Cranex Plus ™ Helps maintain urinary tract health

1. CranexPlus™ Helps maintain urinary tract health

2. OVERVIEW • What is urinary tract infection? • What causes UTI? • Risk factors of UTI • Types and symptoms of UTI • Action of Cranberry and D-Mannose

3. What is UTI? • It is a bacterial infection that affects the urinary system • The urinary system is composed of the kidneys, ureters, bladder and urethra. • When infected the tissues in the urinary tract become inflamed and swollen. This causes hindrance in the normal flow, thus causing pain while passing urine. • It most commonly affects the bladder and urethra

4. What causes UTI? • It is most commonly caused by the bacteria Escherichia coli • 90% of UTI cases are attributable to E.coli • It can also be caused by fungi and viruses

5. Risk Factors • Women at higher risk • Sexually active women • Certain types of birth control • Undergoing menopause • Urinary tract abnormality • Having blockages in the urinary tract • Using a catheter to urinate • Suppressed immune system • Men are also susceptible to UTI (Am J Public Health 1990; 80:331-333)

6. Types and Symptoms of UTI?

7. Cranberry • The fruit is a berry which is larger than the leaves of the plant and is a deep red colour when ripe. • It is considered to be one of the richest antioxidant containing fruits. • It is a major commercial crop in USA and Canada. • It contains phytochemicals which helps prevent cancer and heart disease.

8. Benefits are… • Potent source of antioxidants • Anti-adhesion activity with the help of phytochemical called proanthocyanidins (PACs).

9. Proanthocyanidins (PACs) • The proanthocyanidins found in cranberry differ from those found in other flavonoid rich fruits like grapes. • This is because cranberry proanthocyanidins have A-type linkage. • This linkage is responsible for the anti-adherence property of cranberry 9

10. Action of cranberry • Cranberry may help prevent and relieve symptoms of UTI by primary and secondary means. • The proanthocyanidins (PACs) in cranberry prevent bacteria from adhering to the walls of the bladder and urinary tract. • As a secondary measure, cranberry changes the pH of the bladder to be more acidic, preventing the growth of bacteria.

11. CRANBERRY PACs and Anti-adhesion (Adapted and modified from “Phytonutriance®, CranPure™, a natural high PAC cranberry extract scientifically proven to inhibit the adhesion of E coli on urinary tract walls”) • Bacteria adhere to cells with their hair like structures (fimbriae). • PACs prevent these structures from adhering to the wall of the urinary tract. • Bacteria can then be safely flushed from the body during urination. 11

12. Clinical studies • Walker et al (1997) reported that in a double-blind clinical trial, women treated with cranberry dietary supplement (from spray dried cranberry juice) for six months had a significant improvement in urinary tract infections. • Sobota et al (1984) reported that 15 ounces of cranberry juice cocktail significantly inhibited E.colibacteria from adhering to the urinary tract. Walker E.B. et al Cranberry concentrate :UTI prophylaxis., J. Fam. Pract., 1997; 45, 2, 167-8. Sobota AE, Inhibition of bacterial adherence by cranberry juice: Potential use for the treatment of urinary tract infections. Journal of urology 1984; 131:1013-1016. 12

13. Clinical studies cont.. • Baily et al (2007) reported that a daily dose of 400mg of cranberry extract showed a significant improvement in urinary tract infection , with no adverse effects. • Vidlar et al (2011), reported that in a randomised double blind placebo controlled trial, 500 mg of PAC standardized whole cranberry powder (PACran) reduced UTI recurrences compared to the placebo group. Bailey D.T et al., Can a concentrated cranberry extract prevent recurrent urinary tract infections in women ? A pilot study., Phytomedicine, 2007, 14, 4, 237-41 Vidlar et al 15th annual PhytoPharmcongress in Nuremberg, Germany July 25-27, 2011. 13

14. Clinical studies cont.. 14

15. D-Mannose • D-mannose is a simple sugar found in fruits like cranberries, peaches, etc. • Mannose rich foods have antiviral, antibacterial and anti-inflammatory properties. • It is produced in the body from glucose but in small quantities. • It helps to maintain good bladder and urinary tract health.

16. Action of D-Mannose • After digestion, D-mannose passes into the urinary system • Here it forms a layer on the urinary tract and bladder • When the harmful bacteria enter the urinary tract they adhere to the layer of D-Mannose • During urination, D-Mannose along with the bacteria attached to it is removed from the bladder and urinary tract • This prevents infection

17. Clinical studies • Study on long-term patients (42 females and 18 males) having a history of recurring UTI's. • Therapeutic use of D-Mannose was effective in eliminating or ameliorating UTI symptoms. • 80% of the female study group with Painful-Bladder-Syndrome became symptom free using D-Mannose. Abstracted and Edited from a Report Submitted to Progressive Laboratories by Michael Blue, M.D., Urologist (Norman, OK) 17

18. Composition Directions for usage – 1 to 2 capsules a day

19. Supporting Studies • Cranberry • Prevents E.coli from adhering to the urinary tract wall (Raz et al, 2004). • Cranberry is effective in preventing recurrent UTI. About 50% reduction in disease occurrence was seen in sexually active women with recurrent UTI (Raz et al, 2004). • Meta-analysis studies have found that daily intake of cranberry reduces the risk of recurrent UTI (Jepson & Craig, 2008; Jepson, 2008; Masson et al, 2009 ).

20. Supporting Studies….. • D-Mannose • D-mannose has been found to help in the management of UTI (Wright & Lenard). • When D-mannose is consumed by an individual with UTI, it is absorbed very slowly in the GI tract and is not readily converted to glycogen, like other sugars, for storage in the body but passes directly into the blood stream (Herman, 1971). • D-mannose rich blood passes through the kidneys where D-mannose is extracted from the blood and added to the urine. When the D-mannose laden urine passes through the different parts of the urinary tract, it leaves behind a layer of D-mannose lining the cell wall (Herman RH, 1971).

21. References 1. Moura A, Nicolau A, Hooton T, et al. Antibiotherapy and pathogenesis of uncomplicated UTI: difficult relationships. J ApplMicrobiol. 2009;106:1779–1791. 2. Howell AB, Foxman B. Cranberry juice and adhesion of antibioticresistanturopathogens. JAMA 2002; 287:3082–3. 3. jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Syst Rev. 2008. Issue 1. art. No. CD001321. DOI: 10.1002/14651858. CD001321.pub4. 4. Raz R, Chaza B, Dan M (2004) Cranberry Juice and Urinary Tract Infection. Clin. Infectious Disease; 38:1413-9 5. Rossi R, Porta S, Canovi B (2010) Overview on Cranberry and Urinary Tract Infections in Females.JClinGastroenterol; 44:S61–S62. 6. Wright JV and Lenard L, D-Mannose & Bladder Infection. The Natural Alternative to Antibiotics. Published by Dragonart, Auburn, Washington

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