Tag Archives: elmiron

Elmiron and Aloe Vera Update

aloe vera leavesElmiron has become a very commonly used pharmaceutical in the management of interstitial cystitis which is part of the IC bladder pain syndrome(interstitial cystitis, vulvodynia, chronic prostatitis, IBS, GERD, and fibromyalgia)  For any herbal or pharmaceutical intervention there is always a question overall effectiveness because of other interventions associated with use  Nonetheless it has been shown to be effective in the management of interstitial cystitis
Aloe vera has had a growing popularity in the IC community because of its effectiveness(90% of patients have a 50% reduction of symptoms in 6 weeks) and lack of side effects(Elmiron has an incidence of hair loss that seems higher than its reported 4%)  Certainly aloe is cheaper than Elmiron even with insurance

GAG Layer Disruption and Mannose

 The most well accepted matter science theory as to the cause of interstitial cystitis is that the bladder’s protective glycoprotein layer(aka GAG layer) becomes affected such that the underlying mucosal surface and submucosa are exposed to the urine’s acidity  This acidic submucosal exposure  then produces the bladder wall irritability causing urinary frequency and urgency
From a matter science point of view the reason the GAG layer is damaged is unknown while the energy science understands the process as the hot and mobile qualities affecting the functioning of the bladder  There is as we would expect molecular and energetic transparency since energy and molecules are interchangeable  That is, molecular acidity is represented by the energetic hot quality that leads to IC
Like proteins there are some simple sugars that are not easily made by the body so if these sugars are not readily available in the diet then tissue repair becomes impaired  This is the case with the disrupted GAG layer in which mannose is not available for repair of the damage
The stage is set for repair and that’s where elmiron and aloe which are both able to supply mannose that is deficient in the diet  Aloe molecularly is composed of long chains of mannose molecules   Aloe also does not have the pharmaceutical side effects, improve GI tract function which is usually affected adversely in all diseases of the IC bladder pain syndrome, and has what’s called rasaynana effects  A rasayana has rejuvenative physiologic effects when taken over time which means that reduces the impact of aging, improves decision making, and strengthens and revitalizes the physiology

Forms of Aloe

Elmiron molecule
Elmiron molecule

Perhaps many IC patients will have some flare reaction using aloe vera gel or juice with citric acid as a preservative

The advantage of the freeze dried aloe is that it doesn’t have the need for preservatives such as citric acid which is appealing to those with IC  Some time ago Desert Harvest perhaps to avoid the citric acid preservative began using a freeze dried product in capsule form for IC patients….and maybe the primary reason when they thought of it was to make it more user friendly for patients(everybody is used to taking a pill)Since that time other companies have followed even having powders available  Aloe Farms has such a pill form freeze dried product  In general I have some misgivings about these products because the freeze drying process which may affect the the bioavailablity of the aloe vera herbal nutrient….the rasayana energetic effect of aloe may also be lost since it’s not just about the molecules but also the subtle energetics of the plant which has significant medicinal value
The value of aloe vera gel is that when used as an anupan(serves as a taxicab to take the herbs to targeted tissues) with herbal formulas it can theoretically produce a slow release to the GIT mucosa  Agni is invariably adversely affected so this technique assures that there will be good absorption and assimilation of the herbal mixture  The amount of aloe when used as a anupan is small so citric acid is not a problem  For IC patients using large volumes(6T three times per day) the citric acid could be more of an issue But the remedy is simple….cut back on the dosing
The two brands that don’t have citric acid are George’s and Aloe Farms  Aloe Farms uses Vit C(ascorbic acid)  and potassium sorbate as preservatives  These two gels available don’t have caraggeneen which has concerned the IC community due to studies suggesting the seaweed is carcinogenic in animal studies using large doses(I tend to discount such “unbiologic studies”)  Both available through Amazon or the ic-solutions.tv Amazon store under Health and Personal Care   George’s goes for 7.42 for 32oz and cheaper in the gallon size per oz

George’s gel by their labeling has no preservatives making it a favorable product in the market

Remember that just like pharmaceuticals aloe can become a bandaid so we can go on eating foods that aggravate and produce IC  However when used appropriately to help with symptoms as we make dietary changes makes the most sense

Aloe should not be thought of as THE tool in the tool chest to heal IC but rather as one of the many  Remember that energetically it’s not just one thing that causes IC but a multiplicity of things(foods, incompatible foods, season, lifestyle choices producing too much of the hot quality etc) and so it’s just not one thing that deals with healing IC but a multimodality approach with herbs like aloe vera being one small part

Understanding Chronic Debilitating IC and 5 Things to Do

ChoiceIn the practice of medicine no disease is really the same as someone else’s disease  They all have their nuances of differences   And this is true of IC

No IC bladder pain syndrome is the same from one individual to another  Some have more anxiety and frequency while others have more burning and spasm  Some have other skin and eye conditions associated with their IC  Some are fortunate enough to have a few nonbacterial  “UTIs” and then things seem to rectify themselves and they never have symptoms again

Others are debilitated with symptoms and cannot function  So what’s the definition of chronic IC

The Stratification of IC

The reason that it’s difficult to assess the true prevalence of IC in a given population is that symptoms of the condition can vary widely  Some may have very localized symptoms to the bladder/pelvis and may dissipate over time for one reason or another

Some may struggle with symptoms and then with modifications to diet or using suggested remedies by friends or physicians the symptoms again gradually dissipate over time

These populations of patients are not counted typically in the IC longitudinal surveys  And then there are the men and children affected by the same voiding and pelvic dysfunction that has not as yet been labeled as IC   So you can see that the prevalence of IC may far be underestimated

But then who’s left?  Typically in studies the people with chronic symptoms congregate to form study populations  So what’s chronic IC?

Definition of Chronic IC

Admittedly due to the lateness of detection typically patients have progressed far enough along in their symptom complex that chronicity is part of the picture   Importantly the earlier a clinician can intervene with nutritional information and lifestyle the more likely that the IC will not go onto chronic debilitating disease

Chronic Debilitating IC Definition:  Bladder and/or pelvic pain for greater than 3 years that is constant and that has persisted and increased in intensity and has urologically and gynecologically been shown to have no obvious cause(eg tumor,cancer, bladder stone, ureteral disease)

Now this time frame is arguable but you get the picture that there has to be enough time to establish a pattern of chronicity  This of course is almost always(unless there is relentless pain) punctuated with acute flares

The Value of a Definition

It’s always nice to know where you are on the spectrum of any disease  But even more valuable is to give you an appreciation of what to expect in getting better

Getting better?  Wait, this disease is treatable but not curable   Currently what “treatable” means is that another groping bandaid is applied to try to manage the symptoms   Having trouble?  Try a shortstay in the outpatient surgical unit for a bladder fulguration  Or perhaps low dose Valium

So if one’s open to getting better with IC then you should want to know what to expect

Real Healing Takes Time   The No Bandaid Approach

As you know disease is not created overnight  The imbalance that creates the disease in the body takes time  But slowly but surely the symptoms become full blown and relief is required  So here are 5 things that you should understand and be willing to do if you want to manage your IC effectively

1  Patience and being in it for the long haul    So if you really get this then you realize that it will take time to reverse the imbalance that created the disease in the first place   What’s the time frame?  For every year of imbalance it will take 2 months for the disease course to reverse itself   For example, if you’ve been having problems with symptoms since 1999 then that’s at least 14 years of imbalance exposure which would mean 28 months or +2 years of work  Interestingly most people with IC are an impatient bunch  “I don’t have time to wait for healing to occur  I’ve got things to do, places to go, and people to see”   If you know that about yourself then you have the chance for being more patient about results There is no magic pill with this disease!

2 Choose a healing discipline that can deliver  Obviously the matter science approach with it bandaid approach isn’t working(interstim, bladder distentions, pharmaceuticals)  The energy science approach can affect change but it takes time   Of clinical significance is the now recognized association of fibromyalgia and chronic fatigue syndrome with chronic IC(1)  As IC progresses in its chronic state it’s apparent that patients get sicker  It is at this stage of the disease that the matter science approach to healing comes to a complete standstill in terms of options  It is at this point that the  energy science model of healing can take over due to its understanding of the origin of disease

3 Realize that with chronic disease there is universally a bowel component to the problem  The matter science approach is to micromanage the bladder symptoms when the origin of the disease is at the gut level  Strange as it may sound, IC management requires that the clinician become a bowel health doctor  Otherwise there will be no success  IBS is estimated to be present in the IC population as high as 80%(2) (personally I believe it’s probably 100%..it’s just that the 20% don’t have symptoms severe enough for them to be diagnosed as IBS)  Acid indigestion(GERD) is estimated to be in the range of at least 50%( but again probably higher)  Prelief anyone?

4 Understand a multifaceted approach to disease  There are many causes that brought about the symptom complex of IC  So realize that it will take many different avenues of treatment  So it’s not just one drug(elmiron) or one procedure(interstim) but a multiplicity of interventions from a therapeutic standpoint to bring about change in symptoms

5 Toxicity  Realize that part of the process of healing is detoxification that comes along with the balancing process that occurs with the clearance of symptoms  As a matter of fact the reason that the qualities that produce IC cannot be eliminated from the pelvis is that the toxic load in the pelvis holds them there  So detoxification is mandatory if you are to get relief  But what is detoxification in the mainstream press is not anything close to what real detox is

(1)J Urol. 2010 Oct;184(4):1358-63. doi: 10.1016/j.juro.2010.06.005. Epub 2010 Aug 17

(2)J Urol. 2013 Jan;189(1 Suppl):S66-74. doi: 10.1016/j.juro.2012.11.019

All the best in healing         To Health as a Skill      Dr Bill