Gut health matters.
How does perimenopause affect gut health? Habits for better sleep and a recipe for Coconut & Lime Pancakes.
Phew, we got through January! It can only get better from here on, right? I don’t know about you, but I’m looking forward to brighter evenings, warmer days and signs that spring is on its way. In this edition of Midlife Bites, I look at the link between perimenopause and digestive health — because although there are over 30 recognised symptoms, digestive issues aren’t among them. This seems slightly bonkers as we know that gut health is so important for overall wellbeing and the hormonal fluctuations in perimenopause can have far-reaching impact. Menopause research is understudied and it’s still early days for what we know about the gut microbiome, but if you’ve been having symptoms such as stomach pains, constipation, diarrhoea or bloating, knowing how to give your gut some extra love may help make your perimenopause journey a little smoother.
For paid subscribers, I also take a look into why vitamin D is important during perimenopause: what symptoms may look like if you have low vitamin D; why we should all be supplementing; and why it’s essential for so many aspects of our health and wellbeing. I also share some podcasts that I’ve enjoyed listening to this month.
Finally, there’s been a lot in the news this week about how Rishi Sunak fasts for 36 hours at the start of every week “as part of a general balanced lifestyle”. He’s also quoted saying: "It means that I can then indulge myself in all the sugary treats I like for the rest of the week.” There are many ways in which this message is really unhelpful and I definitely don’t advocate this type of eating behaviour for anyone. Intermittent fasting is linked with some health benefits but it needs to form part of a healthy balanced diet the rest of the time — plus, fasting is not right for everyone. If you’d like to find out more about the pros and cons, I recently wrote an article for the Deliciously Ella blog on whether intermittent fasting is worth the hype.
As always, if you you’d like to discuss your specific health goals and find out how to support your health for the long term, just book a chat — I’d love to hear from you!
Is perimenopause affecting my gut?
You’ve likely heard that gut health matters. In the simplest terms, the gut acts as the first line of defence, protecting from the outside world, while extracting essential nutrients from food (as well as making them) for energy and repair. It also works to eliminate harmful toxins and power the immune system. The collection of microorganisms that populate our gut lining is called the gut microbiome. Everything from diet and medication to genetics and the way you were delivered at birth can affect an individual’s microbiome — and each person’s is totally unique. Poor digestion or imbalances in gut bacteria may result in symptoms ranging from diarrhoea, bloating and acid reflux to fatigue and low mood. But how does gut health impact perimenopause symptoms and vice versa?
Gut microbiome diversity appears to plateau at around age 40 and research has linked menopause with these changes. In the last edition of Midlife Bites, I mentioned the estrobolome, a collection of gut microbes that are capable of metabolising and regulating the amount of circulating oestrogen in the body. When oestrogen is released from the ovaries, it travels around the body in an activated form. To clear it, it’s deactivated by the liver and eventually passes into our gut before being excreted.
The microbes in the estrobolome secrete enzymes called beta-glucuronidases, which recycle oestrogens back into their active forms, meaning they can re-enter the blood circulation. Oestrogen is effectively feeding these microbes and supporting gut bacteria diversity. With a healthy gut microbiome, just the right amount of beta-glucuronidase is produced to keep oestrogen in balance. However, if the estrobolome is disrupted and there’s an excess or shortage of microbes producing beta-glucuronidase, there’s the potential for too much or too little oestrogen being excreted, leading to an imbalance between oestrogen and other hormones. This may negatively impact a wide range of oestrogen-related processes, resulting in the symptoms that many women report experiencing: bloating, weight gain, anxiety, brain fog, low energy, mood swings, loss of libido and poor sleep.
Oestrogen has also been shown to protect the mucus-producing cells in the gut lining against damage. With the fluctuating oestrogen levels of perimenopause, there’s a risk of the gut lining becoming damaged, resulting in unwanted substances or microbes being absorbed into the bloodstream. This potentially compromises nutrient absorption and may trigger an inflammatory response, impacting wider processes throughout the body. Although there’s little robust evidence specifically linking menopause and gut barrier integrity, there is some research to show that gut permeability increases from pre- to post-menopause. As well as being linked with systemic inflammation, greater gut permeability has also been associated with lower bone mass density, increasing the risk of osteoporosis.
Oestrogen also regulates the secretion of the stress hormone cortisol. So, with decreasing oestrogen, cortisol may rise, slowing digestion and leading to symptoms such as bloating, acid reflux and abdominal discomfort.
While we can see that fluctuations in oestrogen may be impacting our gut health and vice versa, it’s also important to note that other factors may also have a part to play. For example, changes in progesterone levels may impact the immune system and gut transit time, which can also lead to changes in gut microbiome diversity.
So, as well as including a variety of brightly coloured veg, wholegrains and legumes, incorporating pro- and pre-biotic foods and reducing processed food in your diet, are there other ways to support your gut during perimenopause? Some research has shown better sleep (increased sleep efficiency and total sleep time) is linked to increased gut bacteria diversity (see below for more on improving your sleep). Moderate exercise has also been found to contribute to a healthy microbiome — this is (of course) in addition to the other positive effects that exercise can have on physical and mental health. Stress (environmental, physical and psychological) can disrupt the structure and function of the microbiome and have a negative effect on digestion, causing IBS-like symptoms. Taking time to breathe deeply before you eat can calm the nervous system and promote better digestion.
Changes in your gut health can be a common symptom during perimenopause, but there are dietary and lifestyle tweaks that have the potential to help you to better manage your symptoms. If you’re experiencing uncomfortable perimenopausal or gut health symptoms, or are looking for guidance to make healthier lifestyle choices, get in touch to find out how we can work together to achieve your goals.
For better sleep
Sufficient sleep is essential for good health. A lack of sleep can affect our hormones, our immune system, our insulin sensitivity and even our gut microbiome. Restorative sleep is deep, uninterrupted and typically 7–9 hours long. To achieve this, we need to embrace ‘sleep hygiene’ — this means practising behaviours that facilitate sleep and avoiding those that interfere with it.
Make the most of the morning sun. Studies show that early morning sunlight exposure can help to strengthen your circadian rhythm. Open your curtains as soon as possible or go for a walk first thing.
Be mindful of caffeine. We all metabolise caffeine differently, but it’s a good idea for everyone to avoid it at the end of the day. Enjoy your coffee and black tea in the morning and stick to herbal teas after lunch.
Stick to a screen curfew. The blue light emitted by televisions, tablets and smartphones reduces the production of melatonin — the hormone that makes you sleepy. Try to turn off all screens two hours before going to bed. If that isn’t possible, consider getting some blue light-blocking glasses (which some people find effective).
Coconut & Lime Pancakes
Serves: 4 (makes 16) | Time: 25 minutes
I make pancakes weekly, they’re so easy and you can get really creative with ingredients — try using spelt or almond flour, blitz in some leafy greens, grate in some carrot or courgette, add apple slices and cinnamon, mix in cooked pumpkin or sweet potato, the options are almost endless. They also freeze well so are great for a make-ahead breakfast option or even as a snack. These fluffy pancakes use coconut flour and six eggs, which means they’re gluten free, high fibre and a source of protein. Coconut flour also has a lower glycaemic index (GI) than regular wheat flour so has less of an impact on blood sugar levels. This is due to the fat and fibre content in coconut flour, which slows the release of blood sugar in the bloodstream; it also means that they’re satisfying, keeping you feeling fuller for longer. Leaving the batter to sit for 10 minutes really does make the difference as the coconut flour absorbs the liquid — the batter will be slightly jelly-like before cooking, but the finished pancakes will be fluffy and delicious!
INGREDIENTS
170g (⅔ cup) full fat Greek yoghurt
6 eggs
1 teaspoon vanilla extract
1 lime, zested
2 tablespoons coconut oil (or butter), melted
1 teaspoon baking powder
½ teaspoon bicarbonate of soda
65g (½ cup) coconut flour
METHOD
In a medium bowl, whisk together the yoghurt, eggs, vanilla extract and lime zest. Then add the melted coconut oil and whisk to combine.
Sprinkle over the baking powder, bicarbonate of soda and the coconut flour. Using a spatula, fold the mixture to combine the flour until no lumps remain. Set aside for 10 minutes.
Place a large non-stick frying pan over medium to low heat. When hot, add 1 tablespoon of batter for each pancake. They will spread so make sure there is enough space between each pancake; you will need to do this in batches.
Cook for 3 to 4 minutes until they begin to set on the top; then flip and cook for another couple of minutes. Repeat until all of the batter has been used.
Serve warm with a dollop of Greek yoghurt, a sprinkling of coconut flakes and a handful of berries.
If you’re interested in working with me on a 1-to-1 basis, why not book a complimentary chat to find out more about how I can support you through perimenopause. And if you’re on Instagram, come and say hi.
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