Women’s Health and the Vaginal Microbiome: A Probiotic Breakthrough

On Wednesday, September 10th, FMCA hosted a special Ask the Expert webinar exploring women’s health and the vaginal microbiome featuring Dr. William Davis, renowned cardiologist and #1 New York Times bestselling author of Wheat Belly and Super Gut.

In this exclusive conversation with FMCA Founder and CEO Dr. Sandra Scheinbaum, Dr. Davis introduced his latest research on a new vaginal probiotic strain, and why it may hold the key to supporting women’s health in groundbreaking ways. Building on his pioneering work in microbiome science, Dr. Davis explained how this strain works, what the research is revealing, and why health coaches and practitioners should be paying attention.

In this interactive session, Dr. Davis and Dr. Sandi explored:

• The latest science on a new vaginal probiotic strain and its impact on women’s health
• How the vaginal and gut microbiomes are interconnected
• What conventional medicine often overlooks when it comes to women’s health 
• How functional medicine health coaches can support clients in restoring balance through safe, accessible lifestyle strategies

Watch the Replay

Women’s Health and the Vaginal Microbiome: A Probiotic Breakthrough, With Dr. William Davis:

More Gut Health Resources

If you’d like to keep exploring the gut microbiome, we’ve got you covered. Here are some top resources from FMCA on gut health, the gut microbiome, and how health coaches can support clients on their path to better digestion and overall wellness:

Podcast Episodes:

• Heart Disease and Gut Health, With Dr. William Davis
• Nurturing Gut Health in Mothers and Babies, With Cheryl Sew Hoy
• The Gut-Brain Connection, With Dr. Vincent Pedre
• AI-Powered Gut Microbiome Testing, With Leo Grady

Blog Articles:

• Healthy Poop 101: The Health Coach’s Guide to Digestion
• 5 Ways to Restore Your Gut Health

Webinar Replays:

• The Gut Microbiome: Uncovering Secrets to Enhanced Health and Wellness
• Healing the Microbiome: A Deep Dive into L. reuteri

Transcript

Dr. Sandi: We certainly have an expert with us today. He is the one and only Dr. William Davis, who needs no introduction. He is, in case you have not read “Super Gut” or his first book, and that is “Wheat Belly,” please make sure you have those on your reading list, and they’re also great books to give as resources for your clients. But today Dr. Davis is here to talk about another topic, a new topic. And so I am going to just dive right in with Dr. Davis, and we’re so happy to have you with us today.

Dr. Davis: Oh, thanks, Sandi. Always glad to be back.

Dr. Sandi: It’s a pleasure. Now, you have a new area of interest, and I’m curious, what is this new vaginal probiotic strain? What led you to develop it, and how is it different from existing probiotics?

Dr. Davis: You know, Sandi, I now have three grandkids. The last one delivered literally about 10 days ago.

Dr. Sandi: Well, congratulations!

Dr. Davis: Babies are healthy, mom’s healthy. But what bothered me about the whole process is their mom, my daughter-in-law, has all kinds of resources available to her. She’s got about eight doctors involved. She’s perfectly healthy, but she’s got a whole bunch of doctors involved. No one talked to her about all the things a woman can do during pregnancy, during lactation, and in general for female health. No one. In fact, my son, just to test the knowledge of the doctors, asked them this, “Hey, what’s the role of probiotics in pregnancy?” And they said, “Oh, they’ve been disproven.” They don’t work. And you and I know the truth is the exact opposite. In fact, it’s exploding. The knowledge, the insight, the power a woman has now over reproductive health is impressive. It’s astounding. But it’s not being passed down.

This is why, by the way, I’m so happy that you’re building your health coach world. Because I think a lot of the answers are going to come from the more open-minded health coaches, because my colleagues have clearly abdicated their responsibility. Okay, maybe it’ll take 30 years now, then they’ll start saying, “Oh, well, there are some things you could do.” But my experience has been that health coaches are first in line to learn about new things. And there’s so much a woman can do to make sure, best she can, to have a full-term pregnancy. Because, you know, if a woman delivers at 28 weeks, that’s catastrophic. That child will be in the NICU, neonatal ICU for weeks, if not months. Mortality’s very high. They have a very high risk of necrotizing enterocolitis, where part of their GI tract dies, literally dies, and has to undergo emergency surgery for which the mortality is 30% chance of dying, a preemie, right?

Well, there’s things a woman can do. And one of those things is to make sure she’s got a microbe in her vaginal canal called Lactobacillus crispatus. So you may recall that Lactobacillus species are very susceptible to common antibiotics. And of course, we’ve all been wildly overexposed to antibiotics. It’s not uncommon by age 40 to have taken 30 courses of antibiotics, 650,000 prescriptions are written every day for antibiotics. And so most of us have lost hundreds, perhaps thousands of species. In fact, there’s a recent study, a 5-day course of antibiotics killed over 1,000 species. Gone. Disappeared. And so overexposure, or even one exposure for that matter, to antibiotics has wiped out many species, but specifically for today’s conversation, Lactobacillus crispatus.

If a woman lacks Lactobacillus crispatus in her vagina, her vaginal microbiome, she’s more susceptible to miscarriage, to premature labor, because when she lacks crispatus, the cervix can become inflamed and an inflamed cervix tends to relax prematurely and allow the baby to merge, even if it’s only 28 weeks. A woman is also more prone to urinary tract infections, incontinence, vaginal infections, both candida as well as bacterial, STDs. So crispatus is the defining microbe in a woman’s vaginal microbiome, and many ladies have lost it. Restoring, it’s easy. One of the great things is when a woman tries to restore crispatus, so it was thought for years that it would be clumsy, because a woman might have to instill it as a suppository into her vagina. No, no, no, no, no, no, no. One of the great things about many microbes, including crispatus, is a woman can take it in orally, say as a probiotic or other source, it will populate the vagina.

How? There’s no connection between the vagina and the GI tract. Well, it must be some kind of translocation. It must be simply by contiguity, nearness in the perineum, the groin area, because no one’s ever identified a direct connection that we know of. Then even more remarkably, Sandi, we’re from here in Chicago, at Loyola, a group at Loyola has done some very elegant work and they’ve shown that this microbe, GI tract to vagina, then to the bladder. You know, we thought for years urine is sterile. No, it’s not sterile. It has its own unique microbiome. It’s not as thickly populated, say as the GI tract or vagina, but it’s supposed to have its own microbiome. And their data shows that if a woman restores crispatus, the frequency of urinary tract infection is cut by about half. And, you know, incontinence is a problem for a lot of ladies, for which there’s really no good solutions. The surgical solutions are terrible and they’re often ineffective. Well, getting crispatus restored reduces urge and stress incontinence, that is coughing, sneezing, bearing down and wetting yourself, which, as you know, is socially crippling and embarrassing. And crispatus can be part of the solution.

Dr. Sandi: Wow, this is fascinating. First of all, I just want to say, I want to make sure everybody who is listening knows that you can write in questions through the Q&A. And then at the end of our interview together, we will open it up and we will respond, Dr. Davis will respond to your questions. So you mentioned that it’s just unbelievable the responses from the conventionally trained doctors. And that was where you were. That was how you started out. So can you can you share, before we go further into talking about vaginal microbiome, in case anyone is not aware of your beginnings in medicine?

Dr. Davis: Sad to say conventional medicine is driven by the desire for revenue and profit. And so almost all of healthcare, modern healthcare is focused on delivery of pharmaceuticals, procedures, things that generate revenue. And that’s what I did for many years. In fact, you go to hospital staff meetings. There was no talk about better ways to prevent coronary disease, or premature labor, or urinary tract infections, or diabetes. It was all about how do we increase our procedural volume by 18% this year? That is the sole focus of healthcare. It has nothing to do with health. That’s why health coaches have are filling this critical need because the doctor doesn’t have the time, is not compensated for telling you things in your health. When’s the last time a doctor spent a half an hour with you, talk about diet, for instance, or the importance of vitamin D and other very important…about addressing the microbiome? Almost none of this comes from conventional doctors.

And that’s why there’s a huge need here. If the doctor wants only talk to you about next colonoscopy or the next MRI or doing something really dumb like dispensing a GLP-1 agonist drug, that’s all they’re interested in. And by the way, part of the enthusiasm for the GLP-1 agonist drugs are the kickbacks that my colleagues have managed to…they have systems. Some clinics, for instance, have their own pharmacies. And so there is in effect…it’s not a direct kickback. It’s an indirect kickback. But they’re making tons of money by dispensing flawed and, in this case, extremely harmful drugs. And so that’s the focus of conventional healthcare. There’s a time and place we need those. If you’re a car accident, or you fracture your hip, or you have a deep vein thrombosis, you need the healthcare system.

But what about all the other things, diet, microbiome, just being healthy, healthy aging, staying youthful for as long as possible? Ain’t going to come from the doctor. It’s got to come from…well, it can come from self-education, of course. But my hope is that comes from people like in the health coaching world who do have…One of the problems with doctors, what I see, is the indifference. Sandi, it’s the indifference, not really caring to know more. And all those say things like, “Well, I did learn that in my training.” Nutrition, you know this, there’s almost no education nutrition. There’s certainly no education in microbiome. And yet the information, thankfully, has exploded. So we need better ways to deliver these kinds of empowering strategies to people.

Dr. Sandi: Absolutely. And that is the critical role of a health coach. And not only is the current system not serving us in terms of what they’re recommending or not knowing the answer. So if you ask someone about probiotic, they may say, “Oh, it can’t hurt. But, you know, I don’t know, go to Walgreens and, you know, they sell some,” but they don’t they don’t give you specifics. It’s just not their area. But not only that, you can’t even get an appointment. I had a friend who was interested in preventive cardiology, and she tried to find one here where we have northern suburbs. 2027 was the first opening for a new patient. So good luck with that. And so we are in bad shape, but we can start to take charge of our health. And this is very exciting, this work on this new vaginal probiotic strain. So what what is it that makes it different from existing probiotics that someone just can’t go out and get a…? There are a lot of probiotics on the market that say they have, you know, 500 billion organisms and they have a whole long list of all the strains. So why is it important to distinguish from others and get the right one?

Dr. Davis: Sadly, Sandi, the current crop of commercial probiotics on the shelf are really nothing more than haphazard, slapdash collections of microbes. In other words, if you’re a standard probiotic manufacturer, you say things like, “Well, I think Bifidobacterium bifidum is good for people. Put it in there. I think Lactobacillus acidophilus is good. Throw that in. How about…?” And they just throw them together often at very low counts. In other words, if there’s 10 billion microbes per capsule, but there’s 10 species in it, you only got a billion or so. It sounds like a lot, but in microbes, it’s kind of trivial. So, by the way, with crispatus, one of the things that you can do, ladies can do is ferment it as something that looks and smells like yogurt. It’s not yogurt. People say, “Can I buy it in the store?” No, you cannot buy it in the store. That stuff is something different. But this stuff we’re going to make looks and smells like yogurt.

But we’re going to use some of my methods of prolonged fermentation because microbes don’t have sex, of course, right? They just double themselves, asexual reproduction. One microbe becomes two, two becomes four, and so on. We’re going to let crispatus double about 36…I’m sorry, about 12 times over 36 hours. And we get something like 120 billion counts per half cup or 120 milliliters a serving. Not as much as my favorite microbe, Lactobaccilus reuteri, where you get 300 billion, but 120 billion, still a lot more than what you would get in, say, a probiotic. And you know what? It makes the tastiest yogurt you’ve ever had. It kind of tastes like thick whipped cream. So a woman can buy her probiotic that has crispatus and then ferment it. It’s a way to save money, too, because you don’t have to keep on buying the probiotic and just make your yogurt your yogurt and then make future batches from a little of the prior batch.

So I bring up the topic of reuteri, also my favorite microbe, that also has a big role to play in female reproductive health because one of the things it does is restores vaginal moisture. You know, as a woman ages, it becomes a universal problem, loss of moisture, sensation, irritation, pain, discharge. And reuteri is one of the things that restores health to the vaginal canal. And a real powerful combination, reuteri with crispatus. So a woman can also ferment those two together. The only downside to that is reuteri tends to generate a lot of sourness in the yogurt while crispatus tends to generates a very kind of sweet, smooth flavor. So it won’t be as tasty if you combine it with reuteri, but it’s a convenience. But the reuteri, also very important for…The only thing I tell ladies is…One thing we don’t know.

So all humans, all humans should have reuteri. Children, older people, young people, teenagers, everybody should have reuteri. But what we don’t know is when we get those huge numbers, is that safe during pregnancy? That we don’t know because one of the effects of reuteri, if we believe the animal data…We’ve been trying to corroborate this in humans, having a lot of trouble with the method of measurement, the assay. Nonetheless, a woman gets reuteri and it causes the hypothalamus to release oxytocin. Ladies may recognize oxytocin because if a woman says, “Hey, I want to deliver my child, 8 a.m. on Wednesday, August 23rd,” she goes into the hospital, they put an IV in her and they give her oxytocin. They call it Pitocin, that’s the brand name. And that provokes uterine contraction.

So while everybody should have reuteri, we don’t know these high numbers that risk provocation of oxytocin, which in other circumstances is a great thing, but we don’t know how safe it is during pregnancy. So the only thing I tell ladies is if you’re going to try to get reuteri during pregnancy, don’t do it as a single fermentation microbe and get those big numbers. Do it with a collection of microbes. Just like your backyard garden, if all you plant are tomatoes, you’re going to have a lot of tomatoes. If you plant tomatoes and cucumbers and squash and watermelon and zucchini, you’re going to have far fewer tomatoes. Because everybody should have reuteri.

Dr. Sandi: Well, if you are interested, everyone listening, you can go to our YouTube channel from FMCA. And a few months back, Dr. Davis came to my kitchen and we did a demonstration. He made the L. reuteri yogurt. And so you can see how it’s done. It’s very, very easy. I always have a supply in my refrigerator. And I had some this morning and I absolutely agree, it is so tasty. My 3-year-old grandkids say, “More yogurt, more yogurt.” It is very good. And so there are many support groups that can help you. And I think as a health coach, this is something that is so ideally suited for you to guide your clients on how to make this, because it does require a certain temperature, cooked or fermented for 36 hours. But it is really a way to get that probiotic in. So can you talk just overall, just circling back to the vaginal biome in general, what is the influence? If a coach wants to explain to somebody how this whole thing works, how does the vaginal microbiome influence overall women’s health and connect it to the gut microbiome? But how would you explain that to somebody?

Dr. Davis: You know, it’s a connection, Sandi, the understanding is still evolving. But it’s become clear. We used to think that the gastrointestinal microbiome was this isolated thing and didn’t communicate with anything else. It’s becoming clear that’s not true. That the gastrointestinal microbiome talks to the vaginal microbiome, the urinary microbiome, the prostate microbiome. The mouth microbiome talks to the stomach, small intestine, brain, airway. In other words, one of my favorite examples, not of much interest to the ladies, but is the prostate gland, which is only now yielding some good information. I call the prostate gland the Grand Central Station of the microbiome because if you DNA sequence…This all came to light because of DNA sequencing, because a lot of these microbes you can’t culture in a Petri dish. They won’t grow. So you have to rely on DNA sequencing because a lot of these microbes die upon exposure to air. If you DNA sequence the microbiome of prostate, you’re going to find fecal organisms, urinary organisms, skin organisms like Cutibacterium, mouth organisms like Porphyromonous and Fusobacterium. In other words, it’s an example of how microbiomes are not isolated. In a person with dementia, for instance, you can find their brains are filled with oral microbes like Porphyromonous and Fusibacterium, also filled with fungi, various species of candida.

So in other words, all these microbiomes talk to each other. And so if you want to get control of the vaginal microbiome, yes, you can get crispatus, get reuteri. Reuteri itself likely does not colonize the vagina. It may. Some strains may. The effect is indirect by way of oxytocin. That is oxytocin’s effect on reproductive health. It’s a huge thing. But it means addressing the gastrointestinal microbiome also. And it’s become clear that the gastrointestinal microbiome has huge implications on pregnancy, on conditions like endometriosis. Endometriosis is almost certain to be a disease of the microbiome, period. And yet we still see ladies going through exploratory laparotomy over and over and over, by the way. It’s a very lousy solution for a difficult and painful problem. It’s becoming clear it is a disease of the microbiome.

Specifically, in a lot of these instances, it’s due to SIBO. That is small intestinal bacterial overgrowth. I used to think that was a rare thing, SIBO. I thought that colonic dysbiosis, that’s easy to explain, right? Overexposure to antibiotics, food additives like preservatives and emulsifying agents, glyphosate and other herbicide residues in our food. Okay, that disrupts the colonic microbiome. But it’s become clear that at least half the U.S. population, half the U.S. population, in excess of 150 million people have SIBO. That is colonic fecal microbes have been allowed to overproliferate, because those antibiotics wipe out healthy microbes like Lactobacillus and Bifidobacterium species, but don’t kill off fecal microbes like E. coli and Klebsiella and Pseudomonas. They overproliferate those fecal microbes and then ascend into the 24 feet of small intestine. Small intestine is not prepared for this. It’s not designed for that. It’s very permeable and is poorly protected. Colon is used to having fecal microbes, small intestine not. Thinner mucus barrier, less of an immune protection.

So when you have 24 feet of fecal microbes living in the 24 feet of small intestine…You know, microbes only live for an hour to several hours long. There’s a huge rapid turnover. Those microbes die. And when they die, especially those fecal microbes, they shed their components, especially components of their cell walls like something called lipopolysaccharide endotoxin. That enters the bloodstream. That’s called endotoxemia. And that’s the driver. That’s how bowel flora can be responsible for effects on the brain like depression, anxiety, cognitive impairment, Parkinson’s disease, on skin, rosacea, psoriasis, on the heart, atrial fibrillation, coronary disease, coronary plaque rupture, and myocardial infarction, heart attack, congestive heart failure. In other words, the microbiome exports defects all over. And that’s probably a big part of the reason, for instance, in ways with endometriosis, they almost always have SIBO.

Dr. Sandi: Thank you. That was a really great description of the underlying mechanisms. We have a lot of questions that come in, so I’m going to turn to those. And I have one other question. What are your thoughts…? I know that there are some companies popping up that are going to test the vaginal microbiome, and I wonder your thoughts on that.

Dr. Davis: You know, you don’t have to do that. If the solution is so benign and accessible, you could test and it can be very helpful. But if you just have average health, pretty good health, you don’t really need to test. About 25% to 30% of ladies have lost crispatus, many still have it. But they also have other species like Gardnerella vaginalis, and Atopobium, and other microbes that really are not that good for you. So there is some value in testing. But here’s one great thing about the microbiome, whether it’s gastrointestinal, or vaginal, or oral, is…in other words, we have to get away from the antibiotic model. That is, if you’ve got pneumococcal pneumonia, take this antibiotic and kill that pneumococcus. If you’ve got a Staphylococcus aureus abscess on your skin, take this antibiotic to kill that Staphylococcus. We don’t have to do that, or rarely do we have to do that in managing the microbiome, because they’re kind of smart. They don’t seem very smart.

But if you restore a defining collection of microbes in the vagina, Lactobacillus crispatus, and to some degree Lactobacillus gasseri, and indirectly Lactobacillus reuteri in the gastrointestinal tract, we restore keystone microbes, Lactobacillus reuteri, Lactobacillus gasseri, and some others. And what they do is they kind of bring order back for you. Even though there may be 200 species that don’t belong there, and you’re lacking 700 other species, over time, just restoring some of these key microbes helps you rebuild. So you’ll see this play out, for instance, people who have Clostridium difficile, not after antibiotics, but are colonized to a low degree with Clostridium difficile, which is a terrible, aggressive pathogen. Well, if you restore all the healthy microbes, it tends to suppress those bad guys for you. You don’t have to specifically knock it out with an antibiotic. This is true for most microbes.

The one exception is fungal overgrowth. Fungal species are so tough to get rid of once they gain hold. So you can have colonic overgrowth of fungi. You can also have so-called SIFO, small intestinal fungal overgrowth. Those guys are really tough to deal with, so that’s an exception to that rule where you just can’t rely on restoring healthy microbes. You may have to specifically kill the fungi. So we use things like berberine, for instance. And by the way, berberine is one of those misused supplements around. People say, “I take berberine to reduce my blood glucose or my blood pressure.” It’s an antibiotic. It’s an antimicrobial, antifungal, antibiotic. And in other words, imagine I said, “Sandi, you should take penicillin for the rest of your life.” Bad things happen. We don’t know what happens with long-term consumption of berberine and other things that have antibiotic properties, but it’s unwise to risk it because it’s antimicrobial.

Dr. Sandi: Yeah, I was making that mistake. So literally, for years, I was just taking berberine with breakfast where I take a lot of supplements. And then I started putting…I would take my probiotics as well. And now adding my yogurt, my own yogurt, gastro-yogurt, I switched…I make two batches. And I have two big bowls, so I alternate. But then when I put them in a smoothie, I’ll put a bit of each, so I’m blending them. But I go, oh, no, I’ve been taking berberine at the same time. This is not good. I’m putting good stuff in and I’m killing it at the same time.

Dr. Davis: Oh, that’s a good point too, Sandi, that berberine also kills off the beneficial microbes we’re trying to restore, like crispatus and reuteri. The berberine kills them. So yeah, we use berberine, but only for brief periods of time, like maybe for a couple of weeks, if you have evidence that you have fungal overgrowth. And it can be very disruptive. So it’s not a pleasant experience to eradicate…I shouldn’t say eradicate. We’re not trying to eradicate fungi. We’re trying to just push them down in numbers. Fungi are everywhere. They’re in your hair, skin, vagina, GI tract, kitchen counter, bowls, air. That’s why some people get a little contamination when they make the yogurt, because they may have sneezed on it, or coughed, or made it in the path of airflow from their air conditioner. And the fungi and molds in the air can contaminate your yogurt. So people have to be aware of that when you’re making your yogurt.

Dr. Sandi: Yeah, you have to sterilize. I run it under an Instant Pot and I run all my utensils under that before I start and make sure the bowl is clean from the dishwasher. So we have great questions that have come in and I want to make sure that we are answering them. So the first one comes from Daniela, and it’s quite a long one. So Dr. Davis, she’s writing about D-mannose, and that is often used for urinary tract health. And it’s a derivative of, I believe, cranberries. And she’s recommended to take…and she lists a lot of different probiotic strains. And she says that she doesn’t see the strain that you’ve mentioned, the vaginal strain. So can you comment on that? And I’m assuming this is just an older product.

Dr. Davis: I’m a fan, Sandi, of restoring things that humans should have had all along but have lost. So we’re all supposed to have reuteri, but almost nobody has it anymore because of its susceptibility to common antibiotics. Likewise, Lactobacillus crispatus. When D-mannose does work, some of the flavonoids, etc. in cranberries does have a modest effect. But is there a D-mannose deficiency? No. I pointed out…There’s something wrong with D-mannose. The problem is once you start to introduce things that are exogenous or foreign to the human experience, you start to get funny effects that you didn’t anticipate. This is true of drugs. It can be true of supplements. So there are supplements that you need, like magnesium, you need it because we have to filter our drinking water. Water in the rivers and streams has sewage runoff and pesticides and herbicides and other crap. So we have to filter our water. Water filtration removes all magnesium. So we have to restore magnesium.

Vitamin D we’re supposed to get from sun exposure. Sandi and I live in suburban Chicago where it’s cold much of the year and you can’t go out naked in January. So we have to take vitamin D. So if you stick to that basic, rule most of the time you’ll find that you can do things, gain huge advantage with virtually no downside because you’re restoring things that you should have had all along. So when we introduce exogenous or foreign things, you risk weird effects. But the evidence is pretty good for D-mannose and it’s pretty good…One of the problems with cranberries is that different preparations prepared differently vary a lot in their polyphenol content and, therefore, vary in their efficacy. But they do work.

Dr. Sandi: Sounds good. Okay. A question came in, vaginal biome changes, does it happen during perimenopause and mesopause? Any estrogen-sensitive strains?

Dr. Davis: Yes, it does change. So it changes through all the phases of a woman’s life from infancy to toddlers to childhood to teenage. It changes numerous times, including in the menopause. The most dramatic change, though, is in the menopause. When most ladies lose crispatus…Here’s something really interesting. I know a lot of ladies are interested in skin health. Well, so a woman loses crispatus as she ages or gets exposed to antibiotics. Restoring it essentially rejuvenates the vagina. Moisture, protection from pathogens, all those good things. Sensation, mucous production, all those good things. Young ladies also have crispatus on their skin. Isn’t that interesting? Where did it come from? Maybe the vagina. Nobody knows. But young ladies all have crispatus. As a woman ages, she loses crispatus, yes, in the vagina, but also on the skin. Now there’s preliminary evidence. A woman restores crispatus and she gets rejuvenation of the skin also.

So I’ve been encouraging ladies to make the crispatus yogurt and try it as a mask. Because there’s no easy way to apply probiotic. I’ve tried. If you try to get the microbe to live in various ointments, salves, creams, it dies or gets contaminated by fungus and mold. So it’s not an easy thing to do. I’ve been trying, but I haven’t succeeded. So a woman can do it on her own, make crispatus yogurt, enjoy it, it’s delicious, and take a little bit, maybe a few times a week…If we believe the preliminary evidence, there’s an explosion in dermal collagen. And so a lot of the things we do, restore Lactobacillus reuteri, increase the dermal collagen, getting collagen, because it’s absent from most people’s diets because we…this nonsense to cut your saturated fat and cholesterol cause most people to abandon consumption of organ meats rich in collagen. So a lot of us supplement collagen because most modern people don’t want to eat heart and brain and pancreas and kidney anymore. So we rely on collagen supplements.

But the topically applied crispatus, based on the evidence we have, appears to stimulate the deposition of collagen in the skin and thereby reduce wrinkle depth. So crispatus, it’s just starting, so interesting. It may…I know that most people attending are ladies, but there’s preliminary evidence, crispatus may be very important for prostate health. You know, if a guy has prostatitis or benign prostatic hypertrophy or prostate cancer, there’s very little that’s truly helpful. You’ve got those exogenous things, like saw palmetto. Well, there’s no such thing as saw palmetto deficiency. What if we instead address microbiome-type issues? One thing is clear, a guy with prostate disease in any form doesn’t have crispatus. Men who have healthy prostates have crispatus. Now, that doesn’t tell us it’s cause and effect, but it sure sounds like it. So I’ve been encouraging guys to all start thinking about the microbiome, especially with regard to crispatus and, by the way, SIBO. About 90% of men with prostate disease have SIBO.

Dr. Sandi: I love it. So I’m going to give some to my husband. So Kathleen is curious about crispatus. And we can spell that…we can write that in the chat, the correct spelling, because some people are wondering. But about urge continence and particularly in menopausal women, which can be quite problematic.

Dr. Davis: So those exploratory studies from Loyola right here in Chicago, they did some very elegant work. A lot of the previous work, earlier work was flawed because they tried to culture microbes. And the vast majority of microbes in the GI tract, the vagina, in the mouth, wherever, don’t grow in culture because they die upon exposure to air. So this Loyola group did anaerobic culture, essentially allowing the microbes to grow either in nitrogen or in a vacuum. And these microbes, all kinds of microbes appeared, all kinds no one knew about. And that’s one of the reasons why they uncovered all this new stuff that in one of the discoveries was that restoration, oral restoration of crispatus reduces incontinence by about half. It’s not a cure. But, you know, because the conventional solutions are so poor, anything a woman can do to reduce incontinence is helpful. So crispatus, at the top of the list. I don’t really know of much else a woman can do short of a surgical procedure.

Dr. Sandi: Yes. So a lot of questions have come in about period and menopause. So the anatomical changes of the vagina during these times, would that influence the vaginal microbiome?

Dr. Davis: Well, probably, probably. That is, it’s a two way street. Vaginal microbiome affects vaginal health, vaginal health affects…Two things I should mention. This came up because of my daughter-in-law getting pregnant, having children. Two basic, basic things that have microbiome implications, though they themselves are not microbes. One is vitamin D. Good evidence getting vitamin D to a healthy level, I aim for 60 to 70 nanograms per milliliter, also shifts the vaginal microbiome to favor crispatus and to discourage unhealthy microbes like Gardnerella. So getting vitamin D, a critical part of a healthy vaginal microbiome through an indirect mechanism.

Likewise, of all things, fish oil, omega-3 fatty acids. You know, fish oil has been a matter of debate for about 30 years, but I don’t know if your listeners know this. In the last three or four years, it’s become crystal clear. Omega-3 fatty acids have spectacular benefits, including regression. Regression. Reduction of cardiovascular events, yes, but also regression of the lipid or fatty components of atherosclerotic plaque. That’s the stuff that ruptures and causes death and heart attack. So fish oil, but it also plays a big role in the vaginal microbiome, so much so that if a woman takes omega-3s during pregnancy, the likelihood of premature labor drops precipitously.

So my daughter-in-law typically delivers at 41 weeks. So omega-3 is critical, but it takes a higher dose. Whenever we talk about components of food, omega-3 fatty acids are a component of food. I used to laugh, Sandi. Years ago, people would say, “I heard extra virgin olive oil is good for you.” Right? And they say, “I take a 50-milligram capsule.” Well, we should be talking about gram or kilogram, 100,000-fold higher doses. So when it comes to components of food, you want higher doses. If I said, “Sandi, you can have some steak, but I’m only going to allow you 50 grams.” What? What? So same thing with omega-3s. We’re going to talk about higher gram quantities. And so the benefits on the vaginal microbiome and enjoying full-term pregnancy typically occurs above 3,000 or more milligrams or 3 grams. I tell my followers to get a minimum of 3.6 grams or 3600 milligrams of EPA and DHA. Both play a role.

And one of the stupidest things I’ve ever seen the pharmaceutical industry do is they’ve commercialized EPA alone. They saw how popular and effective fish oil was, so they wanted a piece of the pie. They wanted a piece of the action. So they commercialized EPA alone, and they showed about a 25% reduction in cardiovascular events. And of course, my colleagues all jump on that bandwagon. Now there’s a sexy sales rep hawking the product, even though you can go to Costco or Sam’s Club and buy the same stuff practically. But if you take that EPA drug, but you want to prevent cognitive impairment from dementia, you’ve got to take fish oil for the DHA. That’s how dumb the pharmaceutical industry can be in the cause of making more money.

Dr. Sandi: Yeah, for sure. So there will be a transcript we can get to that we’ve mentioned a lot of different strands. And Jan wants to know, what strain of L. reuteri are you recommending? So can you comment on that? So I just buy the capsule and put one capsule of L. reuteri.

Dr. Davis: I’ve got to be very careful because we have products, and there’s a lot of regulatory scrutiny when you have products. So I don’t talk about specific products. I’m sorry, I’m not trying to be evasive. It’s just that the federal government is so oppressive when it comes to regulation over products that we don’t mention products. I make no mention of products, sad to say. Look at my “Super Gut” book. Look at my blogs, the williamdavismd.com, where I do specify some of the strains that we can use, but I can’t talk about it. I’m sorry.

Dr. Sandi: And I will respond because I…for example, come to my office hours and I can talk about it there because I am not bound by that. I am a consumer. And can you make the yogurt, this comes up often, if you can’t have dairy?

Dr. Davis: Oh, sure. Well, it depends on why you can’t have dairy. If it’s lactose intolerance, one of the advantages of prolonged fermentation is you maximally convert the lactose to lactic acid. And conventional yogurt, minimally fermented, has a pH of about 4.6. The yogurt made this way using prolonged fermentation, etc., pH about 3.5. That difference between 4.6 and 3.5 is about tenfold greater acidity, and that’s from the lactic acid. That level of acidity denatures or breaks down the casein beta A1. That’s the form of casein prevalent in North America. So you’ve minimized lactose, so most lactose-intolerant people have no problem with this yogurt made with prolonged fermentation. Even some people with immunogenic responses to the casein beta A1 do just fine. But you can also make it with A2 milk, casein beta A2, or goat, or sheep, or if you’re so inclined, camel. Those are all the A2 form, identical to the human form. When you breastfeed a child, it’s the A2 form of casein. Or you can use coconut milk is another good vehicle, canned coconut milk, just makes sure it has no additives, like gellan gum or xanthan gum.

And there’s a couple of additional steps. We preheat it to 180 degrees Fahrenheit for a few minutes. Let it cool. As it’s cooling, we add a teaspoon of guar gum per 13.5-ounce can of coconut milk, and then hit it with a stick blender for about a minute, and then add your microbe. You don’t want to add the microbe, then blend, because you’ll kill the microbe. Those additional steps. Because one of the tendencies of coconut milk is it tends to separate into oil and solids. So adding the guar gum…Some other people add things like gelatin or pectin also, but guar gum works quite easily. Adding the guar gum, and then emulsifying essentially with your stick blender inhibits the separation.

Dr. Sandi: Thank you. And you might find that just by the long fermentation that you don’t have a problem. I found that to be the case. And I use the half and half grass fed, half and half milk. Okay. So should every woman take Lactobacillus crispatus regularly just for a healthy lifestyle even if they don’t have a specific issue where that would warrant restoring the microbiome?

Dr. Davis: I think so, but I think it should be part of a broader effort. Because it’s going to be a lifelong battle, because we’re exposed to so much nonsense in our lives now. So beyond getting crispatus, I think getting reuteri. Now, one of the things we don’t know is if you get these microbes, let’s say from your mom at birth or breastfeeding, you tend to have it for decades. If you get it as a probiotic or yogurt, you tend to have it for a few days, maybe weeks tops. Why? No one knows, but I believe it’s probably from the lack of community or we say guild or consortia. That is, maybe in the future we say something like this. Okay, get the crispatus, but make sure you get these half dozen other microbes and it allows it to take up permanent residence. We say engraftment. Likewise, reuteri, it’s not permanent. Maybe in the future we say get reuteri with these, I don’t know, dozen other microbes, then it will take up permanent residence. So until that happens, you have to kind of do it all the time.

A big thing I should mention is the power of fermented foods. Now, the crazy thing about fermented foods…So those microbes we’ve been talking about, crispatus, reuteri, gasseri, those are human body temperature microbes. They like the temperature of the human body, 98, right, 100, around there, Fahrenheit. The microbes in fermented foods like kimchi, sauerkraut, fermented pickles, kombucha, those are room temperature fermenting microbes. And they’re different. They’re not the Lactobacillus strain for the most part. They’re Leuconostoc strains or Pediococcus or Weisella species that ferment at room temperature. And the odd thing about those species is they don’t take up residence in your GI tract. You eat, let’s say, some sauerkraut…fermented sauerkraut, of course. You eat some sauerkraut, those microbes pass through and you just pass them into the toilet. What good are they? Well, by some uncertain means, the passage of those fermenting microbes somehow provoke the proliferation of beneficial species of the Lactobacillus, of the Bifidobacterium, of the Faecalibacterium, of the Eubacterium. All the beneficial species we want are cultivated somehow. So I think of fermented foods as little farmers. They’re going to grow a little farm for you in your GI tract.

Dr. Sandi: I love that. And what a great way to explain it to clients. That is beautiful. Lois-Ann [SP]. Thank you, Lois-Ann. She said she has cultured Dr. Davis’ yogurt and has used it to heal SIBO and SIFO, yes, from his protocol in “Super Gut.” We have somebody else who said…And it is a variety of reactions. And this comes in from someone who said she made the L. reuteri and she has some loose stools. Anything that you would suggest if you see this as something happening?

Dr. Davis: So when you introduce the Lactobacillus reuteri or some other beneficial microbes, it introduces a tidal wave of change in the composition of the GI tract. And one of the consequences could be diarrhea. It tends to be not a long-term thing, tends to be a transient thing. You can always add some ground golden flaxseed or some psyllium seed to your…By the way, if you hear a bunch of noise outside, that’s the guy working on the lawn here. Sorry. So add some psyllium seed or ground golden flaxseed to bulk up your stools to prevent the diarrhea. But just accept that as part of the process. You’re changing your microbiome and sometimes you’re also killing off unhealthy microbes. If you’ve got a lot of, let’s say E. coli and Klebsiella in your jejunum and ileum and you introduce beneficial microbes, especially microbes like reuteri, Lactobacillus gasseri, Bacillus subtilis, these are bacteriocin-producing species, Sandi. That is, they produce natural antibiotics that kill fecal microbes. When you kill a bunch all at once, they release all that lipopolysaccharide endotoxin, which can cause diarrhea. It can irritate your GI tract. It’s kind of like going through smoking cessation. It’s going to be unpleasant for a few weeks, right? Same thing here.

Dr. Sandi: No? Okay. I want to return to one question about…this is regarding endometriosis. And what would be the best way to treat the microbiome in terms of endometriosis?

Dr. Davis: Well, you want to attack the SIBO first because SIBO, while the implication may be, the consequence may be endometriosis, there are other consequences of unaddressed SIBO. Through that endotoxemia process, weight gain, abdominal fat expansion, inflammation, joint pain, fibromyalgia, anxiety, depression, suicidal thoughts, Parkinson’s disease, Lou Gehrig’s disease, Alzheimer’s disease, atrial fibrillation, coronary disease, type 2 diabetes, fatty liver. In other words, we have to reexamine everything we thought we knew. We didn’t know about all this until recently. And endometriosis. So we attack the SIBO first.

Now, the way I do it…So if you went to your gastroenterologist, most typically they say, “Oh, there’s nothing wrong with you, Sandi. You’ve been talking to Dr. Google again,” or some other stupid answer, right? Or if they do know something, they’ll say, “Here’s a prescription for rifaximin, Xifaxan, the antibiotic. Very expensive. You know, the antibiotic goddess here is part of the reason we’re all in this situation. I have a hard time believing that antibiotics is the solution also. So what I did is this. If you have SIBO, 30 feet of fecal microbes, including in the 24 feet of small intestine, what if you just took one of those commercial probiotics, this haphazard collection of microbes, will the SIBO go away? No, highly unlikely. What if we instead chose microbes that survive past stomach acid, colonize the small intestine, which most microbes can’t do, and then produce bacteriocins in the small intestine?

So I picked Lactobacillus reuteri, Lactobacillus gasseri, and my most recent recipe, I replaced the Bacillus coagulans that I originally had in my book, in “Super Gut.” I replaced it with Bacillus subtilis. It’s a little bit more reliable to fermenting microbe in dairy, and it’s a fantastic bacteriocin producer. In our DNA sequencing, we uncovered genes for seven bacteriocins in subtilis. So you can co-ferment them or individually…Individual fermentation is a little better. You get higher numbers, but you can co-ferment them also. We used long fermentation in the presence with the addition of a prebiotic fiber, like a tablespoon of inulin, and we get hundreds of billions. And that so far, Sandi, has worked far better than I ever expected. We’re going to start a small human clinical trial, actually two of them, to validate all this.

But in the meantime, if the solution is something as benign and accessible as something that looks and smells like yogurt, why not do it? And you get all kinds of other benefits of those microbes, skin benefits, emotional benefits, reproductive health benefits. So what we do with, I call that SIBO yogurt, we take it for four weeks or longer, depending how severe your SIBO is, and then do it intermittently for the rest of your life, three times a week, something like that. Because of that issue, they don’t take up permanent residence, at least until we figure out how to make them take up permanent residence.

Dr. Sandi: And it’s very easy to do. It’s like 5, 10 minutes of actually preparing it. So somebody just got a GI test and came back over abundance, and it looks like Lactbacillus…SPP? I don’t know if you mean…but should they consider this probiotic? I’m assuming it really wouldn’t make a difference, that they are different strains.

Dr. Davis: So that method they used was an old-fashioned method. What they did was…SPP means species. So it says Lactobacillus species. Well, which one is it? Is it Lactobacillus brevis, crispatus, reuteri, gasseri, acidophilus, delbrueckii? So they used an old-fashioned method that doesn’t identify the species nor the strain. So you can’t tell from that test. It’s too crude. If you want to know if there are specific strains present, you do a test that uses what’s called metagenomic shotgun sequencing or complete DNA sequencing, such as Ombre…Stupid names, I know. Ombre does that, Tiny Health does that, some other testing platforms, where they tell you in more detail.

But you know what? Once again, if the method to restore Lactobacillus species is something you make in your kitchen, that’s very easy. And as Sandi points out, don’t make this harder than it is. It makes me laugh because I think about this. People say, “I put boiling water in a teacup and I put a teabag in it. It doesn’t make tea.” Of course it makes tea. So making a yogurt is a little bit more than that, but it really is so easy. If you plant tomato seeds in your garden in springtime, you get tomatoes. You don’t get cucumbers. You don’t get zucchini. You get tomatoes. So don’t make this harder than it is. You’re just planting seeds and providing the environment temperature-wise to get them to grow. That’s all you’re doing.

Dr. Sandi: Absolutely. Can you just comment on spore-based probiotics different from others?

Dr. Davis: Yeah. So in that SIBO yogurt formulation, I used those two spore-formers, Bacillus coagulans, and now I play with Bacillus subtilis. Those are spore-formers. There’s a fiction going around. People say only spore-formers survive stomach acid and bile. That is not true. In fact, we have data going back 30 years that if you take crispatus, or if you take, say, reuteri or gasseri, you can recover it in poop in very high numbers. In fact, Dr. Gerhard Reuter, the academic microbiologist who discovered Lactobacillus reuteri years and years ago, he did a test where people swallowed this mechanical capsule that opened in the ileum and grabbed a sample of poop. And then when people had their bowel movement, they get the capsule, and they examined it for the presence of, in this case…this is before DNA sequencing, for reuteri and gasseri, and they were present at high numbers. So that fiction that only spore-formers survive is fiction. It’s not true.

There are species that are susceptible to stomach acid and drop maybe by 30%, 40%, and pass it through the stomach and duodenum. But a lot of the species we’re playing with, especially those ones that colonize the small intestine, do survive stomach acid. So there’s a role for spore-formers. Most spore-formers are soil microbes, and it’s been in question for a long time. If they’re soil microbes, did you get them from eating onions, or garlic, or carrots, or other root vegetables? It does seem that some spore-forming species, especially Bacillus subtilis, does take up residence in the human GI tract and are meant to be there. The subtilis is really a very much underappreciated microbe. It’s a really cool microbe.

Dr. Sandi: All right. Suzanne wants to know about using the elimination diet as a solution to some of the things we’ve already mentioned, like endometriosis, PCOS, difficulty conceiving. And I’m assuming that that would be a great recommendation and not necessarily interfere with what probiotics you might be needing or wanting.

Dr. Davis: So these elimination diets, whether it’s elimination, or a low FODMAP’s diet, or carnivorous diet, or a ketogenic diet, all those diets where you’re reducing some kind of food are very destructive. They provide upfront relief. So let’s say you’re going to do an elimination diet because you’ve got SIBO, you’ve got bloating and diarrhea and joint pain and anxiety. You eliminate a whole bunch of foods that provide fibers and sugars. You feel better. But a year later, you’ve got a completely disrupted gastrointestinal microbiome, and you set yourself up for inflammatory diseases, neurodegenerative disorders like Parkinson’s disease and dementia, for colon cancer, for diverticular disease. You will gain a bunch of weight in your abdomen. Your blood glucose will go up. Your triglycerides will go up.

In other words, yeah, you’ll see this over and over again. People say, “Oh, I went carnivore, or I did an elimination diet,” or whatever they did. They say, “My bloating is better. My waist shrunk by 8 inches. My glucose and triglycerides, my blood pressure all came down.” And they think, “Wow, I found the answer.” Eighteen months later, weight goes back up, triglycerides go back up, they’re constipated. And if you did a microbiome analysis on their stool, you would see they lost hundreds to thousands of species and they’ve allowed the proliferation of unhealthy species such as Akkermancia. So Akkermansia mucinophila, mucous-lover, is a good microbe. If it occupies 3%, 4%, 5% of the entire microbiome, it’s good for you, reduces blood glucose, supports other beneficial microbes. But if you starve it by doing an elimination diet, or carnivorous diet, or ketogenic diet, whatever, you’re not getting fibers…So imagine you tied your dog up on a chain in the backyard and you forgot to feed it for five days. What’s going to happen to the poor dog? It’ll be dead.

So if you don’t feed your microbes like Akkermancia, they die. Many of them die and you have dramatic reduction in microbes, both beneficial and harmful. But there are species like Akkermancia that are capable of surviving because they have this added capacity to consume human mucous, mucinophila, mucous-lover, and starts to erode the lining of your gastrointestinal tract. And you’re opening the door to ulcerative colitis, diverticular disease, colon cancer, an increase in endotoxemia, weight gain, neurodegenerative disorder. So while it provides upfront relief, it damages your health long term.

Dr. Sandi: Thank you. This has been incredible. We are drawing to a close. I just want to…from Daniela is a…

Dr. Davis: I’m sorry, I lost Sandi. Oh, there you are. You’re back.

Dr. Sandi: Okay. Is there any way to consume the Lactobacillus crispatus without making yogurt?

Dr. Davis: You can take it as a probiotic. Yeah. The downside of probiotics, besides cost, they can be expensive, is the low numbers you tend to get. So most probiotics, for instance, have 1 billion, 2 billion, sometimes more, 10 billion. If there’s more than one species, you have to divide that number by the number of species. So if it’s 10 billion, but there’s 10 species, you got maybe a billion of each. When you ferment it as yogurt…and by the way, you can ferment it in other foods too. I ferment hummus, salsa, pico de gallo, juices. I ferment all kinds of stuff. You increase microbial numbers much higher. So the advantage of fermentation is an increase in numbers. In other words, if you’re going to go to battle with trillions of fecal microbes, for instance, and you come in with a few hundred million, it’s not going to do anything. That, by the way, Sandi, was my original motivation for making the yogurt, the original source of the reuteri was a tablet that had 100 million microbes because it was made for babies. Well, it does nothing for humans, for adults. So that’s when I fermented it to increase it. We get something like 300 billion per half cup serving. That was the motivation to increase the numbers.

Dr. Sandi: Well, this has been fascinating. We’ve had so many questions and I apologize that we could not get to all of them. Sounds like we will have to have Dr. Davis back. You are such a popular presenter, a wealth of information. I always learn so much from you, and I know everybody here did as well. We will get a follow up. You will get this recording. We will have the spelling of the strains that were mentioned as well as we can talk about the products and where somebody can get these strains directly. So I can’t thank you enough. Thank you. This has been absolutely incredible. And we really value everything that you have done for the health of the world and being such a strong supporter of coaches and FMCA specifically. So thank you so much. Thank

Dr. Davis: Thank you, Sandi. Thanks, everybody.

Dr. Sandi: Thank you all. Bye-bye.