By now most people have come across or heard of the gastrointestinal (GI) microbiome and its importance. However, far less of us are aware of the presence of the vaginal microbiome, the microbes that make up your reproductive tract, keeping it healthy and happy.
The Human Microbiome Project undertaken in 2012, sheds more light on the hidden underworld of the vaginal and reproductive tract. It has taught us that the uterus and the vagina are 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. (1) This revelation is important, especially for women who suffer with recurrent urinary tract infections (UTIs) and other vaginal infections.
It is estimated that 50% of females will experience the symptoms of a urinary tract infection in their lifetime.
The vagina is a gateway to the outside world. 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 and its abundance of bacteria.
What causes recurrent UTIs?
E.coli is the most common bacteria to cause UTI’s. It is found in our GI tracts, 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.
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 later blog posts 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. E.coli, the gut 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 diminished, 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.
How do we address this?
- 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 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.
- Maintenance: Encouraging a healthy diet, rich in bio-diverse foods, good hydration, minimal amounts of sugar, processed foods and inflammatory foods. Similarly, incorporating high-grade sporebiotics, bone broths, Collagen, L-glutamine and Omega-fish oils in addition to food should help to maintain gut harmony and resilience.
2. E.coli, the vagina 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. This is one of the reasons why you always hear ‘go pee after sex!’ That is to help 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 it is robust enough to overcome the slight change and return to its healthy, normal, acidic state. It is when this mechanism is interrupted that one can experience an increase in UTIs, bacterial vaginosis or Trichomonas vaginalis, amongst others.
What can upset the vaginal microbiome?
- Sexually transmitted infections
- Exogenous objects
- Smoking
- Different types of contraception including IUD, Copper coil, COCP or Progesterone only pills.
- Menstrual products: mooncups & tampons
- Unfriendly lubricants and saliva!
- Age. Increasing age and the decline in estrogen.
- Washing powders/soaps/douching. The vagina is self-cleaning and doesn’t need soap!
- Antibiotics
- Hormone imbalances
- Gut infections and reduced diversity of bacteria.
Hormone balance and adequate levels 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 actually transported to the vagina and helps play a part in creating and maintaining this food supply. This use of estrogen helps to explain why women often suffer more with UTI’s leading up to at the end of a period as this is the time when our estrogen levels are at their lowest and thus there is a momentary blip in the supply of food to the Lactobacilli. Interestingly, period 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 UTIs 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 are a number of ways to increase them. First, addressing any underlying infections seen in vaginal microbial by testing and treating them. Second, as mentioned above, optimising the gut microbiome to reduce pathogens and create hormone balance. Third, avoiding or limiting each element listed above under ‘what upsets the microbiome'. Lastly, utilising strain specific probiotics and certain vaginal pessaries at the correct time to help increase these Lactobacillus species.
3. E.coli, reduced immunity 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 optimise or adopt.
How to improve immunity
Get more sleep!
Our body repairs and restores itself at night – give it the time to do that. Eight hours of good sleep is optimal for most. The more time in deep sleep, the better. Ensure this is implemented with some of these easy hacks:
- 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.
- 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.
- 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.
- It is difficult and you have likely heard it before, but try and avoid screens and phones two hours before you sleep, this will allow your sleep hormone melatonin to start being produced, aiding in that restful nights sleep.
- Use the sun's natural light 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 minimise downward glare and lighting to allow it to activate!
- Lastly, if sleep has become difficult, be aware of factors that can affect it: hormone imbalances (inc. low progesterone or increased estrogen/thyroid dysfunction/reduced testosterone and adrenal function) play a big part, gut infections/vaginal infections can lead to insomnia, mineral and vitamin deficiencies and undoubtedly many more.
Eat a balanced diet
At each meal, ensure it is a balanced meal with at least 50 grams of protein. The majority of the plate should be dedicated to an array of vegetables and have a small portion of complex carbohydrates.
Eating your vegetables first, then protein and then carbohydrates at the end will help to alleviate the blood sugar spike that occurs after a meal. In addition, stop eating at least four hours before you go to bed and avoid carbohydrates in the last meal of the day. This 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.
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 following.
Vitamins:
- Vitamin A
- Vitamin C
- Vitamin E
- Vitamins B6 & B12
- Vitamin D3
Minerals:
- Potassium, Sodium and Magnesium to support the Adrenal glands.
- Zinc and Copper (ideally in a 15:1 ratio)
- Selenium
- Iron
In addition, support your microbiome, the home of the immune system, and move your body daily!
Have a good day,
Dr Lizzie
1 A. Gonzalez, J.C. Clemente, A. Shade, J.L. Metcalf, Song S., B. Prithiviraj, B.E. Palmer, R. Knight, 'Our microbial selves: what ecology can teach us', EMBO Rep, 12 (2011), pp. 775-784
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