By Dr. D. Lindsey Berkson

Pomegranates are as close to a miracle food as Mother Nature gets. Pomegranates protect your heart, safeguard your estrogens, “sensitize” insulin receptors better than many diabetic drugs without nasty side effects, slow down aging, and fight cancer.  A pomegranate a day keeps the Mack truck of disease away!

My grandmother often said, in her very thick Russian accent, “If it sounds too good to be true, it usually is too good to be true.” This does not seem to be the case with these juicy purple fruits and kernels (arils).

Pomegranates fight against lots of bad stuff: inflammation, oxidative stress, bad cholesterol, heart disease, kidney disease, cognitive disease, diabetes, obesity, and cancer.

Pomegranates support a lot of good actions: nitric oxide availability and levels, kidney health, blood vessel health, heart health, bone health, immune response, mitochondrial activity, and brain protection.

Pomegranates and Heart Health

I went for a thorough cardiac workup in October 2018, not because anything was wrong, but because my odometer was moving past the 200,000-mile marker and needed an under-the-hood checkup. My functional cardiologist, Mark Houston, MD, ran several days’ worth of testing. Included was a thorough look-see at my genes that regulate every aspect of the human cardiovascular system.

Genetic glitches or variants of these genes, referred to as polymorphisms, are a contributor to heart disease. You can take a look at your heart-related genes and see if any of them are glitchy or twitchy, putting you at increased risk of something going wrong (in heart health, this usually means heart attack or stroke).

My genomic panel showed excessive levels of faulty ApoC-III genes.¹ This gene is a key regulator of triglycerides and sugar metabolism.² Elevated levels or impaired genes are associated with lipid issues and glucose metabolism issues no matter how you eat. And, by the way, for those with these glitches eating keto can be very troublesome, rather than healthy. ApoC-III mutations are associated with increased risk of heart disease and Type 2 diabetes.³

This gene also helps your good cholesterol do good things, such as pick up your peripheral cholesterol and take it, in “physiologic garbage trucks” so to speak, back to the liver for healthy processing.

Daily consumption of pomegranate supports health and protects against major diseases.

I had good levels of my good cholesterol. But behind the scenes, because of this genetic glitch, my good cholesterol was actually bad. Thus, I was at risk for nasty stuff. All this created a terrain in which the ketogenic diet I’d been adhering to for the last year was actually working “against” me rather than “for” me.

Dr. Mark said, “You love food as medicine, right? So, I’m prescribing pomegranates.” Dr. Mark said pomegranates are medical food that turn this bad gene “off” and boost the “good” functionality of the good cholesterol. Why? Pomegranates are a marvel food. But this benefit only happens if you consume them in an adequate dose on a regular basis, such as one-fourth to one-half cup most days of the week.

How Pomegranate is A Heart Helper

• Makes ApoC-III glitches work better, which improves triglycerides, lipids, cholesterol, and even blood glucose levels.
  
• Lowers bad cholesterol. High levels of circulating low-density lipoprotein (LDL) are the primary “initiating” events in the development of atherosclerosis (plaque in arteries, which is one hallmark of heart disease). Punicalagin, one of the main plant compounds in pomegranate, binds with a protein that surrounds LDL⁴ and then helps move it out of the bloodstream. Both pomegranate juice and punicalagin remove LDL out of the bloodstream and then stimulate LDL to move into white blood cells, called macrophages, which “lowers” circulating bad cholesterol levels even more.⁵
  
• Lowers oxidized cholesterol. Fats that are oxidized are especially nasty acting and can damage the lining of blood vessels (endothelium), which leads to atherosclerosis (heart disease). Pomegranate juice is rich in antioxidants, which prevent LDL cholesterol from oxidizing and thus protects your precious endothelium and heart.⁶
• Makes cholesterol less dangerous and less sticky. Drinking or eating pomegranates fights heart disease. A scientific way of putting it is that pomegranates have “potent anti-atherogenic” effects. In human studies, drinking pomegranate juice decreased bad cholesterol and made it less dangerous. How? Pomegranate compounds make bad cholesterol less likely to “stick together” in heart-dangerous, potentially clot-forming ways.⁶
• Boosts enzymes that keep blood fats healthier. Pomegranates up-regulate an enzyme called serum paraoxonase. This enzyme protects good cholesterol (HDL) from being oxidized (protects against lipid peroxidation, which is heart dangerous). This enzyme stops blood fats from releasing dangerous pro-oxidative compounds.⁶
• Reduces size of plaque (atherosclerotic lesions). In mice with heart disease (plaque in their arteries) given pomegranate juice, the size of their atherosclerotic lesions reduced by 44% compared with control mice given water instead.⁶
• Lowers blood pressure. A small pilot study out of Israel⁷ (10 patients) found drinking one glass a day of pomegranate juice for one year (consistently) increased antioxidant blood activity by 130%, reversed plaque buildup in carotid arteries by 29%, increased the protective enzyme mentioned above by 89%, lowered blood pressure by 12%, and reduced cholesterol oxidation. They followed these participants for another two years, but the benefits stayed at the level achieved at the end of the first year.
• Blood clotting. A number of studies showed that pomegranates make platelets less sticky and less likely to clot, reducing stroke events in high-risk patients.^6,8,9
• Increases nitric oxide. Several different studies have found that pomegranates boost nitric oxide protection, which keeps the lining of blood vessels (endothelium) more relaxed and healthy and less vulnerable to damage (initiating heart disease)⁹ and reduces dangerous inflammation.⁹ Pomegranates also improve nitric oxide “availability” by the body.¹⁰
• Treats angina. Five days of 7.5 ounces of pomegranate juice was given to ischemic heart patients in the hospital (100 patients randomized to experimental or control groups).Pomegranate juice caused significant reductions in the intensity, occurrence, and duration of angina pectoris in patients with unstable angina. Consistently, the test patients had significantly lower levels of serum troponin and malondialdehyde. The results of this study suggest “protective” effects of pomegranate juice against myocardial ischemia and reperfusion injury.¹¹

Researchers suggest that kidney patients (both with kidney disease not on dialysis as well as those on dialysis), all of whom are prone to heart disease complications, can minimize cardiac damage by regularly consuming pomegranates.¹² Giving pomegranates while on dialysis reduces inflammatory cardiac markers1³ and is suggested by a number of scientists at the conclusion of their research.

I was so excited to see the “benefits” of a regular menu of pomegranates for the heart, I sleuthed the literature to see what else pomegranates might provide for humans.

Diving into the pomegranate peer-review literature opened up a treasure chest.

It turns out that all parts of pomegranates contain healthy plant compounds. Healthy substances are found inside the reddish kernel (referred to as a pomegranate “aril”) and inside the whitish seed core in the middle of the kernel where the distinct oil and fiber lives. Pomegranate juice contains all of these components, though it contains more available sugars when chewing the arils whole.

The pomegranate aril with all these plant compounds is one of the most potent antioxidants known to modern science.

The Many Ways Pomegranates Heal Us

Pomegranates contain a one-of-a-kind omega fatty acid. Arils contain seeds and the seeds contain oils. Most of the oil (80%) is made up of a unique omega-5 fatty acid. Omega-5 is the only known botanical form of conjugated linolenic acid (CLnA), also known as punicic acid. The term punicic acid comes from the fruit’s official name Punica granatum L.

It’s rather extraordinary that no other plant in the world contains omega-5 fatty acid. This oil is a gift to mankind from Mother Nature to help us stay well or fight off disease.

You can chew pomegranate arils mindfully to get the oil out of the seed (if your digestive enzymes are working optimally). Your stomach acid does not inactivate the healthy fatty acids in the seed oil.¹⁴ When making pomegranate juice, the whole aril is juiced so the seed oils are present in the juice.

Punicic acid is rather magical, having anti-cancer, anti-diabetes, anti-obesity, antioxidant, and anti-inflammatory properties.¹⁵ Pomegranates protect mitochondria (energy factories inside cells) from oxidative stress and other stressors and even from intense exercise adverse consequences.^16,17 Mitochondria make energy inside cells. Thus, pomegranates boost energy. Pomegranates protect the liver against oxidative damage.¹⁸

Pomegranates are type-2 diabetics best friend. Why? Pomegranates care-take the insulin receptor just like many diabetic drugs do, but without nasty side effects. Punicic acid (PA), the main ingredient of pomegranate seed oil, is a “peroxisome proliferator-activated receptor gamma” agonist. This means it signals insulin receptors. Yet, unlike synthetic insulin signalers, such as the diabetic family of drugs called thiazolidinediones, pomegranate oil has no nasty side effects.

Pomegranate signals “both” insulin receptors. Pomegranate is a dual activator of peroxisome proliferator-activated receptor (PPAR)-alpha and -gamma. Signaling these receptors improves hyperglycemia, hyperlipidemia (in humans), and reduces fatty and fibrotic heart tissue in diabetic animals.¹⁹

PA exerts anti-diabetic effects via various mechanisms, such as reducing inflammatory molecules (cytokines), helping achieve and maintain healthy blood glucose levels, and antioxidant properties. Pomegranate compounds can reboot damaged pancreatic cells (Islets of Langerhans), at least in rodents.²⁰ Healthy beta cells mean healthier insulin/glucose balance. Pomegranates are so helpful on so many levels where diabetes can cause issues, researchers suggest that pomegranate should be considered in the management of type 2 diabetes.²¹ And pomegranates fight insulin resistance.²²

Pomegranate protects breasts.²³ Pomegranates’ omega-5 fatty acids act as a “selective estrogen receptor modulator” or (SERM). Punicic acid down-regulates (shuts up) estrogen receptor signals. Pomegranate tamps down the signals from estradiol. Thus, pomegranate is a “Food SERM”2⁴ acting like a gentle botanical tamoxifen.

Pomegranate contains plant estrogens, which have estrogenic activities. Because of this some researchers have suggested that pomegranate is clinically helpful for menopausal women to improve depressive states and bone loss.²⁵ I doubt this since pomegranate’s estrogenic activity is protective against estrogen growth signals and tamps down estrogenic signals, rather than increasing them. But it could be that pomegranates help these issues from other mechanisms, such as reducing inflammation and boosting mitochondria.

Some clinicians say that pomegranates are like an “adaptogenic food estrogen,” increasing estrogen when more is needed and decreasing estrogen when less is needed. I have not seen this in the literature, but it’s something to watch out for clinically and in peer review data.

You might wonder: if pomegranates contain estrogens, is this good or bad for cancer patients? Laboratory studies suggest pomegranate plant compounds don’t raise estrogen levels in the blood and may even cause a slight decrease. In one study pomegranate juice consumption was tested for how it affected blood levels of estradiol, estrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG).

Sixty-four healthy postmenopausal women²⁶ were randomly assigned to drink 8 ounces of either 100% commercial pomegranate juice (interventional group) or apple juice (control group) for three weeks. Women on the pomegranate juice had no change in hormones or their hormone binding protein. In a subgroup of 38 normal weight women, women drinking the pomegranate juice compared to a control group had a significant decline in estrone (the pro-carcinogenic estrogen) and testosterone levels.

Pomegranates are a breast and prostate cancer survivor’s best friend. Pomegranate polyphenols (plant compounds) are inhibitory of metastatic processes in breast cancer and prostate cancer cells, suggesting they may prevent cancer progression in general.²⁷

Pomegranate is a powerful tumor fighter²⁸ as shown in many studies. Pomegranate fruit, as well as its juice, extract, and oil, exert anti-inflammatory, anti-proliferative, and anti-tumorigenic properties by modulating multiple signaling pathways. Some scientists suggest pomegranates as promising chemo-preventive/chemotherapeutic agents in both the prevention and treatment of skin, breast, prostate, lung, and colon cancers.²⁸

Surgery, radiation and even chemo mainly address “daughter” cancer cells. Yet it’s “cancer stem cells” that cause cancer to recur. Cancer stem cells (CSCs) help make cancer cells self-renew, initiate tumors, and resist therapy. You want tools to fight cancer stem cells if you’ve had cancer and you want to “make remission your mission.” Pomegranate extract has been found to do this.

Pomegranate compounds inhibits CSCs’ ability to self-renew. Pomegranate compounds make cancer stem cells less active and more of what is called differentiated. Pomegranate also reduces cell migration, a major feature of traveling metastatic cancer. The ability of the magical stuff inside pomegranates to suppress CSCs can be used to both prevent and aid in the prevention of recurrence of cancers, such as breast cancer, according to top cancer centers of New York State.²⁹

So, yes, pomegranate contain some plant estrogens; but like soy compounds, they help keep our estrogens healthier and help fight off cancer where it starts.

Pomegranates help control “growth-out-of-control” from estrogen signals (anti-proliferative and pro-apoptotic effects – good for protecting against cancer in the first place or with recurrence). When mice are exposed to a cancer-causing drug, DMBA, many of them get mammary tumors, but not if they are “pretreated” with pomegranate emulsion.³⁰ This suggests that taking pomegranates daily would protect from various future toxic exposures.

Pomegranate seed oil blocks proliferation (90% inhibition) of ER+ laboratory breast cancer cells (called MCF-7cells, first harvested from a nun and then cultured continually in experimental cancer labs all over the world) and cause 54% of cancer cell death in ER- breast cancer cells (MDA-MB-435).³¹ This is why pomegranate seed oil is good to massage into breasts prophylactically or adjunctively. Run this by your own practitioner that knows your personal history. The use of juice, peel, and oil has also been shown to possess anticancer activities, including interference with tumor cell proliferation, cell cycle, invasion and angiogenesis (getting food to the tumor so it can keep growing).³²

Natural pomegranate peel extract has been found to inhibit breast cancer progression.³³ The pomegranate peel acts by modulating the microenvironment of tumors. For you geeks, this refers to the matrix glycoproteins including MMP9 and fibronectin. These scientists put nasty aggressive triple negative breast cancer cells in with pomegranate peel extract, and these cancer cells died. These are some of the toughest breast cancer cells there are. The authors say that pomegranate peel extract helps stop metastases in these nasty breast cancer cells. Metastases, cells traveling from the primary tumor throughout the body, is how cancer kills.^33,34 But eating the bitter pomegranate peel is not like consuming the sweet arils, so one would have to do this in a concentrate in a capsule.

Blue, purple, reddish plant pigments contain plant anthocyanins. Anthocyanins are pigments that give plants these purple/blue/black colors. These pigments fight cancer cells, especially stem cancer cells, and cause them to “die.” These pigments are found in high amounts in the skin and lesser amounts in the arils, or berries, of pomegranates. But they are cancer fighters.^35,36 I think if I were presently fighting breast cancer, I would be juicing the whole fruit pomegranates when in season. But I have never tried juiced pomegranate peel, and it might just be too bitter!

Pomegranates have anti-inflammatory effects.³² Remember, most diseases are caused by excessive inflammation out of control at specific cellular levels.

Pomegranates have neuroprotective effects. They protect your brain. They are so brain protective that when given to rodents exposed to deadly prions, they postpone the brain damage.³⁷

Kidney Effects

In both Chinese and Western medicine, the kidneys “drive” the health of the cardiovascular system. Often similar molecules demonstrate stress of both systems. Since the kidney and heart are so intertwined, it is not surprising that pomegranates, which are very heart protective, are also very kidney friendly.

Kidney disease patients are at higher risk of heart disease than the typical population. Pomegranates protect these patients in two ways:

• Pomegranates protect the kidney itself, and
• Pomegranates minimize downstream adverse cardiac consequences of kidney issues.

When animals are “pretreated” with nasty compounds that typically damage the kidneys, pomegranate protects the animals from the typical extent of renal (kidney) damage. Pretreatment with pomegranate blocks numerous toxic chemicals that would normally damage the kidney. Pretreatment with pomegranate compounds counteracts kidney inflammation, oxidative/nitrative stress, and apoptosis (kidney cell death). This has been shown in studies exposing mice to multiple kidney stressors, such as injections of nephrotoxic LPS (lipopolysaccharide)³⁸ and lead acetate.³⁹

Adult mice given a shot of a substance that usually induces diabetes and diabetic tissue damage were not damaged in this manner if pretreatment was done with pomegranate compounds.⁴⁰

Pomegranate pretreatment protects kidneys against chloride renal damage in rats.⁴¹ Numerous studies show protection against kidney damage and, in fact, renal stabilization, when cancer drugs (chemotherapeutic drugs) are given after a prophylactic pretreatment of pomegranate juice.⁴²

One study found that giving pomegranate along with the cancer drug cisplatin not only protected the kidney but also helped fight the cancer!⁴³ The scientists recommended pomegranate supplements should be taken to accomplish all of the above, and more.

In fighting cancer, pomegranates are a food adjunctive tool to consider and run by your practitioners.

Dialysis patients have improved kidney and heart health when drinking pomegranate juice.¹³

Brain Effects

Decrease brain inflammation and boost brain protection³⁷ and plasticity. Pre-supplementing 4% pomegranate extract into standard chow and given to rats showed protection of brain neurons, decrease in neuroinflammation, and improvement in synaptic plasticity.

These neuroprotective effects were associated with less adverse brain changes in mice bred to have Alzheimer-like brain changes! These scientists suggest that long-term supplementation with pomegranates can slow down the progress of this cognitive disease.⁴⁴

Where to Get Pomegranate Arils?

Most everywhere. Wal-Mart, Costco, Whole Foods, Trader Joes, and the list goes on. Go to the section that contains fruit in containers. You can use the juice if you have no issues with insulin resistance or blood sugar maintenance. Purchase as many containers of arils as you can and, like myself, fill your freezer and consume one-fourth to one-half cup/day.

As pomegranates go out of season, sometimes they have been frozen. Then they taste a bit alcoholic or fermented, but they still give huge benefits no matter the taste.

Contraindications: There is potential cross-reactivity with peaches. If you are allergic to peaches, you “may” have reactivity to pomegranates.²¹ Tread lightly or don’t eat daily.

May the pomegranate force be with you!

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Devaki Lindsey Berkson, DC, has been in practice in functional medicine, with an emphasis on nutrition, hormones, intimacy, and digestion, for decades. Dr. Berkson is professor for higher board certification programs for medical professionals to become functional practitioners, such as A4M and PCCA. Dr. Berkson was a scholar at a hormone think-tank at Tulane, published original research with the University of Texas Medical School at Houston, and is a research fellow with Health Sciences Collegium.

Dr. Berkson has been asked to be on a panel for the symposium “Functional Medicine is Coming” to the entire hospital staff at Houston Memorial Hospital this summer in 2019.Dr. Berkson wrote the first gut, mind, nutrition book published by Wiley (Healthy Digestion the Natural Way) and one of the first books on hormone-altering-chemicals ( Hormone Deception. Dr. Berkson’s newest book, Sexy Brain, presents the newest health issue (environmental castration) and how to protect our intimacy and brain.

Dr. Berkson consults around the world with patients and their docs. She has a very popular podcast, Dr. Berkson’s Best Health Radio, along with Berkson Blog at DrLindseyBerkson.com.

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