Cystitis

I have been meaning to write something up about this all-too-common medical problem for quite some time now. This is a potentially serious condition in the cat and very aggravating and frustrating one in people, especially the chronic interstitial cystitis seen in the human. Sadly, most sufferers are not being told the true nature of “idiopathic cystitis”, which fall right in line with everything else on this site. Hopefully, the following Email to a frustrated cat owner will help.

“Idiopathic” Cystitis: The Food Connection- A Forum Post

Hi,

It was great to hear from you. Sorry for your kitty’s issues. At her age, our typical cystitis is still the most likely issue rather than something like a bladder tumor but the latter is always a possibility. You still have things to do before getting overly concerned about this. Another possibility is a radiolucent (transparent) stone or a bladder polyp, with these being quite uncommon. Also, female cats are much more likely to develop secondary bacterial infections so a culture may be in order if one has not been done. In the male, the vast majority (90%+) of cystitis is sterile (without bacteria) unless introduced through catheterization. The good news is that she is a female and much less likely to suffer from urinary obstruction than the male, although I have had a few cases of stones obstructing females over the past 30 years.

Sadly, the average veterinarian is not aware of the true causes of “idiopathic” cystitis in the cat. I talked with one of the heads of our largest laboratory (Antech Diagnostics) years ago about feline cystitis and he shed some real light on things. He did his Master’s thesis on cystitis and explained to me that the main underlying cause was either a viral or an allergic condition. Turns out, the two are very related and may actually be one in the same.

And once we understand the true nature of inflammation, we can see how these two can be one in the same as the viruses are present inside the cells and the “allergic reaction” can actually be a response of that virus to challenge of their “home”. Viruses are present in the pet’s(and our) body to facilitate adaptation and allergic reactions are a form of adaptation.

So, in the case of feline cystitis, we know that there is a (contagious) virus that can induce cystitis in a cat when taken from a cat with cystitis and given to another susceptible cat. This has been proven in the lab. As a veterinarian, we don’t see cystitis run through a household…usually. However,  it is not uncommon for multiple cats in a household to have cystitis. We have attributed this phenomenon to feeding the same offending food, which is certainly a part of the problem, but is it the food or is it the presence of the virus….or both?

I like to use cancer as an analogy here. Carcinogens don’t “cause” cancer. Viruses do. Carcinogens trigger viruses into causing cancer. This is a very important thing to understand. (New research is also looking into the role of intracellular bacteria in cancer. This also makes sense- www.bacteriality.com) However, one more thing is required for cancer and many other medical problems to occur- an unhealthy/incompetent immune system. All three must come together for cancer to occur. We all have some cancer viruses in our body, many of which are present in our very genome (DNA). We are also constantly bombarded by carcinogens. So, why don’t we get cancer by age 10? Well, some do. It’s called leukemia…or brain tumors…or kidney tumors, etc. However, the vast majority of cancer happens much later because our immune systems are competent enough to kill those cells that are trying to become cancer cells. But, damage that immune system and watch out.

In cystitis, we have something similar. There is a definite interaction between food and the things causing cystitis because prescription diets have done so much to help curb the incidence. BUT, they have not eliminated the problem, have they? Hills has come close but they use corn in their diets and corn is a biggee when it comes to causing illness, as you apparently know about yourself. And things have gotten much worse over the recent past as corn have been genetically modified (Errrh!!!). In fact, I had a cat last week block up on S/D after having been free of any signs of cystitis for the past 6 years. Interestingly, the last episode was almost on this day 6 years ago.

The literature has said for years that cystitis was a Spring/Fall phenomenon. What happens Spring and Fall? Allergies…and viruses. So which is it? Is it both? Do they work in concert? Yes, I believer that they do. Food lectins stimulate viruses inside the cell to cause inflammation. This is true of the intestinal tract, joints, liver, neurons and bladder. In humans, there is a chronic cystitis called interstitial cystitis. You will find that it is greatly affected by foods and additives if you do an Internet search. Celiac sufferers apparently have a disproportionate amount of this condition. That makes sense to me on many levels. Remember: Food lectins (tiny, antibody sized proteins- http://dogtorj.tripod.com/id55.html ) get to every tissue in the body via the bloodstream. They also travel to the bladder through the urine itself. So, the bladder gets a double-dose of these potentially harmful proteins.

And how do we know that these proteins are doing harm? Well, we know through an interesting observation that glucosamine can help chronic cystitis in the cat. How does glucosamine work in the joints in arthritis? By blocking the attachment of inflammatory food proteins to the joint cells. We know this! Glucosamine blocks the attachment of gluten, dairy, soy, corn, nightshades, legumes, etc. so that they cannot cause inflammation in the cells lining the joints. And it works…up to a point. But once the individual becomes highly sensitized to one or more of these proteins, the glucosamine cannot overcome the challenge enough to prevent symptoms. Only elimination of that protein can accomplish this. I take glucosamine to help me fight unseen gluten, dairy, etc. challenges (e.g. eating out).

So, if glucosamine helps feline cystitis and we know how glucosamine works, then we have gained insight into some of the “causes” (triggers) of cystitis, haven’t we?

The key to controlling feline cystitis is the elimination diet- no gluten, dairy, soy or corn (including corn gluten meal and the oils of these foods). We have now disproven the whole ash thing as the “cause”. Whether high-ash diets at least contribute to the magnitude of the crystal formation is still a question. It makes sense that high magnesium diets would play some kind of role.

But more importantly are the facts that we are feeding cats such an unnatural/biologically inappropriate diet in the form of grain-based, dry foods. We know that grain-based diets are the main causes of crystals in the dog and cat and we know that the cat is a carnivore that would eat moist flesh, not dried foods. In fact, cats are not inherently big water drinkers. Thankfully, many adapt to dried kibble diets and do drink a fair amount of water but many of my clients report never seeing their cats drink water. They do it in the typical stealth fashion of the wild cat: Late at night, they go to the watering hole when no one else is around. So, as a result, we have a bunch of subclinically dehydrated cats walking around, with the evidence being that their urine concentration is off the scale when you check it in the lab. This relatively “thick” urine concentrates their urine minerals and contributes to the formation of crystals and stones. The cat needs to get more water and less grains.

We know now that the crystal formation is secondary to the cystitis. This is supported by the fact that we see cystitis without crystals on a regular basis. These bouts often last 3-4 days and are self-limiting. What does that sound like? A viral infection, right? Others go on to develop crystals are even small stones. The most common crystal is called struvite (ammonium magnesium phosphate), which forms in alkaline urine. But now, because of diets formulated to acidify the urine, we are seeing more and more calcium oxalate crystals and stones, which form in acid urine. This is what we get for trying to control something like urine pH unnaturally, right? So, Hill’s had to change their C/D formulations (C/D-S and C/D-O) to one formula called C/D Multi. Hmmm… Now, if they would only get the corn out of the formula. L

Therefore, “YES!”- the diet plays a huge role in the development of cystitis. Like the cancer-causing viruses in pets and people, the virus could have been present in the cat for years and years, even from birth, but did not manifest until the “perfect storm” occurred for the first time- a combination of food lectins inducing the latent virus to act along with the preservatives in the food, the lack of water, and even the time of the year- when histamine levels reach their peak in the cat’s urine. Yes, cats have a high histamine level in their urine, which is either a cause or an effect- likely both. Cells have a tolerance level (I’m convinced, determined by the virus inside that cell) and when that is exceeded, inflammation occurs. So why the increases in Spring and Fall? The added histamine released during inhalant allergy challenge could certainly do it. Histamine is very inflammatory. The fact that cats go out again in Spring and get challenged by the very viruses that cause the cystitis (as they fight and breed) could also be a factor. In Fall, the cold and flu season hits. What virus doesn’t flare up at that time?

But, not all cats have this problem. In fact, most don’t. It’s because, like most “diseases”, cystitis is a syndrome that occurs when multiple factors come together to produce a negative result. Epilepsy is very much the same. It is rare for any of my patients to have any of these conditions as I have been pushing hypoallergenic diets for over 9 years. I do have those who don’t comply though and they are always the ones with the medical issues of allergies, IBS, cystitis and the like. It really is that clear.

The dry foods that meet this criteria are few and far between. The list I have now is:

1)   Life’s Abundance

2)   Felidae

3)   Wellness Core

4)   Sold Gold Indigo Moon

5)   Dick Van Patten Natural Balance Low Calorie

The key is the elimination of all of the “big 4”- gluten (wheat, barley, rye), dairy, soy and corn. You can find multiple canned foods that meet this criteria. You just have to read labels. Friskies, Sheba, Whiskas, and Fancy Feast all have “clean” varieties. In a crisis, in which crystals are being formed, I would feed a canned food exclusively to increase water consumption. Also, change the water frequently, using filtered water if at all possible, to encourage water drinking.

I hope this helps,

John