Is Gluten Sensitivity Part of Your Bladder Symptom Picture?

It’s a problem no one feels comfortable talking about—always running to the bathroom! Are you one of those people who know the location of every available loo on your daily commute? Are long staff meetings a nightmare? There may be good news in your future, as two recent studies and numerous anecdotal reports point to a frequent and overlooked cause of urinary symptoms such as frequency, urgency, and discomfort—untreated food sensitivities!

We’ve heard quite a bit about growing incidence of food sensitivities in the news lately, especially in children. But adults have food sensitivities, too, and they’re more often likely to be undiagnosed. According to the US Dept. of Agriculture, there are eight top food allergens, which include dairy products, eggs, fish and shellfish, soy, peanuts, tree nuts (like pecans and walnuts), and wheat. Consuming any of these foods, or food ingredients, can trigger an allergic reaction which induces the body to release inflammatory chemicals like histamine from mast cells. And, guess what? The bladder lining contains mast cells, too, and they are capable of releasing large amounts of histamine and other inflammatory substances, which can irritate the bladder and trigger uncomfortable symptoms.

Food allergies are not the only form of food sensitivities. Food allergies involve an immune-mediated response—your body produces antibodies to certain foods, and these antibodies help your body recognize and react to specific foods each and every time you ingest them. Other foods may simply be difficult to digest, or they tend to create inflammation in the body, which can worsen or trigger conditions like chronic pelvic pain and contribute to bladder symptoms.

Some of these inflammatory foods can include members of the nightshade family, such as tomatoes, eggplant, or red peppers. Sugar, whether from cane or sugar beets, is a common trigger of bladder spasms and urinary frequency. Sugar in these forms can also alter conditions of the bladder lining, making it more vulnerable to the microorganisms that cause urinary tract infections.

Let’s go back to wheat, one of the top eight allergens. It’s true that anyone can develop an allergy to wheat, but wheat is also the most plentiful source of a substance known as “gluten”. Gluten is a common name for a group of proteins found in wheat, barley, rye, and related grains, including spelt, triticale, and faro. Gluten is the substance that makes pizza dough stretchy and gives artisan breads their great texture. But in some people, gluten can cause toxicity and inflammation, and our body’s response to gluten can wreak havoc, causing neurological, gastrointestinal, and dermatological symptoms. Recently it has been shown that gluten sensitivity can and does cause symptoms in the urinary tract, including a syndrome, or group of associated symptoms, known as interstitial cystitis, or IC.

In IC, the feeling of nervous tension in the bladder, similar to the feeling you might have when trapped in a rush-hour commute after a sixteen-ounce espresso, is constant. You want to go, and you need to go NOW! Holding your urine in causes extreme tension, anxiety, and pain. For many people, having IC feels like having a bladder infection, one that never goes away. Over time, these sensations escalate and patients often develop pelvic floor tension, which further worsens their condition. Sleep becomes difficult. Bladder capacity can decrease due to the formation of scar tissue, and pain can become unbearable. In fact, those with IC can void extremely frequently—25 times per day or more!

Physicians often find IC difficult to diagnose and treat, but for patients, IC is a very difficult condition to bear. One of the difficult challenges for patients is the “hidden” nature of their condition. There are no outward physical clues to the turmoil taking place inside. Often, even close family members have a difficult time understanding how severe, constant, and overwhelming moderate-to-advanced IC symptoms can be. Until recently, it wasn’t known what “triggers” or provokes periods of worsening symptoms in some people. Experienced IC patients are usually careful to eliminate “extreme” foods like coffee, vinegar, soy sauce, and alcohol, in favor of bland, neutral, and non-acidic foods. Still, they often continue to suffer painful “flares”.

But there was a glimmer of hope from the small percentage of people who seemed to heal spontaneously through a holistic approach involving self-treatment, relaxation, stress reduction, and purposeful attention to diet. One of the food sensitivities mentioned frequently was gluten. Patients in support groups for disorders like IC and celiac disease, a hereditary, autoimmune form of gluten intolerance, self-reported that eliminating gluten helped resolve their bladder symptoms, and in many cases, it was the only “treatment” that made a significant difference.

Wendy Cohan, a registered nurse and IC patient from the Pacific Northwest, was one of the first health professionals to notice and suggest dietary exclusion of gluten in the treatment of IC. After writing several articles for IC and celiac websites, and trying unsuccessfully to interest the scientific community in developing a clinical study, she began writing a book about her experiences in 2008. Her book, The Better Bladder Book – A Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain, was released in November, 2010. Coincidentally, since beginning her book, two small research studies have found a significant correlation between gluten sensitivity and bladder symptoms, especially in IC.

Below is an excerpt from The Better Bladder Book:

“In some people, chronic inflammation and accompanying irritation may indicate the existence of an autoimmune condition like celiac disease. CD and IC often occur together, as reported by participants in support groups for both diseases. These anecdotal stories may have inspired researchers to take a closer look at a possible association between these two disorders. I was extremely pleased to learn that one of the first clinical studies was recently conducted by Chris Smith, MD; Peter Lotze, MD; Chris Jayne, MD; David Goldfarb, MD; and Fred Emmite, RPh, through Texas Medical Center, Baylor College of Medicine, in Houston, Texas. Preliminary results indicate a strong association between celiac disease/gluten sensitivity and IC in all 39 subjects studied, and promising results in the subset of patients placed on a strict gluten-free diet.”

In a separate study based on a self-reported patient survey, the ICA found that 12% of IC patients reported being diagnosed with celiac disease in an online survey of 1,000 participants, supported by the ICA (Interstitial Cystitis Association) http://www.ichelp.org/Page.aspx?pid=450. But even if you don’t test positive for celiac disease, your bladder may still be sensitive when you consume gluten. Non-celiac gluten intolerance affects many more people with a variety of symptoms, but the bladder and or prostate seem particularly sensitive to gluten.  

If your IC isn’t getting any better on standard treatments, testing for food sensitivities should be a priority. Eliminating gluten from your diet isn’t difficult. In fact, following a gluten-free diet is less restrictive and easier to follow than the recommended “IC diet”.

Help is widely available through online sources, including www.glutenfreechoice.com, www.WellBladder.com, dozens of gluten-free cookbooks, and through support organizations like the NFCA (National Foundation for Celiac Awareness).

Copyright Dec. 29, 2010, Wendy L. Cohan, RN

THE SOLUTION MAY BE DIETARY CHANGES THAT ELIMINATE FOOD SENSITIVITIES. 

Now, buy the book that shares this important information. Gluten sensitivity is linked to bladder problems, and all over the world, many of those who have suffered chronic bladder discomfort are beginning to get better - by giving up gluten! This is the only book that tells you why!

For details, see the book website:

www.thebetterbladderbookinfo.com

http://www.amazon.com/Better-Bladder-Book-Holistic-Interstitial/dp/0897935551/ref=sr_1_fkmr1_1?ie=UTF8&qid=1281153182&sr=8-1-fkmr1

By Wendy L. Cohan, R.N.

Celiac Disease & Gluten Intolerance Educator/Urological Wellness Consultant

It’s the problem no one wants to talk about, but we all know exists: that all-too-familiar feeling of urgency and pressure that means you had better get to a bathroom fast. It’s a BLADDER PROBLEM.  The sales of big kid underwear, stress-incontinence pads, adult disposable briefs, and over-the-counter medications like Detro and Uristat make it apparent that bladder problems are unfortunately a common occurrence in many women and men throughout every stage of life.

Bladder issues run the gamut – extended bedwetting in children, frequency and urgency in young adulthood, stress incontinence after childbirth and continuing into the senior years, frequency/urgency syndromes in all ages, and bladder spasms or problems “going” in older men.  Although these are fairly routine bladder issues, a surprisingly large number of people have more serious problems, including recurrent bladder infections, prostatitis (an inflammation of the prostate), or interstitial cystitis (IC - a chronic pain and urgency syndrome also known as painful bladder syndrome - PBS).   

In many patients, urologists and primary care doctors may run tests without finding a discernable cause.  Patients with continued symptoms are usually left with the option of taking medications such as Detrol, Ditropan, or Flomax, which sometimes create problems of their own, including side-effects such as urinary hesitancy.  These medications also do nothing for the accompanying pain and burning that occur in diseases like IC, so patients with more severe symptoms often need to take narcotics and anti-anxiety medications. Medications like Pyridium (the active ingredient in Azo and Uristat) can help with discomfort temporarily, but are not meant to be taken long-term. 

Could there be a common cause underlying many of these bladder problems?  One strong possibility is unknown food sensitivities that trigger either an allergic response, an autoimmune response, or both. Clinical studies have shown that patients with chronic bladder discomfort often have elevated levels of histamine in their urine, as compared to those in control groups.  Patients with chronic bladder discomfort also often show elevated SED rates, a measure of inflammation.  Both of these findings indicate that environmental or food sensitivity, allergy, or other heightened immune response may be responsible for the symptoms they are experiencing.  Another clue is that some patients experience total relief of symptoms when on I.V. fluids in the hospital, when too ill to eat solid food, or when following an allergen-elimination diet.  Food sensitivities have also been implicated in bed-wetting in children, due to irritation of the urinary tract.  Studies have shown that once food allergens are eliminated, the bed-wetting problem often ceases to be an issue.

In some people chronic inflammation and accompanying irritation may also indicate the existence of an autoimmune condition like Celiac Disease (CD), (also called Gluten Sensitive Enteropathy (GSE) or Celiac Sprue).  People with CD experience toxicity when they ingest the proteins in wheat, barley, and rye, commonly known as gluten.  CD and the chronic bladder disease IC often occur together, as reported by participants in support groups for both diseases.  Among IC patients, many suffer gastrointestinal symptoms such as gas, bloating, discomfort, and diarrhea.  Although such symptoms are often diagnosed as Irritable Bowel Syndrome (IBS), it is possible that at least some portion of people with a diagnosis of IBS are actually experiencing a reaction to eating wheat and other gluten-containing grains.  According to published studies, IC is present in 40-60% of patients diagnosed with IBS (irritable bowel syndrome), and 38% of patients with IC have also been diagnosed with IBS.   It seems reasonable that patients with IBS symptoms should be screened for celiac disease and non-celiac gluten sensitivity.  One reason that this may not have been the case is that in the past celiac disease was considered to be rare, mostly affecting young children, and was thought to have a narrow range of symptoms and diagnostic criteria.  This is simply no longer the case.  The incidence of gluten-intolerance is growing, and symptoms in both celiac disease and non-celiac gluten-sensitivity vary widely and are known to affect all age groups.

The gluten sensitivity/bladder sensitivity connection is not well known.  Until I discovered it mysel by years of trial and error, I would not have beliveved it to be possible.  Since my diagnosis with gluten intolerance, and my subsequent recovery from interstitial cystitis on a glutenfree diet, I have learned that I am far from alone in making this connectin  Recently I wrote about my experiences in healing from interstitial cystitis and other health problems on a gluten-free diet, and published the article on a popular celiac suppor website.  The response I recevied was overwhelming.  People wrote to me from all over the U.S., Canada, and the United Kingdom.  Moms wrote about their children, young women wrote about recovering from bladder discomfort, and many older women wrote to say that they no longer suffer from stress incontinence.  All of the people responding to my article discovered the same phenomenon that I had:  excluding wheat and other gluten-containing grains reduced or eliminated their bladder symptoms, which ranged form childhood beswetting to incontinence in seniors  Could avoiding gluten really be the answer for thousands of peope who suffer daily from bladder pain, urgency, frequency and incontinence?

These are some of the many comments I received:

 "I did not have bladder irritation or infection, but I did have stress incontnence.  I was told that was "normal" for a 60 year old woman.  When I went gluten-free 5 years ago, my incontinence disappeared."

"I can actually plan to leave the house now, where I couldn't before without a serious map to all the bathrooms in all the stores on the route".

 "I suspected a connection.  Celiac is in my family - I asked for testing - they said I wasn't thin enough.  FInally I went gluten-free on my own.  This clearead up my constant UTI's, hives on my legs and lower abdomen, bleeding gums, and all the intestinal distress!  It's been 15 months now and I'm feeling better each day.  Many of us with bladder and gastro-intestinal problems can relate to these experiences.

A significant number of people who suffered from IC, a very painful, progressive bladder disease for which there is no cure nor a highly effective treatment, have experienced healing on a gluten-free diet.  Because this disease has impacted me personally, I have been collecting such stories for several years, and included them in the article I wrote.  These are a few of many anecdotes I have collected over the past few years:

     “I have had IC for over a decade.  I have been on a gluten free diet for over six years and that has been the only thing that has given me any relief from IC.  I no longer take any meds at all – I haven’t even been to a doctor for IC in several years.  I would definitely suggest anyone with IC give it a try.  It definitely gave me my life back.” 

    “My IC came first in 1995 and the long road to being diagnosed with Celiac lasted 9 more years.  Finally, I'm beginning to heal.”

      “I have both IC and a wheat allergy, which I ignored and was paying the price with the severe pain with IC. Absolutely nothing was working and no doctor would hear of it being related. Several have told me that diet would not solve anything...That was until my experience with dermatitis (Dermatitis Herpetiformis, a variant of Celiac Disease) forced me to be gluten-free and it has completely stopped the IC pain. It's nothing short of a miracle to have my life back.”  

My own research has shown that the body's response to gluten can cause mouth, lip, and tongue ulcers, esophagitis, deterioration of teh intestinal villi (which leads to malabsorption of nutrients), and pain and inflammation in the illio-cecal junction (the area where the small and large intestine join and in the pelvic and abdominal regions of the body.  Is it any wonder that this destructive process also affects the mucosa lining the bladder?  Doesn't it make sense that pelvic and lower abdominal inflammation surrounding the bladder can produce both urgency and frequency?  A physician wrote to me recently, stating,

"My wife suffered for years with severe, incapacitating interstitial cystitis.  In 2003 she was diagnosed with celiac disease.  Since beginning a gluten-free diet, her interstitial cystitis has pretty much disappeared.  I looked through the literature and found little over the years, but as a clinician, the anecdotal evidance has been impressive.  Why not the bladder mucosa?  Celiac disease seems to stimulate autoimmune reactions just about everywhere else!"

Is there a downside to excluding gluten from our diets?  Following a gluten-free diet can be more expensive, especially if relying on ready-made gluten-free products.  However, eating gluten-containing grains is not necessary from a nutritional perspective – cultures around the world have thrived for thousands of years without them, and alternative grains contain many of the same nutrients, including protein, fiber, B-vitamins, and minerals iron, magnesium, and zinc.  A gluten-free diet is based on the same principles as any healthy diet:  a variety of fresh vegetables, fruits, alternative whole grains, protein sources, and healthy fats.  Brown rice, wild rice, corn, buckwheat and quinoa are easy substitutes for wheat, barley, and rye.  Less-familiar non-gluten grains include sorghum, teff, and amaranth, which are staples in Africa and Latin America.  Your local natural foods grocery store is a great source of these items, sold as whole grains or flours.  Many of Bob’s Red Mill grains and flours are tested for gluten content and labeled gluten-free.

My own health has improved so much on a gluten-free diet that I was inspired to make a career change from hospital nurse to celiac disease and gluten intolerance educator.  I write and publish a resource guide, offer individual counseling to clients new to a gluten-free diet, teach cooking classes, and write numerous articles for websites and local health magazines (see www.glutenfreechoice.com).  One of the questions I see often is, “How long does it take for bladder symptoms that are related to gluten sensitivity to resolve on a gluten-free diet?”  This depends on how severe the problem is, and how long it has persisted.  Some people actually begin to feel better in a matter of a few days, others take a month or more.  Complete healing may even take several years in adults, less time in children.  The good news is that trying out a gluten-free diet is relatively easy, and there is a wealth of resources available to the consumer on this topic.  If you feel better on a three-week trial of a gluten-free diet, then maybe it’s the answer you’ve been looking for.  Be sure to let your doctor know if you are sensitive to gluten.  Gluten-sensitivity has implications for autoimmune diseases, intestinal health, and even neurological and mental-health issues.  Celiac disease increases the risk of developing diabetes and colo-rectal cancer.  Men with urological issues or chronic pelvic pain should always be screened by their doctor for enlargement of the prostate and for prostate cancer.  For more information, check out the following websites:

www.celiac.com, www.glutenfreechoice, www.gluten.net,.

and for interstitial cystitis, www.ica.org (check websites) 

Listen to Celiac Maniac Online Radio, Thursday, Dec. 23rd, from 2-3 PST. I'll be the guest, discussing celiac disease, the connection with IC and my new book. Here's the link: http://www.glutenfreeonlineradio.com/ 

Gluten - What's it all about?

FACT:

Gluten is a protein found in wheat and it's relatives, including spelt, faro, kamut, triticale, barley, and rye.  Oats contain a similar protein, and most gluten-sensitive people cannot tolerate them.

"It seems too good to be true - removing gluten from my diet has been for the most part "THE ANSWER".  Thank you very much.

H.A.

Genito-Urinary Problems in Children and Food Allergy

For an informative look at the link between children's genito-urinary issues (such as bedwetting, recurrent cystitis, vaginitis), go to this article on Alpha Online:

www.nutramed.com/children/children_bladder_kidneys.htm

Bladder Problems and Gluten Sensitivity:  My Story and more...

This article can be accessed clicking on the title above.  This is a very popular article, and the feedback has been over-whelming.  If you know anyone with chronic bladder issues, please encourage them to read this article.  Published September, 2008.                                              ****************

"Thank you so much for this informative article.  I've spent the last month with a urologist testing me to figure our what was wrong.  The first thing I asked him was if there is any relation to my Celiac Disease, "of course not!"  I have piece of mind again!  Thank you!"

Melissa T.