15. Urinary

Question 1

What are 3 nutritional considerations for kidney health

Answer 1

• Hydration — essential to allow efficient filtration and elimination. Include around 1.5–2 litres of filtered water daily (requirements vary — consider constitution, climate, level of physical activity).
• Moderate salt intake — high salt is linked with immune cell activation and renal tissue remodelling ↑ risk of kidney disease.
• Avoid high protein diets — ↑ nitrogenous wastes (e.g., urea, creatinine, uric acid) = ↑ kidney demand. Causes an ↑ in GFR (glomerular filtration rate), which can damage kidney structures over time. Animal protein ↑ risk of kidney damage more than plant protein. Relates to ↑ acid load, ↑ phosphate and ↑ risk of disruption to the gut microbiome causing inflammation.

Question 2

What vitamin make the urine bright yellow?

Answer 2

Riboflavin (B2)

Question 3

what does cloudy urine indicate?

Answer 3

an infection

Question 4

what does froth urine indicate ?

Answer 4

proteinuria (and renal disease)

Question 5

what does red/pink urine indicate

Answer 5

heamaturia or beetroot

Question 6

what is a urine colour red flag?

Answer 6

Very dark urine not relieved by drinking more water is a red flag.

Question 7

What is a UIT?

Answer 7

UTI = Inflammation due to infection anywhere in the urinary tract, ranging from the distal urethra to the kidney

Question 8

what is called a UTI in the kidney, bladder and urethra?

Answer 8

UTI in the kidney is called pyelonephritis; in the bladder, cystitis; and in the urethra, urethritis.

Question 9

key signs and symptoms of UTI for kidney, bladder and urethra

Answer 9

• Cystitis: Dysuria, frequent / urgent urination, suprapubic pain / tenderness, foul-smelling / cloudy urine, haematuria, malaise, fever.
• Urethritis: Dysuria, urethral discharge (e.g., purulent, blood), pruritis (e.g., in men near the penile opening), change in voiding patterns.
• Pyelonephritis: Fever, chills, nausea, malaise, mild to extremely severe ‘loin’ discomfort, blood or pus in urine. May be accompanied by lower urinary tract symptoms. This is a red flag — seek medical attention.

Question 10

causes and risk factors of UTI? x9

Answer 10

1* Women (8 x more prevalent) — shorter urethra ↑ the chance of bacteria ascending to the bladder.
2* Menopause — low oestrogen = ↓ vaginal mucus = ↓ monitoring of bacterial species in the area.
3* Pregnancy — mechanical pressure of the growing uterus on the ureter and bladder preventing complete voiding.
4* Sexual activity (in weak terrain) — introduces new bacteria.
5* Elderly — lowered immunity, decreased mobility, ↓ mucin (protects urinary epithelium), ↓ bacterial adherence, ↑ catheterisation.
6* BPH — ↑ risk; can obstruct urine flow causing bladder urinary stasis.
7* Antibiotics — increases the likelihood of opportunistic bacteria proliferating and migrating into the urinary tract. The urinary system contains a unique microbiome that protects against infection.
8* Intestinal dysbiosis — bacteria can translocate from the perianal region and ascend to the genitourinary tract.
9* ‘Gut-vagina-bladder axis’ — bacterial vaginosis (characterised by ↑ anaerobic bacteria e.g., Gardnerella vaginalis, ↓ Lactobacillus and an alkaline vaginal pH) increases UTI risk.

G. vaginalis can ascend into the urinary tract and appears to damage the bladder lining, while reactivating latent E. coli.

Question 11

Natural approach to UTI - what to avoid? x5

Answer 11

1* Simple sugars and refined carbohydrates: negatively impact the microbiome, increase inflammation and compromise immunity.
2* Substances that irritate the urinary tract epithelium, in particular caffeine, diet soft drinks and alcohol.
3* Caffeine and artificial sweeteners — shown to increase detrusor muscle contraction contributing to urinary urgency and frequency.
4* Red meat, pork and poultry — can act as reservoir for uropathogenic E. coli. Can also promote inflammation (arachidonic acid).

5. Also avoid sexual activity in an acute infection, and body cleaning products that contain irritating chemicals.

Question 12

Natural approach to UTI - what to include? x4

Answer 12

1* CNM Naturopathic Diet: Plant-based diets are associated with ↓ incidence of UTIs: phytonutrients are antimicrobial, antioxidant and anti-inflammatory. High fibre content may modulate microbiota, ↓ intestinal pH and prevent growth of E.coli and Enterobacteriaceae.
2* Prebiotic and probiotic foods — to optimise microbiota colonisation.
3* Ensure optimal water intake to flush bacteria through the urinary tract (incl. herbal teas).
4* Cranberry 15–30 ml unsweetened 100% (undiluted) juice daily or 500 mg powder 3x day. Its proanthocyanins ↓ bacterial adhesion to the bladder epithelium.

Question 13

UTI supplements x6 - see prints for functions

Answer 13

1 D-mannose 500mg every 2 hours for 3– 5 days.
2 Vitamin A 5000 iu / day.
3 Vitamin C 500–5000 mg / day in divided doses.
4 Vitamin D Optimise levels
5 Zinc 15 mg: Preventative. Up to 60 mg during an acute infection.
6 Probiotic Lactobacillus spp.
As per label dose. Probiotic powder can be smeared directly inside vaginal wall.

Question 14

herbs for uti x3

Answer 14

• Crataeva (Crataeva nurvala) — a bladder tonic — helps flush the urinary tract, reducing residual urine in which bacteria can flourish. ↓ UT inflammation. Especially indicated for recurrent UTIs.
• Bearberry (Arctostaphylos uva-ursi) — anti-inflammatory and a urinary antiseptic (attributed to the urinary metabolite hydroquinone).
• Cornsilk (Zea mays) — a mild diuretic and urinary demulcent (soothes mucous membranes of the urinary tract).

Infuse dried herb in 500 ml freshly boiled water:
5 g crataeva, 4 g bearberry, 5 g cornsilk. Strain and take 1⁄2–1 cup every 2–4 hrs. Not to be used in pregnancy

Question 15

What is Interstitial Cystitis?

Answer 15

Interstitial cystitis (IC) = a chronic inflammatory condition of the bladder characterised by pain and a sense of pressure.
* It is not associated with infection and does not respond to antibiotic treatment.
* Significantly > in women than men, though it is thought that many men previously diagnosed with non-bacterial prostatitis may actually have IC.

Question 16

Signs and symptoms of interstitial cystitis ?

Answer 16

Mild to intense pressure / pain in bladder and pelvic area (intermittent or constant),
urinary urgency and frequency,
dyspareunia.
Petechial (pinpoint) haemorrhages are often visible on cystoscopy.

Question 17

interstitial cystitis causes and RF ? x4

Answer 17

Causes and risk factors: Definitive cause is not known.
* Injury to the protective glycosaminoglycan layer of the bladder wall. Increases permeability, allowing potassium and chemical irritants in urine to damage underlying tissues.
* Allergic — elevated IgE levels are observed in some cases of IC. Activation of mast cells ↑ histamine and cytokine release = pain.
* Neurogenic pain — excitation of sensory nerves triggers inflammation through release of neuropeptides. Triggers include mast cell activation, stress, autoimmune events (e.g., SLE, IBD).
* Alterations to the urinary microbiome — ↓ Lactobacillus species, ↓ microbial diversity and ↑ pro-inflammatory cytokines observed.

Question 18

Natural approach to interstitial cystitis x4

Answer 18

1* Follow guidelines for UTIs aiming to remove urinary irritants, reduce inflammation and promote microbial balance and diversity.
2* Assess for food allergy / intolerance. Elimination dieto or IgG / IgE antibody testing. Environmental allergy (mould, pollen, mites etc.) — IgE antibody testing.
3* Follow the CNM Naturopathic Diet emphasising antioxidant-rich vegetables alongside anti-inflammatory foods and herbs e.g., oily fish (EPA); turmeric, fresh ginger.
4* Include aloe vera juice (inner leaf gel) — inhibits COX and hence PG2; appears to increase production of glycosaminoglycans.

Question 19

Nutrients for interstitial cystitis (see prints for functions) x2

Answer 19

1. Quercetin 500 mg twice daily =>
   * Anti-allergic; inhibits histamine release from mast cells.
   * Anti-inflammatory; downregulates NF-κB
   and inhibits LOX and COX.
   * Shown to provide significant improvement in
   IC symptoms at 500 mg twice daily over 4 weeks.
2. N-acetyl glucosamine Dosage: 1500– 2000 mg 3 x daily.
   2bis. Chondroitin: 200–400 mg 3 x daily
   * Increase glycosaminoglycan synthesis in the bladder improving mucous membrane integrity.
   * Reduces inflammation by inhibiting inflammatory cytokine formation.
   * In combination with quercetin, have shown significant improvements for IC.

Question 20

herbs for interstitial cystitis x3

Answer 20

• Support with probiotics (Lactobacillus spp.) as outlined for UTIs.
• Corn silk (Zea mays) and marshmallow root (Althaea officinalis) are demulcent, helping to soothe irritation in the urinary tract and relieve pain. Infuse 1⁄2 teaspoon of each in 150 ml boiled water, 3 x daily.
• Gotu kola (Centella asiatica) — improves integrity of connective tissue and heals bladder ulcerations. 500 mg, 2 x daily.
• Castor oil packs over the lower abdominal / pelvic region can help relieve pain. Contains the fatty acid ricinoleic acid, which has shown significant anti-inflammatory effects applied topically. Keep on for a minimum of 30 minutes.

Question 21

What are urinary calculi?

Answer 21

Urinary calculi = formation of crystalline salts and organic matter in the kidney and bladder (gravel).

Question 22

symptoms of urinary calculi

Answer 22

May be asymptomatic or cause debilitating pain (renal colic) if a stone lodges in a ureter.
Other symptoms: Nausea, vomiting, fever.

Question 23

what are the 4 main types of stones

Answer 23

The main types of stones are:
* Calcium oxalate (the most common).
* Calcium phosphate.
* Uric acid.
* Struvite stones — most often caused by chronic bacterial infection (increases alkalinity of urine promoting precipitation of compounds).

Question 24

Urinary Calculi causes and RF ? x

Answer 24

1* Dehydration — urine becomes too concentrated allowing minerals and other compounds to precipitate out of solution, forming crystals.
2* Altered urinary pH — too acidic = calcium oxalate and uric acid stones; too alkaline = struvite and calcium phosphate stones.
3* Dietary acid load (animal protein, dairy, soft drinks i.e., phosphoric acid) is the greatest predictor of calcium oxalate and uric acid stones:
‒ ↑ secretion of calcium (oversaturates urine)
‒ ↓ secretion of citrate (needed to solubilise calcium oxalate in urine)
‒ ↑ excretion of uric acid (oversaturates urine).
4* High table salt intake — increases urinary calcium.
5* Calcium stones are linked to:
6* – A diet low in fibre, high in refined carbohydrates and alcohol.
7* – ↑ Calcium supplementation and possibly a low vitamin K2 status
(not storing calcium in bones) — consider a link with dysbiosis.
8* High intake of oxalate-rich foods (alongside other factors).
9* Low citrate increases urinary calcium. Can result from excess sodium, low potassium, excessive exercise and acid-forming foods.
10* High protein intake, especially animal protein, increases uric acid (a by-product of protein metabolism).
11* Purine-rich foods e.g., organ meats, sardines, chicken (↑ uric acid).

Question 25

Urinary calculi - natural approach

Answer 25

1* Increase fluid intake (distilled, filtered water) at least 8 glasses daily.
2* Alkalise with a plant-based diet high in chlorophyll. Regular green juices / smoothies.
3* Reduce all animal proteins and high purine foods.
4* Reduce salt intake (i.e., table salt), avoid alcohol (↑ uric acid).
5* Increase potassium-rich foods (fruit and vegetables) to reduce urinary calcium. Fruit is also often rich in citrate.
6* Avoid oxalate-rich foods such as spinach, rhubarb, strawberries, beetroot, almonds and cashews.

Question 26

urinary calculi - nutrients x5

Answer 26

1* Magnesium (600 mg / day) as citrate — ↑ the solubility of calcium oxalate and ↓ risk of calcium phosphate and calcium oxalate precipitating out of solution.
2* Pyridoxine (25 mg / day) — reduces endogenous production and urinary excretion of oxalates.
3* Folate (5 mg / day) — for uric acid stones. ↑ purine scavenging and xanthine oxidase inhibition, resulting in ↓ uric acid production.
4* Blackcurrant juice is alkalising and can be used for uric acid stones.
5* Struvite (10–15%) and pure calcium phosphate stones (~5%): use cranberries and betaine-rich foods e.g., beetroot to lower urinary pH.

Question 27

herbs for urinary calculi ? x4

Answer 27

1* Stinging nettle leaf (Urtica dioica) has diuretic properties and is alkalising. Use as a tea: 1 tsp per cup, 3 cups per day.
2* Combine with demulcent herbs to lubricate the urinary tract (e.g., marshmallow root)
3* Lemon juice 1 teaspoon every 1⁄2 hour for two days can help to soften stones. The citric acid component binds to calcium to promote excretion.
4* Castor oil packs can be applied to front, sides and back to reduce inflammation and decrease spasm