DIET AND INTERSTITIAL CYSTITIS

CAN DIET PLAY A ROLE IN TREATING SYMPTOMS?

Effect of Comestibles on Symptoms of Interstitial Cystitis

• 104 patients surveyed on 175 items of food and beverages

• 90% indicated certain food and beverages exacerbate symptoms

• Patients who noted a relationship between foods and symptoms tended to have a high symptom index

Shorter B, Lesser M, Moldwin RM, Kushner L. 2007

WHICH FOODS SCORED HIGHEST?

• Coffee and tea• Alcoholic beverages• Citrus fruit and juices• Tomatoes and tomato products• Spicy foods, chili• Artificial sweeteners• Carbonated drinks• Vinegar, MSG

Often problematic

• Coffee• Decaf coffee• Tea• Herbal teas• Green tea• Chocolate

Alcohol

• Most problematic

Beer and Wine

• Less problematic

Spirits

Fruit and Juices

• All fruit juices• Cranberry juice• Citrus fruit• Stone fruit• Pineapple• Kiwis• grapes

ACIDS?

• Fisher et al found no decrease in urinary pH after ingestion of acid foods. 1993

• Nguan et al found no statistically significant differences in pain scores between neutral and acidic solution bladder instillations. 2005

• Bologna et al. 70% reported a reduction in pain and 61% a reduction in urgency when taking an alkalinizing agent. 2001

Vegetables

• Tomatoes• Tomato sauces• Tomato juice• Raw onions

Spicy foods

• Chili• Horseradish• Mustard• Hot curry

Artificial Sweeteners

• Diet fizzy drinks-especially with caffeine

• Better choice –Sucralose (Splenda)

OTHER POSSIBLE TRIGGERS

• ARYLALKYMINES – tryptophan, tyramine, tyrosine, phenylalanine

• SULPHITES – preservatives (fruit)

• NITRITES – preservatives (meat)

• MSG – flavour enhancer 621

• ARTIFICIAL COLOURS

ELIMINATION DIETS

• Simple Exclusion Diet – easy to useQuick results

• Empirical Diet – use where most foods are suspected

• Few Foods Diet – most drastic Dietitian recommended

SIMPLE EXCLUSION DIET

• Keep a one week voiding diary

• Eliminate suspected foods - washout• Wait for symptoms to diminish – 1-3 weeks

• Add one food back slowly over 1 week

• Keep a symptom score diary

• Repeat washout period

• Test another food

EMPIRICAL DIET

• Only foods considered safe for IC patients are eaten for 1-3 weeks

• Suspect foods are reintroduced one at a time while keeping a symptom diary

• Other food intolerances need consideration

FEW FOODS DIET

• Only low allergen foods for 10-20 days

• Nutritionally inadequate

• Foods added one at a time while keeping a symptom diary

• Supervision by a dietitian recommended

ADVANTAGES OF DIET FOR IC

• Self controlled

• Effective

• Low cost

• Low risk treatment

• Healthy unprocessed diet

CONSTIPATION

CONSTIPATION AND IC

• Medications

• Fluid intake

• Activity and exercise

MEDICATIONS

• Antacids containing aluminum or calcium• Antispasmodics• Antidepressants• Antipsychotics• Calcium supplements• Diuretics• Iron salts• Opioids• Oxybutinin and similar drugs for incontinence

FLUIDS

• Maintain an adequate fluid intake when on a high fibre diet

• 6 -8 cups including fluid foods – drink when thirsty.