*Premise: this article refers to healthy subjects outside the context of cystitis or vaginal disorders.
It has always been said 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).
The urinary tract is frequently in contact with germs which often leads to a low germ count in the urine culture test (less than 1000 or 10,000 CFU/ml).
Medicine states that such a result cannot be considered a urinary infection in the pathological sense of the term; this low bacterial concentration can be effectively combated by 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 of the medical diagnosis, but that is below the pain threshold and, consequently, asymptomatic or not very symptomatic.
The action of D-Mannose
D-Mannose is a monosaccharide which is contained in small amounts in the skin of some berries or fruits; it can also be extracted, through several processes, from birch bark.
This active ingredient has a natural inhibitory action on the adhesion of the uropathogenic germs to the surface of the bladder mucosa.
This means that supplementation with D-Mannose reduce germs concentration in the bladder.
It is precisely this beneficial effect we need 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.
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 prophylactic long-term D-Mannose is to prefer over a “flash” intake facing an 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 an active therapeutic ingredient and that its use, by allowing a decrease of germs concentration, leads effectively 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 test to check the presence of residual bacteria
– if the urine culture test is negative, we can gradually reduce the intake, beeing careful to manage properly the characteristic signs of cystitis
How to take D-Mannose
D-Mannose should reach the bladder as quickly as possible to potentiate its effect.
For this reason, it is generally advisable (as far as possible) to take it:
– away from meals = 1 h before or 2 h after any food intake
– wait 1 hour without drinking, eating or urinating
– urinate 1 hour after the intake even in the absence of urination stimulus
*all these recommendations should be taken as an 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 the idea that the longer D-Mannose remains in the bladder, the more effective it will be!
Current available scientific data indicate that with an intake 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 the intake to expel D-Mannose and all the uropathogenic germs out of the bladder (refilling the bladder with a new contribution of D-Mannose).
A special warning to all Ausilium users -> to optimize the effects of this active ingredient, we should take the last dose of the night 1 hour before bedtime (with urination before going to sleep) and not before going to bed.