Antacids and the female microbiota: How to care for your inner micro-universe

If you ever thought you were alone, allow me to introduce you to your more than 100 trillion invisible tenants: the microbiota. This isn't just a collection of little bugs; it's a vibrant ecosystem, a micro-universe inside you that exerts an enormous influence on your mood, your digestion, and, most importantly for us, your hormonal health.

Think of it as your second brain... or rather, your second hormonal control center.

The estrobolome

When we talk about hormones and little bugs, we must focus on the estrobolome. Does it sound strange? In reality, it's a specialized subset of your gut microbiota. Its main job is as vital as it sounds: to metabolize and regulate estrogens.

Estrogen, the star of your cycle, travels through the body and ends up in the intestine to be discarded. But the estrobolome has an enzyme (beta-glucuronidase) that can be a bit mischievous. What does it do?

• Activation: This enzyme "deconjugates" the estrogen, meaning it releases it from the waste wrapper that the liver had put on it.
• Reabsorption: The released estrogen is reabsorbed back into the circulation, giving you a hormonal "second round."

If you have a healthy microbiota, this recycling is balanced. But if you have dysbiosis (an imbalance), the estrobolome can be hyperactive, releasing too much estrogen. This can contribute to conditions of estrogen dominance (think endometriosis, fibroids, or severe premenstrual syndrome). No laughing matter.

The scientific scene: when medications disrupt the balance

Where does this imbalance come from? There are many factors (stress, diet, travel, contraceptives), but science reminds us that even very common medications, such as certain antacids, can be disruptors.

A scientific review article (see reference below) published in Pharmacological Reports (Kiecka et al., 2023) analyzes how Proton Pump Inhibitors (PPIs), very common drugs used to reduce stomach acid, can induce significant intestinal dysbiosis.

And what does this have to do with my hormones?

The stomach has an acidic pH to kill pathogens before they reach the intestine. By using PPIs, that acid is neutralized, allowing unwanted bacteria to thrive in the small intestine, especially when the use of antacids is prolonged over time (such as SIBO, a complication the study mentions). This general imbalance of the intestinal flora inevitably affects the estrobolome, which is part of that flora.

If the little bugs responsible for managing your estrogens are overwhelmed or altered by this induced dysbiosis, the final result can be deficient hormonal management, either due to an excess or a deficit of circulating hormones. Even treatment for heartburn can affect your menstrual cycle if used long-term! It is a delicate ecosystem.

What's happening down there?

Now, let's change the scene and talk about the local flora, the vaginal microbiota.

Here, the superstar is the genus Lactobacillus. Its job is to maintain a super acidic vaginal pH. Can you believe that the vaginal pH during fertile years (3.8-4.5) is not far from the pH of a lemon (2-3)?

• The Lactobacillus strain produces lactic acid.
• Lactic acid keeps invaders away (fungi like Candida, or bacteria that cause vaginosis).

When estrogen levels are high (during ovulation, for example), vaginal cells produce glycogen, Lactobacillus's favorite food. More food = more Lactobacillus = more protection. It's a brilliant system!

If estrogen levels drop or if the intestinal microbiota is kind of out of order, the pH increases and it's easier to develop an infection.

How to feed your (millions of) invisible friends

You don't have to be a scientist to care for this micro-universe. Simply be a good host.

• Feed fiber, not sugar: The good bugs love prebiotic foods (onion, garlic, asparagus). Fermentable fiber is their caviar. Variation and regularity in consumption are important. However, sugar and processed foods only feed the less desirable bugs. Although you might prefer churros, think of them, and your body will thank you.
• Be probiotic: Incorporate fermented foods (natural yogurt, kefir, sauerkraut, kimchi). Not all probiotic supplements are the same; look for specific strains based on your goal, and consult a professional.
• Manage stress: The intestine has a direct highway to the brain. Chronic stress releases cortisol, which can damage the intestinal wall and alter the microbiota. Prioritize rest and find your anti-stress method (yoga, walking, or simply turning off your phone).
• Use medications wisely: If you are going to take antibiotics, antacids, or PPIs, talk to your doctor about the necessary probiotic support to mitigate subsequent damage.

Your microbiota is a mirror of your overall health and a key player in your hormonal drama. Give it love, give it fiber, and it will repay you with smooth digestion, a strong immune system, and, what interests you most, a much more stable and happy hormonal cycle. Take care of that inner garden!

[1] Reference: Proton pump inhibitor-induced gut dysbiosis and immunomodulation: current knowledge and potential restoration by probiotics https://pubmed.ncbi.nlm.nih.gov/37142877/