Women are Different Than Men
Jeffrey Mogill, professor of pain studies at McGill University, said: ‘Research has demonstrated that men and women have different sensitivity to pain and that more women suffer from chronic pain than men. Additional research suggests that a woman’s sensitivity to pain changes throughout their menstrual cycle due to fluctuating levels of the hormones estrogen and progesterone. Add to this, the fact that, there are subtle but significant differences between the gastrointestinal tract of men and women. These differences as well as how a woman experiences pain compared to a man, need to be taken into account. This will enable practitioners to more successfully diagnose or treat a particular GI condition. This understanding will also assist the practitioner in identifying the reason a GI condition is not be responding to care or why it seems to be worsening.
- In Western societies, the rates of colon cancer in premenopausal women are often similar or exceed the male rates in all age groups.
- Irritable Bowel Syndrome (IBS) occurs 2 to 6 times more often in women than in men. The etiology is believed to be due to the way intestinal nerves send messages to the brain, the interpretation that the brain makes, and its response back to the gut. If a person has emotional stress, the IBS response appears to be worse. Symptoms often include diarrhea, constipation or combination of both. Bloating and abdominal pain is also part of the syndrome, and often improve after bowel movements. How Our Stress Level Affects Digestion And Assimilation
- Inflammatory bowel disease (IBD) includes both Crohn’s and Ulcerative Colitis. IBD is twice as frequent in women than men. Symptoms may include diarrhea, blood in the stool, weight loss, and anemia.
Mouth and Tongue
According to Linda Bartoshuk, renowned taste researcher, at the University of Florida, more women are classified as supertasters compared to men, being able to taste sweet and bitter foods more intensely. Supertasters are able to experience an exaggerated sense of taste compared to their non-super counterparts – us normal tasters. These supertaster females can also do this feat with a lesser quantity of food, compared to men, who need a larger amount of food to determine the same, bitter or sweet taste. Additional testing has shown that the GI tube, extending down from the esophagus, through the small intestine, colon and into the rectum, is more sensitive to pressure, from an inflated balloon, then a man.
Esophagus and Stomach
- In women, the muscles of the gastrointestinal tract may operate differently than those of men. At the junction between the esophagus and stomach lies the lower esophageal sphincter (LES). This group of muscles, when activated, prevents acid and stomach contents from traveling backward from the stomach. A little further north lies the upper esophageal sphincter (UES). This group of muscles, when activated, blocks any back-flow of food or secretions from gowning into the wind-pipe. The LES in women, especially premenopausal women, squeezes shut with more force than that found in men, making certain that the food and stomach juices stay in the stomach. Studies have also shown that after drinking fluids, the UES In females tightens-up more aggressively than in men. Because of this phenomenon, women may have a greater tendency toward what is termed, globus sensation. Globus sensation is the term used when a person has the feeling of a lump in their throat even though there is no lump present when the throat is examined. Based on the above facts, it seems that women may possess a greater, innate, protective mechanism within the esophagus, compared to men.
- Men and women both experience heartburn, though each may experience it a little differently and for different reasons. Women secrete less stomach acid (HCl) than men and have stronger muscles at the junction of the esophagus into the stomach. These two facts make women less susceptible to ulcers caused by excess HCL as well as being less prone to HCl pushing up into the esophagus, causing damage.
- Since women, on average, produce less stomach acid than men, they also digest food more slowly. Because of this, medications that need an acidic environment to be absorbed, like the antifungals fluconazole and ketoconazole, for example, may not be as effective in women. Also, drugs that require an empty stomach for absorption, like the antibiotic tetracycline, may not work as well if women don’t wait long enough before taking it after a meal. This is an important fact, especially when SIBO, candida, and/or H. pylori is to be treated.
- Females are more sensitive to irritants and statistically more prone to H. pylori bacterial infection of the stomach, as well as ulcers caused by H. pylori. The increases sensitivities as well as having an increased rate of H. pylori infection, make women more prone to gastritis and abdominal pain (stomach) than men. Women may also experience an increased level of pain from both non-h. pylori gastritis or H. pylori-induced gastritis/ulcer.
- Women also seem to have slower emptying of food from the stomach than men. This may explain why females tend to experience nausea and bloating more frequently than men. Certain conditions including diabetes, prior stomach surgeries, infections, medications, and low thyroid levels can cause damage to nerves that are responsible for gastric emptying, leading to a condition called gastroparesis (delayed gastric emptying). Common symptoms include abdominal bloating, nausea, fullness and weight loss. The diagnosis requires specific testing. The treatment involves eating smaller, more frequent meals that are lower in fat. Bile reflux can cause symptoms identical to those listed above and should also be worked up, in order to receive a proper diagnosis.
- Another stomach problem that affects women more than men is inflammation of the stomach (gastritis). More females, use aspirin and aspirin-like compounds than do men. Ibuprofen and acetaminophen are the two most common non-steroidal anti-inflammatory drugs (NSAIDs) used. Women are using these over-the-counter (OTC) medications for a variety of reasons. These drugs, if used persistently, especially in women over the age of 65, are known to cause irritation to the stomach lining leading to ulcers, bleeding, and possibly perforation through the stomach wall.
Gallbladder and Liver
- Like the stomach, a woman’s gallbladder empties (secretes bile) more slowly than that of a man.
- Naturally producing more of the hormone estrogen, a woman is more exposed to estrogens negative effect on the liver. This increased exposure causes bile to become supersaturated with cholesterol, leading to gallstones. These are the two main factors behind why the rate of gallstones is two to three times higher in women than men. This phenomenon is primarily found in women of childbearing age with and even more so in women who are pregnant.
- Both of these facts should be taken into consideration when suspecting or treating SIBO. Stress and being in a sympathetic dominant state can cause a delay or reduction in all facets of digestion. Until the stress component is resolved or corrected, liver, gallbladder, stomach, pancreas, and small intestine support is indicated. Note: do not use HCl while actively treating H. pylori.
‘Leaky gut’ or increased intestinal permeability of the small intestine, can occur after prolonged exposure to emotional stress, alcohol, medications, caffeine and other substances. Leaky gut can also occur after exposure to bacterial, viral or parasite infection. Dr. Alessio Fasano, a pediatric gastroenterologist has extensively researched the link between leaky gut and autoimmune disease. Hashimoto’s thyroiditis is an autoimmune disease of the thyroid and the most common cause of hypo (low) thyroid in the United States. Women are 5-10x more likely to have Hashimoto’s than men. The connection between leaky gut and underactive thyroid should be worked up whenever an elevated TSH (above 3.5) or elevated TPO or antithyroglobulin antibodies found on routine labs. Testing for increased intestinal permeability, via a zonulin test (Cyrex Array 2), is one of the easiest indicators to rule in or rule out leaky gut, as a contributing factor to autoimmune disease.
Colon or Large Intestine
- Perimenopausal women, most likely due to fluctuating hormones, have problems with decreased movement (motility) of how fast food moves through the digestive tract. This can happen to men as well but usually doesn’t become a factor until their 70s or 80s.
- Then, there are significant anatomical differences between the female and male large intestine (colon). For example, the female large intestine is on average 10 cm longer. Due to the increased length and the fact that a woman’s pelvic floor is deeper and wider, there is more opportunity for malfunction. Combined, the hormonal and anatomical differences, will most commonly manifest as constipation and/or bloating.
- Studies have shown that women tend to have a weaker anal sphincter muscle, a shorter anal canal, and tolerate less volume/weight of feces the rectal area. The anal sphincter muscle allows us to have better control over our bowels. Basically, how well we hold or expel our feces (poop). Overall, women anatomically and physiologically, are less able to control their bowels, possibly leading to episode of bowel incontinence or a decreased amount of time from the first sensation until initiating a bowel movement.