“Will D-Mannose help with my interstitial cystitis?” is one of the questions I am most frequently asked by customers, closely followed by, “Can I take D-Mannose and aloe vera capsules together?” I have therefore decided to write a blog post to address these questions in detail!

Regarding the latter, the answer is a simple yes. Yes, you can take D-Mannose and aloe vera capsules together. And yes, you can take each or both of these alongside any other medication you might be using as well. Regarding the former, the answer is less straightforward, but if I had to sum it up in one word I’d go with ‘probably’.

Often, interstitial cystitis (IC) comes about after a bout of bacterial cystitis – in essence the symptoms of the bladder infection remain after the infection itself has seemingly been cleared. In these cases, it is thought that residual levels of bacteria remain in the bladder – alive or dead – and continue to cause problems. Because a certain amount of bacteria must be present before they will show up in laboratory tests, it is possible to have residual bacteria in the bladder, yet still test negative for infection. In such cases, D-Mannose is likely to be helpful, as the bacteria are more inclined to stick to it than to the bladder wall. To put it another way, each bacterium would prefer to attach itself to a molecule of D-Mannose than to a bladder cell. Once attached to D-Mannose molecules, the bacteria then leave the body in the urine. Although the mechanism is not fully understood, even dead or fragmented bacteria seem to behave in this manner, meaning where there is underlying low-grade infection D-Mannose may well be helpful.

However, this is far from the whole story. D-Mannose also has anti-inflammatory properties and in cases of IC the bladder is often inflamed and damaged. D-Mannose stimulates production of collagen and proteoglycans (in other words, the materials the actual bladder wall is made from), which helps the bladder to heal more quickly. It also calms down over-active neutrophils (the white blood cells that attack infection) and activates macrophages (the white blood cells that ‘clean up’ pathogens and dead cells in our bodies), which account for its anti-inflammatory action. By assisting with bladder healing and calming inflammation, D-Mannose may therefore be effective in cases of IC even where there is no underlying bacterial infection. (I was fascinated to learn that aloe vera contains a natural form of mannose called acemannon, which may go some way to explaining why it too has anti-inflammatory and healing properties. I might devote a separate blog post to aloe vera at some stage to explore this more thoroughly and discuss its own role in managing IC.)

The scientifically inclined among you may be wondering why calming down neutrophils should be desirable, given that their job is to attack pathogens. It has been found that while neutrophils are beneficial in acute infection, over a prolonged period of time they actually cause tissue damage and slow down healing. Given that neutrophil levels tend to be elevated in chronic conditions and given that IC is certainly a chronic condition, it may be appropriate to reduce neutrophil activity around sites of inflammation in long-standing conditions so that faster healing can occur. 

So far we have considered only interstitial cystitis. There is a similar condition – and the two are often confused and wrongly diagnosed as each other – called pseudomembranous trigonitis. This is where the squamous cells in the lower triangle of the bladder undergo changes, sometimes resulting in lesions, inflammation, pain, increased urge to urinate, pain during sex and difficulty sitting. These changes can also result in a ‘leaky bladder’ where the permeability of the bladder wall is compromised in a fashion similar to ‘leaky gut syndrome’. This can allow urine to come into contact with layers of the bladder wall that it normally would not, causing ongoing pain and irritation. Clearly these symptoms strongly overlap with those of IC, so confusion and misdiagnosis is understandable.

Although the cell changes associated with trigonitis are found in up to 40% of adult women, it would seem that they sometimes cause no symptoms at all, since anecdotally less than 40% of women complain of urinary tract issues. The exact cause of trigonitis is not known, but it too can often develop subsequent to bacterial UTIs. Fascinatingly, its cause can also be hormonal in nature, with the bladder cells undergoing cyclical menstrual changes similar to the vaginal epithelium. This may explain why many women of menstruating age notice a monthly pattern to the worsening of bladder pain or pelvic pain and may also explain why genitourinary problems frequently start/stop around the menopause. Still further, it could explain the role of oestrogen therapy in treating bladder complaints. To return to the question of D-Mannose, the actions by which it can assist with IC also render it useful in the management of trigonitis.

In a six month study by Michael Blue, a urologist from Oklahoma, 18 women who had UTI symptoms without bacteria being present at laboratory values were given daily D-Mannose. Of these, 17 reported symptom improvement and the remaining participant could not subsequently be contacted. 80% of participants became totally symptom free. This, together with the above information about the actions of D-Mannose, explains why the answer I give to, “Will D-Mannose help with my IC?” is, in its most concise form, “Probably.”

It should be noted that it takes 2-3 months of usage before the bladder wall returns to ‘close to normal’ and therefore using D-Mannose for IC or other forms of painful bladder syndrome is unlikely to be an overnight miracle. Even if symptoms do subside quickly, I would recommend continuing with a daily regime for at least a three month period, if not longer, to give the bladder wall a proper chance to fully renew.

Regarding how much to take, there is no set protocol. I am minded to think that less than the acute dosage and more than the maintenance dosage would be appropriate, though this is based on nothing but my own instinct and anecdotal findings. A teaspoon in the morning and another at night would perhaps be a good starting point, maybe incorporating a third dosage in the middle of the day if you felt things were not improving after a few weeks. There isn’t actually any danger from taking large doses and there are no side effects, though if you do take a lot (for example if you follow the acute treatment protocol for bacterial cystitis), you might get some digestive issues such as wind and diarrhoea. This is often an indication that your digestive health is not what it should be, rather than a fault of the D-Mannose itself. It can indicate a ‘leaky gut’ (see Point 5 of this post for more information) and can thus be a useful message that your digestive system needs some improving. As digestive issues often go hand in hand with chronic health problems, I recommend all IC sufferers spend some time Googling ‘leaky gut’!

As previously mentioned, D-Mannose is safe with all medications and can be used by everyone, even diabetics (though do monitor your blood sugar while using), children and people with candida. Therefore, while it by no means works for all cases of IC, the odds are favourable if you are prepared to stick with it for a few months and aside from the expense, you have nothing at all to lose in trying. There are lots of brands of D-Mannose available, but I recommend using a brand that has nothing added and that does not contain cranberry. The only brand I’ve ever tried, on account of it being used by one of my favourite nutritionists, Kathyrn Marsden, is Waterfall D-Mannose. I love the ethos of Sweet Cures, the company who manufacture it – their founder, Anna, has personal experience of recurrent UTIs – and I wouldn’t be without it in my medicine cabinet. I take the powder form sold here at Tiny Pioneer on a daily basis! A few weeks ago, I spoke to a customer who told me she had switched to a cheaper brand of D-Mannose, but had noticed symptoms starting to creep back. She said she will never deviate from Sweet Cures Waterfall D-Mannose again.

At tinypioneer.co.uk, we offer the plain, powdered form of Waterfall D-Mannose. However, it also comes in tablet form, in flat packs, and in lemon flavour, which I am keen to try at some stage! We offer it as a sort of ‘add on’ product – if you are here buying aloe capsules and paying for delivery anyway, it might be convenient to get a pot of D-Mannose at the same time. However, you should be aware that if you purchase D-Mannose directly from the Sweet Cures website, you get discount on multiple purchases and free first class delivery, so if you want several tubs, or are not buying other products from Tiny Pioneer, save yourselves some money and go to Sweet Cures instead!

Do bear in mind, as always, that I am not a doctor and the information here is not intended to constitute medical advice. Also bear in mind that supplements should only form part of a health management regime and you will experience best results if you also incorporate dietary and lifestyle changes. See previous blog posts Why I Don’t Rate the IC Diet, Tiny Tips for Dietary Approaches… and Tiny Tips for PGAD Flares for further reading.

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