A diverticular disease diet is a diet that increases dietary fiber to recommended levels.
Diverticulosis is a condition characterized by small pouches (diverticula) that form and push outward through weak spots in the large intestine. Once diverticula have formed, there is no way to reverse the process. When diverticula become infected, the condition is called diverticulitis. Most people with diverticulosis do not experience symptoms. As for diverticulitis, the most common symptom is abdominal pain with tenderness around the left side of the lower abdomen. Fever, nausea, vomiting, chills, cramping, and constipation may occur as well. Diverticular disease is common in industrialized countries, especially in the United States, Canada, the United Kingdom, and Australia. It affects about 50% of Americans by age 60 and nearly all by age 80. A low-fiber diet is believed to be the main cause of the disease. It was first described in the United States in the early 1900s, at the time when processed foods were introduced into the American diet, many of which contained refined flour. Unlike whole-wheat flour, refined flour has no wheat bran and is accordingly a low-fiber food. The prevalence of the disease in industrialized countries seems to confirm the connection of diverticular disease with a low-fiber diet, since it occurs rarely in Asia or Africa, where people eat highfiber, vegetable-based diets.
There are several types of dietary fiber, which makes it easy to include it in the diet:
To help increase dietary fiber in the diet, breakfast could include a bowl of porridge made with millet, oats, or brown rice; toast made with whole-grain bread instead of white bread; whole-grain ready-to-eat cereals with milk; or a bowl of fruit instead of fruit juice. During the day, snacks can include fresh fruit; dried fruits like raisins, prunes, dates, apricots; or a few whole-grain crackers. In meals, brown rice should replace white rice. Pasta dishes should include more vegetables and fruit to increase the fiber content of the meal. Serve fruit after meals instead of a dessert. Vegetables should also be eaten at each meal. Sandwiches should be made with whole-grain bread and include vegetables.
Besides adding fiber foods to a diverticular disease diet, the health practitioner may also prescribe a fiber supplement such as Citrucel or Metamucil once a day. These products supply 2–3.5 grams of fiber per tablespoon, mixed with 8 ounces of water. In the past, some physicians have recommended avoiding nuts, popcorn, and sunflower, pumpkin, caraway, and sesame seeds as they believed that particles of these foods could enter, block, or irritate the diverticula. However, no scientific evidence supports this opinion. The seeds in tomatoes, zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds, are generally considered harmless. An eating plan for diverticular disease is usually based on what works best for each person. To help the colon rest, the treating physician may also recommend bed rest and a liquid diet.
Fiber is the edible part of fruits, vegetables, and grains that the body cannot digest. Since they are not absorbed into the body, dietary fibers are not considered a nutrient. Some fiber dissolves easily in water and becomes soft in the intestines, while insoluble fiber passes almost unchanged through the intestines. Both kinds of fiber are required to make stools soft and easy to pass. Fiber also prevents constipation, which makes the bowel muscles strain to move stool that is too hard. This is believed to be the main cause of increased pressure in the colon that may cause the weak colon spots to bulge out and become diverticula.
Many plant foods contain both soluble and insoluble fibers. For example, psyllium husks contain a mixture of 70% soluble and 30% insoluble fibers. Despite the general use of the terms “soluble” and “insoluble” to describe the health benefits of dietary fiber, many nutrition experts are now using the terms “viscous” and “fermentable” to describe the functions and health benefits of dietary fiber. These include:
When increasing the fiber content of the diet, dietitians recommend adding fiber progressively, adding just a few grams at a time to allow the intestinal tract to adjust. Otherwise, abdominal cramps, gas, bloating, and diarrhea or constipation may result. Intake of dietary fiber exceeding 50 g per day may also lead to intestinal obstruction. Excessive intake of fiber can also cause a fluid imbalance, leading to dehydration. This is the reason that people who start increasing their fiber intake are often advised to also increase their water intake. Excessive intake of dietary fiber has been linked with reduced absorption of vitamins, minerals, proteins, and calories. However, it is unlikely that healthy people who consume fiber in amounts within the recommended ranges will have problems with nutrient absorption.
Parents are urged to use caution when adding extra fiber to their child's diet. Excessive amounts of high-fiber foods may cause a child to fill up quickly, reducing appetite and possibly depriving the child of needed nutrients from a well-balanced diet. Older adults and those who have had gastrointestinal surgery should also exercise caution when increasing their dietary fiber intake.
Most people recover fully after treatment for diverticular disease. If not treated however, diverticulitis can lead to the following serious conditions:
Most health practitioners agree that the lack of fiber and bulk in the diet is the major cause of diverticular disease. As foods are becoming more highly refined, more people are suffering from diverticular disease symptoms. Eating a high-fiber diet is accordingly the only requirement highly emphasized by the medical profession. Eliminating specific foods is not considered necessary as no research supports that it may improve the condition. A gradual switch to a diet with increased intake of soluble fiber (green vegetables, oat bran) usually leads to an improvement in bowel function. There is general agreement on food sources being more efficient fiber sources than supplements since they also supply additional nutrients. Excessive use of fiber supplements can also lead to acute digestive problems and blockages.
It is understood that as the body ages the outer layer of the intestinal wall thickens, which narrows the intestine. As a result, stool moves more slowly through the colon, increasing the pressure. Hard stools, such as those produced by a diet low in fiber, can further increase pressure. Repeated straining during bowel movements also increases pressure and contributes to formation of diverticula. As for the cause of diverticulitis, there is broad agreement that it occurs when diverticula become infected or inflamed, but medical experts do not know precisely what causes the infection. It is believed to start when stool or bacteria are caught in the diverticula.
The United States Food and Drug Administration (FDA) has approved the following claims about dietary fiber that can be listed on food labels:
See also Constipation ; Diarrhea diet ; Digestive diseases ; Fiber ; High-fiber diet .
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Academy of Nutrition and Dietetics, 120 South Riverside Plz., Ste. 2000, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, firstname.lastname@example.org, http://www.eatright.org .
Food and Nutrition Information Center, National Agricultural Library, 10301 Baltimore Ave., Rm. 105, Beltsville, MD, 20705, (301) 504-5414, Fax: (301) 504-6409, email@example.com, http://fnic.nal.usda.gov .
International Foundation for Functional Gastrointestinal Disorders, PO Box 170864, Milwaukee, WI, 53217-8076, (414) 964-1799, (888) 964-2001, Fax: (414) 964-7176, firstname.lastname@example.org, http://www.iffgd.org .
National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD, 20892–3570, (800) 891–5389, TTY: (866) 569–1162, Fax: (703) 738–4929, email@example.com, http://www.digestive.niddk.nih.gov .
Monique Laberge, PhD
Revised by David Newton