How can pee be an indicator of health?
The body is constantly working to perform functions estimated in the tens of billions per second. These chemical reactions act like any process, first using ingredients to perform the function and by extension, creating byproducts.
Think of a vehicle that is first loaded with fuel in order to make it move, while also producing byproducts in the form of exhaust coming from the tailpipe.
These byproducts are known as metabolites and when they accumulate, they can have toxic impacts on the body. Like any species, humans take steps to rid themselves of these non-useful byproducts through the urine and feces.
What are these metabolites and where do they come from?
The most common urinary metabolites are nitrogen wastes such as ammonia, creatinine, urea, and uric acid that are produced through protein metabolism. Some are produced through fat (lipid) peroxidation and have been shown to possibly predict whether a preterm infant will develop chronic lung conditions. Some other metabolites include inorganic salts such as potassium, sodium, and chloride, as well as excess water and sugars.
Which of these metabolites give urine its characteristic colour?
That would be a pigmented metabolite known as urobilin, a byproduct from the breakdown of hemoglobin, the character that binds oxygen to transport around the body.
Would you mind walking me through the rainbow and what the colours might mean for my health?
You are far from the first to ask that question! An entire field of medical science revolves around urinalysis, which as you may have guessed, is a combination or urine and analysis. Estimates place the recorded origin of this practice back through to ancient Egypt.
Red – as you may have guessed, red indicates blood in the urine, a sign known as hematuria and one that should warrant an immediate discussion with your primary care provider. Some foods can cause this such as beets, rhubarb, or blueberries, but other more serious conditions such as tumours, kidney cysts, an enlarged prostate, or severe muscular damage could be the cause. Another avenue of exploration are medications such as rifampin or phenazopyridine.
Orange – this could be related to the reasons outlined in red, but to a lesser degree. Basic colour theory shows us that mixing red and yellow together results in orange, so this could indicate some blood in the urine and point to serious conditions such as bile duct cancer or liver concerns. However, medications such as sulfasalazine, some chemotherapy agents, or even some laxatives can cause this colour.
Yellow – a slightly transparent yellow is what one should expect, but 'normal' varies from person to person with individuals having naturally darker or lighter urine. Of note, this can change based on your fluid intake. As you may have already noticed, drinking a lot of water causes the urine to become clearer because you're diluting the urobilin into more fluid. Drinking less water lends itself to a more amber or honey colour as the urobilin becomes more concentrated.
Green – another uncommon colour that is typically due to food dyes, urinary tract infections of Pseudomonas, or certain medications such as amitriptyline, indomethacin, or Propofol. These medications contain phenol, a chemical grouping that can be transformed in the liver into the green pigment.
Blue – as with the green colour, common dyes could cause this change depending on how your body processes them. This colour could also be caused by a genetic condition known as familial hypercalcemia and may show up in infants as 'blue diaper syndrome'. A defect in the breakdown of an amino acid known as tryptophan in the intestines. This should warrant an immediate visit to the doctor.
Purple – this is a very rare, but highly specific colour to a complication of urinary tract infections in those with urinary catheters. It indicates highly alkaline, a pH greater than 7, urine with most experts believing the colour is due to a component known as indoxyl being converted by bacteria into indigo and indirubin. These blue and red pigments mix to create the purple colour.
Black – could be due to high levels of iron, often following an intramuscular injection or medications such as methocarbamol, metronidazole or even laxatives such as senna or cascara.
What are some steps I can take to achieve healthy urine?
This is a large question as we could spend pages talking about each condition, so with that said, let's focus on the larger picture.
If faulty toys were coming off the end of the assembly line, you wouldn't try to fix the end of the conveyor belt, you would find which part was faulty and fix it. Have a discussion with your primary care provider to determine the cause of the change in colour.
Urine pH strips can easily be ordered from some of the large online marketplaces and could allow you to catch something fishy, though hopefully not literally!
However, it's important not to panic and set up an appointment with your primary care provider to help determine the cause of the abnormal reading.
An herb known as saw palmetto (Serenoa repens) has been shown to have benefits as a diuretic, moving potential pathogens through the body quicker. In addition, it showed benefits in reducing painful urination, nighttime urination, and how much is retained in the bladder.
There are also studies looking at how beneficial it can be for individuals suffering from benign prostatic hyperplasia. Some studies have even shown it to be as effective as finasteride and alpha-blockers, common management options for BPH which could reduce the red colour of your urine. Products such as Prostate 1 contain organic saw palmetto and are an easy way to get some of the herb into your diet, especially at its convenient once daily dose.