08/10/2025
Pomegranate juice and inflammatory bowel disease.
A recent study aimed at investigating the effects of pomegranate juice (POMJ) consumption on inflammatory biomarkers and gene expression in patients with IBD in clinical remission, but at high risk for relapse (baseline faecal calprotectin ≥100 µg/g). In this randomised, placebo-controlled, parallel trial, 16 people with IBD (CD 6 (38%) UC 10 (62%)) consumed POMJ or placebo for 12 weeks. The active to placebo allocation was 2:1, given the low number of participants.
POMJ consumption significantly reduced faecal calprotectin (by around 2.4 times) and plasma endotoxin levels. Transcriptomic analysis of peripheral blood mononuclear cells revealed upregulation of genes involved in mucosal immunity, including the aryl hydrocarbon receptor (AHR), neutrophil cytosolic factor 4 (NCF4) and nuclear factor, interleukin 3 regulated (NFIL3).
Urolithin metabotypes are classifications of individuals based on their gut microbiota’s ability to metabolise the phytochemicals ellagitannins and ellagic acid (found in pomegranate, berries and walnuts) into urolithins, bioactive metabolites with anti-inflammatory and mitochondrial benefits. Urolithin metabotypes in the trial participants were predominantly of the B type, associated with intestinal dysbiosis.
The dose of the 100% pomegranate juice was 125 mL twice daily (~>700 mg/day ellagitannins). This is a therapeutically significant amount of actives that can be readily replicated by using an extract of pericarp in tablet or liquid form.
The significance of the finding is limited by the very small sample (n = 16) and the 2:1 randomisation, conferring limited power, especially for between-group comparisons and subgroup (UC vs CD) inferences. Also, it was a short trial (12 weeks) with no assessment of clinical endpoints or histological healing; endoscopic and mucosal cytokine panels did not change. But there is mechanistic plausibility: the upregulation of AHR/NCF4/NFIL3 and pathway modelling align with improved barrier/immune homeostasis, and are biologically consistent with the faecal calprotectin/endotoxin findings. It is, as the authors noted, a proof-of-principle study, with the observed benefits likely due to a modulation of the gut microbiome.
For more information see: https://pubmed.ncbi.nlm.nih.gov/40255128/