By Dr. Mercola
Waking up during the night to urinate (nocturia) is the most common lower urinary tract symptom in men, and is thought to affect more than half of men aged 45 and over. Nocturia is more than just a nuisance; it interferes with quality sleep, leaving you irritable, fatigued, and at risk of the myriad of health problems related to insufficient sleep.
If you regularly wake up two or more times a night to urinate (if you wake up three or more times, this is defined as "severe" nocturia), you might want to give exercise a try. You should be exercising regularly anyway, but new research has revealed that it may be of benefit to men with nocturia, in particular.
Exercise May Reduce Nighttime Urination
After analyzing data from thousands of men, researchers found that men who exercised for one or more hours per week were 13 percent less likely to have nocturia, and 34 percent less likely to have severe nocturia, than those who did not.1
While the study couldn't prove that exercise directly reduced nocturia, the researchers did give several reasons why it may help, including reducing body size, improving sleep, reducing inflammation, and decreasing nervous system activity.2
Benefits to nocturia were found with just one hour of exercise a week, which is the bare minimum of physical activity that most people should be getting. I'd encourage you to do more, at the proper intensity, and see for yourself if it helps you to sleep through the night without waking to urinate.
At the very least, research shows that regular exercisers report sleeping better, including falling asleep faster and having a decreased need for sleeping pills, than they did prior to the start of their exercise program,3 and this alone might reduce your number of trips to the bathroom at night.
What Type of Exercise Should You Do?
Over the last several years, researchers have slowly but surely reached the consensus that high-intensity interval training (HIIT), which is characterized by relatively short bursts of intense exercise followed by periods of rest, far outperforms conventional aerobic endurance type exercises.
Not only does it beat conventional cardio as the most effective and efficient form of exercise, it also provides health benefits you simply cannot get from regular aerobics, such as a tremendous boost in human growth hormone (HGH), aka the "fitness hormone." Perhaps best of all, HIIT requires only minutes, compared to hours, each week.
Part of the key that makes HIIT so effective is that it engages far more of your muscle tissue than conventional aerobic cardio exercise. You have three different types of muscle fibers: slow, fast, and super-fast. Only ONE of these muscles, the super-fast fibers, will impact your production of HGH, which is KEY for strength, health, and longevity.
The vast majority of people, including many athletes such as marathon runners, only train using their slow muscle fibers. In fact, neither traditionally performed aerobic cardio nor strength training will work anything but your slow muscles.
These are the red muscles, which are filled with capillaries and mitochondria, and hence a lot of oxygen. The fast type of fiber, which is also red muscle that oxygenates quickly, is five times faster than the slow fibers.
Power training, or plyometric burst-type exercises, will engage these fast muscles. The super-fast ones are the white muscle fibers. They contain far less blood and less densely packed mitochondria. These muscle fibers are what you use when you do anaerobic, short burst exercises.
Different Types of Exercises
High-intensity burst-type exercises are the ones that will engage these super-fast fibers. They're 10 times faster than slow fibers, and activating them is the key to producing growth hormone.
If you're ready to start exercising or want to make sure your program is allowing you to reap maximum benefits, please read my exercise guidance below. Ideally, you'll want to strive for a varied and well-rounded fitness program that incorporates not only HIIT but other types of exercise as well.
- Interval Peak Fitness (Anaerobic) Training: As mentioned, interval training involves alternating short bursts of high-intensity exercise with gentle recovery periods, and are central to my Peak Fitness routine.
- Strength Training: Rounding out your exercise program with a one-set strength training routine will ensure that you're really optimizing the health benefits of your fitness program. You can also "up" the intensity by slowing it down. For more information about using super slow weight training as a form of high-intensity interval exercise, please see my interview with Dr. Doug McGuff.
- Core Exercises: Your body has 29 core muscles located mostly in your back, abdomen, and pelvis. This group of muscles provides the foundation for movement throughout your body, and strengthening them can help protect and support your back, make your spine and body less prone to injury, and improve your balance and stability.
Foundation Training, created by Dr. Eric Goodman, is an integral first step of a larger program he calls "Modern Moveology," which consists of a catalog of exercises.
- Stretching: My favorite type of stretching is Active Isolated Stretching (AIS). With AIS, you hold each stretch for only two seconds, which works with your body's natural physiological makeup to improve circulation and increase the elasticity of muscle joints. This technique allows your body to repair itself and prepare for daily activity. You can also use devices like the Power Plate to help you stretch.
What are the Underlying Causes of Nocturia?
Urinating six to eight times per day is "average." You might go more or less often than that, depending on how much water you drink and how active you are. Increased frequency can be caused by an overactive bladder (involuntary contractions), caffeine, a urinary tract infection (UTI), interstitial cystitis, benign prostate enlargement, diabetes, or certain neurological diseases.
Typically, the amount of urine your body produces decreases at night, which is why most people can sleep for six to eight hours without having to use the bathroom. If you're getting up during the night to urinate, one of the first steps you should try is limiting fluids three or four hours before bedtime. Water, coffee, tea, and alcohol should be restricted during this time.
For men, an enlarged prostate may affect the flow of your urine and is another common cause of nocturia. Men over 70 have a 50/50 chance of developing an enlarged prostate, known as benign prostate hyperplasia (BPH). This does not equal prostate cancer. However, you do need to address this issue, and unfortunately, the conventional route includes drugs. Some of these drugs can do far more harm than good, and certain types actually carry a warning label that if you have benign prostate hyperplasia, the drug may increase your cancer risk, and/or may promote a much more aggressive form of cancer. There are, fortunately, natural methods that can support a healthy prostate. According to Dr. Rudi Moerck:
"There are things you can do with your diet, and there are things you should do, generally, as a male that can help mitigate this problem… [T]he use of saw palmetto by the American Indians, especially in the Southern States where the saw palmetto plant grows, has been around for thousands of years, and has been used for prostate health for thousands of years."
According to Dr. Moerck, the medical literature contains as many as 100 clinical studies on saw palmetto. One of the first prostate drugs on the US market was actually saw palmetto, released by Eli Lilly Company back in the early 1870s.
"The mechanism of action of saw palmetto is not fully clear," Dr. Moerck says. "We are certainly not making any drug claims, but the anecdotal evidence suggests that there is a reduction in the conversion of testosterone into the dihydrotestosterone, and therefore, men that take saw palmetto will have slightly higher levels of testosterone in their body… That's a good thing... It turns out that if you don't have enough testosterone in your body it can cause all kinds of problems like gaining weight, breast enlargement in men, and problem with urinating. So saw palmetto alone, or with pumpkin seed or lycopene is an interesting proposition… It's something that you should definitely try."
I agree with Dr. Moerck, who recommends a daily dose of 320 mg of saw palmetto oil (using a supercritical CO2 extraction process). Quality is extremely important, however. Saw palmetto is an effective supplement, but only if it's from a high-quality source. Unfortunately, more than half of all the saw palmetto products on the market are ineffective for this very reason…
"Most will not work for you because of one very simple reason," Dr. Moerck explains. "Somebody had the bright idea a few years ago to take dried saw palmetto berries, picked in Florida, and grind them up and put them in a capsule. The berries themselves, those so-called green berries, do not have a lot of oil in them—maybe 8-9 percent oil. So if you put 300 or 500 mg of green berry powder in a capsule, you're only going to get 35 mg of oil. Whereas the right dose, the clinically trial dose, is 320 mg."
The highest-quality products are the organic supercritical-extracted saw palmetto oils, which are very dark green in color. Only one or two out of every 20 brands will be of this high quality. You don't want to take saw palmetto on an empty stomach because it's a fat-soluble supplement, so it will not absorb well without a little bit of fat. I recommend taking it with eggs, which contain phospholipids that enhance absorption of fat-soluble nutrients.
Additional Nutrients That are Important for Prostate Health
Another nutrient that works well with saw palmetto is lycopene, and there's a growing body of evidence indicating that lycopene is beneficial for prostate health. One excellent food source is tomatoes, including organic, non-sweetened tomato sauce. Animal studies have shown that of all the carotenoids, lycopene is the one that accumulates in the prostate of male animals, and this holds true for humans as well.
"[T]he prostate is a very important organ. It just so happens to have the urinary tract that goes right through the middle of it. So that when your prostate starts growing or swelling, it will cut off urinary flow… There have been some good reports of lycopene helping that," Dr. Moerck says.
Another nutrient that has been found to offer significant protection against prostate cancer is vitamin K2. Although I don't typically recommend many supplements, vitamin K is one of the few supplements you may want to seriously consider because many people don't get nearly enough of it on a daily basis through fermented foods. This would include natto, Gouda and Brie cheeses, and fermented vegetables (provided you use the proper starter culture), which are excellent food sources of vitamin K2. What else is important for prostate health and, in turn, may help men avoid frequent nighttime urination?
- Pumpkin seeds: Pumpkin seeds have long been valued as an important natural food for men's health. This is in part because of their high zinc content, which is important for prostate health (where it is found in the highest concentrations in the body), and also because pumpkin seed extracts and oils may play a role in treating benign prostatic hyperplasia (BPH, or enlarged prostate). Research suggests that both pumpkin seed oil and pumpkin seeds may be particularly beneficial in supporting prostate health.4
- Vegetables: Foods that support prostate health include vegetables and fruits rich in antioxidants, vitamins, carotenoids, and lycopene. One 2009 study identified tomatoes, cauliflower, broccoli, and green tea as being particularly beneficial for prostate health.
- Sex (exercise for your prostate): One of the reasons for why regular sex promotes male health is that not only does it exercise your prostate, but when a man does not have regular sexual activity, the sperm and other fluids must be reabsorbed into his body. Eventually, that can cause certain immunological issues.
What Else Might Cause Nighttime Urination?
Nighttime urination isn't only a problem for men, of course. It impacts women, too, and can be caused by other health conditions than enlarge prostate, including:5
- Chronic kidney failure
- Heart failure
- High blood calcium level
- Bladder or urinary tract infection
Certain medications, including diuretics, may also cause nighttime urination, as can obstructive sleep apnea and other sleep disorders (often, nocturia resolves when the sleeping problem is under control). And as mentioned earlier, often resolving frequent nighttime urination may be as simple as limiting how much fluid you drink in the evening, especially if you tend to drink caffeine or alcohol after dinner.