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Maria Shikary

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About Author — Dr. Shikary is a graduate of the Ohio State University School of Medicine, and trained in pediatrics at UCSF in San Francisco. She specializes in holistic/integrative medicine and nutrition.

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Urinary Tract Infections

Urinary Tract Infections or UTIs are one of the most common reason for doctors visits amongst adults, accounting for over 7 million visits per year. Women are eight times more likely than men to get UTIs and there are a few different reasons for this. We have a shorter distance to our bladder and our urethras are straight, measuring about 1.5 inches versus men’s urethras that bend and are about 8 inches long which makes it much harder for those pesky bacteria to get to their bladders. Women’s urethral and anal openings are also relatively closer to one another so bacteria from the gut can more easily get into the urethra and then up to the bladder.

There are a variety of different risk factors for UTIs and believe or not, blood type is one of them. Multiple studies now have documented an increased risk of UTIs with people who have blood types B and AB. This is because some of the most common bacteria that cause UTIs have projections on them that look like B type and thus the body doesn’t recognize them as foreign. The risk is even higher if you have either B or AB type and are a non secretor of a different antibody called Lewis factor. I’m blown away!

Other more controllable factors that increase the likelihood of getting a UTI are sexual intercourse, low water intake, anatomical issues, use of diaphragms or spermicide, and constipation.

Anyone who has had a UTI knows how horrible it can be. Most women, including myself, will do anything to get rid of them and we use a lot of antibiotics as a result. As many of you have read in my earlier blogs, this is a problem because every time we take an antibiotic, we are destroying all those healthy bugs which actually help prevent us from getting UTIs so it’s a vicious cycle. However, there are a few different things that women can try before going to the antibiotic.

  • D-mannose. Probably one of my favorite sugars. D-mannose is a 6 carbon sugar similar to glucose and found in many fruits. The big difference with D-mannose is that it is not used by the body, but is preferentially taken up by a specific type of bacteria called E. coli that is the most common cause of UTIs in women. The theory is that if E.coli attach to D-mannose they will be unable to attach to the bladder wall and then be urinated out. There was one small study that split 300 women with a history of recurrent UTIs into 3 groups. One group got 2 g of D-mannose daily, the second Nitrofurantoin (a common UTI antibiotic), and the third received nothing. Of the three groups, those women in the D-mannose and Nitrofurantoin groups had a significantly lower risk of recurrent UTI and the D-mannose group not only did better than the Nitrofurantoin group but also had a lower risk of side effects from treatment. Given that D-mannose is generally considered safe, it is definitely worth a try for prophylaxis especially if you have a history of E.coli related UTIs.
  • Cranberry juice. Cranberries have a substance called proanthocyanaidins which give them their bright red color and also keep certain types of E.coli from attaching to the walls of the bladder. Sadly, studies done on cranberry juice have been mixed and fail to show any consistent improvement in recurrence of UTIs. This may be because cranberry juice doesn’t have enough of the active ingredients in one serving to fight off all the bacteria in the bladder. Either way, unsweetened cranberry juice isn’t going to harm anyone so also worth a try.
  • Probiotics. My favorite topic. There is good evidence that consistent, daily use of probiotics help decrease rates of UTIs because they push out the bad bacteria and increase the good bacteria that don’t cause problems in the bladder. It’s not enough to just be eating yogurt though, you have to actually take a probiotic supplement. The best are those containing lactobacillus or healthy type of E.coli.

These are just a few of the many things promoted as prevention or treatment of UTIs. People promote homeopathic medicines, grapefruit seed extract and a variety of other things, some of which can be dangerous. What we know for sure is that UTIs are very common and very distressing so keeping up with a good diet, hygiene, and hydration status in addition to the things mentioned above, will get you on your way to a UTI free status and if all else fails, well at least you have PlushCare to take care of your urinary health related needs. Take care and I’ll see you next week!


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