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In this short episode I clarify some thoughts on Uva ursi (Arctostaphylos uva-ursi) and whether you need to alkalinize urine for it to “work.”
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.
You can sign up to catch the recording of the full UTI training for practitioners mentioned in this episode.
Resources to Explore- 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)
Thanks for listening.
I'd love to hear from you. Leave me a voicemail with feedback or submit a question (click the pink "Send Camille a Message" button on the side of the page) 💚
Camille's Helpful Links for Practitioners
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Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
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I'm an herbalist and nutritionist, and in this podcast, I share little tips
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and tidbits that might be helpful for other practitioners.
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I want to talk to you a little bit about Uversi today, also known as Arctostaphalos
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Uversi. That's the scientific name.
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Last week, I did a training for practitioners about urinary tract infections,
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and I thought I could do it in an hour, and I even recorded a podcast,
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a whole podcast episode about how great I am at doing classes that end exactly on time.
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But it turns out I was mistaken, and I definitely could not do it in an hour.
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As a result, by the time we got to the end, we had a little section on herbs,
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and we talked about Uva Ursi, and I made some offhand comments,
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but we didn't really have time to fully flesh out my thoughts on Uva Ursi.
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And I was like, oh gosh, I think I've just slandered Uva Ursi in front of all these people.
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So let me just clarify some things here for those of you who were at the class.
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And actually, I think this will be helpful even if you weren't at the class.
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If you are somebody, pardon me, who has or has thought about recommending uva
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ursi for folks who have urinary tract infections, please listen because there
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are some things that might be helpful for you in this little segment.
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All right, so here's the deal. Uva ursi is like the classic herb.
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If you have a urinary tract infection, most people with any vague background
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in herbalism, integrative health, etc., are going to say, oh,
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uva ursi, that's the herb to think about.
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And you will also see a substantial number of herbalists saying that if you
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take uva ursi, it's most effective if your urine is alkaline,
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so you need to take it with some baking soda. It's like a classic piece of advice.
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In my urinary tract infections class, I said a couple things about uva ursi.
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One was that I have not found it to be consistently helpful for most people.
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Two, I have not really found it to make a difference whether people take baking soda or don't.
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There was a time maybe five or ten years ago when I was like,
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oh, okay, that makes a lot of sense.
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So I tried it. Still, it didn't seem that consistent for me.
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And it didn't seem to matter too much one way or the other if people take the baking soda or not.
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So I said, I don't think of it as a shoe-in. And everybody who has a urinary
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tract infection automatically needs uva ursi.
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Let me just get into a little bit of detail and explain. Okay, first of all,
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the theoretical reason why uva ursi works, or one of the reasons why we might
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think about it being helpful in a urinary tract infection, is that the plant is high in,
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pardon me, a constituent called arbutin.
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Arbutin, when we ingest it, it gets metabolized into something called hydroquinone.
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Now, this actually happens in the liver. We ingest it orally.
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Of course, it goes through first-pass metabolism, it goes to the liver,
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the liver breaks down the arbutin, and it hydrolyzes it.
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One of the things it hydrolyzes it into is hydroquinone.
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Now, hydroquinone by itself is actually potentially hepatotoxic,
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but fortunately, the liver doesn't just leave it to roam around by itself.
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It gets re-conjugated, it gets reformulated, something gets added to it so that
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it's not wandering around harming tissues by itself.
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Then it goes in the blood, and eventually it gets filtered in the kidneys and
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in the urine, Theoretically,
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this now-conjugated form of hydroquinone gets broken down again,
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and the hydroquinone itself is supposedly antimicrobial antiseptic.
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We know that it is antimicrobial from in vitro research. It does seem to be active against E.
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Coli and other uropathogens. Okay, that's great.
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We also have in vitro, meaning test tube outside of the body,
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research suggesting that hydroquinone is most effective in an alkaline environment.
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Urine, of course, is generally acidic.
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Okay, so that by itself has led people to say, oh, okay, well then what we need
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to do if we want to be working with uva-ursi is we need to alkalinize the urine
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so that it can do what it does.
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I want to point out a few things. Number one, this is all based on theory.
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None of this is like, oh, we've done human studies, and we found that if we
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give people baking soda along with their uva ursi, that we have better outcomes,
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or even that more hydroquinone is excreted in the urine or whatever else.
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This is all theoretical.
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I also think it's very reductionistic. Are we thinking that the only thing that
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matters in uva ursi is this one constituent, which is the arbutin,
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and that everything else is just, like, why would we even worry about everything
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else? That doesn't make sense to me.
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Okay, so when I'm thinking about this, I'm like, okay, first of all,
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there's other things in uva ursi that could potentially be helpful.
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It has tannins. Now, we do prepare it generally as a cold infusion or at least
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a short, steeped hot infusion, specifically so we don't get too many tannins
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into the tea because they taste terrible.
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They're too tanniny if you do a lot.
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But even in a cold infusion or a short, steeped hot infusion,
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you're still going to get some tannins, and those tannins are potentially effective.
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There are other constituents. There are flavonoids. There are phenolics.
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There's other types of things in the uversi.
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So why are we pretending that we only care about the arbutin and we're just
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going to do everything we can to maximize the arbutin?
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All right, so that's one problem I have with that.
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Number two, adding baking soda to alkalinize the urine, that by itself is just
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not a neutral thing to do.
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First of all, depending on the dose of baking soda that you're using,
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it's a fairly high amount of sodium.
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So we have to think about that for our clients who might have sodium sensitivities for various reasons.
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You can alkalinize the urine in other ways, like calcium citrate,
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then you start to have to worry about high calcium levels, etc.
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But number two, we know that E.
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Coli, the primary organism that causes most community-acquired urinary tract
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infections, it does better in a more alkaline environment.
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So having an acidic urine actually slows the growth of E.
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Coli. So if we are saying we're going to try to alkalinize urine by taking baking
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soda or calcium citrate or whatever else we're going to try to do, and taking uva ursi,
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there's a chance if we didn't take a high enough dose of the uva ursi or if
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our bodies don't metabolize it the same way as other people's or for whatever reasonâ,
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this particular strain of E. coli isn't responsive to that amount of hydroquinone,
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then what we've done is made it easier for the E.
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Coli to proliferate, or whatever other organism is there, potentially.
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Many of them are sensitive to urine acidity. So there's a chance that the baking
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soda can make things worse. Okay.
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Then, all that, on top of all of that, when you look at historical use of uva
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ursi, which goes back centuries, I didn't have time to fully dive into Girard
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and Culpepper and so forth. But if you look at Mrs.
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Greaves' herbal, she notes that Uva Ursi appears in many of the older texts,
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and essentially all of them recommend it for what we would now call cystitis,
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as well as other more serious urinary tract infections.
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None of those people, the eclectic physicians, Girard, Culpepper, Mrs.
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Greaves, blah, blah, blah, none of these people historically were like,
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and you need to take it with a spoonful of baking soda.
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It has historically been used either as a cold infusion or a short, steeped warm infusion.
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Okay, so, great. That's all lovely.
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So we need to understand there's no clinical evidence specifically suggesting
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that alkalinizing the urine is helpful for uva ursi.
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Number two, there's no historical evidence suggesting that that is helpful.
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Number three, there's a possibility of harm when we add baking soda.
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I'm not saying it's a huge possibility, but I am saying, let's think about it.
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But number four, I'm just going to keep going here.
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Number four, there was a study. I was looking into this a little bit more because
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I was lying in bed thinking like, oh gosh, I need to clarify this.
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But anyway, there's a study by Seegers and colleagues. It came out in 2003 in
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the journal Phytomedicine.
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And this is a small study, but it is in people, volunteers.
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So they had people take arbutin.
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Well, they actually took a plant that has arbutin in it.
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And then they looked at their urine. And what they found, They actually did
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some kind of interesting bacterial research, but they found that the E.
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Coli bacteria could actually take in the free hydroquinone.
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The bacteria themselves could liberate the hydroquinone. So it didn't actually
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matter the pH of the urine.
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They found that the bacteria itself was separating the hydroquinone from its
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conjugate, meaning it's activating the hydroquinone.
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All right, so if we think that bacterial cells, the E.
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Coli and so forth, can actually take up the conjugated hydroquinone,
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the active constituent of uva ursi, and deconjugate it inside the cell where
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it presumably then becomes antimicrobial and does what it does,
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then again, there's not really a reason to think that we need to alkalinize the urine.
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So, for all of these reasons, I think that, first of all, why are we overemphasizing only uva ursi?
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It is certainly an herb that seems to have activity in the urinary tract.
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We do have evidence that arbutin especially does make it into the urine, which is something.
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But the arbutin is not the only part that matters, in my opinion.
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It's a whole plant. Most of us practice whole plant-based recommendations and things like that.
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Number two, if we do think only the arbutin matters and it's all about the antimicrobial
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effects of the hydroquinone, which is a metabolite of arbutin, at that point,
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why do you not just use an antibiotic that you know has antimicrobial properties?
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I mean, anyway, I know that there's effects on vaginal flora and so forth,
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but we're just thinking about an herb as a replacement for an antibiotic.
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I'm not sure that this makes a lot of sense. So I'm in favor,
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if you want to use uva ursi, of just using it as a cold infusion or maybe a
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short, steeped hot infusion, depending on what is convenient and what other
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herbs you want to work with.
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However, I don't think that it's the only thing that we can think about when
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somebody has a urinary tract infection.
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If you want to know more of my thoughts, you can go take the whole entire class
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because I've already gone on quite a long time here.
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But let's not pigeonhole ourselves.
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Into this. Now, if you have experience alkalinizing the urine and finding that
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Uva Ursi works really well under that circumstance and not otherwise, go right ahead.
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I'm not here to tell you that this is the perfect way or this is definitely
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how you should do things, but I do just want you to think about it.
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Does it really matter if we alkalinize urine? How about we just,
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you know, work with the regular plant infusion as has been done historically
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and see where we get from there.
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And I feel like I need to say just a final note, which is, of course,
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if you or somebody else has a urinary tract infection and you are working with
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Uversi or any other plants or any other strategies, we do really want to make
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sure that there's improvement within at least 24 hours,
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maybe 48 if it seems very benign.
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But if there's not improvement or things get worse, it is time to go in to primary
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care or to get some additional treatment because we don't want to run the risk
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of having things worsen.
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Okay. Oh, and I did mean to talk about, you know, you'll hear people saying
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like, oh, okay, well, cranberry and vitamin C can potentially,
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you know, the thought behind those, at least partially, is that they're acidifying the urine.
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It doesn't make sense to do cranberry and uversi because with uversi,
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you need to alkalinize the urine.
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And with cranberry, you're acidifying the urine. Again, I think that that's kind of.
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Well, first of all, the fact that cranberry acidifies the urine maybe a little
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bit, but that's not primarily how it supports people.
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Same with vitamin C. Like, it can acidify the urine to a certain degree.
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But acidifying the urine alone is not enough to treat a urinary tract infection.
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We need more than that for most people.
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But second of all, if we're not saying that uva ursi has to have alkaline urine
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to be effective, then we don't have to worry about that.
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So I don't think it's absolutely ridiculous if somebody wants to drink some
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cranberry juice and take uva ursi.
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To me, I think that's fine, based
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on my understanding of the role of alkalinization in uva ursi activity.
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But you do you if you have different theories and you found different things
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to be helpful in your own clients.
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Amazing. I love that for you. I just wanted to share an alternative perspective
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for people who might be interested and give you a little bit of background on uva ursi.
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All right I will put the link to that Seeger's and colleagues study about the
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about the bacteria taking up the conjugated hydroquinone in case that's interesting
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to anybody as well as a couple of other studies that might be interesting if
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you wanted to dive into uva ursi a little bit more.
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All right if you have any questions let me know. Otherwise, I hope that was helpful.
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Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.
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I'm an herbalist and nutritionist, and in this podcast, I share little tips
00:00:07.777 --> 00:00:09.817
and tidbits that might be helpful for other practitioners.
00:00:10.377 --> 00:00:15.277
I want to talk to you a little bit about Uversi today, also known as Arctostaphalos
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Uversi. That's the scientific name.
00:00:17.417 --> 00:00:21.797
Last week, I did a training for practitioners about urinary tract infections,
00:00:21.797 --> 00:00:27.297
and I thought I could do it in an hour, and I even recorded a podcast,
00:00:27.577 --> 00:00:32.477
a whole podcast episode about how great I am at doing classes that end exactly on time.
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But it turns out I was mistaken, and I definitely could not do it in an hour.
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As a result, by the time we got to the end, we had a little section on herbs,
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and we talked about Uva Ursi, and I made some offhand comments,
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but we didn't really have time to fully flesh out my thoughts on Uva Ursi.
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And I was like, oh gosh, I think I've just slandered Uva Ursi in front of all these people.
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So let me just clarify some things here for those of you who were at the class.
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And actually, I think this will be helpful even if you weren't at the class.
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If you are somebody, pardon me, who has or has thought about recommending uva
00:01:09.717 --> 00:01:12.757
ursi for folks who have urinary tract infections, please listen because there
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are some things that might be helpful for you in this little segment.
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All right, so here's the deal. Uva ursi is like the classic herb.
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If you have a urinary tract infection, most people with any vague background
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in herbalism, integrative health, etc., are going to say, oh,
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uva ursi, that's the herb to think about.
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And you will also see a substantial number of herbalists saying that if you
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take uva ursi, it's most effective if your urine is alkaline,
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so you need to take it with some baking soda. It's like a classic piece of advice.
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In my urinary tract infections class, I said a couple things about uva ursi.
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One was that I have not found it to be consistently helpful for most people.
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Two, I have not really found it to make a difference whether people take baking soda or don't.
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There was a time maybe five or ten years ago when I was like,
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oh, okay, that makes a lot of sense.
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So I tried it. Still, it didn't seem that consistent for me.
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And it didn't seem to matter too much one way or the other if people take the baking soda or not.
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So I said, I don't think of it as a shoe-in. And everybody who has a urinary
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tract infection automatically needs uva ursi.
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Let me just get into a little bit of detail and explain. Okay, first of all,
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the theoretical reason why uva ursi works, or one of the reasons why we might
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think about it being helpful in a urinary tract infection, is that the plant is high in,
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pardon me, a constituent called arbutin.
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Arbutin, when we ingest it, it gets metabolized into something called hydroquinone.
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Now, this actually happens in the liver. We ingest it orally.
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Of course, it goes through first-pass metabolism, it goes to the liver,
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the liver breaks down the arbutin, and it hydrolyzes it.
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One of the things it hydrolyzes it into is hydroquinone.
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Now, hydroquinone by itself is actually potentially hepatotoxic,
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but fortunately, the liver doesn't just leave it to roam around by itself.
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It gets re-conjugated, it gets reformulated, something gets added to it so that
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it's not wandering around harming tissues by itself.
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Then it goes in the blood, and eventually it gets filtered in the kidneys and
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in the urine, Theoretically,
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this now-conjugated form of hydroquinone gets broken down again,
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and the hydroquinone itself is supposedly antimicrobial antiseptic.
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We know that it is antimicrobial from in vitro research. It does seem to be active against E.
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Coli and other uropathogens. Okay, that's great.
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We also have in vitro, meaning test tube outside of the body,
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research suggesting that hydroquinone is most effective in an alkaline environment.
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Urine, of course, is generally acidic.
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Okay, so that by itself has led people to say, oh, okay, well then what we need
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to do if we want to be working with uva-ursi is we need to alkalinize the urine
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so that it can do what it does.
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I want to point out a few things. Number one, this is all based on theory.
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None of this is like, oh, we've done human studies, and we found that if we
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give people baking soda along with their uva ursi, that we have better outcomes,
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or even that more hydroquinone is excreted in the urine or whatever else.
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This is all theoretical.
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I also think it's very reductionistic. Are we thinking that the only thing that
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matters in uva ursi is this one constituent, which is the arbutin,
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and that everything else is just, like, why would we even worry about everything
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else? That doesn't make sense to me.
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Okay, so when I'm thinking about this, I'm like, okay, first of all,
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there's other things in uva ursi that could potentially be helpful.
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It has tannins. Now, we do prepare it generally as a cold infusion or at least
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a short, steeped hot infusion, specifically so we don't get too many tannins
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into the tea because they taste terrible.
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They're too tanniny if you do a lot.
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But even in a cold infusion or a short, steeped hot infusion,
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you're still going to get some tannins, and those tannins are potentially effective.
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There are other constituents. There are flavonoids. There are phenolics.
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There's other types of things in the uversi.
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So why are we pretending that we only care about the arbutin and we're just
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going to do everything we can to maximize the arbutin?
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All right, so that's one problem I have with that.
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Number two, adding baking soda to alkalinize the urine, that by itself is just
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not a neutral thing to do.
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First of all, depending on the dose of baking soda that you're using,
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it's a fairly high amount of sodium.
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So we have to think about that for our clients who might have sodium sensitivities for various reasons.
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You can alkalinize the urine in other ways, like calcium citrate,
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then you start to have to worry about high calcium levels, etc.
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But number two, we know that E.
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Coli, the primary organism that causes most community-acquired urinary tract
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infections, it does better in a more alkaline environment.
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So having an acidic urine actually slows the growth of E.
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Coli. So if we are saying we're going to try to alkalinize urine by taking baking
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soda or calcium citrate or whatever else we're going to try to do, and taking uva ursi,
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there's a chance if we didn't take a high enough dose of the uva ursi or if
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our bodies don't metabolize it the same way as other people's or for whatever reasonâ,
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this particular strain of E. coli isn't responsive to that amount of hydroquinone,
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then what we've done is made it easier for the E.
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Coli to proliferate, or whatever other organism is there, potentially.
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Many of them are sensitive to urine acidity. So there's a chance that the baking
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soda can make things worse. Okay.
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Then, all that, on top of all of that, when you look at historical use of uva
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ursi, which goes back centuries, I didn't have time to fully dive into Girard
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and Culpepper and so forth. But if you look at Mrs.
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Greaves' herbal, she notes that Uva Ursi appears in many of the older texts,
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and essentially all of them recommend it for what we would now call cystitis,
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as well as other more serious urinary tract infections.
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None of those people, the eclectic physicians, Girard, Culpepper, Mrs.
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Greaves, blah, blah, blah, none of these people historically were like,
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and you need to take it with a spoonful of baking soda.
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It has historically been used either as a cold infusion or a short, steeped warm infusion.
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Okay, so, great. That's all lovely.
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So we need to understand there's no clinical evidence specifically suggesting
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that alkalinizing the urine is helpful for uva ursi.
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Number two, there's no historical evidence suggesting that that is helpful.
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Number three, there's a possibility of harm when we add baking soda.
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I'm not saying it's a huge possibility, but I am saying, let's think about it.
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But number four, I'm just going to keep going here.
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Number four, there was a study. I was looking into this a little bit more because
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I was lying in bed thinking like, oh gosh, I need to clarify this.
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But anyway, there's a study by Seegers and colleagues. It came out in 2003 in
00:08:15.034 --> 00:08:16.354
the journal Phytomedicine.
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And this is a small study, but it is in people, volunteers.
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So they had people take arbutin.
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Well, they actually took a plant that has arbutin in it.
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And then they looked at their urine. And what they found, They actually did
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some kind of interesting bacterial research, but they found that the E.
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Coli bacteria could actually take in the free hydroquinone.
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The bacteria themselves could liberate the hydroquinone. So it didn't actually
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matter the pH of the urine.
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They found that the bacteria itself was separating the hydroquinone from its
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conjugate, meaning it's activating the hydroquinone.
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All right, so if we think that bacterial cells, the E.
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Coli and so forth, can actually take up the conjugated hydroquinone,
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the active constituent of uva ursi, and deconjugate it inside the cell where
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it presumably then becomes antimicrobial and does what it does,
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then again, there's not really a reason to think that we need to alkalinize the urine.
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So, for all of these reasons, I think that, first of all, why are we overemphasizing only uva ursi?
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It is certainly an herb that seems to have activity in the urinary tract.
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We do have evidence that arbutin especially does make it into the urine, which is something.
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But the arbutin is not the only part that matters, in my opinion.
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It's a whole plant. Most of us practice whole plant-based recommendations and things like that.
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Number two, if we do think only the arbutin matters and it's all about the antimicrobial
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effects of the hydroquinone, which is a metabolite of arbutin, at that point,
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why do you not just use an antibiotic that you know has antimicrobial properties?
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I mean, anyway, I know that there's effects on vaginal flora and so forth,
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but we're just thinking about an herb as a replacement for an antibiotic.
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I'm not sure that this makes a lot of sense. So I'm in favor,
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if you want to use uva ursi, of just using it as a cold infusion or maybe a
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short, steeped hot infusion, depending on what is convenient and what other
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herbs you want to work with.
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However, I don't think that it's the only thing that we can think about when
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somebody has a urinary tract infection.
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If you want to know more of my thoughts, you can go take the whole entire class
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because I've already gone on quite a long time here.
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But let's not pigeonhole ourselves.
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Into this. Now, if you have experience alkalinizing the urine and finding that
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Uva Ursi works really well under that circumstance and not otherwise, go right ahead.
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I'm not here to tell you that this is the perfect way or this is definitely
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how you should do things, but I do just want you to think about it.
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Does it really matter if we alkalinize urine? How about we just,
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you know, work with the regular plant infusion as has been done historically
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and see where we get from there.
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And I feel like I need to say just a final note, which is, of course,
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if you or somebody else has a urinary tract infection and you are working with
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Uversi or any other plants or any other strategies, we do really want to make
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sure that there's improvement within at least 24 hours,
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maybe 48 if it seems very benign.
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But if there's not improvement or things get worse, it is time to go in to primary
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care or to get some additional treatment because we don't want to run the risk
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of having things worsen.
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Okay. Oh, and I did mean to talk about, you know, you'll hear people saying
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like, oh, okay, well, cranberry and vitamin C can potentially,
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you know, the thought behind those, at least partially, is that they're acidifying the urine.
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It doesn't make sense to do cranberry and uversi because with uversi,
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you need to alkalinize the urine.
00:11:57.937 --> 00:12:01.597
And with cranberry, you're acidifying the urine. Again, I think that that's kind of.
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Well, first of all, the fact that cranberry acidifies the urine maybe a little
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bit, but that's not primarily how it supports people.
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Same with vitamin C. Like, it can acidify the urine to a certain degree.
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But acidifying the urine alone is not enough to treat a urinary tract infection.
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We need more than that for most people.
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But second of all, if we're not saying that uva ursi has to have alkaline urine
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to be effective, then we don't have to worry about that.
00:12:29.487 --> 00:12:33.007
So I don't think it's absolutely ridiculous if somebody wants to drink some
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cranberry juice and take uva ursi.
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To me, I think that's fine, based
00:12:37.627 --> 00:12:43.027
on my understanding of the role of alkalinization in uva ursi activity.
00:12:43.407 --> 00:12:46.947
But you do you if you have different theories and you found different things
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to be helpful in your own clients.
00:12:48.947 --> 00:12:53.987
Amazing. I love that for you. I just wanted to share an alternative perspective
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for people who might be interested and give you a little bit of background on uva ursi.
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All right I will put the link to that Seeger's and colleagues study about the
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about the bacteria taking up the conjugated hydroquinone in case that's interesting
00:13:08.727 --> 00:13:12.287
to anybody as well as a couple of other studies that might be interesting if
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you wanted to dive into uva ursi a little bit more.
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All right if you have any questions let me know. Otherwise, I hope that was helpful.