Urinary Tract Infections (UTIs) are pretty common - approximately 40 - 60% of women will experience at least one in their lifetime. Painful, uncomfortable and annoying, but most of the time, easily resolved. However, an acute UTI can turn into a chronic UTI if left untreated, misdiagnosed or undertreated. Estimates are that 25% of women will experience chronic or recurrent UTIs. Chronic UTIs are defined as 2 or more bladder infections in 6 months or 3 or more in one year. But one of the major barriers to effective treatment is getting an accurate diagnosis. Let’s explore what’s really happening with chronic UTIs, how to effectively test for it and what treatment is available.

The Bladder Microbiome

Everyone is pretty familiar with probiotics these days and no one disputes the existence of the gut microbiome. But did you know that the bladder also has its own microbiome? It’s true - urine is NOT sterile. Multiple studies now conclude that the bladder - and therefore urine - contains a unique set of various bacterial species. The most common being Lactobacillus, Corynebacterium, Streptococcus, Actinomyces & Staphylococcus. Some species are protective and help with overall bladder health, while others are associated with urinary symptoms such as urgency or burning with urination. 

What’s the Connection with Chronic UTIs?

Chronic UTIs can have many of the same symptoms as acute UTIs, but frustratingly, when urine samples are sent for cultures, they often come back as normal. Essentially, when the lab attempts to look for the presence of bacteria, none are found. Patients are often told that their results are normal and diagnosed with labels such as interstitial cystitis, overactive bladder syndrome, bladder pain syndrome, pelvic pain syndrome, etc. But we know that urine isn’t sterile and there is a bladder microbiome so what gives? The answer lies in HOW we test. 

Testing for Chronic UTIs

A standard urine culture is a test where a small sample of urine is collected and then bacterial growth is encouraged over a certain period of time. If minimal or no growth is observed after the prescribed period of time, the sample is deemed normal. But a standard culture is not designed to catch everything that could be present in urine. It uses a very small amount of urine, has a higher threshold for total amount of bacteria present, uses a growth medium that only catches certain types of bacteria and only looks for growth within a 24 hour period. More recent technology such as expanded quantitative urine cultures (EQUC) is capable of growing a much more diverse range of bacteria yielding more in-depth results.

Comparison of a Standard Urine Culture (left) and an EQUC (right). Note both the presence of growth using EQUC and the diversity of species present.

Furthermore, an even newer form of testing involves PCR analysis that looks for actual genetic evidence of which bacterial strains are present in the urine. Additional research has shown that PCR testing can:

• Identify bacteria in appx. 90% of no growth standard urine cultures

• Assess for eight antibiotic resistance genes

• Be 99.9% accurate at identifying all possible microorganisms

This test can determine what types of bacteria are present, how much of the total microbiome they constitute, detect the presence of antibiotic resistant genes and determine which antibiotics the specific bacterial strains are sensitive to. Another study found that participants who had chronic UTI symptoms only had positive urine culture results 30% of the time, while PCR results came back positive 100% of the time!

Bladder Biofilms - Necessary to Treat

Now you know all about the bladder microbiome and PCR testing, but why do some people with chronic UTIs suffer with symptoms for so long even with long-term antibiotic treatment? The answer is biofilms and it’s kinda gross. Once bacteria set up shop within the bladder they begin to embed within the bladder lining and can actually move into the cells. Bacteria then begin to produce a biofilm to anchor themselves in place & avoid immune system attack. A biofilm is an extracellular matrix produced by at least two microorganisms residing together consisting of proteins, polysaccharides, DNA and metalloids. You already know some common biofilms like plaque on your teeth and that slimy film that can build up on a boat or in your sink.

Drawing of a bladder demonstrating bacteria present within the urine and embedding within the lining via a biofilm

Once a biofilm is created it decreases the effectiveness of the immune system and evades external antibiotics/antimicrobials. It’s a great way for bacteria to ensure their own survival, but causes you some serious health problems. Ever wonder why flare-ups happen with a chronic UTI? Flare ups are when bacteria go through phases of multiplying and penetrating deeper into the lining - building up their biofilm and causing a low-grade immune response. If we want to effectively treat chronic UTIs then we MUST address the biofilm factor. 

Treatment Solutions for Chronic UTIs

The treatment goal is to constantly open up a biofilm while simultaneously killing the contents, i.e. bacteria. We need both - break up the biofilm and kill what’s in it. How we accomplish that can depend on where you live and what your healthcare practitioner has access to. Breaking up a biofilm involves using substances only available through a compounding pharmacy. The pharmacy creates a Bismuth-Thiol Complex that attracts the metalloid structure and breaks open the biofilm. Subsequently, your health care provider can use antibiotic or natural antimicrobial therapies to then kill the bacteria. It’s important to work with a skilled provider as long-term use of these substances needs to be closely monitored clinically and through blood work. 

Relief is Possible

So there you have it - feel like you have a UTI, but all the tests are coming back normal? Constantly being told that it’s in your head, just do more physio, clean up your diet or you’re just too stressed? Don’t settle for long-term, debilitating symptoms - be your best health advocate. You owe it to yourself to check exactly what’s happening with the bladder microbiome and try this modern treatment approach. 

If you’re reading this blog post, it’s probably because you’ve just received your pap results and guess what - they’re abnormal. 

Your first thought? What does this even mean?

An abnormal pap means that there are abnormal cells on your cervix → referred to as cervical dysplasia. Your pap result will also give you a rough idea of the grade of dysplasia - how severe the dysplasia is, but to be most accurate this is best followed up by a colposcopy and/or biopsy. 

Cervical Dysplasia (CIN 1)

Depending on the grade, your health care provider may recommend that you repeat the pap in six months, refer you to a colposcopy clinic for further assessment or recommend a LEEP procedure to remove the abnormal cells. Regardless of the recommendation, patients are often told that there’s nothing they can do to affect the health of their cervix. 

Not. True. 

“You can affect the health of your cervix”

There is a whole host of things you can do to take charge of your cervical health after an abnormal pap result - here are my Top 5 Things you can do about your cervical dysplasia right now!

1. Consult your ND to see if Escharotic Therapy is right for you

   • Depending on the degree of cervical dysplasia, a course of escharotic therapy may be a good option for you. This is a topical treatment applied directly to the cervix in your ND’s office over a series of 8 - 12 sessions. The treatment selectively targets the abnormal cells while sparing healthy cervical tissue. 

2. Strengthen your Immune System

   • Cervical dysplasia is caused by HPV - a virus that is virtually everywhere in this world. A healthy immune system should be able to fight off this infection within appx. two years. If the immune system isn’t working properly, HPV can persist in cervical tissue and continue to cause damage to the cells. Ways that you can support your own immune system include getting adequate Vitamin D, eating a Mediterranean-like diet, ensuring enough sleep and using targeted supplements like a mushroom complex. 

3. Boost your intake of Cervix-Friendly Foods

   • Your diet has a HUGE impact on your cervical health! Diets high in Vitamin C, carotenoids, Vitamin E and selenium have been found to be protective against cervical cancer. Higher levels of vegetable consumption were associated with a 54% decrease of HPV persistence. Include such nourishing foods as pumpkin, kale, peppers, carrots, broccoli and spinach. 

4. Balance your Hormones

   • Some research suggests an excess of estrogen may contribute to the development of cervical cancer. This is highly individual, but your cervix does respond to hormonal changes throughout your cycle. If you notice painful periods, PMS symptoms like bloating and irritability or heavy periods, this could be a sign that your hormones need some support. 

5. Find Activities that Promote your Creativity and Relaxation

   • Stress and anxiety directly suppress your immune system and now you know that you need a robust immune system to kick that HPV infection. Studies show that a highly anxious state is even correlated with cervical dysplasia! There’s no right or wrong way when it comes to the best way to relax - find what resonates with you. It could be going for a walk in nature, a high energy spin class, taking up that painting class you’ve been putting off - whatever the activity, choose something that connects to your creativity and nourishes your sense of peace. 

So there you have it - 5 Things you can do right now to heal your cervical dysplasia. The mainstream message is that there’s nothing you can do - just sit back and wait for that next pap test or colposcopy appointment. No way - there are so many things you can do to take charge of your cervical health and heal your dysplasia. Go for it!

You’ve just been diagnosed with Polycystic Ovary Syndrome (PCOS) or maybe you’re suspicious that you have this disorder. You’re in good company - some studies estimate that up to 20% of women worldwide have PCOS. So what do you do? You start googling of course! No shame - we all do it, but pretty soon you feel super overwhelmed by all the conflicting information. How much protein to eat? What type of exercise is best? Should you take inositol, chromium, Vitex, etc.? And how does this impact your fertility? 

That’s why you’re here - I’m so glad you found this article because it’s going to help you understand key shortcuts that can help you focus on the essentials of healing PCOS. Let’s get started!

What is PCOS?

PCOS is best defined as a group of symptoms that primarily affects ovulation and hormone levels. The main symptom is irregular periods - your cycle should be around 28 days long, but with PCOS this can be much longer - I’ve seen it be as long as 50 days or more! A very long period means you likely aren’t ovulating - your body isn’t releasing an egg mid-cycle. 

Other symptoms that can happen in PCOS include hirsutism - excessive hair growth on unexpected places like your chin, cheeks, belly and nipples - acne, weight gain, bleeding for a longer time on your period and infertility. In practice, I’ve also seen significant premenstrual dysphoric disorder (PMDD) associated with PCOS - this is when you experience severe anxiety, irritability and depression in the week leading up to menstruation, which typically resolve a few days into bleeding.

PCOS is essentially a problem with ovulation leading to an imbalance in other sex hormones like testosterone and progesterone. 

What makes dealing with PCOS more challenging?

Now that you have some basics about PCOS - let’s talk about why it seems so difficult to successfully treat. 

First of all, there is widespread disagreement about how to diagnose PCOS. Even the name is misleading - you would assume that in order to be diagnosed with PCOS you would need to have multiple cysts on your ovaries found at an ultrasound. Not true. You CANNOT diagnose PCOS via ultrasound. Let’s say that again - an ultrasound does not diagnose PCOS. Ovaries are not static creatures - they change depending on where you are in your cycle and whether ovulation occurred that month. Having multiple ovarian follicles - sacs that secrete hormones and have the potential to release an egg - is completely normal. Polycystic ovaries can occur with PCOS, but can also occur in other situations - even in completely healthy women.

“PCOS cannot be diagnosed by ultrasound”

— Dr. Lara Briden, ND "Period Repair Manual"

Secondly, there are several different types of PCOS. They include insulin-resistant, post-oral contraceptive pill (OCP), inflammatory and adrenal PCOS. What this means is that PCOS can look completely different for different people! We tend to think that PCOS only happens in someone who is overweight, has abnormal hair growth and irregular periods. But this is only one type of PCOS - in my practice, I’ve seen PCOS in completely different patient populations. The challenge with treatment is that you need in-depth investigation into what type of PCOS you have in order to pick the right treatment strategy. What works for one type, will not work for another. 

Another reason PCOS feels so overwhelming is that there are so many treatment suggestions. A simple google search brings up strategies like inositol, chromium, Vitex, cinnamon, NAC, omega-3s, Vitamin D, berberine…..You can easily wind up on a dozen supplements with zero success and way less money in your wallet. Western medicine offers a completely different route that includes oral contraceptives, intermittent progestins, metformin and infertility treatments. How are you supposed to know your best way forward? Remember - finding the right treatment depends on getting the right diagnosis. Your ideal treatment strategy will vary depending on what your individual labs say - google cannot understand your unique set of health concerns. 

Key PCOS Strategies - Shortcuts to Success!

You understand some PCOS basics, you see that some of the challenges involve inaccurate diagnoses and non-targeted treatments. So let’s get to the shortcuts to make healing from PCOS easy for you:

1. In-Depth Blood Work: in order to properly diagnose PCOS there are some key labs you should have. 

   • Fasting blood sugar and insulin OR a 2-hour insulin glucose challenge test - assesses for insulin resistance, a key underpinning of PCOS. This is NOT the same as doing a fasting blood sugar on its own - you must get an insulin level. 

   • Hormone Testing -

     • Cycle Day 3 = estradiol, FSH, LH, free testosterone, progesterone, androstenedione

     • Cycle Day 21 or 7 Days Post-Ovulation = estradiol, progesterone, DHT, DHEAs

   • High sensitivity C-Reactive Protein (hsCRP) - detects levels of persistent inflammation

   • Full Thyroid Panel - TSH, free T3, free T4 and anti-TPO

   • Vitamin D

   • Cholesterol panel

   • Liver function test

2. Accurate PCOS Diagnosis: your labs will help you understand which subtype of PCOS you have. I love this flowchart from Dr. Lara Briden, ND which helps guide you to which subtype is most appropriate.

3. Targeted Treatment Plan: once you have accurate labs and a working diagnosis for a PCOS subtype, you can then move on to creating a targeted, effective treatment plan. You cannot get results without the first two steps - labs inform the diagnosis which then leads you to the most effective treatment strategy. Instead of throwing a bunch of different supplements at the problem not knowing what will work, do the investigation first and then you’ll understand how to move forward. Most likely, you will need to work with a healthcare professional experienced in PCOS to create the most successful treatment plan for you. 

Next Steps - Take Action!

So there you have it - you’ve got the basics about PCOS, understand why it feels so challenging to get answers and have your new list of shortcuts to achieve success. What do you do now? My suggestion is to find a healthcare practitioner in your area that has a lot of experience supporting PCOS. You’ll get results faster if they can order blood work too. If you live in Alberta, you can book online with Dr. Kate below.

PCOS is 100% treatable, but the biggest shortcut to getting results quickly is understanding how your particular body works and targeting treatment strategies to address the root cause. 

In this episode, Dr. Toni welcomes back Dr. Kate Hadfield to discuss everything you need to know about your cervix, an often overlooked and unknown part of your body. Did you know that you have a huge amount of influence over the health of your cervix and how your body deals with HPV and cervical dysplasia? If you dread getting Pap smears and ever wondered if we still need to subject ourselves to invasive and traumatic Paps anyway, you need to listen to this episode.

Postpartum. Our culture most often associates this word with postpartum depression when really, it refers to the time after a baby is born. Medically speaking, the postpartum period is defined as the first six weeks after a baby is born until the mother’s uterus returns to its pre-pregnancy size. I prefer the description from Midwife Raven Lang, “As long as the baby is still in diapers and you’re up in the night, you’re postpartum”.

Women need a great deal of support during the postpartum period, yet many report that after those first few days of new baby celebration, their support networks tend to fade away. We tend to think that after six weeks, women should be back to normal physically and emotionally – that timeline is often reflected in the length of maternity leave. Women feel social pressure to have it all together by that six-week mark and can feel like failures if they’re still struggling.

Most commonly, women report that they feel more like themselves around the ninth month postpartum, not the sixth week. “Nine months in and nine months out” is something I often tell my patients. But during those nine months, it’s important to nourish your body and support your recovery. This is where Naturopathic support shines.

Naturopathic Support for the Postpartum Period

• Sleep: although we can’t change the challenges of newborn sleep, we can ensure that the mother’s sleep is as restful as possible. Sometimes postpartum depression or anxiety can contribute to difficulty in falling asleep or staying asleep even when the baby is sleeping. Adding in gentle support such as Magnesium, L-theanine or calming herbs can have a profound effect.

• Emotions: no experience is as transformative as becoming a mother and it is completely normal to have a bumpy transition. Adaptogenic herbs can help your body adapt to the stresses of parenthood and create more resilience to those unexpected changes. Nervines are herbs that help to soothe and nourish a frazzled nervous system without being overly sedative.

• Lab work: we tend to focus on newborn health, but routine bloodwork at 6 weeks, 12 weeks and throughout the first year should be standard for mothers as well. It’s important to look at iron levels, a full thyroid panel and any risk factors for anemia as these markers can often change during pregnancy and have a great impact on postpartum well-being.

• Pelvic care: in several European countries, it is part of routine postpartum care for a mother to see a pelvic floor physiotherapist at 6 weeks postpartum. This should be the gold standard everywhere. In addition to a referral for a pelvic floor physio, we also offer Holistic Pelvic Care ™ at Vive Health, which is internal bodywork that incorporates the mental emotional aspect of pelvic floor health – especially important after birth.

This is just a snapshot of how Naturopathic care can support mothers during the tender postpartum time. It is a time of great change, challenge and joy – and every mother’s experience is unique. I think it’s time to take back the word postpartum and drop the negative association with depression. Let’s work together to make postpartum mean a time of nourishment, healing and transition into a new phase of life.

~ Dr. Kate

I was interviewed for an article intitled “Natural Treatment for Incontinence” recently, to talk about naturopathic alternatives to treat incontinence. Check it out here!

An article was published this past Wednesday in “Science Translational Medicine” entitled “The Placenta Harbors a Unique Microbiome”. The researchers collected placentas from 320 subjects and analyzed DNA to accurately identify which strains of microbial life were present. 

In the past, placentas and the intrauterine birth environment were thought to be sterile sites. This study shows that is simply not true. The researchers found microbiota from the Firmicutes, Tenericutes, Proteobacteria, Bacteroidetes and Fusobacteria phyla. But the most interesting piece of information is where the placenta bacteria came from?

Bacteria found in the placenta have to come from somewhere and you would think, geographically speaking, that they would most likely come from the vaginal tract. Not true. Not true at all! Bacteria found in the placenta are most similar to bacteria found in the mouth. Read that sentence again. Lots of research demonstrates the link between pre-term (<37 weeks) birth and periodontal disease (i.e. gingivitis), but this paper provides insight into a possible mechanism. It is possible that bacteria in the placenta are “seeded” from bacteria in the mouth. Additionally, factors that were NOT associated with clustering of the placental micro biome included:

• GBS infection

• Infant gender

• Maternal BMI and,

• Route of delivery (c-section vs. vaginal)

That information alone is highly valuable. It would seem that the critical time period to ensure a "microbially" healthy placenta is prior to conception and placental formation/implantation. This places attention on the importance of patient education regarding healthy dental hygiene practices and the importance of these practices during the child bearing years, especially prior to pregnancy. If something as simple as brushing and flossing twice a day can help prevent preterm labour, every health care practitioner needs to have this discussion with their patients. Who would have guessed that your oral microbial population would be so closely linked with a developing placenta. 

Brushing, flossing and mouthwash, twice a day, here I come.