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Healthy enjoyment
Cranberries from the USA
- Urinary tract
- Oral cavities
- Stomach
- Antioxidants
- Heart and cardiovascular system
Information provided by the Cranberry Marketing Committee for doctors, pharmacists and nutrition consultants
Contains detailed bibliography
The Cranberry for Prevention
Every second women suffers at least once in her life from cystitis, frequently triggered by a bacterial infection through the urinary tracts. Regular consumption of cranberries can reduce the risk of infection.
We would like to encourage you to recommend cranberry products or preparations to your patients. The preventative use of the North American cranberry is based on comprehensive scientific studies.
This is not only proved by an anti-adhesive effect in the urinary tract but also by the positive impact in the oral cavity, stomach and heart. This brochure contains a comprehensive bibliography and documents the current stand of research.
Today cranberries and cranberry products are highly valued as a natural food. Their slightly bitter taste, fruity note and the delicate acidity make the versatile fruit so popular. Juice, dried fruit or fresh, in drinks or in the kitchen – the cranberry is a tasty mouthful.
Their Home is in North America
The natural growing areas of the cranberry (Vaccinium marcocarpon) are the moist areas of North America[1]. Oregon, Connecticut, Massachusetts, Michigan, Minnesota, New Jersey, New York, Rhode Island, Washington and Wisconsin provide ideal conditions for commercial cultivation.
At the end of the 20th century the cranberry appeared on the Europe market, but their cultural history began several hundred years ago. The first proof of the consumption of the fruit dates back to the original indigenous people of North America, who already knew its healing effect and used it for treating injuries and against pain.
Ebert G (2005): Anbau von Heidelbeeren und Cranberries (Cultivation of blueberries and cranberries) Stuttgart: Ulmer
Types of Vaccinium
The results of existing studies refer exclusively to the cranberry growing in North America (Vaccinium macrocarpon). These are very different from the cowberries (Vaccinium vitis-idaea) found in Europe and the mossberry (Vaccinium oxycoccus), which is also known as European cranberry.
Health Claim
In April 2004 the French Agency For Food Safety (AFSSA – Agence française de sécurité sanitaire des aliments) authorized the first health claim for cranberries. Since then, in France products containing North American cranberries are allowed to carry the claim that they can help to prevent the adhesion of E. coli bacteria on the mucus membrane of the urinary tract.
In its announcement the agency stressed that these claims only apply for the North American cranberry (Vaccinium macrocarpon) and not for the other types of Vaccinium.
The claim applies when there is a daily intake of 36 mg proanthocyanidin (condensed tannins) (see Avorn et. al. 1994), measured in compliance with DMAC principles (see Cunningham et. al. 2002), contained in
- 300 ml cranberry nectar with at least 27% fruit content
- Cranberry juice powder (90% dried fruit content)
In 2007 the agency confirmed the anti-adhesive effect for
- 29 g fresh cranberries
- 29 g frozen cranberries
- 39 g cranberry puree
- 27 g dried sweetened cranberries
This is confirmed by the AFSSAPS (Agence française de sécurité sanitaire des produits de santé), which in a statement in 2008 also confirmed the daily consumption of 36 mg PACs for "Non-antibiotic preventive treatment of recurring cystitis".
Dual Benefit for Health
Cranberries have a dual positive effect on health: they have the anti-adhesive capability to prevent certain bacteria docking onto mucus membrane and walls of cells. They also have a high content of antioxidants which contribute towards protecting against free radicals.
Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA (1994): Reduction of bacteriuria and pyuria after ingestion of cranberry juice. In: Journal of the American Medical Association, 271(10): 751-754.
Cunningham D, Vannozzi S, O'Shea E, Turk R(2002): Analysis and standardization of cranberry products. AC S. In: Quality Management of Nutraceuticals: 151-166.
Urinary Tract Infections
Urinary tract infections are among the most common bacterial infections. Especially women are susceptible. They often suffer from an infection of the urinary tract, since their urinary tracts are shorter than that of man. Such infections are above all caused by Escherichia coli bacteria.
Once simply appreciated as a household remedy, now it has been scientifically proven that the regular consumption of cranberries or cranberry products can reduce the risk of a reoccurring urinary tract infection by up to 50% (see Kontiokari et. al. 2001, Stothers 2002).
Harvard Medical School carried out the first broad-based clinical trial. The researchers proved that the regular consumption of cranberry juice significantly reduced the number of bacteria in the urinary tract (see Avorn et. al. 1994).
In 1998 a research team at the Rutgers University in New Jersey, managed to identify the proanthocyanidins (PACs) contained in cranberry juice as the substance responsible for the anti-adhesive effect in the urinary tract. (see Howell et. al. 1998).
Ahuja S, Kaack B, Roberts J (1998): Loss of fimbrial adhesion with the addition of Vaccinium macrocarpon to the growth medium of p-fimbriated E. coli. In: Journal of Urology, 159: 559-562.
Bodel PT, Cotran R, Kass EH (1959): Cranberry juice and the antibacterial action of hippuric acid. In: Journal of Laboratory and Clinical Medicine, 54: 881-888.
Jepson RG, Craig JC (2008): Cranberries for preventing urinary tract infections. In: Cochrane Database of systematic reviews: Online
Foo YP, Lu Y, Howell AB, Vorsa N (2000): The structure of cranberry proanthocyanidins which inhibit adherence of uropathogenic P-fimbriated Escherichia coil in vitro. In: Phytochemistry, 54: 173-181.
Foo YP, Lu Y, Howell AB, Vorsa N (2000): A-type proantocyanidin trimers from cranberry that inhibit adherence of uropathogenic P-fimbriated Escherichia coli. In: Journal of Natural Products, 63: 1225-1228.
(Photo)
Bacteria dock onto walls of bladder.
Continuative research indicates that cranberry PACs have an unusual double-bonded structure (see Howell et. al. 2005). Other foodstuffs do contain proanthocyanidins. However, the microbial anti-adhesion effect in urine, only occurs in the case of cranberry PACs.
"The study shows that not all PAC-rich foods are alike. It is the A-type structure of the cranberry PACs, which could be important for the protection against dangerous bacteria", noted the head of research Amy Howell.
In contrast, tea and cocoa contain PACs with a single-bonded type-B structure, which do not show any corresponding effect. On the other hand, wine grapes contain PACs, which display a minimum effect, which is, however, too weak for commercial use.
Gupta K, Chou MY, Howell A, Wobbe C, Grady R, Stapleton AE (2007): Cranberry products inhibit of P-fimbriated E.coli to primary cultured bladder and vaginal epithelial cells. In: The Journal of Urology: 177,2357-60
Howell AB, Reed JD, McEniry B, Krueger CG, Cunningham DG (2005): A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. In: Phytochemistry; 66: 2281-91
Lavigne JP, Bourg G, Combescure C, Botto H, Sotto A (2008): In vitro and in vivo evidence of dose-dependent decrease of uropathogenic E.coli virulence after consumption of commercial vaccinium macrocarpon (cranberry) capsules. In: Clinical microbiology an infection: The official publication of the European Society of Clinical Microbiology and infectious diseases, 14: 350-355
Liu Y, Gallardo-Moreno AM, Pinzon-Arango PA, Reynolds Y, Rodriguez G, Camesano TA (2007): Cranberry changes the physicochemical surface properties of E.coli and anti-adhesion with uroepithelial cells. Biointerfaces – under publication
Epicatechin Structures
Proanthocyanidin of Type B
(grapes, cocoa)
The Anti-Adhesive Effect
Bacteria, such as uropathogenic E. coli, have P-fimbrial adhesions which can dock onto cell tissue of urinary tracts. Cranberry proanthocyanidins are obviously capable of preventing this by binding with the adhesions, so that these can no longer dock onto the cell receptors (see Ahuja et. al. 1998, Howell et. al. 1998).
Subsequently the E. coli bacteria are washed out with the urinary flow. The anti-adhesion effect of cranberry proanthocyanidins can hence help prevent an infection in the bladder or kidney.
Further-reaching research results show that cranberry PACs are absorbed by the body (see Howell et. al. 2001). This means it can be speculated that the anti-adhesive mechanism of the substances can also be effective in other parts of the body when they are absorbed into the bloodstream.
Fowler JE (1986): Urinary tract infections in women. Urological Clinics of North America, 13(4): 673-680
Greenberg JA, Newmann SJ, Howell AB (2005): Consumption of sweetened dried cranberries versus unsweetened raisins for inhibition of uropathogenic Escherichia coli adhesion in human urine: a pilot study. In: Journal of Alternative and Complementary Medicine; 11: 875-878.
Howell AB, Vorsa N, Marderosian AD, Foo LY (1998): Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. In: New England Journal of Medicine (Letter), 339(15): 1085-1086.
Howell AB, Leahy M, Kurowska E, Guthrie N (2001): In vivo evidence that cranberry proanthocyanidins inhibit adherence of p-fimbriated E. coli bacteria to uroepithelial cells. In: Federation of American Societies for experimental Biology Journal, 15: A284.
Howell AB, Foxman B (2002): Cranberry juice and adhesion of antibiotic-resistant uropathogens. In: Journal of the American Medical Association; 287:3082-3083.
Howell AB (2007): Bioactive compounds in cranberry and their role in prevention of urinary tract infection. In: Molecular Nutrition & Food Research, 51 (6): 732-737.
(Photos)
Anti-Adhesive Mechanism with E. coli
Uroepithelial Cells
Glycoprotein Receptor
E. coli
P-fimbrial + adhesion
Anti-Adhesive Effect of Cranberry PACs, that bond to the bacterial adhesion
Uroepithelial Cells
Glycoprotein Receptor
E. coli
P-fimbrial + adhesion
Consumption Recommendation
The anti-adhesive effect of the cranberry PACs can already be measured with a standard bioactivity test just four hours after consumption (see Foo et. al. 2000). The greatest effect is achieved after eight hours. In the following twelve to 24 hours the protection diminishes.
For reliable, long-term protection it is therefore recommended that the daily intake of cranberries should be divided into two stages: half in the morning and half in the evening (Howell et. al. 2002).
Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M (2001): Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. In: British Medical Journal; 322: 1571-1575.
Kontiokari T, Laitinen J, Jarvi L, Pokka T, Sundqvist K, Uhari M (2003): Dietary factors protecting women from urinary tract infection. In: American Journal of Clinical Nutrition, 77: 600-604.
Manges AR, Johnson JR, Foxman B, O’Bryan TT, Fullerton KE, Riley LW (2001): Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. In: The New England Journal of Medecine; 345: 1007-13.
Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N (1991): Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. In: The New England Journal of Medicine,324: 1599.
Santillo VM, Lowe FC (2007): Cranberry juice for the prevention and treatment of urinary tract infections. In: Drugs Today, 43 (1): 47-54.
Schmidt DR, Sobota AE (1988): An examination of the anti-adherence activity of cranberry juice on urinary and non-urinary bacterial isolates. In: Microbios, 55: 173-181.
Sobota AE (1984): Inhibition of bacterial adherence by cranberry Juice: Potential use for treatment of urinary tract infections. In: Journal of Urology, 131: 1013.
Stothers L (2002): A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. In: Canadian Journal of Urology, 9: 1558-1562.
Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen RA Jr. (1997): Cranberry concentrate: UTI prophylaxis. In: The Journal Family Practice, 45(2): 167-168.
Wing DA, Rumney PJ, Preslicka CW, Chung JH (2008): Daily cranberry juice fort he prevention of asymptomatic bacteriuria in pregnancy : a randomized controlled pilot study. In: The Journal of Urology, 180: 1367-72.
Oral Cavity
The active ingredients of cranberries also have a protective impact in the oral cavity. The first indications of this were provided by a clinical trial at the University of Tel Aviv, which showed that the active ingredients of the cranberry reduce the amount of different bacteria docking onto the surface of teeth and hence slow down the formation of dental plaque. (see Weiss et. al. 1998).
Apparently here an anti-adhesive effect occurs which is similar to that responsible for keeping the urinary tract healthy. Subsequent laboratory investigations confirmed the inhibiting effect on Streptococci mutans and other oral pathogens (see Wu et. al. 2004, Yamanaka et. al. 2004).
Bodet C, Chandad F, Grenier D (2006): Anti-inflammatory activity of a high-molecular-weight cranberry fraction on macrophages stimulated by lipopolysaccharides from periodontopathogens. In: Journal of Dental Research, 85(3): 235-239.
Bodet C, Chandad F, Grenier D (2007): Inhibition of host extracellular matrix destructive enzyme production and activity by a high-mol-weight cranberry fraction. In: Journal of Periodontal Research, 42: 159-168.
Chen L, Heber D, Hardy M, Seeram N, Henig S, Leahy M, Wolinsky L, Qi F, Shi W (2004): Inhibitory effects of Cranberry on Streptococcus mutans biofilm formation. In: IADR, 2918.
Duarte S, Gregoire S, Singh AP, Vorsa N, Schaich K, Bowen W, Koo H(2006): Inhibitory effects of cranberry polyphenols on formation and acidogenicity of Streptococcus mutans biofilms. In: FEMS Microbiology Letters, 257(1): 50-56.
Koo, Nino de Guzman P, Schobel BD, Vacca Smith AV, Bowen WH (2006): Influence of cranberry juice on glucan-mediated processes involved in Streptococcus mutand biofilm development. In: Caries Research, 40 (1): 20-27.
Labrecque J, Bodet C, Chandad F, Grenier D (2006): Effects of a high-molecular-weight cranberry fraction on growth, biofilm formation and adherence of Porphyromonas gingivalis. In: Journal of Antimicrobial Chemotherapy, 58(2): 439-43. Epub 2006 May 30.
These findings could provide important stimulants for the development of oral hygiene products. For instance, Israeli researchers investigated the effect of mouth rinse containing cranberry extract. This not only revealed a reduction of S. mutans but also considerable drop in the total number of bacteria in the mouth (see Steinberg 2004).
This was confirmed by the latest investigation by the University of Laval in Quebec. This indicated that active ingredients of the cranberry hinder the growth of porphyromonas gingivalisand hence prevent the formation of plaque. This means that they could make a considerable contribution towards improved oral hygiene, because plaque is the main cause of the formation of periodontal disease (see Labrecque 2006).
Steinberg D, Feldman M, Ofek I, Weiss EI (2004): Effect of a high-molecular-weight component of cranberry on constituents of dental biofilm. In: Journal of Antimicrobial Chemotherapy, 54(1): 86-89.
Weiss EI, Lev-Dor R, Kashamn Y, Goldhar J, Sharon N, Ofek I (1998): Inhibiting interspecies coaggregation of plaque bacteria with cranberry juice constituent. In: Journal of the American Dental Association, 129(12): 1719-1723.
Weiss EI, Lev-Dor R, Sharon N, Ofek I (2002): Inhibitory effect of high-molecular-weight constituent of cranberry on adhesion of oral bacteria. In: Critical Reviews in Food Science & Nutrition, 42(Suppl.): 285-292.
Weiss El, Kozlovsky A, Steinberg D, Lev-Dor R, Greenstein RBN, Feldman M, Sharon N, Ofek I (2004): A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro ahhesion to hydroxyapatite. In: FEMS Microbiology Letters, 232(1): 89-92.
Wu CD, Zhu M, Turner A, Paul GF, Farnsworth NR (2004): Cranberry extracts inhibit growth/viability of oral pathogens and biofilms. In: IADR, 0746.
Yamanaka A, Kimizuka R, Kato T, Okuda K (2004): Inhibitory effects of cranberry juice on attachment of oral streptococci and biofilm formation. In: Journal of Oral Microbiology & Immunology, 19(3): 150-154.
Stomach
The anti-adhesive effect of the cranberry also enhances stomach health. Various studies also show the effect with Helicobacter pylori. This bacterium is regarded as a contributory cause of various stomach diseases and ulcers in the gastro-intestinal tract, in particular duodenal ulcers, a leading cause of stomach cancers. The active ingredients of the cranberry prevent adhesion to the stomach mucus membrane and thus guard against damage (see Burger et. al. 2000).
Since this effect was observed for both antibiotics-resistant and non-antibiotics-resistant H. pylori, cranberries could probably have a synergetic effect in combination with antibiotics therapy (see Shmuely et. al. 2004). Scientists at the University of Peking even see a possibility that daily consumption of cranberries could reduce H. pylori infections in particularly affected areas (see Zhang et. al. 2005). In China the average frequency of such an infection is 80 percent, compared to 30 percent in North America and Central Europe.
Chatterjee A, Yasmin T, Baqchi D, Stohs SJ (2004): Inhibition of Helicobacter Pylori in vitro by various berry extracts, with enhanced susceptibility of clarithromycin. In: Molecular and cellular Biochemistry, 265: 19-26.
Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I (2000): A high molecular mass constituent of cranberry juice inhibits Helicobacter pylori adhesion to human gastric musus. In: Federation of European Microbiological Societies, 29: 295-301.
Burger O, Weiss E, Sharon N, Tabak M, Neeman I, Ofek I (2002): Inhibition of Helicobacter pylori adhesion to human gastric mucus by a high-molecular-weight constituent of cranberry juice. In: Critical Reviews in Food Science & Nutrition, 42(Suppl.): 279-284.
Kresty LA, Howell AB, Baird M (2008): Cranberry proanthocyanidins induce apoptosis and inhibit acid-induced proliferation of human esophageal adenocarcinoma cells. In: Journal of Agricultural and Food Chemistry, 56: 676-680.
Shmuely H, Burger O, Neeman I, Yahav J, Samra Z, Niv Y, Sharon N, Weiss E, Athamna A, Tabak M, Ofek I (2004): Susceptibility of Helicobacter pylori isolates to the antiadhesion activity of a high-molecular-weight constituent of cranberry. In: Diagnostic Microbiology and Infectious Disease, 50: 231-235.
Shmuely H, Yahav J, Samra Z, Chodick G, Koren R, Niv Y, Ofek I (2007); Effect of cranberry juice on eradication of Helicobacter Pylori in patients treated with antibiotics and a proton pump inhibitor. In: Molecular Nutrition & Food Research, 51: 746-751.
Xiao SD, Shi T (2003): Is cranberry juice effective in the treatment and prevention of Helicobacter pylori Infection of mice? In: Chinese Journal of Digestive Diseases, 4: 136-139.
Zhang L, Ma J, Pan K, Go V, Chen J, You W (2005): Efficacy of Cranberry Juice on Helicobacter pylori Infection: a Double-Blind, Randomized Placebo-Controlled Trial. In: Helicobacter, 10: 139-145.
Viral Infections
Up to now there has been very little research on whether the cranberry's protective function also functions against viruses. However, the first investigations with influenza (see Weiss et. al. 2005) and rotaviruses (see Lipson et. al. 2007) indicate a therapeutic potential.
Lipson SM, Sethi L, Cohen P, Gordon RE, Tan IP, Burdowski A, Stotzky G (2007): Antiviral effects on bacteriophages and rotavirus by cranberry juice. In: Phytomedicine, 14: 23-30.
Weiss EI (2005): Cranberry juice constituents affect influenza virus adhesion and infectivity. In: Antiviral research, 66: 9-12.
(Photo)
Frequency of H. pylori Infections
Many classical holiday destinations such as Spain, Turkey and exotic overseas destinations pose a special danger through a high rate of infestation of helicobacter pylori bacteria – especially for people over age 50.