By John Messmer, MD

The term "diverticulosis" means that diverticuli have developed in the intestine. Most often they are found incidentally when a screening colonoscopy is performed when someone turns 50 or if a lower GI X-ray is done to investigate some symptom. During a colonoscopy procedure, the doctor can see the openings into the pockets; and on a lower GI study, liquid contrast material which is passed into the colon fills the pockets so they can be seen on X-ray.

The diverticuli can cause mild cramping after meals, during a bowel movement, or at other times. Since many things can cause these symptoms, it takes an examination to determine if the problem is due to diverticulosis.

Moderate to severe cases of diverticulitis

Diverticulitis refers to inflamed diverticuli. This is more serious and can lead to hospitalization because the diverticuli are infected and may rupture or bleed. Physicians can often diagnose mild cases by examining a person's abdomen and finding the swollen and tender colon in the left lower abdomen. It is a mild case if there are no signs of infection outside the intestine, if there is minimal to no fever, and if the person is able to drink fluids.

Treatment of moderate to severe cases of diverticulitis

Mild cases can be treated at home by putting the intestines to rest on a clear liquid diet and taking the proper antibiotics. Many times acute diverticulitis requires hospitalization on intravenous antibiotics and bowel rest for days or weeks. Surgery may be needed to clean out the infection and remove the affected bowel. Sometimes a person is given a colostomy to divert the intestinal contents out to a bag so the infected part of the bowel is isolated until it heals. Then it is removed and the intestine is reattached to eliminate the colostomy.

Diverticulitis, diverticulosis, and diet

For years a common recommendation for people with diverticulosis has been to avoid nuts, seeds, and vegetables with husks like corn. People with diverticulosis were also encouraged to eat a low-fiber diet. That is no longer the case. Physicians recommend avoiding only those foods that cause symptoms. As long as there is fiber from a variety of sources in the diet, the diverticuli should be less a problem. We need both gum fiber from fruits and vegetables and bran fiber from grains and seeds to make the contents of the colon the proper consistency. Eating a large bag of popcorn because it has fiber without balancing it with vegetables, fruits, and fluids could provoke trouble.

For more information on a recommended diet to prevent diverticulosis see the following article from TheDietChannel: Diverticulosis, Diverticulitis & Diet.

Diverticulitis, diverticulosis, and activities

Most diverticulitis or diverticulosis is located in the sigmoid colon, which is in the lower left abdomen. As long as it is not inflamed, the abdomen should not be more sensitive to pressure. The colon is far enough away from the other pelvic organs that a woman should not have any difficulty with intercourse unless she has an enlarged uterus that also presses on the colon.

There should be no reason to restrict activity. Most times, exercise may continue as usual. Occasionally, bouncing could cause some discomfort, so some people may find running a problem. However, cycling, rowing, walking, and most other exercises should be well tolerated. If any activity consistently causes pain, a doctor should be consulted rather than just assuming it is the diverticulosis causing the problem. Pain from the uterus and ovaries, prostate, bladder, aorta, kidneys, and pancreas can mimic diverticular pain so it is important to get an accurate diagnosis.

You can prevent diverticulitis and diverticulosis!

As with most health conditions, prevention is better than treatment. A rule of thumb for food fiber is that plants are the source. A variety of plant sources is best so different types of vegetables and fruits should be included throughout the week in amounts appropriate for the number of calories needed. Fruits, nuts, and seeds should be added here and there. Beans, lentils, and other legumes are highly nutritious in addition to providing significant amounts of fiber. Whole grains can also fit into the weekly diet to round it out. For those who do not eat that much food, such as the elderly or those who cannot be as active, a fiber supplement is a reasonable addition.

A healthy body and properly functioning intestine means proper food choices. It is relatively easy and is much more interesting than the same bland, low-fiber stuff that too many Americans call a diet.

For more information see Foods to Avoid if you have Diverticulosis.

By John Messmer, MD

Diverticuli are little pockets or pouches that form outside our large intestines. They are almost never seen in rural African and Asian people, but are quite common in the West—about a third of 50-year-old Americans and half of Americans over 80 have diverticular disease. It is most likely caused by insufficient fiber in our diets.

Processed foods in the American diet

Fiber or "roughage" is the part of the food we eat that cannot be broken down and absorbed. It includes structural parts of fruits and vegetables and the husks of grains. For a long time, grains were processed to remove the husk or bran fiber to make white flour and white rice. Partly this was done because people developed a taste for soft white bread and other flour-based products, and partly to remove the high fat "germ" or the seed part of the grain which could turn rancid in storage. As Americans looked for convenience, many people turned to processed foods and away from the fresh vegetables and fruits that could provide adequate fiber.

What causes a diverticulum?

The colon moves food residue from the junction with the small intestine on the right side, up and over to the left, and down to the rectum where it is stored for defecation. If the contents are soft and easy to move, the colon need only squeeze gently to move things through. When the contents are hard, much pressure is generated by the colon in order to keep it moving.

Squeezing under high pressure pushes the inner lining between the muscles of the intestinal wall much like Play-Doh pushes between your fingers if you squeeze it hard. After a while, the inner lining remains pushed out, forming a pocket or diverticulum. High fiber diets trap water and provide substance to the intestinal contents making the material easier to move and less likely to squeeze between the intestine's muscle fibers.

The reason this is bad is that these little pockets get irritated and inflamed and that can lead to infection and bleeding. Infected diverticuli can become an abscess which might rupture, spilling infection into the abdomen—a potentially lethal problem. Diverticuli also can bleed profusely and treatment is often tricky. Someone on an anticoagulant can bleed to death.

For more information on the treatment and prevention of diverticulosis see the following article from TheDietChannel: Dealing with Diverticulosis and Diverticulitis.

What is the recommended amount of fibre in your diet?

Amazingly, all this is due to inadequate fiber in the diet. To get the proper amount of fiber, about 25 to 35 grams per day, try to include vegetables, fruits, legumes, nuts, seeds, and whole grains in your daily diet. Here are some ways to add fiber to your diet:

• Vegetables - broccoli, corn, Brussels sprouts, eggplant, and greens are higher in fiber.
• Fruits - Berries, nuts, seeds, figs, raisins, prunes, cherries, and bananas are also good sources of fiber.
• Beans - kidney, lima, pinto, peas, and lentils have as much as 14-16 grams per cup.
• High fiber cereal - look for at least 4-6 grams of fiber per serving. If you have not developed a taste for these whole grain and bran type cereals, mix a high fiber brand with your favorite cereal.
• Eat:
• • brown rice instead of white rice
  • yams or sweet potatoes
  • baked potatoes (but to a lesser degree)
  • whole grain baked goods
  • whole wheat pasta.

Fiber supplements are also acceptable, particularly for someone trying to avoid overeating. Supplements made from Psyllium seed are available in several forms and artificial fiber supplements are also available.

Benefits and drawbacks to increased fiber intake

There is one drawback to increasing fiber in the short term. Intestinal bacteria break down the fiber into gases that some may find disturbing. However, if fiber consumption is increased gradually, this will be less of a problem. This same bacterial action might have health benefits to slow absorption of sugar and to reduce cholesterol.

An added benefit is that a high fiber diet tends to make us feel full so we eat fewer calories. Since the intestine works more efficiently, constipation is avoided and reduced pressures reduce the risk of hemorrhoids. It has not been proven that fiber reduces the risk of colon cancer, but it is less common in non-Western people whose diets are higher in vegetables and fruits.

By Wendy Hodsdon, ND

In general, constipation does not seem like a serious problem, but it can predispose a person to hemorrhoids and diverticular disease. It can also increase toxins in the body, which can lead to colon cancer. All of these conditions are related to having excess pressure and prolonged time with stool in the intestine.

Constipation is the major cause of hemorrhoids, parasites, yeast, and allergies; however, genetic weakness of the blood vessels may also contribute. Understanding and treating constipation can help alleviate existing hemorrhoids and prevent more from forming. Hemorrhoids are very common among half of the population over 50 years old. Symptoms may include pain, itching, burning, swelling and bleeding of the anus.

What is constipation?

On average, it takes 17 to 30 hours for food to travel the length of a digestive tract. You can test your bowel transit time by eating beets or taking activated charcoal and seeing how long it takes for the red or black color to show up in you stool. If food travels through the body too quickly, not enough nutrients are absorbed. If it travels too slowly, the pressure in the intestines increases and excess toxins are absorbed instead of being eliminated.

People have different ideas of what it means to be constipated. Some people who have had bowel movements once a week all their life think they have no problems. Other people will feel constipated when they have incomplete bowel movements, even when they move their bowels everyday. Generally, having a bowel movement 1 or 2 times per day is healthy.

What causes constipation?

The 2 main causes of constipation are:

• Lack of fiber in the diet
• Dehydration.

Food allergies also can cause constipation. Food allergies are a likely cause especially if a person alternates between diarrhea and constipation.

How constipation and hemorrhoids are related

Hemorrhoids form when blood vessels are weak or have excess pressure on them. Blood vessels swell because of excess internal pressure from constipation or from weakness of the blood vessel wall. In either case, the swollen blood vessel can burst, causing bleeding, and other symptoms associated with hemorrhoids.

Treating constipation with a healthy diet

Eating a healthy diet is one of the easiest ways to treat constipation. Increase fiber content in your food by increasing the amount of vegetables, fruits, and whole grains. Both soluble and insoluble fibers are helpful in avoiding constipation. If fiber is taken without enough water, it can make constipation worse. Stay well hydrated by drinking plenty of water.

Exercise also can be helpful to stimulate bowel movements. If needed, essential fatty acids, magnesium, certain herbs, and vitamin C can also be used on occasion to keep bowels moving. It is important to answer “calls of nature” promptly. If you feel the urge to have a bowel movement, do not suppress it.

Treating hemorrhoids

Relieving constipation is key in treating hemorrhoids by decreasing the internal pressure inside the intestines and on the blood vessels around the anus. In addition, astringents such as witch hazel can be used topically to tonify the blood vessels. Vitamin A, Vitamin C, Vitamin E, and bioflavonoids strengthen the cells and connective tissue in and around the blood vessels to improve healing.

Conclusion: the best treatment for constipation and hemorrhoids is a healthy diet and regular exercise

Diet and regular exercise can make a big difference in the treatment of constipation and hemorrhoids. To start the healing process:

• Eat a healthy amount of vegetables, whole grains and beans to get a variety of fiber, vitamins and minerals
• Drink plenty of water
• Exercise regularly.

By Michèle Turcotte, MS, RD/LDN

Abdominal gas and bloating are normal conditions. As your body breaks down food into energy, gas is made in the stomach and intestines. Bloating, which is a feeling of fullness in the abdomen, can make you uncomfortable.

Although many people think that they pass gas too often, it is rare to have too much gas. All people pass gas, but some people produce more gas than others. It is normal to pass gas from 6 to 20 times a day. Although this may embarrass or annoy you, excess intestinal gas usually is not caused by a serious health condition. However, check with your physician first to rule out serious conditions such as Crohn’s disease or a bowel obstruction. Changing what you eat and drink can sometimes relieve discomfort caused by gas. In fact, many healthy foods can cause gas and bloating!

Foods and drinks that cause gas and bloating

Eating large amounts of fiber-rich foods too fast can cause gas and bloating. Introduce fiber slowly into the diet by adding a little more to your diet every 2 to 3 days. Many people know that healthy vegetables such as cabbage, broccoli, and onions can cause gas and bloating, but did you know that eggplant, celery, pears, apples, bananas and citrus fruits can be culprits as well?

It’s not prudent to avoid all of these foods completely. Try eliminating them from your diet temporarily; then slowly reintroduce each back into your diet one at a time to identify which food is causing problems.

Legumes (e.g. dried beans, peas or lentils) contain a carbohydrate that is difficult to digest. One way to minimize their gassy effect is to discard the water used to soak beans and the cooking water or try using an over-the-counter product called Beano™. Fruits and sodas contain fructose, a form of sugar that can cause gastrointestinal distress when consumed in large quantities. Read nutrition labels and cut down on products that contain fructose and sugar alcohols, such as sorbitol and xylitol.

Eating too fast or drinking carbonated beverages increases the amount of air swallowed. Most of this air is burped, but some of it can enter the lower intestines and be passed as gas. Slow down and chew each bite thoroughly. Avoid carbonated beverages to see if this makes a difference. Constipation slows down elimination, increasing gas production and cramping. Prevent constipation by consuming a fiber-rich diet and drinking plenty of water daily.

Lactose intolerance

Finally, thousands of individuals suffer from lactose intolerance. Lactose is the sugar naturally found in dairy products and is poorly digested in many people, particularly Asians and African Americans. Lactose intolerance causes bloating, gas, and diarrhea. Luckily, it is easy to substitute regular milk with milk that contains lactase and to consume cultured products, such as yogurt, which contain less lactose. Another suggestion is to try using lactase pills.

Remember, your diet may only be part of your problem. Anxiety and stress can cause bloating, gas, and pain. Practice relaxation techniques such as deep breathing and yoga regularly.

By Wendy Hodsdon, ND

Diarrhea, nausea, vomiting, stomach cramps, bloating, fever, headaches, and fatigue—all symptoms of a common complaint among travelers, otherwise known as Montezuma’s revenge. What causes these gastrointestinal problems? How can you avoid spending your vacation in the bathroom?

Common causes of travelers’ diarrhea

Bacteria that are literally "foreign" to our intestines are the most common causes of travelers’ diarrhea. These bacteria can be strains of E.coli, Shigella, Salmonella, Camylobacter, and Cryptosporidium. Certain parasites such as Giardia, roundworms, and tapeworms are also problems for travelers.

Latin America, Africa, the Middle East, and Asia have with highest incidence of parasite infections. Because parasites are often spread through unclean water and food, it is important to be extra careful when traveling to these places.

Some people exposed to parasites never become infected. Other people have a higher risk. The reason? Some people have stronger immune systems. Those with the highest risk include:

• Young children
• Immunosuppressed people
• People with inflammatory-bowel disease (e.g. ulcerative colitis or Crohn’s disease)
• Those taking antacids or histamine blockers.

Simple precautions to avoid diarrhea

Eat and drink clean food and water. While this may be easier said than done, it is the main way to stay healthy. Water can be treated by boiling, filtering, or adding small amounts of iodine. Bottled water is usually readily available and quite safe.

Eating uncontaminated food can be more difficult. Generally, well-cooked and packaged foods are safe for travelers. Raw fruits and vegetables should be peeled to avoid possible contamination from the outside of the food. Raw or undercooked meat, seafood, unpasteurized milk, dairy products, and mayonnaise are at high-risk of contamination and are best avoided.

Ways to treat infections, stomach problems and diarrhea

1.   Maintain stomach acid levels to kill parasites

The body knows how to resist and eliminate parasitic infections. Its defense system kicks in during digestion. Stomach acid kills parasites before they can grow and infect the body. To increase stomach acid levels, keep stress levels low. Another tip is to swallow 1 tablespoon of apple cider vinegar 10 minutes before meals. Due to lower levels of stomach acid, people taking antacids are more at-risk for infection.

2.   Take probiotics to maintain your good bacteria levels

Another good practice is to increase good bacteria in the intestines. Lactobacillus acidophilus actually crowds out disease-causing bacteria. Supplementing your diet with probiotics (especially lactobacillus acidophilus) while on a trip can help maintain good bacteria levels. A bonus is that probiotics also stimulate the immune system.

3.   Eat garlic cloves or capsules to elimate parasites

Take garlic cloves or capsules at meals to prevent infections. Garlic is a great anti-microbial and assists the body in eliminating parasites; however, this treatment can irritate the stomach and cause garlic breath and sweat. Some forms of concentrated garlic are easier on the body. There are even odor-free forms of garlic for sale. Try this treatment before your trip to see how it works with your system.

4.   Take charcoal capsules to avoid stomach problems

Charcoal capsules can be helpful when eating a variety of new foods. Take a few capsules with meals to help avoid cramping, gas, bloating, and other stomach problems.

What to do if you get diarrhea

If diarrhea develops, let it run its course for few days. Diarrhea is the body’s way of evacuating the parasites. Make sure to drink of water and get plenty of rest. If you’re concerned about dehydration, a sports drinks is helpful. However, if bloody diarrhea develops, consult a doctor immediately.

Prevention is the key to avoiding diarrhea

Diarrhea does not have to be a problem for travelers. With a few simple precautions, you can enjoy the scenery rather than tour the bathrooms of the world!

By Donna Feldman, MS, RD

The human digestive tract is home to millions of bacteria. Some researchers estimate that humans have more bacterial cells than body cells. But when it comes to health, bacteria usually have a bad reputation. For example, if you've ever suffered from "turista" (the intestinal ailment that strikes people who travel to other countries), you're well aware of the effect of unwelcome bacteria on your digestion.

While there are over 400 species of bacteria in humans, not all cause problems. Research suggests that friendly bacteria—probiotics, may help digestion, immunity, allergies and cancer.

What are probiotics?

The United Nation's Food and Agriculture Organization defines probiotics as live microorganisms...which confer a beneficial health effect on the host. In other words, for bacteria to be considered a probiotic, it must be beneficial to humans. As a result, if food manufacturers labels a food as containing probiotics, the benefits must be proven by research.

In the United States, no health claims for probiotics have been approved, but this hasn't stopped the recently surging sales of probiotic products. Yogurt and yogurt-type drinks are especially popular probiotic-containing foods. In the European Union, there are even stricter rules requiring companies to prove the health claims about probiotics. New research efforts are focused on proving the beneficial effects, so that food producers can add these health claims to food labels.

Benefits of probiotics

Anecdotal evidence suggests friendly bacteria help a variety of digestive problems, from turista to irritable bowel syndrome to diarrhea. Scientists also believe probiotics could:

• Reduce carcinogens
• Enhance immunity
• Decrease allergies.

However, none of these benefits have been proven, mainly because the research is complicated and time consuming. What's so complicated? Well, each species of bacteria may come in several different strains. If one strain shows a beneficial effect, researchers can't assume other strains will have the same effect and must test each strain individually.

At the moment, most probiotic-enhanced foods and supplements contain varieties of lactobacillus or bifidobacterium, which are the best known probiotics. As research continues, other types of bacteria may also prove beneficial.

What happens when probiotics are ingested

The concept sounds simple enough. Eat friendly bacteria and they will eventually arrive in your intestine and enhance your overall health. However, the reality is more complex. For starters, the bacteria may not survive the digestive enzymes in your stomach and upper small intestine. The probiotics industry is working to solve this problem by making more viable products so the cultures survive the digestive process. Then, there's the problem of the bacteria needing to eat, which is where prebiotics come in.

Food containing probiotics

Probiotics are not bacteria; they are food for friendly bacteria. The best-known of these are fructooligosaccharides (FOS), a class of sugars that are indigestible by humans. FOS are derived from edible plants like Jerusalem artichokes, and can now be found in a range of specialty food products from yogurt to ice cream to lollipops. FOS can also be purchased separately in capsule or powdered form. Consuming prebiotic-containing products encourage the growth of friendly bacteria in the digestive tract.

Further probiotic research needed

Despite the lack of research-based proof, some health care providers routinely recommend probiotic foods, like yogurt, for diarrhea caused by antibiotics or infection. Someday, friendly bacteria, along with prebiotics, may very well be shown to enhance your health in a variety of ways. Evidence for benefits will lead to an explosion of food products that contain pre- and pro-biotics, or combinations of them termed "synbiotics." But until the evidence is in, yogurt and other foods with friendly bacteria will still be available, and you should be cautious about anecdotal claims that portray probiotics as a panacea.