A urinary tract infection (UTI) can occur over and over again, and while antibiotics work well, patients can quickly develop a resistance to them. Many health care professionals have embraced cranberry juice as a remedy to prevent the recurrence of UTIs, but the calories add up fast when you have to take it day after day for months (obesity is a clear risk factor for infections, especially UTIs).
This is where dietary supplementation makes much more sense (and cents). Supplements have few, if any, calories and offer equal results to cranberry juice, if not better; plus, there’s far better compliance (there’s a 95 percent chance a patient will stick with supplements versus a less than 50 percent chance she’ll continue taking cranberry juice). The key, however, is looking for the right ingredients, so keep reading!
What is Urinary Tract Infection?
The urinary tract extends from the kidneys down to the opening of the urethra.
A UTI can occur anywhere in the tract, including the kidneys, ureters (which connect the kidneys to the bladder), bladder, and urethra. A lower UTI occurs in the bladder or urethra (called cystitis), and an upper UTI occurs in the ureters or kidneys, which is known as pyelonephritis.
Approximately 85 to 90 percent of UTIs are caused by gram-negative bacteria, and about 75 to 95 percent of these bacterial infections are caused by Escherichia coli (from feces). Nonbacterial UTIs (usually fungal causes) are relatively rare; diabetics and people who use a catheter frequently are at higher risk of these types of infections.
Risk factors for UTIs include being female, sexual activity, certain types of birth control, diabetes, menopause, catheter use, and urinary tract obstruction (such as a stone, enlarged prostate, tumor, or narrowing of the urinary tract). Uri- nary tract infections are 50 times more common in adult women than in adult men, probably due to the fact that the urethra is much shorter in women, so bacteria have a short trip to reach the bladder.
Also, during perimenopause and menopause a reduction in estrogen makes it more difficult for normal, “healthy” bacteria to survive, creating room for infection-causing bugs to get a foothold.
Infections in men may be an early indication of a kidney stone or an enlarged prostate.
Some common symptoms of a UTI include:
- Dysuria (pain on passing urine)
- Frequency (having to go often)
- Pressure or pain above the pubic bone in the bladder when not urinating
- Difficulty passing urine
- Cloudy urine
- Hematuria (blood in the urine)
- Pyuria (white blood cells in the urine)
Children may not experience any symptoms, but they’ll often exhibit some red flags, such as irritability, poor appetite, fever, diarrhea, and incontinence. If the infection progresses up to the kidney, it can cause nausea, vomiting, fever, and flank pain.
Many women experience recurrent bacterial infections, usually involving the same strain of bacteria that caused the first infection! The bugs survive treatment with antibiotics and lie dormant, just waiting to take advantage when there’s an opportunity.
Home Remedies For Urinary Tract Infection
1. Cranberry (Vaccinium macrocarpon) 36 to 72 milligrams of proanthocyanidins a day in divided doses for prevention
Cranberries have been used since the early 1800s for bladder problems. While many people automatically reach for supplements made from these bitter-tasting berries at the first sign of that familiar burning feeling, they work best when taken as a preventive—just like multivitamins—especially for people vulnerable to UTIs. Cranberries are 90 percent water, but they also contain quinic acid, malic acid, citric acid, glucose, and fructose. In medical school, I was taught that quinic acid caused large amounts of hippuric acid to be produced and then excreted in the urine, which had an antibacterial effect, but recent studies have debunked that theory.
So how do they work? Current thinking is that fructose and proanthocyanidins (PACs)—especially type A (versus type B)—block E. coli from adhering to the inside of the urinary tract. This is why you want to find a supplement with very high levels of PAC-A. (Some products do list these, but most don’t. You can always call or go on the Web to find the information, but I encourage people to start demanding that these companies report it; it’s that critical.) Cranberry juice contains 37 percent PACs, on average, but cranberry also comes in syrup, capsules, and tablets.
Unfortunately, processing into pills, syrups, or what have you can lower the amount of PACs (more on that later). Lab and clinical studies have found that taking anywhere from 36 to 72 milligrams of PACs daily (divided into two daily doses— morning and evening) reduces the risk of infection. The antiadhesion effects of PACs on bacteria decrease over the course of the day, which is why it’s best to take the supplement in both the morning and evening.
The largest independent clinical review of cranberry juice or supplements and UTIs found that, compared to water or no treatment, these products did not significantly reduce the occurrence of UTIs in any group, including the following (stick with me here, I’m getting to the good part):
- Symptomatic UTI in general (14 percent reduction)
- Women with recurrent UTIs (26 percent reduction)
- Older people (25 percent reduction)
- Pregnant women (no reduction)
- Children with recurrent UTIs (52 percent reduction)
- Cancer patients (no reduction, but more recent research is showing benefits)
- People with neuropathic bladder or spinal injury (5 percent reduction)
However, the impact of cranberry was not significantly different than antibiotics for women with a history of recurrent UTIs (antibiotics worked slightly better) or in children (cranberry worked as well as antibiotics). In other words, they are a viable option to antibiotics—and without the antibiotic resistance.
Here’s how the study authors summed up the research: “The large number of dropouts or withdrawals from some of the studies indicates that cranberry products, particularly in juice form, may not be acceptable over long periods of time. Cranberry capsules or tablets may overcome some issues with compliance, but from the current evidence they do not appear to be any more effective than the juice, although they may be as effective as antibiotics.” Read the last part of that sentence again. Wow! I agree with this finding 100 percent. Besides the taste, cranberry juice is high in sugar and calories. So here is my suggestion for Ocean Spray or another cranberry juice company: Find a way to put 36 to 72 milligrams per day of PACs in a serving of “light” (reduced-calorie) cranberry juice!
The problem with most cranberry supplement studies is that they do not report the amount of PACs in the products tested. So here’s what I look for in a cranberry supplement. (I have five rules and a low or competitive price is just a given.)
- It must have 36 to 72 milligrams of PACs per one or two pills (PAC-A should be as high as possible, too; as PACs increase, so does PAC-A). I look for a pill that contains at least 18 milligrams of PACs or higher, ensuring that two pills will provide 36 milligrams or more. The higher, the better, of course. (Again, you may have to call the company or search online for these numbers.)
- It should come in enteric-coated capsules, which means the contents get released further down the gastrointestinal tract (past the stomach).
- It should report the level of the compound oxalate per pill. High quantities of oxalate can increase the risk of kidney stones, especially in people at high risk for them. One of the only clinical studies of cranberry supplements and oxalate found that people who took them had significantly increased levels of oxalate (more than 40 percent higher on average). This is a big deal because as little as a 10 percent increase in urinary oxalate over the upper limit of normal can lead to stones. The average normal intake of oxalate from the diet is about 150 milligrams per day, but some cranberry pills contain more than 350 milligrams. Look for oxalate levels below 100 milligrams.
- It should contain a little magnesium, potassium, or calcium (10+ milligrams of each) to counter absorption of the oxalates.
- It should be protected from light and higher temperatures. PACs are light and temperature sensitive, so keep the pills in the refrigerator in a container that’s either opaque or dark.
2. Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 probiotics at least one billion CFUs per capsule twice a day
As in the rest of the body, the urinary tract is loaded with good bacteria that keep the bad bacteria under control. Lactobacillus probiotics can produce hydrogen peroxide, which prevents other bacterial invaders from hanging around. If good bacteria are low or absent, E. coli has an easier time thriving. Lactobacillus vaginal suppositories for the prevention of UTIs have mixed research, as do the capsules.
A large clinical trial published in the Archives of Internal Medicine (now called JAMA Internal Medicine) compared Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 twice a day (at least 109 colony-forming units, or CFUs, per capsule) against a common antibiotic (TMP-SMX) in 252 postmenopausal women at high-risk for recurrent UTIs.
The probiotics did not beat the antibiotic, but after a year almost 100 percent of the women who took antibiotics had developed resistance to the antibiotic, compared to no resistance with the probiotic. Regardless, this probiotic combination is now commercially available (look for Fem-Dophilus), so it’s definitely worth a try for preventing UTIs.
3. D-mannose 2,000 milligrams a day in divided doses
D-mannose is a simple sugar that has some preliminary clinical research regarding UTIs. It appears to work by blocking the attachment of E. coli to the urinary tract. A large clinical trial with 2,000 milligrams of D-mannose (dissolved in 6 to 7 ounces of water) showed significant reductions in recurrent UTIs over 6 months, which was similar to antibiotics.
4. Vitamin C
Vitamin C may acidify the urine, making it less hospitable to certain bacteria. Now, it hasn’t been able to do this consistently in studies, but is it so crazy to believe that a vitamin that can reduce the duration of the common cold in some folks might be able to promote an immune response that could deter or block a UTI? Regardless, it’s inexpensive and safe in pregnancy so it’s worth a try (200 to 500 milligrams per day; higher dosages can increase your risk of kidney stones). By the way, did you know that cranberries contain a large concentration of vitamin C, along with many other nutrients? One serving contains 100 to 150 percent of the Recommended Dietary Allowance. Coincidence?
What Supplements Are Useless For Treating Urinary Tract Infection?
This shrub (also known as bearberry) is native to the more mountainous areas of North America, and the herbal supplement has been touted for UTI prevention and treatment in so many alternative medicine books that I have lost count. This is not based on evidence, though, and in my experience, it’s minimally effective. Also, the leaves of the plant contain an ingredient known as arbutoside, which the gut turns into glucose and hydroquinone (long-term exposure to hydroquinone may be carcinogenic).
Avoid uva ursi if you’re pregnant, breastfeeding, or have kidney problems or stomach issues. I have had so many people call me up complaining that a certain supplement they bought at a local health food store gave them stomach pain. I always ask, “Is there uva ursi in it?” And the answer has always been “yes.”
The leaves of this tree contain antimicrobial terpenoids, compounds that could be used against a UTI, but it’s never really been tested for this in a good clinical trial. In very large doses (“large” has never been defined), it could be harmful to the kidneys.
Laboratory studies have suggested that this compound—which is found naturally in a variety of plants, including goldenseal and goldthread— might prevent E. coli from adhering to the bladder wall. However, good research on this is lacking.
This amino acid can make the urine more acidic, which might reduce the risk of UTIs. The average dosage used in a few small clinical studies is 500 milligrams three times a day maximum. The catch is that L-methionine can increase the amount of a compound in the body known as homocysteine, which in the long term could be unhealthy and damage the kidneys.
What Supplements Are Suitable For Kids to Treat Urinary Tract Infection?
In one study of kids with recurrent UTIs, those who drank 2 milliliters of cranberry juice per kilogram of body weight daily (with 37 percent PAC) had reduced risk of UTIs. That is the good news. The bad news is that 30 percent of the kids dropped out of the study because they couldn’t tolerate the juice. Talk with your child’s doctor about the possibility of using supplements at lower dosages.
Other Natural Treatments For Urinary Tract Infection
Heart healthy = urinary tract healthy
This shouldn’t be surprising anymore. Eating a heart-healthy diet delivers nutrients—such as calcium, magnesium, and potassium—that may reduce the risk of kidney stones and UTIs.
However, one of the smartest things you can do is maintain a healthy weight because extra pounds could increase blood sugar levels and the risk of developing insulin resistance, which creates a more favorable environment for a UTI.
Recent research shows that lowering cholesterol levels may also protect the urinary tract and reduce the risk of a UTI because the concentration of other compounds that bacteria have been known to utilize when they invade or adhere to the bladder is reduced as well.
Don’t OD on juices
Fruit juices in general have too many calories, which can increase weight, blood sugar, and the longterm risk of a UTI. However, if you are convinced they work for UTIs and want to sip a few ounces a day for prevention, that’s okay. Drinking just 1.5 to 2 ounces of lingonberry (Vaccinium vitis-idaea) concentrate with cranberry concentrate per day over 6 months showed some benefit in preventing UTIs.
Exercise makes you thirsty, and the more you drink, the more you pee. Urination is a wonderful protective mechanism against bacterial infections because it constantly flushes out little bugs. Exercise also reduces your risk of diabetes and weight gain.
Get your five servings—and more
Eating fresh fruit can lower your risk of UTIs, and so can noshing on fermented dairy products (such as yogurt and kefir), probably because they contain probiotics. However, coffee, tea, nonfermented milk products, and soft drinks do not affect risk.
Switch birth control methods
Spermicide use (including using condoms that contain spermicide) is a very strong risk factor for UTIs, especially when used with a diaphragm. Spermicides alter the natural bacteria balance in the vagina and increase the chance that other more hostile bacteria can settle in. Just an FYI: Sexual intercourse is one of the strongest risk factors for UTIs. Reducing the frequency of intercourse or intermittent abstinence may be beneficial for some people, but that’s for you to decide!
Follow good hygiene
Urinating shortly after intercourse, not delaying urination, wiping front to back with toilet paper, and avoiding douching and wearing tight underwear have not been studied against UTIs, but they just make good sense.
Topical (not oral) estrogen prevention
Postmenopausal women with a history of symptomatic UTIs should ask their doctor about topical (oral has not been effective from four studies) vaginal estrogen cream therapy. It has excellent preliminary evidence from two studies that it is significantly reduces risk in those with recurrent UTIs.
What Else to Know About Urinary Tract Infection?
Officially this might not be a dietary supplement, but Phenazopyridine hydrochlo-ride has a specific analgesic effect on the urinary tract. It’s a dye (an “azo” dye) that coats the lining of the urinary tract and acts like an anesthetic (kind of like a tooth-ache numbing agent for the urinary tract) to reduce UTI pain and perhaps even the burning and urgency. Some examples of products that contain this compound are AZO and URISTAT.