By now most people have come across or heard of the gastrointestinal microbiome and its importance. However, far less of us are aware of the presence of the vaginal microbiome. This is made up of a series of microbes , primarily from one family, that are found in the vaginal tract, the reproductive tract and uterus. The Human Microbiome Project undertaken in 2012, shed more light on the hidden underworld of the vaginal and reproductive tract. It has taught us that the uterus and the vagina is far from the sterile environment we once thought and that the vagina, unlike the GI tract, is inhabited primarily by a few distinct species of Lactobacillus.[i] This revelation is important, especially for women who suffer with recurrent urinary tract infections (UTIs) and other vaginal infections.
The vagina is a gateway to the outside world and it is estimated that 50% of females will experience the symptoms of a urinary tract infection in their lifetime.
-needing to pee more often
-feeling that you need to pee but very little coming out
-pain and/or burning sensation
-lower abdominal pain and/or back pain
The hope is that its acidic environment stops unwanted bacteria and parasites from settling into the vaginal canal as this reduces the chances of cross-contamination to the urethra. The same principle is applied to the gastrointestinal tract due to its proximity to the urethra and its abundance of bacteria.
Escherichia coli (E.coli) is the most common bacteria to cause UTI’s. It is found in our gastrointestinal (GI) tract, in the vagina and lodged behind the cells of the bladder wall. Changes in the environment of the GI tract and the vagina, or a drop in your immunity, can trigger E.coli to grow beyond what is normal.
Below I am going to outline how the microbiome of the GI tract and the vaginal canal can be the root cause behind your urinary tract infections and how to put an end to them! Similarly, I will touch on why it is important to maintain a robust immune system in order to reduce bladder infections and overall chances of suffering with this painful and recurrent issue. In a later blog post I will be extending the principles of the microbiome into the effect it has on fertility, infertility, IVF success rates, miscarriages, and pre-term births.
Three unhappy triads:
1. The Gut, E.coli and a UTI:
In the GI tract, E.coli exists in harmony with a great array of other commensal bacteria. Increased diversity of the good bacteria in the gut ensure that E.coli levels are controlled. However, if the gut microbiome is affected (antibiotic use, stress, poor diet, illness) and the number of good bacteria diminish it allows for opportunistic bacteria, such as E.coli, to grow and populate the tract beyond its normal levels. Now remember, the urethra and vagina are in close communication with the anus which allows for cross-contamination. The end result? A urinary tract infection caused by E.coli overgrowth in the gut.
TEST: Comprehensive stool analysis to understand the composition of your gut microbiome. This shows us what bacteria you have, which ones you are missing or which ones you have too many of.
ELIMINATE: Treatment of any potential pathogens that the stool test showed. This can either be through herbal preparations or, at times, antimicrobial/anti-fungal medications.
BUILD: Strengthen the gut wall again to reduce inflammation and to ensure that what should be in the gut stays in and what should not, stays out.
REPOPULATE: Plant the seeds and water the good gut bacteria. This is first and foremost through food medicine. Prebiotic foods, probiotic foods, foods rich in polyphenols, fiber and more.
MAINTAIN: Encouraging a healthy diet, rich in bio-diverse foods and low intake of sugar, processed foods and inflammatory foods. Similarly, incorporating high-grade sporebiotics, bone broths, collagen powders, L-glutamine and Omega-fish oils in addition to food should help to maintain gut harmony and resilience.
2. The Vagina, E.Coli and a UTI:
In a similar fashion to the gut, the vagina hosts low levels of E.coli. Again, the proximity of the vagina to the urethra allows for that cross-contamination of bacteria if it is given the opportunity to grow in excess. That Is one of the reasons why you always hear ‘go pee after sex!’ as this helps to wash away any potential cross-contamination that may have occurred that could lead to a urinary tract infection.
Lactobacillus are the predominant genus of bacteria that populate the vaginal cavity. The most well-known and abundant forms are Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, and Lactobacillus jensenii. The presence of these creates an acidic environment (PH 4-4.5) which in turn prevents unwanted and opportunistic bacteria from settling and growing in the vaginal tract, leading to infections.
Certain activities and events can transiently affect this acidic environment, but the aim is to ensure that the environment is robust enough to overcome the slight change in PH level and return to its healthy, normal, acidic state. It is when this mechanism is interrupted that one can experience an increase in UTI’s and other common infections such as Bacterial vaginosis or Trichomonas vaginalis.
What can upset the vaginal microbiome?
-Sexually transmitted infections, sex and sperm.
-Different types of contraception including IUD, Copper coil, COCP or Progesterone only pills.
-Menstrual products including mooncups & tampons.
-Unfriendly lubricants and saliva!
-Age. Increasing age and the decline in estrogen.
-Washing powders/soaps/douching. The vagina is self-cleaning-doesn’t need soap!
-Gut infections and reduced diversity of bacteria.
Hormone balance and adequate levels of estrogen are also important to maintain the ecosystem of vagina. Estrogen is needed to create cervical mucus which acts as ‘food’ for the good bacteria. Estrogen made in the gut is transported to the vagina and helps play a part in creating and maintaining this food supply. The estrogen requirement helps to explain why women often suffer more with UTI’s leading up to and at the end of a period as this is the time when our estrogen levels are at their lowest which causes a momentary blip in the supply of food to the Lactobacilli. Interestingly, menstrual blood is also more alkaline and this temporarily increases the PH of the vagina and again puts you more at risk for infection and UTI.
If you suffer with recurrent UTI’s or vaginal infections, then It is worth having the microbiome of the vagina tested to see that you have an abundant presence of these healthy, acid producing bacteria. If you do not, there a number of ways to increase them. First, addressing any underlying infections seen in vaginal microbial testing and treating them. Second, as mentioned above, optomising the gut microbiome to reduce pathogens and create hormone balance. Third, avoiding or limiting each element listed above under ‘what can upset the microbiome?' Lastly, utilising strain specific probiotics and certain vaginal pessaries at the correct time can help to increase these Lactobacillus species.
3. Immunity, E.coli and a UTI:
Believe it or not, the bladder also has its own microbiome. Bacteria such as E.coli however, hide behind cells of the bladder and then, if the immune system drops, they take advantage, infiltrate and start a flare in the bladder which leads to symptoms consistent with a UTI. The immune system works to neutralise and remove pathogens like bacteria, viruses, parasites or fungi that enter the body. Therefore, supporting your immunity is fundamental to reducing these opportunistic infections from thriving. There are many ways to improve immunity and I am going to outline some basic and easy strategies you can optomise or adopt:
Get more sleep! Here is how:
Our body repairs and restores itself at night-give it the time to do that. 8 hours of good sleep is optimal for most. The more time in deep sleep the better and to ensure this implement some of these easy hacks:
1. Wake up and go to sleep at the same time each day (even at the weekends!). No one will ever be perfect here but consistency is key.
2. When you wake in the morning, try and expose your eyes to natural light as one of the first things you do. This kick starts the sleep pressure clock which builds over the day and will eventually make you feel tired at night.
3. Control blood sugar during the day. Insulin secretion and insulin receptor sensitivity is better in the mornings and up until around midday for most, so eat breakfast like a king and then reduce portion size as the day goes on. At each meal, ensure it is a balanced meal with at least 50grams of protein, the majority of the plate should be dedicated to an array of vegetables and a small portion of complex carbohydrates. Eating your vegetables first, then protein and the carbohydrates at the end will help to alleviate the blood sugar spike that occurs after a meal. In addition, stop eating at least 4 hours before you go to bed and avoid carbohydrates in the last meal of the day. Exercise daily, gentle walking after a meal is enough to mimimise a sugar spike. Weight training each week wil also help with insulin sensitivity thus stabalising sugar levels. Each of these will help to encourage a steady state of glucose in the blood during your sleep hours and prevent that recurrent 3am or 4am wake up.
4. It is difficult and you have likely heard it before but try and avoid screens and phones 2 hours before you sleep, this will allow your sleep hormone, melatonin, to start being produced, aiding in that restful nights sleep.
5. Use the natural light from the sun to help guide your day. Once the sun sets in the evening be conscious of in-door lighting and its effects. Turn off overhead lights that are bright, utilise more natural light and lamps that illuminate from the floor up. The sensor that is switched on at night, to start the production of melatonin, sits in the area of your eye lid, so we try to minimize downward glare and lighting to allow it to activate!
6. Lastly, if sleep has become difficult be aware of some less known factors that can affect it. First, hormone imbalances, including low progesterone or increased estrogen, thyroid dysfunction, reduced testosterone and poor adrenal function. Second, untreated gut infections and vaginal infections can cause insomnia and lastly, mineral and vitamin deficiencies and undoubtedly many more.
Optomise Vitamin and Mineral Levels:
In short deficiencies in the below vitamins and minerals will reduce your immune systems functionality. I will delve deeper into these in a future blog post but for now, make sure you are eating a diverse amount of food, enough of it and, if required, supplementing with high grade supplements to restore deficiencies. There are plenty of functional tests and standard blood tests that can help to establish if you are low on any of the below.
-B6 & B12
-Potassium, Sodium and Magnesium to support the Adrenal glands.
-Zinc and Copper (ideally in a 15:1 ratio)
-Iron (check your Ferritin)
In addition, support your microbiome, the home of the immune system, and move your body daily. Note that I am not your doctor and this is not personalised medical advice. I encourage you to work with a practitioner to help create a plans specific to you. If you would like more information, help, access to testing and advice, reach out and book an appointment with us at Mi.