Exploring innovative product formulations for bladder, urinary tract and prostate health.
Let’s face it—incontinence, urinary tract infections and prostates are uncomfortable subjects—so awkward in fact, that many do not seek help from their physicians for urologic health issues.
Yet, Cheryl Myers, chief of education and scientific affairs at Wisconsin-based EuroPharma, revealed, “All told, urinary incontinence—due to a variety of causes—affects at least 25 million Americans. Most of the sufferers are women, but one-third of women and men 30 to 70 years old have experienced some symptoms of urinary incontinence.”1
Ron Antriasian, vice president of sales and business development for Life Extension in Florida, commented on the reluctance to discuss the subject. “Urological issues are typically associated with an older audience, and in the case of reproductive issues, men tend to be less willing to discuss such topics, even with a health professional,” he said. “Therefore, individuals tend to be more reactive in their approach to urological issues than to other categories. That said, both men and women are increasingly becoming more educated about the importance of preventive health regarding their urinary tracts and, in the case of men, their reproductive organs.”
The most common urologic concerns people appear to be seeking natural support for include incontinence, bladder health, urinary tract infections (UTIs), and prostate issues (enlarged prostate, prostatitis and cystitis).
According to Stacey Littlefield, lead product formulator at Illinois-based Redd Remedies, “Many women are seeking natural alternatives for urinary tract infections and incontinence, both of which are very common problems for women. For men, the largest urologic health issue remains associated with prostate health and the effects of an enlarged prostate on the urinary tract system.”
“Incontinence and other bladder issues are big,” noted Myers. “I think you can tell, in part, where the market is headed regarding natural products and supplements when you see a lot of pharmaceutical companies advertising their drugs for these same concerns,” she said.
Low Visibility, Steady Market
The unwillingness to publicly discuss urologic health may be keeping it out of the limelight of natural product discussions, but the market continues to be a steady one. “Depending on the source,” said Antriasian, “the global urology health products market is estimated to be between three to five billion dollars annually. Unlike some other categories such as cardiovascular health and weight loss, the urology market is not what one would typically describe as a high visibility market.”
Myers has found that “The market is quite large and I think you’ll probably find that while most of the customers are generally in the [Baby] Boomer generation and above, there is a wide range of individuals who have urologic health issues. In fact, about one in four women over the age of 18 have overactive bladder issues, and once men reach 60 years old, there is a 50 percent chance they will have to deal with the symptoms of an enlarged prostate,” she said.
Another reason the market is growing is due to the rising concern over the side effects of some prescribed drugs associated with treatment of bladder conditions. This is leading consumers to turn toward more natural solutions.
Myers explained, “Individuals have been seeking natural interventions for bladder issues due to the concern by many integrative practitioners that the common drugs (anticholinergic class of drugs) used for these problems is creating higher risks for dementia, in addition to the many adverse effects associated with their use. In Alzheimer’s disease, there is a significant drop in levels of an important neurotransmitter called acetylcholine. You need choline to make this neurotransmitter. Anticholinergic drugs block the activity of choline, which has caused concern among many individuals in natural health. The ability to reduce these symptoms without blocking choline is considered a great step forward and I think that also opens up a tremendous opportunity to provide a better answer.”2
Cranberry, Saw Palmetto and Pumpkin Seeds
In response to consumer demand, manufacturers are focusing their natural product formulations for urologic health on three main target areas: bladder health (including incontinence) for men and women; urinary tract—primarily for women—but which can also be used by men; and prostate health for men, with additional support for bladder and urethra. Cranberry, saw palmetto and pumpkin seed have traditionally been utilized as key active ingredients in many urologic health products. However, manufacturers are continuing to research and add in new combinations of ingredients—evolving and optimizing their formulations.
Michael A. Smith MD, senior health scientist at Life Extension, summarized the general approach to this class of products. “For prostate health, the classics are lignans, boswellia, nettle root, saw palmetto, pumpkin seed, beta-sitosterol, flower pollen, pygeum, boron and lycopene,” he noted. “Some of them block DHT and estrogen production, while others are antioxidants and anti-inflammatories. For bladder and urethra health, pumpkin seeds strengthen sphincter muscles, while cranberry extract has antimicrobial activity.”
Further insight was provided by Myers, who added, “Cranberry extracts for urinary tract infections (UTIs) and saw palmetto for prostate enlargement have been two of the big ingredients for a long time in this general category. Saw palmetto works via hormonal pathways to stabilize prostate enlargement, to reduce pressure on the bladder. Cranberry is well accepted for prevention or treatment of UTIs, but does not improve bladder capacity, and does not quiet the over-firing nerves in an overactive bladder. Additionally, urological products have typically been divided into women’s and men’s categories, which doesn’t always address the heart of bladder concerns, which in many instances are common to both.”
Incontinence and Bladder Health
For bladder health Life Extension offers Water-Soluble Pumpkin Seed Extract marketed primarily for women, although the product is not gender-specific, noted Smith. As to its benefits, “Laboratory and human clinical studies demonstrate the ingestion of water-soluble pumpkin seed extract can significantly improve the structural support of the bladder and the function of the sphincter muscle,” he said.
EuroPharma’s SagaPro Bladder health supplement for both men and women launched in April 2013, and utilizes a unique clinically studied extract of Angelica archangelica known as “Arctic Angelica” for support of bladder strength and capacity. “This angelica grows in Iceland and is not the same as Chinese angelica (Angelica sinensis), which is otherwise known as dong quai,” clarified Myers. “This product is a favorite in Iceland for bladder health, overactive bladder, nocturia, adult bedwetting and stress incontinence,” she said. “As a proprietary, aqueous extract of Angelica archangelica leaves—crafted from wild-harvested plants that have the good fortune to grow in the pure air of Iceland—it is like no other product offering available.”
“Icelandic Angelica archangelica has anti-inflammatory activity via a very specific pathway in the bladder that results in overproduction of leukotrienes,” Myers continued. “While this is not the same kind of inflammation as occurs in arthritis, or twisted ankles, or sunburns, it still damages bladder strength and nerves that transmit bladder signals. By reducing leukotrienes, Arctic Angelica can stop this cycle.”
More specifically, “The isoquercitrin content in Iceland’s Arctic Angelica may be at least partly responsible for its effectiveness,” suggested Myers. “Isoquercitrin can inhibit the activity of leukotrienes (LTD4) in the bladder and urethra that stimulate receptors which trigger overactive bladder contractions. This is important, because if these nerves are compromised in any way, they affect bladder sensations. For instance, if they are irritated, they send erroneous signals about the need to void, sending you to the bathroom more than you need. On the other hand, if the nerves are damaged, you may not realize you need to go until it is too late. Aside from improving bladder strength and capacity, this extract makes bathroom trips more productive, improving the ability to fully empty the bladder,” she added.
A published study on Angelica archangelica demonstrated improvements for male users with reduced bladder capacity. “In a published study, men with reduced bladder capacity found that the same Angelica archangelica available in SagaPro Bladder Health significantly improved their ability to hold urine,” Myers stated. “In fact, it tripled the time to first awakening to use the bathroom, and reduced the nocturnal awakenings for urination by 50 percent. What’s interesting about this extract is that the action of Angelica archangelica was not on the prostate, but on improving bladder strength,” said Myers.
“Additionally,” Myers continued, “the Angelica archangelica extract was very well tolerated and showed no hormonal effects or unwanted side effects like increased blood pressure or heart rate, or reduced libido. That’s a definite difference from many prescription drugs3.”
Urinary Tracts and UTIs
Cranberry juice has long been associated with urinary tract health. Now, manufacturers such as Redd Remedies and Life Extension are supplementing cranberry with additional effective ingredients such as probiotics, D-mannose and Ellirose.
Redd Remedies offers a product that focuses on urinary tract infections named UT Soothe with Probiotics. “UT Soothe with Probiotics combines food-based ingredients, including D-mannose, a fruit-based blend including cranberry, blueberry, tart cherry and other fruits and a shelf-stable probiotic, Bacillus coagulans,” said Littlefield. “UT Soothe is designed to be used both acutely and preventively for people who struggle with the occasional or recurring urinary tract issues. Because our formula does not contain potentially irritating diuretics or uva ursi, it is safe for both adults and children. The incorporated Healthy Urinary Tract Blend offers individuals a broader spectrum of support than cranberry alone against multiple types of bacteria that can cause urinary tract problems,” she added. It is not formulated for a specific gender.
“The anatomy of the female urinary tract differs greatly from men resulting in the need for additional nutritional support for women,” reported Smith. Life Extension has combined cranberry with Ellirose, “a unique compound available overseas but little known in the United States that provides a synergistic complement to the whole cranberry’s phytonutrient profile,” said Antriasian. This ingredient can be found in the Optimized Cran-Max Cranberry Whole Fruit Concentrate with Ellirose product designed to promote urinary tract health.
How do the cranberry and Ellirose complement each other? “A wealth of published studies indicates that cranberry polyphenols may help to support a healthy urinary tract,” said Smith. “Of particular importance is the flavonoid content of the cranberry, including anthocyanins and proanthocyanidins. These natural compounds exert powerful antioxidant effects that can reduce oxidative stress. Recent clinical data suggest that the proanthocyanidins found only in cranberries also possess unique molecular features that specifically promote urinary system health.”
“Ellirose,” explained Antriasian, “is derived from Hibiscus sabdariffa, a species native to Europe, Asia and Africa. Scientific analysis has shown that this species’ flower and calyx (the green floral envelope surrounding the blossom) are rich in active polyphenols, including flavonoids, sambubiosides and anthocyanins.”
Men’s Prostate Health Plus
While saw palmetto and pumpkin seed have been notably linked to prostate health, a number of new products are hitting the market with ingredients such as Boswellia, flower pollen, nettle, Pygeum, beta-sitosterol and others, which, when used in combination, support the healthy function of the prostate, plus bladder and urethra in men.
EuroPharma’s Healthy Prostate product, “provides clinically studied BosPure Boswellia, saw palmetto, nettle, pine phytosterols (standardized to contain 70 to 80 percent beta-sitosterol) and sesamin from sesame seed extract,” revealed Myers. “The boswellia extract we use is unique,” she said. “It is screened to reduce beta-boswellic acid—an inflammatory compound which often remains in unstandardized boswellia—and has higher levels of AKBA (acetyl-1 1-keto-beta-boswellic acid), its key compound for promoting cellular health. For men’s health and prostate health specifically, testosterone and dihydrotestosterone need to be in proper balance for healthy prostate function and proper urinary flow. The reason you see saw palmetto as such a common men’s supplement ingredient is because it helps support a healthy balance of these hormones and protects prostate cells,” she added.
Life Extension has a number of men’s products on the market including: Triple Strength ProstaPollen, Ultra Natural Prostate, PalmettoGuard Saw Palmetto/Nettle Root Formula with Beta-Sitosterol and Mega Lycopene. “The products contain research-supported ingredients for prostate, urethral and bladder health,” said Smith.
What is unique about the products and their formulations? Smith shared that, “Clinical studies have demonstrated that the flower pollen extracts in Triple Strength ProstaPollen provide healthy support for aging prostate glands. Two fractions in Triple Strength ProstaPollen—G60 (water-soluble) and NAX (lipid-soluble) —support prostate health by helping to maintain smooth muscle tone in the prostate, bladder, and urethra,” he said.
The Ultra Natural Prostate formula “has been upgraded numerous times so that is contains the most scientifically substantiated nutrients to help protect the prostate gland and maintain its health function,” advised Antriasian. He noted some of key ingredients and their effects as follows:
• Standardized lignans from flax seed and Norway spruce knotwood convert to enterolactone in the intestine, which is then absorbed into the bloodstream to provide support for prostate cells against excess estrogen levels.
• AprèsFlex, an extract of Boswellia, supports normal inhibition of 5-lipoxygenase or 5-LOX, an enzyme that is associated with undesirable cell division changes. • Saw palmetto extract helps inhibit dihydrotestosterone (DHT) activity in the prostate, and helps inhibit alpha-adrenergic receptor activity (to support normal urinary flow).
• Pygeum (Pygeum africanum) extract helps suppress prostaglandin production in the prostate and supports healthy urination patterns.
• Graminex Flower Pollen Extract, a European pollen extract that has been shown to help relax the smooth muscles of the urethra and help regulate inflammatory reactions.
According to Smith, there are 11 active, research-supported ingredients in this formulation which in addition to the above, also include lycopene, boron, beta-sitosterol and phospholipids.
The PalmettoGuard Saw Palmetto/Nettle Root Formula with Beta-Sitosterol product “combines saw palmetto with a nettle root extract, boron and rosemary to support a healthy prostate.”
Emerging Research Discoveries
When asked about new studies, Littlefield directed attention to recent research on antioxidant complexes found in food and their potential benefits with regard to urologic health. “Much of the current research on natural ingredients and urologic health is centered around the benefits of the antioxidant complexes found in foods, particularly fruits. While cranberry does offer protection against E. coli specifically, it has been found that eating a diet high in varied antioxidant foods can offer protective benefits for both men and women,” she stated.
Smith summarized other exciting new areas being explored. “Overactive bladder is a hot issue with current research studies underway,” he said. “One natural ingredient is Xanthoceras sorbifolia bunge plant, which is a flowering tree grown in Northern China. In Hong Kong, it’s used as a dietary supplement. Initial studies look very promising. A specialized herbal formula, called Urox, is also being studied. Flower pollen for non-infectious prostatitis is also a hot issue,” he concluded.
Where is the market headed and which particular applications will the market continue to expand in? Littlefield said that, “For women specifically, the demand for natural support for incontinence will continue to grow. For men, there will remain a steady demand for prostate health products.”
According to Myers, “Obviously there’s always going to be a market for women’s urological health supplements, especially concerning urinary tract infections, which typically occur more frequently in women, and men’s prostate support supplements.
As for what retailers can expect going forward, Myers comment was, “I have no doubt that new research will continue and that new botanicals or new combinations of well-known botanicals will be released. It will be fascinating to see which directions urologic health products take as our overall knowledge base expand. I think they’ll see products that, while they may have the same ingredients, differentiate themselves in delivery systems, research, or concentration. And no doubt, there will continue to be many product offerings that are specifically for men or women,” she added.
With regard to overall market evolution, “I anticipate a slow, steady growth to this market,” predicted Antriasian. “Again, because urological issues attract such limited attention in discussions regarding overall health—cardio, cognitive, glucose management, weight management, and other categories attract far more attention—it is incumbent upon the individual to take the initiative to educate him/herself on this niche category.” VR
1 “Urge Incontinence/Overactive Bladder”, from National Association for Continence. Available at: www.nafc.org/conditions/. Accessed: August 19, 2015.
2 “Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement. 2012 Nov 22. doi:pii: S1522-5260(12)00081-7.10.1016/j.jalz.2012.02.005.Affiliations.
3 “Sigurdsson S, Geirsson G, Gudmundsdottir H, Egilsdottir PB, Gudbjarnason S. A parallel, randomized, double-blind, placebo-controlled study to investigate the effect of a proprietary Angelica archangelica extract on nocturia in men. Scand J Urol. 2013 Feb;47(1):26-32.
For More Information:
EuroPharma, Inc., (920) 406-6500
Life Extension, (800) 544-4440
Redd Remedies, (888) 453-5058