Menopause, Aging, and Gut Health
Menopause and aging does a number on your gut. Find out how to fight back.
How Your Gut Works
Trillions of microbes populate the length of the intestinal tract, but don’t worry. Though these microbes aren’t attached to your body like your heart or brain, they’re essential to your survival.
The majority of gut microbes are beneficial bacteria and most of them reside in the colon, or large intestine. Good gut bacteria support their immediate surroundings in a variety of ways and they affect the wellbeing of the rest of the body in many ways. For example, beneficial bacteria create a hostile environment that prevents the proliferation of pathogenic, or bad, bacteria. They also enhance the absorption of calcium and magnesium in the colon, and they produce B vitamins and vitamin K, neurotransmitters, and short chain fatty acids (SCFA) that influence heart, brain, and bone health. Adequate SCFA production is necessary to prevent damage to the gut barrier, which makes it more permeable or “leaky.” When the gut becomes too permeable, substances such as LPS (lipopolysaccharides) escape into the bloodstream, resulting in inflammation that contributes to clogged arteries and other health issues.
The Aging Gut
With age, peristalsis slows, and food moves through the intestinal tract at a slower pace, which can cause bloating and constipation. Pelvic floor dysfunction (PFD) is a weakening of the muscles in the pelvic floor that is more prevalent with age. Menopause is also one of the reasons for PFD. As many as 50% of people (including men) with pelvic floor dysfunction suffer from chronic constipation.
Cells don’t reproduce as quickly or as reliably as they did when you were younger, and that has implications for the gut. You may find you’re less tolerant to dairy products, which is probably the result of a reduction in lactase, the enzyme produced in the small intestine that’s necessary to digest lactose, the carbohydrate found in milk. With lactase deficiency, dairy foods may cause more gas, bloating, and diarrhea.
Stomach acid is key for digestion and maintaining normal pH in the stomach. A decreased production of stomach acid can result in atrophic gastritis, which is ongoing inflammation of the stomach lining and is more prevalent in midlife. Atrophic gastritis can also be caused by an H. pylori infection, so consult your doctor if you’re having stomach issues.
After decades of relative stability, the composition of the gut starts to evolve in midlife, and not in a good way. The gut microbial community becomes less diverse, which is seen as a negative when beneficial bacteria are involved. Gut diversity refers to the number of different species, or types, of microbes that reside in the gut. It’s helpful to think of the gut as a bustling community of tiny organisms that includes mostly good neighbors who cooperate with each other the majority of the time. When pathogenic microbes have the upper hand, the gut gets out of whack, and infection and inflammation ensues.
Gut researchers don’t know for sure what a perfectly harmonious gut community is, but they sure know dysbiosis when they see it. Dysbiosis is an imbalance in the gut that’s associated with a weaker immune system, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), having obesity, and cardiovascular disease. Though dysbiosis is connected to these and other conditions, it’s unclear if dysbiosis is the cause of the disease, or if the disease itself results in dysbiosis. One thing is certain: dysbiosis increases with age and during perimenopause.
Your Gut on Menopause
The relationship between the gut and menopause is complex. Here’s what we know so far.
Microbes in the gut affect estrogen levels in the bloodstream by recycling certain hormones. The estrobolome is the name for the sum of all the genes in gut bacteria that are capable of metabolizing estrogen. When estrogen is conjugated, it’s subject to excretion from the body. Several types of beneficial gut bacteria contain enzymes that deconjugate estrogen, allowing it to be absorbed back into the bloodstream and possibly reducing the effects of menopause. Research suggests that higher numbers and greater diversity of beneficial gut bacteria in postmenopausal women may contribute to higher estrogen levels throughout the body. Progesterone is deconjugated and recycled by gut bacteria, too.
Estrogen and progesterone also help maintain the strength of the gut barrier. A 2020 Journal of Clinical Investigation study followed 65 women from the Study of Women’s Health Across the Nation (SWAN) throughout their menopause transition and found that gut permeability increased during the menopause transition. In the study, greater gut permeability was associated with more inflammation and lower bone mineral density, a red flag for osteopororis.
Some research has observed a connection between changes in gut composition in menopause and more visceral fat (belly fat), lower HDL (good cholesterol) and higher blood pressure. However, more studies are needed to determine just how the gut microbe community contributes to chronic conditions during the menopause transition.
How to Slow the Aging Process
While you should expect some intestinal tract changes during the menopause transition and with age, don’t overlook certain symptoms, such as unexplained weight loss, blood in the stool, chronic diarrhea or constipation, and unresolved bloating. See your doctor right away.
You can’t stop aging, but you can help slow the process by focusing on your gut’s wellbeing because it supports bone health and the immune system, reduces the risk for cardiovascular disease, and much more. Here are some positive lifestyle habits, and some negative, to consider.
Focus on fiber. Gut microbes in the colon break down fiber through the process of fermentation. Prebiotic fiber, also called soluble fiber, is the kind that nourishes gut bacteria. All prebiotics are fiber, but not all fiber is prebiotic. Insoluble fiber is another type of fiber that’s central to gut health. Insoluble fiber retains water and creates larger, softer bowel movements that are easier to pass and helps prevent constipation.
Suggested dietary fiber intakes are based on calories consumed. The Dietary Guidelines for Americans suggests healthy people eat at least 28 grams of fiber every day on a 2,000-calorie eating plan. Most plant foods contain both types of fiber, so you don’t need to worry about getting one type or another as long as you eat a variety of plant foods, which brings me to my next point.
Include a variety of plants. According to the American Gut Project (AGP) a wider array of plant foods supports a more diverse gut community. Different plant foods offer fiber as well as plant compounds called polyphenols that help beneficial bacteria flourish. In the AGP study, people who ate at least 30 different types of plant foods every week had greater gut diversity than people who consumed 10 or fewer different kinds.
If you don’t have intestinal issues that require a limited fiber intake, follow a balanced eating plan with at least five servings (combined) of fruits and vegetables a day and a minimum of six servings of grain foods, including whole grains such as oatmeal, whole wheat bread, and popcorn. Choose beans (legumes), lentils, and dried peas more often. They are high-fiber vegetables that double as a protein source.
Pump up probiotics. Foods with live active cultures, including yogurt, kefir, and certain kimchi and sauerkraut found in the refrigerator section of grocery stores, provide beneficial bacteria called probiotics. Probiotic foods should be consumed on a regular basis to make a difference to gut health. In the case of probiotic supplements, the health effects are strain-specific. For instance, if a specific strain of Lactobacillus bacteria helps manage a condition, it doesn’t necessarily mean that another strain of Lactobacillus will produce the same results. You can review current research relating probiotics to health conditions here. If you want to take prebiotic or probiotic supplements, speak with your health care provider first. Taking too much, or the wrong kind, can upset the gut microbe community.
Reduce stress levels. With all the changes and challenges that midlife presents, stress can be a woman’s constant companion. Stress is a biological response designed to defend the body, which is always seeking balance. Emotions such as anger, anxiety, and sadness, lack of sleep, and nutrient deficiencies are stressful for the body. When you’re stressed, the brain mobilizes the rest of the body to get in gear by triggering the release of the hormones adrenaline and cortisol. Hormones act as messengers to tell organs, including the intestinal tract, how to react. Excess cortisol can slow down the digestive system and cause constipation and bloating, increased permeability, and inflammation. Do what you can to reduce your stress during this busy time of life.
Reconsider red meat: A diet rich in red meat may be detrimental to heart health because of what goes on in the gut. Gut bacteria produce TMA (trimethylamine) from choline and carnitine, nutrients that are highly concentrated in beef, pork, and lamb. The liver turns TMA into TMAO (trimethylamine N-oxide). Excessive amounts of TMAO in the blood have been linked to a higher risk for cardiovascular disease because they contribute to plaque formation in arteries. You don’t have to give up all meat, however. Research shows that switching from red meat to poultry, or a plant-based protein source, significantly lowered TMAO levels in as little as a month.
Mind your medications. Certain common medications, such as calcium channel blockers, diuretics, and iron supplements, can cause constipation by affecting the nerves and muscles in the colon and by binding fluid that makes it easier to pass stool. Drugs can also affect the composition of the gut. One study found that people taking proton-pump inhibitors, metformin, antibiotics, or laxatives had the most changes in their gut microbial community as compared to people who didn’t take these medications. Ask your doctor or pharmacist about the side effects of all the medications and dietary supplements you take on a regular basis.
Limit alcohol. Alcohol promotes dysbiosis and bacterial overgrowth that heightens gut permeability. It increases inflammation within the gut and in the rest of the body as a more permeable gut allows toxic substances to flow into the bloodstream. Experts suggest that women limit alcohol intake to one standard drink per day, defined here.
Do you have questions about gut health?