Gut Health & Hormones in Midlife: What You Need to Know with Dr. Kim Bretz ND

Midlife brings its fair share of gastrointestinal discomforts, from bloating and gas to changes in bowel habits. Many women experience these symptoms, yet the connection between fluctuating hormones and gut health is a topic we don’t engage in enough. It's so critical to bring this conversation to the forefront to understand its impact on women's well-being during midlife. Naturopathic Doctor, Dr. Kim Bretz was the perfect guest to help us do that!

In this episode dedicated to midlife gut issues, especially bloating, we confronted a lot of myths and misunderstandings head-on. For instance, perimenopausal digestive symptoms are often incorrectly blamed on diet alone. In reality, they result from a mix of hormonal fluctuations, life stressors, and sleep disturbances. 

One of the most mind-blowing parts of this conversation included learning about the recent advancements in understanding the difference between bloating and distension. MRI technology now shows us that many individuals with chronic bloating do not produce excess gas but have heightened sensitivity to normal digestive processes. Why does this matter? It highlights the significance of gut-brain interaction disorders and the need for a uniquely supportive approach to diagnosis and treatment.

I loved geeking out with Kim on the latest science and research. We talked about how abdominofrenic dyssynergia illustrates the miscommunication between the brain and digestive system. The diaphragm contracts instead of relaxing during digestion, leading to discomfort without an actual increase in gas production. What this means is that habits like holding in our stomachs, (which we’ve been doing for decades) may worsen the issue. 

Dr. Kim dove into the intuitive eating conversation in addressing the risks of self-directed diets and the importance of professional guidance. Imposing strict food rules can also heighten sensitivity to digestive issues, which means we have more evidence for the value of building balanced plates. 

Dietary diversity is also crucial for your gut to have the chance to thrive, and diets like FODMAP can be helpful but should be temporary with a focus on carefully reintroducing diverse foods.

My hope is that this conversation was incredibly helpful in validating your experience with gut health in midlife and shed light on confusing parts of the puzzle!

To learn more about Kim and the work she does, check out her website at www.drkimbretznd.com and follow her on IG @ drkimbretznd or on Facebook @FundamentalsOfHealth.

TRANSCRIPT

Jenn Salib Huber: 0:00

Hi and welcome to the Midlife Feast, the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Salib Huber. I'm an intuitive eating dietitian and naturopathic doctor and I help women manage menopause without dieting and food rules. Come to my table, listen and learn from me trusted guest experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. And if you're looking for more information about menopause, nutrition and intuitive eating, check out the Midlife Feast community, my monthly membership that combines my no-nonsense approach that you all love to nutrition with community, so that you can learn from me and others who can relate to the cheers and challenges of midlife. 

Hi everyone, welcome to this week's episode of the Midlife Feast. If you are like most of the people that I talk to, at some point you've probably experienced that feeling of ugh. My pants are too tight. I feel really bloated. There's something I'm eating that's not agreeing with me. Maybe you have irritable bowel syndrome. Maybe you've been told that you have a food sensitivity. Maybe there are foods that you're just afraid of eating because you have no idea how they're going to react. If this is you. You will definitely want to tune into this episode with Dr Kim Bretts. Kim is a naturopathic doctor in Ontario and her whole area of interest and expertise is gut health, and what she shares with us in this episode will blow your mind. I'm making that really bold statement because there were a couple of things that I learned that I had never heard about before. So give it a listen and, as always, let me know what you think. Welcome Kim to the Midlife Feast. Oh, thanks so much.

Dr. Kim Bretz: 1:52

I'm really excited.

Jenn Salib Huber: 1:53

I love talking about this area of health and gut and women and all things, so yeah, and gut health, bloating all the things we're going to talk about today has been a frequently requested topic, and I'm so glad that you've agreed to come and talk to us today, because I feel like you are going to be the perfect person, so let's dive into it. We're going to talk about some myths, but I do want to just kind of talk a little bit about what do we know about what happens to gut health that big umbrella term as we work our way through the menopause transition, so from perimenopause and menopause to postmenopause, what do we know? What is actually happening?

The Impact of Perimenopause and Menopause on Gut Health

Dr. Kim Bretz: 2:38

So unfortunately we don't know a lot and I don't think that's terribly surprising, because things are pretty horrific in women's health in general in the area of research and, not surprisingly, that link between hormones and gut is even less with what we understand. Now what we do absolutely see is that women, and especially in what we call disorders of gut brain interaction or functional GI disorders, like irritable bowel syndrome or constipation or dysptheca or things where we're experiencing symptoms that are not Crohn's or Colitis or Celiac or sort of the ones that you get diagnosed on a colonoscopy we see that these levels are really high, to the point and specifically I'm going to use the numbers in Canada. 

But we see, for women in their especially in their reproductive years and leading up and into menopause, the rates of women having at least one of these disorders of gut brain interaction in Canada was 47.6%. So basically one in two women are going to be experiencing this and that study was done across the world and we saw in general same with Canada. Rates in general for the populations were over 40% and then close to that one in two for women. So it's very, very prevalent, even though we don't understand very much and why it's more in women.

Jenn Salib Huber: 4:09

Yeah, and I mean certainly. I think that reflects anybody who works with women. You know gut complaints and you know whether that's constipation, diarrhea, irritable bowel bloating, which we'll talk about shortly. With that, like you know, that discomfort has always been top three reasons why people come into my office, virtually or otherwise. So, yeah, so I think that that's probably going to be pretty relatable for people. Do we know, and we don't know why, other than just we don't know why.

Why Hormone Fluctuation Is to Blame For Gut Challenges in Midlife

Dr. Kim Bretz: 4:43

Yeah, we know that we have things. So we have our hormonal fluctuations and that's happening for every woman. I mean our estrogen, progesterone go up and down within our cycling, reproductive years. That that's happening and that's happening for everyone. So we can see, in general, a lot of women will have a slowdown. That's happening a bit before your period starts. We can get then water retention and bloating. That's happening with that and that happens for women who don't have a lot of complaints and women who do. And then we also see around the time of the period when we have certain other chemicals that are released. We can often see that as our period happens we're also getting loose stool. 

That happens as I don't know some sort of horrific design flaw that came in but certainly not enjoyable. But then we have the menopausal transition and our hormones are now being they're very, very scattered in what's happening. So this feels like it's happening more often. We get more sensations that are happening around that time as well. But we also see sleep disturbances are happening and potentially more abdominal or pelvic surgeries have happened at this point. So again, changes happening in that area. Then we would necessarily see in a 20 year old it's often the numbers aren't as high Very social stress, traumas. Certainly I know being in this midlife time. There's a lot of stresses and pressures that are going on, food changes that we've made, affecting our microbiome, like it's just this whole host of things that I think we want to say hormones, but it's so much more.

Jenn Salib Huber: 6:32

It is. I don't know who you had for physiology. I think we went to the same school in Toronto, but if I have one take home from those four years, this one physiology professor described our digestive tract as one big, long tube with two openings, and I've used that analogy. I'm sure lots of people that I work with are nodding their heads.

And I say that for most of our life, if things are working well, that tube is kind of like a sausage factory and you have different people at different stops along the line and they know their job and it happens like a well-oiled machine with very little intervention. And then all of a sudden we hit our perimenopausal years and this hormonal roller coaster, and all of a sudden it's like everybody forgets where they're supposed to go, and so this sausage maker now is like a drunk sausage maker and you're going to have a series of time where you're having lots of sausages coming out and periods of time where you're having no sausages being made. And it doesn't necessarily mean that it's. 

I mean obviously it's uncomfortable when you're experiencing that kind of digestive dysfunction and it's being augmented in this time of life, but it's hard because we don't have a fix for it, right, like I can't tell someone, this is how we fix it, any more than we can fix any other perimenopausal symptom.

Dr. Kim Bretz: 7:52

Well, and I think that's one of the big messages that we have is that, as our hormones are fluctuating, that portion of things that is simply the transition that's happening. That's not that we can't we can't fix the hormones, so it's not really that portion of it that we're thinking about very much and the very few studies on hormones. What we've seen, with a couple very not well designed studies, necessarily, but looking at either birth control pill, where we've seen often a decrease in symptoms that are happening, and then conflicting results in menopausal hormone treatment studies, there's no consistency in what we're seeing and I think that's because it's probably we don't understand this yet and we have such a varied level of what's happening when the hormones are being given. 

It's that part of it isn't the thing that we're usually trying to fix, because perimenopausal menopause well, there can be symptoms that we want to deal with is not a disease and that process is something that we need to have happen. We're not going to keep menstruating for the rest of our lives, so this is just a thing that is occurring.

Jenn Salib Huber: 9:05

Yeah, Okay, totally agree with all that. Let's dive into the myths. So one of the most common questions that I get anywhere, whether it's in my practice, online, anywhere, is why am I so bloated? So let's just start with that. How do you respond to that question? Because I have to get that a lot.

The Reason You Feel So Bloated

Dr. Kim Bretz: 9:29

Absolutely, and bloating we actually see, especially in these types of things. Bloating there's such a quality of life thing that happens. It has such a huge impact on how we mentally and physically feel. It is absolutely one of the biggest questions that I get and we know when we combine bloating and distension along with our other conditions like IBS or constipation or dyspensia, that we have worse outcomes and worse quality of life. So it's really important, even though it's not being talked about very often.

Jenn Salib Huber: 10:01

So can I stop you there for one sec to clarify Sure. Can we talk about bloating versus distension, because I think that that's an important one.

Understanding the Difference Between Bloating and Distension

Dr. Kim Bretz: 10:09

It is so. Bloating is actually a sensation. We feel that pressure or gas or something and that's the way that we're describing it which is distension, which is actually where we see our abdomen press outwards. So there's that physical often get that comment of I look four months pregnant.

Jenn Salib Huber: 10:32

I look six months pregnant.

Dr. Kim Bretz: 10:34

I look eight months pregnant where we see it happening. So that's the big difference that we're talking about there.

Jenn Salib Huber: 10:41

And I think that's so important because I think a lot of people don't realize that there really is a difference and maybe, as we'll get into, there's a difference in what's happening usually, like that you know distension can have a lot of physical causes that need to be looked into, and things like that versus bloating, which may have more, certainly can have physical causes as well, but sometimes not things that we can fix right.

Dr. Kim Bretz: 11:08

Well, and it's kind of interesting because we're seeing different things right now, which is really exciting. But the way that hopefully we're seeing people think about it right now is that we're trying to figure out where people are on a sort of a continuum of is it altered physiology and again sort of a Crohn's or Colitis? Those are sorts of physiology, strictly physiology conditions, and then is it an altered perception condition and bloating is usually going to fall more on the perception side of things.

And we've seen that recently with some studies that came out I would probably say within the last 10 years or so, that are looking at individuals who have chronic bloating and distension and comparing them to individuals who don't, and they're doing MRIs to look and see how much gas are you producing when you feel the bloating or see the distension or have a challenge meal of something that would tend to make most of us feel pretty gassy and see what is the magnitude of gas that you're producing. 

And in that study we saw that 25% of people who experience bloating and distension are actually producing more gas or have it in sort of abnormal pockets that we were seeing. That means that the other 75% are producing normal amounts of gas. And when we're thinking about this category, this umbrella category of disorders of gut brain interaction, we're seeing that there's a miscommunication between the gut and the brain and we start feeling our digestive processes happening. 

So for a lot of people, they're feeling the gas that they're producing in almost any level, versus those of us who don't experience bloating and distension, who are then just not feeling the experience. Kind of like I wander around my day wearing glasses but not noticing them most of the time. That is what is supposed to happen, but this heightened sensation, we start to feel things a lot more than we should.

Jenn Salib Huber: 13:18

That is fascinating. It is absolutely fascinating and I'm going to say like 8,000 questions and I'm going to try and like keep the lid on for a minute. Yeah.

When Bloating is a Disconnect Between the Brain and the Gut

Dr. Kim Bretz: 13:28

Can I just say one other thing with this, because this is even more fascinating, because when I talk about this, all the time I see patients or if I'm presenting at a conference practitioner, I see their hands going up at this point because it's like, but what about distension? Because I can see the extra gas and that's where I think we take the one step. That becomes even more interesting on this, because if I think about when I get stressed, I get a lot of tension in my shoulders and neck. When we have a lot of GI stress that goes on and we actually, for some people, will have a specific diagnosis around gastrointestinal symptoms, specific anxiety, but we'll see in a lot of individuals that there's a contraction that will happen in the diaphragm. 

So when we eat, this muscle that sits kind of on top of our abdominal organs it's supposed to relax and it actually goes up and it makes more space in our abdomen so that when we bring in food and we bring in liquid and our bacteria produce gases and do the wild and wonderful things they do, we have extra space for that. But when we've had GI issues going on for a long time, we start to contract our diaphragm and it pushes down onto our abdominal organs and there's not a lot of space there. 

And I would say, especially for women, and also think around this around the time of our menstrual period, when we're also drawing in more water, our endometrial lining has thickened, like there's not a lot of space in there and we're contracting everything. Now we can feel things more acutely in that scenario, but we also push out because there's nowhere else to go, although flatulence can also become part of this as well. But this is part of. It is that sometimes 25% of people were producing more gas. 

We can see it extend, but 75% are not. But we can have this abdominofrenic dyssinergia, which is the diaphragm not doing what we want it to do, and we're seeing distention and thinking that must mean more gas and it may not Okay, that just blew my mind because I have never heard that piece of this before. It's so exciting where we're changing and where we're going and retraining and rewiring this miscommunication piece, which is, I think, the really exciting part around. 

We used to say just get less stressed and just don't eat dairy and see what happens and good luck to you. And then that became let's kill off the bacteria and let's take away all the food and I'll meditate. And now we're actually getting concrete strategies around how to deal with this, pairing together our understanding around where we got it wrong, along with having more options available. I think this is a really exciting time in this area of health because we've let people suffer and this is the thing when I talk about this sometimes, again, there's this idea that it's just stress. 

And it's not just stress. It's legitimately that there is this miscommunication in the brain. We can see pain centers lighting up, so, even though there's not more gas being produced, we are getting signals that something is really really wrong and of course we feel like that is dangerous. Of course you're not supposed to feel your digestive process is happening. It is weird and scary to have that happen and then to be told that nothing's wrong. It's hard, it's really really difficult for people and we're moving past that point in time of there's nothing wrong, we can't fix you, we don't have options, and that's amazing.

Jenn Salib Huber: 17:22

It is amazing and I don't know if you've seen any research about this, but I certainly know what I'm doing. When we hang up is so many people who are experiencing body dissatisfaction. It is centered around their abdomen and many of us kind of trained ourselves to suck it all in and hold everything tight. I can only imagine how that is playing into all of this.

Eliminating Foods Means Eliminating Gas

Dr. Kim Bretz: 17:54

I think it is playing a part, even if we may or may not have strong research about that. But we are seeing things around biofeedback and pelvic physiotherapy and some of the physical things to help us in this area. But we still see a lot of times that people are thinking the solution has to be take food away. Because when we take food away, two things are happening. One is that we're not producing as much gas. 

Certain foods feed our gut bacteria and they ferment those or those carbohydrates and they turn it into gases and chemicals. And those gases, for people who are sensing things a lot more, feel uncomfortable so it can feel better to take them away. Or when it goes further and you'll hear this a lot of the time that first it will be like I'm bloated at the end of the day and then it can feel like I'm bloated after any meal and then it's just I'm bloated all the time because now we're just responding to any stretch receptor that's been affected in the gut. 

So we start feeling all the things all the time and that starts to feel like things are more and more dangerous and I must take away more and more foods, even if it's not consistent, or I get bloated with drinking water. I feel too full with water and I often again sort of talk about this with practitioners that what is the condition where water makes us feel bad. That should actually be a warning sign that if there's more and more things that make us feel full or bloated or we have to eat smaller meals and we can't find anything on a test, we need to start thinking about perception issues versus continuing that micromanaging around damage or around diet sorry, and thinking that we're going to find the one magic food versus what we're starting to see now is the more restriction that we have, the more we're seeing this sensitization and what we call visceral hypersensitivity, where you start feeling everything in a much more heightened way around your organs. 

We see motility changes, so again a sensation can cause a physical change. So we see a lot of the time constipation, which is going to increase that sensation of bloating and gas happening, and distension. But we can also see gastric accommodation, so our stomach doesn't expand properly. So we're getting all of these physical changes in response to the more we restrict, even things like intermittent fasting. A lot of my patients will intermittent fast, partly because they've heard about it, because of weight loss, but partly because they'll feel better for the part of the day when they don't eat food, but then they eat a lot at the end of the day and then all their symptoms are ridiculous through the evening. 

But they're like. I made it through work, I made it through my kids coming home from school, but it's not a solution. And so when we try to have things again, if we don't work on some of these other pieces, we just feel bad. Every time we bring something back and we think again something's wrong. Something's wrong, I need to try harder. We become way more hyper, vigilant. It's very difficult for people.

Jenn Salib Huber: 21:18

It is, it is and we're going to keep talking about this, but what I want to do is to just kind of sum up that bloating it's not a myth. You are what you are feeling is real, but it may not be the reason why you have been led to believe, or that there's more to it and we're learning, and that there is likely this complex interplay of things, but it's not usually always something that needs to be fixed in the way that many have been led to believe.

Killing the Bacteria in Your Gut is Not a Health Strategy

Dr. Kim Bretz: 21:51

Right, and I think some of the bigger things around that being fixed has been taking away food and constantly doing things to kill your microorganisms in the gut, which changes your perception. But you can't just keep killing bacteria and not eating food. That's not a good strategy in general for health. It's a horrible strategy for quality of life, and one of the things that I'm really looking for within GI Health is that people can enjoy food. Yeah, that is something that we're looking for, because they don't think health is not being able to eat with your friends and family and being afraid to travel and seeing that kind of your world gets smaller and smaller while you try to micromanage and whack them all your symptoms within your GI Health. That's not getting us to where we want to be. That's not health.

Why Restrictive Diets Can Lead to Disordered Eating

Jenn Salib Huber: 22:46

It's not, and I mean anybody who listens to this podcast probably, like 100%, agrees. And I think that the selling of solutions to symptoms that aren't problems that need to be fixed in that way is a big problem across the entire spectrum of health. Being a symptom, which can be a symptom of something very real, sometimes something very serious, but not in this case. Usually, and then trying to prescribe this like regimented do this, do this, do this, do this and this is how you cure it, has led so many people down years, if not decades, of disorder eating, and I certainly see that people will come to me and saying I saw my first naturopath when I was 16 and when I was diagnosed with XYZ and then my food sensitivities have just gotten worse and now that I'm in perimenopause I can't eat anything and it's really hard sometimes to say that. 

I totally understand that what you're feeling is very uncomfortable and I believe you that your symptoms have gotten worse, but it's not because you're more sensitive to foods, it's not because there's more pathology happening. You've trained your gut in a way to react this way by putting less diversity in. Yes, yeah.

Dr. Kim Bretz: 24:15

It's that very inadvertent trying to do the right thing, and one of the things that I've been talking about with some of my colleagues is this idea especially, I will say, in natural medicine of being early adopters. And it's something that I think we identified that and correctly that food can aggravate symptoms for people in GI sort of stuff. And it was only in 2014 that one of the American Gastroenterology associations was like oh yeah, we're going to identify it now, when people had been saying this is a problem, this is a problem, this is a problem. 

But I think one of the issues with being early adopters is, if we don't keep up with the research, we keep kind of giving the wrong message. So now, yes, food is aggravating people in some cases, but not because the food is bad. In most cases there's things like not allergies and celiac disease, where sure, I'm not going to be saying like here, eat this peanut, I'll hold your EpiPen. That's not what we're looking at. But in many of these other types of conditions, we're actually now seeing that some of the things that we thought were intolerances or things like that or allergies and I'm using air quotes right now because we were using the word wrong and thinking that people, the solution was just to avoid those foods that early adoption of that idea. 

We could empathize with our patients really well, because we did believe that this was happening, but now not being able to move away from it and look at okay, there may be other things that are part of this condition, and actually continuing to hammer down this pathway of take away more and more foods is actually spiraling a lot of people, especially in GI disorders and especially with our female patients in GI disorders, because there seems to be more sensitization that's happening in this population and that's what I do, so I'm going to generalize to that, but I think it's a problem in so many areas.

Why How and When Reintroducing Foods is Critical

Jenn Salib Huber: 26:23

Absolutely, and I just want to have one more thing, and I feel like we have to move on because we have so much talk about. You know, one of the things that I used to do full disclosure, because that's how I was taught is that if we put someone on an elimination diet, that when we reintroduce the foods, we would do like three servings a day for three days. Yes, that's like the recipe for disaster right, if you've got bacteria have not had these foods and then all of a sudden we literally throw large quantities in. It's gonna upset the apple cart any day, any day of the week. 

And so you know when I tell people oh well, why don't we just try reintroducing some of these things so that you can have more options and we can have more diversity in what you're eating? And I say I want you to have a tablespoon of hummus twice a week. Yes, and they're like what I'm like. No, no, If you have not had beans and legumes for 20 years, you're starting with a tablespoon twice a week. And it's incredible how just taking the slow, steady approach of like giving you know your gut bacteria a slow introduction it's like knocking on the door instead of burging in the house, yes Really makes all the difference in the world.

Dr. Kim Bretz: 27:35

I agree and we work especially with our reintroduction programs on when people have been kind of prescribed diets and some of them they're appropriate in the situation, like a low-fought map diet in irritable bowel syndrome, but there's no plan to get people off of it or it's just like I hear try foods and then it goes badly for some of our patients. And if we see not just that we haven't been feeding the microbiota, but we're seeing a lot of this sensitization, hypervigilance, our selective attention on symptoms, we may be going even lower and we're kind of talking about what is it like to sit with a symptom if it's not dangerous? 

This is a really hard thing to go through and that a lot of people are trying on their own and then feeling scared and like something is really wrong and then we want more testing and it kind of spirals in this very, very hard scenario that is also often coinciding when our hormones are making us not sure what's happening as well and you're just like I can't do this and yeah, it's very challenging.

Jenn Salib Huber: 28:47

Okay, so let's talk a little bit about foods, and I know that the question, one of the questions that I get all the time, is what foods cause bloating? Kim.

The Foods That Are Causing Bloating in Midlife

Dr. Kim Bretz: 28:55

Yeah. So when we're looking at that, there are certain foods that contain components that all of us as humans cannot completely break down, and they're often found in our beans and legumes, our grains, some of our nuts, a lot of our fruits and vegetables. So plant-based foods are generally the ones. And it's actually interesting because when I was a naturopathic student and I learned the fact that 90 to 95% of our food is digested and absorbed in our small intestine, I was fascinated with the small intestine and my care about the large colon was almost nothing because I was like it's just a repository for waste, like water comes back in the body. 

Congratulations, yay, large colon, we're done. But I also wanted to think about how do I get that extra 5 to 10%? Because shouldn't I want all the nutrition for my own human cells? So 90 to 95%, we vary deliberately and I don't know how this was set up, but we don't break down all of our food and especially within our carbohydrate foods, we don't have certain enzymes to break it down. 

That 5 to 10% ends up in our large colon and it feeds our bacteria. So they ferment it and they turn it into gases and chemicals, and that's a really good thing. We need that to happen. I'm gonna say germ-free mice where they don't have any bacteria in them. They're weird. They're just weird. One of the things about North America is we're losing our diversity and richness in our microorganisms and part of that is we don't feed them. 

Some of that is a North American diet, where it's highly processed and we just lost those things within our food system. But some of it is where we're deliberately taking them away because the gases make us feel uncomfortable. But some of the bigger ones I actually see people when they decide to go keto, which hurts my love and heart are things like cauliflower and onions and garlic and stuff are really high, and then people go on these diets which already I have concern about. But if you have a sensitization issue and you're like I'm gonna eat all the cauliflower, rice and all of the land, it's going to make you feel horrific like that. 

Apples are really high, but these are all foods that we want to be moving people towards and for many people they're perfectly fine and they don't notice the gas production at all, like it's. It's producing gas for all of us, yeah, but for the people who it's affecting, yeah. We need to work on how to make you not feel it, because you're not supposed to feel it.

Jenn Salib Huber: 31:51

Yeah, so you touched a little bit on FODMAP and I feel like that's a good one to kind of just circle back to you for a second, because there is and correct me if I'm wrong, but there is a large, good evidence base for using this as a therapeutic intervention for people who have IBS. Right, am I wrong? That is?

The Danger of a FODMAP Diet

Dr. Kim Bretz: 32:10

correct and it always has the caveat of this is short term, and I actually often use it to help me understand. Are we getting a lot of this sensation issue that's going on and we can help with people decreasing their symptoms while we're working on some of the other stuff, but for me, our reintroduction starts within four to six weeks of starting the program and it's a very timed what we're doing, which we can slow down and speed up as we need to. So, yes, the guidelines are clear. It's a reasonable option to use, with the very big caveat that we should be off of it within a few months and many people that I'm seeing are coming in on it for years.

Jenn Salib Huber: 33:05

And that's a symptom of because I see the same thing that's a symptom of DIY culture, because you can download guides and apps and you can do this whole therapeutic intervention without any consultation with a professional, without any discussion of pros, cons, risks, benefits, how to start, how to stop, how to modify it to fit your life. And so people will hear, see, be told that a FODMAP diet is good for low, fodmap diets good for IBS, and then they'll just be like, oh, there's an app for that.

Why It’s So Hard to DIY Your Gut Health

Dr. Kim Bretz: 33:38

But it's also challenging and I'm going to say, in a healthcare system where it's hard to get into a gastroenterologist, it's hard in primary care to get someone who really knows about this. They're often like, hey, go on a low FODMAP diet and you're not going to come back at the beginning because your symptoms are lower. And it's often funny because I think I can convince people to try a lot of things because I'm going to talk through the why we're doing it and what is our roadmap and where we're going. 

But in some cases it is harder to convince someone to come off of a low FODMAP diet than it is to go on this insane diet where we're saying you can't eat onions and garlic and cauliflower and apples and like, yeah, absolutely, and all of these things. Like I think sometimes people are happier to do that, to avoid them until it doesn't get better anymore. And that's what we often see is, not only is it not good to stay on it and just beyond the social context of it, we're not feeding our gut bacteria, but usually at a certain point, because this isn't helping the underlying miswiring, like some of the bigger pieces that are going on, then the symptoms start to come back, even though you're doing this, and that's where we see now people like should I take out eggs? Should I take out meat? Should I try? And it becomes even worse in those scenarios.

Jenn Salib Huber: 35:08

Oh, my goodness. Yes, I've seen that a thousand times. I've seen that version of right. So, if I'm understanding and hearing you correctly, there are many foods that produce gas in our colon, which is ultimately a good thing. But not everyone experiences bloating or discomfort or distention, so that there isn't one food or group of foods or foods that you should always avoid if you experience bloating or never avoid. There's no list like that, right.

Dr. Kim Bretz: 35:39

Absolutely. So yeah, I think that we can use some food stuff as a point in time to figure some things out and to help people feel a little bit better while we work on the other stuff. And that's where, going back to where we started on that figuring out, is it altered perception, is it altered physiology? There may be other things that we need to look at to sort of figure out what's happening, and usually it becomes multifactorial because if we're not eating as much like I saw this question recently around I had a patient with constipation and they wanted to do a reset and they fasted for three days and then their symptoms got worse. I'm like, of course it got worse because we require food, like it. 

Just sometimes the things that we're doing are so not logical, but the bloating may feel better during that time period. But it's just this weird sort of. There's so many pieces here that we need to think about both from a physical and a perception sensation. But yes, there's not the, there's not a food that I'd say. This is causing bloating in people versus not happening in the vast majority of people who don't experience bloating in gas like legitimately in the studies, and they range, but we are all supposed to produce, I think, 1.5 to 3 or 4 liters of gas every day, and many people don't feel that at all. Yeah, eating exactly the same foods.

Jenn Salib Huber: 37:13

So important, so important, and I mean for any practitioners who might be listening and even patients. I think it is also really important that the integrative health world, while very well-meaning and that includes our profession of naturopathic medicine often creates a little bit of a haven for people who might have some disordered relationships with food and even eating disorders, to have those food rules validated. 

And I think that it's so important for practitioners listening and I do this a lot in mentoring conversations with others that you really have to weigh the pros and cons of telling someone that they can't have something or that they shouldn't, especially if they already have a very long list of foods that they don't eat. That needs to be a red flag and I think all practitioners who work in this area need to at least be aware of how to screen or refer for eating disorders because it is rampant in English and women in midlife.

Dr. Kim Bretz: 38:21

Well, and I think with that as well, there was a conversation that we had with some colleagues around the idea that naturopathic medicine is where eating disorders go to hide, and it's made more challenging that for a lot of people who go into healthcare and we see studies around dietitians and MDs and we don't have them for MDs at this point, and I don't know that we will, but the high number of disordered eating or eating disorders in healthcare providers and the fact that we will often go into these types of conditions because we saw a benefit with it, but with our healthcare practitioners and I think about naturopaths in general we live in a world where having these restrictions has become normalized and we can find our way within this. 

Not that I think that's good, necessarily, but we can go to a conference where our salad is broken down into everything an individual ingredient and then you just make your own thing and it's all inherently wheat and dairy free and soy free and like all of these things. But most people don't live in that world and so when we're asking people to do things and have expectations around what is happening in the world, where you have to go to your in-laws house for Thanksgiving and have this list of things, or you can't eat in an airport. It just we're underestimating the impact based on our own personal lifestyles in some cases, and I think, as patients, we want to be really cautious about if we're hearing some of these things that, like, this is what I do, and these things that that can be a reverse red flag around how do we think about our practitioners and what are their goals for us? 

And it's just. It's a hard situation, but sometimes as much for patients. We need to be listening to what our practitioners are saying, in the same way that I need to hear some of the warning signs about what my patients are saying and what I think about restrictions or how do we approach food and where is it a complete contraindication and where do we need a team that's going to be working on this?

Jenn Salib Huber: 40:33

Yeah, oh, my goodness, I feel like we could talk for like eight days, but in the interest of letting you get on with your day, is there anything else that you think you, that you want to share, or that you think would be helpful to anyone who's like oh, this is me, this is me.

The Power of Research in Fueling Your Gut Health

Dr. Kim Bretz: 40:51

Yeah. So I think one of the things that I love about this area is that it is growing a body of literature and people who are working in this area so much more right now, and so I feel like sometimes it can just get into the. There's nothing that can be done. This is an area that I think we're going to see quantum leaps and with the change and how we're understanding it over I would say, the last five to 10 years, with having this different approach to things, I am seeing so many more people who are coming off of their even holidays through December saying you know what I ate with my family or I didn't think about my symptoms and that's not a restriction thing anymore I get. 

Changing the way that I practice is changing the way that patients are experiencing their relationship with their health and food and their families and community. I just think it's a really exciting time right now to be working in this area and that patients, I think, can have a lot more hope. That's amazing.

Jenn Salib Huber: 41:55

I love it. Food freedom definitely, yeah, okay, so how can people learn more about what you do and where to work with you?

Dr. Kim Bretz: 42:04

Yeah, so we've got a website at drkimbratsndcom, and Instagram is probably the easiest place to for people to find me. Those, yeah, those are the big ones that we see.

Jenn Salib Huber: 42:17

And we'll have those in the show notes as well. Absolutely so. What do you think is the missing ingredient in midlife, Kim?

The Missing Ingredient in Midlife According to Kim

Dr. Kim Bretz: 42:25

So I've been thinking about this a lot, as I've just come off a few years of midlife just chaos and burnout and being in a place that I didn't want to be anymore and I think it really is that community of people that can support you. My planning for what my second half looks like is not so much about places and things. It is about who is going to be with me along the ride. That is my thing. I love that.

Jenn Salib Huber: 43:02

I love that. That's amazing. Thank you so much for sharing your time and expertise today. This has been wonderful.

Dr. Kim Bretz: 43:09

Thank you, you're welcome Thanks so much for having me.

Jenn Salib Huber: 43:13

Thanks for tuning in to this week's episode of the Midlife Feast. For more non-diet, health, hormone and general midlife support, click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing, because it helps other women just like you find us and feel supported in midlife.