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Interstitial Cystitis - The Aviva IC Treatment Program

Nathan Zassman

Interstitial cystitis (IC) is a health condition that involves a variety of factors (multifactorial). The cause may result from multiple genetic or environmental factors, or from a combination of these factors.

Symptoms of IC are pelvic and/or perineal pain, urinary urgency, an increase in pain caused by holding urine, nocturia (excessive urination at night), and a continual urge to urinate. Pain can range from a mild discomfort or burning, to severe pain in the bladder, lower abdomen, perineum, pelvis, vagina, low back and thighs. Sexual intercourse and menstruation may contribute to these symptoms in up to 75% of women. There can be spontaneous remission, followed by flare-ups. IC is a significant problem for women, as about 90% of IC patients are female. (1). The onset of IC normally occurs in middle age.

IC is common in patients with irritable bowel syndrome, spastic colon, abdominal cramping, hysterectomy, rheumatoid arthritis, fibromyalgia, hay fever, asthma, and allergies to foods and medications. Because IC is a multifactorial syndrome, a broad approach that addresses the many suspected causes brings the greatest chance for success.

IC may be considered an autoimmune disease, and is usually accompanied by inflammation and infection. As one of the theories for IC is that the bladder epithelium is abnormally permeable, and that IC patients have low levels of glycosaminoglycans (GAG) in the bladder and urine, supplements that increase the levels of glycoproteins in the bladder may be helpful. N-Acetyl Glusocamine (NAG) has been found to be an important supplement in the successful treatment of IC, however the addition of MSM or SAM-e may also be helpful, as the methyl donation of sulfur has an anti inflammatory and pain relieving effect on the bladder mucosa. Botanical methyl donors include onion and garlic, however as onion has been found to be implicated as a causative agent, I recommend using fresh garlic liberally in the diet. As it has been noted that IC patients have low nitric oxide levels, L-arginine is recommended to increase NO synthesis. In one study, supplemental L-arginine improved symptoms in 10 of 10 patients. (3) Other studies have found equally impressive results from L-arginine supplementation (4)

Increasing the alkalinity of the body by increasing the intake of alkaline foods (i.e. vegetables), drinking alkaline water (see Alkapure and Alkaplus water filtration systems, Alkalark, and Balance Water Sticks) and decreasing the consumption of sugars, starches and yeast containing foods is also highly recommended, as high levels of acids seem to aggravate IC. As many with IC have been prescribed antibiotics, the use of a broad spectrum probiotic is essential to repopulate the intestinal tract with beneficial bacteria. These beneficial bacteria can also provide benefits to the bladder. Recommended probiotic supplements are listed below.

To combat inflammation, higher levels of marine sourced essential fatty acids (from fish) are recommended, along with anti inflammatory herbs that include curcumin and boswellia. Other botanicals that may be helpful due to their anti-inflammatory effects include licorice, feverfew and ginger. Botanicals with demulcent (soothing to the mucosa) properties include PanaChia, licorice, slippery elm, marshmallow, oat seed, comfrey and corn silk. Choose a licorice that is low in glycyrrhizin, including products by Zagarese.

Dietary changes and striving to identify foods that aggravate IC symptoms is an important part of a successful long term treatment plan. Foods that are often implicated include coffee, chocolate, carbonated soft drinks, citrus fruits, tomatoes, and alcoholic beverages. Acid or potassium levels in foods have been implicated in the mechanism of IC, so monitor if foods high in acids or potassium aggravate symptoms.

To strengthen the immune system, I recommend buffered vitamin C, vitamin E as mixed tocopherals and tocotrienols, Astaxanthin, N-Acetyl Cysteine (precursor to the master antioxidant Glutathione, one of the most powerful antioxidants), and Quercetin, which has anti-inflammatory benefits that are synergistic with marine based essential fatty acids from fish.

Dietary Changes

Foods to Avoid: Alcohol, Apples, Aspartame, Avocados, Bananas, Cantaloupes, Carbonated drinks, Cheese, Chicken livers, Chilies/spicy foods, Chocolate, Citrus fruits, Coffee, Corned beef, Cranberries, Grapefruit, Grapes. Guava, Lemons, Lentils, Lima beans, Limes, Mayonnaise, Nuts [*], Onions, Oranges, Peaches, Pickled herring, Pineapple, Plums, Prunes, Raisins, Rye bread, Saccharine, Sour cream, Soy sauce, Strawberries, Tea, Tomatoes, Vinegar, and Yogurt.

(*) (PanaChia seeds, almonds, peanuts, sesame seeds, sunflower seeds, pumpkin seeds, flax seeds, hemp seeds, pistachio nuts, pine nuts are recommended)

Recommended Supplements: (bid=twice each day, tid=three times a day)

* N-acetyl glucosamine (NAG) 500 mg, tid
* L-arginine 500 mg, tid
* Bioflavonoids 1,000 mg, bid
* Vitamin C (buffered, non-citrus source) 1,000 mg - 2,000 mg, bid - Vitamin C8 by New Roots is exceptional.
* Corn silk 2 capsules, tid
* Kava extract 1 capsule, tid (not available in Canada)
* Astaxanthin 4 mg, bid
* Quercetin (w/bromelain) 800 mg, bid
* NAC - N-Acetyl Cysteine 600 mg, tid (Timed Release is best)
* Super Green Food Powdered Drink, As directed, tid
* Probiotic Supplement, See below for recommendations, tid
* Multi-Vitamin/Mineral Supplement, Taken with each meal, (tid), see recommendations below 
* Omega 3 Essential Fatty Acids, 3-5 grams per day EPA/DHA, see below
* Curcumin, 95% Curcuminoids 1 665 mg capsule, tid
* Boswellin 1 250 mg capsule, tid

The above recommendations may seem complex, however many of the recommendations above are successful in improving general overall health and immunity, and should be part of a healthy nutritional program. As IC may be only one of many health concerns, the program above should result in a significant overall health improvement.

The natural healing process can take time, but the long term benefits are usually long lasting, as once the body has healed, there should no longer be a reappearance of IC symptoms. The alkalizing super green food drink, probiotic, multi vitamin, essential fatty acids, curcumin, and vitamin C are foundational nutrients for improved health, and are recommended even for those who are not experiencing health concerns, but who would simply like to improve their health and wellness, increase energy levels, and strengthen their immune system.

Along with dietary changes, the addition of NAG, L-Arginine, Bioflavonoids, Corns Silk, Quercetin and NAC are targeted at helping the body heal. Improvements are normally seen with three months, and some have seen a 75% improvement within six months. After six months, a reduction in the levels of the specific nutrients can be made, but many are so pleased with the results, they are hesitant to change the treatment protocol.

If a bladder infection accompanies IC, I recommend the addition of D-Mannose. One teaspoon, every four hours is recommended, for a three day period.

If a yeast infection accompanies IC, I recommend Femina Flora, by New Roots Herbals, or the implantation of the Aviva Candida Control Program. Femina Flora includes an applicator and 10 capsules with a variety of bacteria strains that are effective in helping to eliminate yeast infections. One capsule is inserted deep in the vagina each night at bedtime. An applicator is included.

Below is supporting information on the foundational components of the Aviva IC Program.

1. An alkalizing super green food drink made from vegetables or grasses, to be consumed a minimum of twice each day, to a maximum of four times a day. As it is difficult to eat normal salads (as vinegar dressings will often exacerbate IC), drinking a super green food drink will provide the body with the antioxidants, vitamins and minerals that would require many salads to achieve. The alkalizing effect of the super green food powder (and the elimination of acid forming food and drink) is vital to the healing and successful treatment of IC. Super Green Food products recommended include: Pure Synergy, Barleans Greens, Enerex Greens RxEnerex Just Barley, Green Kamut Powder, Earth’s Promise, and Garden of Life Perfect Food.

2. A quality multi vitamin/mineral supplement that is high in calcium and magnesium, to be taken with each meal. Do not choose a "one a day" vitamin, as water soluble nutrients (B vitamins, C, many antioxidants) are excreted within three to four hours of consumption. Recommended supplements in order of preference include AOR Ortho Core (the finest women’s supplement), Vita Synergy for Women (The Synergy Company), New Chapter Every Woman and Every Woman II, , Garden of Life Living Multi for Women, Ultra Preventive X by Douglas Laboratories, and Trace Mineral Research Transcend for Women.

3. A quality Omega 3 Essential Fatty Acid product, to be taken with each meal. The total Omega 3 levels should be 3 Grams or more per day. Take a minimum of 700 milligrams of a combination of EPA/DHA with each meal, and before bedtime. Recommended brands include Nordic Naturals and Carlson Laboratories. Liquids are the best choice, and the new fish oils no longer have an objectionable fishy taste or after taste. Carlson's Finest Fish Oil has a delicious lemon flavour, and can be added to salads.

4. A quality probiotic supplement, taken either before, or with each meal, depending on the supplement chosen. Quality strains of probiotics, also considered “beneficial, or lactic bacteria,” include Lactobacillus Reuteri (Nature’s Way), Lactobacillus rhamnosus, Lactobacillus Acidophilus, Bifidobacterius Bifidum, Lactobacillus Sporogenes, Lactobacillus BOD Strain, bifidobacterium longum, and DDS-1. Fiberrific with Probiotic, which combines a prebiotic (inulin) with probiotic is a new product that is very effective. Finally, Vita Biosa, a liquid probiotic supplement from Germany is exceptional.

Probiotics naturally inhabit the colon and vagina. Research has shown that the presence of beneficial bacteria is associated with a reduced risk of UTI’s (including IC) and bacterial vaginosis. Higher levels of beneficial bacteria in the vagina may inhibit the colonization of unwanted pathogenic bacteria. Beneficial, lactic bacteria also strengthen the immune system, aids digestion, and produce a wide variety of vitamins in the intestine.

Several studies have reported on the significance of friendly bacteria in UTI’s (Asahara et al. 2001; Reid 2001, 2002; Reid et al. 2001, 2002; Strus et al. 2002). Different strains of Lactobacillus introduced orally and vaginally resulted in a a reduced risk of UTIs and improvement of normal vaginal bacteria. Lactobacillus strains taken from healthy vaginal flora were antagonistic against bacteria known to cause urinary tract and vaginal infections.

5. Curcumin may be the most powerful of all herbs, with benefits for a wide variety of health conditions. Recent research has focused on the use of curcumin for both treatment, and prevention of various cancers, and for cognitive and anti-inflammatory (Cox-2 inhibiting) benefits.

Health Disclaimer. ©2004-2012 Aviva Natural Health. References (1.) Hanno P, Levin R, Monson F, et al. Diagnosis of interstitial cystitis. J Urol 1990;143:275-281. (2.) Gillespie L. You don't hove to live with cystitis, New York: Avon Books, 1986:244 (3.) Smith S, Wheeler M, Foster H, Weiss H. Improvement in interstitial cystitis symptom scores during treatment with oral L-arginine. J Urol 1997;158:703. (4.) Korting G, Smith S, Wheeler M, et al. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. J Urology 1999;161:558-565. Additional material references:  Interstitial Cystitis: A New Approach -- Townsend Letter for Doctors and Patients (Hudson, Tori).

Interstitial Cystitis -  Health Disclaimer
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