"What Is 'Leaky Vagina'? (Microbiome Expert Explains)"

Foreign. Welcome to the Love and Guts Podcast. So why should we care about the vaginal microbiome? And just how different is the vaginal microbiome to the gut microbiome? Today I'm delving into this topic with Dr. Jason Horlack. I've had this fabulous man on the show before and we chatted about all things pre and probiotics and the gut microbiota. This podcast episode 15 being one of my most loved and downloaded. So if you haven't listened to it yet, please make sure you do. But for those that aren't Familiar with Jason, Dr. Jason Horolak is a research scientist, educator, naturopath and Western herbalist with more than 18 years clinical experience. Jason practices at Gould's Natural Medicine, 136-year-old Natural Medicine Apothecary and Clinic located in Central Hobart. He did his Honours and PhD degrees examining the causes of dysbiosis and the capacity of probiotics, prebiotics and herbal medicines to modify the gut microbiome and has written extensively in the medical literature on these topics, including 16 textbook chapters. He is on the Medical Nutrition Council of the American Society for Nutrition and was recently awarded a fellowship from the American College of Nutrition for his significant contributions to the teaching and practice of nutrition in Australia and North America. Jason is also a Fellow of the Naturopaths and Herbalists association of Australia. He is Chief research officer at ProbioticAdvisor.com, which offers a searchable database that enables easy evidence based prescribing of probiotic products and online resources for clinicians and health conscious members of the public to learn more about the human microbiome and how they can positively influence these ecosystems. And if you're a practitioner and you've not joined Probiotics Advisor yet, highly, highly recommend that you do. But in this episode we cover what makes up a healthy vaginal ecosystem. What bacteria dominate the vaginal ecosystem? What are the five community states of the vaginal ecosystem? What might a dysbiotic vaginal microbiome be comprised of? How does the vaginal microbiome differ throughout a woman's life cycle? How the vaginal microbiome differs from the gut microbiome? What are some causes of vaginal dysbiosis? What does leaky vagina mean and how does it impact our health? What Jason has used effectively in the treatment of bacterial vaginosis? Why do we love lactic acid in the vagina so much? How do we assess vaginal health and so much more? We go down the rabbit hole of so many things Vaginal Microbiome this episode is sponsored by BetterMe Tea, a tea designed to promote improved gut health and digestion, assisting those who struggle with constipation and sluggish bowel movements to go to the bathroom with ease. And as always, I do like to mention that this information is not intended to diagnose or treat a medical condition, so please ask your health practitioner before beginning any new treatment. And if you love what you hear today, I would love it if you could leave a ratings and review on itunes so that others can find Love and Guts easily and can enjoy the content too. Hi Jason, I'm so excited to get you back on Love and Guts. I had you on the show before and we chatted about all things pre and probiotics and the gut microbiota. And actually this podcast being one of my most loved and downloaded. If you guys haven't checked it out, it's episode 15. But today I'm welcoming you back on to talk about the vaginal microbiome. And I'm so excited to talk about this topic, but I must confess, I did not think I'd be having this conversation with the male.

Fair enough.

Welcome, Jason.

Thank you. It's a pleasure to be back. I love the gut microbiome. That's my first passion. But vagina microbiome is also, I'd say, my second passion. And I think it's an area that is just beginning to get the research that it deserves. And I think soon vaginal microbiome assessment will be part and parcel of a regular checkup for your health, as will gut ecosystem checking too. But I think as we'll get into, the consequences of a Dyswarac vaginal ecosystem are actually quite significant for women, and it's not always associated with symptoms. And that's the problem that yes, if you get symptoms, you might get checked out. But as we'll be touching on, I'm sure there are lots of dysbiotic environments where they have negative health consequences but no symptoms. So women have no idea that they're actually experiencing this. And that's in the long term. There's a number of disease sequelae that are associated with it, but no acute symptoms.

And after doing your vaginal microbiome course, part one, when is part two coming out?

It's when I can find time. I've got another five.

I was putting a rocket up your butt for that because I loved it.

I've got another six to do in September, October, so it's sometime after that where I can find the Right. Headspace to devote to it.

And after doing your. The part one of the vagina microbiome course, it is a fascinating topic and I do see why you and I see it as a big part of something that should be an assessment for our patients. Yeah, yeah. So what, let's get straight into it. What makes up a healthy vaginal ecosystem?

Yeah, if you would have asked that question, you know, 20 years ago, it would have been, oh, it's acidophilus dominated ecosystem, or that one. And. And as you'll probably remember, at one point in time all probiotics were referred to as acidophiluses. Yes, I took acidophilus for this.

That was a probiotic. There was only one and it used.

To drive me mad. Because it's a single species. You can't call the whole category of therapeutic agents by single species names. It's crazy. And we've moved along, thank God. So we're now calling it probiotics. So that's good. But it used to be seen that the vaginal ecosystem was dominated by Lactobacillus acidophilus and with more again, changes in technology have allowed us to realize that, no, it's certainly dominated by Lactobacus psylli. But very rarely does acidophilus itself play any sort of key role in that ecosystem. It's usually one of a number of lactoi species that we find there, four of which tend to dominate, which are Lactocells, Crispatus, lactois, innards, Ginsengi and Gesseri tend to be the dominant ones. But there's also Lactopilis, vaginalis, Fermentum and Johnsonii that are often found in the vaginal ecosystem as well.

So what else makes up the healthy vagino? Jesus. I'm think it's the Australian coming outing me. So what else makes up the healthy vaginal ecosystem? So in regards to say, the ph and the diversity, because it is very different to the gut microbiota, isn't it?

It's very different. So we certainly want, yes, an ecosystem dominated by Lactobacilli. And we'll get into the different community state types shortly, I'm sure. And we want one essentially that has a low ph associated with it too. And that's, I think, for us, thankfully, as clinicians and as patients, to a very quick marker that we can actually use to assess the health of an ecosystem is by checking the ph, because a healthy vaginal ecosystem will always have a PH of less than 4.5 and we can pretty Much guarantee there being a dysbiotic environment when the pH is greater than 4.5. So it's a very quick and easy screening test that can. We might have to follow it up with more testing. Sure. But it's a very quick and easy one to go. Okay, well, if you're in the healthy range, great. If you're not, then we know definitively that there's an issue there, even if you don't have symptoms.

That lack of diversity, rather than lots of diversity is actually considered healthy, isn't it? Rather, yeah, it's completely opposite.

Yeah. For the gut, it's like the more diverse and complex, the better. For the vaginal system, it's the opposite. We really want it to be dominated by one lack of a civilized species making up 98% of what's there is sort of like the ideal with a handful of other species present. Whereas if you've got 50 species in the vagina that are spread out at 12 or 15%, which might be great in the gut, is totally not the case in the vagina. We really want it to be dominated very much by Lactobacilli. And one single species of Lactobacilli too, ideally.

And we do like the Lactobacillus crispatus, don't we? Why do we love that one so much?

Yeah, I think for a few reasons, one of which we know that there's been a number of studies that have come out showing that women that have an ecosystem dominated by that one Lactobacilli type, Lactobacus crispatus, have essentially the lowest risk of developing STIs or STDs, lowest risk of getting cervical cancer, lowest risk of getting bacterial vaginosis. It's the most stable ecosystem. And essentially think of L. Crispatus as a tuffy. It doesn't share space. Well, it doesn't like any other species coming into its turf. And there aren't other Lactobacilli like Lactobis inners is not like that. It's pretty piss weak and will allow lots of other things to come into its turf, sadly. And also with Crispatus, it produces a lot of lactic acid, so it creates essentially what we consider to be the most acidic sort of vaginal PH environment of all those sort of community state types. And that low PH that we get with the Crispada stone ecosystem essentially spells death to invaders. So that will be things like viral pathogens, like even HIV and H, the hpv. And we know that lots of research done in Africa looking at sex workers who are obviously at high risk of hiv, that women that have a crispatus dominated ecosystem have a far lower rate risk of developing and getting aids. It's just like, wow, there's still same sort of sex practices. What's different is what's dominating the vaginal ecosystem and how strong and potent or what sort of guardian they have looking after that ecosystem. And if you've got a crispatus one, it's very good and it tends to be very stable, whereas some other ecosystems, particularly one that's dominated by lateral inners, is not very stable. So it shifts around a little bit more during the cycle, for example.

Yeah. And you call that the transitional. Yes, yeah, the transitional type. And let's get into the types the community states because I want to dig a bit deeper into these different forms and especially looking at the what say a dysbiotic picture might look like versus the, say the one that we want to kind of cultivate in the vagina. So you mentioned that there's five community states of the vaginal ecosystem. And why do they call it community states? I guess it's pretty obvious.

It's interesting terminology. I would probably call it ecosystem type myself and I think that might have a more familiar ring to it. And maybe analogy would be like a forest type, like you might have a tropical rainforest or it's a certain versus a pine forest. They're like distinct species that are present in that sort of ecosystem. But what was fascinating with some pretty pivotal research published 2011, I think it was, that showed that pretty much all women, their ecosystems in vagina will enter into one of those five categories. And this is, I think, quite different than guts, which I think the ecosystems are far more complex and much harder to actually put into those sort of categories, though people have tried. But I think with vagina it's very clear that women will fit into one of these types. So we have ecosystem type 1, which is donated by lactose crispitis, and that occurs in about 25% of women. So one in four women will have that sort of ideal ecosystem type, which is great. And that's least likely to develop bacterial vaginosis or STIs and even better birth outcomes too. We know that they're more likely to get pregnant, have an easier time getting pregnant, a better chance of carrying baby to the full term. So there's a number of research studies exploring the benefits of having that community type ecosystem. So I think there will be, once this research filters out into practice, there's going to be a big push for assessment of vaginal ecosystem health. And also for changing it. Yeah, because there's a number of, I think, pivotal women's health issues that are tied up here that relate to that vaginal ecosystem type. And it's been as an area that's been neglected far too long and we now have enough data, I think, to actually start moving and changing that scenario. Moving back, Community state type one is crispatus. Community state type two is dominated by Lactopilis gasseri. And that makes up a pretty small percentage of about 6% of women. And that's considered to be quite a good ecosystem too. It's a pretty stable ecosystem. It rarely transitions through to anything else. And it also has a pretty good ph, lactic acid production. And then community safe. Type 3 is actually the most common in that it occurs in probably about a third of women, 34% in that pivotal research study. This is when it's dominated by lactealist inners. And we know that the species is present in small amount in pretty much all women. It's just that it very much dominates in these women that have community state type 3. The problem is that the, as I said before, doesn't really prevent bad guys or invaders, pathogens from coming into the territory. It doesn't produce enough lactic acid to create an environment that kills off the viruses and bacteria that are wanting to invade the tissue. And we know that women that have life's inner dominant ecosystem essentially have a higher risk of getting bacterial vaginosis about getting HPV infection and cervical dysplasia.

So why do you think that this type inas is more common? Do you know?

I think they're still teasing that out, but I do think it's got to do with essentially my thinking is it's the factors that cause a dysbiotic environment that essentially create this more transitional state. And then if we have another dysphotic event occur, we never sort of transit back out into a healthier state. And I think for a lot of women, they may get stuck there because they might be taking a course of antibiotics every six months and that might be enough to essentially prevent that ecosystem from settling into a crispitus dominated. And there's possibly also genetics that come into it too. Or not genetics, sorry, I should. It's what you're seeded with too, that if your mom was crispitis dominated, then maybe you'll be more likely to be crispitis dominated. And I think some of those things haven't been teased out so well.

Well, I look forward to hearing about that research and I can't wait to get into some of the causes of vaginal dysbiosis a little bit further on down the track so we can be mindful of that. But yeah, the type 4, the dysbiotic type 4 interests me a little bit. So I'd love to know a little bit more about that type.

Yeah. Because it's still very, very common. It's like, you know, 20 to 30% of healthy. I'll put quotation marks from that. Women will have this community state type. And so it's not symptomatic and it's essentially a. This is where a very diverse ecosystem where there's only small amounts of Lactobacilli and you'll have a spread of other species like Gardnerella, Atopobium and Prevotella and sometimes things like E. Coli, streptococci and fecal bacteria two that I'd like seeing in the gut. I don't necessarily like seeing roseburia and blockchain in the vagina. It's like you don't need butyrate producing bacteria. Wrong spot. So it tells that the ecosystem is out of balance. And when they've got that, there's essentially very little lactic acid being produced. And that lactic acid is key for killing off invading pathogens, as I said before, as well as just the health of vaginal cells too. Because it's a pretty amazing environment, I think, in one respect compared to the gut ecosystem, because the gut bacteria are for the most part reliant upon our food for their nutritional needs. Yes. Some of them eat a little bit of mucus. Yeah. But vaginal ecosystem, the vagina is actually feeding bacteria specifically and it's really trying to nourish those lactobacilli. So vaginal cells secrete some glycogen, which is the type of sugar. But I'll say awareness, there's an awareness that not all Lactobacilli consume glycogen. So it actually secretes some digestive enzymes to break down that glycogen into smaller sugars that Lactobacilli can eat. And it's amazing that I always see it as the vagina nurturing its garden of Lactobacilli because that's really how it is. Which differentiates it a bit from the gut. It's this effort there by the body to actually create that sort of ecosystem. And this is somewhat unique to humans too actually when we start looking at other animal species that they generally will have a diverse vaginal ecosystem. And it's only, only humans that actually have, have a Lack of AI dominated ecosystem.

Is that right?

Fascinating itself, yes.

Wow. So are we the only species?

I think we are from memory, yeah.

Okay, that's fascinating. It is, yeah. And so I do want to get into the lactic acid because I know how important that is. But you. And you've mentioned that the vaginal microbiome differs from the gut microbiome, of course. So when in regards to the food, basically that's one of the aspects that we sort of not we, but the vaginal epithelial cells produce and secrete glycogen to feed the microbes. How else does it differ from the gut microbiome? So we spoke about the. We need more of a lack of diversity rather than lots of diversity. PH is different, so we're looking for more of an acidic environment. And what else? Is there any other differences?

I think there's a bit. I mean, obviously even the types of lactoid that dominate the vaginal ecosystem tend to be different than what we find in the gut. That said, yesterday we saw you git result that had a decent amount of L Crispitis. That was the first time I've seen that. For the most, most part, the vaginal species are quite separate from the gut bacteria. So you might have a number of lactose fly in your gut, but they're not the same as what's actually growing in the vagina. So that's the other thing that's worth to take note. Nor are they the same that you find in fermented food. So you can like reinoculate the vagina with kefir or sauerkraut. It's not going to work.

Thank God for that.

Yeah. I gave a workshop on this too, at a place where there's people who are very much, you know, I'm into fermented food too, but I just want to make that clear that you can't just reinoculate. Those are very key, unique species with very unique attributes that allow them to thrive in that environment and play that protective role. And we don't get that with a strain of Lacto's plantarum from sauerkraut. It's not going to have the same impact in that ecosystem.

And it does. The vaginal microbiome differs throughout a woman's life cycle. Right. Did you want to expand on what the differences are?

Yeah. So certainly pre puberty, it actually is quite a diverse ecosystem and postmenopause it becomes more diverse again. It's really when estrogen levels increase, where we get an increase in glycogen. That's being produced as well as a bit more mucus being produced, and that actually allows the lacto psylli to become. To dominate that ecosystem. So it's very much within that fertile time space where Lactobacilli are the dominant species present. And postmenopause, when estrogen levels drop down again and there's less glycogen being produced, it becomes a more diverse ecosystem. And that's why that population has a higher risk of recurrent urinary tract infections, is because there's a number of species now residing in the vagina in relatively high amounts that have the capacity to ascend the urethra and cause infection, whereas a vaginal lacrocile dominated ecosystem doesn't have that same capacity to cause affections in the vagina or in the. In the urinary tract system. Sorry.

And so why do you think that the microbiome being different in that prepubescent stage, serves the prepubescent person? Like, I wonder why that is. Do you have any ideas around it?

The theory around it is around intercourse. And even the idea that why humans have a lack of a sale dominant ecosystem is because it's evolved, because we're the arguably the only species that has sex not just to mate, but for other reasons. And essentially that when we start getting semen, you know, male semen coming into the picture, which is a very alkalizing fluid, and there's also more bacteria in a semen load than there is sperm, we now know. So it's like it's a great capacity for that to actually alter and potentially pass on infectious organisms too, but also alter that ph, et cetera. So the idea with having a very lactic dominant ecosystem, it can help restore the ph, help prevent any sort of bacteria that are in that load from actually being causing infection or just altering that ecosystem to a less healthy state.

Yeah, okay. And I find that fascinating about the semen. And while we're on the subject of things that can kind of alter the vaginal microbiome and the ph and all that sort of stuff, what are some causes of vaginal dysbiosis? And let's start with that first. And then I'd love to hear about some of the common types of vaginal dysbiosis if we can.

Yeah, I mean, it's worthwhile flowing on a bit from what we were just talking about then that certainly increased frequency of intercourse is a risk factor for vaginal dysbiosis. And that's because of those factors. I've just Said that really is an alkalizing solution being secreted in there. And there's also a load of bacteria.

Multiple injections of different bacterias.

Yeah. And if that happens three times a day versus once every three days, obviously there's a different capacity of the vaginal ecosystem to adapt and deal with that. Yeah. And we also talking about, obviously women that have male partners here. And wearing a condom actually protects the vaginal ecosystem, interestingly enough, as long as there's no spermicide on that spermicide kills the beneficial active cili. So that's another thing to keep in mind. Yes, spermicide use is one of the factors that can be problematic. And certainly what I hinted or mentioned before is that oral or IV antibiotic use will also disrupt the vaginal ecosystem too. So, yes, it causes gut dysbiosis, but vaginal dysbiosis too. And this would not be a surprise for many women who experience thrush after taking a course of antibiotics because of the disruption to that vaginal ecosystem.

Yeah, absolutely.

One of the more fascinating factors, though, that causes a dysbiotic environment is cigarette smoking.

And it's like not kills the vaginal lactobacilli.

It does. There are nicotine and nicotine byproducts or breakdown products that get secreted by vaginal epithelial cells into the vagina itself, which selectively kill off your lactobacilli, which I just find. Wow, a scary thought.

Yes, an absolute scary thought for people.

To think about that particular impact when they're cigarette smoking, that they're actually killing bacteria in the vag as a consequence, which is not something they would have really considered before, which is pretty fascinating. And then some more obvious ones, like the use of bidet toilets where some fecal bacteria will get a bit of a wash into vagina, that's more obvious. But some research showed that topical antifungals, and I think this is again, a more surprising one, that people would assume that I can apply this cannison or whatever antifungal, it'll kill the yeast, but it won't bother my good bugs. But that seems to be wrong for more recent research. And stress. So we've known for ages that stress negatively impacts gut bacterial beneficial microbe counts. But there's research showing that the same similar scenario happens with vaginal lactobacilli too. The counts go down when exposed to high amounts of stress. And that, sadly, is too much a component of many of our lives these days. And I should also flag vagina washing or douching, which thankfully is not that common in Australia or where we practice, But I know in America it's actually quite a common practice and that causes water, let alone with soap or shampoo or perfume that I've read about, we're actually using, which causes massive disruption to the ecosystem.

Do you remember baby powder?

Yeah.

Do people still use it? Actually, yes, I did see someone in the local supermarket, it was a male, actually purchased the Johnson and Johnson baby powder. And I just thought, I remember the days that my mother would say, put that in your pants. It would be like this thing that you would just do for feminine hygiene.

Yeah, yeah, that's right. The whole aisle of feminine hygiene products. It's just like. Really?

Yes.

It's not even. Just like not needed. But it's harmful.

Yes, absolutely. And I want, because I know that you spoke a little bit about the vaginal glitter bombs, which I just think are just hilarious, your course, that people would develop something like this that would make the vagina smell a certain way and look glittery and taste sweet. And taste sweet. Yes.

Yeah, but.

So what are your thoughts on say some of those practices like the vaginal steam baths using organic dried herbs?

Yeah, I would think they're less likely to be nearly as problematic as those like glitter bombs, which.

Oh, for sure. I'm not comparing it. Absolutely not.

Make sure. I clearly reiterate that. And I also think it's because it's. It'll generally be around the outside more around the labia and that lower area, which I think it will have less of a chance of impacting the deeper ecosystem. And I think that's where douching etc becomes far more problematic is there's essentially changing the ph of the environment or introducing soapy things to wash away bacteria deep into the vagina, not just at that outer labia area.

And what about the otherwise known as yoni eggs? What are your thoughts on those? Sticking those? Little different.

Problematic, actually. I mean, if the same woman uses it and it has some vaginal lactobacilli on it and some stick on there after the washing process afterwards, that's not going to be problematic, reintroducing lactobacilli back into that ecosystem. So I think that obviously you could consider ways in which if people were sharing them or something like that.

Oh God, hopefully they're not sharing them.

So if it's just used the way that they're typically used, then I wouldn't expect it to be a problem. Problem.

Okay, good. Good to know, Good to know. And so what are the common types of vaginal Dysbiosis.

I mean, I think the two that probably have the biggest bearing on women's health would be bacterial vaginosis. I suppose that community state type 4 that is asymptomatic dysbiosis. Whereas bacterial vaginosis is essentially a similar ecosystem, but women have symptoms for the most part. So they might get a fishy smell, they might have itchiness, a bit of redness, but a little bit of discharge. But bacterial vaginosis is often misdiagnosed as thrush or candida as well. So we know that bacterial vaginosis is actually more common than thrush, but it's often misdiagnosed as thrush and then B group strep, which can be a symptomatic scenario where it actually causes symptoms and tissue damage. In some women, although I'd say it's relatively rare. Other women, it'll be asymptomatic and still make up a patient where it made up 80 some percent of that ecosystem, but they had no vaginal symptoms. But the biggest issue with that is really around pregnancy and birth where it really needs to be flagged. And if we can find out that it's there beforehand, hopefully we can actually change things around. And also too, whether it's there at 1% of an ecosystem or 80% of an ecosystem has a big difference in terms of what we'd expect with the chance of premature birth and premature rupture the membranes and other issues that we sometimes see associated with the heart or a positive B group strep.

You're just really making stating your case for it being a big part of preparation for pregnancy. I tell you, it's strange that it's not.

I totally hear you on that one. And also because of the improved IVF outcomes that we see with women that have crispatus dominate ecosystems. For me it's. Why is this not like a standard thing we do for all women that are having falling pregnant as quickly as they should in quotation mark be that we should be looking at, okay, this test, obviously this diet and nutritional things, et cetera, that naturopaths, nutritionists are very well trained and versed in for looking at. But we're not so well trained at looking at the general ecosystem. And nor are your typical gyne either, for that that matter, that they're often not paying any attention to that at all because it's not part of their, their way of looking at things either.

And especially with, especially when you're saying with bacterial vaginosis that, you know, it can 50% can be asymptomatic and it typically can be without the inflammation and redness. So, you know, it would be quite easily missed if these sort of forms of testing to assess for that weren't done.

Yeah, because that's the thing. If it's always symptomatic, it would be far less of an issue because most women, not all, but most women, would go and get things checked out when symptoms occurred. But when it's 50%, it's completely asymptomatic, but it's associated with these adverse health outcomes. It's like the only way we find it is by testing.

And you mentioned that it reoccurs frequently post antibiotics, is that right?

Yeah, because obviously conventional medicine, the typical approach is to treat it like they do for most infectious type conditions. It's just that it's not a classic infection in that it's a bacterial imbalance. So often when we're treating pneumonia or something like that, it's one bacterial species that's rampant that we'll just try our best to target and kill off. And then, yeah, in this case, we just have an imbalance of a number of different species which in some cases causes symptoms, some cases not in terms of acute symptoms. But yeah, the rate of return of bacterial vaginosis is extremely high. And that can be, I think about 60, maybe 2/3 of women on average, within four to six weeks will have a return of that bacterial vaginosis ecosystem. Because antibiotics aren't normalizing or optimizing that ecosystem. They're just reducing levels of certain microbes. And that's for most women, isn't enough to restore it or optimize that ecosystem.

Yeah, look, it makes total sense. And you said, I think nearly 70% will have return within 90 days. Scary.

It's just huge, huge recurrence. And it just shows that that approach that is commonly used is not a good approach. Not actually all that. That good. That's not a good outcome for a treatment that has, you know, other. Other, you know, negative consequences like damage to the gut ecosystem too, as a consequence.

So, yeah, it's just like a bad haircut that gets. Keeps getting worse and worse. Try to repair it. Anyway, bad analogy, but you know what I'm saying? So what does it. I want to know more about the leaky vagina. We've all heard about the leaky gut, so. But there is a term called the leaky vagina. So what does it mean? And what are the consequences of having a leaky vagina? It doesn't sound too pleasant. Does it?

It doesn't. It's interesting because I was preparing for lectures, presenting at a conference in Sydney earlier this year, and I was reading through, you know, updating my knowledge on this, on this area, and they kept talking about like sort of lack of integr of the cervical epithelial cells. Just kept coming up again with having a dysbiotic ecosystem because they were always thinking of that similar thing happening in the gut. When we have a dysbiotic thing and then we've got a leaky gut, it's just like they're talking about a leaky vagina. They haven't phrased it like that, but we talk about a leaky blood brain barrier and a leaky gut. And that's really what we're talking about is essentially a lack of integrity of those cervical vaginal epithelial cells. And when we have that lack of integrity, it means that there's a greater risk of acquisition of sti, including HIV and HPV and obviously cervical cancer as a consequence. And arguably there's a lot more to that, including things like endometriosis and other. Just a greater inflammatory male in that woman that comes from having essentially that sort of lack of integrity that's allowing bacterial byproducts through and bacteria and viruses through. And that's a similar thing that we know that the leaky gut has consequences for letting in bacterial byproducts that lead to fatty liver. And we're now looking at things like anxiety and depression being tied into this too. And I think, gosh, we have a similar scenario happening in the vagina too, where these bacterial byproducts, as well as actual bacteria and viruses are penetrating through and getting into the system. And it wouldn't surprise me with research teases out as actually being one of the key drivers of something like endometriosis, which is an extremely common condition these days.

Absolutely. So some of the big drivers to getting a leaky vagina would be chronic reoccurrent microbiome, vaginal microbiome, dysbiosis.

Essentially, it's an ecosystem type that is not dominated by crispitis or ginsengi or gasserii, the ones that produce D lactate and enough lactic acid. That's the key thing, because we know that the polymicrobial asymptomatic dysbiosis picture, it's not very acidic, and lactic acid is essentially the key factor that actually allows vaginal epithelial cells to function properly and to heal up properly and for the healing process to work properly and Even for the mu to trap the protective mucus in there. If we get enough, the PH goes low enough and we have some D lactate there, it actually traps viruses and bacteria far better than if it's not if it's L lactate or if the PH actually changes. So that's the key thing is that, because then that allows those pathogens to come through and interact with epithelial cells and cause inflammation and cause greater leakiness. And the lactic acid sort of turns off some of those pro inflammatory cascades that can happen even when that process has started.

So why else do we love lactic acid? You've mentioned it a few times now and I know that we it's so required in the vagina for as a bactericide and a virucide and anti inflammatory agent as you've mentioned, inhibits pro inflammatory mediators and all that sort of stuff. Are there any other reasons why we love it so much?

I think we've covered it pretty.

Those are pretty big.

You know, things like STIs like chlamydia, gonorrhea, Europathogenic E. Coli, the one that causes urinary tract infections. They all die when exposed to a PH of less than 4.5 with enough lactic acid there. So I mean that's just the key things to remember. But if the PH goes to 4.6 or 4.7, let alone 5 or above, you're not getting any sort of inhibitory effect against those organisms that will otherwise take residing and cause harm and symptoms.

It really is different from, from most part of the body, especially the gut and other areas. When you think of lactic acid people necessarily they, they kind of link it to muscles and soreness and you know, build up and let's not create too much of it. And whereas in this scenario it's like yes, how can we create more lactic acid?

Lactic acid, yeah.

Well, it's a good thing.

Vaginal epithelial cells like we've evolved reliant on that production because, because there's only a small amount that's actually produced produced by vaginal cells themselves. And they rely on bacterial production of that to function properly to. It enhances DNA and cellular repair in those cell types and it's reliant upon that. So there are consequences when it's not getting that food essentially. And that happens with that polymicrobial asymptomatic scenario. It happens in bacterial vaginosis and that later's inner dominate ecosystem which is maybe 34% of the population again. It's asymptomatic, but they're not getting enough of the lactic acid being produced to get the benefit and to protect against that sort of leaky vagina scenario.

Now, I know people are probably chomping at the bit to go, how the hell do I test. How do we assess the vaginal health? Do you want to shed some light on that? What sort of tools do we have at the moment?

Yeah. And we discussed one tool earlier that I think is just worth flagging again, but a simple PH test strip that has the right measures on it. That's the other thing I should mention to you. Most of the ones you can find in the market are looking at saliva or urine ph and they have been 1 in 14 or 16 to 8 on it, which is completely useless for assessing the vaginal ecosystem because you really want to have gradients between three and a half and five and a half or something like that ideally. And they're not that easy to come by. In Australia, again, sadly enough that it's actually hard to get the right tools to even just do a simple health screen by checking the vaginal PH of patients. My clinic, we bring them in, we have to order the kids in from Germany, which is just crazy. This very simple, simple, simple process. But yeah.

Is that where you biome? Is that Germany or you.

Ah, okay. No, that's. That's different. I'm looking more broadly. This is PH test strip that's designed to assess vaginal ph acidity because it's got the right.

I was going to ask you, what's your favorite ph strip? Like, what brand? But if you, you need to get from Germany, do you.

Yeah.

Wow.

But I know there's other places, like from ebay, etc, that people are buying them from, but it's just. You can't just buy it from a supplier here in Australia. You used to be able to, but they stopped making them, which was frustrating. So PH is certainly a very quick and easy way of assessing. So PH of less than 4.5 doesn't guarantee that you've got a. You know, that there's not Candida or other things that are present. But it does tell you that at least you've got a good amount of lactic acid there and you don't have bacterial vaginosis. That's the key thing. And if it. But a PH of less than 4 or greater than that. So more alkaline than 4.5. So 4.6 or 7 or 5 or 6 and a half or 7, something like that, tell you that you have a dysbiotic ecosystem and there's nowhere near enough lactobacilli or lactic acid being produced to get the benefits that we've been talking about now. So I think ph is a great initial screen. Conventional medicine up to this point tends to use culturing. So they sort of take a swab and they sort of grow it out and you get an idea and they look at it and go, okay, well how many gram positive rods are there versus gram negative or gram mixed grams? Usually they kind of come up with an idea of, okay, yeah, you've got bacterial vaginosis, et cetera, but it doesn't tell us details on the community state types. If it tells you that lactozili there or you get a vague three or two plus. Whereas nowadays you can use these molecular assessments. And we've talked about the importance of using those techniques for gut. It's similar thing. If you want a really good picture of the vaginal ecosystem in terms of the species that are present and the spread of those species and exactly which lactobacilli dominate rather than just lactobacilli, it's like, no, which species? I want to make sure it's crispatus. Then you have to use molecular assessments to do so again in Australia, we're behind the times and don't have an easy way of actually doing this, but there is UBIO in the US that are often used for gut assessments that also will assess for general ecosystems too. And it's brilliant when you get the results back and go, ah, okay, you're actually 82% streptococci. It's B root strep, and this is just before pregnancy. That's an important thing to know. Or I had another patient who was 98% lactose crispatus and you're like, yes, perfect. That's the great state to go into when you're going to the stage of wanting to become pregnant. So I think it should be part of that broader screen for probably all women, but it should certainly be part of that screen for women going into that wanting to get pregnant phase. We certainly do a lot with build up your nutrition. Let's take these different vitamins and take this particular type of folate, et cetera, et cetera. But we tend to ignore that ecosystem, which is a key factor in fertility outcomes and birth outcomes too, for that matter.

A massive factor. And it's at the Vaginal Explorer that you would use at the US Practitioners.

Get access to the smart chain, which looks for disease agents and HPV types, et cetera. It's a pretty cool test. But as Australians, we don't have access to that. But the vaginal explorer, which comes as part of their fire site kit, which is, again, another bit of a hassle to actually get it, means that you can get that beautiful picture of what the ecosystem looks like.

And so call out to everyone that has a path lab or some sort of laboratory that might be able to do a vaginal microbiome assessment tool thing for us. That would be amazing.

It would be absolutely fantastic. You'd be the leader at that front bit of the wave, which, because, as I said, I'm sure in 10 years this is going to be common practice by both natural medicine practitioners, but also conventional medicine, too, because the research is building up to the point where it's hard to ignore.

And I'm sure that it would. I think, as a practitioner, once you start to really, truly understand how important these things are to assess, then you want it like yesterday, you want it right now, because you know how much it can really support your treatments.

It's ignorance. It's not like they're like, I'm ignoring that. It's just, I don't know it exists. And you start looking at it and delving into it, you're like, oh, actually, this is really important. Oh, we need to be doing this as a screening test for all of our female patients, because this has got to do with optimizing their health.

Yes, full stop. Absolutely. So what have you found going into treatment? What have you found to be extremely useful in the treatment of vaginal microbiome dysbiosis, such as things like bacterial vaginosis?

Yeah, so with bacterial vaginosis, you know, it's best not to think of as an infection, more of a dysbiotic environment. So we think, how do we improve, you know, just like a gut ecosystem, how do we actually improve the spread of different species? How do we encourage the growth of certain species? And that's the way we look at it, because you look at a bacterial vaginosis result, there'll be lactosulide there. They're just there in teeny tiny amounts, like 1% or 2%. And it's like, okay, well, how do we specifically increase levels of that species? And that comes through with prebiotics and prebiotics we talked about at length last time, but they're selectively fermented substrates that can only be utilized by certain beneficial species. So it's like a selective fertilizer. And luckily, we sort of know, okay, We've got lactobacilli. That's what we want to. Want to fertilize. And we know prebiotics that do that. And there's been some fascinating research studies that have come out over the last couple years. But I must say I've been using vaginal prebiotics in my patients for probably 15 years, particularly one called lactulose. Lactulose, we know, is a gut prebiotic that feeds lactobacilli. Great, that's what we need. So I've been using it for thrush patients and bacterial vaginosis patients for, as I said, over a decade. But there was a very cool study that came out just in the last 12 months that was looking at the potential of gut prebiotics to work as vaginal prebiotics. And they pick lactulose as their top one. And I was like, yes, A bit.

Of a hero product for the vagina, isn't it?

Yeah, because it feeds every single strain of Lactulus crispatus. Loved lactulose, and it can't be utilized as a food source by Candida or the bacterial vaginosis microbes. So it won't work. Even though it's sweet and tastes like sugar and looks like sugar, it doesn't feed the bugs we don't want. It feeds up lactozilli, specifically, and especially L. Crispatus.

And that's the definition of a prebiotic. The selectiveness of what it feeds.

Yeah, because people get lost and they always go, oh, it just feeds bacteria. It's like, no, that's not a prebiotic.

It chooses who it decides to feed.

Yeah, that's right. And that fits the bill. And there's other research going on with glucoligosaccharides and glucomed, for example. It comes from the cognac root. That's had some preliminary good results with normalizing that vaginal ecosystem, too. And I've used that in practice as well, but I've used certainly more lactulose than anything else. So, yes, the vaginal prebiotics. Vaginal probiotics, too. And in this case, we're after probiotic strains with different characteristics than we are for treating H. Pylori infection or ibs, because we want them to have different. Different attributes and different traits. We want them to be able to attach to epithelial cells in the jna, want them to sort of compete with pathogens. We want them to ideally secrete a compound that sort of breaks down pathogen biofilm or pathogens directly. So we're looking at different traits altogether. And luckily there's other researchers that have been doing that too, and ones like Gregory Reed that was probably the pioneer of looking at vaginal probiotics whose developers probiotic preparation that's pretty widely available around the world these days. Back from research went off from the middle and early 1990s, probably 15 years of research before it was ever commercialized. But that's the L. Rhamnosis GR1 and L. Fermentum RC14 Strains used in that combination have now a number of studies showing that they're helpful for the treatment of bacterial vaginos.

So they're the most researched.

Yes.

Yeah.

And there'll be more to look forward to though. There's other strains. You can actually get crispatis strains in the market in Europe and in North America, but sadly not here.

So you've mentioned some of the properties like infiltrating the biofilms and inhibiting gram positive bacteria, all that sort of stuff. Why would the production of hydrogen, hydrogen peroxide be beneficial? You've mentioned with the Lactobacillus fermentum RC14 that it can produce hydrogen peroxide.

Yes, because hydrogen peroxide is a substance which lactobacillite tend to tolerate pretty well, but pathogens don't. So the bugs involved with bacterial vaginosis don't tolerate hydrogen peroxide well at all. In fact, there's a couple of clinical trials using hydrogen peroxide as a dilute, as a rinse or douche for bacterial bacterial vaginosis with one with repeated uses. Outstanding results as well. So that's one of the other agents I use in my bacterial vaginosis patients too as a way of normalizing that ecosystem. Because here you do have a selectively acting antimicrobial that leaves your lactoxili alone, but gets rid of the microbes you don't want in the vagina and that's hydrogen peroxide.

So it sounds very harsh for the poor vagina, the hydrogen peroxide. Yeah, sounds like hair dye.

Lacking vagina myself is not something I had a chance to experiment with because I like doing that with most treatments that I give to patients. I'll try them on myself first, but I couldn't in this case. But I did have some naturopath colleagues who are willing experimentees when that research first came out of going, okay, well similar thoughts are running through our heads and okay, well let's trial it out. It's a 3% dilution at about 20 mils. And we've worked out that Majority of women over years of practice actually tolerate that quite fine, even though John is mildly irritated. But there's a percentage that actually caused quite severe pain for a number of minutes, which is obviously not what we're after. So these days we tend to dilute it down to a third of that. So maybe 1% solution for the first couple of days to see how the treatment goes, then move up towards the 3% dilution, which is what was used in the clinical trial.

And with the lactulose going back to that though, do you always do it in intra vaginally, like via a spray or a syringe, or do you do it orally as well when it comes to treating the vaginal? Or do you do them both? Both or just.

The reality is I'm probably often doing them both. But I think directly direct application to the vagina is really the core aspect of normalizing that, providing a good quantity of that food source, because very little, none of that lactose is going to make its way into the vagina from oral use use, but it will increase levels of lactosuli and bifidobacteria, et cetera in the gut, which we just see is associated with beneficial outcomes and potentially reduced levels of things like Candida and E. Coli, for example. So someone that had recurrent UTIs, then I'd certainly be using lactulose orally and intravaginally as well.

And the same goes for the hydrogen peroxide. Would be obviously just to use intravaginally rather than. You wouldn't even go near doing oral.

No, that's right.

Green tea, I thought was an interesting one. As a vaginal prebiotic. How would you, you know, how would, how does it work as a vaginal prebiotic and like, what are the great properties that you find with green tea and how would you actually utilize that on a woman?

Yeah, we sometimes forget how, how cool some of the things are that are just around us all the time. You see this as like a beverage that you, you drink. We know it's a bit healthy, but we don't necessarily associate all the wonderful health benefits we get from green tea and the attributes that it has. But again, it seems to have a prebiotic like effect. So it feeds up lactobacilli populations because they can eat the polyphenols in the green tea. And the polyphenols are what makes your mouth pucker, the tanniny sort of bits in green tea. So the longer you let that tea brew, the more tannins you actually get. Now the Polyphenols in green tea are also good at killing off microbes we don't want, including things like candida E. Coli bacteria, things that we don't want growing in the vagina. Some cool research showing that the green tea polyphenols break down, establish biofilm, prevent the development of new biofilm as well. So you're looking at that, again, a very selectively acting antimicrobial. Just what we need in this situation. Something that will at the very least leave lactobacilli alone. But in this case, and with the hydrogen peroxide we're getting, or that's why it's a little bit different. Hydrogen peroxide leaves lactobacilli alone, but in this case, green tea actually increases lactobacilli, but damages the other bugs we don't want there. So perfect. I've certainly had women apply it in a few different ways from just making a strong cup of green tea, allowing it to sit, to cool, and they can use that as a douche or they can put into a spray bottle and spray. And you can also even add some latulose to that green tea, and then you've got a double cocktail. Yeah.

So would you recommend, I mean, would it be of benefit for say, just your average woman that's not necessarily wanting to fall pregnant or doesn't really feel as though anything's going on for them at the moment to do like an occasional green tea spray or rinse?

It's a good question. And I think I'd probably prefer to do like a ph test strip first and going, okay, as a general screen, because you may not. You might be one of that. That one in four women that have a beautiful crispada stomach ecosystem, in which.

Case don't want to mess with it.

Yeah, yeah. There's no point messing with it. You're not going to. You've got perfection. There's no point trying to change that. But if you don't, then yes, then there would be, you know, if your vaginal ph is out of whack, then there's certainly a safe way of actually trying to alter that ecosystem. It's obviously better working with a practitioner, ideally, who's got experience using it and can fine tune the doses, et cetera. But it's certainly not the same as using shampoo or feminine hygiene products, which might make it smell like perfume, but actually kills the beneficial things. We're looking at something that actually will help normalize and optimize the ecosystem.

Beautiful. So we spoke about probiotics, your prebiotics things like collectulose and green tea. What about some other things? I know you've mentioned garlic, which I also found interesting.

Yeah. And we might use garlic more for not so much with bacterial vaginosis, but for B groups strep. So that's one of the few herbs. And again, fluent with B group strep, I'd suggest working with a practitioner with experience working with that bug Pickley during pregnancy. But even outside that, because there's a range of herbs we know that have activity against that species. So it's really trying to target as best as possible without damaging your good guys as much as possible. But garlic would fit that category too, because us are certainly did research as part of my PhD looking at the antimicrobial spread of garlic in terms of what good guys did it sort of impact. And lactobacilli were fairly resistant to garlic even in pretty high concentrations, which is great. But it's very effective at getting rid of B group strep.

Beautiful. Anything else for bacterial vaginosis?

Certainly there's been some research using vitamin C topically as well. Again, it's about changing that acidity. And I suppose it's using ascorbic acid instead of lactobacombe lactic acid. And I think in some parts of the world they actually have preparations made from lactic acid. So you can actually use that as a rinse for the vagina too. So I could see the benefit of that, but I'm not sure how often easily available they are here. And those are probably the main ones that I've used in practice. But there are others.

If it works, why would you go? Why would you try anything else? Unless something is just magical that you're very interested in, then you might give it a go. But I think, you know, flatulose is a bit of a hero product and these two probiotic strains work really well then. Yeah, use them. Absolutely.

Yeah. It works in most women. That and the hydrogen peroxide would certainly be my most used combination or agents in bacterial vaginosis, with generally very good results.

And I've had a look at your. The website, the Probiotics Advisor, which I love, by the way. Everyone go and check it out. For you practitioners out there looking for those particular strains in Australia, do you have you found there to be one? I couldn't. I don't think there was one where they were both together.

There is, there's. There's the Blackmores.

Women's Biobalance.

Biobalance. And that's been on the market for a couple of couple of years. And I know biomedic in Australia has recently brought up two. Yeah, okay. So those, those two have got the combination strains that we're after, which is, which is great.

So.

And I was so happy to see them here. I was like reading the research for like years and years going, when are they going to reach the market? When are they coming out? Being immensely frustrated. Then they're out in the States and that was still frustrating because they're like, damn, they're on the market. But nobody here has actually made a move to get them. And then they have, thankfully, so we now can access them, which is fantastic.

Fantastic. And is there anything else that you'd like to bring to light about the vaginal microbiome and the vaginal ecosystem overall that's either fascinating or you'd love for us to know as women and also as practitioners.

I think it's just being aware of its importance. And just because you're not getting symptoms doesn't mean that the ecosystem is in a healthy state. I think those are some of the main points I'd like to get across and how easy it is to just implement a simple ph testing program with your patients to just get an idea of whether that ecosystem dysbiosis might be contributing to their ill health in many ways. Because just think again about a leaky vagina increasing the inflammatory maleur in the system. What diseases do we not associate with inflammation these days? So we might have an avenue of inflammation in this woman that we just hadn't thought of because they're not complaining there's no symptoms. But it should be on our radar and we should be looking at it.

Absolutely. And it should absolutely be part of our preconception testing and care and all that sort of stuff. It's just highly important. I think I'm certainly going to jump off here and do a bit of investigation. Investigation for myself, thank you very much. So my final question to you, which I like to ask all of my guests, is has there been a book or a movie that has had much impact in your life that you can think of quickly and why?

Yeah, I think these days most of what I read when I'm not doing work is actually like fantasy novels and most of what I watch is sort of like sci fi films because it just takes me completely out of this reality because I'm so spending time in the research, spending time seeing patients and treating patients that when I'm on my off time, what I want to do is just not be. I want to be somewhere else for that time. Yeah. And certainly I can think of when I was a kid that I'll be a bit of a nerd, but the Star wars trilogy when I was a kid had huge impact on me. Yeah. Just all the talk about the Force essentially and some of that, you know, remember watching some bits of that. Even now when I watch the Empire Strikes Back when Yoda and Luke Skywalker are talking in the swamp and there's a scene that gets. Always tingles up my spine when Yoda's speaking about the Life Force. Yeah.

So I put that in that category. Yeah. I love it, I love it. And you know, there's always something in it for children and adults in those sort of sci fi mystery sort of movies and everything, which I love. Even if you go back and listen to it, it's like, oh, aha. It still lands with me. Still has much impact. Yes, excellent. And where can people find you and tell us a little bit about your course? So you've, as I mentioned, I've done your vaginal microbiome part one course hanging for the second. I cannot wait. Loved it as devoured it and loved. Loved it as usual. So that's available to practitioners now can it's only available to practitioners, is that right?

Well, it's aimed for practitioners so there's nothing stopping health conscious individuals who want to learn more about that ecosystem from learning more. I'm not going to stop you because I think it's an important empowering step. But obviously the terminology is such that it's aimed for practitioners. That's our target audience and who I do the most of my teaching with. Yes, but I think as we said, it's an important ecosystem. It shouldn't be neglected anymore and we need to start thinking about it. So that's really what was my main driver of getting that course out there because it gives it the opportunity of upskilling people in that area. Because it wasn't part of my naturopathic training, we didn't touch on the general ecosystem besides disease states at all in terms of what was health, what was optimal health. It was not talked about and it really needs be to, to be.

And the reality is it's only really gone a little bit mainstream in the last year or so. So it's not really like it's just all quite. It's evolving, you know, but it has been necessary for a long time. And what I will say about your course though, that yes, it is designed for the practitioner, but even if a woman would like to, to have that education behind them. It invites them to have that conversation with their integrated GP or, or their normal GP or even their functional health practitioner to say, look, what about this vaginal microbiome thing? I heard it's important. Should I do a PH test?

I think that's huge. That's a huge thing. Because that's how practitioners start learning is when patients start asking them questions as well. It puts them on the spot. They're like, oh, I don't want to be on that spot again. I better do some background learning on that area. So I love it.

I love it.

Yes, I agree.

And I think it's empowering for the person because it's like it like me or, you know, going to a mechanic and having no idea and feeling you're at the complete mercy of your mechanic. So having that knowledge to go, hang on a second, something's not quite right. Have we looked at the vaginal microbiome? Maybe we should. So, yeah, Beautiful. And how else can people find you?

Yeah, so they can certainly find me on the Probug Advisor. And I'm also a clinician at Gould's Natural Medicine, which is a clinic in Hook.

Beautiful. And you've got a couple of talks coming up.

I do. I'm speaking at the Australian Naturopathic Summit in Lenox Head in a couple weeks, which is exciting. And then I'm speaking in the UK the weekend after that in Brighton, talking about her medicines and their impact on the gut microbiome. Yeah. Which is exciting. And then I'm doing a webinar series for a UK group called In Vivo, which is sort of a gut masterclass.

Oh, wow. Fantastic.

Which includes the Bachelor of Vaginosis course and more. Yeah.

Will you make that available to us?

Yeah, yeah, well, it certainly is. NVivo is a UK based company, so they're mostly targeting there, but anyone from around the world is welcome to enroll.

Beautiful. Have a look out for that. Well, thank you so much for joining me yet again. I always learn so much from you, Jason, and I always value your time, so. So thank you so much for sharing and shedding your wisdom on us.

You're very welcome and it's wonderful connecting again. I always enjoy our chats too, Linda.

Thanks, Jason. And as always, guys, if you've enjoyed what you've heard today, make sure that you share it with at least one other person you know will benefit and leave a ratings and review on itunes so that others can enjoy the content too. Thank you for making it to the very end of this podcast episode. Just one more thing before you go though. If you're tired of having sluggish digestion that leaves you feeling bloated, toxic, flatulent, flat, or if you suspect that you may have sibo, please do get in contact. You don't have to live with these discomforts. I've seen many people transform simply by seeking the support of a qualified clinician such as myself, so please do get in contact as I would love to help you obtain your optimum health. My naturopathic and nutrition consultations are run online, which means if you're located anywhere in Australia, I can work with you. You can book a consultation directly online, simply go to my website Lindagripprich.com, go to the Book an appointment page or send me an email@infolindagripprich.com and if you're unsure whether seeing a holistic practitioner is right for you, schedule in a complimentary 15 minute Q&A session with me where you get the opportunity to ask how my consultations are run and what to expect from my treatment plans. Again, simply go to my website. Go to the Book a consultation page and you will find the tab there.