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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."
ACTION
PLANS
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."
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