Cranberry juice, that old folk remedy often recommended for cystitis and other UTIs, is now finally getting the credit it deserves from the scientific community. In a study presented in Boston, MA, at the 240th National Meeting of the American Chemical Society (ACS), it was revealed that cranberry juice can effectively prevent UTIs by fighting the Escherichia coli bacteria that cause them.
The study involved growing strains of E. coli-the most common cause of UTIs-in urine collected from healthy volunteers before and after drinking cranberry juice. The E. coli were then tested for their ability to stick together to form biofilms-thin, slimy layers of these microorganisms, surrounded by their own secretions, that provide an ideal environment in which they can thrive. E. coli bacteria that don't stick together are more likely to be flushed out of the urinary tract.
The results showed that cranberry juice prevented E. coli from sticking to either each other or to the surface of a plastic petri dish within just eight hours of consumption. This suggests that the beneficial active ingredients in cranberry juice are quick to reach the urinary tract and can prevent an infection from developing in the first place (www.sciencedaily.com/releases/2010/08/ 100823183807.htm).
This research has important implications, considering just how big a problem UTIs are worldwide. In the US alone, UTIs account for around eight million medical visits each year, for a total annual cost of more than $1.6 billion (Dis Mon, 2003; 49: 53-70). What's more, this evidence confirms the results of recent controlled clinical trials-high-quality scientific studies carried out in people-which found that cranberries, in various forms, can reduce the incidence of UTIs in women who are prone to these infections.
In one study, a year-long trial of 150 sexually active women aged 21-72 years, participants were assigned to one of three groups and given either organic cranberry juice plus placebo tablets, cranberry tablets plus placebo juice, or placebo tablets and placebo juice. The juice dose was 250 mL drunk three times daily, while the tablets were taken two times a day.
Cranberry, in the form of either juice or tablets, significantly reduced the number of women who went on to experience at least one UTI per year (to only 20 per cent and 18 per cent of women with juice and tablets, respectively) compared with the placebo (32 per cent of women). Also, both cranberry groups needed to take fewer antibiotics during the course of the year compared with the placebo group (Can J Urol, 2002; 9: 1558-62).
Another review-this time, a pooled meta-analysis carried out by the prestigious Cochrane Collaboration of the results of 10 trials-concluded that cranberry products (juice
and tablets) can significantly reduce the incidence of UTIs over a 12-month period, particularly in women who suffer from recurrent infections, compared with a placebo control (Cochrane Database Syst Rev, 2008; 1: CD001321).
However, as yet, there's no evidence to show that cranberry can be used to treat a UTI once you've already got one (Drugs, 2009; 69: 775-807).
The proanthocyanidins in cranberry belong to a class of flavanols known as 'condensed tannins', and are thought to be responsible for its beneficial effects in the urinary tract. Other plant extracts also contain these proantho-cyanidins, but it's the specific structure of cranberry proanthocyanidins that makes them particularly effective against UTI-causing bacteria (Altern Med Rev, 2008; 13: 227-44).
In general, drinking 300-500 mL/ day of unsweetened cranberry juice is recommended for UTI prevention, or you could take 400 mg of concentrated cranberry extract twice a day.
Other natural approaches
Besides consuming cranberry products, there's a variety of other natural ways
to prevent UTIs.
Probiotics. As E. coli, the primary pathogen involved in UTIs, travels from the intestines and/or vagina to inhabit the normally sterile urinary tract, improving either the gut or vaginal flora can have a beneficial impact on the urinary tract (Altern Med Rev, 2008; 13: 227-44). Indeed, clinical studies show that certain probiotics-whether taken orally or used as vaginal sup-positories-appear to be effective in preventing UTIs.
In one preliminary trial of nine women suffering from recurrent UTIs, a vaginal suppository con-taining Lactobacillus crispatus, used every other night for a year, led to a marked reduction in recurrence rates. Prior to treatment, the women had an average of five infections every year, but this was reduced to only one bout of infection during
the year they were treated with the probiotic (Int J Antimicrob Agents, 2006;
28 Suppl 1: S30-4).
In another, larger-scale placebo-controlled study, women with UTIs were treated with antibiotics for three days (although recurrences were seen in 29 per cent and 41 per cent of those taking norfloxacin and trimethoprim/sulphamethoxazole, respectively), which was followed by a course of either suppositories containing Lactobacillus or a place-bo. The results showed that the recurrence rate was 21 per cent in the probiotic group compared with 47 per cent in the placebo group (Clin Ther, 1992; 14: 11-6).
Oral probiotics, such as L. rhamnosus GG, have also been shown to cut the incidence of UTIs, although the evidence mostly comes from studies in children (Altern Med Rev, 2008; 13: 227-44).
Vitamin C. In a study of more than 100 pregnant women-who are, as a group, particularly prone to UTIs-half were given 200 mg of ferrous sulphate, 5 mg of folic acid and 100 mg of vitamin C daily, while the other half received only the ferrous sulphate and folic acid. After three months, the researchers found that the occurrence of UTIs was significantly lower (13 per cent) in those taking vitamin C compared with those not taking vitamin C (29 per cent) (Acta Obstet Gynecol Scand, 2007; 86: 783-7).
It's thought that vitamin C (ascorbic acid) may work by acidify-ing urine, thereby creating an essentially 'unfriendly' environment for infection-causing bacteria such as E. coli (Nitric Oxide, 2001; 5: 580-6). Alternatively, it could be that the vitamin's antioxidant activity is responsible for the beneficial effects (Mediators Inflamm, 2005; 2005: 242-4).
Vitamin A. One small randomized controlled trial has suggested that vitamin A may be helpful against recurrent UTIs. A group of 24 sufferers were all treated with antimicrobial therapy, but half of them also received a single dose of vitamin A (200,000 IU), while the other half were given a placebo. In the follow-up a year later, the group given vitamin A had suffered significantly fewer UTIs compared with the placebo group. "Vitamin A supplementation may have an adjuvant effect on the treatment of [recurrent UTIs]," the researchers concluded (Pediatr Int, 2007; 49: 310-3).
Uva ursi. Also known as bearberry (full name: Arctostaphylos uva ursi), this antimicrobial herb is commonly used to prevent and treat UTIs. However, no studies have ever been conducted to confirm its efficacy as a treatment, although one clinical trial suggests that it's an effective preventative.
This randomized controlled trial of 57 women with chronic cystitis showed that a supplement contain-ing standardized extracts of uva ursi leaf as well as dandelion root and
leaf (the latter providing diuretic effects), taken for one month, can effectively reduce the rate of infection during the following year. Indeed, a year later, no one had suffered an infection in the uva ursi/dandelion group, whereas five women in the placebo group did (Curr Ther Res, 1993; 53: 441-3).
According to one review of the literature, uva ursi is best used at the first sign of an infection or for short-term prevention (Altern Med Rev, 2008; 13: 227-44). However, you should also consult a qualified herbalist for advice on the optimal dosage.
d-Mannose. This simple sugar appears to work in a way similar to cranberry juice, preventing certain bacterial strains from adhering to the lining of the urinary tract. In a mouse study, alpha-d-mannose not only prevented adhesion of E. coli, but also blocked its invasion into bladder cells and its subsequent biofilm formation (PLoS One, 2008; 3: e2040).
However, as clinical trials are lacking, we don't yet know whether people who take oral d-mannose would experience the same effects. Nevertheless, a few test-tube studies have looked at the impact of d-mannose in cells taken from both healthy women and those with recurrent UTIs, and found that d-mannose can effectively inhibit nearly half of the E. coli strains found in the human urinary tract (Altern Med Rev, 2008; 13: 227-44).
o Acupuncture. A controlled study comparing real and fake acupunc-ture, and no treatment, in women with recurrent UTIs found that, after six months, 85 per cent of those receiving the genuine acupuncture had suffered no UTI episodes compared with 58 per cent in the sham group, and 36 per cent in the untreated group (Scand J Prim Health Care, 1998; 16: 37-9). A more recent trial also showed similar results (Am
J Public Health, 2002; 92: 1609-11).
Diet. Dr Marilyn Glenville, in her book The Natural Health Bible for Women (London: Duncan Baird Publishers, 2010), offers the follow-ing dietary advice for women prone to UTIs.
o Avoid acidic foods and drinks such as tea, coffee, alcohol, sugar, meat, spicy foods and undiluted citrus juices, all of which can trigger the problem. Keep a food diary to see if any other type of food or drink might be a trigger in your particular case.
Drink plenty of water. But if you already have an infection, you can make barley water: Bring 11/4 L (2 pints) of water to the boil, then add 40 g (11/2 oz) of whole barley and simmer for 20 minutes; add the juice of one lemon, and simmer for a further 10 minutes; remove from the heat and allow it to cool. Sip a cupful over the course of the day. Any leftover barley water can be stored in an airtight container in the fridge for up to 24 hours.
o Eat garlic, which helps to eliminate E. coli and the other bacteria in UTIs. Raw garlic is more effective than cooked, so chop it up finely and sprinkle over salads or use it in dressings. Alternatively, take garlic as a supplement (1000 mg/day of aged garlic).
o Eat organic live plain yoghurt, which contains beneficial bacteria (probiotics) that help to recolonize your gastrointestinal system with beneficial flora.
What causes UTIs?
Urinary tract infections typically arise when bacteria enter the urinary tract via the urethra and multiply in the bladder. Women are especially suscep-tible because of their anatomy-the close proximity of the urethra to the anus, and the short distance from the urethral opening to the bladder. Having sex can sometimes trigger UTIs in women, as bacteria may then be pushed into the urethra. Using a diaphragm can also lead to infections, as the device can push against the urethra, making it harder to completely void the bladder. Any urine that remains is more likely to grow bacteria and cause infections. Here are some tips that can help to prevent UTIs.
o Drink plenty of water, as this will flush the bacteria away
o Don't hold your urine-always go when you feel you need to
Wipe yourself from front to back, as this helps to prevent bacteria in the anal region from spreading to the vagina and urethra
o Urinate after having sex to help eliminate bacteria
o Avoid potentially irritating feminine products, such as deodorant sprays or powders
o Avoid using a diaphragm as a birth-control method if you're prone to UTIs.
Treating UTIs naturally
Urinary tract infections can spread from the bladder to the kidneys and may lead to permanent kidney damage, so it's important to see a doctor at the first sign of infection. However, if you don't want to take antibiotics to get rid of the infection, consider seeing a qualified homeopath or herbalist, who can prescribe remedies according to your symptoms.
Herbal remedies may be especially useful, as many of these have a long history of success in the treatment of UTIs. These traditionally include Agrimonia eupatoria (agrimony), Althea officinalis (marshmallow), Apium graveolens (celery seed), Arctium lappa (burdock) and Zea mays (corn silk) (Altern Med Rev, 2008; 13: 227-44).
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