The Gut Microbiome and Menopause – what’s the link?
The science behind our gut microbiome and its relationship to the rest of our body and mind is fascinating. As our knowledge and understanding grows we are learning more about how it can even relate to hormone balance and so menopause. Your gut health is key to so much!
The trillions of microbes in our gut, or gut microbiome, play an important role in digesting food and are key to a healthy immune system as well as affecting our mental health, inflammatory levels within the body and how we process hormones and drug medications. We know that the greater the diversity of microbes the healthier we tend to be. In addition, there are many factors which can affect the balance of beneficial or more pathogenic bacteria, yeast and viruses found within our gut.
An imbalance of our microbiome, known as dysbiosis, may develop after gut infections, antibiotic treatment, poor dietary choices or with extended stress. When our beneficial gut microbes become outnumbered by more pathogenic ones (or weeds!) this can have many detrimental effects, such as symptoms of IBS, for example gas and bloating. It can also damage the lining of the gut, the gut barrier and the mucosa which protects our barrier health. Our beneficial bacteria are responsible for producing small chain fatty acids like butyrate which help protect the gut lining and increase absorption of nutrients, vitamins, minerals and phytochemicals, essential for hormone and bone health, energy and mood.
We know our mental health, emotional state and mood can all be influenced by the health of our gut microbiome, for example a reduced microbiome diversity in the gut often caused by a restrictive or narrow diet, is related to depression and mood changes. At menopause mood changes, anxiety and depression are common and so optimising gut health is a great tool in helping to balance this.
We also know that menopause often brings unwanted weight gain and that people who are overweight or obese tend to have a different gut microbiota profile to those in a healthier weight range. Optimising our gut microbiome and reducing stress can be key to helping with reducing weight.
We often see specific patterns when we test gut flora using a stool sample, for example low levels of lactobacillus and bifidobacteria strains, which are very important and beneficial, can allow E coli to grow. High levels of E coli and Enterococcus species are often seen in patients with recurrent UTI’s (urine tract infections) and as oestrogen levels drop in the menopause together these two factors can significantly increase the risk of recurrent UTI’s.
The oestrobolome is particularly interesting, it is the collection of microbes in the gut which affect the metabolism or breaking down and clearance of oestrogen in the body. The oestrobolome carefully modulates the circulation of oestrogen through the liver and directly affects our oestrogen levels. Microbes in the oestrobolome produce beta-glucuronidase, an enzyme, that breaks down oestrogens into their active forms. High fat, high protein and low fibre diets are associated with higher beta-glucuronidase activity compared to vegetarian or high soluble fibre diets. Higher beta-glucuronidase has also been found to be associated with an imbalanced gut microbiome profile.
The unbound oestrogens which are released in this process are capable of binding to oestrogen receptors in the body and so can drive oestrogen dominance and influence oestrogen-dependent physiological processes.
Oestrogen dominance is a very common picture in the perimenopausal years and can result in symptoms such as heavier periods, breast tenderness, fluid retention, mood swings and anxiety. It is also often seen in conditions like endometriosis, breast cancer, fibrocystic breast disease and fibroids. Fluctuating levels of oestrogen in the menopause and particularly in the perimenopause can also be a major cause of symptoms such as hot flushes, migraines and mood swings and therefore optimising our oestrobolome can help smooth menopausal changes and balance hormones.
The food we eat has a big influence on our microbiomes. Different microbes thrive on different types of food. You can stimulate the growth of good bacteria in your gut by eating food that encourage your beneficial bacteria, otherwise known as prebiotics.
Probiotic foods on the other hand are those already rich in the beneficial bacteria, in effect you are eating them ready made! Ideally it is best to take a mix of prebiotic and probiotic foods in your diet.
Prebiotic rich foods include apples, asparagus, bananas, cocoa, eggplant, garlic, endive, flaxseeds, honey, leek, konjac, legumes, onion, and peas
Probiotic rich foods include buttermilk, butter, kefir, aged cheese, sour cream, cultured yogurt, kimchi, kombucha, natto, miso, pickled vegetables, sauerkraut, and tempeh
Other top tips to improve your gut health;
- Eat plenty of high-fibre vegetables (ideally aim for 7 portions of vegetables a day)
- Limit or avoid processed foods, foods high in added sugar, artificial sweeteners, and trans fats. These foods will feed the weeds!
- Take antibiotics only when medically necessary. During and after completing a course of antibiotics, eat probiotic foods and take a probiotic supplement. This can help rebuild the population of healthy bacteria in your gut.
- Eat a wide range of plant- based vegetables, aim for 50 different vegetables a week as this increases the diversity of the microbiome in the gut. Try to eat the rainbow!
- Eat a good variety of healthy fats to build up the gut barrier, including nuts and seeds, olive oil, avocado, oily fish.
- Homemade bone broth or collagen powder are also great ways to nourish the gut lining, providing a rich source of glutamine to target the repair of mucosal cells.
- Include polyphenol rich foods such as apples, oranges, berries, cherries, spinach, herbs and spices, olives and asparagus – these foods provide the fuel for a favourable family in the gut; and the beneficial bacteria akkermansia, which is important for the health of the gut barrier.
Dr Sally Moorcroft
Integrative and Functional Medicine Doctor
Orchard Barn Integrative Health Centre, Stallingborough, Grimsby, NE Lincolnshire.