Frequently Asked Questions About The IC Diet

ICN Founder Jill Osborne answers our top questions about the IC diet! 

“What if foods don’t bother my bladder?”

Not every IC/BPS patient is food sensitive and, in fact, food sensitivity helps to identify your unique “subtype” for IC. Patients with Hunner’s lesions are the most food sensitive because they have open wounds on their bladder wall. Patients with estrogen atrophy or chemo cystitis will have food sensitivity because their bladder wall is irritated and/or struggling with dryness . Patients with pelvic floor dysfunction and/or pudendal neuralgia usually have less food sensitivity because their underlying problem is not their bladder but their muscles and/or nerves outside of the bladder. Patients with chronic overlapping pain conditions (IC, IBS, vulvodynia, fibromyalgia, TMJ, migraines, etc.) may also have some food sensitivity, especially to foods that contain caffeine that will irritate their already sensitive nerves.

• If you have pain after urination rather than as your bladder fills with urine, that suggests that your pelvic floor muscles are the problem rather than your bladder wall.
• If you do not react to any foods, this suggest that your bladder wall is healthy and that your symptoms and pain are coming from beyond your bladder.

Ask your urologist or OB/GYN for a pelvic floor assessment to determine if you have pelvic floor dysfunction (aka tight muscles, trigger points, etc.). It would be wise to avoid some of the strong risk foods, particularly coffees, teas and sodas, until your diagnosis is clarified. Bladder wall irritation and pelvic floor tension often co-exist and patients may sometimes have bladder wall flares or pelvic floor flares. Your short and long-term goal is to protect the bladder wall, relax the pelvic floor muscles and restore good circulation in the pelvis.

“Should I buy organic fruits and veggies?”

When it’s possible and affordable, we encourage you to buy organic. Why? Research has proven that pesticides linger not only on the skin but in the meat of various fruits and vegetables. Each year, the Environmental Working Group releases a list of Dirty Dozen™ and Clean Fifteen™ foods that are worth following.

“How much water should I drink?”

Until the bladder wall heals, patients must remember that their bladder is injured and more vulnerable. Unfortunately some patients cut back on their water intake, allowing their urine to become more concentrated and irritating. Urine should be a pale, clear yellow. If urine is dark yellow or cloudy, that suggests that the patient is dehydrated and they should drink more water. If urine is clear, then the patient has gone too far and could be compromising their electrolyte levels. Just drink a normal 6 to 8 glasses of water a day. IC patients generally prefer to sip a glass of water over time rather chugging a large glass of water.

“I’m afraid to eat anything. What should I do?”

There’s no reason to fear food. Rather, fear the food manufacturers who process foods so aggressively that they rarely resemble the real thing and are far more likely to irritate the bladder. Go back to the basics: simple, fresh healthy foods. Try the least bothersome foods from the LIU food list or the foods listed in the Bladder Friendly category of the ICN Food List. An ideal breakfast, for example, would be scrambled eggs and hash browns. Homemade pancakes or waffles could work, ideally served with butter and some bladder friendly jam or real, homemade syrup rather than the preservative filled commercial brands. Looking for an easy lunch? How about a sandwich made with nitrate free turkey or chicken. The Boar’s Head brand is a great choice. You’ll find many dinner and dessert ideas in this cookbook as well!

“I react to some foods on the Bladder Friendly/Safe list. Why?”

The IC diet is very individual depending on the degree of inflammation/injury of the bladder wall. Patients with more mild IC can tolerate more foods while patients with more severe irritation and/or Hunner’s lesions may have a more reactive bladder. Some patients may also have pre-existing allergies and/or food sensitivities that they must respect and avoid. As the bladder receives treatment and begins to improve, foods should be better tolerated. If you have struggled with food sensitivities, you might want to consider having food sensitivity testing (i.e. ALCAT) to help isolate those foods which are irritating your body.

“Why can I eat a food one day and, a few days later, flare from it?”

This is common and related to the level of irritation and inflammation of your bladder wall which, unfortunately, can change on a daily basis. If you’ve been following the IC diet and your bladder is calming down, it’s normal to start trying some of the riskier foods. On the first day, that soda didn’t cause a noticeable reaction though, at the cellular level, it may have triggered some new inflammation. The second day, you enjoy another one and it still seems okay but you’ve triggered another round of inflammation. After you drink your third soda, your bladder starts screaming. That’s due to the cumulative toll of irritation and inflammation of all of the foods you’ve eaten in that specific period of time.

“Why does my food tolerance vary with my menstrual cycle?”

The bladder wall and urethra is extremely responsive to hormone swings thus women frequently struggle with flares the day that they ovulate or a few days before their period. Because the tissues are just more sensitive at those times, you will probably eat more bladder safe foods.

“I feel like I react to every food. What should I do?”

Patients who struggle with severe bladder wall inflammation and/or Hunner’s lesions may feel like every food bothers them. It doesn’t mean that the food is causing their IC. It means that their bladder wall is profoundly irritated and inflamed. Hunner’s lesions, for example, require very specific treatment (fulguration, laser therapy or injection of triamcinolone) that can dramatically reduce pain and discomfort. You may need to do more IC treatments to help calm down the inflammation so that you can start eating more food comfortably. Please refer to the treatment section of the IC Network website for additional information. 

“I can’t live without my soda. What should I do?”

Make no mistake. Your addiction to soda is not your fault. Those companies deliberately use high amounts of sugar and high fructose corn syrup to make you addicted so that you will be a return customer. Some compare the addictive power of sugar to that of cocaine. The soda industry doesn’t care that their products come with a physical price, drives obesity and is a leading cause of diabetes. In their minds, profit is more important than your health. If that doesn’t infuriate you then consider what the high levels of acid found in soda will do to a wound in your bladder. It will make the irritation and inflammation far worse and, if used repeatedly, could make wounds bigger.

Try a sparkling water with a little bit of soda flavoring to make an Italian Soda instead.  That’s much more bladder friendly and will give you that sensation of soda without the acid.  You might also try an old fashioned root beer, which is naturally caffeine free and lower in acid. OLIPOP® makes a classic root bear that also contains probiotics, marshmallow root and slippery elm which may be soothing to the bladder.    Fair warning… it can produce some gas as well. Serve on ice so that it is slowly diluted over time.

“Coffee in the morning helps me have a bowel movement but also hurts my bladder. What should I do?”

It’s true. Coffee helps millions of people have a comfortable bowel movement in the morning but so can a good breakfast. The bowel works via a “food in, poop out” process, also known as peristalsis. When you eat, gentle muscle contractions progress through the bowel to move food along and eventually out. In fact, it’s actually pretty difficult to have a bowel movement before you eat or drink in the morning. Eating and drinking triggers peristalsis. Thus, it’s better to have a good breakfast followed with a mug of something hot to get that started. Because caffeine makes my heart race, I now drink Dandy Blend®, a caffeine free herbal coffee that is rich, flavorful and helps stimulate a good bowel movement. If you must have coffee, try a low acid coffee, such as Bella Rosa, Simpatico or Tyler’s! You can find them in the ICN Shop!

“I’ve lived on junk food. It’s what I’ve always eaten but now it hurts. What can I do?”

For some patients, a diagnosis of IC is a wake up call. Your body is saying that it’s been hurt and needs your attention. Junk food is just that, junk. It has little nutritional value and will not give your body the essential nutrients it needs to heal and function normally. The pain of IC can be a powerful source of motivation to eat better. Don’t waste years like IC patient Judy who suffered needlessly because of her addiction to coffee and soda. Instead ask yourself “How can I help a wound in my bladder heal?” Then focus on those foods that aren’t irritating. You can find a full list of bladder friendly foods here!

“I’m not a cook. I don’t really know how to cook, what should I do?”

You’re missing out on a wonderful hobbie. We have several cookbooks that will give you lots of fun recipes to play with. Just experiment and look for flavors that you enjoy. It takes trial and error but you can do it. You’ll also find some fabulous recipes in the IC Cookbooks and cruising Pinterest where you can see great pictures of what it will look like. Also, look for classes at local kitchen stores (i.e. Sur La Table) or community colleges. We all have to start somewhere and classes are a great way to meet other people!

“Some acidic foods, like lemon, become alkaline in the body. Shouldn’t I eat these?”

No, you shouldn’t. Yes, we say avoid acidic foods because these are easy for patients to identify and not everyone understands  the concepts of acidity and alkalinity. Foods high in acidity or alkalinity are potentially irritating. Our goal here is to avoid pH extremes, whether they be acidic or alkaline. Citrus fruits are highly acidic that during digestion become strongly alkaline. Rather we want to try to eat more pH neutral fruits and vegetables, such as a pear, apple, berries or melon.

“Should I drink alkaline water for my IC/BPS?”

Some patients make the mistake of only drinking alkaline water which, as I say in the previous question, can be damaging. I do not believe that alkaline water should be drunk in any large quantity. If you’ve eaten something acidic and want to neutralize it, you can use the OTC supplement Prelief, some TUMS or, perhaps, a small glass of alkaline water. But, drinking it every day is excessive and expensive. The best water to drink is simple Spring Water or tap water if its’ not heavily treated. Some patients also prefer Fiji or Evian Water.

“Is juicing safe for IC?”

Juicing needs to be approached with caution because it forces you to eat a much higher quantity of certain fruits and vegetables than you normally would if you were eating whole fruit. Obviously, you can’t use any of the citrus fruits, nor should you be using the tart or bitter apples fruits. On the other hand, you may enjoy using the lower acid fruits. I often enjoy banana, mango, peach or blueberry smoothies made ice and coconut milk.

Source: This FAQ list was adapted from the IC Chef Cookbook (2015).

Edited: July 23, 2022 – jho