Preventing UTIs, can you tell me about Uqora?

Ask Dr.Jen

I saw an advertisement for a supplement called Uqora on TV. Is this a good product to prevent urinary tract infections (UTIs)?

– Personal Communication

Short Take

Uqora is an expensive system of three different supplements that claims to prevent UTIs. It does contain one ingredient that has some supporting evidence, D-mannose. No other ingredient in Uqora is backed by robust science. I recommend just buying D-mannose for those who want to try it.  

Tell Me More

Recurrent UTIs are a significant health concern. The risk of recurrence after one UTI is 30% to 44%. If a woman has a recurrent UTI within a few months, there is a 50% chance she will have a 3rd infection by six months. 

Reasons for recurrent UTIs are complex. For some, the bacteria may be more virulent (likely to cause infection), for others, the bacteria develops resistance to antibiotics. Bacteria can also form biofilms, which are complex communities that allow the bacteria to evade the immune system and antibiotics. Other factors involved include sexual activity and menopause. When estrogen levels drop, the bacteria that colonizes the vagina changes, allowing bacteria that can cause infections to overgrow. The decrease in estrogen with menopause also causes a loss of collagen in the vagina, bladder and urethra, which also plays a role. For many there may be genetic and immune system issues that we have yet to understand. 

Recurrent UTIs are painful and frustrating. They can also negatively impact someone’s sex life and when antibiotics are taken repeatedly, the risk of antibiotic resistance and harder to treat infections increases. Antibiotics can also have other medical consequences, such as diarrhea and yeast infections. As recurrent UTIs are a challenging issue and medicine does not have all the answers, it isn’t surprising that people look elsewhere.

So what is Uqora? It’s a system of three products,”Target,” “Control” and “Promote,” but you can also just take one or two of these depending on the “guidance” you get from the website after inputting your medical concerns. Of course the most expensive is the “most popular.” I’m shocked, I tell you.

According to Uqora, “Target is an effective, easy way to flush your urinary tract. We recommend drinking Target at least every three days to flush your urinary tract, and also after sex and other times you need extra support (like after exercise, travel, etc).” 

This makes no medical sense. While it might sound science-ish, your ureters, bladder, and urethra are not clogged with grime, so they don’t need some magical urinary Drano. There is some low quality data that drinking 1.5 extra liters of water a day might reduce the risk of recurrent infections. But this is just water, and the evidence isn’t great and so it’s not recommended. There is no data that “Target” flushes anything, except perhaps your cash. Also, exercise doesn’t cause UTIs.

The active ingredients in “Target” are calcium, vitamin C, D-mannose, vitamin B, magnesium, and potassium citrate. You are supposed to drink this every day if you want ”maximum support.” The only ingredient that has supporting evidence is D-mannose. FYI, calcium and vitamin C supplements are linked with kidney stones, although the dose of calcium here is only 60 mg and unlikely to have any effect. The dose of vitamin C is 480 mg, in the range associated with a higher risk of kidney stones. While vitamin C was previously considered as a prevention strategy for UTIs, there is really no data to back it up and it is no longer recommended.

Okay, on to the “Control”, which claims to treat biofilms.

<Enter sarcasm zone> Wow, the folks at Uqora can cleanse biofilms, and yet they have kept this scientific discovery from the medical world <exit sarcasm zone>.

Biofilms are a huge issue in medicine. If a company had actually solved this problem, and backed that up with high quality clinical studies, it would be in the medical guidelines. However, the ingredients in “Control” are as follows: Vitamin D3, 1500; Turmeric Extract (Curcumin 95%) - 200mg; D-mannose - 600mg; Green Tea Extract 200mg; Black Pepper Powder - 10mg. There is no robust data, or really any data, on this concoction for biofilms. Vitamin D supplements are also associated with kidney stones. In my opinion anyone who insinuates they have a product that is effective against biofilms and has not published peer reviewed research to back it up is a predator.

The third product is called “Promote” (this is getting exhausting), and it contains the probiotics lactobacillus acidophilus, lactobacillus rhamnosus, and lactobacillus reuteri as well as chicory root fructo-oligosaccharides (a prebiotic). We no longer believe that lactobacillus acidophilus is important in vaginal health, so there’s that and there just isn’t good data to support the other probiotics in preventing recurrent UTIs. Yes, the right vaginal ecosystem is important. No, we do not know how to replace it or enhance it. 

So what does all this cost? Well, if you want “maximum support” (because who doesn’t want maximum support?) and buy all three products, that will set you back $120 for one month. Otherwise, it's $78/month for a subscription. 

The only ingredient in Uqora that has any evidence supporting it is D-mannose, something I do recommend, although admittedly the data is lower quality. However, you can buy one month’s worth for about $13.00 and you don’t risk the possibility of kidney stones from the unnecessary vitamin C and D. If you want extra curcumin in your diet, you can get the dose in Uqora with a teaspoon of turmeric. Lots of yummy ways to do that, just remember there is no data to support it for preventing UTIs.

There are some other troubling things about Uqora. Their site is filled with blog posts that are promoted as researched, but the few I read were biased to support the product (no shocker) and low quality studies and review articles were offered as supporting evidence. They are counting that most readers won’t know how to interpret the references.

Uqora also has a “good doc club.” Yes, you can nominate your Uqora-recommending doctor for accolades. This also provides the illusion that Uqora is offering something much more evidence-based than it really is, I mean if all these doctors are recommending it, there must be something to it, right? And if you are looking for a doctor and find one on the Uqora site, you are choosing a pool of providers more likely to recommend untested supplements.

“Good doc club.” As if someone selling supplements is in any position to maintain that list. You definitely won’t be finding my name in Uqora’s “good doc club.”

If you want to try D-mannose to prevent UTIs, the dose is 2 g a day, taken orally. Animal models have shown it prevents some types of bacteria from binding with the bladder and reduces the level of bacteria in the urine. And, as previously mentioned, you can buy a month’s worth for only $13.00 and skip all the other untested fillers. And if you are close to menopause or in menopause, definitely ask your provider about vaginal estrogen as it is VERY EFFECTIVE at preventing UTIs.

And one last thing, this is what Uqora says about their own product…

P.S. If you are from Uqora and think about reaching out to me with your “data” or your “mission”, just don’t. Save your energy for publishing the randomized double-blinded placebo controlled trial completed by a third party that proves your product “cleanses” biofilms. You must be sitting on that data, right? I’ll be sure to read it when its published. I’m always interested in learning and happy to change my recommendations when good science is published.

References

1. Brubaker et al.American Urogynecologic Society Best-Practice Statement:

   Recurrent Urinary Tract Infection in Adult Women.Female Pelvic Med Reconstr Surg 2018;24: 321–335.

2. Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704-711.

3. Wallace WB, et al. Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr. 2011 Jul; 94(1): 270–277.

4. Hooton TM, Vecchio M, Iroz A et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections. JAMA Intern Med 2018; 178: 1509.

5. Porru D, Parmigiani A, Tinelli C et al: Oral D-mannose in recurrent urinary tract infections in women: A pilot study. J Clin Urol 2014;7:208.

6. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019).