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Bad News for Fans of Pomegranate Juice

Paul Edwards

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The "New" Prostate Cancer InfoLink has an article which sums up the results of a recent randomized, double-blind, placebo-controlled, multi-institutional study on the effects of pomegranate liquid extract or juice on prostate cancer patients:


"there may be some benefit to the use of pomegranate juice among men with prostate cancer who carry the Manganese Superoxide Dismutase AA gene — but further studies would be needed to prove this.   There appears to be no significant impact of pomegranate juice in other patients, based on this study".


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I quite liked the pomegranate juice. I gave up on it last year after we had Dr Mark Moyad as our guest speaker,  December 2014 telephone meeting.






[Ed.  Here's what Dr Moyad said to us last year about Pomegranate Juice:


Dr. Mark Moyad: It is probably a good thing sometimes that no one knows where I live. Because I always tell people that, sometimes just speaking your mind and not having any financial connection to any of these companies, sometimes I get nervous when I start my car. That someone is going to put a bomb in my car or something. The reason I say that is because I said for years that I believe the pomegranate juice trial will fail. The reason why I think it is going to fail is because I have been doing this for so long.   I have seen so many people and what you don’t see in a pomegranate trial is you don’t see men lose weight.   You don’t see their blood sugars get better.  You don’t see their blood cholesterol peak.  You see nothing heart healthy but somehow magically it changes your doubling time.  Now, will they beat placebo?


There is this large based retrial that has just completed.  We will not know the answers until Spring.  People have always said to me they appreciate my prediction record.  I probably should have gone into Vegas and betting.  I would have made more money than medicine.  All I have is my prediction records if you look at all my publications. The track record is very good.  They always ask me what do you predict will happen in the pomegranate trial?  My prediction is it won’t beat placebo. 


The reason is why that is, when some men go on pomegranate, they tend to do a lot of other things that are very healthy and that make pomegranate look good.  The second thing is that if you notice from the studies they never go up against orange juice or grapefruit juice or carrot juice which is low in calories and high in potassium.  You don’t go up against anything.  That is not proving anything to me. 


You have to prove you are heart healthy, and first do no harm.  Unfortunately a lot of guys don’t like it but I am being honest that I believe that trial will fail.  I believe it from experience.  I believe it from the fact it is not changing numbers by itself.  We know that.  Somehow magically it is doubling changing time. 


Let me give you an example of how you can change doubling time.  There was a huge drug going through a trial in the United States in the past few years.  The reason why the trial was stopped is that approximately 80% of the men on placebo had an improvement in doubling time just doing what they were doing every day.  There was lifestyle change. 


We will find out in 2015.   I will come back onto the phone and if I am wrong you can throw eggs at me.


I am worried this trial is going to show nothing. The other reason I want to say that is because all these studies are tied into business in a kind of way. The trial ended a while ago and I just think something would have leaked already if there was something positive. For those of you who don’t realise, in the United States a pomegranate juice company were sued by our government, the Federal Trade Commission.  They were sued for making claims that they could not substantiate. It has been very quiet lately.


I have worked with the government in the United States. I have advised and counselled for everyone you can imagine in this country. And when you hear it go this quiet, what it generally means is something happened that was remotely positive but is not that great or nothing happened. 


There is another reason I believe that is going to happen. If you drink pomegranate juice and you are losing weight and your cholesterol is coming down and you are seeing heart healthy changes, just continue what you are doing. In the clinical trials in the most case scenario, I see the men drink a bunch of the pomegranate juice and taking the pills and spending a lot of money and I see them gaining weight.  That makes me nervous. 


I say that every prostate cancer patient should gauge their cholesterol, their blood sugar, blood pressure and weight. Those four parameters should help them identify whether or not they should continue on the Budwig protocol or the pomegranate. Again that is cholesterol, blood sugar, blood pressure and weight. If those are getting better, that is different. " ]

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I am not convinced that the article reports "bad news" for fans of pomegranate juice and I will continue to give pomegranate juice the benefit of the doubt. It depends on expectations of what can be achieved and end points measured. For me, I am looking to prolong the end point before treatment for a rising PSA after surgery and thus any prolongation of PSA doubling time (PSADT) is a good outcome.

I bought access to the original article by Pantuck et al. (Prostate Cancer & Prostatic Disease, 2015, 1-7) and there are several positive aspects in it about pomegranate juice as outlined below. Randomised controlled trials based on diet are notoriously difficult to obtain statistical significance because many factors that can influence the result are not controlled and because of the difficulty of recruitment.


The authors' statements in the article which didn't get in to the Infolink article are: 

  • "The primary objective ... was to compare the effects of pomegranate juice on PSA doubling times in subjects with rising PSA after primary therapy for prostate cancer." The assessment was made following 12 months of treatment.
  • The authors cite published references that pomegranate juice does modulate inflammatory pathways and thus anti tumour effects. Also that "there is substantial evidence that supports the important link between inflammation, reactive oxygen species and prostate carcinogenesis."
  • "A significant body of literature provides evidence for the biological activity of pomegranate juice in prostate cancer cells. In vivo and in vitro studies have shown that pomegranate extracts are capable of inhibiting tumour cell proliferation, migration, invasion, while also inducing apoptosis" (cell death). 
  • "An additional analysis was performed in patients who received a minimum of 12 months of blinded treatment to determine whether length of treatment had any additional impact on PSADT. Median PSADT increased 3.5 months in placebo patients from 12.2 at baseline to 15.7 months (P=< 0.0001), 18 months from 16.1 at baseline to 34.1 months in juice patients (P =< 0.05) and 5.6 months from 13.9 to 19.5 months in extract patients (P= <0.0003)".  There were fewer people in the juice only group and the significance of the increase in PSADT is less than the other groups but still significant and an 18 months improvement in PSADT is something I would be happy with. 

There is also some evidence in other studies that having antioxidants in combination may give an enhanced benefit (say pomegranate juice with green tea) and that milk products may counteract some activity of some antioxidants. Also insulin is noted to cause inflammation and thus if the diet was high in foods that triggered high insulin responses, any benefit from pomegranate juice may be minimised.


Thus for me, and based on this article and others, I will continue to give pomegranate juice the benefit of the doubt and hope it is actually prolonging my PSADT. My PSADT is 23 months at 6 years after prostatectomy but hard to tell if it has increased over time or not. 

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