Urinary Tract Infections – A simple sugar for a common problem

Urinary Tract Infections – A simple sugar for a common problem

Urinary Tract infections (UTIs) are one of the most common infectious diseases that affect 150 million people each year worldwide. Although UTIs affect both sexes, it is more prevalent in women. Scientists found that women who have recurring UTIs see a decrease in their health-related quality of life and workplace productivity.[i]

UTIs are divided into different categories, lower UTIs also known as cystitis and upper UTIs known as pyelonephritis which are based on the anatomical region affection. Lower infections are less complicated than upper infections as they generally affect the urethra and bladder, creating inflammation and pain. Lower UTIs are common and aren’t usually a cause for major concern, however, they need to be treated to lessen the risk of affecting the kidneys. Upper UTIs involve the kidneys and can be serious if left untreated as they could damage or spread to the bloodstream.

Pathogenesis of a UTI

The vast majority of UTIs are caused by the bacteria Escherichia coli (E-Coli), most of which are found in faecal matter that can enter the urethra, triggering the local infection. However emerging data suggests that vaginal dysbiosis may also result in E Coli colonisation and prompt recurrent UTIs, therefore it would seem that the gut, vagina and urinary bladder are jointly implicated in the pathogenesis of a UTI[ii].

Adhesion of pathogens such as E.Coli to the urothelial cells prevents their removal or washing off and is therefore their first step in colonising the urinary bladder and therefore the onset of infection. Uropathogens (a pathogen of the urinary tract), entering the bladder possess various virulence factors including fimbriae or pili which are tiny finger-like projections known as glycoproteins that have the capacity to stick the bacteria to the inside walls of our bladders and urinary tracts so they cannot be rinsed out by urination. They can also form a biofilm around the bacteria which can also cause anti-microbial resistance. Once in position, E-Coli can quickly multiply leading to urine infections[iii]

Grapefruit seed extract (GSE)  has been researched for its anti-fungal, anti-bacterial and anti-viral properties. However, there are also a few studies that address the anti-biofilm effect of GSE on E.Coli which suggests that grapefruit seed extract might be used also as an anti-biofilm agent against E.Coli.[iv]

Symptoms of lower UTIs.

Infections of the bladder (known as cystitis) or lower UTIs can cause a host of symptoms such as[v]

  • Frequent urination
  • Pain or discomfort on urination.
  • Sudden urges to urinate.
  • A sensation of being unable to empty the bladder fully.
  • Lower abdominal pain.
  • Urine that is cloudy, foul smelling or contains blood.
  • Feeling generally unwell, achy and tired.

Lower UTIs still need fast attention to lessen the risk of further infection to the kidneys and into the bloodstream. Women are much more likely to have cystitis than men, as the tube that passes out urine from a woman’s bladder (the urethra) is shorter and opens nearer the back passage (anus) where E-coli can enter.

Other triggers for UTI’s include:

  • Diabetes mellitus
  • Pregnancy
  • Post Menopausal women as changes in the tissues of the vagina and urethra after menopause make it harder for them to defend against infections
  • Catheter-associated UTIs
  • Abnormalities in kidneys, bladder, or urinary system
  • Having an immune system which is not working well (for example, due to AIDS or medication which suppresses the immune system)

Conventional UTI treatment and advice

  • Antibiotic treatment
  • Paracetamol or ibuprofen – to ease pain or discomfort and to lower any temperature
  • No treatment – this is an option if symptoms are very mild (with no other complications etc). Optimal hydration to help flush through the bladder and urethra and rest
  • For recurrent UTIs you may be given low-dose, longer-term antibiotics and/or vaginal oestrogen cream for post-menopausal women.[vi]

Antibiotics have some drawbacks including long-term alteration to the normal microbiota in the vagina and gastrointestinal tract as well as the risk of antibiotic-resistant microorganisms which can lead further to recurrent or chronic infections.

Natural treatments

Many individuals are seeking a more natural approach to treating uncomplicated UTIs as we now see that there is an increasing resistance of uropathogens to antibiotics, and recognition of the generally self-limiting nature of uncomplicated urinary tract infections (UTI) suggests that it is time to reconsider empirical treatment of UTI using antibiotics.[vii] Research into the effects of functional food products, probiotics, and alternative treatments on treating and preventing UTIs are being considered as treatment and prevention of uncomplicated UTIs is reaching a turning point.

The benefits to the individual of empirical antibiotic therapy may no longer outweigh the individual and societal risks and we are approaching a time where there is increasing support for using alternatives to antibiotic therapy – particularly for the prevention of recurring infection.

 Natural treatment strategies may include:

  • Optimal hydration
  • Drinking no-sugar-added cranberry juice
  • Alkaline-supporting diet
  • Avoidance of all simple sugars and refined carbohydrates as well as reducing caffeine-containing beverages
  • Hormone balancing strategies
  • Restoring gut function
  • Restoring vaginal microbiome
  • Improved hygiene
  • Lactobacillus strains of probiotic bacteria could potentially replace low-dose, long-term antibiotics as a safer prophylactic for recurrent UTIs.[viii]

One natural approach that stands out for lower UTIs is the use of a naturally occurring sugar molecule called D-mannose which is taken as a supplement to help treat and prevent UTIs.

What is D-mannose?

D-mannose is a naturally occurring sugar molecule found in relatively large quantities in plants and fruits such as peaches, apples, oranges and certain berries like cranberries and blueberries. It is absorbed in the upper intestines but at a much slower rate than most sugars. Unlike other sugars, D-mannose is not readily converted to glycogen in the liver but instead passes directly into the bloodstream largely unchanged.

As the D-mannose-laden blood passes through the kidneys, a considerable proportion of the sugar enters the urine. The small amount of D-mannose not excreted is harmless and is completely safe for people with diabetes as recent studies have shown.[ix]

As the urine flows out of the body, D-Mannose literally sugar-coats any free-floating E. Coli it encounters, so the bacteria cannot adhere to the inner tissues of the bladder and urinary tract, whilst it rinses it away with normal urination.

Unlike antibiotics, D-mannose does not alter our microbiome or pH balance that sets the environment for a host of further bacteria or yeast overgrowth, it simply helps to relocate misplaced E.Coli from inside of our urinary tracts to outside, studies have shown that it can offer the effective treatment without the side effects often seen with antibiotic use. It is also safe for both adults and children.

Supplementing with D-mannose

D-mannose as a supplement will deliver a concentrated dose of this natural molecule that can not be achieved from food sources alone. You will generally find it in the form of capsules, powder, or tablets. Powder form is an easy delivery method as it can be mixed with water/juice and rapidly dissolves, it is also helpful for those who are unable to swallow capsules or tablets. It can be used for ongoing infections for both adults and children and has shown to be useful for UTI prevention.[x]

We all love the sweetness of life, especially when it can offer us a healing hand when needed so let D-Mannose be your sweet solution to a common problem.


[i] https://www.medicalnewstoday.com/articles/urinary-tract-infections-utis-womens-sleep-sex-quality-of-life

[ii] Meštrović T, Matijašić M, Perić M, Čipčić Paljetak H, Barešić A, Verbanac D. The Role of Gut, Vaginal, and Urinary Microbiome in Urinary Tract Infections: From Bench to Bedside. Diagnostics (Basel). 2020 Dec 22;11(1):7. doi: 10.3390/diagnostics11010007. PMID: 33375202; PMCID: PMC7822161.

[iii] Govindarajan DK, Kandaswamy K. Virulence factors of uropathogens and their role in host pathogen interactions. Cell Surf. 2022 Feb 9;8:100075. doi: 10.1016/j.tcsw.2022.100075. PMID: 35198842; PMCID: PMC8841375.

[iv] Song YJ, Yu HH, Kim YJ, Lee NK, Paik HD. Anti-Biofilm Activity of Grapefruit Seed Extract against Staphylococcus aureus and Escherichia coli. J Microbiol Biotechnol. 2019 Aug 28;29(8):1177-1183. doi: 10.1041/jmb.1905.05022. PMID: 31370119.

[vi] https://www.nhs.uk/conditions/urinary-tract-infections-utis/#symptoms

[vii] Foxman B, Buxton M. Alternative approaches to conventional treatment of acute uncomplicated urinary tract infection in women. Curr Infect Dis Rep. 2013 Apr;15(2):124-9. doi: 10.1007/s11908-013-0317-5. PMID: 23378124; PMCID: PMC3622145.

[viii] Grin PM, Kowalewska PM, Alhazzan W, Fox-Robichaud AE. Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis. Can J Urol. 2013 Feb;20(1):6607-14. PMID: 23433130.

[ix] https://irp.nih.gov/blog/post/2020/11/a-sweet-treatment-for-diabetes

[x] Kranjčec B, Papeš 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. doi: 10.1007/s00345-013-1091-6. Epub 2013 Apr 30. PMID: 23633128.

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Elisabeth Philipps

Karen Devine

Karen Devine

Shelley Harvey

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antibiotic resistanceantibioticsBacteriabladdercranberryD-mannoseNatural remediesUrinary Tract InfectionsUTIs

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