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Exercise Caution Using D-Mannose for Urinary Tract Infections if You Have SIBO

Urinary Tract Infection Wordcloud

D-mannose is commonly prescribed for the treatment of urinary tract infections (UTIs) by many alternative/integrative health practitioners. If you visit the comment sections of blog posts and forums on this topic, you will see that thousands of people attest to the fact that it can be very effective, when the bacteria involved is E.coli. However, as I will demonstrate further ahead, D-mannose can be contraindicated if SIBO is present.

Urinary tract infections are the second most common infection in the United States and are becoming increasingly difficult to treat due to antibiotic resistance. Women are much more prone to a UTI because their urethra (the tube that transports urine from the bladder and out of the body) is shorter and closer to the anus which allows bacteria to enter more easily. Most women have had at least one in their life, but for many, it can become a recurring problem.

Like all microbes, bacteria in the urinary tract build biofilms where they form colonies that enable them to evade the immune system and antibiotics. This contributes greatly to recurrence and resistance. Bacteria in the biofilm can be up to 1000 times more resistant than those outside the biofilm.

Infection may occur anywhere within the urinary tract including the bladder, urethra, ureters (ducts that carry urine from the kidneys to the bladder), or the kidneys. It is much less complicated and risky if it is confined to the bladder. If the treatment of a bladder infection is prompt and effective, then it reduces the risk of traveling to the kidneys.

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In most cases, a UTI is caused by bacteria, but it may also be caused by a fungus. The most common fungus involved is candida, but it could also be cryptococcus neoformans, Aspergillus species, and the endemic mycoses. The most common bacteria involved are E. coli, but other potential suspects are Klebsiella pneumonia, Staphylococcus saprophyticus, and Pseudomonas aeruginosa.

Symptoms of Urinary Tract Infection

If you’ve ever had the pleasure of this experience, then you know the pain in the bladder, pelvic region, lower abdomen or back, associated with a urinary tract infection can be quite intense. It is typically accompanied by an increase in frequency and urgency of urination, incomplete emptying of the bladder, and burning with urination. Urine may be cloudy, or in some cases, dark or bloody, and have a potent or offensive odor.

Some other less reported symptoms may include fatigue, aching in the joints and muscles, pain in the inner thighs, anxiety, and shaking. If fever and chills appear, this is typically a sign that the infection is in the kidneys. In rare cases, a kidney infection can lead to damage to the kidneys or the infection can get into the bloodstream, which creates a more serious condition. Most practitioners consider the presence of back pain as a red flag that infection may be in the kidneys, particularly if the pain is higher up.

Risk Factors and Treatment for UTI

The urinary tract is typically a sterile environment, but infection develops when microbes end up in the region for one reason or another. Some common risk factors include the female anatomy itself, sexual intercourse, diaphragms, spermicidal agents, menopause (due to a decline in estrogen), genetics, feminine hygiene products, and bacterial virulence.

Other risk factors could be abnormalities in the urinary tract, blockages like kidney stones, weak immunity, catheter use, pregnancy, or a recent urinary medical procedure. Although you don’t see this mentioned in the mainstream literature, urinary tract infections are very common in people who are dealing with candida overgrowth in the gut and/or SIBO. Since candida and SIBO are usually managed rather than eliminated, they can contribute to a cycle of recurrence.

Traditional treatment for a UTI includes antibiotics, most commonly Cipro, sulfa drugs, Macrobid, Keflex, and amoxicillin. In the integrative/alternative health approach, natural antibacterials like cranberry extract, D-mannose, coconut oil, olive leaf extract, uva ursi, grapefruit seed extract, colloidal silver, and monolaurin are used. Prior to sulfa drugs, uva ursi was a common treatment for bladder infections. However, do be aware that uva ursi should not be taken longer than two weeks, as it can be toxic with long-term use.

If the infection is caused by a fungus, then an antifungal like Diflucan may be used. Your diet is absolutely critical as bacteria and candida feed and proliferate on sugars and carbs of any kind (including fruit and nuts). So the diet should be low carb and rich in animal protein and fat. And, be sure to drink lots of water and urinate frequently to flush the microbes from your system.

Is D-Mannose Right for You?

I gave D-mannose a try (in 2016) and wanted to share my experience with you. About six weeks ago, I developed a bladder infection. I’ve been working on a SIBO issue for several years, and regular bouts with a bladder infection have accompanied this problem. Prior to SIBO, I would only get them once in a great while. Typically, I take Nature’s Way cranberry extract at the first sign of infection and it usually clears up almost instantly. However, that wasn’t the case this time. I was taking a much higher dose of the cranberry than usual for two weeks and it just wasn’t going away.

At first, the cranberry kept it under control, but then it stopped and things got worse. If I take even one or two bites of fruit or nuts, it becomes very severe. When my kidneys started to hurt, I got scared and figured I better get on an antibiotic. At one point with the antibiotic, the infection was about 95 percent better, but then it started to get worse again. After two weeks on an antibiotic, it did not go away. I was using doxycycline and later learned that is not a good choice for UTIs. But, at the time I didn’t want to continue to expose myself to antibiotics by taking a different one, so I decided to try something natural again since my kidneys weren’t hurting anymore.

I have always been skeptical of trying D-Mannose because I suspected it may cause a flare in SIBO or candida. If you aren’t aware, D-mannose is a naturally occurring sugar found in a variety of fruits (as well as some legumes, vegetables, and other foods) that is similar to glucose. It is believed it works for urinary tract infections by attaching to the E. coli, which prevents the bacteria from sticking to the walls of the urinary tract, and thus allowing them to be easily eliminated with urination. It may also activate a particular type of protein (Tamm-Horsfall) that is used by the body to protect itself against urinary tract infections. D-mannose is only effective against E. coli, which accounts for about 90 percent of UTIs. All the experts claim D-mannose is not metabolized in the same way as other sugar.

Dr. Jonathan Wright says ” Although D-mannose is a simple sugar, very little of it is metabolized. It doesn’t interfere with blood sugar regulation, even for diabetics.”

Dr. Joseph Mercola states it has “no adverse effects, ” and “only very small amounts of D-mannose are metabolized.”

Chris Kresser states, “D-mannose, even in large quantities, does not cause any adverse side effects, and cannot be metabolized the way other sugars can, meaning this supplement is safe for diabetics and others who are avoiding sugar for any reason.”

I know from my own personal experience, and through my clients, that results in supplements often do not pan out as everyone claims they will. Things that shouldn’t feed candida or SIBO in theory often do and cause an exacerbation of symptoms. Before trying the D-mannose, I did a Google search on whether it feeds candida and couldn’t find anything. For some reason, I completely forgot to do a search on whether it feeds SIBO. Although I had researched D-mannose thoroughly, and I saw no mention of a negative effect on SIBO anywhere in the literature. Chris Kresser is pretty knowledgeable about SIBO, so I thought he would have mentioned something in his material if it was contraindicated in this situation.

So, I took a teaspoon of D-mannose powder (2000 mg), which is what Dr. Mercola recommends. Within a very short amount of time, I began to experience intense and extreme indigestion with absurd belching, severe pain and pressure in the belly button area, cecum and appendix area (the area where my SIBO resides), swelling, bloating, acid reflux, lots of rumbling and grumbling, pain and pressure in my lower back and right shoulder, and a significant increase in bladder pain as well as intensity and frequency of urination. The pain was so severe I could hardly walk for several hours. I had so much abdominal swelling and pressure that I thought I would explode. These are all signs that I have consumed something that has fed my SIBO significantly.

I then went to Google and did a specific search on whether D-mannose feeds SIBO and came across this list of supplements from Dr. Alice Siebecker, one of the leading experts on SIBO, and indeed, there it was on the list. D-mannose is listed as a supplement that has the potential to exacerbate SIBO. Even Dr. Siebecker says it is absorbed poorly, but it is a monosaccharide, so may be problematic for some people.

Cranberry Extract vs. D-Mannose

Now, you may be aware that it is believed by many that the primary reason cranberry extract works for a bladder infection is that it contains D-mannose. However, some research has demonstrated that cranberry contains a tannin (particularly proanthocyanidins) that also prevents E. coli from adhering to the walls of the bladder. Additionally, another mechanism of action for cranberry is that it can decrease virulence. So there’s more to cranberry’s effectiveness, besides its D-mannose content. Furthermore, cranberry has demonstrated efficacy for inhibiting the adherence of other types of bacteria besides E.coli, including Proteus spp., P. aeruginosa, E. faecalis, S. aureus, S. typhimurium, and K. pneumoniae, as well as some multi-drug resistant E.coli strains.

Since cranberries contain D-mannose, you may wonder why I was able to take the cranberry extract and not the D-mannose. I assume it is because the cranberry extract contains a much less concentrated amount than taking D-mannose straight and the reason it is effective for me is due to its proanthocyanidins discussed above. Therefore, I thought it might be possible that I could tolerate a smaller dosage of D-mannose. So, a couple of days later I tried the D-mannose again but only took 500 mg. this time. Symptoms were significantly less than they were with the 2000 mg, but I still had some belching and swelling, pain in the belly button area, cecum, and appendix, and an increase in back pain and frequency of urination. Apparently, cranberry extract is still much lower in concentration than even 500 mg of straight D-mannose. So, it appears there is no way I can take this supplement due to the SIBO issue.

My intention here is not to discourage you from using D-mannose. Some research, as well as anecdotal and clinical experience, suggest it is highly effective for many people. However, people who have SIBO are dealing with a different deck of cards, so I just want to make you aware that if you fall under this category of people, then you should exercise caution with this product. As mentioned previously, urinary tract infections are very common in people with Candida and SIBO and many people with Candida have SIBO unknowingly. If you get recurrent UTIs frequently, you should be looking into whether you have Candida and/or SIBO.

On the other hand, even within the population of people who have SIBO, tolerance for a particular substance that feeds small intestinal bacterial overgrowth can vary widely. Each person can have a different threshold and the individual themselves can have a different threshold from substance to substance. Therefore, just because D-mannose is a monosaccharide, does not mean everyone with SIBO will be completely intolerant. Some people may tolerate a little, others may tolerate a higher dose, while others may not be able to consume any. It depends on the severity of overgrowth and which bacteria are present in that overgrowth. Just be aware that the potential for exacerbation exists, proceed cautiously, observe how it affects you, and adjust accordingly.

If you have SIBO, cranberry extract may be a better first choice, if your microbes are responsive to it. Be sure the brand of extract you purchase is standardized for ultimate adherence. You should avoid cranberry juice because it contains sugar that is going to feed microbes.

I also tried baking soda, vitamin C, uva ursi, olive leaf extract, Lauricidin (monolaurin), and probiotics as a vaginal suppository. Olive leaf works pretty well, but I was taking three capsules three times a day with 18 percent oleuropein for two weeks, which had me about 95 percent better. However, if I missed a dose, the infection would begin to increase. I also tried Lauricidin and olive leaf together, but that didn’t work either.

The olive leaf started to increase my norepinephrine level and lower my serotonin levels, which caused a variety of undesirable symptoms and stressed my adrenals, so I had to discontinue. I had no choice but to take a different antibiotic.

Update – May 29, 2016

So, I finished the antibiotics I was on (Cefdinir) three days ago and it appears my bladder infection has finally cleared up. Sometimes an antibiotic is a necessary evil.

By the way, I didn’t want to spend half my day in urgent care or in the doctor’s office surrounded by sick people, so I discovered this fantastic service online called PlushCare. They provide many urgent care services over the phone. The service was quick, professional, and easy. I simply filled out a short form, chose the time I preferred for my appointment and the doctor called me right on time. He asked all the right questions, was very knowledgeable about UTIs, and exhibited a good bedside manner.

I never take any pharmaceutical without researching it first, and when I told the doctor this, he allowed me to hang up and do my research on the antibiotic he thought was best for me and then he called me back. I decided to go forward and he called in a prescription for me at my local pharmacy. I was really impressed with the service. You may want to check it out. They provide service for a variety of conditions besides urinary tract infections, including sinus, asthma, bronchitis, ear infection, allergies, strep throat, and others.

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Center for Disease Dynamics, Economics & Policy. “Second most common infection in the U.S. proving harder to treat with current antibiotics.” ScienceDaily. ScienceDaily, 13 November 2012. www.sciencedaily.com/releases/2012/11/121113122529.htm

Hisano, Marcelo et al. “Cranberries and Lower Urinary Tract Infection Prevention.” Clinics 67.6 (2012): 661–667. PMC. Web. 23 May 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370320/

Kresser Chris. Treat and Prevent UTIs Without Drugs. September 28, 2012.

Sobel JD1, Vazquez JA. Fungal infections of the urinary tract. World J Urol. 1999 Dec;17(6):410-4.

Mercola, Joseph. Dr. D-Mannose for UTI Prevention Validated in a Clinical Trial. April 28, 2014.

20 thoughts on “Exercise Caution Using D-Mannose for Urinary Tract Infections if You Have SIBO”

  1. Awesome article. Thanks. I’m a guy with SIBO and long-term UTI probs. Going to try D-Mannose, but will definitely proceed with care thanks to your article. Well written and informative.

    1. Admin - Cynthia Perkins

      Thanks Reeb. You’re welcome. Sorry for the late response. Very behind on responding to comments.



  2. How do you know if you have Sibo? None of my doctors have ever ?of the tests I’ve asked for so I don’t know whether to take treatments for it not. I’m just trying to keep my stomach lining healthy with the use of zinc carnitine and vitamin u and bone broth. Also, I thought it was interesting that you noticed how Olive Oil xtract affected your seratonin and adrenals. I’ve read it’s ok to use for a month, then take a break, so I was wondering what symptoms you recognized as signs to stop it?

    1. Admin - Cynthia Perkins

      Hi Joanne,

      You can read about SIBO, including testing, on the following page.


      I could tell my norep was rising and serotonin was declining because I developed anxiety, panting, disrupted sleep and felt slightly depressed.

      One may be able to take olive leaf for a period of time before experiencing the negative effects. Length of time would vary from person to person. Some people might be able to take a long time and others might not be able to take it all. I can take it for a few days and sometimes a week before it happens.

  3. Thank you for all the information about what you’ve tried and also about PlushCare. This blog helped me tremendously and I just wanted to give you kudos.

  4. Very helpful information! I have SIBO and I experienced the same reaction to d mannose after a 4 days course. I had no ideea what had caused it and thought it might be the cranberry extract. On the other hand, olive leaf really helps, where did you find that it affects adrenals?

  5. Thanks for this. Was taking d mannose for a UTI and I had severe painful bloating and gas. Never again I’ll stick to cranberry.!

  6. Thank you so much for your article….I’m struggling with what I thought was a mild UTI, I took d-mannose and I was woken up with severe stomach pain, initially I didn’t think it would of been the supplement that made me so ill, but now the pain is slowly subsiding each time I burp.

  7. I have been struggling with UTIs for over 10 years. It’s a vicious circle, frequent antibiotics messed up my gutt, and the imbalance in my gutt causes UTIs… I noticed that my symptoms always got much worse if I took anything with D-mannose. First it upset my stomach quite a bit and inflamed my intestines, then it caused the UTI burning to get much worse. Not sure how to break out of the cycle but I don’t think medical practitioners are aware that d-manose can have negative effect.

  8. After I finished Bactrim, my UTI came back a week later. It did not work for me. My doctor told me to order the Lady Soma Cranberry Concentrate and I wasn’t very hopeful because I’d read that research was inconclusive as to the effectiveness of cranberry. Well, I am happy to say that after 2 weeks of taking 2 Lady Soma Cranberry Concentrates a day, my symptoms are GONE. No more frequency, burning or malaise. I am clear! I must say that the first 2 days I started them, I loaded up on water to flush it out and didn’t fight urges to go. This really worked for me and I would recommend it to anyone who has this problem.

  9. Nowhere in this article did you define SIBO or explain what the symptoms of SIBO are. I read through this entire, long article, figuring that along the way you would surely tell us, for those who don’t know. Got to the end of the article and was very disappointed that no, no info. How helpful is that?

    1. Admin - Cynthia Perkins

      Vanessa, first of all, this article is not about SIBO, it is about using caution when using D-mannose as the title indicates. Therefore, it assumes the individual already knows what SIBO is or otherwise they would have no reason to read the page. However, I provided a link to the SIBO section of my website in the article above. Most people know that when a word is a hyperlink that it is a clickable link and takes you to a page with more information on that topic. All you need to do is click on that link and you will find everything you need to know about SIBO. Here it is again, in case you can’t see it for some reason.


  10. I appreciate this article very much! Your first hand experience with D-Mannose provides me with valuable information. I just finished a 7-day course of Bactrim for a UTI after I tried to treat it naturally. I do NOT take antibiotics unless absolutely necessary. The pain was severe, radiating into my thighs and I was urinating blood. I had my physician (allopathic) do a culture, although she said it was unnecessary and proceeded to take the antibiotic. The culture came back as E. Coli, for which Bactrim does work. I started D-Mannose before finishing the antibiotic, just to make sure the E. Coli is taken care of. I do NOT want an antibiotic again!! As far as I can tell, I’m not having any adverse reactions to D-Mannose, 500 mg, 3 times a day, and this is my third day. Do you think I’m on the right track? If I ask my physician, she’ll just roll her eyes. Thanks again for sharing your experience!

  11. Christy Hollister

    I tried 1 capsule of D-Mannose yesterday for Interstitial Cystitis because I read so many great reviews on how it worked so well and took the pain away. Unfortuantely after getting IC back and 23 years of being symtom free this was the worse flare I have had so far in 3 months…I am always so frustrated and disappointed when I try something that has helped so many and it ends up backfiring on me. I am going to persist and get on a very strict protocol in the next couple of weeks that I know will start the healing process, no more trying supplements here and there that end up making me worse!

  12. Thank you. Your article has been very informative. After taking D-mannose and also battling SIBO for over a year now, the D-mannose caused all my SIBO problems to escalate overnight. I am now more wary of it and will see how well I tolerate Cranberry extract in the future. Also interesting to hear about olive leaf extract. I think I was OK with this, although would not use it for more than a week at a time.

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