Complementary and Alternative Medicine (CAM) – Interstitial Cystitis (IC)
A full understanding of the causes and effective treatment of Interstitial Cystitis (IC) continues to allude the medical community. A number of medications and procedures are available with limited success at controlling the many symptoms of IC including pain, urinary frequency and urgency as well as the many other manifestations of IC.
While definitive management of IC should include consultation with appropriate urologists and/or gynecologists, there is a role for CAM treatment in reducing many of the symptoms of IC and their impact on quality of life.
For further understanding of IC, see:
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CAM Treatment – Interstitial Cystitis
Diet and Interstial Cystitis (IC):
Dietary modification is considered standard IC therapy and has been incorporated into the American Urological Association (AUA) clinical guidelines. Dietary changes control symptoms “pretty well” or “completely” in 50% or more patients. Diet research shows, however, that patients’ sensitivities vary considerably, outside of a few common symptom triggers. recommendations include “avoidance of certain foods known to be common bladder irritants for IC patients such as coffee or citrus products and use of an elimination diet to determine which foods or fluids may contribute to symptoms.”
Recommended foods for IC include those rich in omega 3 fatty acids such as fish (especially salmon), fish oil, flaxseed oil and Vitamin D.
Foods to avoid:
While it is unclear as to the exact mechanism by which foods may make IC worse, abouat half of patients with IC can identify foods and fluids that will worsen their symptoms. The most commonly implicated foods and beverages are coffee, chocolate, alcohol, carbonated drinks, citrus fruits, and tomato-based products. Arylalkylamine-containing foods (tryptophan, tyrosine, tyramine, and phenylalanine) have also been implicated in making IC symptoms worse. Arylalkylamine-containing foods include bananas, alcohol (including beer and wine), aged cheeses, mayonnaise, artificial sweeteners (including aspartame), onions, raisins, sour cream, and yogurt.
Other foods the Interstitial Cystitis Association lists as possibly causing bladder irritation include: certain meats (cured, processed, smoked, canned, aged, or that contain nitrites), fava and lima beans, nuts (except almonds, cashews, and pine nuts), most fruits (except blueberries, honeydew melon, and pears), rye bread, seasonings with MSG, sourdough bread, soy, tea, tofu and tomatoes.
A food/symptom/voiding diary is essential in assessing symptoms to discover potential triggers, and formulate an appropriate elimination diet. As a guide, intake of foods and fluids that exacerbate IC symptoms generally increase painful bladder symptoms within 2 to 4 hours of ingestion.
In order to identify foods that make your IC symptoms worse, it is helpful to implement a diet for 2–3 months that eliminates the suspected foods and fluids that exacerbate IC symptoms and then adding them back one at a time to watch for worsening that will confirm the suspected food as one to be avoided. During the elimination diet it is helpful to also exclude acidic foods which are often implicated in making IC worse. Also, a steady intake of water helps to dilute urine and reduce constipation.
Another Option – JAVAcid®
Because acidic foods such as coffee are some of many peoples favorite foods, it is difficult to give them up. An alternative approach is the use of JAVAcid. JAVAcid is an all natural acid reducer comprised of DGL, Calcium, Vitamin D, natural resistant maltodextrin and prebiotic fiber to help minimize acid production, prevent the painful effects of excessive stomach acid and regulate digestive health. Sold in individual packet servings, one just stirs in a JAVAcid packet to any coffee or coffee drink, even mocha, latte and espresso!
JAVAcid is also great to help the body provide support against many types of acid related stomach disorders like gerd and indigestion. Decreasing extra stomach acid can help relieve symptoms such as stomach pain, heartburn, difficulty swallowing and trouble sleeping. It can also prevent serious acid damage to your digestive system. All of the ingredients in JAVAcid are Generally Recognized as Safe (GRAS) by the US Food and Drug Administration. For more information: www.javacid.com.
CAM Supplements helpful for Interstial Cystitis (IC):
Urinary alkalinization with baking soda or potassium citrate has been an effective treatment for many IC patients.
Nutraceuticals, or chemicals that induce bodily physiological changes, have been popularized in managing IC patients. For example, calcium glycerophosphate reduces titratable acids in foods and has been effective in decreasing the worsening of IC symptoms when bladder irritants are ingested. Additional nutraceuticals sometimes used by IC patients include L-arginine, mucopolysacchrides (hyaluronic acid, chondroitin sulfate (in bladder), and aloe vera, bioflavinoids (quercetin), and Chinese herbs. One herbal remedy thought to possibly be helpful in IC is marshmallow root tea. Vitamin D has also been recommended.
Bioflavinoids are naturally occuring compounds found in plants and fruits that sometimes offer health benefits. The bioflavinoid quercitin inhibits histamine release from mast cells in the bladder, a mechanism that is thought to be related to the symptoms of IC. Quercetin also has anti-inflammatory and anti-oxidant properties. Quercetin is rich in seeds, olive oil, tea (also citrus fruits and red wine though these may need to be avoided with IC).
< span style=”color: #808080;”>Antioxidants besides quercitin that have been recommended by some authorites include Vitamin E, CoQ10 and superoxide dismutase (SOD) although definitive research supportive of their benefits is lacking.
Nitric oxide (NO) induces smooth muscle relaxation in the bladder wall and is involved in immune defense reactions. It has been shown that NO levels are decreased in urine from interstitial cystitis patients. L-arginine, an amino acid, is the substrate for NO production by urinary nitric oxide synthase and nitric oxide synthase activity is decreased in patients with interstitial cystitis.
A number of research studies have evaluated the benefit of supplementing with L-arginine using doses ranging from 1.5 gms to 10 gms orally/day for up to 6 months to increase NO production and reduce the symptoms of IC. While results of these studies were mixed, there does appear to be a benefit from oral L-arginine treatment resulting in a significant decrease in urinary voiding discomfort, lower abdominal pain and vaginal/urethral pain after 2 weeks to 1 month of treatment. Urinary urgency and frequency during the day and night also was significantly decreased.
L-Arginine has been shown to reduce the pain and urinary frequency associated with IC. Improvement of symptoms may take 2-4 weeks of treatment.
Recommended dose: 1500mg/day
Quercitin has been shown to reduce the pain and urinary frequency associated with IC in more than half of people studied. Improvement of symptoms may take 4 weeks of treatment.
Dose: 500mg twice a day
Interstitial Cystitis CAM Tx – Overview
- Complementary and Alternative Therapies as Treatment Approaches for Interstitial Cystitis – 2002
Interstitial Cystitis CAM Tx – Diet
Interstitial Cystitis CAM Tx – L-Arginine
- A randomized double-blind trial of oral L-arginine for treatment of… – PubMed – NCBI
- Effect of long-term oral L-arginine on the nitric oxide synthase pa… – PubMed – NCBI
- Effects of L-arginine treatment on symptoms and bladder nitric oxid… – PubMed – NCBI
- Improvement in interstitial cystitis symptom scores during treatmen… – PubMed – NCBI
Interstitial Cystitis CAM Tx – Quercetin
- Treatment of interstitial cystitis with a quercetin supplement. – PubMed – NCBI
- See also: Stress, the stress response system, and fibromyalgia
Emphasis on Education
ate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
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