Gut Health and Menopause
The ebb and flow of hormones during menopause can play havoc on your gut microbiome. It messes with digestive health, which may result in irritable bowel syndrome or the sudden onset of food intolerances never experienced before.
Gut health is so key it is home to 70% of your immune cells, it is the pathway from where food passes, absorbs, and metabolises to provide all the essential nutrients. The gut microbiome is a combination of trillions of bacteria, fungi, and other microbes. Microbiome, or the good bacteria in your gut, keep you healthy and ensures proper digestion and regular bowel movements. These bacteria can easily get out of balance through diet, lifestyle, medications, anti-biotic use, environmental toxins, stress and emotions.
Role of Ostrogen and Progesterone in Gut Health:
Many women suffer from digestive problems during the menopausal transition. Healthy and optimal estrogen levels are crucial for nurturing the growth of helpful diversified bacteria. Your gut bacteria love oestrogen and progesterone because they are like fuel to them. The problem arises when these hormonal levels start declining, leading to a series of gut complications.
Meet your Estroblome:
As you know, your gut flora is flooded with trillions of microorganisms, each with a particular function to perform. What’s fantastic is that your body has a solely different microbiome department specified for regulating estrogen levels called the estroblome. Is not it surprising that a collection of 60 types of diverse gut fungi and bacteria, called estroblome, are on a mission of metabolising, modulating, and monitoring estrogen activity? Of course, it is!
Estroblome microbes are responsible for producing an enzyme called beta-glucuronidase. If your gut flora is healthy, the estroblome keeps making balanced levels of this enzyme.
Beta-glucuronidase is crucial for breaking down complex carbs and reabsorption of bilirubin and flavonoids. The core job of this enzyme is to convert estrogen into its active form. If it’s not done, estrogen can’t perform the functions it is supposed to do. From preventing cognitive decline and the onset of heart problems to nurturing your skin and hair health, estrogen is equally important.
Any imbalance in the gut flora can fluctuate the beta-glucuronidase levels, which in turn shake off your estrogen levels. Low enzyme levels mean low estrogen, while elevated levels mean more estrogen as it will spike up estrogen reabsorption - both conditions detrimental to health. So we have this amazing system let’s now discuss what can go wrong during menopause if we don’t support our gut health.
Irritable Bowel Syndrome:
Women in menopause are more likely to develop IBS, or it can aggravate the IBS symptoms if they already have it. The fluctuating hormones can take a toll on your gut health, and you may experience worse abdominal pain and other problems like cramping, constipation, and diarrhea this maybe worse in the lead up to your period.
The production of stomach acid depends on the optimal levels of estrogen and progesterone. Stomach acid not only assists in breaking down and absorbing food but also triggers the production of digestive enzymes. Any instability in the stomach acid production can make you a victim of bloating, diarrhea, heartburn, or acid reflux and unfortunately our stomach acid naturally declines as we age. Stomach acid is also needed to separate the B12 from food ready for absorption so you can see how a person can then also be low in B12.
Additionally, declines in ovarian hormone production also affect the production of bile, a fluid involved in fat breakdown and digestion. Now what happens is that liver doesn’t produce enough bile in menopause. As a result, the gallbladder- the storehouse of bile- comes into work. As soon as gallbladder stores start dwindling, fat digestion is disrupted, resulting in the difficult absorption of fat-soluble vitamins.
Acid Relux
This is up there with the most common I see in my clinic on a regular basis during menopause. As our stomach acid levels drop, we cannot break down foods therefore they lay fermenting in the gut leading to excess gases coming back up and making you burp and feel like you have acid burning in your esophagus known as heartburn. If symptoms persist you may be diagnosed with GERD and this is not something you want to leave untreated. Triggers for acid reflux can include alcohol, spicy foods, food intolerances such as glute and dairy, citrus fruits, tomatoes, sugar, high fat diet, coffee and carbonated drinks smoking, obesity, stress, pregnancy and a hiatal hernia. However, it may also be a sign you could have a helicobacter pylori infection so it is key to look at the reasons why you have acid reflux with your GP. There is so much a nutritional therapist can do to help you if you have acid reflux and it all starts with the health of your gut microbiome which you will now discover below where we other gut related conditions.
Dysbiosis (Imbalance of good and bad bacteria in your gut)
Dysbiosis occurs when microbial diversity reduces drastically, and bacterial colonies become unbalanced, disrupting gut flora homeostasis. The key regulator in circulating oestrogen levels is the gut microbiome as discussed earlier is beta-glucuronidase which deconjugates the oestrogen into its active form. In dysbiosis, the unstable composition of the microbiome can inhibit oestrogen deconjugation resulting in low levels of free estrogen circulating in the body. On the reverse high levels on beta-glucuronidase created by gut bacteria imbalances especially high levels of Clostridia, Ruminococcacea, Eschericia can lead to higher levels of oestrogen becoming unbound and therefore lead to excess oestrogen as it gets reabsorbed into circulation from the gut via what’s called enterohepatic circulation.
Menopause-related dysbiosis is primarily caused by shifting estrogen levels, resulting in night sweats, hot flashes, and joint pain. Suffering from dysbiosis means your body is welcoming several other diseases, e.g., IBD (irritable bowel disease), IBS, obesity, diabetes, and allergies.
Signs and Symptoms:
· Halitosis
· Bloating and diarrhea
· Heartburn
· Difficulty in urination
· Vaginal itching
· Unable to concentrate or think clearly
· Nausea and constipation
· Abdominal discomfort
· A feeling of anxiety or depression
· Chest pain
· Rashes
· Fatigue
Leaky Gut:
This is a gastrointestinal condition in which the epithelium covering the inside of the intestinal wall gets damaged or loses its integrity. The gastro epithelium serves as a guard against toxins, pathogens, and undigested food molecules and prevents their influx into the bloodstream. If this barrier gets leaked or disrupted, nasty substances find a way to enter your blood stream causing inflammation, IBS, colitis, and sometimes autoimmune conditions where your body reacts to the food particles being in the blood stream such as coeliac disease and thyroid conditions such as hasimoto’s.
Poor gut barrier integrity can change your metabolic health in no time. It is because changes in intestinal permeability may drive you towards inflammation and food sensitivity so now you are intolerant to more foods.
In addition to making gut epithelial layers, oestrogen helps maintain gut barrier integrity by ensuring diverse gut flora. Low oestrogen levels in menopause result in thinning of the epithelium lining and forming some gaps - leaky gut.
Take a look at the symptoms below how many of them are similar to menopause symptoms??
Signs and symptoms:
· Bloating, gas, or diarrhea that persists for a long time
· Food intolerances
· Aching joints and muscles
· Brain fog
· Weak immune system
· Exhaustion and tiredness
· Lack of focus and mental clarity
· Headache and loss of memory
· Arthritis and celiac disease
· Skin rashes and eczema
· Deficiency of multiple nutrients
· Inflammation
As a result of a leaky gut and poor digestive health, you are more prone to develop food intolerances and allergies. What’s worse is that food intolerance can aggravate your hot flashes.
SIBO (small intestine bacterial overgrowth)
SIBO is characterised by the abnormal overgrowth of bacteria in the small intestine. Gastric acid, digestive enzymes, and bile are all involved in digestion. Their insufficient amounts affect food breakdown, resulting in large undigested carbohydrates in the small intestine. Bacteria feed on these carbohydrates and start multiplying. This overgrowth of bacteria also breaks down bile salts which are required to digest fats which can then result in diarrhea and without fats your body cannot absorb fat-soluble vitamins (A,D,E,K).
Signs and Symptoms of SIBO:
· Bloating and gas problems
· Abdominal pain and distension
· Diarrhea and constipation
· Weight loss and loss of appetite
· Feeling of fullness post eating
· Tiredness
· Deficiency of vitamin B12
· Loss of appetite and indigestion
· Feeling sick and restless
Stress hormone and Digestive health:
Oestrogen is responsible for regulating cortisol levels. As oestrogen levels start declining, cortisol levels go up and slow down the process of digestion, resulting in bloating and acid reflux. The stress hormone cortisol exacerbates the abdominal discomfort in IBS by sparking up histamine production. It not only creates an imbalance between good and bad bacteria but also stimulates the onset of a leaky gut by triggering the release of zonulin. When your body is stressed the first thing it does it shut down digestion and the production of sex hormones as they are not a priority everything goes to the muscles and brain to think about running away from that Tiger!! Our body does not know the difference between the tiger and a bad day at work the impact on us is still the same.
The connection between Gut and Brain:
You may be surprised that your gut and brain are firmly connected. The gut generates approximately 70 % of energy and is also considered the “second brain.” The health of the second brain has a strong tie-up with menopausal symptoms. The gut and brain are connected via the vagus nerve so when you stand in front of a large audience and feel butterflies in your stomach there is that connection. Your gut bacteria produces many neurochemicals your brain needs which impact your mood, memory and did you now approx. 90% of your serotonin your happy hormone is made in the gut so there is the link with low mood brain fog etc symptoms linked to the menopause.
Gut microbiome and weight gain
Weight gain is another common symptom of menopause and whilst there are many possible reasons behind today we are talking about gut health so can that have an impact? Studies have shown that you microbiome plays a role in the production of your hunger hormone ghrelin which controls when you feel full.
Zinc and Digestive Health:
As we age, digestive enzymes and stomach acid start declining, making it difficult for the body to carry out the digestion process. As a result, older people are more prone to bloating, constipation and heartburn as undigested food particles go straight into the colon. Enzymes are proteins crucial for breaking down food into smaller particles.
If you are also heading into aging and concerned about your gut health, then zinc is your good-to-go option. Besides protecting mucosal lining, zinc is also vital for producing digestive enzymes.
Top 10 ways to support a healthy gut micobiome
To boost the growth of diverse microorganisms, decorate your plate with multiple nutrients. You must fill your plate with colorful fruits, vegetables, and whole grains to bring diversity to the estroblome. During menopause, your gut health must be your top priority because neglecting it can throw your body into chaos!
Start your day with lemon and ginger in hot water great for re-setting your gut and reducing inflammation Eat healthy fats like fish, nuts, avocados, and olive oil, as they provide short-chain fatty acids. These fatty acids guard your gut lining by keeping inflammation at bay.
Cut out the consumption of processed foods and white carbs (white rice, bread, pasta), as they are the biggest culprit. Not only do they cause insulin resistance and inflammation, but they also harm the gut flora (harming beneficial bacteria).
Consume foods high in antioxidants and anti-inflammatory properties, e.g., ginger, turmeric, paprika, and basil. These foods boost gut health by regulating the estroblome function and reducing inflammation.
Consume regular helpings of foods rich in polyphenols such as nuts, berries, olives, herbs and spices which enhance the growth of beneficial bacteria and stops the overgrowth of the bad guys. Pomegranate is fantastic for increasing levels of Akkermansia which is so key to your gut health.
Try to consume more fibrous foods. Fiber from plant sources is considered the best food for the gut microbiome. It is because cabbages, cauliflower, brussels sprouts, broccoli, and kale are loaded with phytoestrogens. They keep the oestrogen levels in balance by promoting detoxification.
It is like having a bonus for your gut health when you eat prebiotic foods. Best prebiotic foods include garlic, chicory root, onion, beetroot, grapefruit, legumes, leeks, and artichokes. Certain bacteria feed on the components present in prebiotics, like starch, inulin, and fructo-oligosaccharides. Consequently, they produce acetate, propionate, and butyrate, which benefit gastrointestinal health. In fact butyrate supports the gut barrier, which can stop foods and bacteria from entering into your blood stream.
Eating digestive bitters just before your meal to ensure your digestive enzymes get to work such as a bowl of rocket, kale, dandelion greens with a splash of olive oil and apple cider vinegar is great for reducing the bad bacteria and also helping to reduce any gut inflammation.
Bone broth either buy this or make it yourself but it is full of collagen and glutamine which are fab at healing the gut lining and if you are really brave cabbage juice is also fantastic for gut healing.
Make sure that you take an adequate amount of zinc, especially if you are entering the aging phase. Some best sources of zinc are beans, nuts, seeds, whole grains, quinoa, and meat.
Last of all give your gut time to repair which it does only at night when it is not in use, so try to give you stomach a rest of at least 12 hours from you last meal in the evening to your breakfast and try not to eat 3 hours before going to bed in the evening.
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