Assoc Prof Dr Rosita Jamaluddin is with Universiti Putra Malaysia’s Department of Nutrition and Dietetics and is an expert committee member of the Probiotics Education Programme.
The gut is home to numerous species of microorganisms (mainly comprising bacteria), which are known as the gut microbiota.
They are essential for maintaining good health.
That is certainly not all as the gut microbiota also aids with digestion, thus helping our body absorb various important nutrients.
Perhaps one of the most important functions it serves is in helping to enhance our immune system, thus protecting us from infections and diseases.
The composition of the gut microbiota changes across our lifetime, and is influenced by age, diet, lifestyle, environment and disease.
These changes can have a positive or negative effect on our health and quality of life, especially in the elderly group.
Dysbiosis in the elderly may affect the immune system
The gut bacteria can be roughly divided into two categories, namely the ‘good’ vs ‘bad’ bacteria.
To function optimally, the number of ‘good’ bacteria should exceed that of the ‘bad’ bacteria by almost six to one (85% vs 15%).
Examples of ‘good’ bacteria that live in the gut which are known to have beneficial health effects include Lactobacillus and Bifidobacterium.
Numerous factors can disturb this balance of gut microbiota, such as prolonged use of antibiotics, excessive use of alcohol, smoking and excessive stress. Under such circumstances, there is more opportunity for the ‘bad’ bacteria to overwhelm the ‘good’ bacteria, leading to a condition called dysbiosis.
Studies have also shown that dysbiosis can occur among the elderly, as the diversity of the gut microbiota declines as one gets older.
In addition, the secretion of digestive enzymes and the number and efficiency of immune cells are also known to decline with age.
As a result of these ageing-related changes, the immune system may not function optimally. Thus placing older people at higher risk of infection and diseases, as well as more serious complications from common infections.
Researchers are still studying the causes leading to the changes in microbiota composition and function during ageing.
Ageing also affects the elderly in terms of reduced mobility and having a less diverse diet due to altered food preferences, food intolerance and deterioration of one’s sense of taste. These are some of the factors that can consequently affect the diversity of gut bacteria and their ability to promote overall health.
It is also a possibility that the elderly may not eat healthily due to reduced income in the case of pensioners, or loss of income for those who are no longer working.
This situation would certainly affect them in the dietary sense as they may not be eating healthily.
Leading a healthy and active life is key
To maintain a healthy balance of one’s gut microbiota and promote good gut health in the elderly, it is important to continue leading a healthy and active lifestyle.
Doing so will help support one’s overall health and make a positive difference in one’s quality of life.
Additionally, it will also help prevent chronic diseases, thus minimising the need for medication and hospital stays, which are common health concerns among the elderly.
Here are some simple tips on how one can maintain a healthy and balanced gut microbiota to help support one’s general health/immunity:
- Consume a balanced, nutrient-dense diet that are rich in fruits, vegetables, and whole grains. Eat as many different types of fruits and vegetables as you can and pick them in a variety of colours such as dark-green, red and orange vegetables. Some vegetables also contain prebiotics, which are indigestible fibres that feed the good bacteria.
- Fish should be consumed more often than red meat as the texture is softer and contains more good fat, which is recommended for the elderly. For red meat and poultry, if one faces difficulty with chewing foods, then find ways to modify its texture to suit you. For example, chop into small pieces or mince them first.
- Include probiotic-rich foods in your daily diet – cultured milk drinks and yogurt. Probiotics are essentially the good bacteria in our gut. Alternatively, you can opt for homemade fermented foods such as tempeh, kimchi, sauerkraut, homemade yogurt, tapai pulut, tapai ubi and natto which are also potential sources of good bacteria.
- Reduce the intake of foods high in sugar and fat as these foods are not favourable for good bacteria growth. Choose the daily food intake wisely and make sure it is balance in terms of good nutrition. It will also help someone to manage their finances by leaving out unnecessary expenses in terms of food/drinks that contain less nutritional value, like soda beverages, dried fish and more.
- Eat moderately and avoid oversized portions. Overeating can pave the way to obesity, which is a risk factor for many non-communicable diseases.
- Exercise has been shown to increase the diversity of microorganisms in the gut. Although it can be harder to keep active for some elderly in the later years, they should still try to do simple physical activities to help stay physically active. Aim for light or moderate intensity for short periods of time, and spread them out throughout the week to prevent wearing out. Simple exercises are best, such as brisk walking around or nearby house compound, or indoor exercises such as stationary bike, yoga, tai chi exercises, and light stretching exercises.
Make the right choices
Diet and lifestyle choices play important roles in the way one age and crucial for supporting general and immune health.
This is in view of the fact that one’s immune system generally becomes less efficient with age, leading to a higher vulnerability to diseases in the elderly, including the current Covid-19 pandemic where the elderly is categorised as a high risk group.
As the gut microbiota also undergoes changes during ageing, this may further jeopardise the immune system of the elderly. It is therefore particularly important to maintain good gut bacteria balance to promote immune health of the elderly.
Unfortunately, the elderly may face problems with limited income, thus proper meal planning is important when deciding what groceries to buy.
Emphasis should be given to healthy nutritious food while unhealthy items/food/drink should be minimised (e.g. cigarettes, junk foods, and sweetened beverages such as teh tarik, 3-in-1 instant drinks and carbonated soft drinks) – the money saved can be allocated for healthier food options.
Rely on professional information such as those from the Probiotics Education Programme of the Nutrition Society of Malaysia (www.nutriweb.org.my/probiotics)