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This month we bring you an opportunity to read the booklet by Jonathan V. Wright, M.D. 'D-Mannose & Bladder Infection'. The full text of this book is below for you to read at no cost.
Note that UTI is the American term for what the UK public more commonly call cystitis.

D-Mannose & Bladder Infection

The Natural Alternative to Antibiotics

Jonathan V. Wright, M.D.
And
Lane Lenard, Ph.D.

Published by Dragon Art
36646 32nd Avenue Southeast
Auburn, Washington 98001
Fax #253-874-2677

(c)2001 Jonathan V. Wright, M.D.
All Rights Reserved
ISBN No. 0-9713600-0-6

D-Mannose: The Natural Alternative to Antibiotics for Urinary Tract Infections

In this booklet, we describe a completely natural approach to treating UTI that involves the use of the simple sugar D-mannose, a close cousin of D-glucose. When taken by mouth, relatively large quantities of D-mannose can cure more than 90% of all UTIs within one to two days. Even more remarkably, D-mannose accomplishes this feat without killing a single bacterium!

Yes, you read that correctly. D-mannose cures UTIs, but it doesn’t kill bacteria.

How D-mannose accomplishes this substantial feat will be explained later. Suffice it to say that, because it gets rid of UTI-causing bacteria without committing “bacteria-cide,” people who use it suffer none of the unwanted side effects of antibiotics: no GI side effects, no yeast infections, no resistance. In fact, D-mannose has no adverse side effects of any kind. And as a bonus, it actually tastes good. Where a “spoonful of sugar” helped the medicine go down in Mary Poppins’ day, with D-mannose for UTIs, a spoonful of sugar is the medicine.

Because it is so effective and so benign, women (even pregnant women) who are susceptible to recurrent UTIs can safely take D-mannose as a preventative measure to head off future attacks. D-mannose is also ideally suited for children with UTI. Because it tastes so good (it is a sugar, after all!), children actually enjoy taking it.

Although D-mannose is virtually unknown to practitioners of conventional medicine, many research reports have demonstrated its mode of action and effectiveness against E. coli,* the microorganism that causes most UTIs. Moreover, nearly 15 years of clinical experience have shown that it is just about as effective at curing UTIs as antibiotic drugs.

At first glance D-mannose may sound too good to be true: a “medicine” that’s highly effective, perfectly safe, pleasant to use, inexpensive, and available without a doctor’s prescription. Yes, it is true! Unlike virtually any conventional medication, and many natural or “alternative” treatments as well, D-mannose has no known drawbacks.

If you or someone you love has a UTI or is prone to recurrent UTIs, we urge you to read this booklet and then try D-mannose. Odds are you’ll soon find that UTIs – and antibiotics – are a thing of the past.

The Story of Amy

Amy was not yet five years old when her mother brought her to the Tahoma Clinic in the late 1980s. Amy’s mother also brought with her a very detailed set of notebooks in which she’d recorded descriptions of her daughter’s numerous hospitalisations and extensive tests for nearly continuous urinary tract infections (UTIs). By actual count, Amy had been seen by 72 different physicians, and had been on antibiotics for most of her short life. Extensive tests showed “normal kidneys, ureters, and bladder” with no apparent reason for all the infection. Nevertheless, these doctors had told Amy’s mother and father that they were “running out of effective antibiotics,” and that she would likely need a kidney transplant during the next few years, because her kidneys were beginning to fail from the chronic infection.

Fortunately, Mom also had records of Amy’s many urine bacterial cultures, all of which showed the same bacteria: E. coli. At the end of our consultation, I advised her mother to give Amy ½ to 1 teaspoon (approximately ½ to 1 gram) of D-mannose powder stirred into a glass of water every two to three hours, except when she was sleeping.

A note about terminology:

In this booklet, we use the general term “UTI” (urinary tract infection) to refer to any infection of the bladder, ureters, or kidneys. The majority of us are more familiar with the term bladder infection , which refers to the most common form of UTI. Still, all these infections have a similar origin and are typically treated the same way.

Despite being a bit dubious that a simple sugar prescribed by a “natural medicine” doctor (remember, this was the 1980s) would do anything, she tried it.

Within 48 hours, Amy’s infection vanished. She remained infection free for over two years, relapsing only when her family forgot to take the D-mannose with them on vacation. When she resumed taking it, the infection immediately cleared. Over the next ten years or so, Amy has had no further UTIs and, of course, has kept her kidneys.

Although Amy’s case is extreme, UTI remains a common and distressing disease that affects up to 50% of all women and girls (and a much smaller number of men and boys) over the course of a lifetime. Each year, UTIs are responsible for 10 million doctor visits. Some people seem to be more susceptible than others; women who have suffered one UTI are very likely to experience a recurrence from time to time. 1-4

Some UTIs are merely painful (sometimes very painful) and annoying. However, as Amy’s case illustrates, other UTIs – especially if they’re chronic, recurrent, or not treated promptly and properly – can be quite dangerous. Under these conditions, bacteria may ascent to the kidneys, where infection can lead to serious damage and even kidney failure.

Conventional medical treatment of UTIs involves the use of antibiotics. While these drugs are usually – but not always – effective, curing most infections in a few days, they also have some important drawbacks:

Antibiotics are equal-opportunity microbe killers. Although they usually make quick work of the UTI-causing bugs, they don’t just stop there. They also kill millions of other “friendly” bacteria that belong in the body where they serve numerous important functions.

Because they kill off “friendly ” bacteria living in the gastrointestinal (GI) tract, antibiotics can cause unwanted side effects, such as diarrhoea, constipation, nausea and occasionally, vomiting. If enough friendly bacteria are killed, “not-so-friendly” yeasts, moulds, and bacteria – all of which can produce unwanted toxins – are encouraged to take their places. Since friendly bacteria normally produce significant amounts of several vitamins – folic acid and vitamin K are the best known examples – antibiotic use can contribute to long-term hidden vitamin deficiency.

In addition, many women who take antibiotics (to treat UTI or any other infection) soon come to expect that they will develop a vaginal yeast infection requiring them to take yet another drug – this time an antifungal – to kill the yeast. The reason is that friendly bacteria that normally inhabit the vagina keep the yeast (usually Candida albicans ) population under control. Once these friendly bacteria are taken out of the picture by the antibiotic, the yeast organisms are free to grow unchecked.

Although most of us can tolerate antibiotics without immediate side effects, every year a few people are rushed to the hospital because of allergic reactions to these drugs.

Lastly, the use of antibiotics promotes the development of bacterial species that are able to resist these drugs. Bacteria are very clever in their ability to mutate genes, making themselves “immune” to the effects of antibiotics. Those bacteria that have become immune then pass this ability on to their offspring or other bacteria. The likelihood that resistant bacteria will develop is enhanced by the misuse and overuse of antibiotics. The development of antibiotic-resistant bacteria is a major problem in medicine today that has many experts fearing the inevitable arrival of a “superbug” that is resistant to all known antibiotic drugs.

What is UTI?

A UTI is a bacterial infection (caused by the bacteria E. coli over 90% of the time) that affects the inside lining tissue of the urinary system (or tract). This system includes two kidneys, which form urine from liquid waste in the blood: two narrow ureters , tubes that carry urine from the kidneys to the muscular bladder, which stores it; and a single urethra, the final common path from the bladder to the outside world.

The urinary tract reacts to a bacterial infection in much the same way that the upper respiratory system reacts to a cold virus. The tissues become inflamed, irritated and swollen. Just as it's hard to breathe through swollen and inflamed nasal passages, swollen and inflamed urinary ducts can partially obstruct normal flow, making it painful and difficult to pass urine.

Ordinarily, the urinary system is hostile territory for bacteria, viruses or any other microorganisms. Bugs that do make their way into a healthy urinary tract are likely to find an inhospitable acidic environment (pH <5.5). They are also subject to attack by the body’s immune defenses. (Adult men have the added protection of a specific bacterial growth inhibitor squirted directly into the urinary system by their prostate gland.) Even if micro organisms manage to overcome these considerable obstacles, they would typically be flushed out with the normal flow of urine. So effective are these natural antibacterial defenses that in a study in which bacteria were instilled into the bladders of guinea pigs, simple urination expelled 99.9% of the bugs. 5

Despite all these built-in safeguards, each year millions of people, overwhelmingly women, still develop UTIs. Most UTIs begin when bacteria originating in the bowels travel to and grow in the urethra. Infections limited to the urethra are known as “urethritis.” When bacteria travel upstream to the bladder, the infection is called “cystitis.” Infections that reach the kidneys are known as “nephritis” or “pyelonephritis.”

The E. coli that cause most UTIs are among the most common “friendly” bacteria in the GI tract, where they aid digestion, produce a few vitamins, and in general, behave themselves without bothering us. If, however, when E. coli and other bugs exit the lower GI tract, they manage to gain entry to the urinary tract via the urethra, then they attach to the internal lining of the bladder, multiply and spread.

Although up to 90% of UTIs are caused by E. coli, the remaining 10% are caused by bacteria known as Chlamydia, Mycoplasma, Neisseria gonorrhoeae, and others. Unlike E. coli, these bugs tend to be transmitted via sexual contact and rarely cause the more serious bladder and kidney infections. Chlamydia, Mycoplasma and N. gonorrhoeae infections do not respond to D-mannose treatment and will probably require antibiotic treatment. In addition, a few UTIs are caused by other bacteria, such as Proteus or Staphylococcus (“Staph”). Still, all of these non-E. coli infections combined amount to no more than 10% of all UTIs.

Who Gets UTI?

Anatomy is UTI destiny. Women are far more likely to develop UTI than men. The reason lies in a difference in anatomy between the two sexes. Normal female anatomy, in which the urethral opening, vagina, and anus are all in close proximity, in tailor-made for UTI, because it makes it relatively easy for bacteria from the bowel to gain a “foothold” in the vagina or the urethra or both. Even small differences in the location of these openings can make a big difference. In one study of women who tended to get UTIs over and over again, the urethral opening was just 0.2 cm closer to the anus than women who never got UTI. 6 In males, of course, the urethra exits the body via the penis, making it too far a distance for most E. coli to travel.

The female urethra is also far shorter than the male’s. This means that the distance bacteria have to travel to reach the female bladder is much shorter, increasing the chances that a urethral infection will quickly become a bladder infection, or cystitis.

Poor hygiene. Failure to remove bacteria from the region surrounding the urethra is an important cause of UTI. Because the urethra is in front of the anus, mothers teach their small daughters to “always wipe from front to back” to avoid introducing bacteria from the anus into the urethra. In uncircumcised males, the foreskin, if not cleansed properly, can serve as an excellent breeding ground for bacteria, which could then easily gain access to the urethra.

Blocking the flow of urine. Normally, the flow of urine from kidneys to bladder to the urethra washes out most bacteria. However, anything that inhibits the flow of urine can increase the risk of UTI. Thus, people with certain anatomic anomalies, as well as blood clots, stones, tumours or strictures (narrowings) are more likely to have recurrent UTIs. In men, enlargement of the prostate gland can impede the flow of urine. Bladder weakness due to diabetes, stroke, or other neurologic disorder can sometimes lead to the “pooling” of urine in the bladder after urination. In time, this stagnant, residual urine can serve as a growth medium for bacteria. UTI is also quite common in people who are severely debilitated and require a urinary catheter (a tube inserted into the urethra to drain the bladder), which can easily become contaminated. Although blockages can promote infection in both sexes, they are the primary cause of UTI in males.

Taking the joy out of sex. For many women, the best way to get UTI is to have sexual intercourse. “Honeymoon cystitis” results when bacteria move from the vagina and the perianal area to the urethra during intercourse. (In a similar manner, it is possible to “inoculate” the urethra during masturbation and same-sex sexual activity).

Some contraceptive methods also increase the chances of UTI. Research has shown that women who use a diaphragm with a spermicidal jelly or foam, or just the spermicide itself, are much more likely to develop a UTI the next day. The same thing is true for condoms with spermicide. 7

Not only do spermicides promote the growth of E. coli, they also allow yeasts and other bacteria to thrive in the vagina. 8 It seems that nonoxynol-9, the most commonly used spermicide, kills a lot more than just sperm. It also kills the friendly bacteria, known as Lactobacilli that inhibit the vagina. One of Lactobacilli’s main functions is to produce lactic acid, which lowers the pH of the vagina. The relatively acidic normal environment helps keep the population of yeasts and unfriendly bacteria, like E. coli, under control. With Lactobacilli out of the way, the pH rises (less acid), allowing pathogenic organisms to grow unchecked. Nonoxynol-9 may also promote infection by making it easier for E. coli to stick to the epithelial cells that line the vagina, urethra, and bladder. 9

Antibiotics! Yes, it’s true that antibiotics are widely used to treat UTI, but it’s also true that antibiotics given for UTI or any other infection can actually increase the risk of UTI. How can that be? Like spermicide, many antibiotics kill vaginal Lactobacilli. Once the antibiotic treatment ceases, the absence of Lactobacilli leaves the vagina vulnerable to E. coli (and yeast) infection. 10 Once in the vagina, E. coli can more easily reach the urethra and bladder and begin the infection cycle all over again.

Getting older. The incidence of UTI increases after women reach menopause. The lack of youthful levels of oestrogen leads to a loss of Lactobacilli with a subsequent rise in vaginal pH leading to E. coli (and yeast) colonisation. 11 In very old (and very young) people, urinary and faecal incontinence can also pave the way to UTI.

In the genes. Some people have a genetic predisposition to UTI. In other words, if your mother had recurrent UTI, you have a good chance of having it too. The reasons are not entirely clear, but one possibility is that some UTI-prone women have a protein that makes it easier for E. coli to “stick” to their urinary tract tissue. Other women seem to lack certain antigens that normally inhibit bacterial adhesion (“stickiness”). Still other women have elements in their urine, such as low pH, that actively discourage bacterial growth, making them more resistant to infections. In some fortunate instances, urine may be naturally fatal to many bacteria. 12

Immune impairment. Any condition that impairs normal immune function can make the urinary tract a more hospitable place for bacteria. Thus, people with diseases, such as diabetes or AIDS or people taking immunosuppressive drugs (e.g., corticosteroids), should be extra careful.

What Are the Symptoms of UTI?

Some people with UTI have no symptoms and are completely unaware of their infection. However, it is far more common to have at least some symptoms. The most common symptoms of UTI include:

• A frequent urge to urinate
• Trickling of urine, despite a strong urge to urinate
• A painful, burning feeling in the area of the bladder or urethra during urination or even when not urinating
• An uncomfortable pressure above the pubic bone (in women) or a fullness in the rectum (in men)
• Cloudy, milky or reddish urine

When these symptoms are combined with a fever, one or both kidneys may be infected. Other symptoms of kidney infections are nausea, vomiting and back or side pain below the ribs.

In children, the symptoms of UTI are not always obvious. This is especially true in very young children, who may not be able to describe how they feel. Parents should be on the lookout for UTI if their kids are irritable, have no appetite, have no low-grade fever with nausea and vomiting, and/or if their urine smells “funny”. If children are sick for more than a day with a high temperature but have no “cold” symptoms, they may have UTI.

Conventional Antibiotic Treatment

Conventional medical treatment of UTI involves the use of antibiotic drugs, which typically cure most infections within one or two days. Even though the infection may appear to be gone in a couple of days, doctors often recommend taking antibiotics for 10 to 14 days just to make sure no relatively resistant bacteria survive. Longer treatment is especially indicated in cases where symptoms have lasted more than a week, when the infection is recurrent, or when the individual has diabetes (or other diseases in which the immune system may be impaired). When women are subject to recurrent UTI, many doctors prescribe daily low dose antibiotics for as long as two or three years! One problem with such long-term treatment is that it is guaranteed to seriously disrupt the body’s normal ecological balance by eradicating friendly bacteria, including E. coli in the GI tract and Lactobacilli in the vagina. The antibiotic drugs most often prescribed for UTI include:

• Trimethoprim (Trimpex)
• Trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim)
• Amoxicillin (Amoxil, Trimox, Wymox)
• Nitrofurantoin (Macrodantin, Furadantin; technically termed “urinary tract antispetics”)
• Fluoroquinolones (Floxin, Noroxin, Cipro, Trovan)
• Ampicillin (Many brands)

Treating UTI Naturally with D-Mannose

When faced with a potentially pathogenic germ like E. coli, conventional, pharmaceutically based medicine typically confronts the problem by throwing the most potent poisons it can find at the bugs. While there’s nothing essentially wrong with killing disease-causing bacteria, this approach does have some very serious drawbacks, as we have noted earlier. Happily, “bacteria-cide” is not the only possibly avenue of attack. Another, more natural way to eliminate E. coli infections from the urinary tract is to beat them at their own game. If they’re going to cause trouble, bacteria usually have to find a way to adhere (stick) to the body tissue they’re infecting. In UTI, E. coli attach to cells lining the bladder and urinary tract using filmy hair-like projections called fimbria on their cell walls. 13 At the tip of each fimbrium is a glycoprotein (a combination carbohydrate and protein) called a lectin that is programmed to bind to the first molecule of the sugar mannose that it encounters. 14

It turns out that molecules of mannose (produced inside urinary tract lining cells) naturally dot the surfaces of these cells. Here they act as “receptors”, inviting the fimbria of E. coli to attach, and allowing them to bind to the tissue in a right, Velcro-like grip. 14 If not for this attachment to the cells’s mannose, any E. coli that had successfully ventured up the urethral river would be unable to stick to the slippery surface and would be washed right back out on the next tide of urination.*

What happens when we take D-mannose to treat a UTI?

Now imagine what would happen to E. coli in the urinary tract if those sweet little mannose molecules they crave were present not just on the surface of the epithelial cells but surrounding them in the urine as well. The E. coli couldn’t turn around without bumping into D-mannose “just floating around” in the urine. Unable to resist the tasty bait they suddenly find themselves swimming in, they would latch on to the nearest mannose molecules, and happily sail off into the porcelain sunset. Those few E. coli left clinging to mannose molecules on cells then become easy prey for white blood cells and other agents of the immune system. 15-17

How taking D-mannose can treat or prevent UTI.

In addition to its natural occurrence in the cells lining the epithelial tract, the sugar D-mannose is also found in relatively large quantities in fruit such as peaches, apples, oranges and certain berries, like cranberries and blueberries. Extracted in the form of D-mannose,* a white crystal sugar similar to glucose, it can be easily dissolved in a liquid and swallowed. (Mannose can also be synthesized from other simple sugars.)

When someone with UTI consumes a dose of D-mannose, the sugar is absorbed in the upper GI tract, but at a much slower rate than most other sugars. (For example, glucose is absorbed more than eight times faster.) Moreover, unlike other sugars, D-mannose is not readily converted to glycogen (and stored) in the liver, but instead passes directly into the bloodstream largely unchanged. 18,19

As the D-mannose-laden blood passes through the kidneys, a considerable proportion of the sugar is extracted and added to the urine. The D-mannose-sweetened urine flows from the kidneys through the ureters to the bladder and on to the urethra, literally sugar-coating any free-floating E. coli it might encounter, so they can’s stick to cells any more. It also unsticks most of the E. coli already “Velcro-ed” to the inner surface of the bladder and urinary tract, ultimately flushing them all down the drain.

(* Not all varieties of E. coli find the mannose molecule such a treat. Those that do are said to be “mannose-specific,” and they are the ones that can potentially cause UTI.14 + Many molecules have D- (dextro-) and an L- (levo-) (literally, right and left) forms. It is not uncommon for the D- and L- forms of a molecule to have very different activity profiles. In the case of mannose, only the D- form is useful for dislodging E. coli.)

D-Mannose: Guidelines for Use

Ongoing infections

Children: ½ to 1 teaspoonful
Dissolved in a glass of water or
juice every 2 or 3 house.

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.

UTI, Sugar and Food Allergies

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.

Is D-mannose Safe for People With Diabetes?

People with diabetes usually need to limit their intake of sugar. How does this affect their use of D-mannose? Fortunately, very little. There are anecdotal reports that some people with diabetes experience a transient increase in blood sugar levels, but the effect is not great and never permanent, lasting only for the length of time mannose is used.

Try D-Mannose First!

We strongly urge people with UTI to try D-mannose before resorting to antibiotic drugs. Ninety percent of the time, UTI is caused by E. coli and will respond to D-mannose treatment with significant symptom reduction within 24 hours. (Even though symptoms are improved within 24 hours, D-mannose should be continued for two to three days after the last symptom is gone, just to “make sure.” Unlike with conventional antibiotics, there’s no harm in doing this.) Still, many physicians think it’s a good idea to collect a urine specimen for bacterial culture, if possible just before starting D-mannose. In the one chance in ten that the infection is not caused by E. coli and D-mannose doesn’t work, this allows them to identify the infecting bacteria and select an appropriate conventional antibiotic as quickly as possible.

Summary

D-mannose is a simple sugar that can be used to treat or prevent the 90% or more of UTIs that are caused by the bacteria E.coli. Although D-mannose can eliminate UTIs as quickly as conventional antibiotic drugs, it is far safer because it does not kill E. coli or any “friendly” bacteria. Instead, it makes it impossible for E. coli bacteria to stick to the lining of the urinary tract, which allows the normal flow or urine to wash the bugs down the drain. By using this remarkably safe, effective, inexpensive, natural treatment, women can usually treat their own UTIs without the need for expensive doctor visits, prescription drugs, and insurance company reimbursements.

A WORD OF CAUTION

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

	Antibiotic Drugs	D-mannose
Eliminates UTI within 1-2 days	Yes	Yes
Kills “friendly” bacteria	Yes	No
Can safely stop treatment in a few days	No	Yes
Can cause GI upset	Yes	No
Can promote yeast infections	Yes	No
Can cause allergic reactions	Yes	No
Well-suited for pregnant women	No	Yes
Well-suited for infants and Young children	No	Yes
Well-suited for long-term, Preventative use	No	Yes
Requires a doctor’s prescription	Yes	No

References

1. Harrington RD, Hooton TM. Urinary tract infection risk factors and gender. J Gend Specif Med. 2000;3:27-34.
2. Kunin CM. Urinary tract infections in females. Clin Infect Dis. 1994;18:1-10; quiz 11-12.
3. Ikaheimo R. Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996;22:91-99.
4. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80:331-333.
5. Norden CW, Green GM, Kass EH. Antibacterial mechanisms of the urinary bladder. J Clin Invest. 1968;47:2689-2700.
6. Hooton TM, Stapleton AE, Roberts PL, et al. Perineal anatomy and urine-voiding characteristics of young women with and without recurrent urinary tract infections. Clin Infect Dis. 1999;29:1600-1601.
7. Hooton TM, Scholes D. Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996;335:468-474.
8. Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE, Escherichia coli bacteriuria and contraceptive method. Jama. 1991;265:64-69.
9. Hooton TM, Fennell CL, Clark AM, Stamm WE, Nonoxynol-9: differential antibacterial activity and enhancement of bacterial adherence to vaginal epithelial cells. J Infect Dis. 1991;164:1216-1219.
10. Smith HS, Hughes JP, Hooton TM, et al. Antecedent antimicrobial use increases the risk of uncomplicated cystitis in young women. Clin Infect Dis. 1997;25:63-68.
11. Sobel JD. Pathogenesis of urinary tract infection. Role of host defenses. Infect Dis Clin North Am. 1997;11:531-549.
12. Mulholland SG. Lower urinary tract antibacterial defense mechanisms. Invest Urol. 1979;17:93-97.
13. Fowler JE, Jr., Stamey TA. Studies of introital colonisation in women with recurrent urinary infections. VII. The role of bacterial adherence. J Urol. 1977;117:472-476.
14. Ofek I, Goldhar J, Eshdat Y, Sharon N. The importance of mannose specific adhesins (lectins) infections caused by Escherichia coli. Scand J Infect Dis Suppl. 1982;33:61-67.
15. Ofek I, Crouch E, Keisari Y. The role of C-type lectins in the innate immunity against pulmonary pathogens. Adv Exp Med Biol. 2000;479:27-36.
16. Ofek I, Beachey EH. Mannose binding and epithelial cell adherence of Escherichia coli. Infect Immun. 1978;22:247-254.
17. Bar-Shavit Z, Goldman R, Ofek I, Sharon N, Mirelman D. Mannose-binding activity of Escherichia coli: a determinant of attachment and ingestion of the bacteria by macrophages. Infect Immun. 1980;29:417-424.
18. Herman RH. Mannose metabolism. I. Am J Clin Nutr. 1971;24:488-498.
19. Deuel H, Hallman L. Murray S, Hilliard J. Studies on ketosis: XV. The comparative metabolism of d-mannose and d-glucose. J Biol Chem. 1938;125:79-85.
20. Michaels E, Chmiel J, Plotkin B, Schaeffer A. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urol Res. 1983;11:97-102.
21. Alton G, Kjaergaard S, Etchison JR, Skovby F, Freeze HH. Oral ingestion of mannose elevates blood mannose levels: a first step toward a potential therapy for carbohydrate-deficient glycoprotein syndrome type I. Biochem Mol Med. 1997;60:127-133.
22. Brown D. Antiadherence factor for cranberry discovered. Quart Rev Nat Med. 1998;Dec. 31, 1998:269-270.
23. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322:1-5.
24. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr. 1973;26:1180-1184.
25. Horesh AJ. Allergy and recurrent urinary tract infections in childhood. II. Ann Allergy. 1976;36:174-179.
26. Horesh AJ. Allergy and recurrent urinary tract infections in childhood. I. Ann Allergy. 1976;36:16-22.
27. Raz R. Postmenopausal women with recurrent UTI. Int J Antimicrob Agents. 2001;17:269-271.
28. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329:753-756.

This book is general information, not individualised to any person or circumstance. For specific advice concerning any individual episode of any illness, contact your physician. Discuss the information in this book with your pharmacist or physician to learn whether it is useful and relevant to your family.

“D-mannose is exactly the right treatment for bladder infections caused by E. coli, and that’s over 90% of them. As Linus Pauling said: “the right molecule in the right place at the right time.” A perfect example of orthomolecular medicine.”

John Parks Trowbridge, M.D.
Author of The Yeast Syndrome

“I had heard about D-Mannose at your seminar, and also read about it in your Nutrition & Healing newsletter…I decided to try it personally as I had been having bladder infections nearly every time I had intercourse with my husband. I took ½ teaspoonful before and sometimes ½ teaspoonful after and had no more bladder infections!

I have also recommended it to several patients at the clinic where I work and they have had excellent results as well.”

Terri Crosby-Hornbaker, CH, CN

“When she was younger, our daughter had one bladder infection after another until we started her on D-mannose. We had no problem giving it to her, she loved the taste. She’s had no further infections, except when we forgot to take the D-mannose on vacation with us once.”

Jeri Reddick

“My wife recently had a urinary tract infection. I had just read your article on D-mannose and quickly ordered some…it took only a couple of days on the D-mannose and she felt better.”

T.S.M. (via e-mail)

The effectiveness of D-mannose against bladder and other urinary tract infections was first described in the June 1999 issue of

Nutrition & Healing

An innovative and informative monthly newsletter, written by two of the world’s most experienced and respected clinicians, scholars, and teachers of a more natural approach to health care.

In the past few years, Nutrition & Healing has informed its readers about the first double-blind, placebo-controlled experiment to demonstrate the successful reversal of early cancer of the cervix (“carcinoma-in-situ”) with an extract from common vegetables. It has extensively reported the unpublicised yet nation wide use (since 1983) of bio-identical hormone replacement therapy for women at and after the menopause, hormones exactly identical to those present in a young woman’s body, rather than “hormones” concentrated from horse urine (Premarin®) or originated in a factory (Provera®). Nutrition & Healing reports the latest in effective vitamin, mineral and herbal therapies, as well as reminding us of decades-old but still very useful natural treatments.

Nutrition & Healing is written by Jonathan V. Wright, M.D., Medical Director of Tahoma Clinic, Kent, Washington, USA and Kerry Bone, MCPP, FNHAA, FNIMH, of Warwick, Queensland, Australia. Kerry Bone is a master of herbal therapy and scholarship, and author (along with Simon Mills) of the #1 textbook in herbal medicine, Principles and Practice of Phytotherapy. Dr Wright is a graduate of Harvard University and the University of Michigan Medical School. In medical practice since 1970, he’s also been author of monthly columns in Prevention magazine (1976-1986) and Let’s Live magazine (1986-1996).

Books by Dr Wright include:

Why Stomach Acid is Good For You (with Lane Lenard, Ph.D.)
The Patient’s Book of Natural Healing (with Alan R. Gaby, M.D.)
Maximise Your Vitality and Potency for Men Over 40 (with Lane Lenard Ph.D.)
Natural Hormone Replacement for Women Over 45 (with John Morgenthaler)
The Natural Pharmacy (with six co-authors)
Dr Wright’s Guide to Healing with Nutrition
Dr Wright’s Book of Nutritional Therapy