WHY YOU SHOULDN’T FOLLOW THE INTERSTITIAL CYSTITIS DIET (AND WHAT YOU SHOULD EAT INSTEAD)
Whether you have just been diagnosed with IC, or you’ve had IC or recurring urinary tract infections for years, it can be hard to know where to begin with diet and nutrition!
Have you been told to avoid all acidic foods to stop your IC or UTIs? I know I was. It was hugely damaging to my relationship with food and my health. I cut out a very long list of foods believing they were “acidic” and trigger foods for my IC because I had read in online groups, and several books (written by really well meaning but totally unqualified to give health advice people).
Understandably, in my desperation, I lapped it all up. I lost tons of weight, I was malnourished, depleted, terrified to eat most foods for fear it would “trigger” a flare up. I looked ill and I certainly wasn’t feeling in any way better. If anything I was feeling more and more depressed. It was really getting me down and effecting my mental health.
Sounding familiar?
It's something I help nearly all my 1-1 clients understand and overcome and I want you to know it’s not your fault.
This perpetuation of false information is grossly unhelpful and unnecessary. As a qualified and experienced nutritionist, who has specialised in digestion and gut health for a very long time, and as an IC survivor myself, it’s a topic very close to my heart.
I want to help you by busting some of these IC diet myths because perpetuating stories like “you should avoid all acidic foods'' to heal your bladder are based on assumptions and hearsay, and crucially, they’re impeding your healing.
So let's get started!
HERE’S WHY ACIDIC FOODS ARE NOT IRRITATING YOUR BLADDER
Fruit and veggies are alkalising in the body! They have what's called a low potential renal acid load (PRAL). PRAL is the capacity of any food to be acidic or alkaline once it’s been digested. Digestion changes a food’s pH.
The acidity in "acidic" foods like tomatoes and oranges has been neutralised by the hydrochloric acid in our stomach during digestion.
PRAL groups foods according to their capacity to release acids or alkali. In general, protein rich foods such as meat, eggs and cheese, have positive PRAL (acidic), while fruits and vegetables have negative PRAL (alkaline).
If the PRAL value for a type of food is <0 it is considered that such a food increases alkalinity of the body fluids.
If PRAL >0 the food increases the production of acids in the body.
You can find a table of high and low PRAL foods in Table 2, here.
But remember what we discussed, our goal is not to cut out protein foods. We need protein to repair tissue and irritation.
The secret to lowering our acid production will be to combine more foods that make alkali (fruit and veggies) with protein foods at meal times to strike a balance. Eating a variety of fruits and vegetables daily will be an easy way to achieve this.
Another helpful trick can be to vary our proteins and incorporate some plant proteins like lentils, beans, tofu and tempeh (if tolerated) which may have a neutral effect on the acid load.
WAIT A SECOND MARY! CITRUS IS DEFINITELY ACIDIC, WON’T THIS CAUSE MY BLADDER TO FLARE?
The answer is no!
You see, here’s the thing…
Fruit and veggies including those with an acidic pH are rich in minerals which help produce more bicarbonate (alkaline!). It is all about what our body does with the food. Digestion changes a food's pH.
Acid in… does not equal acid out.
Fruits and vegetables are rich in minerals, calcium, potassium and magnesium: precursors of alkali. So after digestion, that lemon has an alkalising effect.
Is this starting to make sense?
SO WHAT FOODS ARE ACIDIC TO THE BLADDER?
The dietary components that release acid after digestion are proteins. Protein rich foods include meat, fish, dairy (but not milk which is neutral), among others.
We definitely need protein with each meal to support healing and tissue repair. Our aim is always to balance the acidity of protein rich foods by pairing them with alkaline foods (fruit or veggies) at each meal.
WHY DO SO MANY PEOPLE RECOMMEND AVOIDING ACIDIC FRUITS & VEGETABLES FOR INTERSTITIAL CYSTITIS?
Where some of this misinformation possibly stems from is low acid diets designed for gastritis or acid reflux, which occurs before digestion.
It may be helpful for someone with gastritis or acid reflux to avoid acidic foods, like tomatoes and citrus with an acidic pH, because prior to being digested, these foods can irritate the stomach and oesophagus. However, now you know that once food leaves the stomach, it can no longer have the same irritating effects.
Can you start to see how avoiding healthy fruits and vegetables, including citrus (unless you have gastritis/or reflux) could be impeding your healing journey?
BUT WHY IS IT THAT WHEN I AVOID “ACIDIC” FOODS I FEEL BETTER?
If you’re reacting to fruit and vegetables with an acidic pH, then it is possible there are other components of these foods you are reacting to, and not necessarily its acidity.
It could be that these foods also happen to be diuretics, e.g. coffee, which increases our need to pee, or the food is high in oxalates, which some people are sensitive to. But the act of cooking, fermenting and sprouting reduces oxalate content of foods.
I have included a list of the main bladder irritants to avoid in my free ebook here.
There is so much misinformation out there on "acidic" foods in the management of chronic UTIs and IC. I want you to know that while the advice probably started out from a place of kindness, it's nonfactual, and not supported by our physiology or scientific evidence.
KEY TAKEAWAYS ON WHY ACIDIC FOODS DO NOT IRRITATE THE BLADDER IN INTERSTITIAL CYSTITIS (IC)
The pH/acidity of a food changes once it’s digested
Fruit and vegetables balance the acidity of protein foods (like meat, cheese and fish) in our diet
A diet low in fruit and vegetables increases acidosis and inflammation in the body
(Osuna-Padilla, I.A. et al. (2019)), (Remer & Manz, 1995)
NATURAL TREATMENTS FOR INTERSTITIAL CYSTITIS
Now that we’ve busted the acidic foods myth as a trigger of bladder pain (with or without urinary tract infection), remember, it’s unlikely to be just one food or one thing that triggers your IC or UTI. It will likely be a combination of diet and lifestyle factors. It’s far more powerful to focus on the foods that are going to support your IC healing journey.
For instance:
The foods that will support your immune system so you don’t get repeat urinary tract infections, bladder flares, or bouts of thrush or bacterial vaginosis (BV)
Eating an abundance of anti-inflammatory foods to reduce inflammation in the bladder and body
Focusing on foods that are naturally anti-microbial so you keep a healthy balance of bacteria in your gut, bladder and vagina
This is a whole-body approach and it is what I help people do on my 1-1 Heal your Bladder programme.
OTHER NATURAL REMEDIES FOR TREATING INTERSTITIAL CYSTITIS: A ROOT CAUSE APPROACH
Running some functional testing is another great option to consider when healing from interstitial cystitis:
A Urinary Ecologix, a comprehensive urinary analysis test using pQCR technology to assess the microbes in your bladder.
A comprehensive stool test, to check for imbalances in the gut. This may include bacterial or yeast overgrowth, inflammation, markers associated with histamine intolerance, UTIs, and SIBO.
A Vaginal Ecologix test to rule out imbalances in the vagina that may be contributing to tissue inflammation, stinging, tingling, and burning
Vitamin D test. Optimal vitamin D levels are important to reduce the risk of UTIs.
All my 1-1 clients have access to a range of functional medicine clinical testing as an option. Want to find out more about working with me 1-1? Book a call and let’s chat.
References:
Osuna-Padilla, I.A. et al. (2019) Dietary acid load mechanisms and evidence of its health repercussions. Nefrologia. Available at:https://www.revistanefrologia.com/en-pdf-S2013251419301129 (Accessed: November 10, 2022).
Remer, T. and Manz, F. (1995) “Potential renal acid load of foods and its influence on urine ph,” Journal of the American Dietetic Association, 95(7), pp. 791–797. Available at: https://doi.org/10.1016/s0002-8223(95)00219-7. Access full paper here.
