Urinary Frequency & Incontinence

Urinary Frequency & Incontinence – Introduction

Many patients commonly experience symptoms of urinary frequency, urgency or incontinence. They may wake 2-4 times at night to urinate, have a sensation of needing to urinate but produce only a small amount of urine, have frequent or even the surprisingly urgent need to urinate during the daytime.

Does this sound familiar? Many of my patients experience some of these symptoms and believe it’s simply a matter of aging, excessive fluid intake, past pregnancies or an enlarged prostate. Many have not discussed their symptoms with their physician out of embarrassment or because they feel the symptoms will not improve because they are an common part of life.

Fortunately, most of these explanations are incorrect. Accumulating evidence suggests that the increasing numbers of individuals in the U.S. with urinary frequency, urgency or hesitation are due to the growing incidence of obesity and the subsequent development of Insulin resistance.

Urinary Frequency, Incontinence and Weight Loss

More than 13 million Americans including 25% of reproductive age women and up to 50% of postmenopausal women are affected by urinary incontinence (the involuntary leakage of urine with physical maneuvers such as coughing or sneezing). Studies also indicate that men have fairly high rates of urinary frequency as well.

Weight has been identified as a risk factor for urinary incontinence and frequency with each 5-unit increase in body mass index (BMI) associated with a 60% to 100% increased risk of daily incontinence. More than 50% of American women are overweight (BMI 25 to 30) or obese (BMI 30 or greater) and the prevalence of obesity is increasing by almost 6% yearly.

Since weight is a modifiable risk factor for urinary incontinence, weight reduction might be an effective treatment for incontinence. And in fact, clinical research has shown that weight loss improves urinary frequency and incontinence.

One study studied overweight (BMI 25 to 30) and obese (BMI 30 or greater) women with urinary incontinence. Those achieving a weight loss of 5% or greater had a 50% or greater reduction in their frequency of urinary incontinent events.

A 50% reduction in incontinent episodes with weight loss is comparable to the improvement observed with the use of prescription medications commonly prescribed for incontinence and urinary frequency. But unlike prescription medications, supervised weight reduction is safe, inexpensive and has few side effects.

Obesity, Insulin Resistance and Carbohydrates

The increasing rate of obesity is associated with the growing incidence of Insulin resistance. Insulin resistance is the metabolic disturbance that causes a wide variety of medical problems such as type 2 Diabetes, Hypertension, abnormal cholesterol, heart disease and strokes, Sleep Apnea, many forms of cancer and Polycystic Ovarian Disease.

Insulin resistance was originally thought to be consequence of obesity but its cause seems to be more complicated than simply being overweight. Accumulating evidence suggests that insulin resistance is more the consequence of the type of foods we ate in excess while becoming overweight or obese than simply eating too many calories. More specifically, insulin resistance is caused mainly by the excess of carbohydrate consumption in your diet than to simply being overweight.

Growing evidence suggests the excessive intake of carbohydrates in the American diet is causing insulin resistance and the subsequent development of the dangerous medical conditions. Medical science has been partially correct believing obesity was associated with the development of insulin resistance and its associated medical complications. While obesity was associated with insulin resistance, it is not the cause of Insulin resistance. The carbohydrates in your diet are the primary cause of both obesity and insulin resistance.

If carbohydrates are the primary cause of insulin resistance then why does weight loss improve insulin resistance as well as urinary incontinence, frequency and urgency? The reason weight loss helps with these conditions is because people significantly reduce their carbohydrate intake when reducing their calorie intake in a weight loss program.

I have many patients who have successfully treated their urinary frequency and incontinence while reducing their carbohydrate intake. Many of these patients didn’t loose a single pound but still had very significant improvement in their urinary symptoms with carbohydrate reduction alone.

Countless studies demonstrate the ability of weight loss to reverse Diabetes, Hypertension, Sleep Apnea and the risk of stroke, heart disease and cancer. Again, what these countless studies were seeing was not the sole beneficial effects of weight reduction per say but the beneficial effects of reduced carbohydrate intake associated with a decrease in caloric intake that is necessary for weight loss.

When viewed in this respect, it’s easy to understand why some individuals at a normal weight still develop Hypertension, Diabetes or Heart Disease while some persons who are obese will not. The difference is the amount of carbohydrates certain individuals eat irrespective of their weight combined with a wide variety of genetic sensitivity to the ill effects of carbohydrates.

It seems some people can eat more carbohydrates than others and not be harmed as much. This variation in genetic susceptibility is demonstrated with some families showing a greater number of family members with Diabetes or Hypertension.

How Do Carbohydrates and Insulin Resistance Cause Urination Problems?

To understand this, you first need to understand how your body controls the function of your bladder. While the general act of allowing yourself to void urine is generally thought to be under your conscious control, the precise timing and coordination required between the relaxation of the urinary outlet valves and the contraction of the bladder muscles to efficiently empty your bladder is done on a subconscious level.

When voiding, your brain needs to relax and then contact the valves at the bladder outlet in precise coordination with the contraction and then relaxation of the bladder muscle. If this is not coordinated correctly, you won’t completely empty your bladder or you’ll experience cramping of the bladder without the physical need to actually void. The coordination required for efficient bladder emptying is performed by a portion of your neurological system known as the Autonomic Nervous System (ANS).

The ANS is a neurological network connecting your brain, spinal column and nerves to every organ in your body. Because of this connectivity, the ANS helps regulate the function of every organ in your body. For example, the ANS is responsible for maintaining your blood pressure, helping your digestive tract to function correctly, assists in maintaining various hormonal levels in the body, helping our pupils to dilate and constrict, regulating your body temperature with the amount we sweat as well as coordinating bladder function.

When the ANS is not functioning normally, we experience common problems such a frequent urination and incontinence, heartburn, bloating or constipation, lightheadedness, decrease mental acuity, fatigue or excessive sweating. Do you have any of these problems?

How Do Carbohydrates Harm Your Autonomic Nervous System?

The precise mechanism of how excessive carbohydrate intake results in damage to the ANS system is not fully understood but evidence suggests that the high levels of carbohydrates in the typical American diet are in excess of a toxic threshold that the brain can tolerate. Another example of this is the excessive effects alcohol can have on our liver and hearts.

Many studies have shown that drink 1-2 alcoholic beverages such as wine per day is seemingly harmless to our health. But its common knowledge that drinking 1-2 bottles of wine per day more than likely will lead to cirrhosis (permanent loss of liver function) of the liver as well as damage to our heart muscle leading to a condition known as cardiomyopathy.

The growing amount of carbohydrates in the American diet over the last several decades has crossed a toxicity threshold in many individuals. The toxic excessiveness of carbohydrate consumption is resulting not only in the diseases associated with insulin resistance but is also damaging our autonomic nervous system.

Remember, the autonomic nervous system controls the function of all the organs in the body. And when the autonomic system is damaged and not functioning properly, we experience symptoms such as bloating, heart burn, lightheadedness, fatigue, excessive sweating, flushing of our skin, constipation as well as urinary frequency, urgency and incontinence.

How Many Carbohydrates Should We Eat?

To answer this question we need to look the evolution of our Stone Age ancestors and the amount of carbohydrates they consumed. Scientific evidence suggests that our primitive ancestors ate a diet that consisted predominantly of animal tissue (protein and fat) and plants known as browsing foliage (dark green leafy plants).

During the Stone Age, carbohydrates were very uncommon in the wild and consisted of occasional roots, wild fruit or honey. A small amount of sugar known as glycogen is also present in uncooked animal muscle. Overall, the availability of carbohydrates was uncommon. Other than being on a tropical island, when was the last time you saw some fruit such as an apple or orange when walking in the woods? These foods do not grow commonly in the wild. They are cultivated plants that became more readily available after the agricultural revolution.

It is estimated that the average American now consumes more carbohydrates per day than our Stone Age ancestors consumed in a year. The amounts of carbohydrates available for human consumption didn’t begin to increase until the agricultural revolution (5,000 -10,000 years ago when man learned to grow grains such as wheat, barley and millet. The domestication of livestock and the consumption of livestock milk became an additional source of carbohydrates (milk sugars) as well.

But 10,000 years is a very small span of time from an evolutionary perspective. Although there may have been a few beneficial evolutionary mutation associated with protection from infectious diseases in the last 10,000 years, science has failed to convincingly demonstrate any adaptive genetic mutations that might have changed with the subsequent marked increase in carbohydrates in the human diet.

To put the evolutionary time span into perspective, if the entire span of human evolution is represented by a 100-yard football field, the last 10,000 years of the agricultural revolution would encompass only the final 1/4 inch of the entire 100-yard field. As you can see, 10,000 years is not a significant amount of time compared to the millions of years required for human evolution.

The point of this is to help you understand that we were designed through evolution to adapt to eating predominantly animal tissue (protein and fat) and low amounts of carbohydrates. We did not develop the metabolic ability to handle such large quantities of carbohydrates in our diet and our bodies are suffering because of it.

It is estimated that the average American consumes more carbohydrates in a day than our Stone Age ancestors consumed in a year. That’s why we are beginning to think the amounts of carbohydrates in our diet are having a toxic effect on our nervous system.

Neuroplasticity and Carbohydrate Reduction

Neuroplasticity is a relatively new scientific concept that our neurological tissue has the ability to bend or recover from mild levels of insult or damage. Neuroplasticity means ‘nervous tissue’ that has the ability to ‘regain its function’ after being altered just as plastic regains it shape after being bent.

After a stroke, patients have the ability to regain some neurological function. After a nerve or the spinal column is damaged by an injury, remarkable degrees of recovery have been known to occur. The recovery in these cases may not be complete in severe cases but can often be complete with mild injuries to the nervous system.

After the Autonomic Nervous System (ANS) is damaged, it too shows a remarkable to recover from the toxic effects of excessive carbohydrates. I have many patients who have completely recovered from heartburn, erectile dysfunction, lightheadedness and urinary disturbances after reducing their carbohydrate intake.

A general exception to neuroplasticity of the ANS is in patients with long standing type 2 Diabetes Mellitus. In this circumstance, the nerves have been severely damaged by the toxic effects of excessively high blood sugar levels as well as the damaging effects of inflammation associated with insulin resistance. Fortunately, most patients who have worked at controlling their diabetes have a good chance at not experiencing the severe and irreversible ANS dysfunction I am speaking of.

How Many Carbohydrates Are Too Much?

What should you reduce your total daily carbohydrate intake to? The average American diet now consists of 50-60% of calories from carbohydrates. Scientific studies suggest that you can greatly improved health if you reduce your carbohydrate intake to approximately 25% of your total daily caloric intake. This is equal to about 125 grams of carbohydrates per day for women and 150 grams per day for men.

First start by reducing the larger amounts of carbohydrates from your diet; start with the frequent servings of potatoes, rice and pasta and the sugar containing drinks. Replace these with more protein containing food items.

After a week or 2, count the grams of the remaining carbohydrates in your daily diets for a few days. They quickly begin to realize the massive volume of carbohydrates they were consuming on a regular basis.

Reducing your carbohydrate intake to 25% of your total caloric intake has a dramatic improvement in the diseases arising from insulin resistance as well as improving your neurological functioning. Your triglyceride and HDL cholesterol levels improve, your blood pressure will be greatly reduced and your blood sugar levels will normalize as your body’s response to insulin to improves.

Carbohydrate reduction has been calculated to have 6-8 times greater power of reducing the risk of cardiovascular disease (strokes and heart attacks) than do the statin medications that are commonly prescribed to lower a persons LDL cholesterol levels. Why treat these conditions with potentially toxic medications when your can prevent and even reverse these conditions by simply reducing your carbohydrate intake.

Autonomic Testing Guides Treatment for Improved Autonomic Function

The autonomic nervous system (ANS) can be tested and evaluated through a process known as spectral analysis.  This simple, quick (15 minute) and painless test can provide the ritical understanding that helps your physician for their treatment plan.

The ANS can become imbalanced in many different ways.  Some ANS dysfunction requires a short course of medication (3-6 months) alone or in concert with nutritional strategies to reduce systemic inflammation and oxidative stress in order for the brain to regain maximal function.  The safest way to reverse heartburn is with a map of your autonomic nervous systems to guide treatment.

Dr. Nemechek often performs autonomic testing prior to initiating treatment for urinary frequency and other autonomic symptoms (lightheadedness, headaches, fatigue, constipation, heart burn, frequent or urgent urination).  To learn more about this technique visit his practice website at www.DrBuckeye.com.


If your experiencing urinary frequency, urgency or incontinence, you have a very good chance of reducing or eliminating these symptoms through the simple reduction of carbohydrates in your diet. The improvement occurs slowly but steadily over a few to several weeks.

If you would like to learn more about how to reduce your carbohydrate intake and lose weight while your doing it, simply go to www.ScienceofHunger.com and download the free Science of Hunger Weight Loss Guide. It’s full of more information about protein, carbohydrates, Insulin resistance and pointers on changing our diet.

And if you have learned something useful from this article, I urge you to pass it on to 1 or 2 of your friends and encourage them to not only improve their urinary function but their overall health as well.

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Patrick Nemechek, D.O.

Patrick Nemechek, D.O.

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