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There aren’t too many foods that are simultaneously the basis for a juice we give to children, a dish we fetishize on a national holiday, and the antidote for a really painful illness. But such is the complex identity of the humble, bitter cranberry.
The debate over canned versus fresh cranberry sauce is one for the ages, but it’s cranberry juice that’s truly controversial. The juice has enjoyed a reputation as a product that can help fight off urinary tract infections; the problem is that it probably doesn’t do that, as has been shown in study after study. But Big Cranberry won’t let go of this messaging, despite strongly worded condemnations from specialists who treat urinary tract infections.
Ocean Spray, the Kleenex of cranberry conglomerates, has now even launched a product called “Cranberry +health Cranberry Supplement.” It’s a chew that looks a lot like someone scooped a hunk out of a can of jellied cranberries and wrapped it up.
It comes in a seven-day supply for $5.99 and will be available at CVS stores; a 28-day supply will be available soon. On Ocean Spray’s website, the description says that it has “clinically proven cranberry health benefits to help maintain urinary tract health” and one chew is the equivalent of 50,000 mg of fresh cranberries or “more than one glass of Cranberry Juice Cocktail.”
This cranberry chew is the perfect case study to illustrate how supplement manufacturers market their products by exploiting a substance that has a halo of health and a whiff of science around it, then wrapping that all up in some fairly duplicitous marketing.
The uncertain science of cranberries and urinary tract infections
The myth that cranberry juice can help prevent or decrease the symptoms of a urinary tract infection (UTI), a painful and unpleasant condition that causes burning when you pee and the feeling that you constantly have to go to the bathroom, likely still lingers.
The cranberry industry, as Vox’s Julia Belluz has explained, has helped to promote this messaging by paying for and helping conduct its own study and then creatively interpreting data to suggest that cranberry juice does indeed play a role in preventing urinary tract infection. But it likely doesn’t, as a 2012 comprehensive review has indicated and other leading UTI experts have asserted.
It gets more unclear when you look away from the juice as a whole and more specifically at proanthocyanidins, or PACs, compounds in cranberry that have also been studied for the prevention of UTIs. There probably isn’t enough of them in a standard glass of cranberry juice to be effective, which is why researchers turned to supplements, since PACs can be more concentrated and studied in different dosages.
There is some evidence via small studies that PACs stick to the the bladder and urinary tract and prevents bacteria from gathering there, thus supposedly preventing an infection. A larger study published in JAMA in 2016, however, did not support the use of PAC supplements for preventing UTI. It’s an ongoing field of research as scientists (and the industry) seek to find a dose at which PAC may be effective.
There is currently a study underway in Canada which was jointly funded by the Ministry of Agriculture, Fisheries and Food of Quebec and Nutra Canada, a food company which — yep! — manufactured the supplements used in the study.
So there’s definitely not yet an official consensus on the use of supplements. “My interpretation is that there is not terrific data to support the use of cranberry, but the good data that there is, it shows a benefit,” says Dr. Thomas Chi, a urologist and associate professor at the University of California San Francisco. He clarifies that the caveat is most of these are very small studies, and says that in the population he treats, which is people who have chronic UTIs, he sees “very little downside to using it.”
This possibility of a small benefit is why the supplement industry is so successful.
Savvy supplement marketing
There are multiple PAC/cranberry supplements on the market that can be easily purchased on Amazon. But supplements aren’t regulated like drugs are, and manufacturers have very few checks and balances on them regarding ingredients used, proof of efficacy, or even the dose in the product matching what’s on the label. There are FDA rules about what kinds of claims can be made, though. You’ll see so-called “structure/function” claims using very vague language rather than words like “cure” or “treat.”
“Claims on a supplement are obviously very carefully crafted to not overstate what they can actually do,” says Chi. So they are open to interpretation, meaning that consumers may be more likely to assume benefits that the supplements might not actually provide.
The cornerstone of all supplement marketing is that manufacturers start with an assumption that something may work (because maybe there was a small study that was done or it’s an ancient herb that has been used for 5,000 years), then they market it using language that makes you think it does work, without ever actually saying as much. It’s a true art form and Ocean Spray executes this maneuver brilliantly.
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Ocean Spray knows that it is synonymous with cranberries, and its branding is all over the packaging. Immediately this makes consumers comfortable, since it’s a name that they’ve trusted on their salads and Thanksgiving tables for decades.
And in case you’re not clear, it is made from cranberries. The word is on the front four times, as is a picture of the fruit. It even clarifies that the product is made from “real fruit.” This all gives you the impression that it’s food-derived, which means, ostensibly, it’s safe. And it really hits you in the face with the fact that this is not candy, no. It is HEALTH. It’s even in the name!
Next comes that structure/function claim: It “maintains a healthy urinary tract.” It does not say it will prevent a UTI or help relieve the symptoms of one, because it legally can’t. But the company is counting on the fact that everyone knows about cranberry juice’s reputation in that area. “The claim about preserving urinary tract health is a broad claim. How people interpret that is pretty much open,” says Chi. Which is the whole point.
As far as those “clinically proven health benefits,” the company refers in its press release to that same 2016 cranberry study that it funded and authored. And Ocean Spray filed a petition to the FDA seeking permission to claim that their products “reduce the risk of recurrent UTI in healthy women.” In a letter from March, the FDA noted that it will make a decision on the request this month.
When you click on the nutrition information tab on Ocean Spray’s website, it states that the product contains 1,600 mg of “cranberry fruit extract” and 137 mg of “polyphenols (equivalent to 50,400 mg of fresh cranberries).” The polyphenols are presumably PAC, because PAC is a polyphenol. But who knows if it is, because it doesn’t say so explicitly.
Finally, the company is offering this product as a seven-day supply. Coincidence that this is also how long a round of antibiotics for UTI’s is usually prescribed? Cynically, I don’t think so. Ocean Spray can’t and would never say that this package should be used to treat a UTI, but it is surely aware that people buy cranberry juice when they have a UTI. Chi says he still sees this practice in his chronic UTI patients. (He says there is “no data showing you can treat a UTI with a cranberry supplement.”)
It’s all a very calculated ploy to sell you a product that probably does nothing, by relying on lore and reputation. Cranberry juice and UTI’s are inextricably linked, despite weak to no evidence that the drink does anything to alleviate the issue. We are bogged down (SORRY) in years of assumptions, which Ocean Spray is capitalizing on.
Cranberry farmers are having a tough go of it lately. In April, Quartz published a story about how the trade war with China was really hurting them. A Boston Globe report from early September notes that thanks to a two-decade glut, cranberry farmers actually want to destroy some of their crops this year so that prices increase. It’s bleak.
Everyone make an extra cranberry dish this year or toss an extra handful of craisins on your salad. But don’t buy these supplements when you have a UTI.
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