How Pomegranate Promotes Heart Health

Pomegranate is a nutrient-dense food with compounds that promote heart health.^1-4

Preclinical and clinical studies show that pomegranate can improve blood flow,^6,7 reduce arterial blood clots,⁵ and modestly lower cholesterol, triglycerides, and blood pressure.⁸

Most notably, pomegranate has been shown to help prevent and even reverse some of the blood vessel damage that can lead to heart attack and stroke. ^1,2,9,10

A clinical study in patients with atherosclerosis found that pomegranate consumption substantially decreased thickness of carotid artery plaques.⁹

Fresh pomegranate fruit or juice can be high in fructose.¹¹ For those who want to avoid the sugar, pomegranate extracts provide an alternative.

A Nutritional Powerhouse

All parts of the pomegranate plant, including the fruit, leaves, peel, seeds, and flowers, are packed with beneficial compounds.

These include anthocyanins, flavonoids, and unique tannins (such as punicalagin).²

One of pomegranate’s most impressive effects is its ability to protect aging arteries in multiple ways, including preventing and even reversing endothelial dysfunction.^1,2

Endothelial dysfunction refers to damage to the delicate inner lining of blood vessels. This dysfunction is an important contributor to atherosclerosis, the buildup of plaque in the arteries. ^10,12

Atherosclerosis is responsible for a major share of deaths worldwide. ^13,14

Improving Lipid Levels

Animal models have shown that pomegranate can reduce blood levels of total cholesterol, LDL cholesterol, and triglycerides.^15-18

Oxidation of LDL cholesterol makes it more dangerous than normal LDL. Oxidized LDL accumulates in blood vessel walls more easily and accelerates the progression of atherosclerosis. Pomegranate decreases the oxidation of lipids.^19,20

In human studies, pomegranate use significantly reduces blood levels of oxidized LDL and reduces LDL aggregation.^19,21

Restoring Blood Vessel Function

An important indicator of endothelial dysfunction is an impaired ability of blood vessels to dilate (widen) when necessary.^10,22

Pomegranate and its extracts improve the ability of the endothelium to promote arterial relaxation and dilation. ^6,7

Nitric oxide is one of the body’s main vasodilators which means it induces the dilation of arteries.

In endothelial dysfunction, production of nitric oxide declines. Preclinical evidence shows that pomegranate can boost nitric oxide production and improve arterial dilation. ^23-26

Preventing Blood Clots

Endothelial dysfunction and atherosclerosis increase the risk of abnormal blood clots.

Most heart attacks and strokes are caused by clots forming inside diseased arteries, which reduces blood flow to the heart or brain.^27,28

Some of the same compounds contained in pomegranate that benefit arterial health also influence the function of platelets, the tiny cells in our blood that form clots.

Thromboxane A2, which is reduced by pomegranate, activates platelets and causes their aggregation.^29,30

In animal studies, pomegranate reduced clotting associated with platelets and other factors, even when exposed to stimuli that would normally cause their aggregation.^5,29

Improving Blood Pressure

High blood pressure is a major risk factor for atherosclerosis and is closely linked with endothelial dysfunction.^31-33

A class of drug used to lower blood pressure are the ACE inhibitors.

Preclinical and clinical research has demonstrated that, like these medications, pomegranate extracts can inhibit ACE activity. ^34,35 In fact, multiple clinical studies show that pomegranate is able to help reduce elevated blood pressure.⁸

In people with high blood pressure, two weeks of pomegranate intake decreased blood ACE activity by 36%. In this study, pomegranate lowered systolic blood pressure by 5%.³⁵

In other human studies, pomegranate consumption led to reductions in systolic and diastolic blood pressure.^8,36,37

In a study of subjects with atherosclerosis in the carotid artery, one year of pomegranate intake reduced systolic blood pressure by an average of 12%.⁹

Those with systolic blood pressure levels chronically above 115-120 mmHg should seek professional guidance on the appropriate medication and/or lifestyle intervention (such as weight loss) to safely achieve optimal blood pressure control.

Blood Glucose

Poor control of blood glucose levels is a powerful contributor to both endothelial dysfunction and to atherosclerosis.¹

In animal studies, pomegranate extract improved insulin sensitivity and reduced fasting blood glucose levels.^38,39

In studies of patients with type II diabetes or impaired glucose control, a single dose of pomegranate improved insulin sensitivity and blood glucose control.^40,41

Pomegranate may also protect against the damage that glucose causes to tissues, including arteries. A large part of this damage is due to glycation, when sugars bind to proteins and alter their function.⁴²

Punicalagin from pomegranate has been shown preclinically to suppress the glycation of proteins and prevent their accumulation, even in mice fed a high-sugar diet.⁴³

Those with less-than-optimal glycemic markers (glucose + A1C + fasting insulin) despite healthy diet and lifestyle should seek professional guidance on a range of medications that can lower excess blood sugar.

Reducing Atherosclerotic Plaques

Pomegranate has a profound impact on blood vessel health.

In preclinical investigations, punicalagin and pomegranate extract have both been shown to help reverse endothelial dysfunction.^44,45

Animal models of accelerated atherosclerosis also show that pomegranate can prevent and reverse the progression of atherosclerotic plaque.

For example, rodent studies show that pomegranate helped maintain arterial health and significantly slow progression of atherosclerosis.^46,47 In a mouse study, pomegranate reduced the size of plaques by 44%. ²¹

Human trials have found striking effects on improving cardiovascular disease parameters.

One clinical study evaluated patients with atherosclerosis in the carotid arteries.⁹ Pomegranate consumption decreased the extent of atherosclerotic plaque by up to 35% after a year. Those who did not receive pomegranate had a 9% worsening of atherosclerosis.

In adults with ischemic heart disease (insufficient oxygen delivery and blood flow to the heart muscle), pomegranate significantly reduced the intensity, occurrence, and duration of angina (chest pain) episodes.⁴⁸ It also lowered the level of troponin in the blood, an acute marker of damage to the heart muscle.

Another study in patients with heart disease found that while exercise-induced ischemia (reduced blood flow) of the heart increased in a control group over three months, patients receiving pomegranate juice had a significant ischemia decrease.⁴⁹

These studies and others make it clear that pomegranate can help reduce risks for atherosclerosis and symptoms of heart damage in those with existing cardiac issues.

Summary

Pomegranate and its extracts have demonstrated abilities to prevent and reverse endothelial dysfunction, a blood vessel malfunction that contributes to atherosclerosis.

Pomegranate also improves blood pressure, glucose, lipid status, and abnormal clotting.

Through all these actions, pomegranate may reduce the risk of developing cardiovascular disorders and relieve symptoms in people with preexisting heart disease.

If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-866-864-3027.

References

1. Delgado NTB, Rouver WN, Dos Santos RL. Protective Effects of Pomegranate in Endothelial Dysfunction. Curr Pharm Des. 2020;26(30):3684-99.
2. Wang D, Ozen C, Abu-Reidah IM, et al. Vasculoprotective Effects of Pomegranate (Punica granatum L.). Front Pharmacol. 2018;9:544.
3. Kang SJ, Choi BR, Kim SH, et al. Beneficial effects of dried pomegranate juice concentrated powder on ultraviolet B-induced skin photoaging in hairless mice. Exp Ther Med. 2017 Aug;14(2):1023-36.
4. Emami Kazemabad MJ, Asgari Toni S, Tizro N, et al. Pharmacotherapeutic potential of pomegranate in age-related neurological disorders. Frontiers in Aging Neuroscience. 2022 2022-September-01;14.
5. Riaz A, Khan RA. Anticoagulant, antiplatelet and antianemic effects of Punica granatum (pomegranate) juice in rabbits. Blood Coagul Fibrinolysis. 2016 Apr;27(3):287-93.
6. Anwaier G, Lian G, Ma GZ, et al. Punicalagin Attenuates Disturbed Flow-Induced Vascular Dysfunction by Inhibiting Force-Specific Activation of Smad1/5. Front Cell Dev Biol. 2021;9:697539.
7. Roelofs EJ, Smith-Ryan AE, Trexler ET, et al. Effects of pomegranate extract on blood flow and vessel diameter after high-intensity exercise in young, healthy adults. Eur J Sport Sci. 2017 Apr;17(3):317-25.
8. Sahebkar A, Ferri C, Giorgini P, et al. Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2017 Jan;115:149-61.
9. Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr. 2004 Jun;23(3):423-33.
10. Xu S, Ilyas I, Little PJ, et al. Endothelial Dysfunction in Atherosclerotic Cardiovascular Diseases and Beyond: From Mechanism to Pharmacotherapies. Pharmacol Rev. 2021 Jul;73(3):924-67.
11. Available at: https://fdc.nal.usda.gov/fdc-app.html#/food-details/167787/nutrients. Accessed November, 25, 2022.
12. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004 Jun 15;109(23 Suppl 1):III27-32.
13. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507799/. Accessed November, 23, 2022.
14. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/atherosclerosis. Accessed November, 23, 2022.
15. Bagri P, Ali M, Aeri V, et al. Antidiabetic effect of Punica granatum flowers: effect on hyperlipidemia, pancreatic cells lipid peroxidation and antioxidant enzymes in experimental diabetes. Food Chem Toxicol. 2009 Jan;47(1):50-4.
16. Hossin FLA. Effect of pomegranate (Punica granatum) peels and it’s extract on obese hypercholesterolemic rats. Pakistan Journal of Nutrition. 2009;8(8):1251-7.
17. Lei F, Zhang XN, Wang W, et al. Evidence of anti-obesity effects of the pomegranate leaf extract in high-fat diet induced obese mice. Int J Obes (Lond). 2007 Jun;31(6):1023-9.
18. Neyrinck AM, Van Hee VF, Bindels LB, et al. Polyphenol-rich extract of pomegranate peel alleviates tissue inflammation and hypercholesterolaemia in high-fat diet-induced obese mice: potential implication of the gut microbiota. Br J Nutr. 2013 Mar 14;109(5):802-9.
19. Sohrab G, Ebrahimof S, Sotoudeh G, et al. Effects of pomegranate juice consumption on oxidative stress in patients with type 2 diabetes: a single-blind, randomized clinical trial. Int J Food Sci Nutr. 2017 Mar;68(2):249-55.
20. MacRae F Linton M, Patricia G Yancey, PhD, Sean S Davies, PhD, W. Gray Jerome, PhD, Edward F Linton, MD, Wenliang L Song, MD, Amanda C Doran, PhD, MD, and Kasey C Vickers, PhD. The Role of Lipids and Lipoproteins in Atherosclerosis. 2019.
21. Aviram M, Dornfeld L, Rosenblat M, et al. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotic apolipoprotein E-deficient mice. Am J Clin Nutr. 2000 May;71(5):1062-76.
22. Sun HJ, Wu ZY, Nie XW, et al. Role of Endothelial Dysfunction in Cardiovascular Diseases: The Link Between Inflammation and Hydrogen Sulfide. Front Pharmacol. 2019 2020-January-21;10:1568.
23. Delgado NT, Rouver WD, Freitas-Lima LC, et al. Pomegranate Extract Enhances Endothelium-Dependent Coronary Relaxation in Isolated Perfused Hearts from Spontaneously Hypertensive Ovariectomized Rats. Front Pharmacol. 2016;7:522.
24. Omar U, Aloqbi A, Yousr M, et al. Punicalagin Induce the Production of Nitric Oxide and Inhibit Angiotensin Converting Enzyme in Endothelial Cell Line EA.hy926. Universal Journal of Public Health. 2016 09/01;4(5):268-77.
25. Ulfat M, Aloqbi A, Yousr M, et al. Punicalagin Induce the Production of Nitric Oxide and Inhibit Angiotensin Converting Enzyme in Endothelial Cell Line EA.hy926. Universal Journal of Public Health. 2016 09/01;4:268-77.
26. Omar U, Aloqbi A, Yousr M, et al. Punicalagin induce the production of nitric oxide and inhibit angiotensin converting enzyme in endothelial cell line EA.hy926. Universal Journal of Public Health. 2016;4(5):268-77.
27. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/types-of-stroke. Accessed November, 23, 2022.
28. Palasubramaniam J, Wang X, Peter K. Myocardial Infarction—From Atherosclerosis to Thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology. 2019;39(8):e176-e85.
29. Mattiello T, Trifiro E, Jotti GS, et al. Effects of pomegranate juice and extract polyphenols on platelet function. J Med Food. 2009 Apr;12(2):334-9.
30. Brainard BM. Antiplatelet Drugs. In: Silverstein DC, Hopper K, editors. Small Animal Critical Care Medicine. St. Louis: W.B. Saunders; 2015:877-82.
31. Buford TW. Hypertension and aging. Ageing Res Rev. 2016 Mar;26: 96-111.
32. Gallo G, Volpe M, Savoia C. Endothelial Dysfunction in Hypertension: Current Concepts and Clinical Implications. Frontiers in Medicine. 2022 2022-January-20;8.
33. Poznyak AV, Sadykhov NK, Kartuesov AG, et al. Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment. Frontiers in Cardiovascular Medicine. 2022 2022-August-22;9.
34. Dos Santos RL, Dellacqua LO, Delgado NT, et al. Pomegranate peel extract attenuates oxidative stress by decreasing coronary angiotensin-converting enzyme (ACE) activity in hypertensive female rats. J Toxicol Environ Health A. 2016;79(21):998-1007.
35. Aviram M, Dornfeld L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure. Atherosclerosis. 2001 Sep;158(1):195-8.
36. Asgary S, Keshvari M, Sahebkar A, et al. Clinical investigation of the acute effects of pomegranate juice on blood pressure and endothelial function in hypertensive individuals. ARYA Atheroscler. 2013 Nov;9(6):326-31.
37. Asgary S, Sahebkar A, Afshani MR, et al. Clinical evaluation of blood pressure lowering, endothelial function improving, hypolipidemic and anti-inflammatory effects of pomegranate juice in hypertensive subjects. Phytother Res. 2014 Feb;28(2):193-9.
38. Harzallah A, Hammami M, Kepczynska MA, et al. Comparison of potential preventive effects of pomegranate flower, peel and seed oil on insulin resistance and inflammation in high-fat and high-sucrose diet-induced obesity mice model. Arch Physiol Biochem. 2016;122(2):75-87.
39. Sun YL, Zhou FM, Wang HR. Mechanism of pomegranate ellagic polyphenols reducing insulin resistance on gestational diabetes mellitus rats. Am J Transl Res. 2019;11(9):5487-500.
40. Banihani SA, Fashtaky RA, Makahleh SM, et al. Effect of fresh pomegranate juice on the level of melatonin, insulin, and fasting serum glucose in healthy individuals and people with impaired fasting glucose. Food Sci Nutr. 2020 Jan;8(1):567-74.
41. Banihani SA, Makahleh SM, El-Akawi Z, et al. Fresh pomegranate juice ameliorates insulin resistance, enhances beta-cell function, and decreases fasting serum glucose in type 2 diabetic patients. Nutr Res. 2014 Oct;34(10):862-7.
42. Yan SF, Ramasamy R, Naka Y, et al. Glycation, Inflammation, and RAGE. Circulation Research. 2003;93(12):1159-69.
43. Kumagai Y, Nakatani S, Onodera H, et al. Anti-Glycation Effects of Pomegranate (Punica granatum L.) Fruit Extract and Its Components in Vivo and in Vitro. J Agric Food Chem. 2015 Sep 9;63(35):7760-4.
44. Liu X, Cao K, Lv W, et al. Punicalagin attenuates endothelial dysfunction by activating FoxO1, a pivotal regulating switch of mitochondrial biogenesis. Free Radic Biol Med. 2019 May 1;135:251-60.
45. Vilahur G, Padro T, Casani L, et al. Polyphenol-enriched diet prevents coronary endothelial dysfunction by activating the Akt/eNOS pathway. Rev Esp Cardiol (Engl Ed). 2015 Mar;68(3):216-25.
46. Salama AA, Ismael NM, Bedewy M. The Anti-inflammatory and Antiatherogenic In Vivo Effects of Pomegranate Peel Powder: From Waste to Medicinal Food. J Med Food. 2021 Feb;24(2):145-50.
47. Aviram M, Rosenblat M. Pomegranate Protection against Cardiovascular Diseases. Evid Based Complement Alternat Med. 2012;2012:382763.
48. Razani Z, Dastani M, Kazerani HR. Cardioprotective Effects of Pomegranate (Punica granatum) Juice in Patients with Ischemic Heart Disease. Phytother Res. 2017 Nov;31(11):1731-8.
49. Sumner MD, Elliott-Eller M, Weidner G, et al. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol. 2005 Sep 15;96(6):810-4.