50. Pelvic Floor Health with Dr. Betsy Greenleaf

Dr. Betsy Greenleaf 0:04

50% of women and 30% of men will have a pelvic health issue at some point in their lifetime. Wow. And a lot of people will not because of shame and embarrassment, they don't know how to bring up the conversation. Their doctors might not know how to bring up the conversation. These issues get ignored and people really suffer with them. You know, they think that they're the only person having these issues you know, are they chalk it up to like, Oh, I'm getting old or this is just part of aging, when there's just so many different things that can be done about a myriad of of issues that are out there.

Dr. Stephanie Gray 0:39

Welcome to the longevity blueprint podcast, I'm your host, Dr. Stephanie gray. My number one goal with the show is to help you discover your personalized plan to build your dream health and live a longer, happier, truly healthier life.

You're about to hear from Dr. Betsy Greenleaf who will share tips on how diet can improve our pelvic health and even discuss the prevention of conditions like urinary tract infections, vaginitis and pelvic pain. Let's get started.

Welcome to another episode of the longevity blueprint podcast today I have on as a guest, Dr. Betsy Greenleaf. She's a premier women's health expert entrepreneur, inventor and business leader who specializes in female pelvic medicine and reconstructive surgery for over 20 years. Dr. Greenleaf is a trailblazer as the first female in the United States to become board certified in euro gynecology. She possesses a professional reputation that has led to being sought after by medical societies, associations and corporations to provide lectures teaching and advanced training. In 2018. She was honored with the title of Distinguished Fellow of the American College of Osteopathic obstetrics and gynecology for her service and dedication to the field. She holds committee positions on many National Women's Health Organizations. She's a board examiner for the American Osteopathic Board of Obstetrics and Gynecology. She serves as a spokesperson for the American Osteopathic Association with her quotes appearing in many major media outlets.

Dr. Greenleaf is the CEO of the pelvic floor store. www dot the pelvic floor store comm an online store dedicated to finding reliable products for pelvic health. She manages a blog at Dr. Betsy Greenleaf calm and she is the host of some of your parts podcast dedicated to women's wellness and the notion that you are greater than the sum of your parts. Dr. Greenleaf takes a holistic body mind spirit approach to healing and wellness. She believes many of the answers to a healthy life are found within she views her role in life as your wellness guide. So welcome to the show, Dr. Betsy Greenleaf saying obstetrics and gynecology is a little tongue twister.

Dr. Betsy Greenleaf 2:41

I know I know. Thank you so much, Stephanie. I'm so honored to be here.

Dr. Stephanie Gray 2:46

Well, tell me your story. How did you become an OB GYN?

Dr. Betsy Greenleaf 2:49

You know, and it's so funny, because I think about that all the time. Because that's the last thing that I do. Because you're like, who wants to look at that all day long? You know. And it's funny, because when I remember when I was in training, I was at lunch one day in the hospital, and I'm sitting with one of my colleagues, and she was a podiatrist. And I said to her, how do you look at people's feet all day long? And she looked at me and she's like, Are you serious? You're asking. And I was like, Oh, I kind of forgot. But you know, I think it was I was always interested in medicine. And I just didn't know like, I wasn't the person who went to medical school and was like, Oh, I'm gonna be an orthopedist or I'm gonna do this. I just, I just wasn't quite sure. And as I went through all my different rotations, I started to realize that Oh, I like this. I don't like that, you know. So I was really drawn to some of the surgical specialties. And I actually started my training in general surgery. But I was the person who like wanted to talk and get to know my patients and have relationships

Dr. Stephanie Gray 3:51

with them.

Dr. Betsy Greenleaf 3:52

And nothing against general surgeons, but a really good general surgeon is a body mechanic. You know, they're not they're not emotionally attached to their patients, because I can't be they need to get in there, get the job done.

So I really came down to I wasn't cut out for that, because I'd be doing my rounds. It'd be like, so how do you feel now that you had your gallbladder out? You know, and then I realized really, gynecology was really more of where I could to have those relationships with the patients. I could do the surgery, I could do the medicine and really had much more of an interest in that. So it took a little long way around, but I finally figured it out. So yeah. Wonderful. Well, I

Dr. Stephanie Gray 4:31

know you're an expert in pelvic health. So why is pelvic health important?

Dr. Betsy Greenleaf 4:35

You know, it's so funny. What I want to do actually, pretty soon and and I'm debating how I'm going to go about this, but I want to make a challenge on like, Instagram or you know, you know, you see these challenges that go around, they go viral. I would love to have a a viral challenge where people say their favorite pelvic body part where they just go out sighed and yell the word vagina. And the reason because it's almost like that area of the pelvic area, which is from the belly button to the top of the size, it's almost like it doesn't exist. Sure, though there's Americans in general tend to be on a hole, we tend to be very conservative. There's a lot of shame about that area, the body part, male and female. And even in the medical field, you know, I'll find that there are certain orthopedic conditions to certain hip issues that can refer pain to the pelvis that people don't feel in their hip.

And you know, as soon as an orthopedic doctor hears that a patient say like, Oh, my vagina hurts, then they're like, Oh, my God, let me go to an ecologist. Right. So I think that the more we say the words, you become desensitized, because I was like that, too. I was shy and like to talk about body parts of my grandmother referred to the vaginal area, as she called it, your business. So she'd be like, you know, I remember being like five years old and staying at her house, and you know, I take a shower, and she's like, make sure you dry off your business, you know, so we don't even use the right terminology. Right, we're embarrassed. So I mean, luckily, my kids, I mean, I luckily are unfortunately, I don't know what they've heard the word so much. It doesn't mean anything to them. They're like all mommy's a vagina doctor. So the more we say the words, the less we're shocked about it. And then the more we can talk about it, because 50% of women and 30% of men will have a pelvic health issue at some point in their lifetime. Wow. And a lot of people will not because of shame and embarrassment, they don't know how to bring up the conversation, their doctors might not know how to bring up the conversation, these issues get ignored, and people really suffer with them. You know, they think that they're the only person having these issues, you know, or they chalk it up to like, Oh, I'm getting old, or this is just part of aging, when there's just so many different things that can be done about a myriad of of issues that are out there. For one thing in continents.

So yes, King pain when you don't want to, that can start as early as in your 20s. I mean, there's people even younger than that, that have problems controlling their bladder, but can start as early in your 20s and something called urge incontinence where you have to like run to get to the bathroom and pull a problem holding it in. By time you reach your 70s there's more people in their 70s walking around with that than has a common cold. So it is so and it's from the pad industry that it's a $20 billion a year industry. Wow. So that just tells you how many people are really dealing with these issues.

Dr. Stephanie Gray 7:42

I'm glad you brought the incontinence up that in chapter one, the introduction of my book, I talk about how really treating I don't know if you know this, but I i early in my career became a continence nurse certified continence nurse. So I had found out that the number one reason for admittance to long term care facilities was incontinence. And I thought, well, I need to help these patients have a little more dignity and be able to, you know, remain in their homes. And so I actually got trained also as an resp petition and fitting patients for pessaries, those sort of devices. When I still to this day and do pessary fittings, it's kind of an art, not a lot of providers around here do that. But that's what actually kind of cued me into functional medicine because I thought if there's a non surgical non pharmacological option for incontinence, and the pessaries, not for urge incontinence just to be clear, but then there have to be non surgical non pharmacological options for all other conditions. And it kind of just opened my mind to this functional medicine world. But going back to incontinence, let's talk about some solutions. So even for younger women who are starting to experience this, what, what is your best advice? You know, it's

Dr. Betsy Greenleaf 8:41

funny, because I'll tell you, first of all, Euro gynecologists are amazing. We're all amazing. There's only about 1500 of us in the country, and we take care of specifically women with pelvic health problems. But there's also men that would see a urologist, but I think when you go to a doctor, and I'm not saying don't go to a doctor, but what we're trained to do, and what actually happens in the office becomes two different things. Because a lot of times we get very limited time to spend with patients and everyone jumps to like let's do treatment. So unfortunately, I see too many times that people are thrown on medications, told that they need to have surgery, because there's this pressure from the doctors that I need to fix it. But then there's really, there's so much you can do before you even get there. And surprisingly, I think the biggest answer to almost any medical condition in life is looking at your diet. Yeah, because we know that there you go back to Hippocrates who said, Let food be thy medicine. And we've gotten away from that in some ways.

And now we're heading back to it where we're looking at the gut and the gut microbiome and how it affects different health systems. So really, there are so many ways and that the gut can actually help your pelvis. So certain foods can be super useful. To the bladder. So if you have like urge incontinence, which is the most common cause where you're running to the bathroom all the time, you might be eating foods that are irritating you and not realizing it. Or maybe they were foods, you're eating your whole life and we're fine. And then all of a sudden, now you're developing a sensitivity. So in everybody's different in this realm, but typically the things that for most people will bother them are coffee, and even decaf, it has to do with the acidity. Yep.

Dr. Stephanie Gray 10:27

And it still decaf still has caffeine. People think that drink decaf? No, it still has caffeine.

Dr. Betsy Greenleaf 10:33

So sodas, so anything carbonated can be very irritating tomatoes, which are in your night shades, those can be very, very irritating to the bladder, alcohol, and chocolate. So like all the good things here, you don't really want to go out for like an Italian dinner with a nice dessert and with alcohol, because those are all the things that could that could potentially irritate the bladder. But you know, we're not saying like, stop all those foods altogether, what I usually tell people is I'll give them a list of foods that attend in like start with those are citrus, citrus fruits, you start with those and cut them out and see if it makes a difference. And if it doesn't make a difference, or if it if it doesn't make a difference. I mean, ultimately, you'd like to cut them off for 12 weeks, but 12 weeks, sometimes it's really overwhelming for people. So I'll tell them, just just cut them out for two weeks, and we'll see what happens. But if they do get better, you can just add the foods back one at a time.

And see if if one of them bothers you. And you say you've noticed, okay, tomatoes bother me, what does it mean, you can't have tomato sauce ever again, for the rest of your life, you just go Alright, you know, either you go well, when I eat that, I know it bothers me or there's things you can do to counteract it, you can just actually drink baking soda and water, like do a quarter of a teaspoon of baking soda and eight ounces of water. And that will neutralize the acidity. I've tried it myself, I can't stand the taste. But I have patients that swear by it. Or there's over the counter products called pre leaf, which is pretty much the same idea. But in a tablet form. So you're not having a taste that that sodium bicarbonate. So that's the probably the easiest place to start. And then the other thing is, this is counterintuitive. But people that have urinary tract issues tend to purposely dehydrate themselves, because they're like, Oh, I'm peeing a lot. So I'm just not gonna drink.

Well, that actually has the opposite effect. Yeah, because now you're concentrating your urine. And the concentrated urine is more irritating to the bladder. So there's a fine line between drinking a lot of fluids to kind of, you know, ultimately, if you drink in your urine clear, that's, that's a good sign. And that should be enough that it kind of diluted enough so it's not irritating the bladder. So that becomes like a fine line with that.

Dr. Stephanie Gray 12:55

Wonderful, those are all wonderful, awesome tips. I, I will also add to that list of dairy. So for some patients, not everyone, I mean, for some patients, it's the obvious acidity that's causing that and gotta go, gotta go. Gotta go right now, feeling. But I've even had dairy cause patients problems. So sometimes they have to remove that, again, dairy can be irritating the gut, and it's also irritating the bladder. So those are those are great tips. What, what happens to us as we age, so you kind of alluded to this a little bit earlier. As far as pelvic health is concerned, what's happening down there.

Dr. Betsy Greenleaf 13:26

You know, one of the problems is it's happening all over the body, but we ignore the pelvis is that starting in our 30s, we start to lose muscle mass. And so every year we're losing about 30% of our muscle mass. And it's definitely if you don't use it, you lose it. But you know, people go Alright, well I can go to the gym, I can go for a walk, and that's going to exercise my other parts of my body and people are like that, you know, nobody even thinks about the pelvis until it's too late. And so what those weak muscles can lead to is it can lead to difficulty holding in the urine holding in store holding in gas, but they can also make it so that things in the pelvis start to droop. So for women, the bladder may start drooping the the vagina may start drooping is so really doing your key calls is the way to work out the vagina. Now, one of the problems with that everyone goes okay, yeah, do my to do my key goals.

But a majority of people don't do them properly. They found that women often will push down instead of tighten up. And so I have a really good friend of mine who he explains it that he's a picture that you're in front of the queen or you're on national television, and you're about to fart and you want to hold in that fart. He's like, those are the muscles that you want to use. And he said, he said ever since he's explained it, you know like that, but you're in front of someone really important or you're on national TV. Most people are like, Okay, good. I know what muscles those are and they can learn to tighten them. And it's something that we should all be doing every day if we can, but a minimum three times a week, and I usually instruct people, like, try to tighten and hold it to a count of 10. And repeat that 10 times. Or you can do something what's called Quick flex, where you're taking them really fast, you know, like tighten, tighten, tighten, tighten, then you do that 10 times, and then you relax. And then you do that, for repeat, repeat

it for about 10 times. So, you know, there's some other exercises, I know a lot of people are not necessarily getting to the gym Around this time, but even just sitting in a chair and rolling up a towel or putting a ball between your legs, and squeezing against the ball that can also tighten your pelvic floor, so and get those muscles working again. So yeah, definitely, we lose so much muscle mass, and it really affects the pelvis.

Dr. Stephanie Gray 15:51

And that's such a good point, we if we want to I tell patients, at least if you really, you know want to be able to lift heavy, you start working your biceps, so you can recruit and use that muscle as needed when you're gonna go lift something heavy. And same is true with your pelvic floor, you want to try to hold in your urine, but you haven't worked those muscles in years, well, there's not a lot to recruit not a lot to use. So we have to be working those muscles. And as you mentioned, I think this the pelvic floor gets ignored. We don't think about tightening those muscles. So I tell patients at every stop sign I'm you know, I'm trying to tell patients ways to remember to squeeze their pelvic floor. So if they're driving in a stop sign, squeeze the pelvic floor. I mean, whatever they're brushing their teeth, whatever works for them.

Dr. Betsy Greenleaf 16:29

I used to tell people like at every commercial on TV, but now we all fast forward through the commercials.

Dr. Stephanie Gray 16:36

Somehow incorporating this as part of the daily routine would be the best thing to do. So you're working those muscles. And if you don't know how you can certainly see a pelvic floor physical therapist I know postpartum I was just like, I know too much I need to stay ahead of the game, I wanted to go see a physical therapist for the pelvic floor to help me because I wanted to make sure everything was okay. And then that I didn't end up with incontinence. So very important.

What are the risks to the vagina with aging, so other than having a weak pelvic floor, what else can happen?

Dr. Betsy Greenleaf 18:38

What happens is as we start getting into that perimenopausal period and menopausal period, our hormones start to change and we get Moody, we tend to get hot flashes. But what happens to the vagina is the tissue starts sets in. And this becomes very problematic and not just when it causes dryness or maybe can cause pain and discomfort during sexual activity. But it actually starts to change the pH of the vagina. And so you know, we talked about the microbiome of the gut helping with body inflammation, but there's a microbiome in the vagina. And so there's healthy bacteria that likes to live in the vagina lives in balance keeps you from getting bad dental infections keeps you from getting urinary tract infections. But now as we go into menopause, things get thrown off.

So when prior to menopause, that tissue is nice and thick and healthy, because we've estrogen and it's it's like multiple layers of cells thick, and when those cells die off, they slough off and the bacteria actually likes to eat what's called glycogen, which is in those cells, and that's feeds our healthy lactobacillus and so that keeps it going and protects us and lactobacillus protects us by actually making the vagina very acidic. The pH of the giant is normally 3.5 to 4.5. And so it makes the vagina very acidic and it also produces hydrochloride oxide, which chases away the bad bacteria. So now as you're going through perimenopause and menopause, you're not going to have that estrogen. And so we're not making those thick cells.

And now your your cell layers are getting very, very thin, and we're only a couple cell layers thick, and it's not sloughing off. And so the lactobacillus doesn't have any food. So the lactobacillus dies off, and now you're talking about, you're going to have a pH of the vagina closer to five 5.8 even higher. And then what ends up happening is now you have a perfect situation for these other bacteria to get in there. And people are always asking me, like, how is the bacteria getting there, like I clean I clean, it's just bacteria that's around us is, you know, it's like picking up a cold, it just happens. We can't, you know, we can't live in a bubble. And a lot of the bacteria actually comes from our gut, because the rectum and the vagina and the urethra and the tube up throw is so close to

Dr. Stephanie Gray 20:55

gather, even everything's connected, yes.

Dr. Betsy Greenleaf 20:58

Even if you're wiping properly, there's going to be bacteria from the rectum that's going to get into the vagina. And once these, quote bad bacteria set themselves up, then it becomes You know, you're more susceptible to recurrent vasculitis, and it becomes difficult to get rid of, you're much more susceptible to recurrent urinary tract infections. So, unfortunately, during the perimenopausal and menopausal period, the nice thing is, yeah, you know, more periods, but nobody gets the menopause memo that we have all these other issues that start during that time. So Sure.

Dr. Stephanie Gray 21:31

So with a lot of my patients to help improve that, those problems, I do replace estrogen. And so we can kind of get into this conversation here. And I'll let you say your piece on this, but I like to not use Premarin or you know, synthetic or steering on patients. Instead like to use Astra dial which is e two RS three, all which is a three has to be compound in using an estrogen cream has worked wonders in my patients, it's strengthen their tissues. So there there aren't so frail, they don't have pain with intercourse, they're not getting the UTI. They're not getting infections. So I have found replacing estrogen can be very helpful and many of these cases.

Dr. Betsy Greenleaf 22:07

And are you talking about systemic replacement or badgal?

Dr. Stephanie Gray 22:10

So both so yeah, so so I offer patients both some patients honestly don't want to take systemic estrogen replacement. So we'll just give them a vaginal option. Some of my patients are like, bring on the estrogen, I need it for my memory and my bones in my hot flashes and whatnot. So and those patients who we are really optimizing estrogen levels in, they usually don't even need the vaginal option, because they're their estrogen is higher, because of the systemic replacement. Yeah, so

Dr. Betsy Greenleaf 22:37

you know, if medicine did a real disservice to women, because Alright, so it started off when I first trained, it was like, everybody needs to be on hormones, because it protects your heart, and it's healthy, and you need to be on it. And then all of a sudden, they did this Women's Health Initiative study, and they stopped the study, because there was a higher risk. And this was, there's a lot of politics behind this one, too. But there was there was potentially a higher risk of cancer and heart disease in the women that were taking both estrogen and progesterone together. So everybody doctors included, got scared, and everyone's like, no hormones, and so for years, and we're still dealing with this aftermath. And this is I mean, we're talking, oh my god, I was like I was in training. So we're talking like maybe close to I don't know if we're up to 20 years yet, but we got to be getting close to where this is, like almost 20 years old now. But so people are so scared of the hormones. And the problem isn't the hormones. It's what type of hormones you're using. And so that's the problem. So the study was done on older population that may have had those risks, risks already. And then the other problem is they were using synthetic hormones in those those studies

Dr. Stephanie Gray 23:51

given orally, also, and or Yeah,

Dr. Betsy Greenleaf 23:53

and the combination of estrogen and progesterone. But even though that's not bad, all the hormones that were used were synthetic. And we know that especially the synthetic estrogen, when it's broken down in the body, it makes these byproducts that we know are cancerous, so that they can trigger the genes to you know, trigger uncle what's called oncogene so we know that they make this byproduct so and same thing with the with the progesterone. So when you're using these bio identical hormones, which are hormones that are more geared towards your system, you don't get those byproducts. We also know that the synthetic hormones create inflammation, and we know inflammation can lead to a ton of different conditions, health conditions in the body. So yeah, I'm totally for this. The natural the bio identical hormones, not using the synthetic hormones, though they're get from here. So the thing though, it's interesting, there actually are some bio identical estrogens that are on the market. Yeah, yeah. There are some So, um, you know, because then you hear that it was in the news like, oh, compounded hormones like they don't they differ from batch to batch and from place to place. And yeah, that's can be true, but that's why you go to a reputable pharmacy that does a compounding.

And you know, what I like about the compounding is you can tweak the the hormones as you go. But I know some people because they don't like the cost of the compound and ones are a little bit more and sometimes some insurances don't cover it, but there are some natural prescription options to to but yeah, so there's systemic hormones you can take that go through your whole system, there's hormones that can be placed into the vagina that can either be compounded. I find that the two and I'm going to bad mouth two of them. There were two on the market, Badgley for years Premarin which is derived from more sharing, and as it has a lot of synthetic byproducts, and then Asterix and so over the years, I would get people here and there. They'd be like, Oh my god, they burned when I use those pans, it burns when you use a cream.

Well, you know what, as I got more into functional medicine, I found out why there's propylene glycol in those creams, which is a very irritating mucosa and something that we don't want in our creams or in our cosmetics or so that's why there's there's a bunch of different other options that don't contain that they there's ones that can be compounded. For Badgley, if you're someone who's completely opposed to using a hormone in the vagina, then there's some great we've really made some leaps and bounds over the last couple years, probably since 2016. There's been the development of different kinds of cosmetic. When we say cosmetic they they were derived from the cosmetic field with different lasers. So yeah, the lasers have been a game changer, because, yes, they are a big upfront cost. But long term, I actually did the math, they're cheaper than if you're filling your prescription for a lifetime. And so they took cosmetically theirs, which have been around since the 1980s, that we know that they made so a laser is just light energy and the light energy penetrates the tissue, it says making a microscopic injury, which sounds terrible, because there's no other way to say it is making it like a microscopic channel in the tissue.

But that microscopic injury is triggering the body to go, Oh, wait a minute, something's wrong, I need to heal it. So it sends in all these growth factors to heal. And what it actually ends up doing is you increase the blood flow that a tissue increases the healing capacity of the tissue, and the tissue regenerates. And this has been used cosmetically on people's faces since the 1980s. And then I wish I was the person who came up with this. But all of a sudden, we're in the United States that were approved since 2016. But there were bad in Europe there had been around for much longer. Someone was like alright, well, why don't I just make this into a vaginal probe and it does the same thing. And that's what's been the game changer. It's a five minute procedure you come in you have your vagina lasered. Usually the treatments are three treatments to fully regenerate it. And some people need a little bit more, but you do a minimum of three treatments. And they're spaced anywhere from a month to two months apart. And that will last for about a year. And then it does wear off nothing's permanent, because we can't stop the aging process.

But then you come in just once a year and you get your link kind of like your tune up and you get one another laser. So that's been that's been wonderful. Then out of lasers, that industry just kind of exploded, everyone's like wait a minute we can there's other things we can do to regenerate tissue, let's apply it to the vagina. So there's a number of different companies that develop recall radio frequency. And radio frequency uses sound waves to generate heat. And we know that when you heat tissue to a certain temperature, when we heat it too much it damages it. But if we heat it chest to a certain temperature, that it actually triggers a minor injury that triggers the body to want to heal. And then that's regenerate. So we're using we're tricking the body and using its healing properties in combination with heat.

So there's radio frequency, and now there's also some home units that you can buy that uses red light therapy. And looking at the products like the Wii Fit or the Wii Fit plus, which is a device that you use in the privacy of your own home. It has red light, we know that the wavelength of red light penetrates tissue and causes tissue regeneration. And so this is something that you can use at home I usually I love that product, but I like to actually combine it on my patients I'll combine like let's do like a laser and get the tissue really good. And then take your home device and keep it maintained with the home device. So it's so much so fun and I love it because it gives us really a lot of options and I think my goal is to try to find non surgical safe options for people for their pelvic health.

Dr. Stephanie Gray 30:05

Very interesting. I've thought of bringing one of those on board to my practice for those lasers and sounds like you're very much for them and they've helped help your patients.

Dr. Betsy Greenleaf 30:12

They're wonderful. They're definitely they're definitely worth it. I like I said, I know it's a it is a big upfront expense. But I like i said i did I calculated how much people spend on their co pays for those tubes of cream. And oh, over like a lifetime you actually end up i think is I think she has like two years to break even. So yeah,

Dr. Stephanie Gray 30:35

they're interesting. And even the commercially of animal preparations for some patients can be very expensive. I mean, like you're alluding to the copay save they really can be. So we've talked about estrogen deficiency and correcting that. And we've talked about kind of laser to help your tissues will say regenerate or heal. What about improving the microbiome? So we already talked a little bit about diet? Are there specific probiotics that you recommend? How can we nurture our microbiome to also improve our pelvic health?

Dr. Betsy Greenleaf 30:59

So yeah, definitely. So we need to go back in support the gut in general. And you talked about dairy before. So foods that tend to throw up your health, your gut microbiome, for in general, are your glutens, your sugars and dairy. So those are your big three ones. So, you know, because we can get the gut microbiome and ever gets affected affects our hormones, it affects our immunity. So we actually to keep the pelvis healthy, we need to actually support the gut. But then there's also just adding in certain foods that help to support that general health is it's not just like chicken, lactobacillus. And, you know, I get a lot of people like, oh, eat that yogurt that's supposed to be really good for your gut, and I forgot the name, which is good because I don't need to be bad mouthing anybody's brands, but it's not just that there are specific lactobacillus that are specific for women's health. And a lot of people hear acidophilus, and acidophilus is great. But there's also Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus rhamnosus, then ruder II,

and so those are the more healthy bacteria we can get into the vagina by getting into our diet, the better. So the nice thing is, there are so many companies now that have women's brands of of probiotics, so that you can find it you can find it so much easier, you know, when you look at the back, and you can do it through supplements, or you can just do it through diet and just add more fermented foods. We've had our home been playing around with making some of our own fermented foods I know. Now yogurt gets a little tricky because it is a dairy but there is some thoughts that you know, if you can tolerate dairy, that yogurt may not be as bad so I leave it up to the person about what the yogurt we've been making our own yogurt at home, which has been tons of fun. And I actually will take those women's vitamins as probiotics and when I make my when I make my my yogurt, I'll open one and put that in there.

So I know that my yogurt actually even has some of those, those strains in it, but even like kimchi, or sauerkraut or in you can find any of this stuff in the supermarket now, but you want to make sure you don't want to get like a sauerkraut that's been canned, you want to get one that you had to find in a refrigerated section that's, you know, has live bacteria in it. And I love kombucha which is fermented tea. So that's, you know, that has a combination of both healthy bacteria and healthy yeasts.

Dr. Stephanie Gray 33:33

Yep, yep. Which also can help with just in general preventing the urinary tract infections and just vaginitis period. Are there other supplements that you recommend for urinary health like to prevent infections? What else are your next top recommendations?

Dr. Betsy Greenleaf 33:50

Joy cranberries great now, but cranberry, there's a fine line with cranberry. So some people the cranberry because the acidity of the cranberry can actually irritate their bladder, so it's something you have to try. But if it doesn't bother you, cranberry supplements are great to take. I can talk even though there really isn't any kind of data out there that there's data saying that cranberry can help but we don't really know dosages. So the problem with cranberry juice is it tends not to be as concentrated and

Dr. Stephanie Gray 34:23

sugar.

Dr. Betsy Greenleaf 34:25

So I tend to like I tend to like with the cranberry capsules and then people can either take them all the time or a lot of women are susceptible to urinary tract infections after sexual intercourse. Yeah, and so taking those supplements immediately after after sex and even for like a couple of days after that wonderful. d mannose is an is a type of sugar that helps support it's almost like a prebiotic helps support the healthy bacteria. Do you manage to note it's also some people it bothers them because some people that are have sensitivities to what's called the fodmap sugar There's a fodmap diet that some people's intestines can't handle like fructose, the fodmap stands for like fructose and there's all these different sugars. So some people that d mannose. One make upset their the gastrointestinal system and make them more gassy. But if not, d mannose, can be a life changer. So I'm going to take all the time for somebody that has recurrent urinary tract infections, those in combination with probiotics are probably my top three that I love. Yeah,

Dr. Stephanie Gray 35:29

I would totally agree. That's what I recommend for my patients too. And I believe cranberry turns your urine more acidic, which is why you're saying some people can't tolerate it. But then in a more acidic environment, the bacteria can't survive. So that's how that works. Then d mannose has properties as far as binding bacteria, so they don't bind to the bladder wall. So it is sticky like a sugar per se. So if they can bind the bacteria and the bacteria can't bind to the wall and you get get rid of them, then Yay, you're not getting the infection. So that's kind of my understanding of how d mannose works. And I am someone who has who is on a low fodmap diet who has fructose intolerance. So if you're wondering if you have that if you don't tolerate any of the alls, sorbitol, xylitol mannitol, those sort of sugars or that osis the fructose what, what not, you may not tolerate d mannose as well.

So and you probably will know by by trying it but i would agree that d mannose can be a lifesaver for many patients. I have a product that we use here called Sr statten. Once orthomolecular base product for patients who do that when I know an infection is coming on or after intercourse if they know I'm just prone to infections is has some natural antibacterials it has oversea in it as well. It has has some natural diuretics to help you purge the infection there celery seed and there and dandelion if I remember right, and then marshmallow which is a demotion is very soothing to the mucous membrane so essentially helps soothe the urethral tract getting rid of any sort of bacteria so they don't climb up that that tract and cause problems. So that's a that's a lifesaver for many of my patients too. That's an add just an as needed.

Dr. Betsy Greenleaf 37:04

Now the other thing is sometimes actually trying to get the vagina more acidic will actually even help. So using boric acid suppositories yes can be placed in the vagina and you know, it used to be you couldn't find it or you had to have a compound ID. Now, I mean, everywhere I look, there's a company that's coming out with their own version of boric acid suppositories. And in really an ad I actually have used boric acid to treat there's some infections, ureaplasma mycoplasma that are really super stubborn and they get into the urinary tract and that they usually are harbored in the vagina.

They're really difficult to treat. The antibiotics don't often work, but I found that two weeks of boric acid suppositories by acidifying the vagina will make it a hostile environment so that the ureaplasma microbiome doesn't want to be around anymore. And it actually kind of rebalances things. So yeah, using some more natural ways to treat with it, cuz that's the thing is like, you know, people get these infections, and now they go on antibiotics.

Dr. Stephanie Gray 38:10

And now we just throw

Dr. Betsy Greenleaf 38:12

off their gut microbiome, and now they're more susceptible to inflammation and more infections. So as I hate it, like, I am the doctor that does not like to do surgery and does not like to put people on antibiotics, we can keep you off antibiotics and keep you away from surgery, then I've done my job

Dr. Stephanie Gray 38:29

for boric acid. Also for younger women, many times I'll give that to them proceeding their cycle if they know, every single month before believing I have these symptoms, we have to work on everything you've mentioned, like improving the microbiome and optimizing hormones, whatnot. But using boric acid even in the days preceding the cycle can many times help resolve those those cyclical infections that patients feel like they're getting. And, oh, go ahead.

Dr. Betsy Greenleaf 38:52

I'm sorry, the injury is echoes, again, with PH because the vagina wants to be acidic. But when you're cycling and getting the period, the blood is more basic. And so it throws off the pH of the vagina. And that's why some women are susceptible to yeast and bacteria right around their periods. Or I don't exactly understand why nature built us this way. But women's vaginas are very acidic. So 3.5 to 4.5. Ideally, like if we can keep it around four, we're happy. But men semen is closer to a pH of seven or eight. So I don't know why we're built like that. But some women because of sexual intercourse with men that will throw off the page of the vagina and that's another reason why they're susceptible to recurrent paginated and recurrent bladder infections. So trying to acidify the vagina again, get those things you know, the cranberry, the D mannose. The probiotics. I've tried to get things back in balance.

Dr. Stephanie Gray 39:55

Yes. I do want to comment on two things since I have you here. I have to ask You. So also, we talked a little bit about the aging population, but back to the younger population and just struggles that a lot of women, like myself have experienced includes conditions like endometriosis. And I thoroughly believe everything you've said today, especially the diet change is can greatly improved those sort of pelvic health conditions. Also, would you agree? Yeah.

Dr. Betsy Greenleaf 40:23

You know what's really scary when we look at endometriosis. So endometriosis is where the lining of the uterus instead of sloughing off every month with your period, for whatever reason, it goes kind of backwards, and it goes, we're an open system. So it goes back up through the, you know, through the years out into the fallopian tubes and intra abdominal cavity and started growing on other other areas. There's actually been some strange reports where it's gotten into the blood system, and they found it in people's lungs and other area I think is really scary is that I've seen that in combination with polycystic ovarian syndrome where women make multiple ovarian cysts, those two conditions, which can cause pelvic pain.

They weren't common when I started training, but they have exploded in the last 10 years. And so why are we seeing so many more cases of this and why are women really suffering with these conditions? Some of the theories are our inflammatory American diet, you know, we do know that you know, what you are what you eat, if you're eating things that are inflaming you that you're going to trigger inflammation in the body and some people, some people get arthritis, some people get interstitial societies, which is a bladder inflammatory. Some people get endometriosis. Some people get, you know, these ovarian cysts. But the other thing I think is really scary is the amount of environmental estrogens and the plastics in our environment or some of the endocrine disruptors. There's a lot of chemicals in our cleaning products in our cosmetics that actually disrupt our normal home hormones, or tricks the body into thinking that lead these chemicals your body will perceive as an estrogen when it's not. And so we as population as a whole are being exposed to so many more of these environmental toxins and we're seeing a rise in these conditions like the endo metrio says and the polycystic ovarian syndrome because of these things,

Dr. Stephanie Gray 42:21

totally agreed I've done several episodes talking about endocrine disrupting chemicals it's scary because they're everywhere starting at a very young age with plastic and our baby toys and plastic you know mind shower curtains and you know, we eat out of ketchup we have ketchup that comes from a plastic bottle, the plastic specifically the fragrances are really impacting our hormones and can lead to these conditions. So I totally agree I think those are the top two drivers of those sort of conditions, the inflammatory foods and then the toxic, toxic world we live in. The second thing I wanted to go back to and ask you about is your thoughts on oxalates So you mentioned interstitial cystitis and I do just now and I have found in my patient population that sometimes oxalates even help foods that are healthy we think are healthy and they are for many people can drive up conditions like interstitial cystitis. So do you want to briefly mention

Dr. Betsy Greenleaf 43:12

Yeah, so oxalates are these chemicals that are found mostly in your like leafy greens. So we, we joke about it because I have a colleague that calls it killer kale. And I can tell you clockwork January and February, I will see the highest rates of kidney

Dr. Stephanie Gray 43:33

stones,

Dr. Betsy Greenleaf 43:36

interstitial cystitis, flare ups, and vulvodynia. So vulvodynia is pain in the Baltimore area. And this is all from buildup of oxalates in your system. And why is it happening in January and February? Well, because people like me, will go on my new year's resolution, I'm going to eat healthy and people start eating more leafy greens, they start eating their kale, they put it in their smoothies. And you know, once again, not that you need to stop, but certain people are just more susceptible to these high oxalates. And they can cause kidney stones. They can cause inflammation. I mean, we're talking red beefy, like irritated inflammation in the bladder in the vulva area in the vaginal area. And it can be seriously painful. So if you have those conditions, first thing you want to look at is let me try cutting out these high oxalate foods and see if it makes a difference. So yeah, but every January, like January to February is like the oxalate season.

Dr. Stephanie Gray 44:41

It's very interesting. I'm glad glad to hear your opinion on it. So tell us where listeners can find you. I know you have a podcast as well. So tell us about that.

Dr. Betsy Greenleaf 44:53

Yeah, you can find the podcast some of your parts podcast on anywhere you listen to podcasts. But it's a women's while. This podcast where we just talk anything women's wellness and really the focus is that you're greater than the sum of your parts because you really can't separate you know, if you're having a battle issue like we've talked about today, we need to look at your diet we need to look other areas of the body it's not just the power of it's not just the medical issue. I also have a health summit coming up called the happy vagina rally and it's for perimenopausal menopausal women and we have three days of experts just talking all things vagina. You can follow me on Instagram, Facebook, all those things. Just look up Dr. Betsy Greenleaf, you'll find me and then I have my website Dr. Betsy Greenleaf calm, and my practice website which is Greenleaf be well, calm. And our pelvic health store, which is public for store.com. Soon I'm working on a book soon to become is the vagina Diet book. So it's common.

Dr. Stephanie Gray 45:56

So I like it a lot. Give me a moment, we'll post all the links to where listeners can connect with you in the show notes. So I have two final questions for you. So one, I hear you have a free gift for our listeners. So

Dr. Betsy Greenleaf 46:07

tell us what that is. So I have a list of your top 10 pelvic health tips. So these are the top 10 secrets of how to keep your pelvis healthy. We'll provide that to you. And it's a great resource.

Dr. Stephanie Gray 46:21

Thank you. Thank you very much. And then lastly, what is your absolute top longevity tip? You know,

Dr. Betsy Greenleaf 46:27

I think that the biggest tip is we can't take our parts separate that if we're having symptom someplace and in my specialty in the pelvis, then we need to look elsewhere. And so it's not a not just diet and we didn't even talk about you need to look at your sleep, you need to get your hydration, you need to look at your stress levels. You need to look at your diet and all those are so

sound like easy answers. But really, those are the keystones to your health and in keeping your body healthy. So if you're having problems anywhere in the body, but particularly, you know, from my standpoint, the pelvis, we nearly need to get those imbalances first,

Dr. Stephanie Gray 47:11

and finding a functional medicine practitioner, someone who has additional training can help you identify that. Well, I thank you, Dr. Greenleaf, for coming on the show today and reminding us of the importance of improving our many times neglected that pelvic floor. So you're a wonderful guest. Thanks for coming on the show today.

Dr. Betsy Greenleaf 47:28

Thank you so much. I really enjoyed it. It was such an honor to be here.

Dr. Stephanie Gray 47:35

Well, that was a fun interview with a pelvic floor expert. I'd encourage all you listeners to get those Kegels those pelvic floor exercises done weekly, if not daily, but I'm sure Dr. Greenleaf would agree they will pay off long term. Be sure to check out my book your longevity blueprint. And if you aren't much of a reader, you're in luck, you can now take my course online where I walk you through each chapter in the book. Plus for a limited time the course is 50% off, check this offer out at your longevity blueprint.com and click the course tab. One of the biggest things you can do to support the show and help us reach more listeners is to subscribe to the show. And leave us a rating and review on Apple podcasts or wherever you listen. I read all the reviews and would truly love to hear your suggestions for show topics, guests for how you're applying what you've learned on the show to create your own longevity blueprint. The podcast is produced by the team at counterweight creative As always, thanks so much for listening and remember, wellness is waiting.

The information provided in this podcast is educational. No information provided should be considered to be or used as a substitute for medical advice, diagnosis or treatment. Always consult with your personal medical authority.

Transcribed by https://otter.ai