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Paging Dr. Frischer - Diverticulosis
WRITTEN BY :   Dr. Alan Frischer

Are you over 60? If so, there’s a one in three chance that you have this condition. It affects a whopping four out of five people who are over 80! This is an ailment that we should all be familiar with.
Diverticulosis occurs when the outer layer of the large intestine weakens and gives way in many places, leading to the inner lining bulging outward and forming pouches or sacs. Imagine the inner tube on a bike that protrudes out through holes on the walls of a worn out tire. In 10 to 25% of cases the pouches rupture, or become inflamed or infected. This is known as diverticulitis. It mainly affects the sigmoid colon (the part of the large intestine on the left side of the abdomen, leading to the rectum).
Diverticulosis doesn’t usually display symptoms. When it flares into diverticulitis, however, there is a sudden onset of unrelenting pain in the left lower abdomen, fever, and diarrhea or constipation (or even both, on an alternating basis!). It is the most common cause of lower intestinal bleeding, but the bleeding generally resolves in time with treatment.
To diagnose this condition, most doctors will order a CT scan of the abdomen, and a blood test to look for an increased white blood cell count, an indication of an infection.
The treatment is straightforward. In mild cases it can be treated at home with a clear liquid diet, antibiotics, and pain medication. In more severe cases, hospitalization is required for complete bowel rest, intravenous antibiotics, and pain medication. On rare occasions surgery may be necessary to remove a portion of the large intestine.
The actual cause of diverticulosis remains controversial. It is clear that the strength of the colon wall diminishes with age, and may be a factor. Beyond that, there are two main schools of thought in the literature:
•In one camp are researchers who believe sitting on toilets (vs. squatting) while having a bowel movement results in more strain on the bowels. The idea is that when bowels are subjected to lifelong excessive pressure, the result can be protrusions through the bowel wall.
•Others note that diverticulosis became a significant disease in the United States during the early 1900′s, when processed foods were introduced to the American diet. To this day, it is commonly found in countries where dietary fiber has been replaced with processed carbohydrates. Diverticular disease is rare in many African and Asian countries where the typical diet contains abundant natural fiber. Therefore, a lack of sufficient dietary fiber could well be the cause of diverticulosis.
It is fair to say that this issue is not resolved, so I am going to hedge my bets and suggest that it is likely a combination of factors! Do note that there are many excellent reasons to consume more fiber in the diet. Eat fruits, vegetables and whole grains, which will provide necessary bulk, lead to larger stool size, and less straining.
Another controversy involves seeds, nuts and popcorn. People with diverticular disease are typically instructed to avoid eating these foods to avoid painful attacks. However, the most recent study through the University of Washington, involving 47,000 men, found that they did not appear to increase the risk of diverticular disease.
These newest findings, however, haven’t yet changed my own recommendations to patients. The jury is still out – perhaps those of you with diverticular disease should experiment for yourself and see whether avoiding these foods makes a difference. Let me know what you discover!
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: September 08, 2011 – Volume 10 – Issue 21



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