Interstitial Cystitis: Allergies and Diet

Guest Blog Post by ICAF Daily News
 It is not unusual for an interstitial cystitis patient to be diagnosed with overlapping syndromes including food sensitivities and/or environmental allergies. Gluten, diary, pollen, animal dander, and dust mites seem to be the most common culprits.

Allergens cause the body to release a protein that we all know as "histamine. Histamine is typically a harmless substance that your body perceives as harmful. First, the body produces the IgE antibody, which then binds to the allergen. Then, the antibodies attach to one another and create a mast cell which then triggers the release of histamine. When this occurs, an excess amount of histamine becomes active in the body, resulting in bothersome symptoms.

The release of histamine (hist = because it's made up of histidine residues, amine = because it's a vasoactive amine) causes several allergic symptoms. 1) It contributes to an inflammatory response. 2) It causes constriction of smooth muscle.

 

Histamine can cause inflammation directly as well as indirectly. Upon release of histamine by an antigen activated mast cell, permeability of vessels near the site is increased. Thus, blood fluids (including leukocytes, which participate in immune responses) enter the area causing swelling. This is accomplished due to histamine’s ability to induce phosphorylation ( phosphorylation also regulates the activity of proteins, such as enzymes, which are often activated by the addition of a phosphate group and deactivated by its removal) of an intercellular adhesion protein (called (VE)-cadherin) found on vascular endothelial cells (the thin layer of cells that lines the interior surface of blood vessels). That is why histamine is known as being vasoactive (causing constriction or dilation of blood vessels).

Gaps between the cells in vascular tissue are created by this phosphorylation, allowing blood fluids to seep out into extracellular space (means outside the cell). Indirectly, histamine contributes to inflammation by affecting the functions of other leukocytes in the area. It has been suggested by Marone et al that histamine release triggers the release of cytokines and inflammatory mediator by some neighboring leukocytes (1999). These chemicals in turn increases the inflammatory response.

A urinalysis of an interstitial cystitis patient often show an over abundance of white blood cells (leukocytes) but no infection. These finding gave doctors a reason to take a closer look at symptoms that were more common amongst IC patients such as allergies.

What is A Mast Cell?

A mast cell (or mastocyte) is a resident cell of several types of tissues and contains many granules rich in histamine and heparin. Although best know for their role in allergy and anaphylaxis, mast cells play an important protect role as well, being intimately involved in would healing and defense against pathogens. Mast cells are very close to basophil granulocytes (a class of white blood cells) in blood. Two types of mast cells are recognized, those from connective tissue and a distinct set of mucosal mast cells. Mast cells are present in most tissues characteristically surrounding blood vessels and nerves. Mast cells play a key role in the inflammatory process. When activated, a mast cell rapidly releases its characteristic granules and various hormonal mediators into the interstitium (interstice is an empty space or gap between spaces full of structure). Mast cells can be stimulated to degranulate by direct injury (e.g. physical or chemical [such as opioids, alcohols, and certain antibiotics such as polymyxins]), cross-linking of Immunogloblin E (IgE) receptors, or by activated complement proteins. And we know that something we are sensitive to will cause our bodies to release a protein we all know as histamine.

In allergic reactions, mast cells remain inactive until an allergen binds to IgE already in association with the cell so, this tells us that the over abundance of mast cells/white blood cells in our bladders are obviously related to something we have an allergy to.

I was able to eliminate many of my symptoms by eating a clean diet and by cleaning up my environment.

Symptoms

Gastrointestinal:

• canker sores in mouth, irritation of tongue, lips, and or mouth
• vomiting, stomach cramps
• abdominal distention
• intestinal obstruction/bloody stool/colitis
• malabsorption of foods
• loss of appetite
• diarrhea/constipation/painful bowel movements

Respiratory:

• nasal stuffiness, runny nose, sinusitis
• chronic cough, hoarseness, asthma (bronchitis)
  
• middle ear trouble
• pulmonary infiltrates
• tonsil and adenoid enlargement

Skin:

• rashes/atopic dermatitis/eczema/hives
• seborrhea
• hair loss
• dermatitis herpetiformis (a gluten sensitivity)

Mood:

• irritability/restlessness/hyperactivity
• lethargy/ fatigue, "allergic tension-fatigue syndrome", mental depression
• muscle pain
• enuresis (bed-wetting)

Blood:

• abnormal blood clotting
• iron deficiency anemia
• low levels of serum proteins
• thrombocytopenia (low platelet count)
• eosinophilia (allergy-related white blood cells)

Immune Complex Diseases:

• rheumatoid arthritis
• lupus erythematosus
• periarteritis nodosa
• polymyositis
• scleroderma vasculitis
• Henoch- Schonlein purpura
• arteritis
• occult intestinal bleeding gastroenteropathy
• pulmonary hemosiderosis
• orthostatic albuminuria nephrosis (nephrotic syndrome),
• glomerulonephritis (see kidney disease)/ nephrotic syndrome

Allergies to gluten (gluten is found in high concentrations in wheat, barley, and rye): schizophrenia (a mental disorder, benefited in a few cases by avoiding gluten and dairy proteins), celiac disease (a bowel disorder), dermatitis herpetiformis (a skin disorder).

Dietary and Lifestyle Implications:

Allergies are responses to the harmful interaction of our immune systems with agents from the world around us. You can take two broad approaches to improve your condition. First, you can try to find and eliminate the substance that is causing the reaction. Second, you can make your immune system stronger and therefore more resistant to the harmful substance that is at fault.

Why some people are allergic and others are not is still a grand puzzle. Most scientists think that susceptibility to allergens may be due to an inherited predisposition. However, considerable evidence indicates that introducing certain foods (including cow's milk) too soon into an infant's diet, at the time when its intestinal tract and immune systems are still immature, may provoke responses in its tissues that will lead to symptoms of allergy later in life. Similarly, respiratory allergies and skin problems may be started at that tender age, when the infant's immune responses are unable to cope properly with the alien allergens.

The ultimate and best test for identifying the substance suspected of causing an allergy is to eliminate the substance (whether it is a food, or a pollen, or a chemical compound), and then to note if the symptoms disappear and the patient’s health is improved. Confirmation of the diagnosis is made by adding the offending substance back to the patent's diet or environment and observing if the illness returns. Don't overlook the obvious truth that elimination of the villainous allergen is also the ultimate-and only-treatment for "curing" the allergy.

Although countless substances can cause allergies, the foods he eats should be the first suspects that an allergic person should investigate. This is true for two reasons. First, whatever we eat is 100 percent within our control. Therefore, once the cause of a food allergy is identified, you can decide to remove that item from your diet. Second, suspecting your food is a good bet: foods represent one of our most frequent, intimate, and diversified contacts with our environment. Molecule for molecule, we interact with the components in our foods more than with air or water, and, obviously, the complexity of the substances we contact through our foods is many times greater than is that of compounds found in air or water.

Even allergic problems that on first impression seem to be due to agents other than those present in foods (pollens, for instance) can often be helped by a change in diet. The immune system has a limited capacity to handle allergens from many sources. If your immune system is overwhelmed and you can lighten its burden in any way (for example, by eliminating all dairy products), then you will be helped to tolerate the pollen grains swirling about you from the tree outside your bedroom window.

A dietary approach to managing food allergies is the safest and most sensible step you can take for testing and for treatment.

Eliminate entirely the allergens in your environment, whether in air, or drinks, or foods. Most people will resolve their food allergies by using the elimination diet. Start by eliminating the leading causes of food allergies, which are as follows: Animals products (including eggs), chocolate, nuts, shellfish, fish wheat, corn, citrus,tomatoes and strawberries.

The elimination diet allows you to eat the foods that are least likely to cause your allergic reaction. When you begin this diet, allow 14 days in order to completely clear the body of foods that were eaten before starting the diet. By the end of the 14 days, if their trouble was indeed due to their foods, most people will be relieved of symptoms.

(From Julie Beyer: For more information about using an interstitial cystitis elimination diet to determine your personal trigger foods, see the IC Diet Food List.)

References:
Schmidt D, Ruehlmann E, Branscheid D, Magnussen H, Rabe KF. 1999 Aug. Passive sensitization of human airways increases responsiveness to leukotriene C4. European Respiratory Journal 14(2): 315-319.

PLoS One. 2008 May 7;3(5):e2096. Mast cell-derived histmaine mediates cystitis pain. Rudick Cn, Bryce Ph, Guichelaar LA, Berry Re, KlumppDJ, Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.

http://encyclopedia.thefreedictionary.com/Mast+cells

http://www.drmcdougall.com/medical_ailments.html

http://www.slideshare.net/elianacordero/guideliness-on-chronic-pelvic-pain-fall-euro-2008

Julie Beyer, MA, RDN

Author, Speaker, Patient Advocate

www.ic-diet.com 

Just Tell Me What to Eat!

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

For health care workers:  Interstitial Cystitis: A Guide for Nutrition Educators 

 **Please SHARE using the links below!**

Interstitial Cystitis/Painful Bladder Syndrome: AUA Guidelines For The Diagnosis and Treatment

(Note from Julie: Jill Osborne, President and Founder of the Interstitial Cystitis Network recently posted this FANTASTIC summary of the new American Urological Association's Guidelines for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. I asked her permission to reprint it here. To view the original post, visit the ICN forum. Thanks, Jill, for putting this into layman's terms!!)

The long awaited new clinical guidelines for the treatment of interstitial cystitis (aka bladder pain syndrome) were released by the American Urology Association (AUA) this month, offering what may be the most comprehensive clinical care article written to date in the USA. Solidly written, it offers new insight into diagnostic testing as well as a new, six stage IC treatment algorithm that can be used by physicians and patients as you consider your treatment and pain management plans.

Please help us share this vital new resource by printing both this summary and the guidelines out to share with all of your medical care providers.

What is an AUA Guideline?

With its mission of improving the knowledge of urologists around the USA, the AUA occasionally releases documents that assist urologists in the diagnosis and treatment of various urologic diseases. We are thrilled that they devoted almost two years to the creation of a new set of guidelines for interstitial cystitis. They are intended to instruct clinicians and patients how to recognize IC/BPS, make a valid diagnosis and evaluate potential treatments.

Why is it important?

Have you ever had a physician tell you that there were no treatments for IC or a family member who said that IC was a figment of your imagination? How about a physician who refuses to provide pain care? This document provides desperately needed education for medical care providers, patients, family members and the community at large.

Who drafted it?

In 2008, the American Urology Association convened a diverse panel of more than a dozen IC researchers and medical care providers to draft the guidelines. The effort was led by panel chairman Phil Hanno MD (Univ. of PA). An additional 84 peer reviewers reviewed the final document before it was approved by the AUA Board of Directors in January 2011. None of the participants were compensated by AUA for their work.

How was it created?

The panel performed a systematic review of IC research studies published from 1983 through July 2009. Using this research “evidence” as well as “clinical principles” and “expert opinions” offered by the panelists, the guidelines consist of 27 statements to guide a patient through diagnosis and treatment.

What’s their definition of IC/BPS?

They chose to use the definition first established by the Society for Urodynamics and Female Urology.

“An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.”

Is IC more than just a bladder disease?

Citing several studies which explored the related conditions found in IC patients, the authors explored several theories, one of which is “IC/BPS is a member of a family of hypersensitivity disorders which affects the bladder and other somatic/visceral organs, and has many overlapping symptoms and pathophysiology.” IC could be a primary bladder disorder in some patients and yet, for others, may have occurred as the result of another medical condition. The answer remains elusive.

Symptoms

The guideline emphasizes pain as the hallmark symptom of IC/BPS, particularly pain related to bladder filling. Pain can also occur in the urethra, vulva, vagina, rectum and/or throughout the pelvis. Urinary frequency is found in 92% of patients with IC/BPS.

Urgency is an often debated symptom because it is the primary symptom of overactive bladder, a condition often confused with IC. Yet, the authors make a critical distinction. Patients with IC experience urgency and then rush to the restroom to avoid or reduce pain whereas patients with OAB experience urgency and rush to the restroom to avoid having an accident or becoming incontinent.

Diagnosis - Hydrodistentions No Longer The Standard

The authors urge clinicians to perform a thorough history and physical examination of the patient. Symptoms should be present at least six weeks in the absence of infection for a diagnosis to be made. A physical examination of the pelvis should be conducted for both men and women and “The pelvic floor should be palpated for locations of tenderness and trigger points.”

Several conditions should be ruled out, including bladder infection, bladder stones, vaginitis, prostatitis and, in patients with a history of smoking, bladder cancer. Additional testing, however, should be weighed with respect to their potential risks vs. benefits. They offer “In general, additional tests should be undertaken only if the findings will alter the treatment approach.” Cystoscopy and urodynamics, for example, are to be considered if a diagnosis of IC is not clear. The authors do note that cystoscopy helps to rule out other conditions which can mimic IC symptoms, such as bladder cancer or stones.

The presence of Hunner’s ulcers on the bladder wall will lead to a diagnosis of IC however the finding of glomerulations on the bladder wall during hydrodistention with cystoscopy is often vague, variable and consistent with other bladder conditions, thus the panel suggests that “hydrodistention is not necessary for routine clinical use to establish a diagnosis of IC/BPS.” Hunner’s ulcers are described in an acute phase “as an inflamed, friable, denuded area” or in a more chronic phase “blanched, non-bleeding area.”

Pain Management

The guidelines are extremely proactive when it comes to pain acknowledgement and management. The authors offered “Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately.”

Pain management can include the use of various medications, physical therapy and/or the relaxation of tense, painful muscles, biofeedback and a wide variety of other options. The guidelines encourage physicians to refer patients to other pain specialists if they are unable to provide an effective pain management strategy.

Treatment Goals and Principles

The improvement of patient quality of life is the key goal of therapy and consideration should be made for a treatments invasiveness, potential adverse events and the reversibility of a treatment. As a rule, the panelists suggest that treatment should begin with generally safe “conservative” therapies. If no improvement is found, “less conservative” treatments that may have more risk of side effects and adverse events can be explored. Surgical treatment is rarely suggested and only under specific circumstances because it is irreversible.

Grade A = have well-conducted clinical trials and/or exceptionally strong observational studies.
Grade B = have clinical trials that have weaknesses in their procedures or generally strong observational studies.
Grade C = have observational studies that are inconsistent, small or have other problems which could influence the data.

Specific treatment choices should depend upon the patients current symptoms, patient preference and clinician judgement. In addition, it is not unusual for patients to be using multiple, concurrent treatments. If patients have not shown improvement in their symptoms after multiple treatments, the panelists suggest that the diagnosis of IC should be revisited to determine if another underlying disorder (i.e such as pudendal nerve entrapment, endometriosis, etc.) could be present.

The guidelines emphasize the importance of evaluation and tracking a patients progress using a voiding diary and/or other surveys. They suggest that ineffective treatments be stopped after a “clinically meaningful interval.” Only effective treatments should be continued.

First Line Treatments - Should be offered to all patients

Patient Education - Patients should be educated about normal bladder function, what is known about IC and that multiple therapies may need to be tried in order to find symptom relief.


Self-care - Patients should learn about and avoid specific behaviors that can either worsen or give them more control over their symptoms, including: water intake, diet modification to avoid irritating foods and common flare management methods (i.e. the use of heat or cold to relax pelvic floor muscles, the use of meditation or guided imagery to reduce muscle tension, the avoidance of some exercises, tight fitting clothing, constipation treatment, etc.) 
(Julie's note: For more information on determining dietary triggers for interstitial cystitis/painful bladder syndrome, please see Customizing the Interstitial Cystitis Diet and Interstitial Cystitis: A Guide for Nutrition Educators.)

Stress Management - While stress does not cause IC, it is well known to increase IC symptoms and heighten pain sensitivity. The guidelines encourage patients to be aware of their overall stress levels. Stress management and/or better coping techniques should be practiced regularly, perhaps through use of stress management classes and/or the help of a counselor as needed.

(Jill's note - A study released in early 2011 found that cats struggling with feline interstitial cystitis experienced a reduction of their symptoms and became healthier when their stress levels were reduced. This comes as no surprise to the vast majority of patients who have learned, first hand, that high stress can trigger an IC flare. Source: Stella JL, Lord LK, Buffington CA. Sickness behaviors in response to unusual external events in healthy cats and cats with feline interstitial cystitis. Journal of the American Veterinary Medical Association. 238; 67-73, 2011. doi: 10.2460/javma.238.1.67)

Second-Line Treatments

Physical Therapy - If experience and knowledgeable physical therapy staff are available, appropriate physical therapy techniques should be used “to resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures and release painful scars or other connective tissue restrictions.” Kegel exercises and exercises aimed at strengthening the pelvic floor are NOT recommended. Why? In pelvic floor dysfunction, muscles are often too tight and kegel exercises act to increase rather than reduce muscle tension. 

(Jill's note - Two books are available which describe pelvic floor treatment in depth, including a variety of home exercises that can be used to resolve symptoms. Ending Female Pain by Isa Herrera PT and Heal Pelvic Pain by Amy Stein PT) 


Pain Management - “Pain management should be an integral part of the treatment approach and should be assessed at each clinical enoucnter for effectiveness,” the guidelines encourage. With respect to the use of pain medications, such as narcotics, the authors suggest that while the risk of tolerance and dependence is possible, only rarely does addiction occur. They offer “It is clear that many patients benefit from narcotic analgesia as part of a comprehensive program to manage pain.” Yet, they also state that the use of pain medication alone does not constitute a sufficient treatment plan. Pain management should be just one component of treatment.


Oral Medication Options 



Amitriptyline (aka Elavil) has several studies reporting strong success in reducing IC symptoms yet side effects were highly likely with the potential of disrupting a patients quality of life, particularly sedation, drowsiness or nausea. Side effects were the primary reason why patients stopped using the medication. Grade B

Cimetidine (aka Tagamet) acts to inhibit acid production in the stomach. Two long term studies reported that 44% to 57% of patients experienced improvement in their symptoms with no adverse events reported, making this a viable second line strategy. Grade B

Hydoxyzine (aka Vistaril, Atarax) had mixed research studies, one of which reported that 92% of patients experienced improvement yet those participating patients also had systemic allergies. Other studies found much more modest effectiveness (i.e. 23%). Adverse events were common and generally not serious. Grade C



Pentosan polysulfate (aka Elmiron), the only oral FDA approved for IC, is the most studied medication currently use with five placebo controlled clinical trials. The results were clinical significantly (21 to 56% effectiveness). Roughly 10 to 20% of patients experienced side effects that were “generally not serious.” Pentosan may have a lower efficacy in treating patients with Hunner’s Ulcers. Grade B

Bladder Instillation Options

DMSO (aka RIMSO-50), the only FDA approved bladder instillation for IC, is one of three considered a second-line therapy. Several studies were reviewed with various levels of success ranging from 25% to 90%. “If DMSO is used, then the panel suggests limiting instillation dwell time to 15-20 minutes” because longer dwell times are associated with more significant pain. Grade C



Heparin instillations have been studied using various concentrations and treatment modalities (i.e. 10,000 IU heparin in 10cm3 sterile water 3x per week or 25,000 IU in 5 ml of distilled water 2x per week) with intriguing results. The 10,000 IU study showed a 56% improvement at 3 months, whereas the 25,000 IU study showed a 72.5% improvement at 3 months. No placebo controlled studies have been done. Adverse events were infrequent and apparently minor. Heparin is frequently combined lidocaine to create an instillation popularly known as a “rescue instillation.” Grade C



Lidocaine instillations have also been studied in various dosages, cocktails and/or treatment schedules. The guidelines include several formulas for various cocktails that can be used, often including sodium bicarbonate, heparin, lidocaine and/or triamcinolone. Adverse events were typically not serious, earning this treatment option a Grade B.

Third-Line Treatments

Hydrodistention with cystoscopy may be considered if first or second line treatments have no provided relief. The panel ONLY recommends low-pressure (60-80 cm H2O) and short duration (less than 10 minutes) procedures to reduce the risk of bladder rupture. Grade C


Hunner’s ulcers can be treated with fulguration (laser or electrocautery) and/or by injection of triamcinolone into the ulcer . One observational study reported 100% pain relief and 70% reduced frequency from 2 to 42 months after heat treatment. Laser studies showed similar effectiveness however, in both cases, ulcers may require additional treatment. One triamcinolone treatment reported that 70% of patients experienced a sustained improvement over 7 to 12 months. Grade C.

Fourth-Line Treatments

Neuromodulation is not FDA approved for IC treatment but has been used for the treatment of frequency urgency. Neuromodulation can occur at the sacral or pudendal nerve with studies confirming that pudendal stimulation appeared to provide greater symptom relief. Long term follow up data is not available. Grade C



(Jill's Note - We’re stunned to see the panelists conclude that adverse events related to neuromodulation appear to be minor and this is the one area of the report that we strongly disagree with. A review of the FDA MAUDE database for adverse events reveals hundreds of severe complications ranging from MRSA infection, difficulty walking, device malfunction and, in the past two years, more than a dozen reports of fatality. We will be inquiring of the panel if they are aware of this federal adverse event data.)



Fifth-Line Treatments

Cyclosporine A is an immunosuppresant that has been studied in two small trials with IC patients with solid results. One study compared CyA with pentosan and reported a 75% improvement in patients using cyclosporine, as well as a 50% decrease in frequency. The results of two additional studies found sustained pain relief that lasted one year or longer. Unfortunately, there is potential for more severe adverse events, including immunosuppression, nephrotoxicity, high blood pressure, increased serum creatinine and others. Grade C


Botulinum Toxin (BTX-A) injections into the bladder may be considered if other therapies have not produced improvement, however “the patient must be willing to accept the possibility that intermittent self-catheterization may be necessary-post treatment,” often for several months. BTX is not appropriate for patients who cannot self-catheterize. Grade C

Sixth-Line Treatments

Surgical intervention, such as urinary diversion, substitution cystoplasty or cystectomy, may be considered for patients who have found no relief with all other therapies and/or have developed a severe, unresponsive, fibrotic bladder. “Patients must understand that symptom relief is not guaranteed. Pain can persistent even after cystectomy, especially in nonulcer IC/BPS.” Patients with small bladder capacities under anesthesia and the absence of neuropathic pain appear to have a better response to surgical treatment. Grade C


Discontinued Treatments

The panel suggests that the following treatments should not be offered due to the lack of effectiveness found in studies and/or the risk of serious adverse events. In these cases, the risk appears to outweigh the potential benefits.

• Long-term oral antibiotics
• Intravesical Bacillus Calmette Guerin (BCG)
• Intravesical Resiniferatoxin (RTX)
• High pressure, long duration hydrodistentions
• Systemic glucocorticoids

Download the official AUA Guidelines for IC/BPS at:

http://www.auanet.org/content/guidel...ent_ic-bps.pdf

Julie Beyer, MA, RDN

Author, Speaker, Patient Advocate

www.ic-diet.com 

Just Tell Me What to Eat!

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

For health care workers:  Interstitial Cystitis: A Guide for Nutrition Educators 

 **Please SHARE using the links below!**

The Pleasures of Restaurant Dining on an Interstitial Cystitis Diet!

Having a chronic illness like interstitial cystitis can deplete your time and energy, and it can be tempting to order in or eat out. However, eating meals prepared away from home is not always a time saver. Waiting in line for fast food or sitting down to eat at a restaurant often takes just as long as preparing a simple meal at home. It is also much harder to stay on an IC Diet when you eat out because you have less control of the ingredients and seasonings, leaving you at risk for bladder pain and frequency that becomes an IC flare.

That being said, even interstitial cystitis patients have times when they need or want to eat outside of the home. Even if your IC diet is fairly limited, there are steps you can take to make sure the food you eat is as IC/bladder friendly for you as possible. Fast food restaurants offer plain hamburgers and milk or milk shakes in a pinch. Most other restaurants will gladly accommodate special orders from their customers. In most restaurants, you can order baked or broiled chicken with no seasoning, a baked potato or plain rice, and steamed vegetables. When in doubt, ask to talk to the chef personally.

Navigating food choices in other people’s homes, on holidays, or at events like weddings can be slightly more difficult for someone with interstitial cystitis. Your best strategy is to find out ahead of time what is being served and work around it. If you know in advance that the food choices will not be IC/bladder friendly, eat a sandwich or small meal before you go. You can also offer to take a dish to pass, (IC diet friendly, of course) if that is appropriate for the situation. The book Confident Choices: A Cookbook for IC and OAB has dozens of recipes that are suitable for these occasions, including a variety of appetizers. Who knows, your recipes might just become crowd favorites!

I have become a great "window shopper" of food! I can admire it and smell it, but I don't have to eat it!

Finally, keep in mind why you are eating out. I used to remind my weight management patients to "socialize with people not food." The same goes for interstitial cystitis patients on an IC Diet. Part of learning to accept a chronic illness is learning when to let go of the mind set of "it''s not fair." Instead of looking at the great buffet set out at your niece's wedding and worrying about what you cannot eat, choose what you can eat, enjoy that, and spend your energy and emotions connecting with friends and relatives you may not have seen for awhile.

Similarly, when you are at a restaurant, stop focusing on the foods that are not IC friendly and order what will keep your bladder happy. (I have become a great "window shopper" of food! I can admire it and smell it, but I don't have to eat it!) Then focus not only on the people you are with, but also on the other great benefits of eating in a restaurant. Somebody else is doing all of the work! You don't have to grocery shop for the food. You don't have to prepare it. You don't have to set the table. And the best reason of all? You don't have to clean up afterward.

What are your favorite restaurant foods? How do you navigate the food served at a family event our party?

Julie Beyer, MA, RDN

Author, Speaker, Patient Advocate

www.ic-diet.com 

Just Tell Me What to Eat!

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

For health care workers:  Interstitial Cystitis: A Guide for Nutrition Educators 

 **Please SHARE using the links below!**