Natural supplements and the practice of naturopathy aim to enhance internal defences against infection. Naturopathy “remedies” are made from natural sources (e.g. plants or minerals). However do they actually work for urinary tract infections?
Most supplements are available in health food stores, homeopathic pharmacies and online. However, before heading to your local health food store or searching online for suppliers, please consider the following:
- Unlike allopathic medications, little research has been published for these remedies illustrating their efficacy against acute, recurrent and chronic UTI and in particular against biofilms and embedded bladder wall infections of the urinary tract.
- Research produced may often by supported by companies that manufacture or promote a particular product. Make sure you look for independent studies free from financial support bias.
- Treatments are often unlicensed and lack the safeguards in place for conventional therapeutics.
- Controlled trials and studies are often limited in complementary and alternative medicine and involve small numbers of participants. They are often conducted under less rigorous controls, governance and environments than those undertaken for the development of new pharmaceutical medications such as antibiotics. Do your research, there should be clear, peer reviewed, empiric evidence as to the efficacy of complementary therapies rather than theorisation about how they may be beneficial in the treatment of a chronic UTI.
- Don’t believe all apocryphal stories you read online about how a natural remedy or home treatment has resolved someone’s UTI issues. Remember, the bacterial mix in that person’s infection may be entirely different to yours and they may be paid to promote that product.
- There appears to be no global consensus around dosages and length of treatment.
- Natural remedies are often not standardised in terms of quality and manufacturing controls
- Thus natural remedies are omitted from evidence based guidelines because of this lack of evidence supported through randomised control trials. More trials and studies are needed.
Cranberry Juice – not the cure-all for cystitis
For example, consider the widely recommended usage of cranberry as a cure all for a UTI. Published studies focusing on juices, tablets and powders incorporate a wide age range from college students to those in nursing homes. A detailed review published in Jama Internal Medicine in 2012 of 13 Randomised Control studies out of a total of 414 studies then available noted the following:
- Cranberry juice was noted to be more effective than cranberry capsules or tablets in subgroup analysis. However they concluded that hydration when managing a UTI may have resulted in a more successful UTI resolution outcome which may negate the effect of the cranberry juice itself.
- The mechanism behind the protective effect of cranberries against UTIs has not yet been fully determined, thus the benefits of cranberry may result from other unknown substances in the juice, which are not available in cranberry capsules and tablets.
- Drinking a large amount of cranberry juice with high sugar content might raise concerns about sugar control in diabetic patients, and it may cause severe gastrointestinal upset or other adverse effects. Is it realistic to expect UTI sufferers to consume high quantities of Cranberry juice daily?
- Most of the trials did not report their trial processes adequately and suffered from a high proportion of subjects lost to follow-up. This negates any potential initial benefit of using a cranberry product.
- The administration of cranberry-containing products differed significantly in form, daily dosage and dosing frequency in each of the studies. Three trials did not specify the actual cranberry amount used daily.
- Nine of the trials used cranberry juice, and four used cranberry capsules or tablets. Six trials used cranberry-containing products provided by the same cranberry manufacturer and several studies were sponsored by manufacturers, clear bias at work.
- Cranberry-containing products were administered for no longer than six months in most trials.
These detailed review results appear to give no guidance to the reliability of cranberry products against UTI because of the factors outlined above. The National Institute for Clinical Excellence (NICE) in the UK recommend against the usage of cranberry products for those with recurrent urinary tract infections. NICE report in their guidelines from 2018 for those with recurrent UTI “evidence of benefit is uncertain and there is no evidence of benefit for older women”. NICE guidelines for acute cystitis in 2018 state “Be aware that no evidence was found on cranberry products or urine alkalinising agents to treat lower UTI”.
In an article published in The New York Times in 2016, it was concluded that cranberries are not the answer for an active infection.
Most common natural remedies for UTI – do they work?
We have reviewed four of the more popular natural remedies used by naturopaths and complementary practitioners – what they are, do they work for UTIs and if these natural supplements interact with other medications.