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Cranberry

(Vaccinium macrocarpon)

Plant Part Used
Berry
Active Constituents
This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.
Proanthocyanidins, quinic acid.(1)

Introduction
Cranberry fruit juice is recommended by both grandmothers and health care professionals for individuals with urinary tract infections, with research supporting folk uses.(2),(3),(4),(5) Cranberry is a close relative of the American blueberry and European bilberry. It has been used for centuries in cooking and as a garnish.

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In the United States, urinary tract infections (occurring with dysuria, frequency, and urgency) account for a significant number of the bacterial infections that are reported each year. Only strep throat accounts for more prescriptions written annually for infections in adults. By some estimates, more than 50 million cases of urinary tract infections (UTI) are treated annually. One of every five women in the U.S. will suffer from a UTI at some time in her life. The infection is usually caused by the bacteria E. coli (in more than 90 percent of the cases), with the bacteria adhering to the wall of the bladder and causing inflammation, pain, and fever. Although these infections are not usually life threatening or even a significant health risk for most individuals, there is increasing concern over bacterial resistance. One natural therapy, cranberry, has been reported to be clinically useful in treating and managing UTI.
Interactions and Depletions
Interactions
Dosage Info
Dosage Range
300-400mg (standardized extract), 2 times a day.
Most Common Dosage
300mg (standardized extract), 2 times a day.

Dosage of cranberry juice in preventing and treating urinary tract infections (UTI) in individuals has ranged from 5-20oz administered daily (6oz juice = 90gm fresh fruit), with one study having results with 4-6oz of juice daily for 7 weeks.(6) An active UTI requires more juice than the prevention dose. Also, cranberry juice concentrate capsules are available and have been used in the management of UTI. One 300mg capsule twice daily, either 1 hour before meals or 2 hours after a meal, is recommended. Drink plenty of filtered or bottled water throughout the day. Most studies focus on using cranberry juice cocktail in treating UTI. However, cranberry juice cocktails contain added sugar and may be diluted by other juices. While cranberry juice cocktail is effective in reducing the frequency and severity of UTI, the use of 100% cranberry juice is recommended.

Standardization
*Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.
The most current available medical and scientific literature indicates that this dietary supplement should be standardized to 11-12% quinic acid per dose; one can also use freeze dried berries or juice concentrate.
Uses
Frequently Reported Uses
  • Urinary Tract Health
  • Diuretic
Other Reported Uses
  • Preventive For Kidney Stones
  • Antioxidant
  • Kidney Stones
Toxicities & Precautions
General
This dietary supplement is considered safe when used in accordance with proper dosing guidelines.
Health Conditions
Cranberry juice may contain varying amounts of oxalate, a common component of kidney stones. Use with caution in individuals prone to nephrolithiasis. Do not use in individuals currently with nephrolithiasis.(7)
Side Effects
Large doses of cranberry juice may cause mild diarrhea and gastric upset.(8)
Pregnancy/Breast Feeding
If pregnant or nursing, consult a physician before use.(9)
Age Limitations
Do not use in children under 2 years of age unless recommended by a physician.
Pharmacology

Cranberry has been used to prevent kidney stones, as well as to remove unwanted toxins from the body.(10) As early as the 1840's, German researchers were examining the connection between using the cranberry and the incidence of UTI. Researchers thought that cranberry worked for UTI by acidifying the urine, preventing the bacteria from growing. In 1984, a researcher reported that cranberry does not acidify the urine sufficiently to produce an antibacterial effect in the bladder.(11) Instead, cranberry prevented E. coli from adhering to the cells lining the bladder wall, thus preventing infection. Research has reported that this property may be due to a glycoprotein found in the cranberry fruit. Further research reported that cranberry was a potent inhibitor of the most virulent strains of E. coli from attaching to the bladder wall.(12),(13) Studies also report that other members of the Vaccinium genus have similar properties, including bilberry and blueberry.(14) The anti-adhesive qualities of cranberry may prevent E. coli from colonizing in the gut as well.(15) Cranberry was also reported to inhibit the adhesion of H. pylori to human gastric mucus and to human erythrocytes.(16) Researchers suggested that cranberry juice along with a triple antibiotic therapy improved the rate of H. pylori bacteria eradication in females.(17)

A recent human study reported that cranberry juice is an effective antioxidant. The authors suggested that the antioxidant activity may be in part due to the relatively high vitamin C content.(18) Other laboratory studies support the antioxidant capabilities of the flavonoid constituents in cranberry.(19),(20) Cranberry juice may increase plasma antioxidant levels reducing the risk of heart disease.(21) Fiber is a key component lacking in the diet of many people with type 2 diabetes, but with the added fiber in these low-sugar cranberries, glucose appears to absorb more slowly, which helps regulate blood sugar. The combination of less sugar and high fiber could be of benefit to type 2 diabetics.(22)

References
  1. Leung A, et al. Encyclopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetcs. New York: Wiley-Interscience Publication; 1996:50-53.
  2. Leaver RB. Cranberry Juice. Prof Nurse. 1996;11(8):525-26.
  3. View Abstract:  Nazarko L. Infection Control. The Therapeutic Uses of Cranberry Juice. Nurs Stand. 1995;9(34):33-35.
  4. View Abstract:  Lynch DM. Cranberry for prevention of urinary tract infections. Am Fam Physician. 2004 Dec 1;70(11):2175-7.
  5. View Abstract:  Jepson RG. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2004;(2):CD001321.
  6. Gibson L, Pike L, et al. Effectiveness of Cranberry Juice in Preventing Urinary Tract Infections in Long-term Care Facility Patients. J Naturopathic Med. 1991;2:45-47.
  7. View Abstract:  Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology. Jan2001;57(1):26-9.
  8. Behrman: Nelson Textbook of Pediatrics, 16th ed. W B Saunders Company; 2000:2304.
  9. View Abstract:  Dugoua JJ Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol. Jan2008;15(1):80-6
  10. View Abstract:  Schmidt DR, et al. An Examination of the Anti-adherence Activity of Cranberry Juice on Urinary and Nonurinary Bacterial Isolates. Microbios. 1988;55(224-225):173-81.
  11. View Abstract:  Zafriri D, et al. Inhibitory Activity of Cranberry Juice on Adherence of Type 1 and Type P Fimbriated Escherichia coli to Eucaryotic Cells. Antimicrob Agents Chemother. 1989;33(1):92-98.
  12. View Abstract:  Foo LY, Lu Y, Howell AB, et al. The Structure of Cranberry Proanthocyanidins which Inhibit Adherence of Uropathogenic P-fimbriated Escherichia coli In Vitro. Phytochemistry. May2000;54(2):173-81.
  13. Ofek I, et al. Anti-Escherichia coli Adhesion Activity of Cranberry and Blueberry Juices. Adv Exp Med Biol. 1996;408:179-83.
  14. Ofek I, et al. Anti-Escherichia coli Adhesion Activity of Cranberry and Blueberry Juices. Adv Exp Med Biol. 1996;408:179-83.
  15. Ofek I, et al. Anti-Escherichia coli Adhesion Activity of Cranberry and Blueberry Juices. Adv Exp Med Biol. 1996;408:179-83.
  16. View Abstract:  Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS Immunol Med Microbiol. Dec2000;29(4):295-301.
  17. View Abstract:  Shmuely H, et al. Effect of cranberry juice on eradication of Helicobacter pylori in patients treated with antibiotics and a proton pump inhibitor. Mol Nutr Food Res. Jun2007;51(6):746-51
  18. View Abstract:  Pedersen CB, et al. Effects of blueberry and cranberry juice consumption on the plasma antioxidant capacity of healthy female volunteers. Eur J Clin Nutr. May2000;54(5):405-8.
  19. View Abstract:  Wang SY, Jiao H. Scavenging Capacity of Berry Crops on Superoxide Radicals, Hydrogen Peroxide, Hydroxyl Radicals, and Singlet Oxygen. J Agric Food Chem. Nov2000;48(11):5677-5684.
  20. View Abstract:  Yan X, Murphy BT, Hammond GB, Vinson JA, Neto CC. Antioxidant activities and antitumor screening of extracts from cranberry fruit (Vaccinium macrocarpon). J Agric Food Chem. Oct2002;50(21):5844-9.
  21. View Abstract:  Vinson, JA, Kharrat HA, Samman N. Single-dose and supplementation studies with cranberry juice relevant to its role in heart disease as an antioxidant. American Chemical Society, New Orleans. Mar2003.
  22. View Abstract:  Wilson T, et al. Glycemic response of type 2 diabetics to sweetened dried cranberries. FAESEB J. Jul2009;23:900