00:00 – Dr. Girard: I generally tell patients, make sure you’re taking a probiotic that has multiple different species
00:04 – in it. Our gut microbiome should have a very large amount of different species.
00:24 – Melissa: What about the impact of natural antimicrobials on the healthy microbiome of the gut and the vagina?
00:29 – Is that a potential issue? Dr. Girard: Yes, that is definitely a potential issue. The longer that you use some
00:35 – of the bigger, the more potent antimicrobial herbs, the more that this is a potential to have
00:42 – happen, not necessarily for the vaginal area but definitely for the gut. So we do know goldenseal
00:49 – at a higher dose for a longer period of time, we’re talking numerous months, can start to disrupt the
00:56 – the levels of healthy flora in the gut, and same with oregano oil. Oregano oil is
01:02 – another one that can do it. I don’t use oregano oil with many, if any, patients because it is
01:10 – an extremely potent herbal product and it is one of the most likely to disrupt the healthy
01:17 – bacteria, but that might be a trade-off right, if that is working for a patient versus
01:25 – taking an antibiotic which we know is going to have a much bigger impact on their biome,
01:30 – then maybe that is the lesser of two evils. So, you know, it’s not, decisions need to be
01:37 – made with a practitioner about the therapies that you’re choosing and whether to do them long-term,
01:43 – short-term. An educated practitioner is going to be able to help you determine
01:49 – how best to continue treatment. Melissa: Right. When it comes to prevention, you’ve mentioned
01:54 – a few kind of broad spectrum antimicrobials. Is there something that people can be taking longer
02:00 – term once they are well to help prevent something happening again in the future?
02:04 – Dr. Girard: Well I do really like some of the cranberry products. There’s really good research
02:12 – for the 36 milligrams of proanthocyanidins, so I definitely use that for prevention because it’s
02:19 – very safe. It’s even safe for pregnant women. We do know that the PACs are anti-adherent to multiple
02:26 – different bacteria. D-mannose is also very good, but we do know it’s fairly specific to just E. coli,
02:34 – and again D-mannose needs to be taken at the right amount number of times a day in order to be
02:41 – reliable, so there isn’t necessarily, I mean cranberry is made potentially almost
02:48 – like a herb, right. It’s more on the food side of herb spectrum than something more potent
02:56 – in terms of preventing future infections. A lot of the lifestyle behaviors are one of the most
03:02 – impactful factors that we can help counsel patients on, so water intake, they’re
03:10 – getting enough water every day from a good quality water source is one of the is very
03:17 – well-researched to help prevent urinary tract infections. We’re keeping our stress down, how
03:23 – many, I know way too many patients that have the same story of, “I was very stressed out and
03:30 – then I got a really bad UTI.” So learning better ways to manage stress and potentially
03:37 – rooting that stress out of our lives in order to prevent it from happening in the future.
03:43 – Melissa: What about specifically for people who experience UTIs after sex: is there something natural that
03:48 – could be used as a prophylactic there? Dr. Girard: So the herbals that are used to treat an active infection
03:54 – could be used in the same way as a prophylactic antibiotic. Taking the 36 milligrams of PACs
04:04 – is another good strategy if you know that you have recurrent E. coli infections, taking additional D-mannnose.
04:10 – D-mannose is extremely safe, it’s a sugar that doesn’t spike our own blood
04:16 – sugar. Taking a probiotic is another important way to continue. So after intercourse,
04:25 – we tend to use an oral probiotic, not necessarily stand alone though. If a patient is having
04:32 – infections after they have intercourse every single time, then we would potentially step
04:38 – that up and do a vaginal probiotic as well. But even in patients who are occasionally getting an
04:46 – infection after intercourse, yes a probiotic around that time is helpful, but it wouldn’t
04:53 – necessarily be enough to prevent an infection unless it also was one of those
04:59 – probiotics that had the cranberry extract with a certain amount of PACs standardized to it.
05:08 – Melissa: Okay. Do you use compounded probiotic pessaries or is this something that’s available on the market?
05:15 – Dr. Girard: Yeah, there’s numerous products that are available on the market. I’m always looking for ones that
05:20 – have L. crispatus. There is some research that’s coming out that’s indicating that women who have
05:26 – healthier levels of L. crispatus generally have fewer lower urinary tract symptoms. So this is new,
05:34 – so not a lot of the vaginal probiotics products have this yet, but hopefully more are coming.
05:43 – Melissa: When it comes to gut health and UTIs, are there particular strains that you recommend there?
05:49 – Dr. Girard: Well we know that those particular lactobacilli strains that are
05:53 – important for our bladder and our vaginal health, they travel from the gut over to these
05:59 – areas. We don’t 100% know the mechanism by which that happens, so making sure that the gut does have
06:04 – robust lactobacilli levels and a good diversity of lactobacilli is important to help promote the
06:11 – health of those other two biomes. Melissa: Okay is there a certain CFU or how many billions
06:19 – of probiotics that people should be aiming for? Dr. Girard: Well, again, this is an individualized approach. It would
06:26 – depend on whether they’ve used multiple antibiotics, what types of antibiotics they’ve used. We know that the
06:33 – biome recovers much more quickly after, say, a round of amoxicillin versus, say, a round of cipro.
06:40 – Huge differences there. So it’s going to depend on that patient’s history, if a patient comes in and
06:47 – they’ve had lots of antibiotics, then it’s usually a higher dosage, 50 billion potentially
06:53 – even starting and then potentially a lot more depending on how recent that antibiotic use was.
07:00 – And if someone is relatively symptom-free but they’re just looking to prevent, they can
07:07 – go with a lower billion. We don’t necessarily have research to tell us exactly how many billion
07:13 – to be using, it’s more about the different species that we’re using. That is where
07:19 – more of the research lies, with the exception of something like saccharomyces boulardii.
07:24 – We do have some more research that suggests what the dosage that is appropriate for that,
07:30 – so make sure that you, I generally tell patients make sure you’re taking a probiotic that has
07:36 – multiple different species in it. Our gut microbiome should have a very large amount
07:44 – of different species. I think some estimates are saying 1,500 different species of bacteria,
07:51 – so if you have a choice between a probiotic that has two or three strains versus a
07:57 – probiotic that has 10 to 15 different strains, that one is probably going to be better for your gut
08:06 – health versus the actual amount the billions. So that is more
08:15 – of what patients should be potentially looking for for general health, for the health of
08:21 – their digestive system. So I just want to add some additional information about probiotics. Some
08:26 – of the research that’s coming out is showing that we may only get benefit from probiotics
08:32 – as we’re taking them. When we stop taking them, we’re not necessarily getting the benefit from
08:37 – from them necessarily changing our flora. We’re definitely lacking research in that area though,
08:44 – because that’s just unhealthy individuals, that’s not necessarily in individual specific conditions.
08:51 – But what some of the research is showing is that what promotes a healthy diverse gut microbiome
08:58 – is people who eat lots of different types of vegetables, you know, not someone who’s
09:03 – just eating cucumbers and peppers and carrots and that’s, you know, that’s not diversity. There
09:11 – are hundreds of different types of vegetables out there and eating different
09:15 – ones is going to potentially introduce different bacteria into your system. Another way
09:23 – is obviously the probiotic foods, right. They’re going to help enrich our different
09:28 – microbes in our gut depending on that, you know, depending on that particular probiotic food,
09:35 – how it’s made, right. Kombucha has many different bacteria and yeast species versus something like
09:43 – sauerkraut which is more of a lactobacilli, right. But then also where we buy our food is
09:50 – important. There’s actually research that shows buying food from a farmer’s market is more likely
09:56 – to support a more diverse biome in our gut than buying supermarket foods because there’s going
10:02 – to be more trace dirt and, you know, and maybe not so many chemicals that are on the
10:09 – the farmers market produce. So all those things are potentially better at changing our gut
10:17 – microbiome for the better long term. Melissa: Okay, that’s good to know. That kind of takes us into diet, but
10:23 – I wanted to quickly talk about C. Diff. because a lot of patients that have been in long-term
10:27 – antibiotics have an issue with this. Is there an approach that you use when it comes to that?
10:33 – Dr. Girard: When it comes to C. Diff., because it is such a life-threatening condition, it’s very important
10:38 – to work with your medical doctor and take the prescribed antibiotics. There are some
10:43 – adjuvants that some people take alongside to help eradicate the infection, so there are berberine
10:51 – products that may have some activity against C. Diff. and make the antibiotics more successful.
10:58 – Saccharomyces boulardii is a yeast that is able to help patients when they do have a bout
11:06 – of C. Diff. or prevent C. Diff., however it is not a standalone treatment for C. Diff. at all.
11:13 – Melissa: If it can help prevent it, does that mean it might be helpful for people who have a tendency towards C. Diff. to
11:18 – take it when they’re on antibiotic treatment? Dr. Girard: Yes, that is the general approach. If a patient has a
11:24 – past medical history with C. Diff., anytime they take an antibiotic it would potentially be
11:30 – wise to have that addition in there. Melissa: How is the gut microbiome related to frequent UTIs?
11:38 – Dr. Girard: So we do sometimes see that those bacteria that are in the gut are potentially traveling to the
11:47 – urinary tract and causing the infection. The exact mechanisms of that are not 100% understood yet.
11:55 – We suspect because of that shorter difference between the anus and the vaginal canal
12:01 – and bladder and urethra or urethra, that the bacteria are able to migrate across the perineum.
12:08 – However, that I don’t believe is very well understood still. However we do
12:15 – tend to see that those bacteria that potentially are colonized in the gut can
12:20 – cause infections, so one of the mechanisms could be the inflammation that those particular microbes
12:27 – are setting up, right. If we have bad bacteria in the gut, that inflammation may have a systemic
12:33 – impact on the body and that may filter down to a patient’s bladder potentially,
12:41 – so we do need to make sure that the gut is healthy and in order to reduce inflammation in general.
12:48 – Melissa: Okay. Dr. Girard: A lot of people talk about SIBO, and that is definitely
12:55 – something that can create more inflammation and leaky gut and issues in the digestive tract, so there isn’t research right now
13:03 – to suggest that it is helpful for UTI. However, we do have a small study that shows it’s useful for
13:11 – IC patients and of course we also suspect that many IC patients are just undiagnosed chronic
13:18 – UTI patients, so there very well may be a link there and it would make sense if there’s other
13:24 – types of chronic inflammation that can predispose patients to more bladder infections. Why not
13:31 – another condition that creates inflammation in the gut, right? Melissa: Yeah, that makes sense.
13:37 – Dr. Girard: Or yeast, right? And that’s a lot of, that’s another one that is very important for the patient population to
13:43 – be looking at with their naturopathic doctor or other practitioners, functional medicine doctors.
13:50 – That way, because of the antibiotic use, that is probably one of the most common outcomes
13:58 – is a yeast overgrowth in the gut. Melissa: Yeah, we do hear a lot of that from our community. When it
14:05 – comes to diet in general, do you think there is a role of coffee, alcohol and sugar in recurrent UTI?
14:14 – Dr. Girard: Definitely, and this is one of the the facets I talk with patients about the most.
14:20 – There are definitely foods that trigger more inflammation in the urinary tract. Coffee is
14:26 – easily the most well-known, probably second would be alcohol, and sugar is a bacteria’s best
14:34 – friend, right, so most bacteria, not all of them of course, and yeast. So food definitely is something
14:41 – that if you start with an infection, it’s not necessarily going to treat it, but by having a
14:46 – good diet and minimizing those particular foods that you know that you’re sensitive to, you’re
14:52 – able to reduce the frequency of UTIs for sure. A lot of my patients, or not a lot, sorry, a number
14:59 – of my patients, their chronic UTI started after they had five coffees a day and
15:06 – forgot to even take one sip of water, and you know they were going through stress at the same time.
15:12 – Minimizing those things, keeping them at a healthy level is usually tolerable for most patients, so
15:18 – it’s not necessarily about completely avoiding. Some patients do for sure, there’s that small
15:23 – subset that cannot tolerate any, but a lot of the time it’s just not about overdoing it.
15:31 – Melissa: Are there certain vitamins that we should take more of or avoid if chronic UTI is an issue?
15:38 – Dr. Girard: Yes, so I in particular see the B vitamins, certain ones not all of them. B2, B5, B6 are potential irritants. Potassium is
15:50 – a potential irritant. So depending on someone’s multivitamin, or maybe they’re taking a B complex and they are
15:59 – trying to do something good for their body, but unfortunately because of the maybe the chronic
16:05 – inflammation that is present in their bladder, they’re creating, they’re triggering even more.
16:11 – These things seem to also irritate the bladder wall and then that can predispose towards more
16:17 – infections unfortunately, or just in general more symptoms. If you’re a chronic UTI patient,
16:22 – then creating more inflammation in the bladder at any time is going to potentially create a bit of a
16:28 – flare, right. Vitamins that people should be taking more of, that’s again an individualized
16:35 – approach. However, making sure that your vitamin D levels are optimized is very important,
16:41 – and I know lots of other practitioners have talked about that on here with you guys, so
16:46 – I do not as a blanket statement should everyone be taking more of it, because
16:51 – you can develop too high of levels and it can have bad outcomes, but testing your
16:57 – level and then taking an appropriate dosage to help make sure you’re in an optimal level is
17:03 – important for vitamin D. Melissa: Okay. number of people report that they get irritation
17:08 – from taking like a supplement version of vitamin D, especially in capsules or oil-based capsules.
17:14 – Is there another way that you can gain enough vitamin D to make a difference that is not that?
17:20 – Dr. Girard: Well it’s, I mean we can’t necessarily spend all kinds of time in the sun, right? So there is the
17:28 – possibility of them looking into D2 supplements
17:32 – and hoping that their body can convert enough of it to D3. Those patients that are reacting
17:39 – to it , they’re going to want to look at the, we call them excipients, which are the other
17:45 – other types of products in that particular supplement. So we do see that from time to time
17:51 – people aren’t actually allergic or aren’t having a problem with the D itself, they’re having a problem
17:56 – with another ingredient, coconut or some other excipient. D3 does come from sheep lanolin,
18:04 – so you do have to make sure that patients don’t have a wool allergy. Yeah, that maybe,
18:11 – that could potentially be what’s going on for some patients. Anytime you trigger an allergic
18:15 – response in the body, there is the possibility of making bladder conditions worse, right. We see some
18:20 – patients actually using antihistamines in order to to reduce their symptoms, so
18:27 – that could be what’s happening for them. Melissa: Okay, interesting. Do you think it’s
18:32 – possible to target biofilms with treatment and are there any methods that you use to do this?
18:39 – Dr. Girard: So biofilms are, again, a very new new area of research so we don’t necessarily have research that says
18:48 – a particular biofilm disruptor is definitely going to treat a biofilm in the bladder. However,
18:54 – as an adjuvant to the antimicrobial therapy, if we suspect there’s a biofilm, I do think it’s worth
19:01 – adding in, in order to help break down that potential biofilm. So biofilm disruptors
19:11 – do need to be selected based on the patient’s history of their chronic condition. Certain biofilm
19:19 – disruptors are stronger, some are weaker, so it depends on how long a patient has had symptoms for
19:24 – in order to select the right ones. I often see patients coming to me on on biofilm products but
19:32 – unfortunately they’re not likely to have been making a huge impact because the biofilm, as
19:38 – it matures it becomes more organized and harder to to break down, so that needs certain
19:48 – products in order to do that. Melissa: And when you say products, are these the kind of thing
19:52 – that are sold as biofilm disruptors or do you use certain herbs that might have that kind of action?
19:58 – Dr. Girard: I use certain products that are marketed that way. The advanced phase two biofilm disruptor
20:05 – was formulated by Dr Paul Anderson. That’s probably one of the ones, I think your community does
20:11 – know about that one and it is a very good one for more a more advanced biofilm.
20:16 – However, some patients don’t tolerate it. The sulfur compounds in it sometimes irritate some patients,
20:22 – so there are also IV therapies that are used. I’m less knowledgeable in that area, that’s something
20:29 – for an IV certified practitioner to potentially talk about, but yeah there are herbs
20:38 – that are weak biofilm disruptors. The more we research into whether or not a herb has that
20:46 – quality, the more we’re finding. So even juniper has biofilm disrupting qualities. Black cumin
20:53 – seed does. So it just keeps growing, what we’re finding out is able to disrupt the biofilm.
21:00 – Melissa: That’s good news. Dr. Girard: Yeah, and I mean some of the antibiotics disrupt biofilms
21:04 – as well, so it’s becoming a facet that people are really really paying attention to and I hope we get more research as time goes on.
21:14 – Melissa: You mentioned the transience or potential transience of probiotic usage. Do you think it’s possible
21:19 – to actually return to a healthy microbiome once you have had frequent antibiotic use?
21:25 – Dr. Girard: Yeah, I definitely think it is possible. Like I had mentioned earlier, there is research that
21:31 – shows that it does take time but usually the microbiome does return to a state of health. I
21:38 – think one of the most important predisposing factors is your overall diet long term, so
21:48 – if you’ve spent years and years and years on antibiotics and eating poorly and things like
21:55 – that, it’s going to take that much longer for it to recover, but that’s part of what I do
22:01 – as a naturopath, right? We believe in the body’s innate ability to heal and those bacteria are
22:06 – are a foundational aspect to our health, so we definitely feel that as a profession. We believe
22:13 – that that can heal and that diversity can come back. We just need to put the right
22:18 – plan in motion and the right foundation and healthy lifestyle going forward.