The active principles of Uva Ursi (other names: Bearberry, Foxberry, and Kinnikinic) have been studied for several decades. The plant is known in traditional medicine for its disinfectant effect on the urinary tract due to arbutin (or some think free hydroquinone) that is present in bearberry extracts.
Through modern day scientific research in test tubes and animals, researchers have discovered that Uva Ursi’s ability to fight infection is due to several chemicals, including arbutin and hydroquinone. The herb also contains tannins that have astringent effects, helping to shrink and tighten mucous membranes in the body. In turn, that helps reduce inflammation and fight infection.
Antibiotics or Uva Ursi?
Unfortunately, UTIs occur at an incidence of 10 percent per year and account for about 2 percent of all primary care outpatient visits. It is estimated that 93 percent of women with a UTI receive medications (1). More than 20 percent of urine pathogens are resistant to TMP/SMX (Bactrim) and cephalosporins. Half are resistant to amoxicillin. Part of the problem is that antibiotics have been given too freely and for too long so that there is the development of resistant strains that no longer can be killed by the antibiotic. In fact, having used antibiotics before seems to be a risk factor for having a resistant organism in the urine.
One of the answers to this antibiotic dilemma is to delay an antibiotic prescription for a few days as many women will resolve their UTI after just drinking plenty of fluids and urinating often. This has resulted in somewhat fewer antibiotic prescriptions in UTIs (3). Still, you want to be able to take something for the UTI in hope to help the healing process. Besides taking ibuprofen for UTI that can help reduce the inflammation and pain, there are herbal preparations that might ease bladder pain and make it easier to tolerate a delayed prescription for a UTI. Uva Ursi has the potential to decrease the use of antibiotics altogether.
What is Uva Ursi?
Uva Ursi is also called bearberry. Its leaves can be ground up and used to treat UTIs. The extract contains flavonoids, iridoids, hydroquinone glycosides (mainly arbutin, considered the main active ingredient), tannins and terpenoids.
It has been used for centuries all over the world but, in medical circles, fell out of favor, with antibiotics put in its place.
Uva Ursi for UTI: Facts and Myths
Here are some known facts about Uva Ursi (3):
- It is known to soothe bladder lining—pathogens and their toxins will irritate and inflame the inside of the bladder. Uva Ursi contains arbutin, which can stun bacterial growth and reduce the inflammation that causes bladder pain, urgency, and frequency. Therefore, Uva Ursi can decrease UTI symptoms while the host’s defenses are dealing with the infection.
- Uva Ursi has been used for UTI prevention as well but, according to some sources, it can cause liver damage if used for longer than a month at a time.
- A metabolite of Uva Ursi, arbutin, passes through the bloodstream and into the kidneys, where it exerts a diuretic effect. This basically makes you pee more so that the bladder and kidneys can be continually flushed out. Its antiseptic effect works not only in the bladder but in the kidneys as well.
Some people take Uva Ursi alone, while others add urinary demulcents, including corn silk and marshmallow root. A urinary demulcent is an herb rich in mucilage that can soothe and protect irritated or inflamed bladder tissue. Others will add dandelion root, which is an herbal diuretic that helps flush the kidneys and bladder.
One study found that the urine from healthy volunteers who were administered arbutin is capable of fighting off various bacteria including E. coli but with one caveat: their urine was adjusted to a pH of 8. Also, this was an “in vitro” study, meaning that the urine was collected from the participants and then tested in a lab to understand the interaction of arbutin with various strains of bacteria.
More interesting are the results of a double-blind, placebo-controlled (meaning that one group gets a “sugar pill” and the rest are administered a real medicine, but the participants do not know which group they belong to), randomized (participants are randomly assigned to each group) clinical trial that included 57 women who in a previous year experienced at least three episodes of cystitis. The women who were treated with bearberry extract didn’t have incidents of UTI for the next year versus 23% UTI recurrence rate in the group of women who were given a “sugar pill”.
Western Medicine and Uva Ursi
Germany is way ahead of the US when it comes to using herbal medications for many diagnoses. The German Commission has approved Uva Ursi for the treatment of inflammation of the bladder. In Germany, it wouldn’t be uncommon to be prescribed Uva Ursi—not only for a single UTI but for recurrent UTIs that tend to be harder to treat with antibiotics (2). Midwives there often use Uva Ursi in sitz baths after delivery to speed healing of episiotomies and to treat the vaginal and urethral irritation that occurs when giving birth.
There are few clinical trials in humans on the use of Uva Ursi for the prevention and treatment of UTIs. There have been laboratory studies (in vitro studies) showing that preparations of the herb are active against common UTI pathogens, including E. coli (responsible for 80-90 percent of UTIs), Staphylococcus aureus, Candida albicans (a yeast pathogen), and Proteus vulgaris. It has been shown also to be anti-inflammatory, especially when added to other anti-inflammatory medications (like corticosteroids and NSAID drugs).
There was one study of about 60 women who received Uva Ursi (as UVA-E medication) and dandelion leaf versus a placebo drug. It was used to try and prevent UTIs in women who had recurrent UTIs (about three in the last year). At the end of a year, those who took the herbal medication had fewer UTIs compared to those who took a placebo drug. UVA-E is a preparation available as an OTC agent in Europe but not in the US. It contains an extract of Uva Ursi leaves and dandelion root (Taraxacum Officinale). The study concluded that it is effective for prevention of recurrent UTI.
There are some who say that Uva Ursi shouldn’t be used in pregnancy because it can cause uterine contractions (theoretically). It has not been found to increase birth defects in pregnant animals (2). Even so, midwives have been using Uva Ursi in pregnancy with no adverse effects noted or recorded. It is not recommended with breastfeeding as no one knows if it is secreted in breast milk or if it would have an adverse effect on an infant. Other experts say not to take it in the first trimester of pregnancy (2), even though it hasn’t been linked to birth defects.
There is one research study that plans to look into the impact of Uva Ursi compared to placebo and has set up their research protocol. Some of the research participants will also take an NSAID for pain and inflammation. The study will be done on women complaining of UTI symptoms and will get an antibiotic if their symptoms worsen while on placebo or Uva Ursi. Recurrent UTIs will be excluded from the study. The study is just getting underway so it may be a while before we know anything about what the study revealed.
#1 Urine must be alkaline
Some studies conclude that it is important that urine is highly alkalized for bearberry to work. If you are eating a regular mixed diet, it is likely that your urine has a pH of 5 or 6 while the studies performed with bearberry adjusted the urine to a pH of 8. That could be hard to do even if you drink a lot of baking soda 🙂 But if you want to try Uva Ursi to treat or prevent your UTI, this is important to keep in mind. On top of it, Uva Ursi itself makes a slightly alkalizing effect on your urine.
#2 Summer & autumn leaves are more potent
Not all bearberry products are made equal. For example, summer and autumn leaves are more potent than winter ones. Therefore, when you buy a Uva Ursi product it is hard to know how much you need to take to arrive at the high concentration of the potent elements in your urine.
#3 Uva Ursi could be toxic in high concentrations
While no poisonings with bearberry have been identified or reported, researchers point out that hydroquinone which is present in low concentrations in the bearberry products is toxic. However, the amount of free hydroquinone from bearberry ingestion is unlikely to reach toxic levels.
#4 Use bear berry early
Uva Ursi works best at the first sign of infection.
In conclusion, most do not recommend taking bearberry products for prolonged periods of time and as with every herb, supplement make sure to seek doctor’s advice if your symptoms do not improve.
#5 Uva Ursi Dosage
The recommended dose of dried leaves is to take 2-4 grams per day, which are standardized to contain about 400 to 800 mg of arbutin per dose. Soak this amount in 5 ounces of water for 12 hours, strain the herbs, and drink as a tea 3-4 times daily. A cold infusion is probably best if you get nauseous after taking the dried herb. Cold infusions will have fewer tannins in them, which are responsible for nausea.
#6 Cranberry or Uva Ursi
Can you take cranberry and Uva Ursi together? This is disputed by experts. Cranberries are known to acidify the urine, while Uva Ursi works better in an alkaline environment. Even so, Uva Ursi will work in an acidic environment, with its antimicrobial effect unrelated to the urine pH levels. This means you can probably take the two together to treat a UTI. Cranberry has not been found to make that big a difference in the pH of the urine anyway.
Summary of the Facts on Uva Ursi
- Uva Ursi is believed to have antiseptic, astringent, and soothing properties in the treatment of UTI.
- Laboratory studies show it has an antimicrobial effect on E. coli and other urinary pathogens.
- There is evidence that Uva Ursi can cause liver toxicity if taken for longer than a month so it should be taken with caution among people with liver damage. It wouldn’t hurt to have liver testing done periodically if planning to take it for longer than a month.
- A large study on Uva Ursi (plus or minus an NSAID) is underway but the results are not yet ready.
- It probably shouldn’t be taken in the first trimester of pregnancy or with breastfeeding, even though it hasn’t been shown to cause birth defects in fetuses or harm to infants in animal studies.
- Midwives have been using Uva Ursi in pregnancy without adverse effects.
- Uva Ursi has been approved by the German Commission E for use in the treatment of UTIs.
Most of the information for this post I found in this book: Principles and Practice of Phytotherapy: Modern Herbal Medicine, 2e
- Little P, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ. 2010; 340: b5633.
- Romm A, et al. Urinary Complaints. Botanical Medicine for Women’s Health. 2010, Pages 290-305.
- Head KA. Natural approaches to prevention and treatment of infections of the lower urinary tract. Altern Med Rev. 2008 Sep;13(3):227-44.