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Rebalancing the Vaginal Microbiome with Greta Durston · Wellness by Designs - Practitioner Podcast

• 0:19
  Speaker 1: Music.
• 0:19
  Speaker 1: This is Wellness by Design, and I'm host Andrew Whitfield-Cook, and joining us today is Greta Durston, a naturopath who specialises in helping women, and indeed couples, with sexual health, and today we're going to be discussing the vaginal microbiome.
• 0:35
  Speaker 1: Welcome to Wellness by Designs, Greta.
• 0:38
  Speaker 1: How are you?
• 0:40
  Speaker 2: Thank you, I'm great.
• 0:41
  Speaker 2: I'm really looking forward to chatting today.
• 0:43
  Speaker 2: Thanks for having me on.
• 0:44
  Speaker 1: Thank you, I'm great.
• 0:45
  Speaker 1: I'm really looking forward to chatting today.
• 0:47
  Speaker 1: Thanks for having me on.
• 0:48
  Speaker 1: Well, this is obviously a very interesting topic and you and I know somebody that you've learned from, so take us through.
• 0:53
  Speaker 1: How did you learn about the vaginal microbiota?
• 0:57
  Speaker 1: What was it that got you really interested?
• 1:00
  Speaker 2: Yeah.
• 1:00
  Speaker 2: So I guess my interest really comes from my own personal experience, which is the same for a lot of health practitioners.
• 1:08
  Speaker 2: When I was studying naturopathy, I was probably in my second or third year of naturopathy and I had my own symptomatic mycoplasma infection, which is a sexually transmitted infection.
• 1:21
  Speaker 2: It's quite underdiagnosed sexually transmitted infection.
• 1:27
  Speaker 2: It's quite underdiagnosed.
• 1:27
  Speaker 2: And for myself I was misdiagnosed for two years, which means that I ended up getting pelvic inflammatory disorder from that infection, which was misdiagnosed as chronic thrush BV, lots of other things.
• 1:37
  Speaker 2: I even went to the hospital twice with extreme pelvic pain and was just dismissed and told to take Panadol.
• 1:43
  Speaker 2: So it took a lot for my diagnosis.
• 1:47
  Speaker 2: I also had a naturopath at the time who did offer some treatments, but I really only had, you know, vaginal probiotics or, you know, put yogurt on a tampon and put that in your vagina.
• 1:58
  Speaker 2: That was kind of the only treatment I was offered.
• 2:01
  Speaker 2: So when I was sort of finishing my degree and doing my clinic student clinic I just really got interested in that whole area of the vaginal microbiome, got really into hearing Dr Moira Bradfield talking and she had a lot of training on her website.
• 2:20
  Speaker 2: That I did and then I went on to study with her for six months post my graduation and, yeah, learn all things vaginal microbiome through her.
• 2:30
  Speaker 1: So tell us what we know so far, because, like back in the old days of nursing, and we're only talking, you know, 30 years ago, and that's not a lot when you consider the progress that's been made in so many other areas, even, let's say, the early 2000s, it was still mentioned with regards to the vaginal microbiota, the dodeylanes bacillus, what you know, which was, I think, later teased out to be a lactobacilli.
• 3:01
  Speaker 1: So there's really only this recent exploration into the, the milieu of the vaginal microbiota yeah, that is such a funny term, isn't it?
• 3:12
  Speaker 2: and I actually had never heard that until this year, when I was doing some research for another talk that I did, um, and then I went down that rabbit hole of how that came about.
• 3:22
  Speaker 2: Um, and, yeah, so this gynecologist in what was it?
• 3:25
  Speaker 2: 1890s, early 1890s, albert Daudelaine.
• 3:30
  Speaker 2: He made that term the Daudelaine lactobacillus, or Daudelaine's bacillus, I think they called it, which was the type of lactobacillus that they'd found in the vaginal microbiome, different to the lactobacillus species that they'd found in the gut microbiome, in that they have more ability to like, clump together and adhere to the vaginal and vulval walls, so that was kind of all we knew.
• 3:54
  Speaker 2: Yeah, that was sort of all we knew until much more recently.
• 3:58
  Speaker 2: So the first study published of the vaginal microbiome as a whole and kind of classifying the vaginal microbiome, was in 2002.
• 4:06
  Speaker 2: So that's, you know, over a hundred years gap.
• 4:11
  Speaker 1: Okay, so how have we progressed since then, though?
• 4:15
  Speaker 2: So since 2002, we now have much more studies on the vaginal microbiome and really classifying them.
• 4:23
  Speaker 2: So we now know there's different CSTs which you might have heard of, so community state types, which kind of tells us about the types of lactobacillus that are dominant in different microbiomes and therefore how protective they are.
• 4:37
  Speaker 2: So that was a really big step in kind of understanding different microbiomes and then that wasn't just one type.
• 4:43
  Speaker 2: There's also more research now on, you know, how hormones affect the vaginal microbiome and even how you know women of different ascent, like African descent, are less likely to have a lactobacillus-dominated microbiome.
• 4:59
  Speaker 2: So there's so many factors that we didn't think of before that are now actually have research.
• 5:02
  Speaker 2: So there's so many factors that we didn't think of before that are now actually have research Right, so forgive me.
• 5:08
  Speaker 1: so this is African descent, but living in a Western civilisation, or African women in Africa.
• 5:15
  Speaker 2: Both, actually.
• 5:16
  Speaker 2: Yeah, it depends how far their ancestry goes back.
• 5:20
  Speaker 2: So it's more about the environment that their mothers grew up in, right, and what kinds of microbes their mothers came into contact with.
• 5:30
  Speaker 2: Wow, yeah.
• 5:33
  Speaker 1: Interesting, isn't it?
• 5:34
  Speaker 1: So this sort of goes on a little bit, I guess, from the work.
• 5:40
  Speaker 1: When they were talking about.
• 5:41
  Speaker 1: This was the microbiome project and there was the guy I can't remember his name who went over to live with the Hadza tribe in Africa and, interestingly, because they didn't have milk, they were the true hunter-gatherers.
• 5:54
  Speaker 1: So they didn't have the what do you call it, the farming civilisation.
• 6:01
  Speaker 1: They moved with the animals and hunted for for the animals and so milk wasn't really in their diet and they didn't have um, bifidobacteria um, or they didn't have big.
• 6:13
  Speaker 1: Yeah, after sorry, after birth, it weaned, it went.
• 6:16
  Speaker 1: Once the kids were weaned, it, uh, dropped off, their populations dropped off.
• 6:20
  Speaker 1: So that's really interesting about lactobacilli as well.
• 6:25
  Speaker 2: Yeah, so the women of African descent and some other cultures as well.
• 6:31
  Speaker 2: They actually have lower lactobacillus species and can be more bifidobacterium dominant in the vagina as well, which then sets them up for a bit more risk with things like BV and other infections.
• 6:45
  Speaker 1: Forgive me, so.
• 6:46
  Speaker 1: So, because they don't have the lactobacilli, sets them up for bv.
• 6:51
  Speaker 2: Yeah, so the um, the lactobacilli, is the most you know protective bacteria for the vaginal microbiome.
• 6:56
  Speaker 2: So if we don't have that level of protection, um, and we've replaced it with something like bifidobacterium, which is not as protective but you can definitely have a bifidobacterium-dominated vaginal microbiome, we then don't have that level of, you know, ph balance and protection against other bacteria.
• 7:16
  Speaker 1: Okay, so can you take us through some of the more common infections that you see in clinic?
• 7:22
  Speaker 1: So we'll sort of go backwards to the infections and then we'll come forward again to the microbes that are implicated in protection and maybe treatment.
• 7:30
  Speaker 2: Yeah, yeah, absolutely yeah.
• 7:32
  Speaker 2: So there's a few kind of classifications with infections.
• 7:36
  Speaker 2: So the two that we're probably most familiar with is BV or bacterial vaginosis, and thrush.
• 7:43
  Speaker 2: So the difference between those two would be that thrush is a fungal infection, usually caused by candida albicans but there's lots of other candidas that can cause it as well.
• 7:54
  Speaker 2: And then bacterial vaginosis is referring to a dysbiosis in the vagina between the bacteria.
• 8:00
  Speaker 2: So it's not fungal, it's just bacterial.
• 8:03
  Speaker 2: And when we talk about bacterial vaginosis, there's a few kind of criteria that need to be met for an actual bacterial vaginosis diagnosis.
• 8:13
  Speaker 2: And it's tricky because sometimes you'll just miss out on that diagnosis and not really know what to treat.
• 8:17
  Speaker 2: So with bacterial vaginosis, the three criteria there would be that the pH needs to be above 4.5.
• 8:27
  Speaker 2: There's a decrease in lactobacillus species and then an overgrowth of one or more anaerobic bacteria.
• 8:35
  Speaker 2: And it's really important that we understand the differences between anaerobic and aerobic bacteria, because there's another infection called aerobic vaginitis, which is basically bacterial vaginosis, but with aerobic bacteria.
• 8:49
  Speaker 2: And you know, the differences between anaerobic and aerobic bacteria really dictate how we treat it as well.
• 8:56
  Speaker 2: So with bacterial vaginosis, the anaerobic bacteria, it refers to bacteria that doesn't need air to survive, whereas aerobic bacteria refers to bacteria that does do a lot better with air and can grow and populate in air environments.
• 9:18
  Speaker 2: So even if you just think about that alone, things like wearing non-breathable underwear will put you at a higher risk of bacterial vaginosis.
• 9:28
  Speaker 2: So anything where you're creating that damp, dark space with not a lot of breathability, that's putting you at more risk for bacterial vaginosis.
• 9:38
  Speaker 1: Okay, With regards to thrush, again, like we think about the classical symptoms but thrush doesn't always fit into those classical symptoms of the cottage cheese discharge, things like that.
• 9:50
  Speaker 1: Can we go through that and maybe tease apart some of the little hints and tips to how to diagnose correctly?
• 9:57
  Speaker 2: Yeah, absolutely so, I think for me.
• 10:00
  Speaker 2: I kind of think of thrush in two categories, of acute thrush or chronic thrush.
• 10:05
  Speaker 2: So acute thrush is more like you can understand why it happened.
• 10:09
  Speaker 2: So maybe they took antibiotics and then they got a thrush infection because we've killed off some of the bacteria.
• 10:15
  Speaker 2: Now they have this opportunistic fungal infection.
• 10:18
  Speaker 2: So that is like an acute thrush, you know, you might take some antifungals, you might use antifungal cream and it's probably going to resolve and not come back again.
• 10:30
  Speaker 2: That is really like a purely fungal infection in the vagina which can be treated and moved on.
• 10:37
  Speaker 2: It's not really systemic in nature.
• 10:39
  Speaker 2: That's where you're going to see that really cottage cheese discharge, maybe a yeasty sort of odor and some irritation as well.
• 10:50
  Speaker 2: So maybe some itchiness or irritation.
• 10:52
  Speaker 2: So that kind of acute thrush might be from the antibiotics, from sex, from going to a hot environment, so those kinds of acute type infections.
• 11:03
  Speaker 2: Then the chronic infections for thrush, when it becomes really chronic or cyclical in nature, that's when the presentation seems to change a fair bit.
• 11:15
  Speaker 2: So in that more chronic thrush you might see no discharge at all, there might not be any.
• 11:20
  Speaker 2: There might be like a little bit of a white discharge, um, or they can be like quite a liquidy, um gushy discharge with little flecks of fungal bits, so not so much cottage cheese but little tiny flecks where you can see the um fungal infection there.
• 11:36
  Speaker 2: Then the symptoms of the irritation would be quite similar.
• 11:41
  Speaker 2: But it tends to get more irritating the longer it's gone on, because the longer you have it, the longer you've got that penetration of the candida into the tissue which causes that shedding of the tissue, which causes degradation.
• 11:55
  Speaker 2: So we've got a lot of irritation, the tissue is being degraded, you might have easier bleeding.
• 12:01
  Speaker 2: So with sexual intercourse you might get bleeding.
• 12:05
  Speaker 2: So it's just quite different symptoms.
• 12:07
  Speaker 2: In that way, the longer it goes on as well, the more histamine it produces.
• 12:13
  Speaker 2: So candida produces a huge amount of histamine.
• 12:16
  Speaker 2: So it kind of becomes this actually like a histamine-driven infection.
• 12:22
  Speaker 1: That's really interesting yeah.
• 12:23
  Speaker 2: So yeah, I think that's a missing piece.
• 12:24
  Speaker 2: It kind of becomes this actually like a histamine-driven infection.
• 12:26
  Speaker 2: That's really interesting.
• 12:27
  Speaker 1: Yeah.
• 12:27
  Speaker 1: So yeah, can I ask then and I know this is pharmacological therapy, not natural therapy but do you ever find that in these chronic cases, an antihistamine can sometimes take the load off while you're doing other supportive therapy to heal the terrain?
• 12:44
  Speaker 2: Yeah, yeah, it's a great question.
• 12:46
  Speaker 2: So if there's a lot of irritation and a lot of inflammation, then absolutely sometimes they can be useful.
• 12:53
  Speaker 2: I've certainly used them with clients before, especially if it's you know sex and they're trying to conceive or there's something that's really irritating like that, I would get them to take an antihistamine before sex if that's their flare period.
• 13:06
  Speaker 2: That being said, obviously, if you're going to take an antihistamine, it's not going to, you know, reduce the production of histamine, which is why I find it more useful to use something like quercetin or something that really will stop that production long term um something that really um will stop that production long term gotcha.
• 13:26
  Speaker 1: And so, with regards to the you spoke about, um infections and, and you know, upon sex and things like that, there's this um concept of ping pong infection.
• 13:36
  Speaker 1: Do you find, you know, going from one to the other, one to the other, and then it was sort of dismissed for a while.
• 13:41
  Speaker 1: I've seen it quite a bit where you know women come in going or a husband.
• 13:52
  Speaker 1: So do you find either there's a ping pong infection and do you find that it's easy or frustratingly hard to treat the male?
• 13:56
  Speaker 2: Yeah, it, I've definitely seen that multiple times.
• 13:59
  Speaker 2: I I kind of take the approach of is it that it's actually moving from one to the other?
• 14:05
  Speaker 2: Is that the only issue?
• 14:06
  Speaker 2: And it's usually not the only issue, it's usually that.
• 14:09
  Speaker 2: Well, one of the things that I see a lot is that the female or the woman's vaginal microbiome has no protection.
• 14:17
  Speaker 2: The pH is already high, she's already stressed, she's already producing heaps of histamine, so there's already all of these factors going on in her world that mean she has less protection against opportunistic bacteria.
• 14:31
  Speaker 2: So, yes, maybe there is some passing between, but usually they will have the same kind of microbes if there are infections.
• 14:38
  Speaker 2: And if she had enough protection and if she had enough, you know, good hygiene practices and things like that she might not get symptoms from those microbes.
• 14:50
  Speaker 2: That's definitely not with all of them.
• 14:51
  Speaker 2: So some of them we really do need to eradicate in both partners.
• 14:54
  Speaker 2: But I find you know, just making sure that the women's vagina microbiome is as healthy as possible, that will give us the most protection.
• 15:09
  Speaker 1: And I know that we're sort of segwaying away from the female just for a bit, but I need to cover this and that is the practice nowadays of not circumcising males.
• 15:15
  Speaker 1: Do you find that that's an issue with ping pong infection?
• 15:18
  Speaker 1: Do you find that some males have to go and get circumcised, or do you just work around with the treatment?
• 15:25
  Speaker 2: Yeah, that's a great question actually.
• 15:26
  Speaker 2: I mean I haven't seen it be an issue really, but I am always coaching them around washing underneath the foreskin.
• 15:35
  Speaker 2: So, yeah, that might be an issue but it's a very easy hurdle to get over because you can just really wash it properly and so if there's, you can see and you can smell if there's anything kind of getting stuck under the foreskin, so that doesn't tend to be too much of an issue.
• 15:49
  Speaker 2: Where the issue comes with the ping pong infection is usually the seminal microbiome, which is so tricky because we have no direct access to the seminal microbiome.
• 15:58
  Speaker 2: Yeah, it's not necessarily about what's on the head of the penis, it's really the seminal microbiome.
• 16:02
  Speaker 1: Yeah, it's not necessarily about what's on the head of the penis.
• 16:05
  Speaker 1: It's really the seminal microbiome.
• 16:06
  Speaker 1: So therefore testing in the male would have.
• 16:07
  Speaker 1: You'd have to be looking for the culprit yeah, yeah, so there are.
• 16:12
  Speaker 2: There's not a lot of them, but there are some seminal microbiome tests that you can do, um, and then you get a good idea of like everything that's in the seminal microbiome.
• 16:22
  Speaker 2: The hard thing is treatment, because we don't have a direct access.
• 16:27
  Speaker 2: It's not like you can put some herbs straight into the seminal microbiome and flush it out.
• 16:30
  Speaker 2: It's a little bit different.
• 16:31
  Speaker 2: Yeah, not as comfortable with the seminal microbiome.
• 16:37
  Speaker 2: There's not a lot of research on how that happens the translocation from the seminal microbiome to the vaginal microbiome.
• 16:43
  Speaker 2: But there is some research now that has pointed to the theory of the microbes actually attached to the semen.
• 16:49
  Speaker 2: So they like take a little ride on the semen into the vaginal microbiome and that's how they end up there.
• 16:56
  Speaker 2: So I think that's really interesting that they can actually invade the cells of the semen and that it's being carried in that way.
• 17:02
  Speaker 2: So it's always interesting just to talk about.
• 17:05
  Speaker 2: You know how the client has sex?
• 17:07
  Speaker 2: Are they using condoms, um, is there a jaculent going into the vagina or not?
• 17:12
  Speaker 2: So there's lots of different kind of um factors there and back to the vagina again.
• 17:19
  Speaker 1: So you know, once the terrain's inflamed and upset, any sort of you know coupling causes would cause more inflammation and set them up for another sort of wave of infection like I've just.
• 17:33
  Speaker 2: I've had these poor frustrated.
• 17:35
  Speaker 1: I've sent a couple to moira, actually because I just went.
• 17:37
  Speaker 1: Oh my goodness yeah, yeah, yeah.
• 17:40
  Speaker 2: And it's not only that, but yeah, it'll cause more inflammation, um, and the more degraded the tissue is, the easier it is to tear.
• 17:47
  Speaker 2: So if you think about having those tiny little micro tears, um, from intercourse, then that's like a hive for bacteria.
• 17:54
  Speaker 2: So that's, if there's any opportunistic bacteria hanging around, it's going to go and embed itself there.
• 17:59
  Speaker 2: So, yeah, yeah, there's lots of different risks with that as well, and you know the vaginal tissue is such a soft, delicate place and you know the penis tissue is very hard.
• 18:11
  Speaker 2: So in itself, you know it comes with some risks.
• 18:17
  Speaker 1: We need to talk about assessments as well.
• 18:19
  Speaker 1: So you know, like if somebody is going to do a general, like an MSU or a general swab and they're looking for you know, forgive me and the lab technician isn't alerted to looking for a specific organism, then they'll just look for general things like coliforms and things like that, and so, as you say, the infections are missed.
• 18:39
  Speaker 1: What do we need to be alert for?
• 18:41
  Speaker 1: To go listen.
• 18:42
  Speaker 1: Can you please look for this?
• 18:45
  Speaker 2: yeah, that's a really great question.
• 18:46
  Speaker 2: So, yeah, you can get with um your gps.
• 18:49
  Speaker 2: Obviously you can get swabs done.
• 18:51
  Speaker 2: They'll look for the, you know, top um offending microbes in bb and thrush um.
• 18:57
  Speaker 2: The other two, the one that I mentioned before, which is um, mycoplasma um, it is a molecule, so these are like a parasite that um can be found in the vaginal microbiome um.
• 19:08
  Speaker 2: So, uh, mycoplasma genitalium um.
• 19:11
  Speaker 2: There's a couple of other types, um and urea plasma as well.
• 19:15
  Speaker 2: So those two, I believe, need to be tested every time you're getting a swab as well, um just to rule them out, because if they're there you're going to miss them yeah, obviously males very hard to swab, yeah, but you could take a seminal fluid sample, hopefully and catch yeah, it is.
• 19:36
  Speaker 2: It's honestly really tricky to get males tested properly.
• 19:39
  Speaker 2: Sometimes if there's a rash on the penis or around the pelvic area, then they might do a skin scrape or a swab so they might find candida there or other funguses.
• 19:50
  Speaker 2: It's not very often that they do that, and they do usually say oh, that looks like candida, try this cream and then, if it's not, maybe we'll do some other tests.
• 19:59
  Speaker 2: They can do urinary samples so they could pick up microplasma and urea plasma, different fungal infections and BV bacteria from the urine sample as well, but it'll be smaller amounts.
• 20:17
  Speaker 1: So again you'd have to be writing on the request please look for, because otherwise that might.
• 20:21
  Speaker 2: Yeah, absolutely yeah, and in my experience, it is quite hard to get the request please look for, because otherwise that might yeah, absolutely yeah.
• 20:25
  Speaker 2: And in my experience it is quite hard to get the doctor to then look for that if they're not told to test for it usually.
• 20:32
  Speaker 1: And what about things like?
• 20:34
  Speaker 1: We spoke about micro tears in the lining of the vagina.
• 20:38
  Speaker 1: I remember Moira telling me about different types of lubricants that some are more effective, some might even have an irritating effect and some might actually help bad bacteria to grow.
• 20:50
  Speaker 1: Can we go through those?
• 20:51
  Speaker 1: What sort of things are recommended?
• 20:55
  Speaker 2: Yeah, definitely yeah.
• 20:56
  Speaker 2: So I usually recommend using an organic lubricant, usually water-based, so there's either a water-based or an oil-based lubricant.
• 21:05
  Speaker 2: So it's about the type of lubricant it is.
• 21:08
  Speaker 2: And then the ingredients, the specific ingredients.
• 21:11
  Speaker 2: So a really big one that we always talk about is using a non-glycerin lubricant, so something that doesn't have glycerin in there.
• 21:20
  Speaker 2: There's varying research into how glycerin can feed fungal or bacterial infections.
• 21:26
  Speaker 2: The jury is honestly a little bit out on it.
• 21:29
  Speaker 2: It doesn't seem to be really well researched into whether it's actually an issue topically, and usually for me and my clients it's usually about making sure you're washing that off.
• 21:40
  Speaker 2: If you do have a lubricant that's maybe not so vagina microbiome friendly, definitely washing it off.
• 21:45
  Speaker 2: So you might not see those effects if you're, you know, using it for five or 10 minutes, but if it's staying in there, you will start to see those effects.
• 21:54
  Speaker 2: So glycerin also being pH balanced as well.
• 21:58
  Speaker 2: So pH balance to the vaginal microbiome is a big one.
• 22:01
  Speaker 2: So we want that pH to be between about 3.5 and 4.5.
• 22:06
  Speaker 2: Then there's also other more protective ingredients that are in the more natural lubricants.
• 22:14
  Speaker 2: So things like aloe vera, you know things that can be really soothing and also repairing to the vaginal tissue as well, and then in cases, like you know, perimenopausal or menopausal clients, we have a little bit more of that tissue degradation.
• 22:30
  Speaker 2: So we want to be really careful to be promoting the tissue, the vaginal tissue health.
• 22:36
  Speaker 2: So then that's where the oil-based lubricants can be more helpful as well.
• 22:41
  Speaker 2: So a bit more soothing, provide a bit more protection.
• 22:47
  Speaker 1: And can I ask, do any of these lubricants have maybe a base or an addition with, say, coconut oil, like caprylic acid, the antifungal actions of caprylic acid or anything like that?
• 22:59
  Speaker 1: Moira was very interested in butyrate.
• 23:04
  Speaker 2: Yeah, yeah, fungal actions of caprylic acid or anything like that.
• 23:06
  Speaker 2: Um, moira was very interested in butyrate.
• 23:07
  Speaker 2: Yeah, yeah, I haven't heard her talk about um butyrate in in lubes before.
• 23:10
  Speaker 2: Um, I personally steer away from coconut oil as a lubricant, mostly because it is um, it's a really high ph and it really can just throw the ph out.
• 23:19
  Speaker 2: That's not to say that I don't have some clients that use it and it works for them, but um, we don't really usually um recommend um coconut, coconut oil as a lubricant.
• 23:29
  Speaker 2: Um it can.
• 23:30
  Speaker 2: Yes, it does have that antibacterial, antifungal activity.
• 23:34
  Speaker 2: Um, but we don't know how much that kind of affects the, the beneficial flora um and the flora that we actually don't want to grow, like candida and you know those anaerobic bacteria.
• 23:47
  Speaker 1: Right.
• 23:47
  Speaker 1: So with treatment, obviously we're going through prevention and general maintenance and sexual contact, things like that.
• 23:56
  Speaker 1: What about treatments?
• 23:57
  Speaker 1: You mentioned right at the beginning about the issues with, you know, not having things on hand, and part of this was actually a restriction, partly understandable, by the therapeutic goods administration, where at one stage we had pessaries, probiotics in a pessary form that we could give, and now there was that decision made by the TGA to say no, that's considered internal, so anything internal has to be sterilized.
• 24:24
  Speaker 1: Therefore your bacteria is killed.
• 24:26
  Speaker 1: How do we navigate this one?
• 24:32
  Speaker 2: Yeah, yeah, I definitely have some views on this.
• 24:34
  Speaker 2: So there are a lot of you know vaginal probiotics out there that have really good research on being intravaginal probiotics.
• 24:42
  Speaker 2: It really just is about the labeling and I guess you know if we're talking to practitioners, it is up to our own you know our own knowledge and our own prescription to be able to tell our clients whether it's safe or not to use intravaginally.
• 24:58
  Speaker 2: Usually you can ask you know the reps of different the vaginal probiotics and see if it is safe to put intravaginally um.
• 25:02
  Speaker 2: Usually you can ask you know the reps of different um the vaginal probiotics and see if it is safe to put um intravaginally, because it's usually just about the labeling yeah there is a um I guess, the brand new sorry there is.
• 25:14
  Speaker 1: I was just going to interject, um, sorry, I was just going to interject, um.
• 25:19
  Speaker 1: I guess the decision from a practitioner point of view is well, do I give something that has some evidence with treatment effect, or does the patient rely on then going to the supermarket and getting a most probably dead yoghurt which has very little effect?
• 25:41
  Speaker 1: So it's sort of like well, it's risk to benefit, isn't it?
• 25:45
  Speaker 2: Yeah, yeah, exactly, and I guess my advice around that would just to be using a probiotic that has really good translocation.
• 25:52
  Speaker 2: So if you do want to be just using them orally, we need to make sure that we're using strains that have been shown in the research to translate from the gut microbiome over to the vaginal microbiome, because that's what it's doing, right, like you're eating it.
• 26:06
  Speaker 2: It needs to survive your stomach, it then needs to survive your gut, it then needs to come out in your poo and then translocate over the perineum to the vaginal microbiomes, like that's the reality of it.
• 26:17
  Speaker 2: So you want to make sure you're using really specific strains that have been shown in the research to do that.
• 26:27
  Speaker 1: And one of the other things I remember this is decades ago now, but I was.
• 26:31
  Speaker 1: I had this predilection for zinc, zinc, zinc, zinc, zinc.
• 26:35
  Speaker 1: Everybody was zinc deficient zinc, zinc, zinc, zinc.
• 26:37
  Speaker 1: And there was these ladies that would walk past me where I used to consult in the pharmacy, and they'd walk past me to go and get their um myconazole cream.
• 26:47
  Speaker 1: And then it was only after, and it was after months I suddenly went hang on, I'm not getting something here.
• 26:54
  Speaker 1: Iron yeah many of them were iron deficient, so can we go?
• 27:00
  Speaker 1: Can we have a chat about how much work you do about the terrain, the sort of base health of the patient and their immune response health, their immune capacity?
• 27:11
  Speaker 2: Yeah, yeah.
• 27:12
  Speaker 2: So yeah, I always come from a.
• 27:13
  Speaker 2: You know both sides of that story, so you know.
• 27:16
  Speaker 2: Treating internally what are the factors?
• 27:18
  Speaker 2: Why do you have this infection?
• 27:20
  Speaker 2: Not just let's treat the infection, but how did we get here, like, why couldn't your immune system deal with it?
• 27:25
  Speaker 2: And then also treating intravaginally.
• 27:28
  Speaker 2: So I do a bit of both.
• 27:30
  Speaker 2: I'm always treating orally, working on their health as a whole.
• 27:34
  Speaker 2: Is it blood sugar?
• 27:35
  Speaker 2: Is it their immune system?
• 27:36
  Speaker 2: Do they have deficiencies, things like that?
• 27:39
  Speaker 2: Are they deficient in nutrients?
• 27:41
  Speaker 2: Where that impacts your tissue health, where it impacts your ability to grow more layers of your vaginal tissue.
• 27:49
  Speaker 2: So it's those kinds of things that we want to work on internally as well and those things take a long time as well.
• 27:55
  Speaker 2: So to get the most, um, the most sort of uh symptom relief is when we also want to do that um, intravaginal treatment.
• 28:04
  Speaker 2: So in terms of uh things that we can do orally, we want to kind of assess like what, why?
• 28:13
  Speaker 2: Why is this happening for them?
• 28:14
  Speaker 2: So is it their immune system?
• 28:15
  Speaker 2: Like you said?
• 28:16
  Speaker 2: Is it an iron deficiency?
• 28:17
  Speaker 2: Do we need to give them zinc?
• 28:20
  Speaker 2: Are they zinc deficient?
• 28:21
  Speaker 2: Sometimes it is, and you know, things like if there's insulin resistance going on is a huge one for candida infections.
• 28:29
  Speaker 2: So that and so treatment with that, with insulin resistance?
• 28:40
  Speaker 2: Yeah, so, with insulin resistance, I mean it's a lot about, um us changing their diet as well.
• 28:42
  Speaker 2: Um, so changing their diet, opting for um smaller protein rich meals.
• 28:47
  Speaker 2: Um, treatment wise, we can do myo-inositol.
• 28:50
  Speaker 2: I know you've spoken a lot about that in your podcast before.
• 28:52
  Speaker 2: Um, so yeah, we can always do myo-inositol.
• 28:53
  Speaker 2: I know you've spoken a lot about that in your podcast before.
• 28:54
  Speaker 2: Um, so yeah, we can always do myo-inositol.
• 28:56
  Speaker 2: Um, that's usually all I really see that they need is those things.
• 29:00
  Speaker 2: Sometimes I'll do phgg and myo-inositol together for vaginal treatment, and that's giving us a prebiotic for the lactobacillus species, as well as balancing the blood sugar as well.
• 29:13
  Speaker 1: Okay.
• 29:13
  Speaker 1: So I have a question here.
• 29:14
  Speaker 1: One of the treatments that we use for, certainly, cardiovascular cholesterol, lipids, that sort of stuff, but also in part with insulin resistance, is berberine, and there's this ongoing argument about long-term.
• 29:28
  Speaker 1: Berberine might help the insulin resistance, but is it killing your bacteria?
• 29:32
  Speaker 1: What have you seen in clinic?
• 29:34
  Speaker 1: What are the changes?
• 29:37
  Speaker 2: Yeah, look, I kind of stay away from it.
• 29:41
  Speaker 2: My opinion is I don't do a lot of berberine.
• 29:43
  Speaker 2: I will use it for short periods of time, but I'm a microbiome naturopath, right?
• 29:49
  Speaker 2: So my top kind of priority is the microbiome.
• 29:52
  Speaker 2: So if I've got other things that can work just as well and I'm not going to be affecting both the gut microbiome and the vagina microbiome, um, I'm probably not going to use berberine long term.
• 30:02
  Speaker 2: I do think that it's really interesting and there are, um I want to see some, you know some more studies on using particular doses, um with those types of things.
• 30:10
  Speaker 2: But, um, yes, it's useful.
• 30:12
  Speaker 2: No, I wouldn't use it long term.
• 30:15
  Speaker 1: Yeah, I think I agree, Like we need more data on it.
• 30:19
  Speaker 1: Might do this, but at what expense?
• 30:22
  Speaker 1: When you've got this condition, if they don't have that problem, go nuts.
• 30:26
  Speaker 1: But if you do have this problem, are you undoing what you're trying to treat, sort of thing.
• 30:31
  Speaker 2: Yeah, and is there maybe a lower dose that we could use for longer periods?
• 30:37
  Speaker 1: salient point.
• 30:37
  Speaker 1: What about other gut sort of um treatments?
• 30:40
  Speaker 1: If we're talking about the microbiota from the gut, then inoculating the vagina um, what else can we use that you've found favorable?
• 30:50
  Speaker 2: yeah.
• 30:50
  Speaker 2: So a really um, well-researched combination of probiotics is the lactobacillus rhamnosus GR1 and lactobacillus ruteri RC14.
• 31:00
  Speaker 2: They're the most kind of studied combo for boosting the vaginal lactobacillus and that's oral root as well, especially with things like strep B.
• 31:11
  Speaker 2: There are quite a few studies on that combination of crowding out strep B.
• 31:13
  Speaker 2: There are quite a few studies on that combination of crowding out strep B and it also, interestingly, is used to crowd out strep B in the gut.
• 31:20
  Speaker 2: So you're kind of doing both.
• 31:22
  Speaker 2: If you really think it's coming from the gut, it's interesting to just use those specific probiotics internally.
• 31:30
  Speaker 2: We can also similarly use SB internally which will reduce the yeast in candida candida yeast in thrush, translocating from the digestive tract to the vaginal microbiome.
• 31:45
  Speaker 1: So those are a lot of the probiotics that I would generally use.
• 31:48
  Speaker 1: Could you take?
• 31:51
  Speaker 1: Us through dosage regimen on that at all with SB, like how high do you go?
• 31:55
  Speaker 1: I've been very heroic with SB yeah, I usually do.
• 32:01
  Speaker 2: It kind of depends on the um, the dose in each capsule.
• 32:05
  Speaker 2: I usually do two capsules twice daily, but there are some that are a much higher dose and you can get away with one capsule twice daily.
• 32:13
  Speaker 2: Um, but of the kind of standard old school dose, I think the designs for health, one might be a high dose, but I do think, um, yeah, usually you can go for two twice a day uh, anything else, um so general gut healing, um pectin, salivary glutamine, that sort of thing do you ever use that?
• 32:34
  Speaker 2: yeah, absolutely like all the kind of general gut healing will almost always help um.
• 32:39
  Speaker 2: The more specific things that I do use would be things that I know that are going to help to grow um the lactobacillus species.
• 32:46
  Speaker 2: So lactoferrin is amazing um, even orally, um same with lactulose.
• 32:52
  Speaker 2: But you do need to be kind of careful with um lactulose in that it will also feed aerobic bacteria.
• 32:59
  Speaker 2: So if you've got aerobic vaginitis we don't want to use um lactulose.
• 33:04
  Speaker 1: But lactoferrin is um quite safe and you're just using it orally yeah, at low doses, because if you use the full dose don't go out yeah, yeah, definitely low doses.
• 33:12
  Speaker 2: Yeah, yeah, you might the full dose don't go out.
• 33:13
  Speaker 2: Yeah, yeah, definitely low doses.
• 33:14
  Speaker 2: Yeah, yeah, you might make, um, some running stools otherwise, um, but anything that's going to kind of help with that tissue healing in the gut is also going to be beneficial for the vagina as well, and anything where we're um, we're helping to break down biofilms the really big one that we haven't discussed yet um, and also helping to reduce inflammation as well.
• 33:35
  Speaker 2: So some of the things that you can use, even orally, to help with the biofilm degradation would be things like NAC is incredible at that A couple of herbs, pomegranate, green tea both of those have selective antimicrobial actions, so they do target those more opportunistic bacteria and don't have an effect on the lactobacillus.
• 33:58
  Speaker 2: That's really important too, which is what I would use over berberine.
• 34:03
  Speaker 1: Right, mike Ash some years ago mentioned something and this is a different end of the body, I get it, but he was talking about chronic sinusitis mixing sb with nac into a glass and putting a cotton bud and basically inoculating your nose with both the sb and the topical application of nac.
• 34:26
  Speaker 1: Have you ever done that vaginally?
• 34:28
  Speaker 1: Have you ever had experience with nac vaginally?
• 34:31
  Speaker 1: Yeah, oh, yeah, yeah, absolutely, take us through this please.
• 34:34
  Speaker 2: You can do it, yeah, so with the vaginal treatment, I'm always thinking about what do we need to do for the specific microbe that was found, or microbes that were found.
• 34:42
  Speaker 2: Is it likely to create biofilms?
• 34:46
  Speaker 2: Do we need to break those down?
• 34:47
  Speaker 2: So we need something that's going to break them down.
• 34:49
  Speaker 2: Do we need to change the pH?
• 34:52
  Speaker 2: Do we need to change the ph?
• 34:52
  Speaker 2: Do we need to actually kill the microbe?
• 34:53
  Speaker 2: And what is the right herb for that?
• 34:55
  Speaker 2: Um, so all of that we can do um topically.
• 34:58
  Speaker 2: So topically, um nac vitamin c, just ascorbic acid um and bacal skull cap actually, um are great at breaking down biofilms in the vagina.
• 35:08
  Speaker 2: So we can do that with things like rinses.
• 35:11
  Speaker 2: Sometimes we use a really low dose hydrogen peroxide as like the base of a rinse, adding in herbs or nutrients into there, and then you can just apply that topically, so with a syringe into the vagina to help break down the biofilms.
• 35:27
  Speaker 2: So then when you're delivering something antimicrobial in a cream or a pessary or whatever else it might be, you have more of a direct access to that, without all the biofilm in the way what's your view of the um, the pharmaceutical um creams on the market like the?
• 35:46
  Speaker 1: you know the um creams used to acidify the vagina and things like that.
• 35:51
  Speaker 1: Have you found good effect with those as a supportive therapy?
• 35:56
  Speaker 2: Yeah, do you mean things like boric acid and lactic acid or things that are more like antifungal and antibacterial?
• 36:03
  Speaker 1: Things like Vagisil and yeah, that sort of thing.
• 36:09
  Speaker 2: Yeah, I believe Vagisil, from memory, is a lactic acid based product um.
• 36:15
  Speaker 2: I have had some clients using lactic acid um and I mean that's what our lactobacillus produces lactic acid.
• 36:21
  Speaker 2: So it can be really beneficial um to use the lactic acid.
• 36:24
  Speaker 2: But they all kind of interchangeable.
• 36:26
  Speaker 2: So lactic acid, vitamin c, boric acid, um, all of those things um are aimed at reducing the ph.
• 36:33
  Speaker 2: So if we can, you know, reduce the ph in between that 3.5 and 4.5 for healthy vaginal microbiome, and we can boost up the lactobacillus species a lot of the time that's all we need.
• 36:45
  Speaker 2: It's not always, but, you know, a lot of the time we just need to create the right environment that things will sort themselves out.
• 36:53
  Speaker 1: Right.
• 36:53
  Speaker 1: Can I ask also about species?
• 36:57
  Speaker 1: Not necessarily strains here, because we're talking food, but things like, you know, your fermented foods, so the lactobacillus plantarums.
• 37:04
  Speaker 1: Then you've got cheeses, for instance.
• 37:08
  Speaker 1: So we're talking short-chain fatty acids, lactic acid, the propionibacterium Freudian Reiki.
• 37:16
  Speaker 1: There you go.
• 37:17
  Speaker 1: I remembered it.
• 37:19
  Speaker 1: In Swiss cheese it's Edam cheese, emmental cheese.
• 37:22
  Speaker 1: So these are foods.
• 37:24
  Speaker 1: We don't often think of them as therapy in this, certainly not a cheese.
• 37:28
  Speaker 1: And then we've, you know, usually got this an idea of trying to avoid too much dairy.
• 37:37
  Speaker 1: Do you find in the, in this instance, that some of these foods can actually be useful?
• 37:44
  Speaker 2: this is so interesting because you'd think so with the strain specificity in those um foods.
• 37:50
  Speaker 2: But those foods also really high histamine producing foods.
• 37:54
  Speaker 2: So, you know, dairy they're things that are like cultured, they're things that are, yes, they have the bacteria there, but they also have this huge histamine load.
• 38:04
  Speaker 2: So they're not necessarily things that I would recommend because of the histamine side of things.
• 38:10
  Speaker 2: There definitely are some foods that have more specific strains for the vaginal microbiome.
• 38:16
  Speaker 2: So, um, coconut yogurt is one of them.
• 38:19
  Speaker 2: It's not dairy, it's, you know, coconut yogurt.
• 38:21
  Speaker 2: Um, it's really high in lactobacillus strains, specifically because of the way that they manufacture it.
• 38:26
  Speaker 2: So if you get a wild fermented coconut yogurt and coconut kefir as well, um, actually, uh, cow's milk or goat's milk kefir does have a lot less um lactose and it does have the?
• 38:40
  Speaker 2: Um, the lactobacillus species in there as well.
• 38:42
  Speaker 2: So you can get away with some um, some dairy products there, um, but yeah, so things like, uh, either the?
• 38:49
  Speaker 2: Um kefir or the coconut yogurt, um, also things like green tea, like things that are, yes, they're antimicrobial but they have a beneficial action on the lactobacillus species.
• 39:01
  Speaker 2: So we need to just think about is there any negative effect as well?
• 39:06
  Speaker 1: Yeah, sure, I've learned so much from this.
• 39:09
  Speaker 1: This is great, this is really good.
• 39:10
  Speaker 1: But I think it's really a salient point that you give me, certainly, and that is to always, whatever you're thinking, always keep in mind what you might be producing.
• 39:22
  Speaker 1: Like you spoke about the um, the caprylic acid potentially, the coconut oil, lubricants potentially upsetting the um, the ph of the vagina, and then the the um.
• 39:33
  Speaker 1: You know good dairy products if you like, but then they're high histamine.
• 39:36
  Speaker 1: So you've always got to think about this risk to benefit.
• 39:39
  Speaker 1: And what are you doing?
• 39:40
  Speaker 1: Are you causing collateral damage?
• 39:43
  Speaker 2: yeah, absolutely thinking about these things holistically.
• 39:45
  Speaker 2: Yeah, thinking about the whole person and what is the effect, and that's why it's really not I have this microbe and I'm going to treat that it's.
• 39:53
  Speaker 2: I have this microbe.
• 39:54
  Speaker 2: Why did I get this microbe?
• 39:57
  Speaker 2: What's going wrong within my body, or you know what do I need to support, what body systems aren't quite right, and you know what other things is this microbe producing?
• 40:05
  Speaker 2: Some microbes produce their own histamine, so there's, yeah, lots of other things that you need to kind of think about.
• 40:12
  Speaker 1: So what about other we've spoken about the now I've gone blank the RC14 and the GR1.
• 40:20
  Speaker 1: Yeah, that's right.
• 40:21
  Speaker 1: So what are the probiotics Like?
• 40:25
  Speaker 1: What about lactobacillus rhamnosus GG, for instance, the hero of all probiotics which I don't believe in heroes, but do you ever use like a concert of them?
• 40:37
  Speaker 1: Do you ever use probiotics in general?
• 40:41
  Speaker 2: yeah, I use a lot of different probiotics.
• 40:43
  Speaker 2: I'm really specific with the probiotics that I use, but I do use a lot of the lgg, the rhamnosus lgg, if there's any immune stuff going on, which there almost always is, but especially if it's a really um, chronic or embedded infection, um, specifically in aerobic vaginitis I use it a lot as well, um, and in chronic, um thrush, because it is impacting the stability of our mast cells and our ability to reduce or, you know, clear out histamine.
• 41:14
  Speaker 2: So when histamine and the immune system come into play, I'm definitely thinking lgg as well, and I'll often put people on multiple probiotics just because I want really really specific strains and I might do one, one type inside the vagina, intravaginally and then one type orally.
• 41:32
  Speaker 2: So I'm trying to impact the immune system orally and the gut microbiome to impact the vaginal microbiome, and then I might want something that's having a really direct impact on the vaginal microbiome.
• 41:45
  Speaker 1: Gotcha this is so interesting.
• 41:49
  Speaker 1: I'm learning so much.
• 41:50
  Speaker 1: Unfortunately, we're sort of running out of time, but I could talk to you all day.
• 41:53
  Speaker 1: This is fantastic.
• 41:54
  Speaker 1: Thank you, Greta, can I ask?
• 41:57
  Speaker 1: So people are going to want to know like have you got any courses that you help practitioners with, or have you written articles?
• 42:05
  Speaker 2: This is my ultimate goal.
• 42:06
  Speaker 2: Actually, within the next year or two, I would like to have a practitioner course.
• 42:10
  Speaker 2: At the moment, I just have a webinar that's for clients, so people who are student naturopaths.
• 42:16
  Speaker 2: You probably will get something out of it, but it is definitely aimed at clients more than practitioners.
• 42:22
  Speaker 2: So, yeah, keep an eye out.
• 42:23
  Speaker 2: In the next year or two, I should hopefully have a course going for practitioners and going through the kind of nuances of treatment with the vagina microbiome.
• 42:32
  Speaker 1: We'll be hassling you to make sure that gets completed.
• 42:35
  Speaker 1: It's too important.
• 42:37
  Speaker 1: I mean, look, it's too important a topic.
• 42:39
  Speaker 1: Women are really suffering, god, the women that I sent to Moira one woman she was just.
• 42:46
  Speaker 1: She was so angry in love with her husband, but furious that every time they made love something that was supposed to bring them together she ended up with this horrible infection and she was again on the, but furious that every time they made love something that was supposed to bring them together she ended up with this horrible infection and she was again on the roundabout.
• 42:58
  Speaker 1: And it was just this circle of despondency.
• 43:01
  Speaker 1: So I'm glad that people like you and Moira obviously have found some way of being able to really intercede in a truly therapeutic way to help people within their lives.
• 43:13
  Speaker 1: I just love what you're doing.
• 43:15
  Speaker 1: Thank you so much.
• 43:16
  Speaker 2: Thank you, yeah, thank you, it's yeah, and I just can't go unmentioned that this has such a huge impact on people's mental health and just your sense of self and sexuality and you know, your your kind of sensual self.
• 43:30
  Speaker 2: It can put you right off sex.
• 43:32
  Speaker 2: So I think it's really important that we're talking about it now and there's a lot more information out there.
• 43:39
  Speaker 1: Greta Durston.
• 43:39
  Speaker 1: Thank you so much for joining us today and thank you everyone for joining us.
• 43:43
  Speaker 1: Remember you can pick all of the other podcasts on the Designs for Health website.
• 43:48
  Speaker 1: I'm looking forward to a webinar from you soon, greta, and all of the information.
• 43:53
  Speaker 1: We're going to put up as much research as we can.
• 43:55
  Speaker 1: That's pertinent for the vaginal microbiome biota, because it's such an important and interesting topic and it's moving ahead quite quickly now.
• 44:04
  Speaker 1: Thank you so much for joining us today.
• 44:06
  Speaker 1: This is Wellness by Designs and I'm Andrew Whitfield-Cook.