Cranberry Juice – Benefits

One of the most widely held beliefs about UTIs is that drinking cranberry juice (or taking cranberry supplements) can prevent and get rid of them. Almost 60% of women will experience urinary tract infection at some point in their life.

Cranberry is a term derived from the contraction of “crane berry.” The American cranberry (Vaccinium macrocarpon) was historically used by North American Indians to treat UTIs1    The anthocyanidins and proanthocyanidins (PAC) in cranberry are tannins (stable polyphenols) found only in vaccinium berries and function as a natural plant defense system against microbes2,3    

Cranberry (Vaccinium macrocarpon) is a distinctive source of polyphenols as flavonoids and phenolic acids that has been described to display beneficial effects against urinary tract infections (UTIs), the second most common type of infections worldwide. Common preparations with cranberries include fresh, whole berries, gelatinized products, juices (usually 10-25% pure juice) and capsules2,4,5,6,7,8,9 

E.Coli is one of the most common causative organism in UTI. One important property of E. coli is its adherence to the host tissue. The main protein structure related to this phenomenon is the adhesin protein, and its name is based on its shape: pili or fimbriae10 Among other possible mechanisms behind the protective effects of cranberries against UTIs is the capacity of cranberry polyphenols to act as antiadhesive agents in preventing/inhibiting the adherence of pathogens to uroepithelial cell receptors, which appears to be a major step in the pathogenesis of these infections11 

Several studies have shown a protective effect of cranberry against UTIs12,13,14,15,16 and others have not found significant effects17,18 

This current controversy about conflicting results of the clinical and cost effectiveness of cranberry supplements has been attributed to different manufactured cranberry based products and doses, as well as a lack of systematic protocol for the selection of subjects and clinical assay19 

The current hypothesis is that cranberries work principally by preventing the adhesion of type 1 and p-fimbriae strains (particularly from E. coli) to the urothelium20,21,22,23 Another mechanism of cranberry activity is the in vitro reduction in the expression of p-fimbriae in E. coli by changing the conformation of surface molecules24,25 

Most studies have focused on uropathogenic E. coli type 1 and p-fimbriated E. coli, but there are many in vitro studies showing an inhibition of adherence for Proteus spp., P. aeruginosa, E. faecalis, S. aureus, S. typhimurium and K. pneumoniae 2,26,27 Considerable current effort is also devoted to the still-unravelled mechanisms that are behind the UTI-protective effects of cranberry, probiotics and their new combined formulations. Even multi-drug resistant strains of E.coli exhibited inhibition of adherence to uroepithelial cells in the presence of proanthocyanidin28 

Although the side effect profile for this drug therapy is relatively benign drug interections are  seen with nifedipine oxidase , Warfarin29,30. Making it wise to inform your doctor about your current priscription drugs before starting cranberry based therapies.

Probiotic bacteria are considered another promising therapy in UTI prevention and treatment.31,32  Many human intervention studies have evaluated if the consumption of specific strains, such as Lactobacillus spp. can prevent or treat UTIs33,34 Also we should note that the combination of cranberry with some probiotic strains has also been proposed to be effective for the management of recurrent urinary tract infections35 

In female patients the vaginal microbiota, that has predominance of lactobacilli, plays a dynamic and often critical role in UTI pathology by maintaining a low pH and avoiding uropathogen colonization by competitive exclusion. However, hormonal change due to oestrogen deficiency, antimicrobial therapy, contraceptives, incomplete healing and recurrence of UTIs lead to a shift in the local microbiota known as dysbiosis, increasing the risk of pathogens triggering pathologies like UTIs, bacterial vaginosis and yeast vaginitis36,37 

It is worthy of note that cranberries, like some traditional medicines, are a well-known functional food, whose efficacy has been assayed in clinical trials. However, the compounds directly responsible for many of cranberries’ reported health benefits remain unidentified. They are complex mixtures whose constituents have a synergistic effect by acting at different levels on multiple targets and pathways or reducing toxicity and drug side effects38 

It has also been seen that cranberry effectiveness is individual- and/or case-dependent. This variability among individuals and cases has been attributed to different manufactured cranberry-based products and doses, as well as to the lack of systematic protocols for the selection of subjects and clinical studies.

New factors such as host microbiota, endogenous metabolism, host genetics and the immune system may also play a role in cranberry effectiveness against uropathogens. A question that remains to be fully answered is which cranberry and/or cranberry-derived components are mainly responsible for its protective effects against UTIs. Although recent studies have shed light on the anti-adherence activity derived from cranberry consumption, other mechanisms might be jointly implicated that need further investigation.

Refrences:

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