Pomegranate: Perhaps, Paleo’s Healthiest Fruit

Introduction

In Colorado, late fall will shortly be upon us and we will fade into early winter and beyond. For many Paleo Dieters throughout the U.S., this time of season represents the closure of fresh farmer’s markets and the end of the delicious local fruits and vegetables they produce.

Nevertheless, late fall and October also signify the beginning of the Pomegranate season, which in California (the major U.S. producer) runs from October through January1. I am eagerly looking forward to munching down on this succulent and health-giving fruit. In fact, pomegranates are so healthful that they have been described as “Nature’s Power Fruit” by a writer from the Journal of the National Cancer Institute almost 13 years ago2. In the ensuing decade, the scientific evidence leaves little doubt that this fruit, and its juice should be regular components of contemporary Paleo Diets2-16.

History

Pomegranates (Punica granatum) are one of the oldest known edible fruits and are thought to have originated in central Asia, predominantly in Iran14,17. After domestication the pomegranate tree/shrub and its fruit eventually spread to other parts of the world where it could grow and thrive, chiefly in mild, temperate climates14, 17. Wild pomegranate trees/shrubs still exist in present day Turkey18. In the U.S. domesticated varieties are grown mainly in California and Arizona19 and form the greater part of current U.S. pomegranate consumption.

Edible Parts of the Fruit

In the U.S., pomegranates and pomegranate juice have increasingly achieved a wider public acceptance because of their well-known health benefits2-16. The primary, edible portion of pomegranate fruit is called the aril, which consists of the plant’s seed and the surrounding fruit (Figures 1, 2)14. The outer rind of the entire pomegranate fruit is called the peel, and the interior network of peel membranes is frequently called the mesocarp15, 20-22. Most consumers consider the peel and mesocarp inedible.

Although many present-day cultivars of pomegranates maintain pink and red peel colors, wild varieties from Turkey may have peel colors ranging from yellow to purple, and arils with colors ranging from white to red18. Dried arils called anardanas in India are commonly consumed both in India and middle eastern countries14.

Pomegranate juice can be extracted from the entire fruit (peel, aril fruit, aril seed and mesocarp) or a combination of these four elements14,20,22, but it is most commonly made only from the fruit exterior of the arils, with the inner fibrous seed strained out14. The remaining structures (peel, mesocarp and seed) are filtered from the juice and are called pomegranate marc23.

Figure 1. Whole pomegranate fruit; arils attached to fruit’s peel; pomegranate juice

Figure 2. Pomegranate peel, mesocarp and arils (fleshy fruit exterior + interior seeds)

Nutrition

Table 1 below contrasts the nutritional characteristics of fresh pomegranate arils (fleshy fruit exterior + interior seeds) and pomegranate juice extracted from the arils without the seeds.

Table 1. Nutrient values for fresh pomegranate arils (fleshy fruit exterior + interior seeds) and pomegranate juice extracted only from the fleshy aril exterior24.

This Table may appear to be a bit cumbersome at first, but a few critical nutritional points should immediately jump out. First, fresh pomegranate arils are great sources of fiber, as a 100-gram portion of this food (only 83 kcal) provides a whopping 16 % of recommended daily values for fiber. Additionally, a miniscule 83 kcal serving of fresh pomegranate fruit yields 17 % of daily vitamin C requirements, 10 % of daily folate requirements, 21 % of the suggested vitamin K intake and 8 % of recommended daily copper intakes. No matter how you slice it nutritionally, fresh pomegranate arils are superb sources of many vitamins and minerals important to our health.

At first glance from Table 1, it may appear that pomegranate juice is less nutritionally dense (in terms of vitamins and minerals) than its arils’ counterpart. This fact is to be expected because pomegranate juice doesn’t contain all the compounds found in its seed. Nevertheless, both the arils (fleshy fruit exterior + interior seeds) and the juice made from the arils’ fleshy fruit exterior are rich sources of the phytochemicals25 which are primarily responsible for pomegranate’s multitude of health promoting effects2-16.

Pomegranate Phytochemicals

Whether you eat fresh pomegranate arils or drink its juice, you will be enhancing your diet with one of nature’s richest sources of disease preventing phytochemicals25. “Phyto” means “Plant” chemicals which can either prevent or promote disease, or have no effect. The entire pomegranate fruit contains at least 153 phytochemicals including their derivatives14. In the case of pomegranate arils or pomegranate juice, numerous scientific studies show that these foods maintain powerful health promoting effects2-16 with no known toxic properties in their native form20,26.

Pomegranate Polyphenols

Polyphenols represent the predominant class of phytochemicals found in whole pomegranate fruit and are located in the pomegranate peel, mesocarp, arils and juice22. The pomegranate peel and mesocarp contain much higher concentrations of polyphenols than what’s found in either the arils or juice22. Generally, since most people consider the peel and mesocarp inedible, the intake of pomegranate polyphenols stems primarily from consumption of whole arils and juice.

Note that pomegranate supplements exist that are made from the dried peel and mesocarp of pomegranates. These supplements maintain much higher concentrations of total polyphenolics than values in fresh arils or juice. For instance, POM wonderful juice may contain a total polyphenolic content of 2,670 mg/liter whereas POMx capsules may exhibit a total polyphenolic concentration of 623,000 mg/kg26. Obviously, nobody in their right mind would ever consume a kilogram (2.2 lbs.) of pomegranate capsules, but a 1-gram dose (623 mg total polyphenolics) or a 10-gram dose (6230 mg total polyphenolics) are possible with supplements. Personally, I enjoy fresh pomegranate arils or juice, and can achieve a high level of polyphenols without supplements.

Many of the therapeutic effects from pomegranate fruit or juice consumption are attributed to the powerful antioxidant, anti-inflammatory and anti-proliferative effects of pomegranate’s polyphenols5,10,15,20-23,25-27. Pomegranate peel, mesocarp, arils and juice contain at least 48 individual polyphenols which can be subdivided into four major groups: 1) anthocyanins, 2) hydrolysable tannins [including gallotannins and ellagitannins], 3) hydroxybenzoic acids and 4) hydroxycinnamic acids22. For reasons of expense, not all polyphenols are routinely measured26. However, some of the major polyphenolic compounds commonly evaluated in pomegranates include: 1) gallic acids, 2) ellagic acids, 3) punicalagin A and 4) punicalagin B23. The last two polyphenols in this list are found in high concentrations in pomegranates15 and have been reported to maintain “remarkable” anti-inflammatory properties23.

An important factor when evaluating potential health benefits of pomegranate fruit and juice consumption is their total polyphenolic concentrations. Compared to other beverages, commercial pomegranate juices have demonstrated antioxidant activity three times higher than red wine and green tea28. Using a more sophisticated battery of four antioxidant tests (TEAC, ORAC, DPPH and FRAP), Seeram and colleagues27 verified that pomegranate juice had the greatest antioxidant potency of 10 beverages tested and was at least 20 % greater than any other beverage. The order of greatest antioxidant potency for this study was:

1. Pomegranate juice
2. Red wine
3. Concord grape juice
4. Blueberry juice
5. Black cherry juice
6. Acai juice
7. Cranberry juice
8. Orange juice
9. Tea beverages (iced green, black and white teas)
10. Apple juice

Diet and Disease

One of the challenges faced by nutritional scientists, when they ultimately make recommendations regarding what we should and should not eat, is to establish cause and effect between a dietary element and the subsequent development or prevention of disease. Figure 3 below demonstrates the four primary procedures by which causality is established between diet and disease29,30.
No single procedure alone can establish cause and effect29,30, nor can any single study prove causality31. Observational epidemiological studies can only show relationships among variables and cannot provide decisive evidence by themselves either for or against specific hypotheses32. In order to establish cause and effect between diet and disease, it takes more than just observational epidemiological evidence32. There must also be biological plausibility in which evidence gathered from tissue, animal and short term human metabolic studies support causality30. When observational epidemiological evidence is augmented by biological plausibility studies and confirmed by randomized controlled trials (RCT), the case for causality becomes ever more convincing.

Figure 3. Procedures for establishing cause and effect between diet and disease
screen-shot-2016-11-10-at-4-06-36-pm

Pomegranates and Disease Prevention

In the case of pomegranates, a wealth of information exists from tissue and animal studies demonstrating therapeutic effects for all parts of the pomegranate fruit (peel, mesocarp, arils, juice) in treating and preventing a wide variety of disease models.

Numerous epidemiological studies have shown a multitude of beneficial health effects for fresh fruit and vegetable consumption33-37, however little epidemiological evidence is specifically available for pomegranate consumption only. Despite the abundance of animal and tissue (pre-clinical) studies, considerably fewer randomized controlled trials (RCT) in humans have been conducted for pomegranate consumption in a variety of diseases. In some cases, the results of human RCT have been in conflict with tissue and animal trials for a variety of reasons including experimental design flaws5, 26, 38-41. Nevertheless, taken in their entirety the evidence from animal, tissue and human RCT strongly supports pomegranate fruit, juice and extract consumption to be therapeutic for numerous illnesses and maladies2-16, 20, 21, 26, 42-48.

Advanced Glycation End Products (AGE) and Pomegranates

From my previous blog on the topic of advanced glycation end products (AGE), you know that AGEs are compounds that naturally form in our bodies from the chemical reaction of sugars with proteins. In the past decade scientists have discovered that foods also contain AGEs that may greatly add to the AGE burden in our bodies51. If the concentration of AGEs becomes excessive in our bloodstream, they can cause damage to almost every tissue and organ49-51. The problem with AGEs is that they act like a key that permanently turns on low level inflammation49-51 in our bodies by binding to AGE receptors known as RAGEs49, 52.
It is now becoming clear to scientists that high tissue levels of AGEs are associated with almost all chronic diseases that afflict us in the western world53-60. Additionally, excessive AGEs are known to speed the aging process61, 62.

This is where pomegranate fruit (arils, juice, mesocarp, peel) enter the picture. Their high polyphenolic concentrations may act as antioxidants that help to quell the underlying inflammatory process in many diseases4, 5, 8, 9, 20, 21, 27, 28, 43-46, 48. A number of tissue (in vitro) studies63-65 have shown that pomegranate polyphenolics represent potent inhibitors of AGE formation. In mice fed a high sugar, high fat diet, pomegranate juice extract reduced the concentration of blood AGEs compared to a control group3. As with other promising pre-clinical trials (tissue and animal) of pomegranate juice, at least one double-blind, 12 week RCT of pomegranate juice in adults with type 2 diabetes showed no effect upon blood AGEs, but did show an improvement in blood total antioxidant capacity along with a decrease in lipid peroxidation66.

Potential Therapeutic Influence of Pomegranates Upon Other Diseases

Pomegranate fruit (arils, juice, mesocarp, peel and extracts) clearly is not a universal panacea to cure all the diseases and illnesses that afflict humanity, but it does represent a powerful antioxidant and anti-inflammatory agent with the capacity to reduce inflammation throughout the body. Inflammation drives the major diseases of civilization including the metabolic syndrome, cancer and autoimmune diseases.

In this regard pomegranate may improve bone health in animal models4 and have therapeutic effects for humans in cancer prevention and therapy5. It may also aid in the prevention and treatment of cardiovascular disease6. Pomegranate juice consumption may have a therapeutic function in type 2 diabetics by lowering two markers (IL-6 and CRP) of inflammation7. Similarly, in a RCT of 48 obese and overweight patients over 30 days, a 1000 mg pomegranate extract resulted in significant decreases of blood glucose, insulin, total cholesterol, LDL cholesterol, IL-6, CRP and lipid peroxidation8. In a RCT (placebo controlled crossover) 28 subjects consuming 500 ml of pomegranate juice experienced significant reductions of both systolic and diastolic blood pressure, fasting insulin and improved insulin resistance10.

Finally, pomegranate fruit extracts may have therapeutic value for males with sub-fertility due to low sperm counts. A RCT of 66 men with low sperm counts ingested a pomegranate extract daily for three months or a placebo. After the treatment, the men taking the pomegranate extract experienced a 62 % increase in the total number of motile sperm compared to the control group13.

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About Loren Cordain, PhD, Professor Emeritus

Loren Cordain, PhD, Professor EmeritusDr. Loren Cordain is Professor Emeritus of the Department of Health and Exercise Science at Colorado State University in Fort Collins, Colorado. His research emphasis over the past 20 years has focused upon the evolutionary and anthropological basis for diet, health and well being in modern humans. Dr. Cordain’s scientific publications have examined the nutritional characteristics of worldwide hunter-gatherer diets as well as the nutrient composition of wild plant and animal foods consumed by foraging humans. He is the world’s leading expert on Paleolithic diets and has lectured extensively on the Paleolithic nutrition worldwide. Dr. Cordain is the author of six popular bestselling books including The Real Paleo Diet Cookbook, The Paleo Diet, The Paleo Answer, and The Paleo Diet Cookbook, summarizing his research findings.

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