Cranberry juice

Cranberry juice and urinary tract infection

In 2010 a study conducted by the Worcester Polytechnic Institute in Massachusetts found that the ingredients in cranberry juice limit the ability of E. coli bacteria (the main cause of UTIs) to cling to other bacteria. Without other bacteria, E. coli's ability to grow and reproduce is limited. The researchers concluded that cranberry juice helps prevent UTIs, but stopped short of saying the juice cures them. According to WebMD, which reported on the study, study researcher Terri Anne Camesano said people should not self-treat urinary tract infections, and anyone who suspects they have an infection should see a doctor, but drinking cranberry juice may be an easy, inexpensive way to help keep E. coli at bay.

There is some evidence that although long-term use of cranberry juice can help prevent symptomatic urinary tract infections, people do not persist in taking it over long periods.^[4] There is no significant difference between cranberry juices and capsules. It is thought to prevent adhesion of bacteria such as E. coli to the urinary tract, by inducing changes to their fimbriae.^[5]

The proanthocyanidins found in cranberry juice can prevent bacteria from adhering to the epithelial tissue that line many interior parts of the human body.^[6] These adhering bacteria can cause breakdown and inflammation of the epithelial lining of the urinary tract, leading to urinary tract infections.^[6]

In September 2017, Ocean Spray, a major cranberry juice manufacturer, submitted a health claim petition to the FDA. According to the FDA's February 2018 response letter, the company had "requested that FDA authorize a health claim for the relationship between the consumption of cranberry juice products and a reduced risk of recurrent urinary tract infection in healthy women." The FDA stated that they would consider the petition for a "qualified health claim."^[7] This type of health claim label does not require "significant scientific agreement" as the FDA's label with a higher standard, the "authorized health claim," does. Rather, "qualified health claims" only require that the claim be "supported by some scientific evidence." These types of health claims also do not need to "meet the significant scientific agreement standard" and must be accompanied by a disclaimer.^[8]

In May 2018 the National Institute for Health and Care Excellence recommended against the use of cranberry juice for urinary infections^[9].

Dental health improvement

Several clinical studies have shown that cranberry juice promotes good gum health by preventing bacterial adhesion within oral epithelium tissue and preventing dental plaque accumulation.^{[6][10][11][12]}

Manufacturing

Cranberries are a kind of tart red berry produced by various plant species, but it is the large-fruited, or “American cranberry” (Vaccinium macrocarpon), that is farmed for commercial production.^[13] Currently, the main cranberry farming Canadian provinces are British Columbia, Québec, New Brunswick, Nova Scotia and Prince Edward Island.^[13] However, the lower temperatures present in the Eastern provinces require the use of irrigation and flooding to prevent frost damage and moisture loss.^[14] Wet harvesting is the common harvesting method used for cranberries that are to become cranberry juice.^[15] A paddled machine called a water reel harvester is used to separate the ripe cranberries from the vines, then collected through a large suction pipe and transported by truck to a processing plant.^[15] At the processing plant, the cranberries go through a sequence of fruit crushing, mash maceration, mash heating, juice pressing, and pasteurization to produce a cranberry concentrate that is separated from pulp.^[16][17] To prepare a cranberry juice/cocktail product, cranberry juice concentrate is reconstituted with varying amounts of water, specified by the solicitation, contract, or purchase order.^[18]

Pest Management

During growth, cranberry quality can be affected by various pests including: weeds, insects, mites, vertebrate animals, and diseases, resulting in the need for physical, biological or chemical treatments to reduce these impacts.^[13] Canada has a “Pesticide Risk Reduction Program” where the AAFC (Agriculture and Agri-Food Canada) and the PMRA (Pest Management Regulatory Agency) work to confront the dangers pesticides pose to the environment and human health.^[14] Flooding and irrigation often remain the best technique to deter pesticide resistant pests in the cranberry cultivation process.^[14]

Traditional Sterilization Method

Traditionally, cranberry juice is commercially sterilized though thermal processing to eliminate any pathogenic or spoilage-causing microorganisms and spores.^[19] The prepared cranberry juice product is heat treated by high temperature-short time (HTST) or ultra-high temperature (UHT) techniques and packaged into aseptic, hermetically-sealed containers.^[19] During thermal processing, the cranberry juice receives a heat treatment time equivalent to a 5-log pathogen reduction.^[20] Often, the bacterium Clostridium botulinum is given special attention during thermal processing techniques of food.^[19] However, C. botulinum does not grow and produce toxins below a pH of 4.6 and cranberry juice is classified as a high-acid food with a pH of 2.3 to 2.9.^[19][21]

New Sterilization Methods

Recently, new methods of cranberry juice processing include high pressure processing (HHP) and pulsified electric fields (PEF) technology. HHP treatment involves applying pressure (80,000 psi or 550 MPa) to cranberry juice for 1 to 9 minutes to eliminate any harmful bacteria, moulds and viruses.^[22][23] The resulting raw cranberry juice, without thermal processing, is classified as a novel food item by Health Canada.^[22] PEF treatment involves generating a high-intensity electric field inducing a flux of electrical current to flow through the food product to eliminate harmful microorganisms.^[24] PEF treated cranberry juice does not alter the flavour, colour, or aroma profile of the cranberries used, unlike the traditional thermally processed method.^[25]

Additives

Naturally, cranberries are low in sugar content and have a tart or astringent taste.^[26] As a result, unsweetened cranberry juice is generally considered unpalatable by consumers.^[26][6] To make the juice more palatable to consumers, the tart flavour can be changed by blending with other fruit juices or the addition of natural/artificial sweetening ingredients.^[6]

Packaging

All cranberry juice products are required to be packed in aseptic, hermetically seal containers (plastic bottles, cans, cartons) in accordance with good manufacturing practices of their country.^[27][28] The typical container size used are 11.5 or 64 fluid ounce, and each must be filled with the product by at least 90 percent.^[28] Cranberry juice products should also not be packaged more than 90 days prior to their delivery, unless specified in the order.^[27] Ocean Spray and Fruit d'Or cranberry juice products have a frozen shelf life of 24 months and 36 months, respectively.^[29][30]

Labeling

Cranberry juice container labels have the following information printed: product name and code, nutrition facts table, lot/drum number, date of packaging, brix, acidity, net weight, manufacturer name, manufacturer address and country of origin.^[29][30] According to Canada's composition claims, a "no preservatives" claim can be added to cranberry juice products if it only contains naturally-occurring constituents that provide a preservative function such as benzoates.^[31]

Canada

For Canadian markets, cranberry juice is regulated as a processed product under fruit juices.^[32] Cranberry juice must be made from sound, clean, and ripe cranberries. One or more of the following dry sweetening ingredients may be added: sugar, invert sugar, and dextrose.^[32][33] According to the Canadian Food Inspection Agency (CFIA), the common name of this product may appear as “cranberry juice drink/cooler” if at least 25% of the named juice is contained within the net quantity of the product.^[34]

In Canada, cranberries are graded into two categories: Canada No. 1 and Canada Domestic. The cranberries of Canada No. 1 grade are required to be fairly clean; be uniform in size; and free from any damage and/or defect that affects the appearance, edibility, or shipment quality.^[35] The cranberries of Canda Domestic grade are required to be reasonably clean; and be free from any damage and/or defect that seriously affects the appearance, edibility, or shipment quality.^[35] Furthermore, all grades must be properly packaged; be sound; have a minimum surface area of 65% coloured red; and be free of insects and insect larvae.^[35]

United States

For US markets, cranberry juice from concentrate is a blended mixture of cranberry juice or cranberry juice concentrate, water, sweeteners, and ascorbic acid.^[36][37] The cranberry juice or concentrate in the mixture must be produced from clean, sound, mature, well-colored, and washed, fresh or frozen cranberries (Vaccinium macrocarpon).^[36][37] One or more of the following sweetening ingredients may be added: sucrose, liquid sugar, invert sugar syrup, or high fructose corn syrup (40% or greater).^[36][37] The use of food additives (color, flavours, or acids) into cranberry juice depends on the percentage of cranberry juice or concentrate by volume.^[36] Cranberry juice mixtures with 25% or 27% contain none of the mentioned additives, except for ascorbic acid. Cranberry juice mixtures with 22% contain no added color or flavors, but citric acid may be added. Cranberry juice mixtures with 20% may contain color, flavors, and citric acid.^[36] The finished cranberry juice from concentrate product should yield a minimum of one part cranberry juice concentrate to three parts water with a minimum Brix level of 12°.^[36][37] Additionally, each cranberry juice product should be fortified with Vitamin C (Ascorbic Acid), with each serving size delivering not less than 100% of the current US Referenced Daily Intake.^[36][37] The minimum titratable acidity of the cranberry juice product must be 1.67% wt/wt, measured as citric acid.^[37]