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Diverticulosis is a condition in which small, bulging pouches (diverticuli) form inside the lower part of the intestine, usually in the colon. Constipation and. Diverticular disease refers to symptomatic and asymptomatic disease with an underlying pathology of colonic diverticula. Predisposing factors for the formation of. Diverticular disease of the colon is an important cause of hospital admissions and a significant contributor to healthcare costs in Western and industrialized.
Diverticular disease of the colon. Many health- conscious men can recite their cholesterol counts, blood pressure readings, and PSA levels without even glancing at their medical records.
But few of these well- informed gents can tell you if they have diverticular disease of the colon, even though it's an extremely common condition. That's understandable, since the most prevalent form of the problem, diverticulosis, produces few if any symptoms.
Still, when complications develop, blissful ignorance about diverticulosis abruptly gives way to an unwelcome education about the pain of diverticulitis or the bleeding of diverticulosis. It's a learning experience that's particularly unfortunate, since diverticular disease is largely preventable. Your colon. The colon is a 4 1/2- foot- long tube that constitutes the final portion of the intestinal tract.
Read about the three types of diverticular disease, including diverticulosis, diverticulitis, and diverticular bleeding. BootsWebMD explains what a correct diverticulitis diet is, foods to eat and foods to avoid with diverticulitis and how to prepare meals when you have this condition. Dissolution of the struvite stones depends on acidification of the urine through diet or urinary acidifiers. Special diets for dissolution also have reduced protein. Once considered off-limits, nuts and seeds can be part of a diet to reduce the risk of diverticulitis. What is diverticulitis? What causes diverticula and how do diverticula form?
The food you eat is mostly digested in the stomach and small intestine. Residual material enters the colon, or large intestine, in the cecum, which lies in the right lower portion of the abdomen (see Figure 1). From there, digested material travels up the ascending colon, across the transverse colon, and down the descending colon to the final portion, the sigmoid colon, in the lower left part of the abdomen. The intestinal contents take about 1. When healthy, the colon is a smooth cylinder lined by a layer of epithelial cells.
The wall of the colon contains two groups of muscles, a circular muscle that rings the colon and three long muscles that run the entire length of the tube. Like all tissues, the colon requires a supply of blood; in part, it's provided by the many small penetrating arteries that pass through the colon's muscular wall to carry blood to its inner layer of epithelial cells. Figure 1: The colon. Diverticular disease. Most folks who think about the colon worry about the polyps and cancers that may develop from epithelial cells. But problems can also develop in other areas.
Diverticula are sac- like pouches that protrude from the normally smooth muscular layer of the colon (see Figure 2). They tend to develop where the muscles are weakest, at the places where penetrating vessels cross through the muscles. And in Western societies, the great majority of diverticula develop where the colon is narrowest, in the sigmoid. Figure 2: Diverticulosis. Who gets diverticulosis — and why?
Age is a major risk factor. Diverticulosis is uncommon before age 4. Americans will develop the condition by age 6. That makes diverticulosis one of the most common medical conditions in the United States. It wasn't always this way. Diverticulosis was uncommon in the United States 1. What accounts for the difference?
The principal factor is diet, especially the refinement of carbohydrates, which has deprived the typical American diet of much of its fiber content. Diverticulosis is a disease of Western civilization. Dietary fiber is a mix of complex carbohydrates found in the bran of whole grains and in nuts, seeds, fruits, legumes, and vegetables, but not in any animal foods. Because humans cannot digest these complex carbohydrates, dietary fiber has little caloric value — but it has plenty of health value.
Among other things, the insoluble fiber found in wheat bran, whole- grain products, and most vegetables (see table) draws water into the feces, making the stools bulkier, softer, and easier to pass. Dietary fiber speeds the process of elimination, greatly reducing the likelihood of constipation. Some sources of dietary fiber. Food. Serving size. Fiber content(to nearest gram)Cereals.
Fiber Onecup. 14. All Brancup. 10. Shredded Wheat. Oatmeal. 1 cup (cooked)4. Grains. Barley. 1 cup (cooked)6. Brown rice. 1 cup (cooked)4. Baked goods. Rye Krisp.
Bran muffin. 13. Whole- wheat bread. Legumes. Baked beans. Kidney beanscup (cooked)7.
Lima beanscup (cooked)7. Vegetables. Spinach. Broccolicup. 3Brussels sproutscup. Carrot. 1 medium. Tomato. 1 medium.
String beanscup. 2Fruit. Pear (with skin)1 medium. Apple (with skin)1 medium. Banana. 1 medium. Dried fruits. Prunes. Raisinscup. 1Nuts and seeds.
Peanuts. 10 nuts. Popcorn. 1 cup. 1Supplements. Wheat bran (crude)1 ounce. Wheat germ. 1 ounce. Psyllium. 1 tsp. But constipation is the least of the problems. Without enough fiber, the stools are small and hard, and the colon must contract with extra force to expel them.
That puts extra pressure on the wall of the colon — and, as you may remember from Physics 1. Law of La. Place explains that the pressure in a tube is highest where the diameter is smallest. In the colon, that's the narrow sigmoid.
A Harvard study of 4. Men who consumed the most fiber were 4. And the protective effect of fiber remained strong after the scientists took age, physical activity, and dietary fat into account. Over time, a low- fiber diet increases the risk for diverticulosis and its complications.
Because connective tissues tend to weaken over the years, age itself may compound the effect of diet. Other possible risk factors include a high consumption of fat and red meat, obesity, cigarette smoking, and the use of nonsteroidal anti- inflammatory drugs.
On the other hand, a Harvard study found that regular physical activity appears to reduce risk by up to 3. Why worry? Diverticulosis is so common in Americans that it may hardly seem like a disease. Indeed, about 7. 5% of men with the condition never develop serious problems from it, though some of them have occasional abdominal cramps that may or may not stem from diverticulosis. But some 1. 5% to 2. In all, diverticular disease of the colon accounts for 3,4.
United States each year while draining our economy of over $2. That's quite a toll for a disease you may never have heard of. Diverticulitis: Symptoms. Inflammation puts the . The bacteria that are packed into feces by the hundreds of millions are responsible for the inflammation, but doctors don't fully understand why some diverticula become infected and inflamed while many do not.
A current theory holds that the wall of the diverticular sac becomes eroded by pressure, trapped fecal material, or both. If the damage is severe enough, a tiny perforation develops in the wall of the sac, allowing bacteria to infect the surrounding tissues. In most cases, the body's immune system is able to contain the infection, confining it to a small area on the outside of the colon. In other cases, though, the infection enlarges to become a larger abscess, or it extends to the entire lining of the abdomen, a critical complication called peritonitis. Pain is the major symptom. Because diverticulosis typically occurs in the sigmoid colon, the pain is usually most pronounced in the lower left part of the abdomen, but other areas may be involved. Fever is also very common, sometimes accompanied by chills.
If the inflamed sigmoid is up against the bladder, a man may develop enough urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder infection. Other symptoms may include nausea, loss of appetite, and fatigue. Some patients have constipation, others diarrhea. Diverticulitis: Diagnosis. A physician's exam may reveal tenderness over the inflamed tissues, typically in the lower left abdomen; less often, the doctor may feel swelling.
As in other infections, the white blood cell counts are usually elevated. But because these findings are non- specific, further testing is required to establish the diagnosis. The best test is a CT scan of the abdomen, ideally performed after the patient receives contrast material both by mouth and intravenously. And a month or two later, after treatment has quieted things down, the patient should have a colonoscopy, both to evaluate the diverticular disease and to be sure that no other abnormalities are lurking. Diverticulitis: Therapy. Since bacteria are responsible for the inflammation, antibiotics are the cornerstone of treatment.
And because the colon harbors so many bacterial species, doctors must prescribe treatment that will target a broad range of bacteria, including Bacteroides and other anaerobic bacteria that grow best without oxygen, as well as E. A common approach is to prescribe metronidazole (Flagyl, generic) for the anaerobes along with ciprofloxacin (Cipro, generic) or trimethoprim- sulfamethoxazole (Bactrim, generic) for the aerobes.
Amoxicillin–clavulanic acid (Augmentin) is effective against both types of bacteria and is a good alternative. Needless to say, there are many variations on the theme, and doctors must always take their patients' allergies and general health into consideration when they prescribe antibiotics. Patients with mild- to- moderate diverticulitis can take their antibiotics in pill form at home, but patients with severe inflammation or complications (see below) should receive intravenous (IV) antibiotics in the hospital, and then finish up with pills at home. In most cases, seven to 1. Bowel rest is also important for acute diverticulitis. For home treatment, that means sticking to a diet of clear liquids for a few days, then gradually adding soft solids and moving to a more normal diet over a week or two. Intravenous fluids can sustain hospitalized patients until they are well enough to switch to clear liquids en route to a full diet.
Because diverticulitis tends to recur, prevention is always part of the treatment plan. And for men with any form of colonic diverticular disease, that means a high- fiber diet. Diverticulitis: Complications. Ordinary diverticulitis is bad enough, but its complications can be life- threatening. The most common complications include: Abscess formation. An abscess is a walled- off collection of bacteria and white blood cells — pus. Diverticulitis always involves bacteria and inflammation, but if the body can't confine the process to the wall of the colon immediately adjacent to the perforated diverticulum, a larger abscess forms.
Patients with abscesses tend to be sicker than those with uncomplicated diverticulitis, and they have higher temperatures, more pain, and higher white blood cell counts.
Diverticular disease and diverticulitis - Prevention. Preventing diverticular disease and diverticulitis Eating a high- fibre diet may help prevent diverticular disease, and should improve your symptoms. Your diet should be balanced and include at least five portions of fruit and vegetables a day, plus whole grains. Adults should aim to eat 1.
Your GP can provide a more specific target, based on your individual height and weight. It's recommended that you gradually increase your fibre intake over the course of a few weeks. This will help prevent side effects associated with a high- fibre diet, such as bloating and flatulence (wind). Drinking plenty of fluids will also help prevent side effects. If you have established diverticular disease, it may be suggested that you avoid eating nuts, corn and seeds due to the possibility that they could block the diverticular openings and cause diverticulitis.
People usually find out themselves if these foods cause symptoms. Probiotics have also been recommended, but evidence is lacking. Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease. Sources of fibre. Good sources of fibre includefruit vegetables nuts breakfast cereals – but check fibre content as some are very low starchy foods – such as brown bread, rice and pasta Once you have reached your fibre target, stick to it for the rest of your life, if possible. More detailed information on sources of fibre is provided below.
Fresh fruit. Good sources of fibre in fresh fruit (plus the amount of fibre that is found in typical portions) include: avocado pear – a medium- sized avocado pear contains 4. Dried fruit. Good sources of fibre in dried fruit (plus the amount of fibre found in typical portions) include: apricots – three whole apricots contain 5g of fibre prunes – three whole prunes contain 4.
Vegetables. Good sources of fibre in vegetables (plus the amount of fibre found in typical portions) include: baked beans (in tomato sauce) – a half can of baked beans (2. French beans (boiled) – four heaped tablespoons of French beans contain 3. Brussel sprouts (boiled) – eight Brussel sprouts contain 2. Spring greens contain 2. Nuts. Good sources of fibre in nuts (plus the amount of fibre found in typical portions) include: almonds – 2. Brazil nuts – 1. 0 Brazil nuts contain 1.
Breakfast cereals. Good sources of fibre in breakfast cereals (plus the amount of fibre found in typical portions) include: All- Bran – a medium- sized bowl of All- Bran contains 9. Shredded Wheat – two pieces of Shredded wheat contain 4.
Bran Flakes – one medium- sized bowl of Bran flakes contains 3. Weetabix – two Weetabix contain 3. Note – the . Starchy foods. Good sources of fibre in starchy food (plus the amount found in typical portions) include: crispbread – four crispbreads contain 4. Fibre supplements – usually in the form of sachets of powder you mix with water – are also available from pharmacists and health food shops. Some contain sweetener.
A tablespoon of fibre supplement contains around 2. If you require long- term fibre supplements, your GP can prescribe them.
Eating too much saturated fat can cause raised cholesterol. Follow these practical tips on how to cut down. Page last reviewed: 2. Next review due: 2.