Pomegranate Juice is Protective in Diabetes

CME INDIA Presentation by Dr. N. K. Singh, MD, FICP, FACP, F-RSSDI, Director – Diabetes and Heart Research Centre, Dhanbad, Jharkhand, India. Editor, www.cmeindia.in.

Pomegranate Juice – the real fruit powerhouse:

Pomegranate juice has staying power. It’s not a fad. Once people have tasted POM Wonderful, they say they are addicted – and it’s a good addiction to have.”— Lynda Resnick
The derivation of the word pomegranate comes from the Middle French pome garnete (seeded apple).
The pomegranate tree is an excellent pharmacopoeia.
Ayurveda medicine uses not only the seeds, but also the flowers, the rind of the fruit, and the root bark too.
Every part of the plant has its own qualities and, consequently, specific healing properties.
The fresh fruit juice is considered a powerful tonic.

Pomegranate Juice is Protective in Diabetes

In the pomegranate fruit

Peel is about 30% of the fresh weight of the fruit.
Ratio of weights of the peel, arils, and seeds is 50:40:10, respectively.
The edible part consists of prismatic-shaped arils with internal seeds and is surrounded by the pericarp, a white membrane that separates and protects them.
The aril’s juice is intense red due to the anthocyanins contained in the juice.
Pomegranate juice corresponds to sugars, organic acids, pectins, vitamins, and minerals.
The juice is particularly rich in antioxidant polyphenols, including hydrolyzable tannins, condensed tannins, anthocyanins, flavonols, and phenolic acids.
Punicalagins are hydrolyzable tannins and are the most abundant polyphenol in juice, responsible for over 50% of the potential antioxidant of juice.

Credit: Olvera-Sandoval et al, Antioxidants 2022, 11, 553.

Is Juice beneficial for diabetics?

The bioactive compounds in fruits with antidiabetic activity are

Polyphenols

Terpenoids

Saponins

Carotenoids

Alkaloids

Glycosides

Credit: Olvera-Sandoval et al, Antioxidants 2022, 11, 553.

It is well known that slow and steady release of glucose helps maintain reasonable glucose control and pomegranate juice is helpful in promoting a low glycaemic index.
The results of few studies on the hypoglycaemic effects of pomegranate juice in animals and humans are not uniform, as some show hypoglycaemic activity in animals and humans while others show no hypoglycaemic activity effect.

Possible mechanisms of action

The high antioxidant capacity of pomegranate juice’s unique components, such as the predominant punicalagin, may delay type 2 diabetes by neutralizing the generated reactive oxygen species directly.
The juice may also act indirectly through the induction of the expression of antioxidant enzymes.

Some good Studies

Effect	Authors
Insulin-sensitizing and FBG-decreasing effects of a pomegranate seed product	Harzallah et al. (2016)
Antihyperglycemic activity of a diet containing PSP (60 g/ kg/day) has been seen.	Jelodar et al.(2007)
It seems that complementary treatment with PSP (pomegranate seed product) may have beneficial effects on FBG and HbA_1c of patients with T2DM.	DOI: 10.1159/000510986
Due to the effect of combined Aerobic training +pomegranate juice intake in improving T2DM risk factors, it could be recommended for T2DM patients to prevent increased liver enzymes and insulin resistance	Nemati et al. BMC Nutrition (2022) 8:48
Pomegranate polyphenols in pomegranate juice could reduce bread’s acute postprandial glycaemic response (bread is absorbed quickly and causes a quick rise in blood glucose). It was proposed that pomegranate punicalagin inhibits α-amylase, causing sugars to be released more gradually, thus preventing spikes in sugar levels.	Kerimi et al.

CME INDIA Learning Points:

Pomegranate juice has a substantial variety of bioactive compounds.

It has potential action against metabolic disorders, including type 2 diabetes.

In vitro and in vivo studies point to several mechanisms for glucose homeostasis through multiple modes of action.

It has been shown to have increased antioxidant activity, an increase in the function of B-cells, glucose uptake via GLUT2 and GLUT4, lower activity of a-amylase enzyme, reduction of glucose absorption by inhibiting the enzyme α-glucosidase and dipeptidyl peptidase-4, absolutely smashing the sensitivity of insulin receptors with increased activity of the peroxisome proliferator-activated gamma receptor (PPAR-γ).

Pomegranate and its compounds may represent an adjuvant for the current treatments against type 2 diabetes.

Its therapeutic effects can also reduce side effects of drugs by reducing their dosage.

We need more clinical trials to measure their effectiveness by considering variables such as comorbidities, pharmacological interaction, and dietary patterns.

Pomegranate also exerts biological functions through various ways.

It acts as a strong antioxidant agent, reducing inflammation and also decreases the plasma concentration of lipoproteins and formation of atherosclerotic lesions.

Also see:

Inhibit SARS-CoV-2 virus internalization with Pomegranate peel extract

Comments from Discussion Group:

Dr. J. S. Kumar:

Wholesome fruit probably more nutritive than juice

Dr. Shridhar G. R., DM Endo., Vizag:

Fruit has juice also: juice ‘plus’

Dr. Ripun B, Sivasagar, Assam:

Until thorough mechanisms understood how it can cause all those beneficial changes, it remains a belief only; especially the changes in the intestine! Is it through release of SCFA?
All violet peels having fruits impart the beneficial effect through photochemical. But then whether the effects are equal to a drug, that’s the question. These are all additives to treatment if I am not wrong.
Reducing oxidative stress and lipid peroxidation is the main mechanisms.
Discussing about beneficial effect, these cannot be rival to drugs.

Dr. A. Panneerselvam, Diabetologist, Chennai:

Other components are beneficial doubt.
If the diabetic takes pomegranate juice daily that too in larger quantity thinking in terms of more beneficial the FRUCTOSE component pushes them towards uncontrolled state.
They require close monitoring.
Other coloured vegetables are all having all these property without fructose and they are safe.

References:

Panth, N.; Manandhar, B.; Paudel, K.R. Anticancer activity of Punica granatum (pomegranate): A review. Phytother Res. 2017, 31, 568–578
Olvera-Sandoval, C.; Fabela-Illescas, H.E.; Fernández-Martínez, E.; Ortiz-Rodríguez, M.A.; Cariño-Cortés, R.; Ariza-Ortega, J.A.; Hernández-González, J.C.; Olivo, D.; Valadez-Vega, C.; Belefant-Miller, H.; et al. Potential Mechanisms of the Improvement of Glucose Homeostasis in Type 2 Diabetes by Pomegranate Juice. Antioxidants 2022, 11, 553. https://doi.org/10.3390/ antiox11030553
Kawabata, K.; Yoshioka, Y.; Terao, J. Role of intestinal microbiota in the bioavailability and physiological functions of dietary polyphenols. Molecules 2019, 24, 370.
Kerimi, A.; Nyambe-Silavwe, H.; Gauer, J.S.; Tomás-Barberán, F.A.; Williamson, G. Pomegranate juice, but not an extract, confers a lower glycemic response on a high-glycemic index food: Randomized, crossover, controlled trials in healthy subjects. Am. J. Clin. Nutr. 2017, 106, 1384–1393.
Harzallah A, Hammami M, Kępczyńska MA, Hislop DC, Arch JR, Cawthorne 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
Jelodar G, Mohsen M, Shahram S. Effect of walnut leaf, coriander and pomegranate on blood glucose and histopathology of pancreas of alloxan induced diabetic rats. Afr J Tradit Complement Altern Med. 2007 Feb;4(3):299– 305.
Kerimi, A.; Nyambe-Silavwe, H.; Gauer, J.S.; Tomás-Barberán, F.A.; Williamson, G. Pomegranate juice, but not an extract, confers a lower glycemic response on a high-glycemic index food: Randomized, crossover, controlled trials in healthy subjects. Am. J. Clin. Nutr. 2017, 106, 1384–1393
Nemati et al. BMC Nutrition (2022) 8:48 https://doi.org/10.1186/s40795-022-00538-3
D Estherlydia, Sheila John, Sarah Jane Monica and Priyadarshini S.Pomegranate alleviates metabolic syndrome: A Systematic reviewJournal of Pharmacognosy and Phytochemistry 2019; 8(1): 2741-2747