What You DON'T Know About Women’s Health! From Microbiome to Major Impact with Priyanka Jain : 1227

If you think about the vagina structurally, it's essentially an open gateway between the outside world, which has every pathogen you can imagine. Anything that tells you that it is cleaning your vagina, douching, steaming, etc. Not good. The vaginal microbiome is a leading predictor of whether or not a cycle of IVF will succeed. Unfortunately, sex is one of the largest triggers for vaginal discomfort. Bacteria are more likely to cause a problem, but good bacteria are the solution.

Is having semen inside a vagina good for the microbiome or bad for the microbiome? Listening to the Human Upgrade with Dave Asprey. Can we talk about vaginas? Okay, not just vaginas. Can we talk about the microbiome? Okay, not just the microbiome, because I'm actually a fan of both. Let's talk about the vaginal microbiome, because this is something that's really important. It's important whether or not you're equipped with a vagina, and that's because there's all kinds of things going on that are probably as important as your gut microbiome. Microbiome, which is. Which is something that we don't talk about enough. And I have someone who knows a thing or two about this. Her name is Priyanka Jain, and she's the founder of Evie. Evie runs a. What do you like to call a functional microbiome test for the vagina? What do you call it?

Yeah, that sounds great.

All right. Now, I got to know you because you are related to Naveen Jain. He's your dad. And Naveen's been on the show many times, and we've worked together for years.

And.

And I was so impressed when we first talked a couple years ago. I'm like, you know, I got to get her on the show to talk about this microbiome.

Well, I so appreciate you having me.

A lot of people don't know it, but we have an eyelash microbiome.

Wow. I didn't even know that one.

It's super weird. And there's an armpit microbiome. Right? And, like, every part of your body has a microbiome. And I feel like we're at the very beginning of understanding this. But the most important thing would be, let's look at the vaginal microbiome. But what about the penis microbiome? Isn't that something that changes the vagina microbiome? Like, how do we deal with that question?

We could definitely add that to the list of topics for today, because it's.

One of those Things. Okay. Like there's all that, your care practices and what you eat and all of this.

Yeah.

That are going to affect it. And what does it look like when a vaginal microbiome is healthy?

Great question. Great question. Well, first, I just have to say thank you so much for. For having me here. I am. We are endlessly inspired by the incredible work that you do to help people advocate for their own health, understand their own bodies. That's something we care about so much. And we're so honored to. To get to meet the rest of your community here. So thank you again for having me. And like you said, I'm the co founder and CEO of Evie. We are obsessed with the vaginal microbiome here at Evvy. And I could definitely tell you a little bit. Maybe I'll start with just a very quick 101, and then we can dive into all the topics on the vaginal microbiome. But as you mentioned, we have a microbiome in our vaginas. We're typically familiar with the microbiome in our guts in this community, maybe also the microbiome in our. The oral microbiome. But we often haven't thought about the vaginal microbiome unless we are at the doctor with, you know, symptoms and infections. And when you think about the vaginal microbiome, essentially what it is, is like a barrier between the outside world and the rest of your reproductive system. Right. And if you think about the vagina structurally, it's essentially an open gateway right between the outside world, which has every pathogen you can imagine and then some of your most important reproductive organs on the other side. And when the vaginal microbiome is healthy, it's dominated by these protective microbes that are producing lactic acid, hydrogen peroxide. They're taking up space on the vaginal wall. The most common is lactobacilli, which I'm sure this community is familiar with. And when those microbes are dominant in the vaginal microbiome, they're actually keeping pathogens out because when they get into the vagina, they simply can't survive. It's too acidic. There's no space for them. And in that way, the vaginal microbiome keeps inflammation down and keeps those pathogens out of the rest of the reproductive tract. And so it plays this really important role in female health outcomes. But it's not something that we typically pay attention to, as you mentioned.

Okay, so if I have a perfectly healthy vaginal microbiome, not that I actually would, but let's Pretend I would like, how do I know?

Great question. So. Well, first, I'll start with. Actually, one of the leading reasons that women seek healthcare advice in the United States is for vaginal discomfort. And 90% of the time, that's because of imbalances in the vaginal microbiome. So I will say many people know when something is wrong with their vaginal microbiome. Right. That is the leading reason that women are going out to try to get careful. And unfortunately, given many gaps that exist in women's health that I'm sure we will talk about, we are more likely to be misdiagnosed at the doctor's office than correctly diagnosed. And we are more likely not to get better and have our infections come back than we are to get better. And so I think there is a large percentage of women that is highly aware of the fact that their vaginal microbiome is in dysbiosis, but they aren't getting the tools from the traditional healthcare system to actually understand what's going on and proactively manage it.

It seems like most women are saying, well, if it's not itching or burning and it doesn't smell bad, it's perfectly healthy. Is that true?

Unfortunately, that is not true. A study done in the US looked at about 500 randomly selected women and found that 30% of them at any given time had a vaginal microbiome in what would be referred to as dysbiosis, meaning it was not dominated by one of those protective types of bacteria that creates that healthy barrier for you. And what they found is that actually, 84% of people in dysbiosis actually didn't have symptoms. And so, unfortunately, while symptoms are an important part of the equation, they aren't the only part.

Okay, what percentage of people who. Well, I guess this isn't good, because you've had a bunch of women send in to Evie, send in their vaginal microbiome samples so you can run them through AI and report on what's going on. But I imagine you get a lot of women who are saying, well, I'm not just looking for health, but I have a specific problem. If you were to just zoom out and maybe you've done a study, so you pick a thousand women, different ages, you know, different everything. What percentage of them have a good microbiome naturally?

It's a great question. I think part of the challenge is defining what is good. And I think what is good is actually quite specific to the person. Right. What is good in menopause might look different than somebody in puberty might look different, depending if you're on certain birth controls, all of those things are kind of affecting the vaginal microbiome in some specific way. All that to say within Evie's dataset, where we are able to look at it at a much more personalized level, we see about, I mean, again, our data sets probably slightly biased. So I'll caveat with that, given that, you know, I'm sure we have a higher percentage of people who come to us because they have a problem. So that being said, we see about 70% of our patients would benefit from some type of intervention. So we'll offer them things like the right type of vaginal probiotic or certain supplements that can help the healthy bacteria in their vagina thrive. Or we do, we'll help manage their symptoms, depending on what their symptoms are. So we see about 70% of patients would benefit from some type of help.

Of the people who are sending their samples. So it sounds like it. It's the same problem we have with our gut microbiome. No one really knows what a healthy one looks like.

So, okay, I agree and disagree there. I think that they're unlike the gut microbiome. There actually is a better sense of what the vaginal microbiome looks like when it's healthy. In that with the gut microbiome, as you probably know, people talk a lot about diversity, right? But diversity can take so many forms. What type of diversity, you know, what microbes are dominant, et cetera. The interesting thing about the vaginal microbiome is that you actually want the opposite. You actually want low diversity, high dominance, and you want dominance from one of these key types of microbes, probes that are producing those that lactic acid, that hydrogen peroxide. So actually it's much easier, quote unquote, to define healthy in the vagina. And again, this is the leading reason women are at the doctor's office every single day. So this isn't as foreign from that standpoint. We do have a better understanding of healthy, but unfortunately we don't have tools to help measure that. And that's obviously why we started epi.

I guess that's an easier problem because working with, with Naveen and working with what Viome's doing, they added 10,000 new species of what can live in the gut. And I, I do think because of that diversity and the idea of, of more diversity is always better, isn't a really good thing even in your gut bacteria like, oh, look, I've got, you know, murderers and robbers and you know, and a bunch of thugs in there. But I. So there are more types of them, but you want the right types and right ratios. And I think that's a really complex thing. But what you're talking about with vaginal microbiome is that you really just need mostly one species. What is that species?

Yeah. So typically what patients look for is a dominance of Lactobacillus. And specifically, there's a type of Lactobacilli called Lactobacilli crispatus. And Crispatus is the type of microbe in the vagina that people refer to as kind of the local hero of the vagina. Right. It seems to produce the most acidic, highest volume of the type of acid that protects you against infections and downstream health.

And what kind of acid is that?

Oh, gosh, it's D. Lactic acid.

Okay.

And then hydrogen peroxide. And there's also certain bacteria sins where it seems to actually be fighting the pathogenic bacteria actively as well.

Why do so many women have a disrupted vaginal microbiome?

Such a good question. So many reasons. I think. Unfortunately, sex is one of the largest triggers for vaginal discomfort. And as you alluded to, one of the key hypotheses behind that is because of the role of the penile microbiome in addition to actually the microbiome of the semen. And what research has shown is that there's actually more bacteria than there is sperm in semen. Right. So you're. And then in addition to that, semen has a higher pH than the healthy vagina does. So you're raising the pH, you're allowing those pathogenic microbes to potentially start to replicate in a less acidic environment, which we believe is then, you know, transitioning someone's microbiome away from being dominated from. By that high, highly acidic environment. Other triggers are things like hormonal changes. So we talk. We have a lot of patients who are interested in optimizing their vaginal microbiome at different kind of phases in their hormonal journeys. Right. In their 20s and 30s, when they're typically thinking about protection from infections, protection from things like STIs or general discomfort. Obviously, around fertility and pregnancy, there are huge changes in the vaginal microbiome. And the vaginal microbiome is highly predictive of outcomes in fertility and pregnancy, specifically miscarriage rates, preterm birth rates, et cetera, and then also in menopause, where you see that the changes in estrogen actually affect glycogen production. And glycogen is actually one of the main food sources for lactobacilli in the vagina. And so you often see that around these times, you see these fluctuations in hormones that then affect the vaginal microbiome as well.

This would imply that changing what you eat might change your vaginal microbiome. What are the top three healthiest foods to have a healthy vagina?

A question that I wish we had research on, but here we go on the. The challenges in women's health. There has not been any studies that show tangibly how diet affects the vaginal microbiome. Wow. And unfortunately, because of that, and actually this is something my dad and I want to do together because it hasn't been done. And unfortunately, because of that, we have women who go to the doctor all the time, and their doctors tell them diet doesn't play a role. Right. And I always say there's a difference between a study showing that definitively something doesn't play a role and then just the absence of studies at all, which is really where we are for so many issues in the vaginal microbiome.

Okay, so we don't know, but you probably have some good guesses. So tell me the three that you would predict because you've looked at more vaginal microbiomes anywhere else on the planet at this point.

This is true.

How many have you examined? Like what?

We've looked at almost 100,000 vaginal microbiomes. We have the world's largest data set ever on the vaginal microbiome.

Okay, so. And you said 70% of the ones you've looked at. Granted, it might be because people are. Are. Are coming to you because they want to change something, but 70% of them, you did some work, so you have to know something about food.

Yes.

Okay, so. So tell me what you think is the answer. Even though more research is needed, which is the answer every researcher always says.

Even if they're right, that's probably true. So there are a couple of interesting studies on individual ingredients that you can look at foods that have them. For example, vitamin D seems to be playing an important role in vaginal health, which you can hypothesize is because of the role of the immune system in kind of fighting pathogens in the vagina. We've also seen that there's some research on omega 3 fatty acids and that being able to support the mucus in the vaginal. In the vaginal canal, which then supports the vaginal microbiome through that. And then the other thing we've seen is just general hydration being important. Where, when you don't have strong hydration, that can then affect the tissue, and when the tissue is affected, that can then affect the microbes that are living within that tissue.

Does this mean that if women consume electrolytes that help with hydration better than water, that it would improve their microbiome?

You know, that would be a very interesting study question. I think there is a reason to believe that that link could be drawn. I haven't seen it drawn in anything published, but I think hydration definitely doesn't hurt. And we've seen studies that say hydration helps.

So why don't you just do a study at 10 women?

That's a great question. Well, let's. You know what we should do? We should come up with the list of questions that we want to ask out of the EVVY data set, and then we can go pull the data for you and we can publish it together.

Yeah.

And you really only need, like, 10 women who, okay, I got my test, and then I drink electrolytes, I put salt in my water for a week, and then I test it again.

Yes.

And, I mean, you're going to have some drift because some of them are having sex or whatever, but you could probably ask them to be celibate for a week and they might do it.

No, definitely. I think there's. I mean, what's so interesting about our data size because we have almost 100,000 samples, as I mentioned, and we also have so much phenotypic data in addition to the molecular data. Right. So we're also looking at, are there molecular signatures that could be diagnostics for endometriosis or pcos, or menopause or pelvic inflammatory disease? We're looking at ways that you can look at markers in the vaginal microbiome to predict and improve outcomes in ivf, in pregnancy, in cervical cancer progression. And I think there's. What's so exciting about the vaginal microbiome is that it plays this incredibly important role in female health outcomes across the lifespan. And there's so much opportunity to leverage, frankly, this very accessible set of biomarkers to really understand our bodies and improve our health. And so we are very much trying to knock down all of these big questions, leveraging this data set that we've now built. So I will add this to our list, our list of questions.

Okay. I am so intrigued. Okay. Are you all right if I ask a few spicy questions here?

Of course. Anytime.

Is having semen inside a vagina good for the microbiome or bad for the microbiome?

It's bad.

It's bad.

Definitively, it's bad. Sorry.

Doesn't it depend on the semen?

Not really, because of the alkaline nature of semen.

Got it. And I've known quite a few women who said, you know, when I'm with a guy who's not the right guy for me, I get these frequent UTIs. And. And they're not saying it's because, you know, the guy's unhealthy, but, like, the relationship is off. And because the relationship is off, they. I think my vagina is telling me something.

I mean, you know, again, I'm drawing some. Some longer lines here than my science team would like me to draw. But you could say that stress that's coming from being in an unhealthy relationship is affecting your immune system. And we see very close relationships between the immune system and infections in the vaginal microbiome. So I would say there. There's probably something there.

Okay. It. I think there is something there as well. And no one's really done the science to look at the peanuts microbiome and the vaginal microbiome and then combining the two.

Unfortunately not, because it is not the best collection device for penis microbiome, but we are looking at whether the semen microbiome could be collected and looked at in relationship to the vaginal microbiome to help some of our patients that are dealing with recurrent infections. And clearly sex is playing a role.

Yeah. It seems like if you're in a relationship and you're trying to change your. Your vaginal microbiome, looking at your partner would be important. Okay, well, there are a few. Certain situations where the partner's oral microbiome might interact with the vaginal microbiome. You know what I'm saying? Is that good for your vaginal microbiome or bad for it?

Great question. Also not great, actually. There have been studies that show that women who have sex with women are actually at higher risk for vaginal infections. And one of the hypotheses is around oral sex and the relationship of oral sex in the oral microbiome then affecting the vaginal microbiome. So I think, like, the long story short is the less disruption you have into the vaginal microbiome, the better. And thinking about things like the role of condoms or hygiene in sex is incredibly important to maintaining the balance in your rational microbiome.

Okay. I. I believe that. Does this mean that before a guy goes down on a woman that he should maybe use, like, an iodine mouthwash and sterilize his microbiome so he doesn't disrupt his partner.

It's a great question. Classically, my answer is going to be that there's no research on that topic. But given the research that does show that the oral microbiome can affect the vaginal microbiome, I would say that that makes sense. Although I don't know if my dad would feel good about that given he is always talking about the importance of the oral microbiome.

So, okay, so here's my new protocol for pleasuring my girlfriend. It'll be, I'll use like a iodine saline rinse so that my mouth is perfectly clean. And then we'll, you know, have some fun. And several hours later, I will put in one of the viome oral probiotics that would.

There you go.

My stuff. All right.

I think that sounds like a great protocol.

Sounds like a lot of work, though. I'm not sure I'm really going to do it, but I'm going to say that I'm doing it. Okay. Okay. This is super fun that we get to ask these questions because it all, all these matter. We're just talking about biohacking, like what are the things in the environment that are changing things? Okay, what about vaginal steaming?

Not good. Basically, anything that tells you that it is cleaning your vagina, douching, steaming, etc, not useful and actually harmful. Because what you're doing is then you're, you're killing off any type of protective bacteria that you have. You're irritating the vaginal wall. And so the best thing you can do, obviously I'm slightly biased, is look at what's actually going on in your vaginal microbiome. Right. Let's stop guessing. Unfortunately, the standard of care in vaginal health when women go to the doctor is literally smelling swabs and counting shapes under the microscope. Like, this is not science and technology. This is not the 21st century. It's not 2024. So actually, let's use technology. Let's look at what's going on in the vaginal microbiome. Like you said, we've been doing this in the gut microbiome, in the oral microbiome. Frankly, we've been doing this in the animal microbiome, in the plant microbiome, and we just haven't gotten around to doing it for the vagina. Which blows my mind again, given how prevalent these infections are in this important role it plays. Like, it starts with looking at what does yours actually look like? And then specifically what do you need to optimize it. And it's exciting that it's actually modifiable and something that you can change and optimize over time.

Look, let's just be serious. You women, you change every single day. You're just really hard to study. I mean, there's a really good excuse for just ignoring half the population, right?

I mean, don't even get me started. My co founder and I talk about how being a woman is essentially a health hazard and how it's like we have twice the rates of depression and insomnia, we're 80% of autoimmune patients, we have double the chance of Alzheimer's, five times the risk of thyroid dysfunction. And to this day, we're diagnosed on average four years later than men across over 770 of the same disease. And what that comes down to is exactly what you're describing, right? The lack of research that exists in women. And for anyone here who doesn't know, until 1993, women were actually not included in U.S. funded clinical research. And so 1993 was when we passed the NIH Revitalization act, which was the first time we included women of childbearing age in federally funded research. And because of that, the majority of modern medicine is based on whatever was predictive of health and disease in frankly, middle aged, mid sized white men. And we kind of assumed women were small men, we made all the ranges smaller and we thought we had healthcare for women. And I think what we're experiencing is that's not true. And there are likely so many signals that the female body uniquely gives off that if we did a better job measuring and tracking, as you constantly talk about with biohacking, if we could do that for these female specific signals, we could likely improve so many outcomes in women's health. But we're just ignoring these signals because we only studied men. And so we're very. We think the vaginal microbiome is a perfect example of this, where there's a huge opportunity for us to measure, track and optimize the vaginal microbiome in a way that will allow us to, to reduce the risk of so many downstream health impacts for women across their entire lifespan.

I think it makes so much sense. Okay, can we get even spicier? Of course, is squirting good for the vaginal microbiome?

It's a great question. I mean, I can do some guessing here because again, research is dismal.

You have more data than anyone else, so your guesses are more valuable. Like that's how science works.

I'm trying to think. I mean, I don't think we have a strong scientific understanding of what squirting even is. Right?

Oh, we totally do.

Okay, so tell me about that and then I can tell you how it might affect the vaginal microbiome.

All right. This comes from Deborah wickman, who's a 30 year experienced OBGYN and she's in my Apollo group. This is my entrepreneur mastermind with Naveen actually, and Vishnu County. So she's identified these things called skene glands. She calls them mermaid gills. And most women have two. And if they start having the type of sex that causes them to squirt, which usually takes a while, there's a whole practice for that. They actually will grow seven of these on each side. So you actually grow more over time.

Wow.

And then they start squirting more and more. And she. In fact, I'm going to introduce you guys because she's actually measured what the fluid is. It's not pee.

What is the fluid?

It actually is like a filtrate of your blood plasma that's made in the spongy tissues and it likely has a beneficial effect on the microbiome. But she knows the ph and like what's in it, right?

Oh my gosh, I can't wait to ask her.

You guys are going to have like the best conversation ever.

So anyone else who studies vaginas is up my alley.

Oh yeah, you guys will be like fast friends. And so what? I suspect that that matters. Okay, and what about pheromones? Do you pay any attention to those in your research?

We haven't looked at them specifically. Like I said, most of the research we've been focused on is hormones and the role of everything from estrogen to testosterone, menopause, etc, on the vaginal microbiome. But I would be curious, what, what are your thoughts? What's coming to your mind?

Well, women make a. A pheromone called a copulin. And copulins make vaginas endlessly fascinating for men who experience copulins. And then so we, we know that happens. And I just asked one of my favorite doctors while we're sitting here. His name is Dr. GPT. And copulins are volatile fatty acids secreted by the vagina. And they're influenced by the vaginal microbiome.

They are influenced by the vaginal microbiome.

Exactly.

I mean, that would make sense to me because they're likely interacting with whatever the microbes in the vagina are producing.

Right.

And so if you have microbes that are producing certain types of acids that might be very different than microbes that aren't.

In fact, it's amazing the research that's out there. It says a slightly acidic environment, which we talked about.

Yes.

This is a ph of 3.5 to 4.5.

Yes.

Can influence the production and release of copulins. And if you have vaginosis or a change in the vaginal microbiome, you could affect the characteristics of your copulins, which would change your scent profile.

Wow. How? Well, I mean, that makes sense, Right? Because one of the leading symptoms of the vaginal microbiome changing is odor. Right. And it's a. And odor is such a broad term, but it basically just means what's being produced by the microbe smells slightly different than what you expect it to. So that definitely would affect.

And it's funny, most people can't smell a copulin. Interesting. You feel a copulin, but you don't smell it.

Like the way pheromones. Yeah, yeah.

And you're like, I have no idea why she's so attractive. And copulins are a part of that. And you experience them more during oral sex than during penetrative sex. So I'm. I have a theory that they're highly addictive, but that's just a personal theory.

I mean, I. I would believe it. I think that that's a very interesting opinion. And I think. I mean, this is. You're touching on so many great questions. And imagine being somebody who has a vagina, has a vaginal microbiome, and you don't have answers to these questions, let alone what's even going on. Why am I getting these infections? Why isn't this treatment working? Right. It's just unbelievably frustrating how. How much we don't understand about something that is so critical to our health. And I mean, I'm a strong believer that, like, frankly, the people who are going to care the most about figuring this out are the patients and the women who are suffering from the system not understanding it. Right. And I think to what you often talk about, this opportunity for women to take control of their own health will actually enable us to finally build the data set so that we can answer all of these questions. Right. And hopefully with Dr. DBT, we can answer these questions in our massive data set a lot faster. And frankly, I bet we will push forward vaginal microbiome research faster than it's been pushed forward in 50 years because of the role that women will play in helping build that data set over time.

Okay, I like that a lot. I think we've got the new EV campaign. It's like, let's see what we're going to say. We're going to say, upgrade your vaginal microbiome so that you have better pheromones so that he'll be addicted to you.

Yeah. And also, hopefully you're, like, not suffering and, you know, all the things that we also want for women.

Come on. All right, what about during perimenopause?

Great question. So, I mean, actually, what we see at Evie is about 20% of our patients are in perimenopause or menopause, and we didn't build a menopause specific product. But as you probably know, the leading symptom of women in menopause or perimenopause is vaginal symptoms. Right. And so a lot of those patients are coming to Evie saying, you know, I've never had these problems before. I don't know what's going on. I'm getting recurrent bacterial vaginosis or recurrent UTIs or yeast infections, and I can't figure out what's going on. And so, as I started to mention earlier, what research has shown is that the decline in estrogen that tends to happen around men, perimenopause, is then affecting the production of glycogen. Right. Estrogen produces glycogen. And glycogen, as I mentioned, is a critical food source for lactobacilli. So what we're seeing is that as women are approaching perimenopause, not only are they losing this incredibly important food source for that healthy bacteria that we mentioned, but then estrogen is also plays an important role in the mucus and the lining of the vagina. And then as that goes down, you start to see that both the lining is suffering as well as the microbes are suffering. And. And then as these pathogens get into the vagina, they can start to thrive, they can make a home. There's room for them. It's alkaline in there. And so what we're seeing is that women are just suffering from these infections and not getting a lot of answers. And so that's where we're able to actually look at fully what's going on and then help them develop a treatment program targeting the pathogens that are present, rebuilding the healthy bacteria, as well as thinking about vaginal estrogen, all so that you can replenish what's going on in the vagina and help fight these infections long term.

Is bacteria or yeast a bigger problem?

For vaginas, actually bacteria. And what's funny is I think that most of the time, women, when they think about discomfort in their vaginas, they think about yeast infections. Because that's what we talk about, right. And I have a hypothesis that we don't. Even though bacterial vaginosis is more common, like I said, it affects 30% of women at any given time. I think because the main symptom is odor, it's just more stigmatized and less talked about than yeast infections. It's also more prevalent in black and hispanic communities, which we don't fully, fully understand why yet, But I think it's another reason it continues to be stigmatized. But bacterial vaginosis is extremely, extremely common and much more common in yeast infections.

Do scented products affect the vaginal microbiome?

What a great question. Yes. Goes on my list of things not to do. I would say douching, steaming, scented products, all unnecessary. And I think, you know, of course I understand if people want to use a wipe or a wash. And I would just say, as close to water as you can get, the better. And I am constantly reaching out to all of these companies saying, have you tested the effect of your product on the vaginal microbiome? It's kind of wild to me that we're selling all of these products for vaginal ph and vaginal health, and we don't even look at do these products positively or negatively impact the vagina. So I would love for more people to start asking that question so that we make sure we develop products that actually help and not hurt.

I like to put on, like, my big pharma, big chemical hat, and I realized that glyphosate kills bacteria. So maybe, like, a nice glyphosate spray for the vagina would be good for women. Right.

But I wonder if that kills bacteria selectively because, again, you. You obviously. Well, first of all, obviously don't want.

To do that, but it's horrible for everybody, but. But that idea that let's just kill everything and.

Right.

It's the wrong approach, Right?

Well, I think the important thing to mention is that bacteria are more likely to cause a problem, but good bacteria are the solution. Right? So bacteria are both the problem and the solution. Meaning what you want down there is not nothing. You don't want an empty vaginal microbiome. You want a dominated microbiome by the healthy microbes. And so you definitely. That's why douching and steaming and all those things are detrimental, because you don't want to kill everything. Down there, you want those good guys to survive and thrive.

If a woman has really bad bacterial issues vaginally, is there a case for just sort of doing a big reset? Like you actually would want to kill everything and then just restore the vaginal microbiome?

Definitely. And there. What we will do at Evie is a vaginal antibiotic, where we'll look at specifically the antibiotics that are most likely to target the pathogens that you specifically have. And then. And we. We try to do that vaginally so you're not also disrupting the gut microbiome in that whole process. And then we'll look at vaginal probiotics, vaginal supplements, vaginal moisturizers, et cetera, to rebuild that healthy microbiome.

Okay, that's a good situation. So you could do that. And in that case, let's say that you've ordered the ev Vaginal probiotic. How do you get rid of the bacteria that's in there? Is this, like an iodine thing? Is it a. What's that red stuck chlorhexidine? Like, what. What would you do?

We do a vaginal antibiotic for patients who need one. So we'll look at something like a clindamycin or a metronidazole that targets the pathogens that are specifically in that patient's vagina. Because, as you probably know, different microbes have different susceptibilities to different antibiotics. So we'll choose the one that's most likely to target the pathogens that are dominant. Dominant for that patient. It'll be vaginally inserted to clear out the negative microbes. And then we'll use the vaginal probiotics to rebuild the good guys.

Okay, so you would take a antibiotic that's not systemic, I'm assuming, because it just. It's local. Okay, that's really helpful. And then you start using probiotics afterwards. And that's basically like a vaginal reset.

Exactly. And for some patients, what we find is that there's actually a role of something called biofilm. I don't know if you're. I'm sure you're familiar for this with the gut microbiome, but there's a lot of research that's starting to show that one of the reasons that patients might get these infections recurrently is because these biofilms are actually protecting the pathogens. And so even when you take an antibiotic, it's not getting attacked because these biofilms are protecting them. Right. They're these sticky webs that are making it so that it's hard for any type of treatment to reach the pathogens. So we also look for biofilm producing microbes in the vagina. And when those are present, we also look at something like boric acid, which can be used to break down those biofilms to make it more likely that the treatment actually is effective in killing the pathogens before you rebuild the healthy microbes.

Is it useful to just use a boric acid suppository all by itself to break up biofilms?

Some of our patients do do that, and again, our providers prescribe very specific to an individual patient. But yes, we do see patients for whom that's extremely helpful. And we also see patients who get a lot of benefit out of taking or using a boric acid suppository after their menstrual cycle. So menstrual blood actually has a higher ph than you would want in the vaginal microbiome. And so some patients will find it helpful to kind of reduce the quickly to kind of prevent those pathogens from colonizing right after their period and similarly, also after sex. So for some patients who see sex as a trigger after sex, patients will use a boric acid suppository to help bring down the acidity in their vagina again.

Hmm. Okay, so you can tweak all this stuff if you have the data.

Exactly. It always comes back to what's going on for you. I mean, as you always say, right. It's impossible to generalize, and so much of it is exactly what's happening for a specific patient. Can we build their baseline? Can we monitor how it's changing over time with their hormonal cycle, their behaviors? And then we can constantly adjust. Right. We can prescribe the right things for that specific patient to keep it optimized no matter what happens in their lives.

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Women deal with four different stages of hormones. You have the prepubescent time where usually there aren't a ton of issues, although there can be. Then you have the time when you are likely in your fertile window and you're cycling regularly. Then you have perimenopause and you have menopause. How often does it make sense to measure your vaginal microbiome when you're during your menstrual years versus Perimenopause versus menopause Great question.

We have found that for most patients, again, and it really depends on are they experiencing recurrent symptoms or are they just trying to stay on top of that their vaginal microbiome. If you're in the former camp where you are, you have experienced recurrent symptoms. There seems to be some difference between patients that experience infections recurrently and those that don't. We don't fully understand why that is, but if you fall into the former camp, we find that doing a test quarterly where we're able to look at what's going on and modify how much of a probiotic or if you need an antibiotic or if you're developing biofilms, helps us stay more on top of things and prevent you from kind of getting to a state of infection again. Whereas if you're in more of the optimizer camp, we see more like twice a year being the right amount of time for us to catch. I always say catch an imbalance before it becomes an infection, but then you're not testing more often than you necessarily need to.

Okay, got it. So a couple times a year. And it doesn't change during perimenopause. It feels like some women there can be, you know, one to five or even more years where it seems like it's changing every month.

No, it definitely does. Absolutely does. I mean, what I was mentioning around the estrogen levels declining and how that plays a role in perimenopause and just generally hormonal fluctuations. Right. We see this on a micro level in the menstrual cycle. So during the month, you do see that because of the changes in hormones as well as the presence of menstrual blood, you do see kind of a. An expected shift in the vaginal microbiome throughout the month. And you see that on a larger scale through perimenopause. Right. So as those hormones are fluctuating before they've stabilized, you do see that impacted in the vaginal microbiome.

Got it. Once a woman is in full menopause and let's assume she's with a single partner, how likely is the vaginal microbiome to change?

Great question. I mean, still likely to change. Right. You can take an antibiotic for an eye infection. Right. And that's affecting your vaginal microbiome. You could. Your partners, semen could introduce something into your microbiome because they have a certain bacteria that could infect you. Right. So the vaginal microbiome is, for better or for worse, often changing with the changes that we're making in our lives. And it's responsive to that, but then it's also responsive to modifications, which I think is just an exciting thing, because I think in many areas of women's health, there are not a lot of tools. And it's exciting that this is an area that plays such an important role in health and actually can be optimized over time.

So then the right protocol would be if you take oral antibiotics or possibly even topical. But let's just say if you're taking oral antibiotics, when you're done with those, you should be taking a probiotic for your gut bacteria, and you should be Using a vaginal probiotic to restore flora. So everything works the way you want it to.

Right. And I would say it's just the most important to actually look, because here's the other challenge. Except for some patients, they are dominated by healthy bacteria. They aren't prone to disruption. And then taking a vaginal probiotic isn't always a good thing. Right. It's not what we recommend to everyone because you also don't want to create any type of overgrowth or irritation from that lactic acid producing bacteria. So I think it's just an important balance and it's important to know what's specifically happening for you and then taking it from there.

Okay, that. That makes good sense. So measure every six months. Ideally that's relatively expensive, though, if, if you're in menopause and you're not having any problems, you haven't taken antibiotics, you could probably do once a year, right?

Definitely. And if you're not having any types of issues, I think set a good baseline and then if you ever have an intuition around something or you are changing a medication or something in your life is changing, that's a great reason to check in.

How close do you think Evie is to being able to identify things like endometriosis or PCOS or even like cervical cancer?

Great question. I mean, I would love. We do have, like you said, a very large data set of patients who have been diagnosed with endometriosis or pcos or pelvic inflammatory disease or certain types of cervical cancer or hpv. And we also have their vaginal microbiome. Right. And these are the types of studies that I am incredibly excited to run because we haven't looked at those studies with large enough ends to actually identify specific signatures. And one of the cool parts of Evie is that through our testing, we've actually discovered double the number of genomes than had ever been documented on the vagina before Evie through our own test. And so because of that, we can see much more specific signatures that could be potential diagnostic markers for all of these conditions in women's health. And so now that we've discovered all of these genomes, now we're starting to do some really exciting machine learning work on discovering signatures for different conditions in women's health. I would say, realistically, we're probably one to two years away from answering those questions, but we're much closer than science had been before Evie.

I wrote a major book on fertility. It was my first book because the mother of my children was infertile when I met her. And it took about five years of changing diet and nutrition and biohacking to restore her for her full fertility. And we had kids at 39 and 42 without IVF. And writing that book showed me that we have a huge epidemic of infertility, and it's only getting worse. And this is now, Good God, like, 15 years after I wrote the book. And the fertility crisis has gotten to the point where a lot of my friends in their 30s are saying, I hope I can get pregnant. When I was 30, it was, I hope we don't get pregnant unless we want to.

Right.

What is the role of the vaginal microbiome in fertility?

Such a good question and something that we are actually focused on right now at Evie. And I'm excited about the research that we're doing in this space. But there's a lot of research that already shows that the vaginal microbiome is playing a very important role in fertility. And as I was mentioning earlier, it's. It's playing that barrier role. And when that barrier breaks down, what you see is that pathogens are able to travel up the reproductive tract and seem to cause, like, upper reproductive tract inflammation and infection. Right. And generally the immune markers tend to be off when the vaginal microbiome is disrupted. And what you see is that women have a harder time getting pregnant naturally. The vaginal microbiome is a leading predictor of whether or not a cycle of IVF will succeed, with the hypothesis being, yeah, where this is the study we're actually running right now. But there was a paper I read, and this was way back in the day, it was probably five years ago. And I remember this was the day I decided to quit my job to start Evie. It was a very small study. It probably looked at around 30 to 50 patients. And they looked at the vaginal microbiome of patients going through ivf. And ju. Just looking at the vaginal microbiome, not looking at age or anything else, they could predict whether a cycle of IVF would succeed with 94% accuracy. Just looking at the vaginal microbiome. And so it's definitely playing a large role in fertility and outcomes. And again, nobody has done large enough scale research to actually point to the mechanisms of action and the specific moment in the cycle that people should be testing, how they should be using the data. Nobody's actually ever used a commercially available test that could look at all of these markers. And so we're actually running a study right now with a network of fertility clinics looking at the vaginal microbiome of patients going through ivf so we can actually identify the specific markers, build the specific algorithm so we can make that research useful to patients today.

Okay. This means everyone who's having fertility issues or working with IVF should get an EV test.

That is our goal. I am mind blown by the research in the space. It is really just. Yeah, it's crazy to me that the vaginal microbiome is right there. It's so accessible, and we're just not looking at it, even though it's clearly playing this role in so many outcomes. And we're just hoping that we can make it. We will do the work to make it mainstream. Right. To make sure we have enough robust science and research to support that. But from the existing research and anecdotally, we see that it's playing a very large role.

How much is the EV test?

Great question. It starts at $99. We've worked extremely hard to make the test affordable for people. And there's two versions of the test you can buy. You can buy the whole genome sequencing, metagenomics based version of the test. That's our kind of bread and butter. That's what we invented. We brought whole genome sequencing to the vaginal microbiome. And you can also add onto that if you want, what we call our expanded PCR panel, which enables us to look for STIs and antibiotic resistance markers as well.

Okay. And you're gonna give followers a discount on this, right?

Yes. Our discount code is gonna be Dave, which will be live before this episode goes live. And that will give everyone a discount code on that V test.

You get to know how much the discount is or you're figuring out still.

I usually it's $10, but I will double check on that.

All right, so there you go. I gotta save about 10%.

So we're evvy. Com, ev y. Com and on Instagram as well.

I always say, Evie, sorry about that.

That's okay.

All right. Every.com use code Dave. There you go, guys. And it's 99 bucks. You can save 10 bucks or thereabouts with the discount code. This is not an expensive test. And how much does IVF cost?

Like $15,000.

So maybe 99 is just worth it if it's the single biggest predictor of whether your $15,000 investment will work. Like, this is groundbreaking stuff.

Thank you. No, we're very excited. And it's about time that people, I always say, you know, all of the amazing technology and innovation we've had in longev medicine we just haven't applied it to so many obvious areas of women's health. And that's what we're really hoping to do, is bring this amazing technology to this overlooked issue that can really improve outcomes for so many patients.

Can we talk lube?

Yes.

Okay. I know a certain someone who really likes coconut oil. Good or bad?

Good.

Okay. So coconut oil is acceptable. What is the worst possible lube you could use?

So it kind of depends on if you're trying to get pregnant or not. If you are trying to get pregnant, you actually want to use a more alkaline lube because it helps the sperm survive, because, again, it's a more alkaline product. But if you're not trying to get pregnant, then ideally you want something that's maintaining the low vaginal pH. And there are actually some lubes that have been tested for their impact on the vaginal microbiome. Those are the ones I would specifically look for, and I can send you a list of them if that's helpful. But it's just crazy to me that we put lube in the vagina all day and most people haven't even looked at what it does to one of the most important markers of our health.

Why doesn't Evie have a probiotic lube?

It's a great question because we've been really busy doing research. But, yeah, there's a lot of products that we would love to see invented.

That seems like one of those things that people would buy on. On subscription.

I agree.

Be highly sought after, because there's a lot of weird chemical stuff out there that.

Well, if anyone wants to start a probiotic lube. Who's listening to this, we would love to help, and we would love to do the testing and validation of how it helps the vaginal microbiome.

All right. There are a lot of medical practitioners who listen to the show and a lot of biohacking entrepreneurs. You guys may have been to the Business of Biohacking conference that I run every year to teach entrepreneurs how to build companies. So go to businessofbiohacking.com and come next year and bring your business plan for your probiotic lube. I'm not even kidding. We'll help you make it work. We'll hook you up with Priyanka. This is how innovation happens. It's a good idea. I'm not going to do it. You're sounds like you're not going to do it. So somebody. Women need this. It would be really good for the world. Maybe help fix that fertility issue that we have everywhere and just create a lot less suffering. So this. This is something that needs to happen.

Okay, could not agree more. I think something you talk about so much that I love is around precision medicine, right. And the importance of precision medicine. And I think in this new wave of longevity and precision medicine and AI and you name it, one of my biggest fears is that, you know, if we've never studied women, we don't even have the data to train the algorithms on what precision medicine will look like for women. And so I think it's just so important that we, as women take this into our own hands. We build the data sets on our bodies that help us understand what's going on, what's predictive of our health outcomes. Because otherwise, how can we have precision medicine for women, right, if we don't even know what the predictors are of health and disease? And as you know better than anyone, like, AI is only as good as the data we give it. I think it's so important that we start to close this data gap on female bodies, because otherwise, how are we going to ever enable precision medicine for women?

You're totally right. It makes so much sense. Okay.

Did you know the 1993 stop before we met?

No. That's just incredible. And I'm still sort of thinking $99 is not a lot of money compared to the amount of information that you're giving people. I know so many women who are struggling with this, and you guys may say, dave, what do you mean? You know someone like, I'm a biohacker. People tell me their personal stuff all the time at parties. And. And there are no filters.

So same. You can't even imagine the stories I hear.

I can't eat. You must hear even. Even like, spicier ones than I do. And you're like, you have what going on right now? Okay, so, okay, let's talk about some other stuff. Spermicide, like anoxinol 9. That's on condoms. Good for the biome in the vagina. Not good.

No, not good.

Birth control pills, the industrial chemicals that cause all sorts of health problems in women. Good for the vaginal microbiome. Bad for the vaginal microbiome.

Oh, that's a harder question to answer because it depends what the hormonal state is of someone before and after they're on birth control. Meaning that if somebody is getting their hormones artificially in balance through birth control, it can help the vaginal microbiome because you're. You're managing the fluctuations in hormones. But that's not actually fixing the root problem. Right. So what's actually interesting is that there's been a dearth of research classically on different birth controls effect on the vaginal microbiome. That's another thing that we're working to publish our data on. But there has have been studies that show that IUDs specifically have a higher incidence of vaginal infections, potentially because the microbes are actually attaching themselves to the device and then building biofilms onto the device. So it's actually making it harder to clear infections.

Okay. So we don't really know.

We just don't know exactly which one and if it's specific to each person. But again, another thing we have a lot of data on that we would love to publish. So if there are also academics who are listening to this or people who want to partner in publishing, we do have a lot of really interesting data. And we are always looking for partners who want to help publish out of it to answer these types of questions.

Okay, I love that. That's, that's such a big deal.

I know. I'm like, we are raising venture money to try to fund a lot of research and there's only so much I can do by myself, so.

Right, well, it sounds like you're doing a lot by yourself right now. Well, you know, by yourself. You have a whole team.

I do have an amazing team, but yeah, we gotta deliver on some business milestones in addition to all the research I want to do.

Okay, well, I'm, I'm really excited for this because it's an underserved area and it affects quality of life in a major way. Right. And it affects quality of life for women very clearly. There are a great number of men who are partnered with women. Right. And if your partner is uncomfortable for any reason, it lowers relationship quality. Right. Just like, you know, if a guy has, you know, a disrupted microbiome, that's also going to affect your relationship. So the health of both people is critically important. And this, this is a big deal.

Totally. And there's been a lot of studies that show that patients who have vaginal infections have higher rates of depression and anxiety. And also that, I mean, our patients, in our data, I think on average people report their vaginal health has affected their quality of life above a 6.5 out of 10 in terms of how much it's impacted their quality of life. And the number one thing that people say it impacts, to your point, is their relationship. And I think it's so hard for us to see so many women who say, you know, I don't even want to date. Right. I don't want to be intimate with anyone. I'm ashamed of this. I feel like it smells. And it's so frustrating to imagine the stories and experiences they've had in the system just not getting answers. And so we very much are here to change that.

Wow. Well, it's a, It's a big challenge. And you have a hundred thousand samples right now. What's your goal? Like, how many samples do you think you're going to get?

Our goal is to serve, you know, what is there over 125 million women just in the United States. Right. I think the amazing thing about the vaginal microbiome is that it's playing a role in your life throughout your whole life. Right. I would love to get to a point where everyone who has a vagina is able to use Evie once or twice a year. Right. And how do we start to prove to the powers that be that we shouldn't be ignoring this really important vital sign for women?

It's, it's a big deal. And I'm just, I'm still impressed that the cost is, Is that low given.

Very hard on that one.

Few other questions here, please. Vibrators. Good for the vaginal microbiome, bad for the vaginal microbiome. Great.

I mean, again, depends on the type of vibrator. If you're putting something. Well, first thing I'll say is if you're putting something anywhere around your vagina, make sure it's clean. So, like sex toys not being clean, it's a huge issue for vaginal health. And if you are a woman having sex with women, making sure that if your partner is using a tool and then you use it afterwards, that you clean it in between so that you're not transferring bacteria.

Women are going to transfer bacteria. Like they, they, they kiss after they do things, and they just like kind of, you know, scissor, I think is the term we're looking for here. So I'm pretty sure they're sharing a vaginal microbiome.

Right. But less transfer is always better. Less. The less you can avoid things moving between places, the better. And so vibrators in general are definitely not universally detrimental. It's just keep them clean.

Got it. What's the best way to clean a vibrator?

That's a great question. I'm honestly not the expert, but I can guess that probably soap and water is a good, good starting point.

It's a little boring. I. I would say the dishwasher if it's not one. At least if it's waterproof, the dishwasher does a great job of cleaning them. Added bonus that then when some. Someone's emptying the dishes you might have, they have to find you to use the toy and like, everybody wins. Right?

Right, Exactly.

Okay. Are you familiar with the history of Lysol?

Oh, my gosh, of course. Some of my most motivating ads that I look at are the ads around Lysol for vaginal health. It's very offensive for me.

Tell me about them.

So for anyone who doesn't know what we're referring to, I want to say it was as recent as in the 90s, right. That these ads were out and about.

But essentially it was more 70s than 90s. But God, I wouldn't. I would believe it.

I don't know. I. I should look at when the most recent.

You're young enough that to you the 70s and 90s are the same thing. Like, I, I was born in this avenue. Okay.

I. I want to read one of them because they're so wild to me. Okay. She was a jewel of a wife with just one flaw. She was guilty of the one neglect that that many marriages life. But many marriages have been saved with Lysol. What they are referring to is there was a lot of marketing around Lysol being used for the vaginal microbiome to fight odor and discomfort. Obviously, as we've discussed here, that is not a good solution. We should not be using Lysol. I am also just generally offended by the way this is all framed. But I think that as we can probably guess, these are issues that women have been dealing with forever and we just have. We. I mean, the fact that in our lives, this was the way we talked about these infections is just mind blowing to me.

That's insane. Just like, what the heck is going on here?

It's really unfortunate. Sorry. Last thing I'll say on this topic is I think in general, we are just given so much misinformation about vaginal health. I think we are taught to think that our vaginas should smell like a flower, when actually maybe they should smell like the hormone or the pheromone that you were describing. Right. Like, whatever that is, probably doesn't smell like a flower.

Do you think that's misinformation or is it just bad science? Because those are totally different.

That's a great question. I actually think it's potentially neither. And it's just good marketing. Right. I actually think it's Maybe just that companies have seen Summer Z Vagisil. People are self conscious about something because they don't know that it's normal. And they take advantage of that. Right. When you search for vaginal symptoms and vaginal odor, you're hit with non stop ads for products to make your vagina smell like a flower. And so I think it's more good marketing than it is anything else.

One of the things that amuses me greatly is that I think it was Gillette, one of the big razor blade companies. About a hundred years ago or so, they hired one of the early management firms and one of the first PR firms especially, which used to be called propaganda firms. And they said, how do we increase sales of razors? They said, oh, that's easy. Let's convince women to shave their legs. And at the time, no women shave their legs. So they ran some ads in women's magazines saying that hairy legs were unhygienic. And a year later, most women were shaving their legs and they sold a lot more razors. So selling hygiene, in my view of the world, is one of the most powerful marketing tools out there. Because humans have died from plagues and from disease throughout all of our history. And so we have this preconscious fear of things that are not hygienic. And it's not at all rational, but we tell ourselves it's rational. And marketers find they know all the things that affect your operating system before you can think. And man, the ability to tell women to spray Lysol on their vaginas and to shave their legs to be more hygienic. You make a lot of money doing that. It might not be a problem. And for the record, I'm in favor of shaved legs on women just because I like them. But it could also be that that's what I've always seen. Right. We just don't know.

Right. I. I think that is a very powerful example of exactly what we're talking about. Right. I think that women just have been targeted with ads that are telling them how they should look or feel or smell for so long. And I think I'm very excited. I mean, one of the things that I love about Evie is that we have this amazing educational platform which I think you've probably seen online, where we are constantly talking about exactly what we're talking about here. Vaginal odor, vaginal discomfort, lube, sex, all of these things that frankly, women just don't have a lot of information on. But they do have a lot of questions. Right. And so we're creating funny content that answers people's questions based from real doctors and real scientists. Right. And I think that is such an important part of Evie's journey. And frankly, one of our key products, which is just giving people answers to their questions in a way that's not selling them products to make their vaginas smell like flowers.

Okay. What if Evie just ran ads that said, make your vagina smell like it's supposed to.

Right. That's a good idea. I love that. So maybe you're a marketer who knows how to get in under our heads before we. We can think.

I'll be really straightforward. Marketing is a dark art. It's all about getting into someone's subconscious and preconscious so they'll something.

Yeah.

And I'm. I've done almost a billion in revenue with. With that. And you can use it to make people less healthy or more healthy.

Yeah.

Right. So you might as well use every tool in the marketing arsenal to help people instead of to harm them, because you can make profitable stuff either way.

Totally. That's a good point. And if the other people are doing it, then we're losing to them anyway.

For that, I would absolutely click on an ad for Evie that said smell horny. Like, let's just like, there you go. You got the hygiene and you've got the reproductive stuff. These are major. Like, don't die of a disease. Not that we're thinking that or we're feeling that.

Yeah.

And reproduce the species. We all want to do that before we think.

Right.

So push both those buttons. I dare you to run that ad and watch what your click through it is.

I will. I will send it. I will run an experiment and send it back to you. I love making your vagina smell like it's supposed to. That's a great line.

Try that and then try smell horny. Everybody at smell horny again. Like, oh, my God. This is printing money and it's helping women. This is the sacred use of marketing. I love this.

Right. I mean, one of the things I love most is that not only can we help women on a one to one basis, but then when women choose to opt into our research and actually 98% of our patients opt into research through Evie, which I think is just an amazing testament to the role that women want to play in closing the research gap that exists. When people can consent to that, then we actually get to do this research. Right. We can start to answer all of these questions that women have. And I always say, like, women are the only ones who are going to solve this problem. Right. We can't wait for the government to give money to some, you know, research arm who's going to give money to someone who's going to recruit patients. It's like, we can do this way better, faster, cheaper in 2024. And it's exciting to see that, you know, women taking control of their health is what's also actually going to push forward the research and the science.

It is, and I see it happening. And it's really encouraging to me that you have 100,000 women's data points. So now we can really figure out what's going on, and we can just make intelligent choices that have big ramifications.

I mean, like you always say, right? You need the data. You just need the data. And we just haven't had the data on so many things in women's health. And we're going to change that.

Let's get a little bit nerdy.

I can't wait.

One of my favorite biotoxins is called lipopolysaccharide or lp. And this is a common type of toxin that bacteria make to protect themselves. Unfortunately, that toxin is directly responsible for mitochondrial dysfunction. It causes brain fog. It causes all kinds of problems. A disrupted microbiome or a leaky gut. When you have bacteria that make lps, it makes you feel like crap. You get systemic inflammation. Even your blood sugar levels can change. So it's a nasty thing. Do we know if vaginal bacteria make lipopolysaccharides?

It's a great question. I actually just quickly googled this while you asked me this. And Dr. Chachi, PT says that certain gram negative bacteria present in the vagina can have. Well, it doesn't say if it produces it. Sorry. It says that it can be present on the outer membrane of certain gram negative bacteria, and that actually that contributes to inflammation and vaginal dysbiosis.

There you go. So if you want to know the connection between your vaginal microbiome and fertility. Lipopolysaccharides poison mitochondria.

Wow.

This is my favorite mitochondrial.

Oh, my gosh. We need to measure this in our fertility study. I'm writing this down.

You totally do. Okay. And so here's like, the. It's a spiritual kind of esoteric thing, and it's my favorite mitochondrial nerd thing altogether. Mitochondria act as environmental sensors. They're little antennas, and they act as computers because they get a. They get a signal and they decide what to do, and they can make electricity, they can make heat, and they can make a bunch of different chemicals and hormones and things like that, and they're going to do it based on whatever the little computer says to do. So we like to talk about, oh, men and women. We've got 15,000 mitochondria in each of our neurons and each of our heart cells, and that's the biggest density. But if you really dig into mitochondrial literature, women have a hundred thousand mitochondria per cell in their ovaries. Men don't come anywhere close to that.

Wow.

So given that these are environmental sensors, is it possible even that some of the legendary female intuition is residing in the reproductive system? I think it's a good theory. There's probably not even a way to prove that. But. But since we know fertility is linked to mitochondrial function, and there's lots of room for that, and we know that bacteria in the vagina make lipopolysaccharides, if you have a disrupted microbiome, and it's right there next to the ovaries, we actually have a way to understand why this would happen. And that's also why you think about this. You spend $99 on an EV test and figure out if you have a healthy vaginal microbiome, and that's the number one indicator whether IVF is going to work or not. Do you have things poisoning the mitochondria in your ovaries and also the mitochondria that power sperm and the mitochondria that are there in the egg like this. This just makes so much sense. And this is why the interaction of the bacterial world and the fungal world and our mitochondria, it underlies all of reality. So this is why your test is so important.

That's so cool. I can't wait to look at it. If there are. Do you know if there are tests or markers for looking at it for lipobotic?

Absolutely. It's an easy test to run.

Wow. Okay. So we're definitely going to do that in our fertility study, and I can't wait to report back what we find. Yay.

I love getting to come up with new sciencey ideas on a podcast. It's so fun.

That is amazing and so interesting. And I think we will only. We're only at the early stages. I think we know the vaginal microbiome is playing a role. We know having a healthy vaginal microbiome means you are way more likely to achieve reproductive success, healthy reproductive success, avoid having a preterm birth, all of that. And I'm very excited for us to uncover the specific mechanisms of action. This might be one of them that actually explains why, and that's how we get real wide scale adoption when it comes to pcos.

You said that you don't know if there's a connection with the vaginal microbiome. What would you hypothesize and why?

Yeah, there actually is research that shows that patients who have PCOS tend to have a different vaginal microbiome than patients who don't have pcos. Same thing with endometriosis and same thing with pelvic inflammatory disease. Same thing with menopause. That's why I think it's such an exciting marker where we can potentially catch changes that are happening in the body early through the vaginal microbiome. We haven't identified the specific signatures yet that are the predictive markers for pcos. That is what Evie is doing research on. But it does seem like there are differences. And one of the hypotheses goes back to what we've talked about around hormonal fluctuations. Right. Patients with PCOS tend to have more hormone hormonal fluctuations, and those hormonal fluctuations you're likely to see happening in the vaginal microbiome as well, in the way that they're affecting the composition of microbes that are present.

I do know that the number one contributor to PCOS is insulin resistance. You become less insulin resistant and PCOS goes away. But if you're insulin resistant, what happens? Higher blood sugar. You have higher blood sugar. Are you more likely to have bacteria that eat sugar in all of the biomes in the body because there's more sugar present? Yeah. So for women who are interested in pcos, I would definitely get an EV test and see what benefits you get from improving your vaginal microbiome. But you probably need to lay off the sugar, learn how to reset your leptin, learn how to do moderate but not extreme intermittent fasting, and eat less sugar, but not necessarily no sugar. And if you do those things for a few months or maybe read the Better Baby book, which teaches you that stuff, you may find that suddenly your PCO symptoms go down and your fertility goes up. If you want to have kids, it seems like a really good idea.

I remember reading one paper that said something around insulin resistance actually being impacted potentially by the vaginal microbiome, I'm sure by all the microbiomes in your body. And so I think there's a two way situation likely happening. Same with endometriosis, where you see that patients with a disrupted vaginal microbiome tend to progress more and faster with endometriosis. So all of this to say, the vaginal microbiome is such an obvious area to look at as a woman, such an important, vital sign to optimize. And when we optimize it, we are going to improve outcomes across so, so many conditions. Right. And Evie's going to do the work to prove out all the science behind all of this. But the research is there enough to say that optimizing this is a worthy thing to do if you care about optimizing your health as a woman?

I can't argue with that. And if you said, this is a $500 test, I'd be like, there's a lot of those. But this is what a lot of people spend on supplements or coffee, not even good coffee every month. So that works. Are there any other things that come out, like mineral balance? You don't have data on electrolyte or taking fish oil or any of the other just normal longevity things that I teach. Do we know if any of those affect the microbiome positively or negatively?

I think fish oil, you can imagine, might because of what I was mentioning around the omega 3 fatty acids and the role that that plays in the vaginal lining. Like I said, vitamin D seems to play a role. And classically, there isn't really research on the other things. And I would be curious to look at our data set of supplements that our patients report taking and seeing if there's any trends in that as well. So if there's specific ones that you think would be interesting to look at, let me know.

God, there's. There's so many. That would be like a whole brainstorming session. But it feels like things that are going to help your microbiome in the gut are probably going to help. Probably prebiotics would help. We also know that cranberry extract is really good for UTIs, and my guess is that that probably has other beneficial effects.

Yeah, I don't. There is less research on cranberry extract and the vaginal microbiome. Actually, interestingly, the primary link between the vaginal microbiome and recurrent UTIs is that what we find is that when patients UTIs, they take an antibiotic to clear their bladder infection. But then what's happening is that the vaginal microbiome actually acts as a reservoir for that UTI bacteria living in the vagina. And then guess what happens? You pee and you wipe, and the bacteria goes right back from the vaginal Micro to the urethra. And now you have a UTI again. And so what we've found, at least for some of our patients, is that optimizing your vaginal microbiome can then also help prevent UTI.

You know the number one cause of UTIs that no one talks about what it's eating? Oxalates.

Really? Say more about that.

Oxalates are a plant defense compound. I wrote about it in chapter one of the bulletproof diet a long time ago. And I think I under indexed how important oxalates are when you eat them. And these are spinach, kale, raspberries, almonds, sweet potatoes, beets, regular potatoes, most grains. Well, they form razor sharp microscopic calcium oxalate crystals. And 70% of kidney stones are caused by plant toxins, not by eating meat. And you pee out these little crystals, and these little crystals make small cuts in the lining of your bladder and in the lining of your urethra. And when that happens, bacteria can get in. And if you get recurrent ones, like step away from the peanut butter and the almond butter and all the superfoods that you think are healthy, they are not. And if you choose lower oxalate vegetables, and these are usually the old school vegetables like cucumbers, lettuce, wow. Then magically you can have a major reduction in recurrent UTIs.

Wow, that's so interesting. I can't wait to tell our patients that.

It also just so happens that these razor sharp calcium crystals are shown in studies to directly affect mitochondria. They actually cut the mitochondrial membrane. So if you're dealing with problems in your vagina especially, or with UTIs in your urethra, well, maybe looking at not eating certain foods is more important than choosing to eat other foods that are good for you.

Wow, that's so interesting.

Right? So number one is know what bacteria are present. And if you have the healthy lactobacilli that belong in your vagina, those are not going to be infectious. But if you have a disrupted microbiome that includes infectious bacteria and you're eating these foods that are not really good for you, and then you're getting a razor sharp thing that's making little cuts in, in your protective. It's like it's no wonder that you might have recurrent infections. So number one, fix the bacteria. Number two. Yeah, Check out some of the latest stuff I've written about nutrition and just realize oxalates are part of the problem for your vagina.

Yeah, totally. And we know that the gut microbiome is affecting the vaginal microbiome in some way. And one of the things I know you've talked about on the podcast is around how the gut microbiome modulates estrogen. And so I think that's probably one of the key ways that then the modulation of estrogen affects the vaginal microbiome. So all that to say paying attention to your diet is incredibly important, even if what you care about is your vaginal health and not necessarily your gut health, although you should care about both.

Beautiful. Well, Priyanka, it has been so much fun to get to talk about vaginas with you today.

Thank you so much for having me. I love all the honest questions, the the big questions, the small questions, and for everything we don't have answers to. That's why Evie exists. We're here to to close the research gap on these things and we're all ears for topics people want to see us publish on questions they have because we do have an amazing data set that we would love to publish out of.

I also want to thank you for a discount code and just for an affordable product, guys, it's evieevy.com, use code Dave and this is worth doing.

Amen. Thank you so much, Dave. We are so grateful for everything you do for the community and for having us here today. So thank you so much.

See you next time on the Human Upgrade Podcast.

The Human Upgrade, formerly Bulletproof Radio, was created and is hosted by Dave Asperger. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully, read all labels and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in products, products or services referred to herein. This podcast is owned by Bulletproof Media.