When somebody is diagnosed with a disease, after months of symptoms and tests, they quite reasonably expect that a treatment is available for their condition. For example, inhalers for asthma, nitrates for angina, drugs to control Parkinson’s disease symptoms or vitamin C for scurvy. 30 years ago diverticular disease (DD), like scurvy, was considered a deficiency disease which could be prevented and treated by increasing the amount of fibre in the diet with wheat bran. Diet sheets and recipes were handed out and, with a few existing bowel drugs for symptoms, the disease was sorted out. Nothing could be done about the diverticula once they had been formed, so a high fibre diet was and often still is the treatment on offer.
This is 2005, has anything changed since the 1970s?
Reviews show that the old trials of diets and drugs were not up to today’s standards and there is no clinical evidence to show that they work. Wheat bran has fallen out of favour – even a food supplement can have side-effects when used disproportionately. Wholegrain cereals are now recommended. People who have few or no problems with DD do not need different diets or recipes. They can follow the “5 portions a day of fruit and vegetables” currently promoted as a healthy diet for everyone. The importance of variety and plenty of fluids should be emphasised and food should be enjoyed.
Getting “personal” is perhaps the key to looking after DD by diet because the aim is to achieve “personal” comfort with bowel habits. The symptoms if DD can vary between none and serious complications. A person can have distinct painful attacks (not always due to infection), frequent minor problems, daily incapacitating pain, any variation of constipation/diarrhoea and any combination of these over time. It is not surprising that there is no universal diet, drug or complementary therapy that works for everybody or, indeed, the same individual over time, or could be demonstrated in a trial. It still makes sense to use dietary fibre as the first option to avoid constipation but not if there is infection and inflammation (diverticulitis) when the bowel needs rest.
When problems do occur, a lot of “personal” detective work is needed. A survey of over 200 people with DD showed that the main dietary offenders were
- GAS-PRODUCING VEGETABLES – sprouts, cabbage, onions
- FRUIT – citrus fruits and juices
- RICH AND SPICY FOODS – curry, Chinese
- FATTY FOODS – processed, chocolate, pastry
- DAIRY FOODS – milk, cream, yogurt, cheese
Some people could eat seeds and nuts, others could not. Different brands can have different effects e.g. if a probiotic drink also contains a soluble fibre. Reducing portion size and frequency, and finding alternatives may be the answer rather than having a restricted diet. Keeping a diary is a constructive way of sorting out what causes painful gas or diarrhoea, but also look for causes of constipation. Not all bowel upsets can be explained by diet and a diary may reveal other relevant circumstances, activities or occasions. The aim is to be able to avoid and predict problems and this gives less worry and stress, and a sense of control.
© Mary Griffiths 2005
Note This article appeared in the Autumn 2005 edition of Incontact magazine