This article refers to healthy subjects outside the context of cystitis or vaginal disorder.
It has always been accepted that urine (and more generally the urinary system consisting of bladder and urethra) constitutes a “sterile” environment. This scientific information, currently much discussed and subject of many debates in the scientific community, remains valid until today (until proven otherwise).
However, the urinary tract, with no doubt, is frequently in contact with germs which often leads to low germ count urine (less than 1000 or 10,000 CFU/ml).
Medicine states that such a count cannot be considered a urinary infection in the pathological sense of the term; this low bacterial concentration will be effectively combated with our physiological immunological defenses (leukocytes and flora).
Similarly, it is assumed that the typical pain symptoms of acute cystitis (bladder heaviness, lower abdomen pain, painful urination, urinary frequency and urgency) is directly related to germs number.
Therefore, it is quite possible to have a bacterial presence in the bladder that is higher than the established thresholds for the medical diagnosis, but that is below the pain threshold and, consequently, asymptomatic or not very symptomatic.
D-Mannose is a monosaccharide, contained in small amounts in the skin of some berries or fruits; it is also extracted, through several processes, from birch bark.
This active ingredient naturally has an inhibitory action on the adhesion of the uropathogenic germs to the surface of the bladder mucosa.
This means that supplementation with D-Mannose will have the main effect of reducing the germs concentration in the bladder.
It is precisely this beneficial effect that we seek to obtain in case of recurrent cystitis to avoid the systematic intake of antibiotics and their side effects that predispose to recurrence and worsen the overall situation of the urogenital area.
It is obvious that the amount of D-Mannose must adapt to the number of germs to be a fair fight.
However, its relevance is higher in case of chronicity (moderate bacterial concentrations) rather than in the event of acute episode (when germs count explode). For this reason, taking long-term D-mannose in prophylactic form is to be preferred over a “flash” one at the time of the acute episode.
In case of recurrent cystitis with prolonged intake of D-Mannose, the other side of the coin for its effectiveness, is the disappearance of the painful symptomatology despite the persistence of a germs number higher than the “diagnostic standards” set by the urological recommendations in force.
This means that D-Mannose is in fact an active therapeutic ingredient and that its use, by allowing a decrease of germs concentration, effectively leads to the infection eradication (“cure”). Still to achieve this effect, D-Mannose intake should not be interrupted as soon as the symptoms disappear and should last a few weeks or a few months despite the absence of symptoms (acute or latent).
A special warning to all Ausilium users -> before reducing or stopping the intake, it is recommended to proceed this way:
– make a urine culture to rule out the presence of residual bacteria
– if the urine culture is negative, gradually reduce the intake and be careful to manage properly the characteristic signs of cystitis
How to take D-Mannose
To potentiate the effect, D-Mannose should be taken in order to reach the bladder as quickly as possible.
For this reason, it is generally advisable (as far as possible) to take D-Mannose:
– away from meals = 1 h before or 2 h after any food intake
– wait 1 hour before drinking, eating or urinating
– urinate 1 hour after the intake even in the absence of urination stimulus
Of course, all these recommendations should be taken as advice according to the realistic possibilities (“coefficient of flexibility”).
The last point of these recommendations still deserves to be explained.
In fact, this advice is contrasting to the idea that the longer D-Mannose remains in the bladder, the more effective it will be!
In fact, currently available scientific data indicate that for a dose of D-Mannose from 500 mg to 1 g, the maximum concentration of this active ingredient in the bladder will be reached after one hour.
Under these conditions, it seems more appropriate to urinate 1 hour after taking D-Mannose to expel D-Mannose/uropathogenic germ union out of the bladder (allowing the bladder to refill with a new contribution of still “free” D-Mannose to then join the germs).
A special warning to all Ausilium users -> to optimize the effects of this active ingredient, you should take the last dose of the night 1 hour before bedtime (with urination before going to sleep) and not only before going to bed.