Andrew: Well, this is obviously a very interesting topic, and you and I know somebody that you’ve learned from. So, take us through, how did you learn about the vaginal microbiota? What was it that got you really interested?

Greta: Yeah. So, I guess my interest really comes from my own personal experience, which is the same for a lot of health practitioners. When I was studying naturopathy, I was probably in my second or third year of naturopathy, and I had my own symptomatic mycoplasma infection, which is a sexually transmitted infection. It’s quite underdiagnosed, and for myself, I was misdiagnosed for two years, which means that I ended up getting pelvic inflammatory disorder from that infection, which was misdiagnosed as chronic thrush, BV, lots of other things. I even went to the hospital twice with extreme pelvic pain, and was just dismissed and told to take Panadol. So, it took a lot for my diagnosis. I also had a naturopath at the time who did offer some treatments, but I really only had vaginal probiotics, or put yogurt on a tampon, and put that in your vagina. That was the only treatment I was offered. So, when I was finishing my degree and doing my student clinic, I just really got interested in that whole area of the vaginal microbiome, got really into hearing Dr. Moira Bradfield talking, and she had a lot of training on her website that I did. And then I went on to study with her for six months post my graduation, and learn all things vaginal microbiome through her.

Andrew: So, tell us what we know so far, because, back in the old days of nursing, and we’re only talking 30 years ago, and that’s not a lot when you consider the progress that’s been made in so many other areas. Even, let’s say, the early 2000s, it was still mentioned in the, with regards to the vaginal microbiota, the Döderlein’s bacillus. What? You know, which was I think later teased out to be a lactobacilli. But so, there’s really only this recent exploration into the milieu of the vaginal microbiota.

Greta: Mm-hmm. Yeah, that is such a funny term, isn’t it? And I actually had never heard that until this year, when I was doing some research for another talk that I did. And then I went down that rabbit hole of how that came about. And, yeah. So, this gynecologist in, what was it 1890s, early 1890s, Albert Döderlein, he made that term, the Döderlein lactobacillus, or Döderlein’s bacillus, I think they called it, which was the type of lactobacillus that they’d found in the vaginal microbiome, different to the lactobacillus species that they’d found in the gut microbiome, in that they have more ability to clump together and adhere to the vaginal and vulval walls. So, that was kind of all we knew. Yeah, that was sort of all we knew until much more recently. So, the first study published of the vaginal microbiome as a whole, and kind of classifying the vaginal microbiome, was in 2002. So, that’s, you know, over 100 years gap.

Andrew: Okay. So, how have we progressed since then, though?

Greta: So, since 2002, we now have much more studies on the vaginal microbiome, and really classifying them. So, we now know there’s different CSTs, which you might have heard of, so, community state types, which kind of tells us about the types of lactobacillus that are dominant in different microbiomes, and therefore how protective they are. So, that was a really big step in kind of understanding different microbiomes, and that it wasn’t just one type. There’s also more research now on, you know, how hormones affect the vaginal microbiome, and even how, you know, women of different ascent, like African descent, are less likely to have a lactobacillus-dominated microbiome. So, there’s so many factors that we didn’t think of before, that are now, actually have research.

Andrew: Right. So, forgive me. So, this is African descent, but living in a western civilization? Or African women in Africa?

Greta: Both, actually. Yeah, it depends how far their ancestry goes back. So, it’s more about the environment that their mothers grew up in…

Andrew: Right.

Greta: …and what kinds of microbes their mothers came into contact with.

Andrew: Wow.

Greta: Yeah. Interesting, isn’t it?

Andrew: So, this sort of goes on a little bit, I guess, from the work, when they were talking about, this was the microbiome project, and there was the guy, I can’t remember his name, who went over to live with the Hadza tribe in Africa. And interestingly, because they didn’t have milk, they were the true hunter-gatherers, so they didn’t have the, what do you call it, the farming civilization. They moved with the animals, and hunted for the animals. And so, milk wasn’t really in their diet, and they didn’t have bifidobacteria. Or they didn’t have big… Yeah, after…sorry, after birth, once the kids were weaned, it dropped off, their populations dropped off. So, that’s really interesting about lactobacilli as well.

Greta: Yeah. So, the women of African descent, and some other cultures as well, they actually have lower lactobacillus species, and can be more bifidobacterium-dominant in the vagina as well, which then sets them up for a bit more risk with things like BV and other infections.

Andrew: Forgive me. So, because they don’t have the lactobacilli, it sets them up for BV.

Greta: Yeah. So, the lactobacilli is the most, you know, protective bacteria for the vaginal microbiome. So, if we don’t have that level of protection, and we’ve replaced it with something like bifidobacterium, which is not as protective, but you can definitely have a bifidobacterium-dominated vaginal microbiome, we then don’t have that level of, you know, pH balance and protection against other bacteria.

Andrew: Okay. So, can you take us through some of the more common infections that you see in clinic? So, we’ll sort of go backwards to the infections, and then we’ll come forward again to the microbes that are implicated in protection, and maybe treatment, yeah?

Greta: Yeah. Absolutely. Yeah. So, there’s a few kind of classifications with infections. So, the two that we’re probably most familiar with is BV, or bacterial vaginosis, and thrush. So, the difference between those two would be that thrush is a fungal infection, usually caused by candida albicans, but there’s lots of other candidas that can cause it as well. And then bacterial vaginosis is referring to a dysbiosis in the vagina between the bacteria. So, it’s not fungal. It’s just bacterial. And when we talk about bacterial vaginosis, there’s a few kind of criteria that need to be met for an actual bacterial vaginosis diagnosis. And it’s tricky, because sometimes you’ll just miss out on that diagnosis, and not really know what to treat. So, with bacterial vaginosis, the three criteria there would be that the pH needs to be above 4.5. There’s a decrease in lactobacillus species, and then an overgrowth of one or more anaerobic bacteria. And it’s really important that we understand the differences between anaerobic and aerobic bacteria, because there’s another infection, called aerobic vaginitis, which is basically bacterial vaginosis but with aerobic bacteria. And the differences between anaerobic and aerobic bacteria really dictate how we treat it as well.

So, with bacterial vaginosis, the anaerobic bacteria, it refers to bacteria that doesn’t need air to survive, whereas aerobic bacteria refers to bacteria that does do a lot better with air, and can grow and populate in air environments. So, even if you just think about that alone, things like wearing non-breathable underwear will put you at a higher risk of bacterial vaginosis. So, anything where you’re creating that damp, dark space, with not a lot of breathability, that’s putting you at more risk for bacterial vaginosis.

Andrew: Okay. With regards to thrush, again, we think about the classical symptoms, but thrush doesn’t always fit into those classical symptoms of the cottage cheese discharge, things like that. Can we go through that, and maybe tease apart some of the little hints and tips to how to diagnose correctly?

Greta: Yeah. Absolutely. So, I think, for me, I kind of think of thrush in two categories, of acute thrush or chronic thrush. So, acute thrush is more, like, you can understand why it happens. So, maybe they took antibiotics, and then they got a thrush infection because we’ve killed off some of the bacteria, and now they have this opportunistic fungal infection. So, that is, like, an acute thrush. You might take some antifungals, you might use antifungal cream, and it’s probably gonna resolve and not come back again. That is really, like, a purely fungal infection in the vagina, which can be treated and moved on. It’s not really systemic in nature. That’s where you’re gonna see that really cottage cheese discharge, maybe a yeasty sort of odour, and some irritation as well. So, maybe some itchiness or irritation. So, that kind of acute thrush might be, yeah, from the antibiotics, from sex, from going to a hot environment. So, those kinds of acute type infections.

Then, the chronic infections for thrush, when it becomes really chronic or cyclical in nature, that’s when the presentation seems to change a fair bit. So, in that more chronic thrush, you might see no discharge at all. There might not be any. There might be, like, a little bit of a white discharge, or they can be, like, quite a liquidy, gushy discharge, with little flecks of fungal bits. So, not so much cottage cheese, but little tiny flecks, where you can see the fungal infection there. Then the symptoms of the irritation would be quite similar, but it tends to get more irritating the longer it’s gone on, because the longer you have it, the longer you’ve got that penetration of the candida into the tissue, which causes that shedding of the tissue, which causes degradation. So, we’ve got a lot of irritation. The tissue is being degraded. You might have easier bleeding. So, with sexual intercourse, you might get bleeding. So, it’s just quite different symptoms in that way. The longer it goes on, as well, the more histamine it produces. So, candida produces a huge amount of histamine. So, it kind of becomes this, actually, like, a histamine-driven infection.

Andrew: That’s really interesting. So…

Greta: Yeah. I think that’s

Andrew: Yeah. Can I ask, then, and I know this is pharmacological therapy, not natural therapy, but do you ever find that in these chronic cases, an antihistamine can sometimes take the load off while you’re doing other supportive therapy to heal the terrain?

Greta: Yeah. Yeah, it’s a great question. So, if there’s a lot of irritation and a lot of inflammation, then absolutely sometimes they can be useful. I’ve certainly used them with clients before, especially if it’s sex, and they’re trying to conceive, or there’s something that’s really irritating like that, I would get them to take an antihistamine before sex, if that’s their flare period. That being said, obviously, if you’re gonna take an antihistamine, it’s not going to reduce the production of histamine, which is why I find it more useful to use something like quercetin, or something that really will stop that production, long-term.

Andrew: Gotcha. And so, with regards to the, you spoke about infections, and upon sex and things like that. There’s this concept of ping-pong infection. Do you find, you know, going from one to the other, one to the other, and then it was sort of dismissed for a while. I’ve seen it quite a bit where, you know, women come in, going, husband, you know. So, do you find either there’s a ping-pong infection, and do you find that it’s easy, or frustratingly hard to treat the male?

Greta: Yeah. I’ve definitely seen that multiple times. I kind of take the approach of, is it that it’s actually moving from one to the other? Is that the only issue? And it’s usually not the only issue. It’s usually that…well, one of the things that I see a lot is that the female, or the woman’s vaginal microbiome has, you know, no protection. The pH is already high. She’s already stressed. She’s already producing heaps of histamine. So there’s already all of these factors going on in her world, that mean she has less protection against opportunistic bacteria. So, yes, maybe there is some passing between, but usually they will have the same kind of microbes if there are infections. And if she had enough protection, and if she had enough, you know, good hygiene practices and things like that, she might not get symptoms from those microbes. That’s definitely not with all of them. So, some of them, we really do need to eradicate in both partners. But I find, you know, just making sure that the women’s vaginal microbiome is as healthy as possible, that will give us the most protection.

Andrew: And I know that we’re sort of segueing away from the female just for a bit, but I need to cover this, and that is the practice nowadays of not circumcising males. Do you find that that’s an issue with ping-pong infection? Do you find that some males have to go and get circumcised, or do you just work around with the treatment?

Greta: Yeah. That’s a great question, actually. I mean, I haven’t seen it be an issue really, but I am always coaching them around washing underneath the foreskin. So, yeah, that might be an issue, but it’s a very easy hurdle to get over, because you can just really wash it properly. And so, if there’s, you can see and you can smell if there’s anything kind of getting stuck under the foreskin, so that doesn’t tend to be too much of an issue. Where the issue comes with the ping-pong infection is usually the seminal microbiome, which is so tricky, because we have no direct access to the seminal microbiome. Yeah. So, it’s not necessarily about what’s on the head of the penis. It’s really the seminal microbiome.

Andrew: So, therefore testing in the male would have to…you’d have to be looking for the culprit.

Greta: Yeah, yeah. So, there’s not a lot of them, but there are some seminal microbiome tests that you can do. And then you get a good idea of, like, everything that’s in the seminal microbiome. The hard thing is treatment, because we don’t have a direct access, so it’s not like you can put some herbs straight into the seminal microbiome and flush it out. It’s a little bit different. Yeah. Not as comfortable. With the seminal microbiome, there’s not a lot of research on how that happens, the translocation from the seminal microbiome to the vaginal microbiome. But there is some research now that has pointed to the theory of the microbes actually attached to the semen. So, they, like, take a little ride on the semen, into the vaginal microbiome, and that’s how they end up there. So, I think that’s really interesting that they can actually invade the cells of the semen, and that it’s being carried in that way. So, it’s always interesting just to talk about, you know, how the client has sex. Are they using condoms? Is there ejaculant going into the vagina or not? So, there’s lots of different kind of factors there.

Andrew: And, back to the vagina again. So, you know, once the terrain’s inflamed and upset, any sort of, you know, coupling, coitus, would cause more inflammation, and set them up for another sort of wave of infection.

Greta: Yeah, absolutely.

Andrew: Like, I’ve just, I’ve had these poor, frustrated… I’ve sent a couple to Moira, actually, because I just went, “Oh, my goodness.”

Greta: Yeah, yeah. Yeah. And it’s not only that, but yeah, it’ll cause more inflammation. And the more degraded the tissue is, the easier it is to tear. So, if you think about having those tiny little micro-tears from intercourse, then that’s, like, a hive for bacteria. So, that’s, if there’s any opportunistic bacteria hanging around, it’s gonna go and embed itself there. So, yeah, there’s lots of different risks with that as well. And the, you know, the vaginal tissue is such a soft, delicate place. And, you know, the penis tissue is very hard. So, it, in itself, you know, it comes with some risks.

Andrew: We need to talk about assessments as well. So, they’re, you know, like, if there’s, if somebody’s gonna do a general, like an MSU, or a general swab, and they’re looking for, you know, forgive me, and the lab technician isn’t alerted to looking for a specific organism, then they’ll just look for general things, like coliforms and things like that. And so, as you say, the infections are missed. What do we need to be alert for, to go, “Listen, can you please look for this?”

Greta: Yeah, that’s a really great question. So, yeah. You can get, with your GPs, obviously, you can get swabs done. They’ll look for the, you know, top offending microbes in BV and thrush. The other two, the one that I mentioned before, which is mycoplasma, it is a mollicute. So, these are, like, a parasite that can be found in the vaginal microbiome. So, mycoplasma genitalium. There’s a couple of other types, and ureaplasma as well. So, those two, I believe, need to be tested every time you’re getting a swab as well, just to rule them out, because if they’re there, you’re gonna miss them.

Andrew: Yeah, obviously, males, very hard to swab.

Greta: Yeah. Yeah.

Andrew: But you could take a seminal fluid sample, hopefully, and

Greta: Yeah. It is, it’s honestly really tricky to get males tested properly. Sometimes if there’s a rash on the penis or around the pelvic area, then they might do a skin scrape or a swab. So, they might find Candida there, or other funguses. It’s not very often that they do that. And they do usually say, “Oh, that looks like Candida. Try this cream. And then if it’s not, maybe we’ll do some other tests.” They can do urinary samples. So, they could pick up mycoplasma and ureaplasma, different fungal infections, and BV bacteria from the urine sample as well, but it’ll be smaller amounts.

Andrew: So, again, you’d have to be writing on the request, “Please look for,” because otherwise they might Yeah.

Greta: Yeah, absolutely. Yeah. And in my experience, it is quite hard to get the doctor to then look for that, if they’re not told to test for it, usually.

Andrew: And what about things like… We spoke about micro tears in the lining of the vagina. I remember Moira telling me about different types of lubricants, that some are more effective, some might even have an irritating effect, and, you know, some might actually help bad bacteria to grow. Can we go through those? What sort of things are recommended?

Greta: Yeah, definitely. Yeah. So, I usually recommend using an organic lubricant, usually water-based. So, there’s either a water-based or an oil-based lubricant. So, it’s about the type of lubricant it is, and then the ingredients, the specific ingredients. So, a really big one that we always talk about is using a non-glycerin lubricant. So, something that doesn’t have glycerin in there. There’s varying research into how glycerin can feed fungal or bacterial infections. The jury is honestly a little bit out on it. It doesn’t seem to be really well-researched into whether it’s actually an issue topically. And usually, for me and my clients, it’s usually about making sure you’re washing that off. If you do have a lubricant that’s maybe not so vagina microbiome-friendly, definitely washing it off. So, you might not see those effects if you’re, you know, using it for 5 or 10 minutes. But if it’s staying in there, you will start to see those effects. So, glycerin. Also, being pH balanced as well. So, pH balance to the vaginal microbiome is a big one. So, we want that pH to be between about 3.5 and 4.5.

Then there’s also other more protective ingredients that are in the more natural lubricants. So, things like aloe vera, you know, things that can be really soothing, and also repairing to the vaginal tissue as well. And then in cases like, you know, perimenopausal or menopausal clients, we have a little bit more of that tissue degradation, so we wanna be really careful to be promoting the tissue, the vaginal tissue health. So, then, that’s where the oil-based lubricants can be more helpful as well. So, a bit more soothing, provide a bit more protection.

Andrew: And, can I ask, do any of these lubricants have maybe a base or an addition to, with, say, you know, coconut oil, like caprylic acid, the antifungal actions of caprylic acid or anything like that? Moira was very interested in butyrate.

Greta: Yeah, yeah. I haven’t heard her talk about butyrate in lubes before. I personally steer away from coconut oil as a lubricant, mostly because it’s a really high pH, and it really can just throw the pH out. That’s not to say that I don’t have some clients that use it and it works for them, but we don’t really usually recommend coconut oil as a lubricant. It can, yes, it does have that antibacterial, antifungal activity, but we don’t know how much that kind of affects the beneficial flora, and the flora that we actually don’t want to grow, like Candida and, you know, those anaerobic bacteria.

Andrew: Right. So, with treatment, obviously, we’re going through prevention and general maintenance and sexual contact, things like that. What about treatments? You mentioned right at the beginning about the issues with, you know, not having things on hand, and part of this was actually a restriction, partly understandable by the Therapeutic Goods Administration, where at one stage, we had pessaries, probiotics in a pessary form that we could give. And now, there was that decision made by the TGA to say, no, that’s considered internal, so anything internal has to be sterilized, therefore your bacteria is killed. How do we navigate this one?

Greta: Yeah, yeah. I definitely have some views on this. So, there are a lot of, you know, vaginal probiotics out there that have really good research on being intra-vaginal probiotics. It really just is about the labeling. And I guess, you know, if we’re talking to practitioners, it is up to our own, you know, our own knowledge and our own prescription to be able to tell our clients whether it’s safe or not to use intra-vaginally. Usually, you can ask, you know, the reps of different, the vaginal probiotics, and see if it is safe to put intra-vaginally, because it’s usually just about the labelling.

Andrew: Yeah.

Greta: There is a brand-new… Sorry. There is a brand-new…

Andrew: Oh, sorry. I was just gonna interject. Sorry. I was just going to interject. I guess the decision from a practitioner point of view is, well, do I give something that has some evidence with treatment effect? Or does the patient rely on then going to the supermarket, and getting a most probably dead yogurt, which has very little effect? So, it’s sort of like, well, it’s risk to benefit, isn’t it?

Greta: Yeah, yeah, exactly. And I guess my advice around that would just to be using a probiotic that has really good translocation. So, if you do wanna be just using them orally, we need to make sure that we’re using strains that have been shown, in the research, to translate from the gut microbiome over to the vaginal microbiome, because that’s what it’s doing, right? Like, you’re eating it, it needs to survive your stomach, it then needs to survive your gut, it then needs to come out in your poo, and then translocate over the perineum to the vaginal microbiome. It’s like, that’s the reality of it. So you wanna make sure you’re using really specific strains, that have been shown in the research to do that.

Andrew: And one of the other things I remember, this is decades ago now, but I was, I had this predilection for zinc. Zinc, zinc, zinc, zinc. Everybody was zinc deficient. Da, da, da. Zinc, zinc, zinc, zinc. And there was these ladies that would walk past me, where I used to consult in the pharmacy, and they’d walk past me to go and get their miconazole cream. And then it was only after, and it was after months, I suddenly went, “Hang on. I’m not getting something here. Iron.”

Greta: Yeah.

Andrew: Many of them were iron deficient. So, can we go, can we have a chat about how much work you do about the terrain, the sort of base health of the patient, and their immune health, their immune capacity?

Greta: Yeah, yeah. So, yeah. I always come from a, you know, both sides of that story. So, you know, treating internally, what are the factors? Why do you have this infection? Not just, “Let’s treat the infection,” but how did we get here? Like, why couldn’t your immune system deal with it? And then also treating intra-vaginally. So, I do a bit of both. I’m always treating orally, working on their health as a whole. Is it blood sugar? Is it their immune system? Do they have deficiencies? Things like that. Are they deficient in nutrients where that impacts your tissue health? Where it impacts your ability to, like, grow, you know, more layers of your vaginal tissue. So, it’s those kinds of things that we wanna work on internally as well. And those things take a long time as well. So, to get the most sort of symptom relief is when we also wanna do that intra-vaginal treatment. So, in terms of things that we can do orally, we wanna kind of assess, like, why is this happening for them? So, is it their immune system? Like you said, is it an iron deficiency? Do we need to give them zinc? Are they zinc deficient? Sometimes it is. And, you know, things like if there’s insulin resistance going on, is a huge one for Candida infections.

Andrew: And so, treatment with that, with insulin resistance?

Greta: Yeah. So, with insulin resistance, I mean, it’s a lot about us changing their diet as well. So, changing their diet, opting for smaller, protein-rich meals. Treatment-wise, we can do myo-inositol. I know you’ve spoken a lot about that in your podcast before. So, yeah. We can always do myo-inositol. That’s usually all I really see that they need is those things. Sometimes I’ll do PHGG and myo-inositol together for vaginal treatment. And that’s giving us a prebiotic for the lactobacillus species, as well as balancing the blood sugar as well.

Andrew: Okay. So, I have a question here. One of the treatments that we use for, certainly cardiovascular, cholesterol, lipids, that sort of stuff, but also, in part, with insulin resistance, is berberine. And there’s this ongoing argument about long-term berberine might help the insulin resistance, but is it killing your bacteria? What have you seen in clinic? What are the changes?

Greta: Yeah, look, I kind of stay away from it. My opinion is I don’t do a lot of berberine. I will use it for short periods of time, but I’m a microbiome naturopath, right? So my top kind of priority is the microbiome. So, if I’ve got other things that can work just as well, and I’m not going to be affecting both the gut microbiome and the vagina microbiome, I’m probably not gonna use berberine long-term. I do think that it’s really interesting, and there are…I wanna see some more studies on using particular doses, those types of things. But yes, it’s useful, but no, I wouldn’t use it long-term.

Andrew: Yeah. I think I agree. And we need more data on, it might do this, but at what expense, when you’ve got this condition? If they don’t have that problem, go nuts. But if you do have this problem, are you undoing what you’re trying to treat, sort of thing?

Greta: Yeah. And is there maybe a lower dose that we could use for longer periods?

Andrew: Salient point. What about other gut sort of treatments? If we’re talking about the microbiota from the gut and then inoculating the vagina, what else can we use that you’ve found favourable?

Greta: Yeah. So, a really well-researched combination of probiotics is the lactobacillus rhamnosus GR-1, and lactobacillus reuteri RC-14. Yeah. They’re the most kind of studied combo for boosting the vaginal lactobacillus, and that’s oral route as well. Especially with things like strep B, there are quite a few studies on that combination of crowding out strep B. And it also, interestingly, is used to crowd out strep B in the gut. So, you’re kind of doing both. If you really think it’s coming from the gut, it’s interesting to just use those specific probiotics internally. We can also similarly use Sb internally, which will reduce the yeast in Candida, Candida yeast in thrush, translocating from the digestive tract to the vaginal microbiome. So, those are a lot of the probiotics that I would generally use. Then there’s

Andrew: Could you take us through dosage regimens on that, at all, with Sb? Like, how high do you go? I’ve been very heroic with Sb.

Greta: Yeah, I usually do, it kind of depends on the dose in each capsule. I usually do two capsules twice daily, but there are some that are a much higher dose, and you can get away with one capsule twice daily. But of the kind of standard old-school dose, I think the Designs for Health one might be a high dose. But I do think, yeah, usually you can go for two twice a day.

Andrew: Anything else? So, general gut healing, pectin, salivarius, glutamine, that sort of thing, do you ever use that?

Greta: Yeah, absolutely. Like, all the kind of general gut healing will almost always help. The more specific things that I do use would be things that I know that are gonna help to grow the lactobacillus species. So, lactoferrin is amazing, even orally. Same with lactulose, but you do need to be kind of careful with lactulose, in that it will also feed aerobic bacteria. So, if you’ve got aerobic vaginitis, we don’t wanna use lactulose. But lactoferrin is quite safe, and you’re just using it orally.

Andrew: Yeah. At low doses. Because if you use the full dose  out.

Greta: Yeah, yeah. Definitely low doses. Yeah, yeah. You might make some runny stools otherwise. Yeah. But anything that’s gonna kind of help with that tissue healing in the gut is also gonna be beneficial for the vagina as well. And anything where we’re helping to break down biofilms, the really big one that we haven’t discussed yet, and also helping to reduce inflammation as well. So, some of the things that you can use even orally to help with the biofilm degradation would be things like NAC, is incredible at that. A couple of herbs, pomegranate, green tea, both of those have selective antimicrobial actions. So, they do target those more opportunistic bacteria, and don’t have an effect on the lactobacillus. That’s really important too, which is what I would use over berberine.

Andrew: Right. Mike Ash, some years ago, mentioned something, and this is different end of the body, I get it, but he was talking about chronic sinusitis, mixing Sb with NAC, into a glass, and putting in a cotton bud, and basically inoculating your nose with both the Sb and the topical application of NAC. Have you ever done that vaginally?

Greta: Yeah.

Andrew: Have you ever had experience with NAC vaginally? Yeah? Oh, take us through this, please.

Greta: Yeah. Absolutely. Yeah. Yeah.  can do it. Yeah. So, with the vaginal treatment, I’m always thinking about what do we need to do for the specific microbe that was found, or microbes that were found. Is it likely to have caused…to create biofilms? Do we need to break those down? So, we need something that’s gonna break them down. Do we need to change the pH? Do we need to actually kill the microbe, and what is the right herb for that? So, all of that we can do topically. So, topically, NAC, vitamin C, just ascorbic acid, and Baikal skullcap, actually, are great at breaking down biofilms in the vagina. So, we can do that with things like rinses. Sometimes we use a really low dose hydrogen peroxide as, like, the base of a rinse, adding in herbs or nutrients into there. And then you can just apply that topically, so, with a syringe, into the vagina, to help break down the biofilm. So, then, when you’re delivering something antimicrobial in a cream or a pessary or whatever else it might be, you have more of a direct access to that, without all the biofilm in the way.

Andrew: What’s your view of the pharmaceutical creams on the market, like the creams used to acidify the vagina and things like that? Have you found good effect with those as a supportive therapy?

Greta: Yeah. Do you mean things like boric acid and lactic acid, or things that are more, like, antifungal and antibacterial?

Andrew: Things like Vagisil, and… Yeah. That sort of thing.

Greta: Yeah. I believe Vagisil, from memory, is a lactic acid-based product. I have had some clients using lactic acid, and, I mean, that’s what our lactobacillus produces, lactic acid. So it can be really beneficial to use the lactic acid, but they all kind of interchangeable. So, lactic acid, vitamin C, boric acid, all of those things are aimed at reducing the pH. So, if we can reduce the pH, in between that 3.5 and 4.5, for healthy vaginal microbiome, and we can boost up the lactobacillus species, a lot of the time, that’s all we need. It’s not always, but, you know, a lot of the time, we just need to create the right environment that things will sort themselves out.

Andrew: Right. Can I ask also about species, not necessarily strains here, because we’re talking food, but things like, you know, your fermented food, so, the lactobacillus plantarums. Then you’ve got cheeses, for instance. So, we’re talking short chain fatty acids, lactic acid. The propionibacterium, freudenreichii. There you go, I remembered it, in Swiss cheeses, Edam cheese, Emmental cheese. So, these are foods. We don’t often think of them as therapy in this…certainly not a cheese. And then we’ve, you know, usually got this, an idea of trying to avoid too much dairy. Do you find, in this instance, that some of these foods can actually be useful?

Greta: This is so interesting, because you’d think so, with the strain specificity in those foods. But, those foods also really high histamine-producing foods. So, you know, dairy, they’re things that are, like, cultured, they’re things that are…

Andrew: Got it.

Greta: Yes, they have the bacteria there, but they also have this huge histamine load. So, they’re not necessarily things that I would recommend, because of the histamine side of things. There definitely are some foods that have more specific strains for the vaginal microbiome. So, coconut yogurt is one of them. It’s not dairy. It’s, you know, coconut yogurt. It’s really high in lactobacillus strains, specifically, because of the way that they manufacture it. So, if you get a wild fermented coconut yogurt, and coconut kefir as well… Actually, cow’s milk or goat’s milk kefir does have a lot less lactose, and it does have the lactobacillus species in there as well. So, you can get away with some dairy products there. But, yeah. So, things like either the kefir or the coconut yogurt, and then also things like green tea, like, things that are, yes, they’re antimicrobial, but they have a beneficial action on the lactobacillus species. So, we need to just think about, is it going…is there any negative effect as well?

Andrew: Yeah. Sure. I’ve learned so much from this. This is great. This is really good. But I think it’s really a salient point that you give me, certainly, and that is to always, whatever you’re thinking, always keep in mind what you might be producing. Like, you spoke about the caprylic acid potentially, the coconut oil lubricants, potentially upsetting the pH of the vagina, and then the good dairy products, if you like, but then they’re high histamine. So, you’ve always gotta think about this risk to benefit, and what are you doing. Are you causing collateral damage? Important lessons.

Greta: Yeah, absolutely. And thinking about these things holistically, yeah. Thinking about the whole person, and what is the effect, and that’s why it’s really not, “I have this microbe, and I’m gonna treat that.” It’s, “I have this microbe. Why did I get this microbe? What’s going wrong with, in my body?” Or, you know, “What do I need to support? What body systems aren’t quite right?” And, you know, what other things is this microbe producing? Some microbes produce their own histamine, so there’s, yeah, lots of other things you need to kind of think about.

Andrew: So, what about other… We’ve spoken about the… Oh, now I’ve gone blank. The RC-14 and the GR-1?

Greta: Yeah. Yeah, that’s right.

Andrew: So, what other probiotics? Like, what about lactobacillus rhamnosus GG, for instance? The, you know, the hero of all probiotics, which… I don’t believe in heroes, but do you ever use, like, a concert of them? Do you ever use probiotics in general?

Greta: Yeah. I use a lot of different probiotics. I’m really specific with the probiotics that I use, but I do use a lot of the LGG, the rhamnosus LGG, if there’s any immune stuff going on, which there almost always is, but especially if it’s a really chronic or embedded infection. Specifically in aerobic vaginitis, I use it a lot as well, and in chronic thrush, because it is impacting the stability of our mast cells and our ability to reduce, or, you know, clear out histamine. So, when histamine and the immune system come into play, I’m definitely thinking LGG as well. And I’ll often put people on multiple probiotics, just because I want really, really specific strains, and I might do one type inside the vagina intra-vaginally, and then one type orally. So, I’m trying to impact the immune system orally, and the gut microbiome, to impact the vaginal microbiome, and then I might want something that’s having a really direct impact on the vaginal microbiome.

Andrew: Gotcha. This is so interesting, I’m learning so much. Unfortunately, we’re sort of running out of time, but I could talk to you all day. This is fantastic, Greta. Thank you. Greta, can I ask? So, people are gonna wanna know, like, have you got any courses that you help practitioners with, or have you written articles?

Greta: This is my ultimate goal, actually. Within the next year or two, I would like to have a practitioner course. At the moment, I just have a webinar that’s for clients, so people who are student naturopaths, you probably will get something out of it, but it is definitely aimed at clients more than practitioners. So, yeah. Keep an eye out in the next year or two. I should hopefully have a course going for practitioners, and going through the kind of nuances of treatment with the vaginal microbiome.

Andrew: We’ll be hassling you to make sure that gets completed. It’s too important, I mean, it…look, it’s too important a topic. Women are really suffering. I’ve… God, the women that I sent to Moira, one woman, she was just, she was so angry, in love with her husband, but furious that every time they made love, something that was supposed to bring them together, she ended up with this horrible infection, and she was again on the roundabout. And it was just this circle of despondency that… So, I’m glad that people like you and Moira, obviously, have found some way of being able to really intercede, in a truly therapeutic way, to help people within their lives. I just, I love what you’re doing. Thank you so much.

Greta:  Thank you. Yeah. Thank you. It’s, yeah. And it just can’t go unmentioned that this has such a huge impact on people’s mental health, and just your sense of self and sexuality, and, you know, your, yeah, your kind of sensual self. It can put you right off sex. So, I think it’s really important that we’re talking about it now, and there’s a lot more information out there.

Andrew: Greta Durston, thank you so much for joining us today. And thank you, everyone, for joining us. Remember, you can pick all of the other podcasts on the Designs for Health website. I’m looking forward to a webinar from you soon, Greta. And all of the information… We’re gonna put up as much research as we can, that’s pertinent for the vaginal microbiota, because it’s such an important and interesting topic, and it’s moving ahead quite quickly now. Thank you so much for joining us today. This is “Wellness by Designs,” and I’m Andrew Whitfield-Cook.