[32], which was an open, randomized, controlled trial, 150 women were divided into 3 groups: one group drank 50 mL a day of cranberry-lingonberry juice concentrate containing 7.5 g cranberry concentrate and 1.7 g lingonberry concentrate (lingonberry is another fruit of the Vaccinium genus); another group drank 100 mL of a lactobacillus drink; and a third group received no intervention. Of interest too is an epidemiological study [40] that evaluated the relationship between health/sexual behavior and first-time UTI in sexually active women. In some of them, the primary parameter tested was UTI; in other studies, bacteriuria was the primary end point. This pilot study examines the effect of drinking moderate amounts of commercially available cranberry juice cocktail on urinary pH in older, institutionalized adults. This article examines what is known about its effect on the lower urinary tract and considers what advice should be given to those planning to take it. The absolute risk reduction for cranberry products was 12%–14%, similar to the findings of Kontiokari et al. Results of clinical studies suggest a possible clinical benefit of cranberry juice in preventing UTI in some populations.  |  NLM [18] concluded that cranberry juice could not exert a bacteriostatic effect because it was not a rich enough source of hippuric acid, coupled with the fact that it did not lower urine pH sufficiently. After therapy, 53% had a positive response and an additional 20% had a more modest benefit, but 6 weeks after stopping treatment, bacteriuria reappeared in most of the subjects. In 1930, cranberry juice cocktail, comprising a mixture of cranberry juice, sweetener, water, and added vitamin C, was introduced. Urine samples obtained from healthy volunteers who drank cranberry juice prevented uropathogenic E. coli isolates from adhering to isolated uroepithelial cells in bioassays. ... Effect of cranberry juice on urinary pH. Compared with historical controls, the incidence of UTI was significantly reduced, from 27 cases a month to 20 cases a month. In the population that benefits most from the prophylactic effect of cranberry intake (sexually active women with recurrent UTI), trial results repeatedly show an ∼50% reduction in disease morbidity. In the single trial that evaluated the issue of cost, Stothers [31] found that cranberry tablets are more cost-effective than organic cranberry juice. Frequency of bacteriuria was 75% during both placebo and cranberry periods, and the number of UTIs was not significantly different either. Kiel RJ, Nashelsky J, Robbins B, Bondi S. Jensen HD, Struve C, Christensen SB, Krogfelt KA. However, these trials suffer from a number of limitations. Goldman RD. One half cup of cranberry juice provides 60 calories, 20% of the Daily Value for vitamin C, and counts as one-half of a fruit serving toward the United States MyPlate daily nutrition guide. Furthermore, results of the reviewed studies should not be viewed as conclusive because many of the trials suffer from various limitations, including lack of randomization, no or improper blinding, small number of subjects, short trial duration, large number of dropouts, and no reported intent-to-treat analysis [43]. This, too, was not a randomized trial. All these subsequent trials have studied the effect of cranberry in preventing urinary tract symptoms. Jackson B, Hicks LE. [13] published results for 6 men who ingested 100–300 g of cranberries daily. However, the evidence is far from conclusive. Avorn et al. These trials have evaluated various patient populations, including sexually active adult women, elderly or pediatric patients, and patients with different medical conditions. On the basis of these 2 trials, a recent evidence-based answer published in the Journal of Family Practice [44] suggested that a trial of cranberry juice (3 glasses daily) was reasonable for women with recurrent UTI who are being considered for antibiotic prophylaxis. In the additional 7 patients, there were fewer instances of bacteriuria during the cranberry period than during the control period, supporting a moderately preventive role for cranberry juice. During the 1880s, German physicians observed that urinary excretion of hippuric acid increased after ingestion of cranberries. Since Sobota's initial report, several studies have confirmed that the presumed efficacy of cranberry in preventing UTI is related to its antiadherent properties. Stothers [31] performed a randomized, placebo-controlled, double-blind study. Bodel et al. At the end of the 6-month study, bacteriuria and pyuria were present in 28% of urine samples from the cranberry group. Can Fam Physician, 58(4) ... Effect of cranberry juice on urinary pH in older adults. NIH Sobota found that cranberry juice cocktail reduced adherence by >75% in >60% of 77 clinical isolates of E. coli recovered from patients with UTI. The antiadhesive property of cranberries probably helps to prevent UTI in 2 ways: first, it directly prevents E. coli from adhering to uroepithelial cells; and second, it selects for less adherent bacterial strains in the stool. 6 Things You Should Know about UTIs in Older Adults. The same Cochrane reviewer who evaluated UTI prevention also systematically reviewed the literature for trials that evaluated use of cranberries for treating UTI [46]. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. View abstract. HHS Epub 2008 Jan 16. [30] studied patients with bacteriuria, but this was not a randomized trial. [43] reviewed in the Cochrane Library all randomized or quasi-randomized controlled studies for the prevention of UTI with cranberry juice. Cranberry juice and urinary tract infections: what is the evidence? Cranberries have long been the focus of interest for their beneficial effects in preventing urinary tract infections (UTIs). In the study by Kontiokari et al. [38] conducted a large randomized, double-blind study in which 153 asymptomatic elderly women received 300 mL per day of cranberry juice cocktail or placebo. Drugs. UTI treatment. However, these authors concluded that an ordinary serving of 22–54 g of cranberries produced only a very slight increase in urine acidity [14]. After 6 months' treatment, 16% of the cranberry group, 39% of the lactobacillus group, and 36% of the control group had experienced ⩾1 recurrence of UTI. Two additional studies were performed in adult patients, but neither study evaluated clinical outcomes. The increased acidity produced by eating prunes and cranberries, Effect of cranberries on urinary acidity and blood alkali reserve, Effect of cranberry juice on urinary pH in older adults, Predictability of methenamine efficacy based on type of urinary pathogen and pH, Cranberry juice and the antibacterial action of hippuric acid, Reduction of bacteriuria and pyuria using cranberry juice [reply]. Kontiokari et al. The conclusion of the review was that because of the small number and poor quality of trials, there is insufficient evidence to show the effectiveness of cranberry juice for prevention of UTI. doi: 10.1002/14651858.CD001321.pub5. The scientific name for cranberry plant is Vaccinium macrocarpon [4]. Cranberry Juice and Urinary Tract Infection. Foods that have a pH above 7.0 are considered alkaline, while those with a pH below 7.0 are acidic. Rogers J. Evidence regarding the role of cranberries for treating, rather than preventing, UTI is almost nonexistent. Patients were offered cranberry juice in one department and the usual mixed berry juice in the other. Nevertheless, at least one author has warned that ingesting a large amount of cranberries over a long duration may increase risk of some types of urinary stones in high-risk patients because of the increased urinary excretion of oxalate and slight urinary acidification [48]. Cranberries, blueberries, and Concord grapes are the only 3 fruits that are native to the United States and Canada. But for many people, it’s just too sour to handle. Cranberry juice and crushed cranberries have been used for a long time in the treatment and prevention of urinary tract infections. Nursing Research, 28, 287-290. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. In this study, which followed a double-blind crossover design, 19 women with recurrent UTI were provided either cranberry capsule (with 400 mg cranberry solids) or a placebo capsule for 3 months. The single-strength juice is very acidic (pH, <2.5) and unpalatable. 2010 Jun;7(2):227-32. doi: 10.1093/ecam/nem183. Cranberry capsules are an understudied, nonantimicrobial prevention strategy used in this population. These authors concluded that ingesting cranberry beverages reduced the frequency of bacteriuria with pyuria in older women, although they noted that, in elderly women, asymptomatic bacteriuria does not usually require treatment. The chances of having bacteriuria with pyuria were 42% less in the cranberry group than in the control group. Notably, an early study by Bodel et al. Most importantly, the trials have used a wide variety of cranberry products, such as cranberry juice concentrate, cranberry juice cocktail, and cranberry capsules, and they have used different dosing regimens. At the 1-month mark, there was no difference in the percentage of urine samples with bacteriuria and pyuria in the 2 groups (∼25%). Journal of Urology: “Effect of cranberry juice consumption on urinary stone risk factors.” Mayo Clinic: "Urinary Tract Infection." In 1933, Fellers et al. The major organic acids are citric, malic, and quinic acids, with small amounts of benzoic and glucuronic acids [7]. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infection. Fifteen of 22 subjects showed significant antiadherence activity in their urine 1–3 h after drinking 15 oz (443.6 mL) of cranberry juice cocktail [22]. Up to 40–50% of women will suffer from UTI at least once during their lifetime (Foxman, 2003). Although only 10 patients finished the entire course of treatment, results favored the use of cranberry. Articles Citing this One: 1. However, in certain circumstances, cranberry juice may actually increase symptoms of bladder discomfort and frequency or urgency with urination. Patients then switched to an alternative therapy for the next 3 months. At baseline, bacteriuria and pyuria were present in ∼20% of samples in both the cranberry group and the placebo group. We thank Frances Nachmani, Hana Edelstein, and Miriam Ben-Yashar for their assistance in data collection and processing. Urinary tract infections (UTIs) are common. We’ll separate UTI fact from fiction. [17] reported that the addition of vitamin C to cranberry cocktail did not change urine pH. Takahashi, et al. Two studies have evaluated the use of cranberries in elderly women, but unlike the above 3 prospective studies, these trials chose bacteriuria as their primary parameter. Adherence of uropathogens to uroepithelial cells is the initial step in pathogenesis of UTI [20]. Does cranberry juice prevent or treat urinary tract infection? After 4 weeks, the regimens were reversed. In older adults (40–50 years old), a higher urinary concentration of phenolic metabolites of anthocyanin such as syringic acid, p-coumaric acid, 4-hydroxybenzoic acid, and homovanillic acid was associated with higher bifidobacteria level (> 4.47 vs. < 1.18 log 10 copies per g faeces) . This high prevalence and the worrying rise in antibiotic resistance among uropathogens emphasize the need for new approaches for treating and preventing UTIs. Perhaps the single most consistent limitation of these trials is the lack of uniformity regarding the intervention, including the particular cranberry product evaluated (juice, sweetened cocktail, or capsules/tablets), concentration, dosing regimen, and duration of the intervention, which greatly differed from study to study [43, 49]. Cranberry juice and bacterial colonization in children--a placebo-controlled randomized trial. Not less significant is the inconvenience associated with the amount of juice required to assure continuous availability and the need to carry a daily supply if twice- or thrice-daily dosing is needed to work, business, or vacation travel. Similarly, Jackson and Hicks [ 16 ] showed that 710 mL of cranberry juice (25% pure juice) lowered the urine pH of 21 elderly men.  |  Effect of cranberry juice on urinary pH in older adults. In contrast, none of the randomized clinical studies that evaluated patients at high risk of UTI—for example, those with neurogenic bladder—found cranberries to have a beneficial effect. The results of the study have implications for home care nurses who have similar patients in their case loads. Thank you for submitting a comment on this article. A smaller study by Walker et al. Importance: Bacteriuria plus pyuria is highly prevalent among older women living in nursing homes. Numerous clinical studies evaluating the association between cranberry juice consumption with urinary health [20,21,22,23,24,25,26], antioxidant status [27,28], or cardiovascular disease [31,32,33,39], document the health benefits of consuming flavonoids in the form of cranberry products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Most research suggests that ingestion of cranberry juice may be useful in preventing urinary tract infections. Evaluation of methenamine for urinary tract infection prevention in older adults: a review of t... Show details . [35] adds further support to the above findings. Evid Based Complement Alternat Med. [18] in 1959 found that, in 5 healthy subjects, 1200–1400 mL of cranberry juice cocktail slightly acidified urine and increased the amount of hippuric acid excreted in urine to 3–4 g. However, none of the urine samples from these patients was bacteriostatic against Escherichia coli. It should be noted, however, that none of these 3 studies used the popular commercial brand of cranberry juice cocktail. Key points. In 1914, Blatherwick [9] published an article showing that cranberries are rich in benzoic acid, which is then excreted in urine as hippuric acid. UTI prophylaxis. Cranberries for treating urinary tract infections, Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis, National Center for Complementary and Alternative Medicine, © 2004 by the Infectious Diseases Society of America. Does cranberry juice prevent or treat urinary tract infection? Since the study of Papas et al. Front Microbiol. Pass the cranberry juice. Abstract Aim To examine the effect of cranberry ingestion on lipid profiles in Type 2 diabetic patients taking oral glucose‐lowering drugs. Cranberry Juice and Combinations of Its Organic Acids Are Effective against Experimental Urinary Tract Infection. 2013;19(1):112-7. Resistance among urinary tract pathogens collected in Europe during 2018. Kinney and Blount found that certain amounts of cranberry juice (450–720 mL daily) lowered urinary pH. Please enable it to take advantage of the complete set of features! [32]. Among other constituents are flavonoids, anthocyanins, catechin, triterpenoids, organic acids, and a small amount of ascorbic acid. 2017 Apr 4;8:542. doi: 10.3389/fmicb.2017.00542. Summary of prospective studies evaluating prophylaxis of urinary tract infection (UTI) on bacteriuria. Does cranberry juice have antibacterial activity? In-vitro studies have shown that cranberry prevents the growth and adhesion of many bacteria and that cranberry juice prevents urinary tract infections. In 1923, Blatherwick and Long [11] reported a reduction in urine pH level (6.4–4.5) with a concomitant increase in excretion of hippuric acid (0.77–4.74 g) after subjects ate 350 g of cooked cranberries [12]. Until 2000, only 5 trials met all the criteria adopted for evaluation. After 1 year, results showed that 32% of placebo recipients had experienced ⩾1 UTI during the year, compared with 20% in the cranberry juice group and 18% in the cranberry tablet group. The strongest evidence available is for sexually active adult women with previous UTI. Zafriri et al. Haverkorn and Mandigers [39] also evaluated the use of cranberry by elderly patients, but they used a nonblinded crossover design. Clinical inquiries. Drink lots of water! Another nonrandomized study [47] found decreased leukocyte counts in urine samples obtained from handicapped children (most with indwelling catheters) who drank cranberry juice. Even so, the evidence has not been consistent, as two recent studies were both positive for effect of cranberry juice on symptomatic UTI in women with recurrent UTI [5] and inconclusive for the use of capsules on bacteriuria in an elderly population [6]. The key is to drink 100% cranberry juice. Urinary tract infection (UTI), most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans (Foxman, 2014). eCollection 2017. Drinking cranberry juice is just one of the myths about preventing and treating urinary tract infections (UTIs). Cranberry juice typically features a pH of between 2.3 and 2.5, making it a fairly acidic beverage. Although this study was retrospective and examined first-time UTI and not recurrent UTI, it adds to the notion that young, sexually active women constitute a population that may benefit from cranberry products. ... Effect of cranberry juice on urinar y pH in older. These trials did not show any benefit of cranberry for prevention of UTI or bacteriuria. The leading brand of cocktail contains 33% pure cranberry juice. Men and women in a nursing department of a general hospital were provided 15 mL cranberry juice (type not detailed) mixed with water twice daily or the same amount of water daily. Cranberries for preventing urinary tract infections. This pilot study examines the effect of drinking moderate amounts of commercially available cranberry juice cocktail on urinary pH in older, institutionalized adults. Oxford University Press is a department of the University of Oxford. Urine samples were obtained at baseline and at 1-month intervals for 6 months, and tested for bacteriuria and pyuria. Urinary tract infection (UTI) refers to the presence of clinical signs and symptoms arising from the genitourinary tract plus the presence of one or more micro-organisms in the urine exceeding a threshold value for significance (ranges from 102 to 103 colony-forming units/mL). 31 However, all participants were instructed to drink 8 ounces of water twice a day with each capsule administration, so it is possible that the fluid load was … The Cochrane reviewers concluded that randomized studies assessing effectiveness of cranberry juice for treatment of UTI have not yet been conducted. In 8 adult patients with multiple sclerosis randomized to receive 20 days' therapy, cranberry increased acidity of urine, and in 15 patients with spinal cord injury, cranberry reduced bacterial biofilm load in the bladder [41, 42]. Some studies have indicated that the taste and caloric load of cranberry juice cocktail is unacceptable to many patients, especially over the long term [15, 40, 44]. Juice was 250 mL of pure unsweetened cranberry juice taken 3 times daily, and tablets contained 1 : 30 parts concentrated juice taken twice daily. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections, An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates, Adhesive properties of Enterobacteriaceae, Bacterial adherence: receptors and recognition, series B, vol 6, Inhibitory activity of cranberry juice on adherence of type I and type P fimbriated, Inhibition of the adherence of P-fimbriated, The structure of cranberry proanthocyanidins which inhibit adherence of uropathogenic P-fimbriated, Cranberry juice and adhesion of antibiotic-resistant uropathogens. 16 Traditionally, cranberries have also been used for many problems, such as stomach ailments, anorexia, vomiting, and blood diseases, as well as in wound dressings. [30], about a dozen clinical trials evaluating various cranberry products have been performed. Only 21 patients finished the study. News releases, Science Daily. In contrast, Nahata et al. Today, it is known that the low amount of benzoic acid present in the fruit (<0.1% of weight), coupled with maximum tolerated amounts of cranberry juice (∼4 L/d), rarely results in enough hippuric acid excretion necessary to achieve bacteriostatic urinary concentrations [19]. But they increase the odds for delirium, hospitalization and death in older adults who are frail. Journal of Clinical Nutrition. Nursing Times, 01 Nov 1991, 87(48): ... Cranberry juice for urinary tract infection in children. However, educational brochures published by the National Kidney Foundation contain statements supporting the possible use of cranberry juice in helping to prevent the development of UTI [45]. 2005 December;24(6):1065-72. Jackson B, Hicks LE. In the crossover, placebo-controlled, double-blind study of Schlager et al. Two studies have evaluated the potential of cranberry in pediatric patients with medical conditions predisposing them to UTI. The antiadherent effect started within 2 h and persisted for up to 10 h after ingestion [29]. They, too, showed an increase in acidity and excretion of organic acids (including hippuric acid) in urine. It has been demonstrated that the anti‐adhesion effect was dose‐dependent, requiring a daily intake of at least 36 mg PAC. Urinary citrate might originate directly from citrate-containing foods, such as cranberry juice [35], tea [36], and grape juice [25]. Ingestion of large amounts of cranberry juice is required to slightly reduce pH of urine and modestly increase hippuric acid excretion, changes that do not confer significant antibacterial activity to urine. A total of 150 women with previous UTI were divided into 3 groups: persons who received placebo juice and placebo tablets, persons who received cranberry juice and placebo tablets, and persons who received placebo juice and cranberry tablets. Cranberries contain PACs, which help prevent urinary tract infections. Does symptom severity predict response to low-dose onabotulinumtoxinA for the treatment of urgency urinary incontinence? II. The first clinical study evaluating the effect of cranberry on urinary tract was published in 1966. Papas et al. The results of the stu … Most research suggests that ingestion of cranberry juice may be useful in preventing urinary tract infections. [2][2] UTIs are also common in older people, children and in those with neurological abnormalities such as spina bifida. Cost is another issue that affects patient uptake of treatment, because cranberry products are not currently covered by health insurance [44, 49]. This pilot study examines the effect of drinking moderate amounts of commercially available cranberry juice cocktail on urinary pH in older, institutionalized adults. Cranberry juice is an acidic drink with a typical pH between 2.3 and 2.5. USA.gov. Of 21 episodes of UTI, 6 occurred in the cranberry group and 15 occurred in the placebo group. [30] described the effect of cranberry juice in 60 patients with bacteriuria who received 480 mL of juice daily for 3 weeks. Around 60% of women experience at least one urinary tract infection (UTI) during their lifetime,[1][1] of whom up to 20% will experience recurrence. Dried cranberry powder formulated in capsules or tablets is also available. Search for other works by this author on: Infectious Diseases Unit, Wolfson Medical Center, Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women, Probiotic therapy and functional foods for prevention of urinary tract infections: state of the art and science, Anthocyanin recovery from cranberry pulp wastes by membrane technology, The specific role of foods in relation to the composition of urine, Observations on the effectiveness of cranberry juice in urinary infections, Studies of urinary tract acidity. In women with recurrent urinary tract infections (UTIs), long-term antimicrobial prophylaxis is indicated [1]. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 2001 May 14;163(20):2782-6. Therein followed a long period during which the usefulness of cranberry juice was thought to be based on the urinary excretion of hippuric acid, which is a bacteriostatic agent and has the potential to acidify urine [10]. adults. Commercial harvests occur in September and October. Kinney and Blount [15] found that certain amounts of cranberry juice (450–720 mL daily) lowered urinary pH. Further research is required to clarify unanswered questions regarding the role of cranberries in protecting against UTI in general and in women with anatomical abnormalities in particular. In elderly patients, cranberry consumption reduces the incidence of bacteriuria, although this is often not treated with antibiotics. Sobota AE. [32]. COVID-19 is an emerging, rapidly evolving situation. It is now known that E. coli, the most common cause of UTI, have hairlike fimbria that protrude from their surface. R. Raz, B. Chazan, M. Dan, Cranberry Juice and Urinary Tract Infection, Clinical Infectious Diseases, Volume 38, Issue 10, 15 May 2004, Pages 1413–1419, https://doi.org/10.1086/386328. However, the presence of sugar in drinks like cranberry juice can actually cause UTIs. Data sources include IBM Watson Micromedex (updated 7 Dec 2020), Cerner Multum™ (updated 4 Dec 2020), ASHP (updated 3 Dec … Bacteria present in the urinary tract when a UTI occurs use sugar as a nutrient, and sugar also makes the pH of the urinary tract more hospitable for E. coli. Emerging research has unlocked many of the complexities of the urinary tract infection cycle, and recent studies on cranberry have provided much … If one considers the understandably high rate of dropouts, the 50% efficacy rate may drop to a remarkably lower effectiveness. Future trials should also assess patient acceptability of treatment. Therefore, the need for alternative therapies for UTI prophylaxis is evident. Cranberry juice in the treatment of urinary tract infections, A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products against urinary tract infection in women, Randomised trial of cranberry-lingonberry juice and. View abstract. As antimicrobial resistance continues to climb, the time is ripe to recognize the importance of further cranberry research. Objective: To test the effect of 2 oral cranberry capsules once a day on presence of bacteriuria plus pyuria among women residing in nursing homes. Similarly, Jackson and Hicks [16] showed that 710 mL of cranberry juice (25% pure juice) lowered the urine pH of 21 elderly men.  |  Capsules of cranberry concentrate could be a better-tolerated alternative [31]. [18] demonstrated that hippuric acid was bacteriostatic at a minimum concentration of 0.02 mmol/L at pH 5.0, and the antibiotic activity of hippuric acid decreased ∼5-fold as the pH increased to 5.6. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization, The effect of cranberry juice on UTI rates in a long term care facility [abstract P169], Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population, Reduction of bacteriuria and pyuria after ingestion of cranberry juice, Reduction of bacteriuria and pyuria using cranberry juice [letter], First-time urinary tract infection and sexual behavior, Effect of cranberry juice and ascorbic acid in acidifying the urine in multiple sclerosis subjects, Cranberry juice consumption may reduce biofilms on uroepithelial cells: pilot study in spinal cord injured patients, Cranberries for preventing urinary tract infections. Most research suggests that ingestion of cranberry juice may be useful in preventing urinary tract infections. Approximately 1 dozen clinical trials have been performed testing the effects of cranberries on the urinary tract. 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