Bromelain (pineapple enzyme)

Bromelain is sold as a «natural common cold remedy», «cold duration reducer» and «anti-inflammatory throat shield». Adult cold evidence base is limited: no Cochrane bromelain systematic reviews on cold. Cochrane vitamin C cold review (Hemilä 2013) showed moderate symptom duration reduction in regular users; no comparable bromelain data. AAFP, NICE, SEIMC for cold recommend symptomatic therapy: paracetamol for fever, fluids, rest, saline nasal irrigation; bromelain is not in guidelines. In patients on antiplatelets and anticoagulants bleeding risk is increased. If bromelain is self-taken for cold instead of family physician consultation for prolonged symptoms (>10 days), persistent high fever, dyspnoea, purulent discharge, consider seeking a second opinion.

Bromelain is sold in the sports segment as a «natural muscle recovery aid», «delayed onset muscle soreness (DOMS) reducer» and «exercise recovery accelerator». Rondanelli 2018 systematic review analysed DOMS, postoperative and post-traumatic oedema data: effect small and inconsistent, RCT methodological quality low, samples small. IOC consensus statement 2018 (Maughan, Br J Sports Med) for endurance and recovery approves creatine, caffeine, beta-alanine, sodium bicarbonate, nitrates; bromelain is not on the approved list. In athletes on warfarin, apixaban, rivaroxaban, aspirin, bromelain raises bleeding and haematoma risk. If bromelain was recommended as a substitute for a supervised recovery protocol (sleep 7–9 h, active recovery, stretching, protein 1.4–2.0 g/kg body weight), consider seeking a second opinion from a sports physician.