Supporting Our Gut after childbirth, Lifting Our Mood



Anna Field RN-BC, BSN, RD


Did you know that our bodies have between 25-500 million individual bacteria cells per inch of skin? One study found 1,000 species of bacteria on the skin of healthy humans. (1) We are covered in bacteria inside and out. We couldn’t survive without bacteria! 


The total sum of all the microorganisms in our bodies is called our microbiome. These microorganisms include bacteria, fungi, parasites, and viruses. They all peacefully coexist and work together in synergy to promote normal bodily processes, support the total health of the body, and protect us from pathogens. A woman’s microbiome is affected during pregnancy, delivery and the postpartum period.

Normal healthy skin hosts staphylococcus epidermidis, staphylococcus aureus, and micrococcus luteus, to name a few.


The human gastrointestinal tract hosts more than 400 species of bacteria. (2) The microorganisms that make up the microbiome activate the immune system, break down food, aid in extracting and utilizing nutrients, assist in making vitamins and amino acids that our bodies need but do not make, and even affect cognitive function. (3) Normal flora composition is determined by the overall health of the body, the pH of the environment, temperature, oxygen, water and nutrient levels. A baby gets their first collection of microbial flora from the mother - first through the birth canal, and then from her skin and through her breast milk. After birth, the “normal flora in humans usually develops in an orderly sequence, or succession, leading to the stable populations of bacteria that make up the normal adult flora,” writes Charles Davis in his book Medical Microbiology. (1)


PREGNANCY, POSTPARTUM STRESS AND ALTERED GUT MICROBIOME


Pregnancy causes fluctuating hormones, changes in weight, and alterations in diet, altering the microbiome. (4) Additionally, stress, lack of sleep, and antibiotics sometimes administered during delivery or a case of mastitis can change flora composition. 


Antibiotics, used to kill invading pathogens that have made us sick, can also kill the good bacteria of our microbial flora. Antibiotics are not inherently evil; infections that would have killed us one century ago, we now can survive as a result of the advent of pharmaceutical antibiotics. The balance of bacteria can be disrupted, though, leading to health complications. Researchers at the University of Copenhagen and Steno Diabetes Center Copenhagen studied the effects of four days of broad spectrum antibiotics on the gut microbiota of healthy young men. The study reports that the gut microbiota of the subjects took 45 days, on average, to return to baseline. (5) New mothers who received antibiotics during or after delivery will benefit from giving some extra support to their gut microbiota.


How does stress actually harm the gut microbiome?


Cortisol and adrenaline are hormones released by the adrenal glands when you are anxious, nervous, or upset in response to an actual or perceived threat. These hormones can then enter and disrupt the GI tract, having a negative effect on the microbiome of the gut. (6) Have you ever had “butterflies in your stomach” or had to make a trip to the bathroom in response to a stressful event or situation? This is one example of how the brain and the gut are interrelated. 


The brain affects the gut and the gut affects the brain. This relationship has been termed the “brain-gut-microbiome axis” by researchers at the Oppenheimer Center for Neurobiology of Stress and Resilience at the University of California Los Angeles. (7) The gut microbiota control the metabolism of the amino acid tryptophan, which is a precursor to serotonin. (7) A healthy, varied gut microbiota are necessary to produce this so-called feel-good chemical. You may have heard that serotonin is a neurotransmitter in the brain responsible for feelings of well-being and happiness. It regulates processes that affect mood, perception, reward, anger, aggression, appetite, memory, sexuality, and attention, among others. (8,9) The majority of serotonin in the body is synthesized, stored, and released in the gut from a special group of cells called enterochromaffin cells in the intestinal mucosa. (10)




BOOSTING THE GUT MICROBIOME AFTER PREGNANCY


Prebiotics:

Prebiotics are mostly oligosaccharides, a kind of carbohydrate compound, known to resist digestion in the small intestine and reach the colon where they are fermented by the gut microflora. (11)  Prebiotics feed and stimulate the growth of healthy bacteria in the gut microbiome. 

Food with Prebiotics: Artichokes, Garlic Onions, leeks, Bananas, Asparagus, Apple cider vinegar


Probiotics:

Probiotics are the health-promoting bacteria in the gut microbiome. The most widely studied for their health benefits are bifidobacteria, streptococcus and lactobacilli. They work by adhering to the lining of the gut and maintaining the integrity of the epithelial barrier. When taking a probiotic after pregnancy, stay away from store brands and find a brand name product that has been studied and recommended by your doctor. The dosages are measured in colony-forming units. In general, babies and children should aim for 5 to 10 billion CFUs per day and adults should aim for 10-20 billion CFUs per day. (2) Fermented foods such as kimchi, sauerkraut, pickled vegetables and kefir are rich in probiotic good bacteria. 

Food with Probiotics: Kimchi, Sauerkraut, Pickled vegetables, Kefir, organic yogurt, Miso


Tryptophan The gut microbiota control the metabolism of the amino acid tryptophan, which is a precursor to serotonin. (7) To boost and serotonin production in the gut, consume adequate dietary tryptophan, an amino acid. Rich sources of tryptophan are salmon, eggs, spinach, poultry, and nuts. This amino acid is also available in supplement form at health food stores.

Food with Typtophan: Salmon, Eggs, Spinach, Poultry, Nuts


Fiber:

Postpartum constipation can be a real problem during pregnancy, but if you still struggle with this issue beyond delivery, try increasing soluble fiber. Psyllium is a soluble fiber that is sold as capsules or powder. A meta-analysis found that soluble fiber is associated with an improvement in irritable bowel syndrome symptoms. (12) Soluble fiber improves the stool consistency and increases transit time. Fiber should be started at a low dose and gradually increased over several weeks to as much as 20 to 30 g/day. 

Food wtih Fiber: Fruit, Vegetables, Legumes, Nuts, Seeds, Sprouted whole grains


FODMAPs

Feeling bloated? Researchers at Monash University in Australia developed the acronym FODMAPs to describe a group of poorly absorbed carbohydrates that are fermented by the bacteria of the gut. They occur in a wide variety of foods that cause bloating and gas. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. (13) Common FODMAPs are legumes, nuts, lactose in dairy products, fruit, high fructose sweetener, sorbitol and mannitol. Sorbitol and mannitol are particularly high in sorbitol. There are many online resources with complete lists of FODMAP foods. 

Food with FODMAPs: legumes, nuts, lactose in dairy products, fruit, high fructose sweetener, sorbitol and mannitol


Exercise:

Taking your baby for a walk or a stroll around the block actually helps the health of your gut! New research shows that exercise and endurance training increases microbiota derived short chain fatty acids. These fatty acids increase insulin sensitivity (lower blood sugar), reduce inflammation in the body and regulate our appetite and satiety. (14)


Rest:

Lastly, new moms need rest to restore gut health! Sleep provides a “reset” for the body and the gut. The gut is responsible for so much: digestion, neurotransmitter production, waste management, immunity, and more. It needs time to recalibrate as well. With a new baby, sleep can be elusive, but call on friends, family and neighbors when you can!




MAKING IT EASY


-Don’t forget prebiotics, indigestible fibers that feed the bacteria in the gut. Make a salad and toss in some chopped asparagus, artichokes, and onions. Use apple cider vinegar in place of balsamic vinegar for the dressing.


-Consume fermented foods such as kefir, kimchi, and sauerkraut for a dose of probiotics. When purchasing a probiotic supplement, opt for a brand name that has the clinical studies to back up its claims.


-Salmon and spinach for dinner is a great source of the amino acid tryptophan, the precursor to serotonin, the body’s feel-good chemical.


-Add psyllium fiber to a smoothie for increased fiber to support regularity and healthy stools.


-Watch out for FODMAPs like beans, fructose, lactose, and sorbitol, which can cause bloating and uncomfortable gas.


-Exercise (with your doctor’s approval) and rest as much as possible to refresh the gut and mood!



References


1. Davis, C.P. (1996) Medical Microbiology. Galveston, TX.  Univ of Texas Medical Branch.


2. Kligler, B. &  Cohrssen, A. (2008). Probiotics. American Family Physician. 78(9):1073-8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19007054


3. Sordillo, J.E., Korrick, S. & Laranjo, N. (2019) Association of the infant gut microbiome with early childhood neurodevelopmental outcomes. JAMA Netw Open. 2019: 2(3). Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2728623


4. Neuman, H. & Koren, O. (2017). The pregnancy microbiome. Nestle Nutrition Institute workshop series. 2017;88:1-9. doi: 10.1159/000455207. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28346919.


5. Pajella, A. et al. (2018) Recovery of gut microbiota of healthy adults following antibiotic exposure. Nature Microbiology, 2018; 3 (11): 1255 DOI: 10.1038/s41564-018-0257-9


6. Mayer, E.A. (2000) The neurobiology of stress and gastrointestinal disease Gut 2000;47:861-869. Retrieved from https://gut.bmj.com/content/47/6/861


7. Martin, C.R., Osadchiy, V., Kalani, A. & Mayer, E.A.  (2018) The brain-gut-microbiome axis. Cellular and Molecular Gastroenterology and Hepatology. The brain-gut-microbiome axis. 6(2): 133–148. doi: 10.1016/j.jcmgh.2018.04.003


8. Berger, M., Gray, J. & Roth, B. (2009). The expanded biology of serotonin. Annual Review of Medicine. Vol. 60:355-366 doi: 10.1146.60.042307.110802


9. Agus, A., Planchais J. & Sokol, H. (2018). Gut microbiota regulation of tryptophan metabolism in health and disease. Cell Host Microbe. Jun 13;23(6):716-724. doi: 10.1016/j.chom.2018.05.003.


10. Waclawikova, B. & El Aidy, S. (2018) Role of microbiota and tryptophan metabolites in the remote effect of intestinal inflammation on brain and depression. Pharmaceuticals. Jun 25;11(3). pii: E63. doi: 10.3390/ph11030063.


11. Slavin, J. (2013) Fiber and prebiotics: mechanisms and health benefits. Nutrients. Apr 22;5(4):1417-35. doi: 10.3390/nu5041417.


12. Moayyedi P, Quigley EM, Lacy BE, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109:1367–1374


13. Dugum, M., Barco, K, & Garg, S. (2016) Managing irritable bowel syndrome: the low-FODMAP diet. Cleveland Clinic Journal of Medicine. September;83(9):655-662


14. Allen, J.M., Mailing, L., Niemiro, G.M., Moore, R., Cook, M.D., White, B.A., Holscher, H.D., Woods, J.A. (2018). Exercise alters gut microbiota composition and function in lean and obese humans. Medicine and Science in Sports and Exercise. Apr;50(4):747-757. doi: 10.1249/MSS.0000000000001495.