Cranberry juice is an exciting fruit juice for the breakfast table or indeed at any other occasion. EFSA probably gave a sense however of what was to come when it rejected an article 14 submission by OceanSpray™ way back in January 2009. At the time, there was great interest about how cranberry juice was said to be effective at reducing the risk of urinary tract infection (UTI) in women. At the time there was French approval of a generic claim, and marketing teams began to wonder how such claims might be developed for a marketing campaign.
The original wording of the OceanSpray™ submission was:-
“Regular consumption of 2 servings per day of an Ocean Spray product each containing typically 80mg cranberry proanthocyanidins helps reduce the risk of urinary tract infection in women by inhibiting the adhesion of certain bacteria in the urinary tract”.
The French health claims regulatory body (AFFSA) had already given approval in 2004 which allowed the claim: “Helps to reduce the adhesion of certain E.coli bacteria on the urinary tract walls”.
This claim however was generic and did not specifically refer to any products for which EFSA were demanding evidence. EFSA demanded much more in terms of the quality of data and statistical rigour that was expected in a dossier to substantiate an article 14 claim. Again, the NDA panel just recently rejected an Article 13 opinion about proanthocyanidins from the fruit and its juice providing defence against UTI and gum disease because of poor relevancy and data quality.
Claims Needed
Cranberry juice itself has much to recommend it and there are a number or articles which are worth referring to (Raz et al., 2004; Jepson and Craig, 2007), but to make a claim about a specific product such as OceanSpray’s rather than for a generic one requires data pertinent to the product itself. As current experience now shows based on EFSA opinions, information needs to reflect on a number of factors and be absolutely focused. If not, information is simply dismissed. It might be even more difficult to make a claim because of a trial that suggests that cranberry juice is no better than the placebo at reducing recurrence UTI in women (Barbosa-Cesnik et al., 2011). But not all is lost because armed with better information, if the claim does not succeed at first, a resubmission under another article (13.5) is feasible.
The latest evidence suggests that the medicinal properties of cranberries may be attributed to their unique polyphenols or proanthocyanidins (PACs). The growth of bacteria to urinary tract walls is limited by these polyphenols which reduces infection further. EFSA has also been working on a scientific opinion on a powdered form of cranberry extract from Ocean Spray which is to be used in fruit-flavoured beverages, waters, teas and yogurts. The basis for this claim is that there are 80mg of proanthocyanidins in every portion. There have been safety concerns voiced by various bodies because of the likely high intake of polyphenols in children between the ages of one to three.
Recent Research
A meta-analysis and assessment of human clinical trials, published in The Journal of Urology (Luis et al., 2017), suggests that consuming cranberries as opposed to just the juice helps reduce the incidence of urinary tract infections (UTIs). The researchers assessed a total of 28 studies. The results from nearly 5,000 patients were analysed and they found a statistically significant reduction in risk of repeated UTIs overall.
Ângelo Luís, the lead author from the Universidade da Beira Interior in Portugal stated:-
“Our investigation supports that cranberry products can be a powerful tool to fight off frequent UTIs, while recommendations for dosage and duration of treatment require further study, the efficacy of the medicinal properties of cranberry products has been well-established.”
Cranberry Recipes
Take a look at the recipe using cranberries which are used in a delicious cranberry pound cake with orange glaze recipe complete with step-by-step pictures and detailed instructions.
Cranberry Products
Cranberry extracts rather than just the juice are widely marketed throughout the European union and the USA as food supplements for the treatment of urinary tract Infections (UTIs).
Cranberry Products
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References
Barbosa-Cesnik, C., Brown, M.B., Buxton, M., Zhang, L., Debusscher, J., Foxman, B. (2011) Cranberry juice fails to prevent recurrent urinary tract infection: Results from a randomized placebo-controlled trial. Clin Infect Dis. 52(1) pp. 23–30. doi: 10.1093/cid/ciq073
EFSA (European Food Safety Authority) (2009) Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies on a request from Ocean Spray International Services Limited (UK), related to the scientific substantiation of a health claim on Ocean Spray Cranberry Products® and reduced risk of urinary tract infection in women by inhibiting the adhesion of certain bacteria in the urinary tract. The EFSA Journal, 943, pp. 1-16.
Jepson, R.G. and Craig, J.C. (2007) A systematic review of the evidence for cranberries and blueberries in UTI prevention. Molec. Nutr. Food Res. 51, pp. 738-745
Luis, A., Domingues, F., Pereira, L. (2017) Can Cranberries Contribute to Reduce the Incidence of Urinary Tract Infections? A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Clinical Trials. J. Urology 198 (3) pp. 614-621 (Article)
A great comfort. I love cranberry juice especially the unsweetened type. I know that some people poo poo the medical stuff but for me it gave me 90% improvement in my bladder spasms. I also had terrible incontinence from such a bladder problem. The pain from weeing was at least 6 times a night. I had to drink loads of water. I also advise other people taking the capsules with cranberry juice because that also works well. I have had no side effects from drinking juice save for the benefits that this has given me. I know that for some people this sounds mad but it really does work for me. I am so grateful especially for the writing you have done on this. I just hope you continue to spread the word because I know I certainly will.
I have found cranberry capsules very helpful, and would certainly recommend these to other readers. I have seen d-mannose also being recommended for UTIs. Is there any evidence to support their use? I would be really interested in your views
Hi Jackie,
There is regular evidence to support the benefits of taking cranberry juice and cranberry extracts when it comes to reducing the risk of UTIs. The active ingredient are the A-type proanthocyanidins but there may not be enough to produce the desired benefits in either the juice or the capsules. However, the American Urological Association have guidelines on recurrent UTIs in women. They state that clinicians can offer cranberry extracts for prevention to help reduce the occurrence. There is little risk associated with these supplements for one thing. Out of interest, some recent research showed that cranberry juice for example reduced gastric ulcers because of an interaction with bacteria like Helicobacter pylori which are the main cause of that issue. Again antioxidants are thought to be at work here in their interaction with the bacteria. Its still ongoing research.
It is thought that mannose (which is a sugar) attaches to E.coli which causes it to detach from the urinary tract wall. Given E.coli causes 90% of UTIs it seems a good idea to also take capsules containing mannose too. Unfortunately, there is not a lot of research on this subject but just enough to make it an exciting prospect for reducing the incidence of UTI. We don’t recommend using capsules to treat bladder infections so always recommend a visit to the doctor/pharmacist.
Really great to see such insights on an important berry!