Download Improve outcomes with dietary change

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
ˆ 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 ˆ
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
ˆ 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.
ˆ 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.
ˆ Eat breakfast cereals that have whole grains or
bran at least three times a week.
Set Goals
ˆ
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
ˆ
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 ˆ
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 ˆ
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.
ˆ
Replace snacks with fruit, popcorn, whole grain
crackers or party mixes with bran cereal.
ˆ
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.
ˆ
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.