How To Conduct an Elimination Diet for Interstitial Cystitis
Updated: Aug 11, 2022
Are you someone who has constant bladder symptoms? Not sure if diet plays a role in your symptoms? Were you handed the IC diet handout upon being diagnosed with interstitial cystitis only to be sent home to figure it out by yourself?
The IC diet was created to help guide an elimination diet - see this blog post I wrote about why the IC diet was not meant to be followed long term. The thing is, we don’t have very much scientific data to go off of. What is discussed in this post is a collection of things I’ve learned through the few research articles in existence as well as my clinical experience.
What is an elimination diet?
An elimination diet is an eating pattern where you eliminate a certain group of foods and/or beverages for a certain period of time and then add them back into your diet to see if your body has a reaction.
Something to keep in mind is that every person with IC is different, and we all have unique dietary triggers, if any. This is exactly why each person needs to conduct their own elimination diet that is unique to them.
I am going to explain how to conduct an elimination diet, but first, I want to encourage anyone who has access to a dietitian or other medical professional to seek their guidance in doing an elimination diet. If you aren’t careful, you can risk developing nutrient deficiencies, and possibly even malnutrition. Having the guidance of a Registered Dietitian can ensure you are doing the diet in a safe manner.
Who should conduct an elimination diet?
There are various reasons people may conduct an elimination diet, such as GI symptoms like bloating, constipation or diarrhea, as well as other symptoms such as migraines or skin conditions. An elimination is the gold standard for identifying any food sensitivities.
*Notice I said food sensitivities and not food allergies. If you think you may have a food allergy, seek out the help of an allergist who can run a skin prick or blood test to determine if you are allergic to any foods or beverages.*
There are multiple ways that you can conduct an elmination diet. Most include an elimination (avoidance) phase and a testing (challenge) phase. There is a type that avoids just one food or beverage at a time, one that avoids several groups of foods at a time, and a more strict type where you only consume a select group of foods/beverages for a period of time.
My method falls into the strict type of elimination diet. I believe that putting as much time and energy into the elimination diet for about 3 months is the most efficient way. However, I do know that some people are unable to do this, and in that case a more simplified version can be completed over a longer period of time.
How to conduct the elimination diet
I break the elimination diet down into 3 phases: baseline, elimination, and testing. Let’s look at each phase more in depth.
1. Baseline - No changes are made to the diet in this phase. We are simply obtaining baseline data, such as dietary intake, pain levels, frequency of urination, urgency levels, menstrual cycle, stress, etc. This data can help measure progress over the 3 month elimination diet.
2. Elimination - This phase lasts anywhere from 2-4 weeks. A lot of people in the IC community get stuck in this phase for months or even years out of fear or the misconception that they are never supposed to eat the common IC triggers ever again. In this phase, I have my clients elimination the most common triggers and eat off the "bladder friendly" list of the IC diet.
Avoiding triggers for 2-4 weeks helps flush out any dietary triggers in the body and give the bladder a little R&R. Most people experience some level of relief during this phase. If you do not, evaluate if you are truly avoiding all potential triggers and didn’t “cheat” here and there. There is always a possibility that you are in the small group of people who do not have dietary triggers.
3. Testing - The final phase of the elimination diet is the testing, or challenge phase. I have my clients create a list of foods or beverages they want to test. The safe way to approach this is to try items on the “try it” list before the “caution” list, but I do have the occasional client who likes to jump right to “caution” items like wine, coffee, and chocolate. I let this decision up to them.
Each item will be tested for a total of 3 days (can extend to 4 if needed). Start with a small amount on Day 1, and make your way up to whatever a regular sized portion looks like for you.
For example, if you wanted to test coffee, you could follow this testing pattern:
Day 1: 2 oz
Day 2: 4 oz
Day 3: 8 oz
If you have no symptoms each day, continue to a larger amount the next day. If you have a minor flare that you aren’t sure is caused by the item, try the same amount the next day. If you have a moderate-severe flare, track the reaction, remove the item from your diet and return to a bladder friendly diet. Take 3-4 days off (or however long it takes to recover) and move on to the next item on your list. Tracking is essential to this phase; you will not be able to identify what caused a flare if you are not tracking everything.
Other things you need to know about the elimination diet
Data can be tracked in a physical journal, in the Notes app on your phone, an Excel file, or a different tracking app - whatever works best for you. But, notice how much tracking is required. You need to track as much as possible in order to identify patterns in your symptoms.
The goal of the elimination diet is to identify your unique dietary triggers. We want to learn what you can’t, but more importantly, what you CAN eat. The goal is to gain confidence back with eating and break out of the “food fear” mentality that so many people have.
It is important that we touch on mental health/mindset during an elimination diet. If you are not in a good headspace, this is not the time to conduct an elimination diet. You want to have minimal stress as you test items, in order to isolate the reaction of the item. If you are stressed, this can cause a reaction that may be misinterpreted as being related to the food.
Now let’s talk about reaction times. It can take anywhere from 30 minutes to 3 days for a food reaction to present. Again, every single person with IC is different. For example, if I react to a dietary trigger, it typically presents the next morning. But for a lot of people, the reaction can be more immediate (1-2 hours after ingesting). Your reaction could be different for various items (confusing, I know). Since we don’t have much research to go off of, the elimination diet will be the best tool to help you determine your reaction time to each dietary item.
Each dietary item that is tested will be removed after the testing period is completed until the entire elimination diet is complete. This will help isolate each food item as best as possible - think of it as a science experiment - we don’t want too many variables in the equation. So for example, dark chocolate was successful in your testing period, you will remove it until you are done testing all items.
Essentially, you will be creating your own unique “bladder friendly” list. Triggers can change over time, but this is usually gradual. Some people are able to tolerate things years down the road that they couldn’t before.
If you are unable to tolerate a food or beverage that you test, you can always circle back to it later and try it again with Prelief to see if you can tolerate it in a small amount. This will help you learn which items you cannot tolerate at all versus once in a while with the assistance of Prelief. If this helps you go for a drink with friends once in a while, that’s worth it for most people.
Review & Final Takeaways
To review, the IC diet was created to help guide you through an elimination diet to determine your unique diet sensitivities. I recommend breaking the diet into 3 phases: baseline, elimination, and testing. The diet can last anywhere from 3-6 months, depending on how many items you want to test and how your body reacts to each item.
The elimination diet can become tedious and sometimes frustrating, but remember the end goal. With an elimination diet, you can identify your unique triggers and learn what amount of certain items you can consume without a reaction. You will truly learn so much about your body during this period.
If you want more individualized recommendations or are worried about becoming deficient in nutrients, I offer a program called Road To Remission that combines an elimination diet with education and support.