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Improve outcomes with dietary change Diverticular Disease Wheat Foods Council 10841 S. Crossroads Drive, Suite 105 Parker, Colorado 80138 Ph: 303/840/8787 Fax: 303/840-6877 Web site: www.wheatfoods.org Diverticular disease, common in Western societies, is associated with inadequate intake of dietary fiber and age. Many Americans may not realize they are at risk because most people who have diverticular disease are asymptomatic. Therefore, it is important that people learn how to reduce their risk for the disease, and if they have it, how to prevent acute diverticulitis and complications. As a health professional, it is likely that you will be counseling clients on diet and lifestyle changes to help them prevent and manage this disease. You might also experience an increase in diverticular disease counseling because Americans are living longer. Aging populations are at the highest risk, with incidence estimated at 30% for adults older than 50, 50% for adults over 70, and as high as 66% for adults over the age of 85.1 Fiber for Prevention and Management In theory, the development of diverticula may be the result of too much intracolonic pressure exerted on the colon wall.2 Dietary fiber may play an important role in maintaining a proper balance of pressure because highfiber in the diet produces bulky stools that move quicker through the intestinal tract. Increasing fiber in the diet may be protective and is suggested as a rational form of therapy until studies determine the cause of the disease.3 Dietary fiber is also important for clients who have been diagnosed with the disease and wish to reduce their risk of complications such as diverticulitis. According to the National Institutes of Health, people may prevent diverticulitis and reduce symptoms of the disease by increasing dietary fiber.4 Diverticulitis can lead to serious complications and counseling clients on dietary intake can reduce their risk. However, clients should understand that fiber intake will not eliminate the diverticula that have already formed, but might help to prevent additional diverticula and serious complications of the disease. If clients are presenting symptoms, or have been diagnosed with the disease, they should see their physicians for proper treatment and management. 1,2. Beyer, Peter L. Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders. In: Mahan, Kathleen L. and Sylvia Escott-Stump, eds. Krause’s Food, Nutrition & Diet Therapy. Philadelphia, Pa: W.B. Saunders Co.; 2000:687. 3. High-fiber diet. In: Manual of Clinical Dietetics. The American Dietetic Association, Chicago, III: The American Dietetic Association; 2000:714-715. 4. Diverticulosis and Diverticulitis. (n.d.) National Institute of Diabetes and Digestive and Kidney Diseases. Available at http://www.niddk.nih.gov/health/digets/pubs/divert/divert/htm. Accessed July 15, 2002. 5. Aldoori WH, Giovannucci EL, Rockett HR, Sampson L, Rimm EB and WC Willett. A prospective study of dietary fiber types and symptomatic diverticular disease in men. Journal of Nutrition. 1998;128(4):714-719. 6,7. Groff, James L. and Sareen S. Gropper. In: Advanced Nutrition and Human Metabolism. Belmont, CA: Wadsworth/Learning; 2000:114. Know Your Fiber In September 2002, new recommendations for fiber intake were specified by the National Academy of Sciences. Men and women under 50 years of age should get 38 grams and 25 grams, respectively, per day. Adults over the age of 50 should get 21 – 30 grams of fiber per day. Although these recommendations are for healthy adults, they are valuable reference points for clients who want to prevent diverticula or reduce complications. The type of fiber in the diet may also be considered for improving outcomes. Clients should be counseled on eating a variety of fiber sources and a discussion about wheat bran may be helpful. Wheat bran contains predominately insoluble fiber which includes cellulose. Some researchers believe that insoluble fiber, especially cellulose may protect people from diverticular disease.5 “Wheat bran is one of the most effective fiber laxatives because it can absorb three times its weight of water, thereby producing a bulky stool.”6 Furthermore, wheat bran is important for reducing transit time and decreasing intraluminal pressure.7 Teaching clients about the benefits of wheat is also important because bran and whole wheat products are readily available to the public. Suggesting foods that are tasty, economical, easy to find, and convenient to make, will encourage clients to meet their goals. The Wheat Foods Council invites you to use the reproducible client handout on the back for counseling Diverticular Disease 10841 S. Crossroads Drive, Suite 105 Parker, Colorado 80138 Ph: 303/840/8787 Fax: 303/840-6877 Web site: www.wheatfoods.org Diverticular Disease and Fiber Goals for increasing fiber As you age, your risk for developing diverticular disease rises. It is Mark goals you agree to and set a date for estimated that 30% of people over the age of 50, 50% of people over the completion age of 70, and 66% of people over the age of 85 have this disease.1 Follow the Food Guide Pyramid – include at least six servings of grain foods, two fruits, and three Unfortunately, many people may not be aware they even have the disease vegetables in your daily diet. until a complication such as severe pain, cramping, and infection occur. Diverticular disease occurs when pouches, called diverticula, form and Water binds with fiber, drink at least 8 cups of push through weak spots in the colon wall. Complications can develop if the liquid daily. diverticula become infected or inflamed. Although eating a high fiber diet will not eliminate diverticula, fiber will help to reduce symptoms and prevent Eat three servings of whole grain foods each day. complications. If you are looking for ways to help prevent diverticula from forming, you can take action by eating fiber-rich foods. Eat two or three servings of legumes weekly and Dietary fiber helps prevent problems because it helps maintain a proper include them in foods such as soups, wraps, balance of pressure in the colon and keeps stools moving along so you will salads, and pasta dishes. not be constipated. Check with a registered dietitian or physician on how much fiber you should include in your daily diet. Eat breakfast cereals that have whole grains or bran at least three times a week. Set Goals Once you have agreed to increase fiber in your diet, you will want to set some goals. Goals will give you direction and keep things simple while you make changes in your life. Keep your goals reachable and take it step-bystep. For example, eating whole grain foods is important for increasing fiber in the diet, but if you currently do not eat many whole grains, you may want to start by adding a little at a time. Try a little whole-wheat pasta with regular pasta, or mix a little brown rice with white rice. Once you make these simple changes, gradually increase the percentage of whole grain foods. Accepting new foods in your diet sometimes takes time, so it is okay to take it one step at a time. Besides, you should increase fiber intake slowly to prevent bloating, gas, and other discomforts. Shopping and Finding High-Fiber Foods Learning how to shop and find foods that contain fiber are important skills you will need to have to be successful. Look for legumes; foods with bran such as bran cereals and breads; lima beans, green peas, and other vegetables; whole-wheat and whole-grain products; potatoes with skin; and fruit. Many breakfast cereals have whole-grain and bran and are valuable sources for fiber. You may also be told to include wheat bran in your diet because it is one of the best laxatives available.2 Wheat bran and wholewheat foods (whole-wheat foods have bran in them) are easy to find. Making dietary changes can be challenging, but setting goals and agreeing to a step-by-step program will help you be successful. 1. Beyer, Peter L. Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders. In: Mahan, Kathleen L. and Sylvia Escott-Stump, eds. Krause’s Food, Nutrition & Diet Therapy. Philadelphia, Pa: W.B. Saunders Co.; 2000:687. 2. Groff, James L. and Sareen S. Gropper. In: Advanced Nutrition and Human Metabolism. Belmont, CA: Wadsworth/Learning; 2000:114. Learn how to read the Nutrition Facts label on packaged foods to identify fiber in foods. Learn how to read the ingredients list on packaged foods to identify whole grain and bran products. Look for whole grain claims on foods to identify foods that have at least 51% whole grain. Increase fiber slowly by adding one high fiber food each day for a week; increase the number each following week until you meet your goal. Replace snacks with fruit, popcorn, whole grain crackers or party mixes with bran cereal. Learn how to bake and freeze high fiber foods to keep foods with fiber readily available. Check out www.homebaking.org for tips on baking. Use government resources on the Internet to identify foods with fiber. For example, go to www.nal.usda.gov/fnic, click on Food Composition and find the Fiber Content Chart.