Before I wrote the first version of Customizing the Interstitial Cystitis Diet, one concept I had to work around--delicately I might add--was the idea of avoiding acidic foods. In the early years, when interstitial patients were teaching other patients with painful bladders, it was often convenient to"explain" an IC diet to someone quickly by telling them to avoid acidic foods. Interstitial cystitis support groups often came up with their own version of the IC diet to distribute to their members.
That, however, is also part of the historical resistance of doctors and dietitians to accepting a diet for IC. People who have studied biochemistry and physiology know that "acid in doesn't equal acid out." (An acidic orange juice forms an alkaline metabolite when digested, and acidic cranberry juice forms an acid metabolite. In fact, the whole equation changes when you start to combine foods in a meal. Therefore, the acid/alkaline story is incomplete at best when it comes to triggering painful bladder symptoms, and we know that there are other reasons why a food bothers the sensitive bladders of people with IC.
One is an allergic or inflammatory type response that kicks up the degranulation of mast cells in the bladder. This can even be caused by stress. Maybe you or someone you know has gotten hives when they were under a lot of stress—that is the result of mast cells in the skin going haywire, just like can happen in the bladder. (See Interstitial Cystitis: Allergies and Diet to learn more.)
The second way a food can affect the bladder is via a chemical reaction with the nerves. Think about caffeine and MSG—both stimulate bladder spasms or frequency. Most IC patients report that they know they have had something with caffeine in it within a few minutes. (See Is MSG Hiding in Your Food to learn more.)
The third way is related to the acid/alkaline theory but isn't as clear as we would like it to be. To begin with, even a healthy person’s urine pH bounces around all day long. The body pH, however, needs to be kept at a constant level—7.3 to 7.4 pH—or, simply put, we would die. Conveniently, there are feedback mechanisms in our bodies to prevent wide swings of body pH. One of those feedback mechanisms is the urinary tract system. The body pH is kept at equilibrium by expending acidic or alkaline properties often through the urine. Therefore, as you go through the day, depending on what you consume, if you are exercising, or are under stress, your body is very hard at work trying to keep that pH steady. As a result, the urine pH bounces around, as stated previously, in an effort to maintain a steady body pH. (See Body pH vs. Urine pH to learn more.)
Now, the next step in this thought process is to remember that most people have healthy bladders and are not even aware that this is happening. However, an IC bladder is a wounded bladder. Regardless of whether this is from tiny hemorrhages or full blown Hunner's ulcers, these irritated areas have penetrated the protective layers of the bladder down to the nerves. Do you see where I am going with this?
If you had a cut on your hand, would you put it in a bucket of lemon juice (an acid product)? I can already hear you saying, “No way!” But, you also wouldn't put that wounded hand into a bucket of bleach (an alkaline product). That would hurt too! However, neither of those liquids would hurt a healthy hand in the short term. The same goes for your bladder; if the pH of the urine is bouncing around all day and you have wounds in your bladder, you are going to know it!
So, the acid/alkaline story of an IC diet may explain some of the symptoms, but not all of the effects food can have on a painful bladder. The pH issue, however, is not as easily controlled as one might think, nor should we rely only on pH as a way to control our symptoms. Some of the MOST reactive foods are the allergic/inflammatory and neurostimulatory properties of foods.
Finally, an area that needs more attention from researchers is how eating an IC friendly diet can potentially affect the outcomes of other medical treatments. It only makes sense that if you are trying to rebuild the bladder lining, that you would want to make the bladder environment as hospitable to healing as possible. I believe that one way to accomplish this by reducing the intake of foods that assault the bladder.
Author, Speaker, Patient Advocate
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
For health care workers: Interstitial Cystitis: A Guide for Nutrition Educators
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