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Diverticulosis: When Our Most Common Gut Disorder Hardly Existed

September 2, 2019


“Diverticulosis: When Our Most
Common Gut Disorder Hardly Existed” Diverticula are out-pouchings
from our intestine. Doctors like using
a tire analogy, high pressures within the gut
can force the intestines to balloon out through weak
spots in the intestinal wall like an inner tube poking out
through a worn tire tread. This is what they
actually look like. These pockets can become
inflamed and infected, and, to carry the tire analogy
further, can blow out, spilling fecal matter
into the abdomen or the bladder and
lead to death. Symptoms can range from
no symptoms at all, to a little cramping
and bloating, to incapacitating pain that
is a medical emergency. 9 of out 10 people
that die from the disease never
even knew they had it. But the good news is that there
may be a way to prevent the disease. Diverticular disease is the most
common intestinal disorder, affecting up to 70% of
people by age 60. If it’s that
common, though, maybe it’s just an inevitable
consequence of aging? No, it’s a
new disease. In 1907, 25 cases had been reported
in the medical literature. Not in 25% of people
but 25 cases period. And they’re kind of hard
to miss on autopsy. A hundred years ago, in 1916,
it didn’t even merit mention in medical and
surgical textbooks. The mystery wasn’t
solved until 1971. How did a disease that
was almost unknown become the most common
affliction of the colon in the Western world
within one lifespan? Surgeons Painter and Burkitt
suggested diverticulosis was a deficiency disease, a disease
caused by a deficiency of fiber. In the late 1800s, roller
milling was introduced – further removing
fiber from grain and we started to fill up
on fiber deficient foods like meat and sugar. A few decades of this and
diverticulosis was rampant. This is what they
thought was going on. Just as it would be easy to
squeeze a lump of butter through a bicycle tube, it’s easy to move large soft, moist
intestinal contents through the gut. In contrast, try squeezing
through a lump of tar. When we eat fiber deficient diets
our feces can be become small and firm, and so our intestines have to really
squeeze hard to move it along, and this buildup of pressure
may force out those bulges. And eventually, a low-fiber diet
can then sometimes lead to the colon literally ‘rupturing’
itself. If this theory is true, then populations
that eat high fiber diets would have low rates
of diverticulosis. And that’s what’s
been found. More than 50% of African
Americans in their 50’s were found to have
diverticulosis, compared to less than
1% in African Africans, eating traditional
plant-based diets. And by less than 1%,
we’re talking zero out of a series
of 2000 autopsies, two out of 4,000
in Uganda. That’s like a thousand
times lower prevalence. What then, about this newer study
concluding that a low fiber diet was NOT associated
with diverticulosis. We’ll cover
that, next.

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