Cranberry products, including juice and supplements, decrease the incidence of certain bacterial infections. There is an abundance of clinical evidence that supports this concept in the case of urinary tract infections in some people. Further study should be able to establish a precise and systematic approach to using cranberry products in the prevention of urinary tract infections and decreasing the overall incidence of this problem in the population. In addition, cranberry products may decrease the extent of infections by Helicobacter pylori, the bacterial species that causes gastric ulcers, as well as bacterial infections associated with plaque formation on teeth. Finally, preliminary observations suggest that cranberry may have cardio-protective and anticancer properties.

1. NMR News: Volume 3, Issue 4, April 2010
THE NEW AGE OF
CRANBERRIES:
Extraordinary
condition-specific
benefits in a
centuries-old fruit
By: Charles Spielholz, Ph.D.
T
he cranberry fruit comes from a fruit is generally processed into juice, sauce
plant that is an evergreen dwarf or dried fruit; only a small amount of the
shrub or trailing vine. Cranberries cranberry crop is sold as fresh fruit. Almost
are related to the bilberry (see the March all processed cranberry products contain
2010 article on bilberry), blueberry and added sugar or another fruit juice product
huckleberry. Represented by several species because cranberry is generally considered to
of Vaccinium, the cranberry grows in the be too “sharp” or “tart” for the palate.
cooler climates of the Northern Hemisphere. Therefore, cranberry juice is generally
Cranberries are cultivated both in the available as a cocktail mixed with another,
United States and Canada. The cultivated
1

2. NMR News: Volume 3, Issue 4, April 2010
sweeter juice in order to cover the “sharp” magnesium, sodium, phosphorus,
or “tart” taste of cranberry. potassium, flavonoids (including
anthocyanin, peonidin, and quercetin) and
Cranberry products have been
tannins. However cranberries are not
associated with a variety of health benefits.
considered palatable by most individuals
In addition to nutritional benefits, cranberry
and are not generally eaten as a fruit.
has been associated with a decrease in
Processed cranberries are often mixed with
urinary tract infections, ulcers, and dental
sugar; added sugar decreases the nutritional
plaques. In addition,
significance of processed
there are some
cranberry products for many
suggestions that
people.
cranberry may have
benefits related to There have been
kidney stones and multiple observations showing
cardiovascular health as that cranberry (generally the
well as possible species Vaccinium macrocarpon)
anticancer properties. either as a juice or as a
Each of these claims is reviewed. supplement, decreases the incidence of
urinary tract infections in women under
Nutritionally, cranberry contains
certain conditions. Thus far, the best
vitamin A (including related molecules
evidence supports the idea that cranberry
carotene, leutein, and zeaxanthin), vitamin
juice or supplements help prevent urinary
C and K, dietary fiber, manganese, calcium,
2

3. NMR News: Volume 3, Issue 4, April 2010
tract infections in otherwise healthy women cranberry decreases the ability of certain
(1-13). However, there is little evidence that types of bacteria and yeast to adhere to
cranberry is useful for the treatment of uroepithelial cells. In the case of bacteria, it
urinary tract infections. This means that appears that cranberry causes changes in
cranberry products might be a good, non- bacterial fimbriae. Cranberry also appears to
pharmaceutical method of decreasing the contain polyphenols and tannins that play
chances of urinary tract infections and may an antibacterial role. Mechanism evidence of
be particularly useful for people who are this type further supports the clinical
prone to such infections. Please note that observations that cranberry products are
individuals must seek the advice of a useful for the prevention of urinary tract
physician for the treatment of a urinary tract infections.
infection: The data shows that cranberry
Although the evidence that cranberry
products can be useful as a preventative of
is helpful in preventing urinary tract
urinary tract infections, not a treatment for
infections is strong, this evidence needs to
an active infection.
be refined. Clinical trials are needed to
Efficacy of cranberry products in the determine the best dose, duration, frequency
prevention of urinary tract infections has of use, mode of administration, and patient
been supported by data indicating a base. Cranberry does not appear to be
mechanism of action of cranberry against associated with significant adverse effects
bacteria (1, 6, 7, 9, 14-17). Experimental data (discussed below). The patient best suited
and clinical observations indicate that for using cranberry products to prevent
3

4. NMR News: Volume 3, Issue 4, April 2010
urinary tract infections also needs to be Use of cranberry juice in
firmly established. Currently, available data clinical trials for urinary
indicates that women in reasonably good tract infection have suffered from large
health with a history of recurrent urinary patient drop-out rates; this large drop-out
tract infections or whose lifestyle puts them rate may be due to the caloric content of the
at risk for urinary tract infections appear to cranberry product or the "sharp" or "tart"
be the best candidates for using cranberry as taste in unsweetened cranberry products.
a preventive measure. Data for use of
Research also indicates that cranberry
cranberry in the prevention of urinary tract
may be effective at inhibiting the adhesion
infections in women with health issues,
of Helicobacter pylori to gastric mucus and
men, and children are much more
epithelial cells and may suppress this
preliminary and require more investigation.
bacterial species in the human digestive
Cranberry, as a well known food product, is
tract (18-22). In a randomized, double-blind,
generally recognized as safe; adverse effects
placebo controlled, clinical trial, cranberry
are not expected to be a major issue (see
juice was shown to significantly decrease
discussion below). Finally, since most
the extent of Helicobacter pylori in patients
cranberry products contain added sugar in
with such infections (19). This result
order to make the product palatable, it may
indicates that drinking cranberry juice may
be best to use cranberry as a concentrated
be helpful to people with such infections.
supplement without added sugar. Indeed, it
Furthermore, it can be proposed that use of
may be possible to gain greater patient
cranberry products may be able to decrease
compliance with a cranberry supplement.
4

5. NMR News: Volume 3, Issue 4, April 2010
the incidence of gastric ulcers. Of course, the the sugar content. If successful, research
answer to this hypothesis can only be along these lines will center either on
determined by a clinical trial in which the cranberry supplements that do not contain
incidence of gastric ulcers of users of sugar or on active chemical constituents
cranberry products is directly tested. found in cranberry.
Since cranberry is active against There have been at least two reports
certain types of bacteria, preliminary in the medical literature suggesting that
research into the effects of cranberry on consumption of cranberry juice may be
bacteria that cause dental plaque have been useful for decreasing the incidence of
performed. Preliminary research indicates kidney stone formation (26, 27). Results
that cranberry juice or cranberry from these two reports indicated that
constituents inhibit the attachment of oral consumption of cranberry juice increased
bacterial species to model dental surfaces the acidity of urine, decreased the excretion
used in the laboratory (21-25). One of the of oxalate and phosphate, and increased the
studies also showed that dental caries were excretion of citrate. The authors of these two
reduced in laboratory rats treated with reports considered these changes to indicate
flavonoids found in cranberry (25). This a role for the consumption of cranberry juice
work has not yet been extended to humans. in the management of urolithiasis (kidney
Cranberry juice itself as well as other stones). However, these two reports must be
commercial cranberry products will not balanced against a report that indicates that
make useful dental health aids because of cranberry concentrate tablets (as opposed to
5

6. NMR News: Volume 3, Issue 4, April 2010
cranberry juice) increases the risk of For the case of cardio-protective
nephrolitiasis (the condition of having effects, it is hypothesized that the
kidney stones) because of the oxalate phytochemical composition of cranberries
content of cranberry (28). Clearly, no can help decrease atherosclerosis, inhibit the
recommendation can be made with regard oxidation of low density lipoprotein (LDL),
to cranberry products and kidney stones inhibit platelet aggregation and adhesion,
until additional research is performed. decrease total and LDL-cholesterol, decrease
blood pressure and decrease inflammation
Cranberry products have also been
(30-32). However, no recommendations can
associated with cardio-protective effects and
be made regarding the use of cranberries in
anticancer properties (29-39). These
cardiovascular health at this time since there
potential attributes are believed to be due to
is not enough evidence to support such a
the phytochemical content of cranberries, in
view; this work is too preliminary at this
particular the content of flavonoids, which
point.
appear to be high in antioxidant activity,
and hydroxycinnamic Anticancer properties of cranberries
acid. Two classes of are associated with phytochemicals that
flavonoids of particular appear to reduce cell and tissue damage
interest are the from oxidative stress (32, 34). However, the
anthocynanins and only experiments performed thus far have
proanthocyanidins. been in cultured tumor cell lines (35-39).
Proposed mechanisms of action for these
6

7. NMR News: Volume 3, Issue 4, April 2010
phytochemicals include an increased rate of literature indicates that cranberries are safe
programmed cell death (apoptosis) of tumor even for pregnant and nursing women (40).
cells maintained in laboratory culture (35, There was one report linking the use of
36), decreases in the activity of enzymes cranberry juice with a death in a person
required by the cultured tumor cells for taking the blood thinner warfarin (41). That
cellular functions (35), anti-inflammatory report concluded that people taking
properties (36, 37), decreases in the activity warfarin should exercise caution with the
of proteins associated with the development use of cranberry products. However, the
and progression of tumor cells (35, 36) as results of a randomized clinical trial
well as decreases in angiogenesis (39). indicated that cranberry juice did not
However, it is important to note that these interfere with the pharmacokinetics of
laboratory studies and proposed warfarin (42). Individuals using
mechanisms of action have not been pharmaceuticals should speak with a health
correlated with clinical or epidemiological care provider before using a supplement
studies. Therefore, no recommendations can form of cranberries.
be made regarding cranberries and a role in
Evidence shows that cranberry
cancer prevention at this time.
products, including juice and supplements,
Cranberries are not associated with provide a means of preventing urinary tract
any significant adverse effects. Since they infections in certain individuals. Additional
are a food item, cranberries are accepted as clinical trials will establish the exact
being generally safe. In fact, a review of the conditions of using these products
7

8. NMR News: Volume 3, Issue 4, April 2010
effectively. For some people, the use of 7) Jepson RG, Craig JC. 2007. A systematic review of the
evidence for cranberries and blueberries in UTI prevention.
cranberry products as a preventative Mol Nutr Food Res.51:738-745.
measure could decrease the incidence of 8) Santillo VM, Lowe FC. 2007. Cranberry juice for the
prevention and treatment of urinary tract infections. Drugs
urinary tract infections and avoid the need Today (Barc). 43:47-54.
of antibiotics required for treatment. 9) Nowack R. 2007. Cranberry juice-- a well-characterized
folk-remedy against bacterial urinary tract infection. Wien
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of cranberry juice: a double-blind randomized placebo- 23) Yamanaka A, Kouchi T, Kasai K, Kato T, Ishihara K,
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