As one who became "sensitive" to gluten several years ago - I am very careful about how much fiber I eat as I do not tolerate those lovely breads or other foods full of fiber. In a way this has improved my diet as I am not tempted by cakes, pies, and almost all cookies on the market. And I eat a salad every day as well as cooking some spinach to go with my morning eggs lots of fresh fruit and vegetables. It has made me much more conscious of the amount of fiber I eat daily as well as the nutritional value of everything I eat. At my age (I am older than dirt) I do not have much of an appetite and tend to eat very small portions so I like to make them all provide maximum nutrition and leave some room for an occasional glass of wine, or hard cider or in the summer some ice cream.
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I became a vegan four years ago and I have never felt better. My number is normal or below normal. Fruits, vegetables, nuts.
54
Excellent advice. Less animal protein, more vegetable roughage. We did not evolve to eat a diet of meat and sugar.
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@William Burgess Leavenworth
True about the sugar. But meat? I think it's just the opposite--we in fact did evolve to eat meat.
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@RG Yes but occasionally - those guys weren't that great of hunters and you had to eat it all in one day because of predators and it could go off - insects we've evolved to eat for sure every chance you get.
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I had repeated bouts of diverticulitis until my doctor referred me to surgery, which was easy as those things go, and did the job. Both my primary doc and my surgeon encouraged me to eat at least 30 grams of natural fiber a day. Not really too hard if you like whole grains, fruits, and veg; just substitute them for juice and processed foods. My grandma also had bouts of diverticulitis back in the 1950's but her docs told her NOT to eat fiber; I remember how sad she felt about never having fresh strawberries, nuts, or salad again -- and she lived to be over 100, although she did at least once have colon surgery. So -- ?? Part of the current confusion stems from this outdated advice, and part of it from the fact that when you have an active infection you are supposed to "rest" your colon with clear liquid diet, then bland smooth foods, and work slowly back up to the high-fiber routines. And I must add that diet and surgery if necessary are a way better alternative than continued courses of heavy-duty antibiotics, which in addition to unpleasant side effects, will eventually destroy your natural gut biome, leading to further troubles.
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Of course, I agree with a high fiber diet being essential to good health. But I’m surprised that this article doesn’t mention the fact that diverticulosis is an inherited disease. My dad had it, my sister and her daughter have it and I have it. Obviously, that’s not to say that genetics is the only cause. Having a low-fiber diet is awful for us humans. Forget that and eat healthy!
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" was told at the time to avoid eating nuts, seeds and foods like blueberries, strawberries and crackers with seeds. ...
Then last spring he had a third attack. In between the last two episodes, the advice to avoid nuts and seeds was debunked"
Does that debunkment include strawberries and blueberries, my favorites and easy to include in meals/snacks?
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@joan
Yes. Blueberries are especially rich in fiber.
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@joan Yes it does. https://health.clevelandclinic.org/diverticular-disease-greatest-myths-and-facts/
14
An apple a day...
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Along with eating plenty of fiber, drinking little or no alcohol will also help. Alcohol can irritate the intestinal lining and make attacks more likely.
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I am 77 years old, and was taught to eat a lot of whole fruit by my mother when I was a little kid. What makes us so foolish as to chase the latest shiny thing instead of following age-old wisdom?
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Diverticulitis and diverticulosis are chronic diseases and generally a function of the standard American diet (SAD) consisting of refined and processed plant foods, meat and animal products. You can also count on higher colon cancer, heart disease and other chronic disease risk. Increasing fiber in various forms temporarily to relieve the symptoms of these diseases is a band aid at best. The article should have suggested permanently shifting to a mostly whole food plant-based lifestyle. The SAD is a deadly killer and a permanent change is needed to avoid or reverse these common lifestyle diseases.
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@James McNeill
So true. But the question remains: how do you effect this wholesale and permanent change nationwide so that it does become a normal lifestyle habit for this immensely varied population?
What is the percentage of informed and health-conscious people actively and seriously following the diet instructions of modern medicine in the global US population? It must be impossible to measure exactly, but perhaps Jane Brody has some kind of estimate.
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@Roo.bookaroo
This is not a particularly new idea. My 1960's vegetarian cookbooks recommend a diet high in fiber. Nonetheless when I mention the importance of fiber in the diet I am typically met with blank stares. Most people's idea of high fiber is taking some sort of pill or gummy candy. Not dried beans, blueberries, wheat.
33
To quote the late Eule Gibbons: "Ever eat a pine tree? Many parts are edible."
Fibre aplenty ... and you'll smell good, too.
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I am a late 70's old guy who drink lots of very rich in fiber smoothies made mostly of raw fruit (apples, carrots, pears, mango and pineapples) with juice from cranberry, purple carrots & even blueberries. I also drink lots of low sugar natural OJ. I never eat pork, rarely eat beef. I wish that I was in an area where good fish could be had easily but it is not here. Even good salad dressings are treasured.
I do suffer with middle of the night urine runs and then can't sleep w/o sleepers so I moderate on all PM fluid intakes.
I exercise so strenuously daily that my regimen keeps me away from doctors except for periodic check ups. My only real bad ailment is macular degeneration and vision for reading/learning new info is my passion.
I close with a sadness, women do take better medical care of their health while it seems to my observation that men take such better real physical care of their bodies when they are knowledgeable guys. We guys do avoid meds too much. This is sad for me as I do wish for better from both genders. I know/feel that women can look physically fantastic in their golden years while being very fit. I also know/feel that we guys can be better patients, have fewer beer guts while being good examples for our entire family line, if we try.
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Why add fiber to your diet when by grinding your own flour from organic wheat berries you can add fiber and so much more.
My benefits include 4 inches off my wast 20 pounds off my weight all without dieting. Also mixing Einkorn with hard red wheat berries has eliminated my dry eye syndrome.
30
@Allan Fiber should come from a variety of sources, not just wheat. Congrats on improving your health.
26
Well, my friend, eating fruit sounds a lot faster.
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A megastudy done by the American Gastroenterological Association (https://www.gastrojournal.org/article/S0016-5085(15)01432-8/abstract) did not find strong evidence that fiber helps prevent diverticulitis. I'm 64 and have eaten a vegetarian diet rich in fiber (more than the recommended amount) since 1977. Nevertheless, in the past 2-3 years I've had 6 or so attacks, one of which went septic. I decided they were brought on by stress and started managing that much better and have nearly eliminated diverticulitis attacks. Nothing wrong with a healthy diet, of course, but any correlation of low fiber with diverticulitis is weak.
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@Mark Stoll
I'm not sure I could agree with your take on this study. Even if the evidence of high fiber is unclear, they do say:
"The AGA [American Gastroenterological Association] suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis..."
Page 3, https://www.gastrojournal.org/article/S0016-5085(15)01432-8/pdf.
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I found that my diverticulitis attacks occurred during high stress periods as well.
24
Thank you for bringing up this important subject, but I really get frustrated with the public's ignorance on entire topic. This should be basic common sense. When I read the title, my first thought was "in other news, water is wet".
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@Ann First thoughts can be so deceptive. (Thinking Fast). Second thoughts are often far better (Thinking Slow).
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High fiber isn't entirely protective. I ate a very high fiber diet—whole grain bread only, back in the day when you could only get whole grain bread from a health food store, lots of vegetables—but nonetheless developed diverticulosis. I had a first episode of diverticulitis a few months after I had a perforated appendix (perforated during surgery), when I was given huge amounts of antibiotics. My digestive system hasn't been the same since. Beware of antibiotics, especially fluoroquinolones.
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@WF
the study said eating fruit, like apples, pears and prunes was the key, not bread and veggies.
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@WF Start making your own kefir, the probiotics it carries are very potent.
16
Jane Brodt, you are my idol. I have learned so much from your columns and am so grateful for your generosity in writing them that I do not know how to adequately thank you.
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Certainly getting fiber thru vegetables and fruit is first line , but can anyone share their experiences with fiber supplements...
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I started with a nutrition coach a little over a month ago when my health care professional recommended I take a statin for high LDL. My LDL was 246 and HDL 111 (that is a correct number). The nutritionist recommended a 3 week protocol that required discipline (yikes) and supplements including a good dose of organic fiber supplement. I balked. She said FEW adults ingest a healthy amount of fiber. I put this in a blender with a shake mix, chia seeds and organic berries or fruit. It is surprisingly good.
After 3 weeks, my LDL is down 12 points and my weight is down 9 pounds. I have a reprieve from the statin for at least several months until labs are again performed. I will continue the protocol on a less extreme basis and I hope for good results (and pretty proud of myself :-). The fiber has been a very good addition in my case. BTW, I am 67.
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@Thank you Elaine
I’ve learned from Jane and Harvard Medical, supplements are nothing like ‘real food’. The studies reveal It’s true, won’t go into the numbers. I take a few supplements myself but always eat a Complete Diet (Colorful?) No meat.
Thanks.
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@Thank you Elaine Psyllium husk fibre which is the main ingredient in Metamucil is excellent. It was recommended to me by a nutritionist. You can take 2 tablespoons in a glass of water or juice before meals or once a day.
21
One of many reasons to not consume animals and animal products.
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@Randy Not really. Many commentators report being vegetarians and/or eating a high-fiber diet and having diverticulitis nevertheless. I eat meat and fish and have diverticulitis, too, just like these vegetarians.
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@Randy One of many reasons to ignore comments made by never-meat-eaters.
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@me Never-meat-eaters come in all forms; I for one, never eat meat because: HAVE YOU SEEN an abbatoir lately? No torture for me, thanks. I eat a Whole Foods Plant Based diet and I love it. And to think, I once lived on sausages and bacon. OMG what I did to my body in those early years, I shudder to think.
37
There are many fruits to enjoy. Putting them in a blender with water and some sugar then straining the pulp will leave you with a juice and a fiber rich fruit meat that can be made into ice cream for those not getting enough in their normal diet.
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@AC Grindl The column says that eating whole fruits is more beneficial than sauces or juices derived from them. Also not all fruits have equal value. The column specifically points to apples, pears. and prunes. Making sugar-added fruity ice cream may be tasty but it's not "healthy".
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Grinding up whole fruit in blenders is not the same as juicing them, which eliminates the pulp. Blenders deliver every bit of fiber to your smoothie. Just skip the added sugar. It's plenty sweet as it is.
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@AC Grindl For my part I just throw some fruit in a blender with a dash of no-sugar-added almond milk (for a bit of "fat" texture). I wouldn't add sugar. Fruit is already sweet and I know I, and many, eat too much added sugar already.
17
Yikes - If you have diverticulitis - I have had it several times - last episode in 2016 - increase fiber intake SLOWLY - maybe with the help of a nutritionist. My gastroenterologist told me to eat more fiber. Being a vegetarian, I assumed that I was already getting enough. I was not.
It was not until I went to a nutritionist and was guided through how best to increase my fiber intake that I was able to get rid of my attacks of diverticulitis. Increasing fiber intake too quickly can lead to lots of discomfort, and paradoxically, more bouts of diverticulitis.
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@gotribe I agree with reintroducing fiber slowly after a bout of diverticulitis...it's very important. I recently had my first attack and was hospitalized for 4 days on heavy-duty antibiotics. My doctor advised me to slowly ramp up the fiber content of my diet over the next 4 weeks which I obviously overdid. The result was intense cramping and diarrhea lasting a day. I won't repeat that again.
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@gotribe
Yes! A clear liquid diet is crucial after an attack, for a minimum of 24 hrs. Then, only eat low fiber for the next week and only then, begin to introduce high fiber. The infection must be completely gone and the colon healed before demanding it to process high fiber!
I made the mistake of eating high fiber too soon and immediately had a second attack. I take a generic capsule form of high fiber, eat dried prunes every day, pears, apples, wheat bran on my oatmeal with blueberries, barley instead of white or brown rice, lentils, black beans, white beans and no pasta or white rice anymore. I delicious food from the NYT Cooking web site recipes!
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Thanks Jane Brody. I always look forward to Tuesday mornings so I can read your column, which is always helpful and educational. Keep up the good work and see ya next Tuesday!
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If you follow Dr. Greger on YouTube you will gain much more information, scientifically supported.
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Retired MD and have had 3 episodes of diverticulitis, the first confirmed with a CT scan. I would like readers to be aware that in many cases, antibiotics are not necessary for a treatment of diverticulitis. If your discomfort is tolerable (I used acetaminophen), try a liquid diet and tincture of time. If your pain is severe, especially with fever and vomiting, seek medical attention.
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@ML Sweet I have heard from my GI who specializes in diverticulitis that antibiotics re often not necessary/overused. I thought he said acetaminiophen is linked to diverticulitis though -
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@Bonnie W My choices were acetaminophen or an NSAID. As the later may cause gastric upset and prolonged bleeding, I opted for acetaminophen.
9
Thank you for this! My husband was almost forced to take antibiotica. It is such a Pavlov reaction for American doctors!
17
I’ve eating oats with fruits everyday and integral products and I can confirme the difference in my digestion. Nice to read this and keeping on this basic diet.
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@Laura Maia , porridge (Oats) and wheatgerm.
2
As a 39-year-old, I was hospitalized for 3 days with diverticulitis. I hardly ever eat meat and get most of my protein from beans and lentils, I eat fruits and vegetables with every meal, most of our grains are whole, and still. My GI said genetics also plays a part in this. Also, he said that very few adults actually get the fiber that is recommended. He encouraged me to supplement with Benefiber (or the like) once daily, which I do religiously.
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@Michelle L Benefiber once daily is what I do, but I take all of the recommended doses - 2 tsp three times a day- at once with two tablespoons. I hope that is what you meant. Older people like me are on many medications that can cause constipation. 2 Tbsp daily works well for me unless I miss my morning All Bran 1/3 cup with whole milk yogurt, blueberries and strawberries.
Increased fiber helps the all important microbiota in your gut. Whole milk gives you more of the anti-inflammatory omega-3 fatty acid. Lower the fat content and you also reduce this fatty acid. Studies show that you are less likely to gain weight with whole milk than with lower fat varieties
12
I've read a number of articles that all say the same thing this one does: once you hit fifty you're supposed to cut back on your fiber intake. Not once have I read an explanation for why this is advisable. Given that I've got a pretty high fiber diet, as a 54 year-old I'm now worried that I consume too much!
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@Mike Froschl
I've assumed that it assumes a typical attenuation of dietary intake as one hits the backside of middle age into elderhood.
One thing that's not mentioned is that if one eats a high-fiber diet, it doesn't do much good unless you hydrate sufficiently - you need the fluid intake to optimize the use of the fiber. It's an issue for people on the backside of middle age and elderhood who, often subconsciously, tend to consume less fluids in the second half of their day in order to reduce the need of interrupting sleep to urinate (which also increases the risk of UTIs, especially in the very elderly).
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@Mike Froschl: I am with Karl on this -- I think the reduced amounts of fiber in the recommended amounts after 50 reflects a cutback in the amount eaten rather than the source.
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@Mike Froschl
I wouldn't worry about it if I'm any indication. I'm in my 60s and have way more fiber than I need to. I'm not looking for fiber, it just happens to be high in my main foods- produce, whole grain cereals (hot), and legumes. Down side is that I'm in the bathroom often. I've actually been eating more dairy and white bread to try to balance this issue out.
6