You can read a modified version of this post in the summer edition of The IC Optimist.
Introduction
Vitamins and minerals can usually be found in a variety of food sources as well as in supplement form. Some can even be made by your body. Vitamins and minerals perform specific functions for the body and are a vital part of a balanced diet.
It is important to try to get the majority of your vitamins and minerals from food sources. There are, however, a few vitamins that based on anecdotal evidence, seem to cause an increase in Interstitial Cystitis (IC) symptoms. The most popular offenders include vitamin B6 and vitamin C.
When something causes us pain, we tend to avoid it. What this means is a lot of people suffering from IC may be suffering from nutrient deficiencies and not know it.
This post will provide a review of vitamins B6, B12, C, D, iron and calcium. It will discuss what the function of each vitamin and mineral is, as well as provide signs of deficiency and best dietary sources.
Vitamin C
Vitamin C, also referred to as ascorbic acid, is a water-soluble vitamin that is naturally found in foods and available as a dietary supplement. It is an essential vitamin, meaning, the body is unable to produce it and needs to get it from dietary sources.
Vitamin C has various functions in the body. First, it is required for the creation of collagen, amino acids, and certain neurotransmitters. It is also involved in the breakdown of protein. Collagen is an important part of connective tissue, making it essential for wound healing.
Vitamin C is considered an antioxidant. This means it can fight potentially harmful substances in the body - picture vitamin C as a soldier who’s job is to defend the body from potential threats. These threats can cause the development of cancer, cardiovascular disease, and other diseases caused by oxidative stress.
Vitamin C helps the body absorb non-heme iron (the form found in plant foods). For example, if you eat nuts at a meal, the body needs a certain amount of vitamin C present in order to absorb the iron in the nuts.
A deficiency of vitamin C is called scurvy. Back in the 18th century, sailors who ventured on long ocean voyages with no sources of vitamin C would contract or die of scurvy. Once it was discovered that the sailors were dying due to a lack of vitamin C, they began to stock the boats with limes and other citrus fruits.
While we no longer live in the 18th century or traveling via boat for 3+ months, scurvy is still a concern for groups at higher risk. This would include people suffering from IC, as people report citrus fruits and supplementing with vitamin C causes an increase in symptoms.
Early warning signs of scurvy include: weakness, unexplained exhaustion, decrease in appetite, irritability, muscle pain, inflammation/bleeding of the gums, spontaneous bleeding and bruising easily. It takes about 3 months for the body to develop a deficiency.
The Recommended Dietary Allowance (RDA) for vitamin C is 75 mg for females and 90 mg for males. If you consume more than what your body needs, you will excrete it in the urine.
Vitamin C is found in citrus fruits, like oranges and grapefruits, as well as other sources that are considered to be potentially bothersome for people suffering from IC.
IC friendly sources of vitamin C include: broccoli (51 mg/1/2 cup), asparagus, brussels sprouts (48 mg/1/2 cup), cauliflower, spinach, bell peppers (60-95 mg/pepper), blueberries, cantaloupe (29 mg/1.2 cup), watermelon, parsley, kale, squash, zucchini and cooked white or sweet potatoes with skin. You can also find vitamin C (in addition to other vitamins and minerals) in foods that are ‘fortified’, like breakfast cereals.
Vitamin C found naturally in foods may cause less IC symptoms than if supplemented. Try eating 2-3 items listed above each day to provide your body with enough vitamin C. It is important to not eliminate foods from your diet permanently before testing them during an elimination diet. Some people can tolerate small amounts of foods high in vitamin C, such as citrus fruits. Another method some find success with is taking 2-3 Prelief tablets right before you eat a food high in acid that contains vitamin C. Worth a try, right?
In terms of supplementing, it is possible to supplement with a pH-balanced ‘acid-neutralized’ or ‘buffered’ version of vitamin C. It is recommended to test your sensitivity starting with small doses.
B-vitamins:
It is theorized that the GAG layer is damaged in people with IC. B-vitamins are broken down into neurotransmitters that carry messages from the brain to the rest of the body. In someone without IC, the neurotransmitters will not have an effect. However, in people with IC, the neurotransmitters can potentially make their way across the membrane and cause pain, spasms, cramping, and/or burning. The B vitamins play a role in increasing the neurotransmitters serotonin, norepinephrine, and achetylcholine.
For people with mast cell issues, supplementation of vitamin B12 can be problematic as they are often derived through a fermentation process that results in histamine production.
Vitamin B6 Vitamin B6 is a water-soluble vitamin and performs a variety of functions in the body. It is involved in the breakdown of protein, plays a role in cognitive development, is involved in immune function and the formation of hemoglobin.
Vitamin B6 is absorbed in the small intestine. The RDA for vitamin B6 is 1.3 mg for both males and females aged 19-50, 1.5 mg for females and 1.7 mg for males aged over 51 years. Excess vitamin B6 is excreted in the urine.
Vitamin B6 can be found in a variety of foods. IC friendly sources of Vitamin B6 include: chickpeas (1.1 mg/1 cup), poultry (0.5 mg/3 oz), yellowfin tuna (0.9 mg/3 oz) salmon (0.6 mg/3 oz), cottage cheese (0.2 mg/1 cup), rice, squash (0.2 mg/1/2 cup), potatoes (0.4 mg/1 cup), nuts (0.1 mg/1 oz), spinach (0.1 mg/1/2 cup), and watermelon (0.1 mg/1 cup). A deficiency of vitamin B is frequently accompanied by deficiency of other B vitamins and folic acid. Signs of a vitamin B6 deficiency include microcytic anemia, electroencephalographic abnormalities, cheilosis (cracks in the corners of the mouth) and glossitis (swollen tongue). People with mild vitamin B deficiency may not present any symptoms for months to even years.
People at higher risk of vitamin B deficiency include those suffering from malabsorptive conditions such as Celiac disease, Crohn’s disease, and ulcerative colitis. People suffering from autoimmune disorders, such as rheumatoid arthritis often have low vitamin B6 concentrations.
Vitamin B6 can be found in single supplement form as well as in multivitamins and B-complex vitamins. Look for a supplement that does not contain pyridoxine hydrochloride, as this form of vitamin B6 seems to be troublesome for IC sufferers.
Vitamin B12
Vitamin B12 is another water-soluble vitamin naturally present in some foods, but can also be added to foods or taken as a dietary supplement. It is essential for the development and functioning of the nervous system as well as DNA synthesis and red blood cell formation.
Vitamin B12 is bound to protein in food and needs to be released before it can be absorbed. This process begins when food is mixed with saliva in the mouth. It is also freed by the hydrochloric acid found in the stomach. It is combined with a transporter called ‘intrinsic factor’ in the small intestine and is absorbed in the large intestine. When vitamin B12 is supplemented, it is already in free form and does not need to be separated. It is about 50% more biovailable in supplements than food sources.
The RDA for vitamin B12 is 2.4 mcg in people 19 years and older. It is naturally found in animal proteins, such as fish, meat, poultry, eggs and dairy. Fortified cereal and nutritional yeasts also contain vitamin B12 that contain high bioavailability. It appears that the absorption of vitamin B12 is three times higher in dairy products than in meat, fish or poultry.
IC-friendly sources of vitamin B12 include: beef liver (70.7 mcg/3 oz),, clams (17 mcg/3 oz), tuna (9.3 mcg/3 oz), nutritional yeast (8.3-24 mcg/1/4 cup), salmon (2.6 mcg/3 oz), milk (1.3 mcg/1 cup), yogurt, fortified breakfast cereal (0.6 mcg/serving), cheese (0.5 mcg/1.5 oz), eggs (0.5 mcg/1 egg), and turkey (0.3 mcg/3 oz).
Vitamin B12 is available in multivitamins, B-complex, and individual supplements. The most common form of vitamin B12 supplement is cyanocobalamin. Vitamin B12 supplements can be found in a variety of forms, such as sublingual tablets, nasal spray and intramuscular injections.
A deficiency of vitamin B12 can be caused by a lack of intrinsic factor, surgery in the GI tract, prolonged use of certain medications, and dietary deficiency. Signs of a deficiency include megaloblastic anemia, swelling of the tongue, fatigue, palpitations, pale skin, dementia, weight loss and infertility. A deficiency can also cause neurological changes such as numbness and tingling of the hands and feet. Symptoms of a deficiency can take years to present as the body holds stores of vitamin B12 for longer than other vitamins.
People at risk of deficiency include older adults, people with malabsorption disorders, people who had bariatric surgery, and vegetarians/vegans. If a person does not consume animal products, they are putting themselves at risk of a vitamin B12 deficiency and may need additional supplementation.
People with IC may not be able to tolerate a vitamin B12 supplement and should therefore try to get their recommended daily amount of the vitamin through food.
Vitamin D
Vitamin D is a fat-soluble vitamin. Vitamin D has various forms such as vitamin D2 and D3. We get vitamin D through our diet, exposure to sunlight, and dietary supplements.
The function of vitamin D is to aid in intestinal absorption and deposition of calcium in the bones. A deficiency in vitamin D can lead to rickets, osteoporosis, osteomalacia, and muscle weakness. Some people are even misdiagnosed with fibromyalgia due to mistaken muscle pain.
Research has shown that vitamin D may play a role in IC and has anti-proliferative and anti-fibrotic effects in an inflamed bladder. Research has also shown that vitamin D exerts anatomic, hormonal, neurological, and immunological influences on pain manifestation. A study in 2010 found that higher vitamin D levels are correlated with a decreased risk of pelvic floor disorders.
Calcitriol is the best form to use with IC because it is the active form of vitamin D
Depending on where you live or what season it is, it may be impossible to get the recommended amount of vitamin D from the sun. We can’t absorb significant UVB rays in the car or on cloudy days. The UVB rays can’t penetrate our clothing either. If you have long pants and long sleeves on, that leaves little surface area for the rays to be absorbed.
It is rather inexpensive and easy to supplement with vitamin D. The RDA for adults 19-70 years old is 15 mcg or 600 IU. Vitamin D from sunlight, supplements and food sources must undergo processing in the body before being absorbed. If you take a statin, such as Lipitor or Zocor, your body may not absorb as much vitamin D because the two compete for absorption in the body.
IC friendly dietary sources of vitamin D include: oily fish such as trout (16.2 mcg/3 oz), salmon (14.2 mcg/3 oz), mackerel), red meat (1.0 mg/3 oz), fortified cow’s milk (2.9 mcg/1 cup), egg (1.1 mcg/1 egg), mushrooms (9.2 mcg/1/2 cup), fortified breakfast cereal (2.0 mgc/serving).
Iron
Iron is a mineral that the body needs for growth and development. The body utilizes iron to make hemoglobin, a protein in red blood cells that helps carry oxygen to various parts of the body and myoglobin, a protein that carries oxygen to the muscles. It is also essential in the creation of some hormones.
Vegans and vegetarians who do not eat meat are at risk of iron deficiency because the iron in plant proteins is not digested as well as the iron in animal proteins. Adult men ages 19-50 are recommended 8 mg of iron/day. Females of the same age range are recommended 18 mg/day.
IC friendly foods that contain iron include: lean meat, poultry, seafood, iron-fortified breakfast cereal (18 mg/serving), oysters (8 mg/3 oz), white beans (8 mg/1 cup), lentils (3 mg/1/2 cup), spinach (3 mg/1/2 cup), kidney beans (2 mg/1/2 cup), chickpeas (2 mg/1/2 cup), beef (2 mg/3oz), white potato (2 mg/medium potato), and cashews (2 mg/1 oz).
A short term deficiency of iron will likely not show any symptoms, as the body will use its reserves. But when these levels are depleted, iron deficiency anemia can develop. Symptoms include GI upset, weakness, fatigue, and problems with concentrating.
Some chronic illnesses such as rheumatoid arthritis, inflammatory bowel disease, and some types of cancer may interfere with absorption of iron or use stored iron. The recommended method of treatment in these diseases is to treat the underlying cause.
It is important to take iron and calcium at separate times as these nutrients compete for absorption in the body. Certain medications such as proton pump inhibitors, levodopa and levothyroxine can either reduce the amount of iron absorbed or decrease effectiveness of the medication.
Calcium
Calcium is a mineral used in the body to build and maintain strong bones as well as many other essential functions. It is used to help the blood vessels move blood throughout the body and helps release hormones and enzymes. The muscles need calcium to move and the nerves need it to carry out their functions. Calcium is stored in the bones and teeth.
The RDA for adults 19-50 years is 1,000 mg. For females aged 51-70, the recommendation increases to 1,200 mg.
Calcium can be found in the following IC friendly sources: milk (300 mg/1 cup), yogurt (415 mg/8 oz), cheese (300-333 mg/1.5 oz), kale (94 mg/1 cup), broccoli (21 mg/1 cup), canned sardines (325 mg/3 oz), salmon (181 mg/3 oz), fortified breakfast cereals (130 mg/serving), and some breads and pastas.
Calcium is found in many multivitamin supplements. The two main forms of calcium are carbonate and citrate. Calcium citrate can be absorbed on an empty stomach, whereas calcium carbonate cannot. Your body can only absorb about 500 mg at a time, so you may need to take two separate doses to achieve maximum absorption.
Signs of calcium deficiency are similar to vitamin D deficiency. Osteopenia and osteoporosis can occur with severe calcium deficiency.
Iron and calcium supplements can cause constipation. Remember to stay hydrated, be as active as possible, and increase dietary fiber. If these methods don’t help, talk to your doctor about a stool softener or laxative.
Multivitamin
Multivitamin supplements contain a combination of vitamins and minerals. Some people take multivitamins as nutritional “insurance” in an effort to cover all bases. It is important to know that a multivitamin will not take the place of eating a variety of foods in a healthy diet. A multivitamin may be helpful for people who cannot obtain their recommended dose of specific vitamins or minerals through food alone.
With IC, many people report an increase in bladder symptoms after taking a multivitamin. It is thought that the acid in this type of vitamin can be painful for people with sensitive bladders. Usually, vitamin brands will decrease the acid and increase alkalinity of the vitamin to avoid flaring the bladder. They also use calcium ascorbate instead of ascorbic acid, which can decrease the risk of bladder symptoms.
How To Tell If You Are Deficient in a Vitamin or Mineral?
Keep on the look out for signs such as: hair loss, burning sensation of the feet or tongue, wounds that are slow to heal, bone pain, or irregular heart beat. These can be early to late signs of a nutrient deficiency. Ask your doctor for a blood panel to check vitamin and mineral levels in the blood.
Finding A Reputable Supplement Brand Currently, the United States Food and Drug Administration (FDA) does not evaluate the effectiveness, safety, or quality of dietary supplements before they enter the marketplace. This means that a product has no guarantee to contain what it claims to. The FDA does require supplement manufacturers to adhere to Current Good Manufacturing Practices, compliance is not always enforced.
The best way to ensure the quality of a product is to look for one that has been certified by a third-party company. Third-party testing is not required by law, but some manufacturers choose to voluntarily undergo testing to prove the quality of their product. Look on the label for a Certificate of Analysis (COA), which is awarded by an independent third-party company, such as NSF, USP, Banned Substances Control Group (BSCG), or ConsumerLab.
It is important to speak with your doctor, pharmacist, and other healthcare providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.
Conclusion In conclusion, it may be worth it to obtain most of your vitamin and mineral recommendations from dietary sources. If this is not possible, then consider a supplement following the criteria discussed in this post.
Looking for guidance when it comes to diet for IC? Check out my Road To Remission program and how it can help you minimize your symptoms in just 3 months!
Sources: https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/ The Beneficial Role of Vitamin D in Interstitial Cystitis https://pubmed.ncbi.nlm.nih.gov/20308841/ https://www.painful-bladder.org/healthy_lifestyle.html https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ https://ods.od.nih.gov/factsheets/Iron-Consumer/ https://ods.od.nih.gov/factsheets/MVMS-Consumer/