Gut feeling: Why your digestive health matters in midlife

From bloating to brain fog, your gut plays a central role in women's health – influencing your immune system, nutrient levels, and even your clarity of thought. GP Dr Sonja Bobart of D4 Medical in Dublin explains why supporting your microbiome is one of the smartest things you can do for immunity, hormones, and mood.

When it comes to winter wellness, we often think about sleep or supplements, but it turns out, our gut might be doing more heavy lifting than we give it credit for. In fact, when IMAGE ran a nationwide survey for the IMAGE Women’s Health Clinic, digestive health emerged as the number one concern for Irish women.

So what’s really going on in our gut – and what can we do to support it? Dr Sonja Bobart discusses all things gut-health with Ellie Balfe on our IMAGE The Check-in podcast.

The gut: Your body’s second brain

“The gut is basically the gum to the bum,” says Dr Sonja Bobart. “And within that colon, there’s our microbiome. So the microbiome is our second brain, and the reason for that – it controls so much.”

It plays a role in immunity (“80% of our immune system is in our colon”), hormone regulation (“the largest endocrine organ is the gut”), digestion and nutrient absorption, and even mood. “The microbiome controls your nervous system… so if there’s dysbiosis, there’s no equilibrium between our brain and our gut,” she adds.

Dysbiosis – a microbial imbalance in the gut – can cause inflammation, reduce the absorption of key nutrients like B vitamins, and contribute to leaky gut.

Gut issues are more common in women

Irritable bowel syndrome (IBS) affects up to 15% of the population – and disproportionately affects women. “For some reason, it’s more likely in women than men. I don’t know whether it’s an oestrogen-related thing. Possibly,” says Dr Bobart. “Also, I think women are more in tune with their physical health… so it might be underdiagnosed in men.”

That includes more serious conditions like Crohn’s disease, which she says can present in several ways – and can have knock-on effects far beyond digestion.

“Crohn’s can present [with] bloody diarrhoea. It’s a malabsorption problem – several bowel motions throughout a day, potentially bloody. But Crohn’s affects [the body] from the gum to the bum. You get ulcerations all along the gastrointestinal tract, but also can present with something like a low B12, low folate or low serum iron because of that malabsorption as well.”

These nutrient deficiencies can impact energy, concentration and mood – symptoms often dismissed as hormonal or stress-related, but which could be rooted in gut dysfunction. For those with Crohn’s or ulcerative colitis, she advises against taking probiotics without guidance:

“In malabsorption diseases, it’s important not to just take any probiotic… potentially taking any probiotic can exacerbate the Crohn’s or ulcerative colitis.”

Symptoms like bloating, discomfort, and changes in bowel habits that come and go are common, but she warns: “Irritable bowel should always be diagnosed when everything else has been investigated. Make sure it’s nothing to do with the ovary. Make sure it’s not fibroids.”

Anyone over 35 with new bowel symptoms “has to be investigated,” she stresses. “Don’t assume it’s irritable bowel.”