Cranberry Juices and Supplements Review
CL's Tests Show Which
Cranberry Juices and Supplements Are Best and Cost the Least
Medically reviewed and
edited by Tod Cooperman, M.D. 
Last Updated
: 08/29/2021 | Initially Posted:
07/06/2021
Table of Contents
Summary
·
Does cranberry help treat or prevent UTIs? Drinking cranberry
juice or taking a cranberry supplement may help reduce the risk of recurrent
UTIs in women, although the evidence is limited. Drinking the juice is more
likely to help than taking a supplement. More limited evidence suggests
cranberry may also reduce symptoms of overactive bladderand
of lower urinary tract symptoms (LUTS) and prostatitis. See What It Does for details.
There is less evidence of benefit for dried cranberries and cranberry chews,
and the benefit of cranberry for UTIs in children remains uncertain.
·
What is in cranberry that helps it work against UTIs? Cranberries contain
a variety of polyphenolic compounds that include proanthocyanidins
(PACs). PACs have been shown to limit the ability of E. coli bacteria
to adhere to the walls of the bladder and urinary tract. By limiting this
adhesion, PACs from cranberry — particularly water soluble
A-type PACS — may reduce the risk of urinary tract infections (UTIs). See What It Is for more information.
·
Best cranberry juice or pills? ConsumerLab's
tests determined the amounts of water soluble PACs in
cranberry products. Amounts per serving ranged nearly 200-fold, from as little
as just 0.54 mg to as much as 105.6 mg, and the cost to get 36 mg of PACs range
from just 35 cents to $21.67. See What CL Found for details.
Our Top Picks among
cranberry juices and supplements each provided the highest
amount of PACs among competing brands and did so at much lower cost.
·
What to look for on cranberry labels? When looking at the
amounts of PACs listed on labels, it is critical that you also look for the
method used to determine those amounts, because different methods,
such as BL-DMAC (or DMAC/A2) versus OSP-DMAC (or cPAC-DMAC)
can yield very different results (see PAC Test Methods for details) and lack of
a listed method can make any amount meaningless.
·
Is cranberry safe to use? Cranberry beverages or dietary supplements
are generally safe for most people, although people with diabetes, those at
risk for kidney stones, and those with an aspirin allergy may need to use
caution. See Concerns and Cautions for details.
What It Is:
Cranberries
contain a variety of polyphenolic compounds, including proanthocyanidins
(PACs). PACs from cranberry have been shown limit the ability of E.
coli bacteria to attach to the walls of the bladder and urinary tract
and gain a foothold (adhesion). By limiting this adhesion, PACs from cranberry
— particularly A-type PACs — may reduce the risk of urinary tract infections
Type B-type PACs (which are common in other fruits, such as apples and plums,
as well as peanut skins) do not have this activity (Howell, Phytochem
2005).
PAC test methods — Know what to look for
There are both soluble and insoluble PACs. Most testing has focused on soluble
PACs as it is difficult to measure insoluble PACs and there is no validated
compendial method for doing so. More than 91% of cranberry PAC molecules have
at least one A-type linkage (as opposed to B-type) (Feliciano, Food Chem 2012), and, as a result,
PACs from cranberry are generally referred to as A-type PACs.
Products that have shown
benefit in clinical studies have typically provided about 36 mg per serving,
taken twice daily, when measured using the DMAC (dimethylaminocinnamaldehyde)
method with procyanidin A2 reference standard developed by Brunswick
Laboratories (BL), together referred to as BL-DMAC method, (AOAC
2019.06) which specifically measures amounts of soluble PACs. This method is
also called the DMAC/A2 method and will be part of an upcoming
USP (US Pharmacopoeia) Monographs for cranberry and is the method used by ConsumerLab in this Review.
It is useful to know that
research done by Ocean Spray has tended to measure PACs using a different,
proprietary reference standard known as OSP, although also run with the DMAC
method. This approach counts additional cranberry PACs and, consequently,
yields values that are about 3.5 times as large as those derived with the A2
reference standard. (The OSP standard is similar to another proprietary
reference standard known as c-PAC, but neither of these standards are
commercially available.)
Research by Ocean Spray
suggests that an effective dose is 80 mg of OSP-PACs.
According to Ocean Spray, this is the amount that would be found in 8 ounces (1
cup) of cranberry juice cocktail that is 27% pure cranberry
juice. Put another way, it's the amount in 2.7 ounces (about 1/3 cup) of pure cranberry
juice. That is, if a product lists 80 mg of PACs using the OSP reference
standard (the Ocean Spray standard) it likely contains about 23 mg of PACs
using the A2 reference standard.
According to Ocean Spray's website page about
its Pure (100%) Cranberry Juice:
·
Consuming 3 fl oz daily of Pure
Cranberry may help reduce the risk of recurrent urinary tract infection (UTI)
in healthy women (this is footnoted with "FDA has concluded that the
scientific evidence supporting this claim is limited and inconsistent")
·
Each 32 oz bottle is made from the juice of over 2 pounds of
cranberries
Be aware that the USDA, in collaboration with other
groups, has determined the PAC content of a variety of foods, but
these tests, from 2004, rely on old HPLC methods (developed in 1999), as
opposed to the more recent DMAC methods and do not provide meaningful
information in assessing amounts of A-type PACs in foods.
What It Does:
Urinary Tract Infections (UTIs)
Cranberry has been used with some success by women for many decades to prevent
urinary tract infections (UTIs). We now know that polyphenolic compounds in
cranberries, such flavonols, condensed tannins,
phenolic acids (such as benzoic acid), and PACs (proanthocyanidins)
limit the ability of E. coli bacteria that cause the infection
to attach to the walls of the bladder and urinary tract and gain a foothold
(adhesion). Evidence from one clinical trial also suggests cranberry may reduce
symptoms of overactive bladder. As discussed below, much of the research on
cranberry has focused specifically on cranberry PACs.
In 2012, scientists from
Taiwan and Harvard University in Boston reviewed a variety of clinical trials
using cranberry juice or pills, most of which lasted 6 months (Wang, Arch Int Med 2012). Overall, they
concluded that cranberry can reduce UTIs, especially in women who
get them periodically, and that drinking cranberry juice is more likely to help
than taking cranberry pills.
In 2020, the U.S. Food
and Drug Administration (FDA) announced that certain types of cranberry juice
and cranberry supplements may claim to help reduce the risk of recurrent UTIs
in women when taken in specific amounts/dosages (CFSAN Constituent Update, 2020)although
the evidence supporting this claim is limited.
Cranberry juice:
Studies have used anywhere from 1.5 to 25 oz of cranberry juice per day. The
taste, calories, and possible digestive upset may keep you from drinking too
much; each 8-ounce glass of cranberry juice cocktail provides about 120
calories, though 100% cranberry juice and diet versions have less. The FDA has
concluded that drinking as little as one 8-ounce serving of cranberry juice
cocktail daily may help reduce the risk of recurrent UTIs, although the agency notes
that the evidence supporting this claim is limited and inconsistent. The
association between cranberry beverage consumption and reduced risk of
recurrent UTIs seems to be strongest for drinks containing at least 27%
cranberry juice (CFSAN Constituent Update, 2020).
It may be best to divide
the juice into two servings, as the ability of the PACs to prevent E. coli
adhesion lasts for only about 8 hours.
A study among 322 women
(average age 41) with a history of a recent UTI found that those who consumed 8
oz of cranberry juice cocktail (27% pure cranberry juice)
daily for 5 ½ months had significantly fewer UTIs over the course of the study
than those who consumed a placebo drink (39 UTIs vs. 67 UTIs, respectively) (Maki, Am J Clin Nutr 2016).
The cranberry cocktail was provided by Ocean Spray (which also funded the
study). (The actual product is not sold but provided 50 calories per serving,
which appears to be a hybrid of two of Ocean Spray's Cranberry Juice Cocktails
— the diet version, which includes artificial sweeteners and has 5 calories,
and the fully sweetened version which has 110 calories.) A serving contained 41
mg of PACs (BL PACs) or 119 total PACs (OSP-PACs).
Cranberry capsules:
If you prefer cranberry pills, the FDA has concluded that taking a cranberry
dietary supplement providing at least 500 mg of 100% cranberry fruit powder
daily may help reduce the risk of recurrent UTIs, although, again, the agency
notes that the evidence supporting this claim is limited (CFSAN Constituent Update, 2020).
Other experts recommend choosing a product that lists its PAC content and taking
the pills several times a day to provide at least 72 mg of PACs (Howell, BMC Infect Dis 2010).
It's also important to
note that only water-soluble PACs, which include A-type PACs,
have been shown, to date, to affect bacterial adhesion. Cranberry juice contains only water-soluble
PACs (including A-type PACS) while cranberry pomace (seeds, skin, and stems)
contains insoluble PACs. Since the composition of cranberry
tablets and capsules on the market can vary (containing dried juice or juice
extract vs. whole cranberry powder containing cranberry pomace), this might
explain, in part, why some researchers have suggested that juice may be more
effective than pills (Howell, J Diet Suppl 2021).
As discussed below, it
may be best to take each serving of cranberry pills with a full glass
of water.
Clinical findings with
some capsule products:
A branded cranberry juice extract (Ellura/Urell, Pharmatoka) provides 36 mg
of PACs, so taking 2 capsules would provide the 72 mg shown to inhibit bacteria
from adhering to the urinary tract. In a study that appeared to use this
product (the cranberry capsules were provided by Pharmatoka
although the type of PAC was not specified as A-type), taking 2 capsules daily
(providing a total of 72 mg PACs) for 30 days was more effective at lowering
counts of E. coli in urine than taking just one capsule,
however, taking 3 capsules provided no additional benefit over 2 capsules (Bianco, J Am Geriatri Soc 2013).
An official statement about this product by the European Food Safety Authority
(EFSA) noted that current studies do not provide enough evidence to establish a
"cause and effect relationship ... between the consumption of proanthocyanidins in Urell"
and a reduction of bacterial growth in the urinary tract (EFSA 2013).
A study
was conducted to assess the ability of two different cranberry supplements,
after being taken, to inhibit bacterial adhesion in the urine. The study was
conducted among 20 healthy men and women who did not have a current UTI or
history of UTI. The subjects took either AZO Cranberry caplets
containing Pacran whole-cranberry
derived cranberry powder (two caplets containing a total of 500 mg of Pacran yielding a total of 0.94 mg of soluble PACs)
or Ellura cranberry juice extract
(one capsule providing 36 mg of soluble PACs from 200 mg of Gikacran cranberry juice extract) once daily
(with 8 oz. of water) for seven days. It was found that the anti-adhesion
activity in samples of participants' urine (i.e., inhibiting the ability
of E.coli bacteria to adhere to
cells) was, on average, 4 times greater with Ellura than AZO.
However, only trials in people with current UTIs or history of UTIs can determine
if these products actually help treat or prevent urinary tract infections.
[Note: Amounts of soluble PACs in both products were determined in laboratory
analysis using the BL-DMAC method, as used by ConsumerLab
in this Review; the amount of PACs in AZO was
not listed on the label.] (Howell, J Diet Suppl 2021).
In a study of 160 women
who had elective gynecological surgery, those who took 2 capsules twice a daily
of cranberry extract (TheraCran, Theralogix, LLC) (stated to be equivalent to two 8-ounce
glasses of cranberry juice and, according to the Theralogix
website, providing a total of 72 mg of PACs based on BL-DMAC testing) for four
to six weeks after surgery had a significantly lower occurrence of urinary
tract infections (19% got infections) than those who took a placebo (38% got
infections). The women were instructed to drink 8 ounces of water with each
2-capsule serving (Foxman, Am J Obstet
Gynecol 2015). It must be noted, however,
that there were significantly fewer episodes of self-catheterization after
surgery among the TheraCran-treated
patients than among those receiving placebo (31% vs. 50%, respectively), which
could have reduced their risk of infection.
A one-year
placebo-controlled study of elderly women in nursing homes around Connecticut
did not find cranberry supplements to reduce urinary tract infections. The
investigators were aware that evidence (above) better supported the use of
cranberry juice, but they chose to test cranberry capsules (providing
72 mg of PACs) because "the acrid flavor of cranberry juice is difficult
to tolerate in large volumes, especially for nursing home residents because of
swallowing disorders, exacerbation of incontinence, and impaired thirst."
Perhaps due to concern over urinary incontinence, the women were not instructed
to take the pills along with water (as was done in the successful Foxman study,
above), which may have improved absorption of water-soluble cranberry compounds
and flushing of the urinary system. Nevertheless, initial improvement was seen
at 6 months and the treated group experienced much lower rates of
hospitalizations and urinary infection with drug-resistant bacteria than the
placebo group, although these differences were not statistically significant (Juthani-Mehta, JAMA 2016).
Capsules for overactive
bladder (OAB)
A study of 60 women (average age 48) with overactive bladder, a condition
characterized by increased urinary urgency and frequency, showed mixed results
for this condition. The women -- none of whom were on medication for OAB --
took one capsule daily containing 500 mg of dried cranberry powder (NaturexDBS, LLC, the amount of
PACs was not provided). Compared to women who took a placebo capsule, those
taking cranberry reported urinating about two times less per day and a slight
improvement in perception of OAB symptoms, but there was no reduction in the
need to urinate at night or in self-reported quality of life (Cho, J Urol 2020).
Cranberry chews:
A placebo-controlled study among 20 healthy men and women without histories of
current or recurrent urinary tract infections showed that a cranberry chew (Cranberry
+Health by Ocean Spray, which funded the study) taken with 8 oz of
water in the morning and again in the evening significantly increased
anti-adhesion activity in samples of participants' urine, i.e. inhibiting the
ability of E.coli bacteria to adhere
to cells in a culture plate. The chew increased the anti-adhesion activity
against a type of E. coli responsible for the majority of
acute bladder infections and a type implicated in infections that spread to the
kidneys, while the placebo chew had little to no anti-adhesion activity. The
anti-adhesion effect lasted approximately nine hours but was strongest in the
first three to six hours after consumption, similar to the length of time
cranberry juice has been observed to inhibit E. coli adhesion,
as noted above. Each Cranberry +Health chew contains 1,600 mg
of cranberry fruit extract providing 137 mg of polyphenols, including 120 mg of
total cranberry PACs (measured with OSP-DMAC, so equivalent to about 34 mg of
PACs using BL-DMAC, and 6 grams of sugar (Liu, Food Funct 2019).
There are no published studies on the effect of this product in people with UTIs.
Dried
cranberries:
There is not as much research on dried cranberries as there is with juices and
supplements. However, a study among 17 women with a history of recurrent UTIs
showed that consuming 42 grams (about ¼ cup) of sweetened dried cranberries
(Ocean Spray Cranberries Inc.) daily for two weeks reduced the incidence of
UTIs during the following six months to 1.1 infections compared to 2.4
infections during the prior 6 months (Burleigh, Nutr J 2013).
Although there was no placebo control, the researchers noted that the incidence
of UTIs in the cranberry group was also significantly less than found in women
given placebo in other UTI studies. The study did not report the PAC content of
the sweetened dried cranberries, but a separate analysis found that a cup of sweetened
dried cranberries contains about three times the PACs as a cup of cranberry
juice cocktail (Grace, J Food Sci 2016).
Despite this research,
the FDA has concluded that there is not enough evidence to support a
qualified health claim for dried cranberries and reduced risk of
recurrent UTIs (CFSAN Constituent Update, 2020).
Cranberry for UTIs in
children
A small study in children found a 65% reduction in the risk of urinary tract
infections (UTIs) in those receiving cranberry treatment over the course of a
year (Afshar, J Urol
2012). Forty children (5 to 18 years old) with at least two UTIs in
the past year were randomly assigned to drink cranberry juice daily (about 3
ounces per 100 pounds of the child's weight) or a placebo drink. Over the year,
12 children dropped out (equal numbers in both groups), but of those who
remained, 5 of the 14 children in the experimental group developed 5 UTIs over
the year as opposed to 15 UTIs in 8 of the 14 children in the placebo group.
It's important to note that the juice, provided by Ocean Spray, was
"research grade" and enhanced in PAC content, so it may not reflect
current products in the marketplace.
Cranberry
for men
There is some evidence that cranberry powders and extracts may be helpful for
reducing lower urinary tract symptoms (LUTS) such as frequency, urgency and
nighttime urination, in men with non-bacterial prostatitis or benign prostatic
hyperplasia (BPH), as well as in men undergoing treatment for prostate cancer.
Two studies have also found cranberry supplements to lower blood levels of
prostate specific antigen (PSA), and one study suggested slight protection from
UTIs during radiation treatment. These studies are discussed below.
A study among 124 men
(average age 53) with moderate to severe lower urinary tract symptoms
(LUTS) -- such as feelings of incomplete emptying, frequency,
intermittency, straining, urgency, weak stream and waking during the night to
urinate — found that a daily dose of either 250 mg or 500 mg of cranberry
powder (Flowens capsules, NATUREX) taken
once daily for six months significantly decreased self-reported LUTS symptoms
compared to placebo (Vidlar, World J Urol 2016). Both doses reduced overall
symptom scores on the International Prostatism Symptom Score, or IPSS (which
estimates symptom severity on a scale from 0 — 35) by more than three points,
which is considered clinically meaningful by the American Urological
Association. The 250 mg dose reduced symptom scores by an average of 3 points,
and the 500 mg dose reduced symptom scores by an average of 4 points.
Information about the PACs in the cranberry powder was not provided.
A study
in Italy among 44 men age 65 or older (average age 66) with moderate BPH
and recurrent UTIs found that the group who took 120 mg of a
standardized cranberry extract (providing 36 mg of PACs) once daily for two
months in addition to standard management, had an average of three fewer UTIs
than compared to before supplementation, and about 2 fewer UTIs than men in the
control group who underwent standard management but did not supplement with
cranberry. The researchers were employed by the company that made the extract (Anthocran, by Indena) (Ledda, Eur Rev Med Pharmacol Sci 2016).
One study investigated
the effects of cranberry fruit powder in 42 older men (average age 64) with
(LUTS) and elevated PSA levels from chronic non-bacterial
prostatitis and/or (BPH). Men who took the cranberry powder (3
capsules taken at equal intervals throughout the day, providing a total daily
dose of 1500 mg cranberry fruit powder and 4.95 mg anthocyanins) for six months
had significant improvements in symptoms such as frequency, urgency, weak
stream volume, and the need to urinate during the night compared to men who did
not take cranberry. After six months, total PSA levels decreased in 80% of the
men who took the cranberry capsules (from an average of 6.18 mcg/L to 4.53
mcg/L), while levels increase in those who did not (Vidlar, J Br Nutr 2010).
The cranberry capsules were supplied by Decas
Botanical Synergies, LLC.
In a study among 62 men
(average age about 62) with prostate cancer, those who took three
capsules of dry cranberry fruit powder (PACRAN, NATUREX) (providing a
total daily dose of 1,500 mg cranberry powder) 21 to 30 days before radical
prostatectomy surgery had an average decrease in PSA levels of 22% on the day
of surgery, while those who took a placebo had an average increase in PSA
levels of 0.9% (Vladmir, Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016).
A study
among 41 men (average age 68) in New Zealand undergoing radiation treatment for
prostate cancer found that 65% (13 men) of those who took an enteric coated
cranberry capsule (containing 72 mg of proanthocyanidins)
once daily with breakfast during radiation treatment (about 4 months) and for 2
weeks after treatment completion developed cystitis (inflammation
of the bladder) while 90% (18 men) of those taking a placebo developed a UTI —
although the difference was not statistically significant. Those who took the
cranberry capsule reported significantly less pain and burning on urination, on
average, than those who took a placebo (Hamilton, Support Care Cancer 2015).
Interestingly, a larger study (101 men undergoing radiation treatment for
prostate cancer) using the same cranberry supplement showed it to be less
effective than placebo. The researchers noted that the placebo was
beetroot, which may have had some sort of activity (Herst, Radiother and Oncol 2020). Another study in men
undergoing radiation for prostate cancer (external beam radiotherapy), found
one enteric-coated tablet taken daily (VO370 or Monoselect Macrocarpon, PharmExtracta,
Italy), containing 200 mg of cranberry extract standardized to 30% proanthocyanidins significantly reduced urinary urgency,
nighttime urination and total daily urination frequency compared to placebo (Bonetta, Cancer Manag Res
2012). Among the men who took the cranberry tablet, 30%
developed a urinary tract infection (UTI), compared to 60% among
those who took a placebo.
Helicobacter pylori Infection
H. pylori is a bacterium
that can colonize the stomach, causing oxidative stress and changes in
intestinal microbiota. H. pylori infection can cause chronic
gastritis (inflammation of the stomach) and peptic ulcer
disease, as well as other gastrointestinal conditions.
Cranberry juice has shown
modest benefit for reducing H. pylori infection when used
alone or along with antibiotics, although the greatest benefit seems to occur
when used with antibiotics. Research has shown good evidence for cranberry
juice when taken in dosages of 250 mL (about 8 oz) twice daily along with
antibiotics for H. pylori, although some research has found that
only cranberry juice with high amounts of proanthocyanidins
(about 44 mg per 8-oz serving) is beneficial (Zhang, Helicobacter 2005; Shmuely, Mol Nutr Food Res 2007; Li, J Gastroenterol Hepatol 2020).
Cranberry
juice may do this, in part, by increasing antioxidant capacity in the body and
by promoting the growth of beneficial bacteria and reducing harmful bacteria in
the gut. A study in China among 171 men and women in with H. pylori infection
found that consuming 8 oz. of cranberry beverage containing 27% cranberry juice
and 42 mg of soluble PACs (provided by Ocean Spray, which funded the study)
twice daily for one month significantly increased antioxidant capacity (as
measured in the blood) compared to drinking a placebo. In the gut, levels of
beneficial bacteria (such as Bifidobacterium) increased and those
of potentially harmful bacteria (Pseudomonas decreased (Gao, Food Funct 2021).
A preliminary study
suggested a benefit in adding a cranberry supplement to antibiotic therapy to
treat H. pylori infection, although details about the
supplements were not provided (Seyyedmajidi, J Res
Pharm Pract 2016).
Quality Concerns and
Tests Performed:
Because
no government agency is responsible for routinely testing cranberry juices and
supplements for their contents or quality, ConsumerLab.com independently
evaluated several leading products for the following components. In addition,
any tablets or caplets were also tested to be sure that they could disintegrate
("break apart") properly.
PACs
All products were tested for the amount of soluble proanthocyanidins
(PACs), as these appear to be important to the efficacy of cranberry products
in treating and preventing UTIs, as discussed in detail above.
Authenticity
Although the main focus of our testing in this Review was to determine the
amount of soluble, A-type PACs, we also wanted to make sure that the cranberry
ingredient in each product was authentic, i.e., really made from cranberries.
This is because there are sources of PACs that are cheaper than cranberry (such
as peanut skin, plum, grape skin, black bean, and black rice) that can be used
as adulterants to boost the PAC content of a product (Brendler, Botan Adulterants
Bulletin, 2017). However, these sources tend to contain more
B-type PACs than cranberry, while cranberry contains more A-type PACs. More
than 91% of the PACs in cranberry should be A-type PACs, that is, having at
least one A-type chemical bond (Feliciano, Food Chem 2012).
Heavy metals
Although not a major concern with cranberry products, ConsumerLab.com tested
all products for heavy metals (lead, arsenic, and cadmium) to determine if any
exceeded levels that would pose a safety concern.
For more details about
testing, see How Products Were Evaluated.
What CL Found:
Our tests of cranberry juices and supplements showed nearly a
200-fold range in the amounts of PACs across products. Some had levels in-line
with what has shown clinical efficacy, while others contained little — in,
fact, one supplement, AZO Cranberry, had an even lower amount of PACs than expected from its label and was, therefore, Not Approved
for its quality. Three other supplements (discussed further below) also could
not be recommended for use due to low amounts of PACs.
All of the products were
found to contain authentic cranberry and did not exceed ConsumerLab's
limits for heavy metal contamination.
PACs
As shown in the graph below, a serving of each product yielded as little as
0.54 mg of PACs (i.e., A-type, soluble PACs) in AZO Cranberry to
as much as 105.6 mg in 8 fl oz (1 cup) of Ocean
Spray Pure Unsweetened Cranberry.
In juices
Among the juices that we tested, all contained only cranberry
juice without added sweeteners and were not cocktails
(mixtures with other juices). Per serving, there was a 66% difference in the
amounts of PACs in these juices.
The smallest amount PACs,
63.7 mg, was in a 4 tbsp (2 fl oz) serving of Lakewood
Organic Cranberry Juice Concentrate to which 6 fl
oz of water is to be added to make an 8 fl oz serving
of "100% juice." Not only was this the smallest amount
of PACs found per serving but it wasn't even as much as in an 8 fl oz serving of Lakewood Organic Pure Cranberry,
which provided the next lowest amount of PACs per serving -- 75.6 mg. A similar
amount of PACs was found in Trader Joe's 100%
Cranberry Juice, which was the only other juice not from concentrate and,
interestingly, the only juice that was clear and a slightly lighter shade of
red than the others, perhaps due to a lower concentration of cranberry solids.
The largest amount of PACs — 105.6 mg -- was found in an 8 fl oz serving of Ocean Spray Pure Unsweetened
Cranberry, which is reconstituted. It was a darker shade of red than most
others. This color was shared only by R. W. Knudson Family Just
Cranberry, which is also reconstituted and had the second-highest amount of PACs -- 96 mg per 8 oz serving.
In supplements
There was an astounding range of PACs among the supplements, and only two
provided amounts at or above what has shown benefit for UTIs: Theralogix Nutritional Science TheraCran One (which claimed 36 mg of PACs per
capsule but actually provided much more — 62.1 mg), and Ellura (which claimed 36 mg of PACs and
provided a little less — 31.3 mg). It is important to note that both of these
supplements, unlike the others, indicated that their PAC levels are based on
BL-DMAC method (also called the DMAC/A2 method) (discussed above).
The other supplements
provided no more than 4 mg of PACs per serving, and, therefore, we would not
recommend any of them.
As noted earlier, AZO
Cranberry provided the smallest amount of
PACs — just 0.54 mg per 2-caplet serving. AZO's label claims that this serving
provides 500 mg of cranberry whole fruit powder from Pacran and
that 1 serving = 1 glass of cranberry juice, which is footnoted as
"Biological activity of 10 oz cranberry juice cocktail." As cranberry
juice cocktail should be at least 20% cranberry (more typically about 27%), 10
oz should provide the equivalent of at least 2 oz of pure cranberry juice. As
shown in our testing of juices, 8 oz should provide about 80 mg of soluble
PACs, so 2 oz should provide about 20 mg. At just 0.54 mg, AZO provided
about 3% of the minimum amount of PACs one might
expect from its label. It is also nearly half the amount previously reported
with Pacran in a comparison study with Ellura, and it is only about one-quarter the amount
expected based on information about Pacran from its maker, NATUREX, which states
that Pacran is 0.4% PACs when tested
with BL-DMAC, such that 500 mg should provide 2 mg of PACs -- nearly four times
the amount found by ConsumerLab.
It is instructive to note
that Trunature CranMax,
in which we only found 3.8 mg of PACs per capsule, claimed 35 mg of PACs but
it did not specify the type of PACs or the method of PAC
measurement, making this statement fairly meaningless and potentially
misleading to a consumer who compares it to products that list amounts of PACs
based on the BL-DMAC method.
Cost
As shown in the graph below, the cost to get 36 mg of PACs (a dose that, when
taken at least twice daily has shown a benefit for UTIs) ranged from 35 cents
from Trader Joe's 100% Cranberry Juice to $21.67 from AZO
Cranberry (due to its very small amount of PACs).
Products listed as
"Approved" met their label claims and ConsumerLab.com's
quality criteria (see Passing Score).
Top Picks:
Our overall Top Pick among cranberry products for
use in preventing or treating recurrent UTIs is Ocean Spray Pure
Unsweetened Cranberry. It is also our Top Pick among
cranberry juices. It provided the highest amount of PACs per serving of any
product and was relatively low in cost. In fact, to get 36 mg of PACs from
Ocean Spray, you only need to drink 2.7 ounces (mixed with water) which would
cost only 43 cents. Trader Joe's was a little less expensive,
but you would have to drink more juice (and consume more calories) to equal the
PACs in Ocean Spray. Interestingly, Ocean Spray also
claimed fewer Calories per 8-ounce serving (60 Calories) than the other juices,
which listed 70 or 80 Calories. We did not, however, test the products for
their caloric values or sugar content.
Ocean Spray is even less
expensive, in terms of getting PACs, than the least expensive supplement, TheraCran. But the primary reason that Ocean
Spray is our overall Top Pick is because clinical
evidence suggests that a juice may be more effective than a supplement for
preventing UTIs.
If you prefer a
supplement, both TheraCran and Ellura are good choices. They both claim to
provide 36 mg of PACs (based on the same validated test method used in this
Review), but TheraCran costs 92
cents per capsule, which is almost half the price of Ellura ($1.63
per capsule), and TheraCran was
found by ConsumerLab to provide even more than its
listed amount of PACs, while Ellura provided
a bit less. Consequently, TheraCran is
our Top Pick among cranberry supplements.
Test Results by Product:
Listed
below are the test results for 11 cranberry products — five juices (one of
which is a juice concentrate) and six supplements. Products are listed
alphabetically within each group.
Shown in the first column
is the name of the product and its approval status. Products listed as
"Approved" met their label claims and by additional quality criteria
(see Passing Score). In the second column is the
claimed type and amount of the cranberry per serving as listed on the label and
as found by ConsumerLab.com. The findings for authenticity and heavy metals
testing are also in the second column. Taste and color information for each
juice, or pill size for each supplement, is shown in the third column. Cost and
price comparisons are in the fourth column. Calories and nutritional
information, as well as other notable features, are in the fifth column. A
listing of the full nutrition facts and ingredients is found in the sixth
column.
Results of
ConsumerLab.com Testing of Cranberry Juices & Supplements
(Click arrows or swipe left or right to see all columns)
Approval Statusⓘ
Product Name
Claimed and Found Amount of Cranberry and Key
Ingredients
Heavy Metalsⓘ
Juice Taste & Color
or Pill Sizeⓘ
Suggested Daily Serving on Supplement Label
Cost for Suggested Serving
[Cost Per 36 mg Soluble PACs Found]
Price Paid
Notable Featuresⓘ
Full List of Ingredients Per Serving
Cranberry Juices & Concentrates:
APPROVED
Lakewood® Organic Cranberry Juice Concentrate
Dist. by Lakewood®
4 tbsp [59 ml]
Organic cranberry concentrate
Found:
Soluble PACs: 63.7 mg
Purity: Not adulterated
Heavy Metals: Pass
Taste: Extremely sour, slightly sweet; Very dark
red
Enjoy As Is (Undiluted) Or Mix 4 tbsp Of Concentrate
With 6 Fl Oz Of Water To Make 1 Cup (8 Fl Oz) Of 100% Juice.
$2.07/4 tbsp
[$1.17]
[2.3 tbsp; 1.1 oz]
$78.00/six 12.5 fl oz [370 ml] glass bottles (approx.
36 servings)
4 tbsp
Calories:
80
Total Carbs: 19 g
Total
Sugars: 11 g
Pantothenic
acid (B3): 2 mg (40% DV)
Manganese: 0.8 mg (35% DV)
USDA Organic seal. Non-GMO. Kosher, more...
4 tbsp
Calories 80, Total Fat 0 g, Saturated Fat 0 g, Trans Fat 0 g, Cholesterol 0 mg,
Sodium 10 mg, Total Carbohydrate 19 g, Dietary Fiber 0 g, Total Sugars
[Includes 0 g of Added Sugars] 11 g, Protein 0 g, Vitamin D 0 mcg, more...
APPROVED
Lakewood® Organic Pure Cranberry
Dist. by Lakewood®
8 fl oz [240 ml]
Organic cranberry juice
Found:
Soluble PACs: 75.6 mg
Purity: Not adulterated
Heavy Metals: Pass
Taste: Sour but slightly more
tart than others; Red
$2.50/8 fl oz
[$1.19]
[3.8 oz]
$9.99/32 fl oz [946 ml] glass bottle (approx. 4
servings)
8 fl oz
Calories:
80
Total Carbs: 19 g
Total
Sugars: 11 g
Vitamin
E: 2.2 mg (15% DV)
Pantothenic acid (B3): 2 mg (40% DV)
Manganese: 0.8 mg (35% DV)
USDA Organic seal, more...
8 fl oz
Calories 80, Total Fat 0 g, Saturated Fat 0 g, Trans Fat 0 g, Cholesterol 0 mg,
Sodium 10 mg, Total Carbohydrate 19 g, Dietary Fiber 0 g, Total Sugars
[Includes 0 g of Added Sugars] 11 g, Protein 0 g, Vitamin D 0 mcg, Calcium 6
mg, Iron 0.3 mg, more...
APPROVED
Top Pick
among all cranberry products
Ocean Spray® Pure Unsweetened Cranberry
Dist. by Ocean Spray Cranberries, Inc., a Grower
Cooperative, or its subsidiaries
8 fl oz [240 ml]
Reconstituted cranberry juice (from concentrate)
Found:
Soluble PACs: 105.6 mg
Purity: Not adulterated
Heavy Metals: Pass
Taste: Very sour (slightly richer flavor than
others); Dark red
$1.25/8 fl oz
[$0.43]
[2.7 oz]
$4.99/32 fl oz [946 ml] plastic bottle (approx. 4
servings)
8 fl oz
Calories:
60
Total Carbs: 18 g
Total
Sugars: 9 g
Kosher. No sugar added. Non-GMO.
8 fl oz
Calories 60, Total Fat 0 g, Sodium 15 mg, Total Carbohydrate 18 g, Total Sugar
[Includes 0 g Added Sugars] 9 g, Protein 0 g, Potassium 180 mg.
Ingredients: Cranberry Juice (water, cranberry juice concentrate).
APPROVED
R.W. Knudsen Family® Just Cranberry
Dist. by Knudsen & Sons, Inc.
8 fl oz [240 ml]
Reconstituted cranberry juice (from concentrate)
Found:
Soluble PACs: 96 mg
Purity: Not adulterated
Heavy Metals: Pass
Taste: Very sour (slightly medicinal-tasting);
Dark red
$1.67/8 fl oz
[$0.63]
[3 oz]
$6.69/32 fl oz [946 ml] glass bottle (approx. 4
servings)
8 fl oz
Calories:
70
Total Carbs: 18 g
Total
Sugars: 8 g
Non-GMO Project Verified seal. No Preservatives.
No Artificial Flavors. Pasteurized.
8 fl oz
Calories 70, Total Fat 0 g, Sodium 10 mg, Total Carbohydrate 18 g, Total Sugars
[Includes 0 g Added Sugars] 8 g, Protein 0 g, Iron 1 mg, Potassium 160 mg.
Ingredients: Filtered Water, more...
APPROVED
Trader Joe's® 100% Cranberry Juice
Dist. by Trader Joe's
8 fl oz [240 ml]
Cranberry juice
Found:
Soluble PACs: 76.6 mg
Purity: Not adulterated
Heavy Metals: Pass
Taste: Very sour; Red, clearer than others
$0.75/8 fl oz
[$0.35]
[3.8 oz]
$2.99/32 fl oz [946 ml] glass bottle (approx. 4
servings)
8 fl oz
Calories:
70
Total Carbs: 17 g
Total
Sugars: 17 g
Pasteurized. Not From Concentrate.
8 fl oz
Calories 70, Total Fat 0 g, Saturated Fat 0g, Trans Fat 0 g, Cholesterol 0 mg,
Sodium 0 mg, Total Carbohydrate 17 g, Dietary Fiber 0 g, Total Sugars [Includes
0 g Added Sugars] 17 g, Protein <1 g, Vitamin D 0 mcg, more...
Cranberry Supplements:
NOT APPROVED
Azo Cranberry®
Dist. by i-Health,
Inc.
2 caplets
500 mg cranberry whole fruit powder (Pacran®)
(1 serving =1 glass of cranberry juice, footnoted as "Biological activity
of 10 oz cranberry juice cocktail")
Found:
Soluble PACs: 0.54 mg
Much lower amount than expectedⓘ
Purity: Not adulterated
Heavy Metals: Pass
Also tested and passed for disintegration
Medium/large caplet
Take two (2) caplets daily with water.
$0.33/2 caplets
[$21.67]
[133.3 caplets]
$8.16/50 caplets
2 caplets
Vitamin C 60 mg, calcium 110 mg, Bacillus coagulans 30
mg
Azo Cranberry® contains no artificial flavors, artificial dyes, yeast, wheat
or gluten.
2 caplets
Calories 5, Total Carbohydrate <1 g, Dietary Fiber <1 g, Total Sugars
[Incl. 0 g Added Sugars] <0.5 g, Vitamin C (ascorbic acid) 60 mg, Calcium
(as dicalcium phosphate) 110 mg, Pacran® Cranberry (Vaccinium
macrocarpon) Proprietary Blend of Whole Fruit Cranberry 500 mg, Bacillus
coagulans 30 mg.
Other Ingredients: Microcrystalline cellulose, coating (glycerin, vegetable
juice [color], citric acid, sodium ascorbate, sodium carbonate, annatto extract
[color], beta carotene [color], ascorbic acid), more...
APPROVED
Ellura®
Dist. by Trophikos,
LLC
1 capsule
200 mg cranberry juice concentrate powder (Gikacran®)
36 mg PACs
(by BL-DMAC standard method, according to website)
Found:
Soluble PACs: 31.3 mg
Purity: Not adulterated
Heavy Metals: Pass
Large capsule
Take 1 capsule daily with water about the same time each day. For additional
support, take 2 capsules daily for several consecutive days, then return to one
a day. With sexual intercourse: 2 capsules before or immediately after
intercourse, then 2 the next day.
$1.63/capsule
[$1.88]
[1.2 capsules]
$49.00/30 capsules
Contains no GMOs, artificial preservatives,
colors or sweeteners and no corn, dairy, soy, wheat, yeast or gluten.
1 capsule
Proanthocyanidins (PAC) (from 200 mg Cranberry juice
concentrate extract powder (Gikacran®) 36 mg.
Other Ingredients: Mannitol, magnesium stearate, silicon dioxide, hydroxypropyl
methylcellulose (vegetable capsule).
APPROVED
but not recommended
Solaray® CranActin
Mfd. by Nutraceutical Corp.
1 VegCap
400 cranberry berry extract (CranActin® Cranberry
AF™)
Found:
Soluble PACs: 1.1 mg
Relatively low amount (equivalent to about 1.4% of a cup of juiceⓘ)
Purity: Not adulterated
Heavy Metals: Pass
Large VegCap
Take one VegCap with a glass of water four times
throughout the day.
$0.17/VegCap
[$5.40]
[32.7 VegCaps]
$19.99/120 VegCap
1 VegCap
Vitamin C 30 mg
1 VegCap
Vitamin C (as Ascorbic Acid) 30 mg, Cranberry (Vaccinium macrocarpon)
(berry extract) (as CranActin® Cranberry AF™ Extract)
400 mg.
Other Ingredients: Vegetable Cellulose Capsule, Maltodextrin (from Non-GMO
Corn), more...
APPROVED
but not recommended
Swanson® Cranberry
Dist. by Swanson Health Products
1 softgel
420 mg cranberry concentrate
(equivalent to 5,040 mg fresh cranberries)
Found:
Soluble PACs: 1.5 mg
Relatively low amount (equivalent to about 1.9% of a cup of juiceⓘ)
Purity: Not adulterated
Heavy Metals: Pass
Very large softgel
Take one softgel per day with water.
$0.08/softgel
[$1.80]
[24 softgels]
$4.55/60 softgels
1 softgel
Vitamin C 100 mg, vitamin E 2 mg
Precaution: Contains soy.
1 softgel
Vitamin C (as ascorbic acid) 100 mg, Vitamin E (as d-alpha tocopheryl
acetate) 2 mg, Cranberry Concentrate (Vaccinium macrocarpon) (fruit) (from 12:1
concentrate) (equivalent to 5,040 mg fresh fruit) 420 mg.
Other Ingredients: Soybean oil, gelatin, glycerin, beeswax, more...
APPROVED
Top Pick
for cranberry supplements
Theralogix Nutritional Science TheraCran® One
Dist. by Theralogix,
LLC
1 capsule
360 mg cranberry extract
36 mg PACs
(by BL-DMAC standard method)
Found:
Soluble PACs: 62.1 mg
Purity: Not adulterated
Heavy Metals: Pass
Large capsule
Take one capsule per day, with food.
$0.92/capsule
[$0.54]
[0.58 capsules]
$83.00/90 capsules
1 capsule
Calcium 4 mg
NSF® Contents Certified seal. Dye-Free. Gluten-Free. Vegan.
1 capsule
Calcium (as tricalcium phosphate and dicalcium phosphate) 94 mg, Cranberry (Vaccinium
macrocarpon) fruit extract standardized to 10% proanthocyanidins
[36 mg per BL-DMAC standard method] 360 mg, more...
APPROVED
but not recommended
Trunature® [Costco] Cran-Max®
Dist. by Costco Wholesale Corporation
1 veggie capsule
500 mg cranberry concentrate (Cran-Max®)
35 mg PACs
Found:
Soluble PACs: 3.8 mg
Relatively low amount (equivalent to about 4.8% of a cup of juiceⓘ)
Purity: Not adulterated
Heavy Metals: Pass
Large veggie capsule
Adults - One veggie capsule daily with food as a dietary supplement.
$0.10/veggie capsule
[$0.96]
[9.5 veggie capsules]
$17.99/180 veggie capsules
No Artificial Colors Or
Flavors. No Gluten. No Lactose.
1 veggie capsule
Cran-Max® Cranberry (Vaccinium macrocarpon)
(fruit) Concentrate (standardized for 7% [35 mg] proanthocyanidins)
500 mg.
Ingredients: Cran-Max® Cranberry Concentrate, Guar
Gum, Sunflower Lecithin, Hydroxypropyl Methylcellulose, more...
Unless otherwise noted, information about the
products listed above is based on the samples purchased by ConsumerLab.com (CL)
for this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of the
same quality as what was tested.
The information contained in this report is
based on the compilation and review of information from product labeling and
analytic testing. CL applies what it believes to be the most appropriate
testing methods and standards. The information in this report does not reflect
the opinion or recommendation of CL, its officers or employees. CL cannot
assure the accuracy of information.
Copyright ConsumerLab.com, LLC, 2021 All
rights reserved. Not to be reproduced, excerpted, or cited in any fashion
without the express written permission of ConsumerLab.com LLC
ConsumerTips™:
What to Consider When Buying:
It is easy to get confused, misled, and pay more than needed when buying a
cranberry juice or supplement to prevent or treat a UTI. Keep the following in
mind:
·
Try a juice rather than a supplement, as the evidence is better
with juice. You only need to drink about 3 ounces daily, mixed with water (at
least 5 ounces, to make a full 8-ounce cup) or other beverage of your choice.
·
You can avoid a lot of extra sugar and calories buy buying a
pure, or 100%, juice rather than a juice cocktail. An 8-ounce cup
of pure cranberry juice naturally has about 18 grams of carbohydrates (half of
which is sugar), and about 60 to 80 Calories. A similar amount of a cranberry
cocktail has about 120 Calories due to extra sugar from sweeter juices that
have been added or from added sugar.
·
If buying a supplement, choose one that lists the amount of PACs and indicates how
they were measured. If with the BL-DMAC or DMAC/A2 method (which are the
same), look for products that provide 36 mg of PACs per serving. If measured
using OPS-DMAC or cPAC-DMAC, look for products that
provide 80 mg of PACs per serving. Serving recommendations vary across
products, with some recommending just one serving per day and other
recommending more. It may be best to take a serving of a supplement twice a
day, since the effect on reducing bacterial adhesion to the bladder wall may
last only eight hours.
Concerns and Cautions:
Cranberry
juice and pills are generally well-tolerated, although they may cause gastrointestinal
upset in some people (Wang, Arch Int Med 2012). Skin redness
and itching was reported in one person consuming 10 oz of cranberry
juice daily (McMurdo, Age and Ageing 2005).
People with diabetes may
want to avoid cranberry juice and cranberry juice cocktails that have been
sweetened with sugar. (None of the juices in this review contain added sugar, but
all naturally contain about 8 grams or more of sugar per 8 ounce serving).
There is conflicting evidence regarding the effects of cranberry
juice on the risk of kidney stones. Cranberry juice contains moderately high
levels of oxalate, which, in excess, can increase the risk of
certain types of kidney stones (calcium oxalate and uric acid
stones) (Gettman, J Urol 2005).
A small study found that cranberry supplements (i.e.
tablets) raised urinary oxalate levels by 45% in healthy adults but the
increase was greater (65%) when also taken with vitamin C (20 mg) (Redmond,
World J Urol 2018). (Be aware that vitamin
C is a common ingredient in cranberry supplements and can further increase
urinary oxalate levels (Terris, Urology 2001)). On the other hand,
some studies have reported a decrease in urinary oxalate
levels with regular consumption of cranberry juice (McHarg, BJU Int 2003). Although a review of
evidence by the U.S. Pharmacopeia concluded that there is "currently
insufficient data to suggest that kidney stone formation is associated with
intakes of cranberry," (Madden, Planta Sci Med 2021),
to be safe, people with a history of kidney stones should consult with their
physician before use.
Some research and case reports suggest that cranberry juice
and cranberry juice concentrate in capsule form may increase
the risk of bleeding or increase INR (international normalized ratio) in people
taking the drug warfarin (Coumadin) (Ge, Evid Based Complement Alternat Med 2014).
Interactions have generally not been reported when consuming
moderate amounts (8 to 16 oz. per day) of cranberry juice, but have been
reported with higher consumption (1 to 2 quarts per day of juice or 3,000 mg or
more of cranberry extract), typically in individuals who have serious illness
or who are taking additional medications (Madden, Planta Sci Med 2021). The most recent
medication guide approved by the FDA for warfarin notes that some foods can
interact with it but does not specifically mention cranberry (Coumadin Prescribing Information 2019).
There is one case report
of muscle tissue breakdown (rhabdomyolysis) and liver injury (hepatitis) in a
man taking the statin medication atorvastatin (Lipitor) who
also drank 16 ounces of cranberry juice daily for two weeks; muscle and liver
function normalized two weeks after he stopped drinking the juice (Botstein, J Med Assoc Ga 2014).
There is one case report
of cranberry supplementation (2,000 mg of cranberry extract daily) reducing the
absorption of an immunosuppressive medication (tacrolimus) in
a woman who had received a kidney transplant (Dave, Cureus 2016).
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Latest Clinical Research Updates for Cranberry
8/29/2021
Cranberry juice and
supplements may increase the risk of bleeding in people taking the
blood-thinner warfarin in some situations. Get the details about this and other
drug interactions with cranberry in the Concerns and Cautions section of our
Cranberry Juices and Supplements Review.
7/31/2021
Are cranberry juice or
apple cider vinegar good sources of citrate to lower the risk of kidney stones?
Find out in our updated answer to the question: Can lemon juice,
lemonade, or other juices reduce my chances of getting kidney stones?
7/27/2021
Can cranberry extract
reduce urinary frequency, urgency, and infections in men with benign prostatic
hyperplasia (BPH)? Find out in the What It Does section of our Cranberry
Juices and Supplements Review. Also see our Top Picks among cranberry juices and supplements.
Cranberry for H. pylori Infection?
7/24/2021
Can cranberry juice help
treat H. pylori infection – a cause of stomach inflammation
and ulcers? See what a new study found in the What It Does section of our Cranberry
Juices and Supplements Review. Also see our Top Picks among cranberry juices and supplements.
Related CL Answers (2)