Although I have been lucky never to have had one, urinary tract infections (“UTIs”) are a common and recurring problem for millions of Americans, especially women, with complaints of UTI accounting for an estimated 7 million doctor visits every year.
E. Coli, a nasty type of pathogenic bacteria, is thought to be the culprit behind most of these infections, and yet antibiotics don’t seem to work for many women who routinely get UTI.
In cases of chronic UTI, where the same man or woman gets UTI after UTI and antibiotics don’t solve the problem, what are the best natural treatment options?
Are recurrent UTIs caused by yeast infection?
Believe it or not, research on prostate health may provide an answer. I wrote recently about prostatitis, which is essentially the male version of a UTI, where the prostate becomes inflamed, often due to some type of infection. The prostate is a little gland that wraps around the urethra, making it prone to infection and inflammation.
As with UTI, the usual course of treatment is antibiotics, sometimes over a period of years. The problem is modern medicine doesn’t have a good handle on exactly what causes prostatitis, and antibiotics often don’t help cure the issue over the long term. This has led some researchers to believe that in some cases infections like UTI and prostatitis, that are believed to bacterial, are actually fungal in nature. An interesting prostatitis study, that appeared in the Central European Journal of Urology (the “European study”), sheds light on the anti-fungal protocols clinicians are using to treat fungal UTI and prostatitis.
The researchers looked at a group of 1,000 men with prostatitis who hadn’t responded to antibiotic therapy and who had low prostate-specific antigen (PSA) numbers. What they found was that an anti-fungal regimen, combined with potassium citrate (to make the urine more alkaline) and a low carb diet, significantly reduced symptoms for over 80% of men. Presumably, the multiple rounds of antibiotics the men in the study had taken previously wiped out some of their bacterial infection, and it was the fungal pathogens, like Candida Albicans, that were left to fill the void.
In our study patients who received multiple previous courses of antibiotics did show a better response to the antifungal regimen. As previously shown, Candida colonization and invasion of the urinary tract occurs with difficulty except when associated with a bacterial colonization.
In addition to prescribing fluconazole, an anti-fungal drug, the European study authors recommended a low carbohydrate diet, which is often called for by doctors who treat mold and yeast problems because fungal pathogens like Candida feed on sugars.
Urine pH and UTI
But why the potassium citrate to make the urine more alkaline?
The researchers believed E. Coli, the bacteria most often to blame for UTI, was the “bridge” that allowed Candida and other fungal pathogens into the prostate in the first place. Since E. Coli growth is deterred by urine with a higher pH, the researchers gave their subjects potassium citrate, which makes urine more alkaline.
Some studies have shown that an E. coli infection of the urinary tract can act as a bridge, facilitating the colonization of Candida albicans.
A study out of Washington University School of Medicine in St. Louis (the “Washington University study”), that specifically looked at what causes UTI, seems to confirm this method.
Note: some studies and commentators believe potassium citrate is contraindicated for UTI. Supplements like quercetin can have just as much of an alkalizing impact on the urine as potassium citrate and could be a viable alternative for some.
More acidic urine may mean more UTI risk
The Washington University researchers found that those with more acidic urine had greater likelihood of developing chronic UTI. According to the Washington University researchers, when urine is more alkaline, E. Coli colonies are starved of the iron they need to grow in the bladder, urethra, or prostate.
The Washington University study found two key components for inhibiting growth of E. Coli so as to stop recurrent UTI.
- The more neutral pH urine samples showed higher activity of the protein siderocalin and were better at restricting bacterial growth.
- The microbiome played a role – they identified metabolites called aromatics, which are good iron binders, helping deprive the bacteria of iron. Just like with TMAO as a metabolite of choline in eggs, aromatics are not produced by human cells, but by a person’s gut microbes as digest their food.
So, let’s tie all of this together. In both the European study and the Washington study, researchers found that diet and the state of the microbiome play a big role in both prostatitis and recurrent UTI.
The European study was conducted prior to the Washington study, but both groups seemed to understand that E. Coli, the pathogen that is believed responsible for setting off the cycle of chronic infection in the urogenital area, thrives in an acidic environment, which is why the European study authors included a supplement in their treatment regimen, potassium citrate, that alkalizes urine. The Washington University researchers manipulated the pH of urine as well, and found that the number one factor determining recurrent UTI was urine pH.
Natural treatment options for UTI
In light of the two studies, I’ve compiled a list of natural treatment options for chronic UTIs. This list is intended as a launching off point for a discussion with your doctor.
Plant based diet (all UTIs)
This is the first place I would start, and I would do it while monitoring the pH of my urine with an at home test kit. We know from the Washington study that an acidic pH in urine facilitates the growth of E. Coli. The European study teaches us that, at least in men, E. Coli then invites in fungal pathogens, operating as a bridge for yeast infection.
Since a plant based diet has been proven to raise the pH of urine, it would seem like going Vegan, at least for awhile, could kill two birds with one stone. Removing animal protein will cause urine pH to go up, which starves the E. Coli of the iron it needs to survive, which, if there is also a fungal issue, removes the bridge Candida has been using to enter the region.
Of course, the European study takes a slightly different approach by choosing to starve the Candida and yeast, rather than the E. Coli, which is a valid approach in those with a fungal infection, but wouldn’t appear to be as helpful if the issue is just bacterial in nature.
Sufferers of UTI may want to experiment with both a very low carb, as well as a plant based diet, to see which works best.
A note on Vitamin C and UTI
There is a lot of bad advice circulating around the internet about treatment options for UTI. For example, many of the most popular blogs tell readers to try Vitamin C, because it will make the urine more acidic, which is actually the last thing most UTI sufferers want. If you want to supplement with Vitamin C while treating a UTI, use a buffered preparation so as not to raise urine acidity.
D-Mannose (bacterial UTI caused by E. Coli)
The angle of this post has been fungal to this point, however, if recurrent UTI has been caused by E. Coli on its own, which is often the case, D-mannose may be a good natural treatment option.
One of the concerns mentioned in the Washington study is UTI that are resistant to antibiotics. D-mannose seems to work by preventing the bacteria binding to the wall of the bladder which allows the pathogens to be swept away by urine, rather than actually killing the bacteria.
To quote this Italian study which looked at the ability of D-mannose to treat UTI, especially in cases where antibiotic resistance has developed:
The cell wall of E. coli bacteria has tiny finger-like projections that contain complex molecules called lectins on their surface. These lectins act as a cellular glue that binds the bacteria to the bladder wall so they cannot be easily rinsed out by urination.
The Italian study compared D-mannose and, you guessed it, potassium citrate (again to alkalize urine) with a treatment regimen of traditional antibiotics. The study authors concluded that D-mannose was an effective agent to “rinse out” latent bacteria that never left the urinary tract and that had become resistant to antibiotics.
Our clinical experience shows that D Mannose represents a useful choice to address the problem of recurrent UTIs.
What actually appears to occur is the survival of a part of the old colony of bacteria in the urinary tract, they remain latent and are reactivated by various favourable conditions, the relentless recurrences are therefore not considered as reinfection.
The D-mannose researchers are saying that, even when symptoms temporarily cease, women suffering from recurrent UTI never actually get rid of all the bacteria in their urinary tract. Instead, the bacteria essentially hibernate until conditions are once again favorable for growth.
Could the ebb and flow be caused by urine pH?
Probiotics (fungal and bacterial)
In her post on our blog about the difference between bifidobacterium and lactobacillus strains of probiotics, molecular immunologist Jennifer Nguyen lists several strains of lactobacillus bacteria that have shown promise in preventing UTI. Her top strains are: L. casei GR-1, L. rhamnosus GR-1, L. fermentum RC-14 and CRL 1058.1234
While most of us think of the gut as the place where the microbiome resides, the urinary tract has its own microbiome.5 When the balance of bacteria that work to keep the system in balance is disrupted, as it can be with multiple rounds of probiotics, “bad guys” can take a foothold, leading to conditions like UTI. The importance of the microbiome in UTI was also well demonstrated by the Washington study.
For more information, Leigh did an excellent post on the best probiotic strains for beating back Candida.
Key takeaways in treating UTI
The studies I cite above make it clear that E. Coli is the catalyst for most UTIs, however, due to the prevalence of antibiotic therapy that wipes out the balance in the urinary tract microbiome, fungal issues often follow closely behind E. Coli infection, and may be the primary culprit for many people that suffer from chronic UTI.
Dietary interventions that raise the pH of acidic urine may be among the most effective at preventing UTI recurrence.
In cases where one lingering E. Coli infection has never technically left the body, D-mannose provides the best natural treatment option for UTI.