Cranberry
supplement and juice benefit, side effects research, use for UTI and urinary tract health
February 1 2018 by
Ray Sahelian, M.D.
American cranberry (Vaccinium macrocarpon) is one of
only three species of fruit native to North America. The other species are
blueberry (Vaccinium angustifolia) and
bilberry (Vaccinium myrtillus). Cranberry
typically grows in bogs and is a member of the same family as blueberry and
bilberry. Cranberry is widely used to prevent urinary tract infection (UTI). It
was initially believed to function by acidifying urine. However, the
mechanism is now thought to be inhibition of adhesion of bacteria to
uroepithelial cells (cells lining the urethra) by proanthocyanadin, a compound present in cranberry.
Cranberry like other fruits is also rich in phenolic
phytochemicals such as flavonoids and ellagic acid.
Consumption of cranberry has been shown to have a capacity to inhibit
peptic ulcer-associated bacterium, Helicobacter pylori. Cranberries may
also protect against heart disease and certain types of cancer, probably
through the antioxidant and anti-tumor effects of flavonoids.
Benefit, what it is used for
The primary benefit in clinical practice is for the treatment or
prevention of bladder infections. Drinking cranberry juice by itself
offers little help. One has to consume a high potency extract or
concentrate to have it work for UTI infection prevention or treatment.
Form of intake
You can get the benefits of cranberry by drinking the juice,
diluting concentrate with water, taking capsules, or using a
tincture. A cranberry supplement would minimize the high calories that
come from drinking the juice.
UTI treatment or prevention
Cranberry fruit is used primarily for the prevention or treatment of urinary
tract infections or bladder infections.
The use of cranberry juice among individuals to prevent or treat bladder
infection is a common practice. Cranberry may relieve symptoms associated with bladder infection and may reduce
the need for antibiotics. Before the advent of antibiotics,
cranberry juice continued to be a popular treatment for urinary tract infections (UTIs).
The current proposed mechanism of action focuses primarily on cranberry's
ability to prevent bacterial binding to host cell surface membranes. In vitro
studies have observed potent inhibition of bacterial adherence of Escherichia
coli4 and other gram-negative uropathogens.
Cranberry was
initially believed to function by acidifying urine. However, the mechanism is
now thought to be inhibition of adhesion of bacteria to uroepithelial cells
(cells lining inside the urethra and bladder wall) by proanthocyanadin, a
compound present in cranberry. Proanthocyanidins bind to harmful bacteria such
as E. coli, forming a "Teflon-like" coating around them. The coating prevents
the bacteria from sticking to gastrointestinal and urinary tract walls,
preventing infections.
J. Nutr. 2017. Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis.
Cranberry or
trimethoprim for the prevention of recurrent urinary tract infections? A
randomized controlled trial in older women.
J Antimicrob Chemother. 2009.
One
hundred and thirty-seven women with two or more antibiotic-treated UTIs in the
previous 12 months were randomized to receive either 500 mg of cranberry extract
or 100 mg of trimethoprim for 6 months. Thirty-nine of 137 participants (28%) had
an antibiotic-treated UTI (25 in the cranberry group and 14 in the trimethoprim
group). Trimethoprim had a very limited advantage
over cranberry extract in the prevention of recurrent UTIs in older women and
had more adverse effects. Our findings will allow older women with recurrent
UTIs to weigh up with their clinicians the inherent attractions of a cheap,
natural product like cranberry extract whose use does not carry the risk of
antimicrobial resistance or super-infection with Clostridium difficile or fungi.
2009 - The results of a clinical study, recently published in the journal Spinal Cord, indicate that the use of Cran-Max Cranberry Concentrate for people with spinal cord injury resulted in a significant reduction in both the incidence of urinary tract infection (UTI) and the number of subjects with a UTI over a 12-month period. In the randomized, double-blind, cross-over trial, conducted at the Spinal Cord Injury Unit of the Veterans Administration Hospital in Boston, MA, 16 subjects had 21 UTIs while taking the placebo, compared to only six subjects who had seven UTIs while taking the Cran-Max cranberry concentrate. In the article, published in the 2008 edition of the journal, researchers concluded, “Despite advances in the management of neurogenic bladder, urinary tract infection represents a leading cause of morbidity and hospitalization. Cranberry extract tablets should be considered for the prevention of UTI in spinal cord injury patients with neurogenic bladder.” In the study, patients were randomly assigned to receive either Cran-Max tablets or placebo tablets for six months, followed by the alternative preparation for an additional six months. Of the 47 male subjects who completed the study, results showed that patients with a high glomerular filtration rate (a test to measure kidney function) received the most benefit from the cranberry supplement.
Children and UTI
Ann Pharmacother. 2015. Cranberry Products for the Prophylaxis of Urinary Tract
Infections in Pediatric Patients. Cranberry appears effective for the prevention
of UTIs in otherwise healthy children and is at least as effective as
antibiotics in children with underlying urogenital abnormalities.
Pregnancy
Daily cranberry juice for the prevention of asymptomatic bacteriuria in
pregnancy: a randomized, controlled pilot study.
J Urology 2008.
We compared the effects of daily cranberry juice cocktail to those of
placebo during pregnancy on asymptomatic bacteriuria and symptomatic
urinary tract infections. Our data suggest there may be a protective
effect against asymptomatic bacteriuria and
symptomatic urinary tract infections in pregnancy. Further studies are
planned to evaluate this effect.
Benefit in
men
Cranberries may be of benefit in reducing lower urinary tract symptoms (LUTS)
in older men, thereby, improving prostate health.
Researchers treated 42 men with an average age of 63 years who had LUTS with benign prostatic hyperplasia (BPH). They took 1500 mg
of dried powdered cranberry or placebo for 6 months. The cranberry treated group
experienced improvement in rate of urine flow, average flow, and had lower total
PSA levels. Vidlar A, Vostalova J. The effectiveness of
dried cranberries (Vaccinium macrocarpon) in men with lower urinary tract
symptoms. Br J Nutr. 2010.
Cranberry juice versus
cranberry supplement for UTI
For prevention of urinary tract infections, one has to consider the cost
of regularly drinking cranberry juice, as well as the extra calories. As
for cranberry supplements, two studies suggested they may work, but
cranberry supplements come in a wide range of different strengths. Optimal
dose of cranberry supplements and duration of use is not understood well.
It is not fully known whether cranberry supplements are equivalent to
cranberry juice in the fruit's biologically active substances.
Cholesterol impact
Favourable impact of low-calorie cranberry juice consumption on plasma HDL-cholesterol
concentrations in men.
Br J Nutr. 2006. Institute of Nutraceuticals and Functional Foods, Laval
University, Quebec, Canada and Lipid Research Center Laval University
Medical Research Center, Quebec Canada.
Studies have suggested that flavonoid consumption may be cardioprotective, and a
favourable impact on circulating HDL-cholesterol concentrations has been
suggested to partially explain this association. The aim of the present study
was to determine the effect of consuming increasing daily doses of low-calorie
cranberry juice cocktail (CJC) on the plasma lipid profile of abdominally obese
men. For that purpose, thirty men consumed
increasing doses of CJC during three successive periods of 4 weeks (125 ml/d,
250 ml/d, 500 ml/d). We noted a significant increase in plasma HDL-cholesterol concentration after the consumption of 250 ml CJC/d, an effect that plateaued
during the last phase of the stud). Changes in plasma apo A-I and triacylglycerol concentrations were the only variables
significantly contributing to the variation in plasma HDL-cholesterol
concentration noted in response to the intervention. No variation was observed
in total as well as in LDL and VLDL cholesterol. The present results show that
daily CJC consumption is associated with an increase in plasma HDL-cholesterol
concentrations in abdominally obese men. Polyphenolic
compounds from cranberries may be responsible for this effect, supporting the
notion that the consumption of flavonoid-rich foods can be cardioprotective.
Heart and blood vessel health
J Nutr. 2015. Cranberry Juice Consumption Lowers Markers of
Cardiometabolic Risk, Including Blood Pressure and Circulating
C-Reactive Protein, Triglyceride, and Glucose Concentrations in Adults.
The objective of this study was to determine the potential of
low-calorie cranberry juice (LCCJ) to lower cardiometabolic risk. A
double-blind, placebo-controlled, parallel-arm study was conducted with
controlled diets. LCCJ can improve several risk factors of CVD in
adults, including TGs, CRP, glucose, insulin resistance, and diastolic
BP. This trial was registered at clinicaltrials.gov as NCT01295684.
Teeth and tooth health
New research shows a generous helping of cranberry sauce may
actually offer benefits for their teeth. Cranberries, which already are
known to help thwart urinary tract infections, may also prevent tooth
decay and cavities, dental researchers reported in the January, 2006 issue
of the journal Caries Research. The same sticky compounds in the small,
hard red fruit -- which is boiled into a jelly that is a staple at
American winter holiday meals -- that help keep bacteria at bay in the
bladder also appear to help prevent bacteria from clinging to teeth. They
also found cranberry seemed to help ward off plaque, a gooey substance
formed from bits of food, saliva, and acid that can harbor bacteria and
eventually irritate the gums. The ultimate goal is to extract cranberry's
protective properties and add them to toothpaste or mouthwash. In the
meantime, people should be advised against drinking or eating excessive
amounts of cranberry -containing products since sugar is often added to
cranberries. The cranberry seed has not been studied as much as
the juice.
Chemical composition
Cranberry contains a number of compounds including
proanthocyanidins,
anthocyanidins, flavonoids, and hydroxycinnaminic acid. Flavonoids in
cranberries contribute to the red color and have
antioxidant properties. Most of
the compounds in cranberry are antioxidants. The profile of cranberry bioactives
is distinct from that of other berry fruit, being rich in A-type
proanthocyanidins in contrast to the B-type proanthocyanidins present in most
other fruit. Human studies on the health effects of cranberry products
have focused principally on urinary tract and cardiovascular health,
with some attention also directed to oral health and gastrointestinal
epithelia.
Historical uses
Early European settlers first used cranberries because the local fruit
lasted through the winter and enhanced the flavor of gamy meat. The
settlers had learned about the berry's culinary potential from local
Native Americans who endured cold winters by consuming pemmican, a cake
of cranberries, nuts and dried venison or bear meat.
The ripe cranberry fruit was used medicinally by Native Americans for the
treatment of bladder and kidney ailments. Pilgrims called the fruit "craneberry"
because the stem and flower resembled the head, neck, and beak of a crane.
Therapeutic applications of cranberries documented during the 17th century
included the relief of blood disorders, stomach ailments, liver problems,
vomiting, appetite loss, scurvy, and cancer. Native Americans and Europeans
prescribed cranberries for fevers, gastrointestinal problems and dropsy
Dropsy is a term used to describe inflammation or swelling.
Food poisoning protection
Cranberry extract may reduce the likelihood of
food-borne disease. Pathogen levels in raw meat are reduced after the
application of cranberry concentrate. These include significantly reduced
growth of Salmonella, E. coli and other dangerous bacteria. Compounds in
cranberries inhibit the growth of bacteria associated with food-borne
illnesses. Other research has found cranberry juice reduces E. coli,
Salmonella and other bacteria in unpasteurised apple cider. Cranberries
are known to have "anti-adhesion" properties that protect the body from
certain harmful bacteria that cause urinary tract infections, stomach
ulcers and gum disease.
In the US, PepsiCo Inc. and Ocean Spray have formed a
long-term strategic alliance under which Pepsi-Cola North America will
distribute single-serve cranberry juice products in North America under
the Ocean Spray name.
Review
The cranberry is full of antioxidants. The National Institutes of Health
is funding research on the effect of cranberry on heart disease, yeast
infections and other conditions, and other researchers are investigating
its potential against cancer, stroke and viral infections. So far,
research has found drinking cranberry juice can block urinary infections
by binding to bacteria so they can’t adhere to cell walls. Women often
drink unsweetened cranberry juice to treat an infection. A compound
discovered in cranberry, proanthocyanidine, prevents plaque formation on
teeth; mouthwashes containing it are being developed to prevent
periodontal disease. In some people, regular cranberry juice consumption
for months can kill the H. pylori bacteria, which can cause stomach cancer
and ulcers. Drinking cranberry juice daily may increase levels of HDL, or
good cholesterol and reduce levels of LDL, or bad cholesterol. Cranberry
may prevent tumors from growing rapidly or starting in the first place.
Extracts of chemicals in cranberry prevent breast cancer cells from
multiplying in a test tube; whether that would work in women is unknown.
Cranberry
availability from herb and ingredient suppliers
Cranberry is available as a plain cranberry juice concentrate powder or in
various extract potencies, for instance 4 to 1, 12 to 1, 18 to 1
concentrations. One supplier sells cranberry extract as 30 percent total
acid, 10 percent quinic acid and 3 percent total phenols.
Cranberry side effect, caution,
risks, danger, interaction with medications
Fatal hemopericardium and gastrointestinal hemorrhage due to possible
interaction of cranberry juice with warfarin Coumadin.
J R Soc Health. 2008.
We report a case of fatal internal hemorrhage in an elderly man who consumed
only cranberry juice for two weeks while maintaining his usual dosage of
warfarin (Coumadin). We propose that naturally occurring compounds such as flavonoids, which are present in fruit juices, may increase the potency of
warfarin by competing for the enzymes that normally inactivate warfarin. While
traditionally regarded as foodstuffs, consumption of fruit juices should be
considered when patients develop adverse drug reactions.
Elevated International Normalized Ratio after concurrent ingestion of cranberry
sauce and warfarin.
Am J Health Syst Pharm. 2008.
A case of increased International Normalized Ratio (INR) values in a patient
receiving warfarin who consumed a large amount of cranberry sauce is reported. A
75-year-old Caucasian man with atrial fibrillation was taking 22.5 mg of
warfarin weekly for 10 months and had maintained stable INR values between 2 and
3. During a clinic visit one week after Thanksgiving, the patient's INR was 4.8.
The patient was extensively questioned about any changes in his diet,
medications, and health. The patient reported consuming approximately 110 g of
cranberry sauce for seven consecutive days before the clinic visit. He reported
no other diet or health changes. The patient denied alcohol consumption, had not
taken nutritional supplements, and did not miss or double any medication doses
during this time period. The patient's complete
blood cell count and results of a chemistry panel and liver function tests were
within normal limits. He did not have any bleeding or bruising. The only
identifiable change was the addition of store-bought cranberry sauce to his
diet. The patient's warfarin dose was held for two days. Subsequently, the
patient resumed warfarin at a dosage of 20 mg per week. Seven days after the
patient discontinued the cranberry sauce, his INR returned to 2.2 and remained
stable over the next month. Consumption of cranberry sauce led to an increase in
INR values in a patient receiving warfarin.
I wanted to forward a study reference conducted by
warfarin expert Jack Ansell, MD who evaluated the myth (originating only from
isolated case studies in England) that cranberry products can elevate INR test
results. Dr. Ansell found that normal consumption of cranberry products really
had no affect on patient INRs and therefore not a contributor to elevated
bleeding risk. Reference: Ansell, J. 2009. The Absence of an Interaction Between
Warfarin and Cranberry Juice: A Randomized, Double-Blind Trial. Journal of
Clinical Pharmacology. I saw you advise patients are at risk of
bleeding for cranberry and cranberry products. We provide information for our
visitors that cranberry can be safely consumed in normal quantities by patients
taking warfarin. Gary B Liska, Disease Management / Provider Relations Quality
Assured Services, Inc.
Questions
Do sweetened dried cranberries have similar bladder benefits as
the juice?
Dried cranberries do contain the anti-adhesion
mechanism present in cranberry juice, puree and concentrate that prevents
urinary tract infections. However, I am not thrilled about the added sugar.
I am in the
process of buying Prostate Power Rx and, besides, I am going to take a
cranberry (Vaccinium macrocarpon) supplement that it seems to improve the
urinary flow according to a Wikipedia statement. Is there any side effect if I
take both products together?
It is not possible for us to predict any one person's
reaction to a supplement, a combination of supplements, or combining with
medications but we do not see any obvious negative interactions.
Natural Factors, CranRich, Super Strength Cranberry
Concentrate, 500 mg, 180 Capsules
Buy Cranberry extract
Supplement Facts | ||
Serving Size: 1 Capsule | ||
Amount Per Serving | % Daily Value | |
CranRich Cranberry (Vaccinium macrocarpon) Concentrate (36:1) (Fruit) | 500 mg | ** |
** Daily Value not established. |
Buy Cranberry Concentrate extract pills
Genitourinary Tract Support
Herbal Supplement
Cranberry is widely used to support the health of the genitourinary tract.
Research has shown that it has an anti-adhesion factor that prevents
bacteria from attaching to the walls of the urinary tract. This concentrated extract
has a broad
spectrum of cranberry's valuable plant acids. Each pill is
equivalent to drinking several ounces of cranberry juice.
Lifestyle Recommendations: To support the health of the genitourinary tract, drink plenty of pure water; avoid the excessive consumption of sugar, which can lead to increased bacterial levels; and reduce caffeine and alcohol, which may irritate the bladder.