URINARY TRACT INFECTION

Checklist for Urinary Tract Infection (UTI)

Rating	Nutritional Supplements	Herbs
	Bromelain	Cranberry
	Multivitamin-mineral Vitamin A Vitamin C	Asparagus Birch Blueberry Buchu Couch grass Goldenrod Goldenseal Horseradish Horsetail Java tea Juniper Lovage Nettle Oregon grape Parsley Plantain Sassafras Spiny restharrow Uva ursi
See also:  Homeopathic Remedies for Urinary Tract Infection
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of UTIs? Symptoms of a UTI usually begin suddenly and include frequent urination that is irritating or burning, a persistent urge to urinate even after the bladder has been emptied, and cramping or pressure in the lower abdomen. The urine often has a strong or unusual smell and may appear cloudy. In more serious infections, fever, chills, pain in the back below the ribs, nausea, vomiting, and diarrhea may also be present.

How is it treated? Oral antibiotics are typically used for uncomplicated infections. Intravenous antibiotics may be used for more serious infections. Among the many antibiotics commonly prescribed for UTIs are the combination drug trimethoprim/sulfamethoxazole (Bactrim®, Septra®), fluoroquinolones (e.g., levofloxacin [Levaquin™], ciprofloxacin [Cipro®, Cilaxan®]), aminoglycosides (e.g., gentamicin [Garamycin®], tobramycin [Nebicin®, Tobrex®]), and third-generation cephalosporins (e.g., cefixime [Suprax®]).

Dietary changes that may be helpful: When healthy volunteers consumed a large amount (100 grams) of refined sugar, the ability of their white blood cells to destroy bacteria was impaired for at least five hours.¹ Consumption of excessive amounts of alcohol has also been shown to suppress immune function.² Reduced intake of dietary fat has been shown to stimulate immunity.³ For these reasons, many doctors recommend a reduced intake of sugar, alcohol, and fat during an acute infection and for prevention of recurrences.

People who have recurrent or chronic infections should discuss the possible role of allergies with a doctor, since chronic infections have been linked to allergies in many reports.^{4 5 6 7} Identifying and eliminating foods that trigger problems may help reduce the number of infections.

Nutritional supplements that may be helpful: The proteolytic enzymes, bromelain (from pineapple) and trypsin may enhance the effectiveness of antibiotics in people with a UTI. In a double-blind trial, people with UTIs received antibiotics plus either bromelain/trypsin in combination (400 mg per day for two days) or a placebo. One hundred percent of those who received the enzymes had a resolution of their infection, compared with only 46% of those given the placebo.⁸ This study used enteric-coated tablets. Enteric-coating prevents stomach acid from partially destroying the bromelain. Most commercially available bromelain products today are not enteric-coated, and it is not known if non-enteric coated preparations would be as effective.

Many doctors recommend 5,000 mg or more of vitamin C per day for an acute UTI, as well as long-term supplementation for people who are prone to recurrent UTIs. Although no controlled clinical trials have demonstrated the effectiveness of vitamin C for this purpose, vitamin C has been shown to inhibit the growth of E. coli, the most common bacterial cause of UTIs.⁹ In addition, supplementation with 4,000 mg or more of vitamin C per day, results in a slight increase in the acidity of the urine,¹⁰ creating an “unfriendly” environment for some infection-causing bacteria.

Vitamin A deficiency increases the risk of many infections. Although much of the promising research with vitamin A supplements and infections has focused on measles,¹¹ vitamin A is also thought to be helpful in other infections. Some doctors recommend that people with urinary tract infections take vitamin A. A typical amount recommended to correct a deficiency is 10,000 to 25,000 IU per day.

Since the immune system requires many nutrients in order to function properly, many people take a multivitamin-mineral supplement for “insurance.” In one double-blind trial, healthy elderly people who used such a supplement for one year showed improvements in immune function, as well as a significant reduction in the total number of infections (including non-urinary-tract infections).¹²

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Modern research has suggested that cranberry may prevent urinary tract infections. In a double-blind trial, elderly women who drank 10 ounces (300 ml) of cranberry juice per day had a decrease in the amount of bacteria in their urine.¹³ In another study, elderly residents of a nursing home consumed either four ounces (120 ml) of cranberry juice or six capsules containing concentrated cranberry daily for 13 months. During that time, the number of UTIs decreased by 25%.¹⁴ A small preliminary trial found that supplementation with encapsulated cranberry concentrate (400 mg twice per day for three months) significantly reduced the recurrence of UTIs in women (aged 18–45) with a history of recurrent infections.¹⁵

Research has suggested cranberry may be effective against UTIs because it prevents E. coli, the bacteria that causes most urinary tract infections, from attaching to the walls of the bladder.¹⁶ Cranberry is not, however, a substitute for antibiotics in the treatment of acute UTIs. Moreover, in children whose UTIs are due to “neurogenic bladder” (a condition caused by spinal cord injury or myelomeningocele), cranberry juice supplementation did not reduce the rate of infection.¹⁷ Drinking 10–16 ounces (300–500 ml) of unsweetened or lightly sweetened cranberry juice is recommended by many doctors for prevention, and as part of the treatment of UTIs. Alternatively, 400 mg of concentrated cranberry extracts twice per day can be used.

Blueberry contains similar constituents as cranberry, and might also prevent bacteria from attaching to the lining of the urinary bladder.¹⁸ However, studies have not yet been done to determine if blueberry can help prevent bladder infections.

Asparagus (Asparagus officinalis), birch (Betula spp.), couch grass (Agropyron repens), goldenrod (Solidago virgaurea), horsetail, Java tea (Orthosiphon stamineus), lovage (Levisticum officinale), parsley (Petroselinum crispum), spiny restharrow (Ononis spinosa), and nettle are approved in Germany as part of the therapy of people with UTIs. These herbs appear to work by increasing urinary volume and supposedly helping to flush bacteria out of the urinary tract.¹⁹ Juniper is used in a similar fashion by many doctors. Generally, these plants are taken as tea.

Buchu leaf preparations have a history of use in traditional herbal medicine as a urinary tract disinfectant and diuretic.²⁰ However, the German Commission E monograph on buchu concludes that insufficient evidence supports the modern use of buchu for the treatment of UTIs or inflammation.²¹

The volatile oil of horseradish has been shown to kill bacteria that can cause urinary tract infections.²² The concentration that is required to kill these bacteria can be attained in human urine after oral ingestion of the oil. One early study found that horseradish extract may help people with urinary tract infections.²³ Further studies are necessary to confirm the safety and effectiveness of horseradish in treating urinary tract infections.

Goldenseal is reputed to help treat many types of infections. It contains berberine, an alkaloid that may prevent UTIs by inhibiting bacteria from adhering to the wall of the urinary bladder.²⁴ Goldenseal and other plants containing berberine (such as Oregon grape) may help in the treatment of UTIs. These herbs have not, however, been studied for the treatment of UTIs in humans.

Because of the anti-inflammatory effects of plantain, it may be beneficial in some people with UTIs. However, human trials have not been done to confirm this possibility or to confirm the traditional belief that plantain is diuretic.²⁵

An extract of uva ursi is used in Europe and in traditional herbal medicine in North America, as a treatment for UTI.²⁶ This herb is approved in Germany for treatment of bladder infections.²⁷ The active constituent in uva ursi is arbutin. In the alkaline environment of the urine, arbutin is converted into another chemical, called hydroquinone, which kills bacteria. A generally useful amount of uva ursi tincture is 3–5 ml three times per day. Otherwise, 100–250 mg of arbutin in herbal extract capsules or tablets three times per day can be used. Uva ursi should only be used to treat a UTI under the close supervision of a physician.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Acupuncture might be of some benefit for women with recurrent UTIs. A controlled study compared acupuncture to sham (“fake”) acupuncture or no treatment in a group of women with recurrent UTIs. After six months, the women receiving real acupuncture had half as many UTI episodes as the sham group and only one-third as many as the untreated group, a significant difference.²⁸

1. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180–4.

2. MacGregor RR. Alcohol and immune defense. JAMA 1986;256:1474.

3. Barone J, Herbert JR, Reddy MM. Dietary fat and natural-killer-cell activity. Am J Clin Nutr 1989;50:861–7.

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8. Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147–53.

9. Sirsi M. Antimicrobial action of vitamin C on M. tuberculosis and some other pathogenic organisms. Indian J Med Sci 1952;6:252–5.

10. Axelrod DR. Ascorbic acid and urinary pH. JAMA 1985;254:1310–1.

11. Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med 1990;323:160–4.

12. Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet 1992;340:1124–7.

13. Avorn J, Monane M, Gurwitz JH, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 1994;271:751–4.

14. Dignam R, Ahmed M, Denman S, et al. The effect of cranberry juice on UTI rates in a long term care facility. J Am Geriatr Soc 1997;45:S53.

15. Walker EB, Barney DP, Mickelsen JN, et al. Cranberry concentrate: UTI prophylaxis. J Family Pract 1997;45:167–8 [letter].

16. Sobota AE. Inhibition of bacterial adherence by cranberry juice: Potential use for the treatment of urinary tract infections. J Urol 1984;131:1013–6.

17. Schlager TA, Anderson S, Trudell J, Hendley JO. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr 1999;135:698–702.

18. Ofek I, Goldhar J, Zafriri D, et al. Anti-Escherichia coli adhesin activity of cranberry and blueberry juices. New Engl J Med 1991;324:1599 [letter].

19. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 428.

20. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York: John Wiley and Sons, 1996, 104–5.

21. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 317.

22. Kienholz VM, Kemkes B. The anti-bacterial action of ethereal oils obtained from horse radish root (Cochlearia armoracia L.). Arzneimittelforschung 1961;10:917–8 [in German].

23. Schindler VE, Zipp H, Marth I. Comparative clinical investigations of an enzyme glycoside mixture obtained from horse radish roots (Cochlearia armoracia L). Arzneimittelforschung 1961;10:919–21 [in German].

24. Sun DX, Abraham SN, Beachey EH. Influence of berberine sulfate on synthesis and expression of pap fimbrial adhesin in uropathogenic Escherichia coli. Antimicrob Agents Chemother 1988;32:1274–7.

25. Doan DD, Nguyen NH, Doan HK, et al. Studies on the individual and combined diuretic effects of four Vietnamese traditional herbal remedies (Zea mays, Imperata cylindrica, Plantago major and Orthosiphon stamineus). J Ethnopharmacol 1992;36:225–31.

26. European Scientific Cooperative for Phytotherapy. Proposal for European Monographs, Vol. 3. Bevrijdingslaan, Netherlands: ESCOP Secretariat, 1992.

27. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 224–5.

28. Aune A, Alraek T, LiHua H, Baerheim A. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998;16:37–9.

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