Barbara Shorter

Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions

Whats known on the subject? and What does the study add?

Influence of polyunsaturated fatty acids on urologic inflammation

AbstractPurposeStudies demonstrate that polyunsaturated fatty acids, fish oils, and alpha-linoleic acid are beneficial anti-inflammatory agents, which suppress inflammatory mediators and their activity.MethodsThis review focuses on the effects of omega-3 fatty acids (O-3FAs) on three primary urologic organs (bladder, kidney, and prostate) and associated conditions such as urolithiasis, kidney transplantation, interstitial cystitis/bladder pain syndrome, bladder cancer, prostate cancer (CaP), and chronic prostatitis/chronic pelvic pain syndrome.ResultsThe following themes emerged: the potential influence of O-3FA in suppressing urologic inflammation; the supportive role of O-3FA in therapeutic interventions; pro-inflammatory mechanisms of omega-6 fatty acids (O-6FAs) associated with disease progression; and the importance of the optimal ratio of O-6FAs/O-3FAs.ConclusionsThe need for further research on the role of PUFAs in suppressing urological inflammation precipitated.

Statistical Validation of the Shorter-Moldwin Food Sensitivity Questionnaire for Patients with Interstitial Cystitis/Bladder Pain Syndrome

PURPOSE American Urological Association guidelines suggest dietary changes as first line treatment for interstitial cystitis/bladder pain syndrome. We previously developed a validated survey instrument to determine which foods, beverages and supplements exacerbate the symptoms of this condition. In this study we developed a shortened questionnaire that would provide an easily self-administered food symptom history useful for clinical practice and future research. MATERIALS AND METHODS Using data from our previously validated food sensitivity questionnaire we remodeled the original lengthy survey to an abbreviated list including the 35 most problematic comestibles. The instrument was reviewed by a panel of experts for face and content validity, and tested for internal consistency, readability and clarity, and test-retest reliability. RESULTS Of the 124 patients who completed a baseline questionnaire 52 (42%) returned the second instrument 1 week after completing the first instrument. Internal consistency was high (α=0.96). A total of 47 patients (90.4%) indicated that they were food sensitive. Questionnaire test-retest reliability assessed by the Spearman correlation coefficient ranged from moderate (ρ=0.48 for Equal®) to very strong (ρ=0.90 for beer). Discrepancies between the survey instruments in individual comestibles occurred only 1% of the time. CONCLUSIONS Our short form diet history questionnaire based on a previously validated long form is a reliable, newly validated instrument that will help identify comestibles associated with interstitial cystitis/bladder pain syndrome symptoms. Its brevity makes it simple to administer and useful for dietary management in this population.

The Potential Role of Diet in the Treatment of Interstitial Cystitis/Painful Bladder Syndrome

The etiology of interstitial cystitis (IC)/painful bladder syndrome (PBS), a debilitating, multifactorial syndrome of the bladder, eludes doctors. Various causes have been speculated. Consequently IC/PBS is a complex condition to treat. Among the non-traditional approaches used for IC/PBS, dietary changes seem to improve symptoms in some individuals. Most of the data gathered on diet as it affects IC/PBS symptoms is anecdotal. There is a large cohort of IC/PBS patients whose symptoms are exacerbated by ingestion of specific comestibles. The most frequently reported and the most bothersome comestibles include items such as alcoholic beverages, coffee, tea, carbonated beverages, tomatoes and tomato products, and certain spices. A registered dietitian should be consulted so that patients can undertake an elimination diet. After the offending foods have been determined, a diet can be developed to avoid problematic foods and beverages, while meeting daily nutrient requirements.

MP01-15 PERCEPTIONS OF NEPHROLITHIASIS PROMOTING FACTORS AND PREVENTIVE MEASURES: A PROSPECTIVE SURVEY ANALYSIS

RESULTS: 217 PCNLs were completed at our institution between 2010-2015 for stones >2cm. 72 patients (75 kidneys) had large staghorn calculus that met our size criteria. 3 of these were excluded. Overall 28 (39%) of patients were found to have infection stones, either struvite or carbonate. 44(61%) stones were composed of metabolic based stones without any infectious composition. The primary compositions in the metabolic stone group were calcium phosphate (52%), Uric Acid (18%), calcium oxalate (18%), and cystine (12%). In patients with purely metabolic stones, 65% of patients with primarily calcium phosphate hydroxyapatite had positive pre-op urine cultures, while only 12.5% of patients with primary calcium oxalate stones had positive pre-op urine cultures. Preoperative urine cultures revealed Proteus present (4.5% vs 46.4%) for non-infectious and infectious stones. E. Coli was present in preoperative urine cultures (15.9% vs 3.5%) for non-infectious and infectious stones. Proteus was the most common bacteria in infectious stones, while E. Coli was most common with metabolic stones. Infectious stones were 3.2 times as likely to have at least a Clavien-Dindo Grade 1 complication as metabolic stones (p1⁄40.017). CONCLUSIONS: In our study more staghorn calculus were composed of metabolic stones than infectious stones. Calcium phosphate was the most common stone composition for staghorn calculi differing from historical reports of staghorn calculi being primarily infectious. Patients with calcium phosphate stones also had a high rate of positive urine cultures. More research is needed on the cause of this paradigm shift.

Diet Therapy in the Context of Chronic Pelvic Pain

The synergistic relationship between food and well-being is beyond doubt. With the discovery that vitamins and minerals eradicate deficiency diseases, the role of these essential nutrients in maintaining health and mitigating disease has been confirmed for centuries. Indeed, there is now abundant evidence that comestibles enhance health through complex biological mechanisms [1, 2, 3, 4].

Obesity with Comorbid Stress Urinary Incontinence in Women: A Narrative Review to Inform Dietetics Practice

Stress urinary incontinence (SUI) is a common problem among women; clinical treatment guidelines include weight reduction as a strategy for controlling urinary leakage. The purpose of this review was to gather evidence on the association between obesity and SUI and to ascertain whether there are any special considerations for implementing medical nutrition therapy with community-dwelling, obese, adult females with comorbid SUI. Five key findings emerged: epidemiologic studies consistently report statistically significant associations between obesity and SUI, randomized control trials found that weight loss appears to ameliorate SUI symptoms, the SUI-activity link may affect weight management, there is a potential interplay between SUI and the obesity-sleep connection, and dietary components are associated with the exacerbation of urinary symptoms. The pathogenesis of SUI and obesity-related contributions to urinary leakage is included in the introductory discussion. Lastly, insights on special considerations for implementing nutrition interventions with this population are offered.

Diet and Its Role in Bladder Pain Syndrome and Comorbid Conditions

Many patients with Bladder Pain Syndrome (BPS) have sensitivities to various comestibles. There are a variety of pathologic mechanisms suggested to be responsible for the relationship between dietary intake and symptom exacerbation. Based upon the current literature, certain food types affect symptoms of BPS and comorbid conditions more than others, suggesting that a controlled method to determine dietary sensitivities, such as the elimination diet, may play an important first-line role in the management of the BPS patient. When considering dietary intervention in patients with BPS, it is of utmost importance to take into account comorbid conditions when counseling patients.