Pomegranate (Punica granatum)
Abstract and key points
- Pomegranate (Punica granatum) is an edible fruit traditionally used to treat a range of ailments
- Pomegranate juice and extracts have been used in trials in prostate cancer
- Evidence on effectiveness in cancer is insufficient
- Few adverse effects have been reported with the juice but there is limited safety data on other extracts
Pomegranate (Punica granatum) is an edible fruit originating in the Middle East, the juice of which is widely available commercially. Various parts of the fruit including the juice have been used traditionally to treat a range of ailments.
The juice and other extracts have shown a wide range of bioactivity in pre-clinical studies, such as anti-inflammatory, anti-infective and anti-oxidant effects.
On the basis of this research, beneficial effects are claimed in cancer, specifically in the prevention and treatment of prostate cancer.
Few clinical trials in cancer have been conducted to date: an uncontrolled trial showed promising beneficial effects on prostate specific antigen (PSA) doubling time in prostate cancer but subsequent randomised controlled trials have failed to show any difference between pomegranate and placebo. One small randomized clinical trial did not show an effect of pomegranate consumption on breast cancer risk.
Pomegranate juice has been widely consumed for many years and has been used in studies lasting up to 3 years and appears to be safe. A small number of cases of allergic reactions and possible interaction with warfarin have been reported although causation has not been proven. Limited safety data is available on extracts. There has been a report of genotoxicity in an in vivo study using very high doses of whole fruit extract.
There is insufficient evidence from clinical studies to draw conclusions about possible effectiveness in cancer but there do not appear to be any serious concerns as to the safety of pomegranate juice extracts with usual therapeutic doses.
|Citation||Karen Pilkington, CAM-Cancer Consortium. Pomegranate (Punica granatum) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Pomegranate-Punica-granatum. December 16, 2016.|
- Lansky EP, Newman RA. Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer. J Ethnopharmacol. 2007;109(2):177-206.
- Jurenka JS. Therapeutic applications of pomegranate (Punica granatum L.): a review. Altern Med Rev. 2008;13(2):128-44.
- Natural Medicines Comprehensive Database: professional version. Pomegranate monograph. Stockton (CA): Therapeutic Research Faculty. Available at: http://naturaldatabase.therapeuticresearch.com. Accessed 28th February 2017.
- Schubert SY, Lansky EP, Neeman I. Antioxidant and eicosanoid enzyme inhibition properties of pomegranate seed oil and fermented juice flavonoids. J Ethnopharmacol 1999;66:11-7.
- Wang RF, Xie WD, Zhang Z, et al. Bioactive compounds from the seeds of Punica granatum (pomegranate). J Nat Prod 2004;67:2096-8.
- Moneam NM, el Sharaky AS, Badreldin MM. Oestrogen content of pomegranate seeds. J Chromatogr 1988 438:438-42.
- Pantuck AJ, Leppert JT, Zomorodian N, Aronson W, Hong J, Barnard RJ 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 12(13):4018-26.
- Paller CJ, Ye X, Wozniak PJ, Gillespie BK, Sieber PR, Greengold RH 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;16(1):50-5.
- Auerbach L, Rakus J, Bauer C, Gerner C, Ullmann R, Wimmer H, Huber J. Pomegranate seed oil in women with menopausal symptoms: a prospective randomized, placebo-controlled, double-blinded trial. Menopause. 2012;19(4):426-32.
- Langley P.BMJ. Why a pomegranate? BMJ. 2000;321(7269):1153-4.
- Longtin R. The pomegranate: nature's power fruit? J Natl Cancer Inst. 2003;95(5):346-8.
- Ismail T, Sestili P, Akhtar S. Pomegranate peel and fruit extracts: A review of potential anti-inflammatory and anti-infective effects. J Ethnopharmacol. 2012;143(2):397-405.
- Albrecht M, Jiang W, Kumi-Diaka J, Lansky EP, Gommersall LM, Patel A, Mansel RE, Neeman I, Geldof AA, Campbell MJ. Pomegranate extracts potently suppress proliferation, xenograft growth, and invasion of human prostate cancer cells. J Med Food. 2004;7(3):274-83.
- 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 USA. 2005;102(41):14813-8.
- Adams LS, Zhang Y, Seeram NP, Heber D, Chen S. Pomegranate ellagitannin-derived compounds exhibit antiproliferative and antiaromatase activity in breast cancer cells in vitro. Cancer Prev Res (Phila). 2010;3(1):108-13.
- Seeram NP, Adams LS, Henning SM, Niu Y, Zhang Y, Nair MG, Heber D. In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. J Nutr Biochem. 2005;16(6):360-7.
- Zavery B, Appleton L, Sandiford K, Wong H, Hughes J. Complementary and alternative medicine use amongst oncology patients attending a large cancer centre in England. Progress in Palliative Care 2010;18(2): 89-93.
- McLay JS, Stewart D, George J, Rore C, Heys SD. Complementary and alternative medicines use by Scottish women with breast cancer. What, why and the potential for drug interactions? Eur J Clin Pharmacol. 2012;68(5):811-9.
- Medicines and Healthcare products Regulatory Agency (MHRA). Banned and r restricted herbal ingredients (2014). Available at: https://www.gov.uk/government/publications/list-of-banned-or-restricted-herbal-ingredients-for-medicinal-use/banned-and-restricted-herbal-ingredients. Accessed 31st January 2017.
- US Food and Drug Administration (FDA) 2010. Pom Wonderful: Warning Letter. Available at: http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm202785.htm. Accessed 29th February 2017.
- Adhami VM, Khan N, Mukhtar H. Cancer chemoprevention by pomegranate: laboratory and clinical evidence. Nutr Cancer. 2009;61(6):811-5.
- Pantuck AJ, Zomorodian N, Belldegrun AS. Phase-II Study of pomegranate juice for men with prostate cancer and increasing PSA. Curr Urol Rep. 2006;7(1):7.
- Carducci MA, Paller CJ, Wozniak P, Sieber P, Greengold R, Stockton B et al. A phase II study of pomegranate extract for men with rising prostate-specific antigen following primary therapy. J Clin Oncol 2011 (suppl 7; 11).
- Sturgeon SR, Ronnenberg AG. Pomegranate and breast cancer: possible mechanisms of prevention. Nutr Rev. 2010;68(2):122-8.
- Banerjee S, Kambhampati S, Haque I, Banerjee SK. Pomegranate sensitizes Tamoxifen action in ER-α positive breast cancer cells. J Cell Commun Signal. 2011;5(4):317-24.
- Sánchez-Lamar A, Fonseca G, Fuentes JL, Cozzi R, Cundari E, Fiore M, Ricordy R, Perticone P, Degrassi F, De Salvia R. Assessment of the genotoxic risk of Punica granatum L. (Punicaceae) whole fruit extracts. J Ethnopharmacol. 2008;115(3):416-22.
- Jarvis S, Li C, Bogle RG. Possible interaction between pomegranate juice and warfarin. Emerg Med J. 2010;27(1):74-5.
- Komperda KE. Potential interaction between pomegranate juice and warfarin. Pharmacotherapy. 2009;29(8):1002-6.
- Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol. 2006;98(5):705-6.
- Vlachojannis C, Zimmermann BF, Chrubasik-Hausmann S. Efficacy and safety of pomegranate medicinal products for cancer. Evid Based Complement Alternat Med. 2015;2015:258598.
- Freedland SJ, Carducci M, Kroeger N, Partin A, Rao JY, Jin Y et al. A double-blind, randomized, neoadjuvant study of the tissue effects of POMx pills in men with prostate cancer before radical prostatectomy. Cancer Prev Res (Phila). 2013;6(10):1120-7.
- Stenner-Liewen F, Liewen H, Cathomas R, Renner C, Petrausch U, Sulser T et al. Daily Pomegranate Intake Has No Impact on PSA Levels in Patients with Advanced Prostate Cancer - Results of a Phase IIb Randomized Controlled Trial. J Cancer. 2013;4(7):597-605.
- Paller CJ, Ye X, Wozniak PJ, Gillespie BK, Sieber PR, Greengold RH 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.
- Pantuck AJ, Pettaway CA, Dreicer R, Corman J, Katz A, Ho A, Aronson W, Clark W, Simmons G, Heber D. A randomized, double-blind, placebo-controlled study of the effects of pomegranate extract on rising PSA levels in men following primary therapy for prostate cancer. Prostate Cancer Prostatic Dis. 2015;18(3):242-8.
- Nuñez-Sánchez MA, Dávalos A, González-Sarrías A, Casas-Agustench P, Visioli F, Monedero-Saiz T et al. MicroRNAs expression in normal and malignant colon tissues as biomarkers of colorectal cancer and in response to pomegranate extracts consumption: Critical issues to discern between modulatory effects and potential artefacts. Mol Nutr Food Res. 2015;59(10):1973-86.
- Sahebkar A, Gurban C, Serban A, Andrica F, Serban MC. Effects of supplementation with pomegranate juice on plasma C-reactive protein concentrations: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2016;23(11):1095-102.
- Turrini E, Ferruzzi L, Fimognari C. Potential Effects of Pomegranate Polyphenols in Cancer Prevention and Therapy. Oxid Med Cell Longev. 2015;2015:938475.
- Kapoor R, Ronnenberg A, Puleo E, Chatterton RT, Jr., Dorgan JF, Seeram NP, et al. Effects of Pomegranate Juice on Hormonal Biomarkers of Breast Cancer Risk. Nutrition and cancer. 2015;67(7):1113-9.
- Zarfeshany A, Asgary S, and Javanmard SH. Potent health effects of pomegranate. Adv Biomed Res. 2014; 3: 100.
- Park SJ, Yeo CW, Shim EJ, Kim H, Liu KH, Shin JG, Shon JH. Pomegranate juice does not affect the disposition of simvastatin in healthy subjects. Eur J Drug Metab Pharmacokinet. 2016 Aug;41(4):339-44.
- Abdlekawy KS, Donia AM, Elbarbry F. Effects of Grapefruit and Pomegranate Juices on the Pharmacokinetic Properties of Dapoxetine and Midazolam in Healthy Subjects. Eur J Drug Metab Pharmacokinet. 2016 Jun 13. [Epub ahead of print] DOI: 10.1007/s13318-016-0352-3
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