Over the past decade, the gut microbiome has emerged as making an important contribution to human health, with increasing interest into how it may also influence symptoms during and after the menopause transition.Â
Feelings of melancholy and sadness are known symptoms during your midlife menopause transition. This is because the levels of your reproductive hormones are naturally declining and these changes in the brain, may affect some of your mood hormones, including serotonin.
However, many women don’t realise, that these effects begin in our gut. Yes, that’s right. Our gut.
With the fascinating connection between nerves in our gut and nerves in the brain, the gut-brain axis has become an important part of the menopause and brain health research.
What is the Gut-Brain Axis?
This powerful axis connects nerves and hormones between the gut and the brain. Millions of nerves run between your gut and brain. These nerves all ‘talk’ to each other through this pathway.Â
During menopause, inflammatory changes in this pathway, known as neuroinflammation, may contribute to feelings of melancholy and brain-fog. Women often think that they are on the path towards dementia with some of the memory problems they experience.
For many women, adding some oestrogen back into the body via hormone replacement therapy (HRT) may help.Â
What is the connection between menopause and gut health?Â
Scientists now know that age-related neuroinflammation and brain fog are related to changing gut microbiota (this is the term given to the complex biological system of micro-organisms inside our gut).Â
‘The gut microbiota has both positive and negative effects on the body and the brain. The scientific literature suggests that the gut microbiome now influences the brain ageing process and the initiation and progression of neuro-degenerative disorders.’ [Alsegiani & Shah, 2022, p. 2407].
Those of you who’ve been reading my newsletters for a while now (thank you), will have read numerous blogs about the link between gut health and menopause hormonal changes. However, this new research brings neuro-inflammation to our attention.
Neuro-inflammatory changes impact brain fog, anxiety, depression and other emotional and memory challenges that women may experience as we move through menopause.
Hence, in exploring how to manage these symptoms in particular, it’s important to consider the gut-brain association and the arrival of alterations in the gut microbiome composition, which may lead to a condition called ‘dysbiosis’.Â
The microbiome is the community of bacteria that lives in our gut and elsewhere. Researchers now understand that brain health and gut health cannot be looked at in isolation.Â
“The connection between the brain and gut is because messages are sent up and down the vagus nerve – the major nerve that runs from our brain to our heart, stomach and intestines. The vagus nerve therefore, has a profound influence on the gut microbiota as well as pro-inflammatory markers.
The reason for this, is because the vagus nerve transfers stress cytokines (inflammatory markers) between the gut and the brain. So, stress is the ‘hammer’ which acts on the brain and the gut.
When we keep activating our stress response, then this increases the ‘leakiness’ of the gut. When the gut is leaky, we lose the ability to absorb the nutrients we need for our health and this increases oxidative stress in the body.”  [Professor Zoltan Sarnyai, 2019)Â
I couldn’t agree more!
I know from my own experience that when we aren’t sleeping one of the major changes that women experience as levels of reproductive hormones decline, is insomnia, or interrupted sleep.
The catch-22 is, that when we aren’t sleeping our gut isn’t healing properly overnight. As such, inflammation can occur throughout our digestive system. Researchers now believe that these gut inflammatory changes impact the brain and nervous system too.
An enormous number of different microbes inhabit our colon and the concentration of these microbes increases gradually from the ileum (small intestine) to the colon (large intestine).
In normal physiological conditions, the density of the human microbiome is highest in the colon but studies indicate that the amounts and types of microbes are influenced by:Â
- stress
- diet
- infections
- medications/ drugs
- illness
- ageing (including menopause).Â
In these abnormal conditions, fecal microbiome biodiversity is decreased, which then influences a condition called dysbiosis.
This term refers to changes in the resident microbe communities. For those of you experiencing changing gut health, such as bloating, diarrhoea or constipation, then studies have shown that gut dysbiosis plays a role in developing and progressing inflammatory changes around the body, including some psychological and autoimmune diseases. [Shreiner et al, 2015]
If you have experienced brain fog, anxiety and feelings of memory loss, then this is where your dietary approaches are important, as is sleeping all night.Â
At least 50% of women on my coaching pages, tell me that they are experiencing gut health issues that have mainly arrived since they went into their menopause transition.
Unbeknownst to many of them, our changing gut health as we go into a low oestrogen hormonal environment is impacting on anxiety levels, brain fog and depression too.
The question is then, how do we try and keep the gut microbiota healthy and reduce our risk of brain-fog, melancholy and for numerous women, the concern about age-related dementia?
New research suggests that flavonoid-rich fruit intake in midlife and later life has associations with dementia risk. [Lyu, Jacques et al., 2024]
Flavonoid Intake and Dementia Risk Reduction
The Framingham Heart Study is a study on the health of people living in Framingham, Massachusetts which has been going on for over 50 years now. I used to teach about some of their findings about cardiovascular health.
Thatâs why my curiosity was piqued with new research talking about the role of flavonoid-rich fruit intake in midlife and up to 70% reduced risk of dementia. With the average age of the participants being in midlife (45 – 59 years) and with 52% of the 2000+ participants being female, it’s an important study.
Flavonoids are naturally occurring bioactive pigments found in a wide range of plants. Many have been studied for their neuro-cognitive (brain and memory) benefits.Â
15 fruit items were identified as being beneficial. These included:Â
- Raisins
- Grapes
- Prunes
- Bananas
- Cantaloupe
- Watermelon
- Apples or apple juice
- Pears
- Grapefruit or grapefruit juice
- Oranges or orange juice
- Strawberries
- Blueberries
- Peaches
- Apricots
- PlumsÂ
And it seems that those raisin snacks you eat as well as grapes and oranges, may have the most benefit to your brain health. When we eat these fruits, AND we start during menopause, then we may slow down the rate of inflammatory changes in the brain, compared to those who include these foods later in life after 70 years. [Lyu, Jacques et al, 2024]
Then of course, there is that fact that we should also look after our gut health too. I have 3 factors that you can focus on with this aspect of your midlife health as well.Â
3 Things You Can Do to Help Manage your GUT HEALTH in Menopause
When we understand the powerful connection between the brain, the gut, the vagus nerve, existing gut inflammation AND menopause, then apart from our fruit intake, we can also focus on these three factors:
- Sleep All Night – as I keep saying to women, if you aren’t sleeping, then you aren’t healing. this includes your gut. Our gut is also on a 24 hour circadian rhythm as are all of our major organs, so we need to improve our sleep in order to improve our gut. This is why in both of the MyMT programmes, the first module you receive is called ‘SLEEP ALL NIGHT‘ – in this I teach you how to change your diet, how to sleep all night and how to turn around your hot flushes, night sweats and bladder control, so you aren’t waking up! As well, if you are on anti-depressants or you already have changing gut health, then there is a Gut Health module for you to listen to as well.Â
2. Learn the difference between PRE-Biotics and PRO-Biotics: Both of work in different ways to keep our gut healthy. I go into more depth in this in my programmes in the optional Gut Health module for all MyMT⹠women!
Essentially, we have 3 areas for digestion and absorption – our stomach, our small intestine and our large intestine. So, some of you may have problems at any part of the gut-colon tract. This is why gut-health researchers focus on both pre-biotics and pro-biotics.
It’s also why I suggest that Pre-biotics are more important to sort out first than pro-biotics in mid-life. Pre-biotics come from specialised plant fibre that beneficially nourishes the good bacteria already in the LARGE bowel or colon.
While pro-biotics introduce good bacteria into the gut, pre-biotics act as a fertilizer for the good bacteria thatâs already there. They help your good bacteria grow, improving the good-to-bad bacteria ratio. This ratio has been shown to have a direct correlation to your health and overall wellbeing, from your stomach to your brain.
Plant fibres help to promote the growth of many of the good bacteria in the gut and to help alleviate constipation. They contain amylose which also helps to reduce insulin. They are therefore called RESISTANT STARCHES. They don’t get digested in the stomach and small intestine, so they travel further down your gut into your large bowel. They are critical to your on-going health, especially to your brain health.
3. Add Extra Virgin Olive Oil (EVOO) to your diet – at least 20-30 mls daily. Recent data are emerging which demonstrate that the health-promoting benefits of EVOO may also extend to the gut microbiota. For those of us who love the Mediterranean diet, this is good news!
An integral component of the Mediterranean diet, extra-virgin olive oil, is obtained via the mechanical extraction of the olive fruit, without the use of heat or solvents. This precious oil is already well known for its nutritional properties and anti-inflammatory compounds, which exert beneficial effects on a number of markers of cardiometabolic health and chronic disease risk such as Altzheimers Disease.
Now, the health-promoting properties of EVOO extend to the promotion of gut health too because it helps to extend the microbiome diversity.Â
Whether you are just entering peri-menopause, or you are already in menopause, understanding that this time of our lives is the biological gateway to our ageing years is important.
With changes going on all around the body, for too long this age and stage of life has been positioned in ‘sickness’. But it shouldn’t be. It needs to be positioned in ‘wellness’ instead.
That’s what I teach you on the MyMTâą online 12 week programmes, (these differ depending on whether weight loss is desired or not). Thousands of women have joined me over the years and feel as if they have taken back control of an important stage of life. I hope you can join me too, as I can’t wait to show you the way through menopause into your healthy ageing years ahead.
Please start with listening to my Masterclass on Menopause which I tell you about in the video below.
Dr Wendy Sweet (PhD)/ MyMTâą Founder & Member: Australasian Society of Lifestyle Medicine.
References:
Alsegiani AS, Shah ZA. (2022). The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regen Res. 17(11):2407-2412. doi: 10.4103/1673-5374.335837.Â
Bourre J. (2006). Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. Sep-Oct;10(5):377-85. PMID: 17066209.
Ford T., Downey L., Simpson T., et al. (2018). The Effect of a High-Dose Vitamin B Multivitamin Supplement on the Relationship between Brain Metabolism and Blood Biomarkers of Oxidative Stress: A Randomized Control Trial. Nutrients. 10(12):1860. doi: 10.3390/nu10121860.Â
Heitkemper MM, Chang L. (2009). Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gend Med. 2009;6 Suppl 2(Suppl 2):152-67.
Koutsos A, Tuohy KM, Lovegrove JA. Apples and cardiovascular health–is the gut microbiota a core consideration? Nutrients. 2015 May 26;7(6):3959-98.Â
Lyu, C., Jacques, P.F., Doraiswamy, P.M. et al. Flavonoid-Rich Fruit Intake in Midlife and Late-Life and Associations with Risk of Dementia: The Framingham Heart Study. J Prev Alzheimers Dis (2024). https://doi.org/10.14283/jpad.2024.116
Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in psychology, 8, 874. https://doi.org/10.3389/fpsyg.2017.00874
Millman, J. Okamoto, S., Teruya, T. et al. (2021). Extra-virgin olive oil and the gut-brain axis: influence on gut microbiota, mucosal immunity, and cardiometabolic and cognitive health, Nutrition Reviews, Volume 79, Issue 12, December 2021, Pages 1362â1374.
Pesonen, H., Laakkonen, E.K., Hautasaari, P. et al. (2021). Perimenopausal women show modulation of excitatory and inhibitory neuromuscular mechanisms. BMC Women’s Health 21, 133. https://doi.org/10.1186/s12905-021-01275-8
Shreiner AB, Kao JY, Young VB. (2015). The gut microbiome in health and in disease. Curr Opin Gastroenterol. 31(1):69-75. doi: 10.1097/MOG.0000000000000139.Â
Terada T., Mistura M., Tulloch H., Pipe A., Reed J. (2019). Dietary behaviour is associated with cardiometabolic and psychological risk indicators in female Hospital nurses-A Post-Hoc, Cross-Sectional Study. Nutrients. 11(9):2054. doi: 10.3390/nu11092054. PMID: 31480696; PMCID: PMC6770286.
Li Y, Yao J, Han C, Yang J, Chaudhry MT, Wang S, Liu H, Yin Y. Quercetin, Inflammation and Immunity. Nutrients. 2016 Mar 15;8(3):167.Â
Vauzour, D., Camprubi-Robles, M., Miquel-Kergoat, S. et al (2017). Nutrition for the ageing brain: Towards evidence for an optimal diet. Ageing Research Reviews, Volume 35, 222-240, ISSN 1568-1637, https://doi.org/10.1016/j.arr.2016.09.010.
