As we have learned through physiology, cardiovascular disease is alarmingly prevalent. One in four Americans die from cardiovascular disease each year in the United States (CDC, 2020). Studies show dietary supplementation of pomegranate provide health benefits for individuals with cardiovascular disease, cellular inflammation, joint or muscle damage, oxidative stress, and chronic inflammatory diseases (Ammar, 2018) (Danesi, Ferguson, 2017). Pomegranates are antioxidants high in polyphenols, providing anti-inflammatory effects when consumed (Danesi, Ferguson, 2017). Pomegranate juice is reported to be the most potent antioxidant in comparison to other fruits (Danesi, Ferguson, 2017). Pomegranate is effective at reducing LDL oxidation and macrophage foam cell formation; both of which are involved in increased cholesterol and development of atherosclerosis (Aviram, 2004). The mechanisms behind the effects of pomegranate are unclear, but researchers attribute its efficacy to the high content of polyphenols (Danesi, Ferguson, 2017).
A study investigated the effects of pomegranate juice on atherosclerotic patients with carotid artery stenosis. Ten patients received the pomegranate juice supplementation for one year, and five of these ten patients continued the pomegranate juice supplementation for up to three years. These patients continued with their pharmaceutical treatment therapy. Patients ingesting pomegranate juice had a 30% decrease in carotid intima-media thickness, while the control group had an increase of carotid intima-media thickness by 9% (Aviram, et. al, 2004). PON1 activity, an enzyme associated with HDL, increased by 83% in the experimental group (Aviram, et. al, 2004). These patients had a reduced serum LDL basal oxidative state by 90%, a reduction of LDL susceptibility to oxidation by 59%, and reduction of systolic blood pressure by 12% (Aviran, et. al, 2004). The maximum benefits were observed after just one year of consumption, while further consumption didn’t demonstrate any major additional benefits (Aviran, et. al, 2004). In conclusion, consuming 50 mL of pomegranate juice per day can significantly reduce carotid stenosis, increase “good cholesterol” enzymes, reduce “bad cholesterol” susceptibility to be oxidized, and lower blood pressure.
Undoubtedly, there is more research to be done to further understand the physiological mechanisms behind the benefits of pomegranate juice. As healthcare providers, we ought to practice beneficence, providing patients with diverse treatment options, especially if these treatment options may be more beneficial, have less adverse effects, are more natural, and are inexpensive. From an osteopathic perspective, why should physicians prescribe medications with possible side effects if a patient could simply drink a cup of fruit juice?
Aviram M, Rosenblat M, Gaitini D, Nitecki S, Hoffman A, Dornfeld L, Volkova N, Presser D, Attias J, Liker H, Hayek T. 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. doi: 10.1016/j.clnu.2003.10.002. Erratum in: Clin Nutr. 2008 Aug;27(4):671. PMID: 15158307.
Danesi F, Ferguson LR. Could Pomegranate Juice Help in the Control of Inflammatory Diseases? Nutrients. 2017 Aug 30;9(9):958. doi: 10.3390/nu9090958. PMID: 28867799; PMCID: PMC5622718.
“Heart Disease.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Oct. 2020, www.cdc.gov/heartdisease/index.htm.
Hey Lindsey, this was such an interesting idea that you have brought to our attention as we are in the day and age of realizing that diet has such a huge effect on our health. It was crazy to see that pomegranate juice actually has a reversible effect on heart health as many of the studies that we see are preventative. One of these preventative studies that can add onto your case was about the effects of Fiber-rich fruit consumption in a group of Mediterranean youth. The study found that their was an inverse relationship between fiber intake and cardiovascular disease within this group (Buil-Cosiales et al. 2017). With the extensive research that has been done on the impact of food and cardiovascular disease, I think it is fair to say that nutritional methods should be used first before even considering pharmaceutical ones. This is the best way that I can answer the question that you proposed.
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Buil-Cosiales, P., Martinez-Gonzalez, M., Ruiz-Canela, M., Díez-Espino, J., García-Arellano, A., & Toledo, E. (2017). Consumption of Fruit or Fiber-Fruit Decreases the Risk of Cardiovascular Disease in a Mediterranean Young Cohort. Nutrients, 9(3). doi:https://doi.org/10.3390/nu9030295
You have brought up a very good question that I believe lies within the type of society we live in. I believe it has become more of a habit for physicians to often prescribe medication instead of considering alternatives. This habit might be from the way they are taught in medical school or due to packed schedules or a combination. It could also be from patients not wanting to change their lifestyle and think just taking one pill a day is easier. I do agree with you however that medicine needs to move toward more holistic approaches, such as drinking a cup of juice because overprescribing medication can result in adverse reactions. Although physicians’ may think they are doing no harm, they are potentially putting their patients at more risk by prescribing medication instead of looking at other options that may lower this risk. Although technology and advancements can be good, I often feel that our society is so controlled by technology that we often forget about the simple things that have worked in the past. One way to work towards doctors offering more holistic options instead of medication could be having the patients speaking up about wanting other options. The doctor also must remember that the patient has a right to ask for other options and to say no to medication if they do not feel that it is beneficial (autonomy).
ReplyDeleteHey Lindsey,
ReplyDeleteI was curious to see pomegranate juice as a strong antioxidant. I found a study that was tested on elite weightlifters in which participants would either ingest a placebo or pomegranate juice supplements. Essentially at the end of the study, the researchers found that there was a slow down in oxidative stress and an increase in acute antioxidant response; in other words, there was a strong enhancement of enzymatic and non-enzymatic antioxidant responses which impeded oxidative stress (Ammar et al., 2017).
I don’t think advising ingesting pomegranate juice is a bad idea, but given that more studies need to be done, it is, for the time being, a supplement that appears helpful. If a patient in suffering from heavy CAD, I think we ought to give them the strong line of defense to ensure their livelihood. If they choose to do so, they may also supplement with beneficial fruits like pomegranate.
References:
Ammar, A., Turki, M., Hammouda, O., Chtourou, H., Trabelsi, K., Bouaziz, M., Abdelkarim, O., Hoekelmann, A., Ayadi, F., Souissi, N., Bailey, S., Driss, T., and Yaich, S. (2017). Effects of Pomegranate Juice Supplementation on Oxidative Stress Biomarkers Following Weightlifting Exercise. Nutrients, 9(8), 819.