The health of your heart has a lot to do with how well it is nourished. Just like all other organs of your body, your heart is nourished by the arteries that bring those nutrients and oxygen to your heart. Having healthy blood vessels is thus key to maintaining a healthy heart.

Heart disease is the number one cause of death and a leading cause of disability worldwide. It accounts for over 30% of all deaths and contributes markedly to the rising health care costs we see nowadays. The best way to decrease heart disease is through prevention and there are a number of actions you can do to help. One is ingesting adequate amounts of pomegranate, or at least pomegranate extract every day. Pomegranate improves heart health by improving the health of the linings of your arteries.

Your Arterial Linings: Endothelium

Your arteries are lined by a single layer of cells set side to side each other in a sort of a mosaic pattern covering the inside of every artery in your body. This lining is called endothelium. For the best flow of blood, it must act to help your blood to flow within your arteries in as easy a mode a possible. The endothelium therefore has several functions: It is a slick surface so blood “slides” easily through your arteries with minimal “bumps” to impede the flow; it dilates and contracts with ease according to the natural pulsing of the heart; it prevents clot formation within the walls to prevent clogging of the arteries with clots. Poor function of the endothelium is called endothelial dysfunction.

An important substance produced by the endothelial cells that dilates the vessels is nitric oxide. As you age, levels of nitric oxide are reduced, so it doesn’t dilate as well. This equates to a stiffening of the arteries which is not good and could progress to cardiovascular disease. Thus, boosting levels of NO is important.

You want a smooth lining without “bumps”. Deposits of cholesterol and the inflammation of these deposits can worsen the flow. We measure the bad cholesterol in your blood to see if it is elevated, and if elevated, could deposit below the endothelial cells. If these become inflamed, they can become plaques. If this process continues, it becomes part of the development of cardiovascular disease.

The endothelial lining must not increase clotting of the blood that could result in formation of even more “bumps” of clots that could worsen and infringe on the flow of blood along the arteries. This also could result in potential big problems such as strokes and heart attacks.

Pomegranate has been shown to improve the health and function of the endothelium in multiple ways, including increasing NO production, reducing deposition of bad cholesterol in the blood vessels, prevention of oxidative degradation of these lipid molecules, and decreasing inflammation of the endothelium.

Pomegranate Improves Your Endothelial Function

  1. Increased NO (Nitric Oxide) production

Pomegranate helps sustain a higher level of nitric oxide in endothelial calls. Pomegranate extract seems to help to this even better than drinking pomegranate juice;[1] plus you don’t ingest the extra sugars that are in pomegranate juice which may counteract the good effects of pomegranate. The result is better dilation of the arteries and better blood flow.[2]

Better dilation of the arteries should equate to less blood pressure problems. Indeed, studies have shown significant reduction in both systolic and diastolic blood pressures when subjects were supplemented with pomegranate.[3] If you can reduce high blood pressure, you can reduce your risk of developing heart disease.

  1. Decrease Lipids

Pomegranate also decreases lipid abnormalities. Triglyceride levels go down, while the levels of good cholesterol, HDL, go up with regular pomegranate ingestion. This potentially can reduce the ratio of triglyceride-to-HDL cholesterol level, and this risk ratio correlates with less cardiovascular risk status.[4]

When the bad cholesterol deposits under the endothelium, this may start a process resulting in formation of plaques. The bad cholesterol that deposits becomes oxidized and inflammation comes in to try to get rid of these unwanted deposits to make the vessels smooth again and reduce the bumps. If the inflammation continues, plaques form that are then hard to get rid of, and these may calcify making them even more resistant to remove.

Pomegranate extracts have also been beneficial in assisting statins (lipid-lowering drugs) reduce the inflammation caused by bad cholesterol on the vessel walls. When supplemented along with statin drugs, this effect almost doubled while triglyceride-laden macrophage levels, another sign of inflammation, tumbled too compared to the drug-only group.[5]

  1. Decrease Inflammation

Pomegranate has been shown to decrease the inflammation within these plaques while reducing the oxidation that occurs within the endothelium.[6] This is important because it is the inflammation of these deposits that can liquify the plaques and, when severe, can result in the plaques rupturing and obstruct the flow of blood within the vessels. If this happens in the heart this can cause a heart attack.

  1. Decrease Clot Formation

To prevent clotting within the vessels, pomegranate reduces a substance called VCAM-1 that is an adhesion molecule that triggers white blood cells to stick to arterial walls, which would otherwise cause blood clots and trigger inflammation. Anything to decrease clotting on the endothelium is thus a good thing to help blood flow easier within the arteries.[7]

  1. Improve Antioxidant Effects

By preventing the oxidation of LDL that has been deposited under the endothelium, i.e. within the arterial walls, a corresponding decrease in the inflammatory response occurs with less inflammation in the area. Pomegranate is a great antioxidant that functions to protect the endothelial lining through this function too.

Pomegranate Effects on Arterial Thickness

One of the methods that we doctors use to evaluate the thickness of the endothelium and whether it has become thickened from disease is called the carotid intima-media thickness. A sonogram is performed of your carotid arteries in your neck and the thickness of the intima, reflective of the endothelium thickness, is measured. With long term inflammation and deposition of bad cholesterol within the endothelium, this thickness increases and is a good measure of cardiovascular damage.

In one study, people with thickened CIMT who were given pomegranate experienced a 30% reduction in CIMT on average. This resulted in increased blood flow through this artery.[8] Better blood flow through the carotids correlates with increased blood flow through all the vessels of the body since this is a total body problem. Such a significant reduction in CIMT would thus correlate with improved cardiovascular blood flow and better heart health.

Moreover, participants of the study experienced a reduction in systolic blood pressure by 21%, a decrease in oxidation of LDL by 19%, and an improvement in antioxidant status within the vessels by 130% for three years. After three years, there was an additional 16% reduction in oxidation activity.

Conclusion

Endothelial function is very important to maintain good health to your heart and all other organs, since all are nourished via your arteries bringing nutrients to them. There are multiple aspects to a healthy endothelium, including good NO production for dilation of the vessels, reduction of deposition of bad cholesterol under the endothelium, reduction of inflammation, increased antioxidant effects, and decrease in blood clot formation.

Pomegranate, and especially concentrated extracts of pomegranate, are very good at improving the health of your endothelium through these multiple pathways. Ingesting pomegranate every day could therefore help protect your endothelium from some of the destructive effects that can result in cardiovascular disease.

References:

[1] De Nigris F, Balestrieri ML, Williams-Ignarro S, et al. The influence of pomegranate fruit extract in comparison to regular pomegranate juice and seed oil on nitric oxide and arterial function in obese Zucker rats. Nitric Oxide. 2007 Aug;17(1):50-4. doi.org/10.1016/j.niox.2007.04.005

[2] Ignarro LJ, Byrns RE, Sumi D, de Nigris F, Napoli C. Pomegranate juice protects nitric oxide against oxidative destruction and enhances the biological actions of nitric oxide. Nitric Oxide. 2006 Sep;15(2):93-102.

[3] Asgary S, Sahebkar A, Afshani MR, Keshvari M, Haghjooyjavanmard S, Rafieian-Kopaei M. Clinical evaluation of blood pressure lowering, endothelial function improving, hypolipidemic and anti-inflammatory effects of pomegranate juice in hypertensive subjects. Phytother Res. 2013 Mar 21.  https://doi.org/10.1002/ptr.4977

[4] Mirmiran P, Fazeli MR, Asghari G, Shafiee A, Azizi F. Effect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trial. Br J Nutr. 2010 Aug;104(3):402-6. DOI: https://doi.org/10.1017/S0007114510000504

[5] Hamoud S, Hayek T, Volkova N, et al. Pomegranate extract (POMx) decreases the atherogenicity of serum and of human monocyte-derived macrophages (HMDM) in simvastatin-treated hypercholesterolemic patients: A double-blinded, placebo-controlled, randomized, prospective pilot study. Atherosclerosis. 2014 Jan;232(1):204-10. doi.org/10.1016/j.atherosclerosis.2013.11.037

[6] Op cit. Asgary S, Phytother Res. 2013 Mar 21. https://doi.org/10.1002/ptr.4977

[7] IBID.

[8] 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 Jun;23(3):423-33.