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Is there a Simple Way to Prevent UTI’s (Urinary Tract Infections)?

What is A UTI?

Over 50% of women get a UTI during their life time, and for 25% of them they keep coming back, having a huge impact on their quality of life (1,2). (Of course UTI’s can also affect men too, although it’s about 50 times less common than in women).

UTI’s are bacterial infections that can occur at any point of the Urinary Tract from the kidney to the ureter, bladder, and urethra. Infections in the Urethra are known as urethritis and infection in the bladder or the Ureter (the tube which carries urine from the kidney to the bladder) are commonly known as cystitis. If the bacteria reaches the kidney it can cause a kidney infection, known medically as pyelonephritis.

Common UTI symptoms include:

  • Dysuria – which is pain when urinating
  • Frequent or urgent need to urinate, of often tiny amounts
  • Nocturia – frequently needing to go at night
  • Abnormal urine colour often with a strong smell
  • Haematuria or Pyuria– blood or pus in the urine
  • Lower back or abdominal pain

Although these symptoms are unpleasant they are not considered serious, although if the infection does spread to the kidneys it can potentially cause kidney damage or even death.

What Causes UTI’s?

Prevent UTIMost of the time the bacteria that causes problems in our urinary tracts comes from the colon (that’s our backsides!), however sometimes in women the bacteria can also be transferred from the vagina (1-4). Most cases of UTI’s (around 80%), are caused by the bacteria E. coli (5,6,7). E. coli lives naturally in our GI system, although only in small numbers (2). However, when the growth levels of E. coli increase beyond what’s normal, and they get out of balance with the good bacteria, it can start to cause problems for us (8).

E. coli have special finger like projections called fimbriae, which are sticky and made of a glycoprotein called lectin which allows them to stick to the cell walls of our urinary tract (9). The ends of the fimbriae are made of sticky adhesins that stick to receptors on the cells lining the urinary tract. If enough E coli can get into our urinary tracts and stick to the cells, they can multiply and colonise there which causes an infection.

The Problem With Current Treatment Options?

The standard treatment for a UTI is a course of antibiotics, and it’s been this way for many years. Antibiotics are still an effective treatment for uncomplicated UTI’s, however the occurrence of bacteria that are causing UTI infections and that are also resistant to antibiotics are growing (10). Also worryingly, even when treatment successfully cures the infection the use of antibiotics can negatively impact of others areas of our health.

The main issues are that antibiotics also kill off beneficial bacteria in our guts as well as the bad guys, and as the bacterial populations regrow after a course of antibiotics is over, it can cause ‘dysbiosis’ which is an overgrowth of potentially pathogenic bacteria, fungi and other microbes. This can directly lead to fungal infections like thrush (both oral and vaginal), candida overgrowth and other GI infections, most notably Clostridium difficile (11). However, Dysbiosis has also been linked with many other health conditions including skin problems, mental health issues, immune conditions and obesity (12).

So what’s the solution?

Because of the problems with antibiotic treatment and the increase of antibiotic resistant strains of bacteria this form of treatment is becoming less and less effective. So going forward the prevention of UTI’s has become a major treatment goal, especially for people who suffer from recurrent infections (13).

There are 3 major areas we can focus on to help prevent UTI’s. The first is following some basic hygiene rules to stop bacteria from the colon or vagina reaching the urethra.

They are:

  • Urinate when if you feel the need to go, and don’t resist the urge.
  • Wipe from front to back in the bathroom so you are preventing bacteria from entering your urethra
  • Take showers instead of tub baths, and avoid hot tubs/Jacuzzis
  • If you can cleanse your genital area before and after having sexual intercourse, and try to urinate as well.
  • Avoid using feminine hygiene sprays, which may irritate your urethra, also avoid vaginal douching as this can damage the microbial balance in the vagina which can lead to an increase in pathogenic bacteria that could be transferred to the urethra, (it can also increase the chance of vaginal yeast infections and bacterial infections in the vagina.)

2nd Step: Take Probiotics

The second is to take probiotics to keep GI system healthy, restore the normal gut bacterial balance and to make sure the E. Coli and other pathogenic bacteria are under control. Studies are showing that probiotic capsules taken orally can change not just the bacterial balance in the gut, but also in the Vagina.

There is also a close correlation between a change in the normal microbiota (i.e bacterial balance) in the vagina and an increased likelihood of developing a UTI (14).
The micorbiome of the vagina is predominantly made up of Lactobacillus strains, and studies have shown that Lactobacillus probiotics taken orally can actually replenish the micro biome of the vagina (15, 16).

In Finland a study showed that drinking Kefir (fermented milk containing probiotics) 3 times a week reduced UTI’s (17), another study tested probiotic supplements against antibiotics for a year in a group of women who suffered from recurrent UTI’s.

They found that in women that were given antibiotics for a year the average number of UTI’s went down from 7 to 2.9, and that for women given probiotics the average number went down from 6.8 to 3.3 (18). However, although there was a slightly larger reduction in the number of UTI’s in the group of women given antibiotics, in women with ‘complicated UTI’s’ the probiotic group did better, experiencing only 3.4 recurrences as opposed to 4.4 in women taking antibiotics.

Also rather disturbingly, the women taking antibiotics increased the amount of antibiotic resistant E coli that they carried to between 80% and 95% of the total amount, whereas the probiotic group experienced no increase in antibiotic resistance bacteria.

3rd Step: Cranberry Juice and D-Mannose powder

So we’ve already seen that supplementing with probiotics is virtually as effective as antibiotics for preventing UTI’s, and can reduce them by over 50% with none of the dangerous side effects of antibiotics. With good hygiene practices we can reduce this even more, but what if we took it another level? We can do this by also supplementing with Cranberry juice and D-mannose.

Cranberry juice has long been used as a home remedy to treat UTI’s. It was originally believed that cranberries somehow made the urine more acidic which made it difficult for the infectious bacteria to grow there (19). However, we now understand that cranberry juice actually works because it contains 2 compounds that stop the E coli bacteria from being able to stick to the cells lining the urinary tract (known uroepithelial cells)(20).

D-mannose for UTIThe first compound is D-mannose which is a naturally occurring sugar, it is what’s known as mannose sensitive, and the second is a type of condensed tannin called Proanthocyanidin (or PAC for short) and it is mannose resistant. As we saw in the first image above there are finger like projections that come from the E. coli bacteria called fimbriae that the E. coli use to stick onto the cells on the walls of the urinary tract. They use the small sticky adhesins at the end of their fingers to do the ‘sticking’. These adhesins are either mannose sensitive (type 1), or mannose resistant (type p).

Because D-mannose is ‘mannose sensitive’ it plugs itself in the mannose sensitive (type 1) adhesins to stop them sticking to the cells of the urinary tract walls, and because the Proanthocyanidin is ‘mannose resistant’ is can plug itself into the mannose resistant (type p) adhesins.

Although D-mannose is a component of cranberry juice, it’s recommend to take it as a separate pure D-mannose powder as this makes it 10-50 times stronger than the D-mannose in cranberry. Also, although it’s a sugar it’s completely safe to take long term because very little of it is metabolised, and it doesn’t interfere with blood sugar regulation, even for diabetics (21).

Studies on the effectiveness of Cranberry Juice and D-mannose in preventing UTI’s

There have been several studies showing the effectiveness of either Cranberry juice powder or pure D-mannose powder in preventing UTI’s. For example Walker et al (22) found in their experiment that women taking Cranberry Juice powder had on average 2.4 UTI’s per year, whilst those taking a placebo averaged 6 UTI’s a year.

Another study conducted on sexually active women between 21 and 72 put 150 women into 3 groups where one group drank Cranberry proanthocyanidins prevent uti'sjuice, one took cranberry capsules and the other took a placebo. They found 32% of the placebo group suffered 1 or more UTI’s in the year, whereas 20% of the group that drank Cranberry juice suffered one or more UTI’s and only 18% of the group taking Cranberry capsules suffered 1 or more UTI (23).

A study pure D-mannose powder conducted on 308 women after they had recovered from acute cystitis gave them either D-mannose, antibiotics or a placebo. They found that 61% of women in the placebo group developed a recurrent UTI, 20.4% in the antibiotics group developed a recurrent UTI, but only 14.5% of the D-mannose group developed a recurrent UTI (24).

Conclusion

Probiotics, cranberry juice powder and pure D-mannose powder have all shown their effectiveness at reducing UTI’s. Cranberry juice powder and D-mannose are actually more effective at preventing UTI’s than antibiotics, and probiotics have many health benefits outside of preventing UTI’s, and are vital part of any health regime.

At Intelligent Labs we’ve created a specific Probiotic with women in mind (although men can take it too!) that can maximise health in body and mind, and help to prevent UTI’s. We’ve combined the highest quality probiotics (patented probiotic strains produced by Dupont), with organic cranberry juice powder and pure D-mannose powder.

Also each capsule also contains the prebiotics Sunfiber® & FOS. Prebiotics are non-digestible fibres that act as food for probiotics that are essential to ensure the probiotics successfully reproduce in the gut.

Then finally we use an Activ-Polymer™ bottle which features an impenetrable desiccant sleeve wrapped around the probiotic so they are virtually moisture free to ensure the probiotics, and an Oxyfree® desiccant to absorb any oxygen and remove any residual moisture from inside the bottle. This is because probiotics will degrade whenever they are exposed to moisture and oxygen, and we do our utmost to ensure the probiotics reach you in perfect condition.

Click Here to find out more.

*Complicated UTIs were defined as UTIs in women with functional or structural abnormalities of the urinary tract, metabolic and/or hormonal abnormalities, or impaired host responses.

References:

1. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. 2000. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 182(4):1177-82.

2. Howell A, B. 2007. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol. Nutr. Food Res. 51. P:732-737

3.Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. 2000. Risk factors
for recurrent urinary tract infection in young women. J Infect Dis. 182(4):1177-82.

4. Howell A, B. 2007. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol. Nutr. Food Res. 51. P:732-737.

5. Ronald A. 2003. The etiology of urinary tract infection: traditional and emerging
pathogens. Dis Mon. 49(2):71-82.

6. Nicolle LE. 2008. Uncomplicated urinary tract infection in adults including uncomplicated
pyelonephritis. The Urological Clinics of North America. 35(1):1–12, v.

7. Gupta K, Scholes D, Stamm WE. 1999. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA (The Journal of the American Medical Association). 281(8):736-8.

8. Cartwright P. 2011. Probiotic Allies. How to Maximise the Health Benefits of your
Microflora. Prentice Publishing, Ilford. pp85-87.

9. Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N. 1991. Anti-Escherichia coli adhesin activity of cranberry and blueberry juices. N Engl J Med. 324(22):1599.

10. Gupta K, Scholes D, Stamm WE. 1999. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA (The Journal of the American Medical Association). 281(8):736-8.

11. Albert X, Huertas I, Pereiro, Sanfelix J, II, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev.

12. Claire Duvallet, Sean M. Gibbons, Thomas Gurry, Rafael A. Irizarry & Eric J. Alm. Meta-analysis of gut microbiome studies identifies disease-specific and shared responses, Nature Communications 8, Article number: 1784 (2017)

13. Stapleton A. Novel approaches to prevention of urinary tract infections. Infect Dis Clin North Am. 2003;17(2):457–71.

14. Amdekar S, Singh V, Singh DD. 2011. Probiotic therapy: immunomodulating approach
toward urinary tract infection. Curr Microbiol. 63(5):484-90

15. Sarah Cribby, Michelle Taylor, and Gregor Reid, Vaginal Microbiota and the Use of Probiotics, Interdisciplinary Perspectives on Infectious Diseases
Volume 2008 (2008), Article ID 256490

16. Anukam K, Osazuwa E, Ahonkhai I, Ngwu M, Osemene G, Bruce AW, Reid G. 2006.
Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral
probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized,
double-blind, placebo-controlled trial. Microbes Infect. 8(6):1450-4.

17. Kontiokari T, Laitinen J, Järvi L, Pokka T, Sundqvist K, Uhari M. 2003. Dietary factors protecting women from urinary tract infection. Am J Clin Nutr. 77(3):600-4.

18. Beerepoot MA, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM, Prins JM, Koeijers J, Verbon A, Stobberingh E, Geerlings SE. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012 May 14;172(9):704-12.

19. Bodel PT, Cotran R, Kass EH. 1959. Cranberry juice and the antibacterial action of hippuric acid. J Lab Clin Med. 54:881-8

20. Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N. 1991. Anti-Escherichia coli adhesin activity of cranberry and blueberry juices. N Engl J Med. 324(22):1599.

21. D-Mannose for Bladder and Kidney Infections by Jonathan Wright, MD, Editor, Nutrition and Healing, Tahoma Clinic Blog, D-Mannose for Bladder and Kidney Infections

22. Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen RA., Jr Cranberry concentrate: UTI prophylaxis. J Fam Pract. 1997;45(2):167–8.

23. 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. 2002;9(3):1558–62.

24. Kranjčec B1, Papeš D, Altarac S, D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial, World J Urol. 2014 Feb;32(1):79-84.