IC Diet: Should You Be Pro-Probiotics?

It doesn’t take much research on good ol' 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? What about someone who may have taken boatloads of antibiotics like a person with IC/BPS? Should they take more or less probiotics?

Part of what complicates the understanding of this subject is that the science of intestinal bacteria colonies (the microbiome) and its relationship to conditions like painful bladders 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 about the microbiome 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. People even died from urinary tract infections. 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. This is even more tragic when you consider many people with painful bladders were treated as though they had an infection when really they had interstitial cystitis.

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 smaller packages of 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. The good bacteria may even 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 painful 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 and only avoid the foods that affect YOUR bladder. A true IC diet is an individualized diet.
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. The last thing a person with IC needs is a deeply imbedded, resistant infection!
5. Ask your physician about taking probiotic supplements. Many IC patients have added probiotics to their treatment plans. 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!”


Julie Beyer, MA, RDN

Author, Speaker, Patient Advocate

www.ic-diet.com 

Related:

        

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