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:
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:
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:
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:
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.