Too little fibre hurts

It's a fact of life: the modern, westernised diet of chips, crisps and Big Macs provides a lot less fibre than the diet of the 1950s.

While this has many disadvantages, a condition called diverticulitis is one of the more serious "side effects".

Are you heading for this disease? Get the lowdown here.

What it is
Diverticulitis is a condition where little pouches, or "diverticuli", are formed in the digestive tract.

These diverticuli can occur in any part of the digestive tract, but are much more common in the large intestine and sigmoid colon.

It's believed that the pouches are formed due to increased intracolonic pressure, when the muscles of the intestine and colon are overworked in trying to push hard, dry, impacted faeces through the intestine and bowel (Garrow et al, 2000).

The dry, hard and impacted stools are attributed to lack of fibre in the diet over long periods.

A common complaint
Diverticulitis is a relatively common complaint, but up to 80% of patients may never experience any symptoms.

This disease is rare in individuals younger than 40, but can occur in up to 30% of people older than 50 years, 50% of those older than 70 years and 66% in persons older than 85 years (Krause, 2000).

Diverticulitis occurs primarily in western, industrialised societies where fibre intake is low. It is relatively rare in populations eating a high-fibre diet, but as these populations become urbanised and start eating a western, low-fibre diet, the incidence increases significantly (Garrow et al, 2000).

Krause (2000) points out that even domestic animals in western societies have started to develop diverticulitis and its attendant symptoms due to the decrease in fibre in the animals' diets.

Symptoms and complications
As mentioned above, most people with diverticulitis won't even be aware of their condition. However, some patients develop pain on the left side of the abdomen, and notice that their bowel habits change.

Five percent of patients may develop complications that include inflammation, abscess formation (the little pouches become inflamed and sore), perforation (this occurs when one of the pouches ruptures), acute bleeding, obstruction and sepsis.

Generally, about 30% of patients with diverticulitis require hospitalisation and surgery and up to 10% of patients undergoing surgery for diverticulitis complications may die. (Garrow et al, 2000; Krause, 2000.)

It's a serious disease that needs to be treated actively to prevent complications.

A change in treatment
Until the 1960s, dietary treatment of diverticulitis consisted of "resting the bowel" and following a low-fibre diet that didn't contain any roughage, seeds, skins or pips.

However, when scientists observed that the incidence of diverticulitis increased as dietary fibre intake decreased in western societies, a certain Dr Neil Stamford Painter suggested that it was the lack of dietary fibre that was responsible for the disease (Garrow et al, 2000).

Since Painter's revolutionary study in 1972, in which he gave his patients wheat bran to increase their dietary fibre intake and improved their symptoms dramatically, the dietary treatment of diverticulitis has been based on increasing the fibre content of the diet (Garrow et al, 2000).

Krause (2000) reports that, in another study, up to 90% of patients following a high-fibre diet were free of symptoms for five years.

Current treatment options
Antispasmodic medication can help to relieve pain and when infections occur in the tiny pouches, antibiotics may be prescribed. Severe complications may require surgery.

Always see your doctor immediately if your diverticulitis flares up, if your bowel habits change or if you pass blood in your stools.

If you suffer from this condition, you should increase your fibre intake. This may prove difficult if you've been following a low-fibre diet for most of your life. Use the diet outlined below and/or add wheat bran (which you can get from your local health shop) to your breakfast cereal. Wheat bran is more efficient than other types of bran in providing bulk to the stools.

It's important to increase your fibre intake gradually, as you may develop bloating and gas for the first few weeks. As your digestive system gets used to the high-fibre diet, however, these symptoms should disappear.

If you start using digestive bran, use only 1 teaspoon per day for a few days to a week, then add another teaspoon for a few days, and continue adding wheat bran in these small quantities until you achieve the desired effect of soft stools. It's generally not advisable to exceed a dose of 2 tablespoons of wheat bran on a daily basis.

Remember to drink an additional 4 cups of water a day when you follow a high-fibre diet, so that the fibre can swell up and do its job.

Probiotics or 'good microorganisms' may also help to improve bowel movements. You can buy probiotics such as Bifidoforte or Bifidoflora or LP 299V at most chemists and health shops. Use the probiotics as prescribed in the package insert.

Basic high-fibre diet

Fruit (1) or fruit juice (1/2 cup); high-fibre cereal such as All-Bran or muesli (1/2 cup) with fat-free milk or yoghurt (1/2 cup); wholewheat or rye bread with chunky marmalade; hot beverage with fat-free milk.

Plenty of chopped fresh vegetables, raw or cooked or made into a soup (1 cup); wholewheat or rye bread sandwich (2 slices) filled with raw vegetables and fat-free cottage cheese, boiled egg, lean meat, or fish; hot beverage with fat-free milk.

Lean meat or fish (60g); baked jacket potato (1) or brown rice (1/2 cup); cooked or raw vegetables and/or salad (1 cup); fresh fruit (one fruit or ½ cup of fruit salad) or cooked dried fruit (1/2 cup); hot beverage with fat-free milk.

Oatcakes, wholewheat biscuits, Provitas or Ryvitas (2) with hot beverage made with fat-free milk.

Add wheat bran to the breakfast cereal if you require more fibre, and vary the types of fruits, vegetables and high-fibre grains and breads you eat.

Note that this diet can also be used for people who suffer from constipation without diverticulitis. (Adapted from Passmore & Eastwood, 1986, p 633.)

Text copyright: Dr I.V. van Heerden, DietDoc
4 November 2007

(Passmore R & Eastwood, M A, 1986. Davidson & Passmore: Human Nutrition & Dietetics, 8th Ed. Churchill Livingstone, Edinburgh; Garrow JS et al, 2000. Human Nutrition & Dietetics, 10th Ed. Churchill Livingstone, Edinburgh; Krause's Food, Nutrition, & Diet Therapy, 10th Ed. Eds. L K Mahan & S Escott-Stump, 2000. WB Saunders Co, Philadelphia.)

Read more:
A-Z of abdominal pain
Any questions? Ask DietDoc

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