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Preventing cystitis

Urinary tract infections are a problem that many women have to deal with recurrently. A sensation of burning when urinating and a constant feeling of wanting to go to the toilet are typical symptoms of an acute bladder inflammation. Antibiotics are often prescribed to eliminate the cause and calm the inflammation of the bladder. The most frequent pathogen in what is termed “uncomplicated cystitis” is Escherichia coli (E. coli), bacteria that live in the intestinal and vaginal flora. Other pathogens include Proteus mirabillis, Klebsiella and Staphylococcus. The bacteria enter the urethra and from there move up to the bladder. (1) A healthy organism has various protective mechanisms that prevent pathogenic germs from entering the bladder. Recommended preventive measures include raising your natural defenses, keeping your feet and lower abdomen warm, drinking enough liquid, preferably herbal teas and herbal supplements such as goldenrod, birch leaves, nasturtium, horseradish, and numerous other plants that act as diuretics and disinfectants.

The monosaccharide D-mannose has been mentioned increasingly in connection with the prevention of bladder infections caused by E. coli bacteria. Various studies have shown that this sugar is capable of binding bacteria. However, it took several attempts to understand how D-mannose actually worked.

D-mannose belongs to the group of simple sugars and is found in tiny quantities in fruits such as cranberries, bilberries, oranges and peaches. It is produced industrially from maize or birch and beech wood.

D-mannose is not a conventional simple sugar, as it is absorbed directly in the upper part of the gastro-intestinal tract, is detectable in unmodified form in the bloodstream and is excreted through the kidneys in urine. It does not affect blood sugar levels, which is why it is also recommended for diabetics. D-mannose is synthesized in the body itself, because it is required for the construction of cell and mucous membranes.

The mucous membranes of the urinary bladder are covered with a multilayered transitional epithelium (urothelium), and D-mannose is also found on the surface of this. But what is important for the function of these mucous membranes can have a negative effect if E. coli bacteria appear in the urine. Because E. coli bacteria have fine hairs with which they “cling" to the walls of the gut to be able to remain there and fulfil their intended task. If the E. coli get into the urinary tract, this property proves detrimental, as here too, they cling to the mucous membranes – and especially to the D-mannose – and cause inflammation. (2)

The fact that the bacteria tend to attach themselves to the D-mannose led researchers to test what a high concentration of D-mannose in the urine would have on the bacteria. In comprehensive laboratory studies, JR. Neeser, B. Koellreutter and P. Wuersch proved back in 1986 that the E. coli bacteria also attach themselves to D-mannose in suspension in the urine, which can prevent them from accumulating in the bladder. (3)

In a randomized trial, long-term prevention in women using D-mannose was compared with the effect of the chemotherapeutic agent nitrofurantoin, an antibiotic. 308 women suffering from recurrent cystitis took part in the study. All the participants were treated for seven days with the antibiotic ciprofloxacin and then divided into three groups.

The first group was given 2g a day of D-mannose powder diluted in 200ml of water as a prevention against urinary tract infections. The second group was given 50mg of nitrofurantoin a day and the third group was given no further medication. After six months, 98 of the volunteers had suffered cystitis again. Of these, 62 women from the third group receiving no prophylaxis had faced a new bout of cystitis. In the second group, treated preventively with nitrofurantoin, 21 women were affected and in the group of participants taking D-mannose on a regular basis, 15 participants had fallen ill again. (4)

Silvia Bürkle

Metabolic Balance®


1. Schaller P, Raetzo MA, Pittet D: Ich habe Brennen beim Wasserlassen. in: Alltagsbeschwerden, publ. by M.-A. Raetzo, A. Restellini, Verlag Hans Huber, Bern, 1998, p. 385-394

2. Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urol Res. 1983;11(2):97-102.

3. Neeser JR, Koellreutter B, Wuersch P. Oligomannoside-Type Glycopeptides Inhibiting Adhesion of Escherichia coli Strains Mediated by Type 1 Pili: Preparation of Potent Inhibitors from Plant Glycoproteins. Infection and Immunity. 1986; 52(2);428-36

4. Kranjcec et al. (2014): D-Mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J. Urol. 32: 79-84


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