Meta Information
ID:d-mannose
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/dietary/water
Target name:
Adequate Hydration
Severity:
major
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The efficacy of D-Mannose relies on sufficient urine flow to flush out bacteria that have been prevented from adhering to the bladder wall. Dehydration severely compromises this primary mechanism of action.
Actionable advice:
Plenty of water and other fluids should be consumed throughout the day when taking D-Mannose.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
All three groups demonstrated some degree of UTI prevention. The antibiotic prophylaxis group showed the lowest rUTI incidence (mean 0.2 episodes/year, median 0), significantly lower than the increased hydration group (mean 1.08 episodes/year, median 1; p < 0.05). D-mannose showed intermediate efficacy (mean 0.32 episodes/year, median 0), trending toward significance compared to increased hydration.
Label source:
PubMed: International urology and nephrology (2026)
Source url:
Exact phrase from label:
The effect of D-mannose and D-glucose on bacteriuria due to Escherichia coli with mannose-sensitive adhesins was investigated in adult male Sprague-Dawley rats undergoing diuresis.
Label source:
PubMed: Urological research (1983)
Source url:
Exact phrase from label:
Moreover, the action of D-mannose takes place, even if inside the bladder, outside the epithelium on bacteria that have not yet invaded the urothelial tissue. Therefore, its mechanism of action is not directed to host structures but to structures (bacteria) external to the host's tissues.
Label source:
PubMed: Therapeutic innovation & regulatory science (2023)
Action type:
informational_none
Target id:
/condition/carbohydrate-metabolism-disorder
Target name:
Carbohydrate Metabolism Disorders
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Individuals with certain rare genetic conditions, such as Congenital Disorder of Glycosylation Type 1b (MPI-CDG), cannot properly metabolize D-Mannose, which can lead to severe adverse effects like hypoglycemia and protein-losing enteropathy.
Actionable advice:
D-Mannose should not be taken with a known genetic disorder of carbohydrate metabolism.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
the excessive mannose substitution in MPI-CDG can cause the accumulation of mannose 6-phosphate as described in the patient presenting seizures and stupor after intravenous infusion of mannose.
Label source:
Primary literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC7574589/
Action type:
avoid
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
D-Mannose is cleared from the body by the kidneys. Its safety in individuals with significant renal impairment has not been established, and there is a theoretical risk of accumulation or kidney strain with high, long-term doses.
Actionable advice:
It is important to consult a healthcare provider before using D-Mannose for those with known kidney disease.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In patients with ESRD, levels of the Kdn precursor mannose also increased, but within a normal range. Mannose ingestion by healthy volunteers raised the levels of urinary mannose and Kdn.
Label source:
PubMed: The Journal of clinical investigation (2021)
Source url:
Exact phrase from label:
Administration of AG elicited an increase in the excretion of D-mannose (P less than 0.0005), while D-mannose caused AG to appear in urine.
Label source:
PubMed: Pflugers Archiv : European journal of physiology (1992)
Source url:
Exact phrase from label:
On treatment, two patients developed severe portal hypertension, two developed venous thrombosis, and 1 displayed altered kidney function.
Label source:
PubMed: Journal of inherited metabolic disease (2020)
Action type:
informational_none
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The safety of D-Mannose supplementation during pregnancy has not been rigorously studied. Due to the lack of robust safety data, its use is not recommended without medical supervision.
Actionable advice:
D-Mannose is best avoided during pregnancy unless specifically directed by a healthcare provider.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
There isn't enough reliable information to know if d-mannose is safe to use when pregnant or breast-feeding.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if D-Mannose is excreted in breast milk or what effects it may have on a nursing infant. Its use is not recommended due to a lack of safety data.
Actionable advice:
D-Mannose is best avoided while breastfeeding unless directed by a healthcare provider.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
There isn't enough reliable information to know if d-mannose is safe to use when pregnant or breast-feeding.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/condition/sibo
Target name:
Small Intestinal Bacterial Overgrowth (SIBO)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
As a poorly absorbed sugar, D-Mannose can be fermented by bacteria in the small intestine, potentially exacerbating symptoms like bloating, gas, and abdominal pain in individuals with SIBO.
Actionable advice:
This is best used with caution or avoided in those with SIBO, as it may worsen symptoms.
Validation status:
validated_via_expert_review
Evidence tier:
tier_c
Evidence basis:
expert_review_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
SIBO (small intestinal bacterial overgrowth) is an imbalance of the microorganisms in your gut. Try to avoid overfeeding your bacteria with carbohydrates for a few weeks.
Label source:
Expert review: D-mannose is a poorly absorbed monosaccharide that can serve as a fermentable carbohydrate substrate for small intestinal bacteria; SIBO is characterized by increased bacterial fermentation of poorly absorbed sugars leading to gas, bloating, and GI symptoms.
Action type:
avoid
Target id:
/condition/diabetes-mellitus
Target name:
Diabetes Mellitus
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Although D-Mannose is poorly metabolized and most studies show no significant impact at standard doses, very high or chronic doses could theoretically affect blood glucose levels.
Actionable advice:
It is a good idea to check blood glucose levels, especially when starting D-Mannose or using doses higher than 2-3 grams per day.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
the authors state that there is insufficient research on D-mannose to recommend it safely for people with certain conditions, including diabetes, as it may lead to complications. In addition, they note that high D-mannose concentrations correlate with diabetes.
Label source:
Primary literature: https://www.medicalnewstoday.com/articles/d-mannose-and-diabetes
Action type:
monitor
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Theoretically, high doses of D-Mannose could affect blood sugar control, potentially requiring adjustments to the dosage of antidiabetic medications to maintain glycemic targets.
Actionable advice:
It is a good idea to check blood glucose when taking D-Mannose concurrently, and it is important to talk to a doctor if significant changes are noticed.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We have previously shown in large cohorts that elevated serum mannose levels are associated with future development of type 2 diabetes (T2D) and cardiovascular disease.
Label source:
PubMed: Metabolism: clinical and experimental (2020)
Source url:
Exact phrase from label:
The effects on insulin release of alpha-D-mannose and equilibrated D-mannose were studied in the isolated perfused rat pancreas. Although phosphomannose isomerase, in contrast to phosphoglucose isomerase, is stereospecific for beta-D-mannose-6-phosphate, the alpha anomer of D-mannose (2 mg/ml) was significantly more effective than equilibrated D-mannose in stimulating insulin release.
Label source:
PubMed: Endocrinologia japonica (1978)
Source url:
Exact phrase from label:
Glucose and mannose each promoted insulin synthesis and secretion. Mannose at 1,200 mg/dl produced synthesis-secretion coupling similar to glucose at 200 mg/dl.
Label source:
PubMed: Pancreas (1989)
Action type:
monitor
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
A single case report suggested a potential interaction with warfarin, but this is not well-established and the mechanism is unknown. The risk is considered theoretical and low.
Actionable advice:
This is best used with caution, and it is worth monitoring for any changes in bleeding or bruising when taken with anticoagulant medications.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The duration of action of a single dose of racemic warfarin is 2 to 5 days.
Label source:
Action type:
monitor
Target id:
/intervention/cranberry-extract
Target name:
Cranberry Extract
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Both D-Mannose and proanthocyanidins (PACs) from cranberry work via an anti-adhesion mechanism to prevent bacteria from sticking to the urinary tract walls, potentially offering a complementary effect.
Actionable advice:
Consider taking with cranberry extract for potentially enhanced urinary tract support.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CONCLUSION: The long-term ability of an association of cranberry, D-mannose, an innovative gelling complex, and the 2 microorganisms tested to significantly improve the uncomfortable symptoms reported by women with acute cystitis has been suggested.
Label source:
PubMed: Effectiveness of an association of a cranberry dry extract, D-mannose, and the two microorganisms Lactobacillus plantarum LP01 and Lactobacillus paracasei LPC09 in women affected by cystitis: a pilot study. (PMID 25291140)
Action type:
informational_none