DRUGS AND SUPPLEMENTS

Pomegranate (Punica granatum)

March 22, 2017

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Pomegranate (Punica granatum)

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Aldehydes, anthocyanins, apigenin, ascorbic acid, ash, beta-sitosterol, beta-sitosterol esters, calcium, catechins, cellulose, citric acid, coemestrol, compound 25, copper, coumestrol, cyanidins, cycloartenol, daucosterol, delphinidins, ellagic acid, ellagitannins, estrone, fatty acids, flavonols, gallic acid, gallotannins, Granada, granatin B, Grenade, Grenadier, humarain, hydroalcoholic extract (HAE), iron, isopelletierine, isoquerecitrin, leucoanthocyanins, luteolin, magnesium, mannitol, methylgallate, minerals, monoterpenes, oleanolic acid, pectin, pelargonidins, pelletierine, phenolic acids, phosphorus, PJ, policosanol, polyphenols, pomegranate extracts, pomegranin, POMx™, potassium, pulicalagin, Punica granatum, Punica proto-punica, Punicaceae, punicalagins, punicalin, punicanolic acid, punicic acid, qualene, quinic acid, Shi liu gen (Chinese), Shi liu gen pi (Chinese), Shi liu pi (Chinese), sodium, sugar alcohols, sugars, tannins, tartaric acid, tocopherols, ursolic acid, vitamin B, vitamin C, zinc.

  • Combination product examples: Lakewood Organic Pure Pomegranate® (pomegranate juice), Odwalla Pomagrand® (pomegranate juice), POM Wonderful® (pomegranate juice), Pomeratrol™, Radical Fruit® (combination fruit supplement containing pomegranate juice), Swanson Ultra® (pomegranate juice), Weleda® Pomegranate Regenerating Body Care, emerginC® Pomegranate Gel Cleanser, Klorane® No Rinse Care With Pomegranate (conditioner), Radical Fruits®, Xanthigen® (brown marine algae fucoxanthin and pomegranate seed oil (PSO)).

Background

  • Pomegranate (Punica granatum) is grown around the world and has a long history of use as food and medicine. In the United States, pomegranate juice and seeds are used as food.

  • One pomegranate delivers about 40% of an adult's daily vitamin C requirement and is high in antioxidants, which are thought to help reduce the risk of certain diseases. More research is needed before a conclusion can be made on the use of pomegranate for any condition in humans.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grade*

Exercise recovery

Preliminary research suggests that pomegranate may help promote skeletal muscle recovery after exercise and reduce muscle soreness. More studies are needed to confirm these findings.

B

Aging

Pomegranate extract has been studied for its antiaging effects on the skin. However, available evidence is weak, and conclusive results cannot be established. Further research is required.

C

Antifungal

An extract of pomegranate was shown to be as effective as a commonly used gel when applied to the skin for yeast infection associated with mouth sores. Further research is needed to confirm these effects.

C

Antioxidant

Some studies suggest that pomegranate juice may have antioxidant properties, but effects in humans are still unclear. More studies in people with diabetes and cancer are needed.

C

Atherosclerosis

Preliminary results of studies using pomegranate for atherosclerosis (hardening of the arteries) are mixed. Pomegranate juice may lower blood pressure in elderly people with high blood pressure. However, further research is needed to confirm these findings.

C

Chronic obstructive lung disease

It is unclear whether pomegranate juice is helpful for chronic obstructive lung disease. In theory, pomegranate may be beneficial because of its antioxidant effects, but studies in humans do not support this theory. Additional studies in this area are warranted.

C

Coronary heart disease (prevention)

Limited evidence suggests that pomegranate juice may slow progression of coronary heart disease in at-risk people. More studies are needed in this field before any conclusions can be drawn.

C

Dental conditions

Extracts from pomegranate fruits may be beneficial in treating dental plaque accumulation and gum disease. More studies are needed.

C

Erectile dysfunction

Pomegranate juice has been studied in the treatment of mild-to-moderate erectile dysfunction. Early research is unclear, and more studies are needed before a conclusion can be made.

C

High blood pressure

Pomegranate juice may lower blood pressure in patients with high blood pressure.

C

High cholesterol

Consumption of a juice containing a combination of fruits, including pomegranate, was found to have a beneficial effect on blood cholesterol levels. Additional studies in which pomegranate alone is used are needed.

C

Menopausal symptoms

There is currently not enough evidence to support the use of pomegranate in the reduction of menopausal symptoms.

C

Metabolic syndrome

Low-quality studies suggest that pomegranate juice may benefit children who have metabolic syndrome. More research is needed before conclusions can be made.

C

Prostate cancer

Consumption of pomegranate juice may benefit people with prostate cancer. Although early research results are promising, more research is needed before conclusions can be made.

C

Sunburn

Taking pomegranate extract by mouth may reduce damage to the skin caused by exposure to UV rays. More studies in this area are needed.

C

Weight loss

Limited evidence suggests that a combination product containing pomegranate may promote weight loss in obese postmenopausal women. Additional research is needed before any conclusions can be drawn.

C

*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Abortion, allergies, Alzheimer's disease, anemia, anoxic brain injury (lack of oxygen in brain), antibacterial, anti-inflammatory, antimicrobial (kills bacteria and fungi), antiviral, appetite/weight loss in cancer patients, arthritis, astringent (skin tightening), blood thinner, breast cancer, bronchitis, cancer, colic (excessive crying in babies), colitis (intestinal swelling), colon cancer, cosmetic, degenerative diseases (breakdown of tissue or organs over time), diabetes, diarrhea, dysentery (intestinal disorder), earache, excessive menstrual flow, flu, food preservative, gastritis (stomach inflammation), headache, hemorrhoids, immune suppressant, infant eye/brain development, infections, inflammatory bowel disorders, irritable bowel syndrome, kidney disease, leprosy (skin sores and muscle weakness), liver protection, malaria, male infertility, memory, mumps, nasal discomfort, osteoarthritis, osteoporosis, pain, paralysis, parasites and worms, prolapsed uterus (uterus falling into the vagina), rectocele (rectum bulging into the vagina), respiratory disease, ringworm, skin conditions, sore throat, stomach disorders, tooth retention, ulcers of mouth and genitals, vaginal discharge, wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • A general consensus on dosage for pomegranate is lacking. Capsules containing pomegranate and providing 710-1,420 milligrams of extract have been studied for up to four weeks.

  • As an antioxidant, 1,000 milligrams of pomegranate extract in the form of POMx™ capsules has been taken by mouth daily for four weeks. A dose of 50 milliliters of pomegranate juice has been taken by mouth daily for three months. A dose of 100 grams of fresh pomegranate fruit has been taken by mouth for 10 days. A dose of 250 milliliters of pomegranate juice made fresh from pulp has been taken by mouth every morning for four weeks. A dose of 250 milliliters of pomegranate juice has been taken by mouth daily for one week after an overnight fast.

  • To treat atherosclerosis, a dose of 50 milliliters of pomegranate juice has been taken by mouth daily for two weeks. A dose of 240 milliliters of pomegranate juice has been taken by mouth daily for three months.

  • To prevent coronary artery disease, 240 milliliters of pomegranate juice has been taken by mouth daily for up to 18 months.

  • To treat erectile dysfunction, eight ounces of pomegranate juice has been taken by mouth daily for four weeks.

  • To promote recovery from exercise, 250 milliliters of pomegranate juice (POM Wonderful®) has been taken by mouth twice daily for 15 days, and 500 milliliters of pomegranate juice (POM Wonderful®) has been taken by mouth twice daily at 12-hour intervals for nine days.

  • To treat high cholesterol, 400 milligrams of pomegranate seed oil has been taken by mouth twice daily for four weeks. A dose of 40 grams of pomegranate juice has been taken by mouth for eight weeks.

  • To treat high blood pressure, 300 milliliters of pomegranate juice (POM Wonderful®) has been taken by mouth daily for two weeks. A dose of 166 milliliters of pomegranate juice has been taken by mouth daily for two weeks. A dose of 200 milliliters of pomegranate juice has been taken by mouth daily for six weeks by type 2 diabetics. A dose of 50 milliliters of pomegranate juice has been taken by mouth for two weeks.

  • To treat prostate cancer, a dose of eight ounces of pomegranate juice has been taken by mouth daily until disease progression.

  • To treat yeast infections, pomegranate extract has been applied to the skin three times daily for 15 days.

  • To treat dental conditions, a mouth rinse containing pomegranate extract has been used. A pomegranate mouth rinse has been used twice daily for four days.

Children (younger than 18 years)

  • To treat metabolic syndrome, 240 milliliters of natural pomegranate juice has been taken by mouth daily for one month in adolescents 12-15 years of age.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people who have known allergy or sensitivity to pomegranate, any of its parts, or any other members of the Punicaceae family. Cross-reactions between pomegranate, hazelnut, and peanut have been reported. People with plant allergies may have a higher risk of experiencing allergic reactions to pomegranate.

Side Effects and Warnings

  • Pomegranate is generally thought to be safe when the rind (peel), fruit, or seeds are taken by mouth.

  • Pomegranate may cause side effects such as altered heart rate, anaphylaxis (severe allergic reaction) following exercise, blindness, diarrhea, eye itchiness and redness, gas, hives, increased cholesterol, itchy skin, lung spasms, nasal congestion, nausea, runny nose, shortness of breath, and skin swelling.

  • Pomegranate may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

  • Pomegranate may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

  • Pomegranate may affect blood pressure. Caution is advised in people who have blood pressure disorders or in those taking drugs or herbs and supplements that affect blood pressure.

  • Use cautiously in people who have abnormal heartbeat, asthma, diarrhea, or high cholesterol.

  • Use cautiously in people who have liver dysfunction or who are taking drugs that may damage the liver, as pomegranate may cause liver damage.

  • Use cautiously in people who are taking rosuvastatin.

  • Use cautiously in pregnant women, however, pomegranate as a food is likely safe during pregnancy.

  • Avoid in people who have known allergy or sensitivity to pomegranate, any of its parts, or any other members of the Punicaceae family. Cross-reactions between pomegranate, hazelnut, and peanut have been reported. People with plant allergies may have a higher risk of experiencing allergic reactions to pomegranate.

  • Avoid taking pomegranate fruit husk with oil or fats when used to treat parasites, according to traditional Chinese medicine.

  • Avoid taking pomegranate root by mouth, since it contains a toxic substance called pelletierine. Pomegranate root or stem bark should be used only under the supervision of a medical expert. Overdoses of more than 80 grams may lead to bloody vomit, chills, collapse, dizziness, paralysis, vision problems, and breathing problems that could result in death. Dried pomegranate peel may contain aflatoxin, which may cause liver cancer.

Pregnancy and Breastfeeding

  • Use cautiously in pregnant and breastfeeding women, due to a lack of safety data. Although some animal studies show that pomegranate may induce abortion, consuming pomegranate as a food is likely safe during pregnancy. There is little information available on the topical use (application to the skin) of pomegranate during pregnancy and breastfeeding.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • It is believed that taking pomegranate by mouth at the same time as using other agents may not be safe, as pomegranate contains high levels of a compound called tannin. It is recommended that the use of other agents and of tannin-containing agents be separated by the longest period of time possible.

  • Pomegranate may affect blood pressure. Caution is advised in people taking drugs that affect blood pressure.

  • Pomegranate may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

  • Pomegranate may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

  • Pomegranate may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

  • Pomegranate may also interact with agents that affect the heart, agents that affect the immune system, agents that affect the nervous system, agents that induce abortion, agents that treat skin conditions, agents that treat stomach conditions, antibiotics, anticancer agents, antidiarrhea agents, antifungals, anti-inflammatories, antimalarial agents, antiobesity agents, antiparasite agents, antiulcer agents, antivirals, Alzheimer's agents, buspirone, carbamazepine, cholesterol-lowering agents, fertility agents, hormonal agents, impotence agents, memory agents, midazolam, osteoporosis agents, pain relievers, rosuvastatin, and uterine stimulants.

Interactions with Herbs and Dietary Supplements

  • It is believed that taking pomegranate by mouth at the same time as using other herbs and supplements may not be safe, as pomegranate contains high levels of a compound called tannin. It is recommended that the use of pomegranate and of other tannin-containing herbs and supplements be separated by the longest period of time possible.

  • Pomegranate may affect blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure.

  • Pomegranate may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

  • Pomegranate may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the cytochrome P450 system.

  • Pomegranate may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

  • Pomegranate may also interact with Alzheimer's herbs and supplements, antibacterials, anticancer herbs and supplements, antidiarrheals, antifungals, anti-inflammatories, antimalarials, antiobesity herbs and supplements, antioxidants, antiparasite herbs and supplements, antiulcer herbs and supplements, antivirals, cholesterol-lowering herbs and supplements, fertility herbs and supplements, grapefruit, herbs and supplements that affect the heart, herbs and supplements that affect the immune system, herbs and supplements that affect the nervous system, herbs and supplements that induce abortion, herbs and supplements that treat skin conditions, herbs and supplements that treat stomach disorders, hormonal herbs and supplements, impotence agents, iron, memory herbs and supplements, metal salts, osteoporosis herbs and supplements, pain relievers, phytoestrogens, probiotics, uterine stimulants, and vitamin C.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Bae JY, Choi JS, Kang SW, et al. Dietary compound ellagic acid alleviates skin wrinkle and inflammation induced by UV-B irradiation. Exp.Dermatol. 2010;19(8):e182-e190. View Abstract

  2. Bhadbhade SJ, Acharya AB, Rodrigues SV, et al. The antiplaque efficacy of pomegranate mouthrinse. Quintessence.Int. 2011;42(1):29-36. View Abstract

  3. Borochov-Neori, H, Judeinstein S, Harari M, et al. Climate effects on anthocyanin accumulation and composition in the pomegranate (Punica granatum L.) fruit arils. J.Agric.Food Chem. 5-25-2011;59(10):5325-5334. View Abstract

  4. Christaki EV, Bonos EM, and Florou-Paneri PC. Dietary benefits of pomegranates in humans and animals. Journal of Food, Agriculture & Environment 2011;9(1):142-144.

  5. Elfalleh W, Tlili N, Nasri N, et al. Antioxidant Capacities of Phenolic Compounds and Tocopherols from Tunisian Pomegranate ( Punica granatum) Fruits. Journal of Food Science 2011;76(5):c707-c713.

  6. Gullett NP, Mazurak VC, Hebbar G, et al. Nutritional interventions for cancer-induced cachexia. Curr.Probl.Cancer 2011;35(2):58-90. View Abstract

  7. Johanningsmeier SD and Harris GK. Pomegranate as a functional food and nutraceutical source. Annual Review of Food Science and Technology 2011;181-201.

  8. Kahya V, Meric A, Yazici M, et al. Antioxidant effect of pomegranate extract in reducing acute inflammation due to myringotomy. J.Laryngol.Otol. 2011;125(4):370-375. View Abstract

  9. Kelishadi R, Gidding SS, Hashemi M, et al. Acute and long term effects of grape and pomegranate juice consumption on endothelial dysfunction in pediatric metabolic syndrome. J.Res.Med.Sci. 2011;16(3):245-253. View Abstract

  10. Misaka S, Nakamura R, Uchida S, et al. Effect of 2 weeks' consumption of pomegranate juice on the pharmacokinetics of a single dose of midazolam: an open-label, randomized, single-center, 2-period crossover study in healthy Japanese volunteers. Clin.Ther. 2011;33(2):246-252. View Abstract

  11. Niwano Y, Saito K, Yoshizaki F, et al. Extensive screening for herbal extracts with potent antioxidant properties. J.Clin.Biochem.Nutr. 2011;48(1):78-84. View Abstract

  12. Trombold JR, Reinfeld AS, Casler JR, et al. The effect of pomegranate juice supplementation on strength and soreness after eccentric exercise. J.Strength.Cond.Res. 2011;25(7):1782-1788. View Abstract

  13. Zhang L, Fu Q, and Zhang Y. Composition of anthocyanins in pomegranate flowers and their antioxidant activity. Food Chemistry 2011;127(4):1444-1449.

  14. Zheng X, Liu B, Li L, et al. Microwave-assisted extraction and antioxidant activity of total phenolic compounds from pomegranate peel. Journal of Medicinal Plants Research 2011;5(6):1004-1011.

  15. Zhuang H, Du J, and Wang Y. Antioxidant Capacity Changes of 3 Cultivar Chinese Pomegranate ( Punica granatum L.) Juices and Corresponding Wines. Journal of Food Science 2011;76(4):606-611.

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Updated:  

March 22, 2017