Effects of Pomegranate Juice on Ulcerative Colitis

Inclusion Criteria:

• • Adults ≥ 18 yo

• Following a low-polyphenol and fiber diet (< 3 servings of fruits/vegetablesper day)

• Mild-to-moderate UC at the time of screening (2 ≤ partial Mayo scores ≤ 5)

• Supportive evidence of active inflammation (hsCRP >1 mg/L, fecal calprotectin >50 µg/g stool, or abnormal lower endoscopy) in individuals with biopsy-provenUC

• Patients on 5-aminosalicylates must be on a stable dose for ≥ 4 weeks prior toscreening

• Patients on treatment with immunosuppressive therapy (e.g.,azathioprine/6-mercaptopurine, methotrexate) must be on stable dose for 8 weeksprior to baseline visit

• At the time of baseline visit, patients may be on no more than 20 mg/day ofprednisone and 9 mg/day of budesonide MMX

• Subjects must read and sign the Institutional Review Board-approved writteninformed consent prior to the initiation of any study specific procedures orenrollment. A subject will be excluded for any condition that might compromisethe ability to give truly informed consent.

Exclusion Criteria:

• • Non-English speaker

• Vegetarian/vegan

• Known pomegranate allergy

• Documented chronic disease besides UC, including diabetes, renal or liverdiseases, metabolic syndrome, active cancer, MI or stroke, history of gastricbypass

• Patients with CD, indeterminate/severe to fulminant colitis

• History of colectomy or colonic dysplasia

• Presence of ileal pouch or ostomy

• Evidence of active bacterial or viral gastroenteritis as indicated by positivestool studies for ova & parasites, Clostridium difficile, and stool culture

• Recent hospitalizations (within 2 weeks of screening) for UC requiring IVsteroids

• Presence of the following labs indicative of severe colitis: a. Hemoglobin < 8.0 g/dl b. Albumin < 3.0 g/dl

• Recent systemic antibiotics use (within 3 months of screening) or active use ofanti-diarrheal medications

• Taking supplements known to affect metabolism or gut microbiota composition (probiotics, fiber, etc.), unless willing to stop for the study duration

• Use of Total Parenteral Nutrition (TPN)

• Use of cyclosporine, tacrolimus, or thalidomide within 2 months prior toscreening

• Taking exogenous hormones (e.g., hormone replacement therapy)

• Recent weight fluctuations (>10% in the last 6 months)

• Smoker or living with a smoker

• Use of >20 g of alcohol per day

• Unable or unwilling to comply with the study protocol (including unwillingnessto avoid watermelon and other lycopene-rich foods for the whole duration of thestudy)

• Unable to provide consent