Many people may be aware of the potential health benefits of the cranberry. Cranberries are known to be high in antioxidants, which can support heart health and shown in studies to reduce the risk of cancer and Alzheimers. Cranberries are also anti-inflammatory and can be helpful for reducing the occurrence or frequency of ulcers and urinary tract infections (UTIs). The question to ask then is, whats the best way to reap these benefits, by eating cranberries, drinking cranberry juice or taking a supplement? In the interest of time and convenience, a motivator of many peoples dietary habits, taking a supplement may be the most practical route to gain all of the benefits of the cranberry.

Eating cranberries in their unaltered, natural form is certainly good for you as they are low in calories, only 46 calories per cup, are fat free, cholesterol free, sodium free and are a good source of phytonutrients and vitamin A (1). The potential down side is the taste. If bitterness isnt something a consumer enjoys, then eating whole cranberries could be more of a chore than a pleasure. Along with the taste is the sheer amount of cranberries that would need to be consumed daily in order to reap the benefits they produce; an amount more readily found in supplements.

Cranberries have naturally occurring proanthocyanidins (PAC), which is the plant compound that gives cranberries the reputation they have for reducing the risks of UTIs. Cranberry products taken on a regular basis were clinically proven to prevent UTI and may serve as an alternative to recurrent use of antibiotics, states the National Institute of Food and Agriculture. It has been proposed that cranberry products act by inhibiting uropathogenic strains of E. coli from adhering to uroepithelial cells, which is the initial step in development of infection (2). It was originally believed that proanthocyanidins helped reduce the risk of UTIs by making urine more acidic, but it is actually due to bacteria not being able to adhere to the walls that give proanthocyanidin its reputation as a preventative agent.

When taking a cranberry supplement, the dose is typically more concentrated than what you would find in a whole cranberry. Although it would seem that this would automatically make it better, this is not always necessarily the case. When extracting something you are removing part of an item from the whole, which means that although you may be getting a more concentrated dose of the item, the composition of vitamins and other nutrients being extracted from the berry may not all be present in the same way. However, different processing methods can deliver a different result. Therefore, many manufacturers utilize methods that help maintain the original integrity of the cranberry.

In the case of powders, the process of drying the cranberries can also lower the levels of antioxidants, vitamin A and vitamin C. Considering this, certain manufacturers utilize systems that dry at lower temperatures for a longer period of time to maintain the integrity of the powder. This is particularly important for protecting the PAC content of the cranberry powder (3).

With this is mind, supplements have been proven to be more effective than cranberry juice for preventing UTIs, especially since the added sugars found in most juices can actually worsen infections. Of course, some question the effectiveness of cranberry supplements. A recent JAMA editorial stated that there was a lack of efficacy in the use of cranberry powder for supporting urinary tract health following the results of a recent randomized controlled trial that found no significant relationship between the two (4).

In response, the firm Fruit dOr, based in Quebec, Canada, cited a recent in vitro study they conducted, in partnership with UAS Laboratories. The research study demonstrated a synergistic relationship between whole food cranberry extract standardized to 7% PAC content (both soluble and insoluble PAC) and a probiotic formulation of Lactobacillus and Bifidobacterium (5). Specifically, the study found this relationship to be effective for inhibiting the invasiveness of pathogenic E. coli and reduce the risk of urinary tract infection in women.

Results showed that the bioactive PACs found in their whole food cranberry interfered with the invasion of the harmful bacteria by interacting with its surface, essentially wrapping around it. This prevents the harmful bacteria from travelling through the urethra and other parts of the body vulnerable to bacterial infection. The firm also sought to make the distinction between the cranberry juice powder used in the unsuccessful study and their whole food cranberry powder which utilizes the entirety of the fruit. This goes to show that not all cranberry nutraceutical ingredients are created equal.

Supplements are also an effective route for flavonoids, polyphenolic compounds that are responsible for promoting heart health and may possibly reduce the risk of certain types of cancers due to the antioxidants present. Studies show that polyphenols may contribute to a reduction in cardiovascular disease and risk factors increasing the resistance of bad LDL cholesterol to oxidation, inhibiting platelet aggregation and reducing blood pressure (6). One double-blind, placebo-controlled, parallel-arm study assigned volunteers to drink either a low calorie cranberry juice or flavor-, color- and energymatched placebo beverage twice-daily for eight weeks, while on the same controlled diet (7). Results showed a reduction of cardiovascular risk factors among participants who consumed cranberry juice. These risk factors included including diastolic blood pressure, C-reactive proteins, a biomarker for inflammation, triglycerides and blood glucose. Triglycerides, for example, saw the highest reduction in the cranberry group among those with the highest baseline levels. While this research studied cranberry juice, it can make the case for cranberry supplements as well given their more concentrated doses and much lower sugar content.

In the case of cancer, while supplements cannot cure or treat any disease, research shows that cranberry-derived extracts inhibit the growth of cancer cells in vitro. Specifically, cranberry-derived ursolic acid, proanthocyanidins and an organic-soluble cranberry extract inhibit the growth of breast, colon, cervical, glioblastoma, leukemia, lung, melanoma, oral cavity, prostate and renal cancer cell lines, explain the authors of a research paper (8). These findings provide the basis for investigation for in vivo model such as animal studies. In vivo models that do exist have yielded limited results, meaning that further research is required.

Cranberry supplements have also been found to help reduce the risks of peptic ulcers. Helicobacter pylori plays a large part in the creation of ulcers in the gastrointestinal system. Studies are showing that cranberries lower levels of Helicobacter pylori in the stomach in the same way that it is suggested that cranberries help with UTIs, by washing away the bacteria that would otherwise adhere to the walls of the organs (9). In addition, cranberry can also help balance out the rest of the digestive tract due to its ability to increase Bifidobacteria, which promotes balanced intestinal flora and the same polyphenols seen to assist in heart health can also have an anti-inflammatory effect in the digestive tract as well.

Some research has also shown that the composition of polyphenols in cranberries may be helpful for reducing the risk of Alzheimers and dementia. In the case of dementia, the anti-inflammatory properties of cranberries are seen to be the most helpful since dementia is linked to long term inflammation of the body. The development of Alzheimers Disease appears to be impacted by the levels of oxidative stress in the body and the antioxidants and vitamin E found in cranberry help to offset these factors (10,11).

The U.S. Department of Agriculture has set guidelines and regulates cranberry growth and quality in the country.The Federal Food and Drug Administration is responsible for dietary supplements, such as cranberry supplements, under the Dietary Supplement Health and Education Act of 1994. Although this Act prohibits supplement makers from marketing products that are mislabeled or adulterated in any way, doing your homework doesnt hurt. Its important to have confidence in the products you are selling your customers so that they have confidence in you. Providing organic and non-GMO options provides an added layer of confidence.

As with any change in diet or supplementation, it is advisable that customers consult with a medical professional to avoid any potential drug interactions, and to discover what the recommended daily intake should be.

References 1. Cranberries, Raw Nutrition Facts & Calories, http://nutritiondata.self.com/facts/fruits-and-fruit-juices/1875/2, Accessed 1/27/2017. 2. Cranberry Proanthocyanidins As Inhibitors Of Epithelial Cell Invasion By Entheropathic and Uropathogenic E. Coli Strains, http://portal.nifa.usda.gov/web/crisprojectpages/0223796-cranberry-proanthocyanidins-as-inhibitors-of-epithelial-cell-invasion-by-entheropathogenic-and-uropathogenic-e-coli-strains.html , Accessed 1/28/2017. 3. K. Chiarella-Ebner. Powder Play. http://www.wholefoodsmagazine. com/suppliers/features-suppliers/powder-play/, Accessed 2/4/2017. 4. L.E. Nicolle. Cranberry for Prevention of Urinary Tract Infection? Time to Move On http://jamanetwork.com/journals/jama/article-abstract/2576821, Accessed 2/4/2017 5. M.A. Polewski, et al. Ability of cranberry proanthocyanidins in combination with a probiotic formulation to inhibit in vitro invasion of gut epithelial cells by extra-intestinal pathogenic E.coli. http://www.sciencedirect.com/science/article/pii/S1756464616301359, Accessed 2/4/2017. 6. Cranberries (Vaccinium macrocarpon) and cardiovascular disease risk factors, https://www.ncbi.nlm.nih.gov/pubmed/18038941, Accessed 1/30/2017. 7. J.A. Novotny, et al. Cranberry Juice Consumption Lowers Markers of Cardiometabolic Risk, Including Blood Pressure and Circulating C-Reactive Protein, Triglyceride, and Glucose Concentrations in Adults. The Journal of Nutrition. 145(6): 1185-1193. 2015. 8. K.M. Weh, et al. Cranberries and Cancer: An Update of Preclinical Studies Evaluating the Cancer Inhibitory Potential of Cranberry and Cranberry Derived Constituents. Antioxidants. 5(3): 27. 2016. 9.Cranberry.https://www.lahey.org/Departments_and_Locations/Departments/Colon_and_Rectal_Surgery/Ebsco_Content/Diverticular_Disease/Diverticulitis.aspx?chunkiid=21704. Accessed 2/1/2017. 10. Cranberry Research-Antioxidant Intake-Lower Risk of Alzheimer Disease. https://extension.umaine.edu/cranberries/grower-services/cranberry-research/reduced-risk-of-alzheimers/, Accessed 2/1/2017. 11. Cranberry Extract May Be Useful in the Treatment of Alzheimers Disease, http://www.greenmedinfo.com/article/cranberry-extract-may-be-useful-treatment-alzheimers-disease, Accessed 2/1/2017.

Published in WholeFoods Magazine March 2017

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Cranberry Supplements: Not Bitter, Better - WholeFoods Magazine