Wednesday, September 28, 2016

Should You Be Pro-Probiotics?

 
It doesn’t take much research on good old Dr. Google to find people recommending probiotic-laced foods or supplements for a variety of health conditions including interstitial cystitis/bladder pain syndrome. By now, many of us have heard of these supplements that are supposed to replenish the good bacteria of the “gut” (the layperson’s term for the organs of the gastrointestinal system), but what exactly does that mean, who might benefit from them, and is there one food or brand of supplement that is better?

Part of what complicates the understanding of this subject is that the science of intestinal bacteria colonies (the microbiome) is still evolving and is so new that even the most reliable sources of information are either a bit sketchy or they are changing their position frequently. In short, what you read about probiotics today may not be the same information you find tomorrow.
Yet, we do have a baseline of knowledge that is important to understand. Scientists tell us that our bodies are comprised of more bacteria cells than human cells. Now, many of you are thinking, how is that possible? Wouldn’t we die? Aren’t bacteria bad? Well, the answer is more complex than that.

The “Bad” Bacteria

We DO know that bacteria like e. coli, c. difficile, bacillus, and salmonella can cause food poisoning as well as bowel, bladder and kidney infections, even death. We DO know that streptococcus pyogenes (strep) can cause skin infections and pneumonia, even death. And we DO know that infamous sexually transmitted bacteria like gonorrhea and syphilis can cause sterility, insanity, and yes…even death.

Why do I keep emphasizing death? Because you may not even realize it, but death by bacterial infection was actually common a hundred years ago. Yet, how often do we hear of people dying of bacterial infections today? Very, very rarely. Because in a fairly short period of time, scientists and doctors found ways to prevent the spread of bacteria through hand washing, sterilization of instruments, and the use of antibacterial products like bleach, alcohol, and Lysol; and others eventually discovered ways to fight the bacteria once it invaded the body―antibiotics of various sorts. So yes, all of this is good, really good for the most part…except…we also seem to have created a new set of problems, unintended consequences, with all of this focus on cleanliness and “cures.”

The “Good” Bacteria

You see, frequent use of those “lifesaving” antibiotics also seems to wipe out or alter the colonies of good bacteria we have in our body. Think of it this way. When you take certain antibiotics, you may be forcing many of the good bacteria to leave the neighborhood (the colonies they form on the intestinal lining) allowing space for other “bad” bacteria (primarily e. coli and c. difficile) to “move” in and take their place.

Yet, the good bacteria serve a multitude of important functions in our body, and likely provide many more benefits than we even know about at this time. For example, we know that good bacteria in the body, primarily in the intestinal tract, help break down food into nutrients the body can use. We know that good bacteria can aid the immune system and keep other organisms like bad bacteria and yeast from overwhelming our systems. In addition, the good bacteria may play a role in weight management by producing a hormone which triggers satiety in the host (you!). Finally, it is theorized that disruption of the intestinal bacteria can also alter the permeability of the intestinal wall, allowing elements past the protective layer of cells deeper into the structure of the organs, potentially causing inflammatory reactions and disease. Because of all of these functions, a disruption of intestinal bacterial colonies has been linked not only to gastrointestinal diseases like inflammatory bowel disease, but also c. difficile and yeast infections, diabetes, and obesity.

Recent research into interstitial cystitis (and others) have found that patients are lacking in important beneficial bacteria. Known as the DIPP Mystery, these bacteria play important roles in the health of the cells lining our gut. Additional studies are being conducted to determine if men with chronic prostatitis also have similar deficiencies. Why this has occurred is a mystery though a strong contender is the long term exposure to antibiotics over our lifetimes. Learn more about the DIPP Mystery here! 

Establishing and Maintaining the Body’s Bacterial Balance

Certainly, all of that anti-bacteria warfare was and still is important. We definitely don’t want to go back to the days when people died just because they cut their finger while carving meat or they had a baby. We certainly don’t want children to lose their hearing because of repeat damage to their ears by bad bacterial infections. So what can we do to respect and maintain the microbiome (friendly bacterial colonies) that co-exists in our bodies?
  1. Consume plenty of fruit, vegetables, and high fiber foods. Don’t be too concerned if there are fruits you cannot eat. Most bladder patients can eat a wide enough variety of fruits and vegetables to supply their bodies (and their microbiome) with plenty of vitamins, minerals, and carbohydrates to get the job done.
  2. Consume some fermented foods. Fermented foods provide and stimulate the growth of friendly bacteria. This can be hard for some people with interstitial cystitis since many fermented foods like sauerkraut, kimchi, and soy-based foods like tempeh are almost always hard on an IC bladder. Other fermented and cultured foods like yogurt and kefir may be less problematic. As a bladder patient you may be hesitant to try yogurt or kefir; however, with all of the varieties and flavors available, you are likely to find one or two that suit you. Look for labels that say “active cultures.” Some yogurts and even cheeses are fortified with additional cultures. Read the labels. 
  3. Only take antibiotics when you absolutely need to. That doesn’t mean you shouldn’t go to the doctor if you think you have a urinary tract or sinus infection. Rather, don’t just take random antibiotics until the clinician has evaluated your culture to determine the exact medication you need. (A bladder analgesic like phenazopyridine―found in medications like AZO Standard―can help you get through the day or so of waiting to see if you have a UTI.) Consider this: many IC patients have taken multiple courses of unneeded antibiotics in the history of their disease, before someone figured out that they really didn’t have an infection; so let’s not add to that history that may have made your intestines and microbiome fragile.
  4. If you need antibiotics, complete the course following the physician’s directions. If you are supposed to take it three times a day, do it. If you are supposed to take it for seven days but you start to feel better on day four, keep taking it until it is gone. The prescription is regulated to help you fight the bad bacteria in the most effective manner. Is it still killing good bacteria? Most likely yes…but without the whole prescription, you risk allowing the strongest of the bad bacteria to survive, setting you up for resistant infections in the future.
  5. Ask your physician about taking probiotic supplements. Today probiotics are not only found in health food stores, but also at pharmacies and big box stores like Costco and Walmart. Common commercial brands include Culturelle, Align, and TruBiotics. JAVAcid, an acid reducer, also contains important pro and prebiotics!
Will taking a probiotic cure a disease like interstitial cystitis or modify its symptoms? The science is still being explored. Since we are only now beginning to identify the over 500 strains of bacteria that co-exist in the microbiome of our bodies, it is likely that different conditions may require different probiotic supplements. As we often say in nutrition science, “Stay tuned!”


Helping Yourself Is the First Step to Getting Well

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

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Sunday, September 25, 2016

The Mental Gymnastics of Chronic Illness: Why Me?

Let's face it. We all have asked the question. We wonder if antibiotics or gluten or too much sugar have caused our painful bladders. Or we blame our diagnosis of interstitial cystitis on an abdominal surgery. Or we try to pinpoint our diagnosis to a major stressful event. Of course, we don't just throw guesses around about ourselves; this fascination with why people get sick often extends to others: "Did you hear Peggy has breast cancer? It must be all of that coffee she drinks." Or just as likely, "Can you believe that Mike has diabetes? But he is so healthy! He always eats well and he just ran a marathon last fall!" Honestly, a sick person can never win the blame game!

Let's use my friends as an example. I see people who mostly live very healthy lifestyles, yet even among my dietitian colleagues, two of them are fighting breast cancer, one was just diagnosed with celiac disease, and another discovered she had multiple sclerosis a few years ago. These people are long distance hikers, marathon runners, yoga instructors, and even vegans. And me? I have always eaten healthy, was a normal weight, and walked four miles each day until I was diagnosed with IC and later with a genetic form of heart disease. From a cause and effect perspective this is perplexing, so we ponder and propose, fret and fume....why me? How did I get this sick?

Well, I am here to remind you (as I have to do myself!) that even if there are some possible triggers for many diseases or genetic predispositions to others, the fact remains that the causes of chronic disease like interstitial cystitis and illnesses like cancer and celiac disease are often a mystery even to doctors. In most cases, you didn't do anything to "cause" your body to "rebel." There are many complex factors that play into whether a person gets sick or not...so many factors that even if you think you "know" why you got sick, it is probably an overly simplistic explanation.

I have heard people say, I drank a lot of coffee, so I got IC. Maybe....but there are also a lot of people in the world who drink a lot of coffee who do not get interstitial cystitis. And although many IC patients describe their illness developing after a particularly stressful event like a divorce or building a house, others go through those situations and don't end up with painful bladders for the rest of their lives. That is just life.....and so is getting sick. So although there are those rare human beings like my husband's Grandma Grace, who made it to 93 without any serious illness in her life, most people get "something" eventually. IC is just our "something."

So how is a person to sort all of this out? Maybe we don't. Maybe instead of spending hours every day trying to get to the bottom of "why," we leave that question for the scientists to debate and we concentrate on getting better. We eat as many fruits and vegetables as we can to get natural sources of vitamins, minerals, and antioxidants. We choose high quality, lean proteins to help our bodies heal and strengthen our immune system. We consume a modest amount of healthy fats from olive oil and fish each day. We practice stress management techniques like meditation and taking deep breaths. And, of course, we move our bodies more. We take an active role in doing healthy things to make our bodies as strong as possible. What about you? What are you doing to foster a sense of wellness despite having a chronic illness?


 Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder


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Friday, August 12, 2016

How Did I Become an Interstitial Cystitis Diet "Expert?" Well Let Me Tell You!

You know, sometimes you get smart about stuff you never wanted to be smart about and that is what happened to me. In the mid-1990s, I was working as an outpatient hospital dietitian when I saw my first IC patients. Besides wondering how in the world I could help them with this frustrating disease, I was also thinking, “Boy, their symptoms sound like mine!” See, I had been struggling with “bladder infections” for years, many of them not showing bacteria in the urine.

I tried everything―avoiding baths, drinking gallons of cranberry juice (you too?), and taking boatloads of antibiotics. I saw several doctors and began to think I was going crazy. My symptoms were getting worse and worse over time and I was beginning to suspect that I had something worse than an everyday UTI.

Fast forward to 1998, when I found a great interstitial cystitis doctor, and I began my journey to get well. Although there wasn’t any research to support the idea that diet could make a difference in interstitial cystitis patients, I joined the Interstitial Cystitis Network’s Patient Support Forum and “met” thousands of people with IC who were experimenting with diet modification with great results. I tried eliminating the top ten foods and felt immensely better. I started helping people online and over the phone and eventually, wrote my first book for bladder pain patients, Confident Choices®: Customizing the Interstitial Cystitis Diet in 2005.

In addition to that first book, which was updated in 2010, I also answered the call of patients and published Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder, a fingertip ready guide to over 200 bladder friendly recipes, and Interstitial Cystitis: A Guide for Nutrition Educators, giving dietitians, nurses, and other health care professionals the information they need to help interstitial cystitis patients make confident dietary choices.

To be honest, the journey has been amazing. Although I wish I didn’t have IC, I never would have met the amazing people I have over the past 20 years, nor would my career have gone in the direction of publishing books, writing for national publications, and speaking around the country to patients and nutrition professionals without it. I certainly never thought I would I find myself among a small number of nutrition experts in the United States who know how to help interstitial cystitis patients using diet to control the symptoms of this painful bladder condition.

More than anything, I am just like you. I know the frustration of having more education about my disease than the medical professionals I try to get help from. I understand balancing my dietary restrictions with the wants and needs of my family. I have felt the fatigue and anxiety of standing in a grocery store wondering what I can eat. And I have experienced the emotional ups and downs as I navigated the fickleness of having a painful bladder that interjects itself in every corner of my life. I not only have the science and experience, I have the empathy and understanding to help you and other people with interstitial cystitis navigate the path to healing.

To learn more about my journey, see My IC Story. What is your story?


 Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder


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Friday, July 22, 2016

Planning Vegetarian Meals on an Interstitial Cystitis Diet

I am often asked whether a person with interstitial cystitis can create a meal plan on a vegan diet. I always hesitate to answer because a vegan diet is challenging enough without the additional restrictions of another special diet like that for IC, but I will try here.

Just to get everyone on the same page, here are some definitions that can help:
  • Vegetarian diets in general do not include meat, poultry, or fish, although some people who eat vegetarian meals may include fish occasionally. The term "vegetarian" is fairly generic and doesn't describe whether or not a person consumes other animal products such as milk or eggs. 
  • Lacto-ovo vegetarian diets avoid all meats, but DO include milk and eggs. You may also hear of people who will only use milk products but not eggs (lacto vegetarian), or eggs but not milk products (ovo vegetarian). 
  • Vegan diets don't include any animal products at all and, by nature, are the most restrictive and difficult to balance nutritionally. There is some debate whether products created by animals (like honey) should be included in a vegan diet.
In addition to various religious restrictions, many people consume a vegetarian diet for the advertised health benefits: higher fiber, and anti-oxidant consumption and lower saturated fat.

I don't usually recommend a strictly vegan diet for people with IC unless there is a strong religious or personal moral conviction against eating meat or other animal products. Besides the fact that foods that are generally a staple of a vegan diet like soy (including endamame, soy milk, and tofu), tomatoes, citrus fruits, and some legumes (fava and lima beans) can increase interstitial cystitis symptoms, many IC patients find that a consuming high quality protein each day helps them feel better.

Therefore, a good compromise to a vegan diet might be a lacto-ovo vegetarian diet. People with interstitial cystitis generally find that eggs are soothing when they are in a flare, and also, many feel that vanilla milk shakes, warm milk with vanilla, or cottage cheese are soothing foods. You could also consider including fish one or two times a week. If possible, choose organic sources of eggs and milk/milk products to minimize exposure to hormones, steroids, and other chemicals that could stimulate your IC symptoms.

If you choose not to consume any animal products at all, it becomes essential to "complete" your protein intake by consuming the various types of plant based foods each day. A good rule of thumb is to include something from each of the amino acid rich plant groups each day: vegetables, legumes, grains, and nuts/seeds. Each of these food groups supplies a different set of "essential amino acids." Combining these essential amino acids helps ensure that you are getting the most protein possible out of a vegan diet. 


 Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder


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Tuesday, July 12, 2016

What Do Omega 3 Fatty Acids Have to Do with Interstitial Cystitis/Painful Bladder Syndrome?



One of the most common questions I get about interstitial cystitis and diet is, "What supplements should I take?" The answer is not quite so easy since in most cases, we can get a balanced diet from just eating a wide variety of foods. One exception may be sources of omega-3 fatty acids which are important for cellular protection, immune support, as well as cardiovascular health. Omega 3 fatty acids are healthy fats found in foods in three main forms: DHA, EPA, and ALA.

DHA and EPA, or the “fish oils”, are found in salmon, trout, and other fish. These omega-3 sources have been shown by some studies to reduce a person’s risk for heart disease, eye disease, and possibly cancer. DHA has been studied in Alzheimer’s disease (AD) patients and may act as a partial mediator, possibly lowering the risk of AD in some genetic forms of the condition. ALA is found in flaxseed and in small quantities in canola and soy. ALA has not been show to have any significant effects in humans and must be converted to DHA in order to be used, hardly an efficient process. In addition, some studies have discovered that men who eat an average of 1,500 mg. a day of ALA in the form of flax seed oil actually have two times the risk of advanced prostate cancer than those who consumed half that amount. Consumption of flax seeds have not been shown to be a problem for men, and ALA in general does not seem to be a problem for women. 

So why all the hype? Although there isn't any direct evidence that omega-3 fatty acid consumption is related to interstitial cystitis, there is emerging research suggesting that low levels of omega-3s may correlate with inflammatory conditions. In addition, omega-3 fatty acids are, in general, important for cellular health. They are a key component of cell membranes and important for healthy cell replication. This is especially true of epithelial (skin) cells. Many people may not know that the urothelial cells of the bladder wall are very similar to the epithelial cells of the skin. It wouldn’t be too much of a stretch then to believe that omega-3 fatty acids could be important for a healthy bladder. 

Omega-3s, like other nutrients, don’t stand alone, so the best way to get these essential nutrients is directly from food. Consuming three to four servings of fatty fish a week provides most people with the amount of omega-3 fatty acids needed to maintain good health. Some fish may be contaminated with heavy metals or other toxins, so it is important to vary the type of fish consumed and not consume these fish if you are pregnant, nursing, or if your physician has cautioned you against eating fish. The ALA in flax seeds is best digested when the seeds are ground just prior to eating. Flax seeds are also a great source of fiber and lignans, nutrients being investigated for use in the prevention and even treatment of a variety of conditions. 

If you are interested in taking omega-3 fatty acids in supplement form there are a few common sense guidelines:
  • Look for a supplement with more EPA than DHA. A ration of 3:2, EPA to DHA, is common
  • Avoid supplements made from algae oil, which contain only DHA. 
  • Avoid cod liver oil. It is high in vitamin A, which can be toxic in large doses. 
  • Look for brands that meet certification standards, such as the International Fish Oils Standard (IFOS) or the United States Pharmacopeia Convention (USP).
Omega-3 supplements from capsules, liquid or gels are equally effective. Some brands claim to be odorless, however these are usually more expensive. Most people find that taking the supplements with a meal works best.

FOR MORE INFORMATION ABOUT IC and DIET SEE:
If you are a nurse, dietitian, or other nutrition professional, you can earn continuing education for reading Interstitial Cystitis: A Guide for Nutrition Educators.

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Saturday, July 9, 2016

Balancing the Bad with the Good: Managing Stress Helps Manage IC Symptoms



How are you feeling? I mean really feeling today? As I write this, the world is messy right now. And sad. And confused. And if you are like me, all of this unease can settle in your body as depression and anxiety as well as physical pain. No matter what is happening in your world, sometimes it is helpful to take a break from the "breaking news" and alarming stories we hear day after day.

Yes, bad things happen and as human beings, we want to be "in the know" at all times. But it is becoming too much. Each news story is worse than the last. It is easy to believe some days that the world is truly coming to an end....but let's consciously and deliberately balance what we are putting in our minds. Remember the "random acts of kindness" trend? Let's try that again. Talk to your family. Talk to your neighbor. Look people in the eye and smile...offer to help people who need a hand. Be kind to servers in restaurants and leave a little extra tip. Say something positive to everyone you meet..."you have nice eyes, the color of your shirt lights up your face." Teach a child how to be kind to animals...they will grow to be kind to humans later. Go to a place of worship....or fill yourself with peacefulness by visiting a forest. Take a look at a flower blooming...or a blade of grass....or let sand run through your fingers. Buy an adult coloring book and let your creativity flow. If we change our perception of the world....the world will change.

PS: One way you can recognize someone in the IC Community that is spreading love, kindness, and support is to nominate them for the Interstitial Cystitis Network's Angel program. Simply email Jill Osborne at icangels@ic-network.com. For more information see: http://www.ic-network.com/real-ic-angels/ 

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 Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder


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Sunday, May 1, 2016

Are You a Victim or Victor?



By Guest Blogger, Maria McConville, MS, RDN, CPT, CWC

Victim: one that is tricked, duped, mistreated, injured, destroyed, or sacrificed.
Victor: one who defeats an enemy or opponent – a winner.

We all know what it feels like to be a victim of something. Being victimized makes us feel powerless, defeated, and demoralized. But to be the victor, we feel strong, powerful, and confident.

Could being a victim or victor be a choice?

I believe in many circumstances, yes, it is our choice. Whether we are the victim or the victor depends a great deal on our Locus of Control (LOC). Those with more external LOC blame other people or bad luck for things that happen and feel they have little to no control. Those with stronger internal LOC hold themselves responsible for the things that transpire in their lives and feel that they are in control.  Let me give you a few examples:

A person with more external LOC may say, “I can’t eat healthy because my spouse is a meat and potatoes person and that’s what I have to cook.”  Or, “I can’t exercise because I have a stressful  job and after work, I drive my kids around to all their activities.”  These people tend to be the victims of their surroundings or circumstances. They are the people who show up late for a meeting but blame the traffic for their lateness.

Conversely, a person with more internal LOC may say, “My spouse prefers meat and potatoes so I make and eat a small amount of those, but I fill my plate with vegetables.”  Or, “While my kids are at soccer practice, I will walk on the track next to their practice field.” These people hold themselves responsible for not adequately planning for traffic instead of blaming the traffic .

When we point the finger at others or circumstances, we absolve ourselves of responsibility and fall victim, feeling weak and overwhelmed. Taking responsibility, on the other hand, helps us become in command and triumphant.

Being a victim of our circumstances holds us back from meaningful and purposeful growth and change. It keeps us stuck in our muck.  But, through choosing to take control over our thoughts and circumstances and orienting to a more internal LOC, we propel ourselves forward and progress with decisive action.

A very poignant example of this concept comes from the story of Viktor Frankl who was a Jewish prisoner in the death camps in Nazi Germany.  Frankl’s capturers treated him horribly, as you can imagine.  However, Frankl decided that the one thing the German guards could not take from him was his freedom to choose his thoughts. Between his torture and his response to it, was his freedom or power to choose that response.  

Frankl chose not to be disparaged or victimized.  He helped other prisoners find meaning in their suffering and dignity in their prison existence.  They did not let the atrocities steal the freedom of their thoughts and they refused to fall victim to their atrocious situation. Liberated after three years in concentration camps, Frankl returned to his home country of Vienna, where he lectured on psychological healing. He wrote his world-famous book entitled, Man’s Search for Meaning.

I often wonder whether it was happenstance that “Viktor” was Frankl’s first name… perhaps it was no coincidence at all.  Choosing to be the victor will help you take control of the lifestyle habit you want to change whether it is losing weight, starting to exercise, or eating better.

We can orient ourselves to a more internal LOC by taking responsibility for our thoughts, emotions, action, and subsequently our circumstances. 

What will you choose… Victim or “Viktor?”




Maria McConville is a registered dietitian nutritionist and author of the weight-loss workbook, Lose the Diet – Find Yourself for sale on Amazon.com. To learn more about Maria and her book, visit her website: www.balancedbodynourishment.com





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