Fatigue management has been the topic of my posts this week in my private coaching group for Health and Exercise Practitioners who are on one of my courses.
It’s so great to read the discussions in this group and to help Practitioners understand many of the lifestyle solutions that can make such a difference to their clients and help them attract more clients with the results they are getting!
After pioneering the personal training industry for global fitness giant, Les Mills, many years ago, I know the power of ‘getting results’ with clients and how much this influences business growth through ‘word-of-mouth’ marketing.
Fatigue management in menopause is an important topic. Not only do I know this after having over 16,000 women do my menopause transformation online programmes over the years, but because the data from the MyMT™ Symptom Quiz, from over 500,000 women globally tell me too. 83% of these women mention that they feel ‘continuously fatigued’ – for many, this is despite taking HRT.
Many women arrive in their menopause transition exhausted and not sleeping, and wonder why, they are struggling through each and every day. I’m sure you may be noticing this with your clients as well.
How to help clients reduce their fatigue is crucial knowledge for all health and exercise Practitioners to have. To me, this is one of the most fundamental lifestyle interventions that we can support our clients in addressing.
Research backs up my own data too.
‘Of symptoms experienced by women over the course of the menopausal transition (MT), fatigue is clinically significant … and is one of the most common and distressing symptoms associated with menopause. In a cross-sectional study of 300 women, 85.3% of post-menopausal women and 46.5% of peri-menopausal women reported symptoms of physical and mental exhaustion compared to just 19.7% of the pre-menopausal women. There may be financial consequences for midlife women experiencing fatigue’. [Taylor-Swanson et al., 2018].
I’m sure that trying to cope with their fatigue also causes many women to go on various supplements, many of which may not be evidenced for the menopause transition.
However, many of them may not understand that their gut health is changing as are inflammatory changes around the body. Hence, they may not tend not to look at their diet or causes of their exhaustion.
There are a number of factors which impact fatigue during the menopause syndrome.
These factors include high stress levels (which also impacts gut health in women), poor sleep, over-exercising, poor diet, as well as changing liver health and gut health. For millions of women, menopause is also a time when they may experience changes to their gut health, including a condition known as Leaky Gut Syndrome.
This is an inflammatory condition which impacts nutrient absorption and immune function.
Leaky gut syndrome is an inflammatory disease of the gut lining and occurs due to increased intestinal permeability. This allows for the passage of microbial and dietary antigens across the epithelial layer into the lamina propria and into the blood-stream.
Intestinal permeability is a measure of the barrier function of the gut.
With the rise in Irritable Bowel Syndrome in midlife and older women, researchers have found that inflammation can be exacerbated when intestinal permeability of the gut wall becomes dysregulated.
In some of your clients, this may be because they have developed an intolerance or sensitivity to certain proteins in wheat.
There are 2 proteins called gliadin and glutenin and are known as Wheat Germ Agglutinin (WGA). The highest WGA concentrations are found in wheat germ. (de Punder & Pruimboom, 2013). These proteins also comprise ‘glutens’ in starch, wheat, rye and barley.
Gluten, is derived from the Latin gluten for “glue,” so, as you can imagine, this ‘glue’ adheres to tiny microvilli in the gut wall, thus building up over time, preventing nutrients being absorbed. These wheat agglutinins also contribute to inflammation if levels are high enough, or if women have a diagnosed Coeliac Disease.
Wheat agglutinins initiate intestinal permeability through the release of zonulin. This protein is a biomarker of the intestinal barrier integrity of the small intestine. It reverses the integrity of the gut wall, enabling gliadin and other dietary and microbial antigens, to give rise to inflammation in the gut wall.
If your clients are experiencing bloating, IBS or gut discomfort after eating wheat products, then with the changes to the gut wall during menopause as oestrogen levels decline, they may have developed gluten sensitivity.
As such, a vicious cycle is created in which, as a consequence of the persistent presence of pro-inflammatory mediators, intestinal permeability of harmful substances may increase even further.
This means your clients may feel tired, or they can’t recover from exercise, and their immune health begins to change, including worsening of hot flushes … despite HRT.
Wheat Grain, Gluten and Disease
A gluten-free diet has been investigated as a treatment option for other medical conditions, and not just for Coeliac Disease. With the recognition that gluten may be pro-inflammatory in many individuals, there has been interest in dietary changes that reduce or remove gluten, in order to treat other medical conditions – these include:
- Certain forms of dermatitis
- Irritable Bowel Syndrome
- Some neurologic disorders such as Multiple Sclerosis
- Rheumatoid arthritis
- Diabetes mellitus and
- Fibromyalgia.
One of the strategies is to explore whether your client can reduce their fatigue and gut inflammation, by restricting some (but not all) gluten in their diet.
I’m not talking about coeliac disease, whereby patients have a diagnosed intolerance to gluten and must remove it, but instead, just to reduce the gluten load on their gut lining for a minimum of 6 weeks.
Hence, your clients may like to try removing wheat, rye and barley which are known to contain gluten. In contrast however, oats are derived from a different tribe and do not contain pure gluten (Punder & Pruimboom, 2013), so they may be fine with oats, especially organic oats, and to soak them in water overnight to improve the digestibility of them.
What is a GLUTEN Restricted Diet?
Reports of gluten sensitivity without Coeliac Disease date to 1978 mentions El-Chammas and Danner (2011) when discussing a gluten-free diet when Coeliac Disease is not present.
It was back then, that an adult female patient who had normal small bowel biopsies and whose chronic diarrhoea improved within days of beginning a gluten-free diet, was described in medical journals.
Over the decades the concept of gluten sensitivity has gained momentum with insights about improvements in some auto-immune diseases and gut health problems, when wheat products containing gluten have been reduced or removed from the diet.
When describing gluten sensitivity, El-Chammas and Danner (2011), mention the “modern” definition of gluten sensitivity, being,
a “state of heightened immunological responsiveness to ingested gluten in genetically-predisposed individuals”.
This heightened responsiveness is expressed in organs other than the Gastro-intestinal tract. From this increased awareness about gluten, there has been an increasing focus on a ‘gluten-free diet’ over the years too. Some of your clients may already be on this type of diet.
A Gluten-free Diet is different from a gluten-restricted diet. When going Gluten Free, this is defined, as a diet completely free of ingredients derived from gluten containing cereals – wheat (including Kamut and spelt), barley (including malts), rye, and triticale, as well as gluten-containing food additives (in the form of flavouring, stabilizing agents, or thickening agents) and foods contaminated with gluten-containing products (such as non-organic oats).
As such, an important strategy for you to consider in your coaching practice, is to help women to read food labels.
Fatigue management in your midlife clients can’t be under-estimated. It’s an important issue to consider when exploring your client’s symptoms.
As Practitioners, we must also remember that Chronic Fatigue Syndrome (CFS) is a distinctive syndrome characterized by prolonged fatigue in combination with typical symptoms such as muscle and joint pain, or headaches, tender lymph nodes, recurrent sore throat, significant problems with cognition and concentration, memory, and sleep, and chronic muscle aches and pains after physical activity. (Bjørklund et al, 2019).
Many of these symptoms overlap with menopause symptoms, so getting your clients to take them seriously and see their Doctor is also important too.
When we become aware of the crucial impact of fatigue on the quality of life of women in their menopause transition, we can support them in ways that help them to take back control … and for many, this may include getting a Coeliac test, or just reducing their gluten load, so that nutrients which support their energy, such as the B-vitamins and Vitamin D, can become better absorbed.
On a final note, we must also remember that wheat and rye are important sources of carbohydrates, especially for women’s heart health as they age. In their paper exploring gluten and wheat in women’s health, Manza et al, (2024) argue that,
‘women have always been exposed, more than men, to higher social pressure related to nutritional behaviors and greater engagement in controlling body weight.
Hence, they suggest that, ‘since the rise of awareness of gluten/wheat-related disorders in the academic and clinical field in the last few decades, misinformation regarding the gluten-free diet (GFD) and its impact on health has been spreading among the general population, however
It’s a phenomenon that I’ve seen too and in my own programmes, unless women are diagnosed as Coeliac, I try to encourage them to reduce gluten load and improve gut health first, but then to return to normal ways of eating, which includes some wheat products too.
References:
de Punder K, Pruimboom L. The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients. 2013 Mar 12;5(3):771-87. doi: 10.3390/nu5030771.
El-Chammas K, Danner E. Gluten-free diet in nonceliac disease. Nutr Clin Pract. 2011 Jun;26(3):294-9. doi: 10.1177/0884533611405538.
Manza F, Lungaro L, Costanzini A, Caputo F, Volta U, De Giorgio R, Caio G. Gluten and Wheat in Women’s Health: Beyond the Gut. Nutrients. 2024 Jan 22;16(2):322. doi: 10.3390/nu16020322.
Raiteri A, Granito A, Giamperoli A, Catenaro T, Negrini G, Tovoli F. Current guidelines for the management of celiac disease: A systematic review with comparative analysis. World J Gastroenterol. 2022 Jan 7;28(1):154-175. doi: 10.3748/wjg.v28.i1.154.
Taylor-Swanson L, Wong AE, Pincus D, Butner JE, Hahn-Holbrook J, Koithan M, Wann K, Woods NF. The dynamics of stress and fatigue across menopause: attractors, coupling, and resilience. Menopause. 2018 Apr;25(4):380-390. doi: 10.1097/GME.0000000000001025.
