Reviewed by the Goodness Care Medical Team. Updated September 2026.
From your 40s onward, digestion tends to change in predictable ways: heartburn, constipation and dairy intolerance become more common, stomach acid and vitamin B12 absorption can fall, and more of the medicines people take start to affect the gut. Most of this can be managed with fibre, fluids, activity, a healthy weight and a medicines review. The single most important step is bowel (colorectal) cancer screening, which major guidelines now recommend from age 45 for people at average risk.
What changes in your digestion after 40
These are the changes supported by authoritative health sources. Not everyone will notice all of them, and many start gradually.
| Change | What you may notice | What the evidence says |
|---|---|---|
| Heartburn and reflux | Burning after meals or at night | Cleveland Clinic explains that the valve between the food pipe and stomach can weaken with age, and weight gain and some medicines add pressure or relax it further |
| Hiatal hernia | Frequent heartburn | Cleveland Clinic notes that more than half of people have a hiatal hernia by age 60 |
| Constipation | Fewer or harder bowel movements | NIDDK estimates it affects about 33 in 100 adults aged 60 and over, compared with about 16 in 100 adults overall |
| Diverticulosis | Often no symptoms | NIDDK reports it in more than 30% of adults aged 50 to 59 and more than 70% of those over 80 |
| Lower lactase | Gas, bloating or loose stools after dairy | NIDDK says that in people with lactase nonpersistence, lactase levels get lower with age |
| Less stomach acid, less B12 | Often no symptoms at first | The NIH Office of Dietary Supplements says many older adults do not have enough stomach acid to absorb the vitamin B12 naturally found in food |
You may also read that the body’s own digestive enzyme production drops sharply with age. We did not find authoritative health guidance confirming this for healthy adults, so we do not rely on it here. The changes above are the ones worth planning for.
Colorectal cancer screening: start at 45
Bowel cancer screening can find cancer early, and can find growths (polyps) before they become cancer. Current guidance:
- US Preventive Services Task Force (USPSTF): screen adults aged 45 to 75. For ages 76 to 85, the decision is individual.
- American Cancer Society (ACS): start regular screening at 45 if you are at average risk and continue through 75 if you are in good health. From 76 to 85 the decision depends on your health, preferences and past screening. The ACS updated its guideline in May 2026 and kept 45 as the starting age.
Screening test options
Screening does not always mean a colonoscopy. The USPSTF lists several options, including:
- a stool test (FIT or high-sensitivity gFOBT) every year
- a stool DNA-FIT test every 1 to 3 years
- CT colonography every 5 years
- flexible sigmoidoscopy every 5 years, or every 10 years with a yearly FIT
- colonoscopy every 10 years
Any abnormal result from a stool test or sigmoidoscopy needs a follow-up colonoscopy.
Who may need to start earlier
The age-45 advice is for people at average risk. If you have a strong family history of bowel cancer or certain polyps, a personal history of polyps, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), a known genetic syndrome, or past radiation to the abdomen or pelvis, talk to your doctor, as you may need to start earlier or be screened more often. Screening programmes differ between countries, so ask your doctor what is recommended and available where you live, including in Jordan.
Medicines that can affect digestion
People in their 40s, 50s and beyond often start regular medicines. Some commonly affect the gut:
- Acid-reducing medicines (proton pump inhibitors such as omeprazole, and H2 blockers): the NIH Office of Dietary Supplements says they can reduce vitamin B12 absorption from food.
- Metformin (for type 2 diabetes): may reduce vitamin B12 absorption, according to the same source.
- NSAID painkillers (aspirin, ibuprofen, naproxen): NIDDK names these as a common cause of stomach ulcers, particularly with long-term use, high doses, or combining more than one.
- Medicines that can cause constipation, according to NIDDK: calcium channel blockers and diuretics (both used for blood pressure), iron supplements, calcium- or aluminium-containing antacids, opioid pain relievers, some antidepressants, and medicines for Parkinson’s disease.
- Medicines that can cause wind, according to the NHS: including NSAIDs, laxatives, antifungals and statins.
- Some medicines relax the valve at the top of the stomach, which Cleveland Clinic notes can worsen heartburn.
Never stop a prescribed medicine on your own. Instead, ask your doctor or pharmacist for a medicines review once a year, and ask whether your vitamin B12 should be checked if you take long-term acid-reducing medicine or metformin.
Practical steps for a healthier gut after 40
Eat more fibre, gradually
NIDDK advises 22 to 34 grams of fibre a day for adults, depending on age and sex. Good sources include whole grains, oats, lentils, chickpeas, beans, fruit with the skin on, vegetables and nuts. Increase slowly to limit gas and bloating.
Drink enough fluids
Fibre works best with enough liquid. Drink water through the day, and more in hot weather or when you are active.
Stay active
Regular activity helps keep bowel movements regular. The NHS recommends daily activity such as walking. A walk after meals is a simple habit to build.
Manage your weight and your evening meal
Because extra weight increases pressure on the stomach, Cleveland Clinic points to weight management, dietary changes and sleeping position as effective ways to reduce heartburn. The NHS also advises against large meals late at night, which can worsen bloating.
Be smart with dairy
If milk now gives you gas or bloating, you may not need to cut out dairy. NIDDK notes that many people with lactose intolerance can have about 12 grams of lactose (about a cup of milk) with no or mild symptoms, that yoghurt and hard cheeses are lower in lactose, and that lactase products can help.
Look after your B12
Foods that naturally contain B12 include meat, fish, eggs and dairy. If you are over 50, take acid-reducing medicine or metformin, or eat little animal food, ask your doctor whether a B12 test or a fortified food or supplement is right for you.
Where digestive enzymes fit
Digestive enzyme supplements are not a substitute for screening, medical advice or the steps above. But if you notice that certain meals, particularly those with dairy, beans, lentils or cruciferous vegetables, leave you gassy or uncomfortable, an enzyme supplement may help support digestion of those foods.
Goodness Digestive Enzymes combines 13 enzymes in one capsule:
- Proteins: protease, bromelain and papain
- Starches: amylase and glucoamylase
- Fats: lipase
- Dairy: lactase, with 1,000 ALU of lactase activity per capsule
- Plant foods: alpha-galactosidase (for complex carbohydrates in beans, lentils, peas, cabbage and broccoli), plus cellulase, xylanase, hemicellulase, beta-glucanase and pectinase
The directions are 1 to 2 capsules before meals, or as advised by your healthcare provider, and it is intended for adults. It is registered as a food supplement with the Jordan Food and Drug Administration and is available in pharmacies in Jordan and Saudi Arabia, so ask your pharmacist whether it suits your needs. If you take regular medicines or have a digestive condition, check with your doctor or pharmacist first.
For help with specific symptoms, see our guides on relieving gas and bloating and relieving constipation naturally.
When to see a doctor
Do not put down new digestive symptoms to “just getting older.” See your doctor if you have:
- blood in your stool or bleeding from the rectum
- a lasting change in your bowel habits
- unexplained weight loss
- constant abdominal pain
- heartburn most days, heartburn that pharmacy medicines do not help, or food getting stuck in your throat
- ongoing bloating, especially if you are a woman and feel bloated most days
- vomiting, fever, or being unable to pass gas or stool (seek help promptly)
Frequently asked questions
At what age should I start colorectal cancer screening?
For people at average risk, both the USPSTF and the American Cancer Society recommend starting at 45. If you have a family history or other risk factors, ask your doctor, as you may need to start earlier.
Do I have to have a colonoscopy?
Not necessarily. A yearly stool test (FIT) is one of several accepted options. A colonoscopy is needed if a stool test is abnormal. Your doctor can help you choose.
Why do I get more heartburn now than I used to?
Cleveland Clinic explains that the muscle valve at the top of the stomach can weaken with age, and weight gain, some medicines and hiatal hernia add to the risk. See a doctor if you have heartburn most days.
Can I suddenly become lactose intolerant in my 40s?
It can feel sudden. NIDDK notes that in people with lactase nonpersistence, lactase levels get lower with age, so dairy you once tolerated may start to cause gas or bloating.
Should I take a digestive enzyme supplement after 40?
It is not necessary for everyone. It may be worth trying if particular foods cause gas or discomfort. Speak to your pharmacist, especially if you take other medicines.
Do I need a vitamin B12 test?
Ask your doctor if you are over 50, take long-term acid-reducing medicine or metformin, or eat few animal foods. These groups are more likely to absorb less B12.
Sources
- US Preventive Services Task Force: Colorectal Cancer: Screening (final recommendation, 2021)
- American Cancer Society: Colorectal Cancer Guideline – How Often to Have Screening Tests (updated 2026)
- NIDDK: Definition & Facts for Constipation
- NIDDK: Symptoms & Causes of Constipation
- NIDDK: Eating, Diet, & Nutrition for Constipation
- NIDDK: Definition & Facts for Diverticulosis & Diverticulitis
- NIDDK: Symptoms & Causes of Lactose Intolerance
- NIDDK: Eating, Diet, & Nutrition for Lactose Intolerance
- NIDDK: Symptoms & Causes of Peptic Ulcers (Stomach Ulcers)
- NIH Office of Dietary Supplements: Vitamin B12 – Fact Sheet for Consumers
- Cleveland Clinic: Why Does Heartburn Get Worse as You Age?
- NHS: Heartburn and acid reflux
- NHS: Constipation
- NHS: Bloating
- NHS: Flatulence
