Cranberry has Long History of Health Benefits

Studies Show Potent Supplement Promotes Urinary Tract health
By Anil Kapoor, M.D., Urologist

Most of us think of cranberry as a tart, yet tasty berry to enjoy in drinks or with our Thanksgiving dinner. We add it to muffins and cereal, munch on the dried berries, and spread it over our toast. Our love of cranberries as a food follows its use among native cultures and early settlers for its many healing properties. Through the centuries it has evolved from a food and quintessential folk remedy – to a well documented aid for urinary tract health and other maladies.

Historical Use
Cranberries can be found growing in bogs in most of eastern North America, from Canada to the eastern and mid-western United States. Native Americans would sweeten the berries by cooking them in maple syrup or honey. They found the fruit to be valuable for warding off scurvy (vitamin C deficiency). It was also popularly used as a diuretic, astringent and in the treatment of fevers, dropsy, and diarrhea.

As a food source, the usage of cranberry dates back to the colonial days where it was included in the Thanksgiving feast. Interestingly, the harvest time for cranberries corresponds with Thanksgiving making these fruits the perfect addition to the festivities. Since cranberries could be dried and stored for consumption during the winter, they also became a popular at Christmas time.

Early Discoveries
North American Pioneers found that cranberry could help relieve cramps and muscle spasms. The diuretic properties of cranberry were first reported in 1787 when a woman with water retention was treated successfully by eating large quantities of the berries. In the mid-1800s, German researchers discovered that after ingesting cranberries, urinary excretion of hippuric acid was increased. In high concentrations, hippuric acid was believed to have strong antibacterial activity by acidifying the urine. This effect however, failed to be reproduced consistently in clinical studies. For decades, the benefits of these berries remained a mystery, until some ground-breaking research in the 1980’s identified the true mechanism.

Modern Research – active constituents identified
In 1984 a study done in mice (published in the Journal of Urology) demonstrated that cranberry inhibited the adherence of Escherichia coli to the epithelial cells in urinary tracts by 80 percent. E. coli is the primary cause of urinary infections. Similar activity was found in human subjects as well.

Later research identified that certain compounds in cranberry, namely the condensed tannins or proanthocyanidins (a type of flavonoid), were responsible for this anti-adherence effect. These compounds adhere to the tiny hairs of the bacterial surface, thus preventing them from implanting in the mucosal linings of the bladder. Rather, they are flushed out of the body via the urine. In 1991 this finding was duplicated by Israeli researchers and published in the prestigious The New England Journal of Medicine.

Clinical Studies
Now that the mechanism had been identified, it needed to be tested in larger clinical studies. Researchers associated with Harvard Medical School and various Boston-area hospitals conducted a six-month randomized, double-blind, placebo-controlled study on 153 elderly women (average age of 78 and a half years). This particular group was considered high risk, because a large percentage of women over 65 years of age experience at least one urinary tract infection per year.

Volunteers were randomly assigned to consume either 300 mL 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 cranberry juice has an effect on bacteriuria (the passage of bacteria in the urine) or pyuria (presence of pus, indicating white blood cells, hence infection in the urine).

The researchers measured baseline urine samples and six clean-voided urine samples collected at one-month intervals during the six-month duration of the study, looking for bacteria or white blood cells. At the end of the study, the researchers concluded the cranberry juice beverage successfully reduced the frequency of both bacteriuria and pyuria in elderly women. This study provided the first good clinical evidence in a relatively large sampling of patients, that cranberry juice could be beneficial to the urinary tract. (1994, Journal of the American Medical Association).

Another study backed this research, demonstrating that drinking 4 to 6 ounces of cranberry juice daily had a preventative effect for urinary tract infections. The study was conducted in elderly patients in nursing homes. Patients were given small amounts of cranberry juice each day for seven weeks. Of the 28 patients monitored, urinary tract infections were prevented in nineteen subjects. The remaining nine patients had bacteria present in their urine despite drinking cranberry juice.

Other Health Benefits
Cranberries contain a number of nutrients (vitamins and minerals), fiber, and plant chemicals that offer health benefits. The main active constituents are the polyphenol compounds, called flavonoids, which include anthocyanins (which give cranberry its characteristically deep red color), proanthocyanidins, quercetin, and flavonols.

In addition to the bladder benefits, researchers believe that these flavonoids, which are also found in red wine and other fruits, can help protect against cardiovascular disease. Flavonoids inhibit blood clotting, promote vasodilation (increased interior blood vessel diameter, which improves blood flow and reduces blood pressure), and protect cholesterol from oxidation (reducing atherosclerosis). All of these properties offer benefits for heart health.

In preliminary research cranberry has also been found to have some protective effects against cancer. Again the benefits have been linked to the flavonoid compounds, which were found to delay tumor development and reduce the spread of tumors.

Juice versus supplements
While drinking cranberry juice for bladder health is one way to get the health benefits of this berry, it may not be the ideal method. Most commercial cranberry juices contain only 27-33% pure cranberry juice. Sugar and water make up the rest of the volume. Drinking large amounts of cranberry cocktail is not only inconvenient, but it can be expensive and high on the calorie count. For these reasons, supplements are often preferred.

Selecting Supplements
There are a variety of products to choose from which vary greatly in quality, potency, and activity. The most studied cranberry product on the market is CranMax. It features a patented technology, called Bio-Shield, which enhances the bioactivity of the cranberry, so that it gets to the site of action and has sustained effects. This extended release mechanism prevents the E. coli bacteria from settling in the bladder wall and causing an infection, and allows nature to do its job and flush the bacteria out of the body through the urine. In comparison, most cranberry products on the market, which are made from cranberry fruit powder, are quickly destroyed by the stomach acid and only deliver a small amount of cranberry to the urinary tract.

CranMax is a full-spectrum supplement, containing all the vital parts of the cranberry - the fruit, seeds, skin and juice. It is the most potent cranberry supplement on the market, requiring 34 pounds of cranberries to produce one pound of product. CranMax has three times greater antioxidant activity than cranberry juice, 25% more fiber and has been clinically studies for urinary health.

Clinical Studies on CranMax
CranMax has been clinically studied and found to be effective in the prevention of urinary tract infections, and preliminary evidence indicates that it may play a role in the acute treatment of these infections.

Some of the early research on CranMax was conducted in Prague, Czech Republic. Two separate studies involving women at high risk of developing UTI were performed. In both studies CranMax was found to be safe and effective in preventing UTI.

The most recent study on the ability of cranberry to prevent UTI was published in the Canadian Journal of Urology. This one-year study involved 150 women age 21 to 72 who were randomized to one of three groups:

• Placebo juice + placebo tablets
• Placebo juice + CranMax tablets
• Cranberry juice + placebo tablets

The tablets provided a minimum of 30:1 extract of cranberry and were given twice daily. The juice used was a pure unsweetened cranberry juice (not cranberry cocktail) and was given 250 ml three times daily.

The conclusion of this study was that CranMax provided the most effective and cost-effective method of preventing UTI. Those given the cranberry tablets had a 44% lower incidence of UTI compared to the placebo group.

Studies Underway
Two new studies are currently underway with results expected this fall. We are presently conducting a study comparing CranMax extract to prescribed antibiotics for patients with diagnosed UTI’s. The early results look promising for CranMax extract, not only in preventing UTI’s, but also as a potential alternative to antibiotic use in the treatment of UTI’s.

A second study, being conducted at the Veterans Medical Center, West Roxbury, MA, is evaluating the use of CranMax tablets for the prevention of UTI’s in spinal cord injured (SCI) patients with neurogenic bladders. Spinal cord injured patients are at risk for developing urinary tract infections for a number of reasons including abnormal bladder pathophysiology and frequent instrumentation. This study came as a result of the institution’s treatment of approximately 100 patients with CranMax and reports of a significant reduction in the frequency of urinary tract infections.
The study consists of 150 subjects in a double blind, placebo controlled, crossover study. Subjects will be assigned to CranMax and placebo tablets, each over a successive period of six months.

Dosage and Directions
Based on the clinical studies, the amount of cranberry juice that is recommended for prevention of UTIs is 5 to 20 ounces daily. For those unable to drink this amount of juice, or for those concerned about the sugar and calorie count a quality cranberry supplement, such as CranMax, can be considered. CranMax offers demonstrated efficacy against the bacteria that cause UTI and is safe and well-tolerated. The recommended dosage of CranMax is 500mg once daily.