Pomegranate

What it is

Pomegranate is the fruit of the tree Punica granatum L., used both as a food and as a source of concentrated supplement extracts. Reviews describe it as carrying a large number of bioactive compounds, chiefly ellagitannins and ellagic acid together with anthocyanins. The ellagitannins are not absorbed intact: gut bacteria break them down into ellagic acid and then into dibenzopyran-6-one compounds called urolithins. Juice, peel and standardised capsule extracts are all sold, and the parts of the plant differ in their safety profile.

What the research says

The strongest evidence is for a small average reduction in blood pressure: a 2026 meta-analysis of 33 clinical trials pooled a fall of about 3.5 mmHg systolic and 1.5 mmHg diastolic. An earlier systematic review of 8 randomised trials reached the opposite reading of the same field, saying the evidence fails to convincingly show a benefit. For prostate cancer, where pomegranate was heavily marketed, a placebo-controlled trial of 102 men found no difference in PSA. Effects on cholesterol are not clearly established. Reported harms are mostly digestive, with allergic reactions including anaphylaxis described in case reports, and the root, stem and peel are flagged as potentially unsafe in large amounts.

Evidence grade: Limited evidence.

What goes wrong

In the same trial the most frequent adverse events were bowel disturbances, reported with rates in each arm, and no grade 3 or higher toxicity occurred. (Source 1)

• Randomized trial, Moderate certainty.
• Size: 94 patients completing the first period.
• Who: men with advanced prostate cancer.
• How long: 8 weeks.
• Result: obstipation 2/46 (4%) placebo and 1/48 (2%) pomegranate; one placebo patient withdrew for grade 2 obstipation; grade 1 diarrhoea 1/48 (2%) in the juice arm and none on placebo.
• Funding: partially funded by the Biotta AG Company.

Obstipation was observed in both groups: 2/46 (4%) in the placebo group and 1/48 (2%) in group B.

A randomised dose-exploring trial of pomegranate extract in men with rising PSA found no difference between 1 g and 3 g doses, and diarrhoea was clearly dose-related. (Source 2)

• Randomized trial, Moderate certainty.
• Size: 104 patients enrolled and treated.
• Who: men with rising PSA after primary therapy for prostate cancer and no metastases; ITT population 96% white, median age 74.5 years.
• How long: up to 18 months.
• Result: PSA doubling time 11.9 to 18.8 months (1 g) and 12.2 to 17.5 months (3 g), no significant difference between dose groups (P=0.554); diarrhoea 1.9% (1 g) vs 13.5% (3 g)
• Funding: not stated in the abstract.

Although no clinically significant toxicities were seen, diarrhea was seen in 1.9% and 13.5% of patients in the 1- and 3-g dose groups, respectively.

A case report describes anaphylaxis minutes after eating pomegranate in a young woman, explained by cross-reactivity with peach lipid transfer protein. (Source 3)

• Case report, Very low certainty.
• Size: 1 patient.
• Who: an 18-year-old woman with prior reactions to apple and pear juice.
• How long: single exposure.
• Result: angio-oedema, generalised urticaria, glottis oedema, vomiting, abdominal pain and malaise within five to ten minutes of ingestion.
• Funding: not stated.

angio-oedema, generalised urticaria, glottis oedema, vomiting, abdominal pain and malaise five to ten minutes after ingesting a pomegranate

Because pomegranate juice commands a price premium, adulteration with cheaper juices is a recognised authenticity problem, and simple spectroscopy only detects apple juice dilution above about 20% by volume. (Source 4)

• Survey study, Very low certainty.
• Size: laboratory samples of fresh squeezed aril juice spiked with apple juice concentrate.
• Who: not human participants; juice samples.
• How long: not applicable.
• Result: OPLS-DA of UV–visible spectra detected adulteration above 20% v/v apple juice concentrate.
• Funding: not stated.

OPLS-DA analysis of UV–visible spectra proved to be a suitable method to detect pomegranate juices adulterated by more than 20% v/v apple juice concentrate.

NCCIH's position, as of April 2025, is that pomegranate juice may help blood pressure but that lipid effects are unclear and the root, stem and peel may be unsafe in large amounts. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public.
• How long: not applicable.
• Result: no numbers given; a qualitative agency summary.
• Funding: US government agency.

Pomegranate root, stem, and peel may not be safe when consumed in large amounts because they contain substances that can have harmful effects.

What the evidence supports

Pooling 33 clinical trials, pomegranate supplementation was associated with small but statistically significant reductions in systolic and diastolic blood pressure. (Source 6)

• Meta-analysis, Certainty not rated.
• Size: 33 studies.
• Who: adults in clinical trials of pomegranate.
• How long: not stated in the abstract; trials searched from inception to January 2026.
• Result: systolic WMD −3.52 mmHg (95% CI −4.97 to −2.06; P < 0.001); diastolic WMD −1.50 mmHg (95% CI −2.58 to −0.42; P = 0.006); IL-6 SMD −0.82 (95% CI −1.29 to −0.35; P = 0.001); ICAM-1 SMD −0.59 (95% CI −0.97 to −0.22; P = 0.002)
• Funding: supported by the Nutrition and Food Security Research Center, Isfahan University of Medical Sciences.

The Findings from 33 studies indicated significant reductions in systolic blood pressure (WMD: −3.52 mmHg; 95% CI: −4.97 to −2.06; P < 0.001), diastolic blood pressure (WMD: −1.50 mmHg; 95% CI: −2.58 to −0.42; P = 0.006)

An industry-funded 12-week randomised trial of pomegranate extract in older adults reported a fall in systolic blood pressure and in two inflammatory markers, with other markers unchanged. (Source 7)

• Randomized trial, Low certainty.
• Size: 86 participants eligible, 76 completed.
• Who: apparently healthy older adults with no diagnosed disease, normal-weight and overweight.
• How long: 12 weeks.
• Result: systolic BP fell by 5.22 ± 1.26 mmHg (SE), p = 0.04; diastolic 2.94 ± 1.08 mmHg (SE), p = 0.3; IL-6 p = 0.02 and IL1-β p = 0.05; CRP and TNF-α not significant (p > 0.05)
• Funding: industry-funded: funded by Euromed S.A.

Systolic blood pressure significantly decreased in the PE group (by 5.22 ± 1.26 mmHg (SE), p = 0.04), indicating potential clinical relevance, with diastolic blood pressure showing a similar downward trend (2.94 ± 1.08 mmHg (SE), p = 0.3).

Human pharmacokinetic work shows free ellagic acid is only transiently present at low nanomolar levels, with gut-derived urolithin conjugates being the forms actually recovered. (Source 8)

• Blood level study, Low certainty.
• Size: not stated in the review.
• Who: humans given dietary ellagitannin precursors.
• How long: hours to days after intake.
• Result: free ellagic acid at low nanomolar concentrations only transiently; metabolites recovered predominantly as glucuronide conjugates and to a lesser extent sulfates.
• Funding: not stated.

Human pharmacokinetic and urine studies have shown that free ellagic acid appears only transiently at low nanomolar concentrations, whereas downstream microbial metabolites are recovered predominantly as glucuronide conjugates and, to a lesser extent, sulfates.

What the evidence does not support

The same meta-analysis found no significant effect of pomegranate on two endothelial adhesion markers. (Source 6)

• Meta-analysis, Certainty not rated.
• Size: 33 studies.
• Who: adults in clinical trials of pomegranate.
• How long: not stated in the abstract.
• Result: nonsignificant effect on VCAM-1 and E-selectin (no pooled estimate given in the abstract)
• Funding: supported by the Nutrition and Food Security Research Center, Isfahan University of Medical Sciences.

However, analysis indicated a nonsignificant effect on vascular cell adhesion protein 1 (VCAM-1), and E-selectin.

A systematic review of randomised trials concluded the blood-pressure evidence for pomegranate is not convincing, with most included trials showing no between-group difference. (Source 9)

• Systematic review, Low certainty.
• Size: 8 RCTs, 619 participants.
• Who: participants in randomised clinical trials of pomegranate supplementation.
• How long: not stated in the abstract.
• Result: 2 trials showed significant systolic reductions favouring pomegranate; 3 reported no significant difference for systolic and 4 reported no significant between-group difference for diastolic pressure.
• Funding: not stated.

The limited evidence from clinical trials to date fails to convincingly show a beneficial effect of pomegranate on blood pressure.

A double-blind placebo-controlled trial in men with advanced prostate cancer found pomegranate juice did not change PSA kinetics or pain scores. (Source 1)

• Randomized trial, Moderate certainty.
• Size: 102 patients enrolled, 98 randomised and treated.
• Who: men with histologically confirmed prostate cancer and PSA ≥ 5 ng/ml; 68% castration-resistant.
• How long: 4 weeks randomised phase then 4 further weeks of open juice (8 weeks total)
• Result: PSA progression in the first 4 weeks: 41% control vs 38% pomegranate (p=0.83); second period 24% vs 29% (p=0.63)
• Funding: partially funded by the Biotta AG Company.

No differences were detected between the two groups with regard to PSA kinetics and pain scores.

A review of fruit-juice drug interactions reported that in human volunteers pomegranate juice did not impair clearance of a CYP2C9 probe drug and did not significantly alter the pharmacokinetics of a CYP3A probe drug compared with water, and the review judged the risk of pharmacokinetic interaction negligible, although it also counted a small number of case reports. (Source 10)

• Expert review, not systematic, Low certainty.
• Size: human volunteer studies of flurbiprofen and midazolam; case reports counted as pomegranate juice–warfarin (n = 2) and pomegranate juice–rosuvastatin (n = 1)
• Who: healthy human volunteers in the interaction studies; individual patients in the case reports.
• How long: single dose to two weeks of juice.
• Result: no impairment of flurbiprofen oral clearance or CYP2C9 activity in human volunteers; no significant change in midazolam pharmacokinetics compared with water.
• Funding: not stated.

Despite of CYP2C9 inhibition in vitro, pomegranate juice did not impair oral clearance of flurbiprofen and CYP2C9 activity in human volunteers, and can be consumed by patients taking CYP2C9 substrates with negligible risk of pharmacokinetic interaction.

A narrative review argued that the laboratory enzyme inhibition seen with pomegranate juice has not translated into clinically significant interactions in people. (Source 11)

• Expert review, not systematic, Low certainty.
• Size: not stated.
• Who: patients receiving CYP2C9 and CYP3A4 substrate drugs.
• How long: not applicable.
• Result: no quantitative effect estimate; a qualitative conclusion drawn from human pharmacokinetic studies.
• Funding: not stated.

Pomegranate juice may therefore be safely consumed by patients receiving drugs that are substrates of CYP2C9 and CYP3A4.

NCCIH also states that no clear effect of pomegranate on cholesterol and other lipids has been demonstrated. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public.
• How long: not applicable.
• Result: no numbers given.
• Funding: US government agency.

Studies have been done to see whether various products from pomegranate can influence levels of cholesterol and other lipids, but no clear effects have been demonstrated.

Where the evidence is mixed

Because the trial had no placebo arm, the lengthening of PSA doubling time it reported cannot be separated from the natural course of the disease. (Source 2)

• Randomized trial, Low certainty.
• Size: 104 patients.
• Who: men with recurrent prostate cancer.
• How long: up to 18 months.
• Result: median PSA doubling time lengthened from 11.9 to 18.5 months (P<0.001) across both arms; 42% discontinued before meeting the protocol definition of PSA progression or 18 months.
• Funding: not stated in the abstract.

Overall, median PSADT in the ITT population lengthened from 11.9 months at baseline to 18.5 months after treatment (P<0.001).

A systematic review of 20 clinical studies reported that pomegranate improved several metabolic syndrome risk factors but called the trials insufficient to settle formulation or dose. (Source 12)

• Systematic review, Low certainty.
• Size: 20 studies included in qualitative analysis, from 147 eligible records.
• Who: adults in clinical studies of pomegranate and metabolic syndrome risk factors.
• How long: varied; not pooled.
• Result: no pooled estimates; narrative direction of effect on weight, blood pressure, glycaemia, triglycerides, total and LDL cholesterol, HDL cholesterol and insulin resistance.
• Funding: This research received no external funding.

Although relevant effects were observed, additional well-designed clinical trials are needed to determine the correct formulations and doses to be used to prevent or treat MetS components.

That review also noted a shortcoming in the underlying trials: two studies lost more than a fifth of participants. (Source 12)

• Systematic review, Low certainty.
• Size: 20 studies.
• Who: adults in pomegranate clinical studies.
• How long: varied.
• Result: two studies had more than 20% drop-outs; no serious adverse effects reported.
• Funding: This research received no external funding.

The studies did not report serious adverse effects and high drop-outs rates. However, two studies had more than 20% drop-outs.

Where the research disagrees

Whether pomegranate lowers blood pressure enough to count as a real effect

• Authors of a 2026 systematic review and meta-analysis of 33 clinical trials, meta-analysis of clinical trials: The Findings from 33 studies indicated significant reductions in systolic blood pressure (WMD: −3.52 mmHg; 95% CI: −4.97 to −2.06; P < 0.001), diastolic blood pressure (WMD: −1.50 mmHg; 95% CI: −2.58 to −0.42; P = 0.006) (Source 6)
• Authors of a 2017 systematic review of 8 randomised clinical trials (Nutrition Research), systematic review of RCTs without pooling: The limited evidence from clinical trials to date fails to convincingly show a beneficial effect of pomegranate on blood pressure. (Source 9)
• NCCIH, April 2025, agency position: Pomegranate juice or extract may be helpful in reducing blood pressure, but additional research is needed to confirm this effect. (Source 5)

Whether pomegranate juice interacts dangerously with medicines

• Authors of a review of fruit-juice drug interactions (2018), narrative review counting published case reports: pomegranate juice-warfarin (n = 2), pomegranate juice-rosuvastatin (n = 1) (Source 10)
• Andrade, Journal of Clinical Psychiatry, 2014, narrative review of human pharmacokinetic studies: Pomegranate juice may therefore be safely consumed by patients receiving drugs that are substrates of CYP2C9 and CYP3A4. (Source 11)

How much

• Reference intake: No reference intake (RDA or AI) exists for pomegranate from any body we could reach: it is a food and herbal product rather than an essential nutrient, and NCCIH's April 2025 page frames it in terms of safety rather than a required amount. (Source 5)
• Upper limit: No numerical upper limit or ADI for pomegranate was found from any body we could reach. NCCIH (April 2025) gives a qualitative warning instead, that root, stem and peel may not be safe in large amounts. (Source 5)
• Studied: 500 ml of pomegranate juice daily for 4 weeks, then 250 ml daily for a further 4 weeks (1147 mg/day then 573 mg/day polyphenol gallic acid equivalents) in men with prostate cancer. (Source 1)
• Studied: 1 g or 3 g of pomegranate extract (POMx) daily for up to 18 months in men with rising PSA. (Source 2)
• Studied: 740 mg of pomegranate extract in capsules daily for 12 weeks in older adults. (Source 7)

A common belief, and what the research shows

The belief: Pomegranate juice slows prostate cancer, because early studies showed PSA doubling time getting longer.

What the research shows: The lengthening of PSA doubling time came from trials without a placebo group. When pomegranate juice was tested against a placebo drink in 102 men, the authors reported that "No differences were detected between the two groups with regard to PSA kinetics and pain scores." and concluded that "Consumption of pomegranate juice as an adjunct intervention in men with advanced prostate cancer does not result in significant PSA declines compared to placebo." A separate randomised trial of two extract doses found "no significant difference between dose groups (P=0.554)" while both arms appeared to improve, which is what would be expected if the change were not caused by the extract.

Questions and answers

What is it?

Pomegranate is the fruit of the tree Punica granatum L. Supplement forms are made from the juice, the peel or the whole fruit and are concentrated into extracts and capsules. Reviews describe the fruit as containing a large number of bioactive compounds, chiefly ellagitannins such as punicalagins, plus ellagic acid and anthocyanins. (Source 13)

What does it do in the body?

The ellagitannins in pomegranate are largely not absorbed as such. In the colon they are broken down to ellagic acid and then converted by gut bacteria into compounds called urolithins, which are what actually circulates. Most of the biological activity studied in humans is attributed to these bacterial metabolites rather than to the original fruit compounds. (Source 8)

Is it good or bad for you?

As a food, pomegranate juice is regarded as safe and pooled trials point to a small average blood-pressure reduction. It is not a proven treatment for anything, and one systematic review reads the same blood-pressure trials as unconvincing. Which part of the plant is used matters: agency guidance warns that root, stem and peel differ from the juice. (Source 5)

How do you get more of it?

Trials have used the whole fruit, bottled juice and standardised capsule extracts. In a placebo-controlled prostate cancer trial, participants drank half a litre of pomegranate juice a day for four weeks and then a quarter of a litre a day for four more. Other trials used 740 mg of extract in capsules daily, or 1 g to 3 g of a concentrated extract. This describes what was given in studies, not a recommendation. (Source 1)

If it is harmful, what reduces it?

Pomegranate is not a substance the body accumulates or needs to clear, so the question does not apply in the usual sense. It matters only for people who react to it: case reports describe severe immediate allergic reactions to pomegranate, for which the only measure reported is avoiding the fruit. Digestive symptoms reported in trials resolved when the product was stopped. (Source 3)

Why might someone be low in it or missing it?

There is no pomegranate deficiency, because it is not an essential nutrient. What does differ between people is how much benefit they could plausibly get from it: the conversion of pomegranate ellagitannins into urolithins depends on gut bacteria, and people fall into distinct urolithin metabotypes with different conversion capacity, including one group that produces essentially none. (Source 8)

Which whole foods contain it or feed it?

The whole food is the pomegranate fruit itself, eaten as arils or drunk as juice. The same class of precursor compounds, ellagitannins and ellagic acid, is also abundant in walnuts and in several berries, so those foods feed the same gut-bacterial pathway. (Source 8)

What happens if you do not have it?

Nothing specific happens: no deficiency state or disease is described in the literature for not consuming pomegranate. The most that reviews claim is that intake may shift metabolic risk factors, and even there the authors say the trials are not yet good enough to pin down formulation or dose. (Source 12)

How can you test for it?

There is no clinical test for pomegranate status. Research laboratories measure the downstream metabolites instead, in urine and plasma, and the pattern is used to classify people into urolithin metabotypes. These are research assays, not validated diagnostic tests, and the parent compound ellagic acid is barely detectable in blood, which is why metabolites are measured. (Source 8)

References

1. Journal of Cancer. Daily Pomegranate Intake Has No Impact on PSA Levels in Patients with Advanced Prostate Cancer - Results of a Phase IIb Randomized Controlled Trial. 2013. PMID 24069070. Read the source
2. Prostate Cancer and Prostatic Diseases. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer. 2013. PMID 22689129, DOI 10.1038/pcan.2012.20. Read the source
3. Allergologia et Immunopathologia. Pomegranate anaphylaxis due to cross-reactivity with Peach LTP (Pru p 3). 2015. Read the source
4. Scientific Reports. Pomegranate fruit juice adulteration with apple juice: detection by UV–visible spectroscopy combined with multivariate statistical analysis. 2022. DOI 10.1038/s41598-022-07979-7. Read the source
5. National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Pomegranate. 2025. Read the source
6. Elsevier (journal ISSN 2666-1497). Effects of pomegranate on blood pressure and endothelial function: A systematic review and meta-analysis of clinical trials. 2026. Read the source
7. Nutrients. Effects of Pomegranate Extract on Inflammatory Markers and Cardiometabolic Risk Factors in Adults Aged 55–70 Years: A Randomised Controlled Parallel Trial. 2025. DOI 10.3390/nu17071235. Read the source
8. Frontiers in Nutrition. Urolithins in clinical translation: from gut microbial metabolites to precision interventions. 2026. DOI 10.3389/fnut.2026.1854240. Read the source
9. Nutrition Research. Evidence for the effectiveness of pomegranate supplementation for blood pressure management is weak: A systematic review of randomized clinical trials. 2017. PMID 29173650, DOI 10.1016/j.nutres.2017.07.007. Read the source
10. Journal of Food and Drug Analysis. Food-drug interactions precipitated by fruit juices other than grapefruit juice: An update review. 2018. Read the source
11. The Journal of Clinical Psychiatry. Potentially Significant Versus Clinically Significant Drug Interactions: Pomegranate Juice as a Case in Point. 2014. Read the source
12. Nutrients. Pomegranate (Punica granatum L.) and Metabolic Syndrome Risk Factors and Outcomes: A Systematic Review of Clinical Studies. 2022. DOI 10.3390/nu14081665. Read the source
13. Nutrients. The Modulatory Bioeffects of Pomegranate (Punica granatum L.) Polyphenols on Metabolic Disorders: Understanding Their Preventive Role against Metabolic Syndrome. 2023. DOI 10.3390/nu15234879. Read the source