E.coli is usually the perpetrator of urinary tract infections. Cranberry juice DOES “unstick” and “wash” them out, but it only does it in men 

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Do cranberry products REALLY protect against urinary tract infections ?

E.coli is usually the perpetrator of urinary tract infections. Cranberry juice DOES “unstick” and “wash” them out, but it only does it in men

Cranberries have been considered GOOD MEDICINE for centuries.  And today, they are widely touted as natural solution to prevent/manage urinary tract infections.

So do they work ?

The answer it depends.

UTI a big problem  – especially for women

Urinary tract infections are a common somewhat unpleasant health problem that afflicts thousands.  Thanks to hormones and anatomy, women are more likely to suffer from the affliction.  It’s the  significantly shorter urethra, that makes women more vulnerable because it’s easier for nasty visitors to reach the sacred parts and set up shop, when they don’t have far to go.

But it does take a rather special bacteria to do this….

The superpower of uropathogenic E.coli

The bacteria must be able to hold on when the bladder is voided.  For the record, the forces generated by the bladder when you pee are the equivalent of a flash flood,  so if you’re not holding on tight,  you’re gone.

Few bacteria have this superpower.

But some E.coli do.  The rather special clan of E.coli are referred to as uropathogenic E.coli.  The reason they can do this is they have  thin hair-like appendages called fimbrae.

Fimbriae are like climbing cams.

Holding on TIGHT

The bacteria deploy them and this allows them to attach to the uroepithelial cells and hang on for dear life.

Just like climbing cams come in different shapes, so do fimbriae.  Scientists have identified type 1, P and S versions.  These fimbriae slot into sugar grooves on the membrane and when they do, the bacteria are able to latch on and ride out the swoosh.

Setting up base camp

It only takes one or two bacteria to STAY PUT.  Deploying fimbrae makes this a reality.  And  one bacteria quickly becomes a gazillions – they can split into two, every 20 minutes or so.    The survivors start a “little” family-cum-colony often forming a biofilm which quite literally creates the situation that the urine flow is like water off a ducks back.

The trouble is, the family expands and migrates onward and upward.

The ascent

When a critical mass is reached you experience difficulties.  You must go OR ELSE,  the going is often a let down, instead of a torrent it’s a trickle.   A burny smelly PAINFUL trickle !

Bringing bacteria back down to earth

Now antibiotics CAN stop the problem.

But getting high levels of antibiotics to the site of the problem can be a challenge because by the time they get to the nether regions, they have lost their sting, so only select antibiotics work against urinary tract infections.

And of course one of the big draw backs of using  antibiotics is they kill  all bacteria : good, bad and in different.  Unfortunately trouble makers are far more likely to bounce back and cause ISSUES.

Cranberries a gentle alternative

And this is where cranberries come in, they’re touted as a natural alternative to a course of antibiotics. And as I said earlier there is science to suggest cranberries do help.

SOMETIMES.   And this is the problem.

The data is all over the place, the benefits are small and it is not really clear when it helps and when it doesn’t.

The science behind cranberry exterminations

Now the first real science proving the efficacy, came from a study done in 2010.  The study was down in a dish and  showed compounds in cranberry juice  interfered with the ability of bacteria to grip onto uro-epithelial in a dose dependent way. The compound was identified as proanthrocyanidin-A, the polyphenol that dominates in this special little berry.

But later research would discredit this idea.  Since the enterocytes, these are the cells lining the gut, aren’t very good at taking up proanthrocyanidins.  This means they NEVER reach the bladder in high enough concentrations to do ANYTHING.  Oops.

More science PLEASE !

A group of Germany researchers took up the challenge of figuring out the cranberry story.  They did things a little bit differently.  Instead of adding cranberry “juice” to bacteria in a dish, they added cranberry “juice” to healthy volunteers :  8 males and 8 females.

The volunteers consumed 900 mg/day of a pharmacological grade cranberry extract for 7 days.  Along the way, urine was collected and this was squirted onto bacteria tethered to uroepithelial cells in a petri dish.

It did disrupt the attachment…………SOMETIMES.

Pee POWER

Graph showing difference in adhesion levels following treatment with urine from men and women. © Georg Thieme Verlag KG Stuttgart

The anti-adhesion effect was consistently seen in men. But it wasn’t seen in ladies.  In fact, for the most part………. adhesion improved in ladies.  Eish !  Clearly this is not a GOOD THING, especially in light of the fact, women are the ones who are most likely to suffer from urinary tract infections and supplement with a cranberry extract.

Now the gender difference raised a few eyebrows…..

After all Cranberry extract is cranberry extract.

Beyond cranberry power

So out team decided to try to figure out what was different between the guys and girls urine.  Protein analysis of the urine samples identified that the urine that stopped the bacteria sticking had increased amounts of Tamm-Horsfall protein.

Graph showing the difference in THP / uromodulin levels in men and women taking cranberry extract. The white boxes are levels seen in mixed urine, the grey boxes are the levels in men and the black boxes the levels seen in women.  © Georg Thieme Verlag KG Stuttgart

The levels are THP are typically higher in women than men.   The level of THP  correlated with the inhibition of adhesion seen in the dish. In the case of males, the levels increased following cranberry consumption, in females the levels decreased.

So what is Tamm-Horsfall protein  ? 

THP (also known as uromodulin) is a home made protein produced by renal tubular cells in the loop of Henle.  It’s been linked to water/electrolyte balance and to kidney innate immunity.  BINGO !

Structurally it is covered in lots of mannose sugars and these mannose sugars bind to type 1 fimbriated uropathogenic E.coli.

Basically it is acting as decoy.

Instead of latching onto uroplakin on surface of uroepithelial cells, the bacteria latch onto THP and  swished out along with THP.

NOTE :  Taking a mannose supplement will work the same way.  If you have a urinary tract infection taking a mannose supplement for a couple of days can be helpful.   Click here to learn more about mannose in insulin resistance.

Something in the cranberry extract stimulates THP production (in males).

What’s with the female discrimination ?

There is evidence to suggest  THP production is impacted by estrogen, the details are still a bit fuzzy, but this offers a possible explanation for the gender difference.  Hopefully future studies will explore whether THE TIME OF THE MONTH determines how well cranberry extract  works…….

But overall, although the idea of cranberry extract as a natural alternative to antibiotics for UTI prevention is appealing,  the existing evidence suggests that its benefit is limited, especially in women.

So should you take it ?

Based on the current evidence,  a lot of the time, that cranberry extract is just expensive urine.

Having said that………… it is clear, that warding off this unwanted scourge starts with creating BETTER BODY CHEMISTRY.   Factors that you can leverage are urine pH, sugar levels and THP.  Visit the Urine page to catch up on all things urinary tract related.

Further reading

 
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