Swellness is a monthlong series exploring the health and wellness stuff no one talks about.
I suffered my first urinary tract infection in college. I’d gone to religious schools in Florida and we didn’t get any sex ed, so I had no idea you could get an infection from intercourse. I just knew it hurt to pee. Whimperingly, I used my pink flip phone to call my best friend, who told me, “Relax. You probably have a UTI.”
In the U.S. and worldwide, UTIs are the most common outpatient infection: Women are up to 30 times more likely than men to get them, and 75 to 95 percent of uncomplicated UTIs are caused by E. coli. UTIs happen when the bacteria enters the 1.5-inch-long bucatini-like urethra, the opening of which is located just south of the clitoris.
My friend was right — and so began years of UTIs. I’d get them every couple months. It did not matter that I jumped up to go pee post-coitus. (Nor did it matter that I wiped front to back after emptying my bladder, as back-to-front wiping does not, in fact, lead to more UTIs.) My recurrent fate was to sip cranberry juice, swallow amoxicillin, and ask for an antifungal (because antibiotics typically cause yeast infections in turn). This — in the words of another girlfriend with much the same experience — is a “super common but secret hell.”
After a urologist confirmed that there was no apparent reason why I should be getting UTIs, I was given a script for antibiotics to fill and have on hand for the inevitable next one — and that was my M.O. until I was 26. That spring, I was in Amsterdam with a new beau: I was in a lot of pain and out of pills. The health-food shop that I walked into smelled of various medical-grade herbs, and the two gray-haired women who worked there seemed to have command of them all. “Witches!” I gushed when I returned to my boyfriend’s. They’d given me a bottle of D-Mannose, a simple sugar molecule, they explained, that is found in some fruits like apples and that bounces E. coli from the urinary tract. I was to take three capsules (500 mg each) three times a day for three days with loads of water, and then taper off until I felt fine.
Amazingly, and soon, the UTI went away. Antibiotics, I realized, weren’t always best practice — particularly when drug-resistant UTIs have become such a problem. I started taking D-Mannose after sex or if I felt a UTI brewing, and nine years later, I still gulp down D-Mannose whenever I’m feeling UTI-ish.
D-Mannose isn’t exclusive to the Dutch; it’s a go-to in Paris, where I live now. You can buy it at the pharmacy in packages of pink powder sold as Femannose. The supplement is also readily available in the U.S. at Whole Foods and health-food shops, as a powder, capsules, or tablets — it’s just not as familiar. (D-Mannose is often combined with extract of cranberry and probiotics, which have their own science-backed strengths.) “After you told me about it, I immediately went and bought some on Amazon,” a friend reported back, “and it totally worked for me.”
It’s not a given: After a protagonist on Amazon’s teen drama The Wilds name-dropped Uqora — a D-Mannose-powered regimen — Dais Johnston, a staff writer for Inverse, which covers science, tech, and culture, tried it to no avail; only antibiotics resolved her “super aggressive chronic UTI problem,” she said.
“D-Mannose works amazingly for some people but isn’t effective for others,” says Dr. Ashley Winter, a top board-certified urologist. It is among the recourses she discusses with patients, and she encourages people to try it as a preventative or perhaps as a treatment because, she says, it is “very low risk.” There are minimal to no side effects, and it does not promote drug resistance, she added. Just don’t let a UTI progress. After all, a non–E. coli bacteria that D-Mannose can’t help with may be responsible, or there may be a deeper issue, Dr. Winter says, such as kidney stones embedded with bacteria or, in the case of older men, an enlarged prostate preventing them from fully emptying their bladders.
For peri- and postmenopausal women, another complicating factor that is often overlooked is vaginal health: “Vaginal health is extremely important for UTI prevention, but it’s never phrased that way,” Dr. Winter says, explaining that the vagina’s microbiome changes when estrogen drops off during menopause — resulting in far less protection against UTIs. (Dr. Winter is the chief medical officer at Odela, an online clinic that provides low-dose prescription vaginal estrogen cream.) Estrogen also dips after ovulation, which is when I tend to feel UTI-ish and reach for my fruit-sugar friend.
Dr. Angelish Kumar, also a top board-certified urologist — who runs Women’s Urology New York — says that fighting UTIs is “often a multi-prong strategy”: “I recommend D-Mannose to my patients. There is early clinical evidence — and there’s intuitive evidence as well that it works.”
Despite its apparent efficacy across demographics, there isn’t much incentive in the U.S. to put supplements through robust trials. “Because of that, D-Mannose is going to remain under-recommended,” says Dr. Winter. “There’s also a lot of dishonesty in the supplement industry here,” adds Dr. Kumar, “so it’s hard to make sure that whatever’s being marketed is what you’re actually getting.” Her patients have reported good results with D-Mannose from the brand NOW, which is the brand I’ve always used Stateside. (NOW’s analytical tests are performed by fully accredited in-house labs with third-party certification.)
It pisses me off to recall the years of costly urgent visits to the doc for antibiotics for my UTIs, and so I’ll continue to sing D-Mannose’s praises as a potential potion for others. When these things work, says Dr. Kumar, “you should use all the tricks in your bag.”
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