Pomegranate

Pomegranates have been used as medicine for thousands of years. More recently, they have been called a "superfood" that can protect against disease. In laboratory tests, pomegranate shows antiviral, antibacterial, and antioxidant properties. But more research is needed to determine whether it can help prevent or treat illness in humans. In addition, there is some concern that pomegranate juice might interact with medications, much like grapefruit juice does, making certain medications less effective.

Pomegranate fruit extract is a rich source of polyphenols, chemicals in plants that provide their flavor and color. Polyphenols are also antioxidants, meaning they help protect cells from damage and may lower inflammation in the body. Pomegranate fruit is also high in vitamin C. One pomegranate provides about 40% of the daily requirement of this vitamin.

The bark, fruit, root, and rind of the pomegranate tree are used as medicine in Asia and the Middle East. In the West, the fruit and its juice are usually the parts being studied. The juice and rind have antioxidant properties, while the juice, rind, and oil from seeds contain isoflavones similar to the ones in soy.

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Plant Description

Pomegranate grows as a multistemmed shrub or large tree, as high as 20 to 30 feet, that produces suckers from the base. It is native to Iran and is cultivated in the Mediterranean, Asia, Africa, and Europe. Deciduous leaves are opposite, or in whorls, approximately 3/8 to 4 inches long. Flowers are 1 ¼ inch and have a red tubular calyx. The fruit has a leathery skin, usually deep pink or red. The inside of the fruit has white spongy tissue that creates spaces filled with sacs or tart pulp and seed.

Parts Used

The fruit and seed are used in modern herbal medicine. In some traditional folk remedies, the rind and root or bark may also have been used, but they contain potentially toxic substances and should be avoided.

Medicinal Uses and Indications

Cancer

Pomegranate is high in antioxidants and other nutrients, so some people think that drinking pomegranate juice regularly may help prevent cancer.

In test tubes, pomegranate extracts made from juice, rind, and oil slow down the reproduction of cancer cells and may hasten their death. Some extracts also help reduce blood supply to tumors, starving them and making them smaller. Most studies have focused on breast, prostate, and colon cancer cells. In one other study, pomegranate juice extract given to mice slowed down the growth of lung tumors. However, most of these studies have been in test tubes or in animals, not in humans.

In one human study, men who had surgery or radiation for prostate cancer lengthened the amount of time it took for their PSA levels to double by drinking 8 oz. of pomegranate juice each day. Men whose PSA levels double in a short period of time are at higher risk of death from prostate cancer. Those who drank pomegranate juice increased the time it took for their PSA levels to double from about 15 months to 54 months.

If you are being treated for cancer, be sure to ask your oncologist before you take pomegranate or any herb or supplement. Pomegranate may interact with cancer medications, making the medications less effective.

Heart disease

Pomegranate's high antioxidant content has also made researchers wonder if it could treat heart disease.

Pomegranate juice seems to protect LDL (bad) cholesterol from damage. Some scientists think that damage to LDL cholesterol causes plaque to build up in arteries, so stopping the damage might help keep arteries clear. One study of mice with atherosclerosis found that pomegranate juice slowed the growth of plaque formation. A few small human studies in people found that pomegranate juice improved blood flow and kept arteries from becoming thick and stiff. More and better studies are needed to see exactly what benefit pomegranate juice might offer.

Preliminary evidence suggests that drinking pomegranate juice every day may help lower systolic blood pressure (the top number in a blood pressure reading) but not diastolic blood pressure (the bottom number). Other studies suggest that prolonged pomegranate juice intake improves cardiovascular risk factors, slowing the progression of plaque build up on the arteries and enhancing immunity.

Osteoarthritis

Flavonols (a kind of antioxidant) similar to the ones found in pomegranate fruit have been suggested as treatments for osteoarthritis. Osteoarthritis happens when the cartilage in joints wears down and causes pain and stiffness.

Researchers believe flavonols can help block inflammation that contributes to the destruction of cartilage. In test tubes, pomegranate extract blocked the production of an enzyme that destroys cartilage in the body. In one review of the scientific literature, researchers concluded that all of the studies reported positive effects of pomegranate juice or extract on osteoporosis, osteoarthritis, and rheumatoid arthritis. The results were promising; however, more studies, and studies that look at the effects in humans, are needed.

Other Uses

Preliminary studies show that dietary pomegranate produces brain anti-inflammatory effects that may help stall the progression of Alzheimer Disease. Other studies suggest drinking 8 ounces of pomegranate juice daily helps improve performance in tasks related to learning and memory. Pomegranate also has antidiabetic and anti-inflammatory effects in the gastrointestinal tract.

Available Forms

Pomegranate juice is available as a liquid. Pomegranate extract is available in pill, capsule, or powder form.

How to Take It

Pediatric

As part of a healthy diet, normal amounts of pomegranate juice (4 to 6 oz.) are considered safe. DO NOT give pomegranate extract to a child without first talking to your doctor.

Adult

There is no standard recommended dose for pomegranate. Eating the fruit and drinking the juice as part of a healthy diet is considered safe. For other conditions, the following doses have been used:

• Atherosclerosis: 50 ml of juice per day
• High cholesterol: 40 g per day
• Prostate cancer: 8 oz. of juice per day

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider.

Drinking 8 to 12 oz. of pomegranate juice per day is considered safe. Look for 100% juice with no added sugar. If you have diabetes, ask your doctor before drinking fruit juices, including pomegranate.

If you have diarrhea, do not drink pomegranate juice or take pomegranate extract.

Pregnant women should not take pomegranate extract because it may contain fruit rind. The juice, however, is considered safe.

Possible Interactions

Preliminary research suggests that pomegranate juice may interact with several medications (much like grapefruit juice does). For that reason, be sure to tell your doctor if you drink pomegranate juice. If you are being treated with any of the following medications, you should not use pomegranate in medicinal forms without first talking to your health care provider.

ACE inhibitors. These types of drugs are used to control high blood pressure and to treat heart failure and prevent kidney damage in people with diabetes. Scientists believe pomegranate juice has some of the same effects as ACE inhibitors and could make the drug too strong. ACE inhibitors include:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Zestril)
• Ramipril (Altace)

Blood pressure medication. Pomegranate juice may lower blood pressure. If you already take medication to lower blood pressure, pomegranate juice or extract could raise the risk of having low blood pressure.

Statin, medications used to lower cholesterols. There is one case report of a man who developed rhabdomyolysis (a condition where muscle tissue breaks down and leads to kidney damage) after taking rosuvastatin (Crestor) and drinking 200 ml of pomegranate juice weekly. Although scientists are not sure whether drinking pomegranate juice while taking statins caused the condition, you should check with your doctor before drinking pomegranate juice if you also take a statin. Statins include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Warfarin (Coumadin). Pomegranate may interact with the blood thinner warfarin (Coumadin) and increase the risk of bleeding.

Supporting Research

Ahmed S, Wang N, Hafeez BB, Cheruvu VK, Haqqi TM. Punica granatum L. extract inhibits IL-1beta-induced expression of matrix metalloproteinases by inhibiting the activation of MAP kinases and NF-kappaB in human chondrocytes in vitro. J Nutr. 2005 Sep;135(9):2096-102.

Al-Jarallah A, Igdoura F, Zhang Y, et al. The effect of pomegranate extract on coronary artery atherosclerosis in SR-BI/APOE double knockout mice. Atherosclerosis. 2013;228(1):80-9.

Al-Muammar MN, Khan F. Obesity: the preventive role of the pomegranate (Punica granatum). Nutrition. 2012;28(6):595-604.

Asgary S, Sahebkar A, Afshani MR, Keshvari M, Haghjooyjavanmard S, Rafieian-Kopaei M. Clinical evaluation of blood pressure lowering, endothelial function improving, hypolipidemic and anti-inflammatory effects of pomegranate juice in hypertensive subjects. Phytother Res. 2014;28(2):193-9.

Aviram M, Dornfeld L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure. Atherosclerosis. 2001 Sep;158(1):195-8.

Aviram M, Dornfeld L, Rosenblat M, et al. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotic apolipoprotein E-deficient mice. Am J Clin Nutr. 2000;71(5):1062-76.

Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr. 2004;23(3):423-33.

Banihani S, Swedan S, Alguraan Z. Pomegranate and type 2 diabetes. Nutr Res. 2013;33(5):341-8.

Basu A, Penugonda K. Pomegranate juice: a heart-healthy fruit juice. Nutr Rev. 2009 Jan;67(1):49-56. Review.

Bell C, Hawthorne S. Ellagic acid, pomegranate and prostate cancer -- a mini review. J Pharm Pharmacol. 2008 Feb;60(2):139-44. Review.

Bookheimer SY, Renner BA, Ekstrom A, et al. Pomegranate juice augments memory and FMRI activity in middle-aged and older adults with mild memory complaints. Evid Based Complement Alternat Med. 2013;2013:946298.

Colombo E, Sangiovanni E, Dell'agli M. A review on the anti-inflammatory activity of pomegranate in the gastrointestinal tract. Evid Based Complement Alternat Med. 2013;2013:247145.

Davidson MH, Maki KC, Dicklin MR, et al. Effects of consumption of pomegranate juice on carotid intima-media thickness in men and women at moderate risk for coronary heart disease. Am J Cardiol. 2009 Oct 1;104(7):936-42.

Esmaillzadeh A, Tahbaz F, Gaieni I, et al. Concentratedpomegranate juice improves lipid profiles in diabetic patients withhyperlipidemia. J Med Food. 2004;7:305-8.

Gruenwald J, Brendler T, Jaenicke C. Pomegranate. In: PDR for Herbal Medicines. 3rd ed. Montvale, NJ: Thomson PDR;2004:650-51.

Hadipour-Jahromy M, Mozaffari-Kermani R. Chondroprotective effects of pomegranate juice on monoiodoacetate-induced osteoarthritis of the knee joint of mice. Phytother Res. 2009 Jun 5. [Epub ahead of print].

Jaganathan SK, Vellayappan MV, Narasimhan G, Supriyanto E. Role of pomegranate and citrus fruit juices in colon cancer prevention. Worl J Gastroenterol. 2014;20(16):4618-25.

Jurenka JS. Therapeutic applications of pomegranate (Punica granatum L.): a review. Altern Med Rev. 2008 Jun;13(2):128-44. Review.

Kaplan M, Hayek T, Raz A, et al. Pomegranate juice supplementation to atherosclerotic mice reduces macrophage lipid peroxidation, cellular cholesterol accumulation and development of atherosclerosis. J Nutr. 2001;131(8):2082-9.

Khan GN, Gorin MA, Rosenthal D, Pan Q, et al. Pomegranate fruit extract impairs invasion and motility in human breast cancer. Integr Cancer Ther. 2009 Sep;8(3):242-53.

Khan N, Afaq F, Kweon MH, Kim K, Mukhtar H. Oral consumption of pomegranate fruit extract inhibits growth and progression of primary lung tumors in mice. Cancer Res. 2007 Apr 1;67(7):3475-82.

Langley P. Why a pomegranate? BMJ. 2000 Nov 4;321(7269):1153-4.

Lansky EP, Newman RA. Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer. J Ethnopharmacol. 2007 Jan 19;109(2):177-206. Review.

Li J, Zhang F, Wang S. A polysaccharide from pomegranate peels induces the apoptosis of human osteosarcoma cells via the mitochondrial apoptotic pathway. Tumour Biol. 2014;35(8):7475-82.

Pantuck AJ, Leppert JT, Zomorodian N, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. 2006 Jul 1;12(13):4018-26.

Rasheed Z, Akhtar N, Anbazhagan AN, Ramamurthy S, Shukla M, Haqqi TM. Polyphenol-rich pomegranate fruit extract (POMx) suppresses PMACI-induced expression of pro-inflammatory cytokines by inhibiting the activation of MAP Kinases and NF-kappaB in human KU812 cells. J Inflamm (Lond). 2009 Jan 8;6:1.

Reddy MK, Gupta SK, Jacob MR, Khan SI, Ferreira D. Antioxidant, antimalarial and antimicrobial activities of tannin-rich fractions, ellagitannins and phenolic acids from Punica granatum L. Planta Med. 2007 May;73(5):461-7.

Rettig MB, Heber D, An J, Seeram NP, Rao JY, et al. Pomegranate extract inhibits androgen-independent prostate cancer growth through a nuclear factor-kappaB-dependent mechanism. Mol Cancer Ther. 2008 Sep;7(9):2662-71. Erratum in: Mol Cancer Ther. 2008 Nov;7(11):3654.

Rojanathammanee L, Puig KL, Combs CK. Pomegranate polyphenols and extract inhibit nuclear factor of activated T-cell activity and microglial activation in vitro and in a transgenic mouse model of Alzheimer disease. J Nutr. 2013;143(5):597-605.

Sartippour MR, Seeram NP, Rao JY, Moro A, Harris DM, et al. Ellagitannin-rich pomegranate extract inhibits angiogenesis in prostate cancer in vitro and in vivo. Int J Oncol. 2008 Feb;32(2):475-80.

Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P. Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts. A preliminary study. J Int Acad Periodontol. 2003 Oct;5(4):106-15.

Shema-Didi L, Kristal B, Sela S, Geron R, Ore L. Does Pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients? Nutr J. 2014;13:18.

Shema-Didi L, Sela S, Ore L, et al. One year of pomegranate jice intake decreases oxidative streess, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial. Free Radic Biol Med. 2012;53(2):297-304.

Shuid AN, Mohamed IN. Pomegranate use to attenuate bone loss in major musculoskeletal diseases: an evidence-based review. Curr Drug Targets. 2013;14(13):1565-78.

Sumner MD, Elliott-Eller M, Weidner G, et al. Effects ofpomegranate juice consumption on myocardial perfusion in patients with coronaryheart disease. Am J Cardiol. 2005;96:810-4.

Syed DN, Afaq F, Mukhtar H. Pomegranate derived products for cancer chemoprevention. Semin Cancer Biol. 2007 Oct;17(5):377-85. Epub ahead of print.

Toi M, Bando H, Ramachandran C, et al. Preliminary studies on the anti-angiogenic potential of pomegranate fractions in vitro and in vivo. Angiogenesis. 2003;6(2):121-8.

Vasconcelos LC, Sampaio MC, Sampaio FC, Higino JS. Use of Punica granatum as an antifungal agent against candidosis associated with denture stomatitis. Mycoses. 2003 Jun;46(5-6):192-6.

Vidal A, Fallarero A, Pena BR, et al. Studies on the toxicity of Punica granatum L. (Punicaceae) whole fruit extracts. J.Ethnopharmacol. 2003;89(2-3):295-300.

Vlachojannis C, Erne P, Schoenenberger AW, Chrubasik-Hausmann S. A critical evaluation of the clinical evidence for pomegranate preparations in the prevention and treatment of cardiovascular diseases. Phytother Res. 2015;29(4):501-8.

Wang L, Martins-Green M. Pomegranate and its components as alternative treatment for prostate cancer. Int J Mol Sci. 2014;15(9):14949-66.

Related Information

Review Date: 2/2/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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