Posts Tagged ‘Fibre’

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…)

Diverticulitis: a wind of change

Sunday, December 2nd, 2012

There have been many changes over the years in the approach to diverticular disease (DD), even in the names used. Diverticular disease is the overall name. The presence of the grape-like diverticula on the outside of the colon results in a diagnosis of diverticulosis. Diverticulitis occurs when there is infection and inflammation of the diverticula but is often used when there are any symptoms caused by the disease.

Diverticulosis can have episodes of diverticulitis or complicated diverticulitis when problems such as bleeding, abscess, fistula or blockage need surgical treatment. This is a simplistic explanation of what might happen in DD in decreasing numbers, so that only a small fraction of people with DD ever need surgery. Any progression in the disease can stop and revert to symptomless diverticulosis at any time, some people with diverticulosis do not even know that they have it.

There has been confusion over many years about the symptoms with DD. (more…)

Diverticular Disease: Updated Epidemiology

Thursday, May 3rd, 2012

“Ideas, like living organisms, have their natural history, growing from conception through a more or less tumultuous adolescence and reproductive maturity to an old age, when they act as a bar to further progress. During this time they become so modified that their origin is obscured” Sir Richard Doll (1)

Looking at the occurrence of a disease in time and place, and assessing what might have influenced changes, is known as the science of epidemiology. The theory, that diverticular disease (DD) was caused by low levels of fibre in the diet, has been prominent for about 40 years. This was based on the rarity of DD in Uganda compared with Western countries such as Great Britain or the USA. It was assumed that high levels of fibre in the Ugandan diet protected people from DD and that an increase in dietary fibre would prevent DD and its symptoms would be eliminated. This was a conclusion too far. It ignored the rarity of DD in people eating very little fibre (2,3) and that vegetarians can get DD (4,5). There is no evidence that a high fibre diet prevents DD. The theory is so entrenched that if DD appears in a country then it is assumed that its inhabitants have changed from their normal to a low fibre western diet. This is particularly incongruous when applied to right-sided DD in the caecum and ascending colon. Even the theory’s originators thought low fibre levels could not be relevant to this area (6)

Data from post-mortems, mortality statistics and surveys can provide information on the occurrence of DD, each aspect contributing to the overall picture. Song et al. (7) showed how colonoscopy findings, over time, could plot a rising prevalence of DD in Korea. Jun and Stollman in 2002 (8) collected results from research papers on the % of patients with DD in series of examinations by colonoscopy or barium enema Xray. They used these results to show that changes in the prevalence of DD varied greatly in time and between countries. Searching through later research reports mainly in the PubMed website gives this type of information for many more countries. (References to these sources are too numerous to include here). The results fall into 4 distinct patterns of when DD appeared and how numbers have changed over time until 2010. (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…)

Keeping Moving

Thursday, August 26th, 2010

  African schoolchildren 33 English schoolboys 70

 This is not the result of a rugby match but the start of the revolution in the treatment of diverticular disease (DD) in the 1970s. The figures are the average times in hours for food to pass through the digestive system (1) a measurement known as ‘transit time’ The difference in the two figures was attributed to the amount of fibre in the children’s diets. Researchers then tested this theory in adults, for example, adding fibre to a standard diet of five healthy young men reduced the mean transit time from 2.4 days to 1.6 days(2). People with DD had very little fibre in their diets and long transit times (3) (this was the medical treatment at the time so this finding was not surprising) Thus the fibre theory of cause, prevention and treatment of DD was born and dietary fibre has become an institution which has spread throughout medical research. As Dr le Fanu pointed out (4) it has never been demonstrated that those who get diseases eat more or less fibre than those who don’t, nor has it been demonstrated that eating more fibre will prevent diseases.

 There is another way of reducing transit time. (more…)

Getting Personal With Diet

Friday, August 20th, 2010

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? (more…)

What is Diverticular Disease

Thursday, August 5th, 2010

What is diverticular disease

 The large bowel becomes deformed in diverticular disease. The muscles appear to be permanently contracted so that the colon can be shortened and more corrugated. The bowel wall becomes ruptured particularly next to it’s blood vessels and pressure forces the inner layers to protrude through the wall to produce the characteristic grape-like pouches on the outside of the colon. There can be few of these pouches – called diverticula – or the whole colon can be affected. Similarly there can be a wide range of symptoms, but nobody knows how to stop the possible progression of the disease from symptomless, to a chronic, debilitating and recurring syndrome and on to life-threatening complications. Death rates in this country started at nil and have risen throughout the 20th century. With any other complaint, this statistic alone would prompt an outcry for research into causes, prevention and treatment. (more…)