Many of the health issues that can become more prevalent as we age — from an impaired immune system to nutritional deficiencies — can be attributed to a key underlying factor: poor digestive health.
As we age, so does our digestive system, and symptoms such as indigestion, GERD (gastroesophageal reflux disease), diarrhoea, constipation, bloating and flatulence are all known to become more common in older adults.
Here's how to keep yourself in tip-top shape, whatever your age...
1. Chew your food properly
Digestion begins in the mouth, with an enzyme in the saliva called amylase. Adequate chewing increases the surface area of food in the mouth, and allows this amylase to efficiently break it down. As we age, we can start to produce less saliva, and subsequently chewing our food properly becomes even more important. Swallowing unchewed food can put an increased pressure on the rest of our digestive system, resulting in problems such as gas and bloating. It can also negatively impact on the amount of nutrients you absorb from your food.
2. Maintain your smile
Because of the importance of chewing, looking after your teeth and gums is vital with age. Brushing and flossing daily, and getting regular dental check-ups can help promote both a healthy mouth and a healthy digestion. If chewing becomes an issue for dental reasons, choosing softer foods and adding to the diet vegetable-rich soups, stewed fruit and smoothies will help to support the digestion, whilst still providing a good amount of gut-healthy nutrients.
3. Eat smaller meals
As we get older, the stomach cannot accommodate as much food due to decreased elasticity of the stomach wall (it becomes less stretchy). Also, the rate at which the stomach empties food into the small intestine decreases. Eating little and often will ensure that the digestive system is not overloaded, and help avoid digestive discomfort caused by the stomach being too full. Slowing down the rate at which you eat will also allow the body to get better in synch with it's satiety signals, enabling the stomach to tell the brain when it's full up to prevent overeating.
4. Keep fluid intake up
Our digestive tract moves food through the body by a series of muscle contractions, known as peristalsis. A bit like squeezing a tube of toothpaste, these contractions push food along the digestive tract. In older adults, peristalsis can slow down, and this can cause food to move more slowly through the colon. With food sitting for longer in the colon, more water gets absorbed from food waste, and this can result in constipation.Staying well hydrated can help to soften the stools, so they pass more easily through the digestive tract. A good fluid intake can be maintained by drinking plenty of water, herbal teas and broths, and eating "juicy" foods such as tomato, cucumber, watermelon and lettuce. It's also important to be aware that the thirst sensation decreases with age, so waiting until you feel thirsty is not always the best indication of hydration. A better gauge is to pay attention to the colour of the urine, which should be a pale straw colour (any darker and you need to up the fluids).
5. Keep moving
Regular exercise is necessary to promote normal contractions of the bowel, and leading a sedentary lifestyle is another factor that can underlie chronic constipation. This is particularly common in the elderly, when mobility can become restricted. Simply getting up and doing some light movement such as gentle walking can help to ease constipation, as too can stretching and certain yoga positions.
6. Be mindful of lactose
A decline in the production of lactase, an enzyme that digests the lactose in dairy products, can occur with age, leading to an intolerance in some older adults. If you suspect your digestive symptoms might be linked to lactose consumption, it is advised that you see your GP, who is likely to recommend either testing or an elimination diet. If lactose intolerance is diagnosed, milk and milk products should be avoided, but many individuals find they are still able to tolerate cheese and live yoghurt, which have much lower levels of lactose. If following a low dairy/ dairy free diet it is very important that adequate calcium is consumed from other dietary sources such as green leafy vegetables, tofu and sardines (with bones). A vitamin D supplement may also be recommended.
7. Speak to your doctor about medication
One of the major contributors to digestive distress in older adults is prescription medicine. Calcium channel blockers, often prescribed for heart conditions, and pain medication, particularly narcotic , can all cause constipation. Aspirin or other non-steroidal anti-inflammatory (NSAID) pain relievers, sold over-the-counter, can upset the stomach. Metformin, a commonly prescribed oral anti-diabetes drug, can cause nausea, vomiting, dyspepsia, and diarrhoea. If you are concerned, talk with your doctor to see if your medications could be underlying any digestive symptoms.
8. Support stomach acid
In older individuals, conditions that decrease stomach acid secretion, such as gastritis, become more common. Certain medications (such as PPIs) and chronic stress can also impact on this.'Decreased stomach acid output can have a number of negative consequences on the digestive system, because stomach acid assists the breakdown of proteins, stimulates the pancreas and small intestine to produce digestive enzymes, and also prevents pathogens and unhealthy bacteria from moving further down the digestive tract,' explains Dietician Michael Lawler. 'Symptoms are primarily heartburn, bloating, belching, poor digestion, diarrhoea or constipation.'Individuals can support stomach acid production through a number of dietary interventions, including relaxing and eating slowly at mealtimes, and drinking room temperature or warm water or tea with meals rather than chilled drinks.
9. Get your vitamin B12 levels tested
Vitamin B12 (found in animal foods) requires stomach acid to be released from food and absorbed, and if stomach acid output is compromised, it may be that you're not absorbing this vitamin at an optimal level. Pernicious anaemia – where the immune system attacks healthy cells in your stomach, is the most common cause of vitamin B12 deficiency in the UK, and is thought to affect around 1 in 10 people aged 75 or over. Symptoms of low B12 can include brain fog, memory problems, fatigue, depression, muscle fatigue and tingling in the extremities. If you're concerned about B12, it's advised you go to your GP to have your levels tested.
10. Consider a probiotic
The 'live' bacteria in our digestive tract is known to have a huge impact on digestive health, and research has shown us that the composition of this bacteria changes with age.'One of the most significant changes to occur in the digestive system as we age, is a change or depletion in our gut bacteria, which can have a number of direct and indirect effects,' explains Kerry Beeson, a Nutritional Therapist at Optibac probiotics. 'It's known that one of the most significant types of bacteria to decline as we age is the Bifidobacteria species, which has a profound impact on digestion and in particular bowel regularity, as these bacteria reside in the colon where stools are formed.'Low levels of this bacteria may manifest as symptoms such as constipation and bloating. A way to enhance the populations of these bacteria is to supplement with a good quality probiotic supplement.
11. Eat gut friendly foods
The levels of bacteria in your gut can be further boosted through diet. Increasing intake of dietary prebiotics (oats, bananas, leeks, onions, garlic), polyphenols (blueberries, cocoa, green tea) and fermented foods (kefir, kombucha, kimchi, sauerkraut, miso) will all support a healthy gut bacteria environment. By eating an array these foods (the more diverse the better), and keeping sugary foods to a minimum, you can help to encourage the growth of beneficial bacteria, providing a good environment for healthy digestion and absorption of nutrients.
12. Maintain a healthy weight
Gastroesophageal reflux disease (GERD) is the most common upper digestive tract disorder in older adults, and occurs when stomach acid backs up into the oesophagus, causing heartburn and other symptoms. Being overweight has been identified as one of the leading causes of GERD, as excess weight increases abdominal pressure, making stomach acid leakage or back-flow more likely. Maintaining a healthy weight not only decreases the risk of GERD, but facilitates better mobility and physical activity which is essential for good digestive health.