Nolan: This is BayCare HealthChat, and I'm Nolan Alexander. Today we're talking with Dr. Mausam Mehta, a family medicine physician with BayCare, as I ask her six top health questions. So there's a good chance that you have thought of this question, and if you didn't get a chance to ask it to Dr. Metha, well, now is your chance today. So Dr. Mausam Mehta, how are you?

Mausam Mehta, MD: Yeah, I'm doing great. Thank you so much for having me

Nolan: That's my pleasure, and I'm excited to talk with you today to answer these questions because I've got a lot of them. So I'm just going to go on ahead and figuratively rip the Band-Aid off. The first question I got to know, is waking up to pee normal?

Mausam Mehta, MD: So in terms of normal, there's always a balance, right? So there's a normal balance of urinating at nighttime if you wake up once, maybe twice a night, depending on how much water you drink that night. But then there is also a pathologic amount. So when you start to wake up three or more times, that could be cluing into something else going on.

And so, I wanted to highlight two really common conditions that are pretty important to talk about. So one is a very common cause of frequent urination at night called benign prostatic hyperplasia or BPH. This is very common in older men. So as men age, many times their prostate becomes large because of multiple factors, some including hormonal changes.

Symptoms of BPH include most commonly the urinating frequently at nighttime, usually three or more times, but also you can notice a weak urinary stream, feeling like you're not completely emptying your bladder, et cetera.

The other condition that I wanted to touch on that is not as well-known to cause this, but it definitely is a sign, is called obstructive sleep apnea or OSA. And sleep apnea is very common in our adult population. And a lot of times what happens is, there is obstruction of the airways at nighttime. This can happen if your tongue falls back into your airways and temporarily closes the airway pipes, or if there's, for example, increased soft tissue in the neck area, which can compress that airway.

Typically, the signs you'll see are going to be loud snoring, waking up at nighttime, feeling tired when you wake up because you didn't get that full rest at nighttime. But a lesser-known symptom is actually also waking up at nighttime to urinate frequently. So why is that? The mechanism behind why OSA can lead to increased nighttime urination is very complex and not well understood yet, but that's being further investigated.

Bottom line is if you are waking up more than three times a night to pee, then you should talk to your doctor to see if you could have these or some other condition.

Nolan: Okay. I think I have a better understanding of why you went with number three because that just opened the curtain to a whole variety of different reasons. So good to know. Three is the number to keep in mind. Thank you, Doctor.

Mausam Mehta, MD: Yeah.

Nolan: So speaking along the same lines of just sticking in the bathroom here. Is going to the bathroom just in case bad for you?

Mausam Mehta, MD: When you think of going to the bathroom just in case, some people like to go, for example, right before their flight if they're going in their airport or something like that. So if you do it once or twice, it's unlikely to have an effect. But if there is a recurrent pattern of this, it can actually cause some problems.

So there's a urology bladder training guidelines that say going just in case, if it's a pattern, can actually increase your risk of getting an overactive bladder or urge incontinence. So just be cautious about doing this. What overactive bladder is, is when the bladder muscles squeeze too often and it causes the urge to urinate even if your bladder isn't full.

And so if you go to the bathroom just in case, all the time, you're actually training your bladder to say that, "Oh, it's okay to go even if I only have a little bit of urine in there." So that could make overactivity worse. So if it's just a one-off thing, it's okay, but I would say don't make a pattern of it.

Nolan: Define pattern in this instance.

Mausam Mehta, MD: Yes. So I would say, one-off being you do it right before the airport, just once every couple of months or something. Whereas a pattern would be something more so like you're doing it every day or every few days. You want to avoid that more frequent cycle rather than if you do it once every couple of months, there's unlikely anything to come out of it.

Nolan: Well, good to know. So next time we're trying to leave on a long trip and mom's trying to get the kids to go to the bathroom just in case, I'm going to be okay with that, as long as we're not doing that every single day.

Mausam Mehta, MD: Correct. Correct.

Nolan: Another one of our top questions is just like we have been bombarded with advertisements for protein and fiber. It seems like to me every single food brand now has a protein version, extra protein and fiber. So it's all over the place. Is it healthy to have all of that added? And if so, or if not, what is the healthy amount of all this extra protein and fiber?

Mausam Mehta, MD: I think you'll see a pattern in our talk today, but everything should come at a balance. So in terms of protein, what is the recommended amount to have? Based off of some studies, the very minimal recommended allowance of protein for a normal healthy adult is .8 grams of protein per kilogram of body weight per day. So that is the bare minimum to meet metabolic needs for your body.

Now, people are usually doing more than just that, right? People are physically active. And so, typically, to meet the functional needs of what your muscles are using in terms of protein, they actually recommend one gram of protein per kilogram of body weight if you do minimal physical activity, 1.3 grams per kilogram, of your body weight per day if you do moderate physical activity, and 1.6 grams of protein per kilogram per day if you do intense physical activity.

Now, moderate physical activity I would define as doing anything to get your heart rate up. So this could be power walking, jogging, things like that. And the American Heart Association does recommend 150 minutes of moderate intensity activity a week. So if people are aiming to get that amount, then they should be having at least the 1.3 grams of protein per kilogram of body weight per day to be able to accommodate that.

And then minimal would be something less than that, in terms of how active you are. If you're just doing a leisurely stroll, that would be considered as minimal physical activity. And intense if you're doing a high intensity interval training, or if you're doing very intense vigorous, exercises like gym classes, that could be considered intense.

So, just to recap, one gram of protein per kilogram body weight for minimal, 1.3 for moderate, and 1.6 for intense. Now that is what we recommend, but a lot of people now have been really into protein maxxing, which is, they're trying to get as much protein they can. However, if you do go beyond this recommended intake goal, that can result in health problems.

So usually, typically they say chronic high protein intake is going to be greater than two grams per kilogram of body weight per day for adults. And this can result in digestive problems, problems with your kidneys, vascular abnormalities, so definitely don't want to overdo it there.

Nolan: So we hear all about this protein and that's a lot of information and great information to take in to being able to track all of this. What about the fiber component? Is it healthy to have all this extra fiber? What's the healthy amount with that, Dr. Mehta?

Mausam Mehta, MD: Yeah. So, in terms of fiber, the recommended amount of fiber is going to be about 25 grams of fiber for women and 38 grams of fiber for men every day. In a study 10 years ago, the majority of Americans, about 95%, do not meet their recommended fiber goals.

On average, they get maybe 15 grams, so that's 10 grams less than the minimum for women. This is a shame because individuals that consume more fiber have shown reduced risks of getting colon cancer. And more studies are coming out that it also lowers risks of prostate cancer, certain lung cancers, certain ovarian cancers. So fiber is very important.

However, a lot of people talk about fiber maxxing online as well, in addition to protein maxxing. But when you increase your fiber intake, you don't want to do it all at once because that can cause some bloating and discomfort. So you'd want to do it gradually. Maybe that means adding a couple new fruits and vegetables to your diet every week for a few weeks until you get to that goal.

But it's also very important to drink plenty of water to prevent discomfort. And you'll see today that in addition to balance, we have a big theme of drinking plenty of water because most of us are not getting enough water intake as well.

Nolan: I will share something that happened to me exactly this morning. So I did a workout. I try to do a high-intensity interval workout, maybe for not that long of an interval, but afterward I wanted to have a good solid breakfast.

And along the lines, again, of all this advertising that's in our face, we see different types of breakfast cereals. So I want to have a good healthy breakfast cereal. Which leads us into our fourth question: Do healthy breakfast cereals actually exist?

Mausam Mehta, MD: Yeah. So cereal can be a part of a well-balanced and healthy breakfast. I think a lot of what makes people think that cereal can be unhealthy is a lot of the, especially in the recent decades, the increase in the amount of added sugars in them. There's definitely a difference in quality between like a fruity pebbles versus your bran flakes.

But when breakfast cereals were actually first invented, they were meant to be health foods full of vitamins and fiber. Most breakfast cereals today are still often fortified with a lot of vitamins and minerals and can be a really good source of fiber in the mornings. So you just want to make sure you look for ones that don't have a lot of added sugars in them, so that way you can optimize the nutrition value that you're getting from them.

Nolan: Well that is great to hear that there’s still healthy breakfast cereals out there. I’ve got another one of our top questions: How can I build muscle as I age?

Mausam Mehta, MD: So in terms of building muscle, it kind of goes back to our discussion on protein. So as we age, it's harder because older individuals do lose some muscle mass. So it is important for them to do weight training in a safe manner, go to the gym at least three times a week and work on building that muscle.

And then from there, going in and having a higher recommended protein intake. So rather than doing the bare minimum .8 grams of protein per kilogram body weight, they should be having more of the 1.3 to 1.6 grams per kilogram of body weight per day. So that way they can really maintain their muscle mass, build muscle, and not have issues moving forward with that.

Nolan: So last question for you, and I'm very curious about this one. Does hot lemon water have any health benefits?

Mausam Mehta, MD: This one is also an interesting thing for me as well because I've actually been told by my family members that hot lemon water is good for your metabolism, but I never knew why.

So one effect is it actually helps prevent the occurrence of some calcium oxalate-based kidney stones. But, does this have anything to do with metabolism, losing weight, blood pressure, blood sugar, that sort of thing?

So I looked into it, and according to a study in Japan, lemon juice before exercising or before walking can help lower your blood pressure more than just walking alone. But the study was small. It was 100 people, and there were some confounding variables in there. So the effect isn't super well-established.

Another study that I looked into to see if it had any metabolic effect was, it was a randomized control trial, and it used MRI to see the effects of lemon water on the digestive system when ingested before breakfast. So it compared that to just plain water, and then compared to the plain water, lemon water was 1.5 times quicker in gastric emptying, meaning the food was able to get through the stomach quicker, and it also significantly helped lower blood sugars as well, with the digestion. But again, the scale of the study was quite small. They only looked at 10 people. And so there is a caveat to all of this.

Another thing I often hear or get asked by patients is does lemon water help detoxify your liver? While it helps with digestion, the liver is able to detox its own. That's its job in your body. And the best way to support this is by staying hydrated.

So you don't necessarily need to limit it to lemon water. But if you put lemon in your water and it makes you drink more water, then I would say go for it. It's low risk. It's cheap. It's easy. The only things that you'd want to be aware of is lemon water, the acidity can affect your teeth. It can affect your tooth enamel and cause you to be more susceptible to cavities.

So I would say the best way to avoid that is after you drink your lemon water, follow it up with plain water, swish it around in your mouth so you don't get that acid sticking on your teeth. But otherwise, in most cases a pretty low risk, tasty, cheap intervention to try. With the caveat, it may work, it may not work.

I think if you're looking at hot lemon water to lose weight, there's still not enough studies to show that. But if it makes you drink more water and that helps, by all means, go for it.

Nolan: Well, Dr. Mehta, you educated us a great deal right there. You talked about balance, and you even gave a little plug for your friends in dentistry as far as avoiding acidity on our teeth.

Mausam Mehta, MD: Absolutely. Well, my dad is a dentist, so if I didn't do that, I would be in big trouble.

Nolan: Dr. Mausam Mehta, this has been a lot of fun reviewing these six top health questions. I'm walking away feeling a lot better about my health after today.

Mausam Mehta, MD: Thank you so much.

Nolan: And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media, and be sure to check out all the other interesting podcasts in our library.