Cranberry

Synonym(s): anthocyanins, ellagic acid, carnberry, cranberry, cranberry, phenols, proanthocyanidins, Quercetin, Vaccinium macrocarpon

Nutrient group: plant extracts & active ingredients

Sources and physiological effects

Occurrences in food
The cranberry (Vaccinium macrocarpon) is a plant of the blueberry genus (Vaccinium). In nutrition the fruit is usually found in the form of juices, jams, sweets, as dried fruits or in baked goods.
Physiological effects
Antibacterial	Anti-adhesion properties against bacteria on mucous membranes (especially Escherichia coli in the urogenital tract and Helicobacter pylori in the stomach)
Anti-inflammatory effects	inhibition of proinflammatory cytokines and chemokines and inhibition of local release of proteolytic enzymes

Detailed information

Cranberry ingredients

Cranberries are extraordinarily rich in phenolic compounds, including the phenolic acid ellagic acid, the red plant dyes proanthocyanidins and the flavonoid quercetin. In addition to strong antioxidant effects that have a positive effect on all cellular processes, the antibacterial properties of cranberry ingredients are of particular interest for therapeutic use. In in vitro studies it has been proven that the proanthocyanidins inhibit the docking of bacteria to the target tissue and thus prevent the prerequisite for a later infection at an early stage.¹

Proanthocyanidins inhibit bacterial adhesion

Infections by pathogenic bacteria follow a constant sequence. In the beginning there is always the colonisation of the tissue by the bacterium as a prerequisite for a later infection, but without pathological consequences. The key event for the development of an infection is the adhesion of bacteria to the target tissue. This was followed by internalisation, i.e. the uptake of bacteria into the cells of the tissue, and the invasion. Bacteria with high virulence, such as uropathogenic Escherichia coli, the most frequent cause of urinary tract infections worldwide, have developed special abilities to circumvent the body's own defence system, which uses adhesion-inhibiting measures (e.g. through the presence of low molecular weight carbohydrates). The anti-adhesive effect of the cranberry ingredients is based on a direct inhibition of the formation of docking sites on the bacterium (P-fimbria). Special bioactive proanthocyanidins (A-type PAC) are responsible for this effect, which differ from similar compounds in other plant extracts and are ultimately responsible for the specific antibacterial properties of cranberry.^{1, 2}

Cranberry in recurrent urinary tract infections

The anti-adhesive principle of action in bacterial infections leads to a new therapeutic approach, especially in urinary tract infections. There is now a sufficient number of clinical studies in patients with recurrent urinary tract infections that show a significant correlation between cranberry uptake and reduced incidence of urinary tract infections. According to a systematic evaluation of these studies, the Cochrane Institute assesses the preventive benefit of cranberry juice consumption in women with urinary tract infections as sufficiently proven. The results apply to both the daily intake of juice and cranberry dry concentrate.³A Canadian study with 150 sexually active women aged 21 to 72 years shows a significant reduction of urinary tract infections by approx. 20 % ⁴ in both cranberry juice and dry concentrate compared to placebo.

Cranberry and Helicobacter pylori

Bacterial adhesion to the mucosal cells of the stomach and small intestine is also the decisive trigger for Helicobacter pylori infections. In the meantime, the increasing antibiotic resistance of Helicobacter pylori has become such a major problem that interest in alternative strategies has grown significantly. In the meantime, it has been shown that the adhesion of antibiotic-resistant Helicobacter pylori strains can also be reduced by the administration of cranberry proanthocyanidins.⁵ Complementing conventional triple and quadruple therapy for Helicobacter infections with cranberry products can therefore significantly improve the success of Helicobacter pylori eradication.¹

Cranberry proanthocyanidins in caries and periodontosis

Caries and periodontal diseases are caused by pathogenic bacteria that adhere to teeth and gingival tissue. The adhesion of different bacterial strains and the subsequent invasion lead to inflammatory reactions in the gum tissue. In addition to the direct effect of cranberry proanthocyanidins (A-type PAC) on the adhesion of bacteria, anti-inflammatory effects of cranberry ingredients have been demonstrated in periodontal diseases.⁶ Cranberry can suppress the formation of proinflammatory cytokines and chemokines as well as the local release of proteolytic enzymes and thereby slow down the destruction of periodontal tissue.⁷

A new approach to infection prevention and control

The use of the anti-adhesive effect of cranberry ingredients represents a new and intelligent approach in the prophylaxis and therapy of bacterial diseases. Infection prevention and control could be achieved without killing bacteria, thus avoiding the selection pressure associated with antibiotic therapy to develop resistant forms. By combining different active principles (antibacterial, antioxidative and anti-inflammatory), the effectiveness and efficiency of a therapeutic agent can be increased by adding cranberry.⁸

Cranberry and its positive effect on memory and LDL cholesterol

The polyphenols contained in cranberry may have a positive effect on age-associated decline in cognitive performance and LDL cholesterol levels. A randomized, placebo-controlled study showed that daily consumption of 100g of cranberries in the form of freeze-dried powder over a 12-week period resulted in significant improvement in episodic memory performance and neural function in a group of 50-80-year-olds. In addition, the subjects showed a significant decrease in LDL cholesterol levels.⁹

Indications

Effect	Indication	Dosage
Physiological effects with low Nutrient dosages	With recurrent urinary tract infections	800 – 1200 mg/d
	With Helicobacter pylori infection	800 – 1200 mg/d
	For infection prophylaxis at bacteria with pathogenic potency	800 mg/d
	Accompanying the optimization of antibiotic multiple therapy	800 – 1200 mg/d
	To prevent and improve the success of Gingivitis and periodontitis	800 – 1200 mg/d
	For dyslipidaemia	800 - 1200 mg/d

Administration

General Mode of Use
When	Cranberry can be taken with or between meals.
Side effects
No relevant side effects known to date.
Contraindications
No relevant contraindications known to date.

Interactions

Interactions with drugs
None	Currently no relevant interactions are known.
Interactions with other nutrients
Trace elements	Polyphenols inhibit the absorption of iron when taken simultaneously.

References

¹ Nowack, R. 2006. Cranberry als Phyto- Prophylaktikum bei bakteriellen Infektionen. Zeitschrift für Phytotherapie. 27:163-171.
² Bruyere, F. 2006. Use of cranberry infection in chronic urinary tract infections. Med Mal Infect. 36(7):358-63.
³ Jepson, R. G. 2004. Cranberries for preventing urinary tract infections. Cochrane Database Syst. Rev. CD001321.
⁴ Stothers, L. 2002. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary infection in women. Can J Urol. 9(3):1558 – 625.
⁵ Shmuely, H. et al. 2004. Susceptibility of Helicobacter pylori isolates to antiadhesion activity of a high-molecular-weight constituent of cranberry. Diagn Microbiol Infect Dis. 50(4):231-5.
⁶ Labrecque, J. et al. 2006. Effects of a high-molecular-weight cranberry fraction on growth, biofilm formation and adherence of Porphyromas gingivalis. J Antimicrob Chemother. 58(2):439-43.
⁷ Bodet, C. 2006. Inhibition of periodontopathogen- derived proteolytic enzymes by a high molecular weight fraction isolated from cranberry. J Antimicrob Chemother. 57(4):685-90.
⁸ He, X. 2006. Cranberry phytochemicals: isolation, structure elucidation, and their antiproliferative and antioxidant activities. J Agric Food Chem. 54(19):7069-74.
⁹ Flanagan, E. et al. 2022. Chronic Consumption of Cranberries (Vaccinium macrocarpon) for 12 Weeks Improves Episodic Memory and Regional Brain Perfusion in Healthy Older Adults: A Randomised, Placebo-Controlled, Parallel-Groups Feasibility Study. Front Nutr. 9:849902.
¹⁰ Lee, I. T., et al. 2008. Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes. Diabet Med. 25(12):1473-7.
¹¹ Chew, B. et al. 2018. Chronic consumption of a low calorie, high polyphenol cranberry beverage attenuates inflammation and improves glucoregulation and HDL cholesterol in healthy overweight humans: a randomized controlled trial. European Journal of Nutrition. 58: 1223-1235.
¹² Ruel, G. et al. 2008. Low-calorie cranberry juice supplementation reduces plasma oxidized LDL and cell adhesion molecule concentrations in men. Br J Nutr. 99(2):352-9.

References Interactions:
Stargrove, M. B. et al. Herb, Nutrient and Drug Interactions: Clinical Implications and Therapeutic Strategies, 1. Auflage. St. Louis, Missouri: Elsevier Health Sciences, 2008.
Gröber, U. Mikronährstoffe: Metabolic Tuning –Prävention –Therapie, 3. Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2011.
Gröber, U. Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung, 3. aktualisierte und erweiterte Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2014.