Changing Gut Health and Sleep in Menopause
There are three questions that are typically asked of subjects who undergo sleep studies:
- During the last month, have you had problems falling asleep?
- During the last month, did you ever wake up too early, not being able to fall asleep again?
- During the last year, have you been troubled by insomnia to such a degree that it influenced your work ability?
Obviously, there are others, but I wonder how your clients might answer these. If their answer was yes to any of them and they have arrived in their menopause transition or they are in post-menopause, I’m not surprised.
Insomnia, gut health changes and weight gain are hallmark symptoms of menopause and post-menopause for millions of women. But what many of women and Practitioners may not know, is that there is a greater connection between these factors, than they may think.
The brain-gut-microbiome axis is a bi-directional axis in which the gut and the brain communicate constantly. This communication is dependent on three factors:
(a) the correct functioning of the vagal system (the nerve network that runs between the brain, heart and gut).
(b) the correct functioning of the neuroimmune system (the biochemical and electrical processes that connect the nervous and immune systems).
(c) the correct functioning of the circulatory system. [Neroni et al, 2021].
All of these interactions are reliant on one thing – a healthy gut microbiome. The disruption of the circadian rhythm in women, alters the gut microbiome equilibrium. [Li, Hao et al., 2018].
In turn, this alters the sleep quality of women, and vice-versa. It’s a bi-directional relationship, i.e. sleep quality also impacts the health of the gut microbiome.
The term “gut microbiome” is generally used to refer to the 1,000 types of microorganisms that inhabit the gastrointestinal tract, including their genetic material. According to Li, Hao et al, (2018), the most abundant species belong to the phyla Firmicutes and Bacteroidetes. And it’s these species of microbes that are affected the most by the menopause transition.
If the intestinal microbiota aren’t healthy or if women have IBS/ Leaky Gut Syndrome, then this bi-directional relationship is compromised.
With chronic insomnia, this can lead to worsening gut health, and for many women, the accumulation of deeper visceral fat. Over time, this can lead to changing health.
It’s a catch-22 isn’t it? Because the intestines are on a 24 hr circadian rhythm, they rely on a good night’s sleep to remain healthy.
But if your client’s gut health is out of balance, then this also affects sleep. And lack of sleep affects their weight gain during and after menopause … whether they are on Menopause HRT, or whether they are dieting or exercising too.
The Gut Health-Sleep Connection Relies on the Tryptophan Pathway
I am never surprised when women tell me that their gut health is has changed as they’ve come through menopause. I wonder if you have noticed this with your clients too? If so, then I talk about this in the Practitioner course on Lifestyle Science and Menopause and in the Certified Menopause Weight Loss Coach Course.
Menopause was the first time in my life that I began to feel bloated and felt like I had developed Irritable Bowel Syndrome (IBS). A good number of women on my coaching programmes tell me this as well.
As such, numerous women try various supplements for their gut health, and yes, I tried this as well. However, many are too high in added sugars and aren’t sustainable with the cost of them.
As part of our menopause symptom solutions, turning around our gut health is important. I spent hours trying to understand what to do, especially when we are inundated with all sorts of products in the supermarket or pharmacy that purport to solve our gut health issues.
But this is where Practitioners need to better understand the Tryptophan Pathway.
The gut microbiota contributes to the production of serotonin. It does this through the ‘tryptophan-pathway’.
This pathway involves complex interactions between host cellular and bacteria processes, producing bioactive compounds such as 5-hydroxytryptamine (5-HTP) and kynurenine derivatives. In health, the Tryptophan-Serotonin-Melatonin Pathway plays a pivotal role in maintaining homeostasis and supporting physiological functions in humans. Of note, the healthy functioning of this pathway is important for brain health during menopause and it has been implicated in both dementia and Alzheimers Disease. [Miyamoto et al., 2024].
Tryptophan is a protein and it is absorbed in the small intestine.
From the small intestine, tryptophan travels up to the brain to help to make serotonin which then helps to produce serotonin and melatonin – the two hormones which are essential in sleep regulation.
It’s been estimated that 90% of human serotonin is produced by intestinal bacteria that possess the tryptophan gene. (Neroni et al, 2021). But here’s the thing – if your client’s gut health isn’t optimal, the tryptophan pathway may be compromised.
For women with leaky gut syndrome, tryptophan uptake may be reduced. If they also don’t have enough tryptophan-containing bacteria, then this affects sleep quality and duration. It also affects menopause depression and anxiety – tryptophan is needed to help produce the mood hormone, serotonin.
The tryptophan pathway is how the essential amino acid tryptophan breaks down in the body. It splits into three main routes: the major kynurenine pathway (over 95% of breakdown) which creates energy and immune molecules, the serotonin pathway regulating mood and sleep, and the gut microbiome’s indole pathway. [Miyamoto et al., 2024].
If you have clients who are epxeriencing chronic gut health problems, then it’s important that they see someone qualified to check this out. It may be Chrohn’s Disease or Diverticulitis, or any of the myriad of other bowel problems, but first and foremost, women need a proper diagnosis.
Sleep is important for regulating gut homeostasis and for assiting the normal functioning of the Tryptophan-Serotonin Pathway. The gut has it’s own circadian rhythm and works on a 24 hour work/ rest cycle, which is why your client’s sleep is important.
When sleep gets out of balance, then so too does the gut microbione as well as peristalsis (gut motility). The two are related. Tryptophan is the starting molecule for melatonin production in all cell species (Zhao, Yu et al, 2019). This is why foods containing higher levels of tryptophan is helpful in your client’s diet.
Understand the Difference between Prebiotics and Probiotics
Learning the difference between PRE-Biotics and PRO-Biotics is an important part of your menopause coaching knowledge, despite your Scope of Practice. Both work in different ways to keep the gut healthy and because they are readily available in the supermarkets that your clients’ may visit, then it’s important to familiarise yourself with the role of these.
This is the reason I also have a Gut Health module for all MyMT™ women and Practitioners in my programmes and courses.
Essentially, we have 3 areas for digestion and absorption – our stomach, our small intestine and our large intestine.
So, women 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.
CABBAGE is an excellent, affordable prebiotic food. Its rich fibre content passes through the small intestine undigested, reaching the large intestine where it acts as fuel to nourish and grow beneficial gut bacteria.
While pro-biotics introduce good bacteria into the gut, pre-biotics act as a fertilizer for the good bacteria that’s already there. They help the good bacteria grow, improving the good-to-bad bacteria ratio. This ratio has been shown to have a direct correlation to overall health and wellbeing, especially in women.
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 the gut into the large bowel. They are critical to on-going health in women.
In fact, they are really important because consuming resistant starches as pre-biotics on a daily basis decreases anxiety, depression, and stress and enhances lower levels of our stress hormone, cortisol. As a summary, the best plant fibres for pre-biotic health are:
– skin of apples
– bananas
– onions, garlic
– jerusalem artichoke
– cooked and cooled kumara
– cooked and cooled brown rice
– cabbage (cooked slightly for better digestion)
– beans
Foods to Heal the Gut
Fermented pro-biotic foods help to reduce inflammation and prevent disease and infection by enhancing immune response in the intestine. Cheese comes into this category too – yes, a saturated fat, but some saturated fats are also important in our gut health.
The Human Genome Project [HGP] in 2002 was the largest study of gut health and indicated that we all have different gut bacteria levels based on how we have lived our lives. This is why the amount and type of different pre-biotics and pro-biotics that women can tolerate is an individualised response.
In the research from the HGP studies, animals and humans subjected to a high-fat, high-sugar Western diet demonstrated rapid (negative) changes in intestinal microbial community structure, with increased numbers of harmful bacteria.
But within a week, of eating fermented foods and removing sugar and processed foods from the diet, the healthy gut microbial levels were partially restored.
Eat Cabbage!
World renowned Nutrition researcher and Doctor, Professor Jim Mann from Otago University in New Zealand, states that the bio-availability of nutrients from garlic and cabbage also have beneficial healing effects on bowel health.
Cabbage is both a pre-biotic when un-cooked and a pro-biotic when fermented with salt and water, i.e. when made into sauerkraut.
To make sauerkraut, green cabbage is finely chopped and combined with sea salt and water (also known as a brine) and allowed to sit at room temperature for several days.
Cabbage contains lacto-bacillus (a strain of beneficial bacteria) on its surface, and when combined with salt water, these bacteria break down the natural sugars in cabbage into lactic acid. Lactic acid then ferments the cabbage, which turns it into a pro-biotic containing food. Great to know for your clients!
Our gut health is an interesting focus for women in menopause.
As oestrogen production and the receptors decline over time, this is the signal for numerous organs and tissues to make pre-determined biological changes. As such there are structural and biological changes that occur in the gut and digestive system, which includes the liver and gallbladder. For example, bile production decreases by the time women reach 60 years, which means that fat digestion is altered.
Furthermore, many women are losing muscle, which changes their need for proteins and carbohydrates in their diet.
However, perhaps the most important issue for many women, is the knowledge that all of the organs, including the gut, work to a biological circadian rhythm. Hence, if your client’s aren’t sleeping, inflammatory changes in the gut increase, thus causing further negative changes to the gut microbiome.
I hope that you can join me on any of the Certified Courses on Menopause and Lifestyle Science. You can learn more HERE.
Dr Wendy Sweet (PhD)/ Member: Australasian & British Societies of Lifestyle Medicine.
References:
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Buford T. W. (2017). (Dis)Trust your gut: the gut microbiome in age-related inflammation, health, and disease. Microbiome, 5(1), 80. https://doi.org/10.1186/s40168-017-0296-0
Gaber, M., Wilson, A.S., Millen, A.E. et al. Visceral adiposity in postmenopausal women is associated with a pro-inflammatory gut microbiome and immunogenic metabolic endotoxemia. Microbiome 12, 192 (2024). https://doi.org/10.1186/s40168-024-01901-1
Grenham S., Clarke G., Cryan J., & Dinan, T. (2011). Brain–Gut–Microbe Communication in Health and Disease. Frontiers in Physiology, 2 (94), 1-15. https://www.frontiersin.org/article/10.3389/phys.2011.00094
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