Sunday, April 10, 2011

Interstitial Cystitis Patients: Are you one of the “lucky” ones with both IC and IBS?

IBS Free at Last
Guest Blog by Patsy Catsos, MS, RD, Author IBS: Free at Last!

It is not uncommon for people with IC to also suffer from gas, bloating, diarrhea or constipation, whether formally diagnosed with IBS or not. There are changes you can make to your diet that may help. In the past, doctors and dietitians had one primary piece of advice for IBS sufferers: eat more fiber! However, as many of my patients can attest, fiber is not always the answer, and sometimes makes the symptoms of IBS worse. Other standard advice given far too freely includes “no dairy” or “low-fat” or “no red meat”. Recent studies support the idea that these one-size-fits-all diets are misguided, and that many IBS symptoms are actually triggered by certain carbohydrate foods in the diet. I know I am speaking to an audience that understands the reality of food sensitivities, and that symptoms can sometimes be avoided by limiting the presence of trigger foods in the diet.
I have read Julie’s wonderful book, Customizing the Interstitial Cystitis Diet, and I know that many of you are already working with numerous dietary restrictions. Rather than weigh you down with new ones, I’d like educate you a little bit about some common IBS triggers in the diet, known as FODMAPs* carbohydrates. These sugars and fibers have a few things in common: they are poorly absorbed, they are rapidly fermented by the normal bacteria that live in the gut, and they are capable of pulling in and holding extra fluid into the gut. Symptoms can result in those prone to IBS. Examples of FODMAPs are lactose, fructose, sugar alcohols, fructans, and galactans. Sorry for the technical terms; next, we’ll try to focus on foods. I’d like to offer a few recommendations about the foods on the IC Food List, from the FODMAPs perspective.
Beverages: Portions of juice should be limited to about ½ cup per meal.
Milk products: I highly recommend the use of lactose-free milk products for people with IBS. Even if you aren’t extremely lactose intolerant, if you are a heavy user of milk and yogurt it can contribute to the overall load of fermentable carbs in your gut. Lactose-free milk is widely available. Green Valley makes lactose-free yogurt that can be purchased at Whole Foods, but lactose-free yogurt is otherwise hard to find. Greek yogurt would be the next-best alternative. Lactaid brand cottage cheese and ice cream are available. Eggnog calls for a Lactaid pill. Beware evaporated and condensed milk, which are very high in lactose. Hard cheeses contain only a trace of lactose and may be well tolerated.
Meats, fish and poultry: No carbs in sight in this food group, so no worries. Oops, I do see one after all—whey protein powders can sometimes contain large amounts of lactose.
Vegetables: The IC Bladder Friendly and Try It vegetables I see that would also be the most IBS friendly are beets, carrots, celery, chives, cucumber, greens of all kinds, lettuce (not iceberg), olives, parsley, green peas, red bell peppers, white potatoes, radishes, rhubarb, winter squash, yellow squash, zucchini and watercress.
Fruits: This looks like a difficult area, because I see the more acidic fruits are used with caution for IC. These tend to be the same lower-fructose fruits I usually recommend for people with IBS. Best bets might be: rhubarb, bananas, melons, and small servings of raisins.
Grains: Although as a dietitian it pains me to say so, take it easy on the whole wheat and bran-laden breads and cereals. Products made from potatoes, rice, oats, corn and buckwheat tend to be well tolerated.
Sweets and Desserts: Stick to granulated sugar (cane sugar) and real maple syrup to sweeten your treats. Milk-based desserts are delicious and better tolerated when made with lactose-free milk.
Snacks: Nuts, carrots and celery, plain chips and Nature Valley crunchy granola bars work well. Carry some Lactaid pills for those unexpected milk shakes and ice cream cones!
Fats and Oils: All are low in FODMAPs, and should be well tolerated in small servings.
Spices and Herbs: All individual spices and mayonnaise are fine.
That concludes our brief tour at the intersection of eating for IC and IBS. For those of you who would like more information for yourselves or a family member, my book, IBS—Free at Last! (Pond Cove Press, 2009) is available on My blog is They are devoted to a full-fledged, FODMAPs-restricted dietary program for people with IBS. The book provides menus, label reading advice, and food lists—all the tools to help each person figure out whether his or her IBS symptoms are aggravated by FODMAPS, and if so, how to manage it.
*FODMAPs stands for Fermentable, Oligo- Di- and Monosaccharides and Polyols.

For more information see:

Author, Speaker, Patient Advocate 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 

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