The Agony of Cranberry
For anyone struggling with urinary symptoms (frequency, urgency, pressure and/or pain), the first suggestion they often hear from well meaning family members and friends is to drink cranberry juice. And, perhaps for a patient struggling with recurring UTI’s, cranberry may have some benefit (more on that later) but for the interstitial cystitis patient, cranberry products can produce agonizing symptoms.
Many patients with interstitial cystitis struggle with an abraded bladder wall and/or deeper lesions. Products high in acid, such as cranberry juice, scour those wounds and cause more irritation. Known as the “acid bomb” in the IC community, several diet research studies have confirmed this universal truth, cranberry products trigger IC flares.
I’m one of those patients. In my first year of symptoms before my diagnosis, I drank a quart of cranberry juice a day. I still remember bringing bottles to my office and working diligently to drain them. And, by the end of that year, my symptoms had worsened dramatically. I couldn’t sleep through the night. I struggled with terrible urinary frequency and urgency. I was barely able to work and often crying in pain.
The women in my family had relied on cranberry over the years. It was the first thing we turned to when we felt any funky bladder symptoms. We each drank it almost every day. We were Ocean Spray’s dream customers.
Yet, despite the juice, my bladder symptoms spiraled out of control. My urologist never found infection and very quickly suspected that IC was the cause. Eventually, a support group leader taught me about the IC diet. She advised me to avoid drinks high in acid, including coffees, teas, sodas, orange juice and cranberry juice. While I’d love to say that the effect was immediate, I believe that my year of cranberry created far more damage to my bladder and it took months on the IC diet before my symptoms calmed down. I haven’t had a glass since.
Twenty three years later, with thousands of IC diet lists circulating in urology clinics and support groups around the world, I’m amazed by the number of men and women who are still drinking cranberry juice and paying a terrible price for it. Is it the hype? The constant marketing on TV? Old wives tales? It’s certainly good for the cranberry industry. According to a February 2016 report, Americans consume almost 400 million pounds of cranberries per year. Per capita consumption is 2.3 pounds “almost entirely in the form of juice”(1) They have an absolute interest in perpetuating the myth that cranberry juice is good for bladder health .. but is that true?
Does Cranberry Juice Really Help?
Cranberry contains an ingredient called proanthocyanidins (PACS) that can prevent bacteria from attaching to the bladder wall. The problem? According to Dr. Timothy Boone (Texas A&M Health Science Center), “cranberry juice, especially the juice concentrates you find at a grocery store will not treat a UTI… the active ingredient in cranberry is long-gone by the time it reaches your bladder.” (2) He continued “It takes an extremely large concentration of cranberry to prevent bacterial adhesion. This amount of concentration is not found in the juices we drink. There’s a possibility that it was strong back in our grandparents’ day, but definitely not in modern time.” The likely benefit of drinking cranberry juice is that it may help to flush bacteria from the bladder but drinking water can do exactly the same thing without the excess sugar and acid found in juice.
Cranberry capsules, on the other hand, have been shown to lower the risk of UTI’s in some small studies but, again, for the IC patient with a tender bladder, it’s not worth the long term acid induced irritation to our bladder. Remember, our goal is to create an environment that will support bladder healing and tissue repair. Pouring acid on those tender tissues on a daily basis will deter healing.
The Texas A&M study confirms one of the most rigorous reviews of the scientific evidence about cranberry and UTI. A 2012 Cochrane review analyzed 24 research studies that compared cranberry products with other therapies and found no significant evidence that it helped. Some small studies showed minor benefit but large studies did not. They concluded “cranberry juice cannot currently be recommended for the prevention of UTI’s.”(3) They also cast doubt on cranberry capsules noting that the studies and products did not indicate how much active ingredient they contained.
More Sugar Than Coca Cola
Let’s consider another reason why typical cranberry juice products should be avoided. Because typical cranberries aren’t naturally sweet, juices require a lot of sweetener. While the label of Ocean Spray’s Cranberry Juice Cocktail brags that it contains no high fructose corn syrup, make no mistake, this is a high sugar item.
An 8oz glass (1 cup) of Ocean Spray Cranberry Juice Cocktail contains 28 grams of sugar. That’s more than 5 teaspoons. Compare that to an 8oz glass of Coca-Cola, which actually contains LESS sugar at 26 grams. And who just drinks one cup at a time, right? Most people would double that serving on a hot summer day.
It’s also important to note that Ocean Spray Cranberry Blends may also contain more more sugar depending upon the other fruit used. The Ocean Spray 100% Cranberry/Cherry Juice contains 33 grams (over 6 teaspoons) of sugar in just one cup of liquid!
Ocean Spray diet cranberry juice may contain less than 1 gram of sugar but there’s still plenty of reason to avoid it. It uses two artificial sweeteners: sucralose and acesulfame potassium, both of which are hotly debated for their safety though the US FDA considers them safe. It contains three additional acids potentially irritating to a wounded bladder: citric acid, fumaric acid and ascorbic acid. It also contains Red 40, an artificial coloring.
Did They Drink Large Amounts of Juice 100 Years Ago?
Just one hundred years ago, people were limited by the fruits that grew in their area and generally only consumed them when they were ripe, usually for just a couple of weeks a year. Certainly the rich could afford to pay for imported fruit and perhaps fruit juices in their home but most of the population existed on fruits only when in season. Today’s international marketplace makes fruit and fruit juices both affordable and available year round. Of course, manufacturers drive sales by promoting that fruit juices support health. Yet, beneath the hype we have to ask “Is the human body designed to consume such high levels of sugar and acid?” No. We’re omnivores. For thousands of years, we survived on a diet of meat, vegetables and fruits, rarely consumed out of season. Many would argue that large quantities of fruit juices AND sodas are the strongest contributing factors in the obesity epidemic seen around the world.
I don’t believe that anyone with a compromised, sensitive bladder (i.e. interstitial cystitis, chronic prostatitis, bladder cancer, eosinophilic cystitis, ketamine cystitis, etc.) should be drinking any beverage high in acid, including cranberry juice. Cranberry supplements carry the same acid risk. Decades of patient reports combined with solid research studies support this position.
Most cranberry and other fruit juices in your grocery store are a far cry from pure. If you consider the acids, sweeteners, red dyes, they are an IC flare waiting to happen. The high sugar content is also likely to promote greater inflammation rather than reduce inflammation.(4)
I do believe that our diet should include plenty of fresh fruit and vegetables, IC friendly of course. Whether it be organic apples (Gala or Fuji), pears, blueberries and other fruits you can tolerate, they are best eaten fresh off of a tree in your garden, out of a local orchard or purchased at a farmer’s market where you have a chance to talk with the farmers who grew the fruit. Eating fruit in its natural form just makes the most sense.
One last thing! If you are ever offered cranberry or orange juice in the recovery room after having a hydrodistention, just say NOOOOOOO!! Water is a much more bladder friendly option! – Jill O.
Bladder Friendly UTI Prevention Tips
There is a small percentage of IC patients who do get frequent, recurring UTI. There are some common themes:.
Estrogen is essential to the production of mucus on our vulva, in the vagina, urethra, bladder and mouth. It’s that thick, robust layer of mucus which prevents bacteria from reaching the cells beneath. Whether it be the result of natural aging (i.e. menopause) or hysterectomy, a decline in estrogen triggers a reduction in mucus production thus making the bladder and other tissues far more vulnerable to infection and irritation. Many urologists and gynecologists suggest the use of a vaginal estrogen cream to help strengthen those tissues. Watch our video “The Estrogen Chat”
Why are women so prone to UTI after intimacy? Their barely 2″ long urethra is to blame. It’s much harder for bacteria to travel up the 8″ long urethra in the male penis but in women it’s pretty easy for sex to push bacteria into the bladder. So what can you do about it?
- Take a shower before sex.. make washing each other part of foreplay
- Always empty your bladder after sex to remove any bacteria that may have been pushed into the urethra.
- After sex, take a shower or use a peri-wash bottle to rinse any bacteria from your skin. Some women report that Very Private Body Wash helpful in reducing bacteria on the skin.
Water intake helps flush bad bacteria from the urinary tract. Are you drinking 6 to 8 glasses of water a day? If your urine is dark yellow, orange or brown, you’re dehydrated. Urine should be a pale clear yellow in color. And if you’re urine is clear, you’re drinking too much water. Here’s a handy guide from the Mayo Clinic.
When you consider the complex population of both good and bad bacteria in the human body, one thing is clear. Beneficial bacteria keep pathogenic bad bacteria in check. Using a probiotic to help maintain good bacteria in your gut is becoming more and more essential, particularly as research emerged this summer showing that IC patients are deficient in several important beneficial bacteria in the gut. (DIPP Mystery: Why are IC patients deficient in some good bacteria). Could you be deficient in a bacteria that normally keeps the bad bacteria in check? It’s possible especially if you have a history of antibiotic use. Consider using some probiotics and/or ic-friendly yogurt containing live cultures.
A simple sugar not used by the human body, D-Mannose is immediately excreted via our urine where it can help repel some E. coli infections. Bacteria are covered with tiny sticky arms called fibrin that help them attach to cells. Once attached firmly, bacteria then infect the cell causing infection.
Mannose can bind to cells on the tip of the fimbria (FimH receptor) where it competitively blocks attachment to bladder cells. The bacteria/mannose is then flushed out through urine.
Researchers in England compared the effectiveness of D-Mannose with Microbid in the prevention of recurring UTI in 308 women. The results found that D-Mannose performed as well as Microbid but with significantly fewer side effects.(5) They do, however, suggest that future studies be conducted to determine the exact dosage and regimen for D-Mannose use.
- Cranberries. Agriculture Marketing Resource Center. February 2016 – Accessed 8/25/16
- Does Cranberry Juice Treat A UTI? Texas A&M Press Release . February 9, 2016 – Accessed 8/25/16
- Jepson RG, et al. Cranberries for preventing urinary tract infections. Cochrane Reviews. October 17, 2012
- Daniluk Julie. When food causes you pain. CNN Health. July 20, 2012 – Accessed 8/25/16
- Altarac S, et al. Use of d-mannose in prophylaxis of recurrent urinary tract infections in women. BJUI December 13, 2013 – Free article online