Written by Chrystal Moulton, Staff Writer. High-PAC standardized cranberry juice significantly suppressed H. pylori infection at week 8 (p<0.05).
Helicobacter pylori (H. pylori) infection increases the risk of developing gastric cancer 1. Treatments using antibiotics, although effective, have a failure rate of up to 30% and still contributes to development of gastric cancer due to antibiotic resistance 2-4. Cranberry contains proanythocyanidins (PACs) which has demonstrated clinically the ability to suppress infections when consumed regularly 5. Proanythocyanidins (PACs) have been shown to prevent bacterial adhesion to cells in vitro. 6 In the present study 4, researchers tested the effectiveness of daily consumption of proanythocyanidin (PAC) standardized cranberry juice and cranberry juice powder against Helicobacter pylori (H. pylori) infection.
In a randomized double-blind placebo-controlled trial, researchers tested the effect of cranberry juice or encapsulated cranberry juice powder versus placebo against H. pylori infection. 522 volunteers with diagnosed H. pylori infection were randomized to receive either high, medium, or low dose cranberry juice, encapsulated cranberry juice powder (either low or high dose) or placebo. Dosing was based on PAC content. Table 1 shows all test groups and the corresponding doses.
Table 1. Test groups in the trial| Group | No. of participants | PAC dose | Dose form |
|---|---|---|---|
| High-PAC | 74 | 88mg/d | Juice |
| Medium-PAC | 73 | 44mg/d | Juice |
| Low-PAC | 74 | 23mg/d | Juice |
| Placebo | 73 | 0mg/d | Juice |
| High-PAC | 76 | 72mg/d | Capsule |
| Low-PAC | 76 | 36mg/d | Capsule |
| Placebo | 76 | 0mg/d | Capsule |
Participants were expected to follow their designated protocol for 8 weeks. H. pylori infection was measured using C-13 urea breath tests (13C-UBT). C-13 urea breath tests were conducted at baseline, week 2, and week 8. Participants who tested negative at week 8 were retested 45 days later to determine H. pylori eradication.
At the end, 470 participants completed the study with 95.53% compliance. No severe side effects were reported. No significant differences were observed between the groups for both the cranberry juice or cranberry capsule test arms. Significant suppression of H. pylori was observed across all groups at week 2 (p=0.028, p=0.041) and week 8 (p=0.021, p=0.012) for the intent-to- treat analysis and per-protocol analysis, respectively [see Table 2].
Table 2. Rate of H. pylori suppression in cranberry juice test arm| Group | Week 2 | P- value** | Week 8 | P-Value** | ||
|---|---|---|---|---|---|---|
| ITT* | PP* | ITT | PP | |||
| High-PAC | 0.1216 | 0.1385 | ITT: p=0.028 | 0.1757 | 0.2 | ITT: p=0.021 |
| Medium-PAC | 0.0137 | 0.0149 | PP: p=0.041 | 0.0411 | 0.0448 | PP: p=0.012 |
| Low-PAC | 0.0676 | 0.0758 | 0.0676 | 0.0758 | ||
| Placebo | 0.137 | 0.1324 | 0.0685 | 0.0735 |
*ITT: intent-to-treat analysis, *PP: per-protocol analysis, **p-value is across all test groups
In the cranberry juice test arm, intent-to-treat analysis showed no statistical difference between the high-PAC group and the low-PAC group or placebo at week 2. Also, H. pylori suppression rate was significantly higher in the high-PAC group compared to the medium-PAC group (p=0.009) at week 2. For the per-protocol analysis at week 2, same observation was recorded: high-PAC group was significantly higher than the medium-PAC group (p=0.007). However, there’s was no statistical difference between the high-PAC and placebo group. At week 8, H. pylori suppression rate was significantly higher in the high-PAC group compared to all 3 test groups in both the intent-to-treat analysis (p<0.05) and per-protocol analysis (p<0.05). No statistical differences were observed for the encapsulated cranberry powder test arm. Also, due to sample sizes, no robust analyses for eradication rate could be performed.
Overall, high-PAC cranberry juice was significantly more effective at suppressing H. pylori infection rates compared to all other test groups following eight weeks of consumption and more effective than encapsulated cranberry juice powder. These results suggest that cranberry juice could be an effective complement to conventional treatment for H. pylori infection. Further studies will be needed to verify these findings.
Source: Li, Zhe‐Xuan, Jun‐Ling Ma, Yang Guo, Wei‐Dong Liu, Ming Li, Lan‐Fu Zhang, Yang Zhang et al. “Suppression of Helicobacter pylori infection by daily cranberry intake: A double‐blind, randomized, placebo‐controlled trial.” Journal of Gastroenterology and Hepatology 36, no. 4 (2021): 927-935.
© 2020 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Click here to read the full text study.
Posted July 6, 2021.
Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.
References:
- Suerbaum S, Michetti P. Helicobacter pylori infection. The New England journal of medicine. 2002;347(15):1175-1186.
- Graham DY, Fischbach L. Helicobacter pylori treatment in the era of increasing antibiotic resistance. Gut. 2010;59(8):1143-1153.
- Kusters JG, van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clinical microbiology reviews. 2006;19(3):449-490.
- Li ZX, Ma JL, Guo Y, et al. Suppression of Helicobacter pylori infection by daily cranberry intake: A double-blind, randomized, placebo-controlled trial. J Gastroenterol Hepatol. 2021;36(4):927-935.
- Zhang L, Ma J, Pan K, Go VL, Chen J, You WC. Efficacy of cranberry juice on Helicobacter pylori infection: a double-blind, randomized placebo-controlled trial. Helicobacter. 2005;10(2):139-145.
- Burger O, Ofek I, Tabak M, Weiss EI, Sharon N, Neeman I. A high molecular mass constituent of cranberry juice inhibits helicobacter pylori adhesion to human gastric mucus. FEMS immunology and medical microbiology. 2000;29(4):295-301.
