What an L. iners dominant vaginal microbiome means

Over time, here at My Vagina, we have learnt to associate Lactobacillus iners dominance with nutrient deficits and deficiencies of the host – you. This is a clinical observation in our vagina-centric practice.

The most common types of people we see that have L. iners dominance are vegetarians, vegans, fussy eaters, those who don’t care about their diet at all, those with a history of disordered eating, and anyone nutritionally deficient due to absorption issues like intestinal disorders.

We’ve found L. iners dominant vaginal microbiomes sometimes more difficult to shift than others, and that piqued our interest. We can easily modify the bacteria around L. iners, but the L. iners populations were staying steady.

L. iners is genetically very good at sequestering nutrients from its environment in a low-nutrient environment, using a gene that no other lactobacilli have, though to be ‘inherited’ from Gardnerella vaginalis.

Cool sciency stuff!
If you didn’t know, bacteria can pluck DNA off an unrelated bacterial neighbour and take it on as their own. This is how antibiotic resistance genes spread so quickly between bacteria, and why antibiotic resistance is so dangerous.

This particular gene enables L. iners to make cytolysin, a cell toxin, which may help it get nutrients out of a cell by damaging the cell.​1,2​ A bit like cracking open a coconut or egg to get to what’s inside.

L. iners also seems to be quite good at inheriting genes from other bacteria, which may be why L. iners is associated with not-so-helpful vaginal activities.​1​

L. iners, yeast and BV go together

The L. iners-dominant vaginal microbiome also comes with an increased incidence and risk of yeast infections and bacterial vaginosis (BV) because this lactobacilli species is not very good at defending the vagina. High L. iners, yeast and BV go hand-in-hand.

L. iners tend to behave well when in good company and poorly when in bad company, so is associated with an unstable vaginal microbiome​3​.

While we work out the details of L. iners, we’ve got some great tips on how to overcome a sticky L. iners dominant vaginal microbiome.

Which nutrients am I deficient in?

There is some low-hanging fruit to deal with first, nutrients such as protein, iron, zinc, magnesium and B12, but the list of nutrients we humans need is long.

Getting enough of each is achieved with a varied diet and good digestion, not by supplementing with individual items necessarily, with a few exceptions.

If you have a history of disordered eating, please take care with this information and seek support from a practitioner if you need it.

Increasing intake and uptake

Nutrient deficits are easy enough to fix: increase intake of nutrients. Easy, right?

Well, first you need to work out what nutrients you’re lacking, which is tricky in and of itself without testing – which costs money and time.

Then, we need to consider our ability to absorb the nutrients we’re ingesting. Not all digestive systems are created equal.

If your digestive system is not working great (digestive issues) or you’re just not great at absorbing nutrients despite eating plenty of them, there may be some extra work on absorption.

Where to start understanding your nutrient intake

Start with the basics of increasing intake via food/supplements. If you need help solving digestive issues, seek the help of a holistic nutritionist or naturopath.

If you are high in L. iners, then we recommend you start focusing on your nutrient intake and stop fighting with your vagina for a while.

How to check your nutrient levels without at test

But how are you supposed to know what nutrients are in what food, and if you’re getting enough? An app, of course! We have had a look at some options and we really like an app called Cronometer. It’s free.

Spend some time getting to know the app and working out how to add foods and products and view your nutrient levels. The app initially has settings that focus on weight loss, so unless you want this information front and centre, modify the settings to focus on nutrients.

How long do I need to log my meals on Cronometer for?

Log your food, drink and supplement intake every day, every meal/thing that goes into your mouth for 4-6 weeks to get a handle on your overall nutrient levels. It gets more fun the more information the app has, so log everything you can.

Using Cronometer to count your nutrients

You can scan barcodes, screenshot recipes, add recipes from a URL, or add your own recipes and meals from single ingredients.

Be very, very specific so you can see what nutrients you tend not to eat much of, so you can increase those foods. The data is only as good as what you put in.

When the nutrients from a balanced diet are not enough

If you’re chronically stressed, unwell or are otherwise using up a lot of resources (athlete, chronic illness, etc.), you are likely to use up some nutrients faster than others and may like to consider supplementation.

For example, you can’t store B Vitamins, magnesium or vitamin C so you need regular intake. For example, if you’re stressed out all the time, you’ll be chowing through your Bs, magnesium, zinc, and others.

If you exercise a lot, you need lots of protein. If you get bad PMS, you may need more omega-3 fatty acids and magnesium, and so on.

All your nutrients play multiple roles in your body, so don’t skimp on any of them. Also, don’t overdo it – you want optimal levels, not too much and not too little. It can be tempting to go nuts, but if you do that, you’ll throw something else off and that is not the goal.

Getting to optimal, not just scraping by

There are a few key ways to increase nutrient levels. We like to use food as medicine here at My Vagina, but we really want to ensure very basic nutritional requirements to support your body to defend itself so a combination of food and supplements may be right for you.

Remember we’re aiming for optimal, not barely scraping by. That means plentiful supply, regularly, but again, don’t overdo it.

We love a good supplement to boost up your levels without having to work too hard, so use these where you need to and add them to your app – it’ll calculate the nutrients and add them to your scores. Scan the barcodes of your supplements.

Notes on taking iron supplements

Safety: do not take iron supplements if you have a condition that makes this dangerous or are not regularly menstruating. Do not over or unnecessarily supplement iron! It can be dangerous. If you’re not sure, take a test. If you’re below halfway, go nuts on the supps. 

Most multivitamins do not contain iron, since it isn’t for everyone. Usually, people who need an iron supplement are those who are vegetarian, vegan, don’t like red meat much, or are poor absorbers of iron and other nutrients, and those who have heavy or long periods.

But this doesn’t exclude you! Get a test if you’re not sure or do a couple of rounds of bovine lactoferrin.

The good source of iron is why we love bovine lactoferrin – it offers an easily digested form of iron that also provides an immune boost, like a very good 2-in-1 oughta.

There are many ways to increase iron absorption from food and supplements.

How to take iron supplements correctly

First, ensure it is safe for you to take an iron supplement. Then, only take the iron every 2-3 days. Research​4​ shows that the iron is absorbed only every 2-3 days, and on the other days it goes into your bowel and causes microbiome problems and constipation, and is not absorbed.

Always take iron with vitamin C – it increases absorption.

What to look for in a multivitamin supplement

There are a lot of options for multivitamins, so find a brand that comes highly regarded. Garden of Life mykind Organics Women’s Once Daily Multi is not a bad choice, but there are many. If you have a nutritionist, dietician or naturopath, ask them for their recommendations.

How long to supplement for

If you’re low on nutrients, you may need to take a supplement for 3-6 months to rebuild your stores of some nutrients and then improve your diet so you get the nutrients without supplements.

But, if you aren’t able to take care of your nutrient levels via diet, but other nutrients are not stored and you need them each day.

Reassess need every 3 months, and see if there is something that would suit you better, or take something prescribed by a knowledgeable practitioner (holistic naturopath, nutritionist, etc).

Eating your way to less L. iners

Use the app and try to eat a rainbow! Loads of different-coloured vegetables. Fruits. Nuts. Seeds. Legumes. Healthy animals, birds and fish. Cold-pressed oils. Herbs. Spices. Herbal teas.

Getting help

If you don’t know what you’re doing or feel overwhelmed by food and diet, please get help! Here at My Vagina, we know food back to front and would love to help. Book in. There are also plenty of resources online with recipes and guidelines.

This is more about what you add than what you subtract, so add the foods into your eating routines to bump up your nutrients.

References

  1. 1.
    France MT, Mendes-Soares H, Forney LJ. Genomic Comparisons of Lactobacillus crispatus and Lactobacillus iners Reveal Potential Ecological Drivers of Community Composition in the Vagina. Schloss PD, ed. Appl Environ Microbiol. Published online December 15, 2016:7063-7073. doi:10.1128/aem.02385-16
  2. 2.
    Rampersaud R, Planet PJ, Randis TM, et al. Inerolysin, a Cholesterol-Dependent Cytolysin Produced by            Lactobacillus            iners. J Bacteriol. Published online March 2011:1034-1041. doi:10.1128/jb.00694-10
  3. 3.
    Petrova MI, Reid G, Vaneechoutte M, Lebeer S. Lactobacillus iners : Friend or Foe? Trends in Microbiology. Published online March 2017:182-191. doi:10.1016/j.tim.2016.11.007
  4. 4.
    Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica. Published online August 14, 2019:1232-1239. doi:10.3324/haematol.2019.220830


Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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