Knowledge: Cranberry (Vaccinium macrocarpon)

Cranberry (Vaccinium macrocarpon)

One of the few fruits native to North America, cranberries (Vaccinium macrocarpon) have been used by Native Americans as a staple for centuries. It belongs to the Heath or Heather family (Ericaceae), the berries grow naturally in swamps and bogs. They are eaten fresh, ground, or mashed with cornmeal and baked into breads. Cranberries contain a natural preservative called benzoic acid which extends the shelf life. Early Europeans settlers learned cranberries’ many uses from the Native Americans as early as 1620. Cranberry extract is derived from the fruit of the cranberry plant and it is rich in proanthocyanidins (PACs) and other antioxidants. Cranberry extract has been studied extensively for its potential health benefits, particularly in the prevention and treatment of urinary tract infections (UTIs). It is believed that the active compounds in cranberry extract may help to prevent bacteria from adhering to the walls of the urinary tract, thereby reducing the infection risk. Furthermore, cranberry extract is consumed for its health benefits such as heart health, anti-inflammation, and gut health.

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The chemical structures of cranberry anthocyanins.

Applications

Food and beverages

  • Cranberry extract can be added to juices and smoothies to give them a tart and tangy flavor while providing potential health benefits. They are also used as a natural food coloring and flavoring agent in producing food and beverages such as energy bars, granolas, and teas.

Skincare and cosmetics

  • The antioxidant and anti-inflammatory properties of cranberry extract make it a popular ingredient in skincare products, particularly those designed to target acne-prone or aging skin.

Nutraceutical and supplements

  • Cranberry extract is used in the formulation of dietary supplements and nutraceuticals due to its high concentration of antioxidants, especially it is targeted for the treatment and prevention of urinary tract infections.

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HEALTH BENEFITS

UTI Prophylaxis

Cranberry extract may help to prevent and reduce the frequency of urinary tract infections (UTIs) by preventing bacteria from adhering to the walls of the urinary tract. Some studies have documented that cranberry provides a potential alternative to antibiotics (adjunct therapy) in the prevention of recurrent UTIs because antibiotic treatment results in increased resistance to antimicrobials among uropathogenic bacteria in addition to the potential side effects and high cost of the drugs.

Type of study Literature Review
Mechanism of action Researchers hypothesizes that cranberries work principally by preventing the adhesion of type 1 and p-fimbriae strains (particularly from E. coli) to the urothelium. Without adhesion, bacteria cannot infect the mucosal surface. In vitro, this adhesion is mediated by two components of cranberries that are fructose, which inhibits the adherence of type 1 fimbriae, and PAC, which inhibits the adherence of p-fimbriae. The binding of the proteinaceous bacterial fimbrial tips to mucosal surfaces on the uroepithelium occurs as a specific receptor-ligand association favored by hydrophobic interactions. One possible mechanism is that the cranberry compounds, acting as receptor analogs, competitively inhibit the adhesion of E. coli to host cells by binding to the fimbrial tips.

The in-vitro anti-adherence effect of cranberries is dose-dependent. Another mechanism of cranberry activity is the in-vitro reduction in the expression of p-fimbriae in E. coli by changing the conformation of surface molecules. In a recent study, pH-neutralized cranberry juice induced conformational changes in the surface macromolecules of pfimbriated E. coli by specifically decreasing the fimbrial length and density.

 

Type of study Human
Subject 60 women participants in the age group of 18 – 40 with a history of recurrent UTIs, and currently culture positive with mild symptoms of UTI.
Duration 3 months
Dosage 500 – 1000 mg daily cranberry in divided doses.
Group Control group: Untreated

Test group 1: Received encapsulated 250 mg of PS-WCP twice daily (Low dose of 500 mg/day cranberry).

Test group 2: Received encapsulated 500 mg of PS-WCP twice daily (High dose of 1000 mg/day cranberry).

Parameters analyzed
  • Hematological parameters: hemoglobin, WBC and differential count, ESR, platelet count
  • Serum biochemical parameters: FBG, triglycerides, cholesterol, bilirubin, CKNAC, SGOT, SGPT, urea, creatinine
  • Urine analysis: sugar, albumin, ketone bodies, pus cells, RBC
  • Questionnaire-based assessment on patients’ perceived overall improvement of symptoms
  • Presence of urinary E. Coli and other uropathogens
Outcomes Visible benefits

  • The statistical analyses showed that there was no significant changes observed in the hematological and serum biochemical parameters in the treatment groups at the end of the 90-day follow-up period, suggesting that cranberry product PSWCP was safe and nontoxic for human consumption.
  • 18 participants out of 44 in the treatment groups reported that they had complete relief and remission from urological symptoms such as itching and burning sensation during micturition, and frequent urination. Subjects in both treatment groups reported significant improvement of symptoms starting from the 10-day evaluation as compared to the baseline, whereas subjects in the untreated control group did not show any improvement in their symptoms.
  • Both treatment groups also exhibited significant reduction of E. coli load (low dose, p<0.01; high dose p<0.0001; at a statistical significance level of 95%) after 10 days of treatment. E. coli was reduced at highly significant level (p<0.0001), and at a moderately significant (p=0.0151) level in the high dose and low dose treated groups, respectively.
Functions A unique polymeric compound, proanthocyanidin (PAC), is the active ingredient present in cranberries which shows very strong inhibitory activity against mannose-resistant adhesins produced by urinary isolates of E. coli, and therefore, inhibits bacterial adherence to uroepithelial cells.

Cardioprotection

Cranberry extract contains antioxidants that can help to improve heart health by reducing inflammation, improving blood lipid levels, and lowering blood pressure.

Type of study Human
Subject 50 healthy male participants aged 18 to 45 years were recruited for the pilot (n=5) and main study (n=45).
Duration 4 weeks
Dosage 9g cranberry powder daily.
Group Pilot study (To study acute effect)

Control group: Received placebo powder with similar color and taste to cranberry powder which contains a blend of water, maltodextrin, citric acid, artificial cranberry flavor (Lorann oils), fructose, red color, and grape shade.

Test group: Received 9 g cranberry powder containing 525 mg of total polyphenols, of which 374 mg were PACs.

Main study (To study chronic effect)

Control group: Received daily placebo powder with similar color and taste to cranberry powder which contains a blend of water, maltodextrin, citric acid, artificial cranberry flavor (Lorann oils), fructose, red color, and grape shade.

Test group: Received 9 g cranberry powder daily containing 525 mg of total polyphenols, of which 374 mg were PACs.

Parameters analyzed Improvement of endothelial vasodilator function as measured by flow-mediated dilation (FMD) – Improved FMD results in greater perfusion and oxygen supply to peripheral tissues.
Outcomes Visible benefits

Pilot study

Cranberry powder increased FMD at 2h and 4h by 1% as compared to control. The response did not difference between 2h and 4h.

Main study

A one-month consumption of whole cranberry powder led to a significant improvement in FMD, which was by 1.1%, as compared to the control. Similar significant improvements were observed at 2 h after the first cranberry intervention on day 1 but that there were no further improvements at 1 month and 2 h after consumption of the last cranberry powder. There was no significant time × intervention interaction, suggesting that the effect of cranberry did not differ between the time points and was independent of baseline FMD.

Functions Cranberry may induce nitric oxide-dependent vasodilation and therefore ensuring adequate oxygen supply to peripheral tissues. However, proanthocyanidins are barely absorbed in the upper GI tract after acute consumption, so the role of the other flavonoids (anthocyanins, phenolic acids, and flavonols) in the cranberry might be more relevant in mediating early FMD responses.

Support gut health

Cranberry extract can help to improve gastrointestinal health by promoting the growth of beneficial bacteria and inhibiting the growth of pathogenic bacteria in the gut due to its prebiotic potential.

Type of study Human
Subject Adults (n=17) aged 18 – 42 years with BMI 30.5 ± 3.1 kg/m2
Duration 2 months
Dosage 240 mL of cranberry beverage that contains 142.61 mg of total polyphenols, 7.48 mg of total anthocyanins, 1.93 g og dietary fiber, and 1.77 mg of organic acids.
Group Control group: Consumed 240 mL of cranberry beverage consisting of water, milled whole cranberries, natural flavor, sucralose twice daily.

Test group: Consumed 240 mL of placebo beverage consisting of water, sucrose, xanthan gum, malic acid, fumaric acid, natural food color, natural flavor, and sucralose tiwce daily.

Parameters analyzed
  • GI tolerance (cramping, distension/bloating, flatulence)
  • Fecal microbial composition
Outcomes Visible benefits

  • The combined incidents of moderate and severe flatulence were lower after participants consumed the cranberry as compared to the placebo group.
  • Clostridium perfringens (pathogenic bacteria) was present only in the fecal samples of placebo group whereas Coriobacteriaceae (beneficial bacteria) was found abundantly in the fecal sample of cranberry group.
Functions
  • The cranberry prebiotic components, including oligosaccharides and polyphenols may contribute to the increase in the relative abundance of Coriobacteriaceae. Coriobacteriaceae carries out important functions, such as the conversion of bile salts and steroids, activation of dietary polyphenols, and are key in the production of menaquinone-6 homologs of vitamin K. Furthermore, Coriobacteriaceae has been identified as potential biomarkers that link exercise with health improvement and are correlated with the levels of 15 metabolites that are markers of improved health outcomes.
  • Cranberry extract inhibits the growth of Clostridium perfringens due to the activity of its active compounds such as tannin and oligosaccharides. Clostridium perfringens is a gram-positive spore-forming anaerobic bacterium that can cause the major intestinal disease.
  • The fact that cranberry extract can reduce the incidence of flatulence is associated with its beneficial inhibition of the growth of Clostridium perfringens, which is a strong hydrogen sulfide-producing bacterium.

Maintain a good oral health

The anti-adhesive properties of cranberry extract may help to prevent the buildup of plaque on teeth and reduce the risk of gum disease.

Type of study Literature Review
Mechanism of action Effects of caries

  • In oral diseases like caries and periodontitis, cranberries have shown therapeutic potential owing to their anti-adhesive and other anti-microbial properties.
  • The polyphenolic fraction of the fruit is reported to suppress the formation of biofilms and acid production by cariogenic streptococci.
  • In one study, cranberry fraction demonstrated the deactivation of enzymes glucosyltranferase and fructosyltranferase. These enzymes, essential to the formation of glucan and fructan, helped the adhesion of streptococci to the tooth surface, thereby inhibiting plaque formation.

Effects on periodontal bacteria and host mechanisms

  • Cranberries prevent the adhesion of Gingivalis to various proteins including type I collagen, hence decreasing the bacterial coaggregation in periodontal diseases.
  • Cranberries are reported to restrain the proteolytic activity of the red complex specifically the gingipain activity of gingivalis, trypsin-like activity of Tanerella forsythia and chemotrypsin-like activity of T. Denticola. Therefore, it is suggested that this fruit has the potential to limit the pathogen multiplication by restricting their growth resources from amino acids, peptides and also inhibit the tissue destruction mediated by bacterial proteinases.
  • Cranberry components may inhibit the NF-κB and MMP-3, hence regulating aggressive periodontitis’s fibroblast inflammatory responses. (Antiinflammation)

Reference

  1. Journal DOI: 10.6061/clinics/2012(06)18
  2. Journal DOI:10.2174/157340711795163820
  3. Journal DOI: https://doi.org/10.1039/D2FO00080F
  4. Journal DOI: 10.1093/cdn/nzab054_045
  5. Journal DOI: 10.4103/0972-124X.131301
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