Ozone Therapy for Interstitial Cystitis and Bladder Pain Syndrome

Can ozone therapy be used to help treat IC/BPS?  

At a glance:

• All chronic conditions, including IC/BPS, have a root origin that often points to inflammation
• Inflammation is your body’s response to a hidden stressor- and that can be due to infections, environmental toxins, chemicals, radiation, EMF’s, Leaky gut, and stress
• Inflammation can cause pain and tissue damage.
• Cytokines are like hormones of the immune system and are released when the body senses danger or injury. 
• Cytokines can be pro-inflammatory and damaging to delicate tissues of the bladder
• Inflammation associated with IC/BPS is one of the root causes and can often be traced back to chronic infections and immune deficiency
• Oxidative stress occurs when there is an imbalance between the production of free radicals and the body’s defense against the free radical’s harmful effects
• Ozone therapy is promising. Evidence indicates ozone can restore balance to bring the body back to homeostasis to resolve the infections, inflammation and oxidative stress that are triggering the pain and discomfort.

My name is Dr. Mandy LaGreca, founder of IC Healer.  I am a licensed doctor in clinical nutrition (DCN), a Certified Nutrition Specialist (CNS) and a Functional Diagnostic Nutrition Practitioner (FDN-P). I still remember this day like it was yesterday, and I felt like my life was ending. I was told I would have this condition forever.  My 15- year journey with IC/BPS was one of tremendous pain and suffering, but also one that became an opportunity to grow and educate myself so I can free myself from the disease state and bring back homeostasis.  Today, I am in remission from IC/BPS.  I have used the principles of functional medicine and personalized nutrition to identify my root causes and discover healing opportunities from this debilitating condition.  Through this journey, IC Healer was born.

IC Healer is an online clinic designated to helping individuals with IC/BPS to identify their root cause using functional lab testing and a comprehensive health history.  We then use the data from the tests and an in-depth survey to help individuals identify healing opportunities so they can restore homeostasis and ultimately resolve their chronic pain. You can visit us at www.ichealer.com for more information on these programs.

Our Modern Lifestyle puts all of us at risk for developing chronic disease 

I have been blessed to have a plethora of mentors during the past few years that have shaped how I view health and harmony.  Achieving true health is not complicated, but it is not easy in the modern world.  The basic ingredients for true health include very simple ingredients: sunlight, water, nutrients, and good biochemistry. However, the modern world consists of too much time spent indoors, exposure to EMF’s, blue light, computers and cell phones, inadequate exercise, poor food quality, low oxygenation, not enough water, inadequate rest and recovery time, and too much work and stress.  Yes, it is true, some of the luxuries of the modern world (such as electronics and fast food) are also responsible for the exploding rise of chronic illnesses of today.

 All this leads to a biochemistry that has lost balance. And with this loss of balance, cellular function declines, inflammation increases, tissues are damaged, and chronic conditions such as autoimmune disease and cancer can brew.   Our modern world is a perfect environment for chronic disease to develop, and we are all at risk.  Therefore, it is our job to find opportunities to restore balance, and that is where ozone comes into play. 

What is Interstitial Cystitis and Bladder Pain Syndrome?

Interstitial Cystitis and Bladder Pain Syndrome (IC/BPS)  is an inflammatory condition of the bladder that occurs primarily in women (Gaby, 2009). IC/BPS is characterized by urinary frequency, urgency, painful urination and pelvic pain of more than 6 months in duration.  Over 1 million people in the US alone are affected by IC; it can affect men and women of any age, and it also can affect children and adolescents (Grover, Srivastava, Lee, Tewari, & Te, 2011).  IC has been given different names, so often you may hear it referred to as Painful Bladder Syndrome (PBS) or Bladder Pain Syndrome (BPS).  The cause is still considered “idiopathic” or of unknown cause, although many factors such as infection, autoimmunity, and genetic susceptibility could be response for the triggering inflammatory response.  

Chronic Inflammation and IC/BPS Link

Cystitis, or inflammation of the bladder, has a direct effect on bladder function (Grover et al., 2011). The origin can be infectious or non-infectious.  

Infectious origins include many gram positive and gram-negative bacteria such as (Grover et al., 2011):

• Proteus
• Klebsiella
• Citrobacter
• Enterobacter
• Pseudomonas
• Enterococcus faecalis
• Staphylococcus saprophyticus
• Group B strep

Recent studies indicate it is not the infections that directly cause IC/BPS, as it was once thought.  But that the inflammation that the bacteria are promoting are indirectly leading to the pathology. 

Other possible associations with IC include:

• Autoimmunity 
• Oxalates
• Fungal overgrowth/mold toxicity
• Lyme, Bartonella and other coinfections
• Leaky gut
• Autonomic dysfunction
• Exposure to environmental toxins such as mold
• Associations with other conditions such as IBS and SIBO (Turnbell, n.d.)
• Genetics and epigenetics 
• Physical or emotional trauma 
• Genetic predisposition

A central role of inflammation has been confirmed in both human and animal studies.  The conclusion is that regardless of the exact cause, if a noxious stimulus persists for long enough, it can lead to chronic inflammation.  And as a result, we have a perfect storm: a self-reinforcing cycle of persistent inflammation and recurrent injury to the bladder tissue (epithelium) (Sant et al, 2007). 

Ozone to the Rescue: 

The world is facing a resurgence of infectious disease deaths due to organisms easily dispatched in the early days of antibiotics (Rowen, 2018).  We are facing a crisis of antibiotic resistance and chronic infections, such as chronic UTI’s and biofilm infections associated with conditions such as interstitial cystitis. We are finding that these chronic infections cannot be eradicated with antibiotics alone.  This is due to the rapid emergence of resistant bacteria that is occurring worldwide, and this is negatively affecting the efficacy of antibiotics.  Evidence indicates that ozone therapy can be a long practiced and “novel anti-microbial strategy” that may provide the alternate medical shift that can combat the victory of these pathogens (Rowen, 2018).  

Ozone is the strongest naturally occurring oxidant, produced in nature by lighting and UV irradiation.  German doctors used ozone in disinfect wounds during World War I. They later treated blood, a procedure we know today as autohemotherapy. Ozone is directly germicidal, or pathogen killing, and kills 99% of bacteria in a few seconds and is 100X more effective than bleach at killing bacteria (Rowen, 2018).

A very common form of ozone administration is direct application of intravenous gas which has been used for decades as a treatment in Europe (Rowen, 2018). This is known as major autohemotherapy, and it involves removing a certain amount of blood, ozonating it, and then adding the mixture back under gravity.  Include the benefits here for IC/BPS

Ozone gas alone can also be very for the biofilm infections associated with IC/BPS.  Ozone is known to quickly cut through and destroy biofilms. The activity by ozone against resilient biofilm can be particularly beneficial in circumstances where antibiotics generally fail (Rowen, 2018).

How can Ozone help Interstitial Cystitis? 

So, let’s cut to the chase, how does ozone work in the body?

Ozone increases the amount of oxygen in the body, which may help the body to heal by (Minkoff, n.d.):

• reducing the clogging of blood cells
• detoxifying the liver
• improving circulation and oxygen supply
• killing viruses, bacteria and fungus
• improving the activity of the white blood cells
• improving the metabolism of cells
• slowing down the aging process
• upregulating innate antioxidant pathways such as Nrf2
• rebooting the cells that are often stuck in the cell danger response (CDR)

Ozone gas alone can also be very helpful for the biofilm infections associated with IC/BPS.  Ozone is known to quickly cut through and destroy biofilms. This is great news for people who have been dealing with stubborn UTI’s and biofilms.

Ozone to heal tissue damage 

Ozone can also be helpful in promoting tissue repair. Tissue repair involves progressive biochemical and cellular mechanisms in a complex sequence and is initiated at the time of trauma or illness (Neri et al., 2017). In the face of any injury, it is through our natural repair processes that the body recovers and restores its balance. Since the last century, the use of ozone therapy has been proposed in the literature because it is able to influence the oxy-reduction homeostasis. It is considered an alternative treatment for many acute and chronic diseases (Neri et al., 2017).   

Humans are protected from infections through our first line of defense which are the skin and mucous membrane that function as a flexible mechanical barrier. When this barrier is broken, there is a need for repair of connective tissue and regeneration of epithelium.  Ozone can promote an intriguing healing process that begins immediately after injury (Neri et al., 2017) . 

According to Neri et al (2017), all stages of repair are coordinated by growth factors and specific cytokines. Oxygen is considered as a fundamental agent in tissue repair.  Many processes in the body are sensitive to redox balance. These include hemostasis, inflammation, re-epithelialization, vascularization, and nitric oxide activity (Neri, 2017). As a result, ozone therapy in the correct concentration can act in the redox balance to positively support the treatment of wounds. When in contact with organic fluids (at the right concentration) such as saliva, plasma, urine and lymph, ozone powerfully interacts with all tissue components. Ozone can interact with polyunsaturated fatty acids, antioxidants, cysteine, glutathione, and albumin, even with carbohydrates, enzymes, deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) (Neri et al., 2017)

In 2000, Cardoso et al. observed that ozonized water can attenuate the appearance and severity of gastric ulcers, as well as the edema of induced dermal lesions.  He noted that it also acts as a modulator of the inflammatory process by the induction of oxidative stress. In a study in 2005, researchers evaluated adult diabetic patients who had foot ulcers located at the extremities of the body. They observed that in relation to the group treated with antibiotics, the group that received ozone therapy showed a significant decrease in lesions (Martínez-Sánchez et al., 2005)

Redox balance

Ozone therapy can, when in therapeutic doses, act as a non-toxic “therapeutic shock” to the body. This is because it can restore the balance of the redox state through changes in the physiological response. This response may be useful in the treatment of metabolic, inflammatory, infectious and neoplastic disease (Neri et al., 2017).

During normal metabolism, immune cells suck as osteoclasts, platelets, lymphocytes, neutrophils, monocytes and fibroblasts can induce the formation of reactive oxygen species (ROS).  When there is overproduction of ROS, oxidative stress occurs, which is the cause of many diseases, such as cancer and autoimmunity. The therapeutic use of ozone can promote a non-toxic oxidative stress, which consequently induces modifications at the cellular level capable of reversing another preexisting oxidative stress.

In a study carried out by Re et al. in 2008, it was proven that ozone is capable of promoting the increase and preservation of endogenous antioxidant systems, thus promoting an oxidative precondition. Similar results were found in the study by Gracer et al in 2005, which described that the application of ozone in inflamed tissue may favor the synthesis of extracellular matrix, as well as cell proliferation and metabolic normalization.

Ozone for intestinal dysbiosis

Ozone can also be useful to rebalance the gut microbiome.  Dysbiosis is defined as a disruption and alteration of the normal microbial flora.  Intestinal dysbiosis can lead to a set of symptoms and disease involving organs or systems that are far from the gut, and that includes the bladder. It is caused by the functional change in the intestinal lining and the composition of the bacterial flora. Some of the common symptoms include poor digestion, swelling, constipation and diarrhea, mucous in the stools, mood changes, sleep disturbances, vaginal candidiasis, halitosis, headaches, food intolerances, chronic gastritis, and allergies to name a few (Loprete & Vaiano, 2017). 

 In an observational study in 2017 by Loprete and Vaiano, they studied the therapeutic effects of ozonated water and rectal insufflation on 34 patients suffering with intestinal dysbiosis.  The scientific rational for using ozone was based on both a direct and indirect metabolic effects, and also a biological effect.  Metabolically, ozone may accelerate the use of glucose by the cells, increasing the availability of ATP in the cells and the tissues.  There may be some modification of protein metabolism and unsaturated fatty acids that can also can promote a healthier gut terrain.  Biologically, there is a systemic anti-bacterial and antiviral effect.  There also is evidence of increased oxygen transport at the level of the red blood cells.  Through the effects of peroxide, there may be benefits in helping increase the body’s own defenses against pathogens, but also facilitating the metabolism of erythrocytes.  

The results of the study were promising.  All participants found significant improvement from the first treatment, which became even more significant over time until the end of the study.  Based on the results of the study, the authors concluded that the synergy of the approach should be considered a fundamental method in the treatment of intestinal dysbiosis in those patients that are resistant to other treatments.  

Concluding remark

In my clinical practice, I do various nutritional and functional lab tests to identify imbalances in a patient’s biochemistry.  These include full genome stool testing to identify the extent of microbial dysbiosis as well as full genome vaginal testing and PCR urine testing. Other tests include functional nutritional assessment (such as the Nutreval/Metabolomix test) that identify nutritional needs based on enzymes that are involved in systemic biochemical pathways.  Hair tissue analysis testing, toxin testing (such as mycotoxin, glyphosate, pesticides burden), functional blood chemistry testing, iodine testing.  I also really love doing nutrigenomic testing to tie in the missing pieces to why some of their pathways are struggling to reboot. All these provide clues as the areas a patient would need to support their biochemistry to restore homeostasis.  

Ozone is often recommended when a patient is need of additional support when nutritional strategies alone are not effective.  I will often recommend patient start with rectal and vaginal insufflations or ozone suppositories first.  If they have access to a generator, they can also make ozonated water to drink along side of the treatment.  If they respond well, they may want to consider IV treatments.  A last resort would be direct application of ozone in the bladder, which would have to be conducted with a qualified health provider trained in administering ozone internally.  

I truly believe that with the right tools, Interstitial Cystitis and Bladder pain syndrome can be put to remission for most patients.  I have seen it with my own patient population in my clinic.  The number of interventions needed and the time it takes to heal depends on each patient’s unique circumstances.  For me personally, it has taken me about 3-5 years to completely free myself of bladder pain, but I was a very unique severe case.  Most people with multi-pronged systems approach can notice improvements right away.  Ozone therapy is promising as a adjunctive tool to help support the process and shorten the timeline. 

References 

Cardoso CC, Carvalho JC, Ovando EC, Macedo SB, Dall'Aglio R, Ferreira LR. Action of ozonized water in preclinical inflammatory models. Pharmacol Res. 2000 Jul;42(1):51-4. doi: 10.1006/phrs.1999.0646. PMID: 10860634.

 Gaby, A. R. (2009). Nutritional approaches to prevention and treatment of gallstones. Altern Med Rev, 14(3), 258-267. 

Grover, S., Srivastava, A., Lee, R., Tewari, A. K., & Te, A. E. (2011). Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol, 3(1), 19-33. doi:10.1177/1756287211398255

Loprete, F., & Vaiano, F. (2017). The use of ozonated water and rectal insufflation in patients with intestinal dysbiosis. Ozone Therapy, 2. doi:10.4081/ozone.2017.7304

Martínez-Sánchez, G., Al-Dalain, S. M., Menéndez, S., Re, L., Giuliani, A., Candelario-Jalil, E., . . . León, O. S. (2005). Therapeutic efficacy of ozone in patients with diabetic foot. Eur J Pharmacol, 523(1-3), 151-161. doi:10.1016/j.ejphar.2005.08.020

Neri, J., Lomba, E., Karam, A., Reis, S., Marchionni, A., & Medrado, A. (2017). Ozone therapy influence in the tissue repair process: A literature review. JORDI - Journal of Oral Diagnosis, 2, 1-6. doi:10.5935/2525-5711.20170032

Rowen, R. J. (2018). Ozone therapy as a primary and sole treatment for acute bacterial infection: case report. Med Gas Res, 8(3), 121-124. doi:10.4103/2045-9912.241078

Turnbell, L., Mullin, Gerard, Weinstock, Leonard. (n.d.). Systemic Signs of Underlying Digestive Dysfunction and Disease. Principles of Integrative Gastroenterology. 

Sant, G.R., Kempuraj, D., Marchand, J.E. and Theoharides, T.C. (2007) The mast cell in interstitial cystitis: role in pathophysiology and pathogenesis. Urology 69(4 Suppl): 3440.

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