The midlife gut: a tale of two guts

The midlife gut: a tale of two guts

Hey! Dr. Amy here with some real talk about what's happening to our "guts" in midlife - and I'm talking about BOTH kinds.

Let's be honest: when you hit your 40s and 50s, things start shifting in ways nobody prepared you for. Your microbiome starts acting up, and suddenly there's a whole new tenant paying rent in your midsection. Sound familiar?

Whether you're in the thick of perimenopause with wildly fluctuating hormones or you've officially crossed into menopause, your gut is along for the ride. Today, we're exploring two types of gut issues that can plague us during this transition: the microbiome changes that impact everything from mood to metabolism, and the stubborn visceral fat that seems to appear overnight. Because understanding what's happening is the first step to taking back control.

The gut microbiome: your internal ecosystem goes through perimenopause and menopause, too

What’s actually happening

Your gut microbiome – that community of trillions of bacteria living in your digestive tract – doesn't just sit there digesting food. It makes more than 90% of your serotonin, helps absorb nutrients and vitamins, and produces needed nutrients like short-chain fatty acids. But here's what nobody talks about: it goes through perimenopause and menopause with you.

Premenopausal women have a robust gut microbiome with many different gut flora – our gut diversity peaks around age 40. But during perimenopause, as hormones start their rollercoaster ride, your gut bacteria begin to shift. After menopause, diversity continues to decline, and women's gut population begins to look more like that of men.

The science behind the shift

During perimenopause, your estrogen isn't just declining – it's wildly fluctuating. One month it spikes, the next it plummets. Your gut bacteria, which have estrogen receptors, are getting mixed signals.

There's actually a whole contingent of gut bacteria called the "estrobolome" that's dedicated to managing estrogen in your body. When the gut microbiome is healthy, the estrobolome produces just the right amount of beta-glucuronidase to keep estrogen levels balanced. However, when the gut biome is out of kilter during perimenopause thanks to those hormone swings, beta-glucuronidase activity may be altered, which may alter active estrogen levels.

During perimenopause and continuing through menopause, we see:

  • Less microbial diversity. Think of it as your gut garden losing plant varieties.
  • More inflammatory bacteria like Dorea, Prevotella, and Sutterella that are linked to obesity.
  • Fewer beneficial bacteria like Ruminococcus that produce those crucial short-chain fatty acids.
  • Increased microbial translocation. In other words, more bad bacteria cross into your bloodstream where they don't belong.
  • More mood-affecting changes. Researchers found that women with perimenopausal panic disorder had an imbalance of Bacteroides and Alistipes.

Why this matters

A recent study by ZOE scientists found that gut microbiome composition could predict participants' scores on menopause symptom questionnaires. Your gut bugs might literally be influencing how miserable (or comfortable) your transition is.

The midlife midsection: when fat moves downtown (starting in perimenopause)

What’s actually happening

Here's the thing nobody warns you about: belly fat doesn't wait for menopause. It often starts showing up during perimenopause when your hormones are in major flux. Estrogen may be dropping but also spiking. In this state of instability and imbalance, hormonal or metabolic imbalances that were once simmering invisibly on the back burner can start making themselves known.

One of the many changes that occurs during perimenopause and continues through menopause is a tendency for subcutaneous fat (fat that is stored just beneath the skin) to convert to visceral fat. Visceral fat is stored deep within the abdominal cavity and surrounds important organs.

This isn't just cosmetic – we're talking about a fundamental shift in how your body stores energy. During perimenopause, there is a striking change in fat distribution. In menopausal women, belly fat accounts for 15% to 20% of total body fat, compared with 5% to 8% before menopause.

The hormonal storm

Multiple hormones are conspiring against your waistline, starting in perimenopause:

  • Estrogen chaos. During perimenopause, estrogen is all over the place. One of estrogen's actions is to deposit subcutaneous fat onto your hips. As estrogen levels fluctuate wildly in perimenopause, that signal gets confused and fat deposition starts shifting to the abdomen.
  • Testosterone changes. When estrogen levels drop in menopause, the amount of available testosterone increases, which can trigger a redistribution of body fat, often causing accumulation in the abdominal region.
  • Cortisol chaos. Belly fat contains receptors for cortisol, our body's main stress hormone. And let's be real – perimenopause is stressful! When we're stressed out, our adrenals release cortisol. This stimulates these belly fat receptors – resulting in the formation of even more belly fat.
  • Insulin resistance. Lower and fluctuating estrogen levels affect how your body uses insulin, making it easier to store fat, especially around the middle.

Why visceral fat is different

Visceral fat is hormonally active, exacerbating existing hormonal imbalances and making the hormonal roller coaster of perimenopause an even bumpier ride. If you have already noticed the appearance of belly fat during perimenopause, consider this a flashing red flag. It's not just sitting there – it's actively pumping out inflammatory compounds and messing with your metabolism.

The connection: how both guts feed into each other

Here's where it gets interesting - these two "gut problems" aren't separate issues, and they don't wait politely for menopause to start. During perimenopause, as hormones fluctuate wildly, both your microbiome and fat distribution are responding to the chaos.

Gut microbes may participate in sex hormone reactivation and retention in both perimenopausal and postmenopausal women. Hormone-related changes in the gut microbiome are associated with adverse cardiometabolic risks throughout this transition.

Your dysbiotic gut microbiome can contribute to inflammation and insulin resistance, making it easier to accumulate visceral fat. Meanwhile, that visceral fat pumps out inflammatory compounds that further disrupt your microbiome. During perimenopause, this creates a particularly vicious cycle because your hormones are already unstable.

Research-backed solutions for your microbiome

  1. Embrace the Mediterranean way. The number one thing you can do to support a happy, healthy gut with diverse flora is to eat an anti-inflammatory diet rich in fish, whole grains, nuts, and colorful fruits and vegetables that are packed with fiber and nutrients. Studies show that this Mediterranean way of eating is linked to improved gut health, a more diverse gut microbiome, and a more positive bacterial flora.
  2. Strategic fiber intake. Focus on soluble fiber from cruciferous vegetables, beans, avocados, oats, nuts, and seeds. One study found that for every 10-gram increase in soluble fiber daily, belly fat was reduced by 3.7%.
  3. Consider synbiotics or postbiotics. Synbiotics are a newer approach to improving gut health, containing a probiotic-prebiotic combo that works synergistically. But postbiotics – the beneficial compounds produced when probiotics ferment prebiotics – are gaining attention as an even more targeted approach. Postbiotics like tributyrin (a short-chain fatty acid present in the HOP Equalizer pill) can directly support gut health without needing to establish live bacterial colonies. They provide the beneficial end products of fermentation immediately, which is especially helpful when your microbiome is already disrupted during hormonal transitions.
  4. Add fermented foods. Think kefir, sauerkraut, kimchi, and miso. These provide beneficial bacteria and help support microbial diversity.

Research-backed solutions for visceral fat

  1. Prioritize protein. Observational studies have linked higher protein intake with increased lean body mass in postmenopausal women. Furthermore, studies examining belly fat have found that a low-carbohydrate, high-protein dietary combination may yield the most effective results.
  2. Strength training is non-negotiable. Strength training can significantly reduce visceral fat, especially in postmenopausal women. Studies in menopausal women have found that three weekly resistance training sessions resulted in less total abdominal fat and less visceral fat compared to control.
  3. Manage your stress (seriously). Overexposure to cortisol puts us at risk for chronic inflammation, poor blood sugar management, sleep disruption, and yes, excess visceral fat. Managing stress, whether through mindfulness, breathing exercises, or other means, matters, especially during menopause.
  4. Don’t underestimate the importance of sleep. Sleep helps regulate various hormones, particularly leptin and ghrelin, which influence appetite, metabolism, and fat storage. Insufficient sleep can disrupt the balance of these hormones.
  5. Consider hormone therapy. Menopausal hormone therapy (MHT) itself may help reduce visceral fat gain during menopause. According to a 2018 study, mean visceral fat mass around the internal organs was 0.42 kg for women currently using therapy, compared with 0.48 kg both for women with past treatment and those who never received it.

The HOP Box connection

You know I can't write about gut health without mentioning why we included specific ingredients in HOP Box.

  • NewBiome® (tributyrin). This postbiotic in our Equalizer pill supports beneficial gut bacteria's production of short-chain fatty acids.
  • GlucoVantage® (dihydroberberine). This key ingredient helps with glucose control and insulin sensitivity.
  • NR (nicotinamide riboside). The NR in our Hourglass Tipper promotes cellular energy and may help with metabolic function.
  • Magnesium glycinate. This form of magnesium supports over 300 enzymatic processes, including those involved in metabolism.

The bottom line

Both types of "gut issues" during perimenopause and menopause are real, they're connected, and they're not your fault. The hormonal chaos of perimenopause often kicks off these changes before you've even missed your first period. There is no magic way to lose belly fat. It really comes down to the basics of diet and exercise. And, it's important to note that you don't need to lose a lot of weight to realize health benefits. Dropping just 5-10 percent of body weight can improve your metabolic profile and reduce risk.

The encouraging news? Visceral fat responds to lifestyle changes! And unlike many aspects of aging, your microbiome is incredibly modifiable, whether you're in perimenopause or postmenopause.

Start with one thing: add more diverse plant foods to your plate this week. Your gut bugs (and your jeans) will thank you.

What's your biggest challenge with midlife "gut" changes?

HOP to it!

Dr. Amy & the HOP Team

P.S. Remember, this is a marathon, not a sprint. Your body has been with you for decades – show it some patience and compassion as you navigate these changes together. And if you're ready for comprehensive support that addresses both gut health and metabolic function, you know where to find me. 😉

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