7). The optimal range of temperature for bromelain’s activity varies between 10-60°C (8). At temperature above 70°C, bromelain will be denatured and completely inactivated (8). Meanwhile in cold storage condition, bromelain’s activity will begin to diminish after 10 days (8). For canned substitutes, bromelain content may also be reduced due to its destruction during the manufacturing process (7). It is also advisable to consume pineapple between meals to prevent bromelain from being used up for food digestion (10).


While eating pineapple is beneficial, over-consumption can lead to increased sugar and calories (11). Pineapple has a medium glycemic index (GI) with a serve of ¾ cup of fresh pineapple scoring at 56 on the GI scale and thus, should be eaten in small portions (12). For most individuals, sugar from pineapple can be added to their diet as long as its consumption does not constitute more than 10-12% daily calorie intake (13). For individuals with diabetes, pineapple can still be enjoyed but in moderation and with close monitoring of blood sugar if pineapple is introduced into the diet for the first time since your diagnosis (12). Moderate consumption of no more than one serve or cup of pineapple per day will also leave room for you to enjoy the nutritional benefits of a varied diet (14).


A cup of fresh pineapple chunks (165g) contains (15):

· Calories 82.5kcal

· Total fat 0.891g

· Cholesterol 0mg

· Sodium 1.65mg

· Potassium 180mg

· Fibre 2.31g

· Total carbohydrate 21.6g


At the same time, strategically including sources of soluble fibre in planning your daily meals is also a useful way to delay carbohydrate digestion and absorption into the bloodstream (16). An intake of 10g of fibre will help to reduce the post-meal increase in blood sugar level from 1 serve of carbohydrate by 25% (16). While fruits naturally contain soluble fibre, the amount of soluble fibre in a single, typical serve of fruit actually falls well short of 10g (16). Thus, several portions are required and this can be achieved by eating a salad, which combines a variety of vegetables that provides the desired amount of fibre, before consuming pineapple (16). An example of a varied salad may consist (13):


· 2 cups of romaine lettuce 2g fibre

· 1 cup of chopped tomatoes 2g fibre

· 1 cup of red bell pepper 3g fibre

· 1 cup of broccoli 4.5g fibre

Total fibre 11.5g


Other natural dietary sources that assist in inhibiting sugar metabolism in the body such as green tea, blackberry, blackcurrant, strawberry (17) and fresh garlic (18) may also be included in your diet.

If fresh pineapple is not readily available, canned substitutes can be used. Unfortunately, canned pineapples have higher calories and sugar content as well as fewer vitamins and minerals (19). Canned varieties without added sugar or in fruit juice rather than syrup will provide a healthier alternative (19).


For those who would like to supplement bromelain through their diet, it is worth noting that despite being the only major dietary source of bromelain (14), pineapple contains much less bromelain than supplements do, with just a 2.15% of bromelain yield from pineapple stem juice (3). Thus, simply eating pineapple or drinking pineapple juice may not be sufficient to achieve a therapeutic dose (6). However, long-term dietary consumption of fresh pineapple juice can be effective in alleviating inflammation (20).

References

1. National Center for Complementary and Integrative Health. Bromelain: U.S Department of Health and Human Services; [updated 2016. Available from: https://nccih.nih.gov/health/bromelain.

2. Brien S, Lewith G, Walker A, Hicks SM, Middleton D. Bromelain as a treatment for osteoarthritis: A review of clinical studies. Evidence-based Complementary and Alternative Medicine. 2004;1(3):251-7.

3. Joy PP. Benefits and uses of pineapple. 2010.

4. Shruti. Pineapple for oesteoarthritis: healthyy; [Available from: https://healthyy.net/arthritis/pineapple-for-osteoarthritis.

5. Pavan R, Jain S, Shraddha A, Kumar A. Properties and therapeutic application of bromelain: A review. Biotechnology Research International. 2012;2012.

6. Whelan C. Bromelain: Healthline; 2017 [Available from: https://www.healthline.com/health/bromelain#side-effects-and-risks.

7. Atherton M. Arthritis pain: This 35p fruit could reverse joint stiffness and inflammation: Express; 2018 [Available from: https://www.express.co.uk/life-style/health/915185/arthritis-pain-uk-symptoms-joint-pineapple-food-prevent.

8. Tran TT, Le TK, Nguyen MV. Effect of pH and temperature on activity of bromelain in pineapple fruit. 2010.

9. Moacyr Jorge E, Ivan Fabian A, Elias Basile T. Condições de pH e temperatura para máxima atividade da bromelina do abacaxi (Ananas Comosus L. Merril) = Temperature and pH conditions for maximum activity of bromelain extracted from pineapple (Ananas Comosus L. Merril). Acta Scientiarum: Technology. 2011;33(2):191-6.

10. 6 foods that relief arthritis pain Reader's Digest Canada; [Available from: https://www.readersdigest.ca/health/conditions/6-foods-relieve-arthritis-pain/.

11. Schaefer A, Gotter A. The 9 best pineapple juice benefits: Healthline; 2016 [Available from: https://www.healthline.com/health/food-nutrition/pineapple-juice-benefits.

12. Silver N. Is it safe to eat pineapple if you have diabetes? : Healthline; 2016 [Available from: https://www.healthline.com/health/diabetes/pineapples-and-diabetes.

13. Staughton J. Sugar in pineapple: Nutritional information: Organicfacts; 2019 [Available from: https://www.organicfacts.net/sugar-pineapple.html.

14. Ware M. Everything you need to know about pineapple: Medical News Today; 2018 [Available from: https://www.medicalnewstoday.com/articles/276903.php.

15. FoodData Central. Pineapple, raw, all varieties: U.S Department of Agriculture - Agriculture Research Service; 2019 [Available from: https://fdc.nal.usda.gov/fdc-app.html#/food-details/169124/nutrients.

16. Thompson R. Nature's best sugar blockers: Prevention; 2012 [Available from: https://www.prevention.com/weight-loss/a20437837/natural-blood-sugar-blockers-in-high-fiber-foods/.

17. Nyambe-Silavwe H, Williamson G. Polyphenol- and fibre-rich dried fruits with green tea attenuate starch-derived postprandial blood glucose and insulin: A randomised, controlled, single-blind, cross-over intervention. 2016;116(3):443-50.

18. Banigesh AI, Hamad AR, Dihom AA, El-Mahdi IM. Reduction of cholesterol and fasting blood sugar levels by one month supplementation of fresh garlic in diabetic Libyan patients: A double blind, baseline controlled study. Libyan International Medical University Journal. 2017;2(1):47-54.

19. Szalay J. Pineapple: Nutritional facts and health benefits: Livescience; 2019 [Available from: https://www.livescience.com/45487-pineapple-nutrition.html.

20. Hale PL, Chichlowski TM, Trinh KC, Greer KP. Dietary supplementation with fresh pineapple juice decreases inflammation and colonic neoplasia in IL-10-deficient mice with colitis. Inflammatory Bowel Diseases. 2010;16(12):2012-21.

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