IV. 7 Special groups: older adults, immunosuppressed, IBD, pregnancy

The principles of the DiffBiome course apply to everyone, but a few life situations call for special caution. In the next three days we review what to watch out for if you are older, if your immune system is weak, if you have inflammatory bowel disease, or if you are expecting a baby – and why it is worth keeping closer contact with your doctor in such cases.

Older age: more underlying conditions, a more cautious pace

If you are older, your recovery is just as realistic a goal as anyone else's – indeed, recurrent infection more often strikes the older age group, so the DiffBiome course can be especially helpful. The difference lies rather in the fact that in older age there are more often several conditions at once (heart, kidney, diabetes), and you often take several medications. This is not an obstacle, but a reason for your doctor to review the whole picture more thoroughly: which of your medications fits how with the course, and where caution is needed.

In practice this means that dehydration must be watched even more closely – in an older body, fluid deficit causes dizziness, weakness and confusion sooner [159]. Keep fluids at hand, drink regularly, and do not wait until you are thirsty. If you live alone, arrange with a relative to check on you daily during the course.

Two further considerations are particularly important in older age. The first is age-related fitness. Illness and bed rest accelerate muscle loss (sarcopenia) [158], which increases the risk of falls and fractures. That is precisely why exercise in older age is not about performance, but about preserving muscle strength and balance: a regular, safe daily walk, simple sit-to-stand exercises from a stable chair, and – if your doctor approves – light balance and resistance exercises. These should be accompanied by enough protein in the diet, because protein is the building material of muscle, and in older age it easily falls short. The goal is simple: to come out of the course not only symptom-free, but also strong and steady on your feet. In your home environment it is worth reducing fall hazards as well: good lighting, removing slippery rugs, a handrail in the bathroom.

The second is medication review. In older age polypharmacy is common – many medications taken in parallel – and among these there may be some that affect CDI risk or symptoms (for example acid-suppressing PPIs^[G] or motility-slowing agents). It is worth going through the full medication list thoroughly with your doctor once: which agent is still genuinely needed, and which can be safely dropped. This is not an independent decision, but a joint, conscious review – dropping every unnecessary agent is one more layer of protection for your flora.

A weakened immune system: heightened monitoring

If your immune system is for some reason weaker – for example because of post-transplant medications, chemotherapy, biological treatment or an underlying condition – the DiffBiome course can still be considered, but with closer medical monitoring. The reason for this is simple: a weaker immune system is less able to keep in check even those few bacteria that would cause no problem at all in a healthy body.

This does not mean that the course is dangerous for you – that is precisely why donor screening is extremely strict. Rather, it means that your doctor will check on you more often, watch more closely for fever and your general wellbeing, and act immediately at any unusual symptom. Your job at such times is not to play down any symptom, and to report every unusual sign – even if it seems mild.

IBD and pregnancy: limited data, a joint decision

If you have inflammatory bowel disease (Crohn's disease or ulcerative colitis), especially during an active flare, treatment may be started only with particular caution and under the guidance of your treating physician – the inflamed gut may react differently, and the symptoms are harder to separate. The situation is similar with pregnancy and breastfeeding: for these life situations limited data are available at present, so the decision should always be made together with your doctor, with an honest weighing of the expected benefits and the uncertainties. If any of these situations applies to you, do not treat this book as the decision-maker – the book helps you frame your questions, but you find the answer together with your doctor.

🍽️ Eating during these days

On the eating side, the theme of special groups also means a more cautious pace: the basic principle is the same – a varied, fibre-rich diet that feeds the engrafted flora – but the emphasis is on safety. In older age, fluid replacement and enough protein (to preserve muscle strength) are especially important; with a weakened immune system, IBD or pregnancy, it is worth introducing every new source cautiously, in small portions, and adjusting according to tolerance. The concrete eating task for the three days: drink regularly (not only when thirsty), pay attention to protein, and each day include the plant of the day in at least one meal, prepared gently.

For these days (79–81), the Plant Calendar (Appendix F) brings the sources dates (79), fresh figs (80) and poppy seeds (81). Dates and figs are fibre-rich, naturally sweet sources, and poppy seeds provide calcium and fibre. In the second half of the programme (roughly days 61–90), the goal is to sustain full plant diversity^[G] and fermentable fibre sources: varied fibre is food for the useful bacteria, from which short-chain fatty acids^[G] (including butyrate^[G]) form, and these in turn support the gut barrier and diversity. A diverse, stable flora is the basis of resilience – and this is useful for every age group and in every situation. If you do not tolerate one of the sources, or it causes bloating, leave it out and return to it later – for the special groups, this "more slowly, watching" principle applies to eating as well.

Why does this matter?

The special groups are not "exceptions" to recovery – it is precisely in their case that DiffBiome can bring the most benefit, since recurrent infection often hits them hardest. The key is that in these situations treatment is always a joint decision, with closer supervision: you report your symptoms honestly, and your doctor, seeing the whole picture, tailors the course to you. It is this partnership that makes the journey safe.

References

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Malnutrition and dehydration are widespread among older people, while obesity is a growing problem. This ESPEN guideline provides evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and treat malnutrition and dehydration. It also addresses whether — and when — weight-reducing interventions are appropriate in overweight or obese older adults. The practical message is to screen nutritional and hydration status routinely and to apply individualised interventions aimed at preserving function, mobility and quality of life.

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