Highfibre choices

• Breads: wholegrain breads, muffins, bagels, wheatgerm, oatmeal, wholewheat crackers, wholewheat pasta, brown rice, pita bread, tortillas, pumpernickel, rye bread, rye crispbread.

• Cereals: Weetabix, Branflakes, Shredded Wheat, cooked barley, cooked bulgar, Fruit and Fibre.

• Fruit: blackberries, dried dates, raspberries, apple, apricots, banana, avocado, cranberries, currants, honeydew melon, prunes, orange, pear, citrus fruits, cherries, papaya, pineapple, strawberries, rhubarb, figs, kiwi fruit, kumquats.

• Vegetables: Brussels sprouts, parsnips, peas, corn, broccoli, cabbage, carrots, green beans, onions, potatoes, spinach, squash, asparagus, sweet potatoes, yam, cauliflower, tomato, turnip, radish, aubergine, green pepper, snow peas.

• Dairy: all kinds of milk, cheese, yoghurt, eggs, ice cream.

• Meat substitutes: garbanzo beans, kidney beans, lentils, lima beans, split peas, pinto beans, baked beans, soya beans, smooth peanut butter.

• Nuts and snacks: wholewheat pretzels, almonds, cashews, walnuts, sunflower seeds, cakes and biscuits made with oatmeal.

Although not exhaustive, the above lists give an idea of which foods are high in fibre for consuming in a fibre-enhanced diet and further discussion on foodstuffs and eating after an attack of diverticulitis can be found in Chapter 12.

• Fluid intake: stress and inactivity in modern lives today also play an important part in bowel activity. Much has been said in the media about becoming a nation of couch potatoes and taking very little sustained exercise. This, along with fast food, can lead not only to obesity but also to constipation. Many people who suffer from constipation are advised to eat more fibre and then find that the constipation worsens. For the fibre to work efficiently, the fibre needs to absorb more water and 2 litres of water a day will help to swell the fibre and form softer stools that are easier to pass.

A recent literature review on the evidence of high-fibre diets in diverticular disease was undertaken by Aldoori and Ryan-Harsham (2002) using Medline. The objective was to review dietary factors associated with diverticular disease, particularly looking at the role of dietary fibre. In looking for quality-of-life evidence the author was concentrating on the relationship between dietary factors and other lifestyle factors in diverticular disease. In the literature review using publications from January 1996 to December 2001, 30 references were recorded and many of the articles were either focused on dietary intervention in treating symptomatic cases or case-control studies that had limitations in studying diverticular disease and diet associations. Only one large prospective study, undertaken in the USA in 1998, attempted to assess diet at entry into the study before the diagnosis of diverticular disease. The main message from the review was that a diet high in fibre made up of fruit and vegetables with little fat and red meat decreases the risk of diverticular disease. It appears that the insoluble component of fibre is strongly associated with a lower risk of developing diverticular disease. Caffeine and alcohol do not appear to increase the risk of diverticular disease substantially.

The general conclusion from the literature search confirms much of today's current thinking about diet and diverticular disease - that a food intake that is high in fibre and low in total fat and red meat, a higher fluid intake and more physical activity may help to prevent diverticular disease.

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Managing Diverticular Disease

Managing Diverticular Disease

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