In this month’s blog post I am going to talk about different types of water.  Yes, really!  I don’t like to brag, but I have something of a refined palate when it comes to water, having once correctly identified five different types of mineral water in a blind taste test.  I’m like a really boring version of a sommelier!  

Anyone with a bladder pain condition or a propensity to urinary tract infections will know the importance of drinking enough water, as becoming dehydrated can bring on a flare.  Many of you are probably, like me, rather obsessive about staying hydrated and make sure to take a bottle of water with you whenever you leave the house.  What you might not know is that some people’s bladder symptoms worsen or improve depending on the type of water they drink.  In today’s post I will discuss the pros and cons of various types of water! 

Firstly and most obviously we have tap water.  In the UK, it is usually perfectly safe to drink water straight from the tap – and many people do.  It has the advantage of being economical and convenient; you can get tap water pretty much anywhere, any time, and you can put it into whatever drinking utensil you prefer.  We are very fortunate in that regard, as I know there are lots of countries where tap water is unsafe to drink.  However, British tap water is rendered safe to drink by adding chlorine to kill bacteria.  Some people with sensitive bladders feel that this is an irritant.  In some areas fluoride is also added.  I can’t find much information about fluoride and the bladder, but fluoride can disrupt thyroid function and there is some research to suggest that thyroid health can impact on bladder health - see this article and also this one.  Tap water can also contain traces of antibiotics, hormones and pharmaceutical drugs.  Although the levels of these are supposed to be very low, it is known that there is sufficient oestrogen in British sewage to cause endocrine disruption to male fish.  Those with interstitial cystitis often find that their symptoms are very sensitive to hormonal changes, which can be affected by birth control pills, the menstrual cycle, pregnancy and menopause.  For this reason, they may prefer to avoid tap water. 

Another thing to consider where tap water is concerned is the hardness of the water.  Hard water refers to water with a higher content of dissolved minerals, particularly magnesium carbonate and calcium carbonate.  Sometimes the mineral content is high enough that it can be seen – the water will appear cloudy when it is poured from the tap.  Hard water can lead to a build-up of lime scale in pipes and on appliances, and it can also cause soaps to produce less lather. 

It should be noted that in the UK, there is a lot of variation in the hardness of tap water from region to region.  There is also variation in chlorine levels – something you can easily taste and smell if you are on holiday or are a visitor somewhere.  I have heard of people whose bladder symptoms seemed to worsen when they drank water from a different part of the country and you can read more anecdotes to that effect on this Reddit thread.  If your bladder symptoms began when you moved to a place with a different water supply, or seem to flare when you are in a certain part of the country, you might therefore like to consider whether plain old water might be a contributing factor! 

If you want to avoid tap water, one way to do this is by purchasing bottled water.  It seems that there are significant differences in labelling, brand availability and quality in bottled water from country to country, so for this section I will be referring to bottled water sold in the United Kingdom.  I will not be discussed flavoured waters or soft drinks – only plain water.

In the UK, bottled water is generally described in one of three ways:  bottled drinking water (also known as table water); natural mineral water; or spring water.  Bottled drinking water can literally just be tap water that is put into bottles for sale, so if you wish to avoid tap water then you should probably also avoid bottled drinking water.  You can read about the regulations concerning the sale of bottled drinking water on this page from the government website.

Natural mineral water must come from an underground source, which should be specified on the bottle, and must be free from pollution.  The water must be bottled at source and can only receive very minimal treatment, if it is treated at all.  You can read the list of five permitted treatments on this page of the government website.  As the name suggests, natural mineral water contains naturally occurring minerals and so the mineral content of bottled mineral water must be displayed on the label, rather like the supplement facts are displayed on vitamin products.  The pH should also be displayed, which might be an important consideration for interstitial cystitis sufferers.  In the UK, some famous brands of natural mineral water are Volvic, Buxton and Evian.  Interestingly, lots of IC sufferers in the USA seem to like Evian and consider it a more bladder-friendly option than some other brands which I have never heard of and therefore assume to be American.  Even more interestingly, some IC sufferers seem to dislike Evian and felt it exacerbated their symptoms.  I suppose this goes to show that everyone’s triggers are not the same!  When I first got serious about maintaining good hydration, I used to buy large bottles of Evian water and I made sure to drink one every day.  I had read somewhere that natural mineral water might be healthier than tap water and I suppose I must have Googled natural mineral water brands in the UK and decided upon Evian.  I don’t recall ever suspecting that it aggravated my bladder, nor having any particular issues with it, for what it’s worth. 

The advantages of natural mineral water are that, as the name suggests, it contains some essential minerals!  If it comes from reputable brands and is properly labelled, it should also be very safe to drink, given that it will have come from unpolluted underground sources.  On a practical level, buying bottled water also makes it easier to keep track of our fluid intake, which can be important for those whose symptoms are worsened by dehydration.  The disadvantages are that it is expensive and unless you can afford to buy it in glass bottles (which is even more expensive and is also somewhat impractical for putting in your handbag when out and about), you will have to use plastic.  Aside from the environmental concerns that some people might have around this, drinking from plastic bottles leads to the ingestion of microplastics.  Although the long term implications of exposure to microplastics are not yet fully understood, they are known endocrine disruptors (.) and can affect the inflammation process.  Many people with complex or chronic health conditions choose to limit their exposure to microplastics. 

Spring water is very similar to natural mineral water, except that a wider range of treatments is permitted and the mineral contents do not have to be displayed on the bottle.  Nevertheless, many brands of spring water do display a mineral composition on the label.  Highland Spring is a famous brand of spring water in the UK and it displays mineral information on its labels.  Nowadays if I drink bottled water, I generally buy Highland Spring because it scores full marks for being ethical on the Good Shopping Guide table of bottled waters!  Other brands you might have heard of are Strathmore and Harrogate.  The advantages and disadvantages of bottled spring water are much the same as for natural mineral water.  You can see a list of the treatments permitted for spring water on this page of the government website.

Spring water can also refer to a private water supply taken from a spring on one’s own land.  This might then be filtered and/or treated with UV light to render it extra safe to drink.  As few people have access to their own private spring water, I will not discuss that in this post.  Nor will I discuss private water supplies from wells or boreholes. 

One final thing I will say on the subject of bottled water is that you should check that your water is in fact just water.  If it has an ingredients list and shows that other things have been added then it is not technically bottled drinking water, natural mineral water or spring water – it is some other kind of flavoured or enhanced water!  That’s fine as long as you know what you’re getting and are happy with your choice, but do check the label properly before purchasing to be sure! 

If you want to avoid both plain tap water and bottled water, then filtered water might be what you need.  However, there are different types of filters too!  I am feeling a little thwarted right now, because I had planned at this point to talk about the pros and cons of various kinds of water filters, from the standard table top jug filters (like BRITA®), through gravity water filters with charcoal or ceramic cartridges (I have a FreshWater filter with Sugalite cartridges), onto reverse osmosis filters, and finally on to filters that can be plumbed into your house so that your water comes out of the tap already purified.  However, it seems that the world of water filters has come on considerably since I was last shopping for one and I find myself surprised at how advanced jug filters now seem to be (I’m sure they only used to filter out some of the chlorine to improve the taste?!) and disappointed that my own water filter is no longer as state of the art as I thought! 

All I will therefore say is that there are water filters to suit every budget and they can be as high tech or low tech as you want them to be.  The advantages of filtered water are that it is economical; once the initial investment has been made you are essentially just using tap water.  In general, the more expensive filters have a longer life before they need to be replaced.  You can variously get filters that remove chlorine, lead, copper, cadmium, mercury, bacteria, parasites, hormones, pesticides and viruses.  Viruses are usually much smaller than bacteria, so filtration systems that remove viruses are often more expensive.  UV filters, which are effective against both bacteria and viruses, do not remove chlorine, pesticides or oestrogens.  Many filters that remove chlorine, heavy metals and some pesticides do not remove viruses.  There is a famous brand of water filter called a Berkey® which seems to combine various different methods of filtration into one device and as such is able to filter out pretty much everything you’d want to, including 99.9999% of viruses. 

After years of drinking bottled water, it was the cost and the microplastics factor that prompted me to make the switch to a good quality water filter.  I bought what at the time seemed a good compromise between quality and my budget – my Sugalite cartridges remove 99.99% of all particles larger than one micron, including chlorine, pesticides, bacteria and oestrogens.  I would like to upgrade to a superior system when I can, but for the last few years it has seen me right.  I use Super Sparrow water flasks at home, which are obviously better for the environment than single use plastics and reduces my exposure to microplastics. 

The downsides of drinking filtered water are that a really good system will filter out a fair few minerals as well.  Provided you have a good diet and perhaps supplement with extra minerals, this should not be an issue.  The other main downside as far as I am concerned is the faff.  My own water filter is similar in shape and size to a Berkey, meaning I have to empty out any dregs and refill it every 36 hours or so.  It also filters more slowly than a basic jug filter. 

You will find plenty of anecdotes on IC forums from people who claim that switching to filtered water has helped them.  Which filter you choose will very much depend on your budget, your living arrangements (will you share your filter?  Can you have one attached to your taps?) and your own personal requirements regarding how thoroughly you’d like the water to be filtered. 

If you really want your water pure, then distilled water might be the choice for you.  If you remember back to chemistry lessons at school, distillation was the thing where a fluid was boiled in a tube, and then the steam passed along a pipe where it condensed, with the resulting liquid drops being collected in another tube.  A water distiller works a bit like that – in essence it boils your water, which kills off bacteria and viruses, and then sends the steam to be cooled and collected in another section of the device.  At the end, you’re left with water that is almost completely pure. 

The advantages of distilled water are its purity – you end up with water that contains almost nothing else.  Ironically, this is also one of its main disadvantages – it is stripped of almost all minerals and flavour.  People who routinely drink distilled water might therefore need to be extra careful that they do not become deficient in essential minerals like magnesium and calcium.  Other disadvantages of distilled water are the cost of purchasing the distiller unit and the running costs, since water distillers use electricity.  I have never personally tried drinking distilled water, so I’m afraid I can’t share any personal insights about it.  If you Google ‘distilled water interstitial cystitis’ you will find a small amount of anecdotal evidence from bladder pain patients. 

Although there is not one specific type of water that seems to equally suit all bladder pain patients, it certainly seems that several people do notice a change in their symptoms depending on what type of water they drink.  This especially seems to be the case with bottled water in America, where one particular brand seems to have quite a bad reputation for triggering flares (I don’t think we have that brand in the UK).  If you have never considered that your water source might be contributing to your symptoms, it might be worth thinking about and perhaps switching water source for a while.  If you generally add ice to your drinks, remember to switch the source of water you use for your ice cubes too! 

Wishing you the best of health,

Tiny

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