With an ageing population and a rising life expectancy, it is more important than ever to consider how to stay healthy as we age. Over 65s now make up almost 20% of the UK population1, and with a rise in chronic diseases in older people and a high number of people living with co-morbid conditions2 it’s become clear that earlier interventions are needed to keep us healthy.
Although the ageing process is an inevitable part of life, developing illness doesn’t need to be. The notion of ‘healthy ageing’ as defined by the WHO is ‘the process of developing and maintaining functional ability that enables wellbeing in older age.’ The great news is that nutrition and lifestyle play a huge role in staying healthy into later life. The biggest modifiable factors that we have at our fingertips are dietary patterns, alcohol consumption, smoking and levels of physical activity3.
Ageing, inflammation and oxidative stress
Whether or not you go on to develop age-related disease in later life has two main underpinning factors; the presence of chronic low grade inflammation and the increased rate of oxidative stress. When left unchecked, these can lead to damage at a cellular level and contribute to both disease states and accelerated ageing4. Fortunately, we can regulate inflammation through dietary interventions which helps to reduce disease risk as we age5.
Inflammation- inflammation is a natural short-term immune response that protects us from pathogens and heals injuries to tissues. However, when inflammation becomes a chronic, low-level issue, it leads to a number of problems. Age-related chronic inflammation or ‘inflammageing’ is a major factor in the development of age-related illnesses such as cardiovascular disease, diabetes mellitus, cancer and dementia6. Dysregulation of immune functioning and the presence of elevated pro-inflammatory cytokines, alongside the changes to cellular signalling and cell death are all involved in the chronic inflammation seen in ageing7.
Oxidative Stress happens when there is an imbalance between the amount of antioxidants that are able to defend against ROS (Reactive Oxygen Species.) When ROS levels are not quelled, they lead to damage to cells and tissues and accelerate biological ageing8.
Antioxidants are compounds that help to prevent and repair damage to cells caused by oxidative stress. Antioxidant rich foods include colourful fruits and vegetables such as grapes, apples, berries, broccoli, onion and cabbage. There are isolated antioxidant compounds such as vitamin C, glutathione, resveratrol, selenium and curcumin which can be taken in supplement form.
Resveratrol which can be found in the skin of red grapes, has been shown to reduce signs of ageing and increase lifespan by augmenting an enzyme called AMPK which regulates autophagy (cell death and recycling) by altering Atg1gene expression. Autophagy may slow ageing by increasing turnover of damaged cells9.
Gut health and ageing
The health of the gut has a huge impact on all areas of health. In particular, the role of the gut microbiome is recognised as helping to shape our physiology and metabolism. Supporting a healthy intestinal microbiome through diet and targeted probiotic therapy may help to reduce the incidence of age related disease and promote healthy ageing10.
- Dysbiosis of the gut microbiome can trigger chronic low-grade inflammation, leading to many age-related degenerative conditions and unhealthy ageing11.
- There is a decrease in short chain fatty acid producing bacteria as we age which primarily affects gut barrier integrity and gut motility. Modifying the diet by increasing pre-biotic fibre, which feeds the butyrate producing bacteria, can be supportive12. Prebiotic fibre is found in onions, garlic, globe artichoke, cooked and cooled potatoes and soaked oats.
- Akkermansia muciniphila is a commensal bacteria that has been associated with healthy ageing due to its anti-inflammatory effects and preventing degradation of the intestinal mucus lining as seen in older age13. Akkermansia can be increased via consumption of foods rich in catechins like apples, cherries, tea, dark chocolate and ellagic acid like pomegranate, walnuts and blackberries.
- As we age there is a decline in digestive functions, most notably stomach acid levels and digestive enzyme production.Digestive function can be improved via lifestyle practices such as chewing food thoroughly, drinking large quantities of fluid away from meals and taking a teaspoon of apple cider vinegar before meals to stimulate digestion. Targeted supplementation can be used for both stomach acid support and digestive enzyme function.
Vitamin B12 deficiency affects 10% of over 75s and 5% of those between 65 and 74 in the UK14. B12 levels decrease as we age despite dietary intake due to reduced intestinal absorption and use of certain medications like PPIs. B12 deficiency symptoms include weakness, fatigue, nausea, low appetite and weight loss. Low B12 levels contribute to age-related chronic disease such as cardiovascular disease, diabetes and dementia15. Supplementation with the appropriate form of B12 (methyl, adenosyl or hydroxycobalamin) can be supportive after deficiency is identified.
Bridging the nutrition gap
Micronutrient deficiencies are especially important to consider as we age, as they can increase the risk of a decline in functioning, frailty and development of disease16. These deficiencies can occur due to lower dietary intake of certain nutrients and absorption issues. The reduced quality of our food due to modern farming methods, higher intake of processed foods as well as a decline in gut health and sedentary lifestyle mean that we have a lower quality of nutrients available in our food supply. It is advisable to monitor and utilise certain nutrients, such as magnesium, that can help to maintain quality of life and reduce risk of certain age-related diseases.
Magnesium is needed for hundreds of enzymatic reactions which regulate the cellular and metabolic processes in the body. Adequate magnesium is crucial for everything from muscle function to protein synthesis to glucose control and the production of ATP (energy) as well as bone, nerve and heart health17, 18. Magnesium levels decrease as we age. The consequent chronic low levels of magnesium are associated with excessive inflammation and oxidative stress which can lead to age-related chronic diseases like heart disease, hypertension, insulin resistance, depression and fatigue19. Magnesium can be obtained through foods such as wholegrains, nuts, seeds, beans, legumes and leafy green vegetables as well as through oral supplementation. It is well absorbed transdermally via baths/foot soaks and sprays.
Cardiovascular disease refers to a collection of conditions affecting the heart and blood vessels including high blood pressure, angina, coronary artery disease, stroke vascular dementia and heart attack. Cardiovascular disease is one of the leading causes of disability and death in the UK20. The risk for cardiovascular disease increases as we age due to increased levels of inflammation and oxidative stress as well as deterioration of the heart muscle21.
Dietary patterns and lifestyle choices not only play a large role in cardiovascular disease prevention, but also in recovery and management22. Nutrition helps to extinguish uncontrolled inflammation, which is a driver of cardiovascular disease, via several pathways such as modulating the gut microbiome through intake of fibre and certain polyphenol compounds23.
CoQ10 is an essential fat soluble compound which has two mains roles within the body; to support the mitochondria in energy production (ATP) and to protect the body from oxidative stress. It is synthesised endogenously, but it can also be obtained through a small selection of foods or via supplementation. CoQ10 levels have an impact on heart function as the heart requires large amounts of energy and CoQ10 is needed for energy production. CoQ10 acts as a powerful antioxidant and is an essential cofactor for the regeneration of two other antioxidants within the body. As CoQ10 levels naturally decline as we age, lower levels are associated with an increased risk of cardiovascular disease24.
Omega 3 fatty acids EPA and DHA are essential nutrients that we must obtain through diet or supplementation. Oily fish (salmon, mackerel, anchovy, sardines and herring) are all excellent sources of EPA and DHA. If you follow a vegetarian or vegan diet, it is much more difficult to obtain optimal levels of EPA and DHA via diet alone25. Omega 3 fatty acids, also known as n-3 PUFAs are well researched for their anti-inflammatory effects, but their protective mechanisms against cardiovascular disease go much further. Adequate levels support vagal tone which in turn decreases heart rhythm disruption (arrhythmias), reduces the formation of plaques which can lead to arterial disease, helps to keep blood lipids in check, stimulates nitric oxide production, improves the function and health of the lining of the heart and blood vessels (the endothelium) and inhibits platelet aggregation which can damage the endothelium26.
Over 8 million people in the UK are reported to have this degenerative joint condition causing pain, stiffness and swelling 27 OA is more common in those over the age of 45, but age is not an inevitable factor in the development of OA as the ‘wear and tear’ hypothesis suggests. In OA the cartilage that provides a protective cushioning to joints (hyaline cartilage) starts to breakdown and becomes thin. The damaged cartilage then triggers an inflammatory response in the surrounding synovial membrane (fluid and membrane that surrounds the joints) which allows it to leak out of the joint. With less cartilage and synovial fluid, this enables bone to bone friction in the joints which causes further degradation and damage. Following an anti-inflammatory diet and lifestyle can help to reduce the risk of osteoarthritis and help to prevent/slow further damage in existing cases. Focus on reducing alcohol, smoking, getting adequate sleep and exercise and eating a diet rich in fruits, vegetables, wholegrains, healthy fats and protein28.
Collagen type II collagen is found in high concentrations in the hyaline cartilage surrounding the joints. As we age, our ability to produce collagen gradually decreases29. Intake of type II collagen via supplementation may be beneficial as it can help to stimulate the body’s production of cartilage, improve joint mobility and reduce pain30, 31,32.
Type 2 diabetes
Around 5 million people in the UK now have type 2 diabetes, which does not include the nearly 2 million patients who are borderline diabetic 33, 34. There are several risk factors associated with developing diabetes such as diet, lifestyle, ethnicity and obesity as well as increased age. Diabetes mellitus occurs when the body can no longer correctly use glucose for fuel due a loss of insulin sensitivity. This results in chronically high blood sugar and high insulin levels, until insulin levels are down regulated. Both insulin output and sensitivity are reduced in older age due to reduced physical activity and changes in body composition resulting in the loss of lean muscle mass35. Type 2 diabetes is known as a ‘lifestyle disease’ because the risk is increased by dietary and lifestyle patterns. This also means that type 2 diabetes can be reversible in some cases with the appropriate interventions36.
Chromium is a nutrient that helps to regulate glucose levels by supporting the metabolism of carbohydrates, fats and protein as well as enhancing insulin signalling and sensitivity. Chromium levels decrease with age and low levels of chromium are associated with poor insulin sensitivity37. Chromium can be found in foods such as wholegrains, mushrooms, broccoli and brewer’s yeast or it can be consumed in supplemental form as chromium picolinate.
- Healthy ageing is an important focus due to the ageing population and rising chronic disease rates
- How health we are as we age can be modified through diet and lifestyle factors
- Inflammation and oxidative stress are the two major factors contributing to the common diseases we see in ageing
- Antioxidants can attenuate inflammation and oxidative stress and can be obtained via colourful fruits and vegetables or targeted supplements
- Gut health has a huge impact on overall health and can influence how well we age
- Certain bacteria such as akkermansia and butyrate producing strains can support healthy ageing
- Gut function is impacted by ageing and can be supported via dietary and lifestyle measures as well as supplementation
- Vitamin B12 deficiency is common amongst the older population and can contribute to some of the common age-related disease pathogeneses
- Micronutrient deficiencies are important for everyone but especially as we age due to their role in the development of frailty and disease
- Magnesium is a common nutrient deficiency which has a role in the development of age-related chronic disease
- Cardiovascular disease is one of the leading causes of the death in the UK and risks increase with age. Nutrition and lifestyle alterations to modulate inflammation can support heart health and help to prevent age-related cardiovascular disease.
- CoQ10 is an antioxidant that declines as we age and is needed for heart health and the prevention of cardiovascular disease
- Omega 3 fatty acids exhibit several protective effects on heart health
- Osteoarthritis is a common degenerative joint disease driven by inflammation and is prevalent in the older population. It can be prevented/supported via an anti-inflammatory diet and lifestyle as well as collagen supplementation, which helps to repair the damaged cartilage.
- Type 2 Diabetes is more common the older we get due to changes in dietary patterns, insulin signalling and sensitivity
- Chromium is associated with poor insulin sensitivity when low and can be found in certain foods or taken in supplemental form
About the author
BSc (Hons) Dip CNM
Beth became interested in nutrition after experiencing its value in supporting personal and family health issues. She worked in education for many years before deciding to retrain as a Nutritional Therapist and qualifying in 2018. Beth is most passionate about educating others on a wide variety of nutrition topics so that they can feel empowered about their health.
If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
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