Keeping Your Colon Healthy

At your first routine colonoscopy to monitor for colon cancer, there’s better than a 50-50 chance the test will find that you have diverticulosis. Usually the only symptom is a bump-up in your insurance premium, because having diverticulosis increases your risk of developing diverticulitis, which can send you to the emergency room with abdominal pain and a ticket to surgery. Even scarier: It’s been, literally, a hundred years since the conventional medical community updated its policies and talking points on diverticular disease. That means you could become the victim of medical information that’s outdated and often wrong. To protect you, here’s information that’s up to date.

The Diverticulum Story

Think of a rubber bicycle tire, where some of the layers of the rubber have weakened and pulled apart, allowing the inner tube to protrude outward. The “tire” is the thick, muscular, multi-layered part of your colon’s outer wall, and the “inner tube” is your colon’s delicate inner liner. The outer, muscular layers are naturally slightly parted at various locations, to let blood vessels through to feed your inner liner. That creates potential weak spots—which just happen to be where diverticulosis happens. Diverticulosis looks like smooth outpouchings (one diverticulum, several diverticula) of what is otherwise the smooth insides of a uniform, pink tube.

Ninety-five percent of the Canadians who have diverticula get them in the last foot or so of the colon. That’s on the left side of your abdomen.

More and more of us get diverticulosis every year. Only about 10 percent of the population had it in the 1920s. By the late 1960s it was 35 to 60 percent. By your 85th birthday, you’ll have a 2-in-3 chance. You’ll hear that diverticulosis is due to two things: age, and lack of insoluble fibre intake—the kind of fibre that’s commonly referred to as roughage, which adds bulk to your feces and supposedly keeps you regular. They say that as you get older, your colon walls naturally get thinner and weaker. If, on top of getting older, you also get constipated, you’ll have to strain to go. That increases the pressure inside your colon, which forces the parted muscular layers (where the blood vessels come through) to separate even more, and allows your inner liner to pooch through the weak spots.

Diverticulitis is inflammation in one or more of your diverticula. It supposedly happens when food gets stuck in there and starts to fester. As many as 25 percent of the general population get diverticulitis, and the brochures in your doctor’s office will say it’s due to lack of dietary fibre. The common early symptom is tenderness on your left side. The dangerous part is that the inflammation and infection of diverticulitis make tiny holes in your colon’s liner. This allows infection to ooze into the spaces between the layers of your colon’s thicker outer wall, possibly even perforating into the free space of your abdomen. If that happens, you’ve got peritonitis, a potentially life threatening infection.

The treatment of choice for diverticulitis, according to conventional medicine, depends on who’s making the choice. A non-surgeon is likely to recommend that you be admitted to the hospital to get heavy-duty antibiotics. You’ll be given nothing to eat. Instead, they’ll “feed” you intravenously. That’s to help your colon heal. Surgeons, on the other hand, say to get serious and get the surgery, which you’ll need eventually anyway, possibly on an emergency basis. Otherwise, they say, you’ll have more attacks, and pretty soon one of those attacks might kill you, or give you colon cancer. The surgery ranges from draining the pockets of infection with a needle, to removing the affected section of your colon. You might have to wear a colostomy bag until you’ve healed.

The Science

Diverticular disease became a growing concern at about the same time real nutrition and fibre were abandoned in the Canadian diet. In simple-minded fashion, the medical community decided lack of fibre was the culprit. That was their story 50 years ago, and they’re still sticking to it. But after decades of heavy marketing that put a box of high-fibre cereal in every pantry, diverticular disease is still on the rise. In fact, in the seven years from 1998 to 2005, hospital admissions for acute diverticulitis increased 36 percent.

Sure, fibre is part of the story, but it’s just not that simple. Let’s take a look at the real science.

Convention says: Avoid diverticular disease by eating more bran.

Science says: It’s the soluble fibre from fruits, vegetables, legumes, nuts, and seeds that reduces your risk, not insoluble fibre from cereal grains and bran. Soluble fibre stimulates the growth of loyal gut bacteria, especially Bifidobacteria, which are notoriously absent in people who aren’t big eaters of non-animal foods. The prevalence of diverticular disease in vegetarians is about 12 percent, compared to about 33 percent in meat-eaters.

Convention says: Constipation causes straining, which causes diverticular disease. You need roughage to bulk up your feces and stimulate your bowels.

Science says: Gut motility requires healthy gut muscles, not bulky feces. The cells of your colon wall are particular about their fuel: They want short-chain fatty acids (SCFA). That’s why they’re studded with SCFA receptors. It’s also why the favourite food of your Bifidobacteria is the soluble fibre from vegetarian food. As they feed on that fibre, they produce SCFA as a by-product, and your colon cells lap it up. They feed from this direct nutritional source exclusively. It’s a win-win-win: You get great nutrition from vegetarian food, your Bifidobacteria get their favourite fibre and get strong enough to control your less-loyal gut bugs, and your colon cells get the SCFA they need to be healthy and responsive. Defecation happens naturally and easily—no ridiculously bulky stool required.

Convention says: No more corn, popcorn, nuts, or berries that have little seeds. These foods get stuck in your diverticula and cause diverticulitis.

Science says: That’s an old wives’ tale. These foods don’t cause diverticulitis; disloyal gut bacteria do. When Bifidobacteria are well fed with soluble fibre, they’re strong enough to edge out opportunistic bacteria. That’s how you prevent diverticulitis. If you want to talk about foods to avoid, let’s talk about red meat. Evidence suggests that as red meat is broken down in the gut, it produces toxins that weaken your colon wall. Studies show there’s a definite connection between red meat and diverticulitis.

Convention says: Lack of roughage from whole grains and bran is still the main risk factor for diverticular disease.

Science says: Actually, there are several risk factors, including waist circumference, waist-to-hip ratio, and increased body fat. And remember, it’s the soluble fibre in fruits, vegetables, and legumes, not insoluble fibre from whole grains and bran, that does the trick.

Under the microscope, the walls of diverticula are clearly thinned, due to degeneration in the collagen and elastin of the colon. If your colon cells aren’t getting the fuel that keeps them healthy and strong, it doesn’t take much pressure to cause diverticulosis. Well-nourished colon cells are also much better able to heal. For example, studies show that when the colons of lab rats were exposed to a double insult— tissue-damaging radiation, plus colon surgery—the rats that were fed soluble fibre ahead of time healed faster than rats that got only surgery, without the radiation.

You just can’t expect to have strong, fast-healing colon walls if you’re not feeding your colon cells the nutrients they were designed to use as their number-one source of fuel.

Convention says: But bulk is what helps move things through your gut faster.

Science says: Lots of things influence gut motility. First, healthy gut bacteria make lactic acid and acetic acid, stimulating normal, perfect peristalsis (the rhythmic movement in the bowel). Serotonin is also a primary trigger of gut motility, for example. Studies show that people with diverticulitis have less responsive gut serotonin receptors, thanks to unhealthy, inflamed, undernourished colon cells.

Exercise is a significant factor, too. Physical activity definitely reduces the time it takes for stool to move through your gut. And, if you regularly exercise vigorously (for example, getting your heart rate up to 70 or 80 percent of its maximum and holding it there for 20 to 40 minutes), you’ll get a more than 40 percent reduction in your risk of diverticular disease.

Convention says: Every time you suffer a diverticulitis attack, you’re less likely to respond to nonsurgical treatment.

Science says: Not true, but the belief persists.

Convention says: The best treatment for diverticulitis is to have the affected section of colon removed, because having diverticular disease increases your risk of colorectal cancer.

Science says: Not according to a recent, large study of over 4,000 patients. The wholesale use of such major surgery for diverticulitis is just not supported in the research. Unless you’re at risk of a major perforation, you’re probably better off strengthening your colon, rather than cutting it off.

The Fix

The bottom line is that the development of diverticular disease isn’t just part of getting older and not eating enough bran cereal. There are metabolic, nutritional, neural, mechanical, and vascular factors that can help prevent diverticulitis, and heal your colon if you’ve already got it:

*    Freshly ground chia seeds—1 to 3 tablespoons three times a day.

*    Prunes — 2 or 3 with meals. (They’re called “dried plums” now, but they’re still prunes.)

*    Organic Aloe Vera juice — 4 ounces twice daily between meals.

You’ve probably noticed that my recommendations here look very much like my general recommendations for good overall health. That’s no coincidence. Your health depends on what goes on in your gut, so taking care of it just makes good sense.

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