**5.1.1 Dietary and lifestyle modification**

A common sense approach to the treatment of patients with OAB should include counseling patients on dietary and lifestyle modification that may improve their symptoms and quality of life. In general, patients should increase awareness of amounts and types of fluids consumed, especially as it relates to their symptoms. Although not well studied some foods and beverages are believe to increase detrusor activity and symptoms of OAB. The authors recommend that patient's begin to eliminate one food or beverage at a time from the following list:

	- Alcoholic
	- Caffeinated (Coffee, Tea)
	- Carbonated
	- Tomatoes and tomato-based products
	- Spicy foods
	- Citrus juice and fruits
	- Artificial sweeteners
	- Chocolate
	- Corn syrup
	- Sugar
	- Honey

In one study patients with caffeine intake > 400 mg/day were shown to be 2.4 times more likely to have detrusor overactivity. (Arya, et al., 2000) In addition, limiting fluid intake has been shown to reduce frequency and urgency as well as improve quality of life in patients with OAB. (Milne, 2008 and Swithinbank et al., 2005)

Although weight loss is a good lifestyle modification, in general, it has been shown to significantly improve only stress urinary incontinence symptoms, but not OAB symptoms. A large randomized trial of overweight and obese women with urinary incontinence symptoms underwent an intensive 6 month weight loss program compared to a group with a structured education program. (Subak et al., 2009) Mean weight loss was 8 percent (7.8 kg) and 1.6 percent (1.5 kg) in the intervention and control groups, respectively. The authors found that weekly incontinence episodes decreased by 47 percent in the intervention group compared to only 28 percent in the control group. Of note, is that these patients had a significant decrease in stress incontinence, but not urge incontinence episodes.
