- Controlled trials and studies are often limited in complementary and alternative medicine and involve small numbers of participants. They are often conducted under less rigorous controls, guidelines and environments than those undertaken for the development of new pharmaceutical medications such as antibiotics. Do your research, there should be clear, peer reviewed, empiric evidence as to the efficacy of D Mannose rather than theorisation about how it may be beneficial in the treatment of a chronic UTI.
- There are very limited patient research trial studies. More are needed and several are currently in trial publishing in 2020.
- Length of study and size of participant groups. Current studies available have shown trials of under one year and in small patient trial groups. This studypublished in the World Journal of Urology in 2013 noted that in their patient cohort of 399 women those taking D-mannose powder alone showed effectiveness in preventing UTI. However it fared no better than those women taking a daily prophylactic dose of nitrofurantoin and the recurrence rate did not differ between patients who took standard Nitrofurantoin prophylaxis and those who took D-mannose powder. This lack of scientific and clinical rigor applied to study design and outcomes is common with alternative therapies.
- In Vitro vs In Vivo. Most studies undertaken are either in laboratory known as “test tube conditions” or with the use of mice rather than human participants. Human behavioural, genetic, and environmental differences in comparison to those of mice mean it is difficult to compare like with like.
- Different strains of bacteria. Infections are now recognised to be polymicrobial (comprised of more than one bacteria). Not all bacterial strains have these Pili (grappling hooks) and thus D-Mannose molecules in the urine won’t be effective in binding these bacteria to them and expelling them through urination. Instead the bacteria will bind to the urothelium and form bacterial colonies. Indeed certain strains of UPEC do not create Pili.
- Once bacteria have attached to the cells of the bladder wall and started to reproduce, D-Mannose will not prevent the infection developing further.
- There has been insufficient research into the optimum dosage for the prevention of recurrent infections.
- For those with gastric issues such as Crohns or colitis, D-mannose may not be absorbed. Additionally, pathogenic e coli in the intestines may bind to most D-mannose available preventing sufficient molecules being filtered through the kidneys and into the bladder. Different people will react differently to the same D-mannose dose due to their age, weight, and overall health.
- Commercial D-Mannose powder is often made from corn, particularly the less expensive versions. For those with allergies, a reaction to D-Mannose derived from corn may include a mild rash headaches and stomach aches.
- Cost – as with any usage of a supplement on an intermittent or ongoing basis, there is a cost to you financially.
