We’re not talking about shamans driving out evil spirits here, but ancient medical systems that have stood the test of time and are still in use today around the world.
But just because it’s old doesn’t mean it’s any good.
We believe in reason and science. So are they reasonable and scientific? Is there any evidence suggesting they work?
And if there is, which treatments have the best evidence to back them up?
Science, the Method and the madness
We all know what science is right? Atoms and molecules and microscopes and space shuttles and lately endless funny cat videos. Now, that’s what I call progress.
Well, maybe we can do better than that. First we have to define Science. According to the Science Council (seems like they would know) it is “the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence (1).”
And I would even venture to add to that mumbo jumbo that all science is also done within a paradigm, or story about reality, a framework that sometimes limits what kinds of questions can be asked. The paradigms develop over time and can become rigid and unyielding, eventually blinding scientists to the implications of evidence that contradicts their expectations.
So, the key ingredients for pursuing science could be distilled into:
- The pursuit of knowledge
- based on evidence
- gained through the scientific method
- existing within a paradigm
The scientific method according to the Science Council again includes observation, experiments to test hypotheses, repetition, critical analysis and verification and testing.
In practice the way the modern scientific method is used in medical studies is to formulate a hypothesis or educated guess about the way the world works, and create an experiment to see if it’s right.
So what does that look like in medicine? We could hypothesize that penicillin cures UTIs in women, based on the existing evidence that, in a test tube, it kills bacteria that cause UTIs. Our bodies aren’t test tubes, so in order to prove our educated guess we could run an experiment on a 100 patients with UTIs, giving half penicillin and the other half a sugar pill. If significantly more patients on penicillin get better than those on sugar pills, we have evidence that penicillin works.
Of course it gets more complicated than that with different experimental designs like randomized controlled trials, different kinds of bias, different sample sizes and a host of other confounding factors, but the basic idea is that if we collect enough corroborating evidence based on well-designed experiments, we can be pretty sure the evidence is true.
Now, in the past, traditional medical systems didn’t use the exact same experimental framework as western science does today, but the ancients who designed traditional medical systems did base them on their own kind of scientific thinking.
They observed the natural world and the human body and came up with hypotheses that they tested on themselves and their patients. Over the centuries they grouped their observations together and came up with paradigms to make sense of them.
Nowadays researchers in the traditional medical sciences have adopted modern methods, though they are often hobbled by lack of sufficient funds to create the giant intricate trials run by multinational corporations with billion dollar valuations. So a lot of the evidence for traditional medicine is considered sub-par.
That’s definitely not a problem with modern medicine.
Or is it?
Actually, only a small percentage of western medicine is based on high quality evidence – it’s just too difficult to run huge trials to prove every theory. The Cochrane Review concluded after an exhaustive study of published research that about 10% is based on high quality evidence and another 37% on moderate quality evidence, meaning over 50% of modern medical practice is based on low or very low quality evidence (2).
And to make matters worse, every once in a while, even some of that “high quality” evidence is proven wrong, in part because the higher the quality, the more money spent and any time a lot of money is involved there will be a correspondingly high bias on the part of backers.
In practice, once a pharmaceutical drug is approved for any indication by the FDA, physicians use it “off-label” for whatever seems likely to work, based on their understanding of the disease and the medicines effects. Then they observe the patient outcomes (sound familiar?) in much the same way traditional scientists have done for thousands of years.
One of the most widespread examples of this practice in modern medicine was the use of low dose aspirin for decades to prevent a 1st heart attack or stroke in high risk patients. Now after all these years we finally have enough data to know that it hardly has any effect and is not worth the serious bleeding risk (3). It only took about 30 years.
The problem was there was no immediate feedback available to let us know if aspirin was preventing a heart attack or not. Patients at one point were told that they could expect the benefit of heart attack prevention if they took it for at least 10 years.
That’s not the case with UTIs. If something works you’ll know it right away. So without further ado, here’s our list of alternative medicine options.
Alternative Medicine for UTIs
- Herbal medicine
But hold up (oops, there is further ado), if we do have really effective antibiotics that have been proven to cure UTIs, why even consider alternative medicine that might have lower quality or less evidence behind it?
The reason is that most infectious disease specialists in the US are worried about the increasing numbers of antibiotic resistant infections, and some of them are also worried about the damage we are doing to our own healthy bacteria that in some cases may be difficult to reverse.
According to renowned microbiologist Martin J Blaser, MD in his best-selling book Missing Microbes, damage to healthy bacterial populations by antibiotics, especially in our guts, has been linked to such diverse conditions as, dementia, Parkinson’s disease, diabetes, overweight and obesity, inflammatory bowel disease, irritable bowel syndrome, low immune function, allergies, and asthma.
If you are concerned about antibiotic overuse or side effects there are a number of herbal medicine traditions that each have their own approach to treating UTIs. The largest of these are Chinese medicine, Ayurvedic or Indian medicine and Western herbalism.
Since there is not much money to be made in natural cures like herbs, which cannot be patented and then marked-up the way modern pharmaceuticals chemicals are, herbal medicine has not attracted large amounts of money to fund in-depth high quality research studies, which can limit our faith in them.
However it is common knowledge that herbs in general have numerous compounds that have pharmaceutical effects and many of these are the source of our modern drugs like aspirin, which is naturally found in willow bark or penicillin which was first found in the penicillium mold growing on stale bread.
So unsurprisingly some studies suggest herbal medicine may be at least as effective as pharmaceutical drugs and possibly even more effective for treating and preventing UTIs (4, 5). More research needs to be done, but given the low incidence of side-effects with properly prescribed herbal medicine, some low risk women may benefit from trying it out.
Common western herbs used for UTIs
- Uva ursi and dandelion – often combined in one pill.
- Rosemary, lovage and centaury – sold together as Canephron.
If interested in herbal treatments it’s safest to consult an expert in herbs to be sure you don’t harm yourself by choosing an inappropriate remedy or by over-dosing, because although herbs seem harmless there are definitely dangers if they are misused.
Acupuncture is another modality of Chinese medicine which research shows may be an effective treatment for UTIs (6). It is generally considered to be one of the all-around safest alternative medicine treatments, with an extremely low incidence of adverse effects. One concern some people have with acupuncture is that it may be painful, after all it does involve looking like a porcupine for 30-60 minutes after being stuck with a bunch of needles, right?
Well you may have seen acupuncture like that in a movie or on TV, but in general that is usually exaggerated. Most acupuncturists use less than a dozen needles per treatment and they are so thin that most people don’t feel them, but if they do, they might feel like a tiny prick that then goes away after a few seconds. Occasionally a needle will hurt when put in and the acupuncturist will then remove it for you. The aim is to create relaxation during the treatment, not make you grin and bear it.
Supplements and Home Remedies
Most of us (especially MDs) have consulted with Doctor Google. The good doctor likely offered up scores of supplements and home remedies, but do any of them work?
The first thing to know is that in almost every case these are harmless to try as long as you don’t ignore a worsening infection for too long, and you don’t have any warning signs of a severe infection. A large percentage of women will at one point or another wait at least a few days before seeing a doctor and in many cases what seems like a mild UTI does clear up on it’s own. It’s difficult to say whether these were all really UTIs, but one thing is clear: the body does have it’s own defenses to fight off infections.
One study on the natural course of UTIs (meaning what happens without antibiotics) showed that up to 40% of UTIs in women resolve on their own within 9 days. In the same study, if a UTI did not resolve within the first 9 days it was unlikely it would resolve on it’s own without treatment (7).
The second important point is that even a placebo, AKA a sugar pill, with no active ingredients, works for most medical problems in 30-40% of cases, which is probably just another way of saying 30-40% of the time things just get better on their own.
For example, in one study of treatment for recurrent UTIs done over a year, the placebo on it’s own was 40% effective in “preventing” a UTI. The efficacy went up to 66% for a weak antibiotic and 90% for a strong antibiotic. The point is not that the antibiotic is obviously more effective, but that the placebo does have a pretty large effect that some people can take comfort in.
There is at least one important difference between a placebo and doing nothing: human beings hate doing nothing and generally feel more satisfied after having done something they believe is helpful.
So if you can activate the “placebo effect” in yourself by using a supplement or home remedy for a mild UTI, not only is it possible you’ll improve, but there is no risk of side effects.
So even though there is sometimes very little to no good data proving some of the below things work, it doesn’t mean they don’t work, and it doesn’t mean that they can’t be used to help you feel better, at least psychologically. And the way you feel is usually at least as important as anything else.
- D-Mannose / Cranberry Extract
- Vitamin C
- “Flush it out” AKA drink gallons of water”
- Cranberry juice
D-Mannose is a simple sugar found in small amounts in cranberries. If not for the research that has been done, it would be easy to write it off as a placebo, because it is literally a sugar pill. But there are some studies that suggest D-mannose is effective for UTI prevention and treatment (8, 9). The dose found effective for treatment was 500mg 5 times a day for 5 days (someones favorite number is 5) and the ongoing dose for prevention was 1000mg twice a day.
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Our doctors and patients have extensive experience with D-Mannose for UTIs. Out of all the supplements used for UTIs it is probably the best known and likely the most effective. NOW brand D-Mannose is a good one.
Allicin is a component of garlic. Garlic on it’s own has been used for hundreds of years as a natural antibiotic for skin and other infections (and lets not forget the vampires) and purifying the antibacterial component Allicin from it is an attempt to strengthen that effect (watch out Count). There is preliminary lab research showing Allicin can kill bacteria that cause UTIs in a petri dish, even the ones resistant to normal antibiotics, (10,11), but that doesn’t mean it will work when you swallow it, because we don’t know how high its concentrations are in human urine. Still, as usual for these things, you’ll find some people swear by it (or they just don’t like vampires). Allimax is a brand of super concentrated activated Allicin extract that you can try if you’re feeling flush (It’s about a $1 per capsule – maybe just use the cloves around the neck).
The famous two-time Nobel laureate Linus Pauling kickstarted America’s obsession with Vitamin C supplementation in 1970 with the publication of his book Vitamin C and the Common Cold. Over the next year sales of Vitamin C rose 1000%. Since then Vitamin C or ascorbic acid has been touted as a cure for everything from the common cold to heart disease and even cancer. One small study showed it reduced the risk of UTIs in pregnant women from 29% to 12% and that was at a low dose of 100mg per day (12). It is currently unknown if Vitamin C can help treat UTIs, but it is unlikely to hurt at reasonable dosages and who doesn’t like OJ?
Various strains of lactobacilli have been found in small studies to help prevent UTIs in women (13). It is believed that they inhibit the attachment and invasion of infectious bacteria. There is no data on using probiotics to help clear an active UTI, but again: unlikely to be harmful.
Flush it out.
A significant percentage of women report trying to flush it out by drinking a lot of water. There is no evidence that this works to cure a UTI, but there is decent evidence that increasing fluids can help prevent recurrent UTIs, and since even doctors know you should stay hydrated, this is a favorite bit of advice in clinics (14).
Another favorite of women with UTIs is cranberry juice. Many studies, totaling thousands of patients, have looked into cranberry juice and extracts for treating and preventing UTIs, but despite some promising individual studies, overall the results are not that convincing (15) and in some studies patients have dropped out in high percentages because of stomach upset from drinking 2-3 glasses of the sour juice a day. They should have given them some OJ.
The best alternative medicine approaches for acute UTIs are probably acupuncture (seriously) and herbal medicine, but D-mannose is also a good bet.
For prevention you can try Allicin from garlic (insert your own vampire joke here), Vitamin C, probiotics and good ole H2O.