As part of our Lunch & Learn series of webinars, we were joined by Nigel Denby of Harley Street at Home.
Are you struggling with digestive issues or bloating during the menopause transition? Want to know why and what you can do about it? Nigel gave us his expert top tips…
Henpicked: Are bloating and other digestive issues common during perimenopause?
Nigel Denby: Yes, absolutely. In fact, after weight gain they’re the most common thing I’m asked about. In general, at perimenopause women fall into two camps. Those who’ve struggled with IBS and digestive health issues all their lives, who have found a way of managing things but then find different symptoms cropping up. And others who have never really had digestive issues who then start to experience things like bloating, abdominal pain, gas or a change in bowel habits – in that they’re more sluggish or more loose and urgent. There can also be more urgency needing the loo, especially if there are issues with the pelvic floor, or a feeling of never quite finishing.
Some women do get hormonal bloating through their lives. But if you’re struggling most of the time then it’s more likely to be digestive, rather than hormonal.
When you get a build up of gas in your large intestine, it causes your diaphragm to push down to protect the internal organs. The bloat can be quite hard, like a football. You can literally see your tummy almost expand, need to undo your trousers, it’s really uncomfortable. And quite unnerving, if you’re at work, for example.
Henpicked: Why does menopause affect the digestion?
Nigel Denby: We don’t really understand it fully. But we have to look at this in the same way as things like IBS or other digestive health issues. There’s rarely just one cause. The mechanics of how your digestive system works.
The large intestine (colon) rises up on the right-hand side, the transverse colon goes along your rib cage, and the descending colon on your left. We have circular muscles here, these push materials along. When the muscles contract and relax that’s the sensation you get when you need to poo, a process called peristalsis. You shouldn’t really have any control over those muscles, they work automatically.
Occasionally, if you’re stressed and have a lot of anxiety, those muscles can lock and cause a backup, leading to constipation and a sluggish bowel. You get gas build up in there along with the waste material, which can cause the bloated feeling. Then osmosis lets water into that digestive system.
So you have waste material, gas and water. At any minute those muscles will relax and that’s when you’ve got urgency and diarrhea. People who are worriers often send anxiety and stress to their tummy. So we often look at stress management, meditation and abdominal massage to resolve this.
Other things can also be going on. If you’ve had abdominal surgery such as a C section, this can upset the microbiome (friendly bacteria) that live in your gut. Other things that could upset that bacteria include lots of historic use of antibiotics, a poor diet, or if you’ve had food poisoning or gastroenteritis. Occasionally this means you can start struggling to digest a group of foods called FODMAPs, fermentable types of carbohydrates. These are healthy foods but require fermentation in the gut. Whether menopause is a trigger for any one of those things we don’t know. But we can’t get away from the fact that this is real and is impacting women.
Very often they feel vulnerable and reach out for anything that might help. But products off a pharmacy shelf can often be a waste of time. Thankfully, we now have a much better understanding of how to manage digestive issues. This can be liberating for those who have struggled for a long time.
Henpicked: Where do you start in figuring out how to manage digestive issues?
Nigel Denby: Start by keeping a diary, both of symptoms and of food and activity. This can help you to see what the patterns are. Then think about your stresses and look at if there’s any self care in your day or week.
You might want to think about a good-quality probiotic. Probiotics are in the same category as vitamin and mineral supplements, not greatly regulated, so you have to be careful about what you’re buying. They give you good bacteria, but you’re not really meant to take bacteria orally to get through your digestive system and a lot of them don’t even get past your stomach. There are three brands I’d recommend because they’ve done the science and are good quality. Optibac Everyday, Symprove (a water-based probiotic which you keep in the fridge) and VSL#3. Try them for three months to really give them a chance to work.
Henpicked: Are there certain foods to avoid or go for?
Nigel Denby: Go for wholemeal bread, brown pasta, brown rice, lots of fruit and veg, make sure you’re drinking enough water. They’re your basics. If your diet looks pretty good then you can start looking at the potential of the FODMAPs. These are healthy foods but some people struggle if they can’t ferment them as they should. They include things like wheat, pulses, beans and lentils, artificial sweeteners, lactose (sugar found in milk) and quite a big range of fruits and vegetables.
Don’t demonise these foods, however. This is a clinical trial. We’d look at a total exclusion for three or four weeks and see if you feel better. You can then go into a reintroduction of those foods in a very controlled and strategic way to see which cause an issue and which don’t. The third phase starts to then mix them together and this is when we’d build a long-term diet plan.
The whole process can take about three months but if you’ve been feeling lousy for a while it can be a complete game changer. It’s about personalising what you can and can’t tolerate. Try to avoid anecdotal advice, as this is not a one-size-fits-all approach. Stick with the science.
Some people find they get bloating throughout the day, which is where abdominal massage at night can help. Here, you’re manually helping the muscles to relax. Move from right to left, gently massaging.
Henpicked: Can food allergy testing help?
Nigel Denby: If you do this, go to a specialist allergy clinic where they do a skin prick test against lots of potential allergens. There are lots of tests available on the high street or online, but these are not recommended as they don’t give you any science-backed information and can just send you off down a rabbit hole. You can’t do a test for intolerances: the only way to check for these are using the exclusions I’ve mentioned.
Henpicked: Finally, is fasting a good idea?
Nigel Denby: No no no! It absolutely won’t help with digestive issues or IBS.
