Effect of Comestibles on Symptoms of Interstitial Cystitis Barbara Shorter, Martin Lesser,* Robert M. Moldwin†,‡ and Leslie Kushner From the Department of Nutrition, C. W. Post Campus of Long Island University (BS), Brookville, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System (ML, LK), Manhasset and Institute for Urology, Long Island Jewish Medical Center (RMM, LK), New Hyde Park, New York Purpose: Anecdotal evidence suggests that patients with painful bladder syndrome/interstitial cystitis report symptom exacerbation after consuming particular foods, beverages and/or supplements. We determined the prevalence of the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms and identified particular comestible items more likely to affect such symptoms. Materials and Methods: A validated questionnaire designed to detect whether food, beverages and/or supplements have an effect on bladder symptoms was administered to 104 patients meeting National Institute for Diabetes and Digestive and Kidney Diseases criteria for interstitial cystitis. In addition to answering general questions about the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms, subjects were asked to indicate whether each of 175 individual items worsened, improved or had no effect on symptoms. Each response was numerically scored on a scale of -2 to 2 and mean values were generated for each comestible item. Results: Of the surveyed patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation. There was no correlation between allergies and the effect of comestibles on symptoms. Patients who reported that specific foods worsened symptoms tended to have higher O’Leary-Sant interstitial cystitis symptom index and problem index, and/or pelvic pain and urgency/frequency patient symptom scale scores. A total of 35 comestible items had a mean score of lower than -1.0, including caffeinated, carbonated and alcoholic beverages, certain fruits and juices, artificial sweeteners and spicy foods. Conclusions: There is a large cohort of patients with painful bladder syndrome/interstitial cystitis in whom symptoms are exacerbated by the ingestion of specific comestibles. The most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper. Key Words: bladder; cystitis, interstitial; diet; nutritional status; questionnaires P ainful bladder syndrome/interstitial cystitis is a chronic condition characterized by pain of the bladder and pelvic region, urinary urgency, frequency and nocturia. Despite intense investigation to our knowledge the etiology of this disease is unknown, diagnostic criteria are debated and treatment is empirical. More than 180 thera- pies are used to treat PBS/IC with no single modality suc- cessful for all patients. 1 Factors such as stress, medication, allergic reactions, sexual intercourse, hormonal changes and diet may exacerbate bladder symptoms. Patients with PBS/IC frequently report that specific foods, beverages and dietary supplements increase symp- toms. In response many physicians recommend changes to the diet of patients with PBS/IC and IC diets have been developed and distributed by patient support organizations. Nonetheless, the role of diet in affecting symptoms of PBS/IC is based on a paucity of information, mostly anec- dotal reports. In addition, there is controversy about which and how many foods should be eliminated from the diet to improve symptoms. Of particular concern is that patients may eliminate more foods than necessary to avoid increas- ing painful symptoms, resulting in a diet inadequate for maintaining health and long-term symptom improvement. We systematically determined whether specific comestible items exacerbate and/or ameliorate PBS/IC symptoms and whether any generalizations concerning the effect of comes- tibles on PBS/IC symptoms could form the basis for further investigation. MATERIALS AND METHODS A validated questionnaire designed to detect whether food, beverages and/or supplements have an effect on bladder symptoms (fig. 1), 2 and the OSPI 3 and PUF 4 questionnaires were mailed to 327 female patients meeting NIDDK crite- ria 5 for PBS/IC. All patients had been examined and diag- nosed with IC by a single physician at a suburban medical center. Patients were asked to complete the questionnaires and return them to the physician in a postage paid envelope. Returned questionnaires had no identifying information and data were entered into an encoded database. The IC/nutrition questionnaire included general ques- tions about the effect of comestibles on PBS/IC symptoms (fig. 1). Additionally, questions about allergies, medications, Submitted for publication October 24, 2006. * Financial interest and/or other relationship with Condax. † Correspondence: Institute for Urology, Long Island Jewish Medical Center, 270-05 76th Ave., New Hyde Park, New York 11040 (telephone: 718-470-7220; FAX: 718-343-6254; e-mail: rmoldwin@aol.com). ‡ Financial interest and/or other relationship with Ortho-McNeil, Allergan and Astellas. 0022-5347/07/1781-0145/0 Vol. 178, 145-152, July 2007 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2007 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2007.03.020 145