I’m 40 And My Stomach’s Freaking

Bridesmaids via Universal Pictures (2011)

Salad was the last straw. Typically, I’d eat one for lunch — the bigger the salad, the better. But these days, salad and my stomach are not the friends that they used to be. 

I tossed “lots of salad” atop the growing pile of foods that, over the past few years, have started causing me digestive distress. There was Jerusalem artichokes and celeriac; sushi (no more raw fish for me?); and fatty meats. In each case, I had admittedly gone overboard; the adage “everything in moderation” becomes even more true as you get older. But still. Twenty years ago, I could easily eat whatever I wanted, with minimal chance of stomach upset. What was happening to me?

I knew that aging would bring some unpleasant physical effects. I had spent time worrying about my neck, age spots, stuff like that. What I didn’t expect was to bear witness to the fragility of my digestive system.

“Perimenopause is marked by decrease in estrogen as well as progesterone. Both hormones play a big role in the metabolic function of the gut, ensuring proper bowel movements and so forth,” says Dr. Maura Henninger, a New York City-based naturopath. “When hormone levels start to wildly fluctuate perimenopausally, the function of the gut follows suit. So unfortunately in addition to changing hormone levels and all the annoying symptoms that come along with that, gas, bloating, and constipation are very typical. Women come to me thinking they’ve suddenly developed IBS when really it’s part and parcel of moving through these hormonal shifts.”

“For the most part, women are more likely to be food sensitive or to report food sensitivities or IBS-like symptoms than men are.”

Of course, stomach issues — like brain fog or exhaustion — are one of those extremely general health problems that could be caused by any number of issues, some minor, some serious. Tina Ralutz, a registered dietitian nutritionist and health coach at Parsley Health, says that food sensitivities are highly individual, but “for the most part, women are more likely to be food sensitive or to report food sensitivities or IBS-like symptoms than men are.”

She recommends working with a trained healthcare practitioner, if possible, before trying out a bunch of different food protocols or supplements. “If we’re not getting to the root of the issue, then we can compound our stress and potentially add to the problem.”

“When the hormonal environment changes, a lot of women have issues,” says gastroenterologist Dr. Todd Linden. “You can watch the fluctuations in the GI tract through women’s menstrual cycles. In perimenopausal women where the hormonal environment is changing, constipation is a little more predominant. Sometimes it does require a more high-fiber diet. That just helps everything pass through in a more orderly fashion.”

Both Ralutz and Dr. Henninger mentioned stress as a major culprit when it comes to digestive issues. And if there’s one thing I know about women in their 30s and 40s, it is that many of us are extremely stressed out. Especially right now. “I would say the women I treat for perimenopause are typically stressed so many of them aren’t digestive optimally,” says Dr. Henninger.

“Past the age of 30, specifically for women, stomach acid starts to decline over time. However, stomach acid production can fluctuate all throughout our lives depending on stress levels, overall diet, and with antibiotic use,” says Ralutz. “When that happens, the rest of the digestive system is going to be affected because we’re not breaking food down as much as we can. Sometimes that’s where we start to experience things like constipation, gas, burping, diarrhea...not great things.”

What can we do, aside from booking a doctor’s appointment? I was intrigued by a recommendation from Ralutz of digestive bitters, which can be taken to prime your stomach to produce more acid and therefore do a better job at breaking down your meal. “If taken before a meal, what we see is that the bitter compounds will interact with the receptors on the tongue and prompt certain cells of the stomach to produce more stomach acid,” she says. Bitters come in little bottles and can either be sprayed on your tongue or applied via a dropper. 

“It’s not that you have to live like a monk, you just have to be a little nicer to your stomach.”

You can also try probiotics, if you haven’t already. Dr. Henninger advises a rotation of probiotics, “including a women’s probiotic, which will have strains specific to the microbiomes of the vagina and bladder” and a “good broad spectrum probiotic” as well as probiotic foods such as kefir, fermented veggies, kombucha and yogurt. 

According to Dr. Linden, the GI community is very “neutral” on probiotics due to lack of conclusive evidence from medical studies. However, he tells his patients, “If you find one that’s working, you are probably right. Take action, listen to your body, and be very honest with yourself.”

While I’ve been feeling better lately (probiotics, a lot of rice, and plenty of mint tea after meals), I still can’t shake a new feeling of nervousness that one wrong move will throw my system completely out of whack again. I’m slowly coming to terms with the fact that I can’t treat my body like I used to. I need to be more gentle and considerate of it. And perhaps, a giant pot of black coffee and an hour of scrolling Twitter isn’t the best way for me to wake up in the morning. As Dr. Linden says, “It’s not that you have to live like a monk, you just have to be a little nicer to your stomach.”