Nearly two years ago a friend, Valerie, told me she was finding too many foods she could no longer eat without digestive problems, and asked me to post something about food and aging. That time is now, and what I have found is that there is a strong (and much researched) relationship between the food we cook, our biological digestive system, and the impacts of both aging and chemical changes that occur naturally or by prescription. I hope this post, along with my previous one on digestion, starts to answer her question.
Remember I am not a biologist, nutritionist, dietician, or a medically certified person. I am a cook trying to understand as much as I can about digestion as it is important to making the proper decisions when I cook for my own family or friends.
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Seniors Defined
Recap: What is a Senior?
As a recap, all of us are aging as a condition of human birth. However, a SENIOR is someone ~50+ who has started peri-menopause or andropause, their body is beginning to show the effects of aging in their digestive system, and are now having to take 4+ medications daily. To read a more detailed definition please see the previous post: Our Aging Digestion System.
Aging = Chemical + Biological Changes
Aging-Related Changes
The digestive system involves all the areas that process food from our eyes, nose, and mouth, through our body, ending at the large intestines and anus. Nearly every step of the way our body can undergo changes that make eating and digestion difficult. However, this time we are looking at chemical induced changes, biological changes, and changes to our appetite, followed by what to do about all these changes.
Chemical Changes
Essentially there is a chemical “change of life” that affects us biologically, often resulting in: less muscle mass, weight gain, changes in digestion, bloating, belching, slight nausea, abdominal discomfort, issues with saliva production or swallowing, etc (1, 2).
- For women I would say once we start the peri-menopausal stage, our physical relationship with our bodies change significantly as does our chemistry. This stage lasts ~3-5 years and we end up in menopause (for another ~5 years), signaling our child-bearing is naturally over.
- For men it is andropause, which describes age-related changes in hormone levels that often are not as severe as they are for women, but are similar symptoms that can last 20-30 years (3).
But a lot of the chemical changes may also be due to western medicine’s reliance on advocating drugs for every ailment. The complexity of how these medications change our bodies’ chemical composition confuses me and I am not fully confident that the doctors understand this complexity. I know for sure that they jump to a medicine’s name when confronted with a symptom, but do not always advise us on diet or lifestyle changes to deal with problems (except they usually harp on losing weight, and quitting smoking).
In fact, General Practitioners know the least, sometimes, about the aging process and our bodies.
- For instance, at 70 years of age, research has already shown we produce less saliva.
- But taking >4 pills/day may also reduce saliva (4).
- Combined means we will most likely have digestive issues.
Side note: I am not sure when to move from a general doctor to a geriatric medical professional, because presumably a geriatric specialist may know more about the special needs we will have. But from 50s – 60s do we change doctors or keep the ones we are currently using? AARP writes that ~30% of those aged 65 or older should have a geriatric doctor: Geriatricians specialize in the care of people with multiple chronic medical conditions that cause challenges with their day-to-day physical and mental functioning.A 65-year-old with high blood pressure, high cholesterol and type 2 diabetes may benefit, but an 80-year-old who walks five miles a day and is only on one or two medications doesn’t need one.
So here is when you should consider seeing a Geriatrician:
- As we age it becomes harder to metabolize and clear medicines from our body, so if on 4+ medications per day an aging specialist should evaluate our medications.
- If we are experiencing memory problems, even if only to get tested for dementia.
- If we are less mobile, so we can be evaluated and helped to retain independence or to get assistance if needed.
- If we are hospitalized, so we can receive specialized help in our recovery.
Biological Changes (5)
According to Merick, by 75 years of age, the percentage of body fat typically doubles compared with what it was during young adulthood. They also note the distribution of the fat can change, which can absolutely change the way our body looks and moves. This in turn may trigger a change in our diet, as we respond to how these changes in appearance make us feel. But the tricks we used when young to lose weight, may not work well, as other changes are occurring too.
My previous post detailed the digestive system and discussed aging related in that system such as:
- Our eyes, nose and tongue change with time and influence our ability to assess if food looks attractive or detect flavor in a dish, which can lead to a loss of appetite.
- Next for digestion are the changes we experience with our teeth, ability to produce saliva, and our esophagus muscles that may make swallowing and food processing more difficult.
- Followed by our stomachs losing elasticity and acid, and thus lessening its ability to break down food and move it into the small intestines for further processing.
- I spent a little time noting the special role of our liver, pancreas and gallbladder in breaking down the food into sugars, vitamins and proteins; and how, as they lose their conversion ability, digestion becomes harder.
- But also, I noted the critical role played by our microbial environment in that process and how the microbes can be easily harmed, leading to malnourishment.
- And finally ending with problems in our large intestine and anus which can lead to difficult changes in bowel movements.
Finally, our skin also changes and the ability to sense heat may decrease, so remember to test the heat of the food and plate before serving, as seniors are more likely to cut, bruise, or burn ourselves.
Appetite + Digestive Issues
Appetite Changes
Our relationship with food can be very complicated even without the issues of aging; often influenced by external and internal situations. But while we all have appetites of some sort, there is discussion now about what we actually need at various stages of our life (6). Starting at 50 years of age, when things start slowing down, some say we need to focus on exercise, eating a variety of colorful, organic food with healthy nutrients, and with a focus on protein and fiber.
But we also live in a time with a rather large older population, where they are living well into their 80 – 90’s, and their needs may be slightly different. These ages find that people in general experience a poorer appetite and an outright lack of hunger brought on by everything documented in this post. So focusing on the cultural, social, and community aspects of eating may help counter the impacts of an 80+ aging population.
As we age, we already know our metabolism declines (7), which can cause a loss of appetite. But so can depression, which is not a surprise, as we start to lose family and friends to death. Or as we move into retirement facilities and are separated from our community. But more concerning to me is that from 65 forward, the incidents of dementia increase. And that can cause a loss of appetite as well (8).
Signs of Digestive Issues
Essentially, after 50+ we start to become susceptible to a variety of diseases or discomforts (9, 10).
- Disease
- Colon cancer
- Diverticular disease
- Non-alcohol fatty liver disease
- Gastrointestinal Esophageal Reflux Disease (GERD)
- Symptoms
- Heartburn
- Peptic ulcers
- Irritable bowel syndrome
- Diarrhea or Constipation
- Hemorrhoids
- Excess gas
- Bloating
- Excess burping
- Stomach pain
- Fecal incontinence
Taking Medical + Food Precautions
Medical Advice
The point here is someone needs to either speak with their pharmacist, or read the small-print details on the medications you are taking to see what contraindications exist for your prescriptions. It may list a specific food to avoid, like grapefruit, or may indicate a vitamin or other medications that are contraindicated. Pay attention to this detail.
WebMD recommends doing the following to aid your digestive system. Specifically, these ideas are to keep your bowels and stomach working as expected.
- Drink plenty of fluids
- Continue exercise in whatever form you prefer
- Check your medications and any that cause GI issues, and those that do should be at the lowest effective dose,
- Some medications should be taken with food, other on an empty stomach, understand the details,
- Consume more fiber in the form of fruit, veggies, and whole grains.
- Keep a healthy weight for your body.
Women and men have the exact same issues, and the medical response is also the same. Additionally, for both genders it is recommended that attention be given to our sleep patterns and any issues of snoring or interrupted sleep be reviewed as they can be indicators of other issues that need addressing.
Food Advice (11, 12)
Maintain a healthy approach to your diet
- Add fiber to meals.
- Limit salt intake.
- Limit caffeine.
- Avoid white, easy-starch foods (rice, potatoes, bagels, donuts, white bread).
- Drink water or other non-caffeinated, non-alcoholic beverages throughout the day.
- Eat a variety of proteins.
- Eat healthy portion sizes and avoid overeating or consider eating smaller sized meals, more often during the day.
- Avoid or limited irritating foods like: fats, sugars, spice, heat, or fried.
- Maintain a healthy weight.
Avoid reflux-trigger food
These food could mean dairy, or gluten, onions, tomatoes, eggplants, corn, etc. This you can test yourself at home. Identify all possible culprits of your reflux, then eat one of those items and see if you respond. A food diary where you record ALL the food and drink consumed and the symptoms that occurred in one day will help.
Test for food allergies or sensitivities and avoid those foods. This is a quick office visit, lots of pricks generally on your back, and a little discomfort as your body reacts to some items. A quick medication, like an anti-histamine, and you are good to go, with the knowledge of what you are allergic to, in most cases.
- I however am one of those with a non-specific allergy, and who did not show any reaction to the tested items, but clearly have a physical response to dogs, cats and corn in real life. Go figure.
Avoid Food that harbors any bad bugs
As we age and our immune systems are less effective we need to keep an eye out for food that may harbor bad bugs. Things to consider avoiding when feeding seniors with digestive issues:
- Soft cheeses (feta, brie, cotija, etc) are a good example, but if you cook them they can be safely eaten.
- Undercooked eggs, due to the risk of salmonella.
- Unpasteurized foods like raw milk, juice, homemade mayo or hollandaise sauce.
- Raw veggies like sprouts (13).
- Raw fish sushi, or raw fish.
- Shellfish, muscles or oysters; any filter sea animals or bottom feeders.
Check medications to avoid problem foods (14) common examples are below:
- Statins and calcium channel blockers contraindicated with grapefruit.
- If taking Warfarin, be careful with Vitamin K.
- If taking insulin, be careful if consuming alcohol (15).
- Acetaminophen should not be taken with alcohol.
- Digoxin and some herbs may have issues with a heavy fiber diet.
- Antibiotics and dairy can clash (16).
- Antithyroid Drugs and iodine-rich food do not go together.
Consider probiotics (17)
Perhaps eating probiotic yogurt, fresh sauerkraut, drinking kombucha or cooking with tempeh can help sustain healthy gut bacteria. But also consider taking good-gut-bacteria medications or supplements. Of course speak with a medical professional before doing this.
Conclusion
To talk about what we seniors can do to recognize and support digestive health is pretty much what we all expect: eat healthy, get exercise, and stay socially connected. Eat a Mediterranean style diet of in-season, organic, multi-colored mixture of mainly veggies, fruit, nuts, whole grains, and only occasionally flesh (emphasis on fatty fish). Sit up when eating, eat with friends, enjoy the food and take the time to chew and to appreciate what is served.
The addition of chemical health is also known: reduce the number of pills taken by looking for and treating the cause, and not just the irritating symptoms. If you live on Tums or other meds to treat acid reflux, learn which of the causes are yours and start making changes. Eat smaller meals 5-6 times a day, remove foods that upset your stomach, stop soda and alcohol, leave an hour or two between the last meal and bedtime, sleep with head and chest slightly elevated, etc. Try hard and remove the need for the medication.
The biological health is harder since it is a part of our bodies’ aging processes. But still, exercise as you are able to keep strength and flexibility, grow with a community that helps one another, be proactive with biome and mental health practices, and consider living with others. Improve posture, keep bones and teeth healthy, eat slowly, sit up to eat, chew the food well, and so on.
But if cooking for someone with digestive issues consider pureeing foods, serving easy to swallow or easy to chew dishes, whatever matches the issue best. Examples include serving a squash soup instead of fried chicken, a baked sweet potato instead of a hamburger, use the puree cooking technique for making desserts, and consider slightly overcooking a stew so everything is smallish and very soft.
Lets all take care of ourselves and each other.
—Patty
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