How to manage impact of menopausal transition on digestive issues?
Annett, a 53-year-old, a lady in the phase of menopausal transition, came to me seeking help with her periodic abdominal discomfort due to digestive issue, which she felt especially after eating. Her digestive issue started three to four years ago. She started feeling increased gas in her stomach and bloating sometimes. She works out every day, but the gas in her stomach and the bloating makes her look overweight. She is currently working part-time as a human resources manager for a huge corporation. Her husband of 33 years is quite supportive. However, with four grown children and three grandkids and she is babysitting for two of them, her home atmosphere is busy. She hardly has time to sit and eat, and the majority of the time she eats on the go. She admits to skipping meals on occasion. Now she feels bloated after meal all the time and her uncontrollable urge to belch after eating is quite embarrassing. She feels tightness in her abdomen even after a small meal. At the beginning this digestion problem was only 1-2 days per week, but now she has to deal with the discomfort on a daily basis. Her tummy is flat in the morning, but it becomes swollen over the day.
Gastrointestinal health and digestive issues are one of the most widely discussed topics of all time. It includes everything from what you eat and how you eat to digestive irregularities and, finally, a variety of digestive symptoms. All of these topics have one common goal: to maintain your digestive system healthy throughout your life.
Why do naturopathic doctors place such a high value on digestion?
Because good digestion is essential for good health!
Optimum function of your gut is the foundation to live a healthy life and it defines the importance of the impact of digestive function on all other aspects of overall health. For instance, The gastrointestinal (GI) tract has a highly specialized nervous system network, known as the enteric nrtvous system (ENS). ENS is a complex network of different types of neurons and nerve endings which functions as controlling and regulating digestive functions. This function in turn is being managed by a bidirectional inter-relation between central nervous system and gut environment, which explains the importance of microbiota-gut-brain axis. To make it a little more complex, there is a close interconnection between enteric nervous system and Vagus nerve. This is the crossroad between stress, Vagus nerve and your gut microbiota. It explains how stress and overthinking through your own nervous system, depress the function your own Vagus nerve, your calmness network and affect your gut microbiota. No wonder why the impact of your mind in addition to your choice of food on your brain is that much remarkable.
Another interesting thing about digestive system is its dynamic microbiome, a collection of micro-organisms co-existing in whole digestive system and is critically important in optimal gut function, therefore, helping to provide overall health. The presence of healthy microbiome has a key role in relation with several health conditions such as allergy and asthma, mood disorders like depression and anxiety, autoimmune diseases and low immunity, metabolic disorders like obesity and diabetes type two.
Moreover, the gut interface is assumed as external environment for body and the presence of an active immune system and potent defensive function is imperative to keep you immune from pathogenic factors that you receive though eating or are produced by your gut as the remnant of digested food and dead microbiota.
What is a naturopath's take on gut health?
Practicing naturopathy is based on the principle of determining the root cause of events and conditions. For this reason naturopathic doctors spend a significant amount on your first visit taking a comprehensive medical history from you. Then to rule in or out underlying etiologies, functional tests are usually quite useful. For instance, there are comprehensive lab tests for food sensitivities and allergies, microbial overgrowth, imbalance in the intestine, or hormonal issues affecting your gut health, among other things, are very helpful in determining e the root causes of your current concerns.
What to eat for a healthy gut in menopause?
Your digestive system plays a foundational role in supporting your overall health. As you reach to your midlife and you pass through transition phase to menopause you need to have a strategy to keep your digestive system in optimum health.
As I mentioned in my sleep article, menopause is a process, which starts about 10 years before your actual cease of menses. These ten years which is your most active and demanding phase of life and career, is called premenopausal transition which most women have different types of experiences due to decline in function of ovaries and gradual hormonal imbalance. During this period women go through irregularity in menses, different digestive issues, from gas-bloating to constipation and change in taste and appetite, temperature dysregulation and hot flashes, mood fluctuations, wake-sleep pattern disruptions, skin issues and the list goes on and on! The last 12 months before cease of your menses is called perimenopause which all these symptoms become very prominent and noticeable and, in some cases, it has disruption in your daily living life and even your work performances. The twelve months after cease of your menses is called menopause and the decades after that is called post-menopause.
Due to hormonal fluctuation during menopause, you may experience some changes to your digestive system function. You may feel you get bloating more frequently and it stays longer than before. Abdominal discomfort particularly after eating and acid reflux happens more regularly. You may find your taste has changed. You may feel more sensitive to some tastes and more craving for other taste particularly craving for sugar is common. Bowel movements become irregular, and constipation happens more often. Increased gas and bloating and need for belching or rush to the toilet to pass the gas is bothersome particularly, during the business meet ups or family gatherings. In addition, there is a higher probability of increase in the list of your food allergy or your food intolerance which makes it harder to choose what to eat.
Therefore, it is imperative to your health that you understand the process of gradual changes that happens to your body during this transitional phase and learn how to adapt a menopause oriented nutritional habit in order to nourish your body and keep your gut healthy despite all these inevitable changes.
A question that my patients ask me frequently is that why should I emphasize on gut health during menopause? The answer is simple. Because digestion builds the foundation of your health and the food that you eat is the building blocks. Your gastrointestinal tract has four main functions;
1. transportation of nutrients,
2. digestion meaning breaking into absorbable parts,
3. absorption, to uptake the nutrients
4. detoxifying meaning expelling the toxins out of your body.
I always take my chance in here to explain how teeth health is helpful in preparation of food for digestion by chewing and breaking down food particles into smaller pieces for better absorption. No need to emphasize that, taking good care of your teeth and having a healthy set of teeth and gum has a huge impact on proper function of your digestive system.
Food after mouth finds its way down through a tube named esophagus to your stomach and eventually ends up to your intestine, where the nutrients that were prepared along the way, get absorbed in here. A healthy gut under balanced hormonal interaction has a proper motility, enough secretory glands to function on time and appropriate defensive immune system to keep you safe from any external invasion coming in through your mouth. The result of this harmonized orchestra is proper absorption of essential nutrient for your healthy daily function, your brain creativity, and your refreshing night sleep, without you even feeling that all these organs were working congruently to keep you healthy and happy.
In the middle life of a woman somewhere between age of 40-45 the transitional phase of menopause gradually starts. It starts primarily with a hormonal fluctuation and eventually the level of many hormones including estrogens, progesterone, DHEA, and many more declines. This fluctuation alters function of different organ systems of a woman including digestive tract.
What is the effect of menopause on digestion?
The reduction of sex hormones has huge impact on the secretory and motility function of digestive system. Particularly Decline in estrogen has many effects at the cellular level that influence the overall function of your digestive system. I will mention few of the changes that are cumulatively causes for many digestive disturbances during menopause.
Lining of the gut and leaky gut syndrome
The lining that covers the surface of digestive tract becomes thinner and make weaker intercellular connection. The reason is decline in estrogen and its amazing job of repairing, regenerating and rejuvenating collagen. These small filaments of collagen play many crucial roles in protecting your body. Among them, making strong intercellular junction is crucial for keeping integrity of your gut interface against external invaders, such as the microbes (bacteria, viruses, fungi protozoa) and toxic materials. This weak lining cannot keep its integrity as it should and develops gaps between cells. Then the opportunistic invaders can penetrate easily and not only activate your intestinal immune system but also eventually find their way to your internal body contributing to your multiple systemic symptoms. By now you may realize the meaning of the term leaky gut syndrome!
Change in gut microflora
Another outcome of the weakness of gut is unbalanced microbial flora of gut that we call it “dysbiosis”. The problem is either overgrowth of invasive bacteria or reduction in the population of beneficial normal bacteria of intestine. The consequent symptoms are the same, bloating, abdominal discomfort, gas production, diarrhea or even constipation. If this pathology happens in small intestine it is called SIBO (small Intestine Bacterial Overgrowth).
Food hypersensitivity, food allergy
The increased permeability of your gut let the microbes and undigested food pass through the wall of intestine and provokes the local immune system in the intestinal wall. The result is inflammation which can end up to a food allergy. Next time if you eat the same food, you will experience an allergic reaction to the food that you didn’t have problem previously.
Constipation during the transitional phase of menopause is a multifactorial problem that hormonal fluctuation is only part of the root cause. Pelvic floor relaxation, low hydration, low fiber diet, low vegetables and fresh fruit intake, lack of activity and some medications and multidrug are other factors that contribute to progression of constipation.
How can naturopathy help with digestive issues during menopause?
Fifteen Naturopathic approach to gut health:
1. Take care of your teeth
2. Pay attention to your gum
3. Stop smoking
4. Reduce alcohol intake
5. Reduce your daily coffee intake
6. Stay active during the day
7. Wake up by the sun rise and go out to the nature and breath fresh air
8. Chew your food thoroughly
9. Give yourself time to eat
10. practice mediation before a meal to calm down
11. Stay hydrated
12. Eat a predominantly wholefoods diet.
13. Remove refined sugar, processed foods, and smoked food
14. Include fresh fruit and vegetables in your daily diet
15. Keep a food and digestive symptom diary, to identify the probable food sensitivity or allergy.
In my practice, I tend to use primarily herbals and botanical medicine to address different health issues. In addition to herbs, nutritional supplements are my second to go in case of deficiency found in my patient presentation and In combination, most of the time they address many different health issues including digestive problems.
Menopause and Gut disorders can be interrelated which we can help profoundly by use of herbs, botanicals and nutritional supplements. I will list briefly a few of the herbs and nutritional supplements that can help with digestive problems, and I leave the rest and details for your in person one on one visits to be able to tailor a well researched individualized treatment according to your special need and condition.
Supplements:
L-Glutamine, which is an amino acid, can help support the protective lining of your digestive tract.
Peppermint: By being smooth muscle relaxant, anti microbial effect and anti-inflammatory property, works well for bloating and extra gas formation. However, higher dose of peppermint is associated with GERD. That’s why it is best to be taken after consulting with your naturopathic doctor.
Enzymes: its job is breaking down your food to small particle and help with improvement of digestion and absorption. A healthy gut with help of pancreas make all the required enzymes. However, during rehabilitation of gut, it may need external help for a short period of time. So better be taken after consultation with your naturopathic doctor.
Berberine: one of the active constituents of goldenseal and berberis vulgaris is a strong anti microbial and anti inflammatory which can help with many inflammatory conditions including digestive issues.
Probiotics- helps with gut microflora
Plant estrogens from soy, sage and red clover may have some beneficial effects by buffering your estrogen levels. Keep in mind that Each of them has different effect on the level of your hormone and better be taken under monitor of your ND.
Herbs and botanicals:
Glycyrrhiza, Licorice root: Traditional Chinese medicine practitioners believe this herb goes through all twelve meridians! In gastrointestinal problem it is used to settle the inflamed stomach and peptic ulcer. However, because it has a side effect of increasing the blood pressure, the manufacturer has made a form of deglycyrrhizinated licorice (DGL) that does not have that hypertensive potential. Anyway, it is recommended that use of it be monitored by your naturopathic doctor.
Ulmus rubra, slippery elm: the bark of this tree is used to soothe and improve the lining of the gut, helping with peptic ulcers and constipation.
Curcumin: active constituent of turmeric, has a potent anti inflammatory property and is used in many health conditions including GI problem.
Foeniculum vulgare: Fennel seed: Helps with Bloating and abdominal discomfort.
What will happen when you come for a visit?
The first visit that we call history taking can be in person or virtual (phone or video). During 1 – 1 ½ hours visit, we firstly go over your health concerns one by one and then we take a thorough history from all your organ systems to get a holistic understanding of your condition.
In the second visit which is 30-40 minutes visit we do a complete whole body physical examination. Either in first visit or in the second visit we will provide a lab requisition to you.
In your third visit which is usually few days after receiving your lab exam we review the result of lab exam and setup a treatment plan for you.
In each of your subsequent visit, we review what food you are taking, how much, and when you eat. I believe knowledge is the key and during our multiple sessions together, you will learn how the food you eat impacts your health and well-being and how to improve your eating habits to help with your physical and mental health, your night sleep, your ability to think and learn, and your performance in school or at work.
The lab exam and blood draw are done by a lab technician in a life labs center of your choice. However, there is a Lifelabs medical laboratory at 2050 Weston Road, conveniently walking distance to my clinic.
To book your initial appointment you can call at 416-249-4567 or send an email to info@drmanesh.ca or book online athttps://app.outsmartemr.com/online-booking/3252/a3y8k2.
* Disclaimer: The information in this article is property of Dr. Masoumeh Shayesteh Manesh, Naturopathic Doctor and is not intended to diagnose, treat or cure any diseases or promote any products or services mentioned on this website.
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