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Pomegranate

Pomegranate

Common Names

  • Chinese apple

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For Patients & Caregivers

How It Works

Pomegranate was shown effective in lowering blood pressure and high cholesterol. More research is needed to know its benefits for cancer.

Pomegranate is a small fruit-bearing tree native to Asia. Juice from the seed pulp contains compounds known as polyphenols that may contribute to its activity. A few studies suggest pomegranate juice can benefit patients with heart disease and can lower cholesterol and blood pressure. It was shown in laboratory studies to prevent growth of cancer cells. In a human study, intake of pomegranate juice was found to have some benefit in patients with prostate cancer, but more clinical trials are needed to confirm such effects.

Purported Uses
  • Cancer prevention
    Data from laboratory studies showed that pomegranate is effective against tumor cells. A single study in humans showed some indirect benefit of pomegranate juice for patients with prostate cancer, but more studies are needed.
  • Cardiovascular Disease
    A small, short-term study suggests that     pomegranate juice may benefit patients with coronary heart disease, but more studies are needed.
  • Hypercholesterolemia
    There is evidence from a few studies that pomegranate lowers cholesterol level.
  • Hypertension
    A few small scale studies suggest that drinking pomegranate juice may reduce hypertension. More studies are needed to verify this effect.

Patient Warnings
  • Pomegranate juice may increase the risk of rhabdomyolysis (breakdown of muscle fibers and release of muscle fiber contents into circulation) for patients on statin therapy.
  • Diabetic patients should be careful because of the sugar content of pomegranate.

Do Not Take If
  • You are taking medications that interact with grapefruit juice: Pomegranate may have effects similar to grapefruit juice.
  • You are taking warfarin: Pomegranate juice may interact with warfarin.

Side Effects

No significant side effects were reported with use of pomegranate juice.

Special Point

Patients should be aware that pomegranate is not an approved cancer treatment.

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For Healthcare Professionals

Scientific Name
Punica granatum L.

Clinical Summary

Pomegranate is a small fruit-bearing tree native to Asia but is cultivated in many parts of the world including the United States. The fruit juice extracted from the arils of the seeds is used in drinks and as a dietary supplement. Several studies have shown that pomegranate has antioxidant and antiatherosclerotic properties attributed to the presence of multiple polyphenols such as tannins, flavonols, anthocyanins and ellagic acid (1) (2).

Consumption of pomegranate juice was found to benefit patients with carotid artery stenosis (6), in those with hypertension (7), hyperlipidemia (21), mild to moderate erectile dysfunction (19), and in patients with coronary heart disease (CHD) (8), but had no effect in patients with chronic obstructive pulmonary disease (COPD) (9).

In a study of postmenopausal women, intake of pomegranate seed oil did not reduce hot flashes (22). 

Pomegranate juice has been shown to suppress inflammatory cell signaling (1), inhibit prostate tumor growth and lower serum PSA levels (3) (4), and also inhibit aromatase activity, endogenous estrogen biosynthesis and breast cancer cell proliferation (5) in vitro. A pomegranate seed extract alleviated ciplatin-induced hepatotoxicity in animal studies (23). Pomegranate juice was reported to slow the rate of increase of PSA in men with high PSA levels, but data are conflicting (2) (24). However, according to a new study, supplementation with a blend of green tea, pomegranate, broccoli and curcumin resulted in a reduction in the rate of prostate-specific antigen (PSA) increase among men with prostate cancer following a PSA relapse post-radical treatment (25).

Food Sources

Whole fruit, juice

Purported Uses
  • Cancer treatment and prevention
  • Atherosclerosis
  • Coronary heart Disease
  • Hypercholesterolemia
  • Hyperlipidemia
  • Hypertension
  • HIV

Mechanism of Action

Several studies have indicated that pomegranate juice has antioxidant and antiatherosclerotic properties due to the presence of multiple polyphenols such as tannins, flavonols, anthocyanins and ellagic acid. Punicalagin, an ellagitannin, is the most abundant polyphenol that accounts for >50% of the antioxidant activity (1) (2). Some commercial pomegranate juices are marketed with claims of higher antioxidant activity than green tea and red wine (13). However such effects could be due to colonic microflora metabolites and not the polyphenols present in the juice (14). Pomegranate extract can inhibit aromatase activity and decrease the endogenous synthesis of estrogen (5).

Warnings
  • Pomegranate juice may increase the risk of rhabdomyolysis for patients on statin therapy, possibly due to the inhibition of CYP 450 enzymes (17).
  • Diabetic patients should be careful because of the sugar content of pomegranate.

Adverse Reactions

No significant adverse effects were seen with daily consumption of 8 ounces of pomegranate juice in men for over two years (2).

Herb-Drug Interactions
  • Cytochrome P4503A substrates: Studies in rats indicate that pomegranate juice may inhibit cytochrome P450 3A (CYP3A) activity similar to grapefruit juice (10) (11), but a study in humans demonstrated that pomegranate juice did not alter clearance of intravenous or oral midazolam, whereas grapefruit juice is known to have this effect (12).
  • CYP 2C9 substrates: A study done in rats showed that pomegranate juice inhibited CYP2C9 activity and increased tolbutamide bioavailability (18).
  • Warfarin: According to a case report, pomegranate juice may interact with warfarin (20).

Dosage (OneMSK Only)

References

  1. Adams LS, Seeram NP, Aggarwal BB, Takada Y, Sand D, Heber D. Pomegranate juice, total pomegranate ellagitannins, and punicalagin suppress inflammatory cell signaling in colon cancer cells. J Agric Food Chem. Feb 8 2006;54(3):980-985.

  2. 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. Jul 1 2006;12(13):4018-4026.

  3. Lansky EP, Jiang W, Mo H, et al. Possible synergistic prostate cancer suppression by anatomically discrete pomegranate fractions. Invest New Drugs. Jan 2005;23(1):11-20.

  4. Malik A, Afaq F, Sarfaraz S, Adhami VM, Syed DN, Mukhtar H. Pomegranate fruit juice for chemoprevention and chemotherapy of prostate cancer. Proc Natl Acad Sci U S A. Oct 11 2005;102(41):14813-14818.

  5. Kim ND, Mehta R, Yu W, et al. Chemopreventive and adjuvant therapeutic potential of pomegranate (Punica granatum) for human breast cancer. Breast Cancer Res Treat. Feb 2002;71(3):203-217.

  6. 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. Jun 2004;23(3):423-433.

  7. Aviram M, Dornfeld L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure.Atherosclerosis. Sep 2001;158(1):195-198.

  8. Sumner MD, Elliott-Eller M, Weidner G, et al. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol. Sep 15 2005;96(6):810-814.

  9. Cerda B, Soto C, Albaladejo MD, et al. Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr. Feb 2006;60(2):245-253.

  10. Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother. Jul-Aug 2006;40(7-8):1472-1473.

  11. Hidaka M, Okumura M, Fujita K, et al. Effects of pomegranate juice on human cytochrome p450 3A (CYP3A) and carbamazepine pharmacokinetics in rats. Drug Metab Dispos. May 2005;33(5):644-648.

  12. Farkas D, Oleson LE, Zhao Y, et al. Pomegranate juice does not impair clearance of oral or intravenous midazolam, a probe for cytochrome P450-3A activity: comparison with grapefruit juice. J Clin Pharmacol. Mar 2007;47(3):286-294.

  13. Gil MI, Tomas-Barberan FA, Hess-Pierce B, Holcroft DM, Kader AA. Antioxidant activity of pomegranate juice and its relationship with phenolic composition and processing. J Agric Food Chem. Oct 2000;48(10):4581-4589.

  14. Cerda B, Espin JC, Parra S, Martinez P, Tomas-Barberan FA. The potent in vitro antioxidant ellagitannins from pomegranate juice are metabolised into bioavailable but poor antioxidant hydroxy-6H-dibenzopyran-6-one derivatives by the colonic microflora of healthy humans. Eur J Nutr. Aug 2004;43(4):205-220.

  15. Cerda B, Llorach R, Ceron JJ, Espin JC, Tomas-Barberan FA. Evaluation of the bioavailability and metabolism in the rat of punicalagin, an antioxidant polyphenol from pomegranate juice. Eur J Nutr. Jan 2003;42(1):18-28.

  16. Seeram NP, Lee R, Heber D. Bioavailability of ellagic acid in human plasma after consumption of ellagitannins from pomegranate (Punica granatum L.) juice. Clin Chim Acta. Oct 2004;348(1-2):63-68.

  17. Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol. Sep 1 2006;98(5):705-706.

  18. Nagata M, Hidaka M, Sekiya H, et al. Effects of pomegranate juice on human cytochrome P450 2C9 and tolbutamide pharmacokinetics in rats. Drug Metab Dispos. Feb 2007;35(2):302-305.

  19. Forest CP, Padma-Nathan H, Liker HR. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. Int J Impot Res. 2007 Nov-Dec;19(6):564-7.

  20. Komperda KE. Potential interaction between pomegranate juice and warfarin. Pharmacotherapy. 2009 Aug;29(8):1002-6.

  21. Mirmiran P, Fazeli MR, Asghari G, Shafiee A, Azizi F. Effect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trial. Br J Nutr. 2010 Aug;104(3):402-6.

  22. Auerbach L, Rakus J, Bauer C, et al.Pomegranate seed oil in women with menopausal symptoms: a prospective randomized, placebo-controlled, double-blinded trial. Menopause. 2012 Apr;19(4):426-32.

  23. Yildirim NC, Kandemir FM, Ceribasi S, Ozkaraca M, Benzer F. Pomegranate seed extract attenuates chemotherapy-induced liver damage in an experimental model of rabbits.Cell Mol Biol (Noisy-le-grand). 2013 Feb 2;59 Suppl:OL1842-7.

  24. Paller CJ, Ye X, Wozniak PJ, et al. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer.Prostate Cancer Prostatic Dis. 2013 Mar;16(1):50-5.

  25. Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—the U.K. NCRN Pomi-T study. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6.

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