Fantastic article from https://blog.cytoplan.co.uk
A recent German study identified that one in every two people over the age of 65 have below optimum levels of Vitamin D and one in four are low in vitamin B12(1). This concurs with the National Nutrition and Diet Survey results (2013/2014) which showed that levels of some nutrients including B12 and vitamin D are low in the UK over 65 population(2).
As we age we may encounter certain challenges which alter our nutritional requirements. Ensuring intake of optimum nutrition can help prevent frailty and maintain health into old age. In order to remain independent and active throughout life, it is useful to consider changes to nutritional needs from the age of 50, therefore, helping to prevent deficiency later on.
Bruce Ames, a Professor of biochemistry, states that if we are depleted in even one micronutrient, the body will respond with a “triage” process, where it will prioritise vital processes such as ATP (energy) production, i.e. short-term survival, over long-term health. Thus processes critical to survival are favoured over those involved in repair and maintenance. He, therefore, hypothesises that micronutrient deficiencies will accelerate chronic diseases as well as ageing. He states “a multivitamin and mineral is a low-cost way to ensure intake of the recommended daily allowance of nutrients throughout life”.
In this blog, we discuss factors which can contribute to increased nutrient requirements as we age and how to protect against sub-optimal levels.
Factors that may affect nutrient status, particularly as we age are:
Ageing is associated with reduced gastric acid output and production of the digestive enzyme pepsin (secreted in the stomach and responsible for the digestion of protein)(3). Exposure to factors such as Helicobacter pylori infections, smoking, other conditions and medications can all affect acid production by the stomach. Unfortunately, some conditions are treated with proton pump inhibitors which then further reduce gastric acid output.
The consequences of compromised gastric function may include:
- A reduced ability to absorb nutrients, particularly nutrients that require stomach acid in order for them to be cleaved from their carrier molecules. It has been established that B12, iron, magnesium, calcium and zinc absorption, in particular, are affected by low hydrochloric acid in the stomach(4).
- Reduced protein digestion (due to low hydrochloric acid and pepsin secretion) and therefore absorption. This may also mean that larger protein molecules are present in the small intestine, this can be a trigger for inflammation and leaky gut and is associated with food intolerances, atopic conditions and autoimmune diseases(5).
- An increased susceptibility to acute gastric infections or an imbalance in the microflora potentially leading to small intestinal bacterial overgrowth (SIBO), dysbiosis or Candida. Stomach acid is essential for destroying excess or unwanted microbes, if this does not happen effectively these microbes can colonise the small intestine which should be relatively sterile(6).
Over the age of 50, the composition of our microbiota is to a large extent determined by our health and lifestyle when we were younger. A healthy, balanced microbiota is essential for maintaining health as we age and can be significantly affected by many factors including living environment, inflammation, diet, stress, other conditions, infections and medications. Links exist between the microbiota and many diseases and conditions plaguing older adults, including Alzheimer’s, physical frailty, Clostridium difficilecolitis, vulvovaginal atrophy, colorectal carcinoma and atherosclerotic disease.
“Manipulation of the microbiota and microbiome of older adults holds promise as an innovative strategy to influence the development of comorbidities associated with ageing.”(5,6).
Strategies to support stomach function and microbiome balance include:
- Avoiding large amounts of water/fluids with a meal, as it can dilute gastric acid (avoid water 30 minutes before and after a meal)
- Lemon in hot water first thing in the morning can stimulate stomach acid production
- Chewing food thoroughly, which starts the process of digestion and tells the stomach that food is on the way
- A Betaine HCl and digestive enzyme supplement (containing full spectrum of digestive enzymes, particularly proteases) [not suitable for individuals with certain conditions such as gastritis etc]
- Consuming prebiotic and fermented foods to support the gut microbiome: e.g. olives, apple, chicory, onions, dark green leafy vegetables, miso, kefir, sauerkraut, kombucha
- Taking apple cider vinegar with meals. One teaspoon in a little water
- A multi-strain live bacteria supplement
Sarcopenia (muscle loss) is a common cause of frailty and a symptom of reduced nutrient availability. Muscle is considered by some to be the “Anti-Ageing God” because maintaining muscle mass as we age helps to prevent falls and therefore bone breakages, maintains activity and mobility and also helps to improve insulin sensitivity (therefore reducing the risk of diabetes, cardiovascular disease, dementia and cancer).
The pathogenesis of sarcopenia is multifaceted and contributory factors include diet and lifestyle habits that lead to chronic inflammation, hormonal alterations and vascular dysfunction(7). A significant association between muscle wasting and mitochondrial dysfunction has been identified. Mitochondria, the energy-producing powerhouses of cells, become dysfunctional when oxidative damage, which occurs throughout life, reduces their capacity to perform as effectively as they once did. This results in a reduction of ATP (i.e. energy) within the muscle, lowering activity and performance. It can then eventually result in a reduction of muscle fibres. Many factors contribute to oxidative stress and mitochondrial dysfunction including inflammation, nutrient deficiencies, medications, smoking and alcohol(7).
To support mitochondrial function and the maintenance of muscle mass:
- Eat an anti-inflammatory diet rich in antioxidants, reduce red meat and omega-6 fatty acids found in corn and vegetable oils, increase vegetables, especially dark leafy greens and sources of omega-3 fatty acids (oily fish, flax, chia and hemp seeds)
- Ensure an adequate intake of good quality protein e.g. lean meat, fish, eggs, nuts/seeds, beans/pulses
- Antioxidants – Including zinc and vitamin C
- Support mitochondrial function with nutrients such as B vitamins, alpha lipoic acid, L-carnitine and CoQ10
- Remain active, stick to at least the recommended 150 minutes per week. Weight-bearing exercise is important for maintaining muscle and bone strength
As women enter the menopause, production of oestrogen from the ovaries declines and during this time the adrenal glands will take over and produce small amounts of oestrogen which can help to alleviate some of the symptoms associated with menopause(9). Therefore, once menopause begins the adrenals need to work a bit harder.
The adrenal glands are also responsible for the production of stress hormones, cortisol and adrenaline – if stress is a significant factor then the adrenals will focus on producing stress hormones at the expense of oestrogen and progesterone. Stress management techniques are important as well as providing nutrients which support adrenal function.
Nutrients to support adrenal function include vitamin B5 (pantothenic acid), vitamin B6 (P5P), vitamin C, magnesium. Adaptogenic herbs are also used to support adrenal function, particularly during menopause, these include ashwagandha, ginseng, Bacopa monnieri, Rhodiola and liquorice.
As oestrogen is an important hormone for maintaining bone density, osteoporosis can be a concern post menopause. Therefore, nutrients which are important for bone density may be additionally required including vitamin D3, vitamin K2, magnesium and calcium.
The long-term effects of oxidative stress and inflammation can have a significant effect on health particularly the cardiovascular system and cognition(10,11.12). Many people over the age of 50 begin to experience cardiovascular signs and symptoms such as hypertension, dyslipidaemia, angina and atherosclerosis and cognitive problems including poor memory, concentration and brain fog. Again, there are many factors that can contribute to these, but the effects of the environment, diet and lifestyle of the previous 50 years can begin to manifest. We have some innate antioxidant systems and nutrients within our own bodies that help to counteract oxidative damage including glutathione, superoxide dismutase, alpha lipoic acid and CoQ10. As we age levels of these antioxidants decrease and the system can become overwhelmed leading to further damage, mitochondrial dysfunction and chronic disease. Maintaining adequate intake of antioxidants can be an effective way of helping the body to cope with the ageing process, therefore a daily intake of 6-8 portions of vegetables and 1-3 portions of fruit is important, including a large variety of colours and types.
A study published in September 2017 found that more than 49% of people 65 plus, were taking at least 5 medications a day, this has led to concerns over the safety of taking multiple medications long-term(16). Medications can have a significant effect on our nutrient status and increase nutrient requirements, for example by increasing excretion of certain nutrients or reducing the body’s own production.
Some common medications that have an effect are(13,14):
Statins – inhibit the enzyme which produces Coenzyme Q10 (CoQ10), an essential part of energy production as well as an important antioxidant, particularly for the cardiovascular system. It is advisable to supplement CoQ10 when taking statins.
Diuretics – as diuretics increase urination they also increase the excretion of minerals particularly electrolytes (potassium, sodium, magnesium and calcium). A study also identified that people who take diuretics long term have lower red blood cell folate levels and high homocysteine(15).
Proton Pump Inhibitors (antacids) – these inhibit the production of stomach acid and therefore can have an effect on overall nutrient digestion. However, they are most associated with a reduction of minerals, folate and B12 as well as beta-carotene absorption.
Non-Steroidal Anti-inflammatories (NSAIDs) – cause damage to the digestive lining which can in itself cause inflammation, contribute to reduced nutrient absorption and disrupt the balance of the microbiome.
According to US website www.mytavin.com, taking a combination of diclofenac (for pain, omeprazole (an antacid) and simvastatin (a statin) could lead to depletion of the following nutrients:
- Folic Acid
Although exact nutritional requirements will vary between individuals, it is clear that many factors can increase requirements as we age, in particular consideration should be given to the digestive function, supporting muscle mass and potential nutrient depletions from medications.
- Depletions in micronutrients can accelerate the ageing process and increase the risk of chronic diseases.
- Digestive function particularly stomach acid and digestive enzymes may reduce as we age, having a knock-on impact on nutrient absorption and disrupting gut health and the composition of the gut microbes. Friendly gut bugs support digestive function, maintain immune function and reduce the risk of many conditions.
- Maintaining muscle mass throughout life can help protect health as we age and reduce the risk of falls. Continuing to exercise and supporting the cell’s energy production can help to maintain muscle function.
- The adrenal glands produce a number of hormones and they are important for the production of oestrogen and progesterone post menopause. Therefore, menopause increases the need for adrenal support and stress can increase menopausal symptoms. Nutrients important for the adrenals include vitamins B5, B6 and C and magnesium.
- Oxidative stress accumulating throughout life plays a significant role in ageing and age-related diseases (such as cardiovascular disease, diabetes and dementia). Ensuring a daily intake of antioxidants can help to combat oxidative stress – eat your veg!
- Medications can reduce nutrient availability by increasing excretion, inhibit absorption or block production. Therefore, drug-nutrient interactions should always be considered. Useful websites are mytavin.com or drugs.com.
- National Nutrition and Diet Survey 2013/2014
- Feldman M, Cryer B, McArthur KE, Huet BA, Lee E. Effects of ageing and gastritis on gastric acid and pepsin secretion in humans: a prospective study. Gastroenterology. 1996 Apr;110(4):1043-52.
- Champagne ET. Low gastric hydrochloric acid secretion and mineral bioavailability. Adv Exp Med Biol. 1989;249:173-84.
- Textbook of functional medicine. 2008. Institute for Functional Medicine.
- Zapata HJ, Quagliarello VJ. The Microbiota and Microbiomein Aging: Potential Implications in Health and Age-related Diseases. Journal of the American Geriatrics Society. 2015;63(4):776-781.
- Marzetti E, Calvani R, Cesari M, et al. Mitochondrial dysfunction and sarcopenia of ageing: from signalling pathways to clinical trials. The international journal of biochemistry & cell biology. 2013;45(10):2288-2301.
- Dukowicz AC, Lacy BE, Levine GM. Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology. 2007;3(2):112-122.
- Finch CE. The menopause and ageing, a comparative perspective. The Journal of steroid biochemistry and molecular biology. 2014;0:132-141.
- Mikhed Y, Daiber A, Steven S. Mitochondrial Oxidative Stress, Mitochondrial DNA Damage and Their Role in Age-Related Vascular Dysfunction. Olson L, Ross JM, Coppotelli G, eds. International Journal of Molecular Sciences. 2015;16(7):15918-15953.
- Höhn A, Weber D, Jung T, et al. Happily (n)ever after: Aging in the context of oxidative stress, proteostasis loss and cellular senescence. Redox Biology. 2017;11:482-501.
- Mao P. Oxidative Stress and Its Clinical Applications in Dementia. Journal of Neurodegenerative Diseases. 2013;2013:319898.
- A-Z Guide to Drug-Herb-Nutrient Interactions. AR Gaby. 2006. Healthnotes
- Morrow LE, Grimsley EW. Long-term diuretic therapy in hypertensive patients: effects on serum homocysteine, vitamin B6, vitamin B12, and red blood cell folate concentrations. South Med J. 1999 Sep;92(9):866-70.
- Gao, lu & Maidment, Ian & Matthews, Fiona & Robinson, Louise & Brayne, Carol. (2017). Medication usage change in older people (65+) in England over 20 years: findings from CFAS I and CFAS II. Age and Ageing. 1-6. 10.1093/ageing/afx158