Pomegranate: the juice, the capsule and eleven refusals

Two different products get talked about under one name, and only one of them has millimetres attached. Eight randomised trials of pomegranate juice, pooled in 2016, found systolic pressure about 4.96 mmHg lower and diastolic about 2.01 mmHg lower. The odd part is that doses under 240 cc a day gave the largest estimate of all, and a dose-response that runs backwards is what small-study effects look like. At least three later poolings of the same question exist, and we could not obtain them, so this number may already have been revised. The result people quote most is not about pomegranate alone: the prostate capsule held pomegranate, green tea, broccoli and turmeric together, and no design could say which of the four did anything. The largest pooling, 53 trials and 2306 people, prints its effects as standardised mean differences with units attached, which is an arithmetic slip that makes the sizes unreadable. It can tell you the direction and not the amount.

The numbers, per 100 g

What your body absorbs

• Whether pomegranate works on you may depend on your gut bacteria, and nobody has shown that it does. — participants in 33 randomised controlled trials and 12 observational studies (n = 45 studies) Evidence A source
  Equol producers showed lipid-lowering effects in 9 trials and favourable lipids in 3 observational studies while 11 trials and 3 studies found no difference; for blood pressure, 2 trials and 1 study reported reductions in equol producers against 7 trials and 2 studies finding none; one trial showed lipid lowering for urolithin metabotype B while two observational studies linked that same metabotype to higher lipids; the authors conclude the evidence is inconclusive

What it does to your health

• Pomegranate juice lowered systolic pressure by about five millimetres of mercury in pooled trials. — participants in 8 randomised controlled trials (n = 8 trials) Evidence A source
  Systolic pressure fell by a weighted mean difference of 4.96 mmHg (95% CI -7.67 to -2.25, p < 0.001) and diastolic by 2.01 mmHg (95% CI -3.71 to -0.31, p = 0.021); the systolic effect held across durations above and below 12 weeks and across doses, with doses below 240 cc per day giving the largest estimate at 11.01 mmHg

Safety, limits and interactions

• Pomegranate blocked one drug enzyme in a test tube and left it alone in people, and that is one enzyme with one drug rather than a clearance for a medicine cabinet. — human volunteers, with parallel in vitro work (n = not given in the abstract) Evidence B source
  In vitro half-maximal inhibitory concentrations for juice and extract were below 1% by volume with no mechanism-based inhibition, yet flurbiprofen pharmacokinetics were unchanged by either juice or extract against the control beverage, while fluconazole significantly reduced flurbiprofen clearance; the authors conclude pomegranate can be consumed by patients taking CYP2C9 substrate drugs with negligible risk

What people believe that the data does not support

• Europe has refused every health claim ever filed for pomegranate, eleven of them. — — Evidence E source
  The entry claiming that pomegranate helps maintain a healthy prostate and contributes to healthy sexual function in men carries the status Non-authorised; across the eleven register entries naming pomegranate, pomegranate juice, its extracts or Punica granatum in this snapshot, authorised claims number zero and refusals eleven, covering cholesterol, prostate, sexual function, glucose, antioxidant effect and skin

Who this works differently for

• The famous prostate result came from a capsule in which pomegranate was one ingredient of four. — men with localised prostate cancer, average age 74, 60% on active surveillance and 40% on watchful waiting after previous intervention (n = 199) Evidence B source
  Median PSA rise was 14.7% (95% CI 3.4 to 36.7) in the supplement group against 78.5% (95% CI 48.1 to 115.5) in placebo, a difference of 63.8% (P = 0.0008); 8.2% of supplement and 27.7% of placebo men left surveillance (P = 0.014); no differences appeared in the predetermined subgroups or in cholesterol, blood pressure, blood sugar, C-reactive protein or adverse events

What is still unknown

• The largest pooling of pomegranate trials finds small effects on many measures and none on most of them. — participants in 53 randomised controlled trials (n = 2306) Evidence A source
  Standardised mean differences favoured pomegranate for body weight, diastolic pressure, body mass index, systolic pressure, fasting glucose and total cholesterol, and for raising HDL; no substantial change appeared in waist-to-hip ratio, HOMA-IR, waist circumference, HbA1c, ALT, triglycerides, LDL, insulin or AST
• That prostate trial was audited twice by an outside agency, which is unusual for a supplement study. — — (n = 199) Evidence B source
  The trial was approved by the National Ethics Committee, peer reviewed by the National Cancer Research Institute and adopted by the National Cancer Research Network; randomisation was outsourced and the methodology, data collection and storage were verified and independently audited by an external agency to European Good Clinical Practice, with a second external audit before the database was sealed for blinded analysis

The bottom line

Drink the juice if you like it. On everything past blood pressure the same literature is a long list of nulls: across 53 trials there was no substantial change in waist circumference, HbA1c, triglycerides, LDL, insulin or liver enzymes. The prostate trial deserves its own paragraph because it gets quoted so often. Over six months in 199 men under surveillance for localised prostate cancer, median PSA rose 14.7 percent on the four-ingredient capsule against 78.5 percent on placebo. PSA is a marker. Six months of a slower PSA rise is not six months of less cancer, and the trial measured no survival. It was independently audited twice to European Good Clinical Practice, which is unusual for a supplement study, and that is a reason to take the PSA number at face value rather than a reason to buy the capsule. One practical question has a clean answer. Pomegranate blocked the drug-metabolising enzyme CYP2C9 in a test tube and left it alone in people, and the authors conclude that patients on CYP2C9 substrate drugs can eat it with negligible risk. That covers one enzyme and one drug, so it clears pomegranate against that pair and not against your whole medicine cabinet. One thing we cannot give you is the glass itself. Our composition table holds a single USDA row for pomegranate, and it is the raw fruit: 83 kcal, 18.7 g of carbohydrate and 13.67 g of sugar per 100 g. There is no USDA entry for the juice in our cohort, so the drink that carries almost all the evidence on this page is the one thing you cannot check a number against here. There is also an idea you will meet online, that pomegranate works only on people whose gut bacteria make urolithins. A systematic review of 45 studies found the evidence for that inconclusive, with one trial and two observational studies pointing opposite ways. The idea is biologically sound and commercially attractive, which is exactly why the missing result matters. Europe has refused all eleven health claims ever filed for pomegranate, covering cholesterol, prostate, sexual function, glucose, antioxidant effect and skin, and the register carries no reasons.

Sources

1. pom-dr-01 · systematic review
   Evidence for the role of (poly)phenol metabotypes in cardiometabolic health is inconclusive.
   Crit Rev Food Sci Nutr, 2026 · checked 2026-09-22
2. pom-dr-02 · systematic review and meta-analysis of randomised controlled trials
   Quantitative data synthesis from 8 RCTs showed significant reductions in both systolic [weighed mean difference (WMD): -4.96mmHg, 95% CI: -7.67 to -2.25, p<0.001) and diastolic BP (WMD: -2.01mmHg, 95% CI: -3.71 to -0.31, p=0.021) after pomegranate juice consumption.
   Pharmacol Res, 2017 · checked 2026-09-22
3. pom-dr-04 · randomised comparative pharmacokinetic study
   Despite inhibition of CYP2C9 in vitro, pomegranate juice and extract had no effect on CYP2C9 activity in human subjects, and can be consumed by patients taking CYP2C9 substrate drugs with negligible risk of a pharmacokinetic interaction.
   Clin Pharmacol Ther, 2012 · checked 2026-09-22
4. pom-dr-07 · regulatory register entry
   POL-HC-7792 Pomegranate Helps to maintain a healthy prostate. Contributes to healthy sexual function in men. Non-authorised
   EU Register on nutrition and health claims, claim POL-HC-7792, snapshot of 2026-09-21 · checked 2026-09-22
5. pom-dr-05 · randomised double-blind placebo-controlled trial
   The median rise in PSA in the food supplement group (FSG) was 14.7% (95% confidence intervals (CIs) 3.4-36.7%), as opposed to 78.5% in the placebo group (PG) (95% CI 48.1-115.5%), difference 63.8% (P=0.0008).
   Prostate Cancer Prostatic Dis, 2014 · checked 2026-09-22
6. pom-dr-03 · dose-response meta-analysis of randomised controlled trials
   No substantial changes were observed in waist-to-hip ratio (WHR), homeostatic model assessment of insulin resistance (HOMA-IR), waist circumference (WC), serum values of hemoglobin A1c (HbA1c), alanine transaminase (ALT), triglycerides (TG), low-density lipoprotein (LDL), insulin, and aspartate transferase (AST) levels between PO and placebo groups.
   Nutr Metab Cardiovasc Dis, 2025 · checked 2026-09-22
7. pom-dr-06 · trial conduct and audit description
   The randomisation process was outsourced and the trial methodology, collection and storage of data were verified and independently audited by an external agency to ensure adherence to European Good Clinical Practice.
   Prostate Cancer Prostatic Dis, 2014 · checked 2026-09-22