If you are fighting chronic UTIs, your doctor might have suggested Ellura, Utiva or Theracran for UTI prevention. Is it worth all the hype, though?
Quick note: this post was originally titled as “Why I recommend Ellura” when Ellura was one of the very first known PAC supplements on the market. Thankfully, now we have more choices and the competition is driving the prices down. Unfortunately, with the increasing competition, Ellura’s representatives became more aggressive and misleading in their tactics. They joined our Facebook UTI group and were actively promoting their supplement without disclosing their affiliation. Moreover, they have provided misleading information about other brands to our FB community. This provoked us to look further into Ellura’s marketing tactics and evaluate claims that they and their competitors make to win you over. So check out the facts and decide for yourself.
#1 The Controversy Surrounding Cranberry
Cranberries are well known for their health benefits. For centuries, Native Americans used cranberries to improve bladder health and more specifically to prevent UTIs. See our post on herbal remedies for more about alternative remedies for urine infections.
Despite its centuries-long track record, there is still some controversy about cranberry’s role in preventing UTIs. Modern research has painted a mixed picture, with some studies showing cranberries decrease UTIs and others showing no difference compared to a sugar pill.
To be honest, some of the earlier studies were designed poorly because they did not make sure everyone got the same amount of cranberry.
However, recent studies are more careful and yet, there is still some uncertainty about the cranberries’ effectiveness. Despite this controversy, many people swear by cranberry for preventing their UTIs.
#2 How Do Cranberries Prevent UTIs?
For quite some time, we did not know why cranberry worked against UTIs. Doctors knew that cranberry made the urine acidic, which they knew was toxic to bacteria. It also produces nitric oxide, a compound that also helps to kill bacteria.
It was not until 1998 that researchers found the answer. Cranberries work so well against UTIs because they contain compounds called proanthocyanidins A-type (PAC-A or PAC for short).
PAC is great at stopping E. coli, the most common UTI-causing bug, from attaching to the bladder wall. It specifically blocks E.coli’s finger-like projections from grabbing on to the inner lining of the bladder, which is a necessary step for allowing a urine infection to take hold.
What is more, PAC-A is effective not only against normal E. coli but also the multi-drug resistant E. coli, the bugs we no longer have effective antibiotics to treat. While cranberry is most often used for E. coli UTIs, there are studies that show it is also effective against UTIs caused by bacteria other than E. coli.
#3 Is D-Mannose Better Than Cranberry For UTI Prevention?
When considering PAC cranberry products for UTI versus D-Mannose for UTI, it’s important to understand how both supplements work.
UTI starts because pathogenic bacteria (in most cases, E.coli) attach to the bladder lining in the way that it is impossible to simply pee them out.
E.coli can attach to the bladder through 2 different types of pili or “finger-like” projections called P-pili or type 1 pili. Think about pili as tiny tentacles that bacteria use to attach to your bladder lining.
P-pili is more virulent because it tends to cause kidney infections (p for pyelonephritis) while type 1 is less virulent and only causes bladder infections.
D-mannose actually attaches (or binds) to the type 1 pili so the E. coli is flushed out with the D-mannose. So, basically, E. coli grabs on to D-Mannose instead of the naturally occurring mannose on your bladder wall. And, since their “hands” are full of D-Mannose, they lose the ability to attach to the bladder lining.
On the other hand, cranberry blocks both type 1 and P-pili from attaching to the bladder wall (likely through a structural change), so the E. coli is peed out. We think that PAC-A somehow disables the tentacles of the bacteria from working and bacteria could not attach to anything anymore.
#4 How Much PAC-A Do You Need For UTI Prevention?
Not only is it important to know how much PAC you need to fight UTIs, but you also need to make sure that the supplement you take is being true to its word and actually contains what it claims. Studies show that you need between 36 and 72 mg of PAC-A per day for UTI prevention.
Beware of supplements that mention only the amount of cranberry it contains, without specifying the PAC-A content.
Even more alarming, you have to be wary of different brands. Studies show that not only do a lot of “UTI fighting” cranberry supplements on the market not have enough PACs to be effective but many that claim to have PACs may not contain any at all!
#5 What’s better: Ellura, Utiva or Theracran?
There are a handful more brands to consider, but more on this later. First, how to compare the PAC brands among each other?
We look at the main factors that you should focus on when evaluating your options.
One of the popular arguments is whether the supplement is made from juice or the whole berry. There are pros and cons for either option, but they are mostly theoretical. However, it is easier to test PAC supplements that are made from the cranberry juice compared to the ones made from the whole fruit. At the end of the day, they all seem to have same antiadhesion properties when tested by independent labs.
We should also keep in mind, that prominent research labs in Wisconsin and New Jersey that pioneering the work on PAC are coincidently located in the states that are both centers of cranberry production. I’d suggest taking the findings that promote supplements made from juice compared to supplements made from the whole berry with a grain of salt. The cranberry lobby is a powerful force and materially interested in moving more cranberries. Naturally, if you only use the juice to extract PAC you’d need more cranberries compared to the whole fruit method.
Most importantly, the manufacturer should be testing every batch (regardless of the method of production) to contain 36 mg of PACs and to demonstrate anti-adhesion properties. Both Ellura (or Urell® if you live in France and Spain) and Utiva claim to perform these studies for each batch. All other cranberry PAC supplements have a study or two to confirm the anti-adhesion properties of their ingredients.
What about the AAA test data?
If you ask Ellura representatives what makes their product different from others, they say that PAC potency is measured by Anti Adhesion Activity (AAA) and they have the best score. The test demonstrates how effective the product at preventing bacteria from adhering to the bladder. True, the lower the value the better. However, cranberries being a natural product, this value varies from batch to batch. Ask Ellura to show you documentation on the batch you are buying, not simply the lowest value they ever have gotten on the test.
Moreover, their statement that “Ellura has a value of 0.03 vs. TheraCran’s 0.12. ….you would have to take 4 TheraCran capsules to 1 Ellura” is not based on clinical evidence. Clinical trials conducted to date have not taken into account AAA value, only PAC value. We simply don’t know what difference the AAA value makes to a patient if any. At this point, the main conclusion for any test related to PAC is whether the amount present in the capsule is enough to affect the bacteria or not. AAA value is not correlated to any known clinical benefits.
Other microelements to consider
For some patients, the content of oxalates, sugar and vitamin K in cranberry supplements could be important. Compared to cranberry powder supplements, PAC-based pills have negligible amounts of all the above. This means that patients who have a tendency to form kidney stones or are on blood thinners can take PAC supplements safely.
However, Ellura contains .025 mg of salicylic acid (an active metabolite of aspirin) per capsule while Utiva has none. Those with an allergy to aspirin should use caution if taking Ellura.
Your options: 90-day supply
Prices are constantly changing, but as of 06/2019, this is how PAC supplements rank in terms of their price.
All brand below are tested for AAA PAC using the same technology (BL-DMAC) to demonstrate the anti-adhesive activity of the supplements :
Advertised to also contain 36PAC but no information about the tests is provided. We requested the details from the company and are awaiting an answer.
#6 How Often To Take PAC 36 supplements
When you digest a tablet, the PACs quickly reach effective concentrations in the urine, so it can start fighting urine infections.
However, the effects of PACs are at their strongest within 6 hours after ingesting.
One study showed that the E.coli-blocking effect drops quite a bit after 24 hours. These researchers suggest that it may be best to take these supplements twice a day to prevent UTIs.
#7 Will this work for you?
Most studies that looked at PAC cranberry extract focused on overall healthy women (and sometimes children); there is much less evidence that it helps men with urine infections. This is probably because most men have complicated infections. Also, some studies show that elderly women don’t get much benefit from using PAC supplements for UTI prevention.
However, this study suggests that PACs could be useful for patients with catheter-associated UTIs as well.
You can also take any of the PAC supplements at the first signs of a urine infection. Don’t ignore your symptoms; talk to your doctor if you aren’t feeling better in two or three days.
The bottom line is, if you are a woman who has dealt with several UTIs, consider trying a PAC-supplement. It may not work for every woman, but it definitely is a great resource to have.
Was it effective for you? Let us know your thoughts!
- Calijouw M, van den Hout W, Putter H. Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities. J Am Geriatr Soc. 2014 Jan; 62(1): 103-110.
- Chugtai B, Forde J, Howell A. Variability of commercial cranberry products for the prevention of uropathogenic bacterial adhesion. Am J Obstet Gynecol. April 2016; 214(4, Suppl): S500–S501.
- Davidson E, Zimmerman B, Junger E et al. Prevention of Urinary Tract Infections with Vaccinium Products. Phyto Rsch. 2013 Au; 28(3).Howell A. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol Nutr Food Res. 2007 Jun;51(6):732-7.
- Howell A. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol Nutr Food Res. 2007 Jun;51(6):732-7.
- Howell A, Botto H, Combescure C et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidincontent: a multicentric randomized double blind study. BMC Infect Dis. 2010 Apr 14;10:94.
- Howell A, Vorsa N, Der Marderosian A, and Foo L. Inhibition of the adherence of P-ﬁmbriated Escherichia coli to uroepithelial-cell surfaces by proanthocyanidin extracts from cranberries. N Engl J Med. 1998; 339:1085- 1086.
- Juthani-Mehta M, Van Ness P, Bianco L et al.Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial JAMA. 2016;316(18):1879-1887.
- LaPlante KL, Sarkisian SA, Woodmansee S et al. Effects of cranberry extracts on growth and biofilm production of Escherichia coli and Staphylococcus species. Phytother Res. 2012 Sep;26(9):1371-4.
- Micali S, Isgro G, Bianchi G et al. Cranberry and recurrent cystitis: more than marketing? Crit Rev Food Sci Nutr. 2014;54(8):1063-75.
- Vostalova J, Vidlar A, Simanek V. Are High Proanthocyanidins Key to Cranberry Efficacy in the Prevention of Recurrent Urinary Tract Infection? Phytother Res. 2015 Oct;29(10):1559-67.
- Wang CH, Fang CC, Chen NC et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012 Jul 9;172(13):988-96.