Weight Loss on the IC Diet
Part 1: Exercising Our Options
The Dreaded Winter Wardrobe
It was a blustery day last December and I was pawing through my
closet. Vainly searching for a pair of warm pants I could fit into. Suddenly dawned on me that I had moved up a couple of clothing sizes in
recent years. Yep, and I was about to need a new wardrobe again. Not only did
I have the bloated abdomen and fat pad that some of us call "the IC tummy",
but since my IC diagnosis I had put on a layer of fat all over my body. I
decided right then and there I just had to do whatever it took to ditch some blubber.
Well, over the last 6 months I have managed to make a very slow but
weight loss. Though disappointing, losing a pound or two a month seems to be
all I can manage given the limitations of a life with IC, fibromyalgia, and
irritable bowel syndrome (IBS). It may not be a stellar performance compared
to what many people without IC can accomplish, but it will have to do... and
at least I'm continuing to move in the right direction. My husband is
beginning to notice that I look trimmer.
More Good Reasons to Shed Pounds
Maintaining a healthy and attractive weight throughout one's life is a
that many people face. Those of us with IC however, have an additional
challenge: Not only do the metabolic changes of aging cause extra pounds to
appear, but we may also gain weight when we get IC. That hardly seems fair
does it? After all, we are already burdened with a chronic illness. We sure
don't need another source of frustration and lowered self-esteem.
Those extra pounds can be a health risk too-- perhaps even a threat to
our life. Being overweight increases the risk of heart disease, high blood
pressure, diabetes, and even some kinds of cancer.
Why IC May Make Us Heavier
There are several reasons why we may gain weight when we get IC: First
the worse our bladder symptoms are, the more likely we are to become a couch
potato. (When my bladder is aching or my urethra is burning, you can bet I'd
much rather lie around with my heating pad than go for a walk.)
When we begin to avoid foods that cause bladder symptoms, we may
inadvertently substitute other foods that are more fattening, or get lazy
about eating a healthy diet. It takes effort and planning to eat a healthy
diet (whether or not one has IC) and putting out the effort when you are
hurting is hard to do.
Being diagnosed with a chronic illness may negatively impact our
our relationships with the people we care about. We may react to the
becoming psychologically depressed. And like other depressed people, we
ourselves, exercise less, and perhaps eat too much to avoid feeling our
Lastly, some of the medications we commonly take can contribute to a
problem. Tricyclic antidepressants such as amitriptyline and its chemical
relatives (i.e., the muscle relaxant, cyclobenzaprine) may ease our symptoms
but weight gain is a common side effect. Elavil, Tofranil, and other tricyclic anti-inflammatories are another class of drugs associated with
weight gain. (While they are not often prescribed for IC, they are used to
treat autoimmune disorders that some IC patients may have).
Some of Us Lose Weight
There are a few people have a reverse problem: they lose weight after
IC. Many high-fat and high-calorie prepared foods are real bladder-burners,
so naturally when we avoid them we may also lose weight. While some of us
find this a welcome side effect of the change to an IC diet, for people who
are on the skinny side to begin with, it may be a yet another IC-connected
difficulty to deal with. Some people may lose their appetite due to
IC-associated psychological depression too.
Remember that weight loss may also be a sign of a more serious health
problem, so be sure to consult your doctor if you experience a sudden weight
loss not connected to dietary change, your weight loss seems excessive, or if
you are not able to control your weight loss.
Dealing with More Than Just the Weight
If you're overweight, you may find that losing weight with IC is not going to be like losing weight before you had IC. Many diet foods contain artificial sweeteners and flavor enhancers that make our bladder symptoms worse. Often, products designed for weight loss contain caffeine (a well-known bladder irritant). And IC patients with IBS will want to avoid diet foods with Olestra, guar gum, fructose, or sorbitol (these can make IBS worse). High-impact exercise programs can jar and irritate a sensitive bladder so we have to exercise carefully. With so many common weght loss strategies and tools no longer an option, we have to make the best use of the others we can use.
It's also important to realize when we're in over our head and need professional help. If you are seriously overweight or suspect that depression or medications contribute to the problem, speak to your doctor. Don't be afraid or ashamed to utilize other professionals too. Registered dietitians, psychologists and psychiatrists, licensed hypnotherapists, specialists in biofeedback and stress reduction, sex therapists, and clergy, are all great resources to draw on in your battle of the bulge.
A very good book to help you make any kind of change in your life is "Changing for Good" by James O. Prochoska, John C. Norcross, and Carlo DiClemente (published by Harper Collins). The book is written by three professors of psychology who have gleaned practical techniques for lasting change from many disciplines. The book has been used in programs sponsored by the National Cancer Institute and the National Drug Abuse Institute. If motivation and starting on a weight loss program are big roadblocks, this book is definitely worth it. If you have trouble caving in to the desire to eat bladder -provoking foods, this book can help. Bladder says you need to quit cigarettes? Try the steps outlined in this book. Fat is not just what the scale says.
Remember that your body composition-- how much of your total weight is fat-- is more important health-wise than where you are on a weight chart.
Important too, is your general body shape. "Pears" (whose body fat is mostly around the hips and thighs) have less risk for early heart disease and cancer than "apples" (whose weight is mostly around the waist). Are you an "apple" with weak or painful pelvic floor muscles? Losing weight will take off some of the stress on those muscles and may improve your IC, IBS, or fibromyalgia symptoms.
Weight Loss Strategies
Ok, so what can we do to lose that spare tire? In general, we simply do what other people do to lose weight: expend more calories than we take in. That means exercising more, adjusting our diet, or both. But of course we have to exercise without hurting our sensitive bladder, and we need to reduce our caloric intake within the framework of an IC diet.
In planning a weight-loss strategy, I found that it helps to keep in mind that each pound of body fat represents 3500 calories of stored energy. So for each pound you want to lose, you have to expend 3500 calories more than you take in. The American Dietetic Association advises people who want to lose weight safely not to lose more than one pound per week. Although it may be frustrating, a slow pace is doubly important for those whose body's resources are already strained with a chronic illness.
It's always a good idea too, to talk to your doctor before making any drastic dietary changes. He may have some ideas and recommendations that are suited for your personal situation.
Exercise and the IC Bladder
It is well known that exercise can help increase serotonin in the brain as well as burn calories. Increased serotonin is linked with pain relief and a sense of well-being. This may be why some people with IC, irritable bowel syndrome, or fibromyalgia find that light, low-impact aerobic exercise on a regular basis can actually help relieve their symptoms.
I can warn you that exercise won't be easy though, especially at first. Although I avoid bladder-jarring exercise, due to my intermittent bladder flares I've found it very difficult to build up an exercise habit. Every time I have a bad flare-up I am tempted to not exercise. And when I don't exercise for a few days, laziness sets in and the temptation to quit altogether looms very large.
I also found it helps me to realize that I can't handle what I used to. When I started my current exercise program I outlined a plan I thought my body could handle. Then I cut it by half. I knew from previous failures that I tend to overestimate what I can do.
The Interstitial Cystitis Association (ICA) sells a video that has gentle, low-impact stretching exercises designed for people with IC. There is a old 1980's exercise video that has gentle stretching exercises and it is great if you can find it-- Callanetics. Richard Simmons and Jane Fonda have also produced gentle stretching exercise videos. One idea is to rent and review a few dozen exercise videos before purchasing one.
The Arthritis Foundation sponsors gentle low-impact exercise programs in many communities (check the phone book). Meeting other people in groups like this can be downright fun.
While the chlorine in swimming pool water may irritate some peoples' urethras, swimming is excellent exercise if you can do it. Rollerblading or skating are great workouts too and can be non-jarring to the bladder...unless you fall down a lot!
Many people take brisk walks around indoor shopping malls, and the malls in some communities actually have organized groups who do this on a regular basis, usually in the mornings.
Jogging or dancing is good only if you can do it comfortably. (If you jog, be aware of something called "jogger's bladder" that even people without IC get. Emptying the bladder makes it fold up like a deflated balloon. If you then do jarring exercise, the bladder walls can rub against each other and cause irritation).
Step aerobics can be good exercise if they are done smoothly and carefully. I found this exercise was best done after I had been treated for the IC for awhile and the medication had made my bladder less sensitive
Yoga and Tai Chi Chih
Yoga and Tai Chi classes are popular among those with IC and fibromyalgia. Both involve slow-motion stretching and strengthening of various muscles all over the body. The benefits of these forms of exercise may go well beyond the physical aspects of muscle toning and weight loss. In a study led by Dr. Michael Irwin of UCLA's Neuropsychiatric Institute, several dozen adults who performed Tai Chi Chih regularly had increased immunity to a common virus. Tai Chi Chih is a series of 20 movements that most people, including the disabled and elderly, can perform. The slow, graceful, circluar movements are gentle and some people find them soothing and relaxing.
Yoga consists of gently moving into a variety of postures called "poses" which are then held as long as one can, for up to several minutes. The poses firm and stretch the muscles by making use of gravity and opposing muscle groups. Often relaxing music is played, or scented candles are used to enhance the experience. Stress reduction is another goal of both yoga and Tai Chi Chih, these may be just the ticket if you feel stress levels contribute to your weight gain.
Other Creative Options
Enlisting your doctor's help can be a good idea. He or she may refer you to a physical therapist who can assist you in constructing a customized, bladder-friendly, exercise program.
Don't overlook the little ways to burn calories: park farther away from stores and walk; use a manual can opener instead of electric one; and don't use the tv's remote to turn the tv off and on. Disconnect your automatic garage door opener if you have one. Walk briskly around the house while waiting for your cup of herb tea to heat.
Whatever form of exercise you choose, be sure to do "warm ups" first. Warming up is particularly important if you have fibromyalgia and your muscles are tight. A warm or hot shower before exercise is helpful, espcecially in the winter. I've found that the L- arginine suggested by my doctor for my IC also helps me avoid foot and leg muscle cramps.
Next month: WEIGHT LOSS ON THE IC DIET- Part 2, Cutting Calories
Bagels and cream cheese too fattening? Try this flavorful alternative:
Low-Fat Breakfast Bagels
1 whole bagel, split and toasted
1/3 cup low-fat cottage cheese
1/4 cup blueberries (or sliced pear)
1 dash nutmeg, optional
Spread toasted bagel halves with cottage cheese and sprinkle with blueberries. (Omit blueberries if you have vulvar pain and need a low-oxalate diet). Top with dash of nutmeg if desired. (Approx 272 calories, 2g. total fat)
This article originally published May 1999, revised and updated by the author Apr 2003.
The Interstitial Cystitis Network
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