AUA 2009: Food Sensitivities

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(Note: this is an abstract from a conference, not a published study.)


Differences in Food Sensitivities Between Female Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) Patients

Authors: Amin S Herati*, New Hyde Park, NY; Barbara Shorter, Brookville, NY; Julia Tai, Martin Lesser, Robert M Moldwin, New Hyde Park, NY

Introduction and Objective: The high prevalence of food sensitivity in the IC/PBS population is well documented; yet, very little is known about the prevalence of food sensitivity in the CP/CPPS population. The aim of this study is to compare comestible sensitivities between these groups and to determine the association between food sensitivity and the clinical features characteristic of these two disorders. Methods: Three hundred twenty five female IC/PBS patients and 268 CP/CPPS patients were given a validated dietary questionnaire. Data collected included the presence and quality of sensitivity to a wide array of foods, beverages, and supplements. Additionally, a retrospective review was performed to obtain patient characteristics and IC/PBS and CP/CPPS symptoms including: the presence of Hunner’s ulcers, dysruia, nocturia, urgency, straining to urinate, and constipation. Chi squared analysis was used to evaluate the association between comestible sensitivity and clinical features. Results: Response rates for the 325 female IC/PBS patients and the 286 CP/CPPS patients surveyed were 32% and 34% respectively. Of those who responded, a significant difference was seen in the rates of comestible sensitivity: 94.8% of the IC/PBS patients vs. 77.1% CP/CPPS patients (p<0.001). Foods and beverages that were most bothersome to the CP/CPPS and IC groups were identical in both cohorts. Coffee was the most aggravating of all foods followed by tea, alcohol, citrus fruits, spicy foods, and tomato products. Comestibles found to be most alleviating of the symptoms of CP/CPPS and IC include Prelief®, Colace®, Metamucil®, and popcorn. A significant correlation existed between male and female subjects who had the most food sensitivities and those who scored the highest on the CP/CPPS scale (p<0.05) and PUF scale (p<0.05) respectively. No significant correlation was found between the rates of food sensitivity and Hunner’s ulcers, dysruia, nocturia, urgency, straining to urinate, and constipation. Conclusions: IC/PBS patients are more likely than CP/CPPS patients to have food and beverage sensitivity. The most bothersome comestibles among both groups include coffee, spicy foods, alcoholic beverages, tea, citrus fruits, and hot peppers, whereas certain supplements, such as Prelief®, Colace®, and Metamucil® were found to improve symptoms.

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BJU Int. 2012 Jun;109(11):1584-91. doi: 10.1111/j.1464-410X.2011.10860.x. Epub 2012 Jan 11.
Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions.
Friedlander JI, Shorter B, Moldwin RM.
The Arthur Smith Institute for Urology, Department of Nutrition, New Hyde Park, NY, USA.

What's known on the subject? and What does the study add? Nearly 90% of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) report sensitivities to a wide variety of dietary comestibles. Current questionnaire-based literature suggests that citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods tend to exacerbate symptoms, while calcium glycerophosphate and sodium bicarbonate tend to improve symptoms. At present we recommend employing a controlled method to determine dietary sensitivities, such as an elimination diet, in order to identify sensitivities while at the same time maintain optimal nutritional intake. We review current literature with regard to diet's effect upon IC/BPS and common comorbidities (irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, neuropathic pain, vulvodynia, and headache) with a focus upon questionnaire-based investigations. We discuss the pathologic mechanisms that may link diet and IC/BPS related-pain, concentrating upon specific comestibles such as acidic foods, foods high in potassium, caffeine, and alcohol. Up to 90% of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) report sensitivities to a wide variety of comestibles.   Pathological mechanisms suggested to be responsible for the relationship between dietary intake and symptom exacerbation include peripheral and/or central neural upregulation, bladder epithelial dysfunction, and organ 'cross-talk', amongst others.   Current questionnaire-based data suggests that citrus fruits, tomatoes, vitamin C, artificial sweeteners, coffee, tea, carbonated and alcoholic beverages, and spicy foods tend to exacerbate symptoms, while calcium glycerophosphate and sodium bicarbonate tend to improve symptoms. Specific comestible sensitivities varied between patients and may have been influenced by comorbid conditions. This suggests that a controlled method to determine dietary sensitivities, such as an elimination diet, may play an important role in patient management.

PMID: 22233286