UTI Support

Dear Friends

Urinary Tract Infections (UTIs) are the most common non-intestinal infection worldwide (August, 2012). It is estimated that 60% of women have had at least one UTI, 30% have recurrent UTIs.

Recurrent infections occur in 35 to 53% of women that are treated for UTI within 12 months with conventional antibiotic treatments and incur a cost of approximately 2.47 billion dollars in 2000 for women in the United States (Kranjčec, 2014).

Conventional therapy to prevent recurrent UTIs are long-term antibiotic prophylaxis or postcoital antibiotics, which present with a high reoccurrence rate, lead to antibiotic resistance, increase the risk of candida and dysbiosis and disrupt the microbiome of women with potential deleterious side effects.

A Therapeutic Food protocol for UTI:

• Cranberry Pomegranate Synbiotic– 2-3 capsules BID to TID, preventatively.
• Garlic, organic– 1-2 capsules BID to TID.

For bowel regularity, choice of:

• Beta Glucan High Potency Synbiotic– tsp. at night before bed in water.
• Be Regular– 1-2 tbs as needed for regularity.

For liver and antioxidant support:

• Phyto Power– 1-2 capsules BID to TID.

Food Science

Cranberry juice and cranberry extracts were traditionally used for the prevention and treatment of UTIs in early Native American medicine.  A review of the literature on cranberry extract, probiotics, and D-mannose all have clinical evidence to support their use in the prevention of UTIs and are found synergistically in Cranberry Pomegranate Synbiotic to prevent UTIs without contributing to the dybiosis and antibiotic resistance produced by standard antibiotic therapy.

• Cranberry (Vaccinium macrocarpon, Ericaceae), cranberry extracts and proanthocyanidins, and the sugar found in high concentrations in cranberries, D-mannose, inhibit the adherence of E. coli, the bacteria that is most commonly found to contribute to UTIs, to the urinary tract wall. The condensed tannins also prevent uropathogenic phenotypes of P-fimbriated (mannose-resistant) E. coli from adhering to the urinary tract according to its German Commission E monograph, a peer-reviewed monograph used for therapeutic application of natural medicines in Europe.
• Cranberry juice has been shown to have antibacterial effects against Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis. A survey of 400 Norwegian women by Nordeng (2004) found that cranberry was the most commonly used herb during pregnancy with no adverse effects with regular consumption.
• A review by Oppel (2008) concluded that cranberry is effective in preventing UTIs in pregnant and breastfeeding women, except for those at risk of developing kidney stones because of its high oxalate content.
• A study by Kontiokari T, et al. (2001) reviewed research that found cranberry extract 500 mg twice daily of cranberry extract containing 9 mg proanthocyanidins reduced the odds of bacteriuria and pyuria by 42% compared to placebo, reduced the risk of developing a UTI in high-risk patients compared to placebo (62.8% vs 84.8%) when taking 300-600 mL or more of cranberry juice.
• In Kontiokari T, et al. (2001) randomized clinical study 150 women were randomly assigned to receive 50 mL of cranberry-lingonberry juice daily, and found the number of patients who had recurrent infections was significantly lower in the cranberry-lingonberry group than in the lactobacillus or control groups (12 compared to 21 and 19). The authors concluded that the cranberry-lingonberry drink was associated with a 20 percent reduction in absolute risk of UTI compared with control participants.
• A 6-month intervention trial published in Nutraceutical Business & Technology (2011) sponsored study by a cranberry extract company showed that a daily dose of 500 mg of cranberry extract in 165 women with a history of recurrent UTIs reduced the UTI recurrence by 15%.
• A randomized, placebo-controlled, double-blind study conducted in Japan by Takahashi et al. (2013) found that women that drank (125 mL) of cranberry juice before going to sleep for 24 weeks had a significant decrease in the rate of relapse of UTI ( 29.1% versus 49.2%) compared to the control group.
• A clinical trial (Beerepoot, 2011) of 221 premenopausal women showed that continuous antibiotics were more effective in preventing recurrent UTIs than 500 mg cranberry capsules taken twice daily, at the expense of emerging antibiotic resistance.
• A retrospective review of clinical studies by Miceli et; al (2014) on cranberry products strongly support their prophylactic use in young and middle-aged women.
• A randomized controlled study by Bonetta (2012) of 370 patients with prostate cancer undergoing irradiation to the pelvis found a significant reduction in UTIs (8.7%) compared with controls (24.2%) accompanied by a statistically significant reduction in urinary tract symptoms (dysuria, nocturia, urinary frequency, urgency), suggesting a generally protective effect of cranberry extract on the bladder mucosa.

D-Mannose binds to the type 1 pili of enteric bacteria blocking their adhesion to uroepithelial cells, and reduction in bacteriuria levels have been confirmed in in vivo animal model. In laboratory studies D-mannose components had prebiotic activity in promoting non-pathogen probiotics and thus may additionally contribute to the prevention of recurrence of UTIs by addressing the dysbiosis common in patients with recurrent UTIs and Intercystial cystitis.

• A randomized study by Kranjčec (2014) of 308 women with history of recurrent UTI and acute cystitis that took antibiotics previously were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of D-mannose powder in 200 ml of water daily for 6 months, the second (n = 103) received 50mg Nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis. 31.8 % had recurrent UTI: 15 (14.6%) in the D-mannose group, 21 (20.4%) in Nitrofurantoin group, and 62 (60.8%) in no prophylaxis group. Patients in D-mannose group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group. Patients in D-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group.

Probiotics have been shown to be clinically effective in UTI treatment and to prevent antibiotic-induced dysbiosis. 

• A randomized, controlled, clinical study of 252 postmenopausal women in the Netherlands (Beerepot, MAJ, et al. 2012) with recurrent UTIs showed oral doses of 1 billion colony-forming units of Lactobacillus species were as effective as 12 months of prophylaxis with trimethoprim- sulfamethoxazole, 480 mg without leading to antibiotic resistance associated with antibiotic use.
• Another study by Reid, Hammond, and Bruce (2003) showed that taking probiotics at 10 billion of L rhamnosus and L Fermentum RC14 from the day starting antibiotics and for 21 days subsequently significantly reduced the risk of developing bacterial vaginosis.
• Lactobacillus species were shown to inhibit candida albicans and Gardneralla vaginalis species in vitro.
• Other studies that have shown small benefit with using L. thermophilus and L Bulgaricus, and L. GG (which is a rhamnosus sp.) to prevent BV nor vaginal candidiasis.
• A clinical study of 100 premenopausal women with a history of at least one UTI by Stapelton (2011) found a significant reduction in the incidence of recurrent UTIs in women receiving intravaginal lactobacillus as compared to those in the placebo group.

Garlic has been researched extensively for its antibacterial properties that do not contribute to antibiotic resistance.

• Pseudomonas aeruginosa is an opportunistic pathogen that colonizes urinary catheters, forms biofilms, and is responsible for causing persistent and recurrent nosocomial catheter-associated urinary tract infections (UTIs) with increased morbidity and mortality in immunocompromised patients. Antimicrobial resistance to P. aeruginosa is common. In a mouse model of UTIs by Harjai (2010) oral treatment with garlic significantly lowered renal bacterial counts and protected mouse kidney from tissue destruction. In vitro data showed decreased elaboration of virulence factors and reduced production of quorum-sensing signals by P. aeruginosa in the presence of fresh garlic extract.
• Recurrent UTIs with a positive E. coli culture, not improving with antibiotics are common due to the development of antibiotic resistance. Monsour et. al (2014) found that an alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets showed a significant health improvement and symptoms relief without recurrence for more than 12 months.

Be Regular– A contributing factor to UTIs is constipation and dysbiosis of the colonic bacteria.  Including prebiotic and fiber found in Be Regular helps to prevent recurrent UTI infections by promoting non-pathogenic commensal probiotics and the elimination of pathogenic bacteria from the stool.

Phyto Power is included in the protocol because it is high in phytonutrients that aid in elimination of toxins that contribute to dysbiois and rose hips that are high in Vitamin C to protect against oxidative damage as part of the metabolic pathways.

Bibliography:

• August, S. L., & De Rosa, M. J. (2012). Evaluation of the Prevalence of Urinary Tract Infection in Rural Panamanian Women. PLoS ONE</a>; 7(10), e47752.
• Beachey EH. (1981). Bacterial adherence: adhesion-receptor interactions mediating the attachment of bacteria to mucosal surface. J Infect Dis;143:325-345.
• Beerepoot MA, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM et al. (2011). Cranberries vs. antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med; 171(14): 1270–1278.
• Beerepoot et al. (2012). Lactobacilli vs. Antibiotics to Prevent Urinary Tract Infections: A Randomized, Double-blind, Noninferiority Trial in Postmenopausal Women. Arch Intern Med; 172(9):704-712.
• Blumenthal et al. (1998). The Complete German Commission E Monographs Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; Boston: Integrative Medicine Communications.
• Bonetta A, Di Pierro, F. (2012).  Enteric-coated, highly standardized cranberry extract reduces risk of UTIs and urinary symptoms during radiotherapy for prostate carcinoma.  Dove Medical Press; 4: 281-286.
• Dugoua et al. (2008). Safety and efficacy of cranberry (Vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol; 15( 1): e80-e86. Epub Jan 18, 2008.
• Harjai, K., Kumar, R. and Singh, S. (2010), Garlic blocks quorum sensing and attenuates the virulence of Pseudomonas aeruginosa. FEMS Immunology & Medical Microbiology, 58: 161–168. doi: 10.1111/j.1574-695X.2009.00614.x
• Kontiokari T, et al. (2001). Randomised trial of cranberry-lingon-berry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ; 322: 1571–3.
• Kranjčec, B, Papeš, D, Altarac, S. (2014). D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World Journal of Urology, 32(1):79-84.
• Lloyd, Ian,B.Sc(Pharm), C.H. (2014). Cranberry and prevention of UTIs. Pharmacy Practice; 1(10): 95. Retrieved from http://search.proquest.com/docview/1623072718?accountid=26484
• Mansour et al. (2014). Efficient and Cost-Effective Alternative Treatment for Recurrent Urinary Tract Infections and Interstitial Cystitis in Women: A Two-Case Report. Case Reports in Medicine ; Article ID 698758 : 4 pages. doi:10.1155/2014/698758.
• Micali et al. (2014).  Cranberry and recurrent cystitis: more than marketing? Crit Rev Food Sci Nutr; 54(8): 1063–1075.
• Nordeng H, Havnen GC. (2004). Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf; 13(6): 371-380.
• Oppel, M. (2008). Cranberry Effective in Treating UTIs during Pregnancy and Lactation. Herbalgram; (80): 31.
• Reid, G., Hammond, JA, Bruce, AW. (2003). Effect of Lactobacilli Oral Supplement on the Vaginal Microflora of Antibiotic Treated Patients: Randomized Placebo-controlled Study. Nutraceutials and Food; 8: 1-4.
• Shalev E, Battino S, Weiner E, et al. (1996). Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent Candidal vaginitis and bacterial vaginosis. Arch Fam Med; 5: 593–6.
• Stapleton AE, Dziura J, Hooton TM, Cox ME, Yarova-Yarovaya Y, Chen S et al (2012). Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a random- ized controlled trial. Mayo Clin Proc; 87(2):143–150 .
• Takahashi , S, Hamasuna, R., Yasuda, M, Arakawa, S., Tanaka, S, Ishikawa, S, Kiyota, H, Hayami, H, Yamamoto, S. (2013).  A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. Journal of Infection and Chemotherapy; 19 (1): 112-117.
• Terris MK, Issa MM, Tacker JR. (2001). Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology; 57(1): 26-29.
• Whole cranberry powder prevents recurrent UTIs women. (2011). Nutraceutical Business & Technology, 7(5), 10. Retrieved from http://search.proquest.com/docview/928970880?accountid=26484)

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