When a UTI indicates a problem with sugar metabolism
After 20 years of oral contraceptive use, I discontinued hormonal birth control.
And developed my first ever UTI.
Along with that urinary tract infection, my urine started to smell really weird. In my mind, it smelled like it was being produced by a body in ketoacidosis (a severe complication of diabetes). That sickeningly sweet fruity smell with a hint of acetone.
I told 4 different doctors/midlevels and one naturopath about this during the yearlong quest to resolve the condition. I mentioned I felt like I had a sugar metabolism problem, and was pretty much ignored. “Your H1AC levels are normal.” “Your fasting glucose looks good.”
Okay, then what’s causing this UTI?
“Are you wiping front to back?”
Eye roll. Every cell in my body wanted to say “You know doc. When a 40-year old woman enters your office with symptoms of a UTI for the first time in her life, do not ask if she’s wiping front to back."
Instead, I left out the lecture and asked "Is there another test you can run to see whether my sugar metabolism is normal?”
The story of the year-long struggle with recurrent UTIs must rest for another day, however, if you’ve struggled with recurrent UTIs or if you’ve been diagnosed with interstitial cystitis, then be sure to stick around for the rest of today's episode.
Side note: Go ahead and add this interview to your listen list: Chronic UTIs and Interstitial Cystitis (IC) with Ruth Kriz. Ruth is a Nurse Practitioner (NP) who struggled with recurrent UTIs herself for years, was diagnosed with IC, and then figured out through a great deal of research that she still in fact had a UTI and was wrongly diagnosed with interstitial cystitis.
Before clicking over to that episode, here’s another critical piece for you if have recurrent UTIs, have been diagnosed with IC, or experience urinary urgency.
- High sugar in your urine can provide a breeding ground for undesirable bacteria
- Your urethra and bladder are NOT sterile but in fact are populated with good bacteria just like your vagina and GI tract
- High sugar in your urine and ketoacidosis and ketonuria can cause pain with urination and urinary urgency
- You can die from a UTI
Disclaimer: I’m not a doctor or licensed healthcare practitioner. All information provided in this podcast and on any Rain Organica site are for educational purposes only and reflect my research & own experience with the condition described. This is not intended to diagnose, treat, or prevent any illness or health concern. Consult with your physician or healthcare provider for health advice.
We’ll take a closer look at figuring out the UTI piece in a separate episode. For now, it’s important to make the connection between how hormonal birth control impacts your ability to metabolize sugar & how your ability to metabolize sugar is directly linked to your risk of recurrent and more severe UTIs.
How hormonal birth control contributes to insulin resistance (a precursor to diabetes)
First off, let’s establish normal vs. disrupted sugar metabolism. When you eat carbs, your body breaks it down into glucose. Glucose is a primary source of energy for your cells, and insulin is required to transport the glucose from your blood stream into your body’s cells where it can be used for energy.
Insulin resistance is a condition where even when you have insulin released in “normal” quantities by your pancreas, your body’s cells can’t hear it… this may be either because they’ve grown hard of hearing or because insulin’s voice isn’t loud enough for whatever reason. So, your pancreas releases more insulin thinking “if more insulin’s talking to the body, maybe it’ll hear it”.
When your body’s cells become so resistant to insulin’s call that they’re unable to soak up enough glucose from circulation for normal metabolic function, your body has to start using fats for fuel.
When your body starts burning fats for fuel (rather than its preferred fuel, glucose which it makes from carbs), your circulating levels of fatty acids goes up, and fat metabolism leads to the production of ketones, most notably acetoacetate and 3-beta-hydroxybutyrate. Acetone’s also made as a 3rd type of ketone, but it’s not nearly as abundant as the other two.
Now, to be fair, the doctors I saw over this time period did their due diligence to order urinalysis for testing ketones and glucose in my urine. Both were negative (tested in milligrams per deciliter of urine with no indication of what the minimum reporting value is... in other words, whatever levels of ketones or glucose were found, it was below the reporting threshold so reported as negative). So, in their minds, I’m sure they were happy with their level of testing.
And, yet, pretty much as soon as I stopped hormonal birth control, my urine smelled differently (like a light switch change).
Glucose tolerance test for insulin resistance
None of these doctors or HCPs ran a glucose tolerance test (GTT) that might have revealed that I was in fact showing signs of insulin resistance. To be fair, I still haven’t had a GTT ran, however, the following symptoms were proof enough to me that I was either suddenly insulin resistant after discontinuing OCPs or that my body wasn’t producing enough insulin. Those symptoms were:
- Acetone smelling urine
- Occasional “sweet” (acetone) smelling breath
- Urinary urgency & painful urination especially at night and in the morning
- Weight gain
- Loss of appetite
- A cycle with charting consistent with PCOS
Why recurrent UTI and symptoms of a UTI might indicate a problem with sugar metabolism
I chased the UTI rabbit for over a year after the initial diagnosis before finally figuring out that the UTI alone did not sufficiently explain my symptoms and why symptoms would occasionally flare even when I was not struggling with a UTI. I’d asked about everything from:
- Could it be just that time of the month (either when estrogen or progesterone peaked/plummeted) that I was experiencing these symptoms?
- Might it be the pH of my urine? Could it somehow be different now that I’d discontinued OCPs?
- Why did symptoms seem worse on days when I forgot to take my levothyroxine (bioidentical thyroid hormone prescribed for autoimmune thyroid condition)?
When my weight began to creep up while my appetite plummeted, my suspicion was not that my thyroid was suddenly functioning less optimally than it had been, instead it went back to “I feel like I’m not properly metabolizing sugar.”
PCOS and insulin resistance
And, then, I had a cycle consistent with PCOS. I track my cycle using an at home hormone monitor that provides a quantitative value for various reproductive hormones throughout your cycle. For this particular cycle, luteinizing hormone (LH) was all over the place (peaking and then troughing), estrogen struggled to peak, and progesterone was crazy low. When this pattern repeated itself over and over, it began looking really consistent with PCOS somewhere around day 17.
One of the primary contributors to PCOS is insulin resistance. I started incorporating dietary and lifestyle changes immediately to begin supporting increased insulin sensitivity.
I also researched the heck out of the condition to figure out what supplements (if any) might help, why thyroid hormone seemed to help, and also, why was I struggling with sugar metabolism anyways?
Even though a couple of people in my family have been diagnosed with diabetes, they were much older (in their late 60s and 70s) before the diagnosis, and even though I was brought up on a poor diet, my diet today is decent (there’s always room for improvement in diets, but I’m already limiting both grains and highly refined carbs in my diet).
What does hormonal birth control have to do with insulin resistance?
Both estrogen and progesterone impact insulin sensitivity. And, the synthetic estrogens and progestins in birth control also impact insulin sensitivity.
A study way back in 1979 proved that progestins increase insulin resistance, and while some of the progestin generations weren’t around yet (there are 4 generations of progestin today), even back then, the 2nd generation progestin, levonorgestrel, was the worst offender in increasing insulin secretion (and thereby leading to insulin resistance).
Similarly, ethinyl estradiol, the type of synthetic estrogen used in almost every COC on the market (at least here in the US), also impairs glucose tolerance causing reduced insulin sensitivity (elevated insulin resistance).
When I quit hormonal birth control cold turkey, my body was used to being stimulated to release excess insulin by the pill I was using (20 micrograms ethinyl estradiol/100 micrograms (0.1 mg) levonorgestrel) every single day of my cycle.
Suddenly, that stimulus was gone and I was paying the price for the lower insulin levels and reduced insulin sensitivity caused by birth control pills (we could use the term allegedly here or claim that it's just correlative, if that's your preference, I'm going to go ahead and call it for what it is... the pill severely impaired my body's ability to metabolize glucose appropriately).
What scientific research supports hormonal birth control causing diabetes?
Two papers are linked below, one a review paper discussing possible mechanisms for how synthetic estrogens and progestins impact insulin sensitivity, and the second talking about the insanity of prescribing women with PCOS hormonal birth control (many women with PCOS already have insulin resistance).
In summary, combined oral contraceptives and progestin only contraceptives increase insulin resistance AND increase risk of Type 2 diabetes even after discontinuing the pill.
A study published in 2012 cites an epidemiological study among nearly 8,000 non-obese women from developing countries and found a relative risk of 2.4 for developing diabetes among women using levonorgestrel implants and women using non-hormonal methods of contraception. Another study cited in this article found the odds ratio of developing diabetes among Native Americans using Depo-Provera was 3.6, which loosely corresponds to a 360% increase in risk of developing diabetes.
Why stop hormonal birth control today?
If there’s anything I wish I could go back in time and tell my younger self, “don’t use hormonal birth control, find a natural way to prevent pregnancy and a better way to relieve acne” would be it.
Instead, I allowed myself to believe Western medicine doctors who offered it as a “fix all” for acne, painful periods, heavy periods, irregular periods, and pregnancy prevention.
Now, on the other side of hormonal contraception use, I wonder how much has that pill use impacted my long-term health? Will I develop cardiovascular problems even though this isn’t a concern for women on either side of my family tree? Will I develop dementia at a young age? Will I have good bone health or did the pill destroy that too?
Have I predisposed myself to diabetes by taking something I thought was safe?
Here’s the thing. If you’re like me, no doctor has ever breathed a word to you about the risks of the pill aside from increased risk of breast cancer and cardiovascular events (heart attack, stroke, deep vein thrombosis).
Looking back and knowing what I know now about the interconnectedness of the body and about how one system doesn’t go out of balance in isolation, I seriously wonder, did I break myself?
Did my decades of pill use contribute to my gluten intolerance, autoimmune thyroid condition, Raynaud’s syndrome, present concern with insulin resistance, and recurrent UTIs? Was it why I developed gallbladder disease and why my liver hurt so bad?
Yes, I hate a period, and I don’t want children, but I also want a long and healthy life.
And, to achieve that, I stopped taking what I never should have started taking. And, I started tracking my cycles so that I’m able to avoid pregnancy naturally rather than relying on something that dysregulates my body’s proper function.
The purpose of today’s episode is to share this story with you. If you’re a current user of hormonal birth control or have friends and family who are using this method of birth control, my sincerest hope is that by sharing my story, it will help you to understand some of the effects that hormonal birth control may have on your health long-term.
If you’re like me, even if your doctor has recommended that you stop taking hormonal birth control, chances are, they haven’t told you the full scope of why it’s such a bad idea.
These synthetic hormones disrupt more than just your reproductive system and it’s more than just your cardiovascular system that is prone to fall victim to the effects of these endocrine disruptors.
In case you’re wondering more about what your options are for contraception if you were to step away from hormonal birth control, Rain Organica is launching a course in January to explain how it’s possible to avoid pregnancy naturally by learning to track your cycles.
In this course, I share three different ways to track peaks and valleys in your hormone levels throughout your cycle so that you know when you enter your fertile window and when your fertile window closes for that cycle so that you’re able to time sex or use barrier methods during your fertile window in order to avoid pregnancy.
You’re invited to gain early access to the course by signing up now. Simply click here: Fertility Awareness for Confident Contraception to discover more.
The references for this post (including the package inserts/prescribing info for a few different OCPs) is in this Google Drive folder.
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