
To Pee Or Not To Pee
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Is it “strengthening” to hold, or are we doing ourselves harm if we do? Dr. Heba Shaheed explains in this short video:
A flood of reasons not to hold
Humans should urinate 4–6 times daily, but for many people, the demands of modern life often lead to delaying urination, raising questions about its effects on the body.
So first, let’s look at how it all works: the bladder is part of the urinary system, which includes the kidneys, ureters, urethra, and sphincters. Urine is produced by the kidneys and transported via the ureters into the bladder, a hollow organ with a muscular wall. This muscle (called the detrusor) allows the bladder to inflate as it fills with urine (bearing in mind, the main job of any muscle is to be able to stretch and contract).
As the bladder fills, stretch receptors in that muscle signal fullness to the spinal cord. This triggers the micturition reflex, causing the detrusor to contract and the internal urethral sphincter to open involuntarily. Voluntary control over the external urethral sphincter allows a person to delay or release urine as needed.
So, at what point is it best to go forth and pee?
For most people, bladder fullness is first noticeable at around 150-200ml, with discomfort occurring at 400-500ml (that’s about two cups*). Although the bladder can stretch to hold up to a liter, exceeding this capacity can cause it to rupture, a rare but serious condition requiring surgical intervention.
*note, however, that this doesn’t necessarily mean that drinking two cups will result in two cups being in your bladder; that’s not how hydration works. Unless you are already perfectly hydrated, most if not all of the water will be absorbed into the rest of your body where it is needed. Your bladder gets filled when your body has waste products to dispose of that way, and/or is overhydrated (though overhydration is not very common).
Habitually holding urine and/or urinating too quickly (note: not “too soon”, but literally, “too quickly”, we’re talking about the velocity at which it exits the body) can weaken pelvic floor muscles over time. This can lead to bladder pain, urgency, incontinence, and/or a damaged pelvic floor.
In short: while the body’s systems are equipped to handle occasional delays, holding it regularly is not advisable. For the good of your long-term urinary health, it’s best to avoid straining the system and go whenever you feel the urge.
For more on all of this, enjoy:
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You might also like to read:
Keeping your kidneys happy: it’s more than just hydration!
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From banning junk food ads to a sugar tax: with diabetes on the rise, we can’t afford to ignore the evidence any longer
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There are renewed calls this week for the Australian government to implement a range of measures aimed at improving our diets. These include restrictions on junk food advertising, improvements to food labelling, and a levy on sugary drinks.
This time the recommendations come from a parliamentary inquiry into diabetes in Australia. Its final report, tabled in parliament on Wednesday, was prepared by a parliamentary committee comprising members from across the political spectrum.
The release of this report could be an indication that Australia is finally going to implement the evidence-based healthy eating policies public health experts have been recommending for years.
But we know Australian governments have historically been unwilling to introduce policies the powerful food industry opposes. The question is whether the current government will put the health of Australians above the profits of companies selling unhealthy food.
benjamas11/Shutterstock Diabetes in Australia
Diabetes is one of the fastest growing chronic health conditions in the nation, with more than 1.3 million people affected. Projections show the number of Australians diagnosed with the condition is set to rise rapidly in coming decades.
Type 2 diabetes accounts for the vast majority of cases of diabetes. It’s largely preventable, with obesity among the strongest risk factors.
This latest report makes it clear we need an urgent focus on obesity prevention to reduce the burden of diabetes. Type 2 diabetes and obesity cost the Australian economy billions of dollars each year and preventive solutions are highly cost-effective.
This means the money spent on preventing obesity and diabetes would save the government huge amounts in health care costs. Prevention is also essential to avoid our health systems being overwhelmed in the future.
What does the report recommend?
The report puts forward 23 recommendations for addressing diabetes and obesity. These include:
- restrictions on the marketing of unhealthy foods to children, including on TV and online
- improvements to food labelling that would make it easier for people to understand products’ added sugar content
- a levy on sugary drinks, where products with higher sugar content would be taxed at a higher rate (commonly called a sugar tax).
These key recommendations echo those prioritised in a range of reports on obesity prevention over the past decade. There’s compelling evidence they’re likely to work.
Restrictions on unhealthy food marketing
There was universal support from the committee for the government to consider regulating marketing of unhealthy food to children.
Public health groups have consistently called for comprehensive mandatory legislation to protect children from exposure to marketing of unhealthy foods and related brands.
An increasing number of countries, including Chile and the United Kingdom, have legislated unhealthy food marketing restrictions across a range of settings including on TV, online and in supermarkets. There’s evidence comprehensive policies like these are having positive results.
In Australia, the food industry has made voluntary commitments to reduce some unhealthy food ads directly targeting children. But these promises are widely viewed as ineffective.
The government is currently conducting a feasibility study on additional options to limit unhealthy food marketing to children.
But the effectiveness of any new policies will depend on how comprehensive they are. Food companies are likely to rapidly shift their marketing techniques to maximise their impact. If any new government restrictions do not include all marketing channels (such as TV, online and on packaging) and techniques (including both product and brand marketing), they’re likely to fail to adequately protect children.
Food labelling
Food regulatory authorities are currently considering a range of improvements to food labelling in Australia.
For example, food ministers in Australia and New Zealand are soon set to consider mandating the health star rating front-of-pack labelling scheme.
Public health groups have consistently recommended mandatory implementation of health star ratings as a priority for improving Australian diets. Such changes are likely to result in meaningful improvements to the healthiness of what we eat.
Regulators are also reviewing potential changes to how added sugar is labelled on product packages. The recommendation from the committee to include added sugar labelling on the front of product packaging is likely to support this ongoing work.
But changes to food labelling laws are notoriously slow in Australia. And food companies are known to oppose and delay any policy changes that might hurt their profits.
Health star ratings are not compulsory in Australia. BLACKDAY/Shutterstock A sugary drinks tax
Of the report’s 23 recommendations, the sugary drinks levy was the only one that wasn’t universally supported by the committee. The four Liberal and National party members of the committee opposed implementation of this policy.
As part of their rationale, the dissenting members cited submissions from food industry groups that argued against the measure. This follows a long history of the Liberal party siding with the sugary drinks industry to oppose a levy on their products.
The dissenting members didn’t acknowledge the strong evidence that a sugary drinks levy has worked as intended in a wide range of countries.
In the UK, for example, a levy on sugary drinks implemented in 2018 has successfully lowered the sugar content in UK soft drinks and reduced sugar consumption.
The dissenting committee members argued a sugary drinks levy would hurt families on lower incomes. But previous Australian modelling has shown the two most disadvantaged quintiles would reap the greatest health benefits from such a levy, and accrue the highest savings in health-care costs.
What happens now?
Improvements to population diets and prevention of obesity will require a comprehensive and coordinated package of policy reforms.
Globally, a range of countries facing rising epidemics of obesity and diabetes are starting to take such strong preventive action.
In Australia, after years of inaction, this week’s report is the latest sign that long-awaited policy change may be near.
But meaningful and effective policy change will require politicians to listen to the public health evidence rather than the protestations of food companies concerned about their bottom line.
Gary Sacks, Professor of Public Health Policy, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cranberries vs Strawberries – Which is Healthier?
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Our Verdict
When comparing cranberries to strawberries, we picked the strawberries.
Why?
In terms of macros, cranberries start strong with slightly more fiber and carbs, winning the first round.
In the category of vitamins, cranberries have more of vitamins A, B5, B6, E, and K, while strawberries have more of vitamins B1, B2, B3, B7, B9, and C, scoring them a marginal victory here.
Looking at minerals, cranberries have a tiny touch more copper (as well as more sodium), while strawberries have notably more calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, winning another round easily.
In other considerations, both have beneficial phytochemical properties, but cranberries’ health properties are a mixed bag of good and bad, while strawberries’ offerings in this regard (simply: a greater abundance of polyphenols) are solely good, so strawberries win this round too.
Adding up the sections makes for a clear overall win for strawberries, but do enjoy either or both*, as diversity is best!
*Unless one of the below contraindications applies for you, of course:
Want to learn more?
You might like:
Health Benefits Of Cranberries (But: You’d Better Watch Out) ← cranberries’ bonus properties (including: famously very good at decreasing UTI risk) come with some warnings, including that they may increase the risk of kidney stones if you are prone to such, and also that cranberries have anti-clotting effects, which are great for heart health but can be a risk of you’re on blood thinners or have a bleeding disorder.
Enjoy!
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The Thyroid Connection – by Dr. Amy Meyers
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Many people’s thyroids aren’t doing an amazing job, and instead are underactive or overactive, either of which will have a big impact on many areas of health. And yet, it tends to go underdiagnosed. Why?
Dr. Meyers makes the case that many doctors don’t do the right tests, and if they do, often refer to benchmarks that are based on science that was cutting-edge in the 1970s, and declare things “within acceptable ranges” that are not only not optimal, but also likely to get worse if not addressed.
While advocating for proactive (and more comprehensive) testing, once a thyroid condition is identified, she argues for lifestyle interventions as the thing to try first, since many people’s thyroid conditions can be managed this way without the drawbacks of various medical treatments. Nevertheless she does discuss the medical options too, even if she strongly recommends trying out her 28-day plan first.
The style is very accessible pop-science, with minimal jargon, albeit a generous bibliography. She can be a little bit salesy in her presentation, but it doesn’t take away from the valuable content.
Bottom line: if your energy levels aren’t what they used to be, and you’re not positively sure (i.e. you had tests and understand the numbers) that it’s not thyroid issues, then this book is well-worth checking out.
Click here to check out The Thyroid Connection, and get yours in order!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Cardiac Failure Explained – by Dr. Warrick Bishop
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The cover of this book makes it look like it’ll be a flashy semi-celebrity doctor keen to sell his personalized protocol, along with eleventy-three other books, but actually, what’s inside this one is very different:
We (hopefully) all know the basics of heart health, but this book takes it a lot further. Starting with the basics, then the things that it’s easy to feel like you should know but actually most people don’t, then into much more depth.
The format is much more like a university textbook than most pop-science books, and everything about the way it’s written is geared for maximum learning. The one thing it does keep in common with pop-science books as a genre is heavy use of anecdotes to illustrate points—but he’s just as likely to use tables, diagrams, callout boxes, emboldening of key points, recap sections, and so forth. And for the most part, this book is very information-dense.
Dr. Bishop also doesn’t just stick to what’s average, and talks a lot about aberrations from the norm, what they mean and what they do and yes, what to do about them.
On the one hand, it’s more information dense than the average reader can reasonably expect to need… On the other hand, isn’t it great to finish reading a book feeling like you just did a semester at medical school? No longer will you be baffled by what is going on in your (or perhaps a loved one’s) cardiac health.
Bottom line: if you’d like to know cardiac health inside out, this book is an excellent place to start.
Click here to check out Cardiac Failure Explained, and get to the heart of things!
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An apple cider vinegar drink a day? New study shows it might help weight loss
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Made from fermented apples and naturally high in acetic acid, apple cider vinegar has been popular in recent years for its purported health benefits – from antibacterial properties to antioxidant effects and potential for helping manage blood sugars.
Its origins as a health tonic stretch much further back. Hippocrates used it to treat wounds, fever and skin sores.
An experimental study, released today, looks into whether apple cider vinegar could be effective for weight loss, reduce blood glucose levels and reduce blood lipids (cholesterol and triglycerides).
The results suggest it could reduce all three – but it might not be as simple as downing an apple cider vinegar drink a day.
What did they do?
A group of scientists in Lebanon did a double-blinded, randomised, clinical trial in a group of overweight and obese young people aged from 12–25 years.
Researchers randomly placed 30 participants in one of four groups. The participants were instructed to consume either 5, 10 or 15ml of apple cider vinegar diluted into 250ml of water each morning before they ate anything for 12 weeks. A control group consumed an inactive drink (a placebo) made (from lactic acid added to water) to look and taste the same.
Typically this sort of study provides high quality evidence as it can show cause and effect – that is the intervention (apple cider vinegar in this case) leads to a certain outcome. The study was also double-blinded, which means neither the participants or the scientists involved with collecting the data knew who was in which group.
So, what did they find?
After a period of three months apple cider vinegar consumption was linked with significant falls in body weight and body mass index (BMI). On average, those who drank apple cider vinegar during that period lost 6–8kg in weight and reduced their BMI by 2.7–3 points, depending on the dose. They also showed significant decreases in the waist and hip circumference.
The authors also report significant decreases in levels of blood glucose, triglycerides, and cholesterol in the apple cider groups. This finding echoes previous studies. The placebo group, who were given water with lactic acid, had much smaller decreases in weight and BMI. There were also no significant decreases in blood glucose and blood lipids.
From animal studies, it is thought the acetic acid in apple cider vinegar may affect the expression of genes involved in burning fats for energy. The new study did not explore whether this mechanism was involved in any weight loss.
Is this good news?
While the study appears promising, there are also reasons for caution.
Firstly, study participants were aged from 12 to 25, so we can’t say whether the results could apply to everyone.
The statistical methods used in the study don’t allow us to confidently say the same amount of weight loss would occur again if the study was done again.
And while the researchers kept records of the participants’ diet and exercise during the study, these were not published in the paper. This makes it difficult to determine if diet or exercise may have had an impact. We don’t know whether participants changed the amount they ate or the types of food they ate, or whether they changed their exercise levels.
The study used a placebo which they tried to make identical in appearance and taste to the active treatment. But people may still be able to determine differences. Researchers may ask participants at the end of a study to guess which group they were in to test the integrity of the placebo. Unfortunately this was not done in this study, so we can’t be certain if the participants knew or not.
Finally, the authors do not report whether anyone dropped out of the study. This could be important and influence results if people who did not lose weight quit due to lack of motivation.
Is that you mother? The enzymes in apple cider vinegar might be health-giving.
ShutterstockAny other concerns?
Apple cider vinegar is acidic and there are concerns it may erode tooth enamel. This can be a problem with any acidic beverages, including fizzy drinks, lemon water and orange juice.
To minimise the risk of acid erosion some dentists recommend the following after drinking acidic drinks:
- rinsing out your mouth with tap water afterwards
- chewing sugar-free gum afterwards to stimulate saliva production
- avoiding brushing your teeth immediately after drinking because it might damage the teeth’s softened top layer
- drink with a straw to minimise contact with the teeth.
Rinsing with water could prevent acid damaging your teeth.
ShutterstockDown the hatch?
This study provides us with some evidence of a link between apple cider vinegar and weight loss. But before health professionals can recommend this as a weight loss strategy we need bigger and better conducted studies across a wider age range.
Such research would need to be done alongside a controlled background diet and exercise across all the participants. This would provide more robust evidence that apple cider vinegar could be a useful aid for weight loss.
Still, if you don’t mind the taste of apple cider vinegar then you could try drinking some for weight loss, alongside a healthy balanced and varied dietary intake. This study does not suggest people can eat whatever they like and drink apple cider vinegar as a way to control weight.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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