Description

Do you need to alkalinize the urine for Uva ursi (Arctostaphylos uva-ursi) to “work”? Let's talk about it. 

Uva ursi is a classic go-to for cystitis because it contains arbutin, which the body metabolizes to hydroquinone, a compound that shows antimicrobial activity in vitro. That’s the theory. In my opinion, focusing solely on arbutin is reductionistic. The leaves also contains tannins, flavonoids and other constituents that may be helpful. In addition, information on urinary alkalization and uva ursi is theoretical - meaning it has not been tested or demonstrated in humans, and the historical use of the plant is as a cold infusion or short hot steep, not with baking soda.

There’s no clear human evidence that alkalinizing urine improves outcomes with Uva ursi. Also, adding baking soda is not physiologically neutral (it’s a lot of sodium and may be risky for some clients), and many uropathogens like E. coli actually grow better in alkaline urine, so alkalinizing could theoretically make things worse if the herb dose or metabolism isn’t sufficient. A small study that actually is in humans (Siegers et al., 2003) suggests that uropathogenic bacteria can deconjugate the hydroquinone themselves, which would make urine pH less relevant.

Ultimately, I think uva ursi can be a useful part of an herbal approach to lower urinary tract symptoms, prepared traditionally (cold infusion or short steep). Don’t assume it’s the only tool, and don’t automatically add baking soda just because you’ve heard that tip. It helps sometimes, for some people, and not all the time for all people. As always, if symptoms don’t improve within 24–48 hours or they worsen, refer for medical care. 

Resources to Explore

• You can sign up to catch the recording of the full UTI training for practitioners mentioned in this episode. 
• Quintus, J., Kovar, K. A., Link, P., & Hamacher, H. (2005). Urinary excretion of arbutin metabolites after oral administration of bearberry leaf extracts. Planta medica, 71(2), 147–152. https://doi.org/10.1055/s-2005-837782 (there is substantial individual variation in metabolism and quantities of metabolites excreted) 
• Siegers, C., Bodinet, C., Ali, S. S., & Siegers, C. P. (2003). Bacterial deconjugation of arbutin by Escherichia coli. Phytomedicine : international journal of phytotherapy and phytopharmacology, 10 Suppl 4, 58–60. https://doi.org/10.1078/1433-187x-00301 (E. coli can take up conjugated hydroquinone) 
• de Arriba, S. G., Naser, B., & Nolte, K. U. (2013). Risk assessment of free hydroquinone derived from Arctostaphylos Uva-ursi folium herbal preparations. International journal of toxicology, 32(6), 442–453. https://doi.org/10.1177/1091581813507721 (unrelated to this episode, but interesting notes re: safety of uva ursi) 

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