September 2019 Issue

Ask the Expert: Interstitial Cystitis — Can Diet Help?
By Toby Amidor, MS, RD, CDN, FAND
Today’s Dietitian
Vol. 21, No. 9, P. 10

Q: Some of my clients have been asking about dietary treatments for interstitial cystitis (IC). What is IC, and can diet help manage it?

A: IC, also called bladder pain syndrome, is a condition marked by urinary urgency, urinary frequency, and pelvic pain that’s thought to affect 4 million to 12 million people in the United States.1 According to the American Urology Association’s (AUA) 2014 guidelines, diet modification is a first-line management strategy.2

What Causes IC?
According to Thomas H. Rechtschaffen, MD, FACS, a urologist at Advanced Urology Centers of New York, partner at Integrated Medical Professionals, PLLC, and executive board member of the AUA New York section, several theories exist as to what causes IC, but the exact mechanism is unknown. One leading theory, he says, is that a defect in the normally water-tight mucosal lining of the bladder enables irritating substances in the urine to reach the bladder’s muscles and nerves. This results in a collection of inflammatory mast cells, which release histamine, causing the uncomfortable symptoms felt in IC flares. Over time, this chronic inflammation affects the nerves that carry bladder sensations to the point where the normal stretching and collapsing of the bladder becomes painful.

Nondietary Treatments
A common treatment for IC is percutaneous tibial nerve stimulation, wherein an acupuncturelike needle is placed in the skin above and behind the ankle, where a nerve responsible for bladder function and sensation lies. A machine bombards the nerve with a low-amplitude, high-frequency current that results in significant and durable relief of IC symptoms. It’s covered by many insurance plans and enables many patients to decrease or eliminate medications.

Nevertheless, dietary management always should be used in conjunction with other treatments. According to Julie Beyer, MA, RDN, an interstitial cystitis patient advocate and author of several cookbooks for IC, the vast majority of patients find at least some relief with diet, even if other treatments are necessary.

Dietary Management
Although research on dietary management still is evolving, current guidelines from the AUA state that many people diagnosed with IC find that certain foods irritate the bladder and exacerbate symptoms such as urinary frequency and painful urination. Top trigger foods include coffee, tea, alcohol, chocolate, soft drinks, soy, citrus, tomatoes, food additives (such as coloring), and spicy foods. There’s a more extensive list of trigger foods, but Beyer says most patients are affected only by these top foods.2

An elimination diet may help better pinpoint trigger foods for individual patients. Beyer recommends having clients record food intake, lifestyle habits, and symptoms before changing their diets to provide a baseline of symptoms. The AUA advises assessing clients for weight loss or gain, which Beyer says is common in IC due to overapplication of dietary restrictions or increased sedentary time due to pain. IC’s restrictions also can trigger eating disorders in patients with a history of them.

Recommendation for RDs
RDs can serve on a multidisciplinary team that includes a urologist to help clients with IC consume a healthful diet while avoiding foods that trigger symptoms. In addition, RDs can help patients deal with IC’s waxing and waning nature. Beyer says IC’s intensity and a client’s response to treatment can change over time, with the possibility of trigger foods being reintroduced to the diet. She also says IC patients may go through stages of grief over their diagnosis and will accept teaching and coaching differently throughout the process.

— Toby Amidor, MS, RD, CDN, FAND, is the founder of Toby Amidor Nutrition ( and a Wall Street Journal best-selling author. Her cookbooks include Smart Meal Prep for Beginners, The Easy 5-Ingredient Healthy Cookbook, The Healthy Meal Prep Cookbook, The Greek Yogurt Kitchen, and the forthcoming The Create-Your-Plate Diabetes Cookbook and The Best Rotisserie Chicken Cookbook Ever. She’s a nutrition expert for and a contributor to U.S. News Eat + Run and Muscle&

1. Berry SH, Elliott MN, Suttorp M, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011;186(2):540-544.

2. Hanno PM, Burks DA, Clemens JQ, et al; American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Updated September 2014.