The Unique Challenges of Women's Digestive Health

[00:00:00] If you enjoy podcasts like this, you should check out our other shows on Health Podcasts Network. For example, Women Physicians Lead, hosted by Dr. Lisa Herbert, helps women physicians move from surviving to thriving in their personal and professional lives.

[00:00:17] Dr. Lisa shares leadership tips, burnout support, stress management strategies, and inspiration from women physicians who have made remarkable transitions into leadership roles. There is a fantastic episode that you should check out called Taking Care of Your Cell during

[00:00:34] the journey about how women physicians can care for themselves while on their leadership journeys. Check out Women Physicians Lead on your favorite podcast platform or visit healthpodcastnetwork.com. Hi, welcome to another episode of Beyond The Paper Gown, where we consider factors

[00:01:06] both in and outside of the healthcare system that affect women's health and highlight what we can do to improve our own health. I'm Dr. Mitzi Krockover. So have you ever felt like your GI troubles were just shrugged off with probably just stress?

[00:01:22] Or maybe you've been puzzled by how your digestive system seems to have a mind of its own, especially with the ebb and flow of hormonal changes. Well, you're definitely not alone. As a clinician, I've seen firsthand how GI issues can play a significant role

[00:01:37] in women's lives, often with unique challenges that are distinct from men's experiences. Bloating and gas may be nuisances, but they may also be a warning sign of something more serious. Complex conditions like irritable bowel syndrome or inflammatory bowel disease caused by

[00:01:54] autoimmune processes are more frequent in women, and even a seemingly GYN issue like endometriosis has a connection to the gut. The gut also directly communicates with our brain and nervous system, messing with our

[00:02:08] mood as well as causing GI symptoms, which we're only now beginning to learn about how to modify. And there's so much more. So today we are joined by an incredible expert, Dr. Jacqueline Wolfe. Dr. Wolfe brings years of expertise, research, and a profound understanding of how our

[00:02:27] guts work, and sometimes how they don't. She's on faculty at Harvard Medical School and on staff at Beth Israel Deaconess Medical Center and is the author of A Woman's Guide to a Healthy Stomach.

[00:02:40] You know, I'm so glad you're here to join us for a candid conversation about all things GI health. And I do mean candid. We're going to talk about all the things, including how to get rid of gas and constipation, even how often someone should poop.

[00:02:55] So consider yourself warned. But honestly, it's important information and we're here to discuss it. Remember this podcast is for informational purposes only, so do consult with your health care provider for personalized advice. I am delighted to have our guest today.

[00:03:27] Dr. Jacqueline Wolfe is Associate Professor of Medicine at Harvard Medical School and in the Division of Gastroenterology at Beth Israel Deaconess Medical Center. Her specialty is inflammatory bowel disease and women's gastrointestinal health. She's received numerous awards and honors. She's the author of over 60 articles, chapters, reviews and editorials.

[00:03:49] And she also authored a book for the lay public entitled A Woman's Guide to a Healthy Stomach Taking Control of Your Digestive Health. She's appeared on television, radio and in the lay press. Dr. Jacqueline Wolfe, it is so good to see you, albeit virtually, and have you today.

[00:04:06] Thank you so much for being here. Thank you very much. I appreciate that. Oh, I tell you, I have a kind of a funny story. When I was doing my residency in internal medicine at the end, the head of GI and another

[00:04:23] attending motion to me over during rounds and said, what do you think about a GI fellowship? And at the time I said, it's my least favorite body fluids. So I think I'll pass. And in retrospect, that was probably not a really bright thing because again, did not

[00:04:41] understand at the time the breadth of what gastroenterology really covers and perhaps even most importantly, the differences between women and men. And that again, what they were really focused on is trying to get more women in.

[00:05:00] So but I'm delighted that you didn't have that experience in terms of turning away. So talk a little bit about why you did choose gastroenterology. Well, it's interesting because when I first started sort of like you and I started before

[00:05:16] you, there were only a few women in gastroenterology. And you go to conference, there'd be one woman per three rows. And so it was unusual. So when I started and I was trying to decide on my internship in residency, everybody said, well, of course you're going into OBGYN.

[00:05:39] You're a woman. And I go, no. And then they say, well, of course you're going into pediatrics. You're a woman. And I say, no. So but you know what's interesting is the intersection between all of those things. So I went into gastroenterology.

[00:05:57] I did my residency at the University of Chicago. And then I actually short tracked out that time and only did two years and went to Brigham and Women's Hospital at that time was Peter Ben Brigham.

[00:06:12] Now it's Mass General Brigham, but it's still the same hospital and did my fellowship and I was the first woman to complete their fellowship there. Wow. And I did basic research for a long time and then transitioned over to clinical, but I've

[00:06:32] always been interested in identifying something new. And you still heard in your office at that time women saying that their symptoms were not taken seriously. Women weren't taken seriously. And unfortunately that still happens. True.

[00:06:55] But then I moved, I went across the street after a while after many years and I've done mostly clinical and we've been developing a women's digestive health center now. And so what is different between a woman's digestive system and a man's?

[00:07:17] So let's start from the beginning and I am going to back up for what you had said about why you didn't go into GI. So clearly all we thought about was like poop, nausea and vomiting if that's the other thing we were going to do.

[00:07:38] And since then I will back up again. And I did my original research on how viruses cross the GI tract and interacted with the immune system. So since then it's become interesting because you know it's from your mouth and your dental

[00:07:57] health and your microbiome all the way out. And so there are a lot of opportunities for being different. At puberty women obviously get a lot of, they start getting their menstrual cycle with changes in estrogen and progesterone.

[00:08:17] They go through pregnancy where there's a huge change in their hormones and then postmenopausal it's often a little bit more like men. So looking at all that the hormones markedly affect the GI tract.

[00:08:38] And there are a large number of things that are only in women like pregnancy and a number of things that are more common like autoimmune diseases in women than men, gallstones in women as we get older. Endometriosis impacts the GI system.

[00:09:00] Other things like celiac disease is more common in women. Pancreas cysts, some of the cysts there, lupus scleroderma, mast cell activation syndrome, a joint hypermobility that impacts the gut. So there are a huge number of things now that we're aware of being more common in women

[00:09:27] than men and a few more common in men. We do know just look at the microbiome and a lot of the bacteria produce a lot of different things and they produce compounds and these are compounds that are fatty acids so type of fat but small and they're anti-inflammatory.

[00:09:49] So those are also affected by diet, the type of your microbiome. They vary in different conditions. What you eat varies these things and they vary in diversity, varies between men and women, how many different kinds of bacteria you have.

[00:10:14] And some of these bacteria secrete compounds that can go up to your brain for the gut-brain interaction so that we're learning more and more about it. There are a lot of institutions, universities and a lot of people studying the microbiome, how it impacts us.

[00:10:35] And yes, we would love to have probiotics that direct us out the healthy diet. And there's some studies out there but a lot of the studies are not very good.

[00:10:48] It's very hard to get people to stick to a diet and do a good study for over a long term to see a result. So fortunately and unfortunately, a lot of the data we have are in mice or other animals and not as many in people.

[00:11:07] So it sounds like you're not ready to make a recommendation to folks about taking a probiotic? I am not except, I will say. There are a couple good studies and so there are a few studies with what we called irritable

[00:11:24] bowel syndrome where the fiddle bacterium is the type of bacterium like in a line where they did the studies and other bacteria and other probiotics that had a positive impact on decreasing symptoms. There have been some studies with other probiotics and inflammatory bowel disease that contain different bacteria.

[00:12:01] They've looked at a few other probiotics in different conditions. It would be ideal if we knew the right probiotic for the right person and the right microbiome that decreased inflammation, decreased our risk for cardiovascular disease, decreased our risk for diabetes.

[00:12:23] All of those things are really impacted by our gut microbiome. I remember when my kids were on antibiotics, the pediatrician suggested a probiotic just to reestablish the flora. Is that something that you also prescribe?

[00:12:41] So I'm not sure how you're not going to totally reestablish your flora because you don't know what the flora is and the probiotics only have a few bacteria. There are other things you want to do like prevent clostridia difficile, which is a bacteria

[00:12:59] that can then cause colitis and diarrhea and all sorts of problems. From the antibiotics. So often people use that. They also use culturel. There are studies with that when you travel abroad to try to prevent traveler's diarrhea. Let's switch over.

[00:13:23] You talked about the gut brain access, if you will, specifically as it pertains to irritable bowel syndrome. But let's take a step back and just talk about the relationship between the gut and the brain. So there are... I'll even go back further.

[00:13:46] When women had complained of belly pain or belly pain related to their periods, they were not always believed by their physician. And I have to unfortunately admit that... That's an understatement. That there's still not always. I've told them it's all in their head. Yeah.

[00:14:07] Or suck it up, right? Or suck it up. You're a woman after all. Exactly. Exactly. So I have... Nothing but it's sad. I have to say when the men come into my office and have had a kidney stone, they say now I know what labor is like. So...

[00:14:25] But seriously, going back, it is a problem. And so there are a lot of immune cells that secrete compounds that go right up the nerves into your brain and come back. With irritable bowel syndrome, it is twice as common in women than men.

[00:14:49] So there are nerves that we have in our gut that also go up towards the spinal column and go up to the brain and then the brain secrete something and they come back down. These can be little compounds. They can be other...

[00:15:10] 95% of serotonin, which makes you think well and is in your brain. If you're depressed, they try to activate it. That's in your gut. So why is 95% in your gut and only 5% in your brain? So the gut has a major impact on the brain. Interesting.

[00:15:33] With the sake of our listeners, talk a little bit about what irritable bowel syndrome is. What are some of the symptoms? So with irritable bowel syndrome, it's an abdominal pain. It's a change in stools multiple days during the month with just bloating or pain and

[00:15:59] it's defined by the pain. You can have either a diarrhea or constipation and the pain is often better after you have a bowel movement. At the moment, it's more of a clinical diagnosis. So we've ruled out if you have diarrhea, celiac disease, infection, inflammatory bowel disease.

[00:16:18] If you have constipation, we've ruled out any inflammation, blockage or anything. So when you have these symptoms a number of days throughout the month, then irritable bowel syndrome or gut brain disorders and some people have the pain and we can't find anything. Some people it's just constipation.

[00:16:43] You can't go. So these things are very common. Some people get bloating anyway and they don't get the change in stools or quite meet the diagnosis but there are various things you can try such as diet, what we call a low FODMAP diet.

[00:17:05] It's fructose, oligosaccharides, disaccharides, monosaccharides and polyols. That's what it stands for. But at any rate, it's eliminating a lot of complex carbohydrates. In English. I have to always remember what it is and eliminating things that cause bloating and gas like lactose, fructose, sucrose, things like that.

[00:17:30] And there are a lot of good things online for looking at it and a lot of foods that are less likely to cause a problem. So it depends what the problem is. So let's just talk about gas.

[00:17:43] First thing I try, I tell people we'll try a lactose free diet. A lot of people develop a lack, inability to break down the sugar in milk products called the enzyme is lactase. It's breaking down lactose.

[00:18:03] So you see a lot of products out there that are lactose free, lactase milk. They put it in. Yogurt has only a little bit of lactose in it. Some of the cheeses are better than other cheeses.

[00:18:17] So with that, if that's the problem, you can try using lactase like dairy ease or some other compound. If you're going to drink your milk or have your ice cream, you can try the lactate free milk or the lactate milk or whatever.

[00:18:37] Other things, if you have, you can also try other diets and eliminate the cruciferous vegetables. That does it. The fruits do it, like apples which are my favorite this time of year can cause gas imploding. So then you may need to avoid them.

[00:18:57] Beans, beans cause gas in almost everybody but there is an alpha galactosidase. It's an enzyme in bino where it can break down some of these sugars so you don't get as much gas. And a lot of people will take that during the time they're eating beans.

[00:19:16] The other thing is that I find is what if you have a lot of gas bloating, what else might help? Symethicone which is in gas X breaks down little bubbles to big bubbles to let you help get rid of it.

[00:19:31] On the other hand getting rid of gas at the inappropriate times is not the best thing. If it smells bad, it makes a lot of noise or you can't hold it. Another thing I often use is entericotapepermin capsules, things like IbGuard that release

[00:19:51] in your small bowel and that helps improve movement through the gut. But one warning is that it can cause acid reflux because it relaxes the high pressure zone between the esophagus and the stomach.

[00:20:10] So I will tell people not to take that if they have a lot of reflux. But you know they used to hand out mints after dinner and I think it was to allow people to burp so that you can feel better. That's been my feeling about it.

[00:20:31] Other things, probiotics, there has been a study as I mentioned earlier with a line which they advertise saying gastroenterologists approve if you see all the advertisements. That was a study maybe 60% versus 40% of controls got better but it's not in everyone.

[00:20:56] If you have the constipation part, there are medications if increased senior fiber, adding fiber, metamucil or psyllium, citricil, bennie fiber, flax seed doesn't work. I'm making sure you drink a lot of water. Flax seed does not work? No, if it doesn't work then you go to the subpoena.

[00:21:19] I like flax seed. Tablespoon of flax seed, ground or whole or meal in the morning. I think it's good. C-fiber which is a dextrose, whatever works to bulk up your stool. Any of those things you can try.

[00:21:38] You need a lot of fiber, up to 30 grams of fiber if you can do it with fluid water. Now do you count coffee and tea? I don't think so because coffee and tea make you pee and if you pee you're not containing it in your gut.

[00:21:58] Coffee also helps about 85% of people about movement. It affects the colon and it stimulates the colon. So that's another thing. That's interesting. And if you have diarrhea, you can do a little amodium. You can sometimes I find fibercon helps and there are other prescribed medications that

[00:22:22] can help all these things. I don't think I will say with constipation though there are two things. One is you don't get it down and bulk up the other is you can't get it out. And not getting it out is pretty common in women.

[00:22:38] Men can have it too or you can leak out and it's not appreciated by most doctors. Twenty years ago we didn't really appreciate it at all I would say. Probably because most people weren't talking about it I would assume.

[00:22:55] But I think also rectal exams in your doctor's office was just done to look for blood and not done to look for your function. And we weren't sending a lot of people for testing.

[00:23:07] But I will say we have pelvic floor therapists they're fantastic and they can often help a lot as well as online breathing exercises. And what are they helping? How do you know if you need that kind of help?

[00:23:24] So a lot of people will know they feel the stool comes down but they can't get it out. They struggle, they strain and nothing happens. So when you think of function what has to happen the stool has to come down and when

[00:23:41] you're having a bowel movement your anus, that muscle at the very end has to relax. Your pelvic floor has to straighten and it straightens out in the rectum and you get and

[00:23:56] it needs to drop a little bit so you get pressure in the rectum and then you get relaxation so it comes out. If that anus, that muscle stays really tight nothing's going to get through it right?

[00:24:09] You may leak and so if you have a lot of stool left over a little bit may leak out and one that's terribly embarrassing. Two you feel uncomfortable. So if you can't get it out it's a good thing to be checked out.

[00:24:27] A good rectal exam can often tell if they're looking for function we have an erectomotility test where they put in a balloon and see if you can get rid of it and how long it

[00:24:40] takes and at what how big or small and they measure the movement through there and what's happening. They're very good tests and the final test they can put barium up or a contrast and either

[00:24:54] do like you try to then get rid of it and they can look and see what's happening or they can do it with an MRI scan where they also look at your uterus and your bladder and see what's happening with that.

[00:25:08] What we're talking about for right now is constipation and potentially as it relates to irritable bowel syndrome. I have a couple of questions. One very quickly how often should you be pooping? So they tell you what's the normal range and some people have never had that their whole

[00:25:27] life so they claim the normal range is two per day to three per week. Two per day till three per week. In other words, 14 per week or three per week. It varies. Yes. I have to do that math.

[00:25:48] I have some people where it's only two per week and it's been that way since they were a kid and they feel fine so why do anything about it? I have other people who have always their whole life had three per day.

[00:26:03] Yes, but now the issue is solid, liquid. You know. Probably need to put a disclaimer on this part in case people are queasy, but please go on. Right in the middle is pretty much where you want. Okay.

[00:26:21] And I guess any change is obviously something that you want to be aware of as well and which relates to my other question. What would you counsel people in terms of when to seek a physician and when to just say this is probably normal?

[00:26:42] So one thing if you bleed, if you have bleeding that's a warning sign. And if you're just bleeding a lot from your vagina, that's also a warning sign if there's something there. If you lose weight, you often want to get further help and see what's going on.

[00:27:02] If you have a lot of pain, you know, belly pain and it's not just bloating. That's another thing. If you have bloating that never goes down and it's new then it never hurts to see your

[00:27:20] physician so severe weight gain if you have a huge amount of weight gain. If your belly never goes down and it's hard, if you're having a huge amount of diarrhea like if you were having six or eight a day, I mean that needs to be worked up.

[00:27:37] If you can't get it out and you get these bad hemorrhoids and you're bleeding or pain down there, you might think, oh, there's something wrong down there. Maybe I can get physical therapy to get it better. And that's another reason to go.

[00:27:54] Moving on, interestingly, colon cancer is the third most common cancer in both men and women. I don't know anyone who looks forward to a colonoscopy but it seems like we either the incidence is increasing but certainly the age at which it's occurring seems younger

[00:28:19] and in fact the guidelines were just recently changed from starting to screen at 50 to 45. So take us through what's going on and what your recommendations are. I would say so screening decreases cancer risk obviously because you're picking up low things.

[00:28:42] Let's talk about an average risk person that doesn't have a family history of colon cancer. In the past, women's colon cancer lagged behind men by eight years. In other words, if we were screening men at 50, shouldn't we screen women at 58 because their hormones protected them?

[00:29:03] So that's not really known. I do think you needed a 45 if it is no family history so your low risk or family history may be really remote, number one. And not a lot of other cancers that are associated with colon cancer. Yes? Such as?

[00:29:26] Such as breast the brach gene and there's some others where there's a pancreas, a melanoma gene. If you have pancreas cancer melanoma and maybe breast cancer or some of those or ovarian cancer. The family histories where you see a lot of cancer may be also connected to colon

[00:29:49] cancer. And then the question is well if you have a lot of cancer in your family do you want to get genetic testing? That's always a very tricky question. It's important for what kind of screening an individual get but also what your family members might get.

[00:30:10] Should they start screening earlier? So we do recommend if there's colon cancer in the family or polyps screen 10 years earlier to start. So if you have colon cancer in a first degree relative at 50 you want to screen at 40, not 45.

[00:30:31] And when you say screening are you talking about the colonoscopy or are you talking about that cute little blue box? So if you have a risk I would say a colonoscopy. The little blue box which I assume you mean the DNA and everything testing which has

[00:30:50] been improving is about 93 percent accurate and about 43, 45 percent accurate for big polyps but you may miss the little polyps. In people who are predisposed or in young people those may grow faster so that the

[00:31:11] next time you do that you may have missed something that went in got more aggressive and went into a cancer from it. So if you have a family history, colonoscopy, if you don't have a family history, now I again looked at recommendations and one group said oh you

[00:31:33] have to have a colonoscopy. My feeling is screening is the best. Whatever tests you do it's better than nothing. The question becomes about your insurance coverage and it's a really big issue. How much is it going to cost you? Can you afford it?

[00:31:56] Are you going to get the screening because you say I can't afford it? Are you going to get screening because you needed to go to your doctor? You can't afford to go to your doctor. You don't have a primary care doctor. Now you can't get it.

[00:32:09] So all these things unfortunately just impede our screening just like you need to be screened for breast cancer. You need to get your pelvic exams done. You need to get your screening for colon cancer.

[00:32:28] A couple of other questions going back to some of the autoimmune issues and this whole idea about gluten sensitivity. You mentioned celiac if you can explain what that is, which is on one end of the spectrum if you will.

[00:32:43] And people that say they've taken gluten out of their diet, they feel great not necessarily having had any kind of testing in that kind of thing. So what are your thoughts on that? Celiac disease is a reaction you get to gluten, which is a protein in wheat and

[00:33:05] other grains. And it causes damage to the bowel, the small bowel. It is based pretty much most people have a specific genetic type. There are two types that most people, 95% of people with celiac disease have, which is HLA DQ2 or DQ8.

[00:33:36] Just you don't need to remember that and we almost never check for it. But it's also associated with diabetes and other things, other autoimmune diseases. So if we're going to check for celiac disease, the villi are usually very tall and you absorb things on them.

[00:33:57] But in celiac disease that damages them, they get shorter. They're really sort of stubby. And that's in the lining of the bowel. Of the bowel in the small intestines. And then you get under it a lot of inflammatory cells. So that is an autoimmune thing.

[00:34:17] It can cause low iron, low B12, low vitamin D, constipation, diarrhea. And a lot of symptoms. So we look at the blood to check for antibodies. Easy test as long as you aren't deficient in some of the antibodies.

[00:34:39] And then we'll do a biopsy of the small bowel with an endoscopy to see if you have celiac disease. Number one. So some people don't have that, but gluten bothers them. There is a wheat allergy, which I don't think is that common,

[00:34:59] but it's actually like an allergy to anything like the pollen that's coming down right now. And then you have people, they eat gluten, they bloat, they get maybe foggy brain. They get changes in their bowels.

[00:35:17] Well some of it may be irritable bowel syndrome because some people find gluten, yet they eliminate gluten that helps. And other people have this sensitivity and we don't really know what it is. I will put it that way.

[00:35:33] Some of those people may have the gene that I just mentioned. Some of those people may be a relative of the other people. Maybe they were sensitized when they were young and I don't totally know and people are still looking into sensitivity.

[00:35:55] I know that this is a one-off, but my daughter when she was young had a corn, a true corn allergy. She couldn't be gluten-free for the most part because a lot of the gluten-free products have corn in them.

[00:36:09] So which leads me to my other question, if you can just talk briefly about the idea of food allergies and sensitivities. And that is really challenging one. So meat, red meat and the fats in red meat, processed foods, where they have additives in foods,

[00:36:33] all of those things seem to be inflammatory. Regarding what is anti-inflammatory? Well, fish, the Mediterranean diet, there's a Nordic diet. When I reviewed this, I said the ketogenic diet, but I really don't understand in comparison to the others.

[00:36:55] But it's a lot of fruit vegetables because they stimulate the bacteria that secrete these anti-inflammatory compounds. And they release more, so it's more anti-inflammatory, which may be why the Mediterranean diet has less cardiovascular disease and that.

[00:37:16] One thing, obesity has increased and severe obesity is greater in women than in men. And with obesity you get more fat in your liver. You get obviously more heart disease and other things.

[00:37:36] And so do you want to just say just a couple of words about that connection with respect? Because you alluded to it in terms of probiotics or the gut microbiome increasing serotonin, which is what a lot of antidepressants do.

[00:37:54] And so just the effect of food on the gut and the brain. So again, an anti-inflammatory diet causes you to get these bacteria that grow. And they release these fatty acids that can go up to the brain and get up there and cause release of other compounds.

[00:38:19] Or they release these small compounds that affect the brain and just go up to the brain via the nerves, via the vasculature, etc. And if you look at people complaining of, what do I want to call it? Confusion. Like brain fog? Brain fog.

[00:38:49] A lot of people say, well that's wheat. It's something I ate. I get it with that. And that has to be a specific release of compounds from your bacteria. I think that either they are doing a lot of research with this in the air here in Boston

[00:39:10] where I am looking at those compounds being released and what can we do to get the right bacteria into the gut. I'm not sure that we have that. I will say one thing I never mentioned, but there's this inflammatory cell called the mass cell.

[00:39:30] Everyone talks about it now, right? Mass cell activation, mass cell disease. It's involved in endometriosis. It's involved in irritable bowel. It's involved in the Ehlers-Danlos syndrome. Which is that hyper flexibility that you were talking about. The joint hyper mobility.

[00:39:47] So this cell causes a lot of issues and inflammation and may be very responsible for which way our body goes on getting inflammatory response. And we don't really know the full connection between this at all, but if you look at it,

[00:40:05] it's in all of those things and people are trying to evaluate that. And to that point, you mentioned the connection with endometriosis and irritable bowel and now you said that there may be a link with respect or at least commonality in terms of this mass cell.

[00:40:22] If someone comes to you that has both of those and obviously they've probably been to their primary care doctor or their OBGYN to talk about the endometriosis. How do you approach that? What suggestions do you make from a GI standpoint?

[00:40:38] Well, let me say that it's often four to six years for diagnosis for endometriosis. And if you look at the British study was six years. So if they go, people go to their primary care doctor, it may be totally missed. Number one.

[00:40:57] Number two, regarding endometriosis, often if you get that under control, the IBS gets better. But not everybody specifically treats that. I think even in OBGYN. Most people who get it and I have had people where I've been shockingly surprised they've had endometriosis.

[00:41:27] But if you treat that it often helps the IBS. If you treat the IBS what you need to do, it doesn't really help the endometriosis. So the I send people or discuss with their GYN people,

[00:41:43] often if I think they have IBS in pain in one area or bleeding, I might get most places will do an intravaginal ultrasound or an abdominal ultrasound looking for endometriosis and where it is. Here, I think our MRI is a little more sensitive.

[00:42:07] So I might get an MRI of the pelvis looking for implants on the bowel. And I have seen that. I've actually seen them in the bowel, which is rare. Lately we saw them in the stomach and it's reported elsewhere.

[00:42:25] So endometriosis can be anywhere but you need to treat both. And I would go to OBGYN to discuss whether you start with medicine, whether they feel you need a laparoscopy to make a diagnosis or to get rid of the endometriosis or whatever.

[00:42:41] And then a young person, if they're thinking of pregnancy, they really need to go discuss it with OBGYN because there's a high rate of infertility and endometriosis. What did I not ask you that you wanted to make sure that we covered?

[00:42:57] So one thing I want to be sure is pregnancy and pregnancy, you know, even if you're older now, you may have a daughter or even a daughter-in-law who's going to get pregnant. And there are a lot of conditions in pregnancy that affect women, the GI condition.

[00:43:19] nausea and vomiting. You would bet you most people, maybe you, 85% of people have it. And they're different foods, different people can eat. That is better for them. Heartburn. That's what I had. Heartburn in about 85% of people. And it's evenly divided between the three trimesters.

[00:43:46] But what's remarkable is, and I think this is what we need to then get an idea for everyone else. When a woman delivers, I have found that if when the placenta is delivered, the heartburn goes away. It's remarkable, okay?

[00:44:08] That's in people who have had it only related to pregnancy, but almost everyone is related to the placenta. So some people are looking at what's in the placenta that's affecting the heartburn and what impact will that have for the rest of us, right?

[00:44:26] I think we can learn a tremendous amount by why do men not get this? What's the difference? What's the estrogen doing? If you get it and it goes away, oh, that's fantastic. So I think that is really key to what's going on. And in pregnancy is important.

[00:44:50] What's the safety of drugs? What's the level of drugs in pregnancy? They change. Can we lower them? Do we need to raise them? So did you look at both sexes? Did you just do one sex? I think we have so much to learn in this area.

[00:45:08] So much to learn from the man related to the women and the women related to the men in hormones. I think that's a key point on what we need to do and what we need to learn. I couldn't agree more.

[00:45:23] And as my last question to you would be, if you could suggest maybe one or even two action items that our listeners can take right now to help themselves be healthier, what would those be? One, increase your fiber and fluid in your diet, which will help your bowels.

[00:45:44] Two, get your cancer screening and make sure you're up to date. Three, if you have GI symptoms like bloating or whatever, then look at your food. And if you get a specific symptom one night after you go out to eat,

[00:46:03] then it happens another night when you go out to eat. Write down everything you ate and then try to figure out a specific thing. And I think getting exercise, we didn't mention it, exercise is key. And I was going to ask that. It's key.

[00:46:22] It helps stimulate the metabolism. If you go out and do a lot of exercise and never didn't realize you're going to gain weight, muscle weighs more than adipose fat, a tissue or fat. And you want to be healthier in that. That is much healthier.

[00:46:41] Those are the things that, and eat a healthy diet is what I would say. Dr. Jacqueline Wolfe, thank you so much for these great insights. I know I learned a lot and I really appreciate the time you've taken to be with us. You're welcome. Thank you.

[00:46:56] It's a pleasure. Well, it's been an enlightening session discussing the complex world of women's GI health with Dr. Jacqueline Wolfe. So let's summarize the key points, including some solutions and touch on specific issues like endometriosis and colon cancer. We learned that women disproportionately suffer from conditions

[00:47:22] like irritable bowel syndrome, inflammatory bowel disease and celiac disease and how these can significantly affect our lives. Hormonal changes such as those during menstrual cycles, pregnancy and menopause impact on GI symptoms. So understanding this connection is vital for proper treatment and management.

[00:47:41] We also talked about the tendency to overlook or misdiagnose women's GI symptoms. If someone says it's all in your head, now you can tell them it could be connected to my gut. If you're having symptoms of bleeding, bloating, constipation or diarrhea, those should be addressed.

[00:47:58] Dr. Wolfe emphasized the importance of a balanced anti-inflammatory diet, rich in fiber, the potential benefits of probiotics and the positive impact of regular exercise on GI health. And as I mentioned, there is a direct link to the nervous system and the gut

[00:48:15] so we do need to take that into consideration for effective treatment. Indometriosis, often misdiagnosed or overlooked, can significantly impact GI health and many times the two overlap. It's important to recognize those symptoms and seek specialized care. And finally, colon cancer is the third most common cancer in women

[00:48:38] and we discussed the importance of screening. Regular screenings based on age, medical history and family history are key preventive measures. So in wrapping up, remember that understanding your body and being proactive in seeking health care is crucial. It's essential to consult with health care providers for personalized advice,

[00:48:57] especially for conditions like Indometriosis and colon cancer where early detection and treatment can make a significant difference. And if you aren't getting the response you need, be persistent. I thank you for joining us and I hope you're leaving today's episode feeling more informed and empowered about your health.

[00:49:16] I invite you to take a look at our website at BeyondThePaperGown.com where we also have articles, information on events and how you can take action to make a difference in women's health, whether through political advocacy or supporting nonprofit service organizations.

[00:49:31] We even have a marketplace with special discounts for BTPG listeners. And while you're there, subscribe to our newsletter so you're up to date on our podcast and other offerings as well as women's health news. You can follow us on Facebook, Instagram, LinkedIn and YouTube.

[00:49:47] Please leave us a comment when you drop by and if you would before you go, please rate us on your podcast platform. It helps us get noticed. Until next time, take good care. This podcast was produced by Patrick Shambayati and me and Kyla McMillian is our associate producer.