Fruits have never been a diabetes patient’s friend and we do have major controversies surrounding the consumption of various fruits in people with increased blood glucose levels. Being a natural source of sugar, various fruits such as mangoes, sapodillas, custard apple and jackfruits have a reputation of being crossed out of a diabetic patient’s diet as they have the characteristic to increase sugar levels to a great extent. But the notion that no fruit should be consumed by such people is a misjudgment and the restriction on the type and quantity of fruit depends on the daily diet routine and blood sugar levels of the concerned person. Type 2 diabetes exists as one of the most prevalent public health concerns worldwide becoming a global epidemic. Diabetes rates are expected to cross 550 million by 2030 owing to vagaries in diet intake and haphazard lifestyles. Variation in insulin secretions, insulin action or both together characterize type 2 diabetes whose side effect can result in advanced cardiovascular disease. Diabetes also increases oxidative stress and inflammation of which inflammation is greatly affected by dietary components.
Diabetes is often controlled with medications and lifestyle changes. But hypoglycemic drugs present with undesired side effects that often leave patients frustrated and irritated. Till date, the quest for a new anti-diabetic agent has continued. We do have positive results on natural antioxidants such as polyphenols that impart beneficial effects on endothelial function but there are also studies showing their effective results on glucose and lipid disorders apart from having anti-inflammatory effects. Different foods contain polyphenols and are said to have an anti-inflammatory effect that include fruits as well. One such fruit is pomegranate-Punica granatum.
Pomegranate as an Anti-diabetic Agent
Haven’t we all heard it from our elders that the pomegranate is an excellent source of iron that’s used to stave away anemia from attacking a person? Not many individuals choose pomegranate as their favorite fruit as it has a lingering tinge of bitterness even when its available in juice form after adding ample sugar! The fruit is packed with high levels of antioxidants and polyphenols which makes it an excellent research element for anti-inflammatory, anti-atherogenic, antioxidant and anti-hyperglycemic effects. Pomegranate juice (PJ) is rich in polyphenolic acids such as ferulic acid, chlorogenic acid, caffeic acid and gallic acid and non-phenolic acids and the pomegranate seed oil (PSO) contains 80% conjugated linolenic acid or punicic acid. Pomegranate extract (PE) contains much of anthocyanin, punicalin, pedunculagin, punicalagin, gallagic acid and ellagic acid. There are various studies showing PJ as a good source of anti-inflammatory, anticancer, antihypertensive, anti-atherogenic and anti-diabetic agent, the fruit supplements have been shown to improve cognitive and functional recovery in ischemic stroke patients. There is also research evidence that pomegranate juice or extract improves glucose metabolism, lowers insulin requirements and ameliorates insulin sensitivity. The primary way in which PJ brings bout beneficial effects on the body is by reducing oxidative stress, the imbalance between reactive oxygen species (ROS) and antioxidants and lipid peroxidation. There are observational studies that link pomegranate consumption with decreased risk of diabetes and improved glycemic control but their exact effect on insulin and glucose metabolism in humans is inconsistent.
A research team performed a meta-analysis and systemic review of randomized controlled trials (RCTs) to understand the effects of pomegranate consumption on glucose levels and insulin sensitivity. The team selected studies based on various inclusion criteria which included that participants should be above 18 years of age with/without the presence of co-morbidities such as hypertension, diabetes and peripheral arterial diseases. Several keywords were used to extract relevant studies which was done by two investigators who independently performed the searches. From every selected trial several information including the participants’ information such as mean age, sex, body mass index (BMI) and health status were extracted. The initial search yielded 139 studies but after several exclusion criteria the team was left with 16 RCTs. Every trial consisted of 14-74 participants amounting to a total of 627 subjects whose mean age was between 30 and 70 years. Participants were required to have ingested a pomegranate intervention for ≥1 week and studies where pomegranate was combined with other interventions (such as intake of medications for diabetes) were also included when the control group received the same treatment. Of the 16 trials included, 11 trials used pomegranate juice as a supplement, 2 used pomegranate seed oil and 3 studies used pomegranate extract as an intervention and the duration for each lasted anywhere between 1 and 12 weeks. 12 studies consisted of individuals who were at a risk of cardiovascular disease owing to the presence of type 2 diabetes mellites, overweight, obesity, hypertension and metabolic syndrome. Of the remaining 4, 3 trials consisted of healthy subjects and one trial consisted of patients with chronic obstructive pulmonary disease.
The trials primarily focused on differences in the levels of fasting blood glucose (FBG) and fasting blood insulin (FBI) while secondary outcomes included glycated hemoglobin (HbA1c) and homeostatic model assessment of insulin resistance (HOMO-IR). Results showed that:
A study published in the Nutrition Research journal found that regular consumption of PJ helps in controlling blood sugar levels in type 2 diabetes patients but with the only exception that the same was not observed in healthy people. Evidences ae mixed and we are still unable to figure out the exact effect of the fruit on diabetes. Until then, it is always safe to restrict consumption of pomegranate in any form as every fruit contains a certain amount of sugar and it’s only the quantity that varies from fruit to fruit. Practicing healthy lifestyle changes and leading an active life can go a long way towards helping people control blood sugar levels.
Lack of Efficacy of Pomegranate Supplementation for Glucose Management, Insulin Levels & Sensitivity: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0290-1
Antioxidant-rich Pomegranate Juice May Aid Blood Sugar Management for Diabetics: https://www.nutraingredients-usa.com/Article/2014/08/25/Antioxidant-rich-pomegranate-juice-may-aid-blood-sugar-management-for-diabetics-Human-data
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Dr. Nafeesa Imteyaz of First Eat Right clinic, is the Best Dietitian Nutritionist in Bangalore. Best Dietitian Nutritionist in Pune. Best Dietitian Nutritionist in Hyderabad. Best Dietitian Nutritionist in Chennai. Best Dietitian Nutritionist in Mumbai. Best Dietitian Nutritionist in Delhi. Best Dietitian Nutritionist in Kolkata.