Menopause metamorphosis: Gut health

Welcome back to our series on all the changes in menopause that go beyond hot flashes. Today we’re talking about the gut and gut health. We have discussed the importance of the gut microbiome in previous podcasts but never in relation to perimenopause and menopause. And that’s because no one really knew that was a thing until very recently. But it makes sense though since our gut and the biodiversity of the microbiome affects every other aspect of our health why wouldn’t our hormone balance be involved in some way. That’s the topic of today's work IN.

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Transcript

Menopause metamorphosis: Gut health

Welcome back to our series on all the changes in menopause that go beyond hot flashes. Today we’re talking about the gut and gut health. We have discussed the importance of the gut microbiome in previous podcasts but never in relation to perimenopause and menopause. And that’s because no one really knew that was a thing until very recently. But it makes sense though since our gut and the biodiversity of the microbiome affects every other aspect of our health why wouldn’t our hormone balance be involved in some way. That’s the topic of todays work IN.

First as I’ve mentioned before in this series, menopause and perimenopause is an understudied area in science and so much of what passes for medical “knowledge” and the resulting women's health and wellness recommendations is patchy at best. 

You don’t have to take my word for it. If you go to pub med and search pregnancy 1.1 million results, Menopause 97,000, perimenopause 6,343 papers.

Knowing that, there are some studies worth paying attention to and some really strong voices leading the way to better information. In particular Dr. Lisa Mosconi who we talked about last week and also Dr. Mary Claire Haver who wrote the Galveston Diet and The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts has made several guest appearances on some of my favorite podcasts. 

After hearing her speak I had some big AHA moments especially when the discussion turns to the gut. Now I was aware that we can change our gut microbiome purposely by changing what we eat and that process can happen relatively quickly if you’re being intentional about it. What I didn’t know was that the gut microbiome can change on its own without any changes to how you eat. I didn’t know that there’s a difference between the microbiome of men and women from the onset of puberty. 

According to some studies from ZOE

Changes in sex hormone levels influence the makeup of our gut microbiome and it appears to be bi directional. In other words, our hormones affect the gut and the bacteria in the gut can also influence our hormone levels.

Without getting too complicated, during the normal metabolic processes estrogen (all 3 kinds) will at some point make its way to the liver where it gets bound up and eliminated. When that happens the bacteria in the gut can “recycle” literally pull the estrogen back out and release it back into the bloodstream. And apparently not only estrogen but other players too like progesterone and testosterone.

So it seems that certain bacteria love those hormones. They feed on them and then send them back into the bloodstream. Now in previous episodes on the gut we’ve talked about how when we eat we’re not actually feeding ourselves, our body, we’re actually feeding this incredible ecosystem in our gut. And those little guys do the real work to get us what we need. So it makes sense that our sex hormones are also part of the equation. 

There are very few studies asking this particular question though. How do sex hormones affect gut microbiome?

But there was a very small study from Austria that included women on hormonal contraception. The drugs lower levels of estradiol and progesterone. The study found a link between low levels of these hormones and lower gut biodiversity. There were also changes in some of the numbers or abundance of certain types of bacteria.

I’ve spoken before on this podcast about my own history with gut pain. Whether you call it SIBO, IBS/IBD, dysbiosis or “leaky gut” all of those things are painful in real life. And anytime that bacteria ecosystem gets out of balance for any reason we are going to feel it in our gut.

At the time I thought the source of all my own issues was stress. And yes, I was a basket case. I was also probably beginning that metabolic chaos that is perimenopause. Who knew?

SO let’s talk about that gut pain thing. “Leaky gut” has a fancy name. Gut scientists call it Translocation. Sounds like a magic trick. But translocation in the gut is when microbes or any of the chemicals they produce sneak out and get into places they aren’t meant to be like the bloodstream.

Remember the lining of the gut is precious. Literally only one epithelial cell thick. So when the lining of the gut is breached it can trigger inflammation not only in the gut but throughout the body and show up as things like heart disease, cancer and diabetes. It’s not good. But how does estrogen affect this?

Turns out (in animal and lab studies) that estrogen levels (estradiol) can protect mucus producing cells in the gut lining. Protecting the epithelium against injury. And in a rat study using human tissue they showed that activating estrogen receptors reduced translocation.

So interesting to me and I’m not gonna lie, I’m geeking out on this stuff but what we want to know is what does this mean in menopause and perimenopause? 

There is very little direct evidence that associates menopause with gut barrier integrity. But some of these studies suggest that “leaky gut” happens more often in menopause. It certainly begs for more research. 

Now I mentioned at the beginning that this gut/hormone influence goes both ways. Because those bacteria love to recycle all our hormones, what will they do when those levels drop or cease entirely? If we don’t feed them they get hangry and they’re going to wreak some havoc. This is where we can help because what we put on our plate matters.

This is where a little knowledge and intention can go a long way. If you’re like me you might have spent most of your adult life eating to be thin or religiously following the latest government food guidelines. When my gut was at its worst I had to give that up and I’m so grateful that I did. I was forced to change what I put on my plate and why.  And I’m currently making some more changes as I learn more.

The bacteria in the gut can pull our phyto-estrogens from certain plants and isoflavones and then create estrogen like compounds that can bind to estrogen receptors. Now when your estrogen levels are naturally high these compounds can block estrogen receptors but after menopause they work great. Now isoflavones are found abundantly in soy and soy based things but also in chickpeas, nuts, fruit, seeds, veggies. All the high fiber stuff filled with prebiotics that the gut loves. 

And there’s also evidence that consuming animal protein and saturated fat specifically can help heal and protect the gut lining.

Is it possible that eating for your gut and your hormone balance could be one an the same? Could eating a high fiber, rich in protein/fat diet restore some of the action of these sex hormones, lower inflammation and reduce symptoms during and after menopause? It certainly isn’t going to hurt you.

More research would be great. Right now it’s anecdotal. N of one, try it and see. And while we wait for that here are some things to ponder. 

If changes in our sex hormone levels can significantly shift the balance of power in our gut biodiversity AND lead to gut dysbiosis in one form or another AND that gut dysbiosis can trigger widespread inflammation throughout the body and all it’s systems AND if estrogen is antiinflammatory and protective AND if we slowly lose those protective qualities as we approach menopause and beyond, AND we know that inflammation and menopause increases our risk for cardiovascular disease, osteoporosis and dementia, AND a healthy biodiverse microbiome protects the gut lining, lowers inflammation and improves mental health and our immune function AND we can change our gut microbiome within 28 days by changing what and how we eat, doesn’t it make sense to start doing that and support that gut biodiversity in every way we can? Even if you’ve eaten the same way for years. Even if you’ve never heard of any of this, if your doctor has never heard of it (which is sadly too often true)  or if you’re “through menopause” It’s never too late. We’re talking about improving health and overall quality of life beyond hot flashes. How about better bone density and muscle strength to stay out of the nursing home? How about lowering your risk of heart attack? How about improving vertigo and tinnitus? (Didn’t know about that one did you?) How about lowering or eliminating depression, anxiety, panic attacks and heart palpitations? How about lowering chronic pain from inflammation? All of those improvements and all of those benefits can come from improving what we eat no matter where we are on the menopause path.

THe consequences of not paying attention to our gut go beyond physical health. How our gut feels influences how we feel, about everything. It’s integral to our stress response. So it’s a major player in how we navigate all kinds of situations in life. Our “good girl” culture tries to teach us to override those sensations (we call it intuition) from the gut in favor of  being nice, being polite, not  rocking the boat. And as a result we learn to ignore messages from the body about what is good, what is right, what is safe, what is true.That disconnection or chronic pain from the gut further breaks our internal trust compass. Which can lead to and reinforce new onset depression and other mental health issues especially during perimenopause.

The lack of research and training in menopause allopathic medicine has to offer women means that we may need to educate ourselves. Trust your gut. We don’t need to be experts in hormone health or gut health or brain science to make simple, straight forward changes in our lifestyle. And maybe recognize that we are ever changing beings. Those changes don’t have to mean suffering or sliding down the slippery slope into cognitive decline and debilitating pharmaceutical dependance. There is a reason that we survive for so long after menopause. I’v said it before but I don’t think we can hear this enough as women. Our value goes beyond our physical appearance or productivity. Women carry forward the wisdom of society, culture and family. There is purpose in that. It’s something to be nourished and revered not locked away behind a hospital door.

There’s definitely some very negative assumptions about women, menopause and aging in our culture to this day. But they are only true if we agree with them and we don’t have to. We can choose to age differently. We can choose to live differently in this beautiful body we’ve been given. And I think it’s time that we did. Not just for ourselves but for our daughters and granddaughters. 

We have one more topic to touch on in this series and that’s sleep. So that’s next week on The Work IN. Be sure to like, subscribe and download The Work IN so you don't miss anything. If you like what you heard and you want to learn more or you missed some of our other episodes in this series headover  savagegracecoaching.com/theworkin to hear them all and get all the show notes. AND if you want to be the first to know when new episodes hit you can join my weekly newsletter Yoga Life on Main Street where I share all kinds of random tips for real world resilience.