Recurrent Urinary Tract Infections

You must treat the cause of the infection not just the infection.

Antibiotics will kill the infection but if someone keeps getting infections (UTIs) then the underlying cause needs to be treated. Most MDs do not have the time, or knowledge, to investigate the pathophysiology (the physiology behind the pathology). This article covers the two most common contributing factors.

Signs & Symptoms

➤ increased urination

➤ discoloration of urine or cloudy urine

➤ burning urination (sometimes with sharp pain)

➤ blood in urine

➤ unusual odor of urine

➤ back pain

A person can have a UTI without any of the above symptoms. Diagnosis is confirmed with urine analysis. 

Top Two Causes

Recurrent infections means there is a problem causing irritation to the urinary tract system and ultimately compromising immune function which allows for an infection to occur (bacteria are opportunistic and spread where they can). The top two causes are from either the bottom up or from the top down (or a combination of the two). 

From the Top Down

At the top of the urinary tract system are the kidneys. In this scenario, the person is flushing something through the kidneys which is irritating the pee tube (called the ureter) which connects to the bladder. Flushing something means the person's body has identified something as poison and is attempting to rid the itself of it through urinary excretion. This person may have noticed increased urination prior to the infection, especially if there is nighttime urination. The substance they excrete irritates the mucosal lining of the transitional epithelium of the tube which causes inflammation and reduces immune function. 

For example, if someone drinks a lot of beer the body will begin to eliminate the alcohol as a toxic substance. Even though they are drinking liquid, the body metabolizes the alcohol in the liver and then gets rid of it by flushing it out through the kidneys. This explains the dehydration as flushing requires water. The main question for the patient suffering top down irritation is: what are they flushing? It could be alcohol (if they drink often) or it could be a response to a medication they are taking. However, the most common is sugar. If a person develops a carbohydrate metabolic disorder (an abnormal response to carbohydrates) they will not get access to the sugars they eat. The sugars will either convert to fat or get flushed out through the kidneys in the urine (called glucosuria). In the old days, this was referred to as "ant urine" because the ants would go to the urine (because there was sugar in it).

This flushing mechanism can occur even when there is not measurable glucose in the urine as it is a protective flushing response triggered by sensitivity to carbohydrates. For example, I once had a teenage patient that was urinating 8-9 times a night. His other doctors could not figure out the cause and failed to give a diagnosis. After a complete intake, I thought he had dysglycemia (carbohydrate intolerance). I simply reduced the amount of carbohydrates in his diet. Within one week his symptoms were 100% better.

If you think you suffer from UTIs related to dysglycemia, you may want to follow the RESET Food Plan.

Symptoms of Top Down UTIs

➤  craving carbohydrate rich foods or sweets

➤  irritable if haven't eaten (hangry)

➤  shaky between meals or if meals are delayed

➤  increased urinary frequency   

➤  nocturia (nighttime urination)

➤  irritation begins in the urethra (pee hole)  

From the Bottom Up

In this scenario, the problem originates in the vagina itself (not the urethra because the irritation/inflammation is not coming from the kidneys). The vagina is an acidic environment (pH of 3.8 - 4.5) that hosts healthy bacteria which act as a microbiome just like the gut. In fact, think of the gut as the pilot light for a healthy vagina. When the gut microbiome goes down hill then the vagina microbiome (and pH) will also eventually be compromised. The irritation, in this case, begins with an irritated vagina. These patients are worse with sexual intercourse. In the old days, it was referred to as "honeymooner's cystitis" because a romantic weekend full of sex resulted in an infection. However, it's not the sex act. It's the semen. 

Semen is relatively alkaline (pH 7.1 - 8.0). If the vagina is healthy and acidic then it can handle the alkaline semen. However, if the vagina has become more alkaline (not healthy) then the semen worsens and irritates the vagina setting it up for infection. Unfortunately, most MDs will prescribe antibiotics which further disrupt the gut health leading to a vicious cycle of recurrent infections. The patient may even be advised to avoid sex which is not necessary (sex is fine just avoid the semen by using a condom or "pull out"). The ultimate treatment goal for this patient is to improve the health and function of the digestive system.

Symptoms of Bottom Up UTIs

➤  bloated often

➤  gassy (especially if there is foul gas)

➤  abnormal stool patterns (soft, loose, constipated - especially if there is sense of urgency stool)

➤  sticky stool (have to wipe extra)

➤  foul smelling stool  

➤  abnormal vaginal discharge (especially yellowish or smelly)

➤  vaginal irritation or itching  

➤  thick tongue coat (especially if yellowish)  

Treatment

If there is an active infection it still needs to be treated which may involve antibiotics. For my patients, I use plant medicines that are just as effective without disrupting the gut. Once the acute infection is under control then the root cause treatments can be pursued. For top down patients they will need to discontinue consuming the irritating substance. If it is carbohydrate related then they must follow a low carbohydrate diet at least until the symptoms improve and stabilize. For these patients, my clinical treatments will be aimed at supporting kidney function and balancing blood sugars. For the bottom up patients it's all about improving the functions of the digestive system. This includes processes of digestion, assimilation, filtration, and elimination. In each area there needs to be identification of obstructions to normal function and then treatment strategies designed to repair normal function. 

By treating the cause of the infection you will break the cycle of recurrent infections.