Frequently Asked Questions: Diverticulosis and Diverticulitis
Q. Why aren‘t doctors using your method to treat and prevent diverticular disease?
Because it isn‘t based on the kind of interventional therapy doctors traditionally perform, but on basic preventive principles available to anyone. Just as you don‘t need a prescription for a bar of soap to keep your hands germs-free, you don‘t need a doctor to prevent diverticular disease.
The sole objective of my method is to keep a person with a case of preexisting diverticulosis from turning into diverticulitis. Once that happens, it‘s too late for prevention, and you‘ll need a doctor. In an ideal world, after patching you up, doctors would suggest using this method to prevent a relapse. And as doctors learn more about it, some of them certainly will.
Q. Why does fiber seem to help some people with diverticular disease?
It doesn‘t. At best, fiber is a placebo. At worse, it‘s the main cause of diverticular disease. In between, it creates a false sense of security and postpones proper treatment, because fiber may temporarily reduce the symptoms of irregularity by increasing the size and weight of stools, and create the illusion that you‘re no longer constipated. It may also cause diarrhea or semi-soft stools, which, for a while, may clear out the content of an infected diverticulum.
When a person experiences mild diverticulitis, doctors invariably prescribe antibiotics, pain relievers, and anti-inflammatory drugs. The resulting remission results from medication therapy, and not from fiber.
Furthermore, patients with acute diverticulitis aren‘t placed on high-fiber diets to “relieve” it, but on a zero-fiber liquid diet, because gastric surgeons, who are called in to manage the treatment at this stage, are well aware of fiber‘s danger, and prohibit patients from taking it.
The conventional treatment may certainly save you from lethal infection, but not from inevitable relapse and surgery. As odd as it may sound, the standard treatment protocol recommends a high fiber diet for patients who have just recovered from acute diverticulitis (underline mine):
“For the patient who is not very ill, treatment at home is reasonable, with rest, a liquid diet, and oral antibiotics (cephalexin 250 mg qid [four times daily]). Symptoms usually subside rapidly. The patient gradually advances to a soft low-roughage diet and a daily psyllium seed preparation. A barium enema 2 wk later can confirm the diagnosis. After 1 mo [month], a high-roughage diet is resumed.”
THE MERCK MANUAL, Sec. 3, Ch. 33, Diverticular Disease
The key reason behind this oddball strategy is the simple fact that after this intense treatment with antibiotics, the patients‘ intestinal bacteria are wiped out, and they become constipated. A “high-roughage” diet creates the illusion that there is normality, but, alas, this treatment (antibiotics + fiber) is bound to cause diverticulitis again (and not just diverticulitis).
The 17th edition of The Merck Manual finally acknowledged antibiotics-associated colitis: an “acute inflammation of the colon caused by Clostridium difficile [pathogenic bacteria] and associated with antibiotic use.” (3:33:29).
After a certain amount of time this condition may turn into chronic ulcerative colitis, which increases the risk of colon cancer up to thirty-two times, and, according to The Merck Manual, “nearly 1/3 of patients with extensive ulcerative colitis require surgery” (3:33:31), which usually means colectomy (the complete removal of the colon).
Nonetheless, doctors follow this absurd treatment protocol because that‘s the protocol they were taught while in medical schools, and any other approach may trigger a malpractice lawsuit..
This practice is even stranger when you consider that patients are initially (and properly) advised to adopt a fiber-free liquid diet to heal their acute diverticular inflammation. But once the acute stage has passed, their health and recovery is put in jeopardy again by exactly the same fiber that caused their diverticulitis in the first place.
This is a systemic error that snuck its way into medical textbooks and still rules. My work on the adverse role of fiber in human nutrition and disease is the first substantial revision of this destructive doctrine and unhealthy practice.
Q. What are the most common misconceptions about fiber‘s role in diverticular disease?
The therapeutic and preventative role of fiber in diverticular disease is steeped in its own mythology. Let‘s review these myths, as detailed in the article entitled Diverticular Disease by the National Institutes of Health.
For starters, even the opening statement reveals that the beneficial role of fiber in the prevention and treatment of diverticular disease is just conjecture (a theory) without any proof:
“Although not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease.” [link]
Here are the other “dominant” falsehoods from the same source:
“The [diverticular] disease was first noticed in the United States in the early 1900s. At about the same time, processed foods were introduced into the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.”
Not true. The “disease was first noticed” in the early 1900s not because of dietary changes in the American diet, but because in 1895 Wilhelm Conrad Rötgen accidentally discovered X-rays. Before X-rays became commonplace, people were dying from undiagnosed and unknown internal diseases because there were no non-invasive diagnostic tools, no exploratory surgeries, and autopsies were extremely rare. Secondly, since diverticular disease affects primarily people over 50, dietary changes in the early 1900s wouldn‘t even show up in people until the late 1930s or early 1940s.
“Diverticular disease is common in developed or industrialized countries — particularly the United States, England, and Australia — where low-fiber diets are common.”
Not true. Also common in these countries is watching television, drinking beer, and driving a car. But just like any other conjecture, it doesn‘t mean these activities cause diverticular disease. Diverticular disease is more common in developed Western countries not because the traditional Western diet is low in fiber, but because of excessive consumption of fiber and fiber laxatives. If Westerners consumed even more fiber, the incidence of diverticular disease would be even higher, as described in the next myth.
“The [diverticular] disease is rare in countries such as Asia and Africa, where people eat high-fiber vegetable diets.”
Not true. (a) High-fiber diets are prevalent only among the poor and very poor, usually in rural areas; (b) poor people in these regions die well before the age commonly associated with diverticular disease in the West; (c) no reliable healthcare system exists in rural Africa and Asia to provide reliable and relevant health statistic regarding diverticular disease; (d) when Africans do have access to hospitals, doctors have concluded: “The study shows that the African colon has a number of pathological lesions contrary to previous reported literature.” (Ogutu EO, at al; Colonoscopic findings in Kenyan African patients; East Afr Med J. 1998 Sep;75(9):540-3); and (e) affluent Africans and Asians consume very little fiber — as is apparent to anyone who‘s ever visited an authentic Asian (Japanese, Chinese, Thai, Korean, Indian) or African (Moroccan, Ethiopian, Kenyan, South African) restaurant, where the dominant dishes are meat, fish, and sea food, and the side dishes are primarily white rice, whose fiber content is a just 0.4%.
“Both kinds of fiber help make stools soft and easy to pass,” which is good for diverticular disease.
Not true. Insoluble fiber is a bulking laxative. It makes stools large and hard to pass. That‘s why fiber is called “roughage.” Soluble fiber is a hyperosmolar laxative and diarrhea-causing agent. It does makes stools watery, but it also causes bowel inflammation, bloating, and flatulence, and isn‘t suitable for extended use.
“Fiber also prevents constipation,” which is essential for diverticular disease.
Not true. Fiber DOES NOT prevent constipation. Just like aspirin can relieve pain, natural and medicinal fiber can relieve constipation in people because it is a potent laxative. But fiber can‘t prevent constipation, just like aspirin can‘t prevent migraines or arthritis. In fact, if any aspirin manufacturer made such an outlandish claim, the FDA would shut it down.
Also, note that fiber DOES NOT relieve chronic constipation, only sporadic constipation in healthy people. When a few legitimate attempts were made to prove fiber‘s effectiveness for “chronic constipation,” according to the American College of Gastroenterology Functional Gastrointestinal Disorders Task Force (2005), they didn‘t pan out as explained in Fiber Menace's Introduction:
Guidelines for the Treatment of Chronic Constipation:
What is the Evidence?
Specifically, there are 3 RCTs [randomized controlled trials] of wheat bran in patients with chronic constipation, but only 1 is placebo-controlled. This trial did not demonstrate a significant improvement in stool frequency or consistency when compared with placebo — neither did 2 trials that compared wheat bran with corn biscuit or corn bran.
Philip S. Schoenfeld, MD, MSEd, MSc;
Medscape Today from WebMD
Why? Because people who are affected by chronic constipation are also likely to be affected by hemorrhoidal disease and anorectal nerve damage. In this case, large, rough stools are not only undesirable, but are outright damaging. if you already have diverticular disease, your goal is not “large stools more often,” but small stools without straining, and fiber is never going to help you accomplish this reasonable and easily attainable goal.
Q. What is the normal frequency of stools?
Ideally, you should move the bowels after each major meal. Eating and/or drinking stimulate(s) a wave of intestinal peristalsis (gastrocolic reflex) which always precedes defecation. The breaking of this natural pattern of elimination necessitates straining because withholding a bowel movement even once causes stools to enlarge and dry out. This, incidentally, is why you should never encourage children to withhold stools.
Also, stool withholding is the primary cause of “traveler‘s constipation.” Fiber in this case becomes outright dangerous. First, it takes two to three days for fiber to reach an already congested colon. Second, by the time it does, fiber makes matters only worse, because the situation becomes similar to a police car trying to clear out gridlock by driving right into the middle of it. That‘s how some people “earn” diverticulosis — elastic intestinal walls can easily stretch, bulge, and prolapse to accommodate the arriving and expanding fiber.
Q. I don‘t strain, I‘m not constipated, I don‘t consume fiber, I have small stools, and I still have diverticulosis?
Even a single occurrence of intense straining years ago may have created one or more diverticula. And the chances of that happening grow as you get older because aging intestines aren't as elastic and resilient as before.
Q. What if I still require surgery?
Surgery resects (cuts out) the part of the large intestine affected by infected diverticula. If you go back on a high-fiber diet after the surgery, in a few years or even few months time you may develop another diverticulum, because all of the conditions that were in your colon before the surgery will repeat themselves again. Perhaps they‘ll get even worse, following the compulsory treatment with antibiotics. Besides, even if you need surgery, your stools and intestinal flora should be kept as normalized as possible to prevent complications and to speed-up recovery.