00:00 – Dr. Girard: I’m not a practitioner that believes that we
00:03 – get worse necessarily before we get better. Patients should either
00:07 – stay the same for the first couple of weeks or they should start to gradually get better.
00:26 – Melissa: Now I think we can jump into the many questions we got about herbal treatment for
00:31 – UTI. The first one is around the mechanism of action for herbs and how they actually work.
00:40 – Dr. Girard: So herbs are very different from pharmaceuticals. Pharmaceuticals are
00:45 – one particular molecule that is very isolated and delivered at a high concentration with a
00:53 – known mechanism, exactly how they work. Herbs on the other hand, these are plants that have
01:01 – multiple different types of molecules in them. So herbs have many, many different compounds in them,
01:08 – and they’re going to have hydroquinone, they’re going to have tannins, they’re going to have
01:12 – astringents, there’s going to be molecules that are very anti-inflammatory. There’s
01:18 – many different molecules within one single herb and it’s believed that this
01:26 – is what helps them have effectiveness in the human body, because we’re targeting
01:32 – multiple different actions within one medicine essentially. Some of the well-known
01:39 – herbs for the urinary tract have specific antimicrobials that are being
01:46 – researched for their impact and it’s thought that they’re the primary reason that
01:52 – those herbs are working, but that’s not necessarily the case. A lot of patients know about uva ursi, so
01:57 – that particular molecule is called arbutin. A lot of people are using oregano oil and that
02:03 – particular compound is carvacrol. In some herbs, there is a compound called fuyone, that is thought
02:13 – to be the antimicrobial agent that’s primarily working on these particular bacteria. And there’s
02:19 – volatile oils, that’s one of the other really well known constituents that is able to act as an
02:25 – antimicrobial. And volatile oils are one of those compounds that are in a lot of different
02:31 – types of herbs, so and what they do is they potentially damage the cell wall, when you
02:38 – damage the cell wall, then you have the cytoplasmic contents. They basically burst, essentially.
02:47 – Some of the herbs, their constituents disrupt the hydrophobic nature of the cells.
02:54 – Some of them slow the growth, some of them adhere to, right, we know a lot about the anti-adherent
02:58 – qualities with cranberry and with parsley, and there’s just, there’s many
03:06 – herbs that potentially have that specific quality.
03:10 – So that’s what we think is the active constituent, but like I said, we don’t necessarily 100% know,
03:16 – because there are just so many different compounds that are within herbs,
03:22 – and we definitely need more research on that. I mean research is definitely very, very important,
03:28 – but one of the problems with herbal research is that there’s not a lot of funding towards it.
03:33 – Pharmaceutical companies, they really are only interested in being able to develop patented
03:39 – molecules, so studying a herb is not something that is going to help their bottom line. So we
03:46 – really look to our academic institutions to be doing these studies, and there’s of course
03:51 – limited research, it’s often government funded by or by various interest groups
03:57 – so it is important to still look at historical use because herbs have been used for tens of
04:03 – thousands of years as the primary medicine in many cultures and the things that they’re known for
04:10 – have been carefully looked at, but for long periods of time by doctors and herbalists that were
04:19 – using them, so even though that isn’t a formal type of research, it’s still useful information.
04:27 – Melissa: So, on the topic of the research, do we know how many herbs travel through the body? Do
04:31 – they actually reach the bladder or are they thought to work in different ways?
04:37 – Dr. Girard: So herbs, once we ingest them, they are going to be absorbed into the bloodstream
04:40 – and their constituents are going to pass through the liver. Some of them may be broken down, but
04:46 – many of them are going to be filtered eventually by the kidneys and then passed into the bladder,
04:50 – so it is very important for patients to not be over diluting the active constituents when
04:56 – they, not to say be dehydrated, but sometimes I get patients that are having treatment failures
05:03 – but they’re also, I find out they’re drinking four liters of water a day, so the concentration
05:08 – is very important in order for these herbs to act appropriately. And yeah, so
05:15 – besides just the circulation of the herbs in the bloodstream, that there are those
05:20 – constituents, not the herbs themselves of course, but those constituents that have been absorbed,
05:24 – and yes they can pass in through the bladder. The other thing to keep in mind is
05:30 – that most pharmaceuticals are actually derived from plant extracts. In the last 30, 40 years,
05:37 – 70% of pharmaceuticals did originate from extracts from plants that were discovered
05:43 – and then highly synthesized into a single compound for delivery. Melissa: It’s interesting that
05:53 – pharmaceutical companies still won’t fund that research then if they end up taking most of their
05:58 – compounds from plants. Dr. Girard: Well, it’s can they patent it, right?
06:03 – Melissa: Yeah. Dr. Girard: It’s can they take that, can they find that compound,
06:07 – can they patent it, and can they synthesize it in a lab? As,
06:11 – simple as that might sound to someone, it can actually be very complicated to
06:16 – create a similar molecule as to what’s found in a plant in the lab, and then be able to
06:23 – put a patent on that, because it can’t be the exact same molecule, it has to be similar
06:29 – but different, right? And then that process is what gets patented. Melissa: Yeah. Are there different categories
06:36 – of herbs for different purposes? Like prevention versus killing organisms versus repairing the
06:41 – bladder? Dr. Girard: Yes, so absolutely. We have some really big heavy
06:46 – hitters in the antimicrobial herbal world, and then we have certain herbs that are very good at soothing, coating, healing the bladder
06:55 – wall, and then again we have the anti-adherent properties in certain herbs that we use for preventing
07:03 – infections, so definitely. That is a major way that we decide on which herbs to put together
07:11 – and go forward with a patient. Melissa: Are herbal remedies safe for children? And does the
07:16 – approach differ to that of an adult? Dr. Girard: Herbal therapies are definitely safe for children.
07:23 – Children are great responders. They are typically much better at healing than we are, so we are able to use a weight-adjusted
07:31 – dosage for them. There’s a few herbs that I wouldn’t use with children that are more
07:36 – on that stronger side. When we formulate for children, we tend to use more gentle herbs and
07:43 – it tends to work because, like I said, they’re great at healing, those little guys.
07:49 – Melissa: That’s good to know. That’s very helpful. Dr. Girard: Lucky them.
07:53 – Melissa: Are there certain scenarios where herbal treatment might be more effective than antibiotics?
07:57 – So for instance, if your symptoms are very mild or if you have specific organisms or multi-drug
08:02 – resistance or if you just have issues with taking antibiotics. Dr. Girard: So herbal treatments are very
08:09 – effective at treating urinary tract infections. I don’t think we have the research to say that one
08:14 – would be more effective than another, especially in these various different circumstances.
08:19 – Clinically what I see is, definitely for a mild case, an uncomplicated UTI, herbal therapy can
08:27 – be just as effective as an antibiotic therapy. Specific organisms, there is… again it’s so variable.
08:36 – There is too much genetic difference between even amongst E. coli. E. coli in one area may be
08:46 – very susceptible to herbal therapies and then E. coli in another area may be highly resistant,
08:51 – so unfortunately that information still isn’t, we don’t have that, we need more research.
09:01 – But just because something is multi-drug resistant doesn’t necessarily mean that it’s going to be
09:06 – resistant to herbs. It’s something that’s still worth a shot for patients to try and see
09:11 – if that’s going to help improve their symptoms, because symptoms are the thing that we’re treating,
09:16 – we’re not necessarily treating for eradication and we should be treating
09:22 – to make patients have a better quality of life and have improved symptoms, and getting to
09:27 – the point where they have no symptoms, right? Melissa: That would be ideal. When it comes to resistance, can
09:34 – organisms develop resistance to herbs in the same way they can to antibiotics?
09:39 – Dr. Girard: Organisms have a much harder time developing resistance to herbs because of that multi-compound, many different
09:47 – active constituents that are potentially affecting the microorganism, so in that sense it is difficult.
09:55 – And that’s based on expert opinion, we don’t necessarily have the research to say
10:00 – if we do find a particular bacteria that is resistant to a herb, I don’t think anybody has done
10:08 – that research to figure out why and what the mechanism necessarily is, how it figured
10:13 – that out. What we do see in rare instances is when patients use very isolated compounds from a herb,
10:21 – like allicin from garlic, for example, then it’s starting to get more towards something
10:28 – like a pharmaceutical, a single agent that is an antimicrobial, and that gives the particular
10:36 – bacteria an opportunity to figure out how to develop a resistance, so not to say that
10:44 – single extra or a more isolated herbal product is going to put you at risk of
10:50 – developing a resistance, because it still only happens very rarely according to the experts,
10:56 – but it doesn’t mean to say that it can’t happen. Melissa: Now you mentioned earlier already that you can
11:01 – combine herbal and antibiotic treatment, but we also got a couple of questions about Hiprex.
11:06 – Can you talk a little bit about what possible interactions there might be
11:10 – between Hiprex and herbs if used together? Dr. Girard: Sure. So Hiprex is something that’s very good at
11:17 – preventing an infection, very bacteriostatic right. So whether or not a patient should be using herbs
11:25 – with it, if it’s doing its job the way it’s supposed to be, then you shouldn’t necessarily need
11:31 – herbal therapies alongside it. However, if Hiprex isn’t, maybe it’s partially working for a patient
11:37 – and they want to add herbs, you absolutely can do. So there shouldn’t necessarily be an interaction
11:42 – with them, with the one exception of herbs that require a higher pH to be active, so we know
11:50 – uva ursi, for example, that arbutin that I mentioned earlier, it needs to convert to its active form
11:56 – and it needs a higher pH in order to do that. So in those situations, you wouldn’t want to use that
12:01 – herb, but that’s just one of many that could be potentially utilized as an adjuvant to Hiprex.
12:08 – So you can, for sure. Melissa: For those people who are on necessary long-term antibiotic
12:16 – treatment, are there ways that they can support that with herbs? Dr. Girard: Yeah, absolutely, because there are certain
12:22 – side effects that we’re looking at, that we’re keeping an eye on when patients are on long-term therapies
12:28 – with antibiotics. So definitely yeast, right, that’s probably the most common one, and there are lots of
12:33 – really good herbs that can treat yeast and help keep their levels down during
12:39 – antibiotic therapy. Melissa: Are there particular herbs or approaches that are used
12:44 – for specific bacteria?
12:46 – Dr. Girard: So there are certain herbs that we can use that have more of a broad spectrum action against many
12:52 – different bacteria. We don’t necessarily have herbs that per sé work better against a gram positive
13:01 – versus a gram negative. Most of the research that’s done on herbs, they
13:06 – look to see if the particular bacteria grown on a petri dish is sensitive to the herb,
13:13 – how sensitive is it to that herb. So what we do find is that some of the
13:18 – herbs are just, they have that more of a broad spectrum antimicrobial action. So
13:27 – juniper, uva ursi, thyme, goldenseal, those ones are kind of my favorites, they have that
13:32 – broad spectrum ability. But then we’ve got some bacteria that don’t respond as well to
13:38 – those particular herbs and one good example would be pseudomonas. With pseudomonas, there’s some
13:43 – research that shows that, for example, cinnamon at certain concentrations is effective against
13:50 – that particular bacteria, and then there are some bacteria that we wouldn’t even necessarily use
13:56 – herbs as our first line for, for example staph responds to other nutraceuticals very well,
14:03 – lactobacillus, if there’s an overgrowth there, that cytolytic vaginosis, for example,
14:09 – we don’t use herbs at all. Again, we would tend to try a baking soda based type of therapy,
14:17 – so it’s going to depend on the organism for what you’re going to use best
14:24 – for herbs. Melissa: Right. And how are the doses formulated for herbal use?
14:30 – Dr. Girard: So that again goes back to both traditional use and also research, so if we’ve got that research to show that it’s a
14:39 – certain dose that we need then that’s definitely what we go with, but then in lieu
14:45 – of that, the traditional herbalists usually have throughout the years been recording
14:50 – the dosage that they find effective and it usually comes out as a range.
14:55 – So we have, if we have a more sensitive patient we start in the lower end of the range, and
15:00 – if there is a patient who is more treatment-resistant, we might start at a higher end of the
15:05 – range. The one thing to really understand about herbs is that most commercially-prepared products
15:11 – are sometimes as low as a quarter to an eighth of the what’s considered the therapeutic dosage range,
15:20 – so yes they work for lots of patients still, we know that from the communities, right, somebody
15:26 – used x supplement and cured their UTI. So it’s definitely not to say that it can’t be effective
15:32 – at that dosage, but often for most patients we need to be using herbs in the appropriate therapeutic dosage range in order to make sure that they’re getting enough of those compounds
15:43 – to act to actually eradicate the infection or start to eradicate it, depending on whether it’s a more superficial infection,
15:56 – right, an uncomplicated UTI patient versus a potential client or patient that has
16:03 – an embedded infection that goes deeper into the wall. Melissa: That was going to be one of our questions
16:07 – about the herbal products that are available and the dosages of those, but it sounds like even if
16:12 – you’ve used something that is generally available, it might not be effective, but that’s more because
16:17 – of the dosage potentially than the actual herb itself. Dr. Girard: Yeah.
16:22 – Melissa: When it comes to herbal treatments, what method of delivery do you use? Or maybe it’s multiple, like tinctures or powders and pessaries?
16:29 – Dr. Girard: I often use tinctures if patients tolerate alcohol well, right. And that’s quite, you
16:36 – know, that’s the deciding point there. Tinctures are particularly effective because
16:42 – alcohol is a solvent that is able to dissolve both the hydrophobic sort of the, so essentially
16:48 – the oil-based compounds, and the water-soluble compounds, hydrophilic. So having a solvent that
16:55 – can get all the medicinal qualities out of a herb is potentially a more potent therapy and there
17:02 – are ways of getting the alcohol percentage or the amount of alcohol in the product way down. It’s
17:09 – a bit of a complicated process, you can’t just add it to boiling water. That does not evaporate much
17:14 – of the alcohol at all, despite maybe being told that that’s an effective way of removing it.
17:21 – So there is still another method that can be utilized if a patient is sensitive to the alcohol.
17:28 – From there, if alcohol is definitely not tolerated, then usually a powder. Tablets tend to
17:36 – not be a good choice in general unless the formulator is very careful with how
17:42 – their tablet is manufactured so that it dissolves effectively. A lot of the urinary patients,
17:47 – they also have very damaged digestive systems unfortunately because of all the antibiotic use, so
17:53 – putting medicine into a very absorbable form, liquids especially,
18:00 – is going to improve the ability for that medicine to make it into their body and get
18:07 – to their bladder. So powders at times definitely, pessaries sometimes, especially if there’s a
18:14 – vaginal infection, you know, sometimes we do Microgen and we see the same
18:20 – bacteria is colonized in the vaginal canal and then we would treat that
18:27 – area in order to help prevent a reoccurrence happening in the bladder.
18:31 – Melissa: Okay. How long does it usually take to treat a UTI if you’re using the herbal approach?
18:37 – Dr. Girard: Oh, extremely variable, right. Again it’s going to depend on how advanced that infection is, how long they’ve
18:44 – had it. There are even cases where people have had it for a long period of time, two years, you know. I mean, and I
18:50 – know there are a lot of patients that have had it much longer than that, but
18:56 – there isn’t a hard and fast rule there. I usually tell patients, you know, at least a month
19:03 – and as long as we see some improvement then we keep going, right. But sometimes patients respond
19:10 – within a couple of weeks. So I had a patient that was experiencing upwards of 30 urinations a day,
19:18 – you know, frequency. And she had been told she had overactive bladder and we did some testing,
19:26 – it looked to be that pseudomonas was potentially colonized and hadn’t been treated, so we
19:34 – did herbs and within a month her frequency had gone down to a normal range 9 to 12 times.
19:42 – And we continued to see if we could get even better and it stayed where it was, but
19:49 – that’s fine. That was a much better quality of life than 30 times. Melissa: Yeah, much.
19:54 – Dr. Girard: Yeah, so it’s gonna, even duration of symptoms doesn’t necessarily dictate how a patient is going to respond to
20:02 – the right herbal therapy. Melissa: And people often talk about potential liver damage from
20:08 – long-term herbal therapy. Is that an actual risk? Dr. Girard: For some of them, absolutely. I know I’ve talked about
20:14 – uva ursi multiple times, this is probably one of the ones that you need to be the most careful with.
20:18 – It’s really not meant for long-term use. You can use it safely up to a certain amount of time
20:27 – under guidance and then if you were to use it longer, liver enzymes would need to be
20:32 – monitored. So definitely, the liver can be impacted by any nutraceutical, any herb, especially
20:39 – if you’re taking it for a while. I’ve been to webinars on liver function where practitioners
20:47 – have found patients using even as few of five different supplements and
20:53 – found liver enzymes elevated, and then when they took those away or some of them away, the liver
20:58 – enzymes came back down, so it’s not just herbs. We do have to be careful with all products,
21:05 – making sure that our body is tolerating them. There aren’t any herbs that, besides uva ursi, that have,
21:13 – where we would say you have to monitor liver enzymes continuously every six weeks, but if
21:20 – a patient had a history of a liver condition or enzymes that were elevated then we might.
21:26 – Melissa: How do you know if a herbal treatment is working and then how do you know when it’s safe to stop
21:31 – and that you won’t then just get symptoms again?
21:34 – Dr. Girard: So I’m not a practitioner that believes that we get worse necessarily before we get
21:40 – better, unless it’s a Herxheimer reaction that we see for a couple of days. Patients should either
21:47 – stay the same for the first couple of weeks or they should start to gradually get better.
21:53 – Sometimes there’s compounding factors, you know, maybe a patient started therapy at the same
21:59 – time as their cycle started and they were feeling kind of crappy from a different facet
22:04 – to their health, but generally we should see that patients continue to improve on therapy. Stopping
22:13 – the herbs that have been effective for you is an individualized decision process. If it’s going
22:21 – to just cause stress stopping a herb that’s relatively safe, we all know our stress
22:26 – significantly plays a role in the development of these conditions, so that’s something to
22:34 – discuss with your practitioner. It’s very important to work with a practitioner who’s
22:38 – trained in botanical medicine. There are a lot of herbs that have that maybe state online somewhere
22:45 – that you shouldn’t use it for past a certain duration, but a lot of those websites are
22:52 – taking a very cautious approach. Whereas someone who is trained in herbal medicine, they would be
23:00 – able to better guide you on the duration that
23:06 – you could safely use it for as opposed to, you
23:06 – know, stopping something that’s working for you before you feel comfortable stopping it.