Indications

D Mannose SAP provides therapeutic dosages of both D mannose and cranberry extract, both known E. coli adhesion inhibitors in the genitourinary tract. D Mannose SAP may be effective for the treatment of acute E. coli urinary tract infections and for the prevention of recurrent urinary tract infections.

Ingredients

Each teaspoon of D Mannose SAP contains:
Medicinal ingredient:
Cranberry concentrate ... 400 mg

Non-medicinal ingredient:
D-mannose ... 4600 mg

Contains no: Preservatives, artificial flavour or colour, sugar, dairy, starch,
wheat, gluten, soy, corn or yeast

Description

Annually, urinary tract infections (UTIs) are responsible for more than 11 million physician visits in the United States. Although normally a commensal inhabitant of the intestinal and gastrointestinal tract of humans, E. coli is the most common urinary tract pathogen, whose overgrowth and over-colonization accounts for 85% of UTIs. Cranberries have been used as a medicinal agent for centuries to promote health, but recently the scientific literature has proven that proanthocyanidins, contained in cranberries, as well as a simple sugar, D mannose, specifically inhibit the adhesion and proliferation of E. coli in the urinary tract. Cranberry extracts and D mannose each independently inhibit one of two adhesion methods utilized by E. coli. Combined together in a synergistic and novel formula, D Mannose SAP addresses both Type 1 (FimH) and P Type fimbrial-mediated adhesion by E. coli to the urinary tract mucosa. D Mannose SAP is specifically targeted for the treatment and prevention of E. coli UTI.

PURITY, CLEANLINESS AND STABILITY Third party testing on finished product to ensure D Mannose SAP is free of heavy metals, pesticides, volatile organics and other impurities.

URINARY TRACT INFECTIONS (UTIs) AND E. COLI Urinary tract infection is defined by the presence of microorganisms in the urinary tract, including the bladder, prostate, urinary collecting system and the kidneys. Annually, UTIs are responsible for more than 11 million physician visits in the United States. The most common urinary pathogen, whose overgrowth and over colonization accounts for 85% of UTIs, is Escherichia coli (E. coli).(1, 2) UTIs have a high resistance to first-line antibiotic therapies, and treatment with antibiotics is associated with side effects such as nausea, diarrhea, Candida infections and dysbiosis.(3) UTIs are approximately 50 times more prevalent in the adult female population, but may occur in men and children. It is estimated that 30% of women will experience at least a single UTI during their lifetime, and of these women, 25% will experience frequent and recurrence infections. Women are more susceptible to UTIs due to a shorter urethra that allows for more ready colonization and ascension to the bladder. Pregnancy, sexual activity, aging and the use of medical devices (i.e. catheters) increase the risk and severity of UTIs. Symptoms of UTI include increased frequency and urgency of urination, cloudy urine, painful urination and lower back pain.(4, 5)

MECHANISM OF ACTION The bacterial cell wall of E. coli includes protein-like fibers called fimbriae, which readily attach to uroepithelial cells. Adhesion is the first and most critical step to colonization by E. coli and subsequent development of UTI. Proanthocyanidins and fructose, found in high concentrations in cranberry extract, in addition to D mannose, competitively inhibit uroepithelial adhesion by E. coli fimbriae. E. coli fimbriae produce two fimbrial receptor proteins: Type 1 fimbriae receptors are considered mannose-sensitive, and P Type fimbriae receptors are considered mannose-resistant.(6, 7) By inhibiting adhesion, cranberry extract and D mannose are both effective at increasing urinary excretion of E. coli. Cranberry extracts have been shown in studies to effectively inhibit P type E. coli fimbriae within 2–10 hours of ingestion. D mannose, and fructose, a sugar found in cranberry extracts, specifically inhibit Type 1 fimbrial receptors (specifically a protein called FimH),(8, 9) while proanthocyanidins from cranberry extracts specifically target P type receptors.(10)

CRANBERRY AND D MANNOSE RESEARCH Multiple randomized intervention trials have observed a clinical benefit of cranberry products in preventing UTI.(11, 12, 13, 14) These findings include reported reduction of urinary bacteria and discharges following cranberry juice intake. Increased intake of cranberry products has also been associated with a decrease risk of UTI.(15) D mannose has been proven to not only block bacterial adhesion on uroepithelial cells, but also antagonize invasion and biofilm formation, effectively inhibiting the colonization of bacteria on the mucosal surfaces of the genito-urinary tract.(16, 17)

Dose

For acute UTI: 1 teaspoon (5 g) dissolved in water three times daily for two days;
followed by 1 teaspoon per day for four days.
For UTI Prevention: 1 teaspoon dissolved in water per day.

Potential side effects/Safety

Intake of cranberries and D mannose is considered
safe. High intakes of cranberry extracts or juices may
have laxative effect. Cranberries contain moderately
high levels of oxalates, and Terris, et al. reported
that patients at risk of nephrolithiasis should avoid
dietary supplementation of cranberries.(18) In 2004,
the Committee for Safety of Medicines warned health
professionals about the possibility of interaction
between warfarin and cranberry juice,(19) though little
clinical evidence or literature exist to corroborate this.
Caution is advised for the use of cranberry-containing
products with concurrent warfarin use.

References

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1. Nutr 2000;16:684-7.
2. JAMA 2002;287:3082-3.
3. Age Aging 2000;29:9-12.
4. Cochrane Database Syst Rev 2004;54:173-181.
5. Lancet 1999;353:7-8.
6. Crit Rev Food SciNutr 2002;42:273-8.
7. Phytochem 2000;54:173-81.
8. Infection and Immunity 1990;58(6):1995-8.
9. J Med Chem 2010;53:4779-92.
10. CID 2004;38:1413-9.
11. Can J Uro 2002;9-1558-62.
12. J Fam Fact 1997;45:167-8.
13. BMJ 2001;322:1571-3.
14. JAMA 1994;271:751-4.
15. Epidemiol 1995;6:162-8.
16. PLoS ONE 2008;3(4):e2040
17. MolecMicrobio 2005;55(2):441-55.
18. Urology 2001;57:26-9.
19. CurrProbPharmacov 2003;29:8.