Like any treatment option, antibiotics have limitations. Some people may therefore wish to consider UTI treatment without antibiotics or more natural remedies. In this interview series, Dr. Ashley Girard, Naturopathic Doctor from Ontario in Canada, takes us through her naturopathic approach to the UTI treatment.
Dr. Girard draws on her medical knowledge and personal experience to support people with UTIs and other bladder conditions. A keen advocate for naturopathy and using the healing power of nature, she approaches her patients with an individualized, holistic focus as she aims to tackle the root cause of their health problems.
Having gone through the ups and downs of a chronic bladder condition herself, Dr. Girard enjoys giving people hope that it is possible to get better and live UTI free. In addition to her naturopathic practice, Dr. Girard shares news of research and useful tips on her blog, Holistic Bladder Care. You can also follow her updates on her Instagram page.
Take a look at the summaries of our interview with Dr. Girard below, or check out the full videos on YouTube.
Jump To Section:
- A Naturopathic Approach to UTI >>>>
- Is UTI Treatment Without Antibiotics Safe? >>>>
- Herbal Treatment for Recurrent UTI >>>>
- UTI & the Microbiome >>>>
- Hormonal Therapy as a Recurrent UTI Treatment Without Antibiotics >>>>
A Naturopathic Approach to UTI
In Ontario, naturopaths are licensed doctors with a wide scope for offering support to patients. A college oversees the profession, working to ensure patients are kept safe and practice is regulated. In addition to their usual work in diagnosis and running labs, naturopathic doctors in Ontario can undertake further training to prescribe treatments, such as bioidentical hormones.
While there is broad scope in Ontario, Dr. Girard explains that naturopathy services differ depending on the country and region. In some areas, the profession is not regulated. It is important to learn what is available in your area and your naturopathic doctor’s credentials.
Naturopaths focus on considering the patient as a whole, designing individualized treatment that aims to treat the root cause. They like to view the patient as an expert of their own body, seeking to understand the various facets of a patient that may contribute to health issues. Dr. Girard stresses that because we are all different, UTI treatment without antibiotics for one patient is not necessarily going to work for another patient. Because of this, naturopaths don’t tend to work with a “protocol.”
Dr. Girard explains that naturopathic doctors support their patients in a teaching role, helping them to learn the fundamentals of living a healthy life and caring for their bodies. In addition to treating existing problems, this could also help prevent new problems arising.
Naturopaths use the Therapeutic Order help guide treatment decisions. Initially, the focus is on establishing the foundations for optimal health, including diet, lifestyle, and stress. From there, naturopathic therapies will be implemented to stimulate the body’s natural healing mechanisms. This could involve other professionals such as physiotherapists or chiropractors. If this doesn’t work, the last resorts may include pharmaceuticals and potentially high force interventions (e.g. surgery).
Is UTI Treatment Without Antibiotics Safe?
Especially in acute uncomplicated UTI, herbs can successfully and safely eradicate urinary pathogens. Dr. Girard explains that herbs are not necessarily ineffective with recurrent or chronic UTI patients, but these cases are more complex. For example, you may also need to consider chronic inflammation, or issues with hormones and the immune system.
Herbal remedies are generally safe to use without additional antibiotics. However, Dr. Girard points out that antibiotics must be used to treat UTIs during pregnancy, as infection during this time is associated with higher risks. Once an infection during pregnancy has been successfully treated, naturopathic doctors may implement a prevention strategy to prevent recurrence during the rest of the pregnancy.
Explaining that neither one approach is necessarily better than the other, Dr. Girard shares that there is research to suggest that some herbal remedies may enhance the effectiveness of certain antibiotics. For example, garlic extract and Macrobid (nitrofurantoin). She has seen some patients become infection-free after herbal treatment alone, while others may do better with a combination. It all depends on the individual.
Can UTI treatment without antibiotics help me recover?
As someone who has recovered from recurrent UTIs herself, Dr. Girard enjoys giving hope to her patients that they can get better. After a decade of infections, she used only natural medicine for a year which ultimately helped her heal.
She acknowledges that healing doesn’t mean there aren’t going to be small relapses. However, she shares that through this process, you learn what supports and maintains the overall health of your body. This can empower you to manage these small relapses yourself, likely with fairly minimal intervention. Feeling a sense of control over your symptoms and knowing what to do in the event of a relapse can hugely help.
Dr. Girard also discusses how inflammation must be also addressed in order to avoid resistance to treatment, or recurrence. This is because inflammation can be the breeding ground for infection.
Watch the video to hear Dr. Girard’s speak of patients who have resolved their UTIs and are now infection-free following herbal UTI treatment without antibiotics.
Herbal Treatment for Recurrent UTI
Pharmaceuticals work as isolated molecules delivered at high concentrations, with a known mechanism of action. Meanwhile, herbs are made up of multiple different molecules and compounds. For example, hydroquinone, tannins, and astringents.
The fact that herbs are complex and consist of multiple compounds is thought to be a positive thing, in that they may target multiple different actions in the body within one medicine.
There are several herbs known to have antimicrobial properties that are appropriate for the urinary tract. For example, uva ursi, oregano oil, and volatile oils. Dr. Girard stresses that more research is needed to truly understand which molecules within herbs specifically cause the mechanisms of action.
Once herbs are ingested, their constituents are typically absorbed into the bloodstream and then passed through the liver. While some may be broken down, many will eventually be filtered by the kidneys and passed to the bladder.
Some herbs have a more broad-spectrum antimicrobial action, which is suitable for UTI treatment without antibiotics. Some of Dr. Girard’s favorites include juniper, uva ursi, thyme, and goldenseal. While herbal UTI treatment without antibiotics can be very effective, there is no research to say that it is better than antibiotic treatment, or vice versa.
However, what Dr. Girard sees in practice is that for mild acute cases of uncomplicated UTI, herbal treatment is just as effective as using antibiotics.
Dr. Girard doesn’t believe in the idea that patients get worse before they get better. She suggests that you should generally either stay the same for the first couple of weeks or gradually get better. In terms of when is the right time to stop treatment, it is best to work closely with a practitioner trained in herbal medicine.
Can urinary pathogens become resistant to herbs?
In terms of targeting specific organisms, more research is needed to understand why some bacteria are susceptible to herbal treatment and others are more resistant. Dr. Girard shares that an organism with multi-drug resistance will not necessarily be resistant to herbs. Most of the time, it is still worth trying the herbs because even if it doesn’t completely eradicate the infection, it could improve the patient’s symptoms and quality of life.
Is it safe to use herbal treatment with Hiprex?
Hiprex (methenamine hippurate) is a urinary antiseptic that is available in many countries. It is typically very effective at preventing urinary infections. As long as it is doing its job, Dr. Girard says you shouldn’t necessarily need to add in herbal therapy alongside it. However, there aren’t any known interactions should you wish to take both.
How do I determine the proper dose?
There is usually a recommended dose range for herbal UTI treatment without antibiotics. More sensitive patients typically start at the lower end. Those who are more treatment-resistant start with higher doses. It is always best to work with an experienced practitioner to determine the appropriate dose.
Dr. Girard points out that commercially-prepared herbal products often err on the side of caution, and may only contain a quarter to an eighth of the therapeutic dose.
If you have tried a commercially-prepared herbal product and not found it particularly effective, this could be more to do with the dose than the herb itself.
Potential liver damage associated with long-term herbal therapy may be a concern with uva ursi, which is not meant for long-term use. Liver function and enzymes should be monitored in this case.
UTI & the Microbiome
Long-term use of natural antimicrobials, especially the more potent ones, has the potential to negatively affect the healthy microbiome of the gut. However, sometimes the benefits of herbal UTI treatment without antibiotics may outweigh the risk, compared with taking an antibiotic which is more likely to cause damage to the microbiome.
As a result of the microbiome being damaged, there is an increased risk of UTI. The exact mechanism of action for this is not yet fully understood, however it appears that gut bacteria can travel to the urinary tract. Dr. Girard discusses how inflammation could often be to blame, as this could have a systemic impact on the body and filter down to the bladder.
Dr. Girard supports the use of some cranberry products when aiming to prevent recurrence of UTIs. She shares that there is strong research in favour of using 36mg of proanthocyanidins (PACs), which she personally uses for UTI prevention. This is very safe, including during pregnancy.
D-mannose is also recommended, but it is worth considering that it may be fairly specific to E. coli. Also, it must be taken at the right frequency in order to be reliable. Lifestyle habits, such as drinking enough water and trying to keep your stress levels down, are also worth considering when trying to prevent UTIs.
Where C. difficile is an issue, it is always important to work with a medical doctor and take the prescribed antibiotics, because it is life-threatening. Herbal adjuvants, like berberine products, can be taken alongside the antibiotics to support their effectiveness.
Can probiotics help?
Herbs that are used to treat an active infection could also be used in the same way as a prophylactic antibiotic. For example, for people who experience UTIs after sex, taking a herbal remedy after sex may help.
In addition to PACs and D-mannose, taking an oral probiotic could be helpful, possibly in combination with a vaginal probiotic. Dr. Girard especially recommends looking for probiotic pessaries that contain L. crispatus, which is associated with fewer lower urinary tract symptoms.
The recommended number of billions or CFU in probiotics depends on the individual and factors like antibiotic usage. Rather than focusing on the number of billions, the most important thing is to look for probiotics that contain multiple different strains, ideally 10-15.
What about the diet?
Coffee, alcohol and sugar may be particular triggers for many people. Dr. Girard suggests that avoidance doesn’t necessarily have to be the answer. It may be more about minimizing irritants and maintaining a healthy level which is tolerable for the individual. Dr. Girard also talks about how vitamins may play a significant role too.
Should I use a biofilm disruptor?
If a biofilm is suspected, biofilm disruptors can be considered as potential adjuvants to antimicrobial therapy to help break it down. However, biofilm disruptors can vary greatly in terms of strength. The guidance of a professional should be sought out to select the appropriate one.
Hormonal Therapy as a Recurrent UTI Treatment Without Antibiotics
Another option for UTI treatment without antibiotics includes hormonal therapy.
Dr. Girard stresses how having healthy hormones will support the rest of the body. Considering this, she firstly looks at which of her patients’ symptoms may indicate hormone imbalance. She then typically compliments that with testing. From there, she decides whether the patient needs to take estrogen, progesterone, or both.
When estrogen levels in the vaginal area are healthy, this can reduce the frequency of recurrent UTIs. An issue with blood flow or a lack of estrogen receptors in this area could mean low estrogen levels here, which will likely impact the bladder as well as the vagina itself.
It is important for hormonal therapy to be individualized, and to consider whether a patient is pre- or post-menopause. While most of the current research in this area focuses on post-menopausal patients, estrogen levels can start to decline in women as young as 38. In this case, hormonal therapy is a viable option for UTI treatment without antibiotics and UTI prevention.
Dr. Girard explains that there is not sufficient research to say for certain, but overall it seems that bioidentical hormones are safer than non-bioidentical ones. There is an increased risk of stroke associated with conventional hormones, but Dr. Girard stresses that this is very slight. If a patient is finding conventional hormonal therapy to be successful and they are being monitored by their healthcare practitioner, then this slight risk may be justified. However, generally, she supports the use of bioidentical hormones since they may be the next best thing to the hormones naturally present in our bodies.
How do my estrogen levels affect my urinary symptoms?
During the menstrual cycle, hormone levels fluctuate. There is the potential for estrogen and progesterone levels to become too high or too low, and it is important to have the right balance. Dr. Girard often sees patients who get worse right before their period starts, which may be related to their estrogen falling too quickly.
As estrogen levels become lower, we start to get more micro-cuts in the tissue, which then can set up more inflammation and irritation.
If estrogen levels are too high, the immune system may be less able to respond to infection in its normal way. Both of these scenarios can lead to increased urinary symptoms or an infection.
There can be many different factors involved when it comes to hormonal therapy and UTI treatment without antibiotics. In addition to the estrogen and progesterone balance, you also need to consider other hormone systems (e.g. thyroid) and factors like blood sugar. Because of this complexity, it is always important to work with someone experienced in hormonal therapy who will build an individualized treatment plan.
A naturopathic approach to vaginal dryness and pain during sex
It is important to address vaginal dryness and irritation or pain during sex, because this can predispose patients to developing a chronic UTI. For reducing vaginal dryness, Dr. Girard recommends using an aloe-based lubricant. She also recommends ensuring you are taking in enough fatty acids, for example through a high quality omega-3 supplement.
It is worth considering how pain during sex could also be related to other existing problems. For example, it could be worth consulting a pelvic floor physiotherapist.
Trying to find an appropriate treatment for chronic or recurrent UTI can feel like a never ending battle. While antibiotic treatment can be a useful and important option for many, it can often be worth considering options for UTI treatment without antibiotics. As Dr. Girard shares, there are cases where herbal and hormonal therapies can be just as effective as antibiotics, and possibly with fewer risks. We want to thank Dr. Girard for sharing her expertise and useful insights into naturopathic treatment for UTI.
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