Dr Rupy: Do cranberries help prevent urinary tract infections? That is going to be the topic of conversation today. We're going to be diving into this traditional ancient remedy that's been used for millennia to treat bladder symptoms as well as a whole bunch of other things. We've heard for decades, certainly in the natural health industry, that cranberry juice in particular can be beneficial for urinary tract infections, and I'm going to be reviewing why this might be the case and if there is any evidence to support its effectiveness. First off, better managing urinary tract infections and preventing them in the first place is of paramount importance. And in fact, every time I do a clinic, whether that's in hours or out of hours or A&E, I'm always guaranteed to see mostly women with a urinary tract infection. There was a survey that was published in the British Journal of General Practice looking at over 2000 females, and they found that over 890 had reported having at least one urinary tract infection in their lifetime, so that's around 37%. And in the past year, 11% of all the females that they surveyed had a urinary tract infection with 3% having recurrent urinary tract infections, so that's two or more in the last couple of years. So this is a pretty prevalent issue. And this is along a spectrum. So you have uncomplicated urinary tract infections where you go in, most of the time you can be treated with a short course of antibiotics. But there are complicated urinary tract infections that usually have other reasons as to why there might be an infection in the first place. It could involve instrumentation, it could involve damage to the bladder itself. It could be in the context of someone who is elderly or has other comorbidities like cancers. And in certain people who are immunocompromised, it can be a pretty potentially lethal issue. But most urinary tract infections can be quickly treated with a short course of antibiotics, usually something like nitrofurantoin or trimethoprim if you're in the UK. It really depends on local antibiotic guidelines. However, if you're having recurrent courses, it does substantially increase the risk of antibiotic resistance, not just in the community, but also for the individual as well. And this is particularly relevant for anyone who is having recurrent urinary tract infections that we'll get to in a second. So anything that can potentially reduce and prevent urinary tract infections from occurring in the first place, I think is definitely something to be welcomed as well. In some people who have recurrent urinary tract infections, they may have to take multiple antibiotics and different antibiotics as resistance increases. We have broader strength antibiotics like fluoroquinolones, for example, you might have heard of ciprofloxacin, it's quite popular in the states, but they potentially have serious side effects. And then obviously down the line, you are breeding resistance in these bugs as well. And so we don't want this issue to become a major, major problem. In fact, we've done podcasts on antibiotic resistance and the threat that has not just to human health, but planetary health. So definitely something to be taken really seriously as well. So developing a comprehensive, evidence-based toolkit to prevent urinary tract infections, whether or not you want to include cranberries in that or not, I think is of the utmost importance. And the main strategies that you may have heard from clinicians, or your general practitioner, or your practice nurse, whoever it might be, include drinking plenty of water. So this is prevention of urinary tract infections. Number one, drinking plenty of water. This way, you're keeping the bladder tissue hydrated and healthy. Your hydration status is very important generally, not just for reducing the likelihood of infections, but also cognition. There's a whole host of benefits of obviously keeping hydrated, but drinking plenty of fluids is definitely something to to focus on. We also talked about ensuring hydration from the perspective of preventing renal stones. There are some bugs that can actually precipitate renal stones as well. So ensuring that you're drinking plenty of fluids is not just great for preventing urinary tract infections, but potentially, but definitely reducing the risk of kidney stones, also known as renal calculi. Number two, emptying your bladder often. I know it sounds obvious, but as we'll get to in a second when we talk about the mechanism of why bugs can actually cause infections in the first place, if you are keeping your bladder full and you're not expelling urine from your bladder, any potential bugs that you do have in your bladder have more of a chance to stick to the walls of your bladder and cause an infection. So it can create a stronghold, a mini fort that can grow, and that's where you get a stronghold of infection. So emptying your bladder often, super important. A couple of other things, urinating straight after sex. That way, instead of having the introduction of bugs that is likely to happen from the outside to the inside into your bladder during sex, having urination afterwards is certainly something that can push out any bugs and ensure that you're not having them hanging around in the bladder for an extended period of time. Wiping front to back for obvious reasons, you're keeping any bugs that are coming from your digestive tract away from the outside of the genitalia where it can travel into the bladder. There are some birth control products that can be problematic for urinary tract infections, things like diaphragms, for example, or barrier methods of contraception. So particularly for people who are having recurrent UTIs, this is something to consider changing or at least being quite strict with when it comes to hygiene. Obviously, you want to ensure that you have the most comfortable and effective birth control product that is most convenient for you. So that should probably take paramount. Depending on how problematic the issue is, it is something that I would consider changing or at least being a lot more hygienic around as well. Another thing, do not use irritating feminine hygiene products. Not only are they irritating to the skin and the genitalia, they're also irritating to me because they have absolutely no use whatsoever. And I'm talking about the sprays, the deodorants, the specialized washes. All these things can disrupt the normal flora, the normal microbes that live in harmony and actually protect your genitalia and actually protect the likelihood of, protect you from the likelihood of having a urinary tract infection from bugs traveling into the bladder from your external skin, for example. Don't use those products. They're not good for you. They're not, they're more of a marketing tool. So I'd be really cautious about using any of those. There may be a role for probiotics and low sugar diets. However, those have not been shown in randomized control trials. So that's drinking plenty of fluids, emptying your bladder, urinating after sex, wiping front to back, birth control products, considering using different ones. Please don't use feminine hygiene products. And there is a potential role for probiotics and low sugar diets. However, as of 2023, we can potentially add cranberries to this list as well. So first off, what are cranberries? Cranberries are these small sort of creeping plants, also referred to as dwarf shrubs that produce these tart red fruits from late September that always remind me of Christmas. We always have cranberry sauce at Christmas time as many people do. There are two main types. There's the large American cranberry, of course it had to be American. The official Latin name for that is Vaccinium macrocarpon, which is native to the northern part of the USA. You'll find them planted in British Columbia and Canada, but also you do find them in European farms as well these days. And the other one is the small European cranberry, also known as Vaccinium oxycoccus, and it's harvested in the wild more and more distributed along the northern hemisphere. Most of the studies that we're actually talking about and most of the products, I believe, use the American cranberry. So we have to take a little bit of creative license when we're talking about the studies today because they're mainly talking about the American cranberry variety. I don't have any information about if there is a significant difference between the two. We can assume there isn't, but just to be completely transparent, whilst both of them have been studied, only a few studies are actually focused on the European type. So we're going to be using the American for the rest of our conversation essentially. Traditionally, like I said at the top of this pod, cranberries were used as medicines by Native Americans and in some parts of Asia and Europe as well, to prevent and cure various illnesses. And they range from bladder problems, so this has always been known to have some bladder impact, whether that is shown in the evidence or not that we'll come to discuss, and maintaining the digestive system as well. How effective those are for gut dysbiosis or IBS, we're not going to talk about today. We're just going to focus on urinary issues. And over the past couple of decades, various groups of researchers from, not just Europe, but also America and Asia as well, have explored these reported benefits. What makes cranberries so special, both the American and European varieties, they're a source of lots of different nutrients. So the ones that you would typically associate with fruits and berries would be vitamin C, vitamin E, but these also have phenolic acids and anthocyanins, which are particularly important to the prevention of bugs as we'll discuss. They also have many other phytochemicals that are useful for your body as well. But we're going to focus on these phenolic acids, these anthocyanins. What makes cranberries in particular stand out to researchers is this content of something called A-type proanthocyanidins. That's A-type proanthocyanidins. And for the purposes of the podcast and for the fact that I don't want to keep on saying A-type proanthocyanidins, we're going to call them PACs, and that's actually what they're abbreviated to, PACS, and you'll actually see PACs on the front of cranberry-based products because they're referring to this particular polyphenol. As a refresher, proanthocyanidins, I'll say that one more time, are a specific type of plant compound called polyphenols that give the fruit or flowers their dark red, blue, purple colours. And you'll find them in lots of different products and plants. So teas, for example, grapes, bilberry, which is quite a tart, another tart sort of berry, even peanut skins, along with lots of other polyphenols. So this isn't just one element that could be responsible for the potential preventative effects, but there are a collection of other polyphenols and other phytochemicals. But it is the most interesting, at least as far as researchers are concerned anyway. As it relates to urinary tract infections, let's talk about the potential mechanism of action that cranberries have on preventing these infections in the bladder. As we mentioned, urinary tract infections are caused by bacterial colonization of the urinary tract. The most common bug is something called E. coli that most people have heard about, and the prevalence of E. coli causing urinary tract infections ranges from 70 to 90%. It's most of the time whenever we get sensitivity and specificities back from a urinary culture, E. coli is the one that I tend to see. But there are other causative pathogens that cause the corresponding inflammation and the issues and the symptoms associated with urinary tract infections. There's Klebsiella, there's Enterococcus. It does differ according to geography and also the exposure as well. So if people are having urinary tract infections because they have an indwelling catheter, there are some other bugs that they are uniquely susceptible to and that as a clinician, we need to be more aware of as well. But in general, as we're talking about uncomplicated urinary tract infections, E. coli appears to be the most common organism that's causative. And what happens is that these bugs attach to the bladder walls and they create this little fort that I mentioned earlier, and that allows them to grow. The first mechanism that I want to talk about in terms of the three main things is this anti-adherence effect. So this is what cranberries and their derived compounds could be exhibiting, this anti-adhesive capacity against bugs like E. coli that has been exhibited in cell cultures. This is suggested to be the main mechanism behind the implied preventative effects of cranberry consumption and the cranberry byproducts. The reason why I'm saying cranberry byproducts will become clear in a second. And it's important because of what I just mentioned, the adhesion of bacteria. It's sort of like these bacteria are like little Spider-Men and they stick to the walls. So what you want to be doing is pulling Spider-Man off the epithelial lining of the of the bladder. And these compounds in cranberries could interfere with this attachment of bacteria to the epithelial cells of the urinary tract, preventing the colonization and the progression of urinary tract infections. So this is all to say, in other words, if bacteria are unable to adhere to cells, they can't grow and they can't cause that infection, or at least they can't grow as effectively and cause that significant infection as well. The compounds that do this are have been investigated by researchers and this is why PACs, the A-type proanthocyanidins, I'm going to keep on saying this, I know, that we mentioned earlier, these are the compounds that seem to exhibit this anti-adhesive effect. But there are studies that suggest that the concentrations that these PACs have been used in weren't shown to be that high in the urine either. So there might be some other compounds that are involved in this anti-adhesive effect that are detected in the urine after the consumption of cranberries. So it's probably, it's unlikely in biology and this whole subject of food as medicine, it's unlikely down to a single player. It's unlikely down to a single phytochemical, nutrient or whatever it might be, which is why I'm not a fan of individual supplements and I'm more a fan of whole food supplementation. You've seen me do a YouTube video on that before. These cranberries, like many berries, contain many phenolic compounds with complex metabolism. So you might be consuming the PACs, these A-type proanthocyanidins, but what you're getting is a lot more than the sum of that individual compound as a result of digestion. And when you consume these and digestion occurs via your microbes, via your digestive tract, multiple metabolites are created. And we'll talk about that in the next section after this. In fact, 60 phenolic metabolites have been identified in the plasma and urine after consumption of cranberries. So you have this collection of different compounds that could potentially be causing this anti-adhesive effect. And these different metabolites are likely to have additive and synergistic effects. Fancy word for saying the sum of those metabolites together is most likely going to have a much bigger impact than if you're just taking, you know, a single compound in isolation, which is generally how these research studies are done. They look at a single element, a single compound, they look at it in cell culture, they make an attestation as to, you know, whether this is having a positive effect or not. But in reality, when you're consuming this via food or via a supplement, your microbes are digesting it and creating multiple metabolites. So actually, in that individual cell culture, you're missing the milieu of other compounds that are actually engineering this effect that we see in the larger studies. So that's just an aside, the anti-adhesive effects of PACs and other compounds are likely to have a preventative impact on urinary tract infections. Number two, it's also been hypothesized, like I said, that the gut microbiota is involved in metabolizing these cranberry polyphenols into multiple different bioactive metabolites. And these polyphenols in cranberries that are metabolized by the gut microbiota give rise to compounds that don't just elicit an anti-adhesive effect, but they also have direct antimicrobial and anti-inflammatory effects as well. So you could also be having like almost mini antibiotics that are being created by the collection of compounds that are created as a result of gut microbiota digestion. It's a little bit complicated to get your head around in the initial instances, but once you understand, you consume something, by process of digestion, multiple compounds are created. Some of them remove the adherence effect of bacteria, some of them actually impact the bacteria directly, others reduce the inflammation, which means that they can't cause the same cascade of factors that lead to growth of that of that bacteria. It's astounding just how many effects that this one product can potentially have. And the potential, this potential mechanism is also interesting when it comes to understanding the differences in responses between people. So whether or not someone benefits from actually consuming cranberries, either as a juice or in a supplement form for preventing urinary tract infections, might be attributed to their unique intestinal microbiota composition. So for example, if you have a very diverse gut micro population, let's say, you may have an advantage of better metabolizing these PACs, these A-type proanthocyanidins into more metabolites that have these effects on UTI prevention. So the takeaway from this little section is to limit the takeaways because we know that that has additives and fillers and the processing is net harmful to your gut microbes and actually invest in a rainbow diet that adds to the diversity of the microbes and actually creates a thriving population that could generate some more of the benefits from the foods that you do consume. So the gut microbiota is a very interesting area in general, but particularly from the how cranberries can potentiate their potential prevention effects. And the third mechanism is more symptom related rather than having a direct impact on bugs and prevention. So when it comes to urinary tract infection related symptoms, it's suggested that cranberries could also decrease symptoms by suppressing inflammatory cascades. So the typical symptoms that most people complain of when they are suffering with a urinary tract infection are abdominal cramping, pain, tingling or burning when passing urine. If it progresses into what we call a pyelonephritis or a kidney infection, those have a different constellation of symptoms where you're more likely to get things like fever. But urinary tract related symptoms could be improved by reducing inflammation and cranberries could essentially do that. So those are the three potential benefits. You've got less adhesion, so preventing the bacteria from sticking. Number two, gut creating, the gut microbiota creating multiple bioactives that directly impact the bugs. And then you've got the third thing which is more about symptom control, reducing inflammation to improve those common symptoms. These precise mechanisms are still not fully elucidated, but there is some mechanistic data, the ones I've referred to, that support this idea that consumption of cranberries might reduce the incidence of urinary tract infections. And so how we would look at that further is by looking at larger human-based studies to see if these hypotheses are supported. So the big studies and the big study that kind of piqued our interest over here at the Doctor's Kitchen in this area was a big recent update of a review published by Cochrane. So Cochrane, if you don't know, is a reputable source of meta-analysis on human health issues. It's not without its downfalls and issues and controversy, but they are essentially one of the largest organizations that pull together these big, big meta-analyses of studies, and they've looked at cranberries for preventing UTIs. In fact, this is the fifth update since the first publication in 1998, and today's looks at 50 randomized control trials involving over 8,000 people. And the trials compared the occurrence of urinary tract infections in people taking a cranberry product with those taking a placebo, no treatment, or even other treatments such as antibiotics and probiotics. And they found, looking at these, this large collection of studies, that taking cranberries as a juice, tablets, or capsules reduced the number of urinary tract infections in women with recurrent UTIs, in children with UTIs, and people susceptible to UTIs, which is a pretty strong finding on the face of it, on the face of it. But this wasn't the case for elderly people living in an institution, pregnant women, or people with bladder emptying problems. So where you have more complicated reasons as to why someone might be having urinary tract infections, cranberries didn't appear to have as much or any effect. But those in women with recurrent UTIs, children, it appears to have a preventative effect. Compared to other treatments, they did not find enough information to determine whether cranberry products are more or less effective compared with antibiotics or probiotics in preventing urinary tract infections. So more information is needed in that respect. And just as a reminder, in some more severe cases, those suffering with chronic recurrent UTIs, we do offer low-dose antibiotics for an extended period of time that could be months. And that's what they were comparing with with regards to prevention. This is an important finding that provides a lot more clarity to this long debate that I've had with patients and colleagues about whether cranberries are useful for preventing urinary tract infections. And it's something that I'm asked about a lot. Before that, the results were mixed. So the fact that this Cochrane review has shown a benefit compared to the last review that was in 2012 where it didn't show a benefit has added a little bit more gusto to the argument that is pro-cranberry products. Okay, why would there be a change in the last 10 years? So the main reasons are that we've got more recent trials that were more available that weren't previously analyzed. So this is a more up-to-date meta-analysis. Over time, the research has improved in terms of the consistency of how cranberry is consumed. They might be even using higher doses. I didn't actually look into whether the doses between 2012, the last Cochrane review, and today's review or this year's review has changed, but maybe they found a more effective dose. Another complicated issue that is hard to disentangle is the murky influence of industry and funded trials. This review specifically looked for industry influences and found no difference between the results for clinical trials that are supported by commercial organizations like cranberry supplement producers that funded the trials, compared to non-profit academic institutions that paid for their own cranberry products. But it is something that you have to pay attention to whenever you're evaluating the evidence. You always have to be careful with these sort of areas. And I see this quite often in probiotic supplements. So whenever you see, you know, 85% of people found this product improved their XX symptoms or whatever it might be, usually that is a funded trial, particularly if it's on the front of their packaging because they have rights to use that. And it's very easy to cherry-pick data or create a trial that is going to improve your chances of having a positive marketable result. So it's just something that you as a consumer need to be quite aware of. And so this is again, another sort of layer behind the cranberry story as to whether it is useful or not. You just have to be aware of these industry influences. In terms of official guidelines and recommendations, what they're saying is that cranberry, you can actually find in guidelines and in national information brochures for patients these days as a suggestion for prevention. And actually, the European Association of Urology recommends regular consumption of cranberries for UTI prevention. Um, despite the weak evidence that they are aware of, they have a favourable benefit to harm ratio. And I love that that term, this favourable benefit to harm ratio. Whenever I prescribe a pharmaceutical drug, I have to be uniquely aware of the benefits and harms of that drug. When we're dealing with food, as a rule of thumb, it appears to be a lot better in terms of those ratios. So the likelihood that this is going to provide benefit versus the likelihood that this is going to provide harm is much more favourable in my opinion when you're using whole food-based supplements. Where that gets a little bit difficult is where you're extracting a specific polyphenol in this case and putting that in a very high physiological, high dose that you wouldn't find in natural amounts in the product. That's where it veers more towards a drug. And this is where I exercise a lot more caution. So the outstanding questions, I guess, are what are the effects of cranberry for treatment? So we've specifically been looking at urinary tract infection prevention. The review that we looked at didn't look at the use of cranberry for the treatment of urinary tract infections, but rather preventing their occurrence. So that hasn't been investigated, and I would imagine it's probably not going to be as effective as the antibiotics that we have clear use cases for. So I wouldn't even consider that myself. I don't think it would even pass ethics, but it's some pending questions that haven't had the answers to. And the second area is the most frustrating, and that's around doses and formulations. What is still unclear is the formulation and dosage of cranberry products because the review didn't specifically reach a conclusion as to the efficacy differentials between cranberry juice or tablets, which is a raging debate, and about the different doses around the tablets and the extracts. So the certainty of the evidence is quite low. There's there's a lot of research to to evolve. And this is the key question that I think most people will be asking right now and ask me as well. What form and what dose should I take? Is it going to be powdered, freeze-dried, fresh, juiced, etc? And there is no clear evidence regarding the appropriate form, dose, and duration, which is so frustrating. It's the first thing I'd want to know. And thus, I have actually, in looking into this, I actually have concerns about the validity of the entire conclusion, if I'm being really honest, because when you dive a little bit deeper behind the headline, you realize that there is a ton of heterogeneity. So the doses that we are aware of, this is pretty laughable. Most of the studies looked at juice or capsules/tablets. So the 19 studies that used cranberry juice, only cranberry juice, the volumes of cranberry juice ranged from 30 mils, so a small little shot of cranberry juice, to a litre, which is a huge amount. And being a lot more accurate about it, the differences in mils per kilogram ranged from 0.2 mils per kilogram. So I'm a, let's say 70 kilo gentleman, 0.2 mils would be around two mils, no, sorry, 20 mils. And it ranged up to 5 mils. So 5 mils per kilogram for a 70 kilo person is around 350. So there is a lot of heterogeneity, which makes me a little bit nervous about the conclusions of the cranberry juice studies and the studies overall. Of the 30 other trials that evaluated the effectiveness of cranberry tablets, capsules or powder, the doses ranged from one tablet a day to four tablets a day with the doses being 250 milligram powder up to 8 grams. So that is a 32 times difference in the dosage forms. There are some studies specifically looking at PAC content, so that's the proanthocyanidins content, and that ranged from 1.4 milligrams to 240 milligrams per day. So again, another hugely variable dosage. It's strange. I mean, I think if we had a bit more time, we would look specifically at the higher dosed cranberry products to see if that had more or a negligible effect on the likelihood of there being a positive impact of the intervention, i.e. preventing more urinary tract infections. But we haven't managed to dive into that deeper. So in the meantime, my take is, juice, there are pros and cons, capsules, there are also pros and cons as well. The pros of juice are that you have a whole cranberry product minus the fibre. So you're getting a lot of the polyphenols that are going to be concentrated rather than just taking a supplement of a specific polyphenol. Those compounds are likely to have additive and synergistic effects. Cranberry juice is quite nice to drink. But the cons are that you are not having any fibre and that can increase the natural sugar content that goes straight into your bloodstream. And if you're having, you know, 300 mils to a litre every single day, that's a huge amount of sugar to be taking, you know, no matter how tart cranberries are. So that would be my concern with the juice. Capsules, the pros, easy to take, very accessible, cons, cost and quality. Those are the two things I always think about whenever, you know, suggesting a supplement, particularly something that you'd be taking every single day as well. Overall, you know, my take home is these data show that cranberries might be useful, particularly if you experience recurrent UTIs and you're optimizing other areas of your life. If you're susceptible and you're having multiple urinary tract infections, combined with those other measures that we talked about at the top of this podcast, drinking water, ensuring you're wiping the right way, etc, etc. Cranberries could be an important and additive preventative tool to reduce the need for antibiotics. So I'm a fan of cranberries, I would say, even, you know, the heterogeneity of the studies and the how hard it is to get the accurate doses. I am a big fan of cranberries. In terms of treatment, the evidence is insufficient as I've as I've recommended. And you know, in terms of my own practice, recommending cranberry products alongside initial treatment with antibiotics, you know, to offer as a backup preventative tool is something that I think is a relatively reasonable thing for doctors to suggest. But you do have to make sure you go and speak to your doctor if you do have any urinary tract infection symptoms. I would not try and treat with cranberry products alone. You know, if left untreated, like unfortunately I've seen many times in A&E and in general practice, it can lead to worsening infections, that infection can travel to other areas of your body, kidneys, most likely, they can scar, can damage the organ, it can even lead to end-stage kidney disease as well. So untreated or recurrent urinary tract infections are no small task. I would say, you know, whole cranberries, they do have a low amount of sugar. If you're juicing them, you're going to have too much of that high natural sugar, particularly in the high amounts that they're suggesting. So I'd be careful of that. When they're dried, sometimes they do have sugar added to them because they are quite tart. And I've seen that quite a lot in America. And generally, when you see cranberries that are dried, they have added sugar because they are quite tart. They're very similar to barberry or bilberry. There are some sour plums that you get in Chinese cuisine as well. So similar in terms of the tartness. I'm not too sure about the polyphenol content of those other berries. So be wary of those sugary products. The fruit juices, the cranberry juices that I'm aware of, tend to be quite processed as well. Doing a quick search of them, I'd avoid the processed cranberry drinks that usually have cranberry extract mixed in with sugar and other liquids to create a homogenized cranberry-like product. It would be best to just stick with a singular serving of pure cranberry juice if you are going to go for cranberry juice with no added sugar. Capsules, I think is probably the cranberry product of choice. And I would look for something that is independently tested and certified. Some of them specifically mention 240 milligrams of PACs, which I think is a great smart marketing tool because you are literally pointing to the highest amounts of PACs that were shown in the studies that we've been talking about. Whether these are verified and whether these are independently lab tested is quite hard to ascertain, because you'd want someone that is independently verifying that this is a whole cranberry product. If possible, I would go for the whole cranberry product rather than PACs alone as well. So overall, I think it's low risk as well if you specifically if you do have recurrent urinary tract infections. I really don't think there's much for you to lose. And if you can get hold of a cranberry powder, rather than those specific polyphenols that I mentioned, that's probably one to go for. Another sort of follow-up question that I imagine people have is, what about blueberry powder? What about haskap berry powder? There's all these different berries that are grown in similar areas to where you get cranberries, harsh conditions, places like northern hemisphere climates, Canada, parts of Europe, wild berries. You know, what about those? Do they have the same effects? There is some interesting evidence, not to the same quality and magnitude that we've seen cranberries. Cranberries have uniquely captured the attention of researchers, perhaps because of their traditional uses. But it's not the only product that has an association with urinary tract infection. Some that are being investigated include lingonberries. So lingonberries are a staple in Swedish cuisine. They're small, red, tart berries. You usually find them served with meatballs in IKEA, very delicious, very tart, like I said. Those have been studied and there are some positive effects, but not a major amount. Vitamin C, D-mannose, potassium and salt supplements, probiotics, like I mentioned, varying degrees of efficacy. I think it really depends on the individual and the probiotic strain. Probiotic is a big, big umbrella term. It's almost like me just saying, you know, supplements. That's how broad a term probiotics is. There is an interesting one, I probably picked up on it more because of the interesting name. It's called Uva Ursi, or maybe it's Uva Ursi, that's spelled U V A U R S I. It's a shrub with orange berries. So again, you're seeing a theme here. So whether or not berries in general have these benefits because of the polyphenols that they contain, and whether it is even PACs or not, or whether it's, you know, another polyphenol, it's hard to tell. But dehydrated berries probably one to look out for. There are also some suggestions around cinnamon and diuretic botanicals like asparagus. Whether or not that's because of the diuretic effect, i.e. it gets you to go to the toilet more often, expel water from your bladder, so you're constantly urged to go to the toilet. You could probably just do that yourself just reminding yourself to go to the bathroom and drink plenty of water. It's hard to ascertain that. So I would check out those different sources. We've put loads of sources in the Doctor's Kitchen show notes page as well. I'd speak to your practitioner and see whether this is relevant for you. With any supplements, particularly ones that are supplementing an individual polyphenol, you do have to speak to your practitioner to see if you do have any interactions with any drugs that you might be taking. Do remember the lifestyle factors and other preventative issues. And remember from the perspective of avoiding antibiotic resistance, we definitely need to limit our antibiotic use. So anything that prevents urinary tract infections with a good benefit to harm ratio, I'm a fan of, and hence why I think cranberries could be a product that you might want to entertain if you have urinary tract infections or urinary symptoms. Whether or not this works for other bladder related issues like cystitis, which is a common issue, it's again, hard to ascertain, there hasn't been too much research on that. But you know what, worth a try, given the inflammatory cascade effects, a whole cranberry powdered product might be something to to use. I doubt many people are going to be eating cranberries whole every single day, which is why a whole cranberry-based product is probably going to be better from a compliance point of view as well. And the reason why I say whole cranberry product is because you might get that entourage effect of all those other polyphenols that act synergistically to have those impacts on your gut microbiota, on inflammation and the anti-adhesive effects and the other effects that it might be having directly on certain types of bacteria, microbes that are causing urinary tract infections. I really hope you enjoyed that little dive into cranberries and urinary tract infections. If you dig this, let us know on Twitter, and I will see you here next time.
