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Sea Buckthorn and Female Reproductive Health: Rebuilding Mucosal Integrity with Jessie-Anne El-Tannoury · Wellness by Designs - Practitioner Podcast

• 0:12
  SPEAKER_00: This is Wellness by Designs, the podcast for practitioners who want to go deeper.
• 0:17
  SPEAKER_00: I'm your host, Amy Skilton, and today I'm joined by Jessie Ann, a degree-qualified naturopath who specialises in menstrual, hormonal, and sexual health, offering evidence-based naturopathic care for hormonal and intimate health.
• 0:32
  SPEAKER_00: Jessie, you know I'm how excited I am about this conversation today.
• 0:37
  SPEAKER_00: Welcome to the show.
• 0:38
  SPEAKER_00: Thank you for having me.
• 0:39
  SPEAKER_00: It's good to be here.
• 0:41
  SPEAKER_00: Such a pleasure.
• 0:43
  SPEAKER_00: Today we're talking about one of my favorite ingredients, something that I think just has not yet had its time in the sun.
• 0:52
  SPEAKER_00: And it has a connection to both aesthetic properties in terms of beauty as well as sexual and reproductive health.
• 1:00
  SPEAKER_00: But before we get into it, because the conversation is going to be around the health of the female reproductive tract, Jessie Anna, I'd love for you to open us up with the explanation of what happens to vaginal and vulval tissue for women as we enter perimenopause and menopause.
• 1:19
  SPEAKER_01: Yes, definitely.
• 1:20
  SPEAKER_01: And I'm excited to talk about this ingredient as well.
• 1:23
  SPEAKER_01: I think I agree it kind of hasn't had its time to shine.
• 1:26
  SPEAKER_01: We all know about it, but it's definitely underrated.
• 1:29
  SPEAKER_01: And I think when it comes to female health and especially the genito-urinary tract and reproductive health in general, there's obviously a lot that needs to have more light shown to it as well.
• 1:40
  SPEAKER_01: When we're moving through perimenopause and we're moving through menopause and beyond, we all know obviously there's changes that happen to our hormonal levels.
• 1:49
  SPEAKER_01: You know, more time's being spent on talking about testosterone and progesterone progesterone as well.
• 1:54
  SPEAKER_01: But specifically when we're talking about genito-urinary health, with that estrogen decline that happens, we can see an impact on the microbiome itself and also with the integrity of the tissue and the mucosa of the vagina.
• 2:09
  SPEAKER_01: There's a lot of changes that happen during that window through peri and menopause and beyond that extend outside of vaginal health as well.
• 2:17
  SPEAKER_01: We're looking at cardiovascular changes, digestive microbiome changes, energy, sleep, the list goes on.
• 2:25
  SPEAKER_01: But specifically around the ingredient we're going to be discussing today, a lot of it can come back to that genital urinary tract as well.
• 2:34
  SPEAKER_00: Yes, absolutely.
• 2:35
  SPEAKER_00: What's certainly one of those things that I think gets parked a little bit when it comes to the perimenopause and menopause conversation.
• 2:42
  SPEAKER_00: There's so many other symptoms that women might be confronted with, like anxiety, depression, musculoskeletal syndrome, hot flushes, you know, um, all kinds of things are going on and it becomes a bit of a game of whack-a-mole.
• 2:58
  SPEAKER_00: And often symptoms like that women might be a bit too embarrassed to mention, or they might think, oh, that's just not as big of a deal at the moment as my mood or my sleep quality, or you know, other things, metabolic issues that are going on.
• 3:12
  SPEAKER_00: But of course, so many changes are happening with that loss of estrogen where the epithelial tissues are starting to thin, the integrity is being compromised, even blood flow to a degree.
• 3:24
  SPEAKER_00: This has a flow-on effect to hydration of tissues, lubrication, vaginal pH, and even the microbiome as well, making women more vulnerable to UTIs and bacterial infections of the vagina.
• 3:38
  SPEAKER_00: And by extension of that, sexual dysfunction, discomfort during sex, more likely to pick up infections during sex.
• 3:45
  SPEAKER_00: And so it really is an important part of the conversation for women as far as, you know, really supporting this tissue in this area a lot.
• 3:56
  SPEAKER_00: Um, and I think that leads really nicely into speaking about sea buckthorn.
• 4:02
  SPEAKER_00: And I'd love to hear your take on why sea buckthorn oil is such an interesting compound to consider from a female mucosal health perspective.
• 4:12
  SPEAKER_01: Yeah, most definitely.
• 4:13
  SPEAKER_01: And yeah, um just to kind of like touch on what you've just shared as well, when we're looking physiologically at that change in the estrogen, that decline that happens is actually going to impact the glycogen production that happens from the tissues.
• 4:27
  SPEAKER_01: That glycogen is our fuel source for our good bacteria.
• 4:31
  SPEAKER_01: So naturally, as we start to lose that fuel source, we've lost our good bacteria.
• 4:36
  SPEAKER_01: The microbiome itself starts to shift.
• 4:39
  SPEAKER_01: When you see a shift happen in the ecosystem itself, there can be more inflammation, there can be fragility caused to the tissue, there can be more burning, more pain, more itching that also contributes to painful sex and many of the other symptoms as well.
• 4:52
  SPEAKER_01: Um the kind of umbrella-encompassing term that's now referred to a lot of the symptoms and even structural changes that happen is genito-urinary syndrome of menopause.
• 5:02
  SPEAKER_01: And it's really important to understand this umbrella term because so much of what individuals experience falls under this.
• 5:08
  SPEAKER_01: And like you mentioned, sometimes they can feel embarrassed to ask.
• 5:12
  SPEAKER_01: Um, sometimes people don't know what to actually ask about as well, because they can just be like, well, this is what everyone else deals with, right?
• 5:19
  SPEAKER_01: Um, yeah, so it's a very, very important time to kind of uh understand the changes to the tissues themselves.
• 5:25
  SPEAKER_01: So when we're looking at a really beautiful ingredient like sea buckthorn, it's a really, really fatty acid, amiga, rich, and nutrient-dense plant medicine.
• 5:36
  SPEAKER_01: So when you're looking at the changes that happen to the tissue integrity because of that loss of the estrogen and because of the shift in the microbiome, this is a really beautiful plant medicine that we can actually harness and use to support, you know, vaginal atrophy, which is essentially dryness, which can then roll into painful sex and other symptoms that might come up as well.
• 5:56
  SPEAKER_01: Yeah.
• 5:58
  SPEAKER_00: So you mentioned it's an essential fatty acid supplement, but it's not just any essential fatty acid supplement, is it?
• 6:05
  SPEAKER_01: No, no.
• 6:06
  SPEAKER_01: It's our beautiful, and I know how much you love this when we were talking about it the other day.
• 6:10
  SPEAKER_01: Um, it's so incredibly nutrient dense.
• 6:13
  SPEAKER_01: And, you know, obviously when we think about fatty acids, we think about omegas.
• 6:17
  SPEAKER_01: A lot of supplementation may come from, you know, omega-3 or six sources.
• 6:21
  SPEAKER_01: But when we're looking at sea bucks lawn and a plant medicine, it's very rich in omega-7 and omega-9.
• 6:27
  SPEAKER_01: And this is what makes it unique because when we're looking at other orifices and other mucous membranes, that's where we actually want to pull from and utilize omega-7 and omega-9, particularly.
• 6:40
  SPEAKER_00: Yes.
• 6:40
  SPEAKER_00: So omega-7 really caught my attention when Seed Buckthorn first came onto the Australian market.
• 6:47
  SPEAKER_00: And I think it's really an important distinction to make that omega-7, also referred to as palm and lake acid, is uniquely specific for mucosal tissue.
• 6:58
  SPEAKER_00: And although we're not going to touch on this today, unfortunately, because we'd be here for hours, it means it provides hydration and moisturization for all mucosal membranes.
• 7:07
  SPEAKER_00: So nose, sinus, throat, lungs, gastrointestinal tract, even improving viscosity of tears.
• 7:15
  SPEAKER_00: And just a side note, its Latin name, Hippophyramnoides, for anyone who doesn't know, comes from the Latin um translation shiny horse.
• 7:25
  SPEAKER_00: And this plant actually was first discovered in Greek and Roman times because the horses that were nibbling on these beautiful orange berries with the little seeds inside had the shiniest, glossiest coats, the longest, most luscious manes and tails.
• 7:40
  SPEAKER_00: And it's really a bit of a beauty bomb.
• 7:43
  SPEAKER_00: And we aren't going to be talking about its impact on beauty today, but it is one of those fatty acids, the omega-7 component, that just goes straight to the skin and straight to the mucosal membranes, as opposed to something like omega-3 that every cell membrane requires a constant supply of.
• 8:00
  SPEAKER_00: And what that really means is that it can influence those tissues very, very quickly.
• 8:07
  SPEAKER_00: And we will talk more about that in a moment, but there are other things in sea buckthorn oil as well.
• 8:14
  SPEAKER_00: Do you want to run us through some of the other phononutrients in there?
• 8:18
  SPEAKER_01: Yeah, yeah.
• 8:18
  SPEAKER_01: I think clinically speaking, this is actually probably one of my favorite nutrients that I use with a lot of my patients, but it's also really rich in beta-carotene, which is unsurprising given the colour.
• 8:29
  SPEAKER_01: So beta carotene, which as we know converts to vitamin A, also really, really critical and essential, essential nutrient for mucous membrane health and integrity and structure as well.
• 8:39
  SPEAKER_01: So very rich in vitamin A.
• 8:41
  SPEAKER_01: We've also got a little bit of vitamin C, some vitamin E, which also becomes important for mucosa, alongside lots of antioxidants too.
• 8:49
  SPEAKER_01: So and that's not even all of the nutrients that in it.
• 8:51
  SPEAKER_01: It really is a very nutrient-dense plant medicine.
• 8:54
  SPEAKER_01: Um, but those are some of the very important ones that we see have an influence over genital urinary health as well.
• 9:00
  SPEAKER_00: Yes.
• 9:01
  SPEAKER_00: I actually saw it was when I was researching it um some time ago, there's another compound in there called comforol that they're studying for skin cancer as well.
• 9:11
  SPEAKER_00: Interesting.
• 9:11
  SPEAKER_00: So it's a real powerhouse of essential fatty acids, minerals, antioxidants, polyphenols.
• 9:18
  SPEAKER_00: Um, but of course, so many of those are very much like what we see in the plant world, are generated to protect that fruiting body from the environment and understandably often translates into protecting our external membranes from the external environment too.
• 9:35
  SPEAKER_00: So it is really, yeah, I get I've been taking it for I think 16 years at least.
• 9:41
  SPEAKER_00: Wow.
• 9:42
  SPEAKER_00: Um I'm sure it's doing great things for me.
• 9:46
  SPEAKER_00: Um certainly JC Buckthorn stand.
• 9:49
  SPEAKER_00: Yeah, absolutely I am.
• 9:50
  SPEAKER_00: I can't say enough about it.
• 9:52
  SPEAKER_00: Um, and certainly when I was looking at back in the day, I was talking about it through a beauty and skin lens and the way in which it can, you know, um reduce deep wrinkles and smooth out fine lines.
• 10:04
  SPEAKER_00: Um, but down in the vulva and vaginal area, no one's worried about wrinkles.
• 10:10
  SPEAKER_00: But certainly in terms of its results around microbiome health, mucosal health, and improving the symptoms of genitourinary syndrome, there are lots of studies around that too.
• 10:23
  SPEAKER_00: And I want to talk about a landmark clinical trial on humans that was a randomized double-blind placebo control trial where post-menopausal women were using it for vaginal dryness, itching, and burning.
• 10:38
  SPEAKER_00: Can you share with me the results of that trial and what the researchers found and ultimately what that means for women in menopause as far as genito urinary syndrome goes?
• 10:51
  SPEAKER_01: Yeah, most definitely.
• 10:53
  SPEAKER_01: So that randomized control trial was done, yeah, I think on around 116 women, 98 completed it.
• 10:59
  SPEAKER_01: So that was done on oral supplementation that was three grams a day.
• 11:03
  SPEAKER_01: Um, the findings of that study specifically reflected that it improved vaginal atrophy, which is dryness, and it had an improvement in the actual integrity of the epithelial lining in cells.
• 11:15
  SPEAKER_01: So really helping with that strength health of the mucous membranes themselves.
• 11:20
  SPEAKER_01: Um, there was a trend towards an improvement in the vaginal health index, which is referring to things like elasticity, moisture, pH.
• 11:28
  SPEAKER_01: Um, however, there wasn't a significant difference in terms of like the burning and the itch themselves, but we saw a trend towards improvement in other ways, including a slight lowering of the pH.
• 11:40
  SPEAKER_01: So the important thing to note and what's reflected in this research paper is even though there is some phytoestrogens in very small amounts within C buck fawn, um, it wasn't enough to actually be the sole responsibility or mechanism of the improvements that they saw through the estrogen signaling.
• 11:58
  SPEAKER_01: It was more coming from the combination of all those amazing nutrients and bioactive compounds that we've just discussed, improving the actual epithelium itself.
• 12:09
  SPEAKER_00: Yes, well, that makes sense.
• 12:10
  SPEAKER_00: And when we think about if we zoom out to the genito-urinary tract, you know, there's many different moving parts like secretory IgA, the microbiome, you know, many things that would influence that.
• 12:22
  SPEAKER_00: So it is almost certainly going to be used in genito-urinary syndrome alongside other interventions.
• 12:29
  SPEAKER_00: It's not like sadly not a one-stop shop for women.
• 12:33
  SPEAKER_00: Um, but certainly in terms of how that influences health.
• 12:38
  SPEAKER_00: I know clinically many women, like every woman who I've given it to, whether it was originally for a skin thing, have all reported improvements in sexual function and comfort.
• 12:50
  SPEAKER_00: Just in that alone.
• 12:52
  SPEAKER_00: And I think if it is something practitioners are working on, obviously broadening the scope a bit more to consider other interventions would be important.
• 12:59
  SPEAKER_00: But knowing that it has such a profound influence on the epithelial integrity, um, the elasticity and the pH to a degree, it makes sense that this should be a primary staple in something like that.
• 13:14
  SPEAKER_00: In terms of like getting the kind of result that you're looking for, I know I mentioned before because it is so specific for um epithelial tissue, you know, results in the skin, for example, occur much quicker than say with the use of fish oil, because fish oil, like I mean AP and DHA is used everywhere else in the body too.
• 13:35
  SPEAKER_00: But in terms of dosage and a bit of a timeline, what are practitioners needing to understand around how to apply this practically in clinical practice?
• 13:46
  SPEAKER_01: Yeah, well, I mean, I guess in understanding that and speaking on that, like you mentioned, definitely not a one-stop shop.
• 13:52
  SPEAKER_01: It's one piece of the puzzle amongst many amazing interventions that we have that can improve and support all of the symptoms that may arise with GSM.
• 14:01
  SPEAKER_01: Um, so when you're looking at C buckforn research that we do have to date, most of the oral supplementation, all of the research that we have to date, or the oral supplementation is done within a 12-week window.
• 14:13
  SPEAKER_01: So, like you mentioned clinically, sometimes you can see and act faster, but reflective in the research they've done over a 12-week period, which in my clinical experience, as you've mentioned, sometimes I can see improvements as quick as four, four weeks even.
• 14:27
  SPEAKER_01: Um, but obviously sticking to kind of the research that we have, you know, keeping at it for a few months because as we know it's fatty acids, it does take time to, you know, accumulate, do what we need it to essentially.
• 14:38
  SPEAKER_01: Um, yeah.
• 14:40
  SPEAKER_01: There were some research studies done now that we have, which I'm sure we'll mention and touch on in a moment, in terms of pethari insertions.
• 14:48
  SPEAKER_01: And they were done on um a smaller window.
• 14:50
  SPEAKER_01: Well, one research paper was done in a two-week window, but orally speaking, we do want to keep it ongoing and maintained in a longer period.
• 14:58
  SPEAKER_01: Yes, absolutely.
• 15:00
  SPEAKER_01: Yeah.
• 15:00
  SPEAKER_00: I found when I was using it for skin, I had a client who had really dry skin.
• 15:06
  SPEAKER_00: She was in her 40s at the time, and she would have to moisturize her body like multiple times a day.
• 15:11
  SPEAKER_00: You know, during winter, she would take her stockings off and have what she affectionately termed leg dandruff, just you know, that flaking skin.
• 15:19
  SPEAKER_00: And I remember having a conversation with her about whether or not it would help.
• 15:23
  SPEAKER_00: And she said, Oh, look, this runs in my family, like everybody has super dry skin.
• 15:28
  SPEAKER_00: I'm like, oh, okay, well, there might be some issues with fatty acid metabolism or absorption, even maybe it's a digestive issue.
• 15:35
  SPEAKER_00: But I said, let's give it a whirl.
• 15:37
  SPEAKER_00: And I put her on a loading dose, which would have been around three grams a day.
• 15:42
  SPEAKER_00: And within four weeks, she didn't need to use body lotion anymore.
• 15:46
  SPEAKER_00: Amazing.
• 15:47
  SPEAKER_00: Decades.
• 15:48
  SPEAKER_00: So it can improve really quickly, but like you say, there's a you know, there's a lag time with uptake, distribution, tissue response.
• 15:57
  SPEAKER_00: What I will also say clinically, though, is I've found that often once you've reached tissue saturation, results can be maintained at a lower dose as well.
• 16:07
  SPEAKER_00: Um, and so I think certainly for clinicians, it's going to be setting the expectations of look, let's do this for three months, and then we can always titrate down the dose and see if we can maintain your results.
• 16:19
  SPEAKER_01: Yeah.
• 16:20
  SPEAKER_01: Yeah, most definitely.
• 16:21
  SPEAKER_01: And I think, you know, especially when it does come to genital urinary health, you might get to the three-month mark and have some amazing improvements in some ways, but there might be other symptoms that then become more obvious or microbiome that needs supporting in other ways too.
• 16:35
  SPEAKER_01: So definitely can go lower for maintenance once you reach that.
• 16:38
  SPEAKER_01: And that obviously makes space by other interventions as well.
• 16:42
  SPEAKER_00: Absolutely.
• 16:43
  SPEAKER_00: Well, look, you have touched on some of the mechanisms of action around C buckthorn and the role it plays with improving mucosal integrity, but I'd love to go into it just a little bit deeper if we could.
• 16:56
  SPEAKER_00: Um, you mentioned the antioxidant protection, of course, beta-carotene.
• 17:00
  SPEAKER_00: We know vitamin A is important for protecting you know epithelial tissues.
• 17:05
  SPEAKER_00: We know that it has those essential fatty acids which help to improve the hydrolipid film of the skin, but also the protective barrier in the mucosal tissue.
• 17:14
  SPEAKER_00: But there are some more um detailed mechanisms that we could discuss.
• 17:22
  SPEAKER_00: What are your favorites?
• 17:24
  SPEAKER_01: Yeah, I mean, in terms of mechanism in general, I mean, you would probably agree.
• 17:28
  SPEAKER_01: We do need more research to obviously understand like the true mechanism around it.
• 17:33
  SPEAKER_01: There are other snippets of research that exists, uh not done on humans that we can see polyphenols and antioxidants having an amazing impact and influence, and um certain studies on rats also reflecting collagen synthesis and matrix remodeling.
• 17:48
  SPEAKER_01: So there are other mechanisms that are kind of proposed in that sense.
• 17:53
  SPEAKER_01: Um, but with the research we have, obviously it's the beta-carotene and the fatty acids that's more proposed.
• 17:58
  SPEAKER_01: And I think what's important to consider as well is when you're looking at like vaginal mucosa versus vulva, it is actually a different experience in terms of how the tissue and the mucosa is functioning.
• 18:11
  SPEAKER_01: So with the vulva tissue, it can be a little bit more receptive to moisturization.
• 18:15
  SPEAKER_01: Whereas when you're looking at the vaginal canal, we're actually relying on fluid secretion coming from the blood vessels and within.
• 18:22
  SPEAKER_01: So functioning differently, which means different applications, different mechanisms influencing it too.
• 18:28
  SPEAKER_01: Hence why estrogen cream is such an important um, you know, intervention internally as well.
• 18:33
  SPEAKER_01: Um, but yeah, they're the kind of other mechanisms that have been proposed more on like rat and lab studies.
• 18:40
  SPEAKER_01: Um and yeah, with the human research that we have to date, it's it's kind of like we need more research to actually understand the hows and the actual whys of it.
• 18:48
  SPEAKER_00: Yes, yes.
• 18:49
  SPEAKER_00: I mean, certainly in the animal studies, I found the NRF2 signaling really interesting, the influence on inflammatory cytokines and also VEGF and tissue repair.
• 19:00
  SPEAKER_00: And I think it'll be, yeah, it'll be really helpful if we can elucidate whether or not that's what's happening in in humans as well.
• 19:08
  SPEAKER_00: But speaking more of the local tissues, there are also studies using sea buckthorn, um, not just orally but intravaginally as well.
• 19:19
  SPEAKER_00: Can you share what's currently out there as far as how it's being used and what kind of results are being like determined?
• 19:28
  SPEAKER_01: Yeah, definitely.
• 19:29
  SPEAKER_01: So, research-wise, there's been two papers that have been completed.
• 19:32
  SPEAKER_01: Um, one was a sea buckthorn pessary inserted into the vaginal canal.
• 19:37
  SPEAKER_01: Um, this was more done on post-menopausal women in terms of colposcopy results, um, but it did show that it wasn't inferior to estrogen cream and it did have improvement on epithelium.
• 19:49
  SPEAKER_01: So that was pure sea buckthorn that was used.
• 19:52
  SPEAKER_01: Um, that was done over a two-week period as well.
• 19:55
  SPEAKER_01: And then we have another research paper that was done over a 12-week period that was actually a combination mixed gel.
• 20:02
  SPEAKER_01: So it also included things like hyaluronic acid and licorice and a couple of other ingredients, and that yielded great outcomes too.
• 20:09
  SPEAKER_01: So we are seeing through research, even though we again we need more, I feel like that's a repetitive saying that we always go for.
• 20:17
  SPEAKER_01: Um, but clinically speaking, in terms of how I might approach this or how other practitioners that I'm, you know, are my peers, um, there is topical vulva application that can be utilized.
• 20:28
  SPEAKER_01: And then also obviously intravaginal as well.
• 20:32
  SPEAKER_01: Um, they are done on a more discretionary uh way because obviously it depends on the patient that's in front of you.
• 20:38
  SPEAKER_01: Um, some individuals experience tank like tearing and painful sex, whereas other individuals might have chafing and burning, there might be difficulties sitting down, exercising, you know, doing day-to-day tasks.
• 20:50
  SPEAKER_01: So depending on what an individual's actually experiencing can influence on how you're going to clinically apply it as well.
• 20:58
  SPEAKER_01: Um, I find for myself I see really, really nice results doing vulva applications.
• 21:03
  SPEAKER_01: Um, just from, you know, as you mentioned before, those kind of antioxidant pathways, the anti-inflammatory pathways, there can be a lot of relief that actually comes from just a simple, gentle topical application, just to kind of give a little bit more um yeah, relief on a day-to-day.
• 21:19
  SPEAKER_00: Yeah, so that makes sense applying moisture to the tissues that require more moisture.
• 21:25
  SPEAKER_00: Yeah.
• 21:25
  SPEAKER_00: Um certainly from like thought.
• 21:30
  SPEAKER_00: Well, in terms of the practical reality of it, if anyone's not actually seen Sea Buckthorn before, um, as we've mentioned, it's these bright orange berries.
• 21:39
  SPEAKER_00: So the oil is a very vibrant orange colour.
• 21:43
  SPEAKER_00: So I've certainly used it topically on my face as a face mask before.
• 21:47
  SPEAKER_00: Um, but just be mindful of staining clothing.
• 21:51
  SPEAKER_00: So, you know, liners, um, dark underwear, dark pants, otherwise you might have some permanent orange splotches.
• 22:00
  SPEAKER_00: That will ruin the look.
• 22:02
  SPEAKER_01: Most definitely.
• 22:04
  SPEAKER_01: And you know, at the end of the day, it is held as an oil, right?
• 22:07
  SPEAKER_01: So when you are topically applying it to your vulva, you don't actually need very much of it to go very far.
• 22:14
  SPEAKER_01: A lot of people do prefer to hold it in a base of like shea butter or creams, which obviously would change that.
• 22:20
  SPEAKER_01: But if you're going for pure oil and it's going directly onto the vulva, it will stay in your undies.
• 22:26
  SPEAKER_01: So as you mentioned, you do have to wear darker clothing.
• 22:28
  SPEAKER_01: And same rule applies for any um insertions intravaginally as well.
• 22:32
  SPEAKER_01: If if you were to look at doing like a pure capsule insertion, that obviously is going to disintegrate and it's oil within.
• 22:40
  SPEAKER_01: Whereas something being held, you know, in kind of like a you know, a hard pessary or something similar, it's it's gonna disintegrate and potentially stain.
• 22:50
  SPEAKER_00: Yeah, yes, yeah, absolutely.
• 22:52
  SPEAKER_00: Tell me, when we're thinking about utilizing this as a topical or local for topical or local relief, whether or not it's being used orally as well, um, certainly when someone has GSM, they are more at risk of infections like thrush or BV or maybe other infections or irritation like dermatitis.
• 23:14
  SPEAKER_00: Where do you see clinically drawing the line?
• 23:18
  SPEAKER_00: Do you feel comfortable applying it even if there is some other confounding factor going on there?
• 23:25
  SPEAKER_00: Or do you prefer to wait until that's been addressed before applying local sea buckthorn?
• 23:31
  SPEAKER_01: Yeah, that's a good question.
• 23:32
  SPEAKER_01: And I think obviously, um, you know, clinically speaking, for any practitioners that are listening to this, the more cases you see, the more you kind of get that um gauge on what is what when it comes to symptoms and management.
• 23:45
  SPEAKER_01: But typically speaking, I view sea buckthorn as a really gentle, beautiful intervention.
• 23:51
  SPEAKER_01: Um, not so much any contraindications or anything along those lines.
• 23:55
  SPEAKER_01: So if you are supporting an individual that has dermatitis or other conditions, I don't personally or research-wise, it isn't so much a concern.
• 24:04
  SPEAKER_01: Unfortunately, there actually isn't any data of it being used volvily, so per se, anyway.
• 24:09
  SPEAKER_01: So there's no research to pull from that.
• 24:11
  SPEAKER_01: But um if you're dealing with an individual that is experiencing recurrent infections or dermatitis, obviously it is a very important priority in treatment to actually have interventions put in place for that as well.
• 24:24
  SPEAKER_01: The sea buckthorn is really going to be there for supporting the epithelial integrity.
• 24:29
  SPEAKER_01: So trying to reduce thinning and fragility, um, trying to reduce dryness and anti-inflammatory, you know, components as well.
• 24:37
  SPEAKER_01: So that can work quite nicely alongside whatever else you might need to do.
• 24:42
  SPEAKER_01: Um, and I think it's important to consider as well, obviously, there's a lot of debate and chatter around, you know, MHT and different, you know, hormonal therapies that exist, but C.
• 24:52
  SPEAKER_01: Buck fawn and other interventions that can be applied topically can still be used if someone is using oestrogen cream as well, because the maintenance dose for that is only twice a week, right?
• 25:02
  SPEAKER_01: So um it doesn't mean one or the other, it can be in addition to, and that's really patient-centered because you're actually supporting them symptomatically every day that way.
• 25:12
  SPEAKER_01: Um and just to add to that as well, I think it's a really important differentiation to in understanding GSM and the symptoms that patients come to you with.
• 25:23
  SPEAKER_01: Um, because dryness and tearing and painful sex can be so common, there are certain conditions that exist which are known as lycan sclerosis, I'm sure you're familiar with, or even LP.
• 25:34
  SPEAKER_01: Um, these can take so long to be diagnosed.
• 25:38
  SPEAKER_01: It's really important to differentiate if you do have a patient that you're supporting with something like C.
• 25:43
  SPEAKER_01: Buckborn.
• 25:43
  SPEAKER_01: If symptoms really aren't shifting, if a patient starts to notice, like, okay, I'm really itchy or the tearing has gotten worse, or I'm starting to see discoloration of my actual vulva tissue or even structural changes where they start to see their labia shrink or become fused.
• 26:01
  SPEAKER_01: It's really important to differentiate that from just general dryness or other symptoms that can exist under GSM.
• 26:08
  SPEAKER_01: Um, does require referral, does require ideally a vulva dermatologist to look at it as well, um, because that will also influence what other interventions you can be using too.
• 26:19
  SPEAKER_00: Yes, but ultimately the takeaway here is if the tissue needs supporting C buckthon will help support that.
• 26:27
  SPEAKER_00: And then if there's something specific there, then obviously that can be used alongside without any risk.
• 26:34
  SPEAKER_01: Um, most definitely.
• 26:36
  SPEAKER_00: But something you said earlier around the way in which that loss of estrogen and the changes in the vaginal tissue affects blood flow.
• 26:47
  SPEAKER_00: And also that would have a flow-on effect to the microbiome.
• 26:51
  SPEAKER_00: I'd love to chat about the microbiome for a moment and what happens with the pH and the changes in our natural microflora that would ordinarily have been protecting that area.
• 27:03
  SPEAKER_00: And obviously, we understand sea buckthorn can support those things and certainly alongside other interventions, you know, be part of a really powerful protocol to improve the landscape or the environment, so to speak.
• 27:18
  SPEAKER_00: Can you talk to us a little bit about what happens in terms of the acidity and the and the microflora themselves?
• 27:26
  SPEAKER_01: Yeah, most definitely.
• 27:28
  SPEAKER_01: And I'm so excited to talk about this because I think this always needs more airtime.
• 27:32
  SPEAKER_01: So, as we briefly mentioned at the beginning, when you're looking at the decline of estrogen, that has that influence over the glycogen production.
• 27:40
  SPEAKER_01: That glycogen is the fuel source for our good bacteria, which are known as our lactobacilli.
• 27:45
  SPEAKER_01: So through perimenopause, um, obviously that can be a time of, you know, more erratic estrogen, progesterone, things are a little bit, I don't like the word erratic, but we do know it can be a bit of a roller coaster hormonally speaking.
• 27:58
  SPEAKER_01: Then when you move into a time where the estrogen is becoming progressively declining, that is where you can see true influence to the microbiome happen as well.
• 28:07
  SPEAKER_01: Um, that's not to say that if an individual doesn't already have a pre-existing microbiome disturbance, that can kind of put people in a position where they might experience microbiome changes sooner or changeability around that.
• 28:20
  SPEAKER_01: But the microbiome itself, when you're looking at vaginal health, we want it to be dominant in our good bacteria, which is known as the lactobacilli.
• 28:29
  SPEAKER_01: They actually produce the lactic acid and the hydrogen peroxide that keep the environment slightly acidic.
• 28:36
  SPEAKER_01: That slight acidity is what offers us our protection against recurrent infections.
• 28:42
  SPEAKER_01: So if someone is in a more alkaline state, which typically happens in menopausal and beyond individuals, we're actually going to be more predisposed to microbes adhering to the urethra wall, adhering to the vaginal wall, overcrowding, and they're going to take the opportunity in a low lactobacilli environment to overcrowd.
• 29:02
  SPEAKER_01: So when you're hearing about menopausal individuals having higher rates of recurrent UTIs, often we can see higher rates of BV, you know, strep can be problematic as well.
• 29:12
  SPEAKER_01: This is a reflection of the decline and the change in the lactobacilli and the opportunistic microbes, essentially.
• 29:20
  SPEAKER_01: So it's a really, really big factor to consider because sometimes the itching, the burning that they experience can actually be microbial as well as tissue.
• 29:31
  SPEAKER_00: Yes, that's a really good point.
• 29:33
  SPEAKER_00: Um, any sort of change in that environment, of course, will influence the sensitivity and sensations that they experience.
• 29:41
  SPEAKER_01: Yeah.
• 29:42
  SPEAKER_01: Um, it's also important to consider like even individuals that might have recurrent candida as well, the microbes that can be present can actually influence the impact they're having on the tissue.
• 29:52
  SPEAKER_01: So something like candida can cause a lot more inflammation and a lot more fragility.
• 29:57
  SPEAKER_01: So when you're looking at a perimenopausal individual, if they do have a history of recurrent candida and then move into that era where maybe, you know, estrogen's eventually declining, things start to shift, they can already be at a predisposed state for their tissue as well.
• 30:12
  SPEAKER_01: And we do know in the research that impacted tissue, tissue fragility, tissue inflammation does allow for microbes to adhere easier.
• 30:21
  SPEAKER_01: And that's what we see in the research with STIs as well.
• 30:24
  SPEAKER_01: You are going to be at a pre-exposed, you know, uh potential acquisition of STIs too.
• 30:30
  SPEAKER_00: Yes, yeah, really important to consider um for reproductive health generally too.
• 30:35
  SPEAKER_00: Absolutely.
• 30:37
  SPEAKER_00: Just for um a moment, if we can step outside the menopause window, there have been some interesting things coming up around Sea Buckthorn and reproduction generally.
• 30:49
  SPEAKER_00: And a recent review specifically looked at this in terms of gynecological health.
• 30:56
  SPEAKER_00: Do you have anything to share with us about what you've been seeing in this space in terms of its influence on potentially other reproductive conditions, ovarian health, you know, fertility, endometriosis, anything of that nature?
• 31:12
  SPEAKER_01: Generally speaking, when we're looking at the action of sea buckthorn, because when you're looking at the nutrients that can provide antioxidant, anti-inflammatory capacity, we obviously know that that's going to have multiple actions through the body.
• 31:24
  SPEAKER_01: So there are some studies that can reflect cardiovascular protection, immune protection, general anti-inflammatory.
• 31:32
  SPEAKER_01: So, yeah, one of the studies that was completed, it was a rat study.
• 31:35
  SPEAKER_01: So that was a combination of C.
• 31:37
  SPEAKER_01: Buckthorn and St.
• 31:38
  SPEAKER_01: John's Wart.
• 31:39
  SPEAKER_01: That study found that there was a regression in endometrial lesions, a reduction in interleukin 6, which is obviously an inflammatory marker, and then also reduction in tumor necrosis factor as well.
• 31:51
  SPEAKER_01: So that's some pretty interesting and also I'm gonna say promising intervention that's quite gentle and something that we can add on.
• 32:00
  SPEAKER_01: And obviously that has a roll-on effect too.
• 32:02
  SPEAKER_01: Reproductive health, fertility, um, and in addition to that, as well, eye health too, which you kind of touched on in the beginning too.
• 32:10
  SPEAKER_00: Yes, absolutely.
• 32:12
  SPEAKER_00: Wow, it's just, you know, as a more evidence emerges, I think we're going to be learning more and more about the influence and how and why as well on epithelial tissue, and maybe uncovering some of these other adjacent things too, which is really exciting.
• 32:27
  SPEAKER_00: And it's really nice to hear you reflect back that this is a very low-risk and highly effective intervention that can be used alongside local estrogen, systemic hormone therapy, you know, pelvic floor osteo, microbiome, you know, support directly and indirectly.
• 32:46
  SPEAKER_00: And so it can dovetail very nicely into a pre-existing, you know, protocol for GSM or menopause in a broader sense.
• 32:55
  SPEAKER_00: I do wonder though, if we were to sort of sum this all up and tie a pretty little bow on it, um, if a practitioner has just listened to this and is now chomping at the bit to use Steve Barkthorn in practice tomorrow.
• 33:10
  SPEAKER_00: I would love you to share like what you would consider important when choosing a product.
• 33:15
  SPEAKER_00: We've kind of touched on dose and time frame, but we can we can reiterate that.
• 33:19
  SPEAKER_00: What symptoms and clinical outcomes would you monitor and when you'd reassess and essentially when you would decide this is working well or we might need to investigate further or add something else in?
• 33:31
  SPEAKER_01: Yeah, most definitely.
• 33:32
  SPEAKER_01: So, yeah, dosage-wise, we'll just we'll start and we'll touch there.
• 33:35
  SPEAKER_01: So, typically speaking, if I was using this intervention in clinical practice, I would be starting, as you mentioned before, as kind of like a loading dose.
• 33:43
  SPEAKER_01: So I would be starting with the three grams.
• 33:46
  SPEAKER_01: Um, I'm quite individualized in, I mean, as we all are, in the way that I approach my patients because I predominantly see genital urinary health conditions in clinic.
• 33:56
  SPEAKER_01: It's it's what I work with all week.
• 33:58
  SPEAKER_01: So everyone's experience and symptoms are very different.
• 34:02
  SPEAKER_01: So, in terms of kind of deciding uh in this kind of aspect, uh, when you would kind of decide, is this enough?
• 34:09
  SPEAKER_01: Do we need more?
• 34:10
  SPEAKER_01: It's really based on the symptoms that are in front of you.
• 34:13
  SPEAKER_01: Um, I always like to encourage, even if you're in that 12-week window, um, what symptoms are they coming to you with?
• 34:20
  SPEAKER_01: Even if they have a slight improvement, are they still having really painful sex?
• 34:24
  SPEAKER_01: They still having difficulties sitting.
• 34:27
  SPEAKER_01: Um, it is really important in this space to have a multifactorial, you know, intervention plan as well.
• 34:32
  SPEAKER_01: So um obviously we usually check in with our patients every four to six weeks, depending, sometimes too.
• 34:38
  SPEAKER_01: So actually getting that understanding of what improvements they're noticing in their day-to-day.
• 34:44
  SPEAKER_01: And if it's not enough, that's okay.
• 34:46
  SPEAKER_01: We welcome in more.
• 34:47
  SPEAKER_01: And if it is enough, amazing.
• 34:49
  SPEAKER_01: We continue and we can focus on a maintenance dose eventually as well.
• 34:53
  SPEAKER_01: Um, but yeah, I think as you mentioned before, we're looking at different uh, you know, considerations when it comes to women's health, pelvic physios, counselors, stress support, uh, making sure we're supporting their hormones in other ways as well, because we can do the sea buckthorn, but do they have estrogen support coming through?
• 35:10
  SPEAKER_01: Do we have them on a phytoestrogen-rich diet?
• 35:13
  SPEAKER_01: Are they on, you know, MHT?
• 35:15
  SPEAKER_01: What other interventions are in place because we do need those too?
• 35:20
  SPEAKER_00: Yes.
• 35:20
  SPEAKER_00: Oh, that's an amazing way just to summarize it all for a practical application.
• 35:26
  SPEAKER_00: Is there anything else we haven't touched on today that you want to share about sea buckthorn or your approach to this in clinic?
• 35:34
  SPEAKER_01: No, I mean, I think I think sea buckthorn in general, I think hopefully this gives it a little bit more um oomph to people knowing about it because we we both love it and we both want people to know about it more.
• 35:45
  SPEAKER_01: And I think it's just one of those interventions that if we can see and have improvement, how amazing for the individual that we have in front of us, especially when it comes to GSM.
• 35:55
  SPEAKER_01: Um, but I think, yeah, I think if I have any kind of takeaway from this for practitioners, it's just to really watch and monitor symptoms.
• 36:02
  SPEAKER_01: Like I mentioned before with things like lichens and other conditions, we can have the most amazing plant medicine, but we do need to watch and actually see what the improvement is.
• 36:11
  SPEAKER_01: That's probably my biggest takeaway that I in mentoring and when I'm talking with practitioners, it's actually get into the nitty-gritty.
• 36:18
  SPEAKER_01: And I think a lot of these individuals, because it, you know, talking to the doctor, a lot of their questions and experiences comes from a place of shame.
• 36:27
  SPEAKER_01: There's still a lot of taboo in talking about, you know, genital urinary issues.
• 36:32
  SPEAKER_01: So don't feel weird asking your patients these nitty-gritty questions because most of the time they'll respond to you and say, This is too much information, I don't want to tell you.
• 36:42
  SPEAKER_01: And my response is that doesn't exist in my clinic.
• 36:45
  SPEAKER_01: There's no such thing as TMI.
• 36:47
  SPEAKER_01: Like I want to actually hear, is there tears, what's going on?
• 36:50
  SPEAKER_01: And that's going to help guide you best if you if you have that approach.
• 36:54
  SPEAKER_00: Yes, I think um maybe asking the kind of leading questions that are easy to say yes and no to might be a really nice way to, you know, rather than having someone try to explain it and feeling awkward.
• 37:07
  SPEAKER_00: But ultimately, you know, for for patients or for us as practitioners, it's no different to talking about scalp health, oral health, gut health, kidney health.
• 37:18
  SPEAKER_00: It's it's an organ in our body that requires TLC and support.
• 37:23
  SPEAKER_00: And in this case, for a woman, when they are transitioning, their hormones are shifting, all of those hormone-sensitive tissues are also going to be impacted.
• 37:32
  SPEAKER_00: And so it makes sense that this is likely going to be to some degree or another part of someone's journey as they go through perimenopause and menopause.
• 37:41
  SPEAKER_00: So yes, thank you, Jesse Ann.
• 37:44
  SPEAKER_00: It's been such a delight and pleasure to have you on the show and talking about my favorite ingredient.
• 37:50
  SPEAKER_00: Appreciate picking your brains today.
• 37:53
  SPEAKER_01: Amazing.
• 37:54
  SPEAKER_01: Thank you so much for having me.
• 37:55
  SPEAKER_01: And yeah, I don't, I don't think we missed anything, did we?
• 37:58
  SPEAKER_00: I don't know.
• 37:59
  SPEAKER_00: I don't think so.
• 38:00
  SPEAKER_00: I think we absolutely covered it.
• 38:02
  SPEAKER_00: That being said, there will be a white paper on Seabuckthorne on the Designs for Health website available soon.
• 38:08
  SPEAKER_00: So for anyone who wants to dive into the research, they can explore that.
• 38:12
  SPEAKER_00: We'll also leave um links to find Jessie Ann and the show notes as well if you'd like to connect with her and interested in mentoring with her.
• 38:20
  SPEAKER_00: But yes, thanks again, Jesse Ann.
• 38:21
  SPEAKER_00: Sea Buckthorn is absolutely one of my hero ingredients.
• 38:24
  SPEAKER_00: And that was just such a great conversation about its role in genito-urinary health.
• 38:30
  SPEAKER_00: And listeners, if you found this episode useful, please share it with a colleague who would get value from it.
• 38:35
  SPEAKER_00: It's the best way to help more practitioners find the show.
• 38:38
  SPEAKER_00: You'll find the full show notes, references, and every past episode on the Designs for Health Australian website.
• 38:44
  SPEAKER_00: I'm Amy Skilton, and this is well in Aspire Designs.
• 38:48
  SPEAKER_00: Until next time, look after yourselves as well as your patients.