Vitamin C (ascorbic acid)

Urinary tract infection prevention
Those suffering from chronic recurring UTIs can take precautions to reduce the frequency of infections. Proper hydration is essential because fluids dilute the bacteria in the urine. Probiotics are also helpful as they promote the presence of healthy bacteria in the intestines, where most UTI bacteria originate. Also, because most UTI are treated with antibiotics, which destroy the intestinal flora, replenishing intestinal bacteria may help to prevent recurrence. Irritants to the bladder such as caffeine, alcohol, and spices should be avoided.

In recent years cranberries have received much attention because of their beneficial properties with respect to urinary tract health. Research supports their use in the treatment of bacterial infections caused by E. coli, the organism behind most urinary infections.

Characteristics of cranberries
Cranberries are a favorite food of cranes, hence their name. Native Americans were the first to use the berries as a food source. They have been used in the treatment of UTI for many years and are now regarded as a non-pharmaceutical approach for the treatment and prevention of simple UTI infections. Cranberries are effective in the treatment of the majority of UTI, however, not all UTIs are caused by E.coli, the bacteria against which cranberries have demonstrated efficacy.

Cranberries have many other health benefits. Like other berries, cranberries contain an abundance of antioxidants and were shown to be extremely helpful at reducing oxidative stress.

Pharmacology
• The consumption of cranberries acidifies the urine, which reduces bacterial growth.
• Cranberries also contain certain tannins, more specifically proanthocyanidins that have been shown to reduce bacterial adherence to the urinary tract wall. 3 hours after taking cranberry, molecular changes in the adhesion apparatus used by bacteria to attach themselves to the urinary tract wall have been found. This is a significant benefit in the treatment of UTIs as adherence is essential for infection.
• The proanthocyanidins found in cranberries might have anticarcinogenic activity

Research summary
If bacteria cannot attach themselves to the urinary tract wall, they cannot cause an infection. However, once attached to the urinary tract wall, bacteria cannot be removed by the body's normal clearing mechanisms. Studies have documented that drinking eight glasses of cranberry juice twice a day can eradicate most UTIs. If consumption is maintained, infection is unlikely to recur; a Harvard study has demonstrated that regular use of cranberry juice reduced bacterial growth in the urinary tract. Studies have demonstrated that infections can be reduced by over 50% in elderly women drinking 300 ml of cranberry juice per day.

Consumption of cranberry juice reduces urinary wall problems in patients with severe problems. Elderly hospitalized patients had significantly fewer E. coli urinary tract infections if they were given cranberry juice as a prophylactic. Cranberry can also potentially be used to treat recurrent kidney stones because supplementation reduces ionized calcium in the urine.

Cranberries contain antioxidants and 100g of cranberry has the same ability as 1000mg of vitamin C and 3700 mg of vitamin E at preventing the oxidation of LDL cholesterol. Cranberries also increase the clearance of LDL cholesterol by the liver reducing circulating oxidized LDL levels.

Indications
The importance of antioxidants in health promotion is well established. Berries typically have a high concentration of antioxidants and cranberries are no exception. Where cranberries stand apart is in their ability at preventing the adhesion of pathological bacteria to the urinary tract wall. This is particular helpful for the prevention and treatment of urinary tract infections.

Why Cran-UTI?
The benefits of cranberries for the treatment and prevention of urinary tract infections have been demonstrated. Drinking 8-16 ounces of cranberry juice per day is unrealistic for most. Self-medication with cranberry juice cocktail is common in the treatment of UTIs, unfortunately cranberry cocktails contain a lot of sugar and only 23% juice. They are not a good choice for the therapeutic use of cranberries and should not be used by diabetics because of the high sugar content. Also, cranberry tablets are more cost effective than cranberry juice in the treatment and prevention of UTI. Cran-UTI is a concentrated extract containing 630 mg of cranberry, the equivalent to roughly 1 1/2 cups of cranberries.

References

• Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 1994 Mar 9; 271(10): 751-4.

• Zafriri D, Ofek I, Adar R, Pocino M, Sharon N. Inhibitory activity of cranberry juice on adherence of type 1 and type P fimbriated Escherichia coli to eucaryotic cells. Antimicrob Agents Chemother 1989 Jan; 33(1): 92-8.

• Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002 Jun; 9(3): 1558-62.

• Howell AB. Cranberry proanthocyanidins and the maintenance of urinary tract health. Crit Rev Food Sci Nutr 2002; 42(3 Suppl): 273-8.

• Howell AB, Foxman B. Cranberry juice and adhesion of antibiotic-resistant uropathogens. JAMA. 2002 Jun 19; 287(23): 3082-3.

Bioactive compounds in cranberries and their role in prevention of urinary tract infections.
Mol Nutr Food Res. 2007 May 9;
Howell AB.

Cranberry (Vaccinium macrocarpon Ait.) ingestion has long been associated with prevention of urinary tract infections. The beneficial mechanism was historically thought to be due to the fruit acids causing a bacteriostatic effect in the urine. However, recently, a group of proanthocyanidins (PACs) with A-type linkages were isolated from cranberry which exhibit bacterial antiadhesion activity against both antibiotic susceptible and resistant strains of uropathogenic P-fimbriated Escherichia coli bacteria. The link between cranberry ingestion and maintenance of urinary tract health as well as the structural diversity, pharmacokinetics, quantification, and bacterial antiadhesion bioactivity of the A-linked cranberry PACs are reviewed.


A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity.
Phytochemistry. 2005 Sep;66(18):2281-91.
Howell AB, Reed JD, Krueger CG, Winterbottom R, Cunningham DG, Leahy M.

Clinical, epidemiological and mechanistic studies support the role of cranberry (Vaccinium macrocarpon Ait.) in maintaining urinary tract health. Cranberry proanthocyanidins contain A-type linkages and have been associated with preventing adhesion of P-fimbriated uropathogenic Escherichia coli to uroepithelial cells. It is not known if the presence of the A-type linkage is a prerequisite for anti-adhesion activity. Other commercial sources of proanthocyanidins with all B-type linkages have not previously been screened for this activity. The goals of this study were to compare the in vitro anti-adhesion activity of A-linked proanthocyanidins from cranberry juice cocktail with the anti-adhesion activities of B-linked proanthocyanidins from commercial grape and apple juices, green tea and dark chocolate, and determine if anti-adhesion activity is detectable in human urine following consumption of single servings of each commercial food product. Structural heterogeneity and presence of the A-type linkage in cranberry proanthocyanidins was confirmed utilizing MALDI-TOF/MS and DI/ESI MS, as was the presence of all B-type linkages in the proanthocyanidins from the other commercial products. The isolated A-type proanthocyanidins from cranberry juice cocktail elicited in vitro anti-adhesion activity at 60 microg/ml, the B-type proanthocyanidins from grape exhibited minor activity at 1200 microg/ml, while other B-type proanthocyanidins were not active. Anti-adhesion activity in human urine was detected following cranberry juice cocktail consumption, but not after consumption of the non-cranberry food products. Results suggest that presence of the A-type linkage in cranberry proanthocyanidins may enhance both in vitro and urinary bacterial anti-adhesion activities and aid in maintaining urinary tract health.