Episode 19: How Hormones Impact Gut Health

Does it seem like your hormones are impacting your gut?

This episode breaks down the role hormones have on digestion, and how they can impact digestive disorders like IBS.

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Welcome back to The Gut Show! Today's episode is all about how hormones can affect your gut health. This is going to be targeted a little bit more towards irritable bowel syndrome (IBS), but it's still going to be helpful no matter if you have a digestive disorder or not. So we're going to start with our sex hormones, which are going to vary from females to males. And when we're talking about this, it's important to realize that if you're on any hormone replacement therapy, then this might look different, so just kind of keep that in mind if that is something that you are currently going through.

So the different sex hormones for women, it's estrogen and progesterone, those are the main two. And then for men, it's testosterone. We all have different levels of these hormones, so it's not that women do not have testosterone, and not that men don't have estrogen or progesterone, but those are going to be the main ones that are involved in the process for each gender. While talking about sex hormones, we also want to discuss the hormone like substance called prostaglandin, and this is going to be most common for females, especially with the menstrual cycle.

So our changes in ovarian hormones, which would be estrogen and progesterone, during the menstrual cycle can modulate GI contractility, or muscle function, gut transit, or the speed of digestion, secretion, which is the release of things that need to be released in order for digestion to happen. visceral sensitivity, which is involved with pain, and immune function at multiple target sites, including those located in the GI tract, and in the brain, because the gut and the brain are fully connected. So when we're thinking about the immune system, with the gut, that's where our common interpretation of the immune system is going to come from protecting ourselves from disease and also inflammation. In the brain, it's protecting the brain against inflammation, so it can help with protecting against neurodegenerative disease, but it can also help prevent inflammation in the brain, which can lead to other issues.

So when we're looking at female sex hormones, estrogen interacts with serotonin, which is produced in the gut, and corticotropin-releasing factor or CRF signaling systems. So this can play a role in the change of symptoms with the change in estrogen that we see throughout life cycle as well as throughout a menstrual cycle. There's a distribution of estrogen receptors along all levels of the gut brain axis where they gut and the brain are communicating, which can explain those interactions even more. So there are lots of different reasons why changes and estrogen can impact how the gut functions.

The receptor could also indicate that our GI system is meant to react and sense sex hormones. So because they're in place where they are, there's a thought that our GI tract is meant to react to these changes in estrogen. So that being said, it's a normal reaction to react, but the severity of what that normal looks like is going to vary from person to person, and they become what we consider to be abnormal or uncomfortable and not necessary to have to go through. We know that birth control may decrease IBS symptoms specifically, but there are also studies that report increased symptoms with the use of birth control, so it can depend on the type of hormones that are affected with the use of contraceptives. So we need to research more to be able to better understand this and then make sure that we're researching specific populations with GI conditions and different types of contraceptives so that we can have better quality of studies and better information to understand how this could play a role.

What I've seen personally in practice is that every single person is different and has a unique response to birth control based on what type they're using. And so it's really important to discuss that with your gynecologist or whoever you're working with, with your birth control, and make sure that they understand any symptoms that you're having, and be able to correlate, did those symptoms increase with the use of birth control? Did they go down with the use of birth control? And could there be, you know, an effect that's going on there? It's also really important to note with your gynecologist if you're still having a full menstrual cycle, like are you having ovulation, like is it actually happening or not, just be able to understand how your menstrual cycle as a whole is impacted by the type of birth control that you're using, because that's going to be helpful in understanding some of the pieces that we talked about with menstrual cycle.

Pregnancy is characterized by high ovarian hormone levels, as well as an increase in opioid mediated at Tinto says ception is a harder to say. What this mean is that there's an opioid like reaction that's happening right. And so we know that for some people pregnancy may improve symptoms, but may cause more constipation and reflux for others due to elevated progesterone. So reflux is going to happen because of anatomy. If there's, you know, the belly is taking up all the space and creating pressure, reflux can happen, it can also happen along with constipation for many people, because of elevated progesterone. For some people pregnancy improves of their symptoms, aaybe because of the elevated progesterone, the decreased estrogen that might be present, but for others, it might worsen symptoms. And again, this can vary person to person.

We know that IBS symptoms can be induced during short term decline of ovarian hormones, but menopause, where the hormones do come back down a bit, this is typically marked by a significant decrease in symptoms. So I've seen many people who are diagnosed with IBS after menopause, typically, what we see is post infectious IBS, so where there's an infection, or foodborne illness that then contributes. Those who have dealt with IBS for the majority of their life, and other functional disorders, if there's a connection with hormones, and if there's a significant connection there, then that might actually improve in menopause. And again, the studies that we have aren't amazing, they're not replicated, this isn't an area that people are really looking at, but it could be something to keep an eye on. You may notice as you age, your symptoms could potentially improve or they could worsen based on other factors that are going on. So we also know that the gut kind of slows down and metabolism works differently as we age. So there's a lot at play here. But menopause could potentially help decrease symptoms.

When it comes to the menstrual cycle, so looking at females who have a menstrual cycle, or those who identify differently that still have a menstrual cycle, the changes in hormones throughout the cycle can impact the symptoms that somebody is having, which is really important to note. So during your menstrual cycle, the first day of the menstrual cycle is marked by menstruation, it's the first day of a full bleed. During menstruation we know that estrogen and progesterone are both low, energy and mood are typically low and there's a risk of cramps and bloat, and you are likely to have looser stool, so it's common to have what we call a period poops, which are looser bowel movements, and looser stoled likely related to the blood flow that's happening, as well as how the muscles are contracting. After the menstruation, then we move into the follicular phase. So if estrogen actually begins to increase, progesterone begins to kind of settle off, so whenever estrogen increases, mood also improves and symptoms aren't really affected.So during menstruation, maybe have looser stool, maybe some bloating and cramps that could be related to not the gut at all, but whatever's happening with the sex organs around the same area. But then as we move into the follicular phase, estrogen increases, mood improves and symptoms typically calm down that would have been caused by the change in hormones.

After the follicular phase, then we're at our ovulation. So this where estrogen has been increasing, estrogen and testosterone for females both peak, energy is high, but there is a risk of constipation and bloat, especially on the day of ovulation. There's going to be more cramping that's involved, but constipation and bloating are very common around this ovulation period, which can be a couple of days. After ovulation, estrogen begins to drop and this is when we're in what we call the luteal phase, which kind of includes menstruation a little bit, but the luteal phase, estrogen begins to drop, progesterone increases, this is where we typically feel okay, but then as estrogen gets higher and higher, our progesterone gets higher and higher, then we start to mood starts to worsen. So leading up to menstruation mood will worsen and there's typically an increased risk of symptoms both constipation and diarrhea around this time.

So most people who are dealing with IBS or digestive issues around their period are going to notice symptoms at ovulation and may notice symptoms a few days leading up to menstruation. For some this can carry over into menstruation because of some of the other symptoms that are going on through menstruation itself, but also the looser bowel movements that are happening. For those that deal with maybe constipation predominant IBS, menstruation might actually be fairly pleasant, but those few days before and leading up may not. So that's what's happening through the menstrual cycle!

So the next set of hormones that we want to look at and how they impact digestion are going to be the gut hormones. The role of our gut hormones is a little bit less complex and detailed in the role of our sex hormones. The ones that we want to focus on are cholecystokinin (CCK), motilin and vasoactive intestinal peptide (VIP). What we know from research so far is that cholecystokinin and motilin may be involved in postprandial symptoms, which means post meal, so after a meal symptoms, and so they may be the hormones that are involved in those symptoms if you're having them like directly after a meal. So a lot of other reasons why symptoms can happen directly after, but when it comes to the hormonal response, and these hormones are involved in the digestive process and so they might be involved in some of these symptoms.

VIP may be abnormally concentrated in IBS, which can cause cramping and watery diarrhea. And now is this chicken or the egg…..is it IBS first and then this is concentrated, is this concentrated, and then IBS happens. That's something that we don't quite know, the studies are again, they're not well in depth when we're looking at IBS, there's not a lot of studies out there, there's not a lot of replication, but this is something that could be linked. Overall, we do need more research. We know there's a link there, we know there's potential for a deeper understanding of IBS symptoms linking with hormones and how maybe IBS impacts hormones and vice versa, but right now, we just don't have a lot of research to explain it. So hopefully this will be something that they look at in the future as we begin to learn and understand IBS even better.

Another set of hormones, and this is going to be the last set that we really focus on for this episode, that's the stress hormones. So the ones that we're going to focus on are cortisol, corticotropin releasing hormone and adrenalcortico tropic hormone. What we know from research compared to women without IBS, we know that cortisol has shown to be elevated in women with IBS in the morning, with a decrease in the evening. This is fascinating. And again, studies aren't super in depth. So it doesn't mean that this is absolutely guaranteed to happen, or that we truly understand why it's actually happening. But what we have seen is that women without IBS don't have this increase in cortisol, which is our stress hormone, but women with IBS did have that increase in cortisol in the morning. Now is that due to an increase of panic and stress as the gut is turning on? The panic that goes around having a bowel movement and you're getting into the day? Is this something that's not related to that, is it something that hits first that causes some of that panic? That's something that we would need to explore later on. What we do know though, is that cortisol or stress hormone is involved in producing many of the physical effects caused by emotional stress, which is a big deal.

So corticotropin releasing hormone which is CRH, is shown to cause stress related intestinal muscle activity. So that muscle activity that is related to stress, which could be cramping, it could be slow, or motility where the muscles slow down and kind of lock up, it could be where they go faster. CRH is shown to cause this, and it's shown to be stronger and longer lasting in those with IBS. Now is that because of that brain connection, again, we don't know but we do know that it is stronger for those with IBS and can last longer, which may be why symptoms do last longer in moments of stress. So anxiety about a meeting, someone might get you know, a little bit of stomach upset, or someone with IBS may have a lot of stomach upset, possibly CRH could be a piece of that puzzle.

We know that cortisol activates the HPA axis which is our gut brain communication pathway, and can induce a th two response by the mucosal system that can increase mast cell numbers. So mast cells are the mast cells in the gut they produce and release abundant histamine, serotonin and proteases. And they can cause kind of an excitement of the primary efferent neurons in IBS patients compared to healthy controls, which just means more symptoms for those with IBS.

We also know that mast cells when they degranulate, are part of the inflammation response and might be part of like an immune response that we see with IBS. And with those who are dealing with a histamine intolerance, or mast cell activation syndrome, and this is something that's really important because cortisol is a piece of this. So cortisol can activate that HPA axis to then induce this response to increase mast cell numbers, and then we know that those with IBS tend to degranulate or break down these mast cells more effectively, it's not a good thing that we don't, we really don't want because that can lead to an inflammation and immune response, that release of histamine, which can be that kind of allergy like response. And so there's a lot that can happen there that might be also tied to cortisol. IBS, patients were reported to secrete more CRH than healthy controls, and to have an accelerated rates of acth and cortisol secretion in response to CRH. So remember, AC th is adrenocorticotrophic hormone. So those IDs are going to secrete which is release and produce more of the CRH than healthy controls, which can have an accelerated rate of also this acth and cortisol, in response to the increase in CRH. So more stress hormones are being released. And then we also know that during acute physical visit, physical, logical, physical, logical, redo that. We also know that during acute psychological stress, individuals with IBS were reported to show no evidence, or no difference in the cortisol response compared with those without IBS. But individuals with IBS did display higher CRH and acth responses compared to those with that IBS. A lot of things, so what we see is that it might be this combination of hormones as like a stress family versus just cortisol itself. And it could be higher in those with IBS, which could explain that increase. issue with the gut brain connection that we see with IBS, as well as stress being a trigger for ideas. So with this conversation around hormones, the question is, what do you do about it? How do you support your hormones, so then also support your gut and keep them in balance.

So when we're looking at that the big goal really is balance, because hormones love to kind of work in synergy with one another. And so as we balance them out, and kind of keep them in a steady state, they're able to do their jobs well without overdoing it and leading to issues right. So one of the things that we can do is sleep, it sounds really simple, but when we sleep, your hormones are really synced up to the master clock, which we call the circadian rhythm. consistency with sleep times quantity of sleep hours, and quality of sleep all matter. And so kind of going to bed around the same time, waking up around the same time can be highly effective. Enjoy healthy fats, we know our healthy fats from fish and plant sources are directly involved in hormone support. And so having you know, vegetable oils, avocado, nuts, and seeds, and fish sources, those are a great way to make your hormones a bit happier, and help stabilize them and keep them consistent. Eat enough food is another big tip and something to really focus on, especially those who are dealing with digestive conditions. I often see people under eating because they're avoiding food to avoid potential triggers. But what we know is that eating too little calories due to either poor appetite, eating disorders or restriction due to symptoms can knock our hormones out of place and increase our susceptibility to those stress hormones. So if you're not sure, if you're eating enough of you have no idea like what enough actually means. That's where you would want to work with a dietitian, one on one to get some guidance and figure that out for you, as well as figure out how to listen to other hormones that might be communicating to you, in order to get some some more consistent results with that. And then the last one is to manage stress more effectively.

There's so many layers to this. But to simplify, you know, we want to remove stressors that are present. And then we want to have your stress management strategies like sleep and exercise, balanced meals, mindfulness, boundaries, rest, all in place to help improve our tolerance to stress and the way that we can process stress, getting the body into kind of a rest and digest mode is going to support hormones as a whole. And also keep cortisol and those other stress hormones down as much as possible to prevent that constant stress response, which is our body's fight or flight. And so our body's not going to work efficiently and effectively when we're in that state when many of us are chronically in that state because of poor stress management strategies. And yoga could be a great thing to add a meditation practice. There's a lot of things out there that you can implement and So I hope this was a helpful conversation all around hormones. The big takeaway is that hormones can be involved. They're involved in digestion. They're involved in IBS and digestive disorders. We don't know exactly how but we know that they're there. So support your body on that hormonal level. And if you are looking for support with that, that is something that we are passionate about at Gutivate! And so our, we have a Master Method Foundation's course that will go over some of this information as well as our group and one to one program. So if you're interested, schedule a consult call where we can talk more and see if what we do can benefit you for what you're looking for. So have an amazing rest of your day, wherever you are, and I will see you in the next episode!