The more we understand how our body works, the better we can approach and protect our health.
The truth of the matter is our body’s function is interrelated to both external and internal factors (environmental, consumption, movement, medications, etc.). The healthiest approach is one from all angles, after taking into consideration what is best for your body, and working with a medical team you trust.
Dr. Jacqueline Wolf, Associate Professor of Medicine at Harvard Medical School, has valuable insight into the human digestive system. Wolf is a gastroenterologist at Beth Israel Deaconess Medical Center in Boston.
Asking experts to pinpoint the most complex aspect of their specialty is a loaded question.
With Wolf’s vast experience, she said, “I would have to say, and people may disagree, but with the trillions of bacteria, viruses, and fungi in our gut, the gut microbiome [is] probably the most complex part of the gastrointestinal system.”
She also explained that at this moment in time, it is not well understood by experts. Research is underway in many facets of her specialty.
Bacteria, viruses, and fungi “impact how we absorb our food, how we feel after we eat, and other interactions that we get, and may be important in impacting [conditions like] Celiac Disease, irritable bowel syndrome and the mucosal immune system.”
“The microbiome consists of tiny organisms (bacteria, viruses, and other microbes) found in the gastrointestinal tract, primarily in the small and large intestine.”* Wolf explained that these parts of our body secrete compounds that can impact mood, affect risk for cancer and affect overall feeling of well-being. The gut flora — another term for the microbiome — has a major impact on its human host. However, what the “ideal” gut flora for maximum health is not known.
Wolf started her career by “looking at how viruses cross the gastrointestinal (GI) tract and interact with the mucosal immune system which clearly has had a major importance in Covid.”
To this day, she feels the “understanding about why there is a difference in the intestinal conditions of men and women” and “what happens to the GI tract as [we] age” are under-represented in research and awareness. In addition, the impact the gut microbiome has on our general health, since it “also affects cardiac health, kidney health, brain health, changes with each new advance with research.”
While a bit of spotlight has been turned on it, Wolf underscored, “I think that is a major thing that … we are going to find out, is how that impacts our food usage and our health.”
No two people are alike and I was curious how different genders were impacted by digestive issues, i.e. what is most prevalent?
One difference may be the way we are formed. Colonoscopies may be more difficult in women. One study concluded that gastroenterologists may find it takes more time to perform colonoscopies and encounter difficulties with female patients “because the colon may be longer and twisty,” compared to men. Other contributing factors for this difference in ease of colonoscopy in men, compared to women, is that women may have scar tissue due to a condition called endometriosis, where the lining of the uterus is outside of the uterus where it can bleed (like it does during the menstrual period) and previous surgeries such as C-sections or hysterectomies.
It turns out, the major player in the difference between GI tracts in men and women is hormones. Wolf said, “The impact on the hormones on the GI tract are really important.”
Taking pregnancy into account, “When we have really active hormones and then compare that situation to the post-menopausal time when they’re taken away, you can see what changes in the gut.”
Pregnancy comes with a whole host of changes for women, including constipation, and acid reflux. Morning sickness and nausea that most pregnant women experience in at least the first trimester, are accompanied by “smell and taste changes.”
Wolf said, “We do know that hormones affect the gut microbiome and that the gut microbiome (the bacteria there) release compounds that are active in the brain.” While not confirmed, she said it may be “change in the gut microbiome that affects the brain that affects the smell and taste.”
Rest assured that after delivery of a baby (if constipation and heartburn were a new onset), “Most times your heartburn is gone as soon as you deliver the placenta.” Complications are rare after delivery, she said in this regard, as “heartburn in pregnancy doesn’t usually cause ulcerations, Barrett’s Esophagus, [or] more trouble swallowing. So the hormones must be protective for that,” said Wolf.
Let’s look at the most common conditions and their impact on the different genders.
Colon cancer
“Colon cancer prevention is really important in both men and women … and more recently we are seeing the incidence of colon cancer, the time people get it, is getting younger and younger,” Wolf said.
She noted that routine screening for colon cancer has been moved up to age 45 (noting both men and women should get routine screening). If your doctor has not brought it up yet, remember, it’s your health – inquire and take the next step to undergo screening.
Focusing on being on the “offense” of health matters, compared to “defense,” can greatly change the course of life and influx of stress. Interestingly enough for women in previous studies, “the onset of polyps and colon cancer was about eight years later than the onset in men.”
Wolf explained that the risk for men is higher likely due to hormones. Populations at higher risk for colon cancer include individuals with “genetic pre-disposition to cancer, [as] sometimes there are different cancers that run with colon cancer … such as adenomatous polyposis syndromes, ovarian cancer or BRCA,” to name a few. “African Americans [tend to] get colon cancer at a younger age,” Wolf shared.
Barrett’s Esophagus
Wolf explained that this condition is “where people have had acid reflux and then they get a change in the lining of their esophagus which predisposes them to esophageal cancer.”
Both Barrett’s Esophagus and esophageal cancer are more prevalent in men, she said.
The most prevalent conditions women experience:
Irritable bowel syndrome (IBS)
In the United States, Wolf said IBS “is about twice as common in women as in men, and it is associated with other things like endometriosis … and we think it may be related to an inflammatory cell called a mast cell, which is increased in both endometriosis and IBS.”
Once again, hormones come into play and impact the GI tract. As Wolf explained, “About 2 weeks before women have their menstrual period, they often get more constipated, then they get their menstrual period and then they may get looser stools.” She said many patients look forward to their menstrual cycle in order to have constipation relief.
As much as many would rather pass on the conversation, it’s time to talk constipation and diarrhea. I think it would be difficult to imagine that there are individuals who have not experienced these particular issues. For those who may be chronically dealing with either, it’s important to seek professional advice and actively treat it.
For constipation, Wolf said, it’s a multi-tiered approach**:
“We’ll often start with fiber;** [then]
- Miralax, which is over the counter (A packet or a cap full – 17 grams and you can go up to 2 of those a day.)**; or
If that doesn’t work move on to one of the medications,” such as:
IBS
Amitiza** (approved for women)
Linzess** (approved for men/women)
Trulance** (approved for women)
IBS-D (Diarrhea)
Motegrity** (only approved after others have failed)
Peppermint oil is a natural route that has evidently gained traction. “It actually has an effect on motility (mobility) in the gut” and when “compared to Bentyl (dicyclomine) … worked just as well as 40 milligrams, a day”** Wolf said.
Peppermint oil “also helps move the gas” and can aid with “abdominal cramping.” Wolf explained that it may increase reflux and make individuals urinate more, since it relaxes the muscle between the stomach and esophagus (lower esophageal sphincter) and in the bladder (detruser muscle). Therefore, if someone has heartburn / reflux issues, peppermint oil is likely not to be tolerated. You can also inquire at your pharmacy about a peppermint oil that is more of a solid, “that can deliver to the small bowel,”** she said.
Another remedy, that isn’t well studied yet, is “DGL”** -Deglycyrrhizinated licorice, which people have commented to her as beneficial.
IBS is complicated as it can present with constipation and/or diarrhea. Wolf said that Kate Scarlata’s website has great resources to individuals on the low FODMAP diet.
“What is really important, and people don’t realize, is when someone has constipation the issue may be getting the stool down or getting the stool out, or both,” she continued.
A glance at the innerworkings: “The function of the anus doesn’t work and then movement doesn’t work, so when you push to have a bowel movement, your anus and muscles should relax, and then your pelvic floor should straighten and you should be able to push the stool out.”
What commonly happens? “With many people, it tightens and the pelvic floor may not move at all, or it may move too much, and then [the stool] can’t come out,” Wolf explained.
Working with a specialist in pelvic floor therapy, while said to be somewhat uncomfortable by some patients, can be very helpful.
Gallstones
Gallstones are “much more common in women and can occur in about 8/100 women in pregnancy. Having gallstones does not necessarily mean that someone will need surgery. Surgery is done when there are symptoms due to the gallstones or abnormal gallbladder.”
Wolf said there is both a hereditary and ethnicity element to risk factors. “Native Americans and Mexican Americans have an increased [evidence of] risk for gallstones.”
Autoimmune conditions
Wolf reported that “Most autoimmune conditions are more common in women, but there is one that’s more common in men, called primary sclerosing cholangitis, that you see in people with inflammatory bowel disease.” However, in most studies, both Crohn’s disease and ulcerative colitis affect both populations nearly equally.
Something worth instilling in our memory: “This is a whole system, it is not just the GI tract, you need to remember that the skin, the heart, the kidneys, everything is related.”
So, “Everything goes into your gut that you eat or drink and it’s impacting you,” Wolf emphasized.
This is a perfect time to review your daily habits, have frank discussions with doctors before starting on new medications (Dr. Pearce explains in this article why should tell your doctor about the supplements you take), and learn what options (food/exercise/etc.) are available and within your budget to lead the healthiest life possible.
As we continue to learn from experts we have the opportunity to improve our health.
*https://www.health.harvard.edu/blog/diet-disease-and-the-microbiome-2021042122400
**No content on THM should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Dr. Wolf recently retired from the editorial board of Harvard Health Publications and is a contributor to the Discovery Channel program “Mystery Diagnosis.”
She is instrumental in Foodicine Health, a non-profit organization focused on public education and advocacy regarding the importance of “Special Diets” that are prescribed for individuals with chronic illnesses or food allergies. Learn more at www.Foodicinehealth.org.
Watch for more from Dr. Wolf in “Nutrition at the root of a healthy digestive system” on December 22, 2022