Why do I need to get up during the night to wee? Is this normal?
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It can be normal to wake up once or even twice during the night to wee, especially as we get older.
One in three adults over 30 makes at least two trips to the bathroom every night.
Waking up from sleep to urinate on a regular basis is called nocturia. It’s one of the most commonly reported bothersome urinary symptoms (others include urgency and poor stream).
So what causes nocturia, and how can it affect wellbeing?
A range of causes
Nocturia can be caused by a variety of medical conditions, such as heart or kidney problems, poorly controlled diabetes, bladder infections, an overactive bladder, or gastrointestinal issues. Other causes include pregnancy, medications and consumption of alcohol or caffeine before bed.
While nocturia causes disrupted sleep, the reverse is true as well. Having broken sleep, or insomnia, can also cause nocturia.
When we sleep, an antidiuretic hormone is released that slows down the rate at which our kidneys produce urine. If we lie awake at night, less of this hormone is released, meaning we continue to produce normal rates of urine. This can accelerate the rate at which we fill our bladder and need to get up during the night.
Stress, anxiety and watching television late into the night are common causes of insomnia.
Effects of nocturia on daily functioning
The recommended amount of sleep for adults is between seven and nine hours per night. The more times you have to get up in the night to go to the bathroom, the more this impacts sleep quantity and quality.
Decreased sleep can result in increased tiredness during the day, poor concentration, forgetfulness, changes in mood and impaired work performance.
If you’re missing out on quality sleep due to nighttime trips to the bathroom, this can affect your quality of life.
In more severe cases, nocturia has been compared to having a similar impact on quality of life as diabetes, high blood pressure, chest pain, and some forms of arthritis. Also, frequent disruptions to quality and quantity of sleep can have longer-term health impacts.
Nocturia not only upsets sleep, but also increases the risk of falls from moving around in the dark to go to the bathroom.
Further, it can affect sleep partners or others in the household who may be disturbed when you get out of bed.
Can you have a ‘small bladder’?
It’s a common misconception that your trips to the bathroom are correlated with the size of your bladder. It’s also unlikely your bladder is smaller relative to your other organs.
If you find you are having to wee more than your friends, this could be due to body size. A smaller person drinking the same amount of fluids as someone larger will simply need to go the bathroom more often.
If you find you are going to the bathroom quite a lot during the day and evening (more than eight times in 24 hours), this could be a symptom of an overactive bladder. This often presents as frequent and sudden urges to urinate.
If you are concerned about any lower urinary tract symptoms, it’s worth having a chat with your family GP.
There are some medications that can assist in the management of nocturia, and your doctor will also be able to help identify any underlying causes of needing to go to the toilet during the night.
A happy and healthy bladder
Here are some tips to maintain a happy and healthy bladder, and reduce the risk you’ll be up at night:
- make your sleep environment comfortable, with a suitable mattress and sheets to suit the temperature
- get to bed early, and limit screens, or activites before bed
- limit foods and drinks that irritate the bladder, such as coffee or alcohol, especially before bedtime
- sit in a relaxed position when urinating, and allow time for the bladder to completely empty
- practice pelvic floor muscle exercises
- drink an adequate amount of fluids during the day, and avoid becoming dehydrated
- maintain a healthy lifestyle, eat nutritious foods and do not do anything harmful to the body such as smoking or using illicit drugs
- review your medications, as the time you take some pharmaceuticals may affect urine production or sleep
- if you have swollen legs, raise them a few hours before bedtime to let the fluid drain.
Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow, Medical Program, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Breathe; Don’t Vent (At Least In The Moment)
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Zen And The Art Of Breaking Things
We’ve talked before about identifying emotions and the importance of being able to express them:
Answering The Most Difficult Question: How Are You?
However, there can be a difference between “expressing how we feel” and “being possessed by how we feel and bulldozing everything in our path”
…which is, of course, primarily a problem in the case of anger—and by extension, emotions that are often contemporaneous with anger, such as jealousy, shame, fear, etc.
How much feeling is too much?
While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?
For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently bad. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.
A good example of this is complicated grief and/or prolonged grief.
But what about when it comes to anger? How much is ok?
When it comes to those around you, any amount of anger can seem like too much. Anger often makes us short-tempered even with people who are not the object of our anger, and it rarely brings out the best in us.
We can express our feelings in non-aggressive ways, for example:
and
Seriously Useful Communication Skills!
Sometimes, there’s another way though…
Breathe; don’t vent
That’s a great headline, but we can’t take the credit for it, because it came from:
Breathe, don’t vent: turning down the heat is key to managing anger
…in which it was found that, by all available metrics, the popular wisdom of “getting it off your chest” doesn’t necessarily stand up to scrutiny, at least in the short term:
❝The work was inspired in part by the rising popularity of rage rooms that promote smashing things (such as glass, plates and electronics) to work through angry feelings.
I wanted to debunk the whole theory of expressing anger as a way of coping with it,” she said. “We wanted to show that reducing arousal, and actually the physiological aspect of it, is really important.❞
And indeed, he and his team did find that various arousal-increasing activities (such as hitting a punchbag, breaking things, doing vigorous exercise) did not help as much as arousal-decreasing activities, such as mindfulness-based relaxation techniques.
If you’d like to read the full paper, then so would we, but we couldn’t get full access to this one yet. However, the abstract includes representative statistics, so that’s worth a once-over:
Caveat!
Did you notice the small gap between their results and their conclusion?
In a lab or similar short-term observational setting, their recommendation is clearly correct.
However, if the source of your anger is something chronic and persistent, it could well be that calming down without addressing the actual cause is just “kicking the can down the road”, and will still have to actually be dealt with eventually.
So, while “here be science”, it’s not a mandate for necessarily suffering in silence. It’s more about being mindful about how we go about tackling our anger.
As for a primer on mindfulness, feel free to check out:
No-Frills, Evidence-Based Mindfulness
Take care!
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The Anti-Stress Herb That Also Fights Cancer
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What does Rhodiola rosea actually do, anyway?
Rhodiola rosea (henceforth, “rhodiola”) is a flowering herb whose roots have adaptogenic properties.
In the cold, mountainous regions of Europe and Asia where it grows, it has been used in herbal medicine for centuries to alleviate anxiety, fatigue, and depression.
What does the science say?
Well, let’s just say the science is more advanced than the traditional use:
❝In addition to its multiplex stress-protective activity, Rhodiola rosea extracts have recently demonstrated its anti-aging, anti-inflammation, immunostimulating, DNA repair and anti-cancer effects in different model systems❞
Nor is how it works a mystery, as the same paper explains:
❝Molecular mechanisms of Rhodiola rosea extracts’s action have been studied mainly along with one of its bioactive compounds, salidroside. Both Rhodiola rosea extracts and salidroside have contrasting molecular mechanisms on cancer and normal physiological functions.
For cancer, Rhodiola rosea extracts and salidroside inhibit the mTOR pathway and reduce angiogenesis through down-regulation of the expression of HIF-1α/HIF-2α.
For normal physiological functions, Rhodiola rosea extracts and salidroside activate the mTOR pathway, stimulate paracrine function and promote neovascularization by inhibiting PHD3 and stabilizing HIF-1α proteins in skeletal muscles❞
~ Ibid.
And, as for the question of “do the supplements work?”,
❝In contrast to many natural compounds, salidroside is water-soluble and highly bioavailable via oral administration❞
~ Ibid.
And as to how good it is:
❝Rhodiola rosea extracts and salidroside can impose cellular and systemic benefits similar to the effect of positive lifestyle interventions to normal physiological functions and for anti-cancer❞
~ Ibid.
Source: Rhodiola rosea: anti-stress, anti-aging, and immunostimulating properties for cancer chemoprevention
But that’s not all…
We can’t claim this as a research review if we only cite one paper (even if that paper has 144 citations of its own), and besides, it didn’t cover all the benefits yet!
Let’s first look at the science for the “traditional use” trio of benefits:
When you read those, what are your first thoughts?
Please don’t just take our word for things! Reading even just the abstracts (summaries) at the top of papers is a very good habit to get into, if you don’t have time (or easy access) to read the full text.
Reading the abstracts is also a very good way to know whether to take the time to read the whole paper, or whether it’s better to skip onto a different one.
- Perhaps you noticed that the paper we cited for anxiety was quite a small study.
- The fact is, while we found mountains of evidence for rhodiola’s anxiolytic (antianxiety) effects, they were all small and/or animal studies. So we picked a human study and went with it as illustrative.
- Perhaps you noticed that the paper we cited for fatigue pertained mostly to stress-related fatigue.
- This, we think, is a feature not a bug. After all, most of us experience fatigue because of the general everything of life, not because we just ran a literal marathon.
- Perhaps you noticed that the paper we cited for depression said it didn’t work as well as sertraline (a very common pharmaceutical SSRI antidepressant).
- But, it worked almost as well and it had far fewer adverse effects reported. Bear in mind, the side effects of antidepressants are the reason many people avoid them, or desist in taking them. So rhodiola working almost as well as sertraline for far fewer adverse effects, is quite a big deal!
Bonus features
Rhodiola also putatively offers protection against Alzheimer’s disease, Parkinson’s disease, and cerebrovascular disease in general:
Rosenroot (Rhodiola): Potential Applications in Aging-related Diseases
It may also be useful in the management of diabetes (types 1 and 2), but studies so far have only been animal studies, and/or in vitro studies. Here are two examples:
- Antihyperglycemic action of rhodiola-aqeous extract in type 1 diabetic rats
- Evaluation of Rhodiola crenulata and Rhodiola rosea for management of type 2 diabetes and hypertension
How much to take?
Dosages have varied a lot in studies. However, 120mg/day seems to cover most bases. It also depends on which of rhodiola’s 140 active compounds a particular benefit depends on, though salidroside and rosavin are the top performers.
Where to get it?
As ever, we don’t sell it (or anything else) but here’s an example product on Amazon.
Enjoy!
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- Perhaps you noticed that the paper we cited for anxiety was quite a small study.
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Calisthenics for Beginners – by Matt Schifferle
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For those who are curious to take up calisthenics, for its famed benefit to many kinds of health, this is a great starter-book.
First, what kind of benefits can we expect? Lots, but most critically:
- Greater mobility (as a wide range of movements is practiced, some of them stretchy)
- Cardiovascular fitness (calisthenics can be performed as a form of High Intensity Impact Training, HIIT)
- Improved muscle-tone (because these are bodyweight strength-training exercises—have you seen a gymnast’s body?)
- Denser bones (strong muscles can’t be built on weak bones, so the body compensates by strengthening them)
A lot of the other benefits stem from those, ranging from reduced risk of stroke, diabetes, heart disease, osteoporosis, etc, to improved mood, more energy, better sleep, and generally all things that come with a decent, rounded, exercise regime.
Schifferle explains not just the exercises, but also the principles, so that we understand what we’re doing and why. Understanding improves motivation, adherence, and—often—form. Exercise diagrams are clear, and have active muscle-groups highlighted and color-coded for extra clarity.
As well as explaining exercises individually, he includes three programs, increasing in intensity. He also offers adjustments to make exercises easier or more challenging, depending on the current condition of your body.
The book’s not without its limitations—it may be a little male-centric for some readers, for instance—but all in all, it’s a very strong introduction to calisthenics… Enough to get anyone up and running, so to speak!
Get started with “Calisthenics for Beginners” from Amazon today!
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How Old Is Too Old For HRT?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝I think you guys do a great job. Wondering if I can suggest a topic? Older women who were not offered hormone replacement therepy because of a long term study that was misread. Now, we need science to tell us if we are too old to benefit from begininng to take HRT. Not sure how old your readers are on average but it would be a great topic for older woman. Thanks❞
Thank you for the kind words, and the topic suggestion!
About the menopause and older age thereafter
We’ve talked a bit before about the menopause, for example:
What You Should Have Been Told About The Menopause Beforehand
And we’ve even discussed the unfortunate social phenomenon of post-menopausal women thinking “well, that’s over and done with now, time to forget about that”, because spoiler, it will never be over and done with—your body is always changing every day, and will continue to do so until you no longer have a body to change.
This means, therefore, that since changes are going to happen no matter what, the onus is on us to make the changes as positive (rather than negative) as possible:
Menopause, & When Not To Let Your Guard Down
About cancer risk
It sounds like you know this one, but for any who were unaware: indeed, there was an incredibly overblown and misrepresented study, and even that was about older forms of HRT (being conjugated equine estrogens, instead of bioidentical estradiol):
As for those who have previously had breast cancer or similar, there is also:
The Hormone Therapy That Reduces Breast Cancer Risk & More
Is it too late?
Fortunately, there is a quick and easy test to know whether you are too old to benefit:
First, find your pulse, by touching the first two fingers of one hand, against the wrist of the other. If you’re unfamiliar with where to find the pulse at the wrist, here’s a quick explainer.
Or if you prefer a video:
Click Here If The Embedded Video Doesn’t Load Automatically!
Did you find it?
Good; in that case, it’s not too late!
Scientists have tackled this question, looking at women of various ages, and finding that when comparing age groups taking HRT, disease risk changes do not generally vary much by age i.e., someone at 80 gets the same relative benefit from HRT as someone at 50, with no extra risks from the HRT. For example, if taking HRT at 50 reduces a risk by n% compared to an otherwise similar 50-year-old not on HRT, then doing so at 80 reduces the same risk by approximately the same percentage, compared to an otherwise similar 80-year-old not on HRT.
There are a couple of exceptions, such as in the case of already having advanced atherosclerotic lesions (in which specific case HRT could increase inflammation; not something it usually does), or in the case of using conjugated equine estrogens instead of modern bioidentical estradiol (as we talked about before).
Thus, for the most part, HRT is considered safe and effective regardless of age:
How old is too old for hormone therapy?
👆 that’s from 2015 though, so how about a new study, from 2024?
❝Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).❞
❝Among senior Medicare women, the implications of menopausal hormone therapy use beyond age 65 years vary by types, routes, and strengths. In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with estradiol rather than conjugated estrogen.❞
Read in full: Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses
As for more immediately-enjoyable benefits (improved mood, healthier skin, better sexual function, etc), yes, those also are benefits that people enjoy at least into their eighth decade:
See: Use of hormone therapy in Swedish women aged 80 years or older
What about…
Statistically speaking, most people who take HRT have a great time with it and consider it life-changing in a good way. However, nothing is perfect; sometimes going on HRT can have a shaky start, and for those people, there may be some things that need addressing. So for that, check out:
HRT Side Effects & Troubleshooting
And also, while estrogen monotherapy is very common, it is absolutely worthwhile to consider also taking progesterone alongside it:
Progesterone Menopausal HRT: When, Why, And How To Benefit
Enjoy!
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Cabbage vs Cauliflower – Which is Healthier?
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Our Verdict
When comparing cabbage to cauliflower, we picked the cauliflower.
Why?
First, let’s note: these are two different cultivars of the same species (Brassica oleracea) and/but as usual (we say, as there are a lot of cultivars of Brassica oleracea, and we’ve done a fair few pairings of them before) there are still nutritional differences to consider, such as…
In terms of macros, cabbage has very slightly more carbs and fiber, while cauliflower has very slightly more protein. However, the numbers are all so close (and the glycemic index equal), such that we’re going to call the macros category a tie.
In the category of vitamins, cabbage has more of vitamins A, B1, E, and K, while cauliflower has more of vitamins B2, B3, B5, B6, B7, B9, C, and choline. Superficially, this is a clear 8:4 win for cauliflower; it’s worth noting though that the differences in amounts are mostly small, so this isn’t as big a win as it looks like. Still a win for cauliflower, though.
When it comes to minerals, it’s a similar story: cabbage has a little more calcium, iron, and manganese, while cauliflower has a little more copper, magnesium, phosphorus, potassium, and zinc. This time a 6:3 win for cauliflower, and again, the margins are small so there’s really not as much between them as it looks like. Still a win for cauliflower, though.
In short: enjoy either or both (diversity is good), but the most nutritionally dense is cauliflower, even if cabbage isn’t far behind it.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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Our ‘food environments’ affect what we eat. Here’s how you can change yours to support healthier eating
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In January, many people are setting new year’s resolutions around healthy eating. Achieving these is often challenging – it can be difficult to change our eating habits. But healthy diets can enhance physical and mental health, so improving what we eat is a worthwhile goal.
One reason it’s difficult to change our eating habits relates to our “food environments”. This term describes:
The collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.
Our current food environments are designed in ways that often make it easier to choose unhealthy foods than healthy ones. But it’s possible to change certain aspects of our personal food environments, making eating healthier a little easier.
Unhealthy food environments
It’s not difficult to find fast-food restaurants in Australian cities. Meanwhile, there are junk foods at supermarket checkouts, service stations and sporting venues. Takeaway and packaged foods and drinks routinely come in large portion sizes and are often considered tastier than healthy options.
Our food environments also provide us with various prompts to eat unhealthy foods via the media and advertising, alongside health and nutrition claims and appealing marketing images on food packaging.
At the supermarket, unhealthy foods are often promoted through prominent displays and price discounts.
We’re also exposed to various situations in our everyday lives that can make healthy eating challenging. For example, social occasions or work functions might see large amounts of unhealthy food on offer.
Not everyone is affected in the same way
People differ in the degree to which their food consumption is influenced by their food environments.
This can be due to biological factors (for example, genetics and hormones), psychological characteristics (such as decision making processes or personality traits) and prior experiences with food (for example, learned associations between foods and particular situations or emotions).
People who are more susceptible will likely eat more and eat more unhealthy foods than those who are more immune to the effects of food environments and situations.
Those who are more susceptible may pay greater attention to food cues such as advertisements and cooking smells, and feel a stronger desire to eat when exposed to these cues. Meanwhile, they may pay less attention to internal cues signalling hunger and fullness. These differences are due to a combination of biological and psychological characteristics.
These people might also be more likely to experience physiological reactions to food cues including changes in heart rate and increased salivation.
Other situational cues can also prompt eating for some people, depending on what they’ve learned about eating. Some of us tend to eat when we’re tired or in a bad mood, having learned over time eating provides comfort in these situations.
Other people will tend to eat in situations such as in the car during the commute home from work (possibly passing multiple fast-food outlets along the way), or at certain times of day such as after dinner, or when others around them are eating, having learned associations between these situations and eating.
Being in front of a TV or other screen can also prompt people to eat, eat unhealthy foods, or eat more than intended.
Making changes
While it’s not possible to change wider food environments or individual characteristics that affect susceptibility to food cues, you can try to tune into how and when you’re affected by food cues. Then you can restructure some aspects of your personal food environments, which can help if you’re working towards healthier eating goals.
Although both meals and snacks are important for overall diet quality, snacks are often unplanned, which means food environments and situations may have a greater impact on what we snack on.
Foods consumed as snacks are often sugary drinks, confectionery, chips and cakes. However, snacks can also be healthy (for example, fruits, nuts and seeds).
Try removing unhealthy foods, particularly packaged snacks, from the house, or not buying them in the first place. This means temptations are removed, which can be especially helpful for those who may be more susceptible to their food environment.
Planning social events around non-food activities can help reduce social influences on eating. For example, why not catch up with friends for a walk instead of lunch at a fast-food restaurant.
Creating certain rules and habits can reduce cues for eating. For example, not eating at your desk, in the car, or in front of the TV will, over time, lessen the effects of these situations as cues for eating.
You could also try keeping a food diary to identify what moods and emotions trigger eating. Once you’ve identified these triggers, develop a plan to help break these habits. Strategies may include doing another activity you enjoy such as going for a short walk or listening to music – anything that can help manage the mood or emotion where you would have typically reached for the fridge.
Write (and stick to) a grocery list and avoid shopping for food when hungry. Plan and prepare meals and snacks ahead of time so eating decisions are made in advance of situations where you might feel especially hungry or tired or be influenced by your food environment.
Georgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin University and Rebecca Leech, NHMRC Emerging Leadership Fellow, School of Exercise and Nutrition Sciences, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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