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Naturopathic Health Care Inc.

Dr. Jon Dunn, Licensed Naturopathic Doctor
MAY  2009
Bladder Infections and Bacterial Biofilms
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Overview
There are three types of UTIs as defined by location: urethritis, cystitis and pyelonephritis.  Urethritis affects the urethra with a burning sensation.  Cystitis or bladder infections cause urgency, frequency and crampy pelvic pain.  Pyelonephritis involves the kidneys causing fever and pain in the low to mid-back.  Ninety five percent of UTIs are caused by two bacteria; Escherichia (E) coli and Staph saprophyticus.  Once thought of as simple rudimentary rod or spherical shaped organisms that reproduce quite quickly, the life cycle of bacteria is actually complex, sophisticated and communicative exhibiting a degree of social organization.

The first thing the body does when it senses foreign bacteria in the urinary tract is to shed surface cells in an attempt to sweep away the invader.  Bacteria have two methods to evade this initial response.  First, they can anchor themselves to the bladder wall with finger like roots called lectins.  Second, once they sense that the critical mass of a new bacterial colony has been achieved, they begin to produce a biofilm.   Biofilms are not new to nature, they are quite common.  Biofilms are what make stream-bed rocks slippery to walk on. 

A biofilm matrix forms an eggshell-like shield against antibiotics and immune cells, sheltering bacteria safely inside, like eggs in a carton.   This biofilm matrix has the capacity to collect and expel antibiotics that have penetrated its surface.  Once this “bomb shelter” has been set up, bacteria can become a thousand times more resistant to antibiotics. The Center for Disease control estimates that 70 percent of bacterial infections are biofilms.

As bacteria mature inside this film, they change shape, put out tentacles to the matrix and each other, and multiply.  The 20 minute reproduction cycle of bacteria allows them to quickly adapt and adjust to changes in their environment.  During this time bacteria can exchange bits of resistant coded DNA that float from one bacterium to another.  After they mutate, new found traits of resistance are passed on to the progeny.  Even harmless bacteria can pass on DNA traits of resistance to more dangerous types of bacteria.  Once shed from the biofilm, bacteria move off to congregate and form additional biofilms. 

Bacterial cells at different depths of the biofilm grow at different speeds.  Some antibiotics only kill fast growing bacteria, leaving the slow growers unharmed.  The negative charge of biofilms restricts entry of some antibiotics, while other antibiotics are neutralized by specific biofilm enzymes.  Following antibiotic treatment, biofilms have the ability to remain dormant until sufficient stress on the host catalyzes their reemergence.  It is this biofilm persistence that predisposes otherwise healthy women to recurrent UTIs.

Plants have had to cope with biofilms since the dawn of time and have developed many traits to inhibit biofilm formation.   By understanding these traits, it is possible to develop viable natural treatment interventions for UTIs.

UTI Risk Factors
There are many factors which can predispose to a bladder infection.  Antimicrobial agents including antibiotics and spermacides can disrupt the bacterial population of the vaginal canal leading to infection.  Poor hygiene, hypoglycemia, diabetes, constipation, allergies, stress, use and misuse of birth control devices, new or multiple sexual partners, increased vigorous sexual activity, hormonal changes such as menopause and neglecting to urinate before and after sexual activity all increase the risk for a UTI. 

Treatment Considerations
I find that herbal medicine in combination with other natural therapies can offer a variety of advantages over conventional antibiotics.  Natural treatments can make the environment inhospitable for bacteria while providing antimicrobial and soothing aide for UTIs.  Natural treatments, if used at the very outset of a UTI have good success.  They also hold a place for chronic resistant infections.  

If your condition doesn’t resolve in 48 hours be sure to seek medical help.  If you experience fever, back ache and nausea seek medical care immediately, don’t try and treat with natural remedies.  Other conditions of non-bacterial origin may be at fault and need to be considered if treatments are not working as they should.  Urinary tract irritants include yeast, dyes, artificial sweeteners, volatile oils, caffeine, some B vitamins and allergies, especially to citrus.  With interstitial cystitis, a non-bacterial ulcerative condition of the bladder, even cranberry may be irritating.  Sexually transmitted diseases such as herpes, Chlamydia and gonorrhea may need to be ruled out if treatments fail to give the desired results.

Flavanoids
Arctostaphylos uva-ursi  (uva ursi) is an herb which contains flavanoids, like quercetin, that provide anti-adhesive properties inhibiting bacteria from taking root.  Triticum repens (couch grass) contains mannose and this gives a sort of teflon coating to the urinary tract, repelling invading bacteria.  Mannose can also be purchased as a stand alone concentrate.  Vaccinium macrocarpon (cranberry or bearberry) and the Vaccinium family member’s blueberry, huckleberry and bilberry also possess this anti-adherence characteristic.  To be the most effective these berries need to be as fresh as possible, unsweetened and concentrated.

Antimicrobials
Good herbal antimicrobials include Echinacea spp., Calendula officinalis, Barosma (buchu) , Usnea barbata (old man’s beard), Berberis quifolium (Oregon grape) and Baptisia tinctora (wild indigo).  Chimaphila umbellate (pipsissewa) helps flush the urinary system while providing antiseptic aide.  Uva ursi and Hydrastis canadensis (goldenseal) are antimicrobials that also increase the alkalinity of urine to help antimicrobials work more effectively. 

Soothing Herbs
Soothing herbs for the urinary system include Althea officinalis (marshmellow), Zea mays (corn silk), Symphytum officinale (comfrey) and Ulmus rubra (slippery elm). 

Pain and Cramps
Pain due to spasm can be relieved with anti-spasmodic herbs such as Viburnum opulus (cramp bark), Piper methysticum (kava) and Dioscorea villosa (wild yam). 

Chronic Conditions
For chronic urinary problems consider the herbs Serenoa repens (saw palmetto), Chimaphila  and Solidago species (goldenrod).   These three, in combination with several of the antimicrobials, flavanoid herbs and soothing herbs, should be taken for one to two weeks beyond symptoms in order to eliminate residual biofilm.

All of these herbs can be taken individually or in combination.  I will typically make up a tincture of several of these herbs, as indicated, dosing approximately one teaspoon (total) four to six times a day in liquid. 

Probiotic or healthy bacteria can be taken orally and as a vaginal suppository to inhibit unwanted bacterial proliferation.  Dosage is about 1/4 teaspoon for each location one to two times a day.  Lactobacillus rhamnosus and Lactobacillus  fermentum have the most supporting evidence in reducing unwanted bacteria in the urinary tract and vaginal canal.  Lactobacillus acidophilus and bifidus are good second choices.  Refrigerated brands offer the best quality.

An excellent homeopathic consideration for UTIs is cantharis.  You can take it every few hours for one to two days if needed.  With homeopathy, more is not better, so as soon as your symptoms resolve, stop taking it, and if your symptoms don’t improve in one to two days, stop taking it.

Prevention of Recurrence
While keeping in mind the risk factors previously mentioned with an emphasis on healthy lifestyle habits, here are some additional tips to help prevent recurrence. 

Avoid sugar, fruit juices, white flour and other non-nutritional products including alcohol, coffee and any food allergens, at least until you feel better.  Foods to favor include garlic, onion and lots of water: about 1/2 your weight in ounces each day with at least eight ounces before sexual activity.  Remember, always wipe from front to back rather than back to front to minimize unwanted bacterial transmission.  Take showers instead of baths, wear cotton underwear and avoid chemical laden feminine hygiene products that may irritate the urethra.

I hope you have enjoyed this month’s newsletter.  As always, comments and feedback are welcome.

In Health,    

Jon Dunn, ND
Urinary tract infections (UTI) or bladder infections are one of the most common reasons for a woman's visit to her doctor.  One out of five women will experience a bladder infection each year, and almost ten percent of women will have three or more UTIs in a given year. 

Bacteria have methods to evade antibiotics
If your condition doesn't resolve in 48 hours, be sure to seek medical help.
Avoid sugar, fruit juices, white flour and other non-nutritional products
Significant health risks can occur with a UTI, including irreparable kidney damage if not properly addressed.   Antibiotic resistant bacteria are a big part of the problem, especially for chronic and recurrent UTIs. A new era of understanding the complex world of bacteria - including their production of biofilms to resist antibiotics - is unfolding.

Dr. Dunn's new office is just "down the hall and to the right"

Dr. Dunn is moving to his new office on May 1, 2009.
A few steps away from his current space, the new room provides more space and light.
The new address simply changes the suite number from M to C.

North County Naturopathic Health Care, Inc.
201 Garden View Court,
Suite C
Encinitas CA 92024
Suite Change
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Suite A-9
Palm Desert CA 92260
(760) 341-6502             Jon@DrJonDunn.com