“All Disease Begins in the Gut.” 

This statement was touted by Hippocrates over 2000 years ago.

Today, his ancient words of wisdom echo in many of the treatment rooms of modern integrative and functional medicine physicians. Was he (and are they) right?

As the world’s population ages at a faster pace, it’s becoming obvious that our superficial attempts to prevent wrinkles and manage other progressive physical changes is not influencing our health span. In fact, our current approach to medicine, aka managing diseases, is not only NOT resulting in healthier people, it’s actually decreasing life span!

Previously, I reviewed the issues with handling sickness (“sick care”) vs. optimizing wellness. We are lacking a systemic approach to get to the root cause of why one’s body and mind can deteriorate. We also need more effective holistic medical solutions to address what can be done to support ourselves as we advance in years.

Wouldn’t you rather live your years vibrantly and healthily vs. playing whack-a-mole with symptom management?

Enter the topic of our gut…

Why We Should Pay Attention to Our Gut Health as We Age

The more researchers discover about the role that our gut microbiome has on both our physical and psychological states, the more conventional medicine is believing that Hippocrates was indeed correct. Our digestive system is a key area for maintaining health, resiliency, and a positive mood.

Our gastrointestinal tract supports the assimilation and absorption of nutrients, excretion of wastes, contains over 70% of our immune cells, produces 90% of our serotonin, makes various neurochemicals, helps regulate hormone excretion, and communicates with our brain to help supervise many bodily processes through the gut-brain axis. And, yes, it even impacts the skin.

This means that one of our main focuses for “aging gracefully” should be on how to keep our guts in tip-top shape.

In this post, I will give an overview of eight common digestive issues that occur with aging. Then, I will provide a summary of a personalized naturopathic and functional medicine approach to help reduce symptoms and optimize gut health.

Having knowledge of these conditions and the steps that can be taken to address them is important at any age.

After all, “an ounce of prevention is worth a pound of cure.”

8 Common Digestive Disorders That Occur with Aging

Below are eight of the most common gastrointestinal conditions that occur with aging. They are extracted from my original article published on Rupa Health.

1. Constipation

Constipation is a gastrointestinal condition of infrequent or hard to pass bowel movements.

Constipation can be caused by many factors and can be divided into primary and secondary constipation.

“Functional,” idiopathic,” and “primary” constipation are terms used to clarify that one’s main medical problem is constipation itself rather than a symptom of another underlying condition…

Secondary constipation occurs due to an underlying health issue or a side effect of a medication.

Some of the causes of constipation include:

• metabolic and endocrine issues
• dehydration (inadequate fluid intake)
• alcohol
• medications
• nervous system imbalances (systemically and in the gut)
• immune-mediated disorders
• lack of activity
• dietary factors

2. Slower Digestion

In general, it is common for the digestive tract muscles to slow down with age. Slower digestion also tends to be more predominant in the elderly with chewing disorders, reduced physical activity, and who are frail. Transit time (the passage of stool after one consumes food) is likely prolonged in the stomach and the colon, not the small intestine.

Slower digestion can result from an aging gut having impaired smooth muscle contractions, deregulated nervous system communication, and compromised cells that secrete digestive enzymes and regulate motility.

3. Lower Stomach Acid

The stomach secretes hydrochloric acid (HCL) to aid in the digestion of protein and absorption of nutrients. 

It is often believed that as one ages, their secretion of HCL decreases; however, this may not be the case. One review found that stomach acid secretion was either unaffected or increased in the elderly; however, the risk factors and conditions associated with lower HCL were higher. These include H. pylori (Helicobacter pylori) infection and atrophic gastritis.

Besides aging, stress, vitamin deficiencies, medications, and stomach surgery are also risk factors for lower stomach acid.

4. Lower Digestive Enzyme Production

Pepsin, a stomach enzyme that helps with protein digestion, declines after 70 years of age. Furthermore, studies show that subjects above 65 years of age had significantly reduced bicarbonate and enzyme (lipase, chymotrypsin, amylase) secretions. Lack of these enzymes can lead to malnutrition, compromised digestion, and other health consequences.

5. Heartburn (GERD)

Gastroesophageal reflux disease (GERD) is an upper gastrointestinal condition in which the stomach content flows back up into the esophagus. This results in various symptoms and is commonly referred to as heartburn.

It’s common for adults to have occasional heartburn. But, as we get older, it can become more frequent.

Risk factors for GERD include:

• certain medications
• impaired motility
• hiatal hernia
• decreased saliva and bicarbonate production
• lower stomach acid
• weight changes
• reduced pressure on the valve between the esophagus and stomach

6. Polyps

The elderly are more at risk for colon polyps (small growths in the colon). Polyps are often painless and found routinely with screening. Nearly all colorectal cancers are thought to arise from adenomatous polyps, but this progression is often prevented with the proper removal and regular colonoscopies.

Although there is no consensus on the underlying causes of increased polyps in aging, it may be related to age-related changes fueled by lifestyle factors…

The cells in the gastrointestinal tract lining are in a state of rapid renewal and turnover throughout the lifespan. In aging, there is likely an accumulation of cells in the GI tract with an imbalance in the breakdown. This occurs along with an altered mucosal immune response in the gut lining.

7. Ulcers

Ulcers, or perforations in the stomach that bleed, are more common in the elderly.

Risk factors for ulcers include:

• reduction of acid protective compounds in the stomach
• increased prevalence of H. pylori infections
• gut motility changes
• altering gastrointestinal hormones
• psychological and social stressors
• NSAIDs (Non-steroidal anti-inflammatory drugs)

8. Microbiome Imbalance (Dysbiosis)

The microbiota found in our digestive tract can become imbalanced by various environmental, dietary, and lifestyle factors, complicating digestive disorders…

Starting in mid-to-late adulthood, microbial populations shift. As time passes, gut microbiomes become increasingly personalized to individuals and can be a factor in determining one’s health span.

For example, the ratio of microbiota in the elderly has been shown to correlate with measures of frailty, co-morbidity, nutritional status, and inflammation. There is also evidence of less short-chain fatty acid production and changes in digestive capacity in the colon as a result of these alterations. Furthermore, opportunistic, pro-inflammatory bacteria increase with advancing age.

Interestingly, a lower colonic fermentation has also been observed in older women vs. younger women. This could also relate to the changes that occur with sex hormones in menopause with age and its impact on the gut microbiome.

Functional Medicine Labs to Assess Digestive Health as You Age

In my Rupa Health article, I list in detail the conventional labs and imaging which should complement functional medicine measures to rule out possible pathologies.

Medications and lifestyle factors should also be assessed for their contribution to all digestive complaints.

Below is a general summary of these laboratory markers.

Basic Labs

The following lab tests can help to assess for infections and blood sugar issues that can contribute to digestive problems and malabsorption:

• A complete blood chemistry
• A white blood cell differential
• HbA1c (hemoglobin A1c)

Other tests that may be deemed necessary to run include:

• A comprehensive thyroid panel (to rule out hypothyroidism as a secondary cause of constipation or slow digestion)
• An iron panel to assess for bleeding problems
• Immune and inflammatory markers

Imaging and Testing

Proper imaging and testing for lower colon abnormalities, ulcers, and GERD should be performed.  You can access the full list here.

Dysbiosis Markers

The following markers can help to assess digestive health and microbiome balance:

• Comprehensive stool tests – These offer a complete look at gut health by measuring pathogens and analyzing digestion, nutrient absorption, inflammation, and immune function (including celiac markers).
• Testing for SIBO (small intestinal bacterial overgrowth), H.pylori, and other pathogens– These results may help to diagnose infectious causes of GERD, ulcers, and other digestive disorders.

Naturopathic and Functional Medicine Supportive Treatment for the 8 Common Digestive Disorders

Constipation

Integrative interventions for constipation include:

• hydration
• nutrition
• supplements
• fiber
• probiotics
• synbiotics (a combination of prebiotics and probiotics)
• exercise

Read more about the specifics of these supportive treatments here.

Digestive Enzyme Support

Supplementing with digestive enzymes and HCL can help assist with digestive function and may alleviate many digestive complaints including heartburn, constipation, and slow transit.

Nutrients such as iron, zinc, and B vitamins are essential to produce stomach acid and should (also) be supplemented if low.

H. Pylori Treatment

H. Pylori is commonly treated with either antibiotics or herbal and supplemental antibacterials.

Doctors may also choose to use high doses of probiotics to drive out the overgrowth of harmful bacteria.

GERD Treatment

Certain foods may aggravate GERD and may initially need to be avoided until the root cause is addressed. These include alcohol, high-fat foods, chocolate, mint, acidic foods, and caffeine.

Herbs called demulcents can be soothing to irritated stomach tissue. Licorice and slippery elm are examples of these types of botanicals that have some evidence for addressing GERD symptoms. The supplemental hormone melatonin has also been shown to be helpful for digestive health and GERD.

Polyps Treatment

Suspicious polyps should be removed surgically when found. This is to prevent cancer growth.

Polyps may have genetic and environmental causes; therefore, promoting a healthy microbiome by the measures below may also be helpful for prevention.

Dysbiosis (Microbiome) Support

The following will assist in building and maintaining a healthy microbiome that supports a robust digestive system. These actions can be implemented throughout the lifespan.

Incorporating the following into one’s diet:

• fermented foods (such as yogurt, kefir, sauerkraut, etc.)*
• polyphenol-rich foods (e.g., cocoa, green tea, and coffee)
• fiber (note: too much can aggravate some gut conditions)
• Probiotics (specifically in the genus lactobacillus and bifibacterium)
• Lifestyle changes (e.g., more sleep, stress reduction, and exercise)

*Fermented foods can release histamine, so be cautious if you are histamine sensitive.

Essential Oils for Gut Health

Essential oils were not included in the Rupa article, yet they have many properties that support digestion. They are antimicrobial, anti-inflammatory, antioxidants (alleviating cellular stress), soothing to the mucosa, and benefit the mind-body connection.

Essential oils have also been shown to be beneficial to the microbiome. Evidence is pointing to the fact that although they have antimicrobial properties, oils are likely selective. They tend to decrease pathogens and detrimental microbiota overgrowths while sparing, or enhancing, beneficial microbes.

Some of my favorite essential oils for overall gut health include:

• peppermint
• frankincense and myrrh
• cardamom
• oregano and thyme
• ginger
• fennel
• juniper
• tarragon
• copaiba

Summary on Keeping Our Gut Healthy as We Age

Digestive disorders are a common malady that occurs more frequently with advancing years. They affect 62 million Americans and are the cause of 48 million ambulatory care visits annually.

As stated in my article:

More and more researchers and physicians are realizing that we need to consider the home of the trillions of tiny microbes in our bellies to have a fighting chance of avoiding disease progression that affects all our organ systems as we advance in years.

By exploring the root causes of some common digestive issues that occur with aging, implementing the proper diagnostics, and incorporating dietary, lifestyle, herbal remedies, (essential oils), and supplements, we can address the contributors to them to keep ourselves “young at gut.”

Please share your thoughts below.

Naturopathic Medicine and Holistic Resources for Digestive, Hormonal, and Mood Support

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References Cited

https://pubmed.ncbi.nlm.nih.gov/29444202/

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm

https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

https://pubmed.ncbi.nlm.nih.gov/29444202/

https://www.rupahealth.com/post/gut-brain-axis

https://www.webmd.com/digestive-disorders/features/digestive-health-aging

https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017946/

https://www.medicalnewstoday.com/articles/types-of-constipation

https://www.medicalnewstoday.com/articles/types-of-constipation

Access all the references in the original article here.