UTI Info Accordion Category: Complementary Medicine

Powder or Capsules and understanding D-Mannose formulations

D-mannose is sold as both as a powder or as capsules. Which type you use, is up to you and personal preference.  Suppliers include

Sweet Cures – Waterfall D-mannose

Now Foods D Mannose 

West Coast Mint

However it is important to understand the differences between D-mannose formulations, particularly for those with allergy issues.

Manufacturers can use various raw sources for the production of D-mannose or D-mannose can be synthetically produced. Manufacturers refer to this as pure or synthetic production. Natural sources can be from birch trees, palm kernels, potato, corn or fruits such as cranberries and pineapples. Synthetic sources such d-fructose or d-glucose or pure starch through bio-conversions are inexpensive starting materials and widely available.

For those with corn allergies, always check with the manufacturer as to the source of their D-mannose before purchasing and the environment in which the product has been packaged. If you have a known corn allergy or suffer a reaction after using D-Mannose, consider an alternate that is made from pineapples or cranberries or derived from birch/beech wood hydrolysate.

The production of D-mannose can also introduce additives, in particular if taken in capsule form. Silica, magnesium stearate, rice flour, artificial sweeteners and heavy metals can all be included as bulking agents or form the body of an individual tablet. This ensures cheaper mass production. Do your research first especially if you have allergy issues or are following a preferred regime of avoidance such as soy, gluten or GM products.

Sadly sometimes price does reflect quality of manufacture and purity of product so buyer beware.

When researching a brand look at the amount of pure D-mannose in each pot or tablet. The higher the better. A teaspoon of powder should offer around 2000 mg of D-Mannose and a tablet around 500mg. And remember Cranberry products are not the same as D-Mannose. Cranberry extract and juice has been shown not to be effective against recurrent and chronic UTI.

We debunk the cranberry myth here.

D Mannose further reading and references

Further reading:

Adhesive Pili in UTI Pathogenesis and Drug Development Spaulding CN, Hultgren SJ. Adhesive Pili in UTI Pathogenesis and Drug Development. Pathogens. 2016;5(1):30. Published 2016 Mar 15. doi:10.3390/pathogens5010030

D-Mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial Altarac, S. and Papeš, D. World J Urol. 2014 Feb;32(1):79-84. doi: 10.1007/s00345-013-1091-6. Epub 2013 Apr 30.

D-mannose: a promising support for acute urinary tract infections in women. A pilot study Domenici L, Monti M, Bracchi C, Giorgini M, Colagiovanni V, Muzii L, Benedetti Panici P. Eur Rev Med Pharmacol Sci. 2016 Jul;20(13):2920-5.

Oral D-mannose in recurrent urinary tract infections in women: a pilot study Porru, Daniele & Parmigiani, A. & Barletta, Davide & Choussos, D. & Bassi, Silvia & Miller, O. & Gardella, Barbara & Nappi, Rossella & Spinillo, A. & Rovereto, B.. (2013). European Urology Supplements. 12. e894-e895. 10.1016/S1569-9056(13)61373-1.

The efficacy of D-mannose in the prevention of recurrent urinary tract infections compared to long- term antibiotic therapy Stompro, Kristine. (2017).

Use of D‐mannose in prophylaxis of recurrent urinary tract infections (UTIs) in womenAltarac, S. and Papeš, D. (2014), Comment. BJU Int, 113: 9-10. doi:10.1111/bju.12492

References:

1. Foxman B. Urinary tract infection syndromes: Occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect. Dis. Clin. N. Am. 2014;28:1–13. doi: 10.1016/j.idc.2013.09.003.

Griebling T.L. Urinary tract infection in women. In: Litwin M.S., Saigal C.S., editors. Urologic Diseases in Amerca. U.S. Government Printing Office; Washington, DC, USA: 2007. pp. 587–620.

Flores-Mireles A.L., Walker J.N., Caparon M., Hultgren S.J. Urinary tract infections: epidemiology, mechanims of infection and treatment options. Nat. Rev. Microbiol. 2015;13:269–284. doi: 10.1038/nrmicro3432.

2. Adhesive Pili in UTI Pathogenesis and Drug Development Caitlin N. Spaulding and Scott J. Hultgren Pathogens. 2016 Mar; 5(1): 30.

How to use D Mannose

  • Take a half to one teaspoon of D-mannose in no more than half of a glass of water. Then wait for about 45 mins to an hour. After that, drink plenty of water. Once the D-mannose has been absorbed into the bloodstream and flushed through the kidneys, this will concentrate the D-mannose in your urine allowing it to bind to the UPEC bacteria. Continue this every two to three hours for up to five days.
  • Only use D-mannose at the very beginning of symptoms. If symptoms have not diminished or completely disappeared after a short period, do not wait any longer and go to the doctor. A full-blown UTI might benefit from D-Mannose supplementation, but there is a risk that bacteria are growing at a faster rate than can be cleared through D-mannose especially if the bacteria are resistant to it. Remember, D-mannose only works for UTIs caused by E. coli bacteria.  A delay in seeking treatment if symptoms worsen or do not significantly improve can result in worsening the infection leading to possible kidney infection or at worse sepsis.
  • If antibiotics are prescribed, supplementing with D-mannose could be an option to speed up recovery, but do not stop the antibiotic treatment to switch to D-mannose. A course of antibiotics should always be completed unless side effects are experienced and a medical professional advises cessation.
  • Some find it beneficial to follow up a flare up or acute attack by taking a preventive D-mannose dose daily. This is usually one teaspoon 2-3 times daily. Consider taking D-mannose every time you think your vaginal flora or immune system are compromised (with the first signs of a yeast infection, after sex, illness etc.).
  • Take the DM away from any acidic food or drink as it will counteract its effects and the urine must be kept alkaline. This includes the use of Hiprex, a urinary antiseptic which is activated when urine is very concentrated and acidic. Gram-negative bacteria such as e coli reproduce more slowly in an alkaline environment allowing for the potential of greater attachment to the D-mannose molecules in your urine.
  • Initial usage of D-mannose can lead to loose stools for a few days.  If diarrhoea continues, consult with your specialist as to continued usage.  Users also report gas and bloating as other side effects.  It may potentially exacerbate symptoms for those with small intestinal bowel overgrowth (SIBO).  If this applies to you consider adjusting your dosage or discuss its usage with your consultant.

Issues with D Mannose:

  • Controlled trials and studies are often limited in complementary and alternative medicine and involve small numbers of participants. They are often conducted under less rigorous controls, guidelines and environments than those undertaken for the development of new pharmaceutical medications such as antibiotics. Do your research, there should be clear, peer reviewed, empiric evidence as to the efficacy of D Mannose rather than theorisation about how it may be beneficial in the treatment of a chronic UTI.
  • There are very limited patient research trial studies. More are needed and several are currently in trial publishing in 2020.
  • Length of study and size of participant groups. Current studies available have shown trials of under one year and in small patient trial groups.  This studypublished in the World Journal of Urology in 2013 noted that in their patient cohort of 399 women those taking D-mannose powder alone showed effectiveness in preventing UTI. However it fared no better than those women taking a daily prophylactic dose of nitrofurantoin and the recurrence rate did not differ between patients who took standard Nitrofurantoin prophylaxis and those who took D-mannose powder. This lack of scientific and clinical rigor applied to study design and outcomes is common with alternative therapies.
  • In Vitro vs In Vivo. Most studies undertaken are either in laboratory known as “test tube conditions” or with the use of mice rather than human participants. Human behavioural, genetic, and environmental differences in comparison to those of mice mean it is difficult to compare like with like.
  • Different strains of bacteria. Infections are now recognised to be polymicrobial (comprised of more than one bacteria). Not all bacterial strains have these Pili (grappling hooks) and thus D-Mannose molecules in the urine won’t be effective in binding these bacteria to them and expelling them through urination. Instead the bacteria will bind to the urothelium and form bacterial colonies. Indeed certain strains of UPEC do not create Pili.
  • Once bacteria have attached to the cells of the bladder wall and started to reproduce, D-Mannose will not prevent the infection developing further.
  • There has been insufficient research into the optimum dosage for the prevention of recurrent infections.
  • For those with gastric issues such as Crohns or colitis, D-mannose may not be absorbed. Additionally, pathogenic e coli in the intestines may bind to most D-mannose available preventing sufficient molecules being filtered through the kidneys and into the bladder. Different people will react differently to the same D-mannose dose due to their age, weight, and overall health.
  • Commercial D-Mannose powder is often made from corn, particularly the less expensive versions. For those with allergies, a reaction to D-Mannose derived from corn may include a mild rash headaches and stomach aches.
  • Cost – as with any usage of a supplement on an intermittent or ongoing basis, there is a cost to you financially.