Home Ingredients Birch Leaf (Betula pendula)

Birch Leaf (Betula pendula)

Betula pendula Roth and/or Betula pubescens Ehrh. (and hybrids), folium
Evidence Level
Preliminary
5 Clinical Trials
4 Documented Benefits
1/5 Evidence Score

Birch leaf is the dried leaf of the silver birch (Betula pendula) or downy birch (Betula pubescens), sold as tea and as water-extract capsules or tablets for flushing the urinary tract. In the EU it is registered only as a traditional herbal medicine: regulators accept its use to increase the amount of urine as an add-on in minor urinary complaints on the basis of long-standing use, and found no published clinical trial that supports this use. The only patient studies of birch leaf alone are a 15-patient placebo-controlled tea study and an uncontrolled open study; most other work is in animals or the lab. It is a different product from birch sap and from betulin, which comes from the bark. People sensitive to birch pollen, people told to limit fluids because of serious heart or kidney disease, pregnant or breastfeeding women and children under 12 should not use it.

Studied Dose EU traditional-use doses: 2 to 3 g dried leaf in 150 ml boiling water up to 4 times daily, or 0.25 to 1 g dry extract 4 times daily, for 2 to 4 weeks with plenty of fluid. The only placebo-controlled study used 4 cups of tea daily for 20 days.
Active Compound Dried leaves of Betula pendula and/or Betula pubescens. The European Pharmacopoeia requires at least 1.5% flavonoids (as hyperoside); the leaves contain about 1% to 3.5% flavonol glycosides (hyperoside and other quercetin, myricetin and kaempferol glycosides), plus chlorogenic and caffeic acids, tannins, proanthocyanidins, malonylated dammarane triterpene esters and potassium. The EMA recognizes no single active constituent.

Benefits

Traditional use to increase urine flow

The European Medicines Agency accepts birch leaf as a traditional herbal medicine to increase the amount of urine and flush the urinary tract as an add-on in minor urinary complaints, provided enough fluid is drunk. That acceptance rests only on long-standing use: tea and extract products have been sold in Poland and Germany for more than 30 years.

Supported by Trial 2, Trial 1

Urine output compared with plain water

European regulators found no published clinical trial supporting birch leaf for increasing urine flow. Early studies in a few healthy adults, summarized in their review, found no significant rise in urine output after a birch leaf infusion compared with plain water. Animal studies gave varied results, so the effect in people is unproven.

Supported by Trial 2, Trial 1

Single-herb studies reviewed by European regulators

The only patient studies of birch leaf alone that regulators found were a 20-day placebo-controlled tea study in 15 people with urinary infections and an open study in 1,066 users without a comparison group. They judged both designs insufficient and accepted no use for infections.

Supported by Trial 2, Trial 1

Multi-herb blends that contain birch leaf

Birch leaf has been tested in people only as part of blends, such as a goldenrod, Java tea and birch capsule and a berberine, arbutin and birch mix with D-mannose, in people with repeat urinary infections or urinary catheters. None had a placebo group, and a German health technology review found only one isolated result for a uva ursi and birch product that was hard to find or no longer sold.

Supported by Trial 5, Trial 2

Mechanism of action

1

Flavonoid-rich extracts and urine output in animals

In rats, a flavonoid-rich water extract raised urine output by 54% over 3 hours, while other birch leaf extracts and fractions, a dammarane ester fraction and a standardized extract given for 3 days did not change urine volume. The EMA judged the animal findings inconclusive, though compatible with a mild water-flushing effect.

2

Less E. coli attachment to bladder cells in the lab

A water and ethanol birch leaf extract reduced attachment of urinary E. coli to human bladder cells in a dish by acting on the cells (half-maximal at 415 micrograms per ml). A hot water extract slowed E. coli movement, and malonylated dammarane esters from the leaves, extracted when brewed with giant goldenrod, reduced bacterial adhesion. These are test-tube findings only.

3

Tea phenolics reach urine as gut microbe metabolites

In work on silver birch leaf tea, gut bacteria broke the tea's phenolic compounds into smaller molecules, and in an in vivo test, urine collected after intake contained glucuronides and sulfates of caffeic acid and dihydroxyphenyl valerolactones, products of gut microbial metabolism. The tea also lowered IL-6 and IL-8 release from cells in the lab.

Clinical trials

1
Birch Leaf Tea vs Placebo Tea in Lower Urinary Infection: 15-Patient Pilot RCT (not PubMed-indexed)
PubMed

Randomized, double-blind, placebo-controlled pilot study of 4 cups of birch leaf tea daily for 20 days, known only from the summary in the EMA assessment report. (Engesser et al. 1998, summarized by the EMA)

15 patients with infections of the lower urinary tract; end-of-study results are given for 7 on birch leaf tea and 6 on placebo tea.

Urine microbial counts fell by 39% on birch leaf tea and by 18% on placebo tea. At the end, 3 of 7 patients on birch leaf and 1 of 6 on placebo no longer had an infection. No statistical test is reported in the summary, and the EMA judged the design insufficient to support any well-established use.

2
Birch Leaf Dry Extract in 1,066 Users With Urinary Complaints: Open Non-Interventional Study (no control group)
PubMed

Non-interventional (observational) study of a dry aqueous birch leaf extract (4-8:1) at 180 to 1,080 mg daily or more, mostly for 2 to 4 weeks, known only from the summary in the EMA assessment report. (Müller and Schneider 1999, summarized by the EMA)

1,066 patients: 73.8% with urinary infections, cystitis or other inflammatory complaints (56% of whom also took antibiotics), 14.2% with irritable bladder, 9.3% with stones and 2.7% with other complaints.

Symptoms disappeared after treatment in 78%, 65% and 65% of the first three groups, and in 80% of those with antibiotics versus 75% without. Mild adverse effects were reported in 8 people. With no control group and frequent antibiotic use, improvement cannot be credited to birch leaf.

3
Goldenrod, Java Tea and Birch Blend Added to Antibiotic Prophylaxis (combination product, not randomized)
PubMed

Comparative study, not randomized and with no placebo, of a Solidago, Orthosiphon and birch extract (Cistimev), 1 capsule daily for 3 months, added to 3 months of weekly antibiotic prophylaxis. (Frumenzio et al. 2013, Arch Ital Urol Androl)

164 consecutive female patients in Italy with recurrent urinary tract infections: 107 took the blend plus antibiotics and 57 took antibiotics alone.

During treatment, relapse rates did not differ (11.2% vs 10.5%, p = 0.854). In long-term follow-up, relapse risk was 2.5 times higher with antibiotics alone (p < 0.0001). The groups were not randomized and differed in size, and birch's own share of any effect cannot be separated.

4
Goldenrod, Java Tea, Birch and Cranberry Tablet in Urinary Catheter Users: Single-Blind Pilot RCT (combination product)
PubMed

Single-blinded, randomized, controlled pilot study of a Solidago, Orthosiphon, birch and cranberry extract tablet (Cistimev Plus), 1 tablet daily for 30 days, versus no treatment. (Cai et al. 2014, World J Urol)

83 outpatients in Italy with indwelling urinary catheters (48 tablet, 35 no treatment); 10 dropped out.

At 30 days, per protocol, positive urine cultures were found in 10 of 43 on the tablet vs 16 of 30 untreated (p = 0.013). The primary outcome was a lab culture, not symptomatic infection, there was no placebo, and the blend includes cranberry, so birch's contribution is unknown.

5
Berberine, Arbutin and Birch Blends With D-Mannose vs Proanthocyanidins With D-Mannose (combination product)
PubMed

Preliminary comparison, indexed as a randomized trial, of three plant-extract combinations each given with D-mannose: berberine, arbutin and birch (group A); the same plus forskolin (group B); or proanthocyanidins (group C). (Genovese et al. 2018, J Chemother)

Patients with uncomplicated recurrent urinary tract infections in Italy; the abstract does not give group sizes, doses or the birch plant part.

Groups A and B had fewer recurrent cystitis episodes during treatment and follow-up and lower median urine bacterial loads than group C. There was no placebo or untreated group, and every arm contained D-mannose and other active ingredients, so birch's own effect cannot be judged.

Side effects and drug interactions

Common Potential side effects

Digestive complaints (nausea, vomiting, diarrhea) and allergic reactions (itching, rash, hives, runny nose) are listed in the EU monograph, frequency not known. In an open study of 1,066 users, mild side effects were reported in 8, and adverse reaction reports for one dry extract product included leg swelling.
Not for people sensitive to birch pollen; the EU monograph lists this as a contraindication. In skin tests, crushed birch leaf gave immediate reactions in 28% of people allergic to birch pollen and in none of the control patients.
Not for people told to restrict fluids, for example with serious heart or kidney disease, because the traditional use depends on drinking plenty of liquid.
Not recommended during pregnancy or breastfeeding or for children under 12. Adequate genetic toxicity tests have not been done: a commercial extract gave a very weak positive bacterial mutation test, while a 2022 cell study found no genotoxic effect for a birch leaf and lemon product.
See a doctor if symptoms persist or if fever, painful urination, cramping or blood in the urine appear. The stabilized fresh-leaf liquid extract is made with 50% to 60% ethanol.

Important Drug interactions

The EU monograph lists no reported interactions, and none have been studied in people.
Prescription diuretics (water pills): any added effect on urine flow is theoretical and unstudied; tell your prescriber before combining them.
Lithium: any increase in urine flow could, in theory, shift lithium levels; a theoretical concern worth raising with the prescriber.

Frequently asked questions about Birch Leaf (Betula pendula)

How is birch leaf different from birch sap and betulin?

Birch leaf products use the dried leaves of silver or downy birch, which are what the EU monograph covers. Birch sap is the watery fluid that flows from the trunk when it is tapped. Betulin is a triterpene taken from the bark, whose cork tissue holds about 22% betulin, and its approved medicinal use in Europe is a wound gel. Findings for one do not apply to the others.

Has birch leaf on its own been tested against a placebo?

Only once, as far as European regulators could find: a 15-patient double-blind pilot in which 4 cups of birch leaf tea a day for 20 days was compared with a placebo tea in people with urinary infections. It is known only from the EMA summary, reports no statistics, and was judged insufficient. Early studies in a few healthy adults found no significant rise in urine output compared with plain water, and no published trial supports its use to increase urine flow.

Can people who have been told to limit fluids use birch leaf?

No. Its traditional use depends on drinking extra liquid to flush the urinary tract, so the EU monograph rules it out for anyone advised to reduce fluid intake, for example because of severe heart or kidney disease. Check with your doctor first.

Should people sensitive to birch pollen avoid birch leaf?

Yes. The EU monograph lists hypersensitivity to birch pollen as a reason not to use it. In skin tests, crushed birch leaf caused immediate reactions in 28% of people allergic to birch pollen, and birch sap in 39%.

How much flavonoid does birch leaf contain?

The European Pharmacopoeia requires at least 1.5% flavonoids, measured as hyperoside. Leaf batches analyzed in France averaged about 3.3% in silver birch and 2.8% in downy birch, with more in young silver birch leaves than old ones. Based on rat work, researchers estimated that at least 50 mg of flavonoids a day, about 2 to 3 g of leaf as tea several times daily, would be needed for any effect on urine.

What is Birch Leaf?

Birch leaf is the dried leaf of the silver birch (Betula pendula) or downy birch (Betula pubescens), sold as tea and as water-extract capsules or tablets for flushing the urinary tract.

What is Birch Leaf used for?

NutraSmarts does not list Birch Leaf under a health category. What the research covers: The European Medicines Agency accepts birch leaf as a traditional herbal medicine to increase the amount of urine and flush the urinary tract as an add-on in minor urinary complaints, provided enough fluid is drunk.

What is the recommended dosage of Birch Leaf?

The clinically studied dose is EU traditional-use doses: 2 to 3 g dried leaf in 150 ml boiling water up to 4 times daily, or 0.25 to 1 g dry extract 4 times daily, for 2 to 4 weeks with plenty of fluid. The only placebo-controlled study used 4 cups of tea daily for 20 days. Always follow the product label and check with a healthcare provider for personal advice.

Is Birch Leaf safe, and does it have side effects?

Side effects and cautions reported for Birch Leaf include: Digestive complaints (nausea, vomiting, diarrhea) and allergic reactions (itching, rash, hives, runny nose) are listed in the EU monograph, frequency not known. It may also interact with some medications. Birch Leaf is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Birch Leaf interact with any medications?

Possible interactions include: The EU monograph lists no reported interactions, and none have been studied in people. Prescription diuretics (water pills): any added effect on urine flow is theoretical and unstudied; tell your prescriber before combining them. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Birch Leaf?

NutraSmarts rates the evidence for Birch Leaf as Preliminary (1 out of 5). It is backed by 5 study summaries and 16 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(16 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Betula pendula Roth and/or Betula pubescens Ehrh. as well as hybrids of both species, folium (EMA/HMPC/573241/2014). European Medicines Agency. 2014;Final, adopted 24 November 2014; published 13 March 2015..SourceUsed to support: Not PubMed-indexed; official EU monograph. Lists birch leaf only under traditional use: a traditional herbal medicine to increase the amount of urine to flush the urinary tract as an adjuvant in minor urinary complaints, based exclusively on long-standing use. Gives the doses (2 to 3 g as tea up to 4 times daily; 650 mg powder twice daily; 0.25 to 1 g dry extract 4 times daily; liquid extracts; 2 to 4 weeks with adequate fluid), contraindications (birch pollen hypersensitivity; conditions needing reduced fluid intake such as severe heart or kidney disease), no use under 12 or in pregnancy and lactation, no reported interactions, digestive and allergic reactions of unknown frequency, and missing genotoxicity tests.
  2. European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Betula pendula Roth and/or Betula pubescens Ehrh. as well as hybrids of both species, folium (EMA/HMPC/573240/2014). European Medicines Agency. 2014;Final, adopted 24 November 2014; published 13 March 2015..SourceUsed to support: Not PubMed-indexed; the EMA's scientific review. Describes the leaf constituents (1% to 3.5% flavonol glycosides, tannins, dammarane esters, potassium); summarizes early healthy-volunteer studies with no significant rise in urine output versus water, a 15-patient placebo-controlled tea pilot (microbial counts down 39% vs 18%), and an open study in 1,066 patients; animal diuresis results it calls inconclusive; and a weak positive Ames test. Concludes the clinical data cannot support a well-established use, no published trial supports the urine-flow use, and no active constituent can be recognized.
  3. Frumenzio E, Maglia D, Salvini E, Giovannozzi S, Di Biase M, Bini V, Costantini E. Role of phytotherapy associated with antibiotic prophylaxis in female patients with recurrent urinary tract infections. Arch Ital Urol Androl. 2013;85(4):197-9. doi: 10.4081/aiua.2013.4.197.PubMedUsed to support: Non-randomized comparison in 164 female patients with recurrent urinary infections: a Solidago, Orthosiphon and birch blend added to 3 months of antibiotic prophylaxis did not change relapses during treatment, while relapse risk in long-term follow-up was 2.5 times higher with antibiotics alone. A three-herb product, no placebo.
  4. Cai T, Caola I, Tessarolo F, Piccoli F, D'Elia C, Caciagli P, Nollo G, Malossini G, Nesi G, Mazzoli S, Bartoletti R. Solidago, orthosiphon, birch and cranberry extracts can decrease microbial colonization and biofilm development in indwelling urinary catheter: a microbiologic and ultrastructural pilot study. World J Urol. 2014;32(4):1007-14. doi: 10.1007/s00345-013-1173-5.PubMedUsed to support: Single-blind randomized pilot in 83 catheter users: a Solidago, Orthosiphon, birch and cranberry tablet for 30 days lowered positive urine cultures versus no treatment (10 of 43 vs 16 of 30, per protocol). A four-herb product, no placebo, and symptomatic infection was not measured.
  5. Genovese C, Davinelli S, Mangano K, Tempera G, Nicolosi D, Corsello S, Vergalito F, Tartaglia E, Scapagnini G, Di Marco R. Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections. J Chemother. 2018;30(2):107-114. doi: 10.1080/1120009X.2017.1393587.PubMedUsed to support: Preliminary study of three plant-extract combinations with D-mannose in recurrent urinary infections: berberine, arbutin and birch blends (with or without forskolin) were followed by fewer recurrences and lower urine bacterial loads than a proanthocyanidin blend. No placebo; multi-ingredient products.
  6. Institute for Quality and Efficiency in Health Care (IQWiG). Bladder infection: Do herbal remedies help with recurrent bladder infection? IQWiG Reports, Commission No. HT20-01. 2022;Cologne (Germany): IQWiG; 2022 Feb 24. NCBI Bookshelf NBK590220..PubMedUsed to support: German health technology assessment of 15 studies of herbal preparations for recurrent bladder infections in women. Found an indication of benefit only for cranberry versus placebo; a preparation with uva ursi leaves and birch had only an isolated study result and was hard to find or no longer marketed.
  7. Carnat A, Lacouture I, Fraisse D, Lamaison JL. [Standardization of the birch leaf]. Ann Pharm Fr. 1996;54(5):231-5..PubMedUsed to support: Analysis (in French) of dried Betula pendula (14 batches) and Betula pubescens (3 batches) leaves: similar flavonoid patterns, with total flavonoids of 3.29% and 2.77% and hyperoside of 0.80% and 0.77%; flavonoid levels were higher in young leaves than in old leaves.
  8. Rafsanjany N, Lechtenberg M, Petereit F, Hensel A. Antiadhesion as a functional concept for protection against uropathogenic Escherichia coli: in vitro studies with traditionally used plants with antiadhesive activity against uropathognic Escherichia coli. J Ethnopharmacol. 2013;145(2):591-7. doi: 10.1016/j.jep.2012.11.035.PubMedUsed to support: Lab study: an ethanol-water extract of Betula leaves (pharmacopoeia grade) reduced adhesion of uropathogenic E. coli to T24 bladder cells by acting on the bladder cells (IC50 415 micrograms per ml), without direct toxicity to the bacteria or cells. Not a human study.
  9. Wojnicz D, Kucharska AZ, Sokół-Łętowska A, Kicia M, Tichaczek-Goska D. Medicinal plants extracts affect virulence factors expression and biofilm formation by the uropathogenic Escherichia coli. Urol Res. 2012;40(6):683-97. doi: 10.1007/s00240-012-0499-6.PubMedUsed to support: Lab study of six plant extracts against uropathogenic E. coli: Betula pendula and Urtica dioica extracts significantly reduced bacterial motility, and all extracts showed some anti-biofilm activity. Not a human study.
  10. Boertz S, Dey M, Herrmann F, Esch S, Sendker J, Dobrindt U, Hensel A. Complex Standard Formulation as an Example for Synergism and Improved Antibacterial Activity Against Uropathogenic Escherichia coli for Urinary Tract Infections. Planta Med. 2025;91(8):419-429. doi: 10.1055/a-2563-7503.PubMedUsed to support: Lab study of a German four-herb tea formulation (Betula leaf, couch grass, giant goldenrod, restharrow): brewing the herbs together extracted malonylated dammarane triterpenes from birch leaves that reduced type-1 fimbrial activity and adhesion of uropathogenic E. coli; separately brewed extracts did not. No effect on bacterial growth. Not a human study.
  11. Rickling B, Glombitza KW. Saponins in the leaves of birch? Hemolytic dammarane triterpenoid esters of Betula pendula. Planta Med. 1993;59(1):76-9. doi: 10.1055/s-2006-959609.PubMedUsed to support: Isolated three hemolytic dammarane triterpene esters from Betula pendula leaves and could not confirm earlier reports of saponins; a fraction of these esters given by mouth did not increase urine output in rats.
  12. Peron G, Yerkassymova A, Zengin G, Dall'Acqua S. Investigating Systemic Metabolic Effects of Betula alba Leaf Extract in Rats via Urinary Metabolomics. Metabolites. 2025;15(7):471. doi: 10.3390/metabo15070471.PubMedUsed to support: Rat pilot study: a standardized birch leaf extract (hyperoside 0.53%) at 25 or 50 mg/kg by mouth for 3 days did not significantly change 24 hour urine volume or sodium and potassium excretion, though urinary metabolite profiles shifted. The authors state the study did not confirm a diuretic effect.
  13. Popowski D, Kruk A, Pawłowska KA, Dolzkho D, Korczak M, Piwowarski JP, Roszko M, Granica S. Evaluating birch leaf tea as a functional herbal beverage: Beneficial impact on the urinary tract, and metabolism in human organism. Food Res Int. 2024;189:114481. doi: 10.1016/j.foodres.2024.114481.PubMedUsed to support: Silver birch leaf infusion: lab assays showed lower IL-6 and IL-8 secretion and anti-adhesive activity against uropathogenic E. coli on T24 bladder cells; gut microbiota broke down its phenolics, and urine metabolomics after intake found glucuronides and sulfates of caffeic acid and dihydroxyphenyl valerolactones. No clinical outcomes were measured.
  14. Lahti A, Hannuksela M. Immediate contact allergy to birch leaves and sap. Contact Dermatitis. 1980;6(7):464-5. doi: 10.1111/j.1600-0536.1980.tb05567.x.PubMedUsed to support: Scratch-chamber skin tests in 117 atopic people and 33 controls: crushed birch leaf gave immediate reactions in 28% and fresh birch sap in 39% of those allergic to birch pollen, and in none of the controls. Basis for the birch pollen caution.
  15. Efthimiou I, Vlastos D, Triantafyllidis V, Eleftherianos A, Antonopoulou M. Investigation of the Genotoxicological Profile of Aqueous Betula pendula Extracts. Plants (Basel). 2022;11(20):2673. doi: 10.3390/plants11202673.PubMedUsed to support: Cell micronucleus study of two commercial aqueous Betula pendula leaf products: the birch leaf and lemon juice product lacked genotoxic potential but was cytotoxic at all tested concentrations, and both products reduced DNA damage from the mutagen mitomycin C at some concentrations. Lab data only.
  16. Scheffler A. The Wound Healing Properties of Betulin from Birch Bark from Bench to Bedside. Planta Med. 2019;85(7):524-527. doi: 10.1055/a-0850-0224.PubMedUsed to support: Review by the inventor of the betulin gel patents, who directed its maker Birken until 2016 (a disclosed conflict): betulin is a triterpene extracted from birch bark, whose cork tissue contains about 22% betulin, and a betulin oleogel was approved in Europe in 2016 for partial-thickness wounds. Cited to distinguish bark betulin from birch leaf.