DIVERTICULOSIS

Diverticulosis, otherwise known as pockets or pouches of the colon, is very common. You can access a full description of this condition at Diverticulosis. The condition is almost certainly caused by a low fiber intake over a lifetime. This results in high pressures in the colon, which very, very slowly, over many years, cause ballooning of tiny weak points in the colon wall resulting in diverticuli. When these pockets become infected, diverticulitis occurs, a painful and, at times, serious condition. Rural Africans who consume 50 or more grams of fiber a day over a lifetime do not get diverticulosis. Yet, they do when they eat a Western diet with low fiber. Low fiber intake can result in small, thin and/or hard pellet stools, which usually means high pressure within the colon. Again, this high pressure is what causes these pockets to balloon out forming diverticuli.

These are dietary recommendations for people with diverticulosis. However, specific advice will depend on the stage of diverticulosis. Is it early diverticulosis? Is it advanced with fixed changes in the colon? Are there symptoms? Or is it acute diverticulitis where the colon is recovering from infection around these pockets?

Stages of Diverticulosis

Diverticulitis – Diverticulitis means that one or more of these weak-walled diverticuli has become infected and inflamed. At this point, the physician will want to put the bowel and even the patient at rest. Early on, a diet consisting of clear liquids is often prescribed to ensure maximum bowel rest. As recovery proceeds, the diet is advanced to a Low Fiber Diet, progressing gradually to a High Fiber Diet when recovery is complete.

Quiet, early and moderate diverticulosis – This is where most people are. The physician may have discovered a few or a moderate number of diverticuli on colonoscopy as an incidental finding when screening for colon cancer. Because it is just mentioned in passing, not too much importance may be attached to it. This is a mistake, as now is the time that something can really be done. Remember, it is the increased pressures that the colon can exert within itself that causes diverticulosis. A bulky stool helps prevent this. Plant fiber, especially the insoluble fiber, is the best. These are the fibers that do not produce colon gas. The easiest to take are wheat bran, amaranth, barley and others as listed in Fiber Content of Foods.

Quiet but advanced, fixed and/or narrowed diverticulosis – In many older folks, the diverticulosis has become so severe that the colon, just above the rectum, becomes fixed, twisted or gnarled by fibrous tissue within the bowel wall. At this stage, the colon is less likely to be massaged back to its normal size. The dilemma here is that large stools can seldom be produced, as the only thing that can get through this narrowed portion of the colon is smaller, even pellet-like stool. Still, it is worth trying small doses of extra food fiber or supplements to see what can be accomplished.

Go to High Fiber Diet for full details. The goal is to increase the daily fiber to 20, 30 or even 40 grams per day. You do not want to do this all at once, and, especially with excessive amounts of soluble fiber as this fiber is the one that, if taken to excess, promotes the bacterial production of harmless colon gas and flatus.

Insoluble Fiber

This fiber, also known as roughage or bulk, does not dissolve in water but paradoxically hangs onto water in the large bowel. This creates a large, soft and bulky stool. It promotes regularity and seems to be associated with a reduced chance of getting colon polyps and colon cancer, as we believe cancer inciting agents are swept through the bowel in a more rapid manner. In addition, it may promote weight loss and it can enhance diabetic control. Foods that are high in insoluble fiber are:

• whole wheat bread and baked goods
• wheat bran
• whole grain breads
• vegetables and fruits, especially the skins
• peanuts
• Brazil nuts
• popcorn
• brown rice
• The section, Fiber Content of Foods, provides detailed information on the insoluble fiber content of many foods.

Soluble Fiber

This plant fiber does dissolve in water. In the colon, it provides food for the enormous number of bacteria that thrive there and, in so doing, provides many health benefits. Soluble fibers also promote regularity by increasing growth of the colon bacteria. Foods that are high in soluble fibers are:

• oats in any form – cereal, muffins, etc.
• apples, oranges, grapefruit, peaches, concord grapes
• prunes, pears, cranberries
• beans
• beets
• carrots
• sesame seeds
• psyllium found in dietary supplements and cereals

The section, Fiber Content of Foods, provides information on the soluble fiber content of many foods.

Nuts, Seeds and Popcorn

From time immemorial, physicians have been advising patients with diverticulosis to avoid these items. Didn’t it just make sense that these could get inside colon pockets, rattle around and injure the colon wall? It was just like dried seeds inside a gourd that you can hear rattling around when you shake it. I have never agreed with this. I have never heard a patient rattling after eating these things. Furthermore, all of these items become digested or totally sodden and soft by the time they reach the colon. Most important of all, they contain excellent amounts of fiber, which is exactly what the colon wants. So, I have always recommended nuts, seeds and popcorn for diverticulosis patients. Now, I have been supported in this recommendation by a 2007 study where a large number of diverticulosis patients who took these foods were matched against those who did not. You guessed it. The ones eating nuts, seeds and popcorn had less diverticulosis problems than those who did not.

Prebiotics

Prebiotics are the relatively newly discovered types of plant fiber that have been shown to promote beneficial changes in the colon. These are present in certain plant foods as well as in our prebiotic products. In diverticulosis, all the soluble fiber foods and supplements can be a healthy addition. However, if too much is taken, then excessive colon gas can occur. If it is trapped behind a narrowed diverticular colon, there may be cramps and bloating. The advice is to take these healthy fibers in small, but increasing amounts and see if symptoms develop.

Summary

Diverticulosis is a disorder of the Western diet which has occurred along with the ingestion of large amounts of animal products and small amounts of beneficial plant food and their beneficial fiber. At any stage, but particularly in the early one, increasing fiber intake will be very helpful. Reducing high pressure in the colon and a more regular, softer bowel pattern may be the observed benefit. The unseen one, in the long term, is the large number of positive health benefits that dietary fibers, especially the prebiotic ones, can confer on future health.

Author: Frank W. Jackson, M.D.