Why menopause can be a blow to the gut...
Professor Barbara Ryan and Elaine McGowan, aka The Gut Experts, are on a mission to help women deal with issues triggered by changing hormones
We’re getting better at talking about menopause, with women becoming more aware of symptoms, from lack of energy to brain fog, which can be due to fluctuations in sex hormones. But a lesser known side-effect is the trouble it can trigger in the gut.
It seems fluctuations in our oestrogen and progesterone levels, along with other important hormones, such as cortisol and testosterone, can lead to constipation, bloating or loose bowel motions and diarrhoea.
Some women develop gut problems for the first time around the onset of perimenopause, while pre-existing conditions such as irritable bowel syndrome can also be impacted. Hormonal changes can increase pain sensitivity in the gut and affect the balance of its microflora too.
So what can be done to help?
Combating constipation
Bowel function can become more sluggish around perimenopause. It’s likely the result of many complex interactions between hormones, gut microbiota and other lifestyle factors.
Fibre
Generally 20-35g per day is recommended. Fibre is found in plant-based foods, such as fruit, vegetables and wholegrain foods.
Try eating the rainbow, to get a colourful variety on your plate.
If you have too little fibre in your diet, it’s important to start low and go slow, as if you increase it quickly you can suffer from bloating. Easy sources include two kiwi fruits or two small satsumas per day.
One heaped tablespoon of whole or ground linseed or flaxseed can be added to cereals, yogurts, soups and salads.
Fluids
■ Drink 1.5-2.5 litres of fluid per day. Water is the best source, but herbal teas and decaffeinated tea and coffee count.
■ Caffeine acts as a bowel stimulant. Strong tea, coffee and 80-90 per cent dark chocolate all contain caffeine.
■ Prunes and apricots contain sorbitol, a good natural laxative.
Beat the bloat
Abdominal bloating and distension (when the tummy looks like you could be six months pregnant) can become a problem. This is uncomfortable, as well as embarrassing for some women.
■ Avoid processed and convenience foods. These are often high in salt and hidden ingredients that can worsen bloating.
■ Eat slowly and don’t gulp your food. Speedy eaters tend to swallow more air while eating.
■ Constipation can lead to bloating so pay attention to fibre if you’re prone to sluggish bowels. Fructose ( fruit sugar) should be limited to two to three portions, which are spread across the day.
■ Cut out, or reduce, onions and garlic in your diet as these are a common cause of bloating
■Herbal teas are great at soothing the gut. Peppermint is particularly effective. You should reduce carbonated drinks, which can lead to trapped wind.
■ Exercise – gentle yoga, walking and jogging will all be helpful.
Dealing with diarrhoea
■ Reduce your caffeine intake – caffeine is present in tea as well as coffee.
■ Is your fibre intake too high? If so, try reducing it to around 18 -20g of fibre per day, then gradually increase levels as symptoms improve.
■ Avoid any sweeteners containing “ol” at the end, in particular xylitol, sorbitol and foods containing them, which are present in many ‘diet’ foods and drinks. ■ As with bloating, avoid onions and garlic and too much fructose. Alcohol should be kept to a minimum.
Menopause weight gain
■ During perimenopause and menopause, many women slowly gain weight. Multiple studies suggest that 2-7lb is common. This may be because hormonal changes, combined with a lack of energy, poor sleep and mood changes can trigger poor food choices.
■Reduced sex hormones can lead to loss of muscle mass, which reduces metabolic rate, meaning you burn fewer calories. Perimenopausal women typically require 1,600-1,800 calories as opposed to the 2,000 they needed when younger. Try to:
■ Eat more plant-based foods: Vegetables, fruit, salads, grains and legumes are naturally low in fat, low in calories, high in fibre and contain bulk, which is filling and satisfying.
■ Each day, you should aim to eat three to four portions of wholegrain cereals and breads or legumes, as well as five to seven portions of fruit, vegetables and salad.
■ Watch your white carbohydrate intake: Opt for wholegrains over processed carbohydrates like white bread, biscuits and cakes.
■ Eat fish at least twice a week: Oily fish are rich in anti-inflammatory omega-3 fatty acids, white fish is rich in protein and low in fat.
■ Choose lean protein: Skinless chicken and eggs keep you full for longer.
■ Watch your alcohol intake: Alcohol is high in empty calories, so it has no nutritional value and contributes to weight gain. It also has a negative effect on mood and sleep.
■ Exercise regularly: Aim for 30 minutes of brisk walking five times per week.
■ Get quality sleep: This can be difficult during perimenopause and menopause if you are experiencing hot flushes, but a 2016 study at King’s College London found sleep-deprived people consumed an average of 385 extra calories per day – that’s the equivalent of about four slices of bread.
‘‘ Many women slowly gain 2-7lb, which may be due to hormones and poor sleep
■ Consultant gastroenterologist Professor Barbara Ryan and clinical dietitian Elaine McGowan are the authors of What Every Woman Needs to Know About Her Gut (£16.99, Sheldon Press). thegutexperts.com
● A change in bowel function or any new digestive symptoms should always be discussed with your GP