Pomegranate is a deciduous shrub or small tree, sometimes thorny, growing to 16 feet (five meters) tall.1-3 It has oblong, shiny, leathery leaves up to three inches (eight centimeters) in length, and the scarlet funnel-shaped flower has five-to-eight rumpled petals with a matching calyx.1-5 The fruit is a large berry with tough, leathery skin (called a husk, rind, or pericarp), with a persistent calyx and fleshy pulp enclosing edible seeds.2,3,5
The pomegranate is believed to have originated in Persia (modern-day Iran), Afghanistan, Pakistan (particularly the province of Baluchistan),6 and perhaps northern India. It was spread throughout the Middle East to Southeastern Europe around the Mediterranean, to China, North Africa, and eventually to warm regions of the New World.2,3,7 In India, P. granatum is found in the wild only in the Western Himalayan regions comprising the states of Jammu, Kashmir, Himachal Pradesh, and Uttarakhand.8 To the northwest of Iran — in Armenia, Azerbaijan, and Georgia — there are wild pomegranate groves found outside of abandoned ancient settlements.9 Naturalized in Western China, it was probably introduced there from Central Asia during the Han Dynasty (207 BCE to 220 CE).10
The pericarp and pulp of the fruit as well as the root bark are used either culinarily or medicinally.1-3
HISTORY AND CULTURAL SIGNIFICANCE
Pomegranate is one of only two species in the Punica genus; it was the sole genus in the Punicaceae family prior to its reclassification in Lythraceae.7 The generic epithet, Punica, is the feminized Latin name for Carthage, originally from the Greek Phoinix referring to the Phoenician settlers around Carthage. The specific epithet, granatum, means seedy or grainy. Prior to its renaming by Linnaeus in the 18th century, the plant was known as Malum punicum, the apple of Carthage.7
In the 12th century, the Anglo-Norman name for the fruit, pome gernate, became pume grenate in Old French and eventually pomme grenade in Modern French.11 By the 15th century, hand-thrown weapons made of cast iron and filled with gunpowder had been invented and called grenades. To this day, opening a grenade exposes tiny balls of shrapnel that resemble a pomegranate’s seeds.
The name for pomegranate in both Arabic (rumman) and Hebrew (rimmon) means “fruit of paradise,” and it has been a symbol of love since ancient times.1,7 It was mentioned multiple times in the Biblical Song of Songs, also known as the Song of Solomon (Solomon 4:3, 4:13, 6:7, 6:11, 7:12, and 8:2); it played a large role in the Greek myth of Persephone; and it was associated commonly with Aphrodite and Dionysius.1,7 Even Shakespeare made note of the pomegranate tree in Romeo and Juliet.12
Pomegranate has been affiliated with abundance, blessings, fertility, immortality, invincibility, posterity, prosperity, and the endurance of marriage.1,7 While its multitude of seeds might explain why pomegranate is linked with fertility, it is interesting to note that in one version of the Greek myth, Persephone, daughter of the fertility goddess, Demeter, disobeyed her father, Zeus, and ate some pomegranate seeds while in the underworld, causing Demeter’s distress and the onset of autumn and winter in the world above (i.e., an interruption of fertility).13 Perhaps not coincidentally, contraception was one of the earliest reported medicinal uses of pomegranate. The Greek physician Soranus recorded five prescriptions for either oral contraceptives or vaginal suppositories made from pomegranate seeds or rinds.14 Hippocrates (468-377 BCE), Dioscorides (40-90 CE), and Ibn Sina (Avicenna, 980-1037 CE) also described the contraceptive use of pomegranate seeds or rinds.14 By the Middle Ages, though, pomegranates had disappeared from medical writings for this purpose.
Historically, pomegranate has been significant in several cultures for its food and medicinal uses, as well as for its spiritual and artistic symbolism. The fruit was an extremely useful way of transporting liquid when traveling through the desert.7 In addition to its juice, the arils (juicy pulp covering the seeds) were and are a distinctive component of certain Middle Eastern dishes: fesenjan (lamb or chicken stew with walnuts and pomegranates), khosaf al-rumman (pomegranate with nuts and orange flower syrup), and pomegranate khoresh (stew), to name a few.
Pomegranate is mentioned as a remedy for roundworm in the Ebers Papyrus (the oldest preserved medical document, from Egypt, ca. 1500 BCE).15 Hippocrates used pomegranate seed extracts for numerous ailments including skin and eye inflammation and as a digestive aid, while Dioscorides recommended various pomegranate parts, sometimes in combination with other ingredients, for stomach ailments, mouth and genital sores, gum disorders and loose teeth, as well as for expelling parasites.7 Treatment of bronchitis, diabetes, diarrhea, hemorrhaging, leprosy, and snakebites are all traditional uses of pomegranate.7 Both the dried fruit rind and pulp have been used commonly for upset stomachs and diarrhea, prepared as infusions (teas) or tinctures (alcoholic extractions).3
Most parts of the pomegranate including the flower, fruit rind, leaf, dried seed and fresh seed, root bark or trunk bark, fresh fruit and preparations thereof (e.g., juice) — have defined therapeutic applications in traditional medicine systems such as Ayurveda, Siddha, gSo-ba Rig-pa (Traditional Bhutanese), Sowa-Rigpa (Traditional Tibetan), Traditional Chinese Medicine (TCM), Traditional Iranian Medicine, Unani, and European Homoeopathy. The fresh fruit and fruit juice are used widely as foods and the juice also is used as a source of polyphenols. Essential oils, extracts, and waters of various plant parts, as well as isolates and derivatives such as pomegranate fruit peel extract octenylsuccinate, seed oil hydroxyphenethyl esters, and sterols obtained from the seed oil, are used as cosmetic ingredients.
The flower, fruit, fruit rind, and seed of P. granatum L. var. granatum are used specifically in Ayurveda, Siddha, Sowa-Rigpa (Amchi), and Unani systems of traditional medicine in India, and in regional Indian folk medicines. The materials of commerce are obtained from both cultivated and wild-collected sources. The flower of P. granatum L. var. nana Pers. (cultivated) is used in Indian folk medicine.16
In TCM, pomegranate husk/rind (called shi liu pi) is used to treat diarrhea, dysentery, rectal prolapse, spermatorrhea and premature ejaculation, uterine bleeding, vaginal discharge due to kidney instability, and to kill and expel parasites.17 It also is used topically for ringworm and in combination with other herbs for the conditions mentioned above.17
The dried ripe fruit (with seeds removed) is used in Tibetan medicine to restore weak digestive heat, to correct indigestion and loss of appetite, and for all forms of cold diseases and disorders of the lungs.18 In the Bhutanese system of medicine, it functions as a primary component of herbal combinations in pill form indicated for treatment of indigestion and diarrhea.19
According to the World Health Organization (WHO) monograph Cortex Granati, therapeutic uses described in pharmacopeias and well-established documents for preparations of the root bark and/or trunk bark (aqueous decoction and/or hydroalcoholic fluidextract 1:1) include treatment of diarrhea and intestinal parasites. In systems of traditional medicine, preparations of the bark are used for treatment of dyspepsia, sore throat, menorrhagia (heavy menstrual bleeding), leucorrhoea (vaginal discharge), and ulcers.20
CURRENT AUTHORIZED USES IN COSMETICS, FOODS, AND MEDICINES
In the Ayurvedic system of medicine (recognized in India, Bangladesh, Bhutan, Malaysia, Nepal, and Sri Lanka), the therapeutic uses of the different plant parts are similar to what has been described previously, with some notable exceptions:
The fresh fruit juice of pomegranate at a dose of 15-30 mL is used in formulations for treating conditions including bleeding disorder (hemorrhagic diseases, i.e., bleeding with stools or from nose, excessive bleeding during menstruation, or bleeding from any other part of the body without injury), burning sensation in the eyes, chest, palm and/or soles of feet (e.g., diabetic neuropathy); cough, diarrhea, fever, loss of taste sensation, rheumatoid arthritis, and thirst.21
The dried and powdered fruit rind at a dose of 3-6 g is indicated for bleeding disorder and disorders of blood, burning sensation, cough, diarrhea, dysentery, fever, halitosis (bad breath), hyperacidity of the stomach, loss of taste sensation, and throat diseases.21
The dried leaf at a dose of 5-10 g is indicated for treatment of bleeding disorder, cough, diarrhea, digestive impairment, dysentery, fever, helminthiasis (worm infestation), loss of taste sensation, and stomatitis (inflamed and sore mouth).21
Dried powdered pomegranate seeds are used in Ayurvedic medicine at a recommended dose of 5-10 g for treatment of burning sensation, fever, and morbid thirst.22
In the Unani system of medicine (recognized in Bangladesh, India, Malaysia, Pakistan, and Sri Lanka), various pomegranate plant parts also have different therapeutic indications usually occurring as components of complex formulations:
The dried leaf at a dose of 5-10 g is used for diarrhea, chest pain, palpitations, spermatorrhea (involuntary discharge of semen without orgasm), stomatitis, and vomiting.23
The dried seed at a dose of 5-10 g is used for treatment of cardiac weakness, chest pain, jaundice, as an emetic (to induce vomiting), and as a purgative (for intestinal evacuation in certain diseases).24
The fresh seed prepared as juice at a dose of 25-60 mL is used for treating anemia, burning in the chest, general weakness, jaundice, nausea and vomiting, and polydipsia (chronic excessive thirst).
In Canada, extract of pomegranate fruit and/or aril is classified as a medicinal ingredient of licensed natural health products (NHPs) requiring pre-marketing authorization from the Natural Health Products Directorate (NHPD) and manufacture in compliance with NHP Good Manufacturing Practices (GMPs). “Provides antioxidants” is the NHPD-authorized use for the extract.26
Several pomegranate ingredients also are permitted for use as non-medicinal components of licensed NHPs for specific purposes, including “concentrated pomegranate juice” as a flavor enhancer, “Punica granatum fruit extract” as a fragrance ingredient in topical application NHPs, and various extracts of the pericarp and/or seed and fixed oil of the seed as skin-conditioning agents.27
In the United States, essential oils, solvent-free extracted oleoresins, and natural extractives of pomegranate are classified by the Food and Drug Administration (FDA) as Generally Recognized as Safe (GRAS) for use in conventional food products.28 For use as a source of polyphenols, a pomegranate fruit juice monograph is under development by the United States Pharmacopeial Convention for inclusion in the forthcoming ninth edition of the Food Chemicals Codex.29
Pomegranate plant parts also are permitted for use as dietary supplement components, requiring FDA notification within 30 days of product marketing (if a “structure-function” claim is made) and product manufacturing according to dietary supplement GMPs.
In the European Union, the present regulatory status for the use of fruit oil and rind of P. granatum in conventional food products is uncertain. There has been a request made to determine if the fruit oil and rind will require authorization under the Novel Food Regulation.30
Additionally, the 2013 European Pharmacopoeia Commission work program is developing a new quality standards monograph for the homeopathic preparation “Punica granatum ad praeparationes homoeopathicas.” 31
There are nearly 30 different pomegranate ingredients authorized for use in cosmetic products by the European Commission Health and Consumers Directorate — too many to list and discuss in this review. Some examples include the fruit juice for masking (reduces or inhibits the basic odor or taste of the product) and skin-conditioning functions. Fruit water (an aqueous solution of the steam distillates obtained from the fruit) is authorized for functions including astringent (contracts the skin), flavoring, tonic (produces a feeling of well-being on skin and hair), and masking. “Punica Granatum Sterols” (a mixture of sterols obtained from the fixed oil of the seeds) is used for skin- and hair-conditioning functions.32
Corresponding to some of the authorized uses discussed in this article, quality standards monographs are available for specifying and testing the various plant parts of P. granatum (e.g., fresh fruit, dried fruit rind, dried leaf, dried seed, fresh seed, root bark or trunk bark) published in the Ayurvedic Pharmacopoeia of India (Vol. 2, 1999, and Vol. 4, 2004),21-22 Unani Pharmacopoeia of India (Vol. 2, 2007; Vol. 4, 2007; and Vol. 6, 2009),23-25 and WHO monographs (Vol. 4, 2009).20
For quality control in food applications there are also pomegranate standards, specifications, and test methods available from the East African Community (East African Standard CD/K/102:2010),33 The Food and Agriculture Organization (FAO) of the United Nations (Codex Standard 310-2013),34 the Government of India Ministry of Agriculture (AGMARK Grading and Marking Rules 2004),35 and the International Organization for Standardization (ISO 23393:2006).36
Pomegranate is a relatively good source of several vitamins and minerals such as vitamin C, thiamin, riboflavin, niacin, calcium, iron, and magnesium.37 All plant parts contain polyphenols; the pericarp (both the peel and the membrane) has the largest concentration.5 Polyphenols are responsible for the astringency of the juice and comprise two major classes of compounds — hydrolysable tannins and flavonoids — which are believed to be responsible for pomegranate’s beneficial actions. Numerous in vitro studies have documented the strong antioxidant properties of pomegranate.5
In 2012, a randomized, placebo-controlled, parallel group study examined the effect of pomegranate juice on pulse wave velocity (PWV), a measure of arterial stiffness that is a predictor of future cardiovascular events.38 Healthy participants (n=51) were randomly assigned to consume 330 ml/day pomegranate juice (PJ; Pomepure®, extracted using an industrial centrifugal juice extractor, The Pure Juice Company Ltd; Twickenham, UK) or placebo beverage for four weeks. Measurements were made at baseline and four weeks. While mean arterial pressure and diastolic and systolic blood pressure all decreased in the PJ group, PWV did not. The authors state numerous limitations to the study, among them the fact that subjects’ compliance was not confirmed, dietary intake was not assessed, the intervention period (four weeks) was short, and the pomegranate juice was not profiled to check for adulteration, although its total antioxidant capacity and content of phenolic compounds and potassium were consistent with reported values.
A study published in 2012 investigated the results of a randomized, placebo-controlled, double-blind clinical trial wherein 101 chronic hemodialysis (HD) patients received, during each dialysis, 100 cc PJ (0.7 mmol/100 cc juice polyphenols, Naturafood Ltd; Givat Hen, Israel) or matching placebo, three times/week for one year.39 HD patients frequently experience increased systemic inflammation and oxidative stress leading to atherosclerosis. The PJ group experienced reduced inflammation biomarker levels and protein and lipid oxidation. PJ intake also resulted in fewer second hospitalizations due to infections and improvement in the atherosclerotic process in 25% of patients. The beneficial effects disappeared three months after the study ended. The authors state that the findings are novel and should be replicated and validated in order to make PJ intake a part of dialysis therapy.
A number of human clinical studies have been conducted investigating the efficacy in cardiovascular health of POM Wonderful® Pomegranate Juice (POM; proprietary product made exclusively from the whole fruits of the ‘Wonderful’ variety, POM Wonderful, LLC; Los Angeles, CA). In a small, open-label, parallel group clinical trial in 2004 that ran for one year, 19 patients with carotid artery stenosis (CAS, hardening of the carotid artery; 70-90% occlusion) were randomly assigned to take 50 ml/day POM or no treatment.40 The group taking POM experienced a decrease in the properties that lead to hardening of the arteries, such as carotid thickness, lowered systolic blood pressure, and platelet aggregation. However, the two groups were not treated equally; there was no placebo for the control group, and the POM group received more interventions — such as blood draws and carotid ultrasounds — than the control group.
A three-month, open-label, control group comparison published in 2006 was conducted with 10 non-insulin-dependent diabetics and 10 healthy age-matched controls.41 Each participant was given 50 ml of concentrated POM diluted 1:5 with water to equal eight oz./day. In the diabetic group, serum C-peptide levels were reduced by 23% after POM consumption. Results also indicated that POM had a beneficial effect on oxidative stress experienced by diabetics. Additionally, POM consumption did not worsen the diabetic parameters, as the authors had feared.
A 2005 randomized, double-blind, placebo-controlled clinical study investigated the effect PJ had on myocardial perfusion in patients with coronary heart disease (CHD) and myocardial ischemia.42 Over three months, 45 patients with stable CHD ingested 240 ml (eight oz.) POM per day or a modified sports drink placebo. At baseline and at three months, patients underwent treadmill or pharmacologic stress testing. Of the 39 individuals who completed the regimen and underwent testing, stress-induced ischemia decreased in the POM group (by 17% compared to baseline) and increased by 18% in the control group.
In a small open-label study in 2001, 10 hypertensive patients (seven male, three female, all nonsmokers, two diabetic, and two hyper lipidemic) consumed 50 ml POM concentrate per day for two weeks to see if it had an effect on hypertension and angiotensin converting enzyme (ACE).43 Blood pressure and ACE activity were measured before and after POM intake. Juice consumption resulted in a small (5%) but significant reduction of systolic blood pressure and a significant (36%) decrease in ACE activity in seven of the 10 patients.
An 18-month, multi-center, randomized, double-blinded, two-dose human clinical trial in 2013 investigated the ability of a pomegranate extract (POMx) to increase prostate-specific antigen doubling time (PSADT) in men with rising PSA and no metastases.44 PSADT is a predictor of metastasis-free survival and overall survival in patients who have undergone primary therapy for localized prostate cancer. In this study, 104 patients were randomly assigned to receive three capsules of POMx (1000 mg/capsule, polyphenol extract, comparable to about eight oz. pomegranate juice, POM Wonderful, LLC) or one capsule POMx plus two placebo capsules (to equal three capsules). Both low-dose and high-dose groups experienced (greater than or equal to) six-month increases in PSADT without adverse effects. The authors state that the significance of the study is unclear and that placebo-controlled studies are needed in this patient population.
In a 2006 phase II, open-label, single-arm clinical trial, 46 men with recurrent prostate cancer and rising PSA took eight oz./day of POM until their disease progressed.45 PSA values were measured at least three times over six months prior to the beginning of the treatment, and PSA values as well as blood and urine for laboratory studies were taken at three-month intervals. A positive response was defined as a 50% decrease in measured serum PSA levels, and progressive disease was defined as either a > 100% increase in PSA compared with the best response observed or any documentation of metastatic or recurrent disease. Treatment with POM significantly lengthened the PSADT in the patients; mean PSADT increased from 15 months at baseline to 54 months after treatment; and seven subjects experienced decreased PSA over time.
A few studies have investigated the potential of pomegranate to help with the control of dental plaque. In one study published in 2009, 32 healthy men and women with good oral hygiene habits in a randomized, single-blinded, controlled study were assigned to rinse their mouths three times daily (one minute per rinse) with 35 ml of a pomegranate extract-containing aqueous solution (Pomella® Extract; standardized to contain 30% punicalagins, Verdure Sciences; Noblesville, IN) or placebo rinse for four weeks.46 Saliva samples revealed that rinsing with a flavonoid-rich pomegranate extract reduced total protein, which can correlate with lowered plaque formation, as well as reductions in cell injury indicators, sucrose degradation, and possible oral oxidant stress, as well as increased radical scavenging capacity.
In an earlier study, 60 subjects were divided into three groups of 20 who, following 24 hours of no dental hygiene, had dental plaque samples taken, then rinsed with one of three mouthwashes.47 The mouthwashes were chlorhexidine gluconate (0.12% PerioGard®, Kolynos of Brazil; São Paulo, Brazil [now Colgate-Palmolive; New York]), or hydroalcoholic extract (HAE, 1:1 by volume) of pomegranate (50-60 mg/mL)(Federal University of Ceará, Fortaleza, Brazil), or a control of just the hydroalcoholic extract. The subjects in the HAE and PerioGard groups showed a positive response, i.e., a reduction in oral bacteria as measured by colony forming units (CFUs) after rinsing. The HAE group had an 83.5% reduction and the PerioGard group had a 79.0% reduction in CFUs. The control group had a non-significant reduction of 11.3%. The authors speculate that the equivalent effect of HAE of pomegranate to chlorhexidine may be due to the hydrolysable tannins in pomegranate, particularly punicalagin, but that further studies are needed to identify the active constituents.
According to the Iranian regional standard for pomegranate, “In addition to Iran which has the highest area under cultivation, highest production, and is the number one exporter, other countries including Turkey, Afghanistan, Pakistan, India, Armenia, Georgia, Tajikistan, Jordan, Egypt, Italy, Tunisia, Azerbaijan, Libya, Lebanon, Sudan, Myanmar, Bangladesh, Mauritania, Morocco, Cyprus, Spain, Greece, France, China, Japan, and the US are among the countries which have areas under pomegranate cultivation.However, among these countries, India, the Central Asian Republics, Upper Caucuses, and Spain have the highest area under cultivation and varietals diversity. Consumption of pomegranate in Iran is estimated to be on average between 7-8 kg per person per year.”48
Total worldwide production of pomegranate is approximately 1.5-to-two metric tons (MT), with Iran and India producing most of the global supply. For the juice market, Iran and India together account for about 95% of concentrate production.49
In the United States, most of the pomegranate crop is grown in California. Canada is the number-one export destination for US-grown pomegranates, followed by Korea, Taiwan, Australia, Japan, Mexico, and Russia.50 In 2011, California had an estimated 30,000 acres (12,140 hectares) of pomegranates under cultivation.51
Pomegranate dietary supplement sales were ranked 42nd in the US food, drug, and mass market channel in 2012 with $2,558,509 in sales, down 25.4% from the previous year.52 In the natural food channel (not including Whole Foods Market), pomegranate ranked 66th with sales of $1,062,539, down 3.4% from 2011.53 (These statistics do not include the sales of pomegranate juices, which are significantly higher.) In Canada, at the time of this writing, there were 188 licensed NHPs containing pomegranate as a medicinal ingredient and another 70 NHPs containing some form of pomegranate as a non-medicinal ingredient.54
The United States Agency for International Development is currently working with Afghanistan to increase its pomegranate production and exportation. Trade relationships were established in 2011 among Kandahar pomegranate traders and India, Pakistan, and Europe, ultimately leading to exports of more than 2,700 MTs of pomegranates from Afghanistan.55 In the year ending May 2012, Innova Market Insights stated that new products featuring pomegranate increased 15% worldwide from the previous year.56
—Gayle Engels and Josef Brinckmann
- Still DW. Pomegranates: A botanical perspective. In: Seeram N, Schulman R, Heber D, eds. Pomegranates: Ancient Roots to Modern Medicine. Boca Raton, FL: CRC Press; 2006:199-209.
- Bruneton J. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing; 1999.
- Van Wyk BE, Wink M. Medicinal Plants of the World. Portland, OR: Timber Press; 2004.
- Bown D. Herbal: The Essential Guide to Herbs for Modern Living. New York, NY: Barnes and Noble; 2001.
- McCutcheon A, Udani J, Brown DJ. American Botanical Council Proprietary Botanical Food Product Scientific and Clinical Monograph for POM Wonderful®Pomegranate Juice. Austin, TX: American Botanical Council; 2008.
- Unani Pharmacopoeia Committee. Anardana (seed). In: The Unani Pharmacopoeia of India, Part I, Volume II. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 2007.
- Stover E, Mercure EW. The pomegranate: a new look at the fruit of paradise. Hort Science. August 2007;42(5):1088-1092.
- Narzary D, Mahar KS, Rana TS, Ranade SA. Analysis of genetic diversity among wild pomegranates in western Himalaya, using PCR methods. Sci Hort. 2009;121:237-242.
- Schindler S. Punica granatum. In: Monographs for Selected Wild Collected Plants of Commercial Interest from the Caucasus Region. Eschborn, Germany: Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH. 2010.
- Qin HN, Graham S. Punica Linnaeus. In: Flora of China. Beijing: Science Press. St. Louis, MO: Missouri Botanical Garden. 2007;13:283.
- Gearing J. Pomegranates and Hand Grenades. Beyond Words – Language Blog. ALTA Language Services website. Available at: www.altalang.com/beyond-words/2009/07/13/pomegranates-and-hand-grenades/. Accessed October 8, 2013.
- Shakespeare W. Romeo and Juliet. Act 3, scene 5, line 4.
- Riddle JM. Eve’s Herbs: A History of Contraception and Abortion in the West. Cambridge, MA: Harvard University Press; 1999.
- Foster S, Johnson RL. National Geographic Desk Reference to Nature's Medicine. Washington, DC: National Geographic; 2006.
- Ebbell B (Translator). The Papyrus Ebers: The Greatest Egyptian Medical Document. Copenhagen: Levin & Munksgaard; 1937. Available at: http://web.archive.org/web/20050226100008/http://www.macalester.edu/~cuffel/ebers.htm. Accessed September 27, 2013.
- Ved DK, Goraya GS. Demand and Supply of Medicinal Plants in India. Dehra Dun, India: Bishen Singh Mahendra Pal Singh. 2008.
- Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica, Revised Edition. Seattle, WA: Eastland Press; 1993.
- Dawa D. Punica granatum L. In: A Clear Mirror of Tibetan Medicinal Plants, Volume One. Rome, Italy: Cultural Association Tibet Domani. 1999.
- Sebru-4. In: Traditional Medicine National Formulary, second edition. Institute of Traditional Medicine Services. Available at: www.health.gov.bt/itms/06medicine/06htm/06meng_s/72se.bru-4l.htm. Accessed October 2, 2013.
- World Health Organization. Cortex Granati. In: WHO Monographs on Selected Medicinal Plants, Volume 4. Geneva, Switzerland: World Health Organization. 2009.
- Ayurvedic Pharmacopoeia Committee. Dadima (fresh fruit); Dadima (fruit rind); and Dadima (leaf). In: The Ayurvedic Pharmacopoeia of India, Part I, Volume IV, First Edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 2004.
- Ayurvedic Pharmacopoeia Committee. Dadima (seed). In: The Ayurvedic Pharmacopoeia of India, Part I, Volume II, First Edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 1999.
- Unani Pharmacopoeia Committee. Anar (leaf). In: The Unani Pharmacopoeia of India, Part I, Volume II, First Edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 2007.
- Unani Pharmacopoeia Committee. Anar (dried seed). In: The Unani Pharmacopoeia of India, Part I, Volume IV, First Edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 2007.
- Unani Pharmacopoeia Committee. Anar (fresh seed). In: The Unani Pharmacopoeia of India, Part I, Volume VI, First Edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha & Homoeopathy (AYUSH). 2009.
- Natural Health Products Directorate (NHPD). Monograph: Pomegranate. Ottawa, Ontario: NHPD. August 12, 2013. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/search-rechercheReq.do. Accessed October 2, 2013.
- Food and Drug Administration (FDA). §182.20 Essential oils, oleoresins (solvent-free), and natural extractives (including distillates). In: Code of Federal Regulations, Title 21 (21CFR). Washington, DC: National Archives and Records Administration’s Office. 2013.
- United States Pharmacopeial Convention. Pomegranate Juice. Food Chemicals Codex Forum. June 2013.
- European Commission Health & Consumers Directorate. Novel Food Catalogue. Brussels, Belgium: European Commission. Available at: http://ec.europa.eu/food/food/biotechnology/novelfood/novel_food_catalogue_en.htm. Accessed October 2, 2013.
- European Directorate for the Quality of Medicines (EDQM). Updated work programme of the European Pharmacopoeia. Pharmeuropa. March 2013.
- European Commission Health & Consumers Directorate. Cosmetic Ingredients and Substances (CosIng®) Database. Brussels, Belgium: European Commission. Available at: http://ec.europa.eu/consumers/cosmetics/cosing/. Accessed October 2, 2013.
- East African Community. East African Standard CD/K/102:2010. Pomegranate fruit — Specification and test methods. Arusha, Tanzania: East African Community. 2010.
- Food and Agriculture Organization (FAO) of the United Nations. Codex Stan 310-2013. Codex Standard for Pomegranate. Rome, Italy: FAO. 2013.
- Government of India. Grade Designation and Quality of Pomegranate. In: Fruits and Vegetables Grading and Marking Rules, 2004. New Delhi, India: Ministry of Agriculture. 2004.
- International Organization for Standardization. ISO 23393:2006. Pomegranate fruit — Specification and test methods. Geneva, Switzerland: International Organization For Standardization. 2006.
- Duke JA. Dr. Duke's phytochemical and ethnobotanical databases. Available at: www.ars-grin.gov/cgi-bin/duke/farmacy2.pl. Accessed September 25, 2013.
- Lynn A, Hamadeh H, Leung WC, Russell JM, Barker ME. Effects of pomegranate juice supplementation on pulse wave velocity and blood pressure in healthy young and middle-aged men and women. Plant Foods Hum Nutr. 2012;67:309-314.
- Shema-Didi L, Sela S, Ore L, et al. One year of pomegranate juice intake decreases oxidative stress, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial. Free Radic Biol Med. 2012;53(2):297-304.
- Aviram M, Rosenblat M, Gaitini D, et al. 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;23:423-433.
- Rosenblat M, Hayek T, Aviram M. Anti-oxidative effects of pomegranate juice (PJ) consumption by diabetic patients on serum and macrophages. Atherosclerosis. 2006;186:363-371.
- Sumner MD, Elliott-Eller M, Weidner G. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol. 2005;96(6):810-814.
- Aviram M, Dornfeld L. Pomegranate juice consumption inhibits serum angiotensin converting enzyme activity and reduces systolic blood pressure. Artherosclerosis. 2001;158:195-198.
- Paller CJ, Ye X, Wozniak PJ, et al. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer. Prostate Cancer and Prostatic Diseases. 2013;16:50-55.
- Pantuck AJ, Leppert JT, Zomorodian N, et al. Phase II study of pomegranate juice for men with rising prostate-specific antigen following surgery or radiation for prostate cancer. Clin Cancer Res. 2006;12(13):4018-4026.
- DiSilvestro RA, DiSilvestro DJ, DiSilvestro DJ. Pomegranate extract mouth rinsing effects on saliva measures relevant to gingivitis risk. Phytother Res. 2009;23:1123-1127.
- Menezes S, Cordeiro L, Viana G. Punica granatum (pomegranate) extract is active against dental plaque. J Herbal Pharmacother. 2006;6(2):79-92.
- Islamic Republic of Iran. Project document for a regional standard for Pomegranate. Joint FAO/WHO Food Standards Programme. FAO/WHO Coordinating Committee for the Near East Fifth Session. Tunis, Tunisia. January 26-29, 2009.
- Brinckmann J. Taking a closer look at the pomegranate fruit trade from Africa. In: Market News Service for Medicinal Plants & Extracts. Geneva, Switzerland: ITC/UNCTAD/WTO. 2011;37:7-13.
- Pomegranate. The California Rare Fruit Grower’s website. Available at: www.crfg.org/pubs/ff/pomegranate.html. Accessed October 1, 2013.
- Geisler M. Pomegranates profile. Agricultural Marketing Resource Center (AgMRC) website. Available at: www.agmrc.org/commodities__products/fruits/pomegranates-profile/. Accessed October 1, 2013.
- Symphony IRI Group, a Chicago-based market research firm. FDM market sales data for herbal supplements, 52 weeks ending December 23, 2012.
- SPINSscan Natural, Total US, 52 weeks ending December 24, 2011 and year ago, SPINS-defined herbal category.
- Natural Health Products Directorate (NHPD). Licensed Natural Health Products Database (LNHPD). Available at: http://afghanistan.usaid.gov/en/USAID/Activity/112/Global_Development_Alliance_for_Strengthening_Market_Chains_for_Afghan_Raisins_and_Pomegranates_GDA. Accessed October 1, 2013.
- Innova Market Insights. Today's superfruit stars. Nutritional Outlook website. Available at: www.nutritionaloutlook.com/article/today%E2%80%99s-superfruit-stars-3-10560. Accessed October 1, 2013.