Episode 159 - Antibiotics, probiotics and your healthy vagina in pregnancy
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome everybody to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson and today we're talking all about keeping your vagina healthy during pregnancy and I've invited Rebecca Edwards from Activated Probiotics to talk all about this. I'm going to let her introduce herself and tell us about her expertise and why she is the person that should be talking to us about keeping your vagina healthy during pregnancy. Rebecca, welcome.
Rebecca:
[0:54] Thank you so much, Mel. It's such a pleasure to be with you and your amazing, amazing community. I'm Rebecca. I'm the Director of Education at Activated Probiotics. And essentially what that means is that I get to talk a lot. And I get to talk a lot about my favorite things, which are probiotics, research, human health, and vaginas. Believe it or not, I actually completely love talking about vaginas because I just think they're the most amazing human organ ever. and I think they don't
Rebecca:
[1:22] get enough attention and they definitely don't get talked about enough. So the opportunity to discuss vaginas with a passionate midwife and a community of people who are really interested in what goes on in them and what comes out of them and what's happening in there, this is just a dream come true.
Rebecca:
[1:40] So Activated Probiotics, we're a Melbourne-based practitioner-only probiotic research and production company. We're really interested in looking at what are the therapeutic outcomes that we can achieve by working with the microbiome, where is the research in this incredible world of microbiology, and how can we... The exact right strain of magic probiotic bacteria into the hands or the tummy or the vagina of the person who really needs some microbiome support. So I'm so lucky I get to spend all of my time reading probiotic research, talking about probiotic research, and really hearing about the impact that the right probiotic can make on someone's life and quality.
Mel:
[2:28] And how does one come to be the head of education at a probiotic company? What's your qualification in training?
Rebecca:
[2:37] I think it's really interesting that I'm not sure you can ever actually outrun your destiny. And, you know, medicine caught me, but it caught me in an unusual way and from an unusual angle. And I ended up becoming a naturopath because I was actually secretly quite interested in the way the human body works and in, you know, I suppose the whole field of medical science. But I still wanted to do it my way so had this real rebellion broke my dad's heart went and became a naturopath and from there the world just unfolded for me that I grew up in you know in Perth in Western Australia which is an amazing place to live but feels really isolated and I really wanted to spread my wings and I went and moved to London just for 12 months and ended up there for 10 years.
Rebecca:
[3:22] And I worked as a lecturer, a practitioner. I did lots of different things in the world of naturopathic medicine over there. Ended up with my husband's job in California for a few years and again, did some work in lecturing and education. And I've just always loved explaining, you know, the science and the complex ideas to people to help them take that information and use it to make their lives better. So education has always been this, you know, this kind of thread running through my entire career. Moved to Melbourne a few years ago from the States. So the opportunity came up at Activated Probiotics to, you know, create this role around practitioner education and providing education to, you know, to the community in general. And this is what I've been doing for the last, you know, five or six years.
Mel:
[4:12] So essentially... You've committed all of your time now to exploring the microbiome, how to improve it, probiotics, and you've perfected the art of telling people
Mel:
[4:26] about it, which is what we're going to do today. But I feel like we need to start right at the beginning. If people listening today just have no idea about the microbiome, because that's what we're going to be talking about today. Can you explain to us what is the
Rebecca:
[4:43] Microbiome now my brain is exploding with all the different areas we can cover but to put it really simply your microbiome is the community of microscopic organisms which lives on you and in you you know you think of yourself as a singular being but you are not. You are an entire universe. You are the host to trillions of little lives whose lives depend on you and your existence. Every single surface on the human body, every single cavity, every single liquid, everywhere you have human cells, you have microbial life. So you are a walking cloud of microbes. And they are largely bacteria, but you also have viruses and fungi. And you have this universe of life everywhere. You have more microbes living on you and in you than there are stars in the sky. You have more microbes than and there are grains of sand on the biggest beach you can imagine, you have all of these individual creatures probably isn't the right word, but individual organisms living on you.
Rebecca:
[6:01] We are yet to understand if there is any place in the human body which is sterile. At the moment, we don't think there is. We think that every surface, whether that's your skin or whether it's the internal surfaces in your body, every cavity is absolutely jam-packed with microbes. When we use the word the microbiome, often people are referring to the gastrointestinal microbiome. And this is the largest community of microorganisms. Your microbiome, if you really want to put it into a box, technically it's probably an immune organ or system. We don't officially call the human microbiome a body organ yet. I suspect we probably will one day, but I'm really comfortable calling it a body system. So your gastrointestinal microbiome is really an immune system, if you like, or interplay, but it's not the only significant community of microbes you have. You also have other collections which have distinct differences from what's going on with your gastrointestinal microbiome. One of them is the oral microbiome. The collection of microbes in your mouth is considered to be the second most significant microbiome in human ecology. And it's really different to what's going on in the digestive tract because it's serving different purposes.
Rebecca:
[7:16] And then the microbiome that you and I are going to be discussing today is the vaginal microbiome. And this is really different from what's going on in both the gut and the mouth. And again, it's serving different purposes. It's doing different things and it has different properties. And generally, when we use that word, the microbiome, and we're talking just about the gastrointestinal microbiome, what we want to see going on with the digestive microbiome is actually really different from what we want to see going on in the vagina. Everyone has a completely unique gastrointestinal microbiome and it's dynamic it's constantly changing the microbes that are currently present in your digestive tract right now at this moment they may be quite different tomorrow or even later on today depending on what you're eating or what's going on with your hormones or how much movement you're doing or where in the world you are. And there's a lot of this change is being fed by, literally fed, by what you're putting into your body.
Rebecca:
[8:19] While everybody on this earth has a unique microbiome, your microbiome is as unique to you as your fingerprint. The one thing we're really confident in saying about the digestive microbiome is that diversity correlates to greater health outcomes. So generally, if we're working with someone's digestive microbiome, what we're aiming to do is enhance the presence of a range of microbes. We want to see more diversity, but that's almost the opposite to what we want to see in the vaginal microbiome. It's not diversity we need to see in the vagina, it's stability.
Rebecca:
[8:55] And that's because what's going on in the vagina is really different to what's going on in the digestive tract. What's going on in the vagina is so much about protection because one of the reasons the vagina is my favorite organ is because she's doing double duty. She is not just a reproductive organ. She's also a really important immune organ because she's the gateway to the uterus and the rest of the upper reproductive tract. Yes, the vagina is about allowing things in and things out, but it's also significantly about protecting this place where a baby may be developing. The vagina maintains this really important acidic pH to help restrict the growth of pathogens and thus reduce the likelihood of an infection ascending into the upper reproductive tract.
Mel:
[9:53] What I'm hearing is that essentially every single part of our body is covered by an ecosystem of little microorganisms that obviously have a particular function in each individual area and that the microbiome of our gut is different to the microbiome of our mouth and our vagina and I assume our ears and all the other organs have their own microbiome that correlate with a particular function. They all have a job to do but it might be different to the other collection of microbiomes around the body. So we know what the microbiome is. We know that the different parts of our body have different microbiomes and there's a growing area of research around what happens when to us when that microbiome is out of balance.
Mel:
[10:44] So what causes imbalances in our microbiome?
Rebecca:
[10:49] So because it is, you know, this dynamic system, it's responding to everything that we are living through as humans, essentially. We now have a developing understanding and a pretty good understanding that a lot of the chronic health challenges we see in modern life may be related to disturbances in the microbiome or really significantly and really interestingly a deviation in the normal maturation of the neonatal microbiome. So what I mean by that is anything that could potentially disrupt the initial colonization and development of microbial communities in a newborn baby may actually have lifelong consequences. And this becomes really relevant in your area of work.
Mel:
[11:39] This is what I want to stop you right there for a minute, because this is one of my big concerns and fears for us as a human race. Because so many women, And I think it's something upwards of 30% to 50% of women will have antibiotics during labour for various reasons. And we know that that can be one of the things that disrupts our microbiome. But you're saying that if a baby is exposed to an altered microbiome at the time of birth, that has a lifelong impact upon the maturation of their microbiome?
Rebecca:
[12:22] Potentially. So there's, you know, there's still a lot of understanding that we need to attain. So I'm really careful about speaking in absolutes.
Rebecca:
[12:32] What I'm really confident in saying at the moment is that we understand that where there is an interruption to the normal development of a baby's microbiome, there is an increased risk of several immune outcomes. Some of those which have been most studied include atopic conditions such as asthma and allergies. And we know that something that's really relevant to us here in Australia, we have one of the highest rates of pediatric allergic conditions in the entire world. And I know that there is research looking at the relationship between Australia's significantly higher use of intrapartum antibiotics and our higher rate of pediatric allergies. So things that can disrupt the normal development of the neonatal microbiome include.
Rebecca:
[13:32] Antibiotics during pregnancy, antibiotics during labour, antibiotics administered directly to the neonate after birth. We're not so sure about the impact of antibiotics given to breastfeeding mums yet. We, you know, need to understand more research there. We understand that mode of delivery can make a difference to the acquisition of the microbiome. You know, we understand this makes a difference. It may not be as significant a difference as we've previously focused on because the factor that is most likely to be shaping the ongoing development of the microbiome is mode of feeding.
Rebecca:
[14:10] So breast milk itself is a probiotic. It's absolutely teeming with bacteria. Every mouthful of breast milk is full of probiotic bacteria, if you like. You know, it wasn't that long ago that we were talking about breast milk as though it was sterile, but contained prebiotic substances. We now know that's not true. We know that it's full of both bacteria and the prebiotic substances or the fuel source to help encourage the blooming process.
Rebecca:
[14:43] Of bacteria in the baby's digestive tract. We also know that when babies latch onto the nipple to feed, that they're also encountering the maternal glycobiome. So the community of microbes, which are present on the surface of the nipple itself. And, you know, you've been a breastfeeding mom. I'm sure you've got lots of breastfeeding moms listening to this. You know that when you're breastfeeding, you've got milk everywhere and you've got all of those, you know, kind of wrinkly folds and nooks and crannies and creases on the surface of the areola. And milk, microscopic amounts of milk collects in all of those little folds and bacterial colonies form. And when you latch the baby onto the breast, the baby is taking in bacteria, not just from the milk, but also from the skin as well. So the mode of feeding, we know, influences the development of the microbiome. And then we've got other factors as well. So we develop our microbiome vertically and horizontally.
Rebecca:
[15:42] Vertical transmission is from mother to child. So this is during pregnancy. This is during birth. This is during breastfeeding and skin to skin. But then horizontal acquisition is the way the microbiome is influenced by interactions with the community. This is something that I love to talk about, the importance of babies being cuddled by different generations in the family. But we know that we are in an era where we're actually seeing microbiome loss at the moment. Every generation of humans is essentially being born with a narrower and less diverse microbiome than the generation before. And we're aware of many what we call ancestral species of human microbiota, which have been lost. We don't see those anymore. So if we can, giving a newborn baby to grandma or great-grandma to have a kiss and a cuddle may be allowing the transmission of some of great-grandma's ancestral microbes to then colonize into this little developing new person.
Rebecca:
[16:48] But we also know that it's really interesting, birth order plays a role in the development of your microbiome. We know that children who are subsequent children, those who have older siblings, they're more likely to have more microbial exposure and exhibit a diverse gastrointestinal microbiome, which is what we want, because those older siblings are themselves bringing microbes back into the home. And this is then allowing for exposure to these more diverse microbes coming into the home as well. We also see a significant reduced risk of these allergic conditions in children who grow up rurally, who grow up on farms and again the hypothesis is that they're having a greater microbial exposure because of their interactions with animals and soil.
Rebecca:
[17:39] So the environment plays a role in assisting the development of the microbiome, as well as human interaction, as well as obviously what you're eating. And then, you know, that comes back to the whole mode of feeding in the first few months of life, when we know that breast milk shapes a microbiome more associated with health than babies who are given formula. But as solids begin to be introduced to the baby, this is when we see a blooming in diversity. And every different type of food will essentially be providing substrates or fuel sources for different microbes. So we often talk about, you know, eating the rainbow or eating a variety of
Rebecca:
[18:24] foods as being one of the best ways to help shape a more diverse and healthily composed microbiome. So wherever there is a disruption to any of these processes, this is where we may see a deviation in the normal development of a child's microbiome, which may then predispose them to a greater risk to, you know, one of these conditions associated with a less than optimal immune response.
Mel:
[18:55] So we collect our microbiome over our life cycle. Part of that is at birth when babies pass through the vagina and that an interruption in that passageway, so via cesarean section or the use of antibiotics during labour that can impact it. And we did look into this at one of the episodes that we did with Dr. Sarah Buckley. We had a look at the recovery phase and I suppose I want to give some hope to some parents out there who are thinking, oh, man, I had antibiotics and I had the cesarean section and what's going to happen to my baby? There is research about the recovery of the microbiome and with conscious effort, knowing what impacts it and what enhances it, they have done some research and found that within one to two years you can restore the baby's microbiome to, you know, to kind of catch up to the babies who perhaps were born vaginally or whose mothers didn't have antibiotics. So one of the messages too is, yes, the microbiome is sensitive to things that can create an imbalance. You know, our modern lifestyle, a lot of our food is sprayed, the soils are depleted, not only in nutrition, but also in microbial biodiversity.
Mel:
[20:12] And also, I think the sanitation of society, you know, we're all about a kind of, I feel like we're assaulted with imbalanced opportunities throughout modern society. And some of the counteractive measures could be to, you know, touch the soil, get on the ground, get a little bit dirty. Let's not be too scared because not only are we avoiding or trying to avoid pathogenic bacterias, where simultaneously we'll be preventing ourselves from attracting good bacterias that can diversify our microbiome.
Rebecca:
[20:45] I always encourage people to remember that your microbiome is dynamic. It's not static. It's not set. And you have opportunities to influence your microbiome with every decision you make, especially around what you're putting in your mouth. So your diet becomes your best opportunity to interact with your microbiome. And it sounds really boring, but, the best advice that we can possibly give for probably just about any health condition out there rings true for looking after your microbiome, which is eat more plants. Eat more plant food. This is the single best piece of advice we can give about your microbiome. Eat as many different plant foods as you can every week.
Rebecca:
[21:30] Where there has been research in this area, the bit that has been done indicates that eating 30 distinct different plant foods a week has been shown to enhance the diversity of your microbiome. That's actually not as hard as it sounds because the definition of a different plant food can be as simple as eating a pink lady apple versus eating a golden delicious apple versus a granny smith apple. The different polyphenols and fibers that are present in these different species will be supporting the growth of different microbes in the gastrointestinal tract.
Rebecca:
[22:09] So eating different types of fruit and vegetables, drinking different types of tea. Tea is amazing for your microbiome diversity. You know, making sure you're adding herbs and spices to your food. All of this is providing different substrates into your digestive tract. So you've got lots of opportunities to interact with your you know the little pets that are living inside you if you like think of them like that as little fellow travelers with everything that you're putting into your mouth and then obviously we've got interpersonal interactions as well that you know when you kiss someone you're exchanging millions of microbes into each other's mouths and this may be having an influence on your oral microbiome and oh my goodness if we want to go down a rabbit hole we can talk about the relationship between the oral microbiome and pregnancy outcomes.
Rebecca:
[23:02] Pregnant woman is oh my gosh such an incredible universe all in herself but the placental microbiome because yes there is a microbial community living on the placenta of course there is the placental microbiome has more in common with a pregnant woman's oral microbiome than it does with her gastrointestinal microbiome and this is one of the reasons why looking after your oral health should be such a priority during pregnancy and ideally before pregnancy but you know life doesn't always work like that but looking after your oral health is one of the best things you can do for your microbiome health during pregnancies and.
Mel:
[23:43] I want to put a plug in here for you know you're talking about vegetables I also think you can even go one step further and this is something that I've tried to do for my kids one of the motivations for gardening for me grow my veggies with the manure that my animals poop out because I realized that the soil, the quality of the soil and the diversity in the soil can directly impact the health and diversity on the veggies. And I'm like, how can I get as much diversity into my kids? And sometimes, a lot of times, if the veggie looks clean from the garden, I won't even wash it because I'm like, no, it's like that's a valuable microbiome down the sink instead of in their bodies. So I want to ask about this issue of antibiotics during pregnancy and birth, because so many women are exposed to them. What impact does antibiotics have on the microbiome? Is it catastrophic or is
Mel:
[24:44] it short-lived, long-lived? What happens when you take an antibiotic?
Rebecca:
[24:48] It's a really good question. And I think the answer is different depending on which microbiome community we're talking about. So if in thinking about the context of this conversation, let's focus on what happens in the vagina when you take an antibiotic. And we've acknowledged already that a lot of women in Australia in particular are administered antibiotics at some stage of their perinatal journey. The way that antibiotics work is that they need to enter your bloodstream to fight the infection. And this is because every part of the human body is supplied by our systemic circulatory system. This is how oxygen and nutrients get to all of our cells. Your blood supply is linking every cell in your body. So if you have an infection in your big toenail, you're still going to swallow antibiotics orally. And most antibiotics are designed to make their way intact through the stomach and then in the first part of the digestive tract, the duodenum, be absorbed very quickly across the duodenal wall into systemic circulation. So the impact that antibiotics have on, say, your gastrointestinal microbiome is not through passing through the digestive tract. It's almost from the other side. It's from being in the bloodstream.
Rebecca:
[26:12] In your digestive tract, you've got all of these folds and nooks and crannies where your microbial communities live. And all of these little areas are being supplied by your systemic blood supply through the gastrointestinal wall. So the way that antibiotics are negatively impacting your gastrointestinal microbiome is through your circulation. When it comes to the vagina, it's the same story that, you know, you're not taking, if a woman is given antibiotics during labor, the antibiotics are not being put in her vagina, they're being put in her bloodstream and they're being put there either through oral administration or intravenous administration. So they're in the blood and then all of the microcapillaries, which are supplying energy and nutrients to the vaginal wall, will then be carrying these.
Rebecca:
[26:57] Antibacterial metabolites to reduce the presence of this bacteria. So that's kind of always setting the scene with antibiotics, that they're working from your blood, not from your gut or not from your vagina. And there are topical applications like skin conditions, for example. You may put an antibiotic cream or ointment directly onto an infection, but if we're talking oral antibiotics, they're in your blood. So the impact they have on your microbiome, depending on the type of antibiotic and the type of bacteria they're affecting, will be to see a rapid diminishment in both the number and the diversity of that microbial community. So what we see in the digestive tract and the vagina is a, you know, a reduction in the presence of microbes which normally inhabit those spaces.
Rebecca:
[27:48] This is where things get really interesting because, you know, what's that saying? Nature abhors a vacuum. Well, microbes are opportunistic little packets, I'll tell you that. And this is where we see this rapid but temporary diminishment of our own microbiome, which we call our commensal microbiome. When we see a diminishment in our commensal microbiome, we see essentially vacant real state is suddenly created, that there are all of these surfaces and nooks and crannies where there is this rapid reduction in the number of microbes who normally live there. And this then presents an opportunity to what we call pathobionce.
Rebecca:
[28:31] Pathobionce is a name we give to microbes who are neither good nor bad. So we might talk about good bacteria in terms of different genera of bacteria, Like, you know, you're probably familiar with things like lactobacilli and bifidobacteria. And these are, generally speaking, what we'd consider good bacteria. Then we've got what we might call bad bacteria or pathogens. And this might be things like Clostridium difficile, or it might be like hemorrhagic strains of E. coli. And these are, you know, unarguably bad bacteria. But we've got an awful lot of microbes that exist somewhere in the middle. They're neither good, you know, being associated with health promotion, nor bad, being able to cause disease.
Rebecca:
[29:15] Their, you know, goodness or badness depends on their number. And if their numbers are generally quite low and kept quite low due to the presence of our own protective microbes, they're not causing any harm.
Rebecca:
[29:30] But if they are able to rapidly proliferate, to reproduce at a great speed, and their presence in that part of the body increases significantly and very quickly, they can begin to cause problems. And a great example of this would be not a bacterium, but would be candida, which is a type of fungus. Most of the time, many of us will have small levels of different species of candida in the digestive tract, in the vagina at any time. It's not, strictly speaking, a commensal microbe because it's not health-promoting, but it's not a pathogen because it's not disease-causing unless the numbers can increase rapidly. Now, let's say we've now talking about the vagina, we've got someone taking antibiotics. There's been a sudden drop in the number of lactobacilli, which usually live in the vagina because they've been killed off by the presence of these antibiotic metabolites in the bloodstream. Now suddenly, candida, which lives in very small numbers in the vagina.
Rebecca:
[30:33] Sees all of this great open space that is there for the taking, and it begins to colonize all of this mucous membrane tissue and rapidly begin to expand its colonies, have lots of babies very quickly. So now you've got an enormous shift in this microbiome in the vagina, which is normally composed significantly of lactobacilli, now with the lactobacilli going on a little holiday, you've got the opportunity for candida to begin to, you know, significantly grow. Or there may be other bacterial microbes, which again generally exist in very low levels in the vagina.
Rebecca:
[31:09] If they're not as affected by the type of antibiotic given, again, they've got this opportunity to grow quite quickly. And then we see a big shift in the microbial landscape. So this is one of the ways that antibiotics can cause a noticeable shift in the vaginal microbiome. There can be less noticeable shifts. There can be, you know, microbial growth that may not produce significant symptoms that someone may not notice.
Rebecca:
[31:38] In terms of what happens next, in an ideal world, when the antibiotic therapy is ceased and conditions in the body return to normal, if you like, we ideally would see a return to a commensal microbiome which somewhat resembles the microbiome we had before the antibiotic therapy. And again, this is an area where we still need more research. We still don't really understand exactly how someone's microbiome, whether that's the oral microbiome, the gastrointestinal, the vaginal or other, how exactly it is impacted by antibiotics and how long it takes to recover and if that recovery is complete. There's not a huge amount of good quality research in this area yet. For a lot of people, they might come to you with a problem and they'll say it all started after a course of antibiotics or, you know, an illness that ended up with a treatment for antibiotics. And for a lot of, you know, vaginal pathologies, that can absolutely be a thing that we see a lot of women with recurrent thrush, for example, who say, well, look, it's never really been right since I had, antibiotics.
Mel:
[32:48] You were talking about the imbalance, the growth of candida, and that's one of the main things that grow if you're getting symptoms of thrush.
Rebecca:
[32:56] Yeah, well, it's really interesting. You know, the world of vaginal pathologies is fascinating. And this is an area where I think women have not been well served. But for a lot of women, they've always felt and been educated that if anything feels off down there, you know, if there's any kind of itching or unusual odour or discharge, it's going to be thrush.
Rebecca:
[33:15] But the thing is that thrush or candidiasis is actually not the most common
Rebecca:
[33:21] vulvovaginal infection or imbalance. You're actually more likely to experience bacterial vaginosis than you are thrush or candidiasis. But bacterial vaginosis is very often misdiagnosed as thrush. And bacterial vaginosis or BV is itself a really interesting condition. And, you know, goodness me, we're learning more about this all the time. But BV is interesting because it's technically, it's a vaginal dysbiosis or bacterial imbalance rather than a true pathogenic infection. What we see with BV is notably a shift away from a protective acidic pH. And this comes back to what I was saying earlier about, you know, the different functions that the vagina is performing. It's not just a space for semen to reach the uterus and for menstrual blood and babies to get out, that it is this really important layer of defense. And the way that the vagina does defend the upper reproductive tract is through maintaining an acidic pH.
Rebecca:
[34:31] The reason this is important is because many microbial pathogens find it harder to proliferate or breed in a more acidic environment. So by being significantly more acidic than the digestive tract or than the surface of the skin or than other parts of the human body. The vagina can selectively allow the growth of different pathogens. And this can be one of the potential consequences of a disruption to the vaginal microbiome, such as we see in antibiotic use, that the reason the vagina maintains this acidic pH is due to its dominance of one particular genus of bacteria, lactobacilli.
Rebecca:
[35:15] Lactobacillus is the name we give this genus of bacteria, which are rod-shaped bacteria. And the reason they're called lactobacilli is because there's nothing to do with lactose. I get this question all the time. Is this bacteria that are found in milk? No, not at all. Lactobacillus is referring to the production of lactic acid. Lactic acid is an acidic metabolite which is released by these bacteria as they ferment or feed on different substrates or fuel sources. In the vagina, their main source of fuel is glycogen. Glycogen is produced in the wall of the vagina under the influence of the hormone estrogen.
Rebecca:
[35:58] So when we have a woman of what we call menstruating age, someone who has essentially reached puberty and has not yet gone through menopause, then we have a significant presence of estrogen in the bloodstream, which then allows the vagina to produce plenty of glycogen, which then feeds the growth of lactobacilli. And one of the main purposes of lactobacilli is to produce this lactic acid which keeps the vagina acidic. Keeping it at a lower pH or a greater acidity means that we then reduce the opportunities of potential bad bacteria or pathogens or things like candida which also you know doesn't always love an acidic environment. We're reducing their opportunity to grow and proliferate. And thus we are keeping upper reproductive tract, you know, safer. So that then becomes interesting when we see a reduction in lactobacilli due to antibiotic use. We will then often see that we lose this protective acidic pH and we then see more diversity in the vagina. And this is where our desires for the gastrointestinal microbiome and the vaginal microbiome are totally different. Coming back to a healthy digestive microbiome is diverse. A healthy vaginal microbiome is not diverse. It is stable. And that stability comes from the dominance of lactobacilli.
Mel:
[37:24] So with the kind of common pathologies that happen inside our vaginas, so if we're thinking thrush and bacterial vaginosis, you're saying that's not... An infection as we know it, it's an overgrowth and undergrowth and an imbalance in the microbiome. And so we're not fixing bacterial vaginosis like we would fix other bacterial issues that we have in our bodies. You know, if you have a bacterial infection, you think, great, I'm going to have antibiotics. But this version of bacterial dysbiosis, maybe we'll call it, antibiotics isn't the answer. And you may have seen it too but you know my first qualification was in naturopathy as well and we used to talk about the boric acid suppositories for bacterial vaginosis and dysbiosis and is the idea behind restoring the acidity of the vagina is to restore that balance rather than sort of kill stuff.
Rebecca:
[38:31] Yeah this is really interesting because when we see women being treated for BV and that treatment is antibiotics, the hypothesis here is that by killing off the bacteria which are overgrowing, if you like, in this dysbiotic vagina, you are then taking back the space for the lactobacilli to re-establish themselves. But the thing is that 25% of women treated for BV relapse within one month and 70% of women experience long-term recurrence. We know that antibiotic use is not an effective way to treat BV.
Rebecca:
[39:12] And to me, the whole philosophy is wrong. It's not just about let's find the baddie and take him out. It really needs to be about, it's not just about, you know, hunt and destroy. It's about feeding the, creating the environmental conditions that allow for the restoration of a healthy vaginal microbiome. And this really means helping to restore that important pH.
Rebecca:
[39:38] We also need to look at other factors such as, you know, what is a woman's oestrogen status? And this is, again, really interesting in the intrapartum or perinatal space because we know that genitourinary syndrome of breastfeeding can make a difference to a woman's vaginal health status as well. That when you are breastfeeding and there is this lactational ovulation suppression, that this can reduce levels of estrogen, which can then make it a little bit more difficult for the vagina to sustain its normal acidic environment. And this is where we may need to look at providing more support with perhaps specific species of vaginal, you know, probiotic bacteria, which have been shown to help regulate this space.
Mel:
[40:27] And my understanding too of pregnancy and why women are more prone to dysbiosis in their vagina during pregnancy is that it's quite a progesterone-dominant state when you're pregnant. And that in itself, paired with the reduction in estrogen, reduces the acidity in your vagina. And so there's some women who just cannot get rid of their bacterial, vaginal bacterial issues in pregnancy because of the hormone scenario that they're in. I mean, this is the thing. We're so used to thinking about the body's inner reductionist way and I feel like the microbiome is you can't help but acknowledge the interconnectedness of the body when you're talking about the microbiome. So for us to be speaking about the microbiome of the vagina, it would be remiss not to discuss the interconnectedness of that and I know that by trying to just talk about vaginal microbiome, we're really coming at it from a medical and reductionist way. And I'm curious to know, you know, when you talked about the antibiotics travels through the blood and therefore it has a direct impact on the microbiome in the vagina, is the same thing happening to all the other microbiomes all over your body at the same time as well? Because it's a great question.
Rebecca:
[41:47] And the answer is yes. That when you take, you know, when you take a systemic antibiotic, when you take it orally or when you take it intravenously, it's going to have an antibacterial effect on every microbiome. Yes.
Mel:
[42:01] Because you're taking, you know, it's like, how do you, how does the antibiotic know where to go? You know, women get an antibiotic when they have a cesarean section, sometimes if they've had a third degree tear or an episiotomy or for whatever reason, how does it know where to go? Well, it doesn't specifically go to the spot that's infected or the spot that's at risk of being infected. It goes everywhere. It's the whole thing. everywhere. And this is the argument that we have when we're using
Mel:
[42:27] Preventative antibiotics for things like a GBS infection as a routine thing and you know the UK has got some great research that's come out of there about why they don't routinely screen and use antibiotics for GBS and it's because we don't fully understand the impact of antibiotics on our bodies but also we know that the overuse of antibiotics is already creating a problem that we already know of, you know, reserve them for really serious circumstances for when you actually need them rather than in maternity care, they are just thrown around like, well, these antibiotics and it just, there's this huge overuse. I suppose part of why I wanted to talk to you about this is to remind people that we can't flippantly be using antibiotics because they do have an impact on our microbiome and the long-term well-being of ourselves and our babies. And if you aren't consciously correcting that or you don't even know that you have to correct it,
Rebecca:
[43:31] It could be.
Mel:
[43:33] A source of lifelong illness for you and your child and you don't even realise where it's come from. And it might sound a bit sort of too much to be saying that, but I don't think it's far off the mark.
Rebecca:
[43:45] But every time you are taking a course of antibiotics, there are consequences. And there needs to be a risk-benefit analysis performed. And, you know, I definitely know that there is a lot of interest in the medical community in reducing the overprescription of antibiotics.
Mel:
[44:04] But also maybe we can chat about is there something we can do to alter the amount of GBS, group B strep, in our vaginas? Because the stat that gets thrown around is that approximately 30% of women, if you swabbed everybody in the street, would have GBS, positive GBS in their vagina. It generally doesn't cause us a problem. On the odd occasion, it can cause a baby a problem. Is there a strain of probiotic that women could use to avoid swabbing positive for GBS?
Rebecca:
[44:41] Potentially. And again, I'm just going to preface this answer by saying the research is not there yet, but we can talk about the mechanisms we do understand. So when I was using that term, lactobacilli dominating the vagina, et cetera, we just now need to have a little kind of conversation about microbiology here. When we talk about bacteria, we break them up into several different categories, if you like, or to name them. Let me give you an example of, say, a probiotic supplement you might, take that you might purchase from your pharmacy or naturopath. If you have a look at the box, you'll notice that the bacteria have three parts to their name. So I'm going to give you an example here, Lactobacillus plantarum 299V. This is a really well-researched strain of probiotic bacteria.
Rebecca:
[45:31] Lactobacillus refers to the genus of bacteria. And in Australia, most probiotics are coming from one of two genera. They're either coming from the Lactobacillus genus or they're coming from the bifidobacterium genus. And a way to kind of make this visual and understandable, I've got a little analogy that I find works really, really well. If you imagine that the genus of bacteria is something equivalent to a primary school, imagine the school that your kids go to or that you went to as a little one or a school near you, imagine that that is the school of lactobacillus. And all of the kids who go to that school, every day they're walking under a doorway that says lactobacillus and they're all school kids. And there's another school across town, which is also a primary school full of kids, and that's the school of bifidobacterium. And all of those kids, they wear a different uniform, but they're still school children. They just go to a different school.
Rebecca:
[46:20] So that's kind of equivalent of the understanding of a genus of bacteria. Within this primary school, the Lactobacillus school, you've got lots of different classrooms. And we can think about each classroom as like a species of bacteria within the Lactobacillus genus. So in the Lactobacillus school, we might have an Acidophilus classroom.
Rebecca:
[46:40] A Rhamnosus classroom, a Paracaceae classroom, a Plantarum classroom, a Crispatus classroom. And these are all species of bacteria within this genus of Lactobacillus.
Rebecca:
[46:52] So if we think about the Plantarum class, we walk into this classroom, we open the door, we've got 30-odd kids sitting in this class, and they all represent different strains of Lactobacillus Plantarum. So there's a 299V, there's a 6595, there's an LPO1, there's a HEAL9, there's a KA-BP12. These are all different strains of lactobacillus plantarum and they're all doing different things in the same way as you've got 30 kids in a class who have got a lot in common who have similar knowledge who know how to do similar things but they're still individual students so in any classroom you've got kids all learning the same things but you've got one who is just innately good at maths you've got another one who's a poetry genius you've got another one who can throw a football further than anyone else. And these are just their natural talents that they can do better than anyone else. In the same way as you've got, you know, Plantarum 299V, we know can, for example, has been shown to enhance the absorption of iron from iron supplements. We know that Plantarum LP01 has been shown to reduce constipation. We know that Plantarum KABP12 has been shown to reduce high cholesterol levels. So it's about matching up the exact strain of probiotic with the outcome that you want to see in your patient.
Rebecca:
[48:17] Getting back to the whole vaginal group B strep issue.
Rebecca:
[48:22] It's not just about flooding the area with lactobacilli. It's about understanding that different species and even different strains are performing different functions or mechanisms. And what's interesting is that generally we use the term lactobacilli, just talking at this genus level, to be associated with overall vaginal health and maintenance of this protective pH. But there's a species of lactobacillus which is especially good at maintaining this acidic pH and that is a species called lactobacillus crispartis.
Rebecca:
[49:01] So crispartis is one of what we call the native vaginal species of lactobacilli and of all of our understanding of the vaginal microbiome at this point in time we're most confident in saying that a vaginal microbiome which is significantly dominated by the presence of Lactobacillus crispartus, is the microbiome profile least associated with a number of vulvovaginal infections or representations. So where we have high presence of crispartus, we are less likely to see bacterial vaginosis. We are less likely to see colonization by group B strep, by E. Coli, by Gardnerella vaginalis, by Klebsiella, by several different either pathogens or pathobionts. And there's a reason for this.
Rebecca:
[49:52] Crispatus of all the native vaginal species is the one which produces the most lactic acid, the most hydrogen peroxide. So it is essentially the most effective at maintaining this acidic environment. It's also a really cool little microbe in that it has a special interaction with immune cells in the vaginal environment and essentially primes them to be more effective at suppressing the proliferation of pathogens or pathobionts. So Crispartus has this unique relationship with the vaginal immune defence as well as maintaining pH.
Rebecca:
[50:33] When we look at microbiology mechanistic research, we see that there is a negative co-occurrence pattern between lactobacillus crispartis and group strep B. And what that means essentially is that where you have a significant presence of crispartis, you do not have an environment where group strep B is able to overgrow easily. Now, that's about the extent of what we can say confidently from research, is that where we have high presence of crispartis, we're less likely to see an increase in the significant presence of strep B. I cannot tell you that there is research showing that using a probiotic-containing lactobacillus crispartis will result in a negative group B strep test because that research hasn't been done. So I cannot make that confident statement, but I can tell you that the understanding of the microbiome is where we have a high presence of crispartis, we are less likely to see an overgrowth or presence of strep B.
Mel:
[51:40] So that's the lactobacillus Crisp Artists.
Rebecca:
[51:44] Strip Artists, yes. Which I think is a really cool word, yeah. C-R-I-S-P, crisp, and then A-T-U-S, Artists, Crisp Artists.
Mel:
[51:53] Okay, so for you staying at home, for women who have a particular interest in reducing the potential of having GBS in their vagina, it's something they could try. Yes. You seek out a supplement with this particular strain. And I know when I was pregnant, suffering from thrush, there was a particular strain that was pretty much in all of the candida probiotic formula, one of the bolati strains. Yeah. I want to say sacramental, that one.
Rebecca:
[52:27] Yeah. And, you know, this is where I think it's great to get professional input. If you you know we know we now know so much more about the world of probiotics than we did I often think back when I was a naturopathic student like 25 years ago probiotics were talked about like they were just all one thing you know so you'd treat your patient using your herbs and your dietary therapy and then you'd tell your patient and get a probiotic and get it from the fridge in your health food shop because you know they need to be in the fridge to keep them alive and we look we now know that's absolutely not true that probiotics are actually not particularly temperature sensitive. It's not about the temperature. It's much more about keeping them dry than keeping them cool.
Rebecca:
[53:09] And we, you know, no longer kind of give that advice about they need to be in the fridge. They definitely don't. But we also now see the world of probiotics as almost an entire world of medicine on its own. That like we were just talking about with all these different, you know, understanding the genera, the species and the strain, that every strain of probiotic bacteria is like its own individual medication or its own individual herbal medicine or nutrient or, you know, homeopathic or whatever form of medicine you like to use. Think about every strain of probiotic bacteria as a distinct, discrete entity. In the same way as you wouldn't, you know, expect if, imagine going into a pharmacy and saying to the pharmacist, I've got a headache, what do you recommend? And the pharmacist saying, ah, you need medication. take medicine and you'll be fine you wouldn't say to someone oh you've you know you want to prepare your vaginal microbiome for a strep b test take a probiotic you wouldn't you would talk about the different probiotic types that may be able to confer that therapeutic outcome and this is why i think you know conferring with a practitioner a professional who has a good understanding of probiotics becomes really important and this is why it's so exciting to, you know, to talk to a midwifery community about probiotics.
Mel:
[54:34] Well, in your professional opinion, If a woman was thinking, right, I'm pregnant and I want to take something, some probiotic strains that are going to give me the best chance at good vaginal health, which strains would be kind of our best bet?
Rebecca:
[54:51] Yeah, for sure. So again, depends on what outcome we're looking to achieve, but I would absolutely be looking for a product containing Lactobacillus crispartis. If we've got additional concerns, there are additional probiotics I'd be looking at. So for example, someone who's prone to candidiasis or thrush, there are two particular strains I'd be looking for there, Lactobacillus fermentum LF10 and Lactobacillus acidophilus LAO2. And those two strains studied together have been shown to significantly reduce the recurrence of vaginal candidiasis. So, you know, there's this whole world of probiotics to look at, but those are definitely three I would be looking at. And that actually brings us to another question, which is how do you get these probiotics into the vaginal microbiome?
Mel:
[55:40] I was just about to ask you that because I discovered the world of vaginal probiotic suppositories during pregnancy and it's something that benefited me. And so just as a consequence, I offer it as an option to my clients who are struggling with vaginal biotic imbalances and recommending suppositories over oral dosing. That could be completely off the mark, but I'm very keen to hear what you think about the idea of sort of direct application of probiotics into the vagina as a way of recolonizing or balancing.
Rebecca:
[56:21] Well, it's a really fun conversation because you get to talk about bacteria in all these crazy ways because a lot of the research on vaginal outcomes in
Rebecca:
[56:31] probiotic therapy is actually being done on oral ingestion. And then this poses the question, if you're swallowing the probiotic bacteria, how are they getting into the vagina? And the answer is fascinating. So the leading hypothesis here is that the vaginal microbiome is actually seeded from the rectal microbiome. That bacteria are making their way to the vagina from the rectum. And that the perineum is essentially a bacterial highway that's.
Rebecca:
[57:07] And there's a reason why all of these places are existing in such tightly packed real estate, that there is communication constantly between the urethra, vagina, and anus. And so when we take probiotics orally, they're actually emerging from the rectal opening and then being selectively uptaken by the vagina. There's some really cool research that shows that women who have what the researchers call the highest rectal reservoirs of Lactobacillus crispartus, so in other words, a rectal swab has found high levels of crispartus living in that area, women with the highest rectal levels of crispartus are the least likely to experience a vulvovaginal infection. And this supports that hypothesis that the vaginal microbiome is being significantly influenced by the rectal microbiome. Now, there's a really different pH change, you know, pH environment between the rectum and the vagina. And so all of the rectal bacteria are not going to be able to be taken up by the vagina. It selectively allows, and this is why the vagina is so cool.
Rebecca:
[58:22] Selectively allows proliferation and colonization by species of bacteria which have this high acid tolerance. And this is also really interesting because when we take these vaginal probiotics orally, they are not being destroyed by stomach acid, which can be a problem for some orally ingested probiotics. That your stomach acid is inherently naturally antibacterial. It's protective. It's an immune organ itself. But these vaginal species, they're acid tolerant. They're actually not bothered by stomach acid. So they're just making their merry way through the digestive tract. They're emerging alive and, you know, undamaged from the digestive process at the rectum and then making their way across the perineum and influencing the vaginal microbiome in that way.
Mel:
[59:14] That is so fascinating and the first time I've ever heard that in my 25-odd years in the natural medicine world and in midwifery. So when we take it orally, it travels all the way through the digestive system and that was one of my questions is how does it survive because they've always been pitched as really delicate and if they get too warm or they get sun on them or whatever, they just die. And then, so they're acid tolerant. They're traveling through your gastrointestinal tract, ending up in the large intestine and then traveling from the large intestine into our vaginas across our perineum and colonizing the vagina that way. And then, so it's not like they're not traveling through the blood like an antibody.
Rebecca:
[1:00:02] Yeah, that's a really important point. Really, really important. Probiotics never enter your bloodstream. And this is one of the reasons why they're considered such a suitable intervention to use alongside medications, because they're not going into your blood, which means they're not in your liver, which means they're not able to disrupt the metabolism of medication. So unlike many things like different herbal medicines or even different nutrients, vitamins, minerals, they're not going to disrupt the way a prescribed or over-the-counter medication is going to act on the body. So they're so suitable to use alongside whatever else is going on. So the way that probiotics work, what they're doing, a lot of people have this idea that you take a probiotic to recolonize your digestive tract or rebuild your microbiome or put good bacteria back in. It's actually not what they're doing. The probiotics that you're taking are not becoming part of your microbiome. They're not colonizing. They're not rebuilding.
Rebecca:
[1:01:02] They're not even hanging around. They're just passing through. You know, we always like to say that probiotics are here for a good time, not a long time. They're just making their way through your digestive tract. They are emerging out the other end. They're ending up in your toilet. But it's the interaction they have with the mucous membrane surfaces as they're passing through with your own commensal microbiome, with your immune cells as they are passing through, which leads to significant change. When it comes to the vagina, those microbes which are making their way through the digestive tract across the perineum to the vagina, they're also actually not colonizing the vagina. They are influencing the vagina.
Rebecca:
[1:01:45] The environment to allow the vaginal microbiome to regulate itself. And this is why I love them so much because they truly are working with the body to bring itself back into homeostasis or balance. So if you're taking a probiotic with lactobacillus crispartis, what the crispartis is doing that you've taken when it comes into contact with the vagina is it's feasting on the glycogen or other substrates present in the vagina. It's producing this lactic acid and hydrogen peroxide metabolites. It's encouraging the vaginal immune system to suppress the proliferation of any baddies or pathobionts. And then that bacteria itself is then essentially being lost. It's not sticking to the vaginal wall and forming colonies, but its influence is allowing the vagina to re-establish its own balance. How cool is that?
Mel:
[1:02:42] It is so cool. And I knew that not all probiotics, I mean, they're saying not really all, any of the probiotic supplements hang around and recolonize. They're creating an environment that allows for recolonization of the microbiome that was already there. So that initial microbiome that's already there, the colonizing microbiome, that's the microbiome that we develop through our lives at birth, through interaction with the world. I assume through the consumption of foods like sauerkraut and yogurts and all the probiotic stuff that we can eat, does that create an environment that colonizes?
Rebecca:
[1:03:26] It's a good question. Most of the time, fermented foods that we're consuming are, don't actually contain a lot of live microbes. The reason we call them fermented is that they contain more products of fermentation. So when you're eating yogurt, you're actually not eating a lot of live bacteria. You know, the reason yogurt tastes so tangy and sometimes almost feels like fizzy or bubbly is because what you're tasting are the acidic metabolites, which have been produced by the bacteria as they have feasted on the prebiotic substrates in that milk. And you know the things like sauerkraut and kombucha etc they probably don't have a lot of live microbes in there and the live microbes that are there again they're unlikely to be hanging around fermented foods are not probably not giving us a lot of microbes which are becoming part of our microbiome but they're offering health benefits in many many other ways you know the microbes that we know are likely to kind of stick around are those we encounter in our first few months of life.
Rebecca:
[1:04:32] And so this is why, this brings us kind of full circle right back to the beginning of our conversation. This is why that establishment of a healthy neonatal microbiome becomes, I think, one of the most important primary outcomes we should be considering with the creation of life.
Mel:
[1:04:49] So if we want to give everybody a really quick fire list of how do you set up your early stage microbiome there's a few that I can think of but obviously if the mother has a healthy microbiome in her vagina the baby's going to pass through and that kicks off their own colonization so doing what we can as mothers eating plant-based foods also the reduction of very sweet and high processed food and then for our babies if we can have vaginal births or we do know some great benefits for the microbiome for extended skin to skin breastfeeding contact various family members to strengthen the family microbiome is there anything else women can do for their babies to help set that healthy microbiome absolutely
Rebecca:
[1:05:44] And i would say it actually goes back a step further, that we understand now, and this is a big switch from how we used to talk about this, we understand that babies are not born sterile, that their first microbial contact is not when they're coming through the birth canal, that there is a fetal microbiome which is developing along with the developing baby. So the initiation of a healthy microbiome colonization is occurring during pregnancy. So supporting that healthy maternal microbiome, however we can during pregnancy, is important. And I'm also really conscious of speaking to pregnant women or women who may be looking back on their postpartum journey, their pregnancy journey, I never want to create a sensation of guilt or regret. I always want to point out that wherever you are right now, there is always something you can be doing. And, you know, I'm so, I never want anyone to kind of listen to what I'm saying and think, oh my gosh, I did everything wrong. Like that's, that's not, not what I'm intending and not what I would hope anyone would feel. But during pregnancy, the best thing we can do is again, eat as wide a variety of food as we can, acknowledging that's not always possible. You know, if you're throwing up 20 times a day, you probably don't even want to look at a salad, you know. So whatever you can do to support a diverse microbiome during pregnancy is important.
Rebecca:
[1:07:07] Supporting your oral health during pregnancy, the importance of this cannot be overstated. Making sure that you are keeping up with your dental hygiene visits, that you're doing everything you can to maintain a healthy mouth. That you are supporting your immune system the best way you can to avoid the likelihood of being prescribed antibiotics during pregnancy for whatever reasons we can. Then if we can support a physiological birth, fantastic.
Rebecca:
[1:07:34] If we can support breastfeeding relationship, that's probably the most important thing we can do.
Rebecca:
[1:07:40] And then it's a really surprising but well-researched intervention that I haven't mentioned yet. And I love talking about this one. Get a pet. Have animals in the house because we actually have really good research indicating that where children grow up with pets in the house, we see a reduced risk of these atopic and allergic conditions. And the research is really interesting because it is strongest for what is called in the research a third mammal. So it's not about goldfish or birds, it is specifically about mammals who have hair.
Rebecca:
[1:08:15] And the research is strongest for two particular species of pet cats and dogs but we can finally settle the cat versus dog debate because one of these two comes out significantly on top when it comes to being able to reduce the risk of allergies do you want to take a guess mel it's dogs it's dogs ah yes i know and this makes me very happy because i'm the biggest dog girl in the world and love my dog yes this is i think such a beautiful positive thing that we can do is share our home with a dog and share that microbiome. It's really interesting we know that where we do share our homes with pets, we actually, our family microbiome encompasses our pets as well and we're all influencing each other. That we will have, all of us, the people and the pets, will have greater microbial diversity because we're all sharing our microbes.
Mel:
[1:09:10] And I've also heard that houseplants, bringing plants into the home also increases the microbiome of the space.
Rebecca:
[1:09:18] Absolutely. Because where you've got plants, you've got a soil microbiome. You've also got the individual microbes present on the leaves themselves. And then it's highly possible that you've got metabolites or products being produced by the plants, which are also encouraging the growth of microbes in the humans that they're sharing that space with too.
Mel:
[1:09:38] Amazing. Now, I realise we moved on a little bit fast from the vaginal suppository story too, because I feel like women are sort of going, wait, are you going to finish that story? So, yay or nay on the vaginal suppository probiotics?
Rebecca:
[1:09:53] So generally in my kind of education role, I err towards the cautious side and my kind of broad educational content would be take advice on inserting anything in your vagina during pregnancy from a birth professional. So that is not a piece of advice I'm going to be giving. I'm going to say that, you know, again, taking probiotics orally has been very well studied and I'm very comfortable with oral administration. When it comes to insertion into the vagina during pregnancy, I think there are probably different factors which would influence the risk of this. If, for example, you know that a woman has a risk of, for whatever reason, premature membrane rupture, etc., or cervical damage, I'd be a lot more cautious about suggesting insertion. Certainly, I know, you know, there are, again, plenty of pieces of research showing that direct intravaginal application has been shown to improve particular outcomes. I'm not aware of much probiotic research that's been done on intravaginal application during pregnancy. And, you know, again, this is where I would defer to the birth professionals.
Mel:
[1:11:15] Yeah, I did find the same thing because, as I said, one of my struggles through my first pregnancy was just persistent thrush. So I was always looking for answers and finally at my second pregnancy when it happened again and I feel like I got on top of it in my second pregnancy with the addition of a lot more fermented foods and the difference that I did in my second pregnancy was the vaginal probiotics over the oral one. So I did experiment on myself, but also knew that there wasn't a lot of research in this area and that I was kind of on the edge of, you know, the understanding of what we could do during pregnancy. Look, I think we have gotten so much out of this conversation, so much so that I'm reconsidering my career and so interested in learning more about the microbiome. I'm still going to be a midwife. Don't worry, guys. But probably three times a week, I think, what else would I do if it wasn't midwifery? And you've just really inspired an interest in me about the diversity of the microbiome as well as the diversity of the different probiotics for different things. And I did notice with the activated probiotics products,
Mel:
[1:12:34] The products are very specific and now I'm understanding why there's a dental health one and an osteo health one and an iron one and a skin one and, you know, this and that and a women's one. And so that kind of explains why there's been such a focus on that diverse range.
Rebecca:
[1:12:54] Specificity, yeah.
Mel:
[1:12:55] Yeah. Well, you may understand why now. Incredible. So I'm going to try and summarize this for women because I've been able to understand everything that you've been talking about, partly because I'm a health professional, but I'm also a naturopath and, you know, proficient in professional language. So I'll see if I can like whittle this down to, you know, a two minute summary. But essentially the microbiome are tiny little critters that live in all orifices and surfaces of our body and there's a different microbiome in different areas because they function differently the interest for us from the great birth rebellion podcast is which microbiomes relate to health of women and babies through pregnancy and what i've heard is that the oral microbiomes particularly important with relation to the placental microbiome and then the vaginal microbiome, which happens to be connected to the rectal and urinal microbiome, but they are all connected.
Mel:
[1:14:01] What you said was is that the microbiome does not travel around the body through the blood. It needs to transmit itself and colonize different areas from other body parts. And so when we take an antibiotic, for example, that travels through the blood can have a direct impact upon the vaginal microbiome, but the oral taking of probiotics doesn't take the same route. It's got to go all the way through and then enter from basically inside out. Outside in and so that could theoretically be an argument for vaginal suppositories but there's not a whole lot of research on pregnant women and the use of vaginal suppositories so anybody selecting that option would be kind of taking the outcomes into their own hands But certainly, a healthy microbiome has been linked to a reduction in potential pregnancy complications. And there's a lot of research around healthy vaginal microbiome and preterm birth, for example. Just one area.
Rebecca:
[1:15:11] Yeah, which we haven't even delved into today.
Mel:
[1:15:13] No, absolutely. I mean, we just can't. and what we know is is that the probiotics they aren't you're not taking them and then they recolonize your microbiome that microbiome is influenced mostly by what you're exposed to or not exposed to in the early parts of your life and so what I'm hearing is we can influence the health of our children not only by focusing on the well-being of our own microbiome but helping them establish theirs in the early years and would it be accurate to say that the microbiome is resilient enough to recover if we've had a bad start because I think people might listen and think well that's it I'm screwed my children are screwed I
Rebecca:
[1:16:04] Know which is awful and I never want anyone to feel that.
Mel:
[1:16:06] Yeah so what what hope is there for us and our children who didn't have a great
Mel:
[1:16:11] start that and that we're now recognizing that, what can we do?
Rebecca:
[1:16:16] Okay, the best thing you can do is let go of any guilt that, you know, all of us have, we can't change what's happened in the past and everything we did was the decisions we made with the information we had at the time. So never want anyone to take on any guilt or regret. It's all done. Every day represents a new opportunity for interacting with your microbiome through your diet, through your interpersonal interactions. You know, go and do some gardening. Cuddle your pet. Go and have a physical coffee with a girlfriend in person rather than on the phone. You know, hug your neighbours. Book a holiday.
Rebecca:
[1:16:56] But all of these things are representing opportunities for you to be guiding and shaping your microbiome. But the most significant thing for sure is your diet, is really having a think about where can you add more variety into your diet of foods which have come from plants, even if it is as simple as starting with adding in a cup of green tea a day, which will be encouraging different microbes from those that are being encouraged by black tea. Even if it's switching up your soy milk for almond milk or oat milk from time to time. Even if it's buying a different colour apple or capsicum from what you usually routinely use. Growing different herbs in your garden for making salads at home. Using more olive oil. Olive oil is fantastic for your microbiome. Contains all of these lovely polyphenols which have been shown to enhance diversity and microbial growth. So, you know, making sure that you're using olive oil for your cooking and for your salad dressing rather than different kinds of oils. You know, again, it's just an acceptance that the whole world is interacting with our little microbial communities and switching things up a little bit, making changes can be helpful there.
Mel:
[1:18:16] Incredible advice all within reach if you don't even want to buy anything all you've got to do is just change up what you're doing in your regular day so exposing yourself to more of the world the actual world touching things animals critters soil other people having a patch with someone you love all these things just build our microbiome thank you so much Rebecca this has been eye-opening for me and I thought I knew stuff. So I can just imagine what people are learning out there listening to the Great Birth Rebellion podcast. I feel like we've just touched the surface. So there's way more to this. So Rebecca is from Activated Probiotics and I will put all of their details in the show notes if you want to learn more about them. Thank you everyone for being here at the Great Birth Rebellion podcast and thanks to you Rebecca. To get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes
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