5. CONTENTS
Chapter One: Bladder Basics.................................................4
Chapter Two: Urinary Tract Infections..............................6
Chapter Three: Diagnosis And Medical Treatment....10
Chapter Four: Lifestyle Approaches for
Urinary Tract Health............................................................... 14
Chapter Five: Supplements for
Urinary Tract Health................................................................17
Resources....................................................................................... 30
Selected References....................................................................31
URINARYTRACT
INFECTIONS
6. 4 U T I
Chapter One
Bladder Basics
I
nfections of the urinary tract are the second most common type
of infection in the body, after respiratory tract infections. Accord-
ing to the most recent National Health and Nutrition Examina-
tion Survey (NHANES), 34 percent of adults over 20 report having
had at least one occurrence of a urinary tract infection. These infec-
tions are painful and can pose serious health issues if left untreated or
treated ineffectively.
For some people, urinary tract infections (UTIs) can be a recurring
problem. Nearly 20 percent of women who have a UTI will have another,
and 30 percent of those will have yet another. Of the last group, 80 per-
cent will have recurrences. In the United States alone, 9.6 million doc-
tor visits are attributed to UTIs each year, costing Americans more than
$1 billion annually.
To properly protect the urinary tract from infection, it is important to
understand the basics of bladder function. The urinary tract, which con-
sists of the kidneys, ureters, bladder, and urethra, is responsible for filter-
ing and removing liquid waste products from the body.
The kidneys are a pair of purplish-brown organs that lie on either side
of the spine at about waist level. These organs perform several vital func-
tions. They remove excess liquid and wastes from the blood (the result
is urine), they keep a stable balance of salts and other substances in the
blood, and they produce a hormone that aids in the formation of red
blood cells.
Long, narrow tubes called ureters carry urine from the kidneys to the
bladder. The bladder is a small sack-like organ in the lower abdomen that
collects and stores the urine. When urine reaches a certain level in the
bladder, the muscles lining the bladder contract to expel it. Urine is emp-
tied out of the body through the urethra—a small tube that connects the
bladder to the outside of the body. A muscle called the urinary sphincter,
located at the junction of the bladder and the urethra, must relax at the
same time the bladder contracts to expel urine.
The average adult passes about a quart and a half of urine each day—
or more or less, depending on fluid and food consumption. The volume
formed at night is about half that formed in the daytime.
7. U T I 5
adrenal gland
aorta
iliac artery
kidney
ureter
urinary bladder
urethra
The urinary system was created in a way that naturally helps ward off
infection. The ureters and bladder normally prevent urine from backing
up toward the kidneys, and the flow of urine from the bladder helps wash
bacteria out of the body. In men, the prostate gland produces secretions
that slow bacterial growth. In both men and women, the immune system
also fights off infection. However despite these innate safeguards, infec-
tions still occur.
In this booklet you will learn about bladder health and the risk fac-
tors, symptoms, and management of urinary tract infections. We’ll also
discuss and how to prevent UTIs with lifestyle strategies, nutritional sup-
port, and supplements.
8. 6 U T I
Chapter Two
Urinary Tract
Infections
A
urinary tract infection is a bacterial infection that affects any part
of the urinary tract. Urine contains a variety of fluids, salts, and
waste products, but it is normally sterile (free of bacteria, viruses,
and fungi). An infection can develop when organisms, typically bacteria,
enter the urethra and travel into the bladder or kidneys. These organisms
can multiply in the urinary tract and cause an infection.
An infection that is limited to the urethra is called urethritis. The
most common type of UTI is an infection of the bladder, also called
cystitis. These infections are rarely serious and easily treated. If a blad-
der infection is not treated, bacteria can travel higher up into the ureters
and infect the kidneys. Infection of the kidneys, known medically as
pyelonephritis, is much more serious. As a rule, the farther up in the
urinary tract the infection is located, the more serious it is. UTIs are
much more common in adults than in children, but about 1 to 2 per-
cent of children do get these infections, and they are more likely to be
serious in children.
More than 90 percent of UTIs are caused by the bacteria Escherichia coli
(E. coli), which is present in the colon and anal area. These bacteria can
move from the area around the anus to the opening of the urethra, par-
ticularly during sexual intercourse and with improper wiping techniques
after using the toilet (wiping from back to front).
Normally, urination flushes the bacteria out of the urethra. However if
there are too many bacteria or if a person does not urinate regularly, the
bacteria can travel up the urethra to the bladder. When E. coli bacteria get
into the urinary tract, they attach themselves with tiny hairs (pili) to the
mucous lining of the urethra and bladder. Securely anchored in place, the
bacteria are able to multiply and establish an infection.
UTIs can also be caused by infection with Chlamydia and Mycoplasma.
These organisms affect both men and women, and they tend to be spread
through sexual activity. These types of infections require treatment of
both partners.
9. U T I 7
Symptoms
The most common initial symptom of a UTI is a strong and frequent
urge to urinate. There is often pain and burning upon urination. Very
little urine is released at a time, and the urine that is released may be
cloudy (from pus) or tinged with blood. The urine may also have a stron-
ger smell. The urge to urinate recurs quickly and discomfort may occur in
the lower abdomen or back. Not everyone with a UTI will experience all
these symptoms, but most people will have at least some of them.
Symptoms are often mild to start and become increasingly uncomfort-
able as time goes on. Some people feel a continuous need to urinate and
are unable to sleep at night. Most people urinate about six times a day,
so when the urge happens more frequently or is accompanied by pain or
burning, a UTI should be suspected.
If a UTI infection goes untreated it can spread up from the bladder into
the kidneys. Symptoms of a kidney infection include lower back pain,
chills, fever, nausea, and vomiting, along with the previously discussed
symptoms of a lower urinary tract infection.
UTIs are not an exclusively
female burden, yet women
constitute the overwhelming
majority of those affected.
Detecting a UTI in children can be challenging because they may not
have the classic symptoms, and they are unable to express what they are
feeling. Possible signs of a UTI in a child are unexplained irritability, a
change in appetite, vomiting, diarrhea, a change in urinary pattern, incon-
tinence, or loose stools. Infants and children are also more likely to have
fever with a UTI.
Symptoms of infection in elderly people may include fever or hypo-
thermia, loss of appetite, fatigue, confusion, and change in mental status.
Prompt diagnosis and treatment of a UTI is critical to prevent the prob-
lem from spreading and causing serious damage to the urinary tract. If a
kidney infection goes untreated it can lead to kidney damage and kidney
failure, which can be life-threatening.
10. 8 U T I
Risk Factors
UTIs are not an exclusively female burden, yet women constitute the
overwhelming majority of those affected. There are several reasons why
women are more likely to develop UTIs. Since a woman’s urethra is much
shorter than that of a man and is located closer to the rectal area, it is
easier for bacteria to enter and travel up into the bladder.
Sexual intercourse is the most common cause of UTIs in women aged
20 to 40. During intercourse, bacteria can be pushed from the rectal area
toward the vagina and can then enter the urethra and ascend to the blad-
der. Women who have frequent sexual intercourse may experience blad-
der or urinary tract infections more often. Case in point: Many women
develop UTIs during or after their honeymoon—commonly referred to as
“honeymoon cystitis”. Although it is rare, some women get a urinary tract
infection every time they have sex.
Allergies can be a hidden factor in causing UTIs. For example, having a
sensitivity or allergy to the material in condoms (latex) or to the chemi-
cals in spermicides can trigger a UTI. Researchers have also found that
women whose partners use a condom with spermicidal foam also tend
to have growth of E. coli bacteria in the vagina. It is possible that the sper-
micides upset the normal flora in the vaginal area, allowing the E. coli
bacteria to flourish.
Studies have also found that women who use a diaphragm are more
prone to UTIs. This may be due to the diaphragm’s pushing against the ure-
thra and making it harder to completely empty the bladder. The urine that
stays in the bladder is more likely to collect bacteria and cause infections.
During pregnancy women are more prone to develop UTIs that affect
the kidneys. Research suggests that up to 8 percent of pregnant women
develop a urinary infection. There are a few reasons why pregnant women
are at greater risk: The growing baby can put pressure on the bladder,
preventing the bladder from completely emptying; hormonal changes
during pregnancy can also increase the likelihood of infection. Doctors
typically do routine checks on the urine of pregnant women because unde-
tected infection can increase the risk of complications and miscarriage.
Menopause also increases the likelihood of UTIs, because a decline in
estrogen levels often leads to thinning of the urinary tract, making it easier
for bacteria to break through and create an infection.
UTIs aren’t only for women; men can get them too, although they are
not as common in men as in women. In men, enlargement of the prostate
gland can put pressure on the urethra and the bladder opening. This pre-
vents complete emptying of the bladder and may result in infection.
11. U T I 9
UTIs can also be caused
by waiting too long to uri-
nate. Holding your urine can
cause the bladder (which is a
muscle) to stretch beyond its
capacity. When this happens
chronically it can weaken the
bladder muscle, prevent the
bladder from emptying com-
pletely, and increase the risk
of infection.
A suppressed immune sys-
tem can also make a person
more susceptible to UTIs.
Conditions such as diabetes,
AIDS, cancer, and stress can
weaken the immune system,
affecting its ability to fight
off infection.
Catheters, which are tubes
placed into the urethra and
bladder to drain urine, are
another common trigger for
UTIs. People who cannot void
on their own, such as those
with spinal cord injuries and
those who are unconscious,
may require a catheter to
drain the bladder. Bacteria can enter during insertion and removal of the
catheter. For this reason it is important that health care professionals take
steps to reduce the risk of contamination when handling catheters.
Children who are born with malformations of the urinary tract that
obstruct the flow of urine are at greater risk of infection. In some cases
these abnormalities can be corrected with surgery, sometimes a catheter is
used, and in other cases regular antibiotics are used to prevent infection.
Kidney stones can also obstruct the urinary tract, resulting in UTI.
Elderly individuals, both men and women, are more likely to harbor
bacteria in their genitourinary system and are more susceptible to UTIs
than younger people. In some elderly individuals, there may be bacteria
in the urine yet no other symptoms of a UTI. This is usually referred to as
asymptomatic bacteriuria and it is not necessarily treated with antibiotics.
Menopause
also increases
the likelihood
of UTIs.
12. 10 U T I
Chapter Three
Diagnosis And
Medical Treatment
I
t is very important that anyone with a suspected UTI have prompt
diagnosis and treatment to avoid complication and potential kidney
damage. In diagnosing a UTI, a doctor may perform several assess-
ments, including symptom evaluation, physical tests, urinalysis, and, in
some cases, blood tests.
Diagnosis
Many medical offices perform “dipstick” urine tests. These simple tests
only take a few minutes to provide results. The strips detect nitrite, which
is formed when bacteria change nitrate in the urine to nitrite. The test can
detect about 90 percent of UTIs when used with the first morning urine
specimen and may be useful for women who have recurrent infections.
Urine dipstick test kits are also now available without a prescription.
In some cases, a laboratory urine test may be ordered. These tests mea-
sure white blood cells, which, when elevated, are a sign of infection. They
also determine which bacteria are causing the infection and to which
antibiotics these bacteria have resistance or sensitivity. This is rarely nec-
essary with a simple infection but can be helpful in treating severe or
recurrent infections.
Laboratory test results take a few days to come back. Since prompt treat-
ment is important, health care providers often prescribe an antibiotic even
before they get the test results back. Once the results are available the pro-
vider will check to ensure the antibiotic prescribed will work against the
bacteria causing the infection. Blood tests are rarely required except when
complicated conditions like pyelonephritis or kidney failure are suspected.
Certain individuals, such as young, sexually active women, may require
a physical examination when showing UTI symptoms, since the symptoms
are similar to those caused by pelvic infections. In men, a rectal examina-
tion is done to check the prostate for enlargement, which is a risk fac-
tor for UTI. Prostate infection (prostatitis) also needs to be considered as
these infections can be serious and require longer treatment with antibiot-
ics than a UTI.
13. U T I 11
Further diagnostic tests may be necessary in cases of frequent recurrent
infections, blood in the urine, or other underlying problems. These tests
may include ultrasound, pyelogram (x-ray image of the bladder), or cys-
toscopy. In a cystoscopy, a thin, flexible tube with a camera is inserted
through the urethra into the bladder to allow the doctor to detect abnor-
malities inside the bladder.
Medical Treatment
The medical treatment for UTIs involves use of antibiotic medications.
The most commonly used antibiotics include trimethoprim with sul-
famethoxazole (Bactrim or Septra), ciprofloxacin (Cipro), norfloxacin
(Noroxin), ofloxacin (Floxin), and, less commonly, nitrofurantoin (Mac-
rodantin and Macrobid).
The choice of drug and the duration of therapy depend on the type
of bacteria causing the infection (this is identified by the urine test),
the severity of the infection (whether the kidneys are involved), and the
person’s history (previous use of antibiotics and allergies). Some cases
require seven to 10 days of antibiotics, while other infections are treated
with either a single one-time dosage or a two to three–day course of ther-
apy. The shorter treatments can be used when the infection is limited to
Certain individuals may require a
physical examination when showing UTI
symptoms, since the symptoms are similar
to those caused by pelvic infections.
14. 12 U T I
the urethra or bladder and there aren’t any complications. While these
shorter treatments are more convenient, they require a higher dosage of
antibiotic—and potentially more side effects.
Severe infection involving the kidney may require hospitalization and
treatment with higher dosage antibiotics for several weeks.
It’s important to take all antibiotics as prescribed, for the full duration
of the treatment. You may notice your symptoms disappear soon after
beginning antibiotic treatment, but that doesn’t mean you can stop taking
them. If you do, the infection may still be present and can recur. If you
have a kidney infection, it may take one week or longer for your symp-
toms to go away.
During treatment with antibiotics it is important to drink lots of water,
which helps to cleanse the urinary tract. Be sure to avoid coffee and alco-
hol, which can promote dehydration.
In addition to antibiotics, health care providers sometimes prescribe
a medication called phenazopyridine (Pyridium) to relieve the bladder
pain and discomfort. This drug is helpful, but a word of caution—it colors
your urine bright orange, so don’t be alarmed when you void. Acetamino-
phen (Tylenol) can also be used to manage pain and/or fever, and a heat-
ing pad may help with the pain.
After treatment your health care provider may order another urine test
to be sure the infection is cleared. In some cases, the infection does not
go away with the first treatment. If you are being treated for an infection
and continue to have pain with urination, your symptoms worsen, of you
develop signs of kidney infection (lower back pain, chills, and fever) seek
medical attention right away.
Pros And Cons of Antibiotics
While antibiotics are sometimes necessary, particularly for the treat-
ment of an infection, they should be used cautiously because of the vari-
ous health and societal risks associated with their use.
Antibiotics have many side effects, including nausea, diarrhea, stomach
cramps, and vomiting. In fact, diarrhea is the most common adverse effect
of antibiotic therapy, affecting up to 26 percent of people who take them,
with hospitalized patients having a higher risk. Antibiotics indiscriminately
destroy bacteria throughout the body, not just in the area where infection
is present. While destroying the bad bacteria that cause infection, they also
destroy the good or beneficial bacterial flora that line our gastrointestinal
and genitourinary tracts—one course of antibiotics can deplete your normal
flora for six months. This can lead to overgrowth of yeast and many other
15. U T I 13
unpleasant side effects. Diarrhea, while common, is not a minor concern. In
some cases it can be serious and is associated with an increase in hospital
stay, a higher risk for other infections, and a threefold increase in mortality.
Antibiotics also carry the risk of allergic reactions, ranging from hives
and skin itching to anaphylactic shock, which is life-threatening. The com-
monly used medications trimethoprim and sulfamethoxazole have a high
incidence of mild allergic reactions and rare but serious complications.
Today’s broad-spectrum antibiotics are very powerful; while they are
highly effective in eradicating the harmful bacteria, their use can lead
to other problems. The inappropriate use and overuse of antibiotics is
a major factor in the development of the bacterial resistance that has
recently gained wide attention. Bacteria are becoming less susceptible to
the common drugs we use, rendering our antibiotic arsenal less effective
at protecting us. The overuse of antibiotics is of particular concern among
the elderly, who are at greater risk of infection and are more sensitive to
antibiotic side effects like diarrhea, weight loss, and poor appetite.
For all of these reasons, the use of antibiotics should be minimized. The
first line of defense for people at risk of UTI should be preventative strate-
gies, such as the ones outlined in the coming sections of this booklet. When
antibiotics are taken for an infection, it is important to replenish the normal
gastrointestinal flora with the use of probiotics. Probiotics help to reduce
the risk of gastrointestinal side effects, strengthen the immune system, and
reduce the risk of infections. This will be discussed further in Chapter 5.
Vaccines For UTI
In the future, it is quite possible that a vaccine will be developed to help
protect people against UTI. Researchers in different studies have found
that children and women who tend to get UTIs repeatedly are likely to
lack proteins called immunoglobulins, which fight infection. Children
and women who do not get UTIs are more likely to have normal levels of
immunoglobulins in their genital and urinary tracts.
Some researchers theorize that increased urinary antibodies can prevent
bacterial adherence to the urinary tract, inhibit the activity of the bacte-
rial, and therefore decrease infection and the recurrence.
Preliminary research suggests a vaccine may help patients build up their
own natural defenses to infection. The dead bacteria in the vaccine do not
spread like an infection; instead, they prompt the body to produce antibod-
ies that can later fight against live organisms. Researchers are testing injected
and oral vaccines to see which works best. Another method being considered
for women is to apply the vaccine directly as a suppository in the vagina.
16. 14 U T I
Chapter Four
Lifestyle Approaches For
Urinary Tract Health
A
number of dietary, lifestyle, and hygiene factors can help improve
urinary tract health and reduce the risk of infection. Following are
some recommended guidelines.
Dietary Strategies
Diet can play a significant role in the health of your urinary tract.
• Drink eight or more glasses of water daily to help flush bacteria
out of your bladder. Increase fluid intake if you are exercising or
spending time in the sun. Dehydration concentrates the urine and
increases the risk of infection.
• Eat foods high in water such as watermelon and celery.
• Drink cranberry juice, which contains antioxidants called
condensed tannins or proanthocyanidins, which prevent bacteria
from adhering to the bladder walls. As you will read in the
following section, many studies have shown that cranberry can
prevent bladder infections. Pure cranberry juice is best, but it
is quite tart, so consider adding a natural sweetener such as
stevia or agave. Drink three 8-ounce (250 ml) glasses daily. Juice
cocktails are an alternative that offer better taste and tolerability,
but contain less juice and have added sugar. If you go that route,
you’ll need three 16-ounce (500 ml) glasses daily.
• Eat blueberries, which contain the same beneficial antioxidants as
cranberry.
• Add garlic to your diet. Garlic contains compounds that strengthen
the immune system response and help fight infection.
• Greens drinks, such as Kyo-Green, contain wheat and barley
grass that provide various nutrients and also help to alkalize (pH
balance) the body and support overall health.
• Avoid caffeine; it has diuretic properties, which promote fluid loss,
making urine more concentrated.
17. U T I 15
Drink eight or more glasses of
water daily to help flush bacteria
out of your bladder. Increase fluid
intake if you are exercising or
spending time in the sun.
18. 16 U T I
• Alcohol is dehydrating and reduces immune function, so it should
be avoided.
• Avoid foods made with refined sugar and flour, which may hamper
immune function.
Lifestyle Strategies
• Urinate regularly as you feel the need. Resisting the urge and holding
in urine concentrates the urine and any bacteria in the urine.
• Support immune function by exercising regularly, getting adequate
sleep, and minimizing stress.
• Quit smoking. Smoking irritates the bladder and is known to cause
bladder cancer.
Hygiene
Good personal hygiene can help to protect against UTIs. Always wipe
from front to back after a bowel movement or urination, to prevent bacte-
ria from the rectum entering the urethra. Women should wash the perineal
area (between the rectum and vagina) daily. Uncircumcised men should
pull back the foreskin and wash the area around the urethral opening.
Washing before and after sexual intercourse may help reduce a woman’s
risk of getting a UTI. It is best to wear cotton underwear, which allows the
skin to breathe; change clothing promptly after swimming.
Vaginal dryness can cause friction and irritation, which may trigger a
UTI. Using a lubricant during sexual intercourse may help. Changing sex-
ual positions may also help to reduce friction on the urethra. Feminine
hygiene sprays and scented douches should be avoided as they can irritate
the urethra. Women who get frequent UTIs may want to avoid using a
diaphragm, as they have been shown to increase UTI risk.
19. U T I 17
Chapter Five
Supplements For
Urinary Tract Health
T
he most researched and effective supplement for urinary tract
health is cranberry. As you’ll learn in this section, the beneficial
uses of cranberry extract go well beyond the urinary tract.
Cranberry
Known in the scientific world as Vaccinium macrocarpon, cranberry is by
far the most well-studied natural product for bladder health. Cranber-
ries contain a number of vitamins, minerals, fiber, and plant chemicals
that offer a range of health benefits. The main active constituents are the
flavonoids, including anthocyanins (which give cranberry its character-
istically deep red color), proanthocyanidins (an antioxidant that is the
active ingredient in fighting urinary tract infections), quercetin (an anti-
histamine with anti-inflammatory properties), and flavonols (a type of
bioflavonoid). Cranberries also contain resveratrol, another phytochemi-
cal with antioxidant power. Resveratrol, which is also present in grapes
and linked to the French Paradox, has been studied for its anticancer and
heart-protective effects.
History of Cranberry
At one time, cranberries were called cow berries, likely stemming from
the fact that the word vaccine is old Latin for “of cows.” European settlers
in North America once called the fruit the “crane berry,” possibly because
the vine blossoms resembled the bill, head, and neck of a crane, or the set-
tlers saw cranes eating the berries. Over years, the name crane berry then
evolved into cranberry.
Cranberries have been a vital part of the human diet throughout history.
In Denmark, a clay mug discovered in a Bronze-Age tomb was found to
contain the remnants of a cranberry and wheat drink, thought to be an
early Scandinavian beer. North American cranberries were introduced to
Europe as early as the mid-1500s. Cranberries are still strongly associated
with the North American Thanksgiving feast, a tradition that dates back
to the colonial days and the time of the first Thanksgiving celebrations.
North American aboriginals had been using cranberry for centuries by
20. that time. Its juice produced rich red dyes. It was dried with meat to make
pemmican, a high-energy food. Cranberry was considered a medicinal
remedy for scurvy, fevers, diarrhea, and swelling. They also used cran-
berry as a diuretic and as an astringent on wounds and abrasions, as well
as a treatment for UTIs. These early societies discovered the remarkable
health benefits of cranberry, but it would take centuries for scientists to
substantiate these effects.
Cranberry Research Timeline
Nineteenth-century German researchers recognized that cranberry con-
sumption increased the acidity of urine, and they believed this had an
antibiotic effect in the urinary tract. This was the commonly held belief
until almost a century later when researchers made some signifi-
cant and surprising discoveries.
In 1984 a study conducted by Youngstown State Univer-
sity researchers and published in the Journal of Urology
described how cranberry inhibited the adherence of
E. coli (the primary cause of urinary infections) in
the urinary tracts of mice.
In 1991 researchers at Tel Aviv University also
described anti-adherence properties of cran-
berry juice. While they did not identify the
active compounds, their findings were pub-
lished in the prestigious New England Journal
of Medicine.
Harvard Medical School
researchers conducted
the first well-controlled,
large-scale clinical trial to
demonstrate that drinking
cranberry juice
cocktail regularly
significantly
reduced the
18 U T I
21. U T I 19
presence of bacteria in the urine. This study evaluated the effects of
cranberry juice on 153 elderly women (average age of 78.5 years), who
were at increased risk of UTI. Participants were randomly assigned to
consume either 300 ml (10 oz.) of cranberry juice cocktail per day or a
placebo drink made to look and taste like cranberry juice, but without
cranberry content. The study was designed to measure whether cran-
berry juice had an effect on bacteriuria (the passage of bacteria in the
urine) or pyuria (the presence of pus, indicating white blood cells and
infection in the urine).
The researchers measured urine samples collected at one-month inter-
vals during the six-month duration of the study, looking for bacteria or
white blood cells. At the end of the study, they concluded the cranberry
juice beverage successfully reduced the frequency of both bacteriuria and
pyuria in elderly women.
The researchers found that the effect was not because of more acidic
urine (the urine of the cranberry-juice drinkers was no more acidic than
those drinking a non-cranberry placebo drink) and speculated that there
was something specific in cranberry that prevented bacteria from adhering
to the urinary tract. This study, which was published in JAMA provided the
first solid clinical evidence, in a relatively large sampling of patients, that
cranberry juice could be beneficial to the urinary tract.
A few years later, researchers at Rutgers University identified the active
compounds in cranberry responsible for this anti-adherence effect as con-
densed tannins, or proanthocyanidins (PACs). These compounds adhere
to the tiny hairs of the bacterial surface, thus preventing the bacteria from
implanting in the mucosal linings of the bladder. This research was pub-
lished in The New England Journal of Medicine, in October 1998. Another
study at Rutgers University in 1998 found that anthocyanidins in blueber-
ries worked in the same fashion to prevent UTIs.
Building on the anti-adhesion theory, in 1998 researchers at Tulane Uni-
versity School of Medicine found that cranberry juice actually changed the
shape of E. coli. Examining the effects of cranberry juice on the growth
and development of E. coli in the laboratory, the researchers found that
the hair-like structures that E. coli use to attach to cells in the bladder were
inhibited from growing in the presence of cranberry juice. This provided
the first visual observation of a change in structure of the bacteria that
would prevent them from attaching to cells in the urinary tract.
The effects of cranberry were further revealed in 2001 by research con-
ducted by Rutgers University and presented at an Experimental Biology
conference. This new research suggested that once cranberry PACs are
absorbed into the bloodstream, they become available to other sites
22. 20 U T I
throughout the body and may function as anti-adhesion agents and/or
antioxidants. For the first time, in vivo research helped confirm the role
of cranberry compounds as the active compounds responsible for anti-
adhesion of certain E. coli bacteria in the urinary tract. An animal model
was used to perform this research.
Findings published in a research letter in the June 19, 2002, edition of
JAMA reported that not only are cranberry PACs able to inhibit the adhe-
sion of antibiotic-susceptible bacteria, but resistant strains as well. The
authors also report that the anti-adhesion effect can last up to 10 hours after
consumption, suggesting that two servings of cranberry juice cocktail a day,
consumed at appropriate intervals, may be more beneficial than one.
In 2004, The Cochrane Collaboration published a research review con-
cluding that there is some evidence that cranberry juice may decrease the
number of symptomatic UTIs in women. The Cochrane Collaboration
is a non-profit organization based in the UK whose mission is to help
people make well-informed decisions about health care by developing
systematic reviews of the effects of health care interventions. The review-
ers concluded that “there is some evidence from two good quality ran-
domized controlled trials that cranberry juice may decrease the number
of symptomatic UTIs over a 12-month period in women.”
Cranberry made worldwide
headlines in April 2004 when
the French government
granted approval of cranberry
juice as an antibacterial agent
for urinary tract health.
Cranberry made worldwide headlines in April 2004 when the French
government agency AFSSA, which regulates food products in a way simi-
lar to the United States Food and Drug Administration, granted approval
of cranberry juice as an antibacterial agent for urinary tract health. Sev-
eral other countries, such Canada, are also allowing urinary tract health
claims for cranberry, based on the substantial evidence demonstrating
safety and efficacy.
23. U T I 21
In September 2006, research by scientists at Worcester Polytechnic Insti-
tute (WPI) revealed that cranberry may provide an alternative to antibiot-
ics, particularly for combating E. coli bacteria resistant to conventional
treatment. This research showed that the PACs in cranberry affect E. coli
in three devastating ways, all of which prevent the bacteria from adhering
to cells in the body, a necessary first step in all infections:
• They change the shape of the bacteria from rods to spheres.
• They alter their cell membranes.
• They make it difficult for bacteria to make contact with cells, or to
latch on to them should they get close enough.
While the majority of research on cranberry juice for urinary tract health
has yielded positive results, there have been a few studies questioning its
benefits. The amount of juice used in the studies has varied greatly and most
studies utilized cranberry juice cocktail rather than pure juice. Most juice
cocktails contain 27 to 33 percent cranberry juice; sugar (glucose-fructose)
and water make up the balance. For those watching their weight and trying
to control blood sugar, all this excess sugar presents a problem. Pure juice is
available in health food stores but it is quite expensive and very tart. For all
of these reasons, cranberry supplements offer significant advantages.
The Most Effective Cranberry Extract
The majority of the research on cranberry supplements has been con-
ducted on a product called Cran-Max. This full-spectrum supplement con-
tains all the vital parts of the cranberry—the fruit, seeds, skin, pulp, and
juice. Utilizing a special patented technology called Bio-Shield, the key
nutrients found in the berries—the anthocyanidins—are protected from
stomach acid, improving the body’s absorption.
Research on Cran-Max
Preliminary studies conducted in Prague, Czech Republic, evaluated the
benefits of Cran-Max for urinary tract health. In the first of the studies,
24 women who suffered recurring UTIs were divided into two groups.
Women in the first group received doses of antibiotics and Cran-Max once
they developed a UTI; those in the second group received antibiotics alone.
The purpose of this study was to see if Cran-Max could prevent UTIs in
women at high risk. The results were impressive. The group taking Cran-
Max had fewer UTIs than those getting the antibiotic alone and no side
effects. The second Czech study went a step further, demonstrating that,
on its own, Cran-Max significantly lowered the risk of UTIs in frequent
sufferers as well as lowering E. coli bacteria counts in those subjects.
24. 22 U T I
A 2002 study published in the Canadian Journal of Urology further sup-
ports the benefits of this concentrated cranberry supplement for urinary
health. This one-year study involved 150 women between 21 and 72 years
old who were randomly placed into one of three groups to receive either
placebo juice and placebo tablets; placebo juice and cranberry extract tab-
lets; or cranberry juice and placebo tablets.
The cranberry tablets were taken twice daily. The juice used was a pure,
unsweetened cranberry juice (not cranberry cocktail) and was given in
250 ml doses three times daily.
The conclusion of this study was that the cranberry tablets provided
the most effective and cost-effective method of preventing UTIs. Women
given the cranberry tablets had a 44 percent lower incidence of UTIs than
the placebo group. Since this study was published in a mainstream medi-
cal journal it has been instrumental in gaining the attention of medical
doctors who might not otherwise learn of the value of a natural product
such as cranberry for urinary tract health.
French researchers conducted a study to see if a single post-coital (after
intercourse) dose of Cran-Max could reduce the risk of UTI. This study
involved a group of 120 women with a history of recurrent UTI. The study
was conducted over 45 days, and women were randomized to receive Gyn-
Delta (French brand of Cran-Max), cranberry extract, or placebo. Women
were instructed to take their treatment six hours after intercourse. During
the study period, only 10.8 percent of the women in the GynDelta group
suffered from a UTI compared to 18.9 percent in the cranberry extract
group and 43.2 in the placebo group. Thus the researchers concluded that
the Cran-Max product was most effective in preventing post-coital UTI.
The most recent study on Cran-Max involved 137 women with recur-
rent UTI. The women were randomized to receive either 500 mg of
Cran-Max or 100 mg of trimethoprim (an antibiotic) for six months.
The researchers found that the time until the first recurrence of UTI was
not significantly different between the groups. The lead researcher con-
cluded: “Our trial is the first to evaluate cranberry (Cran-Max) in the
prevention of recurrent UTIs specifically in older women, and the first
head-to-head double-blind comparison of cranberry versus antibiotic
prophylaxis. Trimethoprim had a very limited advantage over cranberry
extract (Cran-Max) in the prevention of recurrent UTIs in older women
and had more adverse effects.”
This landmark study adds to the growing body of evidence on cranberry
for bladder health. More people today are interested in natural methods
for prevention of UTI and are trying to avoid antibiotic use due to con-
cerns with side effects and resistance.
25. U T I 23
Emerging Uses For Cranberry
Researchers around the world are continuing to study the properties of
cranberry, and with that exciting new uses are being discovered. Prelimi-
nary studies show that cranberry provides us with a wide range of benefits
for the health of our gums and heart, and it can possibly help prevent
ulcers and cancer and fight respiratory infections.
Oral Health
In the same way that cranberry fights bacteria in the urinary tract, it
appears to do the same in the mouth. Dental plaque, which is a major
cause of gum disease, is composed primarily of oral bacteria that attach to
the tooth and gum surfaces. These bacteria form a biofilm that is resistant
to saliva and brushing. By inhibiting this process, cranberry can play an
important role in oral health.
Researchers have found that a mouthwash containing cranberry greatly
decreased the amount of a specific bacteria (Streptococcus mutans), which
is known to cause a large percentage of cavities. In a study published in
the Journal of the American Dental Association, 60 participants were assigned
Researchers have
found that a
mouthwash containing
cranberry greatly
decreased the amount
of a specific bacteria
(Streptococcus
mutans), which is
known to cause a large
percentage of cavities.
26. 24 U T I
to either a placebo or experimental group and asked to use a mouthwash
twice daily for 42 days. Researchers measured total salivary bacteria at
baseline and compared this to the level on day 42 of the study. Those
using the cranberry-containing mouthwash had a significant reduction in
bacteria compared with the placebo group. Adhesion to the tooth surface
was also reduced. Two other recent studies have corroborated the benefits
of cranberry for oral health.
Heart Health
Flavonoids are potent antioxidants that may help to reduce the risk of
atherosclerosis. Atherosclerosis occurs when LDL cholesterol accumulates
and hardens (oxidizes) in the arteries, restricting blood flow and increas-
ing the risk of heart attack or stroke.
Cranberries contain significant amounts of flavonoids and polyphenolic
compounds that have been shown to offer heart health benefits. Prelimi-
nary studies conducted at Laval University and Scranton University have
found that cranberry can inhibit LDL oxidation and raise HDL (good)
cholesterol levels. Ongoing research continues to suggest that cranberries
may offer a natural defense against atherosclerosis and heart disease.
Ulcers
Though peptic ulcers were long attributed to stress and high stomach
acidity, more recently it has been proven that the bacteria Helicobacter
pylori is the real culprit. It is estimated that approximately 50 percent of
persons above the age of 60 are infected with H. pylori, and 25 million
Americans will suffer from peptic ulcers at some point in their life.
That same cranberry-derived substance that inhibits UTIs and gum disease
has also been studied for its possible prevention of peptic ulcers. In a pre-
liminary laboratory test, cranberry juice was found to inhibit the adhesion
of H. pylori to stomach cells. This suggests that cranberry may be beneficial
in the prevention of peptic ulcers. While this is very exciting, further research
is needed to explore the value of cranberry in protecting against ulcers.
Cancer
Several clinical studies have investigated the anticancer properties of cran-
berry on various cancer cells including breast, colon, prostate, and ovarian.
In these studies the phytochemicals in cranberry were shown to inhibit the
proliferation and spread of cancer cells. These effects have been attributed
to the phenols, flavonoids, and anthocyanins present in cranberry.
Researchers at Cornell University tested the effect of cranberry on human
breast cancer cell proliferation. In small doses administered over four
27. U T I 25
hours, some of the cancer cells began to die. When the dose of cranberry
extract was increased for the same number of cancer cells, 25 percent more
of those cells died. The researchers kept increasing the extract dose, and
also the time that the cells were marinating in the extract. Larger doses
and more time resulted in greater numbers of cancer cells dying at a fairly
early stage in the natural life cycle of the cell. Since there are many different
types of breast cancer, it’s unclear whether cranberry extracts would affect
any case of breast cancer as effectively as these did in the lab studies.
Cranberry can inhibit LDL
oxidation and raise
HDL (good) cholesterol levels.
Otherresearchhasfoundthatcompoundsincranberriesmayhelpimprove
the effectiveness of drugs that are used in chemotherapy to fight ovarian can-
cer. In a cell culture (laboratory) study, scientists demonstrated that human
ovarian cancer cells resistant to platinum drugs, such as cisplatin, became up
to six times more sensitized to the drugs after exposure to cranberry com-
pounds in comparison to cells that were not exposed to the compounds.
Although preliminary, the findings are encouraging, because they suggest
that cranberry can reduce the harmful side effects associated with using high
doses of platinum drugs for the treatment of ovarian cancer.
Fighting Infection
A study conducted at the University of Michigan indicates that cran-
berry juice may help fight respiratory and middle ear infections in chil-
dren. The study, conducted in laboratory conditions, found that cranberry
juice inhibits the growth of some types of Haemophilus influenzae bac-
teria. This strain of bacteria, commonly found in the noses and throats
of healthy adults and children, is the primary cause of respiratory and
middle ear infections.
Cranberry proanthocyanidins may affect H. influenzae in the same way
they affect E. coli in the urinary tract, preventing the pili (small hairs on
the bacteria, used to anchor to other cell walls) from adhering to other
cells and developing into an infection. While this is a promising new use
for cranberry, researchers caution that these findings are preliminary and
need to be confirmed in human clinical trials.
28. 26 U T I
Several new studies are underway evaluating the therapeutic effects
of cranberry. The National Institutes of Health is funding research on
cranberry’s effects on treating urinary tract infections, heart disease, yeast
infections, and gum disease. Other researchers are investigating its poten-
tial against cancer, stroke, and viral infections. With mounting research
published in mainstream medical journals, cranberry is now getting the
attention it deserves.
Supplementing With Cranberry
The recommended dosage for Cran-Max is 500 mg daily for prevention
of UTI. Some preliminary reports suggest that Cran-Max, at a dosage of
500 mg twice daily, can be helpful for acute treatment if taken at the first
onset of symptoms. Studies involving Cran-Max have found it to be gener-
ally well tolerated with no significant adverse effects.
The dosage of cranberry juice has varied in the research. The most sig-
nificant study on cranberry juice utilized a dosage of 250 ml of pure juice
three times daily. Those with diabetes or insulin resistance should limit
their intake of juice cocktail as it contains a significant amount of sugar.
Cranberry juice, consumed in amounts found in foods, is thought to be
safe in pregnancy and breastfeeding. There is no evidence of harm to the
mother or baby as a result of consuming cranberry.
Some controversy exists as to whether cranberry can enhance the blood-
thinning effect of blood thinner drugs such as warfarin. There have been
a few case reports of people experiencing a change in INR (international
normalized ratio—a measure of blood coagulation) while drinking cran-
berry juice along with warfarin. It is uncertain whether this was coinci-
dental or a result of a drug interaction. A recent study conducted at the
University of Sydney and published in the British Journal of Pharmacol-
ogy found that cranberry juice could significantly increase the effects of
warfarin. Until more is known, cranberry should be used cautiously in
those taking anticoagulants such as warfarin.
Probiotics
Another important supplement for overall health and optimal urinary
tract health is probiotics. Probiotics is a term used to describe “friendly” or
beneficial bacteria that are normal inhabitants of our gastrointestinal and
urinary tract. These bacteria are also referred to as our normal flora. Although
it is hard to imagine, there are literally billions of bacteria that normally live
in our bodies. These bacteria provide many health benefits by protecting
against infection, aiding detoxification, producing vitamins, aiding diges-
tion, supporting immune function, and improving cholesterol levels.
29. U T I 27
Many different strains or types of probiotics exist in nature. Lactobacil-
lus acidophilus is the strain used to make yogurt and cheese and is also
found in supplements. Acidophilus and the well researched L. gasseri are
prevalent in the intestines and the vaginal area, where they help prevent
infections. Other common strains found in humans include L. bulgaricus,
L. reuteri, L. plantarum, L. casei, B. bifidum, B. longum, S. salivarius, and S.
thermophilus, and the yeast Saccharomyces boulardii.
A number of factors, including stress, travel, poor diet, and infection,
can upset the balance of normal flora. One of the most significant insults
to our normal flora is the use of antibiotic medications. As discussed ear-
lier, antibiotics indiscriminately destroy both the bad and good bacteria.
An upset of normal flora balance can lead to vaginal and yeast infections,
along with unpleasant conditions such as diarrhea. For these reasons, it is
wise for anyone taking an antibiotic to replenish the normal flora with a
probiotic during and after antibiotic use.
The concept of taking microorganisms to improve health has been
around for decades. Yogurt has long been thought to have health benefits.
As early as 1908, Metchnikoff, a Nobel laureate, put a scientific spin on
the ingestion of microbes in stating that “ingested lactobacilli can dis-
place toxin-producing bacteria, promoting health and prolonging life.”
Many scientific studies have shown that probiotics can be useful for a
variety of health conditions, including preventing and treating traveler’s
diarrhea and yeast infections, enhancing immune function, and promot-
ing urinary tract health.
Probiotics And UTI
The wide availability and use of antibiotics has limited the attention
paid to probiotics for UTIs. Yet, some preliminary evidence and a solid
rationale warrant the use of probiotics to support urinary tract health.
Most urinary-tract pathogens (E. coli) originate in the intestines. Increas-
ing probiotic counts in the intestinal tract, through oral supplements,
may help protect against transfer of pathogenic bacteria to the vaginal
and urethral area. Probiotics help fight infection by producing substances
such as lactic acid, bacteriocins, and hydrogen peroxide that suppress the
growth of harmful bacteria and by boosting immune function. Lactoba-
cilli have been shown to produce compounds such as biosurfactants and
collagen-binding proteins that inhibit pathogen adhesion and, to some
extent, displace pathogens from the uro-vaginal area.
Some studies have looked at intravaginal use of probiotics for treating
UTI. The close proximity of the urethra to the vagina allows potential
30. 28 U T I
probiotic transfer from vaginal application. In these studies, intravagi-
nal insertion of various lactobacillus strains was found to reduce the fre-
quency of recurrence of UTIs in those at high risk.
Probiotics may be particularly helpful in preventing recurrent and
chronic UTIs and potentially decreasing the risk of antimicrobial resis-
tance. While more work is needed to determine the efficacy of probiot-
ics for UTIs, evidence supporting their value for helping to restore and
maintain urogenital health is building, and they do offer a range of other
health benefits.
Guidelines For Using Probiotics
Probiotics can be obtained by consuming cultured dairy products (such
as yogurt) or probiotic supplements. Probiotic yogurts are gaining a lot of
attention for their beneficial effects on gastrointestinal health. While they
do offer some benefits, they typically contain fewer active cultures than
do supplements. Another advantage of supplements is that they typically
contain human strains of probiotics, while yogurt contains dairy strains.
Additionally, supplements are recommended for those who want consis-
tent benefits with probiotics.
Many brands of probiotic supplements are on the market, so here are a
few features to look for when choosing a product:
• Human origin for optimal implantation in the
gastrointestinal tract.
• Dairy free (some people are sensitive to lactose).
• Acid resistant (so that it can survive stomach).
• Potency greater than 1 billion cfu/gram.
• Packaged in glass bottles (to preserve the active cultures).
• Guaranteed stability at room temperature (products that
require refrigeration are not only inconvenient but they have
questionable stability).
Avoid products that say “providing xx cells at time of manufacture,”
because there could be several months between manufacture and pur-
chase; this disclaimer means that the company does not guarantee potency
of their product.
One brand I recommend that meets the above criteria is Kyo-Dophilus
by Wakunaga of America. Wakunaga probiotics are manufactured with
the highest quality and with guaranteed stability. They offer a variety of
formulas and are available in powder, chewable tablets, and capsules.
31. U T I 29
Wakunaga offers a unique formula called Kyo-Dophilus plus Cran-
berry Extract that combines Cran-Max with Kyo-Dophilus probiotics
(Lactobacillus and Bifidobacteria). These ingredients have been clinically
studied and found to be beneficial for the urinary tract, intestinal func-
tion, and many other aspects of health. Taken regularly, this product can
help reduce the risk of bladder and yeast problems, as well as support
healthy intestinal function and overall immune health.
Probiotics Dosage Guidelines
The usual adult dosage is one-half to one billion live cells daily with
meals. Since the stomach is more acidic when it is empty (pH of 1 to 2)
it is best to take your probiotics after meals (food dilutes stomach acid
and raises the pH). This can help enhance the survival and growth of
the bacteria.
Probiotics are generally well tolerated. Some people experience a tem-
porary increase in intestinal gas, which often goes away with time. When
taking probiotics along with antibiotics, separate them by two to three
hours to prevent the probiotics from being destroyed. There is some evi-
dence that probiotics can be damaged by alcohol and should not be taken
at the same time.
Many health care professionals feel that probiotics should be taken
regularly by all individuals to optimize health and compensate for issues
of modern living that deplete our normal flora (such as consumption of
foods high in preservatives, increased antibiotic use, and stress).
Summary
Urinary tract infections are common. They can be painful and uncom-
fortable and can cause serious health problems. As you have read in this
booklet, there are many factors that can affect the health of the urinary
tract. Following a healthful lifestyle and taking supportive supplements
can go a long way in reducing your risk of unpleasant UTIs. The significant
overuse of antibiotics is a major health concern today because it leads to
both side effects and antimicrobial resistance. Thus, products and mea-
sures to help prevent and treat infectious diseases in a safe and effective
manner are highly desirable. Mounting scientific research is substantiat-
ing the benefits of natural substances such as cranberry and probiotics
for the prevention of urinary tract infections and to optimize treatment
and overall health. Because these natural substances have such broad and
important health benefits, I often recommend them as a part of an overall
health promotion plan.
32. 30 U T I
Resources
American Urological Association
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 866-746-4282
Fax: 410-689-3800
Internet: www.urologyhealth.org
National Kidney and Urologic Diseases Information Clearinghouse
(NKUDIC)
3 Information Way
Bethesda, MD 20892-3580
Phone: 800-891-5390
Fax: 703-738-4929
www.kidney.niddk.nih.gov
The Cranberry Institute
http://www.cranberryinstitute.org/
The National Women’s Health Information Center
U. S. Department of Health and Human Services
Office on Women’s Health
www.womenshealth.gov
For information on Cran-Max, visit:
www.cranmax.com
For information on Kyo-Dophilus, Kyo-Dophilus plus Cranberry
Extract, and other Wakunaga products, visit:
www.kyolic.com
For information on cranberry juice, visit:
www.oceanspray.com
For more information about the author of this booklet, visit:
www.sherrytorkos.com
33. U T I 31
Selected References
Avorn J, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA;
271: 751–754, 1994.
Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections
in women: A review. Clin Ther; 30:453–468, 2008.
Bauer HW, et al. A long-term, multicenter, double-blind study of an Escherichia coli extract
(OM-89) in female patients with recurrent urinary tract infections. Eur Urol; 47:542–548,
2005.
Birkbeck, J., Nutrition news. Cranberry juice and middle ear infections. 15 April 2003
http://www.everybodv.co.nz/nutiitioti/22NovO2-cranberry.htm.
Bohbot JM. Results of a randomized, double-blind study on the prevention of recurrent
cystitis with GynDelta®. The Gynaecologist’s and Obstetrician’s Journal, January, 2007.
Bruce AW, Reid G. Intravaginal instillation of lactobacilli for prevention of recurrent
urinary tract infections. Can J Microbiol; 34:339–43, 1988.
Burger O, et al. Inhibition of Helicobacter pylori adhesion to human gastric mucus by
a high-molecular-weight constituent of cranberry juice. Critical Reviews in Food Science
Nutrition; 42(Suppl.), 2002.
Dugoua JJ, et al. Safety and efficacy of cranberry (Vaccinium Macrocarpon) during
pregnancy and lactation. Can J Clin Pharmacol; 15(1):e80–e86, 2008.
Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic
costs. Am J Med;113 Suppl 1A:5S-13S, 2002.
Howell AB, Vorsa N, Marderosian AD, Foo LY. Inhibition of the adherence of p-fimbriated
Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from
cranberries. The New England Journal of Medicine; 339:1085, 1998.
Howell AB, Leahy M, Kurowska E, Guthrie N. In vivo evidence that cranberry
proanthocyanidins inhibit adherence of p-fimbriated E. coli bacteria to uroepithelial cells.
Federation of American Societies for Experimental Biology Journal; 15: A284, 2001.
Howell AB, Foxman B. Cranberry juice and adhesion of antibiotic-resistant uropathogens.
Journal of the American Medical Association; 287, 2002.
Jepson RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections.
Cochrane Database Syst Rev;(3):CD001321, 2004.
Krueger CG, et al. Potential of cranberry flavonoids in the prevention of copper-induced
LDL oxidation. Polyphenols Communication; 2:447–448, 2000.
Liu Y. Cranberry changes the physicochemical surface properties of E. coli and adhesion
with uroepithelial cells. Colloids and Surfaces B: Biointerfaces; 65(1): 35–42, 2009.
McFarland LV. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea.
Dig Dis; 16:292–307, 1998.
McMurdo M, et al. Cranberry or trimethoprim for the prevention of recurrent urinary
tract infections? A randomized controlled trial in older women. Journal of Antimicrobial
Chemotherapy; 63(2):389–395, 2009.
34. 32 U T I
Mohammed Abdul MI, et al. Pharmacodynamic interaction of warfarin with cranberry but
not with garlic in healthy subjects. Br J Pharmacol;154(8):1691–1700, 2008.
Narayansingh R and Hurta RAR. Cranberry extract and quercetin modulate the expression
of cyclooxygenase-2 (COX-2) and I-kappa-B-alpha in human colon cancer cells. Journal of
the Science of Food and Agriculture; 89(3):542–547, 2009.
Ofek I, et al. Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. New
England Journal of Medicine; 324:1599, 1991.
Reed, J. Cranberry flavonoids, atherosclerosis and cardiovascular health. Critical Reviews in
Food Science Nutrition; 42(Suppl.):301–316, 2002.
Reid G, Bruce AW, Taylor M. Instillation of Lactobacillus and stimulation of indigenous
organisms to prevent recurrence of urinary tract infections. Microecol Ther; 23:32–45, 1995.
Reid G, Bruce AW, Taylor M. Influence of three-day antimicrobial therapy and Lacto-
bacillus vaginal suppositories on recurrence of urinary tract infections. Clin Ther; 14:11–16,
1992.
Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the
treatment of urinary tract infections. The Journal of Urology; 131:1013–1016, 1984.
Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of
naturopathic cranberry products as prophylaxis against urinary tract infection in women.
Can J Uro; 9(3):1558–1562, 2002.
Suna Jie and Liu RH. Cranberry phytochemical extracts induce cell cycle arrest and
apoptosis in human MCF-7 breast cancer cells. Cancer Letters; 241(1):124–134, 2006.
Website: National Institutes of Health, National Institute of Digestive and Diabetes and
Kidney Diseases. Accessed June 21, 2009.
http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/index.htm
Website: National Institutes of Health, Cranberry monograph. Accessed June 20, 2009.
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-cranberry.html
Website: Worcester Polytechnic Institute. Accessed June 22, 2009.
http://www.wpi.edu/News/Releases/20067/cranberry.html
Weiss EI, et al. Inhibiting interspecies coaggregation of plaque bacteria with a cranberry
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For more information about the author of this booklet, visit
www.sherrytorkos.com
35. but what about the health
of your probiotics?
If you’re getting your probiotics (live cultures)
from the refrigerated section, you might want to
reconsider. Moisture’s the main enemy of probiotics,
not heat.When probiotics are refrigerated, condensation
develops,killing these beneficial bacteria. Keeping what’s inside the bottle dry helps keep the probiotics alive.
Kyo-Dophilus®,specially-cultured,human strain probiotics work better because the natural environment
of these bacteria is the human intestinal tract,unlike dairy-strain probiotics.
In fact,independent tests show that Kyo-Dophilus is still stable,even after four years on the shelf! Not so
for most refrigerated probiotics (especially if they are in plastic bottles), which die out in as little as a
few weeks.
And Kyo-Dophilus is guaranteed stable when you take it, not just when it is manufactured — without
refrigeration.
TakeKyo-Dophilus,thehealthyprobioticyoucantrust.
Kyo-Dophilus with Enzymes, Kyo-Dophilus Vegetarian
and Kyo-Dophilus One Per Day also available.
Kyo-Dophilus®
36. U
rinary tract infections (UTIs) are the second most
common type of infection diagnosed in the United States.
Not only are these infections uncomfortable and painful,
if left untreated or treated ineffectively, they can pose serious
health issues. Accomplished author and holistic pharmacist
Sherry Torkos outlines her comprehensive plan to not only help
prevent UTIs, but treat them as well. Her natural treatment plan
features a scientifically proven cranberry supplement, along
with other dietary supplement recommendations and diet and
lifestyle advice. Her holistic plan will also help readers naturally
enhance the overall health of their urinary tract.
COMPREHENSIVE PREVENTIONand
TREATMENT PLAN
Sherry Torkos is a practicing pharmacist, author, and certi-
fied fitness instructor. She received her bachelor of science
in pharmacy from the Philadelphia College of Pharmacy
and Science. Sherry is actively involved in providing educa-
tion on natural health matters and is frequently interviewed
on radio and TV talk shows throughout North America and
abroad. Sherry has authored 14 books and booklets, includ-
ing The Canadian Encyclopedia for Natural Medicine, The
GI Made Simple, and Winning at Weight Loss.
ABOUT THE AUTHOR OF THIS BOOKLET
URINARYTRACT
INFECTIONS
betternutrition.com
NUMBER 27
magazine presents
