Daily D-mannose should not be recommended to prevent future
episodes of clinically suspected urinary tract infections in women
by healthcare providers. This is the primary outcome of a
598-patient, peer-reviewed, randomized, double-blinded,
placebo-controlled study published in The Journal of the American
Medical Association (JAMA) on April 4th,
2024.
ATLANTA, June 18,
2024 /PRNewswire/ -- Urinary tract infections (UTIs)
are a pervasive issue, particularly among adult women, 50%-60% of
whom will endure at least one in their lifetime, prompting ongoing
research into effective prevention strategies. A recent
large-scale, multicenter study published in JAMA Internal
Medicine challenges the perceived efficacy of D-mannose, a
popular supplement touted for UTI prevention. This article delves
into the study's findings, its implications for clinical practice,
and the broader conversation about UTI management and the need to
seek and utilize more effective alternatives.
The Study and Its Findings
The UK study was conducted across several medical centers and
involved a demographic comprising 598 women with an average age of
58, both premenopausal and postmenopausal. Participants were
randomized to receive either D-mannose or a placebo daily. Despite
high adherence to the regimen, the primary outcome revealed that
D-mannose did not significantly reduce the incidence of recurrent
UTIs compared to placebo.
Key points from the study include:
- No Significant Reduction in UTI
Recurrence: The findings explicitly challenge the existing
perception of D-mannose's effectiveness in preventing recurrent
UTIs.
- Secondary Outcomes: Across both groups, there were no
significant differences in the duration of UTI symptoms, antibiotic
use, time to next UTI, the number of suspected UTIs, or UTI-related
hospital admissions.
- High Incidence Rate: Both the treatment and placebo
groups experienced high rates of recurrent UTIs, underscoring the
ongoing need for effective prophylactic measures.
Clinical Versus Microbiological Diagnosis
One of the study's critical aspects was its reliance on
clinically suspected UTIs rather than microbiological confirmation.
This approach highlights the real-world challenges in diagnosing
and managing recurrent UTIs in a primary care setting. Over 60% of
the clinical encounters involved urine cultures, which is
substantial for a trial of this nature but also points to potential
misclassification of up to 40% of UTIs in the study.
The frequent discrepancy between clinical symptoms and
microbiological findings complicates UTI diagnosis. Many women
experience asymptomatic bacterial colonization without UTI
symptoms, while others report symptoms that are not due to a
microbiological UTI. This conundrum often leads to the
overtreatment of asymptomatic bacteriuria, particularly in elderly
populations, where it should generally be left untreated unless
specific symptoms are present.
The Drawbacks of D-Mannose
Contrary to its widespread use, D-mannose has shown minimal data
supporting its efficacy and is not listed as a recommended option
for UTI management by the American Urological Association (AUA),
Society of Urodynamics Female Pelvic Medicine & Urogenital
Reconstruction (SUFU), and the American Urogynecologic Society
(AUGS).
Aside from its ineffectiveness in reducing UTI recurrence,
D-mannose may pose risks for certain populations. The supplement is
known to induce insulin secretion, which can be problematic for
individuals with diabetes or insulin resistance, including those
with prediabetes. This factor limits its use and raises concerns
regarding its overall safety and appropriateness as a prophylactic
treatment.
Conclusions and Future Directions
The study's meticulous design and comprehensive statistical
analysis provide a robust basis for its conclusions. With no
significant difference in UTI prevention between the D-mannose and
placebo groups, the findings are both sound and clinically
applicable, suggesting that D-mannose should not be recommended for
women with recurrent UTIs.
Wai Lee, MD, Director of Female
Pelvic Medicine and Reconstructive Surgery at the Smith Institute
for Urology at North Shore University Hospital at Northwell Health,
states, "This study reinforces our role as physicians to guide
patients away from costly supplements with little or no benefit,"
emphasizing the significance of steering patients towards
evidence-based solutions.
Further research is needed to explore other potentially
effective prophylactic measures that could better serve this
at-risk population, ideally focusing on strategies that align
closely with clinical evidence and patient safety.
Proven Non-Antibiotic Alternatives
D-mannose is a simple sugar that binds to sugar receptors
throughout the body and is mostly absorbed before ever reaching the
bladder. If it does reach the bladder, D-mannose only binds to one
of the appendages of the infection-causing bacteria: Type 1 pili
and not the P fimbriae, the primary causer of UTIs. This is an
important distinction, as the adhesion to the P fimbriae is the
initial step in causing a UTI, while Type 1 pili simply provokes an
inflammatory response prior to the UTI and a mild bacterial
anti-adhesion effect.
Proanthocyanidins (PAC) derived from 100% pure cranberry juice
extract have been shown to have the highest anti-adhesion
activity (AAA) by targeting E. coli and a broader spectrum of
uropathogenic bacteria that cause UTIs. By binding to both bacteria
appendages, P fimbriae and Type 1 pili, this highly soluble PAC
blunts the inflammatory response and aids in the removal of
infection-causing bacteria through the urine stream.
Dr. Lee states, "Unlike cranberry supplementation, which is a
grade C recommendation by the AUA/SUFU/AUGS recurrent UTI
guidelines, there is no consensus on D-mannose. In my practice, I
prefer a high-quality cranberry supplement rich in soluble PACs,
specifically Ellura."
Suzette Sutherland, MD, Director
of Female Urology at University of
Washington, attests to the transformative impact of Ellura
in her practice. "The data is just not there to support D-mannose
use for UTI prevention," Dr. Sutherland remarked. "There is plenty
of solid science and data behind the use of cranberry supplements
as long as they are designed to be potent enough – which means they
are made with 100% soluble cranberry juice–based PAC to effectively
control the bacteria that cause UTIs."
As healthcare professionals and researchers continue to advocate
for evidence-based solutions in UTI management, Ellura by Solv
Wellness stands out as the only cranberry compound on the market
today that delivers all the components needed for an effective
UTI-preventing supplement: 36mg of 100% cranberry juice–based
PAC for improved solubility (bioavailability) and AAA, leading to
enhanced effectiveness.
UTI sufferers deserve reliable and scientifically validated
approaches to prevent recurrent UTIs. Ellura by Solv Wellness is
backed by 21 clinical studies and has 19 traditional medicine
approvals worldwide.
Read more about Ellura's superior efficacy when compared to
D-mannose in this Journal of Dietary Supplements study
from May 28, 2024.
About Solv Wellness, LLC
Solv Wellness, LLC, delivers products backed by science for
often stigmatized pelvic health conditions. For too long, women's
needs at midlife and beyond have been underserved by the scientific
and healthcare communities, and as a result, many women often dread
much of what aging brings. Solv Wellness is committed to helping
bring clarity and confidence to women by providing meaningful
solutions, backed by science, to the issues women experience at
midlife and beyond. Solv Wellness is the company behind
Ellura®, Via™, and Māge™. Ellura is a clinically proven
UTI supplement for non-antibiotic management of recurrent urinary
tract infections. Via is an FDA authorized 510K nonhormonal vaginal moisturizer made with
the highest-quality ingredients that help replenish moisture where
women need it most. Māge is a state-of-the-art pre- and probiotic
supplement that helps support the entire female pelvic triangle:
the gut, vagina, and urinary tract.
For more information about Solv Wellness and its product
offerings, visit solvwellness.com.
For scientific data, dosing information, and more, please
visit hcp.solvwellness.com.
Contact Info:
Candice Mailman
Senior Marketing Manager
candice@solvwellness.com
+1 (609) 731-9649
Statements in this release have not been evaluated by the
FDA.
These products are not intended to diagnose, treat, cure, or
prevent any disease.
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