Self Help:
Key nutritional supplements
Other nutritional supplements that may be helpful
- Bromelain (enteric-coated tablets, 400 mg per day for two days): The enzyme bromelain (from pineapple) appears to enhance the effectiveness of antibiotics in people with UTIs. In a double-blind study, 28 individuals with a UTI received antibiotics plus either bromelain or a placebo. Signs of infection resolved in all of those who received bromelain, compared with only 46% of those given placebo. The bromelain used in that study was in the form of enteric-coated tablets. Enteric-coating prevents the stomach juices from partially destroying the bromelain. Most commercially available bromelain products today are not enteric-coated, and it is not known how the potency of these different products compares.
Key herbs
Other herbs that may be helpful
- Cranberry (Vaccinium macrocarpon) (drink 300–500 ml [10–16 oz] of unsweetened or lightly sweetened cranberry juice per day; or take 400 mg of concentrated cranberry extracts twice per day): Modern research has confirmed the benefits of cranberry for the prevention of urinary tract infections. Researchers have suggested two possible ways in which cranberry is effective against UTIs: it prevents E. coli, the bacteria that causes most urinary tract infections, from attaching to the walls of the bladder; and it contains hippuric acid, a compound that has been found to have antibiotic activity.
Note: cranberry is not a substitute for antibiotics in the treatment of acute UTIs.
Dietary changes that may be helpful
- Avoid sugar: When healthy volunteers ingested 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.
- Avoid alcohol: Ingestion of excessive amounts of alcohol has also been shown to suppress the immune system.
- Reduce dietary fat: Reducing the intake of dietary fat stimulates immunity.
- Allergies: People who have recurrent or chronic infections should discuss with a doctor the possible role of allergies. Chronic infections have been linked to allergies in many reports. Identifying and eliminating the foods that trigger problems may help reduce the number of infections.
Other integrative approaches that may be helpful
Dietary Modification
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 Supplement Treatment Options
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
Contraindications
Refer to the individual supplement for information about any side effects or interactions.
Botanical Treatment Options
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 BID 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 BID 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 TID. Otherwise, 100–250 mg of arbutin in herbal extract capsules or tablets TID can be used. Uva ursi should only be used to treat a UTI under the close supervision of a physician.
Contraindications
Refer to the individual herb for information about any side effects or interactions.
Integrative Options
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
Resources:
An international patient experience survey is being conducted at
www.cystitispatientsurvey.com.
See related studies
