1. DIET AND INTERSTITIAL CYSTITIS CAN DIET PLAY A ROLE IN TREATING SYMPTOMS?

2. Effect of Comestibles on Symptoms of Interstitial Cystitis 104 patients surveyed on 175 items of food and beverages 90% indicated certain food and beverages exacerbate symptoms Patients who noted a relationship between foods and symptoms tended to have a high symptom index Shorter B, Lesser M, Moldwin RM, Kushner L. 2007

3. WHICH FOODS SCORED HIGHEST? Coffee and tea Alcoholic beverages Citrus fruit and juices Tomatoes and tomato products Spicy foods, chili Artificial sweeteners Carbonated drinks Vinegar, MSG

4. Often problematic Coffee Decaf coffee Tea Herbal teas Green tea Chocolate

5. Alcohol Most problematic Beer and Wine Less problematic Spirits

6. Fruit and Juices All fruit juices Cranberry juice Citrus fruit Stone fruit Pineapple Kiwis grapes

7. ACIDS? Fisher et al found no decrease in urinary pH after ingestion of acid foods. 1993 Nguan et al found no statistically significant differences in pain scores between neutral and acidic solution bladder instillations. 2005 Bologna et al. 70% reported a reduction in pain and 61% a reduction in urgency when taking an alkalinizing agent. 2001

8. Vegetables Tomatoes Tomato sauces Tomato juice Raw onions

9. Spicy foods Chili Horseradish Mustard Hot curry

10. Artificial Sweeteners Diet fizzy drinks -especially with caffeine Better choice – Sucralose (Splenda)

12. OTHER POSSIBLE TRIGGERS ARYLALKYMINES – tryptophan, tyramine, tyrosine, phenylalanine SULPHITES – preservatives (fruit) NITRITES – preservatives (meat) MSG – flavour enhancer 621 ARTIFICIAL COLOURS

13. ELIMINATION DIETS Simple Exclusion Diet – easy to use Quick results Empirical Diet – use where most foods are suspected Few Foods Diet – most drastic Dietitian recommended

14. SIMPLE EXCLUSION DIET Keep a one week voiding diary Eliminate suspected foods - washout Wait for symptoms to diminish – 1-3 weeks Add one food back slowly over 1 week Keep a symptom score diary Repeat washout period Test another food

15. EMPIRICAL DIET Only foods considered safe for IC patients are eaten for 1-3 weeks Suspect foods are reintroduced one at a time while keeping a symptom diary Other food intolerances need consideration

16. FEW FOODS DIET Only low allergen foods for 10-20 days Nutritionally inadequate Foods added one at a time while keeping a symptom diary Supervision by a dietitian recommended

17. ADVANTAGES OF DIET FOR IC Self controlled Effective Low cost Low risk treatment Healthy unprocessed diet

18. CONSTIPATION

19. CONSTIPATION AND IC Medications Fluid intake Activity and exercise

20. MEDICATIONS Antacids containing aluminum or calcium Antispasmodics Antidepressants Antipsychotics Calcium supplements Diuretics Iron salts Opioids Oxybutinin and similar drugs for incontinence

21. FLUIDS Maintain an adequate fluid intake when on a high fibre diet 6 -8 cups including fluid foods – drink when thirsty.