11: What to Actually Eat for Gut Health in Perimenopause (Part 2)

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What to Actually Eat for Gut Health in Perimenopause

Welcome Back

Welcome back! Last week we talked about what the microbiome is and why perimenopause is wreaking havoc on your gut – the hormone changes, the vaginal microbiome shifts, why you’re suddenly bloated when you never were before. Today we’re getting into the good stuff – what you can actually DO about it. What should you eat? What about probiotics? And my exact protocol for when you need antibiotics. Let’s dive in.

Start With What You’re Feeding Your Gut

After we make sure we aren’t carpet bombing any of our biomes and are taking care of our oral health, where do we go next? The most obvious place is what we are feeding our gut.

The first thing we must talk about, which I mentioned last week, is fiber. There are so many types of fiber. The bigger categories are soluble – meaning it dissolves in water – and insoluble – which does not dissolve in water and instead adds bulk. Most fibrous foods are made of a combination of the two.

Your gut lining is a very thin tube with several layers. One of them is a mucosal layer. The soluble fiber helps to create a gel that supports the mucus lining of the gut and the insoluble fiber acts more like a brush to clean the gut and stimulate production of the mucus lining.

If you do not eat enough fiber, the little friends in your gut get hungry and start snacking on the mucus lining of your gut, which can lead to problems with the integrity of the barrier – aka leaky gut.

So to help feed our friends – remember they are making vitamins for us, supporting our immune system, helping to break down and digest food, we need them – we want to give them what they want. Yummy fiber.

Plant foods in general help feed the microbiome and beyond fiber they provide vitamins, minerals, phytonutrients, polyphenols, and flavonoids that keep your gut healthy.

Rather than getting bogged down with the nitty gritty of the types of fiber and what each plant food provides from a vitamin and nutrient perspective, I think it’s easier to remember that most plant food is made of a combination of fibers and different vitamins and minerals. So the easiest way to get enough of everything you need is to eat a wide variety of plant-based foods.

The Power Players: Foods That Support Your Gut

Here are some standouts to include if you tolerate them:

Beans/Legumes/Lentils

These are fiber packed! Like I mentioned earlier, 1 cup of canned black beans has 18g of fiber. You know where I’m going with this – fiber with protein is the secret to stable blood sugar and keeping yourself full and satisfied.

This includes all types – any color lentil, any variety of bean, soybeans or edamame, dips like hummus, fun snacks like flavored lupini beans. You can make dips out of them, make brownies and cookie dough out of them, or blend them into soups for a creamier texture. They are great additions to salads, tacos, meal bowls, and many sautéed dishes.

Dark Leafy Greens

Kale, collards, spinach, lettuces, beet and turnip greens, bok choy. Some of these have great fiber but they are also powerhouses of nutrients. You can throw them frozen in smoothies or add them to dishes like pasta sauces and stir fries. You can add them to salads, use them for pestos and sauces, or throw them in soups and even meatballs.

Polyphenols

These are the dark colored pigments you find in dark chocolate from the cocoa, coffee, berries, pomegranates, cherries, cloves, red onions, plums, grapes, many nuts and seeds and olive oil as well as soy products. Many probiotic companies make companion products with polyphenols to help feed the probiotics.

Nuts and Seeds

Many of these have a lot of fiber for their size, healthy fats, a little protein, and are excellent snacks and dish toppers. You can throw them on salads, add them to smoothies, finish off soups or stews, or have them as a standalone snack or mix them with each other. They add a nice crunch to yogurt, an acai bowl, and chia pudding is one of my favorite breakfasts.

Fruits

Lower glycemic fruits are great microbiome supports here – berries, apples, pears, kiwi, citrus – frozen or fresh they have fiber and lots of nutrients necessary for your gut. Figs, dates, prunes, and other dried fruits can be used to treat constipation.

The thing to consider is that these are also likely to bump up your blood sugar – that may not be an issue for you, but if you are insulin resistant or have blood sugar issues like crashes all day or getting hangry, then they may not be the best foods for your body at this moment.

Same with higher sugar fruits like mangos and pineapples. They are delicious and wonderful, but if you have blood sugar issues, they are probably better in smaller servings with food friends like protein and fat.

Veggies

All of the other veggies you eat fill in here. I think we all get stuck in ruts of habit and convenience – I know I am absolutely guilty of this! It’s so easy to just make green beans, broccoli, potatoes, carrots, and salad with cucumbers every week.

There is a whole world of vegetables out there and they all offer a slightly different set of fibers and nutrients for our microbiome. I know preparation can be scary, but the internet is full of recipes and videos for any vegetable you find. Try a new one the next time you go to the supermarket. Stop by a grocery store that has different vegetables than you are used to.

Fermented Foods

These don’t have a ton of fiber per se, BUT the fermentation process is caused by growing bacteria which our gut likes. There was a really interesting small trial done at Stanford looking at a high fiber diet versus fermented foods for changing the microbiome, and the fermented foods changed the microbiome more than the fibrous foods.

If you like and tolerate them, a few servings a day can be a great addition to your gut health routine.

The 40 Plant Foods Framework

I know people will ask for numbers, so when I am working with clients I tell them to aim for 40 different plant foods a week. This sounds like a lot, but that includes tea, coffee, nuts, seeds, vegetables, fruits, spices, herbs, beans, legumes, and lentils.

You are probably getting 15-20 with no effort at all. Put a sprinkle of cinnamon in your coffee? That’s 2! Have some almonds and pumpkin seeds on your chia seed pudding with mixed berries – that’s 6!

If you keep track for a week or two you will get a feel for what that is like and you can switch up your shopping list to have more things on rotation. Easy ways to add are using frozen vegetables and fruits that you can add to dishes, buying a few nuts or seeds you like to sprinkle on dishes, adding a few different spices or herbs to your pantry, or trying some new teas.

Quick pause – if you’re finding this helpful, would you share this episode with one friend who’s struggling with bloating, energy crashes, or mysterious symptoms her doctor keeps dismissing? Screenshot this episode, send it her way, and tell her ‘Your gut might have answers.’ Helping women understand they’re not crazy and perimenopause is REAL is exactly why I do this work. Okay, back to it…

What to Eat Less Of (Without Demonizing Food)

This is an interesting question. Things that we know can lead to less diversity and potential overgrowth of microbes that can lead to poor gut health are over-consumption of sugar, over-consumption of processed foods, over-consumption of alcohol, over-consumption of artificial sweeteners.

I say over-consumption because I don’t want to demonize any food group and each person’s tolerance and resilience is different. I have worked with clients who can drink lots of diet soda and they don’t seem to experience any changes. Others have diet soda and it causes cravings and they have a hard time sticking to their food goals.

I personally am someone who can’t have a lot of added sugar. I have dealt with lots of candida issues in the past and added sugar is a big trigger for me, especially if I am stressed or sleep deprived. Once you’ve had chronic yeast infections, the consequences of too much sugar are too high. So for me this switch was hard at first, but now it’s not a problem. I have very few sugar cravings and when I do get them I know I am stressed, tired, or my cycle is off from previous stress and sleep.

Some people can use processed foods in their diet and it helps them reach their goals. Now I don’t think it’s fair to put a protein powder or a grass-fed meat stick in the same category as an Oreo. And hey, if Oreos are your thing and you feel stellar, keep on truckin’ my friend.

But if you are still here, chances are there is something going on in your body that makes you wonder if your gut is playing a role. This is where some self-experimentation comes in. What are the big things I consume a lot of? Perhaps once you finish the current box you can trial not buying whatever it is at the store next week.

Pay attention to how your body feels – is your mood different? Your digestion? Your sleep? How is your skin? Sometimes these things are dose dependent – you might be able to have 1 drink a week and that’s fine, but 2 or 3 gives you issues.

Sleep, Stress, and Hormones

The next things that affect the microbiome are sleep, stress, and hormone changes.

Lack of sleep decreases the diversity of microbes in our gut, which can lead to opportunistic bacteria getting more real estate. It can also lead to inflammation and the normal cleaning that happens in the gut during sleep can’t take place.

Stress also decreases diversity of the microbiome. It can affect motility, which can also lead to opportunistic bacteria taking up more real estate. Both of these can affect metabolism and insulin resistance.

Hormone changes, like perimenopause, also decrease microbiome diversity. Estrogen and progesterone play a role in motility, the diversity of the microbiome, estrogen recycling, and inflammation. The vaginal microbiome also changes during perimenopause, making it less diverse and more susceptible to infection.

My Antibiotic Protocol

Okay, so you have no choice and need to take antibiotics. What do you do? There are lots of practitioners who have different protocols and a lot of them work. This is mine:

During antibiotics: Take Saccharomyces boulardii. These guys are placeholders. They are transient – meaning they don’t take up permanent residence – but they do hold space so opportunistic bacteria who evade the antibiotics can’t start taking up real estate unchecked.

After the antibiotics and a month of Saccharomyces: Is everything back to normal function? Great! You win and can pass go AND collect $200.

If not – if you have mild issues that are annoying like a little gas and bloating that you never used to have, some changes to your bowel movements – using a probiotic could be beneficial.

There are a lot of brands out there, so you want to make sure they have tested their product and it does what it says it does. You want to look for something that is third-party tested – meaning someone who doesn’t work for the company is running the test. And you want to make sure it addresses what you are having issues with.

I like the brands Pendulum, Microbiome Labs, and Seed:

• Pendulum is akkermansia focused which has metabolic effects and also addresses gas, bloating, and digestion
• Microbiome Labs is a spore-based probiotic with a lot of their own trials that addresses GI complaints
• Seed uses a probiotic and prebiotic combo with lots of trials looking at IBS

After antibiotics, take something to reseed.

If you have disruptions a month or so after the antibiotic, you may want to use a product that repairs the lining – this could be useful. This is also when working with a practitioner can make a world of difference. You are an expert in your body, but if you have never had gut issues or disruptions, some guidance and advice can be the difference between success and a Reddit rabbit hole.

Food – this is not the time for comfort food. As your biome is reseeding you want to feed it with the foods that will feed the bacteria you want. Whole foods, very little sugar, minimal processed foods. Variety – polyphenols and probiotic-rich foods. Fermented foods if you tolerate them.

Should All Perimenopause Women Be Taking Probiotics?

I don’t think everyone needs to take probiotics. That said, I think that paying attention to your gut health and noticing signs of gut issues that don’t show up in “traditional” gut symptoms like gas, bloating, constipation, or loose stools is important. A dysbiotic gut can also cause inflammation, brain fog, cravings, and weight gain.

Perimenopause means we need to be more mindful of our gut health. Start with what you are putting into it, then look at things that you may need to have less of. How is your sleep? How is your stress? Are you moving your body? All of those are playing a role in your gut health. Are you over-sanitizing your life? Exposure to dirt, trees, nature in general, as well as not unnecessarily killing any microbes that are helpful for us is really important for our overall gut health.

Are you dealing with something you think could be gut-related and tried all of those things? Then it might be time to get some practitioner support. The world is full of supplements that claim to do a million things. Remember that supplements are not regulated like medications, so not all claims are accurate and they don’t need research and trials like medications do. Before you spend $500 on supplements you are unsure of, reach out to a CNS or other practitioner that can guide you through the process.

If you’re wondering whether your symptoms are actually gut-related, my Lab Review service can help you understand what’s really going on. We’ll look at your bloodwork together and I’ll help you see the connections your doctor might miss – like how your iron levels connect to your gut health, or why your thyroid is struggling. You can find that at meganpfiffnernutrition.com/lab-review.

And if you’re not sure if what you’re experiencing is perimenopause, your gut, or something else entirely? My Symptom Decoder quiz helps you identify your unique perimenopause pattern so you know exactly where to start. It’s free and takes about 3 minutes – find it at meganpfiffnernutrition.com/symptom-decoder.

The Reality of Gut Healing Timelines

Let me be real with you about timelines because I think this is where a lot of people get discouraged. Gut healing is not a two-week fix. If you’ve been dealing with dysbiosis, inflammation, or leaky gut for months or years, you need to give your body time to heal.

I generally tell clients to expect 3 to 6 months of consistent changes before they see significant improvement. Some things – like reducing bloating or improving energy – might happen faster, within a few weeks. But deep gut healing, rebuilding diversity, repairing the lining? That takes time.

And in perimenopause, it might take a little longer because you’re fighting against fluctuating hormones. Your estrogen drops, your gut gets disrupted, your estrogen spikes for a bit, things improve, then it drops again. It’s not linear. So give yourself grace and stay consistent with the basics – the fiber, the variety, the sleep, the stress management. Small changes compound over time.

Three Quick Wins You Can Start Today

Here are some quick wins you can focus on this week:

1. Ditch the antibacterial mouthwash
2. Add 1 fermented food to your week
3. Count your plant foods for a week and add 5 more the next week

Your gut isn’t broken. Your perimenopause isn’t in your head. And small, consistent changes really do add up. Take one thing from today’s episode and try it this week. Your microbiome – and your whole body – will thank you.