D-Mannose: A Sugar to Prevent Recurrent UTIs

de Lonlay P, Cuer M, Vuillaumier-Barrot S, et al. Hyperinsulinemic hypoglycemia as a presenting sign in phosphomannose isomerase deficiency: A new manifestation of carbohydrate-deficient glycoprotein syndrome treatable with mannose. J Pediatr 1999;135:379-83. View abstract.

D-MANNOSE – Uses, Side Effects, and More

D-mannose is a kind of sugar that is related to glucose. It’s found in many fruits, and also occurs naturally in the human body.

D-mannose might help treat a deficiency caused by a genetic defect. D-mannose might also prevent certain kinds of bacteria from sticking to the walls of the urinary tract and causing infection.

D-mannose is used for an inherited disorder called carbohydrate-deficient glycoprotein syndrome type 1b. It is also used for UTIs, but there is no good scientific evidence to support this use.

Uses & Effectiveness ?

Likely Effective for

• An inherited disorder called carbohydrate-deficient glycoprotein syndrome type 1b. Taking d-mannose by mouth can improve digestive problems, low blood sugar, and blood clotting disorders in people with this condition. It’s not clear if it helps prevent liver problems.

Side Effects

When taken by mouth: D-mannose is possibly safe for most adults when taken for up to 6 months. It can cause diarrhea and nausea. There isn’t enough reliable information to know if d-mannose is safe or what the side effects might be when taken for more than 6 months.

Special Precautions and Warnings

When taken by mouth: D-mannose is possibly safe for most adults when taken for up to 6 months. It can cause diarrhea and nausea. There isn’t enough reliable information to know if d-mannose is safe or what the side effects might be when taken for more than 6 months. Pregnancy and breast-feeding: There isn’t enough reliable information to know if d-mannose is safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.

The problem isn’t a shortage of people wanting to be doctors, but rather, too few opportunities for training. Medical schools have increased class sizes by 30% since 2002, but federal funding for residency training – an essential step in the process of becoming a practicing physician – has not increased since 1997, according to Inside Higher Ed.

Children: D-mannose is possibly safe when taken by mouth in children with an inherited disorder called carbohydrate-deficient glycoprotein syndrome type 1b. It can cause diarrhea, loose stools, bloating, and nausea in these children. There isn’t enough reliable information to know if d-mannose is safe to use in children who do not have this condition.

Interactions ?

We currently have no information for D-MANNOSE overview .

Dosing

There isn’t enough reliable information to know what an appropriate dose of d-mannose might be. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult a healthcare professional before using.

REFERENCES:

. Damen G, de Klerk H, Huijmans J, den Hollander J, Sinaasappel M. Gastrointestinal and other clinical manifestations in 17 children with congenital disorders of glycosylation type Ia, Ib, and Ic. J Pediatr Gastroenterol Nutr. 2004;38(3):282-7. View abstract.

Alton G, Hasilik M, Niehues R, et al. Direct utilization of mannose for mammalian glycoprotein biosynthesis. Glycobiology 1998;8:285-95. View abstract.

Davis JA, Freeze HH. Studies of mannose metabolism and effects of long-term mannose ingestion in the mouse. Biochim Biophys Acta 2001;1528:116-26. View abstract.

de Lonlay P, Cuer M, Vuillaumier-Barrot S, et al. Hyperinsulinemic hypoglycemia as a presenting sign in phosphomannose isomerase deficiency: A new manifestation of carbohydrate-deficient glycoprotein syndrome treatable with mannose. J Pediatr 1999;135:379-83. View abstract.

de Lonlay P, Seta N. The clinical spectrum of phosphomannose isomerase deficiency, with an evaluation of mannose treatment for CDG-Ib. Biochim Biophys Acta. 2009;1792(9):841-3. View abstract.

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

Freinkel N, Lewis NJ, Akazawa S, et al. The honeybee syndrome – implications of the teratogenicity of mannose in rat-embryo culture. N Engl J Med 1984;310:223-30. View abstract.

Harms HK, Zimmer KP, Kurnik K, Bertele-Harms RM, Weidinger S, Reiter K. Oral mannose therapy persistently corrects the severe clinical symptoms and biochemical abnormalities of phosphomannose isomerase deficiency. Acta Paediatr. 2002;91(10):1065-72. View abstract.

Hendriksz CJ, McClean P, Henderson MJ, et al. Successful treatment of carbohydrate deficient glycoprotein syndrome type 1b with oral mannose. Arch Dis Child 2001;85:339-40. View abstract.

Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014 Feb;32(1):79-84. View abstract.

Lenger SM, Bradley MS, Thomas DA, Bertolet MH, Lowder JL, Sutcliffe S. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(2):265.e1-265.e13. View abstract.

Marchiori D, Zanello PP. Efficacy of N-acetylcysteine, D-mannose and Morinda citrifolia to treat recurrent cystitis in breast cancer survivals. In Vivo. 2017 Sep-Oct;31(5):931-936. View abstract.

Mention K, Lacaille F, Valayannopoulos V, et al. Development of liver disease despite mannose treatment in two patients with CDG-Ib. Mol Genet Metab. 2008;93(1):40-3. View abstract.

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

Murina F, Vicariotto F, Lubrano C. Efficacy of an orally administered combination of Lactobacillus paracasei LC11, cranberry and D-mannose for the prevention of uncomplicated, recurrent urinary tract infections in women. Urologia. 2020:391560320957483. View abstract.

Niehues R, Hasilik M, Alton G, et al. Carbohydrate-deficient glycoprotein syndrome type Ib. Phosphomannose isomerase deficiency and mannose therapy. J Clin Invest 1998;101:1414-20. View abstract.

Ofek I, Goldhar J, Eshdat Y, Sharon N. The importance of mannose specific adhesins (lectins) in infections caused by Escherichia coli. Scand J Infect Dis Suppl 1982;33:61-7.

Ofek I, Mosek A, Sharon N. Mannose-specific adherence of Escherichia coli freshly excreted in the urine of patients with urinary tract infections, and of isolates subcultured from the infected urine. Infect Immun 1981;34:708-11. View abstract.

Penel-Capelle D, Dobbelaere D, Jaeken J, Klein A, Cartigny M, Weill J. Congenital disorder of glycosylation Ib (CDG-Ib) without gastrointestinal symptoms. J Inherit Metab Dis. 2003;26(1):83-5. View abstract.

Porru D, Parmigiani A, Tinelli C, et al. Oral D-mannose in recurrent urinary tract infections in women: a pilot study. Journal of Clinical Urology. 2014. 7(3):208-213.

Schaeffer AJ, Chmiel JS, Duncan JL, Falkowski WS. Mannose-sensitive adherence of Escherichia coli to epithelial cells from women with recurrent urinary tract infections. J Urol 1984;131:906-10. View abstract.

Venegas MF, Navas EL, Gaffney RA, et al. Binding of type 1-piliated Escherichia coli to vaginal mucus. Infect Immun 1995;63:416-22. View abstract.

Vicariotto F. Effectiveness of an association of a cranberry dry extract, D-mannose, and the two microorganisms Lactobacillus plantarum LP01 and Lactobacillus paracasei LPC09 in women affected by cystitis: a pilot study. J Clin Gastroenterol. 2014 Nov-Dec;48 Suppl 1:S96-101. View abstract.

Westphal V, Kjaergaard S, Davis JA, et al. Genetic and metabolic analysis of the first adult with congenital disorder of glycosylation type Ib: long-term outcome and effects of mannose supplementation. Mol Genet Metab 2001;73:77-85. View abstract.

D-Mannose: A Sugar to Prevent Recurrent UTIs?

You know how cranberry juice remains one of the most popular home remedies for UTIs? Well, it turns out that the high D-mannose content in cranberry explains its efficacy for UTI symptoms. D-mannose, a simple sugar that’s related to glucose, is a valued anti-infective agent that is able to block bacteria from adhering to cells and flush them out of the body.

You don’t usually think of a simple sugar as a protective agent, right? But studies show that mannose has promising therapeutic value, especially for women dealing with recurrent urinary tract infections. Plus, the simple sugar boosts the growth of healthy bacteria in your gut and improves bladder health — all without negatively affecting your blood sugar levels.

What Is D-Mannose?

Mannose is a simple sugar, called a monosaccharide, that’s produced in the human body from glucose or converted into glucose when it’s consumed in fruits and vegetables. “D-mannose” is the term used when the sugar is packaged as a nutritional supplement. Some other names for mannose include D-manosa, carubinose and seminose.

Scientifically speaking, mannose is the 2-epimer of glucose. It occurs in microbes, plants and animals, and it is found naturally in many fruits, including apples, oranges and peaches. D-mannose is considered a prebiotic because consuming it stimulates the growth of good bacteria in your gut.

Structurally, D-mannose is similar to glucose, but it’s absorbed at a slower rate in the gastrointestinal tract. It has a lower glycemic index than glucose, as after it’s consumed it needs to be converted into fructose and then glucose, thereby reducing the insulin response and impact on your blood sugar levels.

Mannose is also filtered out of the body by the kidneys, unlike glucose that’s stored in the liver. It doesn’t stay in your body for long periods of time, so it doesn’t act as fuel for your body like glucose. This also means that mannose can positively benefit the bladder, urinary tract and gut without affecting other areas of the body.

UTI Prevention (and Other Uses and Benefits)

1. Treats and Prevents Urinary Tract Infections

D-mannose is thought to prevent certain bacteria from sticking to the walls of the urinary tract. Mannose receptors are part of the protective layer that’s found on cells that line the urinary tract. These receptors are able to bind to E. coli and washed away during urination, thereby preventing both adhesion to and invasion of urothelial cells.

In a 2014 study published in the World Journal of Urology, 308 women with a history of recurrent UTI, who had already received initial antibiotic treatment, were divided into three groups. The first group received two grams of D-mannose powder in 200 milliliters of water daily for six months. The second group received 50 milligrams of Nitrofurantoin (an antibiotic) daily, and the third group did not receive any additional treatment.

Overall, 98 patients had recurrent UTI. Of those women, 15 were in the D-mannose group, 21 were in the Nitrofurantoin group and 62 were in the no treatment group. Of the patients in the two active groups, both modalities were well-tolerated. In all, 17.9 percent of patients reported mild side effects, and patients in the D-mannose group had a significantly lower risk of side effects compared to patients in the Nitrofurantoin group.

Researchers concluded that D-mannose powder significantly reduced the risk of recurrent UTI and may be useful for UTI prevention, although more studies are needed to validate these results.

In a randomized cross-over trial published in the Journal of Clinical Urology, female patients with acute symptomatic UTIs, and with three or more recurrent UTIs in the preceding 12-month period, were randomly assigned to either an antibiotic treatment group (using trimethoprim/sulfamethoxazole) or to a regime including one gram of oral D-mannose three times daily for two weeks, following one gram twice daily for 22 weeks.

At the end of the trial period, the mean time UTI recurrence was 52.7 days with the antibiotic treatment group and 200 days with the D-mannose group. Plus, mean scores for bladder pain, urinary urgency and 24-hour voidings decreased significantly. Researchers concluded that mannose appeared to be safe and effective for treating recurrent UTIs and displayed a significant difference in the proportion of women remaining infection-free compared to those in the antibiotic group.

Why might mannose be such an effective agent for preventing recurrent UTIs? It really comes down to microbial resistance to traditional antibiotics. This is an increasing problem, with one study showing that more than 40 percent of 200 female college students with UTI symptoms were resistant to first-line antibiotics.

The study, published in Antimicrobial Agents and Chemotherapy, concludes with this warning: “Given the frequency with which UTIs are treated empirically, compounded with the speed that E. coli acquires resistance, prudent use of antimicrobial agents remains crucial.”

2. May Suppress Type 1 Diabetes

Researchers were surprised to find that D-mannose may be able to prevent and suppress type 1 diabetes, a condition in which the body doesn’t produce insulin — a hormone that’s needed to get glucose from the bloodstream into the body’s cells. When D-mannose was administered orally in drinking water to non-obese diabetic mice, researchers found that the simple sugar was able to block the progress of this autoimmune diabetes.

Because of these findings, the study published in Cell & Bioscience concludes by suggesting that D-mannose be considered a “healthy or good” monosaccharide that could serve as a safe dietary supplement for promoting immune tolerance and preventing diseases associated with autoimmunity.

3. Works as a Prebiotic

Mannose is known to act as a prebiotic that stimulates the growth of good bacteria in your gut. Prebiotics help feed the probiotics in your gut and amplify their health-promoting properties.

Research shows that mannose expresses both pro- and anti-inflammatory cytokines and has immunostimulating properties. When D-mannose was taken with probiotic preparations, combined they were able to restore the composition and numbers of indigenous microflora in mice.

4. Treats Carbohydrate-Deficient Glycoprotein Syndrome Type 1B

Evidence suggests that D-mannose is effective for treating a rare inherited disorder called carbohydrate-deficient glycoprotein syndrome (CDGS) type 1b. This disease makes you lose protein through your intestines.

It’s believed that supplementing with the simple sugar may improve symptoms of the disorder, including poor liver function, protein loss, low blood pressure and issues with proper blood clotting.

Risks and Side Effects

Because mannose occurs naturally in many foods, it’s considered safe when consumed in appropriate amounts. However, supplementing with D-mannose and taking doses higher than what would be consumed naturally may, in some cases, cause stomach bloating, loose stools and diarrhea. It’s also believed that consuming very high doses of D-mannose can cause kidney damage. According to researchers at the Stanford-Burnham Medical Research Institute in California, “mannose can be therapeutic, but indiscriminate use can have adverse effects.”

People with type 2 diabetes should use caution before using D-mannose products because they may alter blood sugar levels, though typically mannose itself doesn’t negatively impact blood sugar. To be safe, speak to your doctor prior to beginning any new health regime.

There’s not enough evidence to support the safety of mannose for women who are pregnant or breastfeeding. Based on the current research, there are no known drug interactions, but you should speak to your health care provider if you are taking any medications.

Top 20 D-Mannose Foods

D-mannose naturally occurs in a number of foods, especially fruits. Here are some of the top D-mannose foods that you can easily add to your diet:

1. Cranberries
2. Oranges
3. Apples
4. Peaches
5. Blueberries
6. Mangos
7. Gooseberries
8. Black currants
9. Red currants
10. Tomatoes
11. Seaweed
12. Aloe vera
13. Green beans
14. Eggplant
15. Broccoli
16. Cabbage
17. Fenugreek seeds
18. Kidney beans
19. Turnips
20. Cayenne pepper

Supplements and Dosage

It’s easy to find D-mannose supplements online and in some health food stores. They are available in capsule and powder forms. Each capsule is usually 500 milligrams, so you end up taking two to four capsules a day when treating a UTI. Powdered D-mannose is popular because you can control your dose, and it easily dissolves in water. With powders, read the label directions to determine how many teaspoons you need. It’s common for one teaspoon to provide two grams of D-mannose.

There is no standard D-mannose dosage, and the amount you should consume really depends on the condition you are trying to treat or prevent. There is evidence that taking two grams in powdered form, in 200 milliliters of water, every day for a six-month period is effective and safe for preventing recurrent urinary tract infections.

If you are treating an active urinary tract infection, the most commonly recommended dose is 1.5 grams twice daily for three days and then once daily for the next 10 days.

At this time, more research is needed to determine the optimal D-mannose dosage. For this reason, you should speak to your doctor before you begin using this simple sugar for the treatment of any health condition.

Final Thoughts

• D-mannose is a simple sugar that’s produced from glucose or converted into glucose when ingested.
• The sugar is found naturally in many fruits and vegetables, including apples, oranges, cranberries and tomatoes.
• The most well-researched benefit of D-mannose is its ability to fight and prevent recurrent UTIs. It works by preventing certain bacteria (including E. coli) from sticking to the walls of the urinary tract.
• Studies show that two grams of D-mannose daily is more effective than antibiotics for preventing recurrent urinary tract infections.

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