Midlife Digestive Changes: Feeling It In Your Gut
Women's Health Access Issue 91,
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Three women, ages 35, 42 and 51 sat together at a business lunch,eating sandwiches that were brought in before their meeting. The first two women polished off the meal in no time, wanting to get down to work. The third woman, in her early fifties, left most of hers untouched. "Aren't you hungry?" one of the two women asked her. "Yes, but I can't eat that much that fast anymore." she explained. "Im menopausal."
Changes in memory, mood, energy and libido are often talked about in association with menopause. But midlife hormonal fluctuations affect the way women digest and metabolize food. Digestive changes may be sutble and go unnoticed in some women-others will experience these differences:
Stomach distenstion after eating.The stomach takes longer to emtpy as a woman's hormone ratio changes in menopause, explains Larrian Gillespie,MD,author of The Menopause Diet(Healthy Life Publications, 1999). A progesterone/estrogen imbalance causes the delay in gastric emptying, she says, when estradiol levels drop and progesterone exerts an antagonistic effect on gastric nerves.
Appetite changes.When food stays in the upper part of the stomach longer, the release of a hormone called cholecystokinin is delayed. This hormone is released by the pancreas, and signals your gallbladder to contract. When this synchrony is upset, women begin to show a delay in gallbladder emptying as well. When the gallbladder doesn't empty on time, you will not feel full after eating. Not feeling full can lead to eating larger portions and more calories.
Tendency towards heartburn.The woman in the business meeting had learned from painful experience that it was wise for her to eat only a few bites of her sandwich at a time. Upset stomach and heartburn are also linked to progesterone's influence, notes Dr. Gillespie.
Progesterone relaxes the lower esophageal sphincter, the muscle that would normally keep acid from flowing back out of the stomach. Women who once would eat big, spicy meals in the evening with no problem may find they no longer can do that as menopause approaches. At night, lying flat allows the acid to flow from the stomach and irritate the esophagus, producing the burning sensation known as heartburn.
More bloating and gas.Hardly the subject of polite conversation, but this is a reality for many women in midlife. Why? Dr. Gillespie explains that enzymes produced in the duodenum to break down food become less efficient as we age. As a result, incompletely digested food particles travel through the intestines. A diet that is too rich in sugar and fat will not be digested efficiently but ferments in the intestines, creating inflammation and gas.
Changes in metabolism/weight gain. A husband and wife in their late forties are having dinner in an Italian restaurant, enjoying the delicious homemade bread. What happens to these carbohydrates in their bodies is very different, however, at this point in their lives. "As estradiol levels drop and gastric emptying slows down, women's bodies pull out the carbohydrates and store them as fat. Men, on the other hand, use carbohydrates for immediate fuel and energy," says Dr. Gillespie. The reason? Insulin sensitivity changes during menopause. This hormone becomes less efficient in stabilizing glucose ( blood sugar) levels and more prone toward its other function, which is storing fat. Progesterone, along with its reproductive functions, stimulates the pancreas to produce insulin. An out-of-balance progesterone/estrogen ratio can result in your pancreas pumping out more insulin than you need. That Italian bread, rather than fueling your body with energy, is more likely to settle in as fat cells.
Gallstones and Ulcers.Women may become more prone to gallstones in midlife as the gallbladder works less efficiently and doesn't empty completely after eating. A diet high in saturated fat elevates this risk. Gallstones-mineral deposits in the gallbladder or bile ducts-can exist for years with no symptoms and without requiring treatment. However, they can also become extremely painful.
Digestive changes may also leave you more susceptible to infectious H. pylori bacteria, which causes ulcers. Inflammation of the stomach, delayed emptying, and/or decreased immune response can allow the bacteria to take a stronger foothold.
Delayed Bowel Transit. Just as hormone changes may slow the process of emptying the stomach and gallbladder, estrogen decline can also mean that it takes your body longer to get rid of waste. The longer it takes for food to move through the bowel, the more bowel tissue is exposed to irritants and chemicals in food.
IRRITABLE BOWEL SYNDROME
Sometimes called "spastic colon", irritable bowel syndrome (IBS) is characterized by diarrhea, constipation, or both, as well as abdominal pain and bloating. "Irritable bowel syndrome usually begins when people are in their twenties, and not in midlife," says Radhika Srinivasan, MD, a gastroenterologist and assistant professor of medicine at Temple University in Philadelphia. "Any significant changes in bowel habits need to be worked up, and not just summed up as irritable bowel syndrome," she says. That work up may include thyroid testing, says Dr. Larrian Gillespie. "Thyroid changes at menopause can alter mucous membranes ( in the intestines ) that are the first line of defense against chemicals in waste. When those membranes are changed, IBS can set in."
What do you need to do to maintain good digestive health during perimenopause, menopause and beyond? The experts advise these steps:
Think Small.Meals, that is. Women with PMS are often counseled to eat several small meals daily to counteract low blood sugar, fatigue, anxiety, and irritability. Small, mixed meals also provide excellent protection later in life against heartburn, bloating and gas. Your body doesn't have to work as hard to process small meals. Your insulin, cholesterol, and cortisol ( stress hormone ) levels will be more stable with frequent "mini meals" of 250 calories or so, according to Dr. Gillespie.
The Right Mix.With diet books all the rage and virtual war between "high fat" and "low fat" gurus, it can seem perplexing to figure out the best combination of foods for energy, weight maintenance, and hormone balance. Dr. Gillespie's book, The Menopause Diet, makes this easy-to-remember suggestion: Think of your plate as a clock. Fill the portion between 12 and 5 o'clock with low glycemic carbohydrates ( lentils, black beans, chick peas, winter squash for example ). Fill the section between 8 and 12 o'clock with protein ( lean poultry, fish, low-fat cheese), and the little space between for a small amount of food with healthy, unsaturated fat ( salad or vegetables with olive oil). Fatty and sugary foods, never in the "healthful" column, are even more potentially troublesome as we age.
Exercise.Regular exercise is a must to maintain good digestive health, stabilize blood sugar, and lower cholestereol. Staying active will keep abdominal weight gain-the plague of many perimenopausal or menopausal women-to a minimum. Your gallbladder function will improve, you'll reduce your risk of colon cancer, and you'll have less stress, too.
Evaluate.Knowing your hormone levels can give you and your doctor a clearer picture of your overall health, incudling what is happening with your digestive system. Along with insulin, the hormones estradiol, progesterone, and thyroid can impact digestion and metabolism. Talk with your doctor about measuring your hormone levels, and discuss hormone replacement therapy (HRT) options.
Review your medications.Certain medications, particularly some taken for arthritis or osteoporosis, have gastrointestinal (GI) side effects, Dr Srinivasan points out. "Take medication upright, with plenty of water. Never just swallow (medication) with saliva," she says. Some nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis will have fewer GI side effects than others. If you are taking medication for arthritis or osteoporosis, talk with your doctor about your choices. And, says Dr. Srinivasan, be sure to let your doctor know if you have a personal or family history of ulcers.
Screen.The risk of colon cancer increases with age. At age 50 and every five years thereafter, you should have a sigmoidoscopy, a visual examination of the inside of the rectum and sigmoid colon using a flexible instrument called a sigmoidoscope. To women who may be reulctant to undergo this screening, Dr. Srinivasan has this advice. "It's like immunizing your kids. They yell and scream for a minute, but you do it religiously to protect them from disease. Sigmoidoscopy is similar. It's five or ten minutes of discomfort to protect you from colon cancer in the long term."