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Cystitis Treatment Methods - Fighting Cystitis & UTIs with Waterfall D-Mannose®

Cystitis treatment methods

Waterfall D-Mannose seems to be most successful when a good level of mannose has been achieved in the urine. If you don't have access to a nutritionist who is an expert on the use of the product, these guidelines may help.
It's clearly important to know the best way to take Waterfall D-Mannose for your own case, so please read this page.

Treating an Established Infection with Waterfall D-Mannose


1. Immediately: 1 heaped teaspoonful. (2 - 3 grams worth of the tablets...)

2. After 1 hour: Another heaped teaspoonful.

3. 2 to 3 hours later: Level teaspoonful.

4. Every 3 hours for first 2 days: Level teaspoonful.

5. Day 3 assuming symptoms have abated, Level teaspoonful every 6 hours.

6. Day 4 onwards, reduce to 1 or two level teaspoonfuls until you have finished the 50g pack.

7. It's a mistake to stop taking the product too soon - you don't want to give any bacteria the chance to lurk around and get the infection going again.


At first onset of symptoms, or as soon as possible, take a heaped teaspoonful of Waterfall D-Mannose in a cup of tea or fruit juice (apple, lemon, or pineapple, not cranberry or orange).

Repeat the above, then take a level teaspoon of Waterfall D-Mannose every three hours when awake for the first two to three days of treatment. (If you have a raging infection you may need to also take a dose during the night.) Then gradually reduce the dosage to three times a day or less until you have finished the first pack.

Some people have taken a spoonful an hour until symptoms have eased off.

Taking the product with a single tumbler of water (about 150 - 200ml or a third of a pint) allows a good concentration of mannose to build up in the urine. Customers say they get better results when they don't drink anymore and don't urinate during that hour after taking the product.

Then, an hour later, take another heaped teaspoonful. Immediately drink some more tea, water or juice to help get rid of any bacteria that are in the urine.

One of the most common mistakes is to drink too much with the Waterfall D-Mannose, preventing it from ever achieving a high concentration in the urine. So bear in mind that the object is to achieve a high enough concentration of Waterfall D-Mannose in the urine.

The next most common mistake is not drinking enough! It's important to get enough liquid into you to allow the product to be absorbed. Your body absorbs glyconutrients using water to allow them to be transported through your gut. Take a glass of water with the product, not just a spoonful!

Try to keep the urine alkaline rather than acidic. We believe that acidic urine usually makes the situation worse, for a number of reasons. Our customers often test their urine and give us feedback - the ones with acid urine say that it is harder to beat the problem - the ones who keep their urine alkaline are usually saying they get fast results. And invariably, people who have been taking cranberry have said it hasn't stopped the problem, or has made it worse.
If you have been infected with E.coli, you may notice a strong smell in your urine initially. This could be because of the bacteria being flushed away.

Maintenance Dose Levels

Waterfall D-Mannose appears to work best to prevent new infections arising when taken regularly. Some people take a spoonful before bed - others take it in the morning also. It's probably best to experiment and find out what works for you according to your own propensity for infection, and also on the health of your immune system.

We have talked to a lot of customers now, and our experience tells us that if you have only ever had one bad case of cystitis, and it is completely gone, you may not need to take the product every day. If on the other hand, you tend to get a lot of cystitis, you may need to take the product once or twice a day for 3 months or more to reduce or eliminate that propensity for cystitis.

Typically, it takes a 50g pot of the product for a simple infection. After that, we suggest using another tub over the next month, at one level teaspoonful before bed, or first thing in the morning (depending on whether you tend to wake up with infections, or they happen during the day.)

The effect of the product does appear to be dose-related. If you have a high propensity for cystitis, it is likely to take more of the product to keep infections at bay for you than it would for someone who only gets it occasionally.

Using Waterfall D-Mannose for Prevention

The preventative measure varies according to your propensity for infection... You'll probably find what suits you best through trial and error. These are suggestions.

Suggested maintenance regime for first 3 months:

  • Occasional sufferers (every few months) - 1 level teaspoon a day.

  • Regular sufferers (every few weeks) - 2 - 3 heaped teaspoons a day.

  • Interstitial cystitis and Painful Bladder Syndrome sufferers: 2 - 3 heaped teaspoons a day.

  • Catheterising and indwelling catheter sufferers: 3 - 6 level teaspoons a day. Use more around fresh catheter fitting. See catheterisation

  • Cystitis related to sexual activity only: 1 level to heaped teaspoonful an hour before sex. Don't urinate until after sex. Then take another level teaspoon of Waterfall D-Mannose . The following morning take another. Timing is important. It takes an hour for 90% of the d-mannose you take to get into your urine, so if you don't follow the regime properly, for at least the first 3 months of treatment, an infection is likely to start. After 3 months (approx) with no infection, it is usually safe to be a little more daring, and occasionally just take the product after sex. But on the whole, be careful!

Episodes related to Sex

Suggested routine:

  • Take 1 level to heaped teaspoonful of Waterfall D-Mannose one hour before sexual activity.

  • It is important to get the timing right - better to lose a bit of spontaneity than get an infection.

  • Don't urinate until afterwards.

  • Immediately afterwards, go and urinate and take another teaspoonful of the product.

  • The following day, if your typical attacks tend to happen 18 to 24 hours after sex (common) take a level teaspoonful every six hours.

  • If despite this, you feel an attack of cystitis beginning, take a heaped teaspoonful immediately, then another one an hour later. Usually this will stop an attack in its tracks. If not, go on to the normal dose of a level teaspoonful every three hours until symptoms abate, then reduce to half that dose for the next day or two until you are sure you are totally clear.

  • Keep up the normal hygiene standards.

  • After using Waterfall D-Mannose like this for a few months, you may occasionally risk sex without taking the product beforehand. However, if you do this, best to take some extra afterwards.

  • Gradually, you should be able to return to a normal sex life.

Men: Waterfall D-Mannose appears to work as well for men as for women, but infections after sex are less of a problem for men. However, men with a propensity for cystitis will probably find it beneficial to urinate after sex.
Men with normal healthy bladders usually won't need to take Waterfall D-Mannose as a preventative as often as women. Some just take it when the feel the symptoms coming on. Others take a couple of measures a week. We suggest trial and error.

Note: Cystitis problems in men may be an indication of a prostate condition, so you should never just self-treat the condition unless you've been thoroughly checked out by a doctor and you know you are dealing with a simple bacterial infection. However, Waterfall D-Mannose won't harm you, so it is safe to take while you are waiting for an appointment. If it clears up your problem meanwhile, that's a bonus.

Stopping spontaneous attacks of cystitis in their tracks

Suggested approach: When you feel an attack of cystitis beginning, take a heaped teaspoonful immediately, then another one an hour later. Usually we have found that this will stop an attack in its tracks. If not, go on to the normal dose of a level teaspoonful every three hours until symptoms abate, then reduce to half that dose for the next day or two until you are sure you are totally clear. Finish the pack to try to give your bladder a good clean out.

Frequency of Using Waterfall D-Mannose

For people with a real propensity for cystitis, Waterfall D-Mannose can be taken as frequently as required. There are no known side-effects apart from diahorrhea if you take too much, as with all sugars. However, it is worth noting new research that shows that sperm attach to the egg in the same way that E.coli attaches to tissue cells - using mannose receptors. So if you are a woman taking Waterfall D-Mannose regularly, you may prevent pregnancy. This could be a downside or an upside, obviously depending on whether you want to achieve pregnancy or not.
However, the research is sketchy, and normal use means that the Waterfall D-Mannose you take is probably completely out of your system within four hours, so any contraceptive effect must be very temporary. And you don't get pregnant when you are having sex. It usually takes from 12 to 36 hours for the sperm and the egg to get acquainted. So you could be standing in a bus queue or using the photocopier at work when you conceive.

The Propensity for Infection Diminishes

When you take Waterfall D-Mannose on a regular basis, it has become very clear to us from the hugely positive feedback of our customers, that the propensity for cystitis and related infections gradually diminishes. There appear to be a number of reasons for this, and they complement each other:

The immune system is likely to regain its capabilities as you no longer require regular doses of antibiotics.

  • Waterfall D-Mannose seems to gradually impoverish bacterial colonies that can be living behind biofilms in your bladder, protected from antibiotic attack. As the bacteria release their pods, (perhaps during or after stimulation due to sex) if you have Waterfall D-Mannose in your urine, it may lock up the bacteria before they get a chance to reinforce their colonies.

  • As previously mentioned, the attachment of bacteria to mannose appears to be bio-molecular. That being true, the only way E.coli, Klebsiella, and similar bacteria, logically, can resist attachment to the free mannose in the urine, is by not having the lectins that attach to the mannose - and by not having these lectins they would not be able to attach to the lining of the bladder. So unlike when you use antibiotics, the natural variation and evolution of E.coli works in your favour.

  • By taking Waterfall D-Mannose as a preventative, fresh infections are less likely to get the chance to become established. In practice, we find it's unusual for a customer to come back to us and say they've been taking the product regularly when a fresh infection arose. You either decide to take a prophylactic measure regularly or just take some Waterfall D-Mannose immediately you feel the symptoms coming on. You should soon be able to get complete control of the problem.

Pregnant Women, Children, Babies, and Pets

Waterfall D-Mannose is a glyconutrient, (a rare but simple sugar) not a toxin, so is much safer to use than any known antibiotics.

For children, babies, and pets, the dose should be adjusted according to proportion of adult human weight, and the amount of fluids they drink.

As a glyconutrient, Waterfall D-Mannose will cross the placental barrier, but is most unlikely to cause any damage to the unborn child, just as a spoonful of sugar would not. In fact research shows that the unborn baby needs d-mannose for normal development. (You produce a certain amount naturally anyway). However, if you are pregnant we strongly recommend that you consult a medical professional before taking the product.

But what about that one study from 1985...

The only research [J Clin Invest. 1985 June; 75(6): 1927®1934. Fuel-mediated teratogenesis. Use of D-mannose to modify organogenesis in the rat embryo in vivo. T Buchanan, N Freinkel, N J Lewis, B E Metzger, and S Akazawa] showing any negative effect on the embryo was, as the title suggests, a study of what happens when you deny embryos fuel. It was based on stuffing mother rats with huge amounts of d-mannose (not Waterfall D-Mannose) (at over 1000 times the weight equivalent human dose) every hour for 24 - 36 hours as a deliberate effort to interfere with the embryonic nutrient absorbtion. You don't burn d-mannose as fuel, so basically they were starving the embryos. A small human of 50kg would have to take 54 x 50g packs at one sitting, (more than most people will use in 3 years) then 312 x 50g packs over the next 24 - 36 hours (more than most people will use in 18 years) to ingest the same amount of d-mannose per kilo of body weight. A small number of the embryos deprived of normal nutrients during the study did develop problems - but basically, the study showed that d-mannose is the safest of all sugars because all the mother rats survived with no observed side effects.

Problem/Special Cases

What we've found out about problem cases:

When you have an E.coli infection, and you achieve a high concentration of Waterfall D-Mannose in the urine, overwhelmingly positive feedback to us suggests that you will generally have no problem getting rid of the infection.
However, a few conditions can make it more difficult to achieve that high concentration in the urine. People who have a condition such as Celiac disease, Chrohn's disease, or Whipple's disease, inflammation of the lining of the small intestine, or an infection with a parasite such as Giardiasis or Hookworm, have problems absorbing nutrients from food. Very high levels of intestinal bacteria (especially E.coli or Salmonella) may also reduce the amount that gets into the urine. In this case, it seems logical that the D-Mannose would still be working, but by attaching to the intestinal bacteria instead of to the urinary tract bacteria.

The solution in these cases would appear to be to either increase the dose levels or frequency or both.
On the other hand, people with Hodgkin's disease, or Scleroderma or similar, may have enhanced nutrient absorbtion ability and may need to take less Waterfall D-Mannose to achieve the same effect.

Urethral Infections

A suggested way ahead:

For purely urethralinfections, it can take longer to get rid of infections because, logically, the Waterfall D-Mannose in the urine doesn't get long enough to be in contact with the urethra. To make it work better, you might want to try the method doctors recommend to get a clean mid-stream urine sample (break the flow to flush clean the urethra). So if you want to give that a go, you could use clean fingers to hold some urine in your urethra when you are almost finished urinating and there isn't a lot of pressure behind the flow. Count to 60, and let go. You could to do this each time you urinate with Waterfall D-Mannose in your system. This would perhaps allow the Waterfall D-Mannose time to detach the bacteria from your urethral wall. Customers tell us it takes up to seven days to clear urethral symptoms, but they often start to feel relief after a day or so.

At first, you may find it uncomfortable to use this method, but most people find it is only uncomfortable the first few times.

It's no use using 'bladder control' to stop the flow - your urethra would not be full of urine - you need to stop it from the outside...

If your symptoms do not go away quickly, you should go back to your doctor. Remember that cystitis-like symptoms can be caused by other problems such as blockages, bladder stones, prostate problems, failing kidneys, STDs and virus and fungal infections.

Fighting Kidney Infections

E.coli related kidney infections are difficult to get rid of with normal dose levels of Waterfall D-Mannose. If you do decide to attempt to go down this alternative route, you should have your prescribed antibiotics at hand in case it doesn't work. First take your doctor's advice.

A customer told us that she was successful at fighting an antibiotic-resistant kidney infection using the following method:

She took two to three heaped teaspoonfuls of Waterfall D-Mannose every two to three hours for about 15 hours. At the end of that day the pain in her kidneys had totally disappeared, and she then went on to normal dose levels of Waterfall D-mannose for a few days.

[Also note that, as with most glyconutrients, taking Waterfall D-Mannose at much higher than usual dose levels (and especially combined with the aloe vera and garlic) is likely to have a drastic laxative effect. Don't stray far from a toilet!]
During that first day she drank about 4 litres...

In between doses, she took 2 cloves of garlic blended in apple juice. We suggest it's best to use fresh garlic - customers have tried the garlic pearlies and powders - and said they don't work to help clear kidney infections! Preferably use organic garlic. We prefer nature's way...

She also took a glass of strong Aloe Vera juice (botanical name Aloƫ Barbadensis Miller) every three hours. Best to use fresh Aloe Vera plant leaf if you have that plant, or can get it. It is often stocked by local garden centres. The way to do it is to snip off a leaf of Aloe Vera at the base, wash it well, and liquidise it in a blender with about 3/4 pint of apple juice. This will provide you with 2 glasses of Aloe Vera. The juice you buy at health food shops is not nearly as strong as this method of production. Also, the pre-prepared juice has lost many of the active ingredients. But use it if you must - just take more. Back to the liquidising... Smaller leaves can be liquidised whole, but with larger leaves, bigger than 15 inches long, or older plants, it is best to squeeze out the gel from the leaf, and discard the rest. The bigger ones (if they have yellow veins in them) can make you feel ill, or cause diarrhoea, if you take them whole.
We've had varied feedback on this - it could make you feel ill, and it will definitely make your breath vampire-repellent for days, but on the whole our feedback suggests that taking this treatment has a reasonable chance of clearing up bacterial origin kidney infections. Since unfortunately it doesn't work for everyone, sometimes you will do all of this and it will not be successful and you'll end up having to take the antibiotics anyway.

Our own view is that it is probably better to try the antibiotics first for kidney infections, and if they don't work, consider the Waterfall D-Mannose treatment. In the end, it has to be your choice. Remember that you should consult your doctor on any important health matters. You should consult a qualified medical herbalist for proper guidance on taking any herb such as Aloe Vera. Remember also that if your kidneys are in trouble, you can overload them by drinking too much fluid.

Interstitial Cystitis - a way forward

Our experience has shown us that Waterfall D-Mannose is not effective against every type of interstitial cystitis. However, it does seem to work for some people. Interstitial cystitis can have many causes, one of which is related to previous infections, and although the urine can be clear, there can be remnants of E.coli bio-molecularly attached, though dead, to cells of the bladder, or buried in the walls of the bladder.

Originally, we were very doubtful whether the product would work for interstitial cystitis at all but the results the product is achieving have helped change our minds on this subject. That said, the mechanism of how d-mannose works on interstitial cystitis is not clearly understood. It's hard to believe that something so simple as pure Waterfall D-Mannose can solve a problem when medical science, experience, and expertise have all failed to provide a satisfactory or lasting solution.

The mechanism remains uncertain, but the bio-molecular attraction of the E.coli lectins for mannose may tell part, or even most of the story. And logically, the E.coli don't have to be whole, or still alive for that bio-molecular attraction and attachment to take place. What we would say is that it is well worth trying Waterfall D-Mannose for this condition, and it certainly can't do any harm. It is not always a fast fix for sufferers of interstitial cystitis, but as part of a long term strategy it won't do any harm and may just surprise you.

We've had some people with interstitial cystitis say Waterfall D-Mannose is the only thing that has brought them relief after many years of suffering. One customer has made it very clear that Waterfall D-Mannose is the only reason he has not killed himself. That's a bit too intense for us - we don't want our product to mean life or death. What if we missed a post or something?

But it really saddens us when it doesn't work for everyone - it's not a panacea.
Other sufferers have told us that the relief with Waterfall D-Mannose was almost immediate, which leads us to suspect that they may have been wrongly diagnosed with interstitial cystitis, and probably had a low level of infection, which was causing the pain, but was not considered enough of an infection to treat with antibiotics.
Labs often do not consider you to have an infection if a urine test shows you to have less than less than 10,000 E.coli per cubic millilitre. However, E.coli can double their colony size every 20 minutes in the right conditions (for example if you have conditioned them with cranberry).

The other option to explain the relief is the possible cleansing effect of Waterfall D-Mannose on the bladder, combined with the d-mannose known anti-inflammatory properties*. After taking the product for 2 to 3 months, most bladders are very close to being completely back to normal, whether the problem has been bacterial or interstitial.
* from "Mannose stimulates fibroblasts to make more collagen and proteoglycans, which means that healing is speeded up, pain is lessened, and skin integrity returns to normal faster. Mannose also works to correct over-active neutrophils (T cells) that cause misguided inflammation. Researchers in Australia have confirmed this action. "

We got this message from a sufferer:

"I've had interstitial cystitis for nine years, with all the worst of the symptoms. I've never heard of anyone who had it as bad as me. I had all of this incredible pain and it got to the point where I couldn't even go out of the house. I was on permanent antibiotics for ages, but they didn't seem to do any good, and I've been probed, prodded, stretched, injected, and flushed out (agonising) so many times that it got to the point where I was living in permanent agony. Anyway, my doctor referred me to a new consultant, and after a look through my notes, he casually said, 'I think the best thing we can do is whip your bladder out.' I was appalled, and just ran out of the office crying. When I got home, I started searching online, and found your wonderful product. I was sceptical, because I've tried so many different remedies before, but when you've got so much pain, you are willing to try anything. I couldn't believe it! Within a couple of hours of starting with Waterfall D-Mannose, I realised that the pain was disappearing. By the third day, I felt better than I've felt in years. Now I get the occasional bad day when I have to take heaps of the sweet cure to control the problem which is obviously still hovering around, but basically I've got my life back, and I'm keeping my bladder which is now functioning perfectly well thank you... I'm telling everyone I meet, and I'm taking the doctor your information to show him. I'm on a mission now! People are not going to get their bladders 'whipped' out if I can help it. Thank you, thank you, thank you." Aime

The following extract is from a 6 month clinical trial of d-mannose, this part directly concerning sufferers of interstitial cystitis: Abstracted from a study by Michael Blue, M.D., Urologist (Norman, OK).
"Those females who were not confirmed by culture to have bacterial UTI but had UTI-associated symptoms were classified into a painful-bladder-syndrome (PBS) group. Of the 18 PBS females who were treated daily with two scoops of D-Mannose, 17 (94%) reported symptom improvement, the lone exception being a subject unable to be contacted, but also not returning for treatment. Eighty percent became totally symptom free."
Currently, Waterfall D-Mannose is undergoing clinical trials in Italy for use against Interstitial Cystitis. The study by a well known urologist and researcher, Dr Daniele Porru is still in progress. His interim report is "So far, I’ve had positive feedback from various patients... Significant side effects (gastroenteric or other kind) have not been reported."

Using Waterfall D-Mannose to reduce E.coli infections related to catheterisation

Suggested ways to get the maximum benefit:

The dose level of Waterfall D-Mannose for catheterised/catheterising people, men or women, generally needs to be higher than the dose level for people who do not catheterise. The actual amount you need to take will be found best by trial and error. Best to start on higher dose levels and gradually reduce the dose to the point where you are still keeping infections at bay. If you feel an infection starting, it is an indication that you may not be taking enough to cope with the level of bacteria present in the urine. If you stay symptom free for a period of time when you would have expected an infection, it is usually safe to reduce the dose frequency or level, and perhaps just take more around the time of changing the catheter.

Catheterised patients or people who self-catheterise are prone to bladder and urethral infections because bacteria are everywhere, even in the air. So no matter how clean you are, it is difficult to prevent contamination of the catheter and reinfection. Besides using Waterfall D-Mannose as recommended for treating normal cystitis, (which even in cathterising people is often enough to solve infections and keep them at bay) there are other ways you can help. Clearly, this advice is not going to be suitable for everyone, so take what you find useful from it. We learned some of what we know about using catheters with Waterfall D-Mannose from a gentleman called Tony Treadgold who is a spinal injury patient who astonished his consultants by successfully keeping infections at bay without antibiotics during a six-week stint in hospital. This, while everyone else despite prophylactic antibiotics, was getting infection after infection.

Also, people with supra-pubic catheters usually just need to take extra Waterfall D-Mannose , especially around the time of changing the catheter.

After dealing with a lot of people with this problem, we have learned a few tricks that you can try. Take these precautions with fresh catheters too, and if you are not self-catherising, don't let someone else contaminate you. The plain fact is that contamination of catheters does not need to happen, and you might have to speak up to protect yourself, and refuse a catheter that is not sterile, or you see being contaminated.
Remember that despite existing precautions, you are still having problems with infections (or you would be unlikely to be reading this), so please do not lightly dismiss the precautions here.

  • Before handling the catheter, bathe and wear fresh clothes (or no clothes) to ensure that the catheter does not come into contact with anything that may contaminate it. So don't let the catheter touch anything that is not sterile. If you cut it, ensure that the scissors are sterile. Don't put it down on the bedclothes.

  • During this entire procedure, be careful not to touch hair, nose, or anything else that is not known to be sterile. Best to tie your hair back first if it is long.

  • The nose and mouth are harbours for E.coli. Best to wear a surgical mask. If you cough or sneeze without a mask at any time during this procedure, you have probably contaminated the catheter, or your gloves, and must start again.

  • Scrub up properly using an antibacterial liquid wash, right up to the elbows. Also very carefully (but gently) wash the genital area.

  • Wear sterile disposable gloves before opening the catheter pack. Lay the catheter on a sterile tray and cover it with a suitably prepared lid.

  • If reusing a catheter, (inadvisable, with the ready availability of sleeved disposable catheters), after cleaning it, flush it through with a solution of Waterfall D-Mannose (a teaspoonful in 50ml sterile water). Remember that E.coli can survive boiling, so ordinary boiled water is not clean enough. Sterile water can be obtained from most large chemists.

  • If using a fresh catheter that needs to be soaked, consider changing to a ready-to-use type. In any case, do not soak it in ordinary tap water ® tap water is invariably contaminated with E.coli. Use sterile water, or boiled water with an approved sterilising solution in the water.

  • Allow the Waterfall D-Mannose to remain in the catheter for five minutes, then empty the catheter.

  • Change your gloves, being careful not to contaminate the outside of the fresh gloves.

  • Wipe the outside of the catheter with a sterile cloth soaked in sterile Waterfall D-Mannose solution.

  • Fill the catheter with a sterile solution of Waterfall D-Mannose . Peg the other end (with a pre-sterilised pag) to prevent emptying, and insert the catheter when it is full of Waterfall D-Mannose . If doing this yourself, you are better in a squatting or sitting position if possible (over the sterile tray or basin that the catheter is in).

  • Allow the Waterfall D-Mannose to remain in the catheter for five minutes before releasing the peg.

  • Finally, since a lot of people are originally catherised because of pain when their bladder is filling, rather than because they need one due to, for example a spinal injury, if you manage to remain symptom free using Waterfall D-Mannose , and you have urinary control, you could consider coming off the catheter entirely.

Intravenous Treatment with Waterfall D-Mannose

A specially prepared version of Waterfall D-Mannose can be given intravenously in solution, to bypass the digestive system. However, this is not a home procedure, so don't attempt it. If you are a medical professional who requires Waterfall D-Mannose for intravenous use, please call us to make the order, as the intravenous product is not available to the general public. It is a very expensive product, and must be prepared for injection in an authorised laboratory.

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