Diet Modification & The Bladder
If only we had a dollar for every well-intentioned family member or friend who encourage urology patients to drink cranberry juice because they believed it was “good for bladder problems!” Unfortunately, they are also wrong. Research has confirmed that foods and beverages high in acid and caffeine can worsen bladder and prostate symptoms. Something as simple as a daily cup of coffee can provoke serious pain and discomfort. Diet modification is a simple, affordable and effective strategy that may help!
The ICN Food App
Author: Jill Osborne MA – Updated – July 24, 2013
When researchers Robert Moldwin Md, Barbara Shorter RD & colleagues at Long Island University published the results of the first formal research study exploring the role of diet and interstitial cystitis (Effect of Comestibles on Symptoms of interstitial cystitis), their results validated what thousands of patients have known for decades, that certain foods can and do trigger bladder frequency, urgency, pressure and/or pain. Ninety percent of the patients who participated in that ground breaking study reported food sensitivities, a number which has since been replicated in several IC studies. In 2013, the same research team demonstrated that men with chronic prostatitis (Effects of Foods and Beverages on the Symptoms of Chronic Prostatitis/Chronic Pelvic Pain Syndrome) share similar food sensitivities.
The excessive intake of caffeine is a strong risk factor. Researchers in Massachusetts found that men who drank an average of 2 cups of coffee per day were more likely to develop lower urinary tract symptoms and difficulty with urine storage while women developed progressively worse symptoms of urgency. (Intake of caffeinated, carbonated, or citrus beverage types and development of lower urinary tract symptoms in men and women.)
Diet modification is a cornerstone of bladder management and is recommended as a first line intervention in the AUA Guidelines for the Diagnosis and Treatment of IC/BPS (2011). Please note, however, that patients often have unique and individualized food tolerances.
How Do Foods Irritate The Bladder? It is not unusual for a healthy bladder to become irritated by urine, such as in patients going through chemotherapy or with patients abusing ketamine. But, when you have an injured or wounded bladder, urine can reach deeper into the bladder wall where it can directly stimulate nerves, stimulate mast cells to release histamine and create profound irritation.
What ingredients are notorious for causing problems??
- CAFFEINE - Caffeine acts as a diuretic, stimulating more frequent urination and also causes urine to become more concentrated with urea and ammonia. All caffeinated products (coffees, teas, green teas, energy drinks, etc.) should be stopped immediately.
- ACIDIC FOODS - Foods high in acid (i.e. citrus fruits and juices, cranberry, vinegar) create irritation in much the same way that acid poured on a wound on your hand would feel. It hurts! Cranberries, for example, contain quinic, malic and citric acid which may help us understand why cranberry juice is irritating for most of us.
- ALCOHOL - In an ICN Survey, beer, wine and spirits bothered roughly 95% patients though there is some wiggle room with lower acid varieties.
- POTASSIUM - Some, but not all, patients may struggle with high potassium foods though research studies have found that bananas and yams, both high in potassium, are usually bladder soothing. Try small amounts of high potassium foods to see if you tolerate them well.
- HISTAMINE - Researchers have found that the bladders of IC patients have high numbers of activated mast cells. These mast cells have released histamine which then provokes an allergenic reaction in the bladder, triggering frequency, urgency and/or pain. Not surprisingly, foods high in histamine, such as chocolate and red wine, are well known to trigger bladder discomfort.
- ARTIFICIAL SWEETENERS - Both research studies and patient stories have confirmed that most artificial sweeteners (aspartame, saccharin, sucralose, etc.) appear to be bladder irritating, particularly aspartame (i.e. NutraSweet®). Most diet products, such as sugar free iced tea or soda, should be avoided.
- MSG, NITRITES & NITRATES - MSG is a mast cell degranulator and for patients sensitive or allergic to it, can cause rash, hives, asthma and sudden diarrhea known as”Chinese restaurant syndrome.” IC patients have long reported that foods containing high levels of MSG and/or nitrates trigger bladder symptoms and discomfort, thus we suggest avoiding these foods whenever possible.
- VITAMINS & SUPPLEMENTS - Both patients and research report that multivitamins can trigger bladder symptoms due, most likely, to high levels of Vitamin C (ascorbic acid) and Vitamin B6. Unless you have a medical condition that requires using a multivitamin, we suggest that you avoid vitamin supplements and waters in favor of eating fresh foods and vegetables.
- CHOCOLATE - Chocolate contains several ingredients that have the potential to exacerbate IC symptoms: theobromine, caffeine, phenylethylamine, tannins and oxalates. Well known for triggering migraine headaches, IC patients often report flares from eating chocolates, particularly cheaper milk chocolate products
Patients may also have individual and often unpredictable reactions to various foods.
The IC Food Lists – How To Begin
If you are newly diagnosed and your bladder symptoms are raging, you may be in so much discomfort that you simply can’t tell if foods irritate your bladder. Diet modification is a critical first step in gaining control over your symptoms. Ask yourself “would you pour coffee on an open wound on your hand?” The answer, of course, is “no.”Then how can you justify pouring acid on a wound in your bladder? It’s time to take charge of your diet to protect and soothe your bladder.
For the next three to six months, you should eliminate the most common IC offenders that we discussed previously, but you’ll also need to do quite a bit of experimentation and perhaps even an elimination diet as you create your own, personalized food list.
Research Study Derived Lists
These are the foods that research studies have determined to be either the “more bothersome” and “less bothersome” foods for IC patients. Table 1 includes the most bothersome foodswhich you should remove immediately from your diet. In Table 2, you will find foods which IC patients were generally able to enjoy without irritating their bladders provided, of course, that you don’t add risk foods to them (i.e. hot spicy sauces). Obviously, there are a lot of foods that are not covered by this list that you will find covered in the next list.
|The Most Bothersome Foods*||The Least Bothersome Foods*|
|Coffee - Regular & Decaf|
Tea - caffeinated
Carbonated beverages - cola, non-colas, diet & caffeine-free
Alcohols - Beer, Red Wine, White Wine, Champagne
Fruits - Grapefruit, Lemon, Orange, Pineapple
Fruit Juices - Cranberry, Grapefruit, Orange, Pineapple
Vegetables - Tomato & Tomato Products
Flavor Enhancers - Hot peppers, Spicy foods, Chili, Horseradish, Vinegar, Monosodium glutamate (MSG)
Artificial Sweeteners - NutraSweet, Sweet ‘N Low, Equal (sweetener), Saccharin
Ethnic foods - Mexican, Thai, Indian food
Milk - low-fat & whole
Fruits - Bananas, Blueberries, Honeydew melon, Pears, Raisins, Watermelon
Vegetables - Broccoli, Brussels Sprouts, Cabbage, Carrots, Cauliflower, Celery, Cucumber, Mushrooms, Peas, Radishes, Squash, Zucchini, White potatoes, Sweet potatoes & yams
Poultry - Chicken, Eggs, Turkey,
Meat - Beef, Pork, Lamb
Seafood - Shrimp, Tuna fish, Salmon
Grains - Oat, Rice
Snacks - Pretzels, Popcorn
|*Friedlander J. et al. Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU International. BJU Int. 2012 Jan 11.|
The ICN Food List
The ICN is pleased to release a new revision of the ICN Food List blending the data obtained in the new IC diet studies in conjunction with information and reports gathered from IC patients and support groups for the last twenty years. This diet list replaces old, outdated lists. The 2012 ICN Food list combines information from patients and research studies into a comprehensive, alphabetized list of foods, offering bladder friendly, try it and caution variations of foods. A major goal of this document is to provide a list of foods for those patients who find themselves confused and/or afraid to eat. This new guide is a thirteen page document in printer friendly pdf format. To download your copy, please click the image below or the following link: http://ic-network.com/downloads/2012icnfoodlist.pdf
The Worst “Risk” Foods
Both research studies and patients have proven that the foods below are the worst offenders. Even one small serving a day can trigger a night of sleeplessness and pain. Thus, these are the first foods that MUST be eliminated from your diet. In our experience, the patients who continue to consume these foods, especially that one cup of coffee or soda 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 - 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 your 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 (Simpatico, Puroast, 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, ENERGY DRINKS & FANCY WATERS - 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 due to the presence of artificial sweeteners like aspartame. Throw in caffeine, green tea and/or multivitamins found in energy drinks and vitamin waters and it’s a guaranteed bladder trigger.|
|#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 less acid and are easier for an IC bladder to tolerate. It’s also helpful to dilute juices with water and/or ice.|
|#5 – BEER, WINE & SPIRITS - When alcohol is poured on a wound, it hurts. Right? Right! Thus, it comes as no surprise that drinking alcoholic beverages can trigger discomfort in patients. In fact, 95% of patients participating in an ICN survey reported that their symptoms worsened when drinking alcohol. However, there is some varation in that. Pale lagers or ales were better tolerated than dark ales. Low acid wines better than high acid. Lighter colored spirits (i.e. sake) did better than darker ones. You can read much more about alcohol and the IC friendly variations in our 2012 Guide to the ICN Diet.|
|#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, most artificial sugars create profound irritation and discomfort.|
|#7 – CHOCOLATE - 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 its core, a very healthy, simple and 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 more 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.
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 & Davidson’s Teas makes several which are fairly IC friendly, including Gingerbread Spice, Carob Mint, French Vanilla & others.
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.
Prelief Can Help Reduce Acid
Foods high in acid, such as coffee, orange or cranberry juice, chocolate, and hundreds of others, create tremendous irritation in much the same way that acid poured on a wound on your hand would feel. It hurts. Now, IC’ers are finding that taking Prelief tablets or granulate with those acid foods is a great help. A recent study, Hill, et al, done on 750 IC patients in New York, confirmed that non-drugPrelief was of better help with IC pain and symptoms than any oral drug or any invasive procedure, including surgery, with few or no side-effects. Prelief is a dietary supplement that takes the acid out of foods, and does it very well. Made by AkPharma, Prelief is available through many local drug stores, the Preliefwebsite and, of course, through the ICN Shop.
Apps, Books & Cookbooks
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.
|The ICN Food List ApplicationNew 02/12 – The Interstitial Cystitis Network Food List App is designed to help patients struggling with urinary discomfort choose foods that will soothe rather than irritate their bladders. Ideal for use when shopping or eating out, it contains a searchable database of more than 250 foods broken out into three categories: bladder friendly, try it and caution.Price: Just 99 cents in the App StorePlatform: iPhone, iPad (Android version under construction)Learn more and watch a video!|
|2012 Guide to the IC Diet - ICN Publication – The 2012 Guide to the IC Diet offers a complete review and update of the IC diet, ideal for patients who don’t have access to the web and/or prefer to read off line. You’ll find two new food lists, including the first alphabetized list of more than 250 foods each broken down into “friendly,” “try it” and “caution” categories. We share detailed information not just on what you shouldn’t eat, but also what you can eat and should enjoy daily! Patient success stories are shared and the three authors of the IC Cookbooks each offer their own insights!Now available in print or as a pdf file for instant download.|
|A Taste of the Good Life: A Cookbook for an IC Diet by Bev Laumann – The first book published about IC and diet, it remains a best seller, perfect for people who love to cook! provides great recipes (check out the recipe for carob brownies!) and shares how to find low acid versions of your favorite foods (such as wine, coffees) and much more. Of special note is an appendix dedicated to vitamins and lists IC friendly foods that you can eat to get that vitamin. Buy Now!|
|Confident Choices: Customizing the IC Diet by Julie Beyer RD – Written by a registered dietitian, this book is perfect for patients who aren’t sure what to eat or who are worried about eating a balanced diet. It offers fifteen chapters, including flare foods, discovering your trigger foods, planning meals, ideas for breakfast, lunch and dinner, some IC friendly recipes, dietary supplements and IC diet success stories. Buy Now!|
|Confident Choices: A Cookbook for IC and OAB by Julie Beyer RD – The second in this series, it offers a simple, easy to read review of the IC diet, as well as a variety of tasty recipes and meal ideas. Also includes an IC friendly shopping list. This book is ideal for patients who are worried that they aren’t eating a balanced diet. Buy Now!|
|The Happy Bladder Cookbook by Mia Eliot – Written by IC patient Mia Eliot in 2010, the Happy Bladder Cookbook offers 75+ flavorful and creative recipes that are compliant with the 2009 IC/PBS Diet Food List. If you’re looking new fresh flavors, tastes and ideas to liven up your diet, this is a lovely addition to your IC cookbooks.Available in print or as a pdf file for instant download|
|The Happy Bladder Christmas Cookbook by Mia Eliot – New for the Holiday Season, IC patient Mia Eliot has written a new holiday cookbook offering 75+ flavorful and creative recipes for breakfast pastries, candies, cookies, cakes, pies and much more! These will liven up your holiday desserts yet are compliant with the 2009 IC/PBS Diet Food List. If you’re looking some wonderful new recipes, this is a lovely addition to your IC cookbooks.Available as a pdf file for instant download|
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.