We use lactulose vaginally for many variations of vaginal dysbiosis, such as bacterial vaginosis (BV), to selectively promote the growth of protective lactobacilli species.
We use lactulose to boost a protective vaginal microbiome because lactobacilli species love it, but they are not the only ones.
Thus, with some bacterial profiles, we tend to avoid lactulose as it can make infections worse by feeding certain pathogens.
Using lactulose to boost lactobacilli species is a good strategy in bacterial vaginosis, but not aerobic vaginitis (AV), if you are prone to urinary tract infections or if your microbiome report contains large amounts of any of these listed bacteria.
How much is too much lactulose-using vaginal bacteria?
When collectively, any of the bacteria listed below make up more than 10-20% of the total vaginal microbiome, it is recommended to avoid lactulose vaginally. If any of these microbes are present in any number, consider your use of lactulose carefully.
If you have a history of urinary tract infections, it may also be best to avoid vaginal lactulose in case you inadvertently feed your UTI-causing pathogens in the nearby urethra. This doesn’t always happen, but vaginal lactulose can trigger a UTI if the conditions are favourable.
Lactulose is galactose and fructose!
Lactulose is made up of two sugars: galactose and fructose. Not all microbes can utilise these sugars.
#notallaerobes
As you can see, many of the listed bacteria below are not strictly aerobic – in fact, most of them use a combination of aerobic and anaerobic respiration.
Whether they can utilise lactulose (galactose or fructose) or not has no real bearing on a bacteria’s respiration style – not all aerobes are galactose or fructose lovers, so therefore stick to the list when making your choices.
Please note that this list is not exhaustive – we only have the information from available research specifically into lactulose, but more exists separately for galactose and fructose. If lactulose worsens your symptoms, stop using it and try something else.
Group B Streptococcus is not on this list!
Streptococcus agalactiae, also known as Group B Strep or GBS, does not utilise lactulose as an energy source, and therefore lactulose can be used in GBS vaginal infections safely.
Getting a test to see what vaginal bacteria you have
Don’t know what bugs you have? Get a comprehensive vaginal microbiome test, and if you’re not sure how to interpret the results, book in to the My Vagina clinic for analysis.
Please note that the study used as a reference is using bacteria in the digestive tract, thus excluding many vaginal lactobacilli.
Key:
- Obligate anaerobe – can only survive in an oxygen-free environment
- Facilitative anaerobe – can survive in oxygen-free and oxygenated environments
- Obligate aerobe – can only survive in oxygenated environments
Lactulose-utilising bacteria1
- Bifidobacterium adolescentis (obligate anaerobe)
- Bifidobacterium dentium (anaerobe)
- Bifidobacterium pseudocatenulatum (obligate anaerobe)
- Bifidobacterium sp. (anaerobe)
- Clostridium leptum (obligate anaerobe)
- Clostridium nexile (obligate anaerobe)
- Clostridium perfringens (obligate anaerobe)
- Clostridium scindens (obligate anaerobe)
- Enterobacteriaceae bacterium (facultative anaerobe)
- Enterococcus casseliflavus (facultative anaerobe)
- Enterococcus faecalis (facultative anaerobe)
- Enterococcus faecium (facultative anaerobe)
- Enterococcus gallinarum (facultative anaerobe)
- Enterococcus saccharolyticus (facultative anaerobe)
- Escherichia coli (facultative anaerobe)
- Escherichia fergusonii (facultative anaerobe)
- Eubacterium rectale (obligate anaerobe)
- Klebsiella aerogenes (formerly Enterobacter aerogenes (facultative anaerobe)
- Klebsiella pneumoniae (facultative anaerobe)
- Klebsiella sp. (facultative anaerobe)
- Klebsiella variicola (facultative anaerobe)
- Lactobacillus acidophilus (facultative anaerobe)
- Lactobacillus delbrueckii subsp. bulgaricus (facultative anaerobe)
- Lactobacillus fermentum (facultative anaerobe)
- Lactobacillus plantarum (facultative anaerobe)
- Lactobacillus reuteri (facultative anaerobe)
- Lactobacillus spp. (facultative anaerobe)
- Leuconostoc mesenteroides (facultative anaerobe)
- Marvinbryantia formatexigens
- Megamonas funiformis (anaerobe)
- Mitsuokella multacida (obligate anaerobe)
- Pediococcus acidilactici (facultative anaerobe)
- Pseudomonas putida (obligate aerobe)
- Ruminococcus gnavus (obligate anaerobe)
- Ruminococcus obeum (obligate anaerobe)
- Streptococcus anginosus (facultative anaerobe)
- Streptococcus equinus (facultative anaerobe)
- Streptococcus sanguinis (facultative anaerobe)
- Weissella paramesenteroides (facultative anaerobe)
References
- 1.Mao B, Li D, Zhao J, et al. In Vitro Fermentation of Lactulose by Human Gut Bacteria. J Agric Food Chem. Published online November 3, 2014:10970-10977. doi:10.1021/jf503484d
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