Continuing with our vitamin and mineral series, in this month’s blog post I will be discussing the particular things that people with interstitial cystitis and other chronic bladder issues should look out for when choosing multivitamin products.  In the first post of the series, I shared my general tips for choosing high quality vitamin and mineral supplements, but did not focus in detail on the special requirements that individuals with bladder conditions might have.  In the second and third posts, I talked about fill weights, label claims and compound ingredients.  In today’s post, I want to concentrate specifically on multivitamins for interstitial cystitis. 

Please bear in mind that I am not a doctor and this blog post is for entertainment purposes only.  It represents my own personal thoughts and opinions and should not be used to diagnose or treat any medical condition.  It is also not intended as an advisory resource for choosing nutritional supplements.  Always consult with a qualified healthcare practitioner before taking a new supplement or making dietary changes. 

The first thing that interstitial cystitis patients should check when purchasing a vitamin product is that any vitamin C is present as a mineral ascorbate and not as ascorbic acid.  Most bladder pain patients are not able to tolerate ascorbic acid, but any kind of ascorbate is fine.  Calcium ascorbate and magnesium ascorbate are the two most popular forms of buffered vitamin C, but you might also see zinc ascorbate, sodium ascorbate, or the brand name Ester-C.  It does not really matter how much vitamin C is in a multivitamin product, as you will probably want to take extra anyway.  Personally I like to get at least two grams a day of vitamin C, which is too much to fit into a multivitamin.  For that reason, I’m not bothered about how much is present in my multivitamin as long as it is in a bladder friendly form. 

The next thing bladder pain patients should check is that no vitamin B6 is present, especially in the pyridoxine HCl form.  If you know you are able to tolerate the P5P form of vitamin B6 then feel free to use multivitamin products that contain that.  I am fine with P5P and I get bad premenstrual symptoms if I am without vitamin B6 for long, so I use a product that contains P5P, but I would not use one that contained pyridoxine. 

You should choose a product that contains a meaningful amount of vitamin A and in my opinion this should include a retinyl form, not just beta-carotene.  As mentioned in the first post of this series, the conversion of beta-carotene into vitamin A is not always suitably efficient.  Vitamin A is important for bladder pain patients as it has been shown to improve the clinical symptoms of urinary tract infections.  It also promotes wound and ulcer healing, which might be relevant to those with Hunner’s lesions or other GAG layer damage, and it reduces renal scarring.  According to this study, vitamin A deficiency impedes the regeneration of mucosal barriers damaged by infection and it reduces the activity of neutrophils, macrophages and natural killer cells.  It contributes to the normal maintenance of mucous membranes, skin and the immune system and it has anti-inflammatory actions.  For these reasons, I consider vitamin A to be very important for those with recurrent UTIs or interstitial cystitis and I like to see at least 2000iu of it included in a multivitamin as either retinyl acetate or retinyl palmitate. 

Another thing I think interstitial cystitis patients should look for in a multivitamin is a meaningful amount of all the B vitamins, except for vitamin B6.  I would include folate and biotin in this category, the former of which should be in methylfolate form.  B vitamins variously contribute to normal psychological function, normal functioning of the nervous system, normal maintenance of the mucous membranes and skin, and normal energy-yielding metabolism.  They are important in managing stress symptoms, depression and anxiety.  Chronic pain definitely places stress on the body, so people with chronic bladder pain conditions are likely to need extra B vitamins.  I have found that a fair amount of interstitial cystitis patients are also quite highly strung, with a tendency to be anxious.  Obviously B vitamins’ role in maintaining healthy skin and mucous membranes is very relevant to conditions of the genitourinary tract.  One of my pet peeves is to see multivitamin products that contain only token amounts of B vitamins.  I like to see at least 20mg of vitamins B1 to B5 and at least 100mcg of folate, biotin and vitamin B12 – this is especially true of products designed for those with chronic pain conditions. 

Next, vitamin D.  Vitamin D deficiency has been linked to pelvic floor disorders including urinary incontinence and pelvic pain.  Supplementation with vitamin D has been shown to strengthen the bladder lining and protect it from E. coli infection, while vitamin D3 analogues have anti-inflammatory effects in interstitial cystitis.  Vitamin D deficiency is linked to several autoimmune disorders, while supplementation has been linked to a lower rate of the same.  Interstitial cystitis may be an autoimmune disease in its own right and it often presents with other autoimmune conditions like fibromyalgia, Sjogren’s syndrome and Crohn’s disease.  I therefore consider a high amount of vitamin D3 to be an important component of a multivitamin product aimed at IC sufferers.  Amounts of less than 1000iu would, in my opinion, necessitate a separate vitamin D3 product being added to one’s daily regime.  The tolerable upper limit is 4000iu, but you should note that some studies into vitamin D and autoimmune disorders use higher amounts than this.  I would encourage you to conduct your own investigations when deciding how much you would like to take each day!       

Vitamin E is something I consider absolutely crucial for most interstitial cystitis patients.  Dr Marilyn Glenville, who specialises in women’s hormone health, recommends it for symptoms of both premenstrual syndrome and menopause.  A significant portion of customers I speak to tell me that their interstitial cystitis began or worsened around pregnancy or menopause.  Some people also notice that it is worse at certain times of the month.  Vitamin E is commonly taken by people with hormonal problems and I certainly had a much easier time with my own PMS when I added an extra 400iu into my daily regime.  Vitamin E has potent anti-inflammatory properties and it is also important in maintaining normal immune function and fighting infections.  For these reasons, I consider it essential that those with interstitial cystitis make sure their vitamin products contain good levels of vitamin E.  It is important to choose products that offer the natural d-alpha form or mixed tocopherols. 

Moving on to minerals, one mineral that complements vitamin E and helps it to work more effectively is selenium.  This study showed that vitamin E and selenium together might be more effective than either agent alone.  Selenium contributes to normal immune and thyroid function, both of which are important considerations for those with interstitial cystitis.  More than one third of women with chronic lower urinary tract symptoms have hypothyroidism, while hyperthyroidism has been associated with bladder pain syndrome and interstitial cystitis.  It is therefore crucial that people with chronic bladder conditions monitor and optimise their thyroid function.  To this end, they should seek out multivitamin products that contain a meaningful amount of selenium. 

Another mineral crucial for producing thyroid hormones and maintaining normal thyroid function is iodine.  It is therefore important for people with interstitial cystitis to use a multivitamin supplement that contains iodine, unless they have some compelling reason not to.  If the supplement contains iodine, make sure that it also contains selenium to balance it, especially as this study shows that the two minerals work well together for the prevention of anxiety and depression! 

Iron deficiency anaemia impairs thyroid metabolism, while thyroid hormone imbalances can lead to poor iron absorption.  Iron is therefore another mineral important in thyroid health.  Furthermore, it seems likely that iron deficiency plays a role in persistent genital arousal disorder.  It is therefore important that women who menstruate choose a multivitamin supplement that contains iron, unless they already have an excess of iron.  Iron status can easily be checked via blood testing.  Males and postmenopausal woman might also require a supplement that contains iron if their iron levels are low, although iron deficiency anaemia in these groups is less common than in menstruating females. 

Manganese is a mineral known to alleviate symptoms of PMS, so women whose interstitial cystitis symptoms are affected by their menstrual cycle should certainly look for a multivitamin with a high level of manganese.  Manganese also contributes to the normal formation of connective tissue, which would of course include the epithelial tissue of the bladder!  I like to see at least 2mg. 

Copper is another mineral involved in normal formation of connective tissue, as well as normal function of the immune system.  Copper deficiency is linked with increased risk of infections, so clearly it is another nutrient important for individuals prone to UTIs or with GAG layer damage in the bladder.  Taking high doses of zinc depletes copper levels, but for some reason many people are fearful of using products that contain copper and it is often left out of multivitamin products.  If your multivitamin contains zinc, it should also contain copper unless you have a good reason to avoid copper.  Be aware that taking copper on an empty stomach makes me feel very nauseous, so if you use a copper-containing product, be sure to take it with some food!    

Although calcium and magnesium are very important minerals, the required daily amount of each is so high that they are rarely present at meaningful levels in multivitamins.  It is almost always necessary to supplement them separately, or to make conscious and consistent efforts to obtain them from food sources.  For this reason, I consider them irrelevant in multivitamin products. 

Together with the information in the earlier blog posts in this series, I hope that interstitial cystitis patients will now feel better equipped to choose multivitamin products that meet their needs.  It’s always annoying to buy a multivitamin and then have to supplement with extra amounts of almost every nutrient on top.  Ideally, we want our multivitamin to eliminate the need for as many bolt-on products as possible!  By keeping in mind the points of this final post in our series, I hope you will be able to choose clean, effective, high-quality vitamin and mineral products that can help you to enjoy better bladder health and general health! 

Join me next time for a very special announcement and in the meantime, take care.

Tiny x

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