Cranberry Vaccinium macrocarpon – monograph


Cranberries, proanthocyans and urinary tract infections, cystitis
Cranberries, their phytonutrients including proanthocyans and urinary tract infections, cystitis

Cranberries have different names: large lingonberry, cranberry, atoca or ataca (mainly in Quebec). Atoca is a name borrowed from the Iroquois language. In Europe, it is called the cranberry. In America, cranberries grow in regions along the northern part of the United States from Maine to Wisconsin and along the Appalachian Mountains in North Carolina. Further north, it is also heavily cultivated in Quebec and Ontario. The cranberry fruit, along with Concord grapes(Vitus labrusca)and wild blueberries(Vaccinium angustifolium) is one of the 3 fruits native to North America. Cranberries grow in peatlands in cold regions, require a lot of water and do not exceed 30 cm in height. Cranberries are a perennial place that, if the conditions are favorable to it, can live up to 100 years. As peatlands are very fragile and vulnerable to agricultural activities, its cultivation therefore raises some environmental concerns. The need to build ponds for this crop and the use of large quantities of water for irrigation and flooding of cranberries at various stages of their growth has an impact on the water table. Dikes are raised to retain water. When the water is discharged, residues of fertilizers and chemical pesticides used to grow it can contaminate the fish. At least for the time being, these effects are relatively small, given the still small size of cranberry farms. However, there is a positive effect to all this because cranberry bogs are home to a very diverse fauna that includes ducks and geese, otters and mink, the Sand crane and many other species.

The terms « cranberryand atoca » apply indifferently to the fruit of Vaccinium macrocarpon and Vaccinium oxycoccos. The fruit of Vaccinium macrocarpon is however larger than that of Vaccinium oxycoccos. In Canada and the United States, the Vaccinium macrocarpon species is by far the most cultivated. It is very important to note this difference because oxycoccos cranberries do not contain the same phytonutrients. Its amount of type A proanthocyan (effective in fighting urinary tract infections) is different. Therefore, Natural Health Products approved by Health Canada cannot be made with European cranberries.

Only American cranberries (vaccinium macrocarpon) are accepted for these purposes.

Wisconsin is the main producer of cranberry macrocarpon with nearly 60% of U.S. production followed by Massachusetts. The productions by state were in 2015 the following:

  • Wisconsin with 5,022,000 tons
  • Massachusetts with 2,352,000 tons
  • New Jersey with 595,000 tons
  • Oregon with 562,000 tons
  • Washington 198,000 tons

For Canada, it is 3,950 hectares of cultivation for a total of 79,000 tons. Quebec and British Columbia each produce about half of the Canadian total. Fruits processed in Quebec are marketed in the form of fresh fruit, frozen whole fruit, juice concentrates, dehydrated fruit, coulis and candied fruit.

Cranberry has a tangy taste. It has a certain density of tannins that contain antioxidant compounds. An interesting fact is that 20% of American cranberry production is consumed at Thanksgiving.

Phytonutrients and minerals

Cranberries, like blueberries, sit atop plants in terms of the quality and quantity of phytonutrients they contain. Cranberries contain different types of flavonoids (powerful antioxidants that neutralize free radicals)(put a link with free radicals). The 3 main classes of flavonoids found in cranberries are anthocyanins (anthocyanins) that give it its red color, flavonols and proanthocyans (proanthocyanins). The proanthocyans present in cranberry fruits are unique since they are type A (double bond between epicatechin units) while the majority of proanthocyanins found in other fruits are type B (single bond).

Cranberries contain resveratrol (a polyphenol) in a concentration that would be no more and no less than that of grape juice. On the other hand and unlike red wine, very little study on this subject has been done on cranberries. It contains an appreciable amount of ursolique acid. Cranberries are also a good source of vitamin C.

Its medicinal virtues

The therapeutic applications of cranberries date back to the 17th century and were aimed in particular at the relief of scurvy (vitamin C) and stomach and liver disorders. In April 2004, cranberry macrocarpon was the first plant ingredient to be granted a health claim by the French Agency for health product safety.

However, both cranberries and wild blueberries are still the subject of intense research that tends to show that they offer many other health benefits, but that the studies are not yet complete and decisive enough for Health Canada to recognize them for this purpose. However, these possible benefits affect several diseases:

  • Cardiovascular

The high content of flavanoids contained in cranberries would help reduce the risk of atherosclerosis. In vitro research has shown that these same flavanoids prevent the aggregation of blood platelets and the oxidation of bad cholesterol (LDL). Its consumption would also increase good cholesterol (HDL) while lowering blood pressure. It is therefore recommended for those who have high cholesterol.

  • Urinary tract infections:

The scientific community agrees that the very high concentration of proanthocyanes in cranberries contains anti-adesins that prevent Ecoli bacteria from sticking to the tubes of the system and thus creating infection.

  • Cancer

In vitro studies have shown that extracts and compounds from cranberries can inhibit the growth and proliferation of different types of cancers including breast, colon, prostate and lungcancers.

  • Protection of neurons

    (Parkison, Alzheimer’s)

Brain cells (neurons) communicate with each other. With age, some circuits experience oxidative stress damage and communications between certain neurons can be weakened. This can affect various motor and cognitive aspects. Cranberries, like their close cousin, the wild blueberry, help protect neurons and repair some of the damage caused by free radicals. On this topic in particular, it is the anthocyanins contained in cranberries that are the most effective molecules.

Regular consumption of cranberries, wild blueberries and other berries is therefore recommended to help protect us from degenerative diseases such as Alzheimer’s and Parkinson’s.

  • health
    den taire
    a canneberge et ses proanthocyanes contre la parodontie

Cranberries and their proanthocyans against periodontics. Cranberry consumption could inhibit the production of acid by a bacterium involved in the development of tooth decay(Streptococcus mutan)and reduce the formation of the dental biofilm that causes dental plaque. It would also reduce the risk of periodontics. However, it is unlikely that the consumption of cranberry juice in itself can have a beneficial effect on oral health because of the insufficient contact time between the oral surfaces (teeth, gums) and the polyphenols of the cranberry.

Health Canada Product Monograph

Date: 2011-03-28

Name of NHPID

Vaccinium macrocarpon

Proper name(s)

Vaccinium macrocarpon Aiton (Ericaceae)

Common name(s)


Material of origin


Route of administration


Dosage form(s)

  • Foods or food-like dosage forms such as bars, chewing gum or beverages are excluded from this monograph.
  • Acceptable dosage forms include, but are not limited to, strips, capsules, tablets, chewable dosage forms (e.g., tablets, gummies), liquids or powders.

Recommended use(s) or purpose(s)

Statement(s) specifying the following:

  • Used (traditionally) in herbal medicine/herbalism to help prevent (recurrent) urinary tract infections
  • (Used in herbal medicine/herbalism for) helps prevent recurrent urinary tract infections in women
  • Provides antioxidants for the maintenance of good health



Preparation: Fresh fruit equivalents

Dose(s): do not exceed 30 Grams per day, fresh fruit

Preparation: Juice

Dose(s): do not exceed 950 Milliliters per day, fruit juice

Recurrent urinary tract infections – traditional; Recurrent urinary tract infections – herbal medicine.

Preparation: Fresh fruit equivalent

Dose(s): 10 – 30 Grams per day, fresh fruit

Preparation: Juice

Dose(s): 90 – 950 Milliliters per day, fruit juice

Refer to Appendix 1 for relevant examples of dose and frequency preparations for use, as referenced above. The purpose of Annex 1 is to provide guidance to industry.

Duration of use

Recurrent urinary tract infections – traditional: Use for at least 4 weeks so that you can see the beneficial effects
Recurrent urinary tract infections- herbal medicine: Use for at least 4 weeks so that you can see the beneficial effects

Mention of risks

Statement(s) specifying the following:

Precaution(s) and warning(s):

  • Consult a health care practitioner prior to use if you are taking blood thinners
  • Consult a health care practitioner prior to use if you have ever suffered from kidney stones
  • Recurrent urinary tract infections – traditional; Recurrent urinary tract infections – herbal medicine:
    Consult a health care practitioner if symptoms persist or worsen.

Statement not required

Known adverse reaction(s):
Statement not required

Non-medicinal ingredients

Must be selected from the current Natural Health Products Ingredient Database and must meet the restrictions defined in the database.


  • Finished product specifications must be established in accordance with the requirements outlined in the NHPDNatural Health Product Quality Reference Guide.
  • The medicinal ingredient must comply with the requirements set out in the Natural Health Products Ingredients Database(NHPID).
  • The medicinal ingredient may conform to the specifications set out in the Cranberry Liquid Preparation monograph published in the U.S. Pharmacopoeia (USP).
  • Note: The above information should not be provided with the officinal DLMM but Health Canada may request it if necessary.

References cited

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  • Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy I, Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. Journal of the American Medical Association 1994;271(10):751-754.
  • Barnes J, Anderson LA, Philipson JD. 2007. Herbal Medicines, 3rd edition. London (UK): Pharmaceutical Press.
  • Blumenthal M, Hall T, Goldberg A, Kunz T, Kinda K, editors. 2003. The ABC Clinical Guide to Herbs. Austin (TX): American Botanical Council
  • Bodel PT, Cotron R, Kass EH. 1959. Cranberry juice and the antibacterial action of hippuric acid. The Journal of Laboratory and Clinical Medicine 54(6):881-888.
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  • Gettman MT, Ogan K, Brinkley LJ, Adams-Huet B, Pak CYC, Pearle MS. Effect of cranberry juice consumption on urinary stone risk factors. Journal of Urology 2005;174(2):590-594.
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  • Jepson RG, Craig JC. 2008. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub4.
  • McGuffin M, Kartesz JT, Leung AY, Tucker AO, editors. 2000. Herbs of Commerce, 2nd edition. Silver Spring (®): American Herbal Products Association
  • Mills S, Bone K. 2005. Principles and Practice of Phytotherapy. Toronto (ON): Churchill Livingstone.
  • Rindone JP, Murphy TW. Warfarin-cranberry juice interaction resulting in profound hypoprothombinemia and bleeding. American Journal of Therapeutics 2005;13(3):283-284.
  • Ruel G, Pomerleau S, Bouture P, Lamarche B, Couillard C. 2005. Changes in plasma antioxidant capacity and oxidized low-density lipoprotein levels in men after short-term cranberry juice consumption. Metabolism Clinical and Experimental 54(7):856-861.
  • Siciliano A. Cranberry. Herbalgram 1996;38:51-54.
  • Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Canadian Journal of Urology 2002;9(3):1558-1562.
  • Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology 2001;57(1):26-29.
  • Upton R, editor. American Herbal Pharmacopoeia and Therapeutic Compendium: Cranberry Fruit (Vaccinium macrocarpon Aiton) – Standards of Analysis, Quality Control, and Therapeutics. Santa Cruz (CA): American Herbal Pharmacopoeia; 2002.
  • USDA 2010: United States Department of Agriculture, Agricultural Research Service, National Genetic Resources Program. Germplasm Resources Information Network (GRIN) [online database] . Beltsville (MD): National Germplasm Resources Laboratory. [Vaccinium macrocarpon Aiton.: Last updated 2010 January 14; Accessed 2011 March 22]. Available from:
  • USP 34: United States Pharmacopoeial and the National Formulary (USP 34-NF29). Volume 1 Rockville (MD): The United States Pharmacopeial Convention 2010
  • Valentenova K, Stejskal D, Bednar P, Vostalova J, Cihalik C, Vecerova R, Koukalova D, Kolar M, Reichenbach R, Sknouril L, Ulrichova J, Simanek V. 2007. Biosafety, antioxidant status, and metabolites in urine after consumption of dried cranberry juice in healthy women: a pilot double blind placebo-controlled trial. Journal of Agricultural and Food Chemistry 55(8):3217-3224.
  • Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen RA. Cranberry concentrate: UTI prophylaxis. Journal of Family Practice 1997;45(2):167-168.

References reviewed

  • Barnes J, Anderson LA, Philipson JD. 2002. Herbal Medicines: A Guide for Healthcare Professionals, 2nd edition. London (UK): The Pharmaceutical Press.
  • Blatherwick NR, Long ML. 1923. Studies of urinary acidity. II. The increased acidity produced by eating prunes and cranberries. The Journal of Biological Chemistry 57(3):815-818.
  • Boon H, Smith MJ. 2004. The Complete Natural Medicine Guide to the 50 Most Common Medicinal Herbs, 2nd edition. Toronto (ON): Robert Rose Inc.
  • Bristol Myers Squibb. 2005. Coumadin (warfarin) package insert. Princeton (NJ): Bristol-Myers Squibb [Consulté le 27 février 2009] . Disponible en ligne à :
  • Brown DJ. 1996. Herbal Prescriptions for Better Health. Rocklin (CA): Prima Publishing.
  • Chandler F, editor. 2000. Herbs: Everyday Reference for Health Professionals. Ottawa (ON): Canadian Pharmacists Association and the Canadian Medical Association.
  • Di Martino P, Agniel R, David K, Templer C, Gaillard JL, Denys P, Botto H. Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World of Urology 2006;24(1):21-27.
  • Fetrow CW, Avila JR. Professional’s Handbook of Complementary and Alternative Medicines, 3rd edition. Philadelphia (PA): Lippincott Williams and Wilkins; 2004.
  • Foster S, Tyler VE. Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 4th edition. Binghamton (NY): Haworth Herbal Press; 1999.
  • Gibson L, Pike L, Kilbourn JP. Clinical study: Effectiveness of cranberry juice in preventing urinary tract infections in Long-Term Care Facility patients. Journal of Naturopathic Medicine 1991;2(1):45-47.
  • Gotteland M, Andrews M, Toledo M, Munoz L, Caceres P, Anziani A, Wittig E, Speisky H, Salazar G. 2008. Modulation of Helicobacter pylori colonization with cranberry juice and Lactobacillus johnsonii La1 in children. Nutrition 24(5):421-426.
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  • Greenblatt DJ,von Moltke LL von, Perloff ES, Luo Y, Harmatz JS, Zinny MA. 2006. Interaction of flurbiprofen with cranberry juice, grape juice, tea, and fluconazole: In vitro and clinical studies. Clinical Pharmacology and Therapeutics 79(1):125-133.
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  • Henig YS, Leahy MM. 2000. Cranberry juice and urinary tract health: science supports folklore. Nutrition 16(17/18):684-687.
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  • Jepson RG, Milhaljevic L, Craig J. Cranberries for preventing urinary tract infections (Review). The Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001321.pub3. DOI: 10.1002/14651858.CD001321.pub3.; 2004.
  • Lavigne JP, Bourg G, Combescure C, Botto H, Sotto A. 2008. In-vitro and in-vivo evidence of dose-dependant decrease of uropathogenic Escherichia coli virulence after consumption of commercial Vaccinium macrocarpon (cranberry) capsules. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases 14(4):350-355.
  • Lilja JJ, Backman JT, Neuvonen PJ. 2007. Effects of daily ingestion of cranberry juice on the pharmacokinetics of warfarin, tizanidine, and midazolam – probes of CYP2C9, CYP1A2, and CYP3A4. Clinical Pharmacology and Therapeutics 81(6):833-839.
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Appendix 1: Examples of Dosage Preparations, Frequencies and Directions for Use

Fruit juice preparations containing the equivalent of:

  • 120 to 950 ml of cranberry juice, per day (Blumenthal et al. 2003)
  • 7 ml cranberry cocktail per kg body weight, per day (Ruel et alab 2005) (30% cranberry juice)
  • 250 ml cranberry juice, 3 times a day (Stothers et al. 2002)
  • 30 to 300 ml of unsweetened cranberry juice, per day (Upton 2002)
  • 300 ml cranberry cocktail, per day (Avorn et alab 1994)(30% cranberry juice)

Other preparations:

  • 200 mg dehydrated cranberry juice, 2 times daily (Valentenova et al. 2007)
  • 400 mg dehydrated cranberry juice, 2 times daily (Valentenova et al. 2007)
  • Preparations containing the equivalent of 10 to 20 g of fresh fruit, per day (Mills and Bone 2005)
  • 400 to 800 mg of dehydrated concentrate (25:1), daily (Mills and Bone 2005)
  • 400 mg dehydrated cranberry extract, 2 to 3 times daily (Upton 2002)
  • Dehydrated extracts containing the equivalent of 10 to 30 g of fresh fruit (25:1), per day (Upton 2002)
  • 400 mg cranberry concentrate / concentrated cranberry extract, 2 times daily (Walker et al. 1997)

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