Incontinence Problems at Any Age

June 29, 2020

Most people are surprised that food may be impacting incontinence problems. Listen in as two nutritionists share foods tha are known bladder irritants. Plus those that can help strengthen and maintain key muscles necessary for bladder control.

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Transcript:

KARA: Welcome to Dishing Up Nutrition! Today's show is brought to you by Nutritional Weight & Wellness. My name is Kara Carper and I'm a licensed nutritionist. I also have a master's degree in holistic health and I'm very excited to be here this morning with my co host Melanie Beasley. Melanie is a registered and licensed dietitian. She has been practicing nutrition for three decades, I think, in a variety of settings, but...

MELANIE: You don't always need to say that. haha!

KARA: Well, okay, sorry. You would never know by looking at you Mel, but both Mel and I we've personally had our share of health challenges over the years. Some of you maybe have even heard some of our personal stories if you've tuned in for many years. And if you also have health challenges, we understand. We know what you're going through. We also understand the importance of eating real food to conquer those health challenges. So we want to welcome you and welcome all of our listeners to today's show. And the topic of our show today is Incontinence Problems at Any Age. And isn't that interesting because you always think incontinence is just, you know, someone's getting older, but it really can affect a lot of different ages.

MELANIE: Every, every age. You know, from...

KARA: Bedwetting...

MELANIE: Bedwetting from the time you're little, you know, up until end of life. It can affect people. It affects quality of life. So I'm really excited that we're talking about this and putting things out on the table for people to think about. Good morning everyone. I bet some of you are thinking, "what is my diet and nutrition have to do with incontinence or lack of bladder control?" Well, many of our clients have said to us, "I thought my problem was a structural problem and only my doctor could help me, certainly not a dietitian or a nutritionist." I don't know about you Kara, but they fill out a lengthy wellness form to come in for us to look at it. And that's one of the questions on there. So some of you may also be thinking the exact same thing. So it may be surprising to know that a large number of our clients ask us for help with incontinence, which is defined as involuntary loss of urine. But Kara you and I were talking about it's more than just, you know, expand a little bit on what you were saying that you had listened to that medical...

KARA: Oh yeah, I was just listening to a doctor. She was a urologist and she was just discussing kind of like the criteria for diagnosing incontinence and, you know, it's the involuntary loss, but it's also the frequency, that urgency, you know, "I have to get to the bathroom right away. I can't wait." Also night, you know, nighttime frequency is one of the diagnoses as well. You know, if people are getting up two or more times per night that would fall under incontinence as well.

MELANIE: Yes. And it affects, it affects sleep, which we've talked about before.

KARA: Definitely. Yeah.

MELANIE: And because incontinence is such a very personal topic, it can also be rather embarrassing to a significant number of people. Many people feel uncomfortable talking about it even to their doctor. And when we bring it up, I think they, they're almost relieved to have someone to discuss that issue with. For that reason, we want to get into this topic, get it out in the open. As a dietitian who's helped numerous people overcoming incontinence. I believe your food choices can work magic on the symptoms of incontinence. Kara and I are going to talk about the foods that are certainly considered bladder irritants. We will also talk about foods that help strengthen and maintain certain key muscles that are necessary for bladder control.

KARA: And incontinence - it's a really common problem, like we already mentioned for both men and for women. And in fact, 25 million adults in our country suffer from incontinence. 75 to 80% are women. That's probably not a surprise. In reality, you know, one in four women over the age of 18 will experience episodes of leaking urine. And, and this is the statistic that kinda got me is that half of women over 60 struggle with this. But again, it can happen to under 60 as well.

MELANIE: Absolutely.

KARA: And stress urinary incontinence - that that's just kind of a, not a separate diagnosis, but kind of a subcategory that usually shows up, you know, after childbirth and after menopause for women and then some prostate cancer treatment can also trigger incontinence for men.

MELANIE: Yes. And I'm getting men to talk about it in clinic, I find too that they're happy to bring it up, but you have to bring it up first because people just assume, well, this is just who I am. I'm getting older. This is my portion that I have to deal with now, not knowing that there can be some help. Well, have you noticed the number of TV ads for disposable incontinent products now?

KARA: Yes. I have.

MELANIE: Some people call them adult diapers. I don't like that. I think it's um... In 2018, $5 billion were spent on the purchase of incontinence products. The cost of these incontinence supplies can easily be 200 to 300 per month. The national association for incontinence reports that the psychological costs of urinary incontinence can be depression, isolation, decreased self esteem, and work-related difficulties.

KARA: Wow. Yeah. And I mean, even the sleep piece to think about how lack of sleep, if you're getting up several times at night and you don't get that quality or length of sleep that can affect mood, that can affect work performance, immune system. So it's a big issue. And why is incontinence so prevalent? Well, one reason it could be from following a low fat, low calorie style of eating in addition to not eating enough protein. And often those will go together. So, and a lot of, you know, we say women because I think a lot of women are, you know, wanting to lose weight and they're working, they're trying to do this by going fat free, low calorie. And that automatically sort of cuts out a lot of protein in the diet because if they're trying to avoid fat you're, you're not getting a lot of protein. So following a low fat, low protein diet has left some people with weak pelvic floor muscles and thin fragile tissues in the urethra. So it's a lack of beneficial, healthy fats and then a short changing the amount of protein that you're getting that could really have a direct influence on incontinence. And I always tell clients how important it is to eat sufficient amounts of beneficial healing fats. I mean, I feel like we're always kind of trying to promote the healthy fats, right Mel?

MELANIE: We are. We're trying to overcome decades of fear of fat. Fat phobia.

KARA: It is. Probably 40 to 50 years of that. So... but those healing fats really work to... they hydrate all tissues, but they, you know, particularly for this topic, they hydrate the tissues of the urinary tract. And then eating sufficient protein - that's really key for building muscles. Well guess what? That can also help with building bladder control muscles. We need those critical muscles to be flexible and strong and think about the control mechanism of your shutoff valve for urination as it needs healthy fat to be able to turn that on and off. So you don't want your shutoff valve to be stuck in the on position, kind of that leaky bladder. And you don't want to not have enough strength in your pelvic floor muscles to stop that flow of urine. You know, so it is important to remember that that is a muscle.

MELANIE: It is a muscle. And I am, you know, I, I believe a lot of women, most women have probably heard of the kegel exercise and that was the attempt, always the attempt to help with muscle building. What kinds of fats are considered healing fats? Which fats hydrate those key tissues and what fats are damaging them? Let's talk about that. Well, these beneficial healing fats are olive oil, coconut oil, avocado oil, a safflower mayo, nuts, olives, cream, and butter. Nobody's suffering there. You need to eat those delicious fats.

KARA: They do. That's where we get our flavor, right? From all those wonderful fats.

MELANIE: It makes everything delicious. The fats you want to avoid are damaged, refined fats, such as soybean oil, vegetable, canola oil, corn oil, and cottonseed oil. And oh my goodness. I remember 20 years ago teaching that these were the good oils and...

KARA: The vegetable oils. Right. Right.

MELANIE: The vegetable oils. And now we know, let's face it, many food manufacturers are still using these damaged fats, even in light of the research. In their processed food products, you'll find damaged fats. Here's one example: cotton seed oil can be found in many prepackaged bag of nuts. So we're picking up those nuts thinking we're getting healthy. And I tell my clients, "the front of the package is designed to sell you. The back of the package informs you." So roll it over. Look at the ingredients. That's all I want you to look at and look for cotton seed oil. Look for soy oil. It can be found in a lot of these. Remember to always check your food labels because these refined damaged fats can lead to stiff and inflexible tissues, which may in turn cause your shutoff valve to not work very well.

KARA: And we don't want that. We definitely don't. It is actually time for our first break. So we're going to talk more about that when we come back and you're listening to Dishing Up Nutrition, it's brought to you by Nutritional Weight & Wellness. As nutritionists and dietitians, we're often asked this question, "what supplements can help with incontinence?" One of my favorite supplements for tissue hydration, it's the activated form of an Omega six fatty acid. It's called GLA, which stands for gamma linoleic acid. To hydrate their tissues, I suggest that clients take six of these soft gels per day, preferably taking with meals, maybe two with each meal. After about a month, you know, people start to notice improvement with skin, eyes, things get more hydrated. And so it's, it's really just kind of hydrating tissues, which means that the urethral tissues will also be hydrated and we will be right back.

MELANIE: Welcome back to Dishing Up Nutrition. The supplement I always recommend for incontinence is magnesium glycinate. And for people who experienced more constipation, I recommend mixed magnesium. It's well known that magnesium is a mineral that all of our cells rely on to function well. A common sign, a common sign of magnesium deficiency is muscle cramps, charlie horses, toe cramps. And when the bladder is magnesium deficient spasms can occur, which leads to urinary incontinence. Because magnesium is a mineral, I suggest taking 400 to 600 milligrams of magnesium glycinate at bedtime. And it'll help relax your muscles and provide you with that better, blissful sleep.

KARA: Magnesium is really our friend. You know...

MELANIE: It's my favorite mineral.

KARA: You were saying before, before the show, I said, I think everyone should take magnesium, but I mean, really it is about three out of four people are known to have a magnesium deficiency.

MELANIE: Yes, but you know you want to caution our listeners to just running out and grabbing any magnesium.

KARA: Yeah, good point.

MELANIE: I had a client this week and she was having so much trouble with diarrhea and she'd run out and grabbed a magnesium and a form of it that causes diarrhea and is poorly absorbed, so you gotta be careful.

KARA: Right. And that's why you particularly recommended the glycinate or the mixed magnesium actually has some glycinate and citrate in it. It's a nice combination. So that is really important. Now before break, I mean, our show today is incontinence and we were just talking about how healthy, healing fats can really hydrate the tissues and how protein can help to support the pelvic muscle. And we need both of those things when there's incontinence. But if you're wondering how much fat does it take to hydrate the tissues and restore good functioning of the urethra, as a general rule, I would tell clients, use about one tablespoon, which is 10 to 14 grams of fat. And that's per meal and for a snack as well. On average, that means that people would be consuming six to seven tablespoons of healing fats per day. And now I know that can be a little bit confusing when we talk about tablespoons. It's butter, olive oil, coconut oil. For something like a healing fat would be an avocado. The portion would be more like a half of an avocado.

MELANIE: Yeah. Had it for breakfast.

KARA: Yeah, love avocados!

MELANIE: Our shutoff valve is actually a muscle. And so I love that you said that because if you are a bodybuilder goes to the gym to build more muscle, the personal trainer typically recommends what? Protein. And that's because they understand that to build muscle and increase strength, your muscles need the nutrient protein. Many of the women I've worked with eat a small portion of protein and only at dinner. I mean, that's just the habit that they're in. Well for muscle support, I usually recommend eating protein throughout the day. For instance, two to three ounces of protein for breakfast. And snacks, two ounces and then four ounces at lunch. Think of the Palm of your hand without your fingers and your thumb. That's about the amount of cooked animal protein. And then the same for dinner, which adds up to at least 12 to 14 ounces of protein each day. It's best to eat a variety of proteins also. So you want to get a variety, not just dried chicken breast, but grass fed beef, organic chicken, pork wild caught fish, organic eggs, lamb, whey protein powder. Collagen powders provide protein. Change up your recipes, so you don't get bored. Your goal is to hydrate the tissues in your urethra and strengthen the key muscles that support your bladder. That's the goal.

KARA: Yeah. And what you said is so true about it's really common for people to just be getting protein for dinner. You know, you think about, "oh, I'm going to make a nice chicken or steak dinner". And then for breakfast, I think the reason people are usually low in protein, they might have a very high carbohydrate based breakfast and/or lunch: cereal, pancakes, toast, things like that. Pasta for lunch. So we get kind of caught up into this carb overload and end up really low in protein at the end of the day.

MELANIE: And just to touch on something, I have a lot of clients that come in and say, "well, I had my nuts for protein at snack or I had my beans". Well, honestly, if you look at the amount of protein per cup of nuts versus the amount of protein per cup of beef, it's really not the best source of protein. It's hard to get enough.

KARA: And same with, you know, peanut butter, like a peanut butter sandwich. You know, a good quality peanut butter would be a healthy fat, but not a very high source of protein there in nuts or nut butters. So that's a great point. Now, if you're someone that's ever said, "oh my gosh, I sneezed while I was standing in line at the grocery store checkout and I wet my pants" or "I'm afraid to go to any aerobics classes. I don't want leakage and I don't want to embarrass myself". So if that resonates with you, we just want you to know that changing your nutrition is well worth the effort. And I want to talk about some foods to avoid if you're experiencing incontinence. And as Melanie mentioned earlier, there are certain foods and drinks that are considered bladder irritants. And Dr. Christiane Northrup explained in her book, *The Wisdom of Menopause*, coffee's a bladder irritant. And if you're experiencing incontinence, you'd have to ask yourself, "is coffee a bladder irritant for me? Do I need to give up coffee so that I can have more bladder control?" Now coffee is going to be an irritant for some, not for everybody, but if you have bladder issues, you know, Mel and I honestly think it would be worth experimenting and giving up coffee or caffeine for at least a month, you know, four to six weeks.

MELANIE: And let that irritation calm down and, you know, just to plug in there: one of my favorite drinks, which is very coffee-esque is chicory root or dandelion root tea. And you can doctor it just like you would doctor coffee, with some full fat cream in there. Really delicious. And it's very coffee-esque.

KARA: It is I, yeah, I actually have some at home. I mean, there's different brands. Teeccino.

MELANIE: That's my favorite.

KARA: That's the one I have as well.

MELANIE: So as a whole, we find caffeine is a powerful substance that could increase bladder activity for many, many people. Caffeine is a diuretic. So drinking soda, coffee, caffeinated tea, eating chocolate, or taking over the counter medications that contain caffeine may actually result in urgency and urination and even incontinence. So to be on the safe side and to determine the effects of caffeine has on your body, we suggest eliminating these items. The coffee, the tea, the energy drinks. Even some of the bubbly drinks now can have caffeine. You've got to watch for that. Even green tea. Chocolate. For six weeks and throughout that time, just check your symptoms. How do I feel, what's going on? Rate yourself on a scale of one to five. And let's talk more about this eliminating caffeine when we come back, because I think it's really important.

KARA: You're listening to Dishing Up Nutrition. Now, if you have nerve damage due to childbirth or surgery, you might find that taking extra B vitamins is very helpful. Vitamin B12 in particular has been found to be very beneficial. And we'll talk more about that when we come back from break.

MELANIE: Welcome back to Dishing Up Nutrition brought to you by Nutritional Weight & Wellness. To build muscle, it's important to eat sufficient protein. You may find that whey or paleo protein powder is a convenient source of protein to use NutriKey Wellness Whey is a tasty protein powder to add to a shake? It smells delicious. I can't do dairy, but I'm really jealous of the people that can do that whey protein.

KARA: Oh, that one really is good.

MELANIE: Is it?

KARA: I'm sorry that you can't have it.

MELANIE: Well, if you're dairy sensitive like me and I do love my protein powder. I suggest the paleo protein by NutriDyn or Designs for Health. Both of these protein powders have a great flavor. They mix well. And if you have questions, you can chat with one of our Nutritional Weight & Wellness staff members by calling 651-699-3438 or you can email us at weightandwellness.com. And before we went to break, we were talking about the effects of caffeine on the body, specifically your shutoff valve, right? Well, by eliminating caffeine, you may find that your incontinence problem is gone. Certainly you can lessen it significantly. And after working with so many clients who've struggled with incontinence or leakage or urgency, I found that what people eat and drink can have profound effect on bladder control. Keep in mind that 50% of older adults have issues with incontinence. So I tell my clients, they feel so embarrassed and so... different, but I tell them if you're sitting in a room full of people, you look to the left, or you look to the right, as somebody has that same struggle, you are in good company. It's just the hidden secret.

KARA: Yeah. You know, and it reminds me of we have, we do a lot of shows on digestive issues, constipation, and at Nutritional Weight & Wellness, we're not afraid to talk about these personal issues. And they're so common. So we want to just encourage people. You know, you're not alone.

MELANIE: You are not alone. And you have someone who will walk you through those struggles.

KARA: Yes. Talk to your nutritionist, talk to your doctor about it. What about alcohol? You know, what have you experienced after drinking a couple of glasses of wine, beer, or cocktails? Clinically, we have found alcohol acts as a blatter stimulant, and the result is often an urgency and a frequency in urination because it's, it's similar to caffeine. Alcohol is a diuretic as well.

MELANIE: It is, it is. And what have you found when you eat or drink something that contains artificial sweeteners? I'm thinking if people make an alcoholic beverage with a diet soda, it's a double whammy. So if or when you drank a diet soda, did you ever notice more frequent episodes of urination during the day or night? Several studies have linked increased frequency of urination with a variety of artificial sweeteners. And I'm thinking sucralose, aspartame, acesulfame.

KARA: Yes. Yes. Those are the three really common ones. And sucralose is Splenda. Aspartame... another name is NutraSweet. So those are really things. You gotta check labels.

MELANIE: Even your protein powders.

KARA: Yes. That it can be anywhere. And if a client comes in with a breath mint in their mouth or their chewing gum, you know, we always want to see the package, don't we? Let's see, let's look at the ingredients of the breath mint or the gum. And sadly, most of them, breath mints and gum, contains some type of artificial sweetener. And I have found that gum is often the source of bladder urgency for a lot of clients. Another product where artificial sweeteners can be hidden is protein powders. You go to some of the bigger box stores and people think they're getting a good protein powder, but again, flip that container around. You've got to look at all the ingredients.

MELANIE: All the way to the end.

KARA: I would say most, at least half, you know, are going to have artificial sweeteners. And that can cause increased frequency of urination. On the other hand, the high quality protein powders, what you want to see in, like, for example, like our protein powders at the office, they're going to be sweetened with things like Stevia or monk fruit. Now those are natural sweeteners. They're not artificial sweeteners. So they are not going to cause urgency of urination. It's just, it's all about checking labels and you might be really surprised at what you find.

MELANIE: And at first, when you start checking labels, I mean, you want to poke yourself in the eye. It's just so much reading that you have to do, but once you have a couple brands you are comfortable with, and you can just get about the business of shopping and check periodically to see if your brand has changed.

KARA: Yeah. It can be overwhelming at first, but just like any new habit, it just gets easier and you become more comfortable and you know, okay, sucralose. Nope. I can't buy that one. Now a study published in March 2016 in the journal Research and Reports in Urology reported that artificial sweeteners can increase the likelihood of an overactive bladder. Published studies and clinical observations have both found artificial sweeteners to be a bladder irritant. And so I guess we're just kind of driving that point home, but because artificial sweeteners are becoming more and more prevalent, you know, people think they're, they're avoiding sugar. Oh, look, it says low sugar or no sugar. I'm always a little skeptical of that, like low sugar labels.

MELANIE: Especially with the trending keto diets.

KARA: Yeah.

MELANIE: So many products are coming out with artificial sweeteners saying, they're touting, "I don't have sugar", but wow, who wants to put something artificial...

KARA: Yeah, there's just so many side effects of these, these chemical artificial sweeteners.

MELANIE: And if you're trying to figure out what foods or drinks cause more incontinence, we recommend keeping a food journal. Good old fashioned food journal to track your meals and beverages. And this is a really, really great way for you to realize that connection between caffeinated beverages, alcohol, artificial sweeteners, and incontinence. And I would add in there MSG. So it may surprise you to learn that a large variety of teas are often bladder irritants. Even the, you know, the ones we love that are healthy. The organic green tea or black tea. So if you keep a food journal and you have urine leakage, you can look back at what you ate or drank or bring it to your nutritionist and let us help you unpack some of these issues. Then you can zero in on the culprit. Concrete data will help you with what foods and beverages that you have to eliminate. So, working with several clients, I, one client comes to mind. This wonderfully talented woman who was a performer and she had some problems with urinary urgency, incontinence, even stool incontinence. And we, she actually missed one of her grand performances because of having that on the way, in the taxi cab. And so we really zeroed in on what she was eating and this food diary really helped us. And it turned out, we'd eliminated all of the culprits that we knew: the caffeine, the artificial sweeteners. But for her, it was some food intolerances and gluten and dairy were the culprits. So sometimes it can seem muddy trying to figure out what's causing the problem. And you need someone to sort through that. Not to holler at you for what you're eating, but to be a detective on your side.

KARA: Right. Right. It's not about like judging, like, oh, my dietitian is, you know, she's going to be upset that I ate this.

MELANIE: Of course not.

KARA: We just look at that as gathering information. And it helps to put the pieces of the puzzle together.

MELANIE: Because we've, we've been human. Right?

KARA: Yeah. Of course.

MELANIE: You come in and you've got Skittles in your food diary, we're not so interested in slapping your hand as much as we're interested in, well, what's in those that could be causing a problem.

KARA: Is it the sugar? Is it the artificial sweeteners? Is it the caffeine? The gluten, the dairy? Yeah. There's a lot of different ways to track as well. I'm kind of a paper to pen person. I mean, I like, I like things written.

MELANIE: I do too.

KARA: And we have some, we have a great food journal, or we used to at the office, but there's a lot of apps. People can track on their phones. And so there's a lot of different ways to go about journaling.

MELANIE: Yes. Even take, if you're so busy, everybody has their phones...take a picture of everything you put in your mouth. You can always scroll through and look at it that way.

KARA: Yeah. That's a great one too. We're kind of talking about all the different triggers for urinary incontinence and Mel and I are, we're pleased that there are fewer and fewer smokers these days just for overall health reasons. But unfortunately, for people who are still smoking and the chemicals in cigarettes have been shown to irritate the bladder and increase the risk of bladder cancer as well. And, of course, urinary incontinence. So that we just wanted to mention that that tobacco is definitely an irritant.

MELANIE: For sure. Well, what about drinking filtered water? It's a natural instinct to limit water intake, to reduce bladder control symptoms. The problem in limiting your water consumption is a whole host of other things that are not going to function well in the body. It can actually make the problems worse for incontinence because it dehydrates all of your tissues that need to be hydrated. So if you find that your skin on your face or your arms is looking dry and kind of wrinkly, then the tissues around your shutoff valve may become dehydrated, which means they could become stiff and not flexible enough to work properly.

KARA: That's right. So kind of what you're saying is what you can see on the outside, like your skin. That could be a reflection of what's going on in the inside as far as your tissues as well.

MELANIE: I remember doing a test. We would do a test with clients in hospitals where you would pull the skin up on their hand. And if you let go and it didn't recover quickly, it was a sign of dehydration.

KARA: Sure. No, that's a great one. People can still do that today. And we had talked earlier about the nutrient GLA. Gamma linoleic acid. That's the Omega-6 fatty acid. And just to kind of reiterate that's really, really good for hydrating tissues. So that would, that would help with the issue that you were just talking about too, for external skin problems.

MELANIE: Yes, even the cracked heels.

KARA: Sure. Yeah. Or kind of like, we talk about the bumpy skin and your elbows, or the backs of your arms. It can help with all that. Well, it's time to go to another break and you're listening to Dishing Up Nutrition. Incontinence. It's a frustrating and very often a hidden condition. Like we said, under-diagnosed, because people just are afraid to talk about it. There's a lot of different causes, but there's also a lot of solutions. We believe the best and safest solution is to look carefully at your food choices and your nutrition. And it's just amazing the results that we have achieved through real food nutrition. So we both just encourage you, make an appointment with one of our expert dietitians or nutritionists and we can help you achieve amazing results. There's a couple different ways to do that. You can call (651) 699-3438. You can go online weightandwellness.com to make an appointment that's convenient for you. And I would suggest checking your health insurance because you may have benefits that will cover nutritional counseling. And we will be right back.

MELANIE: Welcome back to Dishing Up Nutrition. We have discussed today incontinence and incontinence can have many causes, but no matter what the cause food matters. This is the bottom line. We have found that with carefully thought out healing food plan and key supplements, the symptoms of incontinence will most likely get better. If you have stopped going to your exercise class or out in public with friends or public activities or traveling because of incontinence, we just may have a solution for you. It is not an invasive solution. It is a real food solution. Very gentle, right? Again, if you want to ask any questions, call us at (651) 699-3438 or email us at weightandwellness.com. In addition to that, all of the key products we discussed today are available to order through our website, weightandwellness.com and you have the option to choose free delivery or curbside pickup to receive your order. So we're still here.

KARA: I just did a curbside pickup yesterday.

MELANIE: Did you?

KARA: It's really convenient. Yeah.

MELANIE: It is. It is nice. I want to talk a little bit about the curbside pickup. I mean, we have that going on because of the climate that we have with COVID-19 and what I'm finding when I'm assuming clients, or when I'm talking to them on the phone is many of them are slipping into the old comfort foods, the packaged foods, and they're just riddled with guilt over it because they're grabbing, they're stocking up. They knew they wouldn't go bad. And so it's, it's been really interesting. One of my zoom clients, I said, well, let's go see, we had some symptoms that we were trying to deal with. And I said let's, it was easy for her to just go grab three or four packaged foods out of her pantry and come back to me and then grab the supplements she was taking and come back to me and we could walk through them together and kind of figure out, okay, you've been eating these, this is in there that could be contributing. Instead of her standing in the grocery store by herself, when you zoom a client at home, you have access to their pantry and the refrigerator, you know, we're not going to peak in there and give you, you know, thumbs down. We're just going to say, let's look at that. And they're like, oh, I don't know, but they can walk, pick it up, bring it back, and we can help. It's like, we're there in your home helping you sort through.

KARA: What a great benefit, I mean, to the uncertain times and all kind of the negative aspects of what's occurring, but that actually is a real value is that as a dietitian, you know, you're able to just look at the label with the client.

MELANIE: And help them out and they can be in their jammies.

KARA: And yeah, the whole packaged food thing. I mean, I think so many of us, you know, in our house too! I mean, we try to do it as healthy as possible, but we stocked up on some canned items that we may not normally have purchased as many.

MELANIE: Survival. People were feeling that survival push.

KARA: We didn't know at the beginning. I mean, we still kind of don't know, but particularly at the beginning, I think there's a lot of stocking up and people are still kind of getting through the pantry. They still have a lot of that stuff.

MELANIE: I'm circling back to the podcast we had on how to stock your pantry with Marianne. That was invaluable. I thought that was a really good way to help people, even people that just don't want to go out and grocery shop cause it's winter, you know, that's a really good podcast.

KARA: Yeah, you can, you can take that podcast and you can, and it doesn't have to be COVID 19, you can use that information, like you said, for bad weather. For a storm in Minnesota. So let's kind of get back to what types of foods we want to be avoiding if there's incontinence. What should we avoid for the best bladder control? Well, we would suggest tackling incontinence by really making your diet as simple as possible and at Nutritional Weight & Wellness, we recommend what we call an anti inflammatory eating plan. Now what that means, it typically an anti inflammatory eating plan is going to have no grains. So examples of grains would be bread, pasta, bagels, a lot of baked goods...

MELANIE: Corn.

KARA: Corn, yes, definitely.

MELANIE: Rice.

KARA: Corn and rice. Also dairy. Dairy is a big one for a lot of people can create more inflammation. So with dairy, that means you would be avoiding things like yogurt, cheese, ice cream, and then we want to eliminate soy as well. Soy has definitely been found to be inflammatory and, according to researcher and author Anthony Jay, soy is also estrogenic. And so would you mind just explaining a little bit about estrogenic? Basically it can create higher estrogen levels in your body.

MELANIE: Higher estrogen levels. It's sort of the artificial estrogens.

KARA: Yes. Thank you.

MELANIE: Not the ones we make in our body.

KARA: And you can check out that well-researched book *Estrogeneration*. You can listen to a dishing out nutrition podcast that was dated March 8th of this year, 2020. And that was titled *Estrogeneration: How Estrogenics Are Making You Fat, Sick and Infertile*. So that would be a good one, if you do want to learn more about that topic.

MELANIE: You know, it's just detoxifying everything that you can find that's not from nature, you know, and going back to, if you can't pluck it or chase it, don't eat it. And look in your pantry and ask yourself these things and the dietitians and the nutritionists at Nutritional Weight & Wellness. So just following the simple anti-inflammatory menu. Follow this menu very carefully for about three weeks and if you see some positive results, follow it for another three weeks. And after six weeks you get to determine, is it effective? Has it been helping you control your bladder issues? Our simple menu plan is to eat eggs, fish meat, a variety of vegetables, at least one tablespoon of that beneficial fat we were talking about at every meal and snack. This plan may be challenging, especially at first, but it's a true test of how food and nutrition can make all the difference. Kara, you and I've seen this in clinic and it's a joy to work with clients when they get some relief. And most of our clients wants to set an eating plan specific to their knees. Many of you listeners are under the assumption that incontinence gets worse as we age, but just like your brain needs key nutrients as we age, ALL of our tissues need key nutrients to function. Well that said, if you eat and drink the foods and beverages that are healing for you and avoid the foods and beverages that are bladder irritants that we've discussed, your incontinence may not get worse as you age. And it may be gone altogether depending upon the cause.

KARA: Right. And we just want to emphasize that it's worth it. It's worth putting in the effort if you're experiencing something debilitating like incontinence.

MELANIE: Because it's quality of your life.

KARA: It def... Yes, exactly.

MELANIE: Everyone deserves quality of life, I would say. And getting a little bit of relief. Is everything.

KARA: Yeah. And so what is, what do you have to lose to try something for four to six weeks? And so let's just recap what we talked about today. So for incontinence, there are things that we want to include in our diet: healthy fats, protein, but we also want to be cognizant of eliminating caffeine, alcohol, tobacco, artificial sweeteners, and you know, our goal at Nutritional Weight & Wellness: it's to help each and every person experience better health through eating real food. It's simple, it's a powerful message though. Eating real food is life changing. Thank you so much for joining us today and be well.

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