There are many dietary supplements that purport to help the symptoms of interstitial cystitis. Some have been thoroughly tested in high-quality, blinded and controlled clinical trials. Others have no evidence of efficacy at all. Most fall somewhere in the middle - anecdotally reported to be helpful by many patients, but lacking in published scientific evidence. Hopefully this article will help you evaluate what might be best for you - there's also a full review of many of these supplements in The Interstitial Cystitis Solution.
Supplements can have many benefits for IC - they are far less expensive than prescription medication, often have fewer side effects, and can be purchased online or over-the-counter at stores. In general, supplements are not rigorously proven in clinical trials, and the claims on the bottles are not evaluated by any regulatory agency (that's why you'll see the little *Statements not evaluated by the Food and Drug Administration* disclaimer on most bottles). We've included links below to some of the brands we typically recommend to our patients.
As with medication, there is no 'one size fits all' approach - everyone with IC is unique and responds differently. You may want to try several of the options below and see what works best for your body. Using a symptom log (you can download and print the PelvicSanity Symptom Log for IC) can help you evaluate if the supplement is showing a benefit for you. Finding the right supplement can have significant upside for you, and little downside. As we always say: if it works, keep it; if not, discard it!
Inflammation, when trapped in a region, can increase pain and cause dysfunction (think of a knee swollen with arthritic pain, for example). With IC, inflammation tends to gather in the lower abdomen, just above the bladder, and on the inner thighs. You can test yourself by trying to (gently) lift the skin on your stomach or inner thighs up and away from the muscle underneath - if it feels tender or difficult to lift, it's likely that inflammation is playing a role in your condition.
L-Arginine - A common amino acid that is both made by the body and found in many foods, L-Arginine isn't generally included in many multivitamins or supplement blends because there is generally enough already present. It is a precursor to nitric oxide, a molecule that helps open up blood vessels and increase circulation.
The idea behind L-Arginine is that increasing blood flow and opening up blood vessels can help clear away some of the inflammation that builds up in the pelvic region with IC. It's one of the only supplements that has been truly evaluated in a published, scientific study specifically for interstitial cystitis. In a double-blind, randomized, controlled study of about fifty patients, 48% reported a significant overall improvement with their symptoms with 1,500 mg daily of L-Arginine. (As a comparison, two similar trials of the prescription drug Elmiron showed only 28% and 32% of patients showed a global benefit.) The group that received the placebo (sugar pill) only reported a 24% improvement. Improvements were noted in pain intensity, pain frequency, and urinary symptoms.
Omega-3 Fish Oil - Omega-3 is a type of oil found in (you guessed it!) fish that helps to fight inflammation. It's counterpart, Omega-6, is found in processed foods and increases inflammation - not surprisingly, most of us consume far more of the bad Omega-6 than the good Omega-3 oils. One study found that the American diet has more than twenty times as much of the 'bad' oils than the good Omega-3s.
Interstitial cystitis and pelvic pain both cause inflammation to build and linger around the bladder and pelvic floor, causing additional pain and dysfunction. Taking Omega-3 supplements (or trying to eat more fish!) can help balance out the bad oils in our daily diet and fight inflammation. When looking for a good Omega-3 supplement, try to find one with a 1.5:1 ratio of EPA:DHA, the two major components.
The majority (around 80%) of patients with IC have some level of food sensitivity. For many, this involves only a small handful of trigger foods - common triggers include citrus fruits and juices, caffeine, alcohol, tomatoes, artificial sweeteners, and spicy/exotic foods. Others are more diet-sensitive and have to be more careful about the foods they avoid.
Calcium Glycerophosphate (Prelief) - A mineral supplement and antacid, Prelief is the most common brand name for IC patients. Calcium glycerophosphate is taken before meals, particularly before eating or drinking a known trigger, to try and mitigate the dietary trigger. While there is conflicting evidence around the impact of acid - and 'acid in' does not always equal 'acid out' - in a survey conducted by the Interstitial Cystitis Association, Prelief was the highest-rated supplement, with nearly 75% of patients reporting a positive effect. When taken right before meals or eating a trigger food, the supplement has been reported to reduce both pelvic pain and urgency. This may be a great option for patients who are highly food-sensitive.
Bladder Building Blocks
Some patients (about 10%) have very clear damage to the bladder lining. Known as Hunner's lesions, these bladder wounds can be cauterized and sealed to reduce symptoms. It has been hypothesized - but never convincingly proven - that some other patients may have microscopic damage to the bladder wall. Not large enough to be seen or to treat conventionally, breaks in the bladder lining may allow the irritants within the urine to penetrate and irritate the bladder. The supplements on this list attempt to provide the molecules that make up the bladder lining, giving the body the 'building blocks' to repair the bladder lining.
Aloe Vera - A cactus plant, aloe vera is one of the world's oldest known herbal remedies. It's commonly found in many cosmetics and lotions, and used to sooth burns and on healing wounds.
Preliminary research in animal models has found that oral aloe vera actually increased the production of GAG molecules in healing wounds - GAG molecules are the major component of the bladder lining. While this theory remains unproven in humans, it's an interesting hypothesis to treat the bladder right at the source.
In a large survey of 600 patients with IC conducted by Desert Harvest Aloe Vera, 92% of respondents reported "significant relief" from oral aloe vera. Although the results are not from a controlled study, and may self-select for patients who had benefit from the supplement, respondents reported improvements in pain, urethral burning, and urinary urgency/frequency.
Combinations of different supplements and medications can often be more beneficial than a single treatment, especially for a condition like IC where everyone responds differently. You can create a combination yourself of some of the above supplements, or some manufacturers have created a pre-mixed combination of different supplements for IC.
CystoProtek - A combination of different supplements, CystoProtek is another common choice for patients with IC. It combines elements from the anti-inflammatory and bladder building block segments above. These pills contain three components that are building blocks of the bladder lining, as well as two anti-inflammatory supplements. Chondroitin sulfate (150 mg), sodium hyaluronate (10 mg) and glucosamine sulfate (120 mg) are all GAG molecules that are found in the bladder lining, while Quercetin (150 mg) and Rutin (20 mg) are both anti-inflammatory flavonoids. Little scientific evidence is available about how this supplement affects interstitial cystitis, but anecdotally many patients report relief.
While these are some of the most common and most studied of the supplements on the market for interstitial cystitis, there are many more that may have similar benefits that have been less studied. Your symptom log can be a crucial resource as you evaluate which (if any) of these supplements has the most benefit for you. Hopefully this article will help you find a supplement that gives some relief without the side effects of many medications!
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.