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Episode 206: Women’s Health, etc with guest Dr. Abigail Aiyepola

Published on July 18, 2013, by in Uncategorized.
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We have a special guest this week.  Dr. Abigail Aiyepola joins us to discuss various topics on women’s health including bacterial vaginosis/vaginitis.  Enjoy this week’s podcast and we hope to have more guests soon to talk about all the hot topics.

 

 

 

 

 

 

 

 

 

References:

Strains of Lactobacillus strains with clinical potential for urogenital health

  • **All of these are found in the vagina and has anti-pathogenic properties. Problem is that all of these are not commercially available
  • L. Ruteri: inhibiting property of GBS, candida, gardnerella,
  • L crispatus CT VO5
  • L rhamnosus GR-1 (resistant to spermicide)
  • L. fermentum RC-14
  • Additional species:
    • L. salivarius
    • L plantarum
    • L acidophilus
    • L gasseri
    • L jensenii
    • L iners
  • OTC Products with these strains:
    • Integrative Therapeutics: rhamnosus GR-1, ruteri RC-14 (ProFlora)
    • Vitania: plantarum, salivarius, rhamnosus & acidophilus (FemEcology)
    • Jarrow: rhamnosus and ruteri (they have a product containing these two)

 

Use of Lactobacillus for tx of vaginitis

–        Looked at all of the research over 10 years

  • plenty of evidence that oral probiotic supplementation colonizes the vagina

–        Must supplement for 2-6 months to MAINTAIN continued colonization

–        Controlled trials are encouraging, but few

–        Review of Studies (VVC & Lactobacillus)

  • First two (positive)
  • Next 3 (positive–rhamnosus)
  • Yogurt positive
  • Last two negative
    • yogurt for two months
    • no effect of prevention p-abx use (but what species did they use)
  • Hilton: L GG bid/7 days; > sx/signs for VVC; 4/5 cultures neg after tx
  • Williams: L acid weekly vs Rx vs P; VVC culture (15.5% vs 14% vs 32%
  • Reid: L rhamnosus GR-1+> fermentum RC-14 oral for 60 days vs P; 30% improvement vs 12%
  • Reid: L rhamnosus GR-1 + L fermentum RC -14 oral bid x 14 days; no sx of VVC
  • Reid: 3 groups had different amounts of Gr-1/RC-14 Vs GG only; N flora 12/13 groups 1,2,3 vs ¼ in group 4
  • Hilton: 8 oz  L. Acid yogurt x 6 mo then none x 6 mo; decreased ave # of VVC during 6 mo of yogurt
  • Shalev: L acid yoghurt x 2 mo then none x 2 mo then pasteurized x 2 mo. vs pasteurized then none then yoghurt; no significant differences
  • Pirotta: no effect of oral or vaginal prevention of post-antibiotic use

–        Study of azole drug + vag specific probiotic

  • Randomized DBPC trial, n = 55 women with VVC
  • Tx: single dose of fluconazole plus 2 oral caps/d x 28d of
    • L. rhamnosus GR-1 and L. reuteri RC-14
    • or placebo
  • At 4 weeks, probiotic group cured compared to the placebo group (p < 0.05).
  • Probiotic group showed
    • less vaginal discharge (10.3% vs. 34.6%)
    • lower presence of yeast (10.3% vs. 38.5%)

Letters Applied Microbiol 2009;48:269-74.

  • **Note: If not responding do both
    • also start to suspect C. glabrata instead of C. albicans!!
    • C. glabrata: boric acid helps!!

 

 

Yeast Vaginitis (VVC—Vulvovaginal Candidiasis)

–        Lactoferrin and VVC

  • 34 patients aged 25-45 years and presenting signs and symptoms of acute vulvovaginal candidiasis. The patients have been treated with a cream containing lactoferrin 4%, 5 g of cream in vagina and 2 gm applied on the vulva twice a day for 7 days
    • RESULTS
      • 27 women completely recovered, 5 showed a good improvement and only 2 women were still suffering from vulvovaginitis at the end of treatment.
    • CONCLUSION
      • a cream containing lactoferrin seems to be clinically effective in the treatment of acute vulvovaginal candidiasis, with a good response on all the characteristic symptoms of this infection

                                                                                          Minerva Ginecol. 2008 Apr;60(2):121-5

 

 

–        Yogurt and VVC

  • **one positive study, one negative study
  • Small crossover trial with women with recurrent VVC found that daily ingestion of yogurt with L. acidophilus for 6 months reduced the mean number of infections and C. albicans colonization of the vagina an rectum  when compared to 6 months with no yogurt consumption (0.38 vs. 2.54 [p = 0.001] and 0.84 vs. 3.23 [p = 0.001], respectively).1
  • A RDBPCT in women (18-50 years) who were prescribed antibiotics for non-GU infections received an oral combination of L. rhamnosus and B. longum or oral placebo and/or a intravaginal pessary containing L. rhamnosus, L. delbrueckii, L. acidophilus, S. thermophilus or a placebo pessary (potencies or strain designators are not given) for 6 days during antibiotics and for 4 days after. The results fail to show a preventive effect for probiotics.2

1. Ann Intern Med 1992;116:353-7

2. BMJ 2004;329:548-52

 

 

Bacterial Vaginosis (BVV)

–        Compounded Lactobacillus plus estriol

  • L. acidophilus tablets and 0.03 mg estriol or placebo tablet every night for 6 days.
  • 2 weeks: 75% cure rate in L. acidophilus and estriol group vs 25% in placebo
  • 4 weeks: 88% were cured in tx group and only 22% in placebo group.

                                                        Arzneimittelforschung 1996;46

  • **An important compounded med: lactobacilli and estrogen
  • **Gynoflore vaginal suppositories (available in canada, not in us)
    • This combination is very exciting!
    • this compounded formula is great use of a compounding pharmacy—put in some rhamnosus as well as lactobacillus

–        L. gasseri and L. rhamnosus

  • •Randomized DBPC of 100 women (mean age 34 years) with BV
  • •Tx: 2% vaginal clindamycin cream x 7d and then randomized to receive vaginal capsules for 10 days containing either
    • –placebo or
    • –combination of L. gasseri and L. rhamnosus (10 bn CFU/capsule)
  • Repeated for 3 cycles
  • Probiotics did not improve efficacy of BV treatment during the first month of treatment.
  • However, women initially “cured” were followed for 6 menstrual cycles or until relapse within that time. At the end of 6 months:
    • 64.9% of the probiotic-treated group were still BV-free
    • compared to 46.2% in the placebo group

BMC Women’s Health 2008;8:3.

–        L. rhamnosus & L. ruteri for BV in Black women

  • DBPC Trial, n= 125 premenopausal African women (18-44 years old) with diagnosed BV
  • 1 week oral metronidazole, then one month of
    • one capsule of L. rhamnosus GR-1 and L. reuteri RC-14
    • or placebo
  • In the probiotic group, 88% cured compared to 40% in the placebo group.
  • Of the remaining subjects12% in probiotic group, none had BV, but had mild sx, compared to remaining 30% in placebo group, of which half had BV.

Microbes Infect 2006;8:1450-4.

  • **Note: Oral metronidazole is a common rx given by physicians (a vaginal metronidazole would have been MUCH better! No need to expose them to the SEs of oral)
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Episode 205: Hodge Podge

Published on June 13, 2013, by in Uncategorized.
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IMG_0971We couldn’t decide what to discuss for this episode so we just decided to talk about it all, therefore, the episode is justly named Hodge Podge.  We talk about physiotherapy modalities like cold laser, iridology, nasal specific treatments and a bunch more.  Enjoy!

References:

Davis GE, et al. A complication from neurocranial restructuring: nasal septum fracture. Arch Otolaryngol Head Neck Surg. 2003 Apr;129(4):472-4.

Washington K et al.  Presence of Chapman reflex points in hospitalized patients with pneumonia. J Am Osteopath Assoc. 2003 Oct;103(10):479-83.

Prevalence of hiatus hernia varies from 10% in the under 40 years to 70% in those over  70 years. 

Wikipedia today states that “Well-controlled scientific evaluation of iridology has shown entirely negative results, with all rigorous double blind tests failing to find any statistical significance to its claims.” They talk about some studies, but of course…

 

 

 

 

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Episode 204: Energetic Medicine

Published on April 25, 2013, by in Uncategorized.
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FountainThe doctors talk about everyone’s favorite topic, energetic medicine.  This can kind of  a loaded term considering energy has a number of possible definitions.  But as you will hear the topic can generate more debate than just about anything in the naturopathic realm.

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Episode 203: Stress

Published on March 14, 2013, by in Uncategorized.
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IMG_0183Drs. Noska and Davis discuss the meaning of stress, and share their perspectives on stress management.

 

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Episode 202: Medicinary Ethics

Published on February 28, 2013, by in Uncategorized.
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IMG_0506Ethical issues that come up with an ND practice, including keeping a medicinary, relationships with pharmaceutical and nutraceutical companies, and more.
The good Drs. digress quite a bit.

 

 

 

References:

Of principles and pens: attitudes and practices of medicine housestaff toward pharmaceutical industry promotions

No free lunch

The effects of pharmaceutical firm enticements on physician prescribing patterns. There’s no such thing as a free lunch.