What is a UTI?

Urinary tract infections (UTIs) are bacterial infections of the urinary tract (the bladder and other urinary structures). They affect women 4x more often than men, and forty to sixty percent of women will get a UTI sometime in their lifetime. Unfortunately, some women will develop recurrent UTIs and will have multiple infections per year. Many UTIs will clear on their own without treatment but most people who seek conventional treatment will typically be prescribed an antibiotic. UTI’s are most often caused by E.Coli, a bacteria found in stool.

UTI’s can become more complicated and are associated with higher risks in people with diabetes, pregnant women, and those with compromised immune systems. If you’re in one of these groups, you should absolutely see your doctor at the first sign of a UTI.

Do you have a UTI?  

Some urinary tract infections are asymptomatic, especially in children and the elderly. For those who develop symptoms, they are most commonly:

  • Urinary urgency – a strong urge to void the bladder, even when little urine is present
  • Pain and burning with urination
  • Urinary frequency – frequent need to void the bladder
  • Blood and/or cloudy urine
  • Pelvic pain

Fever, back (kidney region) pain, chills, shaking, nausea and vomiting are signs that the infection has reached the kidneys – a much more serious infection that warrants an urgent visit to your doctor.

UTIs are easy to diagnose with a quick medical intake and a urine sample. Ideally, a positive urinalysis test is followed with a urine “culture and sensitivity” test to evaluate which antibiotic should be used for patients choosing to treat with antibiotics.

Why seek alternative treatment?

In some infections, antibiotics are absolutely appropriate. While antibiotic medications are useful and have saved many lives, they also have some issues. In uncomplicated UTIs, antibiotics may not be necessary. Here are some of the arguments against antibiotic use for uncomplicated UTIs:

  • In most cases, they aren’t necessary. The main reason cited for using antibiotics to treat uncomplicated UTIs is prevention of kidney infections. But the authors of this manuscript reviewed studies on the incidence of uncomplicated UTIs progressing to kidney infections and found this progression to take place only in about 2% of UTI cases.
  • Published side effects – Medication side effects will obviously vary based on the type of antibiotic used. Antibiotic side effects are often an afterthought but these are really no joke! For example, this recent study found an association with the fluoroquinolone group of antibiotics (commonly prescribed for UTIs) and aortic aneurysms. This same class of antibiotic is well known to cause Achilles tendon rupture. I don’t know about you, but I’d rather deal with an uncomplicated UTI than take the risk of having these side effects!
  • Destroying with your microbiome – We have much yet to learn about our body’s delicate microbial (healthy bacteria) balance. We know enough to know that our microbiomes effect immunity, metabolism, growth, brain function, and more. This study explores the idea that antibiotics may disrupt the functions of the microbiome, potentially “leading to acute or chronic diseases in some individuals.”
  • Yeast infections – 22% of women who are treated with antibiotics for an uncomplicated UTI will develop a vaginal candida (yeast) infection. Some will also develop an oral yeast infection (thrush). Many of these will then require antifungal medication to treat the candida infection. The genital mucosal tissue has its own microbiome balance and when we disrupt that with antibiotics, side effects are common.
  • Antibiotic resistant infections – Antibiotic resistance is a growing problem. Some of the antibiotics that used to be commonly used to treat UTIs are no longer effective against the bacteria most commonly implicated, E. Coli. This manuscript has a helpful illustration that shows that antibiotic resistance tends to emerge in less than 10 years after a new antibiotic is introduced. This means that when we really need antibiotic treatment, we run the risk of not having any effective options because the bacteria have become resistant to all the available options. Bacteria are more intelligent than we think!

Prevention as Cure

One thing I love about naturopathic medicine is the emphasis on prevention. Naturopathic medicine is proactive medicine. In many cases, preventative practices can help people avoid a UTI. These are especially important for women with recurrent UTIs.

  • Women should wipe “front to back” – the bacteria in stool can cause a UTI, so we want to keep it away from the urethra.
  • Avoid thong underwear – for the same reason as above.
  • Avoid tight fitting pants, opt for looser styles made of breathable fabrics like cotton blends.
  • Urinate before and right after sexual intercourse.
  • If you use a diaphragm or spermicide for birth control, consider switching to another form as these contraceptives have been shown to increase the risk of UTIs in women.
  • Some natural substances have been shown to be effective in preventing UTIs – vitamin C and cranberry are some examples. We will discuss these in more depth below.
  • Some women with recurrent UTIs are prescribed long-term antibiotics. While this may prevent infection during the course of the antibiotic, more than 50% of women will have another infection within three months after ceasing the treatment. This article concludes that prophylactic antibiotic use has no effect on propensity to become infected again after antibiotics are discontinued.

Chronic Infections

Recurrent infections tell us that there is some underlying cause that is not being effectively addressed. One area where naturopathic medicine really shines is in looking for the root cause of an illness. In this case we would investigate potential obstacles to wellness, such as – an imbalanced microbiome (aka dysbiosis), dietary irritants (excess alcohol), nutrient deficiencies, hormonal imbalances, immune imbalances, and so on. Theoretically, when the underlying cause(s) are addressed, the propensity for recurrent infection should diminish.

Food is Medicine

Even for acute infections, diet can be your best friend or your worst enemy. Some foods can irritate the urinary tract. These are best to avoid during a UTI and also in anyone who would like to focus on UTI prevention:

  • Caffeine in coffee, tea, and chocolate – Yes, all of these wonderful delicious things can aggravate urinary tract symptoms. Caffeine acts as a diuretic and can lead to dehydration and very concentrated urine. This is the exact opposite of what we need to flush out the urinary tract – abundant hydration and more dilute (therefore less acidic) urine.
  • Alcohol – For essentially the same reason as above, alcohol is a diuretic and can lead to dehydration.
  • Sweeteners – Artificial sweeteners like aspartame have been shown to be toxic to the kidneys and urinary tract. One of many reasons to avoid chemical sweeteners!
  • Nicotine – Ok, not a food but nicotine intake should obviously be avoided for a long list of reasons. Urinary tract health falls on that list.
  • Carbonated drinks – Even non-caffeinated carbonated drinks have been shown to irritate the lower urinary tract. Sadly, if you are prone to UTIs, fizzy water is not your friend.
  • Tomatoes and tomato-based foods – Though tomatoes have many health benefits, they are highly acidic and can irritate the urinary tract.
  • Food intolerances – If you have foods that you know of that bother you, do a trial of avoiding them to see if your urinary symptoms improve. For example, if eating cheese gives you constipation, you may have a food intolerance. If eating gluten gives you eczema, you may have a food intolerance. Though these symptoms may seem unrelated, these symptoms are indicative of inflammation and inflammation increases the risk of infection. A naturopathic or functional doctor can help you tease out your food intolerances, but a little trial and error on your own can also go a long way.

On the flipside, there are a few foods that may be beneficial to increase for better urinary tract health. Here is the lowdown on those:

  • Water – Good old H2O! So simple yet I review fluid intake with patients on a daily basis and most people are deficient in water intake. A good general rule to follow is to drink half of your body weight in water per day. For example, a 150lb person should aim for 75 oz per day. During an acute infection water intake should increase to help flush out the urinary tract. There is even some evidence that chronic low fluid intake can be linked to UTIs as well as other, more serious diseases of the urinary tract. .
  • Garlic – Garlic has gotten a lot of attention in the medical world as a potent and inexpensive antibiotic plant. This study found that garlic is effective against a broad spectrum of bacteria, even antibiotic resistant bacteria. Secondarily, garlic can be used to treat vaginal yeast infections that can sometimes occur after a UTI is treated with antibiotics.
  • Celery – The humble celery plant has been shown to have anti-adhesive properties against E. Coli bacteria in the urinary tract. This essentially means that compounds in celery make it harder for E. Coli organisms to stick to the walls of the urinary tract, thereby making it easier for the body to flush out the bacteria into the urine. Celery has other great health benefits too, so eat up!
  • Parsley – This study showed that a combination of parsley, garlic, probiotics, cranberry, and l-arginine (an amino acid) produced health benefits and urinary tract symptom relief in patients with recurrent urinary tract infections. We need more info about this, but this combination shows promise as a cost-effective and efficient treatment for antibiotic-resistant urinary tract infections. Most people know parsley as a garnish but it’s actually a tasty herb. My favorite way to incorporate it is in smoothies and salads. It’s great in middle eastern inspired recipes like tabbouleh.
  • Cranberry – Cranberry wins the ‘most popular’ award for UTI plant medicines. Though studies on effectiveness are quite mixed, there is enough evidence to support its effectiveness to keep it on the list. There have been animal studies that suggest that cranberry is more helpful for prevention of UTIs than treatment of acute infections. I suggest plain (unsweetened) 100% cranberry juice. This is usually just found at health food stores. Most “cranberry juice” at conventional grocery stores is actually apple or grape juice. These blends are very high in sugar and likely ineffective. It’s also available in a variety of supplement forms of mouth-puckeringly sour juice isn’t your bag.

Other Natural Remedies

In addition to using food as medicine, some natural supplements may also be effective for preventing and treating UTIs:

  • D-Mannose – D-Mannose is a type of sugar that appears to work by preventing bacteria from sticking to the walls of the urinary tract. This study showed that D-Mannose was more effective than Nitrofurantoin (a commonly used antibiotic drug) in preventing UTIs. Participants in the D-Mannose group also had significantly fewer side effects than in the antibiotic group.
    • Here is a great D-Mannose product, here is another that has D-Mannose + a few of the other compounds mentioned in this article.
  • Vitamin C – Vitamin C is commonly found in supplement products. It is high in many fruits and vegetables. This study showed that pregnant women who supplemented with just 100mg of vitamin C per day were half as likely to contract a UTI than those that did not supplement with vitamin C.
  • Probiotics – Probiotics can be found in fermented foods like yogurt and sauerkraut as well as in a variety of probiotic supplement products. Though we have much more to learn about probiotics and UTI treatment, this study found 2 strains of beneficial bacteria to be effective at restoring and maintaining a healthy vaginal bacterial balance. Lactobacillus reuteri and Lactobacillus rhamnosus are the strains to look for. We also have some evidence to support the use of probiotics alongside antibiotic treatment. This study found that children who were given both probiotics and antibiotics were less likely to have a UTI with fever than those given an antibiotic alone.
    • Here is a high quality women’s probiotic with lactobacillus rhamnosus
    • Here is a great probiotic to take alongside and after antibiotic use
  • Oregano Essential Oil – This study found oregano oil to be effective against 2 organisms that can cause UTIs – E. Coli and Psudomonas aeruginosa. These benefits were even found in antibiotic-resistant strains of these bacteria.
  • Thyme Essential Oil – This study corroborated the findings about oregano oil in UTI-associated organisms (above) and also found thyme essential oil to be effective.
  • Uva Ursi – Uva Ursi, also known as Bearberry, is commonly found in anti-UTI herbal blends. It appears to be safe and effective as a urinary antiseptic.
  • Buchu – Buchu is an herb that has been used in South Africa for centuries. It is a diuretic and has evidence to support its effectiveness in UTIs as well as stomach aches, coughs, and joint pain.
  • Goldenseal – Goldenseal is high in the plant compound berberine, which has proven to have strong antibiotic activity.
    • Here is a nice buchu, uva ursi, berberine and cranberry blend
  • Zea Mays – Also known as cornsilk, zea mays has demonstrated have anti-adhesive activity on urinary tissue. This means it prevents unwanted bacteria from sticking and hanging out in the urinary tract. This study had the same result and also showed that the anti-adhesive effects are more profound when zea mays is combined with another herb, urtica. These two plants appear to have a synergistic effect. Plant synergy is common in the world of herbal medicine, which is why I often recommend herbal combination products rather than single herb remedies.
    • Here is a nice zea mays tincture
    • You can mix it 50:50 with this urtica/nettle leaf tincture
  • Vaginal Estrogen – Last but not least, vaginal estrogen treatment has been shown to dramatically reduce the incidence of UTIs in postmenopausal women. Estrogen stimulates the production of a beneficial probiotic lactobacillus, so it makes sense that it would help prevent urinary and vaginal infections. Topical vaginal estrogen appears to be more effective than oral estrogen pills. This option is available by prescription only.

In summary

Urinary tract infections are very common and are usually uncomplicated bacterial infections of the lower urinary tract. Though urinary tract infections rarely progress to more serious problems, the symptoms are so uncomfortable that most people seek treatment to eradicate the discomfort quickly. Most people, especially women, will experience at least one UTI in their lifetime. There are a number of ways to prevent UTIs from occurring in the first place. Urinary tract infections are often treated with antibiotics but there is plenty of evidence to question this practice and seek alternative treatment options. Many foods, nutrients, and herbs have been studied and shown to be effective against E. Coli, the bacteria most likely to cause a UTI.

Key points:

  • Prevention is key – practice good hygiene to minimize the chance for bacteria to enter the urinary tract.
  • Hydration and healthy diet go a long way in prevention and treatment of a UTI.
  • Minimize substances that can aggravate the urinary tract – caffeine, alcohol, carbonated drinks, artificial sweeteners, acidic foods, and nicotine are amongst the most irritating.
  • If you are pregnant, diabetic, immunocompromised, or have signs of a more serious urinary infection (fever, chills, nausea, back pain) you likely have a more complicated infection – seek medical treatment right away.
  • There is evidence that should lead us to question the use of antibiotic medications to treat uncomplicated infections.
  • There is plenty of evidence to support herbal and nutrient products to prevent and treat uncomplicated UTIs.

 

Resources

About urinary tract infections

https://www.ncbi.nlm.nih.gov/books/NBK470195/

Human microbiome and antibiotics

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586385/

Fluoroquinolone antibiotics and aortic complications

https://www.ncbi.nlm.nih.gov/pubmed/29519881

Fluoroquinolone antibiotics and Achilles tendon rupture

https://www.ncbi.nlm.nih.gov/pubmed/16456878

Antibiotic complications – resistance, candida, impact on microbiome

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622145/

Prophylactic use of antibiotics for UTIs

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC274058/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962349/

Sex and UTI’s in women – spermicide, diaphragms increase risk

https://www.ncbi.nlm.nih.gov/pubmed/8672152/

Caffeine and carbonated beverages – effect on the lower urinary tract

https://www.ncbi.nlm.nih.gov/pubmed/23722012

Smoking and lower urinary tract symptoms

https://www.ncbi.nlm.nih.gov/pubmed/26706744

Aspartame and kidney toxicity

https://www.ncbi.nlm.nih.gov/pubmed/29038387

Hydration and UTIs

https://www.ncbi.nlm.nih.gov/pubmed/7648069
https://www.ncbi.nlm.nih.gov/pubmed/23673384

Celery

https://www.ncbi.nlm.nih.gov/pubmed/29496563

Parsley, garlic, cranberry, probiotics, arginine – effective in antibiotic-resistant UTIs

https://www.ncbi.nlm.nih.gov/pubmed/25587284

Garlic antibacterial

https://www.ncbi.nlm.nih.gov/pubmed/10594976

Cranberry – mixed studies on effectiveness

https://www.ncbi.nlm.nih.gov/pubmed/19441868

D Mannose vs nitrofurantoin – equally effective in prophylaxis of UTI for chronic UTI sufferers

https://www.ncbi.nlm.nih.gov/pubmed/23633128

Vita C

https://www.ncbi.nlm.nih.gov/pubmed/17611821

Probiotics and vaginal microbiome

https://www.ncbi.nlm.nih.gov/pubmed/19741517
https://www.ncbi.nlm.nih.gov/pubmed/18685506

Probiotics and antibiotics used together

https://www.ncbi.nlm.nih.gov/pubmed/24427497

Oregano essential oil for E. coli and Pseudomonas a.

https://www.ncbi.nlm.nih.gov/pubmed/23484421

Antibacterial EOs – thyme, oregano

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6100505/

Berberines antibiotic

https://www.ncbi.nlm.nih.gov/pubmed/29232416

Uva Ursi/Bearberry

https://www.ncbi.nlm.nih.gov/pubmed/30000963
https://www.ncbi.nlm.nih.gov/pubmed/24296864

Buchu

https://www.ncbi.nlm.nih.gov/pubmed/9924759

Zea Mays – anti-adhesion

https://www.ncbi.nlm.nih.gov/pubmed/26210697

Zea, Urtica – antiadhesive and synergistic

https://www.ncbi.nlm.nih.gov/pubmed/23211661

Managing recurrent UTI’s – estrogen

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/