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

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.

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.

References

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.
https://www.ncbi.nlm.nih.gov/pubmed/10654372

Mercola, Joseph. Dr. D-Mannose for UTI Prevention Validated in a Clinical Trial. April 28, 2014.
https://articles.mercola.com/sites/articles/archive/2014/04/28/d-mannose-uti-prevention.aspx