Fact or Fiction? Diet does make a difference!

While patients have long known that many foods can irritate the bladder, it wasn't until the Summer of 2007 that Robert Moldwin Md, Barbara Shorter RD & colleagues at Long Island University published the first formal validated research study which proved that certain foods badly irritate the bladders of the vast majority of patients. The release of this study in the peer reviewed medical journal, the Journal of Urology, should finally provide evidence needed for those medical care providers (doctors, nurses and even dietitians) and family members who simply did not believe that diet made a difference or said "Where's the proof?" Click here to read a lecture provided by Barbara Shorter that reviews the results of the study!

Reference: Shorter B, Lesser M, Moldwin RM, Kushner L. Effect of comestibles on symptoms of interstitial cystitis. J Urol. 2007 Jul;178(1):145-52. Department of Nutrition, C. W. Post Campus of Long Island University, Brookville, New York, USA.

How foods Irritate The Bladder

Urine is composed of water and various toxins and substances that our body is trying to eliminate. It is not unusual for a healthy bladder to become irritated by urine, such as in patients going through chemotherapy. Another common sign of bladder irritation is the increased frequency that coffee and tea drinkers often complain of. But, when you have an injured or wounded bladder, urine can reach into the deeper into the bladder wall where it can directly stimulate nerves, stimulate mast cells to release histamine and create profound irritation.

What foods are notorious for causing problems??

Foods high in acid (such as orange or cranberry juice) create tremendous irritation in much the same way that acid poured on a wound on your hand would feel. It hurts! Foods that stimulate nerves, such as caffeine, are notorious for triggering the already sensitized nerves in the bladder. Thus, if you're struggling with frequency or pain, this means that your bladder nerves are involved. It's foolish to irritate the nerves to trigger yet more frequency. Foods high in histamines, such as chocolate, can trigger an allergy like reaction. Some, but not all, patients may struggle with foods high in sodium or potassium. Patients may also have individual and often unpredictable reactions to various foods.

• Ask Questions in our IC Diet message board

The Top Forbidden Foods

The top forbidden foods & beverages are those that bother most IC patients most of the time. They are NOTORIOUS for causing IC flares. Even one small serving a day can trigger a night of sleeplessness and pain. Thus, these are the first foods that should be eliminated from your diet. In our experience, the patients who continue to consume these foods, especially that one cup of coffee a day (decaf or regular), are those who suffer the most with pain and discomfort. Furthermore, we believe that no therapy can counteract the damage and irritation created by a daily "acid" wash from these foods. If you want your bladder to calm down, your first step is to eliminate these risk foods.

#1 - COFFEES - This is a no-brainer. Coffee's (regular & decaf) are, by far, the most irritating to an IC bladder, not just for the caffeine but also for the very high acid level. We strongly suggest that you avoid all coffees if you are currently symptomatic. When you're bladder has calmed down and your symptoms have improved, first try the herbal coffees (Pero or Cafix) and then try a low acid regular coffee (Puroast or Euromild).

#2 - REGULAR & GREEN TEAS - Regular teas (hot and iced) get their flavors from "tannic acid" and thus easily irritate the bladder. Green teas are also notoriously acidic despite the advice of family and friends who say that it helps. It doesn't. The worst tea of all? Powdered sugar free instant iced teas which are also filled with nutrasweet and other irritating preservatives. If you're desperate for tea, try a plain herbal chamomile or peppermint teas which are calming and soothing to smooth  muscle of the bowel.

#3 - SODA & DIET SODA - Think about it? If a soda can remove rust from a penny, just imagine what it would do to  a wound in your bladder. Sodas are highly irritating not only for the citric acid used for flavoring, but also for the preservatives and flavorings. Diet sodas are even worse because nutrasweet is metabolized into a very strong acid and basically scours the bladder. If you're desperate for a soda, try an organic root beer but, please, only once a month.

#4 - FRUIT JUICES - Fruit juices, particularly cranberry, orange, lemon and tomato juices, are very acidic because each glass carries the acid of not just one piece of fruit, but many that have been squeezed to make that juice. Juices are notorious for triggering an IC flare. We suggest that you try pear or apple juice, preferably a "baby" version. Why?? Baby juices use much less acid and are easier for an IC bladder to tolerate.

#5 - MULTIVITAMINS - The use of multivitamins has become quite controversial in recent years in part because of research which has found that some cancers (i.e. prostate) grow more aggressively in patients who take a lot of vitamins. The fact is that our body can't use the massive amount of vitamins found in supplements, thus they are quickly excreted out of the body through our urine. Both Vitamin C (Ascorbic Acid) and Vitamin B6 are notorious. Unless you require multivitamins for another medical condition, we suggest that stop any multivitamins to determine if they are irritating your bladder.

#6 - ARTIFICIAL SUGARS - Artificial sugars (Nutrasweet, Aspartame, Sweet N Low, etc.) continue to generate a lot of criticism. In the Summer of 2005, a study was released that found that patients who used artificial sugars, as apposed to regular sugar, had a much higher likelihood of obesity. In the IC bladder, artificial sugars create profound irritation. We strongly suggest that you remove artificial sugars from your diet.

#7 - CHOCOLATE - Arrhhh!! We hear your cries of frustration. Yes, we hate to say it, but chocolate can trigger an IC flare. Chocolate is notorious for triggering IBs, allergies and, in an IC bladder, irritation and pain. If you're desperate for chocolate, try a white chocolate or a very dark, semisweet chocolate. It's the cheaper milk chocolates that seem to be the most irritating. We've also found some amazingly good carob candies that can easily satisfy your sweet tooth, including carob rice crunch bars, carob english toffee, carob honeymoons & more! You can purchase these in the ICN Shop! !

Eating with IC

Debunking the IC Diet

The IC Diet is, at it's core, a very healthy, simple natural diet. What it requires is that you eliminate many of the premanufactured foods that are notoriously irritating. If you're addicted to junk food, this is going to be a big change. Rather than buying premade foods (i.e. like Macaroni & Cheese), we suggest making it homemade where you know exactly what's put in it. So, keep it simple and, when possible, organic. Organic foods are less contaminated with pesticides and chemicals which could irritate the bladder.

MEATS - You can have almost any fresh meat that you want but be quite careful with the sauces. BBQ sauce and steak sauce can be very irritation. Want a steak?? Go for it. Instead of ketchup or using strong spices, how about sauteing some mushrooms to go with it instead. Be wary of preserved meats, particularly pepperoni, salami's etc.

VEGGIES - Luckily, most of the veggies are IC friendly with the exception of concentrated tomato products (i.e. tomato sauce, soup, etc.) Asparagus has bothered some patients.

DAIRY - Milk and eggs are IC friendly. Approach cheeses with caution. The milder and fresher the better. So, try a plain fresh mozzarella, cottage cheese, or soft monterey jack. Farmers cheeses, string cheeses and even parmesan cheese (in a small amount only) seem to be IC friendly for most patients. It's the harder, aged cheeses, like cheddar, edam, brie, or gouda that can cause problems for some patients.

BREADS - When possible, go for the fresh, preservative free breads made by a local bakery. If you have a breadmaker, make your own. If not, go for the simple breads, such as wheat, oat, white and rice. Rye and sourdough breads may create some problems. The Ezekiel brand of breads and Dr. Oetker line of baking mixes are very popular.

FRUITS - Fruits are the hardest part of the IC diet because most fruits are very acidic. We suggest starting with pears and blueberries. If you do well with those, try a mild sweet apple (like Gala or Fuji) and just have a few slices to see how you feel. If you tolerate the apples well, try the tropical fruits of mango or papaya. If those sit well, try the melons like watermelon, canteloupe or honeydew. Please note, however, that melons do provoke symptoms for quite a few patients just, hopefully not you! Please avoid all citrus and be careful of citrus.

DESSERTS - You can't go wrong with fresh, vanilla ice cream. Caramel sauce is IC friendly. Snickerdoodle and other vanilla cookies seem to be IC friendly. If you're a chocaholic, look for carob candies instead. We've found some amazingly good carob candy made by Queen Bee Gardens.

• Find great diet articles in our feature column, Fresh Tastes by Bev, filled with menu ideas, IC friendly recipes and much more!
• Find recipes in the IC Chef On-Line Cookbook

ICN Comprehensive Food List

Now it's a question of finesse. We each have individual tolerances to various foods and your job is to figure out what foods bother you. It takes time, patience and good deal of trial and error. An elimination diet may be very helpful.

We've created a master list of foods and ranked them as "usually okay," "maybe okay" and "usually problematic." Go through this list carefully and you may find some hidden triggers still in your diet.

Fair warning. There are many of confusing diet lists passing through the IC community which often contradict each other. We've combined all of the lists that we can find to develop our master list. If you have a list which says that eggs are bad for IC, it's an older, outdated list and is not accurate. Eggs are fine for IC and, in fact, egg whites are natural acid reducers.

Click here for the master list of foods!

Hot Drinks

We know that you're missing your coffee or teas but, if your symptoms are active, you have to calm and soothe your bladder first. We suggest starting first with hot water with honey (or sugar) or hot milk. Starbucks can easily give you hot milk with vanilla flavoring as a great morning start.

The first teas to try are peppermint or chamomile herb teas which are very bladder and bowel friendly. If you do well with these teas, you're next step is to try an herbal tea made from roasted carob. Celestial Seasonings makes several which are fairly IC friendly, including Gingerbread Spice, Almond Sunset, English Toffee and Vanilla Hazelnut.

If your bladder is tolerating the roasted carob teas, you could then try the herbal coffees (Pero or Cafix). These are an acquired taste but quite a few patients like them. If your bladder doesn't react to the herbal coffees, then try the LOW ACID regular coffees made by Euromild or Puroast. Please note, however, that if you're bladder is symptomatic, we strongly suggest going back to the basics... water or milk.

More IC Diet Resources

Over the years, we've developed many resources about the diet on the ICN. From an on-line cookbook to providing monthly columns on diet in our magazine, you'll find plentiful information here. But, before we get into the basics of the IC diet, we thought we'd share the many resources now available on the site.

• Fresh Tastes by Bev - an ICN feature column by author Bev Laumann
• IC Chef Cookbook - an on-line archive of IC friendly recipes
• Guest Lectures by Bev Laumann, Barbara Shorter RD and Julie Beyer RD on the IC Diet
• Diet and IC Discussions in the ICN Forum. Ask questions about diet here
  

Suggested Readings on the Interstitial Cystitis Diet

Three books are now available that can help you fully understand the IC diet, provide tips on eating a healthy diet and how to find low acid versions of your favorite foods.