Healthy ageing: nutrition and lifestyle support

By Beth Raven @ Cytoplan

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 health^{17, 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

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.

Osteoarthritis

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 pain^{30, 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.

For references, visit Cytoplan website.

Cytoplan will be visiting at the ANP Naturopathic Summit.