Cranberries in the Treatment of Male Urinary Tract Problems

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Reference

Vidlar A, Vostalova J, Ulrichova J, et al. The effectiveness of dried cranberries (Vaccinium macrocarpon) in men with lower urinary tract symptoms. Br J Nutr. 2010;104(8):1181-1189.

Design

Participants were randomly divided into two groups: control (n 21; mean age 64·0 (SD 5·4) years) and cranberry (n 21; mean age 62.0 (SD 5.4) years). In the cranberry group, three capsules (1500 mg CFP per d) were taken at approximately equal intervals daily throughout the day for the 6-month period. They were instructed not to consume food rich in phenolics, especially anthocyanin-containing fruits, and to make no other dietary or lifestyle changes during the study. The control group received the same instructions as the cranberry group but no cranberry supplementation. Physical examination, International Prostate Symptom Score (IPSS), quality of life (QoL), five-item version of the International Index of Erectile Function (IIEF-5), basic clinical chemistry parameters, haematology, Se, testosterone, PSA (free and total), C-reactive protein (CRP), antioxidant status, transrectal ultrasound prostate volume, urinary flow rate, ultrasound-estimated post-void residual urine volume at baseline, and at 3 and 6 months, and urine ex vivo anti-adherence activity were determined in all subjects.

Participants

42 men from the Czech Republic

Study Parameters Assessed

Forty-two men, aged 45 to 70 years (mean age 63 (SD 5·5) years), participated in this study. All subjects entering the study had lower urinary tract symptoms (LUTS), elevated PSA and/or BHP (BPH). Other inclusion criteria were histological findings of acute or chronic non-bacterial prostatitis, normal urinary sediment and negative bacterial cultivation of urine. The diagnosis was asymptomatic inflammatory prostatitis category IV according to the National Institute of Health classification system. Exclusion criteria included abstaining from supplements such as Se, vitamins E and D, lycopene or herbal products with possible effects on prostate health, a diet rich in isoflavones, antibiotics, anti-inflammatory drugs, alpha-blockers or 5alpha-reductase inhibitors. In addition, those with food allergies, chronic liver or kidney diseases, gastrointestinal or metabolic disorder or any other chronic health condition such as diabetes were excluded from the study. All exclusionary criteria was identified from interview.

Key Findings

  • The daily dose of cranberry fruit powder (CFP) contained 223mg organic acids, 1·65mg anthocyanins, 29·5 mg condensed tannins and 52mg total phenols.
  • Patients who received cranberry for 6 months had a statistically significant lower IPSS and QoL score than controls.
  • A lower IPSS score reflected improvement in the irritative and obstructive symptoms.
  • All parameters of urination, average urinary flow rate, prostate bladder voiding and post-void residual urine volumes were significantly improved in at least 70% of participants of the cranberry group.
  • In the control group, the tested parameters did not change with the exception of post-void residual urine volume where a statistically significant deterioration was found.
  • Haematology values were unchanged with the exception of a significant increase in erythrocytes in the cranberry group, which, however, was within physiological limits.
  • PSA total decreased in approximately 80% of patients in the cranberry group.
  • Although changes in the values of several 'safety' markers were statistically significantly different, after 6 months for both groups, the fluctuation was within normal physiological limits.
  • In summary, the cranberry group compared with the control group stabilized and this might be true for oxidative stress markers as well. In addition, this study showed that cranberries may ameliorate LUTS, independent of benign prostatic hyperplasia or C-reactive protein level.
  • Differences in urine adherence ex vivo in both groups were not significantly different.
  • No adverse events were recorded.

Practice Implications

Naturopaths and herbalists have used cranberry extracts for urinary tract disorders for decades. Today, patients are requesting botanical diuretics, antimicrobials and anti-adherence agents, renal protective’s and herbs for their LUTS or BPH, even though these may be met with reservation by their urologists. Cranberry fruit and juice are noted for their ability to inhibit the binding of pathogenic E. coli strains and other microbes to the bladder epithelium.1 As male baby boomer’s age, the prevalence of LUTS from an enlarged prostate will surely increase. LUTS refers to a complex of irritative and obstructive voiding symptoms that are common in both ageing women and men. Prostate enlargement and BPH affect primarily older men. The incidence of LUTS associated with BPH increases dramatically with advancing age. The current conventional treatments for BPH , 5-alpha-reductase inhibitors , causes hormone changes associated with unpleasant sexual side effects, in particular, erectile dysfunction and decreased libido.2 Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which accounts for 90% to 95% of all prostatitis cases, is a clinical entity defined as urologic pain or discomfort in the pelvic region, associated with LUTS and/or sexual dysfunction, lasting for at least 3 of the previous 6 months. Symptoms of CP/CPPS can diminish quality of life and impair physical and psychological function. Natural treatments can provide this group of patient’s great help since conventional therapies have poor success rate.3

The result of the cranberry/ LUTS trial in men is compelling but not conclusive due to the small number of subjects recruited. Although a larger trial is needed, the use of concentrated cranberry powder, at about 500mg tid may be safe and adequate for any man suffering from LUTS regardless if the symptoms are derived from CP/CPPS or BPH. Two other natural agents that may work well to treat BPH and CP/CPPS are rye pollen extract and beta-sitosterol.4,5,6 Rye pollen extract was used in combination with betasitosterol, saw palmetto and vitamin E in one study that showed favorable results for men with BPH/ LUTS.7 It would be prudent to use cranberry powder (Vaccinium macrocarpo), betasitosterol, rye pollen extract, vitamin E and saw palmetto in men with LUTS from any prostate related origin.

About the Author

Geo Espinosa, ND, LAc, CNS, RH (AHG), is a renowned naturopathic and functional medicine doctor recognized as an authority in urology and men’s health. Espinosa is the founder and director of the Integrative and Functional Urology Center at New York University Langone Medical Center (NYULMC) and lectures internationally on the application of integrative urology in clinical settings. He has been recognized as one of the top 10 Health Makers for Men’s Health by sharecare.com created by Dr. Mehmet Oz and WebMD. Espinosa is the author of the popular book Thrive, Don’t Only Survive: Dr. Geo’s Guide to Living Your Best Life Before & After Prostate Cancer. On his time off from work, he enjoys writing on his popular blog, DrGeo.com and spending time with his family.
 

References

  1. Yarnell E. Botanical medicines for the urinary tract. World J Urol. 2002;20(5):285-293.
  2. Hegarty PK, Hegarty NJ, Fitzpatrick JM. Sexual function in patients with benign prostatic hyperplasia. Curr Urol Rep. 2001;2(4):292-296.
  3. Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011;305(1):78-86.
  4. MacDonald R, Ishani A, Rutks I, Wilt TJ. A systematic review of Cernilton for the treatment of benign prostatic hyperplasia. BJU Int. 2000;85(7):836-841.
  5. Wagenlehner FM, Schneider H, Ludwig M, Schnitker J, Brahler E, Weidner W. A pollen extract (Cernilton) in patients with inflammatory chronic prostatitis-chronic pelvic pain syndrome: a multicentre, randomised, prospective, double-blind, placebo-controlled phase 3 study. Eur Urol. 2009;56(3):544-551.
  6. Wilt T, Ishani A, MacDonald R, Stark G, Mulrow C, Lau J. Beta-sitosterols for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2000(2):CD001043.
  7. Preuss HG, Marcusen C, Regan J, Klimberg IW, Welebir TA, Jones WA. Randomized trial of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Int Urol Nephrol. 2001;33(2):217-225.