Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated March 1, 2017

Pomegranate (Punica granatum)

What is it?

Scientific names, brand names, common names

Pomegranate (Punica granatum Lythraceae) is the edible fruit of the pomegranate plant, a small tree native to parts of Southeast Asia and cultivated in China, India, the Mediterranean region and parts of the USA 1,2. The outer leathery skin (pericarp) encloses numerous seeds, each surrounded by a translucent sac that contains the juice. Thin, bitter-tasting membranes form a network throughout the fruit. Various parts of the fruit can be utilised or consumed; most commonly the seeds andjuice 3. Common names include dadim fruit, dadima, granada, grenade, Shi Liu Pi 3.

Ingredients/Components

The juice contains polyphenols, mainly anthocyanidins and tannins (including ellagic acid, punicalagin and punicalin), and minerals 1,4,5,39. It also contains ascorbic acid (vitamin C), citric acid, oxalic acid and tartaric acid 1. The seeds contain polyphenols as well as various fatty acids and non-steroidal, oestrogen-like substances 6. The fatty acid component comprises over 95% of the seed oil 1. Tannins are found  in the fruit peel 3. The peel also contains substantial amounts of phenolic compounds including flavonoids 1.

Application and dosage

In general, there is no consensus on dosage 3. In trials in prostate cancer, doses of juice equivalent to between 240ml (8 ounces, 570 mg total polyphenol gallic acid) to 720ml (24 ounces, approximately 3000 mg of polyphenol extract) daily have been used 7,8. The larger dose was administered as capsules with each capsule containing 1g of polyphenol extract comparable to approximately 8 ounces of juice 8. However, this dose was associated with more frequent adverse effects, specifically diarrhoea (see Safety section). Other parts of the plant have also been used. For example, two daily doses of 30mg seed oil (containing 127 μg of steroidal phytoestrogens per dose) was used to treat women with menopausal symptoms 9.

History/providers

The pomegranate has been described in ancient texts including those of Greek mythology, has been held sacred by many of the world’s religions and is featured in several medical coats of arms 10. Thought to have originated in Iran and Afghanistan, cultivation and use of the pomegranate spread through Asia, Mediterranean countries and parts of America 1,10. Pomegranate has been part of folk medicine in many cultures and is used in several systems of medicine, including Ayurvedic and Unani medicine, for a variety of health problems 2. Parts of the plant, such as its bark, petals and peel continue to be used in the Middle East, Asia and South America to treat conditions ranging from diarrhoea and dysentery to gum disease 11,12. Pomegranate has been used in the Indian subcontinent for the treatment of intestinal worms, nosebleeds, ulcers, sore throats 12. In the West, interest in the medical potential of pomegranate began slowly in the 1990s, stimulated by researchers in Israel who reported benefits on cardiovascular health 11.

Claims of efficacy/Alleged indications

The antioxidant, anti-carcinogenic, and anti-inflammatory properties of pomegranate have provided a focus for research 1,12. It has been suggested that pomegranate has potential in the treatment and prevention of cancer, cardiovascular disease, diabetes, oral and dental conditions, erectile dysfunction, bacterial infections and antibiotic resistance 2. It has been used orally for a wide range of conditions including atherosclerosis, congestive heart failure (CHF), hyperlipidaemia, hypertension, myocardial ischaemia, acidosis, haemorrhage, HIV disease and intestinal worms 3. Oestrogenic activity, albeit weak, has led to interest in its potential benefits in menopausal symptoms 1,9. The main interest in the area of cancer has been in the prevention of prostate cancer based on early reports of in vitro activity. Pomegranate is also suggested for other cancers including breast, colon and liver cancers, again based primarily on its activity in vitro 12

Mechanisms of action

The major effects of constituents of pomegranate extracts are anti-inflammatory, antioxidant and anticancer activity 1. In cancer prevention, the relevant activities include those on carcinogenesis, the cell cycle, differentiation and enzyme activity, including inhibition of carbonic anhydrase and aromatase 1. Activity relevant to treatment of cancer includes effects on angiogenesis, apoptosis, tumour cell invasion and proliferation 1. Pomegranate extracts have shown significant anti-tumour activity against human prostate cancer cells: cold-pressed oil and polyphenols extracted from the juice and pericarp (peel) suppressed the proliferation, pericarp polyphenols and seed oil inhibited growth of xenografts and various extracts suppressed invasion 13. Similar inhibition in tumour growth was shown in a subsequent animal study 14. A significant decrease in serum prostate-specific antigen levels was also demonstrated. In breast cancer ellagitannin-derived compounds inhibited aromatase activity as well as cell proliferation 15. Ellagitannins also reduced inflammatory cell signalling in colon cancer1 while quercetin has been shown to inhibit lung cancer cell growth with effects via the cell cycle and induction of apoptosis 1. The juice appears to have great bioactivity than the single purified active ingredients 16.

Pre-clinical studies have demonstrated a range of effects on various cancer cell lines, including breast, colon and prostate cells 1. Pomegranate juice, peel and oil have been shown to interfere with tumour cell proliferation, cell cycle, invasion and angiogenesis1. Recent studies have also reported anti-oestrogenic effects 24 and a possible effect in sensitising cells to the cancer drug tamoxifen 25, both potentially of benefit in breast cancer .

Prevalence of use

Pomegranate juice is widely used as a beverage. A survey of patients attending a cancer centre in England revealed that 1.7% (7 out of 422 patients) used pomegranate 17. A more recent survey, also in the UK, reported use by 13.6% of women with breast cancer 18.

Legal issues

Pomegranate juice and fruits are widely available in most countries. Pomegranate seed oil and capsules or tablets containing pomegranate extract can be purchased from health food shops and some pharmacies, as dietary supplements. In the UK, preparations containing pomegranate bark can only be sold in registered pharmacies and by or under the supervision of a pharmacist 19. In a case of a manufacturer making claims of effectiveness of pomegranate preparations without sufficient supporting research being available, this led to the FDA issuing a warning letter 20.

Costs and expenditures

The cost of pomegranate products varies considerably. Pomegranate juice can be purchased for between 2 and 16 Euros per litre depending on the quality and source. The cost of pomegranate seed oil varies between 5 and 15 Euros per 10ml. Pomegranate extract tablets or capsules cost 4 to 20+ Euros per 30.

Citation

Karen Pilkington, CAM-Cancer Consortium. Pomegranate (Punica granatum) [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Pomegranate-Punica-granatum. March 1, 2017.

Document history

Fully revised and updated in March 2017 by Karen Pilkington.

First published in January 2013, authored by Karen Pilkington.

References

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