Conditions, Interstitial Cystitis

The Allergic Bladder

Interstitial cystitis is often associated with a range of other degenerative diseases such as IBS, IBD, Fibromyalgia, Sjoegen’s, Lupus and also allergies.

‘Classic’ interstitial cystitis has some common features with allergies such as increased mast cells, histamine and inflammation.

Is something else causing IC, allergies and associated diseases or could allergies be a root cause? What if some cases of IC are simply a symptom of food intolerance? I call this the allergic bladder.





Allergies and Intolerances  

An allergy is a reaction by our immune system against a foreign molecule (usually a protein) or an ‘antigen’.

But sometimes we simply mean an ‘intolerance’ when talking about allergies.

A true allergy is dangerous and can be fatal in cases of anaphylactic shock. We know this can happen in cases of peanut allergy for example, where even the smallest amount of peanut can be dangerous. A true allergy is mediated by IgE antibodies and the reaction is usually immediate.

Antibodies are protein molecules that play an important part in our immune system. They bind to antigens entering the body (such as viruses and bacteria) and alert the rest of the immune system to deal with the invader.

This involves mounting an inflammatory response and as part of this response mast cells release high amounts of histamine, the chemical chiefly responsible for reactions such as swelling and itching.

The body normally makes antibodies to food (IgA and IgG), but these don’t provoke a major immune response. IgE antibodies are a different matter: they are designed to mount a strong immune response.

This is why an IgE mediated allergy can be so dangerous. This kind of allergy however is fairly rare.

An intolerance also usually leads to symptoms, but they can be mild and they can be delayed. Therefore, it is often hard to figure out what (and if anything) caused the symptoms. There can be several reasons for these kind of ‘allergies’ and a localized immune reactions may play a role.

For example:

  • Poor digestive chemistry (low levels of digestive juices and/or enzymes) – this could lead to proteins being not properly broken down and being detected as ‘foreign, or intolerance symptoms due to fermentation of undigested foods etc.
  • Lack of enzymes – a good example is lactose intolerance where the inability to digest lactose (due to a lack of the lactase enzyme needed to digest lactose) leads to symptoms.
  • A hyper-permeable gut: this is often referred to as ‘leaky gut’. The gut wall normally lets small molecules through into the blood but when the passages become bigger, molecules (for example food) that shouldn’t normally get through end up in the blood and could cause an immune response.

It is possible to have immune system involvement without a ‘classic’ IgE allergy.

For example there can be ‘localized’ IgE reactions only affecting one organ.

There can be reactions that don’t involve IgE antibodies but activate immune cells (such as mast cells) nonetheless.

Or there can be early stages of coeliac disease, where the immune system reacts to gluten and starts destroying the gut lining (autoimmunity).

Seasonal allergies, such as hayfever are also IgE mediated although not dangerous like classical IgE mediated food allergies.

Allergies/Intolerances and Symptoms

There is an array of non-specific symptoms that could be related to allergies and intolerances. Some of them are so seemingly unrelated that most people would never suspect or even look for an allergy or intolerance.

For example:

  • Digestive symptoms (diarrhoea, constipation, wind, bloating, nausea, vomiting etc)
  • Headaches and migraines
  • Muscle aches, aching joints, backache
  • Heart palpitations, chest pain
  • Red, watery, itchy eyes
  • Water retention
  • Flushing, sweating, chilling,
  • Fatigue
  • PMS
  • Behavioural problems (ADHD, hyperactivity etc)
  • Anxiety, depression
  • Inflammation, burning
  • Eczema, rashes

The Allergic Bladder

The prevalence of allergies in IC patients has been reported to be 40 – 80% and the condition often co-exists with autoimmune conditions (conditions in which the immune system attacks our own body tissues) [1].

The bladder is one of our eliminatory organs – its job is to eliminate waste. Therefore, inflammatory compounds may also pass through the bladder and could be highly irritating, potentially leading to pain. I’ve recently experienced a flare of bladder symptoms after food poisoning from mussels (probably due to toxins rather than bacteria). This flare lasted until the ‘poisoning’ subsided.

I’ve spoken about mast cells in the past. Mast cells are immune cells mainly found on mucosal tissues such as those lining the bladder (also the digestive tract and the airways).

Mast cells are one of the type of immune cells that react to a foreign invader. They also react allergens (or antigens) that the body perceives as foreign invaders.

Mast cells the release inflammatory compounds such as histamine, that cause swelling, burning and pain.

Some people have reported to me that their IC flares up more in allergy season. This may be because mast cells are more frequently triggered.

Therefore it would make sense that other allergies/intolerances we maybe aren’t aware of could also trigger bladder symptoms.

Eosinophils are another type of pro-inflammatory immune cell that are sometimes raised in IC [2] (that may be diagnosed as eosinophilic cystitis). Eosionophils are usually associated with parasites and other infections.

Intolerances that aren’t a severe allergy are often hard to pinpoint as reactions can be delayed and sometimes more than one frequently consumed food could be a trigger so that symptoms are always present. The effects could kick in soon or it could take a few days.

Allergic reactions could also be present in one organ (such as the gut) and still trigger changes in another organ through ’cross-talk’ [3]. This may explain one of the connections between IBS and IC.

So what if bladder irritation as part of an allergic response could be a factor in some cases diagnosed with IC?

Trigger Foods

Diet has certainly been show to play a role in IC. Several foods have been identified to be triggers in IC including acidic foods, coffee, tea and artificial sweeteners [3].

However, these foods are not common food intolerance culprits (although they may be for some people). The more logical explanation here would be that they are all acidic and therefore exacerbate an already inflamed bladder wall (try pouring lemon juice on a wound and see what happens!).

All foods containing proteins and carbohydrates have the potential to trigger intolerances. This can be very individual.

There are however some common trigger foods:

  • Gluten Grains (especially wheat)
  • Corn
  • Peanuts
  • Nuts and Seeds
  • Soya
  • Celery
  • Shellfish
  • Eggs
  • Dairy

There is also the chance of cross-reactions, where one food’s proteins look similar to another’s (for example corn and wheat).

Another problem could be poor digestive chemistry. Foods may not be broken down adequately and end up in places they do not belong.

For example, the inability to deal with oxalates (an acid found in some plant foods) may lead to oxalates forming crystals that could hurt the bladder wall.

Poor protein breakdown could also lead to more ammonia and uric acid in the urine, both being ‘toxic’ waste products of protein metabolism with a potential for causing irritation.

What to Do

My IC symptoms completely resolved on the GAPS diet, a diet that eliminates all grains, processed foods, Legumes and sugar. I’m fairly certain that the restrictive nature of the diet removed foods that played a role in my symptoms.

And I am not the only one who’s had success with this kind of approach.

One doctor achieved symptom improvement in 80% of his IC patients [4] by using an elimination diet and food diaries.

Other doctors have reported that patients with high mast cell counts in their bladders see improvements when treated for allergies [5].

The first step should be to improve digestive chemistry (if you feel it’s below par):

  • Chew thoroughly and don’t eat when stressed
  • Don’t drink a lot of fluids with meals (as they dilute stomach acid)
  • If that is not enough, digestive aid supplements may help (e.g. digestive enzymes, digestive bitters, betaine HCl)

Many sufferers may already be following a so-called ‘IC diet’ that restricts common trigger foods. But as explained above, these foods may simply cause pain because of their acidity.

This diet may not be enough. An elimination diet that removes all possible triggers of an intolerance should be considered. Although this level of restriction can be extremely daunting and disruptive (and I don’t think extreme long-term restriction is healthy either) it may be the only way to truly allow some healing to take place.

I recommend the Autoimmune paleo diet in my Interstitial cystitis diet approach. The reason for this is, that it removes all common food intolerance triggers whilst being extremely nutrient-dense and nourishing.

A few months on this diet may be all that’s needed and once trigger foods have been removed it is much easier to re-introduce them one-by-one to see which foods are actually an issue.

I strongly believe that diet is a major factor to consider when tackling bladder symptoms.

Has diet made a difference to your symptoms? Do you suffer from allergies and think they could play a role in your IC? Let me know in the comments!



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Sources

Brostoff, Jonathan and Ganlin, Linda The Complete Guide to Food Allergy and Intolerance (Bath: Quality Health Books, 2008)

Lomer, M. C. E. (2015), Review article: the aetiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther, 41: 262–275. doi:10.1111/apt.13041 http://onlinelibrary.wiley.com/doi/10.1111/apt.13041/full

  1. VAN DE MERWE, J. P., YAMADA, T. and SAKAMOTO, Y. (2003), Systemic aspects of interstitial cystitis, immunology and linkage with autoimmune disorders. International Journal of Urology, 10: S35–S38. http://onlinelibrary.wiley.com/doi/10.1046/j.1442-2042.10.s1.10.x/abstract
  2. YAMADA, T. (2003), Significance of complications of allergic diseases in young patients with interstitial cystitis. International Journal of Urology, 10: S56–S58. doi:10.1046/j.1442-2042.10.s1.12.x http://onlinelibrary.wiley.com/doi/10.1046/j.1442-2042.10.s1.12.x/abstract
  3. Friedlander, J. I., Shorter, B. and Moldwin, R. M. (2012), Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions. BJU International, 109: 1584–1591. doi:10.1111/j.1464-410X.2011.10860.x
  4. Steven Smith C, Reed HH (2013) A Relationship of Interstitial Cystitis and Atopy. J Aller Ther 4:131. doi: 10.4172/2155-6121.1000131 https://www.omicsonline.org/a-relationship-of-interstitial-cystitis-and-atopy-2155-6121.1000131.php?aid=11889
  5. News Medical Experts explore link between allergies and interstitial cystitis June 22, 2009 https://www.news-medical.net/news/20090622/Experts-explore-link-between-allergies-and-interstitial-cystitis.aspx

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