Pomegranate: The Ultimate Bypass To Bypass Surgery?

Millions take toxic cholesterol and blood pressure lowering drugs that may do nothing to reduce heart disease specific mortality. Pomegranate juice, on the other hand, actually reverses underlying pathologies of the cardiovascular system that lead to bypass surgeries and heart attacks. 

One of the most amazing clinical studies ever performed in the history of medicine has been hidden away behind a pay wall for over a decade. When I first stumbled upon this clinical pearl years ago in the form of the publicly indexed abstract on pubmed.gov, my jaw nearly dropped.

Particularly compelling was this line from the abstract:

"Pomegranate juice consumption resulted in a significant IMT [intima media thickness] reduction, by up to 30%, after 1 year."

So, what does this reduction in the intima media thickness (IMT) mean? 

The intima media is the middle portion of the arteries that become inflamed and fill up with plaque comprised of oxidized fats, alive and dead immune cells and their debris, in the condition known colloquially as "blocked arteries." As the intima media grows thicker, less space is available for the blood contents to move through the opening (lumen) of the arteries. When the arterties eventually close or are blocked, catastrophic injury or death may follow. Therefore, anything that can safely reduce and even reverse intima media thickening is the holy grail as far as obtaining a root cause resolution of atherosclerosis.

Indeed, in a world where the #1 cause of death is cardiovascular disease, and where we preemptively medicate millions more with drugs that only reduce surrogate markers for cardiovascular disease risk – i.e. lipoproteins carrying cholesterol – without showing any convincing effort that it is reducing cardiovascular disease or all-cause mortality, how could something so simple and powerful as pomegranate be overlooked? In fact, if a simple daily dietary intervention like this truly is capable of regressing and/or reversing the underlying disease process in the arteries that behind the massive burden of heart disease related deaths in the Western world, it would seem highly unethical not to use it.

And so, in this article, we wish to bring some of the finer details of this clinical trial to light, to further substantiate the value of botanical and food-based interventions not only in preventing but treating major chronic disease processes like cardiovascular disease, the developed world's most deadly disease. 

The Pomegranate "Artery Cleaning" Clinical Trial

Published in Clinical Nutrition in 2014 and titled, "Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation," Israeli researchers discovered pomegranate, administered in juice form over the course of a year, reversed plaque accumulation in the carotid arteries of patients with severe, though symptomless, carotid artery stenosis (defined as 70–90% blockage (stenosis) in the internal carotid arteries).

The study consisted of nineteen patients, 5 women and 14 men, aged 65-75, non-smokers, with asymptomatic severe carotid artery stenosis were enrolled in the study. They were randomized to receive either pomegranate juice or placebo. Ten patients were in the PJ treatment group and 9 patients that did not consume PJ were in the control group. Both groups were matched with similar blood lipid and glucose concentrations, blood pressure, and with similar medication regimens which consisted of blood-pressure lowering (e.g. ACE inhibitors, β-blockers, or calcium channel blockers) and lipid lowering drugs (e.g. statins).

The 10 patients in the treatment group group received 1.69 ounces (50 ml) of pomegranate juice per day (about the size of a shot glass), which contained .036 milligrams of total polyphenols (primarily tannins and anthocyanins), for a period of 1 year, and five out of them agreed to continue for up to 3 years.  

The remarkable results were reported as follows:

"The mean intima media thickness the left and right common carotid arteries in severe carotid artery stenosis patients that consumed pomegranate juice for up to 1 year was reduced after 3, 6, 9 and 12 months of pomegranate juice consumption by 13%, 22%, 26% and 35%, respectively, in comparison to baseline values."

While these results are impressive, if not altogether groundbreaking for the field of cardiology, they may be even better than revealed in the baselines  When one factors in that the carotid artery stenosis increased 9% within 1 year in the control group, the pomegranate intervention group may have 

he We can assume that if the pomegranate group had received no treatment, the thickening of their carotid arteries would have continued to progress like the control group at a rate of 9% a year, i.e. 18% within 2 years, 27% within 3 years. This could be interpreted to mean that after 3 years of pomegranate treatment, for instance, the thickening of the arteries would have been reduced over 60% beyond what would have occurred had the natural progression of the disease been let to continue unabated.  

The researchers identified three likely mechanisms of action behind pomegranate's observed anti-atherosclerotic activity:

• Antioxidant properties: Subjects receiving pomegranate saw significant reductions in oxidative stress, including decreases in autoantibodies formed against ox-LDL, a form of oxidized low density lipoprotein associated with the pathological process of atherosclerosis. Decreases in oxidative stress were measurable by an increase in the blood serum enzyme paraoxonase 1 (PON1) of up to 91% after 3 years; PON1 is an enzyme whose heightened activity is associated with lower oxidative stress. All of this is highly relevant to the question of pomegranate's anti-atherosclerotic activity because of something called the lipid peroxidation hypothesis of atherosclerosis, which assumes that it is the quality of the blood lipids (i.e. whether they are oxidized/damaged or not), and not their quantity alone that determine their cardiotoxicity/atherogenicity.
• Blood Pressure Lowering Properties: The intervention resulted in significant improvement in blood pressure: the patient's systolic blood pressure was reduced 7%, 11% ,10%, 10% and 12% after 1, 3, 6, 9, and 12 months of pomegranate consumption, respectively, compared to values obtained before treatment. Pomegranate's ability to reduce systolic blood pressure indicates it has a healing effect on the endothelium, or the inner lining of the artery which fails to relax fully in heart disease; a condition known as endothelial dysfunction. 
• Plaque Lesion Stabilization: Because two of the ten patients on PJ (after 3 and 12 months) experience clinical deterioration, carotid surgery was performed and the lesions were analyzed to determine the difference in their composition to those who did not receive pomegranate. The researchers noticed four distinct differences in the composition of the pomegranate-treated lesions:

1.     Reduced Cholesterol Content: "The cholesterol content in carotid lesions from the two patients that consumed PJ was lower by 58% and 20%, respectively, in comparison to lesions obtained from CAS patients that did not consume PJ (Fig. 3A)."

2.     Reduced Lipid Peroxides: "[T]he lipid peroxides content in lesions obtained from the patients after PJ consumption for 3 or 12 months was significantly reduced by 61% or 44%, respectively, as compared to lesions from patients that did not consume PJ (Fig. 3B).

3.     Increased Reduced Glutathione Content: "A substantial increase in the lesion reduced glutathione (GSH) content, (GSH is a major cellular antioxidant) by 2.5-fold, was observed after PJ consumption for 3 or 12 months, (Fig. 3C).

4.     Reduced LDL Oxidation: "LDL oxidation by lesions derived from the patients after PJ consumption for 3 or 12 months, was significantly (Po0.01) decreased by 43% or 32%, respectively, in comparison to LDL oxidation rates obtained by lesions from CAS patients that did not consume PJ (Fig. 3D)."

Essentially these results reveal that not only does pomegranate reduce the lesion size in the carotid arteries, but "the lesion itself may be considered less atherogenic after PJ consumption, as its cholesterol and oxidized lipid content decreased, and since its ability to oxidize LDL was significantly reduced."  

This finding is quite revolutionary, as presently, the hazardsdangers of carotid artery stenosis are understood to be based on the lesion size and not quality. This dovetails with the concept that the sheer quantity of lipoproteins (i.e. "cholesterol") in the blood can not accurately reveal whether those lipoproteins are actually harmful (atherogenic); rather, if lipoproteins are oxidized (e.g. ox-LDL) they can be harmful, whereas non-oxidized low density lipoprotein may be considered indispensable for cardiovascular and bodywide health. Indeed, in this study the researchers found the pomegranate group had increased levels of triglycerdies and very low density lipoprotein, again, underscoring that the anti-atherosclerotic properties likely have more to do with the improved quailty of the milleu within which all our lipoproteins operate than the number of them in and of itself. 

Finally, it should be pointed out that all the patients in this study were undergoing conventional, drug-based care for cardiovascular disease, e.g. cholesterol- and blood pressure-lowering agents. Not only did the pomegranate treatment not appear to interfere with the drugs, making it a suitable complementary/adjunct therapy for those on pharmaceuticals, but it should be pointed out that the control group's condition got progressively worse (e.g. the mean IMT increased 9% within 1 year), speaking to just how ineffective drugs are.