DIET AND INTERSTITIAL CYSTITIS

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 use Quick 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.

DIET AND INTERSTITIAL CYSTITIS