Pregnancy Use

Likely to be safe when consumed in dietary amounts; however, safety is not known when used in larger quantities.

PRACTICE POINTS/PATIENT COUNSELLING

• Cranberry preparations are widely used to prevent and treat minor UTI.

• Overall, clinical testing suggests that the juice and solid-dose forms may have significant beneficial effects for UTI management.

• Cranberry exerts bacteriostatic effects by reducing bacterial adhesion to host tissues.

• Overall, evidence suggests no significant alteration to urinary pH at doses less than 330 mL daily.

• Cranberry products have also been used to treat gout and to deodorise urine in peoplewith incontinence.

• Preliminary research suggests a possible role in preventing conditions such as Helicobacter pylori infection and dental plaque formation.

ANSWERS TO PATIENTS' FREQUENTLY ASKED QUESTIONS

What will this herb do for me?

Cranberry products appear to reduce the risk of developing UTI and may be useful as a treatment in minor UTI. When will it start to work?

Studies using 1-2 glasses of cranberry juice suggest that 4-8 weeks' continual use is required; however, faster effects using concentrated tablets or capsules have been reported.

Are there any safety issues?

If fever or pain exists or symptoms of UTI become more severe, seek medical advice. REFERENCES

Ahuja S, Kaack B, Roberts J. Loss of fimbrial adhesion with the addition of Vaccinium macrocarpon to the growth medium of P-fimbriated Escherichia coli. J Urol 159.2 (1998): 559-62. Cranberry 328

AvornJ et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 271.10 (1994): 7514.

Bomser J et al. In vitro anticancer activity offruit extracts from Vaccinium species. Planta Med 62.3 (1996): 212-16.

Burger O et al. Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. Cr it Rev Food Sei Nutr 42.3 [Suppl] (2002): 279-84.

Foda MM et al. Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population. Can J Urol 2.1 (1995): 98-102.

Grant P. Warfarin and cranberry juice: an interaction? J Heart Valve Dis 13.1 (2004): 25-6.

Greenblatt DJ et al. Interaction of flurbiprofen with cranberry juice, grape juice, tea, and fluconazole: in vitro and clinical studies. Clin Pharmacol Ther 79.1 (2006): 125-33.

Häkkinen SH et al. Content of the flavonols quercetin, myricetin, and kaempferol in 25 edible berries. J Agric Food Chem 47.6 (1999): 2274-9.

Jepson RG, Mihaljevic L, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev2 (2004): CD001321.

Kessler T, Jansen B, Hesse A. Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Eur J Clin Nutr 56.10 (2002): 1020-3.

Kontiokari T et al. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 322.7302 (2001): 1571.

Nahata MC et al. Effect of urinary acidifiers on formaldehyde concentration and efficacy with methenamine therapy. Eur J Clin Pharmacol 22.3 (1982): 281-4.

Re id G. The role of cranberry and probiotics in intestinal and urogenital tract health. Crit Rev Food Sei Nutr 42.3 (Suppl) (2002): 293-300.

Saltzman JR et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr 13.6 (1994): 584-91.

Schlager TA et al. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr 135.6 (1999): 698-702.

Sharon N, Ofek I. Fighting infectious diseases with inhibitors of microbial adhesion to host tissues. Crit Rev Food Sei Nutr 42.3 (Suppl) (2002): 267-72.

Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infections. J Urol 131.5 (1984): 1013-16.

Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 9.3 (2002): 1558-62.

Super EA et al. Cranberry use among pediatric nephrology patients. Ambul Pediatr 5.4 (2005): 249-52.

Ulbricht CE, Bäsch EM. Natural Standard Herb and Supplement Reference. St Louis: Mosby, 2005.

Weiss EI et al. Inhibiting interspecies coaggregation of plaque bacteria with a cranberry juice constituent. J Am Dent Assoc 129.12 (1998): 1719-23 [published erratum J Am Dent Assoc 130.1 (1999): 36 and 130.3 (1999): 332].

Yan X et al. Antioxidant activities and antitumor screening of extracts from cranberry fruit (Vaccinium macrocarpon). J Agric Food Chem 50.21 (2002): 5844-9.

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