Can Food Fight Infection? A View On Diet, Behaviour and Recurrent UTIs with Nutritional Therapist and Intimate Health Specialist Kate Waters

Foundations of Nutrition & UTIs

1. From your perspective as a nutritional therapist, how does diet influence urinary and intimate health?

We need a good foundation of nutrition for our body to function optimally and to repair itself. Food is more than fuel — it provides the information, and building blocks our bodies need for key processes to work properly.

Beyond food, nutritional therapy also considers targeted supplementation. This is where we can use specific nutrients to provide targeted support for e.g. the immune system to function optimally and to help the bladder and surrounding systems recover more effectively.

 

2. Are there specific nutrients or foods that support the urinary microbiome and help maintain balance?

The research is growing on this, but we know that supporting your gut and vaginal microbiome will in turn support your urinary microbiome. Beyond that several nutrients will play a key role by promoting immune function and reducing inflammation:

1. Vitamin D: Vitamin D plays a crucial role in supporting immune function and modulating the body’s defence mechanisms. It also strengthens the urothelial barrier.
2. Omega-3 Fatty Acids: Found in fatty fish, walnuts, flaxseeds, and chia seeds -omega-3’s have anti-inflammatory properties and for cell membrane integrity.
3. Zinc: This mineral is crucial for immune health, helping to support the body's defence against pathogenic bacteria, while also playing a key role in repairing the epithelial lining of the bladder. Found in meat, shellfish and pumpkins seeds.
4. Vitamin A: Supports the integrity of mucosal surfaces, including the urinary tract, and plays a role in immune function, which can help maintain a healthy microbiome. Found in meat especially offal, eggs, then it is converted from orange foods (beta-carotin) to vitamin A in the body, some of us have genetic variants that mean we are not great converters.
5. Sulforaphane-rich Cruciferous Vegetables: Vegetables like broccoli, Brussels sprouts, and kale contain sulforaphane, which has major anti-inflammatory and antioxidant properties, reducing inflammation and supporting healing.  For raw versions (where sulforaphane is most potent as it is heat sensitive) eat rocket, watercress, radishes and mustard leaves or snack on raw broccoli with hummus or create a raw cauliflower salad. The list for this nutrient dense family of vegetables is long!

Prevention & Triggers

3. What types of foods or eating habits may help reduce the risk of recurrent UTIs?

Eating in a way that supports the immune system and reduces inflammation is key. Essentially, a Mediterranean-style diet, full of vibrant, whole foods and "lashings of olive oil", provides a great foundation for general health and resilience against infections like UTIs.

·        Reduce sugar – as sugar can feed harmful bacteria and contribute to inflammation.

• Rich in good quality protein – to support tissue repair and immune function.
• Includes healthy fats – particularly omega-3s from oily fish, nuts, seeds, and generous use of olive oil.
• Abundant in vegetables and fruit – aim for a wide variety of colours to provide a broad spectrum of antioxidants and polyphenols.
• Incorporates unrefined whole grains and legumes – for fibre and nutrients that support gut and immune health.

4. Are there particular ingredients or foods that can irritate the bladder or act as common triggers?

Yes, some foods can irritate the bladder in certain individuals, but it’s highly individual and not universal. Common triggers may include:

• Coffee/Caffeine (+ tannins in tea)
• Acidic foods like vinegar, lemon juice, and tomatoes
• Chilli (but other spices are fine and good for us!
• Alcohol - White wine, beer, cider
• Chocolate
• Fermented foods (only for some)
• Sugar! It’s not good for anyone, keep as a treat.

However, just because these foods appear on a list doesn’t mean they will affect everyone. It’s essential to understand your own body and how it responds, rather than removing foods unnecessarily. Many people with bladder issues tolerate these ingredients just fine. In clinic, I spend more time helping people reintroduce foods they’ve cut out rather than getting them to following restrictive diets like the IC diet.

Food is something we need to put into our bodies every day, but it is also something we can control – having a bladder condition can feel very out of control….so we start cutting out foods, to try and find control but with that we start to fear food. This activates our nervous system to become hypervigilant, causing more fear which in turn increases stress chemicals that can increase pain in the body. When we're hyper vigilant we tighten our muscles, we are not relaxed and that in itself can lead to more bladder symptoms. We then blame the foods we've been eating because we need some control, which in turn leads to more removal of food.

When we take more and more of these foods out of our diet, we reduce the amount of information coming into the body, this in turn can cause the immune system to become more hyper vigilant itself, so you start to react to foods that were previously not a problem, creating histamine reactions or digestive issues. This can cause people to try a low fodmap diet or a low histamine diet, removing even more foods and we see this becoming a self-perpetuating problem where the cycle goes round and round of fear and pain and food creating a complex issue.

5. Many people know that hydration is important — but are there specific fluids (or drinks to avoid) that make a difference?

Hydration is important but also not drinking too much.

Many of my clients have been advised by their health care provider to increase their water content without first checking how much they're drinking. I have had many clients drinking 3+ litres of water, which is a lot (unless you are an athlete who is sweating a lot)! This is going to increase your frequency and urgency simply because you are putting a lot more water in. We want to be somewhere between 1.5 to 2 litres a day. If drinking more water helps your symptoms of course you want to do this but try not to go above 2-2.5 litres and then think about adding in electrolytes because you're going to be flushing them out.

But there can also those who are drinking well under 1.5 litres because liquid makes their bladder hurt. The dehydration however perpetuates problems within the bladder.

When it comes to fluids to avoid, there are several key culprits:

• Coffee
• Alcohol
• Fizzy drinks
• Sugary beverages

Additionally, I’m not a fan of artificial sweeteners. While they may not contain sugar, they still signal to your brain that sweetness has hit the tongue! But because there's no real sugar to be processed, the body then then craves more sweet things. This creates a cycle of sugar cravings and can be disruptive to overall health.

 

Supplements & Natural Support

6. There’s growing interest in natural remedies like cranberry extract and D-mannose. What’s your take on these?

I work a lot with natural remedies in clinic in the form of supplements, chronic conditions definitely need more than just a great diet (although that is the best place to start!). What is important to remember is that every single UTI or bladder condition is completely different to the next person, because you are an individual. So, there is no set protocol of supplements that will work for everyone and it's about what your body needs rather than a blanket approach for everybody.

• D-mannose: This can be particularly helpful for some people, especially when taken in the correct dosage. Research suggests that during an active infection, a dose of 2 grams every 2-3 hours may be necessary to be effective. Maintenance dose is 1g per day. D-mannose works by preventing certain bacteria from sticking to the bladder wall, making it a useful preventive measure for some.
• Cranberry extract: Cranberry contains proanthocyanidins (PACs), which may help reduce bacteria from adhering to the bladder walls, potentially preventing infection. However, it may not be as effective once an infection has already set in. Avoid the sugary cranberry drinks, cranberry is very sour!

7. How do probiotics, fermented foods, or fibre-rich diets factor into UTI prevention and overall intimate health?

Fermented foods and fibre-rich diets are crucial for supporting a healthy gut microbiome. A well-functioning gut creates short-chain fatty acids and other beneficial compounds that help the gut operate optimally. When the gut is healthy, the immune system works more efficiently. Additionally, a healthy gut helps ensure regular bowel movements. When constipation is reduced, there is a lower risk of bacteria translocating to the vagina or bladder, which could potentially increase infections.

Probiotics can be useful in restoring balance to a disrupted microbiome, but it’s important to nurture and feed the microbiome with a good diet first before considering probiotics as a corrective measure.

For the vaginal microbiome though certain probiotic strains of Lactobacillus are particularly helpful. Research has shown that strains like Lactobacillus crispatus and Lactobacillus rhamnosus can be beneficial in supporting the vaginal environment.

Bladder microbiome: The bladder microbiome is still an emerging area of research. It wasn’t until 2014 that Wolfe and his team discovered the bladder microbiome wasn’t sterile! So, we are still learning here. Research suggests that similar strains of Lactobacillus, which are beneficial in the vagina, may also have a role in supporting bladder health. Working on the vaginal microbiome often helps to regulate the bladder microbiome.

 

Lifestyle, Hormones & Behavioural Change

8. How do life stages such as menopause or hormonal changes influence UTIs?

This is a big question! Hormonal shifts at various life stages can impact urinary health. We have some titles for this now. There is the Genitourinary Syndrome of Menopause and the Genitourinary Syndrome of Lactation:

• Menstruating Cycle: Through our cycling years oestrogen levels are lower around menstruation and naturally you will find a shift in the vaginal microbiome at this time. The fluctuations in oestrogen throughout the cycle can influence the amounts of lactobacilli bacteria in the vagina, due to oestrogen supporting the production of glycogen which feeds our beneficial bacteria. When oestrogen is low, lactobacilli will be low. These lactobacilli are important for maintaining a healthy acidic pH - around 3.8 to 4.5. For some they may find they are more prone to UTIs around mensuration, I always start thinking about the vaginal microbiome then.
• Postpartum and Breastfeeding: After childbirth and while breastfeeding, oestrogen levels can be low. Even when menstruation resumes, some women may continue to experience lower oestrogen levels for some time. This can lead to many symptoms similar to menopause.
• Perimenopause and Menopause: The transition into menopause, often spanning 10 or so years of perimenopause, brings significant hormonal shifts. Oestrogen levels can fluctuate between high and low until they settle low as menstruation ceases. These hormonal changes can affect the lactobacilli as mentioned previously and create a more alkaline environment where there is a greater chance of overgrowth pathogenic bacteria, which can contribute to infections, including UTIs.
• Tissue Health: Oestrogen also helps maintain the health and thickness of the vaginal and bladder tissues. During periods of lower oestrogen, such as in menopause, there is a thinning of the vaginal and bladder mucosal membranes, which can lead to increased fragility and irritation. This can create an environment where pathogens are more likely to thrive. Thinner tissues are also more susceptible to friction and damage, which can exacerbate urinary symptoms and increase the risk of infections. There is a lot of research now for vaginal oestrogen therapy to reduce both vaginal and bladder symptoms.

 

9. Are there any behavioural or emotional patterns you see in clients that tend to correlate with recurrent infections?

Obviously, this depends on the individual but as I see a lot of chronic conditions in clinic these are patterns, I observed the most when there are long-term health issues at play:

1. Fear

Fear is the most prevalent emotional pattern in my clients, and it is completely understandable. They are in pain but add in health care providers using 70 year old testing methods which are not accurately finding the bacteria in the bladder, meaning they are being told that their Drs do not know what is wrong with them, or how they can help them further. This adds to the fear, frustration and uncertainty.

Many women experience gaslighting because bacteria is not being found, where they are told it’s “all in their head” or it’s suggested they take antidepressants. One was told recently that she must have phantom limb syndrome because the antibiotics were not working. This exacerbates feelings of fear, and fear activates the nervous system into a hypervigilant state, which as we have discussed can worsen the perception of pain and drive further anxiety and more pain.

As a result, much of my work involves creating a safe space for clients where they feel heard and nurtured, and allowing space so they can slowly start to trust their bodies again. Addressing the fear and its effect on the body is key to helping clients to find resolution of symptoms.

2. People-Pleasing & Poor Boundaries

Many clients have spent their lives saying “yes” to others, prioritizing others' needs over their own. This can be in both work and personal relationships, leading to emotional burnout. The metaphysical definition of bladder problems often relates to feeling “pissed off” which resonates with many of my clients.

Many women I work with have spent so much time nurturing others that they haven’t nurtured themselves. Helping them develop the ability to say “no” when needed and start setting clear boundaries is a huge part of the work. As they start to prioritise their needs to gain a little control over their lives, this can be a vital step in healing.

3. Holding On to Past Trauma

A significant emotional hurdle for many clients is the fear of letting go, this might be around the story of what they have been going through with their illness. Recurrent infections and ongoing health issues can become central to one’s identity. Many clients have been ill for a long time, and their condition has dominated their lives. For some, support groups can become both a source of comfort but also a trigger, as they unintentionally reinforce the fear state, when others are lost in the hopelessness that can come with chronic conditions.

While it is understandable that they may feel victimised by their condition and the medical system, helping them shift from a victim to a survivor mindset is crucial. This shift requires re-framing their experiences and seeing that there is hope for change. It often involves unpacking old patterns and perceptions about themselves and their illness, this can all take a while to unpick! These support groups are so useful (and essential to many) but if you are searching them at midnight or googling your condition this is only going to be driving your hypervigilant nervous system.

 

Alcohol & Intimate Health

10. What impact does alcohol have on urinary or vaginal health? Is it something you recommend limiting for those prone to infections?

Unfortunately, alcohol can have a variety of negative impacts on overall health including disrupting blood sugar levels, interfering with sleep and reducing gut absorption of nutrients. However, I don’t believe in imposing strict restrictions on my clients unless it directly impacts their symptoms. It's important to pay attention to how alcohol affects the body, and if it doesn’t seem to be causing any issues, occasional consumption should not be a problem.

Alcohol Choices and Bladder Impact

Some types of alcohol may be less irritating to the bladder. For instance:

• Spirits like a gin and tonic or vodka with soda may have less of an impact on the bladder compared to fermented beverages like beer or wine.
• If alcohol is consumed, it’s recommended to drink in moderation and to stay hydrated by having water between alcoholic drinks.

 

Balance and Joy in Life

It’s important to maintain balance in life, including enjoying social occasions. Restricting oneself too much or feeling isolated due to food or drink limitations can cause stress and nervous system disruption. If alcohol isn’t causing bladder issues, a social drink in moderation is perfectly fine. However, if alcohol does exacerbate symptoms, it may need to be limited or eliminated.

 

Trends & Tailored Advice

11. Are there any popular dietary trends — like plant-based, low-carb, or keto — that are particularly beneficial or problematic when it comes to UTIs?

I try not to use any specific diet in clinic because all of them come with some sort of restriction and as mentioned earlier when there is food restriction often it goes hand in hand with hyper vigilance and the circle of fear, pain and food. However, if somebody is already eating e.g. a plant based diet or a low carb diet, and it is helping their symptoms then I would just work with them alongside that to make sure there are no nutrient deficiencies. It always comes down to the individual and what their body needs, what their genetic makeup is like but also one person's plant based diet or low carb diet can be completely different to another person's. I’m looking at is there enough protein, are they eating enough variety of veg, are they tired in the afternoon and if so, why? If you’re eating a specific diet but super healthy, loads of energy and sleeping well, then there is no need to change it!

12. What simple, practical tips would you give someone looking to support their urinary and intimate health through food and lifestyle?

Be Mindful of Food Removal: Before cutting out foods based on internet lists or advice from chat forums, carefully assess whether those foods are actually causing a problem for you.

Reduce Sugar Intake & Balance your blood sugar levels. This can help maintain your energy levels throughout the day and support overall health.

Eat lots of different coloured vegetables and make sure there is variety: This helps ensure you're getting a wide range of nutrients that support both gut and intimate health.

Maintain Regular Bowel Movements:  Avoid constipation as it can lead to issues with the bladder and translocation of microbes.

Support Your Vaginal Health: Avoid douching the vagina it’s a self-cleaning organ. You don’t need to use soap on the vulva; water is enough for cleaning!

Be Aware of Microbiome Transfer: Understand that your vaginal and urinary microbiomes can be influenced by others through kissing, touching, or sexual contact. This can introduce new bacteria or disrupt the balance of your microbiome.

Stay Hydrated: Drink enough water but avoid overhydrating.

Support your immune health by ensuring you have sufficient vitamin D and other key nutrients like zinc but also lowering stress levels as stress reduces our immune function.

Nurture Your Nervous System: Practice relaxation techniques like mindfulness or breathwork to help reduce the impact of stress. Sleep is the best thing you can do for your nervous system and for healing! Create a night time routine and go to bed by 10.30pm (boring but essential to heal!).

Manage Fear and Anxiety: Recognize that the fear or anxiety you may be feeling can worsen symptoms. Seeking support and guidance can help you navigate these emotional challenges and reduce their impact on your physical health.

 

13. Do you have a sample “bladder-friendly” daily menu or go-to meals, snacks that you recommend your clients?

I generally avoid giving specific menus because I want my clients to take ownership of their food choices and discover what works best for them. However, I do offer some general principles to guide them:

1. Protein at Every Meal: Ensure there’s a source of protein with every meal. This can be from plant or animal sources.
2. Colourful, Nutrient-Dense Vegetables: Include a variety of fruits and vegetables, especially those with deep colours like reds, blues, and purples. Ensure an abundance of greens like rocket, watercress, broccoli or cabbage.
3. Breakfast: Breakfast doesn’t need to be cereal or toast. Eggs with a side of rocket and watercress or a red lentil dahl with coconut sambal, or a chicken noodle soup.
4. Lunch: I recommend avoiding sandwiches in favour of meals that pack in more nutrition. Soups, leftovers, or a salad bowl are great options. To build a bowl consider black beans, black rice, quinoa, lentils, or buckwheat for carbs, with a protein like tofu, tempeh, prawns, or chicken. Top with greens and colourful vegetables, such as carrot, radishes, sweet potato, green beans, or spring onions. Add herbs like parsley, cilantro, or basil. If you tolerate vinegar or lemon juice, a tangy dressing works well; if not, try a yogurt-based dressing or just olive oil and salt.
5. Evening Meals: Its actually better for us to eat a larger lunch and a lighter evening meal. For dinner, reduce the amount of carbs and focus on protein and vegetables. Ideally, aim to eat before 6-7 PM to allow for a 12-14 hour fast overnight (depending on how your body feels). If you struggle with sleep, a protein snack before bed can help.
6. Snacks: Great snack options include:

• • A handful of nuts and with some fruit
  • Vegetable sticks with hummus
  • Oat cakes with cottage cheese or hummus
  • Miso soup 

 

How can people get in touch with you?

Via my website www.katewaters.co.uk you can contact me via email nutrition@katewaters.co.uk

I have lots of free information on Instagram @katewatersnutrition

or on my Facebook page https://www.facebook.com/katewatersnutrition

Kate Waters

Intimate Health Specialist

Nutritional Therapist Dip CNM mANP CNHC

Behavioural Change Coach mICTAM