Posts Tagged ‘Constipation’

Diverticular Disease: The Fibre Story

Thursday, September 14th, 2017

In the early part of the 20th century constipation was not generally related to any individual illness. The idealised achievement of daily defaecation meant constipation was common particularly in the elderly. Treatment was not free until the NHS came along and natural and herbal laxatives were well used medications. Diverticular disease (DD) became recognised more before WW11. The distinguishing symptoms were pain, fever and diarrhoea. A low residue diet was recommended to reduce diarrhoea and give the bowel rest. Serious pain sometimes resulted in surgery. Infection and inflammation (diverticulitis) were not always present but pieces of food and faeces were trapped in diverticula. Avoidance of coarse fruit and vegetables, seeds and pips was recommended.

Hospital diet sheet for diverticulitis 1961………”forbidden foods – all fried foods, pips and skins of fruits, pastry, suet puddings, coarse stalky vegetables, salads, onions and celery, chunky marmalade, jam with pips or skins, wholemeal or brown bread, coarse biscuits-Ryvita, digestive, Allbran, oatmeal, Weetabix, Shredded Wheat, fruitcake or scones, nuts, dried fruit.”

A significant change in diet started about 1970 when treatment for diverticular disease (DD) was suddenly reversed.

Hospital diet sheet for diverticulis 1982………..”you can eat a normal varied diet but include…… (all of the forbidden foods from 1961 except fried food)….SUPPLEMENT meals with 2 teaspoonfuls of unprocessed bran twice daily. EAT LESS white flour in any form and white and other sugars. DIETARY FIBRE ….by helping to restore normal function of the digestive tract, fibre can be useful in the treatment of constipation and diarrhoea”

  • Who persuaded health professionals that wheat bran was good for diarrhoea?
  • What was the evidence for this complete reversal of treatment?
  • Did anyone ask patients if this helped them?
  • Who was behind this change?

(more…)

Diet and Fibre: A Wind of Change

Sunday, March 3rd, 2013

The theory that diverticular disease (DD) was caused by insufficient fibre in the diet was proposed about 40 years ago. Many websites, books and health professional reviews still persist in the recommendation that dietary fibre levels should be increased up to 30g or more per day (1,2). Some still suggest the use of added wheat bran which was found to cause problems some time ago. A wind of change is blowing through DD from a new generation of researchers and editors not afraid to point out the lack of evidence and shortcomings of the fibre theory. For example, Peery et al. (3) found that a high fibre diet with increased frequency of bowel movement was associated with a greater prevalence of diverticulosis. Low levels of dietary fibre do not cause DD (4) and increased fibre levels do not prevent diverticulitis (5).

Extra fibre merely adds to the problem (more…)

Colon Wall Muscles in Diverticular Disease

Sunday, September 2nd, 2012

MUSCLE LAYERS

Between the mucus producing lining and the outer layer of the colon wall, there are two major muscle systems. The inner circular muscles surround the colon, contraction can close the colon or they can act in waves to propel contents along. Between the appendix at the beginning and the rectum at the end of the colon, longitudinal muscles are gathered into three bands known as taenia. This arrangement allows contractions to shorten the colon and propel faeces without compressing them. Coordination between the two types of muscle can produce a variety of movements. An earthworm moving along soil is a good example to observe a similar system.

MOVEMENTS ALONG THE COLON

In the caecum, repeated circular muscle contractions mix the liquid contents (chyme). These change into backwards and forwards segmenting and propulsive movements to dry and move the mushy contents along the ascending and transverse lengths of the colon. Longitudinal muscles become more involved as faeces become more solid in the second, left side, of the colon. Occasional powerful contractions sweep faeces into the descending and sigmoid areas. Faeces are stored with the sigmoid area acting as a vertical warehouse with supporting arcs of circular muscle. Strong contractions of longitudinal muscles produce a concertina effect to push out colon contents on defaecation. The first half of the colon is controlled automatically by the vagus nerve from the brain. The left side has some local nerve reflexes and a person can have some influence such as when to defaecate.

CHANGES WITH DIVERTICULAR DISEASE

Changes in the colon musculature in diverticular disease (DD) were described even before the early 20th century when DD was rare, (1) and in many reports since. Muscle abnormality and dysfunction persisted in the colon after resection of the areas with diverticula (2). Long sections of the left colon can change in appearance without any diverticula which may only occur years later. The muscular abnormalities are the primary pathogenic mechanisms of DD (3). DD is only diagnosed when diverticula are observed, changes in muscles have had little attention especially in areas without diverticula. (more…)

Animal, Human and Fibre Trials

Wednesday, January 25th, 2012

Animals do get diverticula and hence ‘diverticulosis’. Like mankind, such diverticula can be found in several organs such as oesophagus, ureter, bladder, jejunum or small intestine. This condition is rarely encountered in veterinary gastroenterology (1), there are only occasional case reports. Animals do not get the kind of colon diverticular disease (DD) that began to increase in humans in the western world from the beginning of the 20th century. Questions about human DD were inevitably directed towards diet. What changed around the 1900s and would a human diet produce colon DD in animals? (more…)

A look at the fibre theory

Thursday, August 11th, 2011

Diet sheets, recipes and menus are frequently requested by people newly diagnosed with DD but there is great variation in which foods help or cause problems for different people. A strict diet is not needed other than one which has plenty of variety and fluids, and conforms to the healthy diet currently recommended for everyone. Anything which is found to cause problems should be avoided, or reduced in amount or frequency but not to the extent that diet becomes restricted. People have different tastes and food should be enjoyed.

AFRICAN DIETS

DD patients, new and old, will find that many resources recommend a diet high in fibre, some to the extent that fibre needs to be doubled in quantity with the aid of wheat bran. The fibre and bran treatment for DD started about 1970 when some doctors working in Uganda (1) found no cases of DD and attributed this to the large amount of fibre in the diet. As Mr Hutchinson described in the last Incontact magazine, too much fibre can have its own adverse effects (very high incidence of sigmoid volvulus). Was this evidence from Uganda sufficient to conclude that a low fibre diet was the cause of DD and increasing dietary fibre, and bran in particular, would both prevent and treat DD? (more…)

Migraine, the gut and diverticular disease

Tuesday, September 14th, 2010

MIGRAINE AND GUT MALFUNCTION

What has migraine got to do with diverticular disease?”

That was the occasional response when DD sufferers were asked in a survey if they or any blood relative have/did have migraine. However, 42% of females and 29% of males had migraine themselves or a blood relative did. Some noted that they ‘used to have’ migraine. These figures are far higher than the 10% or so incidence of migraine expected at retirement ages. A survey of migraine sufferers in Ireland found that 51% had also been diagnosed with IBS. A survey of people with IBS found a 60% greater prevalence of migraine than in non-IBS controls (1). There was a frequent association between headache, including migraine, and gastrointestinal symptoms (acid reflux, diarrhoea, constipation and nausea) in a Norwegian report (2).

Patients who did not respond to a high fibre diet, who had a single, intermittent abdominal pain were investigated in Leeds (3). Symptoms and family history suggested that 49% of them might have abdominal migraine and 32% of these had typical migraine symptoms during the attack. Mulak (4) noted that migraine and IBS often coexist. (more…)

What is Constipation, Diarrhoea and Normal

Thursday, August 12th, 2010

 

Scientists desperately try to put values on body functions to measure and classify symptoms. This enables statistical comparisons to evaluate the effects of diseases and treatments. Defaecation is a good example of this and also of the influence of history, fashions and personal opinions. (more…)