I often recommend quercetin to my clients that I educate on supplements that are beneficial for modulating inflammation. During my research on the benefits of quercetin, I found some interesting literature that seems promising in the therapy of bladder conditions. UTI’s are one of the most common bacterial infections of the bladder and account for almost 95% of all the visits to physicians for UTI’s (Wang et al., 2012). Patients with acute cystitis always have symptoms of dysuria and increased frequency and urgency of urination. As I have already experienced, this can seriously affect a person’s quality of life. The incidence of acute cystitis is high, and the course of acute cystitis is urgent. If acute cystitis cannot be treated promptly, it will be transformed into chronic cystitis. “It can also be transformed into cystitis glandularis, and finally into bladder cancer. It can also induce nephritis. Therefore, timely treatment of acute cystitis is necessary” (Wang et al., 2012).
Currently, acute cystitis is commonly treated by systemic application of antibiotics and anti-inflammation agents. However, only a small amount of systemically administered drugs can reach the bladder. In recent years, the anti-inflammatory effect of querctin (QU) has been well recognized, demonstrating promising clinical application. Recently, it was found that QU can be used to prevent interstitial cystitis (Wang et al., 2012). There are many quercetin containing supplements available in the market, and some of them specifically aimed to treat the bladder. One of them, Cystoprotek, contains QU and rutin with the aims of reducing bladder wall inflammation (Theoharides, Kempuraj, Vakali, & Sant, 2008). Unfortunately it was recently pulled off the market. An older product, Cysta-Q, was shown to provide symptomatic improvements in patients with IC (Katske et al., 2001). Personally, neither of these supplements did anything significant for my IC symptoms at the time I was taking them. This could be due to the inability of the active ingredients to reach the bladder.
Another product that seems promising is Perque Repair Guard. The antioxidant value is of 12 servings of fruits and vegetables. It has 1g of quercetin per tablet. And other healing ingredients such as pomegranate juice powder, OPC, magnesium, chlorophyll, turmeric, and vegetable fiber.
Interestingly, some clinicians are exploring intravesical administration. This means directly instilling the drug solution into the bladder through a urethral catheter, ensuring maximum delivery of active ingredients to the bladder (Wang et al., 2012). According to Wang et. al, the bladder is an idea organ for regional therapy because it urethra provides easy access of the therapeutic agent to the bladder (Wang et al., 2012). In addition, intravesical drug administration has other potential benefits such as avoiding the first-pass metabolism, increasing drug utilization and reducing system toxicity and side effects (Wang et al., 2012). The study conducted by Wang et. al involved encapsulating nanoparticles of water soluble QU into micelles to ensure proper absorption. The results of this study found that intravesical application of the micelles did not induce any toxicity to the bladder. Even better, intravesical administration of QU micelles efficiently reduced the inflammation of the bladder with E. coli-induced acute cystitis. Results indicated that the quercetin micelle treatment can efficiently reduce the edema and inflammatory cell infiltration of the bladder in an E. coli-induced acute cystitis model (Wang et al., 2012). The data from this study proved the hypothesis that QU had potential application in acute cystitis therapy. I am looking forward to seeing future studies in the application, as there are millions of men, women, and even children suffering from this very debilitating condition!
Katske, F., Shoskes, D. A., Sender, M., Poliakin, R., Gagliano, K., & Rajfer, J. (2001). Treatment of interstitial cystitis with a quercetin supplement. Tech Urol, 7(1), 44-46.
Theoharides, T. C., Kempuraj, D., Vakali, S., & Sant, G. R. (2008). Treatment of refractory interstitial cystitis/painful bladder syndrome with CystoProtek–an oral multi-agent natural supplement. Can J Urol, 15(6), 4410-4414.
Wang, B. L., Gao, X., Men, K., Qiu, J., Yang, B., Gou, M. L., . . . Wei, Y. Q. (2012). Treating acute cystitis with biodegradable micelle-encapsulated quercetin. Int J Nanomedicine, 7, 2239-2247. doi:10.2147/ijn.s29416
I have been very interested in histamine and histamine intolerance from the time I was first diagnosed with IC and noticed that allergy medications helped me during flare-ups. It is well known that there is an involvement of mast cells and cystitis related pain. “Interstitial cystitis has been found in combination with some allergic or autoimmune disorders and histopathological abnormalities resembling allergic disorders, including mast cell activation, histamine release, and eosinophil infiltration” (Lee, Doggweiler-Wiygul, Kim, Hill, & Yoo, 2006). Clinical studies demonstrate elevated mast cell numbers in the lamina propria of IC bladder biopsies. This may explain why neuromodulatory therapies suggest are partially effective in IC therapies, as “neural-immune interactions play a role in IC pathogenesis” (Rudick, Bryce, Guichelaar, Berry, & Klumpp, 2008). Mast cells contain preformed stores of immune mediators, such as histamine and TNF, and can be activated to release these stores by neurotransmitters such as substance P, a polypeptide thought to be involved in the synaptic transmission of pain and other nerve impulses. It is hypothesized that the activation of bladder related circuits in the CNS initiate substance P by peripheral nerves in the bladder can promote mast cell activation, mediated by substance P (Rudick et al., 2008). The mast cells are thought to induce bladder inflammation by acting on the bladder epithelium (lining). Also, increased levels of urinary histamine metabolites have been detected in IC patients. This is thought to be due to the accumulation of mast cells in the lamina propria.
A role for histamine and histamine receptors in pain responses has been documented in both humans and animal models. “However, histamine can be derived from various cell types, including mast cells, basophils, and histaminergic neurons” (Rudick et al., 2008). More recently, inflammatory cells such as neutrophils and dendritic cells have been shown to produce histamine. In fact, it has been demonstrated in various clinical settings that antihistamine therapy improves IC-related pelvic pain, and the mechanism for this effect is unknown. However, it can be inferred that this is due to histamine activation. Irritable bowel syndrome (IBS) is another chronic condition that resembles IC in the characteristics of pathology. “In IBS, pain is correlated with activated colonic mucosal mast cells in proximity to nerves” (Rudick et al., 2008). In fact in IBS, colonic tissue extracts often reveal elevated histamine. These findings support the idea that mast cell histamine may mediate pain in multiple pelvic pain syndromes (Rudick et al., 2008).
With my clients, we have a test I run by Dunwoody that can test for histamine intolerance. This test will measure histamine levels, DAO (an enzyme that breaks down histamine), and DAO: histamine ratio. Classic symptoms of histamine intolerance include gas, high blood pressure, arrhythmia, nausea, hives, stomach ache, itching, cramps, headache, sneezing, dizziness, congestion, runny nose, shortness of breath, especially after meals containing histamine. Low DAO is also associated with the same symptoms along with inflammation, arthritis and certain neurological conditions such as MS. Low DAO is also associated with leaky gut and poor gut function and immunity. It can also be a trigger for depression and anxiety. Individuals with the inability to break down histamine seem to “react to everything” or seem to improve on anti-histamines. I have to mention that the low histamine diet, combined with DAO enzyme before meals, has been shown to be really helpful in managing IC pain related to mast cells. To really get on the road to healing and run some of the key functional tests, contact me at firstname.lastname@example.org so I can better guide you!
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References:Lee, J., Doggweiler-Wiygul, R., Kim, S., Hill, B. D., & Yoo, T. J. (2006). Is interstitial cystitis an allergic disorder?: A case of interstitial cystitis treated successfully with anti-IgE. Int J Urol, 13(5), 631-634. doi:10.1111/j.1442-2042.2006.01373.x
Rudick, C. N., Bryce, P. J., Guichelaar, L. A., Berry, R. E., & Klumpp, D. J. (2008). Mast cell-derived histamine mediates cystitis pain. PLoS ONE, 3(5), e2096. doi:10.1371/journal.pone.0002096