Gut instinct: how to prevent age-related digestive issues like heartburn

There’s a lot of mystery around the gut and what exactly goes on in there. For the most part… you simply don’t want to know. But here’s what you can do to avoid these common gut-related health conditions as you age.

‍By Sarah Coleman

The best way to protect your gut from age-related conditions is to build up your gut’s resilience. This way it can easily bounce back after interference and prevent common issues as you age. 

As we get older, our gut changes in ways that can significantly impact our overall wellbeing. This is because your gut influences many aspects of health, including your immune system, mental health, and risk of diseases such as cancer, autoimmune disorders, endocrine conditions, and gut disease. It’s the unsung hero of overall health.

What is gut resilience?

Gut resilience refers to the ability of the gastrointestinal system to stay healthy and bounce back from disturbances. This involves the health and integrity of the gut barrier, a delicate layer that regulates the passage of nutrients and blocks harmful substances. The gut microbiome is also key in supporting gut resilience, it is made up of a community of microorganisms mostly living in the colon. 

Maintaining gut resilience is crucial for overall health as we get older. It serves a key defence against "inflammaging," the chronic low-grade inflammation linked to ageing, and ensures the proper functioning of our immune system and other bodily processes. If gut resilience declines it can result in many age-related conditions that people over 50 are particularly susceptible to.

Gut conditions over 50s need to look out for

The most common gut conditions to keep an eye on include gastroesophageal reflux disease GORD, diverticular disease, constipation, colorectal polyps, and complications from non-steroidal anti-inflammatory drugs (NSAIDs).

Gastroesophageal reflux disease (GORD)

"Heartburn," “indigestion,” and “acid reflux” are the commonly used terms for GORD, a chronic condition in which the stomach's acidic contents frequently reflux back up the oesophagus, causing irritation and burning pain in the chest and neck.

In people with GORD, the small band of muscle that stops food from refluxing up from the stomach is weakened due to various factors including age, obesity, smoking and alcohol consumption. 

Complications from GORD can include tooth decay, sore throat, chest pain, a persistent cough and problems sleeping.

Diverticular Disease

Diverticular disease affects a third of Australians over 45 and two-thirds over 85. In this condition, small bulges or pouches develop in the colon wall (diverticulosis), which can become infected (diverticulitis). 

Although the exact cause of diverticulosis is unknown, we do know that weakening of the colon as we grow older, and not getting enough fibre in our diet are big risk factors. Lack of fibre in the diet means that poop moves slowly through the colon, building pressure and creating “blowouts”. 

Other risk factors include a diet high in red meat, fat and alcohol, as well as being overweight and smoking. Recent research also suggests that ongoing mild inflammation and changes in the gut's microbial balance are possible factors. Read Citro’s article on how to reduce inflammation for healthy ageing.

Constipation 

Constipation is a common health condition, particularly in people over 65 years. It involves infrequent bowel movements, usually less than three times a week, with hard, dry poo (stools) that are difficult to pass. 

Symptoms of constipation may include feeling like you have not completely emptied your bowels, abdominal cramps, bloating and general discomfort. 

You can expect occasional constipation and it often resolves without treatment. If it persists for over a few weeks, a check with your GP will be required. Long-term constipation can lead to complications such as haemorrhoids, faecal impaction, rectal prolapse, and other issues linked to ongoing straining during bowel movements.

Bowel (colorectal) polyps

Bowel (colorectal) polyps are small growths that appear on the inner lining of the large intestine or colon, and sometimes in the rectum. While many of these polyps are harmless, some can develop into colorectal cancer over time.

The development of polyps is commonly linked to genetic factors or inflammation in the colon, influenced by what we eat or whether we exercise or smoke. Identifying and removing these polyps early can prevent them from becoming cancerous.

Complications from NSAIDs use

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are common medications used to relieve pain and reduce inflammation. However, they can have side effects that affect your gut. When taken frequently or in high doses, NSAIDs can irritate the lining of the stomach and intestines. 

This irritation can lead to issues like stomach aches, ulcers and bleeding in the gut. Therefore, it's important to use NSAIDs as directed and be aware of their potential impact on the gut to avoid these complications.

Keep an eye on your gut health as you age

As we get older, so does our gut. Understanding how your gut can change is essential for preventing and managing digestive issues in the future. Here’s a list of some of the common changes to keep an eye on as you age. Though some of them are internal and may be hard to pick up on, noticing general changes in your digestive system and bowel movements is important.

Appetite and taste: Changes in your hormones can blunt your sense of smell and taste. Some people might find that their enjoyment of food is lessened and that they eat not as often, leading to weight loss and nutrient deficiencies. This phenomenon has been dubbed the “anorexia of ageing”. 

Stomach acid: Stomach acid is essential for breaking down protein, releasing nutrients from food, and preventing gut infections. As we get older, the stomach produces less acid, which can lead to nutrient deficiencies and an increased risk of infections.

Saliva: Your body may produce less saliva, leading to a dry mouth and difficulty swallowing (xerostomia). 

Slow Movement: Food moves a little more slowly through the gut, which can lead to conditions like constipation. 

Digestive enzymes: There is a general decline in the production of digestive enzymes, which may play a role in the digestion and absorption of nutrients from our diet. 

Gut microbes: Shifts in the populations of gut microbes often lead to a decrease in beneficial populations and an increase in potentially harmful ones. This change can affect digestion, nutrient absorption, and immune function.

Gut barrier: The integrity of the gut barrier can become "leaky" with age, allowing more harmful substances to move into the body, triggering the immune system and causing inflammation. If this inflammation does not resolve, it can lead to "inflammaging".

Check out Citro’s article on the gut microbiome for more info about how to improve your gut microbes and gut barrier, and prevent inflammaging. 

While this list may seem daunting, don’t despair. There is plenty you can do to build gut resilience and health by boosting gut microbes and maintaining a healthy gut barrier.

Strategies for building gut resilience

Simple changes to your diet and lifestyle can help prevent the development of these common gut diseases. Here's a list of evidence-based recommendations to help you build a healthier, more resilient gut:

Diet

Fill up on fibre: Include fibre-rich foods in your diet, such as whole grains, fruits, vegetables, and legumes. These foods help maintain healthy populations of microbes in your gut and prevent constipation, diverticular disease, and bowel polyps. 

Steer clear of processed foods: These reduce the diversity of your good gut microbes and promote inflammation in the gut. 

Keep hydrated: Drinking regular glasses of water throughout the day supports digestion and prevents constipation. 

Limit red and processed meat in your diet: A diet high in red and processed meats may increase the risk of gut disease. 

Include probiotics and prebiotics in your diet: Probiotics are live microbes that benefit gut health, while prebiotics are non-digestible fibres that feed these beneficial bacteria. Probiotic-rich foods include yoghurt, kefir, and fermented vegetables, while bananas, garlic, and onions are examples of prebiotic-rich foods.

Follow a Mediterranean-style diet: The Mediterranean diet and other “Blue Zone” eating patterns are high in unprocessed and nutrient-rich foods that support healthy gut microbes and reduce inflammation. While you’re at it, read about the MIND diet for maintaining brain health and reducing risk of dementia.

More on this here: Mediterranean diet 101

Lifestyle

Aim for a healthy weight: obesity is associated with an increased risk of gut disease. 

Get regular exercise: physical activity improves gut health by stimulating regular bowel movements and reducing inflammation. 

Get enough sleep: good sleep is essential for general and gut health. Aim for 7 - 9 hours per night. Check out the 7 surprising ways to get a better night's sleep.

Manage your stress: Stress can worsen digestive symptoms. Practise stress reduction techniques such as meditation, yoga and mindfulness to help boost gut health.

Get checked

The importance of regular screenings and checkups cannot be stressed enough. Prevention is the best cure. Here are some bowel cancer warning signs to look out for: 

• Blood in your poo or on the toilet paper
• A change in bowel habit that lasts for more than 2 weeks (such as constipation, diarrhoea or feeling of incomplete emptying) 
• A change in the shape or consistency of your poo (has it become narrower or contains mucus?)
• Pain or swelling in your abdomen 
• Unexplained weight loss, weakness or anaemia
• Pain, swelling or a lump in the anus or rectum

The best reminder is sent to you on your 50th birthday. A gift from the National Bowel Cancer Screening Program. When the test hits your letterbox every two years - just do it. One icky moment might just save your life!

Read more on Citro about colonoscopies and vital health checks to have in your 50s.

Implement these tips

Knowledge is power. Understanding how your gut changes as you get older will help you put diet and lifestyle strategies in place to maintain a resilient gut and reduce the risk of developing common age-related digestive conditions.