 Just wish you could sleep through the night without being jolted awake with the need to pee? Well, if this happens to you once in a while, it's probably no issue. But today we're going to discuss why this might be happening on a regular basis, either every night or several times a night. We'll start with men first, but women stay tuned. This is for you as well. Now, first of all, the most common obvious cause of men getting up to go in the night is an enlarged prostate gland. Now, an enlarged prostate gland is incredibly common. 50% of men over the age of 50 actually have an enlarged prostate gland, and it jumps to 80% of men 70 and older. Even scarier, one in nine men will deal with prostate cancer in their lifetime. We recently heard about this happening to King Charles and notoriously to our own Secretary of Defense. So it's a very common problem. Now, are there symptoms that you might have an enlarged prostate? First of all, one of the more common ones is you find yourself getting up once or twice at night to go pee. The other maybe not so obvious is that it takes you a while to standing there to get your stream started and you have to wait and think about it. The other thing that's incredibly common is if you have an enlarged prostate, you actually don't completely empty your bladder. Now, here's a trick that I've learned from my urology colleagues right down the hall from my office in Palm Springs is that once you finish, go do something for 10, 20 minutes and then come back and try again. You'll notice that you have actually quite a bit of urine in your bladder. And particularly if you're planning on making it through the night, men, go to the bathroom about 20 minutes before you plan on going to bed and then do it again right before you go to bed. But one of the things that you're not going to believe me about is that an enlarged prostate is not something that is normal as you get older. I'll say that again. It is not normal to have an enlarged prostate as you age. And there is now significant impressive evidence that prostatic hypertrophy, prostatic enlargement is actually due to leaky gut, to intestinal permeability, to literally bacteria and bacterial particles going directly from the rectum to the prostate. They sit right next to each other and that inflammation in the prostate is what causes prostatic hypertrophy. Now, I'll give you a personal example. I used to have an enlarged prostate, but when I started on my program, miraculously my prostate shrunk. Miraculously. Well, it's not miraculous at all. I stopped seeding my prostate with bacteria and bacterial particles, LPSs, and the inflammation that accompanied that died down. So I'm approaching my mid-70s now and I don't have an enlarged prostate and I don't have to get up at night. So think about that the next time you get up at night and are bothered by that, maybe, just maybe, changing your diet and eliminating leaky gut is just what you're looking for. Now, how do you deal with this? Well, the easiest way is to get my new book gut check. It gives you the whole plan of stopping leaky gut. Or you can come and visit at episode 164 right here with Dr. Mark Stengler's conversation, who gives great advice on how to deal with an enlarged prostate. Are there supplements that can help? There are actually a number of interesting supplements on the market that are certainly worth trying, but you're not really going to impact the underlying cause of this. Are there foods to help? Well, the best foods to help are actually the foods that feed friendly bacteria and avoiding the foods that are going to cause leaky gut. And just to reiterate, try to stay away from almost all grain products except millet and sorghum. Try to stay away from beans unless they're pressure cooked or fermented the appropriate way. Try to stay away from the nightshade family of vegetables. Potatoes, eggplant, tomatoes, bell peppers, goji berries, or peel and de-seed them or ferment them. And women, I haven't forgotten about you. Women do feel a need to be in the middle of the night. Now in my practice, I actually see a lot of women that have irritable bladder. And there are various theories about what causes irritable bladder. And obviously the first that comes to mind is a acute or a low-grade urinary tract infection, a UTI. Now where UTIs come from has been changed subject to debate with the discovery of the human microbiome. In the years we were convinced that most urinary tract infections came from either honeymoon cystitis and one does not need any imagination to imagine where that comes from. But number two, most women were blamed for wiping the wrong way, wiping up rather than down. But in fact, most urinary tract infections have now been traced to particular strains of E. coli, which are prevalent in factory farmed chicken. Now how in the world is that possible? Well, I told you women that pay attention to what was happening to men. The E. coli that you eat colonize your rectum. And they have a direct shot from your rectum to your bladder. And they set up shop inside your bladder. Now what's interesting is that E. coli is capable of not only causing this bladder irritation and infection, but there are some fairly simple maneuvers to make these guys less likely to colonize your bladder. Everybody knows about the benefits of cranberry juice in urinary tract infections and avoiding urinary tract infections in women. But the active ingredient in cranberry juice is a compound called D. mannose. It's actually an interesting sugar molecule that coats E. coli, that prevents them from establishing themselves in your bladder, establishing a biofilm. And I found it particularly effective in my patients. So the dose is 500 milligrams. And I like people to take it at least twice a day, once in the morning and once at night. And it's been very, very useful in my practice. However, there are a lot of women and men for that matter who have irritable bladder that has absolutely nothing to do with urinary tract infection. And what's been interesting to me is that many of my patients with irritable bladder are sensitive to a type of lectin that I've not written about in any of my books previously until gut check because I didn't want people to think I was crazier than everybody thinks I already am. This class of lectins are called aquaporins and there won't be a test. But aquaporins are present in potatoes, white potatoes. They're present in spinach. They're present in corn. They're present in soybeans. They're present in tomatoes and they're present in bell peppers. Oh, and by the way, they're present in tobacco. You'll notice a number of the things I just named are nightshades. These are different than the regular lectins in that they can actually cause bladder irritation. And one of the surprising things is that a number of, particularly my female patients, they're big time spinach eaters or French fry eaters or baked potato eaters and they love their tomatoes. So this is another reason to be on the lookout for these culprits. Now, bad news, with regular lectins you can peel and deseed these particular nightshade family and eliminate most of the lectins. But unfortunately, the aquaporin is in the flesh. And so for you folks, I want you to actually get rid of your peeled and deseeded tomatoes, your peeled and deseeded peppers, your tomato sauces that are peeled and deseeded, your tomato paste, and just see if that makes a difference. I think it might surprise you. We've had some really good success with this in our female patients. I know you want to have your spinach salad, but if you have an irritable bladder, try this trick. Get rid of the spinach for a while. Get rid of your French fries for a while and stop eating popcorn. Now, if none of these signs are your issues, here's what else can be happening. People who have congestive heart failure or who have swelling in their feet or their lower legs, one of the things that happens when you lay down is that all that fluid gets reabsorbed from your feet and legs, and it's pumped back to your heart because you're now flat. And your heart has to dispose of all that extra fluid and it hits your kidneys. So if you have swelling in your lower legs, that's usually the culprit. One of the things you can do early in the evening is stretch yourself out on a couch while you're watching TV or better yet, do exercise snacking where you just do some jumping jacks or dance to a music for two to three minutes and pump that extra fluid back to your heart before you go to bed. Now, the second thing that happens is a great number of us unfortunately drink a lot of water or drink alcohol for dinner or late into the evening and that water has to go somewhere. And so first things first, don't have that glass of water before you go to bed. Secondly, please stay up after drinking alcohol because another thing that's going to really wake you up is that alcohol wearing off about two to three hours after you go to bed and you'll be wide awake. Finally, many, many people unwittingly are woken up by sleep apnea and that sudden need to take a breath because quite frankly, you've become hypoxic. You have low oxygen levels. One of the best ways, if your partner tells you you're snoring, please take that seriously. That snoring is not normal. Get yourself an aura ring, which I have on here. They're relatively affordable. I have no relationship with them except I'm a big fan and an early adapter. Aura rings can actually watch and report the number of times you have episodes of drop in oxygen saturation on your nightly report. And if you see that as a common occurrence or if you see that that episode correlates with you waking up wanting to go to the bathroom, then it's time to get a sleep apnea study. They're actually easy to obtain. They can even be done now at home. You don't have to be overnighted in a sleep apnea center. So last, any other tricks? Well, Dave Asprey recently mentioned using raw honey or MCT oil to help. I certainly haven't seen that in my practice, but I'm not a huge fan of raw honey in the first place because sorry, it's still fructose. Does it have some interesting prebiotics and possibly probiotics? Yes, it does. But I think the benefit outweighs the risk or the risk outweigh the benefit. Again, try D-Manos particularly if you're a woman and see what happens. Okay. Now I know what you're saying. I just wake up at two or three o'clock every morning and it has nothing to do with needing to pee and I can't go back to sleep. And I hear that all the time from a lot of my patients. First of all, once again, please, please, please do not have a heavy meal or drink alcohol and then go to sleep. It's nearly a guarantee that you'll be up in two or three hours. Many of my patients are woken up with heartburn or GERD and that's what wakes them up. One of my tricks, and remember I was a cardiothoracic surgeon for most of my career and we operated on people with GERD, heartburn. And one of the things that we learned very early is we could prevent a lot of heartburn and GERD by having our patients sleep on their side, their left side. Now what happens when you sleep on your left side is you actually, you trap a lot of air in the top part of your stomach called the fundus. And it actually pushes up on your left diaphragm and it's actually one of the main causes of hiccups, by the way. But if you sleep on your left side, that air is basically forced out of your stomach in the form of belching or burping. And that air no longer is going to actually push contents out of your stomach. Now how do you sleep on your side? Well, get yourself some big pillows and put one behind you and one in front of you. There are actually devices, pillows that you can buy on the internet that force you to sleep on your left side. Finally, get yourself a lot of dogs. We have four dogs on our bed and invariably one or two of the dogs luckily lean against my left side, my back side, and kind of force me onto my side. Lastly, I should mention, get yourself dogs that don't want to get up in the middle of the night to go pee. That's a very important consideration that I'm still trying to teach my rescue dogs to do. Finally, listen to your spouse or significant other. If they tell you you're snoring, take that seriously and get yourself a test because that, quite frankly, can save your life. And one of the classic signs of sleep apnea is this waking up at night and can't get back to sleep. Finally, it could be something very physiologic. Around four o'clock in the morning, normally, a hormone called cortisol, the arousal hormone, begins normally rising to get you ready for the morning. It raises norepinephrine adrenaline to get your blood pumping to actually raise your blood pressure so that when you step out of bed being prone, you don't faint when you fall out of bed. The other thing it's trying to do is mobilize sugar so that, believe it or not, you don't faint from lack of sugar when you get up and you'll have plenty of glucose before you break your fast, break fast to get you going in the morning. And sometimes it's just a simple sleep process that is entirely normal. One of the benefits of having dogs is that they will usually get you up around sunrise. And quite frankly, my wife and I get up about five o'clock in the morning because that's the time to get up if you have dogs. So those are the tricks. If you find that late morning, like four o'clock in the morning, five o'clock in the morning, you just can't get back to sleep, that's actually a sign that your cortisol is working properly and a lot of times get a dog and you won't have to fight it anymore. Now, if you're still experiencing all of this, please, please, please, this is something you do not want to ignore. Men, a big prostate can actually damage your kidneys because you do not empty your bladder properly and urine backs up in your kidneys. It's called obstructive uropathy and it's a fixable condition that you want to fix because I've seen too many men damage their kidneys often to the point of no return because they put up with the fact that they have to get up two, three, four times a night because of this big prostate. So if that's you, go see your urologist or at least talk to your family doctor. More amazing episodes just like this one. Watch now to have your body absolutely convinced that there is not a famine, that things are ripe for having a baby or growing a baby or feeding a baby and this is not the time for time-restricted eating.