A Probiotic Approach to Yeast Infections

Vaginal infections can be annoying in the least. They're itchy and uncomfortable (a new patient once told me that she needed a natural remedy fast or she was going to buy Brillo Pads!), and they can even get even painful if there's a lot of local irritation. Most vaginal infections are caused by one of several species of yeasts (fungi) in the Candida family, which is why we call them “yeast infections.”

Yeast infections in themselves aren't harmful in otherwise healthy women.* In fact, most of these organisms live in healthy balance as a normal part of our vaginal flora. But certain factors can kick them into high gear and make them think they have the run of the place. This typically happens when the vaginal pH or microbiome gets disrupted, or when there is an imbalance in your gut microbiome or your blood sugar is high. That's when these otherwise small players in your vaginal ecology can cause itchy, irritated, burning vaginas and vulvas (the outside parts down there), frequent urination, and often some type of discharge and mild yeasty odor.

The Natural Path to Preventing and Healing Yeast Infections

Yeast infections respond best to a 1-2 punch – knock down their numbers with vaginal probiotics and if necessary, herbal treatments, while restoring balance to your overall microbiome and health.

Treating yeast infections naturally is generally very effective for mild to moderate infections, great for preventing them from recurring and is safe. In my practice I even use this approach during pregnancy. The “PATH” to treatment is Promoting healthy vaginal flora, Avoiding things that trigger infection, Treating the infection, and Healing sensitive tissue if there's been a lot of irritation.

If you have an active yeast infection now (this should ideally be confirmed by your primary medical provider) that just recently started, or want to prevent a yeast infection from recurring, take a look at the triggers below and make sure that you're eliminating exposure to those now and for at least a few weeks. (If you get a lot of recurrences, then avoid sugar and alcohol for 2-3 months). Reduce all of the chemical exposures permanently because they're endocrine disruptors, too, and are just an unnecessary health risk.

Step 1: Eliminate triggers

Here are 6 big triggers that get your vaginal microbiome out of whack by changing your local pH, damage the healthy local flora, or jack up your blood sugar – and that have likely caused your yeast infection to occur, or recur.

• Sugary foods: Yeast loves sugar (if you've ever baked bread, you've seen this in action!) and sugar also interferes with healthy immune response so it's double trouble for yeast infections. Eating too much sugar? Time for a sugar detox! If you have chronically elevated blood sugar, then restoring blood sugar balance is essential for getting off the yeast infection treadmill – and taking care of your health in the long run.
• Alcohol: Okay, sorry ladies, but yup – this is one of the biggest culprits I see in my practice, and even that healthy red wine feeds the yeast (after all, what is wine but yeast and sugar?!!). So best to give up the cocktails (also high in sugar) completely, and all alcohol in general at least until you get your body back in balance. Out with friends and know you're gonna' have that drink anyway? Try tequila or vodka with sparkling water and a splash of cranberry juice or squeeze of lime. I promise it's every bit as buzz friendly and delicious – and is lower down on the sugar scale.
• Fragrances, softeners, chemicals in your TP, menstrual products, soaps, etc. – all of these spell disaster for vaginal health. It's worth the investment for clean and green menstrual products, and only use natural, unscented products in and around your precious vulva and vagina.
• Sex: Oh, heck no, I'm not suggesting avoiding sex (unless you're just not into it right now and that's cool, too). But many of the condoms and lubes on the market can be a problem for your flora down there. So this is another area to consider making some changes in if you're getting recurrent infections – and not just yeast, but BV, too, which these can increase the risk Another thing to know is that there can be some funny interactions between partners – like our vaginal pH can get triggered by the higher pH of semen, and receiving oral sex, depending on the partner's oral flora, or where you are in your cycle (i.e., closer to your period, or during menopause) leading to yeast infections. If that's happening for you, use a condom for intercourse, and rinse off and insert a probiotic vaginally (I explain this below) within a few hours of oral sex.
• Antibiotics: These play Russian roulette with your gut and vaginal flora, killing off “good guys” and “bad guys” in equal measure, leaving the heartier organisms to take over. Sadly, most antibiotics are way overprescribed – so the first thing to do is find out whether you really need the one being offered. If you do, then pair it up with a few weeks of a good probiotic product that has a combination of Lactobacillus and Bifidobacterium strains listed on the bottle.

Step 2: Use probiotics

Your main treatment is going to be the use of vagina-friendly probiotics vaginally and orally.

• Orally, take Lactobacillus reuteri and Lactobacillus rhamnosus, 1-2 capsules daily depending on the severity of your current symptoms or how often you get recurrences, for 6-24 weeks, again, depending on your yeast infection severity and frequency. Basically, you want to take these daily until you're free of infection for 6 months.
• Vaginally, you're going to alternate products, one day using the above product blend, and the next day, a product containing Lactobacillus crispatus. A number of studies now show that these three probiotic strains can dramatically improve the vaginal ecosystem and heal and prevent vaginal yeast infections, both by restoring the local flora, but also by resetting the gut microbiome as well. To insert the capsule, use your fingers the way you'd insert a tampon, and gently push the capsule back the length your finger will go or until you feel resistance – whichever comes first. You may want to wear a light pad if you do this treatment during the day, or do this before bed and let it dissolve and do its work while you're sleeping.
• Also, take 20 mg of zinc citrate orally, daily, especially for recurrent infections and take a multivitamin if you haven't been eating your best to help boost your immune system, and consider adaptogens if you think it's stress that's making you susceptible or throwing your system off.

While I don't generally recommend specific products, these specific strains aren't super easy to find. For the Lactobacillus reuteri and Lactobacillus rhamnosus in my practice I use Integrative Therapeutics Women's Pro-Floravailable through the Replenish Formulary, or you can use a product like Jarrow Femdophilus for the  Lactobacillus crispatus, Physioflor.

Step 3: Heal your gut

While a one-time yeast infection doesn't necessarily need more than the above treatment, if your getting recurrent infections, then it's usually an indication that some gut healing is in order. Removing sugar and simple carbohydrates from your diet is an important step, as is taking the probiotics mentioned above. Eating a health diet rich in good quality protein, 6-8 servings of veggies/day, getting gut-healthy fiber in your diet from complex whole grains, legumes, and flax seed, and including at least 1/4 cup of lactofermented veggies in your diet daily is also important. For a more comprehensive approach to healing your gut, follow my 4-R Program, or get a copy of my book. The Adrenal Thyroid Revolution, which is for so much more than that, and contains a comprehensive 4-week gut healing plan.

Step 4: Heal irritation

If you have a lot of local irritation (burning, burning when you urinate, frequent urination due to irritation or itching), these solutions can help you to heal inflamed, irritated, and even damaged tissue. Pick 1-2 approaches; the suppositories are for when the yeast infection seems hard to kick and you want to try something natural before considering medications. You can:

• Apply 2 tablespoons of live active culture yogurt to the vagina and vulva daily for 3-5 days. To apply inside the vagina, use your fingers or carefully use a vaginal applicator. This is very soothing to irritated tissue and also has probiotics – so you're getting extra benefit.
• Many herbs have healing properties that can help in the topical treatment of vaginal infections. Aloe vera gel can be applied liberally to the vulva to heal irritated and inflamed tissue. Make sure it is pure aloe gel without preservatives – the added preservatives, even citric acid, can burn sensitive tissue. Keep a peri-rinse bottle (available at any pharmacy) filled with filtered water or preferably, calendula tea (1 Tbs calendula to 1 cup of boiling water, steep 30 minutes, strain, cool, and put in peri-bottle), 1 teaspoon of sea salt, and 5 drops of lavender essential oil, near the toilet and rinse your vulva with it each time you pee to help resolve irritation and cut down on the yeast growth. Shake well before each use.
• Herbal suppositories can be prepared at home with a blend of herbs specific for vaginal yeast infections and can provide effective, soothing relief, heal tissue, and have antimicrobial action for the vaginal canal – knocking down the yeast numbers while you use the probiotics to restore balance. You can make a large batch yourself easily, and at minimal cost, by following the instructions below. Keep them in the freezer to be defrosted on an as needed basis, or you can purchase a suppository blend from a company such as Vitanica.

Here's one of my favorite suppository blends for treating vaginal yeast infections.

• 1 cup cocoa butter
• 1/2 cup coconut oil
• 3 Tbs calendula oil
• 1/4 tsp thyme essential oil
• 1/4 tsp lavender essential oil
• 2 Tbs goldenseal root powder

To prepare the suppositories:

1. Melt the cocoa butter and coconut oil together in a saucepan. When melted remove the pan from the burner.
2. Add all of the herbal ingredients and stir well.
3. Pour into the suppository mold (see below). Refrigerate until firm. Insert vaginally 1 per night for 7 days; repeat if needed.
4. Always wear a sanitary pad while you sleep with the suppository in place. It will melt and will otherwise stain bedding or undies!
5. Results are typically seen within several days, however you may treat up to a week and repeat if necessary.

Suppository molds can easily be prepared at home by using aluminum foil that has been folded several times lengthwise, and then widthwise, to form a trough approximately 8 inches in length and 1/2 inch in width. Alternatively, suppository molds can be purchased online. The base of the suppository is a combination of coconut oil and cocoa butter, to which is added the desired combination of medicated oils, powdered herbs, and tinctures. This mixture is then poured into the mold, refrigerated to harden, cut into pieces the size of the patient's pinky finger, and inserted as needed.

What About Medications?

Look, if you need to treat in a hurry and be done with it, or if you have a raging yeast infection, anti-fungal medication is totally appropriate, and a 1 to 3 day course for most women is a reasonably safe and effective approach. I always prefer vaginal suppositories over oral medication as there is less systemic absorption this way.

However, if you have frequent or recurrent infections, anti-fungal medications are just a band-aid covering an underlying problem and don't treat the root cause – why you're getting them over and over. Addressing the root causes actually improves your health and the infections stop recurring as a positive ‘side effect.' During pregnancy, it's a whole other matter – there are some risks to the anti-fungals that should at least be considered before using them, and if you can use a natural approach, I believe that is ideal.

For simple, mild and moderate yeast infections, avoiding triggers and using probiotics is often enough to do the trick. For more resistant yeast infections, it may take a little extra effort to treat naturally, but you can rest assured that the treatment is safe for you and overall an eco-friendly solution that you can feel good about.

*Anyone experiencing recurrent vaginal infections that don't respond to simple treatment, or are a new or persistent symptom, should see a physician to get appropriate testing. Some diseases including diabetes and HIV can cause repeated vaginal infections. Women with HIV or undergoing cancer therapy please check with your doctor before self-treating with natural medicines or foregoing conventional medication for treatment.