The Medical Professional's view

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D-Mannose: Guidelines for Use

Ongoing infections
Children : ½ to 1 teaspoonful dissolved in a glass of water or juice every 2 or 3 hours.
Adults : 1 teaspoonsful dissolved in water or juice every 2 or 3 hours.

Preventing infections
Start with quantities noted above,
Adjust amounts downward if Possible

Preventing "honeymoon cystitis"
1 teaspoonful one hour prior to
immediately afterwards.

What is the proof that D-mannose really works? First, the "molecular mechanism" of the action of D-mannose on E. coli is scientifically proven. There's no argument at all about this among researchers who've studied it. Second, literally tens of thousands of women working with natural medicine doctors have successfully applied this science to their won UTIs.

Considerable circumstantial evidence, combined with common sense and over 15 years of clinical experience, makes a compelling case for the therapeutic value of D-mannose. In one laboratory study, for example, rats' urinary tracts were inoculated with E. coli . Within one day, those rats also given D-mannose were found to have significantly lower levels of bacteria in their urine. 20 In another study, administering a mannose-like substance (methyl a-D-mannopyranoside) to E. coli -infected mice led to a 90% reduction in bacterial attachment to the urinary tract. Research in humans shows that ingesting D-mannose significantly elevates blood mannose levels, a prerequisite if urinary levels are to rise. 21

Perhaps the best available evidence, though, comes from the experience of people who have used it. At the Tahoma Clinic, we have been recommending D-mannose to people with UTI since the mid-1980s with great success. While it would certainly be nice to have the results of a double-blind, placebo-controlled study to prove this, it's hard to doubt the value of D-mannose when we see case after case like that of Amy, described at the beginning of this booklet, or of four-year-old Anne Marie, who had a very serious genetic disease called galactosemia:

Among her other problems, Anne Marie had been suffering from an E. coli -based urinary tract infection for almost two years. Nearly constant antibiotic treatment had been ineffective in clearing her infection. As part of Anne Marie's overall treatment plan, I advised her parents to take her off the antibiotics and begin giving her D-mannose (½to 1 teaspoon (approximately ½ to 1 gram)) stirred into some water or juice every three to four hours. Her UTI vanished within two weeks and never returned. When Anne Marie's parents took her back to her urologist for what had previously been monthly or bimonthly visits, they were told to check back again in another two years!

D-mannose can also be very effective in cases of " honeymoon cystitis ." Caroline was a married woman, who was avoiding sex because she would get a bladder infection "every time" she and her husband had intercourse. Not surprisingly, this was causing some discord in her marriage. Since a culture of her urine showed the presence of E. coli , she started taking D-mannose, 1 teaspoon one prior to intercourse and again shortly afterwards. The result? No further infections.

We have found that women prone to very frequent recurrent UTIs not necessarily related to sexual intercourse can also often benefit from taking D-mannose preventively at the same dose. To save expense, some women have been able to "taper down" their dosage and dose frequency.

By far the most frequent use of D-mannose has been by thousands of women who have suffered single (nonrecurrent) episodes of bladder infection. In over 90% of such cases, 1 teaspoon of D-mannose every two to three hours clears the infection in one to three days.

It is not just Tahoma Clinic patients who are achieving these remarkable results with D-mannose. We often hear from other medical practitioners who give it to their patients. The following is typical:

"During my 38 years of practice, I have tried everything imaginable for kidney and bladder problems with mixed results or at least not reproducible results. To this day, we have not had a single patient that did not improve with D-mannose . Even some of the ones that were of chronic nature have improved to the point that a single weekly dose of D-mannose is keeping them problem-free."

Preventing UTI

In addition to taking D-mannose, people can do many things to avoid getting bladder infections and other UTIs. Some are hygienic, while others involve diet. None of them requires taking any drugs:

• Drink a lot of water or other fluids, 48 to 64 ounces daily, if possible. Fluids keep the urine flowing, so invading bacteria are likely to be washed out.

• Drink cranberry juice . For many years, UTI-prone women, who wanted to avoid antibiotics, have tried drinking cranberry juice. It turns out that cranberry juice works, in part, because it contains some D-mannose, as well as a substance called proanthocyanidin that works in a slightly different way to make it difficult for E. coli to "stick around," 22,23 . However, the amount of D-mannose (even with proanthocyanidin) in a glass of cranberry juice is far less than the therapeutic dose we recommend in this booklet. Plus, most cranberry juice products are loaded with added sugars, the kind of sugars that are known to suppress the activity of the white blood cells that destroy unfriendly bacteria (see below). Although drinking large volumes of cranberry juice would probably not, by itself, be sufficient to cure an established infection, drinking unsweetened cranberry juice may help prevent future infections.

• Take vitamin C supplements. Use the ascorbic acid form of vitamin C, which can help acidify the urine and thus, discourage bacterial growth.

• Hygiene : For women: "front to Back" wiping. (As guys, we apologise for repeating what every woman learned from her mother, but we'd be open to "scientific criticism" if we didn't.) Men who've been lucky enough to escape circumcision should keep their foreskin area clean. In uncircumcised infants, foreskin infections are up to 20 times more common compared with circumcised infants. 1 For both: Cleanse the genital and anal areas before sexual intercourse.

• Don't "hold it in." It's always best to urinate when we feel the need, if possible. Resisting the urge to urinate too often or for too long can damage the delicate tissue that lines the urinary tract and permit bacteria to thrive.

• For just a few of us: take showers, not baths . Bath water contains millions of bacteria that get washed off our bodies. It is quite possible that E. coli from the anus could float over to the vagina or urethra. If you've had frequent UTIs, but can't resist a long, hot soak in the tub, take a cleansing shower first.

• Avoid using feminine hygiene sprays and scented douches . These products may irritate the urethra, which could lead to infection.

The World According to the FDA

In an ideal world, the scientific and clinical evidence discussed here should be sufficient at least to pique the interest of medical practitioners. Unfortunately, in the early 1960s, Congress gave the Food and Drug Administration (FDA) the exclusive legal power to decide which remedies were "proven" or which were not. As discovered by Federal judges in recent court cases (e.g. Pearson v. Shalala ), The FDA admitted that it has no objective standard for such proof. Lacking such a standard, the FDA has been able to "disapprove" nearly all remedies that are not sponsored by a major pharmaceutical company, except when they have been ordered to do so by a court. 1 Sadly, the FDA has convinced nearly all practicing physicians, as well as the media, that without "FDA approval," a remedy is "unproven," even when real-world proof is abundant.

The use of patented, FDA-approved antibiotic drugs for treating UTI is supported by large, expensive, double-blind placebo-controlled laboratory and clinical trails that are paid for by the pharmaceutical (patent medicine) industry. 2 Because natural substances like D-mannose cannot be patented, they do not offer the astronomical profits that patentable drugs do. In the absence of a financial incentive to do the same kinds of trials on D-mannose, there are very few pieces of published evidence one can point to to "prove" definitively (according to the FDA's undefined standards) that it is as effective and safe as we say it is.

1 The FDA has never officially denied the statement made by Dr Richard J. Crout, Director, FDA's (then) Bureau of Drugs: "I never have and never will approve a new drug to an individual, but only to a large pharmaceutical firm with unlimited finances." (Quoted in the Spotlight for January 18, 1982.)

2 By law passed in 1992, pharmaceutical companies are permitted to pay the FDA hundreds of millions of dollars to help expedite new drug "approvals." Not surprisingly, this practice, known as Prescription Drug User Fees, leads to scandalous conflicts of interest that have recently been decried in an editorial the British medical journal, The Lancet, 2001;357:1544-1545.

Preventing UTI

In natural medicine, it's axiomatic that refined sugar and hidden food allergies are "behind" most recurrent infections, because refined sugar interferes with the ability of white blood cells to engulf and destroy microorganisms. 24 Food allergies appear to irritate and inflame "target-organ" tissues, making infection easier and may also interfere with the function of the immune system.

As long ago as 1976, results were reported from a study of 50 children (aged 4 to 18 years) who had chronic recurrent UTI despite urologic examinations that were otherwise completely normal. All the children had an allergic "background," including hay fever, persistent coughing, nasal obstruction or other breathing difficulty (e.g. asthma, eczema, hives, or recurrent skin rashes). All were asked to follow elimination diets, take "anti-allergic" medication, and to receive specific allergy desensitisation. Of the 50 children, 42 (84%) "definitely benefited," while nine had a "rapid and spectacular cure," 19 had cures after six to nine months, and 14 were "noticeably improved." Only eight of the fifty children showed no improvement. 25,26

Doctors working with the "natural" approach to health care find that eliminating sugar and food allergies is frequently sufficient to significantly reduce the incidence of any recurrent infection, including UTI, in both children and adults.

UTI and Menopause

Women generally find that their chances of developing a UTI increase as they reach their menopausal years. When oestrogen is plentiful, "friendly" bacteria known as Lactobacilli thrive in the vagina, happily spewing lactic acid into their surroundings. This naturally created, normally low pH (relatively high acidity) of the vagina discourages the growth of E. coli and other bacteria. As oestrogen levels fall during and after menopause, though, the Lactobacillus population begins to dwindle, which allows the pH to rise (become less acidic), making the area more hospitable to E. coli (and yeasts). Replacing missing oestrogen can help restore this natural defense. In a randomised, double-blind, placebo controlled study published in the New England Journal of Medicine, 93 postmenopausal women with a history of recurrent UTI applied a cream containing the natural oestrogen oestriol or a placebo to their vaginas. After eight months, the women in the oestriol group had had more than 50% fewer UTIs than the women in the placebo group (31% vs. 67% respectively.) 27.28

In addition to preventing UTI, there are many other good reasons for menopausal women to replace their oestrogens and progesterone as their ovarian function wanes. However, please avoid - at all costs - conventional pharmaceutical HRT ("hormone" replacement therapy) that employs such unnatural or synthetic hormone-like drugs as Premarin, Provera, Estrace (the "oestrogen patch") and other patented products. While they may reduce the chances of getting a UTI, they can be very dangerous and may cause many unpleasant side effects.

If a woman decides to use hormone replacement, it's essential for her to opt for the use of natural, identical-to-human oestrogens, including oestrone , oestradiol and especially oestriol in the proportions in which they occur naturally in healthy young women. The use of natural human estrogens by menopausal women is a vitally important subject that is beyond the scope of this booklet. To learn more, please read Natural Hormone Replacement for Women Over 45 by Jonathan V. Wright, M.D., and John Morgenthaler, Smart Publications, Petaluma, CA, 1997.

UTI and Menopause

If a UTI treated with D-mannose does not show significant improvement within 24 hours (about 10% of cases), it is likely that the causative organism if not E. coli, and a visit to the doctor for a conventional antibiotic drug is therefore necessary.

D-Mannose vs. Antibiotics for Bladder Infections