Indications

Cranberry SAP-UTI supplies a minimum daily dose of 54 mg of proanthocyanidins from whole cranberry extract to optimize protection against the adhesion of bacteria to urinary tract and bladder walls. Scientific research has shown that proanthocyanidinrich cranberry supplementation interferes with bacterial adhesion and prevents occurrence of UTI's.

Ingredients

Each vegetable capsule contains:
Cranberry concentrate ... 600 mg
Proanthocyanidins ... 27 mg
From 100% ripe red cranberries (Vaccinium macrocarpon Aiton
(Ericaceae))

Contains no: preservative, artificial flavor or color, sugar, milk, wheat, corn or yeast.

Description

Native to North America, cranberries have been used as a medicinal agent for centuries. Cranberries contain proanthocyanidins, which have been shown to inhibit the fimbrial adhesion of bacteria, including Escherichia coli, to the urinary tract epithelium, hence preventing bacterial proliferation and infection. These unique proanthocyanidin compounds, and not acidification of the urine, are suggested to be pivotal in preventing urinary tract infections (UTI's).

NATURAL SYNERGISTIC BLEND Cranberries contain a diverse range of phytochemicals. Cranberry SAP-UTI is manufactured from whole ripe red cranberries containing the berry's natural blend of antioxidants and other phytonutrients. The synergy of the complex phytonutrient blend provides increased bioavailability and protective health benefits.

PURITY, CLEANLINESS and STABILITY Third party testing on finished product to ensure Cranberry SAP-UTI is free of heavy metals, pesticides, volatile organics and other impurities.

CRANBERRIES AND PROANTHOCYANIDINS Cranberries or Vaccinium macrocarpon are one of three fruits native to North America and have been used as a medicinal agent by Native Americans for centuries(1, 2). The single strength juice extracted from cranberries is highly acidic (pH 2.5), astringent and quite unpalatable. Cranberries contain a wide variety of diverse compounds which are responsible for the fruits' biological effects(3). Cranberries supply a rich phytonutrient blend containing anthocyanidins, proanthocyanidins, flavonol glycosides, sugars, organic acids and phenolic acids. Proanthocyanidins are a group of condensed tannins (polyphenolic compounds) that have been isolated from cranberry fruit and that are believed to be responsible for the health benefits associated with cranberry intake(4). Specifically, increased dietary consumption of cranberry products have been associated with a reduced risk of urinary tract infection (UTI) and maintenance of urinary tract health(1, 2, 4 7).

URINARY TRACT INFECTIONS (UTI's) Urinary tract infection is defined by the presence of microorganisms in the urinary tract, including the bladder, prostate, collecting system and kidneys(2). Annually, UTI's are responsible for more than 11 million physician visits in the United States(5). UTI's have a high resistance to first-line antibiotic therapy(5) and treatment with antibiotics is associated with side effects such as nausea, diarrhea and candidal infections(6). UTI's are approximately 50 times more prevalent in adult women than adult men; however, UTI's can occur in men, women and children(7). It has been estimated that 30% of women will experience at least one UTI during their lifetime(7), and of these women, 25% will experience frequent recurrent infections(8). Women are most susceptible to UTI's because they have a short urethra that allows for bacteria to easily ascend into the bladder(7). Pregnancy, sexual activity, aging and use of urogenital medical devices (i.e. catheters) increase the risk and severity of UTI's. Symptoms of UTI's include frequent and urgent need to urinate, cloudy urine, painful urination and lower-back pain(2).

MECHANISMS OF ACTION Acidification of the urine? Cranberries are very acidic, containing quinic acid, malic acid and citric acid(1, 3, 7). Early research observed that cranberry quinic acid produced large amounts of hippuric acid, a strong antibacterial agent excreted in the urine(1, 4, 7). For years, researchers believed that the bacteriostatic effect of cranberry consumption was related to the acidification of urine; however, several studies failed to confirm this hypothesis, as consumption of cranberries only produced very slight increases in urinary acidity, and did not alter antibacterial activity in the urinary tract(1, 2). Due to a lack of scientific substantiation, urinary acidification is no longer believed to be the mechanism responsible for the action of cranberry on UTI's(1, 4). Anti-adherence UTI's are most often caused by uropathogenic bacteria that are harbored in the colon and ascend up the urinary tract, adhere to mucosal surfaces, proliferate and cause infection(4). The most common urinary pathogen accounting for 85% of UTI's is Escherichia coli (E. coli)(2). The bacterial cell wall of E. coli contains protein-like fibers called fimbriae that readily attach to uroepithelial cells(9). E. coli fimbriae produce two fimbrial adhesions; type 1 (mannose sensitive) and P type (mannose resistant)(1, 9). It is the adherence of bacteria (E. coli) to uroepithelial cells that is the critical step in the development of UTI's(9). Cranberries contain two anti-adhesion compounds: fructose and proanthocyanidins(1, 4, 9). While fructose inhibits type 1 fimbrial E. coli adhesion, proanthocyanidins competitively inhibit P type fimbrial adhesion and proliferation, resulting in an increased excretion of E. coli in the urine. To date, there is substantial in vitro and in vivo evidence showing that proanthocyanidins effectively inhibit P type E. coli from adhering to uroepithelial cells(4, 9) from 2–10 hours after ingesting cranberries(1). However, since proanthocyanidins are more effective at preventing bacterial adherence than displacing adhered bacteria from uroepithelial cells, cranberry consumption is indicated for prevention rather than treatment of UTI's(1, 6).

CRANBERRIES, UTI'S & NUTRITION RESEARCH Randomized intervention trials have observed a clinical benefit of cranberry products in preventing UTI's(1, 10 13). Scientific evidence reports that sexually active women with recurrent UTI's show greatest benefit from the preventative effects of cranberry intake with an associated 50% reduction in UTI disease morbidity(1). Furthermore, evidence from a randomized clinical trial on elderly women reported a significant reduction in bacteria and pus found in the urine after cranberry juice intake(13). An epidemiological study on first-time UTI's and sexual behaviors found that regular consumption of cranberry juice was associated with a decreased risk of UTI's(14). As compared to the preventive effect of cranberry in UTI's, there are no scientific studies evaluating the effectiveness of cranberry products in the treatment of UTI's(1, 7). More scientific evidence is needed to confirm the proactive findings obtained to date.

Quantity

60 capsules/bottle

Dose

2 capsules once or twice daily with meals or as directed by your health care
practitioner.
2 capsules provide 54 mg of proanthocyanidins.

Potential side effects/Safety

Intake of cranberries is considered to be safe(1). However, high intakes
of cranberry juice may have a laxative effect(1). Cranberries contain
moderately high levels of oxalate and Terris, et al.(15), reported that patients
at risk of nephrolithiasis (kidney/urinary stones) should avoid dietary
supplementation of cranberries.
In 2004, the Committee on Safety of Medicines warned health
professionals about the possibility of interaction between warfarin and
cranberry juice(16). However, it is not known whether other cranberry
products, such as capsules or concentrates, might also interact with
warfarin, though similar caution should be considered. Currently, there
is not enough information available to assess the interaction of cranberry
intake with the use of dietary supplements and medications.

References

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1R. ERFaEz RR,E CNhazCanE BS, Dan M. CID 2004;38:1413-9.
2. Henig YS, Leahy MM. Nutr 2000;16:684-7.
3. Seeram NP, Adams LS et al. J Agric Food Chem 2004;52:2512-2517.
4. Howell AB. Crit Rev Food Sci Nutr 2002;42:273-8.
5. Howell AB. JAMA 2002;287:3082-3.
6. Harkins KJ. Age Ageing 2000;29:9-12.
7. Jepson RG, Milhaljevic L, Craig J. Cochrane Database Syst Rev 2004;2,CD001321.
8. Stapleton A. Lancet 1999;353:7-8.
9. Foo LY, Lu Y, Howell AB, Vorsa N. Phytochem 2000;54:173-181.
10. Strothers L. Can J Uro 2002;9:1558-62.
11. Walker EB, Barney DP, Mickelsen JN et al. J Fam Pract 1997;45:167-8.
12. Kontiookari T, Sundqvisi K, Nuutinen M et al. BMJ 2001;322 :1571-3.
13. Avorn J, Monane M, Gurwitz JH et al. JAMA 1994;271 :751-4.
14. Foxman B, Geiger AM, Palin K, et al. Epidemiol 1995;6:162-8.
15. Terris MK, Issa MM, Tacker JR. Urology 2001;57:26-9.
16. Committee on the Safety of Medicines. Curr Prob Pharmacov 2003;29:8.