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Info - E.coli Metabolises Cranberry and Acidic Vitamin C (Ascorbic Acid)

Cranberry is often recommended for urinary tract infections, but E.coli is an acid adaptive bacterium, and is capable of synthesising its nutritional requirements from the surrounding acids in its environment. Since cranberry produces hippuric acid in the urine, thus creating acidic urine conditions, [Evidence] when cranberry is taken, (or take Vit. C) it provides E.coli and other gram negative bacteria a suitable environment in which to multiply.

In fact, giving cranberry juice to women with confirmed bacteriuria, considerably increases the chances of the infection recurring, with increasing severity.

This is completely at odds with almost everything you read or hear about cranberry. However, most of the information available focuses on a possible anti-adhesion effect, ignoring the feeding effect. Clinical trials of cranberry are not well conducted, as a rule, and have results that are inconclusive, borderline placebo, or negative. However, negative results are not well publicised because people producing cranberry have no motivation to publicise these results.

There is a small anti-adhesion effect from cranberry, but we believe that for the vast majority of bladder infection agents, the increased bacterial metabolic rate that results from the acidic urine that you get from drinking cranberry more than cancels out any anti-adhesion benefits from taking it.

On the other hand, it seems to be the case that for most gram negative bacteria, living in alkali conditions is like living in their own waste - not ideal conditions. In alkaline urine they slow down their metabolic rate and it can take them twice as long to produce a cell division (to double). That's why taking potassium citrate, which makes the urine more alkaline [Evidence] can help ease the situation, and Vitamin C in the form of Ascorbic Acid, (which mostly ends up in the urine), makes the situation worse.

Another reason not to take cranberry is that it stops antibiotics from working. Many antibiotics work by damaging the cell walls of bacteria. Putting hippuric acid into the urine (by taking cranberry) initially kills off the bacteria that have thinner acid-susceptible cell-walls, leaving only thicker-skinned acid-resistant individuals to multiply and pass on their resistant genes. Antibiotics like penicillins and cephalosporins often don't manage to kill these thick skinned bacteria. Add to that the fact that within three generations the bacteria can fully metabolise hippuric acid, creating all the Pyrenes and Amino acids they need to thrive.

Often, what you find when somebody has been taking cranberry is that the infection returns to full strength within a week or two of finishing the course, if it even dies down at all with the antibiotics.

Major misunderstanding...

Since the healthy vagina is colonized by lactobacilli, which are beneficial microorganisms that maintain an acidic (low pH) environment in the vagina, it is often assumed that a similar low pH environment in the urine makes the bladder hostile to bacteria. This is simply not true. The bladder and the vagina are entirely different environments. In the vaginal area, Lactobacilli compete with other bacteria for resources, and as a by-product, they produce hydrogen peroxide which also creates a hostile environment for bacteria. The tissues of the vagina and the Lactobaccili cells are adapted for exactly this environment, and they are healthy when the pH is low - when the environment is acidic.

Urine, on the other hand is most unlikely to have Lactobacilli living in it, and bacteria that do colonise the bladder are usually pathogenic, and much tougher than Lactobaccilli. For the most part though, like Lactobaccilli, these pathogens do enjoy an acidic environment, and they don't thrive well in an alkali environment. And there's the point of it... the pH environment that provides a healthy living area for friendly bacteria in the vagina also provides a healthy environment for the distinctly unfriendly bacteria in the bladder.

It is also known that if the E.coli in your body originated from cattle fed on a high grain diet, they can be 1000 times more resistant to acid than other E.coli. These bacteria absolutely thrive in acids. They are tough little bugs that adapt to utilise the environment they are exposed to. They can even get through stomach acids intact.

Acid resistant bacteria populate the human gut when you eat meat or food contaminated with the acid-loving strains, [Evidence] so the very first time you get an E.coli infection, the bacteria can already be acid resistant. (When you get an E.coli infection, the bacteria has invariably been at some point in a human bowel - it could be that person you just shook hands with... and not from you or your partner.) And since Trimethoprim is often used to prevent and treat infections in chicken and cattle, the bacteria are also likely to have genetic Trimethoprim resistance 'built in'.

The cycle: E.coli and Klebsiella (and some other gram negative uropathogens) have 'burst cycle' population explosions that occur under optimum feeding conditions. It goes like this - you drink cranberry or something else that makes the urine acidic - or get dehydrated and there is a build up uric acid in the bladder. Within a short period of time when the acidic urine gets into your bladder, the E.coli in there burst into a frenzied multiplication cycle, doubling their colony size over the next 20 to 30 minutes [Evidence]. They use up the acids in your urine in the process, and pass alkalis and endotoxins into the urine. As the urine becomes more alkaline, and the bacteria are effectively living in their own waste, they gradually become semi-dormant, slowing down their multiplication rates by as much as 100%. You take another drink of Cranberry or eat some more cranberry tablets, and start the process off again. It's not that they can't metabolise alkalis, but they don't seem to be so efficient at that.

So challenge anyone who tells you to take cranberry for an E.coli infection. Because they're wrong.

If you ask "Where did you hear that cranberry could be helpul?"

The answer is usually "That's what everyone says. Everyone says cranberry is the thing for UTIs and the like..."

So it's a self-perpetuating urban myth. But unfortunately it's not harmless, not funny, and not true.

It's a well known fact that many people get bacterial cystitis when they are dehydrated and thus build up a high level of urea (uric acid) in the urine. There must be some bacteria present for any bacterial infection, but the cystitis happens because the bacteria have been given the acidic environment in which to multiply out of control. You get a feel for the hardiness of E.coli when you consider that urea is a powerful antiseptic. E.coli says "Hmm, I like that. Please can I have some more urea?..."

By avoiding cranberry, vit C in the form of ascorbic acid, alchohol, red meat and coffee, and making the urine more alkaline [More] you take away the acids that are one of the bacteria's primary sources of nutrition, effectively starving them. Better to use a citrate salt like potassium citrate, magnesium citrate, calcium citrate or sodium citrate to make the urine more alkaline. But as always, consult a good nutritionist about any dietary changes.

But Cranberry Always Seems to Help at First!

When you first take cranberry, it kills off any bacteria that cannot survive the acidic environment, and in any colony of bacteria there will be some ‘weaklings’. So cranberry usually provides very temporary relief that is followed by considerable worsening of the symptoms. [Our customers have repeatedly told us this]. This is logically because the bacteria that weren't killed off produce, when they multiply, more bacteria that like the acidic environment, and if you didn't already have acid loving bacteria in the first place, because uropathogens are very fast mutators, they are likely to produce mutations that can make better use of the acidic environment than the original cranberry survivors. This is the similar to the reproductive mechanism that produces antibiotic resistant bacteria.

Until very recently it was believed that the acid in cranberry killed the uropathogens. But that's not what happens. As explained, they adapt quickly to acidic conditions. The adaptation is by survival and multiplication, so you just end up with tougher E.coli. [Evidence]

If you have even once had a bladder infection or UTI, taking cranberry makes it more likely that further infections will follow, because there are likely to be some remaining bacteria in the bladder behind biofilms under the surface skin of the bladder, just waiting for the right conditions to start multiplying again. [Evidence] And as explained, once they get into your urine again, they feed on the acids cranberry provides.

Now, how angry does this make you?

You get a first time urine infection - you get antibiotics. You take cranberry at the same time, and because you are helping the bacteria to grow, and making them tougher, the antibiotic fails. You go for more antibiotics, drink even more cranberry, and here you are now reading this page, still with problems perhaps years later...

Note: The above information refers to gram-negative bacteria like E.coli and Klebsiella. This covers the vast majority of bladder infections. However, cranberry may be slightly useful against Proteus type infections. Unlike E.coli, Proteus types generally multiply slower in acid urine, [you can deduce this logically from the fact that P. mirabilis produces urease, and splits urea to CO2 and NH3 to increase pH and increase uroepithelium toxicity.] So basically it's doing the exact opposite of E.coli, which produces alkalis. Summarising, this boils down to the fact that if you have a Proteus infection, cranberry and vit C might actually be a good way to go. To reinforce this point, the two customers out of many thousands in the past four years who said cranberry was actually helping them, turned out to have Proteus mirabilis infections. You are more likely to get proteus if you have recently been catheterised in hospital, or had a bladder operation. [Evidence].

Generally, with the rarer, complex, antibiotic resistant, or mixed bacterial type infections, it is best to have infection/s identified specifically at a specialist lab. If Proteus is identified, also ask which type - the susceptibility of Proteus to particular antibiotics varies with type. The doctor will be doing guesswork unless he/she knows enough detail about what is affecting you.

Once you know what pathogen or combination of pathogens is causing your infection, you will be better equipped to fight it, just as knowing that cranberry can make most urine infections worse, better equips you to deal with the infections.

For Psuedomonas, Staphylococcus, Streptococcus, Enterococcus, and Proteus bacteriuria, if antibiotics are continually failing, you need to find a natural way to beat the bacteria, or you could end up being hospitalised to have super strong broad-spectrum antibiotics dripped into your veins in doses that may destroy your immune system for good. For E.coli, Klebsiella, and similar, D-Mannose is worth trying first. There have been many reports that supplementing your diet with this harmless natural glyconutrient - which of course cannot be patented by drug companies - is more effective at supporting your body in dealing with urinary tract infections, than the antibiotic 'kill or cure' heavyweights.

Vitamin C: This risk increases again if Vitamin C (in the form of Ascorbic acid) is taken alongside the cranberry. The body is incapable of making much use of Vitamin C in this form, and most of it ends up in the urine, providing any bacteria present in the urine with another prime source of nutrients. A buffered form of Vitamin C should be used instead, like Calcium Ascorbate.

Evidence...

Where's the evidence that E.coli survive acidic environments, you may well ask. Really, a search on Google Scholar will provide plenty of examples. However, here are some to start with.

This example is interesting because most people eat meat, or vegetables that may be contaminated with bacteria from meat. It shows that E.coli can survive stomach acid and therefore populate the gut, from where, of course, they can get into the environment and up the urethra to your bladder, there to live in comfort. They might even build a home there...
http://www.news.cornell.edu/releases/Sept98/acid.relief.hrs.html

The following one contains this:

"In humans, the normal stomach has a pH of 2, which is highly acidic. The acid environment kills most pathogens. However, if the pathogen is acid tolerant, the stomachdoes not produce enough acidity or the person is taking antacid tablets, the harmful organism can slip past the stomach acid barrier and cause disease. In humans, pathogenic E. coli can cause intestinal bleeding, severe diarrhea and kidney failure. "
http://www.math.unl.edu/~jump/Center1/Labs/HighFiber2.pdf

And this one about 'extremeophiles' contains the following:

"Gastrointestinal pathogens and human health Other microbes, while not acidophiles, are studied because their acid-resistance systems allow them to survive the low pH in our own stomachs and cause disease. Two such microbes are Escherichia coli, a well-known gastrointestinal pathogen, and Helicobacter pylori, which causes stomach ulcers."
http://serc.carleton.edu/microbelife/extreme/acidic/index.htm

New Evidence!... 19th of January 2011

Scientific Document: Ocean Spray cranberry Products® and urinary tract infection in women - Scientific substantiation of a health claim related to Ocean Spray cranberry Products® and urinary tract infection in women pursuant to Article 14 of Regulation (EC) No 1924/2006 [1]

www.efsa.europa.eu/en/efsajournal/pub/943.htm 

Scientific Document: Scientific Opinion on the substantiation of a health claim related to a Uroval® and urinary tract infection pursuant to Article 14 of Regulation (EC) No 1924/2006.

www.efsa.europa.eu/en/efsajournal/pub/1421.htm 

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