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by G. Heidi Cannon
Urinary Tract Infections
The New Power of Cranberry
Urinary tract infections (UTIs) in otherwise healthy women are very common. In fact, according to the National Institute of Health, next to the common cold and flu, UTIs are the second most common infection among women.
For a woman with a UTI there is usually substantial pain, irritation and an ongoing discomfort until cured. UTIs have been called “the infection that drives women crazy.” The symptoms are burning, stinging, pain during urination, frequency, urgency and nocturia (getting up in the night). Pain can be severe, even excruciating, in the lower back and pelvis.
Any woman who has had a UTI wants to avoid getting another. Prevention against the onset of a new UTI is the key. Until now preventive measures have largely relied on the use of antibiotics, with all the disadvantages. There has been a distinct need for a satisfactory alternative to antibiotics as prophylactic regimens. Now there is good news for women—a new natural solution has been shown to be remarkably effective in stopping UTIs before they begin.
UTIs are a serious health problem for women
UTIs are a ubiquitous problem affecting women of all ages—from small children to elderly women. About five percent of schoolgirls have a UTI by the time they leave high school. Sexually active women in their reproductive years are prone to getting UTIs. After menopause the incidence of UTIs increases steadily with aging. In nursing homes it is estimated that 50 percent of female residents have recurring UTIs.
Recent NIH statistics show that annually in the U.S. alone there were over nine million doctor visits and over one million hospitalizations involving UTIs. Add to these numbers the countless additional millions of infections which are self-medicated by U.S. women each year.
Why are women so susceptible to UTIs? The basic female anatomy predisposes them to urinary tract infection. Because the urethra opening is located very close to the anus, fecal bacteria can invade the urethra and travel the short distance to the bladder. If these bacteria are not washed out in the urine stream or eliminated by the body’s immune system, one of several types of infections can occur. UTIs are caused when the bacteria successfully adhere to the cell walls of the urinary tract and colonize.
Many women suffer from frequent UTIs. Approximately 15 percent of patients experience two or more infections per year. Women who have had recurrent UTIs are likely to continue having them. Recurrent UTIs are costly to society in terms of medical costs and are estimated to be a major cause of lost work days.
Women with recurrent UTIs may either be more susceptible to such relapse or infection than other women and/or they may experience more infection because of behavioral factors such as sexual activity or poor hygiene habits. The frequency of UTIs is best viewed as an interplay between host susceptibility and the natural temporal variability of virulence factors in the colonizing bacteria. Reinfection rates are highly variable and not really predictable—some women have multiple, very closely-spaced recurrent infections whereas others will have recurrent infection separated by infection-free periods of months or years.
Treating a urinary tract infection
Individual episodes of UTIs are treated with a short-course antimicrobial therapy. For recurrent UTIs the conventional therapy is repeated treatment with full course or prophylactic antibiotics. Antibiotics cure an existing UTI by killing the bacteria then present. But the surprising news is that antibiotics have little or no impact on whether a subsequent infection will occur.
This was recently emphasized again in a large randomized double blind trial of 688 women who were treated with short course antibiotics when they developed a UTI. Within four to six weeks between 11 percent and 16 percent of these patients suffered a recurrence (relapse or reinfection). The rate varied depending upon which of three leading antimicrobials was used.
In another large study of 179 adult women, 44 percent of the patients had a recurrent UTI within the following year after being given antibiotics for the index episode. Other studies have demonstrated that when continuous antimicrobial prophylaxis is discontinued, even after extended periods of such regimen, over 60 percent of women who are subject to getting recurrent UTIs will reinfect within three to four months.
There are other major problems associated with antimicrobial therapy: (1) the side effects; (2) the high costs; (3) the inconvenience; (4) the impact on the friendly flora in a woman’s body, especially in the genitourinary tract; and (5) the rapid emergence of resistant bacteria.
In the aforementioned study of 688 women, one third of these women (31–39 percent) suffered adverse events (side effects) from taking the antimicrobials. The destructive power of antibiotics on a woman’s friendly flora is well-known. It is no secret that antibiotics are expensive and the antibiotic prophylactic regimens require a lot of doctor interface and add burdens to one’s daily life. No wonder that many patients have an aversion to continued use of antibiotics over an extended time and are asking their doctors for alternative approaches.
Bacterial resistance is now a major concern
Bacterial resistance to antibiotics is front page news. The media is full of alarming stories about the ever-increasing resistance of bacteria to antimicrobial therapies. A recent U.S. News and World Report cover story (May 1999) headlines: “Losing the battle of the bugs. Common bacteria are now so resistant to antibiotics that they can kill.”
Many articles in the professional journals sound a similar warning. Doctors and scientists agree that antimicrobial prophylaxis should only be used for a certain time because the organisms that cause UTI develop a resistance to the drug being used. The efficacy of antimicrobial therapy prophylaxis is related to and limited by the prevalence of resistance organisms in the community. At a certain point efficacy of this prophylaxis is reduced. These resistant organisms may then serve as a reservoir for urinary infection. Reflecting this trend, a woman with recurrent UTIs is likely to be given a round-robin of rotating medicines as doctors try to keep one generation ahead of mutating, antibiotic-resistant bacteria.
Attacking the bacteria which cause most UTIs
The vast majority of UTIs are caused by E.coli bacteria. They look a bit like a spider and have hair-like protrusions called fimbriae (or pili), which they use to adhere to the walls of the urinary tract.
In the 1980s, university researchers in both Israel and the U.S. separately reported in peer-reviewed articles that cranberry was a natural substance that E. coli didn’t like and that cranberry juice strongly affected the adherence of E. coli to human urothelial cells. Then in 1999 scientists at Tulane University announced new findings that cranberry juice caused a change in the very cell structure of E. coli, disabled the bacteria’s fimbriae and inhibited agglutination (colonization). Shortly thereafter researchers at Rutgers University identified condensed tannins or proanthocyandins as the anti-adherence factor in cranberry.
Cranberry does not kill E. coli—instead it works by interfering with and preventing the bacteria’s ability to adhere and colonize. Therefore there is no impetus for E. coli to develop resistance to it or to mutate into new forms. Thus cranberry looks good in the laboratory but how does this translate in actual consumer or clinical application in a product form?
Cranberry food products
Cranberry blended juices sold commercially actually contain only 27 percent cranberry juice. The remainder of the beverage is usually sweetened water, added because of the tartness of the berry and to make the beverage palatable for public consumption. In fact this product is called “cranberry juice cocktail” and typically has loads of calories. Although for decades women have sought to self-medicate against UTIs by drinking cranberry beverage, a landmark study has shown that it may be necessary to drink large quantities of such beverage daily for at least four to six weeks before measurable results in reduction of likely pathogens are detectable.
In the early 1990s cranberry dietary supplements were introduced, made from cranberry juice concentrate (a food product) spray-dried into a powdered form. But the cranberry in these products is greatly devitalized by the processing method of both making the juice and converting it into a powder. Various chemical flow agents have been added. The natural potency of the herb is not here. And the recommended dosage of these products tells the story—usually from three to eight or more capsules per day. These devitalized and diluted powders essentially do not contain enough cranberry actives to effectively prevent UTIs.
The need for a nutraceutical cranberry
There has been a need to create a new nutraceutical cranberry product—a dietary supplement containing the full value of the fruit in a powder form, one powerful enough to serve as a new preventive/prophylactic answer to urinary tract infection.
Ideally this would be a powerful cranberry supplement in a capsule form that (1) could be taken daily in a health maintenance regimen by women who are at risk for recurring UTIs and (2) could be recommended by doctors to their patients for prophylactic use after they had been treated with antibiotics for an existing infection. Preferably this supplement would have a dosage requirement of just one capsule a day and would be moderately-priced to enable widespread use.
Introducing the nutraceutical cranberry
Now such a true nutraceutical cranberry supplement is available. Clinically-tested and proven to be remarkably efficacious as a preventive/prophylactic against UTIs, the trade name of this product is Cran-Max. It is manufactured by Cape Cod Biolab Corporation.
Cran-Max is a differentiated product in a 500 mg capsule form specially designed for its nutraceutical role. It is much more powerful cranberry than conventional cranberry food juice and supplements. Recommended dosage is just one capsule a day.
Cran-Max is made from the complete cranberry—the fruit solids, seeds, skin and juice—and thus contains the full synergistic spectrum of the berry. In addition it has an all-natural, sustained-release delivery system called Bio-Shield which has been shown to increase the bioavailability of its cranberry actives to the targeted sites of action in the body.
Since the development of Cran-Max the product has been evaluated in a number of clinical studies in the U.S. and Europe, in both hospitals and urologic clinics.
In a recent six-month clinical trial conducted in the Czech Republic involving 49 participants (25 on Cran-Max and 24 in a control group), researchers compared the efficacy of Cran-Max as a prophylactic against a continuous low dose chemotherapeutic regimen. The results, reported recently at an international urologic congress, strongly favored Cran-Max as a preventative against UTIs. During the study period the control group collectively suffered 55 UTIs while those patients on Cran-Max had only nine recurrences. The researchers further noted that Cran-Max was far less expensive and had no side effects whereas the control group had 14 adverse events.
Similar results have been recorded in the other studies of Cran-Max performed to date. Additional clinical trials of the product are now underway or soon to start in Paris, Finland and in several cities in the U.S.
There is an ever-increasing emphasis on providing therapy for treatment of UTI that is effective, economical and is sensitive to the problem of emergence of resistant bacterial strains. This new nutraceutical cranberry product now provides women and their physicians with a helpful and effective new tool to manage recurrent urinary infections and a means to substantially reduce the amount of antibiotics used in prophylaxis against UTIs.
G. Heidi Cannon is the author of Winning The Age Game, New Beginnings: Cosmetic Surgery for Men and Women (Doubleday) and other books. She is currently president of a consulting company specializing in the natural products and optimum health industries and director of the Women’s Studies Center of Cape Cod Biolab Corporation.
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