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Wee, piddle, pee, golden liquid, biofluid: are you extracting the urine?

Last Word contributor Didapper examines the medicinal uses of urine, including the growing practice of swigging one’s own for its alleged health benefits

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Drinking one’s own urine has been claimed to prevent or cure a wide rangeof health problems, including allergies, cancers and infections. In Japan and parts of China, millions of people drink their own wee every day. The practice has also long been popular in other Asian countries, particularly India.

One of the best known modern advocates of urine drinking was the Indian politician Morarji Desai. During a US television interview in 1978, while he was India’s prime minister, he stated that drinking their own urine was the perfect solution for the millions of Indians who could not afford medical treatment. He was widely ridiculed, yet went on to live to the age of 99 years — perhaps helped by his urine therapy?

Urine drinking is practised in India not just for medical reasons but also as an aid to yogic meditation. This 5,000-year-old practice is claimed to rejuvenate both body and soul.

And now a growing number of people in the western world also indulge in a daily dose of wee — alternatively known as auto-urine therapy, urinotherapy or urotherapy.  Among British advocates is the actress Sarah Miles, who has, for more than 30 years, drunk a daily cup of pee, stating that it has kept her “healthy and vigorous”. Other public figures who indulge include several prominent sportsmen across the Atlantic.

The usual “prescription” is to drink a cup (about 250ml) of mid-stream urine taken from the first flow in the morning. Some advocates also recommend one or more further doses during the day.

Neophytes often report symptoms such as nausea, vomiting, diarrhoea, headache, palpitations and fever during the first few days of oral urine intake. Because of this — and probably to help get used to the bitter taste — some proponents recommend beginning with just a few drops under the tongue and then gradually increasing the dose to the full cupful.

As well as being consumed, urine has long been used in folk medicine as a topical treatment for wounds and for various afflictions of the skin, eye, ear and nose.

In ancient Rome, Pliny the Elder recommended fresh pee for treating sores, burns, haemorrhoids, chaps and scorpion stings. In the 16th century, Thomas Vicary, surgeon to Henry VIII, advocated that all battle wounds should be washed in urine. And more recently, the pop singer Madonna has admitted to tinkling on her tootsies to treat a persistent problem with athlete’s foot. It seems that three- to four-day-old urine can be used for topical therapies.

One of urine’s best known medical uses — particularly since 1997, when it featured in an episode of the US situation comedy “Friends” — is to relieve the pain of jellyfish stings.

Urine is also used for cosmetic purposes. The Romans employed it as a tooth-whitening agent, thanks to the bleaching effect of urea. A famously insulting poem by Catullus ends with a line that has been translated (not terribly accurately) as “the fact that your teeth are so polished just shows you’re the more full of piss”.

It is interesting to note that the US Army cautions against drinking urine in an emergency because urine’s salts may exacerbate dehydration. However, it does suggest using urine to cool the body by soaking a cloth in it and placing on the head.2

Active ingredients?

Many advocates of urine therapy see it as a miraculous elixir that has rapidly solved their health problems. Conditions alleged to have been cured range from asthma to AIDS, from bed-wetting to blindness, from common cold to cancer, from earache to eczema, from flatulence to flu, from itching to infertility, from sleep loss to sickle cell anaemia and from toothache to tuberculosis. And devotees lucky enough to have avoided such health problems drink their urine in the belief that it prevents illness.

Despite an impressive mass of anecdotal testimony, there seems to be scarce reliable scientific evidence to support urine therapy — although it must be acknowledged that testing it to an acceptable evidence-based standard is not easy because of the difficulty of constructing double-blind clinical trials.

And investigating how urine therapy might work is also difficult because urine is an incredibly complex biofluid (see Panel). Nevertheless, some intriguing theories have been put forward. One of these is that urine drinking may help to fight cancer by introducing tumour cell antigens to the immune system, stimulating the production of antibodies. For similar reasons, many people believe that urine has an action akin to immunisation in warding off other afflictions such as infections and allergies. In vitro, urine has been observed to inhibit the growth of some micro-organisms.1

An intriguing aspect of the morning’s first pee is that it normally includes significant quantities of conjugated esters of the hormone melatonin, which is secreted by the pineal gland only during sleep. It has been postulated that these esters may account for urine’s use as an aid to yogic meditation. Although the esters are inactive, the theory is that when subjected to gastric acid they are deconjugated back to the active form. The resultant restoration of melatonin to night-time levels enhances physiological prerequisites for meditation such as decreased body awareness and heightened visualisation.

Since melatonin is known to interact with the immune system, it has also been suggested that high levels in early morning urine may be at least partly responsible for urine’s supposed antibacterial, antiviral and antifungal actions.

Does it work?

When it comes to topical uses of urine, there is certainly some evidence of beneficial action. In particular, Vicary’s 16th century recommendation for battle wounds was probably good advice. Urine is normally sterile when it leaves the bladder and — particularly if you avoid the initial flow, which might wash bacteria from the urethra — could be valuable for irrigating wounds in a battlefield emergency. Nowadays we have access to plastic pods of sterile normal saline wound-wash, but 500 years ago urine was probably a better wound cleanser than any sources of water then available. If I suffered a scuzzy wound in the wild with nothing else to hand, I might well follow Vicary’s advice.

The urea that makes up 2.5 per cent of human urine could give wee some mechanism of action in a range of skin conditions. After all, urea is an ingredient of various topical dermatological products, although usually at a greater concentration than in urine, with strengths of 10–40 per cent used as an emollient in conditions such as psoriasis and eczema and up to 50 per cent for the avulsion of damaged portions of nails.

And what about urine’s alleged antimicrobial activity? By piddling on her pedal appendages, Madonna has been following the advice of alternative medicine proponents who believe that urine has antifungal properties. Although there is no reliable scientific evidence to support any antimicrobial action for urine, urea in much higher concentrations does have bacteriostatic properties.

There is also a lack of evidence to bolster the popular folk remedy of urinating on jellyfish stings. In fact, this practice might make the pain worse by activating any cnidocytes (venom sacs) left behind at the site of the sting. The ideal treatment depends on the jellyfish species involved. Many stings are alkaline and can be alleviated by applying a mild acid, such as vinegar, but some are acid and are better treated with a mild alkali such as baking soda. Urine, however, is typically pH-neutral (pH 7), although it can vary between pH 4.6 and pH 8, depending on the donor’s diet. If you do not know the jellyfish species involved, the best treatment is usually hot water or lidocaine cream, or both, if available.

Pharmaceutical products

Although whole human urine currently has no application in orthodox medicine, some of its constituents have been put to use. As well as having the medicinal properties mentioned above, urea (now synthesised rather than extracted from pee) is the main content of some instant cold packs used to reduce swelling. These packs contain urea crystals and an internal water bag; rupturing this bag starts an endothermic reaction that cools the pack.

And urea labelled with carbon-13 or carbon-14 is used in a breath test to determine the presence of Helicobacter pylori in the stomach and duodenum. The test detects the characteristic enzyme urease produced by the bacterium.

Another important constituent of urine is the enzyme urokinase, which, unlike urea, cannot yet be synthesised and so is either extracted from human urine or obtained from neonatal kidney cells grown in tissue culture. Urokinase is used clinically as a thrombolytic agent. It is costly, but it is the most effective drug in myocardial infarction. It is also used to treat deep vein thrombosis, pulmonary embolism and occluded intravenous or dialysis cannulas. And it is administered intrapleurally to help drain pleural effusions and empyemas.

Human urine also contains various sex hormones that could, in theory, be used clinically. Although human piddle has not yet been exploited for this purpose, equine wee-wee has been used for many years. Marketed since 1942, the product Premarin, used for hormone replacement therapy, consists of conjugated oestrogens obtained from the urine of pregnant mares.

So, whether or not you believe the disciples of urine therapy, the golden liquid certainly has its place in medicine. And perhaps some of its many microconstituents really do have beneficial effects when urine is ingested. Now that these substances have been identified, research could begin on possible candidates for urine’s claimed benefits.

 

See other Christmas miscellany articles.

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11131969

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