Medicine is Male – Why We Finally Need to Look at the Female Intestine Differently

Daylista: Before we go deeper: What personally led you to gut health and a holistic approach – was there a key experience?

Dr. Seiderer-Nack: Even during my studies, I was interested in immunology and the gut, and during my specialist training, I intensively researched questions related to the gut. At the same time, I also found complementary medicine fascinating – and now I'm lucky enough to combine both, as in my practice I can bring together scientific insights, conventional medicine, holistic therapy approaches, and microbiome medicine.

Daylista: When we talk about women's health, one question is central: Why has medicine so long made no distinction between women and men in its approach?

Dr. Seiderer-Nack: Generally, the idea of gender-specific medicine (also called gender medicine) is still relatively new in medicine. Only in recent years have research data provided more information that women and men show significant differences in genetics, immune regulation, microbiome, pain regulation, or metabolism, or that diseases can show very different symptoms.

Daylista: So that affects many specialist areas?

This is evident not only in infectious diseases or cardiovascular diseases, but also in autoimmune diseases or mental illnesses. And even if we are making such great progress in research, there is still a long way to go before this knowledge changes our thinking and actions in clinical and everyday practice.

Daylista: This touches on a point that many women experience in their daily lives: dealing with pain. What is the "Gender Pain Gap" all about?

Dr. Seiderer-Nack: We understand this to mean that pain in women is often not taken as seriously or treated as effectively as in men. There are good studies from the last three years that show that women, on average, have to wait longer for pain treatment in the emergency room than men. In addition, we still pay too little attention to how differently pain perception and processing can be gender-specific.

Daylista: Can you give us a concrete example?

Dr. Seiderer-Nack: Women often have visceral hypersensitivity, meaning they perceive pain from the abdominal area more intensely. This can sometimes be amplified cyclically by hormones such as estrogen or prostaglandins. This is well documented in science, but in clinical practice with patients suffering from endometriosis or irritable bowel syndrome, it is often ignored, and pain is solely attributed to psychological stress.

Daylista: You described the gut as a control center. What role do hormones play – throughout the cycle, perimenopause and menopause?

Dr. Seiderer-Nack: Female sex hormones like estrogen or progesterone don't just act on the uterus; they also affect the gut and its nervous system – and can thus influence the gut's transit speed, as well as pain perception or histamine release. For example, the increase in progesterone during pregnancy causes the gut to slow down – and constipation is a common problem for expectant mothers. But hormonal changes can also manifest as gut discomfort over the course of the cycle – for instance, with bloating and gas in the second half of the cycle or PMS.

Daylista: And regarding the microbiome specifically: Is there such a thing as "female" patterns?

Dr. Seiderer-Nack: What many people don't know: the gut microbiome of sexually mature women actually has a different composition than in men and, through its enzyme activity, also influences a woman's estrogen levels. So there is a very complex interplay between hormone balance and the gut here.

Daylista: And what changes during menopause?

In menopause, for example, the gut microbiome changes again and becomes more "masculine." And that could also be a reason why many women report more gut problems during this phase.

Daylista: Between the microbiome and the mind lies a highway of nerves and neurotransmitters.
What exactly is meant by the gut-brain axis?

Dr. Seiderer-Nack: This refers to the complex reciprocal interaction between the central nervous system and the nervous system of the gut – both are in constant exchange via nerves, hormones, and neurotransmitters and are strongly influenced by the immune system and the microbiome. Incidentally, 90% of the information flows from the gut towards the brain.

Daylista: What happens if this axis is disturbed?

If there are disturbances in this complex interplay, conditions such as irritable bowel syndrome can occur. However, we now also know that processes in the gut can influence diseases in the brain – for example, in multiple sclerosis, Parkinson's disease, or dementia, but especially in mental illnesses.

Daylista: What are common gut diseases in women?

Dr. Seiderer-Nack: Worldwide, more than 70% of all patients diagnosed with irritable bowel syndrome are female – women are therefore a real risk group here among the groups mentioned above.

Daylista: What comorbidities are associated with these diseases?

Dr. Seiderer-Nack: Many patients with irritable bowel syndrome report fatigue, lack of energy, and sleep disturbances. In addition, as with many pain conditions, we also frequently find depressive moods and psychological stress.

Daylista: If the gut and brain communicate so closely, our inner compass also comes into focus. Can we trust our gut? How much truth is there to "gut feeling"?

Dr. Seiderer-Nack: Gut feeling is not imagination – after all, we have our own gut brain that constantly supplies our cerebrum with information, produces its own neurotransmitters, and is in close contact with the microbiome and immune system. Even if we are only at the beginning of understanding this complex structure: signals from the gut play a role not only in digestion, that much is already clear.

Daylista: "You are what you eat" – how much influence can we exert with a good diet?

Dr. Seiderer-Nack: A lot!
Generally, a plant-based diet with plenty of fresh vegetables and wholegrain products is a good basis, preferably in a Mediterranean form with high-quality fatty acids (omega-3 FAs in olive oil, linseed oil or fish) and without highly processed convenience foods.

Daylista: And what role do fiber play?

Fiber is the crucial factor for the nutrition of gut bacteria and thus for gut health. These can form valuable short-chain fatty acids such as butyrate (a salt of butyric acid) from these otherwise indigestible food components. These fatty acids are not only important for the supply of the intestinal mucosa, but also have a strong immune-regulating effect that they can exert throughout the body – and can, for example, protect us against inflammatory reactions. Without sufficient fiber, not only is digestion sluggish, but our metabolic and immune regulation is also out of balance. With about 30g of fiber per day in the form of whole grain products and vegetables, we are on the right track. At the same time, we also see how much damage highly industrially produced food can cause to the gut and the microbiome due to its high content of bad fats, sugar and additives.

Daylista: Is there "the" one good diet or is everything individual?

Dr. Seiderer-Nack: We need a good foundation, meaning a fiber-rich, wholesome, anti-inflammatory diet. The Mediterranean diet is a good basis here and clearly preferable to a diet with many convenience foods and additives. But there are also many individual factors that play a role and should be considered, such as pre-existing conditions and food intolerances.

Daylista: Heard a lot, little clearly defined – time for a classification. What is a "leaky gut" – and what is it not?

Dr. Seiderer-Nack: The term "leaky gut" is not a conventional medical diagnosis but rather a colloquial description for a "permeable gut". The term can cause confusion, as it doesn't mean that the gut has holes or that intestinal contents spill into our body. Scientifically, we see that the intestinal barrier, i.e., the boundary wall made of very tightly packed intestinal cells, is normally very impermeable, meaning only very specific substances from the gut are absorbed into the body. However, if this intestinal barrier is damaged (e.g., by inflammation), this barrier can become more permeable, and as a result, the immune and nervous systems come into contact with more foreign substances. This can (but doesn't have to) be the starting point for increased inflammatory processes in the body.

Daylista: How can I directly strengthen my gut? Are there superfoods?

Dr. Seiderer-Nack: Trace elements, vitamins, and polyphenols play an important and versatile role – for example, through their effect on intestinal muscles, the microbiome, or even the gut-brain axis. Especially during hormonal transition phases, women often have a higher demand here.

Daylista: For doctors to help effectively, precise information is needed. How can I best monitor my symptoms and describe and localize abdominal pain as accurately as possible?

Dr. Seiderer-Nack: We recommend that our patients keep a diary in which they note their symptoms (abdominal pain, diarrhea, constipation, bloating, or fatigue) and document them with their cycle and diet. This helps to better identify possible connections. Precise descriptions are naturally helpful: how long after eating do the symptoms occur, are they more cramp-like or constant, is there a connection with bowel movements or the simultaneous occurrence of bloating?

Daylista: Finally: your most important advice – short and clear?

Dr. Seiderer-Nack: Try to trust your gut feeling more again - Don't let yourself be driven crazy by the thousand different dietary tips on social media and seek out reliable sources of information.