And why it is important during perimenopause and menopause…
Research is emerging almost daily showing that having a healthy balance of gut bacteria doesn’t just improve your digestive health but can lead to better mental well-being and reduce the risk of many chronic diseases.[1] Gut function is also known to play a big role in regulating hormones[2] and we are beginning to understand more about how exactly the hormone changes during the perimenopause and menopause can affect the delicate balance of our gut-residing microbes.[3]
There is certainly no shortage of bacteria in our gut: It has been reported that the average woman has around 10-100 trillion of microorganisms.[4] When our gut flora is in balance, they work to support a normal gut function. They help to perform a number of crucial roles in the body like digesting food, synthesizing some vitamins (including B vitamins and vitamin K), protecting immunity and maintaining urogenital health. Every one of us has an entirely unique microbiome, originally shaped by genetics – and by how you were birthed i.e. a vaginal birth vs caesarean. This Influences the types of microorganism that colonise your gut.[5] but over time primarily determined by lifestyle (including taking medicines like antibiotics) also affect the balance of microorganisms in the gut.[6]
Does perimenopause/menopause affect your gut health?
Yes. Recent data suggests that women have a different microbiome to men[7] and during perimenopause and menopause this delicate ecosystem of micro-organisms becomes less diverse[8] which can impact on your body and mind and is linked to:
- Oestrogen levels – The estrobolome is the name given to a subset of bacteria in the gut that helps metabolise and regulate the hormone oestrogen in the body.[9] Going through the menopause has been linked to an altered estrobolome plus generally lower gut diversity. Creating a thriving gut bacteria can influence how well you cope with symptoms of the menopause.[10]
- Appetite & metabolism – Your gut bacteria can affect how effectively you digest different foods and even produce chemicals that make you feel fuller for longer after eating.[11] When oestrogen levels decrease, levels of fat tissue in menopause increase and the potential to gain weight increases.[12]
- Mental wellbeing: The link between the brain, gut and microbiome (generally referred to as the gut-brain axis) has been at the forefront of news and medical research for the last decade or so.[13] One recent study showed the importance of a healthy microbiome in minimizing anxiety and depression (both are known to affect or be common symptoms women experience when going through perimenopause and menopause).[14]
- Sleep – Recent studies also suggest that diversity of the gut microbiome promotes healthier sleep.[15] This is especially significant given new research from Health & Her[16] reveals sleeping problems to be the one of the most common symptoms for menopausal women
- Vaginal health – Just like the gut the vagina is home to billions of diverse bacteria – primarily from the Lactobacillus family – and this vaginal microbiome plays an important role in maintaining vaginal health. This is of special concern during perimenopause and menopause when levels of hormones, particularly oestrogen, decline, and can cause vaginal dryness and/or atrophy potentially making sex uncomfortable and putting you at increased risk of urinary tract infections (UTIs) like cystitis. Antibiotics are often prescribed to treat UTIs, and these are known to kill off the good, as well as bad, bacteria in the gut. This is why taking a probiotic supplement is often recommended to help recolonise the good bacteria in the gut after a course of antibiotics.[17] You can consider taking live cultures from the Lactobacillus family either as yoghurt or in capsule form.
10 tips to support your gut (what to include and avoid)
In short, a healthy gut is defined as having a good balance of microbes, with more good bacteria than bad, and maintaining this delicate balance, so the harmful ones don’t crowd out the good. There are many factors that can throw it out of balance – and whilst some of these are unavoidable features of daily life like stress, coming down with a stomach virus, lack of sleep, ageing and having to take medication (like antibiotics) – there are many things you can do to influence and improve its health including:
1. Feed it well.
Your diet is, unsurprisingly, significant in shaping your microbiome. Research suggests that what allows different microbes to thrive is:
- Eat a diverse range of fresh produce – Evidence suggests you should aim to consume 30 different plant-based foods per week, including some fruit, plenty of veg, pulses and grains.[18] A diverse and varied diet is best.
- Foods that should be included regularly in your meals, as they have been shown to be particularly beneficial for good gut health, include foods high in prebiotics. Specific types of fibres that are used as a food source by the same groups of live bacteria in the gut are often found in food supplements. Food such as bananas and oats as well as garlic, onions, leeks, Jerusalem artichokes and pulses contain plenty of this fibre. Probiotics can be found in natural live yoghurt, kefir (a fermented milk drink), miso, sourdough bread and fermented foods like sauerkraut. Most of these foods are vegan-friendly and you can get vegan yogurts and yoghurt drinks derived from plant-based sources like nuts, soy, peas or oats and most do include gut-friendly active live cultures like their dairy-based counterparts. However, some do come loaded with added sugars so choose ones with minimal or no added sugar as high levels of sugar can irritate the gut and reduce your beneficial bacteria.[19]
- Eat more vitamin-packed plant-based foods– it can be helpful to avoid thinking in terms of what you can’t eat and instead concentrate of what you can have more of – like micronutrient, water and fibre packed vegetables and some fruits. The water and fibre content help support a healthy GI tract including increasing transit time (keeping us regular), reducing the opportunity for bloating and feeling bunged up.[20] Nutritional therapist Rosie Letts has more helpful diet hints in how to eat for a healthier menopause.
- Get more fibre – According to government guidelines, we should be eating around 30g of fibre per day[21] and yet the average adult currently only gets around 20g per day.[22] Eating enough is associated with a lower risk of heart disease, stroke, type 2 diabetes and bowel cancer.[23] It can also help improve your digestion and reduce constipation. High fibre foods like fruit and vegetables, pulses, seeds and nuts also play a role in feeding your live cultures in the gut and helping them to increase in number.
To increase the amount of fibre in your diet:
- Choose wholemeal, granary or sourdough bread over processed white bread.
- Start the day with a high fibre breakfast – whole grain cereals, porridge or overnight soaked oats with fruit, nuts and seeds are all good sources of fibre.
- Eat more pulses such as lentils, beans or chickpeas.
- Fruits – ideally choose ones that are lower in sugar like berries, kiwis and plums as opposed to higher sugar options like pineapple and mango.
- Vegetables – aim for a range of leafy greens like broccoli and kale and different coloured veg including tomatoes, red and yellow peppers and sweet potato.
2. Stay hydrated
Mild dehydration is also one of the most common causes of slower bowel movement.[24] It is suggested that, on average, a woman should be getting around 1.5-2 litres of water a day, but that can depend on your size, the climate, how much exercise you do and what you are eating.[25] Eating plenty of water-rich foods like watermelon, tomatoes, cucumber, courgettes, celery, yogurt, eggs and poached fish can all contribute to your daily fluid intake. It is often the case that signs that you are thirsty can be confused with hunger, make sure you stay hydrated and watch out if you are someone who can misread these signals. Being even mildly dehydrated can cause poor concentration and forgetfulness[26] too. Many women experience this during menopause – and so it is important to make sure you drink plenty of water.
3. Increase your intake of probiotics
Probiotics include a variety of microorganisms including bacteria & yeast. They are available in various quantities via supplements and food. Probiotic foods include live unsweetened yoghurt, kefir (a fermented milk drink) and fermented foods like sauerkraut and kimchi but if you don’t get many probiotic foods in your diet a supplement can help.
Live cultures can be found in a range of vitamins and minerals. As a general rule, the higher the strain count of bacteria in a supplement, the better for creating a healthy colony of gut bugs, as long as the strains are guaranteed to be as listed on the supplement and shown to reach the gut. And remember to take your supplement with a cold drink, as a hot one can actually kill off the live bacteria in it.
4. Exercise
Exercise helps to stimulate the gut and increase intestinal activity encouraging food to move along the digestive tract, so you are less likely to become constipated.[27] It can increase your microbial diversity, and studies have shown that working out has a positive effect on the strains of beneficial bacteria in your gastrointestinal tract.[28] A study carried out on women has shown doing as little as three hours a week of light exercise led to beneficial microbiome changes compared to those who were sedentary.[29] Furthermore, exercise outdoors is correlated to increased microbial diversity. Exercise outside in nature, as often as you can. There are plenty of exercise ideas that are beneficial for menopause and perimenopause from lighter exercise like walking, swimming, cold-water swimming and yoga to strength training, dancing and HIIT (High Intensity Interval Training).
5. Manage stress & anxiety
We all get stressed but when it is sustained or chronic it can put a huge toll on your gut health and mood. We know, for example, that 95% of serotonin (the so-called happy hormone) is found in the lining of the stomach and intestines and this hormone acts as both a mood stabiliser and influences healthy sleep patterns.[30] Exercise can help to reduce stress and anxiety by increasing production of feel-good endorphins, helping you to sleep better and generally boost your energy and well-being. Yoga, meditation and breathing exercises are also useful de-stressing tools. Other things that can help include limiting your sugar and caffeine as well as alcohol intake, getting enough sleep and possibly limiting how much social media or distressing news bulletins you are looking at.
6. Listen to your body
We talk about our ‘gut feelings’ and ‘gut reactions’ – emotional responses felt in the gut but yours might also be trying to communicate with you in other ways. For example, if you are commonly plagued by physical symptoms like bloating, constipation and/or diarrhoea, flatulence, indigestion, nausea and/or abdominal cramps this can be a cry for help from your gut. Each person is unique, what matters is that it’s normal for them, so when your gut microbiome is balanced you should have little difficulty digesting your food or eliminating waste. If you are regularly experiencing these problems these should be your warning signs to consult with your GP or healthcare professional.
7. Cut down on alcohol
The good news is that moderate amounts of alcohol are unlikely to upset your gut microbiome too much. The bad news is that drinking excessive amounts and doing so regularly can weaken the gut lining by causing inflammation and reducing the variety and number of different species of bugs in your gut.[31] This can lead to acid reflux and bloating (something that many women struggle with during menopause already).[32] Drinking regularly also racks up your sugar intake which can lead to increased insulin resistance, enabling fat to be stored more easily. Given that your declining oestrogen levels during menopause can cause your fat to be distributed around your middle – knocking back the wine is only likely to exacerbate the problem.[33] Plus, as our Health & Her research confirms many women report being increasingly intolerant to the effects of alcohol during the menopause. Read more about how alcohol can affect you in How does alcohol affect menopause?
8. Reduce your sugar intake
Consuming too many added or ‘free’ sugars (these include white table sugar, honey, maple syrup, treacle and golden syrup)[34] can lead to inflammation in the body and changes to gut bacteria – including reducing the good kind.[35] Aim to cut down on any added sugar and avoid obviously sugary foods like cakes, biscuits, chocolate and sugary breakfast cereals and try to get a sweet hit from healthier sources like fruit, dried fruit, dark chocolate and even vegetables (roasting vegetables like corn, carrots, sweet potatoes, butternut squash, parsnips and beetroots causes them to caramelise and taste deliciously sweet) or spices like cinnamon (adding this to cereal, stewed or baked fruit and/or porridge adds a calorie-free sweetness). And whilst they may not contain any actual sugar switching to artificial sweeteners does not appear to be the answer to improving the health of your gut either. Research findings are conflicting, but some suggest sweeteners negatively affect intestinal bacteria, gut motility (the ability of food to pass through it) and worsen the effects of existing gut conditions like IBS in some people.[36]
9. Eat more mindfully
When and how we eat can have just as much of an effect on our gut health as what we eat. For example, eating too fast and on the go can lead to indigestion, bloating and acid reflux and over time can lead to poorer digestion. Speed eating like this can also make it harder to recognise you are full – it is said it takes 20 minutes for the stomach to recognise it is full and suppress the hunger hormone ghrelin. Interestingly, research also shows that chewing your food for longer is less likely to make you want snacks later in the day.[37] Evidence also shows that fast eaters are twice as likely to be obese than those who take time to savour their food.[38]
10. Avoiding processed foods
Processed foods that contain trans fats,[39] some sweeteners[40] and additives[41] can threaten the health and stability of our intestinal inhabitants causing inflammation in the body and increasing levels of destructive bacteria. For this reason, try to cook from scratch as much as you can so you know exactly what you are putting in your body.
Finally, give your gut a break – quite literally. Avoid eating too much before getting into bed to give your gut bugs a bit of a well-earned rest from all the hard work of digesting your food. Similarly, if you have had a day or two of overindulgence on the food and drink front give your gut a day or two off and eat smaller amounts or maybe even fast for a short time. Increasing research suggests fasting increases microbial health and fitness (this is basically what you are doing at night when you are asleep) and the trend for intermittent fasting may help to improve the health of your gut microbiome.[42]
How do you tell if your gut is healthy?
Your gut health is not static and can change according to a range of factors but there are a few signs to look out for which indicate whether yours is generally healthy or not including:
1. Your bowel habits.
These are generally a pretty good barometer of your digestive health. While experts still appear to be arguing over a precise definition of what constitutes a normal and healthy amount of bowel movements there is a general agreement that somewhere in the region of between three times a day and three times a week are considered healthy. Others suggest it is less a numerical definition and more to do with whether you are straining, are in pain and/or the hardness of your stools that are more potent indicators. A piece of research called The Bristol stool chart outlines the types of stool people may pass and what is considered a healthy stool and when to seek help.[43] Bottom line: you know what is normal for you so if the frequency and consistency of your bowel movements suddenly changes and doesn’t change back after a couple of days or weeks this could indicate a problem, and we would suggest contacting your local GP or healthcare professional. Also, the time of day you move your bowels can also be a consideration – if you are frequently having to get up in the night to go (especially with diarrhoea) this could suggest a potentially serious problem including diabetes, a food intolerance or infection.[44]
2. The look and texture of your poo.
According to The Bristol Stool Chart a healthy gut produces predominantly medium to dark brown poo.[45] If it is orangey, green, black, red or yellow (although this can sometimes be the result of what you have eaten or if you have taken iron supplements) this could suggest a gut that needs help. Similarly, it should be relatively smooth in texture, roughly sausage-shaped and sink in the toilet bowl. If it floats, you frequently have diarrhoea or you are passing hard, rabbit-bean sized pellets. Research shows these can be signs of a gut that could be in trouble.
3. How often your stomach is ‘upset’.
It is quite normal and natural to feel uncomfortable and bloated after a big meal. It is also perfectly natural to fart – indeed it is a natural by-product of the trillions of gut bacteria happily nibbling away on the food you eat. But…if you are frequently feeling bloated and full of gas along with feelings of discomfort like trapped wind, constipation, indigestion and nausea, this can be a sign your digestive system is not functioning well and we would suggest contacting your local GP or healthcare professional.[46]
References & sources
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477631/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110851/
[3] https://joinzoe.com/learn/gut-microbiome-menopause-changes
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426293/
[5] https://www.nature.com/articles/s41467-019-13014-7
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/#:~:text=Antibiotic%E2%80%90induced%20changes%20in%20microbial,infection%20with%20pathogens%20such%20as
[7] https://thegutstuff.com/the-microgenderdome-why-the-gut-differs-between-males-and-females/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379122/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017946/
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379122/
[11] https://pubmed.ncbi.nlm.nih.gov/27616451/
[12] Crandall DL, Busler DE, Novak TJ, Weber RV, Kral JG. Identification of estrogen receptor beta RNA in human breast and abdominal subcutaneous adipose tissue. Biochem Biophys Res Commun. 1998;248(3):523–526.
[13] https://www.nature.com/articles/s41579-020-00460-0
[14]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/
[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779243/
[16] Health & Her research conducted Oct 2020 – Sept 202
[17] https://www.nhs.uk/conditions/probiotics/
[18] https://joinzoe.com/learn/30-plants-per-week
[19] https://www.science.org/doi/10.1126/scitranslmed.aay6218
[20] https://newsinhealth.nih.gov/2017/05/keeping-your-gut-check
[21] https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/#:~:text=Government%20guidelines%20say%20our%20dietary,ways%20of%20increasing%20our%20intake.
[22] https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/
[23] https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/
[24] https://pubmed.ncbi.nlm.nih.gov/14681719/
[25] https://www.healthline.com/nutrition/8-glasses-of-water-per-day#TOC_TITLE_HDR_5
[26] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207053/#:~:text=Problems%20with%20cognitive%20performance%20that,anxiety%20(4%2C21).
[27] https://pubmed.ncbi.nlm.nih.gov/30843436/
[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357536/
[29] https://pubmed.ncbi.nlm.nih.gov/28187199/
[30] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/#:~:text=The%20gut%20provides%20approximately%2095,to%20the%20central%20nerve%20system.
[31] https://pubmed.ncbi.nlm.nih.gov/26695747/
[32] https://pubmed.ncbi.nlm.nih.gov/18460167/
[33] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258798/#:~:text=Thus%2C%20the%20change%20in%20body,hypertension%2C%20hyperlipidemia%2C%20and%20diabetes.
[34] https://www.nhs.uk/live-well/eat-well/food-types/how-does-sugar-in-our-diet-affect-our-health/
[35] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284805/
[36] https://joinzoe.com/learn/artificial-sweeteners-gut-bacteria
[37] https://www.sciencedirect.com/science/article/abs/pii/S0195666312004710?via%3Dihub
[38] https://pubmed.ncbi.nlm.nih.gov/26100137/
[39] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117213/
[40] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363527/
[41] https://www.gastrojournal.org/article/S0016-5085(21)03728-8/pdf
[42] https://insight.microba.com/blog/what-science-says-about-intermittent-fasting-and-the-gut-microbiome/
[43] https://plr.cht.nhs.uk/download/1111/Healthy%20Bowel%20A4#:~:text=Bristol%20stool%20chart,for%20you%2C%20and%20your%20bowel.
[44] https://www.medicalnewstoday.com/articles/321936#causes
[45] https://www.health.com/condition/digestive-health/bristol-stool-chart
[46] https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/stomach-ache-and-abdominal-pain#:~:text=See%20your%20GP%20if%20you,you%20go%20to%20the%20toilet
