(July 2015) Approximately one-quarter of the world’s population (mostly women) will have a urinary tract infection (UTI) in their lifetime. Men tend to get UTIs when they grow older, but women are more susceptible because of the way they’re built. A strong urge to urinate and a burning sensation when urinating are the most common symptoms of UTI. Antibiotics can help, but many who get UTIs have recurrent infections. That’s because bacteria (mostly E. coli) form biofilms (slime) in the bladder that resist antibiotics and immune defenses.
There’s a fascinating podcast online on how the body prevents UTI. The battle in your bladder is all about keeping iron levels to a minimum so bacteria cannot grow and produce biofilms. My anti-biofilm agents (bismuth thiols) also work by disturbing iron metabolism in bacteria, but that’s another story.
It’s been known for some time that humans produce a protein called siderocalin that binds chelators (scavengers) used by bacteria to obtain iron in the urinary tract. Not allowing bacteria to get iron is a common mechanism the body uses to protect against disease. But women with cystitis (bladder infections) have elevated levels of siderocalin, so apparently this protein is not sufficient to stop UTI.
It turns out that two other factors need to be present to effectively keep iron away from E. coli. A new study in the Journal of Biological Chemistry (Shield-Cutler et al, 2015) showed that we also need to keep our urine at a reasonably high pH (a pH of 6 is too low, but 6.8 is effective). The pH in human urine ranges between 5.5 and 7.4, depending on the diet. Secondly, we need to produce high levels of what are called aryl alcohols in the urine to fully protect our bladders from infection. These substances are known to make urine smell strong. Aryl alcohols are likely produced from several food substances. They are metabolites from healthy diets, particularly those that contain compounds called proanthocyanidins (PACs). Aryl alcohols may also be derived from aromatic amino acids in protein, such as L-phenylalanine.
PACs are a class of polyphenols found in a variety of plants, including pine bark (Pycnogenol), grape seeds and skin, wine, apples, cinnamon, and chocolate. Bilberry, cranberry, black currant, green and black tea also contain these flavonoids. It is not clear which of these food items produce the most or best aryl alcohols in urine, but it’s likely that many of them do.
It’s particularly interesting that cranberry is on this list, since it is known to be a remedy for UTI. Cranberries help prevent biofilms by making it hard for bacteria to take hold in the urinary bladder. However, cranberries don’t seem to work for everyone. It may be that other factors like urine pH need to be ideal for cranberries and other PACs to work efficiently.
With all the acid-forming foods in our diets, it is hard to keep the pH of the urine at a high level. Most protein, carbs and fats are acid-forming and must be balanced with non-starchy plant foods to increase urinary pH. The best way to maintain a high urine pH is to consume lots of alkaline-forming foods. Here’s a list of the most extreme alkaline formers:
Another way to quickly bring up the pH of urine is with the use of bicarbonates. The common one is bicarbonate of soda (Baking soda), but it’s loaded with sodium. The preferred form for this purpose is potassium bicarbonate (obtainable from nuts.com), since potassium is an important nutrient, especially for bone health, that we don’t get enough of. As little as 1/4th teaspoon can raise urine pH substantially, and a 1 tsp may raise it to ideal levels. (I place 1/4th of a tsp in a large glass of water twice daily.) The total amount of potassium amounts to less than 1000 mg, which is about 20% of the daily requirements for this vital nutrient. It’s possible to measure the effect one hour afterward in urine with pH strips available for this purpose. There are also powders sold in health food stores to help increase urine pH and restore bone health.
One note of caution with bicarbonates: The problem is getting thru the stomach, which is supposed to stay acidic to digest food and to ward off ulcers. So use them wisely (at least 30 minutes before eating, or at least 2 hours after eating). If you have ulcer issues, or they appear to upset your stomach, back off and use less. That’s why I recommend small amounts at a time.
Interestingly, some of the foods that make your urine pH more alkaline are also foods that can provide more aryl alcohols in the urine. It all really comes down to eating a healthy diet but, for those with UTI problems, a super healthy diet may be required.
Also for consideration is D-mannose, which is 10-50 times stronger than cranberry, and may resolve over 90% of UTIs.
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Do you have to be careful drinking mineral water away from eating so stomach acid is not diminished? I drink Gerolsteiner and it has roughly 600 mg of bicarbonate per 8 oz. Thanks.
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Just wanted to say: I LOVE YOU!! I am a Nurse Practitioner who has long history of UTIs and have been watching the web for UTI prevention. DMannose and all other treatments did not work for me. I will add all these suggestions (would never have known about the Shield-cutler article except for you!!) to my regimen and let patients know. Also enjoyed other articles about Cholesterol treatment and will read all your entries. THANK YOU THANK YOU THANK YOU!!!
You’re so sweet. I’m glad I could help. Yeah, I take an 1/8 of a teaspoon of potassium bicarbonate (PBC) first thing in the morning, and wash it down with tea. Lots of water is good, too. You might consider doing the same in the evening, but don’t let it interfere with food digestion. Take it at least 30 minutes before eating, or a couple few hours afterward. The jury is still out on when to take it, but you can tell you did it wrong if it upsets your stomach. It could also contribute to ulcers in some susceptible people, if you take too much. The amount you take is really dependent on 1) the amount of potassium you get from fruits and veggies (alkaline-forming foods), and 2) the pH of your urine. I would monitor it with pH strips to see if you can keep it near 6.8-7.0 day and night. I also make an organic cranberry jam using PBC. You’ll get around 300 mg of potassium from each 1/8th tsp, which is a nice complement to a healthy diet.
Thanks for the great advice and cautions – I was nauseated yesterday after using the .. Good to know why! (And of course, as you know, anyone with kidney function issues should not use potassium supplements– it could cause potassium build-up and may cause dangerous heart rhythm.). I will try the organic cranberry jam. Sounds delicious!
loving your blog, I would love to ‘follow” it so to be notified every time you make a post but cannot find the “follow” option?
a little icon with a paintbrush and wrench pops up on the lower right-hand side of my screen that allows me to follow people.
and thanks for loving my blog!
Hello drwillip!!! How Funny! I see that it’s been a year. I’ve been thinking of you–so I’m back just surfing your site! This past year has been amazing for me since following you advice! After using a bit of bicarb every night, I had only 1 UTI (while traveling — didn’t drink enough H2O).
Did have to give up the K bicarb — using Na instead. Also eating mostly alkaline foods. Strange that the medical profession says keep urine acid to prevent UTI. That only caused me more UTIs and pain. Also I’m using Prelief before eating to reduce acid in foods (coffee, tomato sauce etc) and it works great to cut down on bladder discomfort that always made me afraid that I was getting a UTI. I’ve cut way down on my coffee and dairy intake also.
Thanks Again for the wonderful information — so freeing! I’m starting to lose my fear of UTIs. What a blessing you have been to me!
Wishing You All the Very Best! Carla
It’s special when someone like you provides positive feedback. It was not my discovery, but I’m glad I relayed it to you. It’s also freed me from a chronic, low-level, urethral infection, which would recur every time I drank a bit too much wine. I hated having to take antibiotics with each occurrence. I’m now taking a 1/4 tsp potassium bicarbonate with each morning’s green tea. I believe I also need the extra potassium to offset my high sodium (sea salt) diet. Taking the bicarb an hour or two before my first meal keeps it from interfering with digestion. All is well, especially knowing that I did you a service.
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I am Really confused! I have suffered UTIs since my 20s. (Im now 48). Last year i had such a severe attack from ecoli, i became incontinent and house bound for nearly a year. I was given Hiprex (menethamine) and told to take it for a year by my urologist. But now my gp says there is little evidence Hiprex works! I also thought it was slightly acid forming as one doctor told me the vagina needs to be acidic to control bacteria. I have read your diet advice with interest!! But i wonder if hiprex is undoing all my efforts of taking apple cider vinegar , fermented foods, and cutting out sugar? I am really confused !!
i’m not a physician, but i try to employ natural remedies to illnesses before taking meds. if i were you, i’d get more alkaline foods in my diet, get your urinary (not vaginal) pH up to close to 7, and eat the foods i mention that are full of flavonoids, like cranberries, etc. i would also try D-mannose. Read my most recent article about extreme alkaline and acid-forming foods: https://thescienceofnutrition.me/2018/02/04/extreme-alkaline-acid-forming-foods/. and good luck.
HI Dr. Willip! Me — Carla — again. I have been using sodium bicarb as I mentioned a year ago, with good results preventing UTI — except when I don’t drink enough water — only 2 this year. THANK YOU! I have a new discovery that I thought you (or readers of this blog) might be interested in. I tried K+bicarb (potassium bicarb) recently and suddenly developed symptoms of UTI with no relief with antibiotics. Thinking about it – the symptoms started with the use of (K+ =potassium). I did some research and discovered that K+ is a known irritant of the bladder — in fact a bladder installation of K+ is used to diagnose interstitial cystitis. I have tested myself positive for this. Now I know to avoid high K+ foods. Here is a comprehensive article if anyone is interested.
Wishing You All the Best in The New Year!
Good stuff! I’m glad you’re doing better, and were able to distinguish the sodium from the potassium form of baking soda for your purposes. I continue to take the potassium form, because I use a lot of sea salt, which is high in sodium. And, I don’t have any problems with UTI. Thanks for sharing.
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