IC Special Report Diet - Interstitial Cystitis Network
IC Special Report Diet - Interstitial Cystitis Network
IC Special Report Diet - Interstitial Cystitis Network
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<strong>IC</strong>N special report: DIET<br />
published by the <strong>Interstitial</strong> <strong>Cystitis</strong> <strong>Network</strong> • volume 1, issue 2 • Summer 2004<br />
Understanding<br />
<strong>Diet</strong> and <strong>IC</strong><br />
How Some Foods<br />
Make Symptoms Worse<br />
Patient Reactions<br />
to Food<br />
The <strong>IC</strong> <strong>Diet</strong>:<br />
A List of Problem Foods<br />
Our Five Worst Foods<br />
Plus An <strong>IC</strong>N<br />
Guest Lecture<br />
by Bev Laumann,<br />
author of<br />
“A Taste of the<br />
Good Life: A<br />
Cookbook for<br />
an <strong>IC</strong> <strong>Diet</strong>”
<strong>IC</strong>N special<br />
report: DIET<br />
from the editor<br />
Published by the <strong>Interstitial</strong><br />
<strong>Cystitis</strong> <strong>Network</strong><br />
Editor: Jill Osborne<br />
Advertising Sales: 707-538-9442<br />
e-mail: jill@ic-network.com<br />
<strong>Interstitial</strong> <strong>Cystitis</strong> <strong>Network</strong>:<br />
http://www.ic-network.com<br />
info@ic-network.com<br />
Administrative Offices:<br />
4983 Sonoma Highway, Suite L<br />
Santa Rosa, CA USA 95409<br />
The cornerstone of most effective <strong>IC</strong><br />
treatment programs begins at home with<br />
diet modification. <strong>IC</strong> patients often have<br />
irritation, inflammation, small petechial<br />
hemorrhages and, for some, larger Hunner’s<br />
Ulcers in their bladders. As a result, these<br />
tender, wounded tissues are vulnerable.<br />
Would you pour coffee on a skinned knee<br />
Would you bathe a blister in diet soda or<br />
tomato sauce Of course not!<br />
I once talked with a woman who said<br />
that she had tried “everything” for her <strong>IC</strong>,<br />
including undergoing Interstim. When I<br />
asked her what she was drinking, she confessed<br />
that she was drinking twelve cans of Ginger Ale a day. I was<br />
stunned. Can you imagine what that amount of acid was doing to her the<br />
wounds in her bladder It’s no wonder that she was struggling with pain<br />
and that she wasn’t responding to therapies.<br />
The husband of a young <strong>IC</strong> patient in Finland called our office out of<br />
desperation. His wife was suffering horribly with pain. She had several<br />
Hunner’s Ulcers and had recently had a hydrodistention that she hadn’t<br />
yet recovered from. The pain was out of control. What was she drinking<br />
each day Four to six cups of coffee a day, as well as a pack of cigarettes.<br />
She was paying a huge price in greater pain.<br />
Far more frequently, I talk with patients who confess that they have<br />
one cup of coffee a day, usually decaf. Yet, the acid in that one cup of coffee<br />
can create enough irritation and inflammation to cause more <strong>IC</strong><br />
symptoms and, perhaps, counteract some of the new tissue growth and<br />
healing that may have been occurring.<br />
It’s not worth it! If you’re struggling with <strong>IC</strong> symptoms and/or pain,<br />
your first objective should be to reduce irritation in your bladder, not add<br />
to it. It takes discipline to follow the <strong>IC</strong> diet but it can payoff with<br />
reduced symptoms. We carry several <strong>IC</strong> friendly foods and beverages in<br />
our <strong>IC</strong>N shop that you can also explore!!!<br />
Sincerely,<br />
Jill Osborne<br />
Editor and <strong>IC</strong>N Founder
contents<br />
4 Understanding <strong>Diet</strong> and <strong>IC</strong><br />
by Jill Osborne and Bev Laumann<br />
4 How Some Foods Make<br />
<strong>IC</strong> Symptoms Worse<br />
by Jill Osborne and Bev Laumann<br />
6 The <strong>IC</strong> <strong>Diet</strong>: A List of Problem Foods<br />
by Jill Osborne and Bev Laumann<br />
9 Our Five Worst Foods<br />
by Jill Osborne and Bev Laumann<br />
11 <strong>IC</strong>N Guest Lectures:<br />
The Role of <strong>Diet</strong> and <strong>IC</strong><br />
featuring Bev Laumann<br />
16 The Fish Story<br />
by Bev Laumann<br />
18 Sweets for My Sweet<br />
by Bev Laumann<br />
19 The Vitamin C Vegetables<br />
by Bev Laumann<br />
Copyright ©2004. Any reproduction is prohibited without prior written permission from<br />
the <strong>IC</strong>N.<br />
The necessary disclaimer: Active and informed <strong>IC</strong> patients understand that no patient,<br />
or web site or presentation on a web site should be considered medical advice. We<br />
strongly encourage you to discuss your medical care and treatments with a trusted<br />
medical care provider. Only your personal provider can and should give you medical<br />
advice.<br />
Opinions expressed in articles are those of the authors and do not necessarily reflect<br />
those of the <strong>IC</strong>N or its editorial board. The <strong>IC</strong>N assumes no liability for any material<br />
published herein.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 3
Understanding<br />
<strong>Diet</strong> and <strong>IC</strong><br />
by Jill Osborne and Bev Laumann<br />
"For almost six<br />
months, I drank a<br />
quart of cranberry<br />
juice every two days.<br />
Why Because everyone<br />
said it would help.<br />
I had no idea that cranberry<br />
juice was an <strong>IC</strong><br />
trigger. They were<br />
wrong. It hurt and<br />
made my <strong>IC</strong> much<br />
worse!"<br />
—J. Osborne<br />
PATIENTS’ REACTIONS TO FOOD:<br />
WE’RE ALL ALIKE, BUT<br />
DIFFERENT<br />
Though a few people with <strong>IC</strong><br />
have bladders that are not sensitive<br />
to food, for the overwhelming majority<br />
of us, what we consume plays a<br />
significant role in how severe our<br />
symptoms are. While it’s true that<br />
some common trigger foods, such as<br />
coffee or cranberry juice, provoke <strong>IC</strong><br />
symptoms for nearly everyone, it’s<br />
also true that each of us has a different<br />
tolerance level for many of the<br />
trigger foods. For instance, some <strong>IC</strong><br />
patients may comfortably eat a small<br />
quantity of a specific food, yet if they<br />
eat more, they will have an <strong>IC</strong> flare.<br />
Others, to their great frustration,<br />
may not be able to tolerate even a<br />
single bite of that same trigger food<br />
without suffering increased symptoms.<br />
Still others may be able to<br />
consume all they want of that food<br />
with no trouble at all. This variation<br />
in our response is why no one can<br />
create a list of foods to avoid that<br />
will apply uniformly to absolutely<br />
everyone with <strong>IC</strong>.<br />
<strong>IC</strong> patients usually spend their<br />
first six months to a year discovering<br />
the ways in which their <strong>IC</strong> food triggers<br />
are similar to others’, and the<br />
ways in which their bladder reacts<br />
differently. They do this either<br />
through random trial and error, or<br />
via a systematic approach with an<br />
elimination diet. We’ve outlined<br />
here the most common <strong>IC</strong> triggers as<br />
well as a variety of elimination diet<br />
approaches and some <strong>IC</strong> friendly<br />
foods.<br />
HOW SOME FOODS MAKE <strong>IC</strong><br />
SYMPTOMS WORSE<br />
While it hasn’t been scientifically<br />
established exactly why the foods on<br />
the <strong>IC</strong> diet list cause flares, urologists<br />
4 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
and <strong>IC</strong> researchers have proposed<br />
some credible explanations based on<br />
what we currently know about the<br />
foods and about <strong>IC</strong>.<br />
If you recall the physiology of <strong>IC</strong><br />
then you understand that <strong>IC</strong><br />
involves mast cells in the bladder.<br />
These mast cells are not unlike the<br />
mast cells that line our sinuses and<br />
give us hay fever symptoms. Many of<br />
the foods on our <strong>IC</strong> <strong>Diet</strong> list are<br />
quite high in histamine, an irritating<br />
substance that can provoke mast<br />
cells.<br />
Another problem <strong>IC</strong> patients may<br />
have is increased nerve sensitivity in<br />
the bladder. Some of the items on<br />
the diet list actually stimulate and<br />
sensitize nerves, and that’s not something<br />
we want to do to an already<br />
oversensitive bladder.<br />
Dr. Lowell Parsons, a renowned<br />
<strong>IC</strong> researcher at the University of<br />
San Diego, has noticed that several<br />
foods on the list contain large<br />
amounts of potassium. Because some<br />
patients’ bladders are known to react<br />
when potassium salts are instilled in<br />
the bladder, Dr. Parsons has suggested<br />
that for those patients, part of the<br />
problem may be the foods’ potassium.<br />
Many people have noticed that<br />
some foods on the <strong>IC</strong> diet list, particularly<br />
fruits and tomatoes, contain<br />
a substantial amount of acid. Food<br />
acids and their potential effect on <strong>IC</strong><br />
symptoms have been the focus of<br />
much discussion over the years.<br />
While we don’t have any concrete<br />
answers yet to questions of why these<br />
foods bother <strong>IC</strong> patients, <strong>IC</strong><br />
researchers do know that certain<br />
explanations for the acid food effect<br />
are not credible.<br />
Sometimes referred to “pseudo-science”,<br />
the myths explaining the acid<br />
food effect may sound plausible, but<br />
are not founded on known medical<br />
facts or unbiased scientific evidence.<br />
Typically these myths are touted by<br />
someone trying to sell <strong>IC</strong> patients<br />
something.<br />
The pseudo-scientific food myth<br />
<strong>IC</strong> patients run into most often on<br />
the internet is the one that claims<br />
that <strong>IC</strong> urine (or the <strong>IC</strong> body in general)<br />
is too acidic and if it was alkaline,<br />
the patient wouldn't suffer.<br />
Acid foods, it says, bother the bladder<br />
because they make the body<br />
chemistry, and thus the urine, more<br />
acid. In truth, the effect of wellknown<br />
urinary alkalinizers such as<br />
PolyCitra is not universal among <strong>IC</strong><br />
patients. Some patients say it makes<br />
their <strong>IC</strong> better, others tell their doctors<br />
it actually makes their <strong>IC</strong> worse.<br />
What’s more, some acid foods make<br />
the urine acid while others actually<br />
turn it alkaline. Drink a lot of cranberry<br />
juice and your urine will reliably<br />
turn acid, and if you’re an <strong>IC</strong><br />
patient, your <strong>IC</strong> will flare up. Do the<br />
same with orange juice and your<br />
urine will become alkaline. But even<br />
though your urine is alkaline, you’ll<br />
probably have quite an <strong>IC</strong> flare-up!<br />
Why does one acidic food turn the<br />
urine acid and the other turn it alkaline<br />
Because each substance is utilized<br />
by the body differently.<br />
There are a variety of lists floating around the<br />
<strong>IC</strong> community which document some of<br />
the diverse <strong>IC</strong> food irritants.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 5
The <strong>IC</strong> <strong>Diet</strong>: A List of Problem Foods<br />
There are a variety of lists<br />
floating around the <strong>IC</strong> community<br />
which document<br />
some of the diverse <strong>IC</strong> food irritants.<br />
Many lists are similar, yet not identical.<br />
Whether or not a particular food<br />
is listed is sometimes a matter of the<br />
beliefs, priorities, or personal experience<br />
of the author(s).<br />
The problem foods we’ve listed<br />
below are the most common ones<br />
that thousands of <strong>IC</strong> patients have<br />
reported trouble with. Your goal is to<br />
determine IF these foods irritate you,<br />
perhaps by using an elimination diet!<br />
If you are like most, you’ll probably<br />
be able to eat a few of the foods listed<br />
as “problematic”. You also might<br />
have to avoid a few others listed as<br />
“okay”. Remember, this list is only a<br />
rough guide. Be prepared to be creative<br />
with your meals and in your<br />
kitchen!<br />
Please note: About 15% of<br />
women with <strong>IC</strong> also have vulvar<br />
pain (vulvodynia). Some of the<br />
foods in the “May Be Okay” column<br />
have high levels of oxalates, which<br />
women with vulvodynia react to.<br />
Those who don’t have vulvodynia<br />
typically don’t react to the oxalates,<br />
so they may have a much easier time<br />
getting away with foods in the “May<br />
Be Okay” column.<br />
Usually OK May Be OK Usually Problematic<br />
Beverages<br />
chamomile tea<br />
Evian® water<br />
Gerber® pear juice<br />
milk<br />
mint tea<br />
alfalfa tea<br />
bottled water<br />
coffee substitutes<br />
low acid decaf coffee<br />
low acid juices<br />
gin<br />
rice milk<br />
root beer w/ ice<br />
rum<br />
tap water<br />
vodka<br />
beer<br />
carbonated water<br />
chocolate milk<br />
citrus juices<br />
cranberry juice<br />
herb teas w/rose hips<br />
most fruit juices<br />
regular coffee<br />
sodas<br />
soy milk<br />
tea<br />
wines<br />
Grain<br />
Products<br />
buckwheat<br />
corn bread<br />
couscous<br />
matzo<br />
millet<br />
oat bread<br />
pasta<br />
pitas<br />
potato bread<br />
quinoa<br />
rice<br />
spelt<br />
white bread<br />
amaranth<br />
grits<br />
oatmeal<br />
rye bread<br />
sourdough bread<br />
some graham crackers w/o<br />
problem ingredients<br />
whole wheat bread<br />
bread or cereal<br />
w/preservatives<br />
soy flour<br />
Fats<br />
and<br />
Nuts<br />
butter<br />
canola oil<br />
coconut w/o preservatives<br />
coconut oil<br />
corn oil<br />
margarine<br />
olive oil<br />
peanut oil<br />
safflower oil<br />
sesame oil<br />
shortening<br />
soy oil<br />
almonds<br />
cashews<br />
tahini<br />
sunflower<br />
seeds<br />
filberts<br />
hazelnuts<br />
macadamia nuts<br />
mayonnaise<br />
most salad dressings<br />
peanuts<br />
pecans<br />
pistachio nuts<br />
English and black walnuts<br />
6 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
Usually OK May Be OK Usually Problematic<br />
Soups<br />
homemade soups<br />
from ok meats<br />
and vegetables<br />
Health Valley® chicken broth<br />
some canned soups<br />
w/o problem ingredients<br />
bouillon cubes<br />
bouillon powder<br />
most packaged and canned<br />
soups<br />
Meat,<br />
Fish<br />
and<br />
Poultry<br />
beef<br />
chicken<br />
eggs<br />
fish<br />
lamb<br />
liver (beef or chicken)<br />
pork<br />
shellfish<br />
shrimp<br />
turkey<br />
veal<br />
anchovies<br />
bacon<br />
Canadian bacon<br />
caviar<br />
corned beef<br />
liverwurst<br />
prosciutto<br />
some sausages w/o problem<br />
ingredients<br />
bologna<br />
ham<br />
hot dogs<br />
most sausage<br />
pepperoni<br />
salami<br />
smoked fish<br />
Cheeses<br />
and<br />
Other<br />
Dairy<br />
cream cheese<br />
cottage cheese<br />
feta<br />
mozzarella<br />
ricotta<br />
string cheeses<br />
whipped cream<br />
vanilla ice cream<br />
buttermilk<br />
canned Parmesan<br />
Cool Whip®<br />
Monterey jack<br />
some sherbets<br />
some frozen yogurt<br />
Rice Dream®<br />
aged cheeses<br />
blue cheese<br />
brie<br />
brick parmesan<br />
camembert<br />
cheddar<br />
edam<br />
emmenthaler<br />
gruyer<br />
hard jack<br />
roquefort<br />
sorbet<br />
soy milk<br />
soy cheese<br />
sour cream<br />
stilton<br />
swiss<br />
yogurt<br />
Vegetables<br />
and<br />
Dried<br />
Beans<br />
broccoli<br />
brussels sprouts<br />
cabbage<br />
carrots<br />
cauliflower<br />
chives<br />
collard greens<br />
corn<br />
cucumber<br />
kale<br />
lentils<br />
lettuce<br />
mustard greens<br />
mushrooms<br />
most dried beans<br />
okra<br />
parsley<br />
peas<br />
potatoes<br />
pumpkin<br />
radishes<br />
snow peas<br />
split peas<br />
summer squash<br />
turnips<br />
winter squash<br />
yams<br />
zucchini<br />
avocado<br />
beets<br />
chicory<br />
cooked bulb onions<br />
cooked leeks<br />
dandelion greens<br />
eggplant<br />
low acid tomatoes<br />
purslane<br />
raw green onions<br />
rhubarb<br />
rutabagas<br />
swiss chard<br />
spinach<br />
turnip greens<br />
watercress<br />
chili peppers<br />
fava beans<br />
lima beans<br />
pickles<br />
raw bulb onions<br />
sauerkraut<br />
soy beans (edamame)<br />
tomato<br />
tomato sauces<br />
tomato juice<br />
tofu<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 7
Fruits<br />
Usually OK May Be OK Usually Problematic<br />
dates w/o preservatives<br />
coconut w/o preservatives<br />
pears<br />
bananas<br />
blueberries<br />
brown raisins<br />
cherimoya<br />
citrus peels<br />
crenshaw melon<br />
dried currants<br />
Gala apples<br />
honeydew<br />
mango (small amt)<br />
maraschino<br />
cherries<br />
rhubarb<br />
watermelon<br />
apricots<br />
all citrus fruit<br />
cantaloupe<br />
cherries<br />
dried fruit w/ preservatives<br />
peaches<br />
most plums<br />
most dried figs<br />
golden raisins<br />
grapes<br />
guava<br />
kiwi fruit<br />
most berries<br />
passion fruit<br />
papaya<br />
persimmon<br />
pineapple<br />
starfruit<br />
Desserts<br />
and<br />
Sweets<br />
brown sugar<br />
carob<br />
carrot cake<br />
creme brulee<br />
custards<br />
divinity<br />
homemade pound cake<br />
homemade white and yellow<br />
cakes<br />
homemade vanilla frosting<br />
homemade caramel frosting<br />
honey<br />
licorice<br />
maple syrup<br />
pear pastries<br />
sugar<br />
sugar cookies<br />
tapioca<br />
vanilla ice cream<br />
vanilla pudding<br />
banana bread<br />
blueberry pastries<br />
caramel candies<br />
peppermint ice cream<br />
plain pastries w/ almonds<br />
plain cheesecakes<br />
some frozen yogurt<br />
some hard candies w/o<br />
acids<br />
some popsicles<br />
Splenda® (sucralose)<br />
stevia<br />
white chocolate<br />
acesulfame K<br />
aspartame<br />
catsup<br />
chocolate<br />
coffee ice cream<br />
desserts w/ problem nuts<br />
mustard<br />
pastries w/ problem fruits<br />
pecan pie<br />
sorbets<br />
store-bought<br />
fruitcakes<br />
mincemeat pie<br />
Nutrasweet®<br />
saccharine<br />
Seasonings<br />
and<br />
Additives<br />
allspice<br />
almond extract<br />
anise<br />
basil<br />
caraway seed<br />
coriander<br />
dill<br />
fennel<br />
garlic<br />
mace<br />
marjoram<br />
oregano<br />
poppy seed<br />
rosemary<br />
sage<br />
salt<br />
thyme<br />
tarragon<br />
vanilla extract<br />
black pepper<br />
celery seed<br />
cilantro<br />
cinnamon<br />
cumin (small amt)<br />
dried parsley<br />
dried chervil<br />
ginger<br />
lemon extract<br />
malt powder<br />
nutmeg<br />
onion powder<br />
orange extract<br />
turmeric<br />
ascorbic acid<br />
autolyzed yeast<br />
BHA and BHT<br />
benzoates<br />
caffeine<br />
cayenne<br />
cloves<br />
chili powder<br />
citric acid<br />
hot curry powder<br />
hydrolyzed protein<br />
meat tenderizers<br />
miso<br />
oleoresin paprika<br />
paprika<br />
red pepper<br />
soy sauce<br />
tamari<br />
vinegar<br />
worcestershire sauce<br />
MSG (monosodium glutamate)<br />
metabisulfites<br />
sulfites<br />
8 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
Our Five Worst Foods<br />
These foods win our vote as the<br />
biggest misery makers for people<br />
with <strong>IC</strong>! These are the<br />
foods we hear about from <strong>IC</strong> patients<br />
all the time. Of course just because<br />
they cause trouble for so many others,<br />
that doesn’t guarantee they’ll<br />
make you miserable too. But if you<br />
do eat these, watch out! Be sure to<br />
pay close attention to how you feel<br />
afterwards. If you feel worse, then<br />
there is a good chance that this is a<br />
trigger food for you. Information is<br />
power. Whenever possible, talk with<br />
other patients and compare your<br />
trigger foods. They may help you discover<br />
some hidden triggers in your<br />
own diet.<br />
#1: Cranberry juice<br />
Otherwise known as the ACID<br />
BOMB when it hits, cranberry juice<br />
may be the biggest<br />
bladder irritant in an<br />
<strong>IC</strong> patient’s diet. It's<br />
often recommended<br />
for consumption during<br />
urinary tract<br />
infections because it<br />
is believed to have<br />
substances in it that<br />
help keep bacteria<br />
from sticking to the<br />
bladder wall. (If they<br />
can't stick, they can't<br />
infect. They just get<br />
flushed out). But<br />
cranberry juice can<br />
be difficult for an <strong>IC</strong><br />
bladder to tolerate. If<br />
you have to have it,<br />
try diluting it by half<br />
or more!<br />
#2: Coffee<br />
Yes, we know that “lattes” and<br />
other coffee products are all the rage<br />
these days. However, in a sensitive<br />
bladder, the caffeine and tannins in<br />
coffee have little competition for<br />
causing intense irritation. Some people<br />
can tolerate low-acid decaf coffees,<br />
while others try (less caffeinated)<br />
teas. But for the most sensitive<br />
<strong>IC</strong> patient, by far the safest option<br />
for a hot drink in the morning is hot<br />
water and honey.<br />
#3: Carbonated beverages<br />
Whether it be plain carbonated<br />
Perrier water or flavored sodas, <strong>IC</strong><br />
patients often complain about their<br />
effects on the bladder. The biggest<br />
problem appears to be the acid,<br />
though most flavored sodas also have<br />
big doses of caffeine.The most difficult<br />
carbonated beverage for an <strong>IC</strong><br />
bladder to tolerate appears to be diet<br />
cola. <strong>Diet</strong> colas are a quadruple<br />
whammy of acidic carbonation, citric<br />
and other acids, caffeine, and<br />
artificial sweeteners—four wellknown<br />
bladder irritants. Taken all at<br />
once it can be an <strong>IC</strong> bladder’s nightmare!<br />
If you must have a soda, try a<br />
non-diet, usually non-caffeinated,<br />
root beer—and load the cup with<br />
plenty of ice to dilute<br />
it!<br />
Low<br />
acid tomatoes may be<br />
good substitutes for<br />
some people. A Taste<br />
of the Good Life: A<br />
Cookbook for an<br />
<strong>Interstitial</strong> <strong>Cystitis</strong><br />
<strong>Diet</strong>, has a lengthy list<br />
of lower-acid tomato<br />
#4: Tomatoes<br />
They’re found in so<br />
many foods these days,<br />
tomatoes and tomato<br />
products are darn hard<br />
to avoid. Though we<br />
think of them as mild<br />
mannered vegetables,<br />
those tempting red<br />
globes are really a very<br />
acidic fruit. A few <strong>IC</strong><br />
patients can tolerate<br />
tomato sauces on pizzas<br />
and pasta, but most<br />
cannot.<br />
varieties you can grow at home!<br />
#5: Tobacco<br />
Ok, we admit it, we cheated to<br />
get this one on the list... tobacco<br />
isn’t really a food. But it does have<br />
some significant effects on an <strong>IC</strong><br />
bladder. For one, it acts to constrict<br />
the bladder’s blood vessels, interfering<br />
with the body’s natural way of<br />
washing out inflammatory substances<br />
from the bladder tissues. Veteran <strong>IC</strong><br />
patients prefer less pain rather than<br />
more. Is that cigarette worth a night<br />
and day of pain<br />
Otherwise known as<br />
the ACID BOMB when<br />
it hits, cranberry juice<br />
may be the biggest<br />
bladder irritant in an<br />
<strong>IC</strong> patient’s diet.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 9
THE TWO HARDEST FOODS<br />
TO GIVE UP<br />
As a support group leader, every<br />
once in a while I encounter an <strong>IC</strong><br />
patient who, despite their horrible,<br />
continuous pain, insists on drinking<br />
coffee and/or eating chocolate bars.<br />
Coffee and chocolate are<br />
among the most common<br />
comfort foods. We<br />
depend on these to wake<br />
up, soothe our bad mood,<br />
or just give us a cheerful<br />
lift. In addition to caffeine,<br />
these both have a load of<br />
substances any one of which<br />
can potentially affect an <strong>IC</strong><br />
bladder.<br />
For me, as an <strong>IC</strong> patient, it was a<br />
choice between pain and frequency<br />
or coffee. I chose not to be in pain.<br />
But, still, some coffee addicts insist<br />
that they can drink coffee and not<br />
experience discomfort. I say, PROVE<br />
IT!<br />
Coffee and chocolate<br />
are among the most<br />
common comfort foods.<br />
We depend on these<br />
to wake up, soothe our<br />
bad mood, or just give<br />
us a cheerful lift.<br />
TAKING A PRO-ACTIVE ROLE<br />
IN YOUR DIET<br />
As a support group leader, I sometimes<br />
talk to patients who won’t take<br />
the time to explore the connection<br />
between pain and diet. I don’t understand<br />
why. If I am eating something<br />
which is flaring my bladder, my<br />
pain requires that I stop. It’s an<br />
easy choice... and, yes,<br />
even chocolate isn’t<br />
worth it. If you want to<br />
TAKE CHARGE of your<br />
<strong>IC</strong> flares, your first step may be<br />
exploring the world of dietary<br />
triggers and <strong>IC</strong>.<br />
Information is<br />
power. Whenever possible,<br />
talk with other<br />
patients about their forbidden foods.<br />
The best approach is to TAKE<br />
ACTION and keep a food diary.<br />
Your starting list should include<br />
those foods which you suspect<br />
inflame and irritate your bladder.<br />
Then, as you eat suspect food, keep<br />
track of how you feel afterwards. Is<br />
your frequency and pain increased If<br />
it is, place it on your forbidden list<br />
and avoid it for a while.<br />
Another approach that <strong>IC</strong><br />
patients with determination take is<br />
to try an elimination diet. By avoiding<br />
foods which you suspect are triggers<br />
for awhile, you can then reintroduce<br />
suspected foods one at a<br />
time, and honestly assess whether it<br />
causes your symptoms to worsen. If<br />
you feel fine, with no increase in<br />
symptoms, you may be able to return<br />
this food to your diet in moderate<br />
quantities. If it causes pain, definitely<br />
avoid it!<br />
SUGGESTED READING<br />
A Taste of the Good Life: A<br />
Cookbook for an <strong>IC</strong> <strong>Diet</strong> by Bev<br />
Laumann. Currently available in the<br />
<strong>IC</strong>N Shop!<br />
The Best Guide to Allergy,<br />
Consumers Union Edition (by A.<br />
Giannin, N.D. Schultz, T.T. Chang<br />
& D.C. Wong) has an outstanding<br />
and comprehensive listing of food<br />
allergies, food groups & a variety of<br />
elimination diets.<br />
The only way to know if coffee,<br />
chocolate, (or any other comfort<br />
food) bothers your bladder is to do<br />
your own research! How Complete<br />
a voiding diary for a few days, WITH<br />
COFFEE AND CHOCOLATE, in<br />
your diet. Then, keep the same diary<br />
and avoid drinking and/or eating<br />
either for a week!<br />
If your voiding diary shows that<br />
you urinate less and/or are in less<br />
pain when you’re not consuming<br />
them, then they are clearly irritating<br />
you! Do you need any more evidence<br />
than that<br />
10 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
<strong>IC</strong>N Guest Lectures:<br />
The Role of <strong>Diet</strong> and <strong>IC</strong><br />
Featuring Bev Laumann<br />
Author of A Taste of the Good Life: A Cookbook for an <strong>IC</strong> <strong>Diet</strong><br />
Event date: June 29, 2004<br />
Founded in 1999, the <strong>IC</strong>N Guest Lecture<br />
series brings the world’s best researchers,<br />
doctors and advocates for <strong>IC</strong> directly to the<br />
homes and offices of patients in need. This<br />
lecture was sponsored by Akpharma, makers<br />
of Prelief (http://www.prelief.com), and<br />
AstraTech, makers of the Lo-Fric® Catheter<br />
(http://www.astratech.com)<br />
Tonight we welcome Bev<br />
Laumann, author of A Taste of<br />
the Good Life: A Cookbook for<br />
an <strong>IC</strong> <strong>Diet</strong>. Bev is one of the most talented,<br />
educated and enthusiastic <strong>IC</strong><br />
experts in the country today. She is a<br />
former <strong>IC</strong> support group leader in<br />
Orange County, California. In addition,<br />
she has written what is, by far, the<br />
most popular <strong>IC</strong> book today.<br />
In “A Taste of the Good Life” she<br />
answers many of the questions that<br />
we all face in handling diet and <strong>IC</strong>.<br />
She has written dozens of columns on<br />
the <strong>IC</strong> network in her “Fresh Tastes”<br />
series that are designed to give you <strong>IC</strong><br />
friendly food and meal ideas. Bev is<br />
also a consummate researcher. She<br />
has worked, and continues to work,<br />
with a number of researchers around<br />
the country in various food/diet related<br />
issues.Welcome Bev!!!<br />
Thank you very much. I’m glad to<br />
be here.<br />
Is diet important to <strong>IC</strong> patients<br />
Most people who have <strong>IC</strong> find<br />
that changes in their daily diet make<br />
a profound difference in their bladder<br />
symptoms. Of more than 550 <strong>IC</strong><br />
patients responding to a recent<br />
online survey conducted by the <strong>IC</strong>A,<br />
84% of those who had tried the <strong>IC</strong><br />
diet said that it helped reduce their<br />
symptoms. How did those patients<br />
find out about the diet Almost half<br />
of the survey respondents found out<br />
about it not from their doctors but<br />
from other sources such as fellow <strong>IC</strong><br />
patients, support groups, or web sites.<br />
Historically, the <strong>IC</strong> diet is not something<br />
doctors came up with. It's a<br />
discovery that thousands of patients<br />
made over the years and shared with<br />
each other.<br />
So, while we now can ace out<br />
which foods tend to be troublemakers,<br />
little is known scientifically<br />
about how and why they cause us<br />
misery. Various doctors and organizations<br />
offer slightly different versions<br />
of the diet but the most reliable ones<br />
to start out with are those offered<br />
here on the <strong>IC</strong> <strong>Network</strong> and at the<br />
<strong>IC</strong>A’s website. Because no two people<br />
are alike, no two diets will be<br />
exactly alike. So, regardless of which<br />
diet version you start with, over time<br />
you will learn to customize it to suit<br />
your body.<br />
How should a patient approach<br />
the diet<br />
For newly diagnosed patients the<br />
idea that I like the most is a threestep<br />
process that confirms whether<br />
your bladder is affected by diet, identifies<br />
the major problems, then finetunes<br />
the diet to your needs. Here’s<br />
what you do:<br />
(1) Keep track of your symptoms,<br />
rating them on a scale of 1-10.<br />
(2) Begin a very restricted diet<br />
that includes only relatively safe<br />
foods such as Evian water, carrots,<br />
lettuce, rice, and cooked chicken.<br />
You can have all you want of these<br />
foods... but no seasonings, no butter,<br />
nothing else!!!! Continue rating your<br />
symptoms while you stick to this<br />
stringent diet about THREE days. A<br />
person can’t survive on just these<br />
foods. We need as broad a diet as<br />
possible to insure good nutrition so<br />
you have to expand your diet by<br />
adding foods as quickly as possible. If<br />
you are diet sensitive, your symptoms<br />
should begin to wane by the third<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 11
day of the strict diet. Gradually add<br />
foods to your diet while watching<br />
your symptom level.<br />
(3) Try a new food every two days.<br />
If you get no reaction, try another<br />
food. If your bladder reacts, let it<br />
calm down before you add another<br />
food. Start with foods that are not<br />
listed on the <strong>IC</strong> diet as “problematic.”<br />
Test the problem foods LAST...<br />
after you already have a diverse diet.<br />
This technique is what doctors call<br />
an elimination diet. For more information<br />
on how to do this safely, take<br />
a look at the <strong>IC</strong> <strong>Network</strong>s’ patient<br />
handbook which has a chapter on<br />
elimination diets. With an elimination<br />
diet... it may take a while to sort<br />
out what you can eat, but be patient.<br />
In the end, you will have an <strong>IC</strong> diet<br />
customized just for you.<br />
What are the most common <strong>IC</strong><br />
diet pitfalls<br />
By far the biggest pitfall we need<br />
to avoid when manipulating our diet<br />
is jumping to conclusions. When you<br />
try a food, make sure you are trying<br />
just the food—not the food and also<br />
preservatives, spices, or other substances.<br />
Test foods in their purest<br />
forms. If you want to test pears, for<br />
instance, eat a fresh pear. Do not<br />
test pears by eating pear bread, pear<br />
jelly or other foods that contain<br />
pears.<br />
Be aware, too, that not all ingredients<br />
in prepared food have to be on<br />
the label. Have you ever wondered<br />
why milk stays homogenized rather<br />
than separating Milk has emulsifiers<br />
in it that keep the<br />
cream from rising to the<br />
top. Those emulsifiers<br />
are not required to<br />
be listed on the<br />
label. Federal law<br />
has many loopholes<br />
and peculiarities like<br />
that.<br />
What are the high-risk foods<br />
The foods <strong>IC</strong> patient bladders<br />
react to typically fall into one of four<br />
categories:<br />
Be aware, too,<br />
that not all<br />
ingredients in<br />
prepared food<br />
have to be<br />
on the label.<br />
(1) Nerve stimulants<br />
(2) Foods that taste acidic<br />
(3) Foods that have high levels of<br />
potassium<br />
(4) Foods that the patient may<br />
be allergic to<br />
The worst foods are those that fall<br />
into more than one category such as<br />
coffee. Coffee has caffeine, a nerve<br />
stimulant. It also has several strong<br />
acids. The same came be said of tea<br />
and soft drinks. Other nerve stimulants<br />
that are big problems are aspartame<br />
and monosodium glutamate<br />
(MSG). Fruit and fruit juice is<br />
another big problem<br />
for us.<br />
Food acids come in<br />
two types: (1) acids<br />
that the body uses up<br />
and (2) acids that the<br />
body doesn’t use. The<br />
acids it uses, such as citric<br />
acid, are changed and become<br />
part of other chemicals rather than<br />
going into the urine and turning it<br />
acidic. The food acids that the body<br />
doesn’t use, however, just go directly<br />
into the urine and can turn the urine<br />
acidic. But, for us, it doesn’t matter<br />
whether the food makes our urine<br />
acid or not. The important tell tale<br />
indicator is whether or not the food<br />
tastes acid. Take orange juice and<br />
cranberry juice, for instance. Both<br />
are notorious for causing bladder<br />
pain, but cranberry juice will turn<br />
the urine acidic and orange juice will<br />
do just the opposite... it will turn the<br />
urine alkaline.<br />
To go back to the nerve stimulants,<br />
let’s look at MSG. It is naturally<br />
occurring in lima beans. Lima<br />
beans are often a problem for <strong>IC</strong><br />
patients. MSG also occurs as a result<br />
of processing in such substances as<br />
hydrolyzed protein, soy sauce, and<br />
autolyzed yeast. Caffeine, another<br />
nerve stimulant, is also found in<br />
chocolate and is found in maté and<br />
guarana. Those last two are now<br />
being added to beverages without<br />
any warning about the caffeine they<br />
contain. So, you would be foolish to<br />
try some of the new drinks that come<br />
with a lot of extra herbs in it.<br />
12 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
Start with foods that are<br />
not listed on the <strong>IC</strong> diet<br />
as “problematic." Test<br />
the problem foods<br />
LAST... after you<br />
already have a diverse<br />
diet. This technique is<br />
what doctors call an<br />
elimination diet.<br />
Are there any <strong>IC</strong> Friendly<br />
Beverages<br />
Water, of course, is the most <strong>IC</strong><br />
friendly beverage available. Evian<br />
water has a very good reputation<br />
with <strong>IC</strong> patients. It is not acidic and<br />
has a little natural sodium bicarbonate,<br />
which neutralizes a little bit of<br />
stomach acid. Another choice would<br />
be milk, unless you’re<br />
allergic to it. I also<br />
wrote a column on<br />
the many brands of<br />
bottled water that<br />
you can also read to<br />
compare the different<br />
types of water available.<br />
A few select herb<br />
teas are mint and<br />
chamomile. Spearmint is milder than<br />
peppermint and if you drink a lot of<br />
it, it would be better accepted by<br />
your intestinal tract. Chamomile is<br />
soothing. Another choice that some<br />
<strong>IC</strong> patients find helpful for their<br />
bladder is Marshmallow Root Tea.<br />
If you’re looking for something<br />
that has a coffee flavor, consider trying<br />
first Teeccino Herbal Coffees.<br />
These are carob based and have no<br />
caffeine... and come in a number of<br />
flavors. They are in the <strong>IC</strong>N shop if<br />
you want to look at the ingredients,<br />
etc. We can talk about coffees for<br />
hours and I do want to cover other<br />
things so check out the columns that<br />
I’ve written on the <strong>IC</strong>N “Fresh<br />
Tastes” column series for more information.<br />
Hot water and honey, though it<br />
sounds bland, rarely irritates the<br />
bladder and is easy to drink especially<br />
when out at a restaurant, etc. etc.<br />
Another choice for something to<br />
drink, particularly if you’re sick with<br />
a cold is Pacific Brand Free Range<br />
Chicken Broth. If you can find it, it<br />
comes in little individual one-cup<br />
servings that you can heat up. It<br />
makes a delicious warm cup in cold<br />
weather and has no MSG unlike<br />
most brands of chicken broth.<br />
For a summer drink, you might<br />
like the Davidson’s Children’s Tea<br />
chilled over ice or, iced pear juice.<br />
The Children’s tea (made by<br />
Davidson’s) has only chamomile and<br />
hibiscus. It’s very fruity, but not bitter<br />
or acid. It smells almost like fruit<br />
punch. Cold pear juice is probably<br />
your best choice on a hot summer<br />
day if you’re looking for a fruit drink.<br />
Jill and I were just comparing the<br />
fruit juices that we each can drink<br />
and it proves just how individual our<br />
<strong>IC</strong> diets can be. I, for<br />
example, can drink<br />
blueberry juice, but it<br />
bothers Jill’s bladder.<br />
Jill can drink pineapple<br />
juice, but it bothers<br />
my bladder. This<br />
is why that elimination<br />
diet that I<br />
talked about earlier is<br />
so important. You<br />
will find foods that you can tolerate<br />
easily, but you've got to try them<br />
carefully.<br />
Are eggs <strong>IC</strong> friendly<br />
Eggs and high protein foods, in<br />
general, will turn your urine acid but<br />
we’ve always said that that doesn’t<br />
seem to matter. However, the egg<br />
white is very alkaline even though it<br />
has protein in it, which can turn<br />
your urine acid. In general, eggs are a<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 13
good source of protein and mild for<br />
the bladder. Unless you are very<br />
allergic to eggs, it shouldn’t be a<br />
problem.<br />
It’s summer and we want our<br />
salad dressings. What <strong>IC</strong> friendly<br />
ideas do you have<br />
Here are several ideas to try. Some<br />
may work for you, and some may<br />
not.<br />
#1. Avoid salad dressings with any<br />
preservatives or chemicals. Newman’s<br />
Own Oil & Vinegar dressing is pretty<br />
mild and you may be able to get<br />
away with it.<br />
#2. If that’s too acid, here’s another<br />
idea to try: Sprinkle dried herbs<br />
over a damp salad and toss. You’ll get<br />
the flavor without the vinegar. Herbs<br />
like basil, parsley, oregano, marjoram,<br />
garlic powder would be worth<br />
trying.<br />
#3. Flavored oils are another great<br />
alternative, such as basil or garlic flavored<br />
olive oils. Just stay away from<br />
the chili or pepper flavored oils.<br />
#4. Mayonnaise and mayonnaise<br />
type salad dressings are good for<br />
some people but not others. It's very<br />
individual.<br />
Are all soda pops bad for you<br />
They all are very acid. They all<br />
contain citric and phosphoric acid<br />
and some contain caffeine also. In<br />
addition, canned soft drinks usually<br />
contain sodium benzoate or potassium<br />
benzoate as a preservative. The<br />
potassium benzoate will not only<br />
become acid in your stomach but it<br />
will also supply potassium, which<br />
may stimulate pain-conducting<br />
nerves. This is why foods that are<br />
high in potassium can trigger some<br />
problems. Other high potassium<br />
foods include: orange juice and<br />
bananas. If you have to have a soda<br />
while you’re out try a root beer<br />
because it doesn’t usually contain<br />
caffeine. And, if it’s on tap as<br />
opposed to being in a can, it may not<br />
have preservatives either.<br />
Are bananas <strong>IC</strong> friendly<br />
Although bananas are high in potassium,<br />
they are not acidic. So, if you<br />
are not very potassium sensitive, you<br />
may be able to get away with<br />
bananas. A banana, in fact, is a good<br />
test for potassium sensitivity because<br />
they are the food that contains the<br />
most potassium. Potatoes would not<br />
be a problem. Most <strong>IC</strong> patients eat<br />
lots of potatoes without a problem.<br />
The level of potassium is nowhere<br />
near the potassium in a banana, for<br />
example.<br />
Can some alcoholic beverages,<br />
like white wine, be taken in moderation<br />
without hurting the bladder<br />
White wine has less histamine<br />
than red wine... but both have<br />
enough histamine to bother <strong>IC</strong> bladders.<br />
It just depends on how sensitive<br />
your bladder is to both the acid and<br />
the histamine in wines.<br />
Unfortunately, the wines that are<br />
the most acidic have the least histamine<br />
and vice versa. If you want to<br />
try a wine, try a white wine (like a<br />
chardonnay) rather than a red wine.<br />
Is it Safe<br />
Don’t feel bad about putting ice in<br />
your wine to dilute it. You’ll still get<br />
the flavor, but you just don’t look<br />
cool!<br />
Do you encounter patients who<br />
say that diet doesn’t make a difference<br />
in their symptoms<br />
Yes, there are people who can<br />
seemingly eat anything without a<br />
change in their symptoms. They<br />
tend to be very severe cases or very<br />
mild cases. For those who are newly<br />
diagnosed and are in severe pain<br />
they may not notice that their symptoms<br />
are fluctuating. Therefore, they<br />
may not notice, at first, the effect<br />
that diet would have. But, after<br />
they've been on a treatment for a<br />
while, and their symptoms become<br />
better, then they will notice the difference<br />
that diet makes. For the people<br />
who have very mild cases, often<br />
treatment does so well at controlling<br />
their symptoms that they simply do<br />
not pay attention to the little ups<br />
and downs that diet makes.<br />
Why won’t a product that reduces<br />
stomach acid help reduce bladder<br />
acid<br />
It depends upon what it is and<br />
how it reduces the stomach acid.<br />
Many stomach acid reducers DO<br />
help <strong>IC</strong>. Prelief neutralizes stomach<br />
acid, as does Tums or baking soda in<br />
some water and even Zantac and<br />
Tagamet may also help <strong>IC</strong> bladders.<br />
What’s the difference between a<br />
sensitivity and an allergy<br />
An allergy is mediated by a substance<br />
called IgE and sensitivity is<br />
not. A true allergy can be tested for<br />
at an allergist’s office. You may or<br />
14 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
may not react with your bladder to<br />
foods that you have a confirmed<br />
allergy to. Most patients probably<br />
have a sensitivity rather than an<br />
allergy.<br />
Do you have any suggestions for<br />
patients who are thinking about seeing<br />
a nutritionist<br />
Anyone can call himself or herself<br />
a nutritionist, but what we need to<br />
see is a registered dietitian. The<br />
American <strong>Diet</strong>etic Association has<br />
an 800 number and they can refer<br />
you to a dietician in your area.<br />
<strong>Diet</strong>icians are licensed and after you<br />
explain to them what foods you cannot<br />
eat without experiencing discomfort,<br />
they can work with you to<br />
find alternatives that will give you a<br />
balanced diet.<br />
I have <strong>IC</strong> and IBS...are there certain<br />
foods that I should stay away<br />
from for both of these conditions<br />
And are there certain foods that are<br />
safe for both of these conditions<br />
Caffeine is bad for both conditions.<br />
Anything that is a nerve stimulant<br />
is going to be bad for both conditions<br />
including aspartame,<br />
Nutrasweet, and MSG. Two things<br />
that are not necessarily bad for an <strong>IC</strong><br />
bladder but will cause a flare for IBS<br />
are high fructose corn syrup and sorbitol.<br />
The International Foundation<br />
for Functional Gastrointestinal<br />
Disorders (IFFGD) has identified<br />
these as two of the most problematic<br />
food substances. Just how they cause<br />
a problem is unclear<br />
How about foods that can help<br />
keep our bowels together without<br />
irritating our IBS or <strong>IC</strong><br />
Suggestions for high fiber foods<br />
Constipation is a problem for<br />
most <strong>IC</strong> patients whether or not they<br />
have IBS because many of the meds<br />
used to treat <strong>IC</strong> are constipating.<br />
There are several foods that are fairly<br />
bladder safe and will help out with<br />
the constipation, including: oatmeal,<br />
whole wheat bread, Ezekiel<br />
Breads (are very high in fiber and,<br />
because they aren’t processed and<br />
have no preservatives, seem to be<br />
favorites for many <strong>IC</strong> patients),<br />
cooked and fresh vegetables, and salads.<br />
Is chocolate safe<br />
Chocolate has histamines that<br />
will affect the mast cells in the bladder.<br />
It also has caffeine, acids and<br />
lots of substances to irritate the bladder<br />
when it’s in urine. If you have to<br />
try chocolate and just can’t stand it,<br />
try very expensive dark chocolate.<br />
Stay away from cheap supermarket<br />
candy bars. The cheaper chocolate<br />
seems to be more irritating perhaps<br />
due to the way it’s refined and/or it<br />
could be additives and/or preservatives.<br />
Personally, I can get away with<br />
Godiva chocolate a whole lot better<br />
than Hershey’s. Some people can get<br />
away with white chocolate but not<br />
the brown chocolate. Also, don’t forget<br />
carob which is not the world’s<br />
greatest substitute but it can do in a<br />
pinch and is safer than chocolate for<br />
the bladder.<br />
Now Available in the <strong>IC</strong>N Shop at:<br />
http://www.ic-network.com/shop/<br />
or by calling (707) 433-0413<br />
• ”A Taste of the Good Life: A Cookbook for an <strong>IC</strong> <strong>Diet</strong>”<br />
by Bev Laumann<br />
• Organic Chamomile & Organic Peppermint Teas<br />
• Teeccino Brand Herbal Coffees<br />
• Golden Orchards Creamed Honeys<br />
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• A Perfect Pears Cinnamon Pear Jelly, Pear & Fig Jam, Cinnamon<br />
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Is sodium and salt a bladder irritant<br />
In general, <strong>IC</strong> patients don't have<br />
a problem with salty foods. However,<br />
since we’re all different, if you think<br />
that salt may be an issue for you try<br />
and test it out first. Moderation in<br />
everything is recognized as a healthy<br />
lifestyle. So, mild to moderate<br />
amount of salt may be fine, but<br />
heavy use may cause other issues<br />
such as high blood pressure, etc.<br />
Where can I get a complete list of<br />
the <strong>IC</strong> diet<br />
In my book! That’s a great question.<br />
In A Taste of the Good Life...<br />
I have extensive lists of <strong>IC</strong> foods that<br />
will help you learn the safe versus<br />
risky foods. You can buy that from<br />
the <strong>IC</strong> <strong>Network</strong> Shop.<br />
Is homemade better than readymade<br />
Yes, simply because it doesn’t have<br />
the additives.<br />
Is smoking also bad for the bladder<br />
Yes, because one of the things that<br />
it does is constrict blood vessels<br />
thereby cutting off blood supply to<br />
the bladder. Smoking is the #1 cause<br />
of bladder cancer. Just think about...<br />
all of the chemicals from tobacco sitting<br />
in your bladder for hours.... its a<br />
risky chemical stew... and it would be<br />
far better to quit smoking. You think<br />
<strong>IC</strong> is bad Bladder cancer is far<br />
worse!<br />
Active and informed <strong>IC</strong> patients<br />
understand implicitly that no patient, or<br />
website or presentation on a web site<br />
should be considered medical advice.<br />
We strongly encourage you to discuss<br />
your medical care and treatments with a<br />
trusted medical care provider. Only<br />
your personal provider can and should<br />
give you medical advice. The opinions<br />
expressed by our speaker may not represent<br />
the opinions of the <strong>IC</strong> <strong>Network</strong>.<br />
© 2004, The <strong>IC</strong> <strong>Network</strong>, All<br />
Rights Reserved.<br />
This transcript is copyright protected<br />
and may not be reproduced or distributed<br />
without written consent from the<br />
<strong>Interstitial</strong> <strong>Cystitis</strong> <strong>Network</strong>. For information,<br />
please contact the <strong>IC</strong>N at<br />
(707) 538-9442.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 15
The Fish Story<br />
by Bev Laumann<br />
Low in fat, high in Omega-3<br />
fatty acids that protect the<br />
heart and arteries...nutrition<br />
experts recommend serving<br />
fish at least twice a week!<br />
There’s no doubt that eating<br />
fish is a healthy habit, and in<br />
recent years it has become<br />
more popular too. Fish is not only<br />
lower in fat than beef or poultry, but<br />
it is also rich in omega-3 fatty acids,<br />
a fact that no doubt has led to its<br />
popularity. Omega-3 fatty acids are<br />
substances that research suggests may<br />
protect the heart and arteries.<br />
Nutrition experts recommend eating<br />
some form of seafood at least twice a<br />
week.<br />
Most people with <strong>IC</strong> can eat fish<br />
and unless you have an allergy to it<br />
(fish is a common allergen), chances<br />
are you won't have any trouble from<br />
your bladder. <strong>IC</strong> patients with food<br />
allergies may find their bladder also<br />
seems to react to foods they are allergic<br />
to.<br />
FISH ALLERGY<br />
So how do you know if you’re<br />
allergic to fish Just because you<br />
don’t break out in a rash or start<br />
sneezing when you eat a particular<br />
food, doesn’t mean you aren’t allergic<br />
to it. An allergist can test you for<br />
food allergies. Several kinds of tests<br />
are available including a skin-prick<br />
test, a blood test, or a challenge test<br />
(where you eat the food and watch<br />
for symptoms). You may have to<br />
hunt around to find an allergist who<br />
does blood-based food allergy testing.<br />
Many do not. One kind of blood test<br />
for food allergy may be called a<br />
RAST test or an ELISA test. One<br />
manufacturer of such a test, US<br />
Biotek, has an informative web site<br />
you may find interesting<br />
(www.usbiotek.com).<br />
One lady who had had <strong>IC</strong> for several<br />
years was clued in to the possibility<br />
of food allergies when she<br />
noticed that she had a runny nose<br />
quite often during dinner. Another<br />
<strong>IC</strong> patient who was recently tested,<br />
was surprised when her doctor told<br />
her she had food allergies. She didn’t<br />
sneeze or break out in an obvious<br />
rash in response to any food. But<br />
when she eliminated the allergenic<br />
foods from her diet, her <strong>IC</strong> improved.<br />
If your bladder seems to react to<br />
fish (and it may be a delayed-type<br />
reaction where the symptoms come<br />
on 12 to 24 hours after eating fish),<br />
you might also consider the possibility<br />
that you are reacting to preservatives,<br />
not the fish itself. Sulfites and<br />
phosphates are sometimes used as a<br />
dip to preserve seafood. (You may<br />
not taste sulfites, but if they've used<br />
too much phosphate dip the fish may<br />
taste “soapy”.) Sulfites are known to<br />
be especially allergenic. Try preservative-free<br />
fish from a natural foods<br />
store, or fish you catch yourself.<br />
When buying fish, be sure it is<br />
fresh, not old. Fish shouldn’t have a<br />
strong “fishy” odor. That’s a sure sign<br />
that the fish is decomposing. Be sure<br />
that you buy from a reputable dealer<br />
too, one who does not sell fish<br />
caught in contaminated waters. If fat<br />
content is important to you, remember<br />
that fish that is white or lightcolored<br />
(orange roughy, perch, snapper,<br />
or sole) is leaner than fish that is<br />
darker in color (Atlantic salmon,<br />
tuna, or mackerel).<br />
SPECIES TO KEEP AN EYE ON<br />
A few alarming studies over the<br />
last several years have shown that<br />
some Americans are consuming too<br />
much mercury. And despite being<br />
otherwise a very healthy food choice,<br />
a few fish species have routinely<br />
been found to contain dangerously<br />
high levels of mercury. Other species<br />
16 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
found in supermarkets may have<br />
high levels of PCB’s (polychlorinated<br />
biphenyls)—an industrial chemical<br />
whose use has been banned, though<br />
it persists in the environment.<br />
Mercury, a toxic metal that can<br />
cause permanent nervous system<br />
damage, is particularly harmful for<br />
pregnant women and children. PCB’s<br />
have long been suspected of causing<br />
cancer and compromised immune<br />
systems. Certain fish species absorb<br />
these dangerous chemicals because<br />
the food they eat is laden with it. As<br />
big fish eat small fish and then are in<br />
turn eaten by bigger fish, toxic substances<br />
become concentrated. These<br />
harmful chemicals are the most concentrated<br />
in species of large fish at<br />
the top of the food chain—swordfish<br />
and tuna for instance. Because <strong>IC</strong><br />
has aspects of immune system<br />
involvement as well as involvement<br />
of the central nervous system, we'd<br />
be well advised to keep tabs on our<br />
intake of these fish. Who needs to<br />
add any more fuel to the fire<br />
The federal government advises<br />
that sensitive populations avoid<br />
these species altogether, because they<br />
are very high in mercury: swordfish,<br />
shark, king mackerel, and tilefish<br />
(which is sometimes called “golden<br />
snapper” or “golden bass” in stores<br />
and restaurants). Farmed salmon and<br />
catfish may have high levels of<br />
PCB's. Although there is some disagreement<br />
over the situation with<br />
tuna steaks and canned tuna, many<br />
toxicology experts think one should<br />
limit the intake of these. Michael<br />
Bender, director of the non-profit<br />
Mercury Policy Project, was quoted<br />
in the Wall Street Journal in<br />
September 2003 as saying, “Based on<br />
the data, yeah, we think that tuna<br />
steaks and sushi should be in the ‘do<br />
not eat’ category for pregnant<br />
women and kids.”<br />
SAFER SPECIES<br />
The following species are both<br />
low in toxins and a good source of<br />
protein and omega-3’s: oysters,<br />
clams, scallops, shrimp, cod, tilapia,<br />
perch, flounder, sole, wild salmon,<br />
and farm-raised rainbow trout,<br />
among others. With all the debate<br />
over fish safety you might be tempted<br />
to pop a few fish oil supplement<br />
pills, or reel in your own fish.<br />
Fish oil may not be a good idea<br />
because PCB’s reside in the fats and<br />
oils of fish. With unregulated dietary<br />
supplements, you have no way of<br />
knowing what kind of fish was used<br />
in the manufacture, and whether or<br />
not it came from polluted waters.<br />
Before eating any fish you catch,<br />
check the local advisory on the EPA’s<br />
web site: www.epa.gov/ost/fish/.<br />
There, you can check on the body of<br />
water where you fish by clicking on<br />
“National Listing of Advisories”.<br />
Here are two delicious, bladder-friendly, and easy-to-prepare fish recipes.<br />
Cousin Addy’s Oven-Baked Catfish<br />
serves 2<br />
2 servings cleaned fish filets<br />
3 Tbsp. olive oil<br />
2 cloves garlic, sliced<br />
1-1/4 tsp. dried thyme<br />
1/2 tsp. dried parsley<br />
1/4 tsp. dried basil<br />
1/8 tsp. ground cardamom<br />
1/4 cups unseasoned, preservative-free bread crumbs<br />
Pat fish dry and preheat oven to 400 degrees F. Coat a baking dish lightly<br />
with oil. In a small skillet, cook garlic in the olive oil just until tender.<br />
Remove from heat and stir spices into the hot oil. Place filets in the baking<br />
dish and pour oil and herbs over fish, scraping bits of herbs from the skillet.<br />
Bake uncovered in 400 degree F. oven for 10 minutes. Sprinkle bread<br />
crumbs on top of fish and return to oven. Bake another 15 minutes until<br />
fish is opaque (test by cutting a small slit in the thickest part).<br />
NOTE: This recipe was originally meant for catfish, but I’ve tried it with<br />
tilapia and red snapper with great results!<br />
Nut-Topped Orange Roughy<br />
serves 4<br />
4 orange roughy filets, cleaned, skinned and patted dry<br />
6 Tbsp. olive oil<br />
3/4 cup almonds (or cashews)<br />
3 tsp. dried basil<br />
Preheat oven to 350 degrees F. Spray a covered baking dish with nonstick<br />
spray or lightly coat it with olive oil. Arrange the fish filets in the baking<br />
dish. Chop the almonds in a food processor or chopper until they are<br />
fine particles. Combine the olive oil, chopped almonds, and basil. Spread<br />
the nut mixture over the tops of the fish. Cover and bake in a 350 degree F.<br />
oven for 15-18 minutes, or until fish is opaque and flakes easily with a fork.<br />
This article originally published April 1999, revised and updated by the author<br />
Oct. 2003.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 17
Sweets for my Sweet by Bev Laumann<br />
Ilike to snack on candy now and<br />
then but Valentine’s Day has<br />
always been a great excuse for me<br />
to temporarily pig out. And until<br />
recently I was lucky to have never<br />
gained any weight from my mid-winter<br />
spree. In fact, for many years I<br />
was the family’s unabashed chocoholic.<br />
So understandably, avoiding<br />
chocolate due to my <strong>IC</strong> isn’t easy<br />
or pleasant. But at least with chocolate<br />
I instantly recognize it and know<br />
what I’m letting myself in for.... a lot<br />
of bladder pain.<br />
Artificial sweeteners though, are<br />
not like chocolate. They’re sneaky.<br />
Unless you carefully read the label,<br />
they lurk unsuspected in candies, ice<br />
creams, snacks, drinks, and other<br />
treats. Aspartame is one of the bladder<br />
burning artificial sweeteners we<br />
encounter the most.<br />
Aspartame enables many people<br />
to enjoy sweet foods—diabetics,<br />
hypoglycemics, and people looking<br />
to shed a few pounds, for instance.<br />
But for those of us with <strong>IC</strong>, aspartame<br />
is far from good news. It can<br />
increase our urgency, frequency and<br />
bladder pain. Troubles with aspartame<br />
are not limited to <strong>IC</strong> sufferers<br />
though. People with phenylketonuria<br />
shouldn’t consume it. (Their<br />
bodies can’t properly deal with one<br />
of its breakdown products, phenylalanine).<br />
And many migraine sufferers<br />
find that aspartame provokes<br />
headaches too.<br />
Aspartame is broken down in the<br />
digestive tract into other compounds,<br />
two of which are aspartic<br />
acid and phenylalanine. No one<br />
knows why <strong>IC</strong> patients have trouble<br />
with aspartame, but these two breakdown<br />
products are likely suspects.<br />
Phenylalanine is found in the protein<br />
of many foods. Some susceptible<br />
people seem to be sensitive to<br />
increased amounts of it, regardless of<br />
the source. The body can convert<br />
phenylalanine in food to tyrosine,<br />
which can in turn be converted to<br />
tyramine (a substance that constricts<br />
blood vessels and affects blood pressure,<br />
among other things). Many of<br />
the foods that people with <strong>IC</strong> or<br />
migraines find troubling are high in<br />
tyrosine and/or tyramine—foods like<br />
red wine and cheddar cheese.<br />
So if your Valentine’s Day plans<br />
include sharing a few sweets with<br />
your sweet, be sure the treats are the<br />
old-fashioned kind—made with<br />
sugar. Some candies that <strong>IC</strong> patients<br />
can often tolerate include: divinity,<br />
caramels, licorice, taffy, butterscotch<br />
drops, carob candies, nougats, some<br />
mint gumdrops, horehound drops,<br />
and peppermint sticks. And speaking<br />
of sweet treats (the non-chocolate<br />
kind) here is a recipe for one quickto<br />
make delicious homemade candy.<br />
Easy Butterscotch Fudge<br />
makes about 3 lbs. candy (108 pieces); preparation time, 20 minutes<br />
3/4 cup margarine<br />
2/3 cup evaporated milk (NOT condensed milk)<br />
3 cups sugar<br />
1 pkg (12 oz) Nestle's butterscotch morsels<br />
1 jar (7oz to 8 oz) Marshmallow creme<br />
1 cup chopped almonds (optional)<br />
1 tsp. vanilla extract<br />
candy thermometer<br />
Lightly grease a 12 x 9-inch cake pan or a casserole dish. Mix margarine, milk,<br />
and sugar together in a large (2 or 3 quart) heavy saucepan. Stir constantly while<br />
bringing the mixture to a full rolling boil over medium heat.<br />
Continue boiling until candy thermometer reaches 235 degrees F., stirring constantly<br />
to prevent scorching (this takes about 5 minutes). Remove from heat.<br />
Quickly stir in butterscotch morsels, marshmallow creme, nuts and vanilla until all<br />
are mixed in well. (Butterscotch morsels will be melted and evenly distributed<br />
throughout). Pour into a prepared pan. Set aside to cool at room temperature. When<br />
cooled, carefully cut into 1-inch squares. (Candy will be relatively soft).<br />
Note: If you live at an altitude of 1000 above sea level or more, decrease the temperature<br />
on candy thermometer 2 degrees for every 1000 feet above sea level. If the<br />
butterscotch morsels provoke your bladder, there are many other variations of this<br />
recipe to try!<br />
Variations: There are so many fun variations on this recipe that you'll be tempted<br />
to try them all. Here are a few.<br />
Butterscotch-carob marbled fudge: Make butterscotch fudge as above, but omit<br />
almonds and substitute 1 cup of carob morsels, stirred in quickly after adding the<br />
butterscotch morsels.<br />
Basic vanilla fudge: Prepare recipe as above, but use Ghirardelli’s white baking<br />
chips instead of butterscotch (these contain a little cocoa butter, but taste like vanilla,<br />
not chocolate).<br />
Orange-creme fudge: Substitute 2 tsp. orange extract for the vanilla, and add 3<br />
drops yellow food coloring and 2 drops red if desired. (You can also stir in 2/3 cup of<br />
chopped orange slice gumdrop-style candies if they are low enough in citric acid for<br />
your bladder).<br />
Vanilla-Mint fudge: Make basic vanilla fudge but use 3/4 tsp. mint extract and 1/4<br />
tsp. vanilla. Add 5 drops of green food coloring, and omit the almonds. Pour into pan<br />
to cool. Immediately sprinkle top of fudge with 2/3 cup of finely cut up mint gumdrops.<br />
Cut when cool.<br />
Any of these candy squares can be decorated with white or colored icing (powdered<br />
sugar mixed with egg white), using a pastry tube and a fine writing tip.<br />
For Valentine’s day, draw hearts... or write words on each piece to spell out a<br />
message.<br />
This article originally published Feb 1999, revised and updated by the author Jan<br />
2004.<br />
18 • <strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004
The Vitamin C Vegetables by Bev Laumann<br />
Ever wonder if you’re getting<br />
enough vitamin C It’s something<br />
that a lot of us think<br />
about (or perhaps we should think<br />
about). Of course we can eat pears<br />
without suffering, but when it comes<br />
to vitamin C, pears just don't measure<br />
up to such “high-C” fruits as<br />
oranges, guavas, or strawberries.<br />
So what bladder-friendly foods do<br />
have plenty of vitamin C Although<br />
most people don’t realize it, broccoli<br />
and bell peppers are excellent<br />
sources of this important vitamin.<br />
In fact, according to the American<br />
<strong>Diet</strong>etic Association, a half-cup of<br />
raw red bell pepper has about 50%<br />
more vitamin C than a medium-sized<br />
fresh orange. Even cooked, a halfcup<br />
of broccoli boasts of just as much<br />
vitamin C as an orange.<br />
Several other vegetables also contain<br />
vitamin C in healthy doses. For<br />
instance, most adults can get all the<br />
daily vitamin C they need by eating<br />
about 2/3 of a cup of fresh green bell<br />
pepper, 1/3 cup of fresh red bell pepper,<br />
or 2/3 cup of cooked kohlrabi.<br />
Even a medium-sized baked potato<br />
has about 40 percent of the adult<br />
requirement of vitamin C (if you eat<br />
the skin).<br />
Hearty homemade soups are one<br />
way to get vitamins from vegetables<br />
as well as warm yourself up on a<br />
blustery, bone-chilling January day.<br />
Just remember not to overcook<br />
your soup and use a lid on the soup<br />
pot to retain as many vitamins as<br />
possible.<br />
Here is an easy-to-make soup from<br />
my cookbook, A Taste of the Good<br />
Life: A Cookbook for an<br />
<strong>Interstitial</strong> <strong>Cystitis</strong> <strong>Diet</strong>. Served<br />
with some crusty bread and a fresh<br />
pear, this soup makes a delicious and<br />
vitamin-packed meal.<br />
Busy Day Chicken-Broccoli Soup<br />
(serves 2)<br />
4 c. bladder-safe chicken broth<br />
(see note*)<br />
3 cloves garlic, chopped<br />
1/4 c. fresh carrots, peeled and<br />
chopped<br />
3/4 c. cooked chicken, in bite-sized<br />
pieces<br />
2 c. frozen broccoli florets<br />
1/4 tsp. dried thyme<br />
1/8 tsp. onion powder<br />
1 bay leaf<br />
salt (and/or pepper) to taste<br />
1/3 cup dry egg noodles<br />
Add all ingredients except noodles<br />
to a soup pot and bring to a simmer.<br />
Simmer about 12 minutes. Add noodles<br />
to the soup. Simmer a few minutes<br />
more, just until noodles are tender.<br />
Remove bay leaf before serving.<br />
This recipe also is delicious when<br />
using leftover turkey. Vitamin C:<br />
approx. 74 mg. per serving (about<br />
120% of the adult RDA for vitamin<br />
C).<br />
*Note: The key to making this recipe<br />
bladder-safe is the chicken broth. Be<br />
sure to use a brand that does not contain<br />
bladder provokers like monosodium<br />
glutamate (MSG), yeast extract,<br />
or hydrolyzed protein. Most chicken<br />
broth and chicken soups do contain<br />
some form of MSG. Either it is added<br />
in pure form (which means<br />
“monosodium glutamate” will be on<br />
the label), or it is contained in other<br />
ingredients in the broth (which<br />
means that though the bladder irritants<br />
are there, they won’t be listed<br />
on the label).<br />
Health Valley makes an excellent<br />
canned, low-fat, MSG-free chicken<br />
broth that also has significantly less<br />
salt than most brands. The company<br />
is a division of Hain Celestial Group,<br />
whose products are marketed nationally.<br />
Many, many grocery chains<br />
carry Hain products so it may be relatively<br />
easy for your local store’s<br />
manager to special order the Health<br />
Valley chicken broth for you. Here is<br />
the company’s toll-free number,<br />
manned from 8:00 am to 4:00 pm<br />
Pacific time: 1-800-423-4846.<br />
You may be able to find out from<br />
them which stores near you carry<br />
Hain or Health Valley products.<br />
If you cannot locate a bladder-safe<br />
chicken broth, you can also make<br />
your own broth and freeze it.<br />
SOUP TOPPERS<br />
Give any soup a festive look and<br />
boost its vitamin C by topping it<br />
with a couple tablespoons of your<br />
favorite raw vegetable garnish. Any<br />
of these work well: alfalfa sprouts;<br />
shredded carrot; finely chopped<br />
green, yellow, or red bell pepper;<br />
minced fresh parsley; chopped fresh<br />
broccoli florets; or finely shredded<br />
raw red cabbage.<br />
REFERENCES<br />
Roberta Larson Duyff. The American<br />
<strong>Diet</strong>etic Association’s Complete<br />
Food and Nutrition Guide. 1998.<br />
Chronimed Publishing. Minneapolis,<br />
MN.<br />
USDA Nutrient Database for<br />
Standard Reference, release<br />
12. Oct. 13, 1998. U.S.<br />
Department of<br />
Agriculture,<br />
Nutrient Data<br />
Laboratory.<br />
This article<br />
originally published<br />
Jan<br />
1999, revised<br />
and updated by<br />
the author Jan<br />
2004.<br />
<strong>IC</strong>N SPECIAL REPORT ON DIET • SUMMER 2004 • 19
Urinary Urgency,<br />
Frequency,<br />
Pain...<br />
My symptoms are real. And what I eat does affect me.<br />
People like me are sensitive to the acid in<br />
food. Many foods we eat cause us discomfort<br />
in our stomach, in our digestive system; even<br />
our bladder.<br />
You may already know that certain foods can<br />
cause heartburn but what you may not know<br />
is that these same foods can also cause urinary<br />
urgency, frequency, pain, bloating, even<br />
diarrhea. If these symptoms sound familiar,<br />
you might want to know about Prelief.<br />
Until I, myself, found Prelief, I thought that<br />
I would no longer be able to eat so many of<br />
the foods I enjoy...<br />
Now I just take Prelief with every<br />
meal*, and I don't have to worry about<br />
being uncomfortable.<br />
Prelief is clinically proven.<br />
Ask your doctor.<br />
*So easy! Two small tablets<br />
three times a day!<br />
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For literature and a coupon, call 1-800-994-4711 or visit www.prelief.com