A New Approach to Common Bladder Infections

By Professor W J Serfontein, MSC, PhD (LEIDEN).

Following a distinguished career in research and teaching, Professor Serfontein has now turned his attention to publishing. He is author and co-author of more than 70 publications and has also presented papers at several major international scientific congresses.

If you’ve ever had a urinary tract infection you’ll know how agonisingly painful it is, how it always happens at the most inconvenient time, and how it can seem to be ruining your life – not to mention your sex life. It can also lead to complications such as kidney infections and bladder scarring. Treatment with antibiotics is not the answer – they sort out the problem in the short term, but resistance rapidly builds up. What are natural alternatives?

Bladder infections (cystitis) are extremely common in the population at large, especially in women. It’s not uncommon for a woman to get cystitis every time she has sex, and many boys too suffer from some form of a bladder infection at least once a year. Routine treatment involves antibiotic and antimicrobial treatment, sometimes for prolonged periods of time. Treatment with these drugs has many undesirable side-effects and is not always effective in the long term because of re-infection as a result of the bacterial population in the gut, which in turn results from a sugar-laden diet.

The most common urinary pathogen is Escherichia coli, which is thought to cause up to 90% of bladder infections. E. coli is normally part of the intestinal flora, and not an inhabitant of the bladder and urinary tract. If it gets into these organs it multiplies, causing the well-known symptoms of recurring bladder infections. The cell walls of the bacteria are covered with finger-like projections, the tips of which are coated with glycoproteins (lectins) that enable the bacteria to attach to the wall of the bladder. The pathogens may gradually be washed away by the stream of urine, but often this does not happen fast enough to prevent symptoms.


Naturopaths have traditionally used cranberry extract (liquid or tablets) to treat cystitis. It was soon discovered that the active component in cranberry is D- mannose, a naturally occurring hexose sugar closely related to glucose. It appears that D-mannose prevents the pathogens from sticking to the bladder wall, thereby facilitating their removal from the bladder by the urine stream. Unlike glucose, D-mannose is not readily metabolised in the body, so when it is taken orally a large proportion of the dose is excreted in the urine, thus reaching the bladder where it is able to perform its function of assisting the body to eliminate the pathogens.

Washing away bacteria with the help of D-mannose-containing cranberry preparations is a better way to deal with bladder infections than treatment with antibiotics. Antibiotics not only eliminate unwanted pathogens but also kill many desirable micro-organisms in the gut – this is especially the case with long-term and often-repeated courses of antibiotics, which may lead to serious health problems.

Cranberry extract, however, is not the best possible source of D-mannose. E. coli is an acid-adaptive bacterium that creates its own acid environment in the urine. Cranberry also produces acids (hippuric acid), thus providing an optimal medium for the growth of the bacterium. Initially, cranberry improves the condition because of the presence of D-mannose in the extract, but many patients find that its beneficial effect decreases with time, and later on cranberry may even aggravate the condition because of the acid production.

Taking potassium citrate with the cranberry may improve the situation somewhat. Avoiding acid-producing nutrients such as unbuffered vitamin C, coffee, red meat, alcohol and other acidifying foods and alkalinising the urine with alkalinising foods and minerals (e.g. magnesium) may be of further benefit and make it possible to create conditions that are unfavourable for the growth of E. coli.


The above information indicates that avoiding cranberry could be an important step forward. Dr J Wright and others have shown that taking pure D-mannose instead of cranberry is the way to go. In this way, it’s possible to get much more of the active compound without the disadvantages associated with cranberry.

A product has recently been developed that takes the above considerations into account. It also contains other ingredients that have traditionally been used to treat bladder infections, such as uva ursi and cat’s claw extract. The presence of these ingredients ensures that the product will be active against other pathogens that may be involved, such as Proteus species (e.g. Proteus mirabilis) and Klebsiella. Although these are not responsible for bladder infections nearly as frequently as E. coli, which causes 90% of common bladder infections, they should be considered in resistant cases that do not respond well to conventional treatment.

For further information on bladder infections, in general, go to https://web.archive.org/web/20120104015249/http://www.cystitis-cystitis.com:80/e-coli-cranberry.htm For more information on the product referred to above phone 012 811 0432.