Our digestive tract, which starts at the mouth and ends at the anus, is an amazing interconnection of organs which are hollow and are together vital for life itself. As the food we eat with our mouth moves along the oesophagus, stomach, the small intestines, large intestines, it is broken down from its solid form, and further digested to release nutrients that are absorbed to nourish our body to support growth, cell repair and for energy. The digestive tract is supported from the outside by organs like liver, gall bladder, pancreas etc.
Diverticulum, Diverticula & Diverticulitis:
Large intestines, also called colon, is the last part of the digestive tract that ends at the anus. Its length is about 150 cms. Its main function is reabsorption of water, minerals and the formation of stools. It is also the space where billions of bacteria live and support our body. Sometimes a sac forms in the wall of the colon, bulging outwards; this is called diverticulum. If there is more than one, it is called diverticula and if they are inflamed or infected, they are diverticulitis. Usually they appear on the left colon as a result of increased pressure and can be asymptomatic for a lifetime. Diverticula have been linked to obesity, high-fat low-fibre diets, and inactive lifestyles. Diverticulitis can be a simple inflammation or a more serious condition requiring hospitalisation or even surgeries. Diverticulitis may cause abdominal pain, fever, nausea, constipation and diarrhoea sometimes.
Medical Nutritional Therapy:
Prevention is better than cure so eating a diet that has fibre reduces the risk of diverticulitis. It softens the stools and ensures quick passage. A diet rich in both soluble and insoluble fibre is recommended. Add fresh vegetables in all your meals; half your plate should contain seasonal vegetables. Carrots, green leaves, cauliflower are all rich in fibre. Whole grains like wheat, bajra, maize, buckwheat, ragi, and barley, all add up to increase the fibre in your daily food. At least two of your major meals must have whole grains. Whole dals and legumes like rajma, chana, lobia, whole moong, and sprouted pulses are other good sources of fibre. Swapping fresh fruit juices with 2-3 whole fruits, especially oranges, guava, apple with the skin, and pomegranates with the seeds are smart choices. If you are prone to constipation, then including fibre supplements like physillium husk, at least 3 times a week works well.
Along with fibre, fluids are also essential; if the amount of water you drink is less than what is absorbed by the fibres then the stools tend to become hard. To keep the stools soft, drink up. Water is the best fluid but fresh vegetable soups, vegetable juices, fresh lemon water, coconut water, green tea also add up to the total. The recommended adequate intake of water is 35ml/kg body weight.
Probiotics have a positive role to play in diverticulosis. As the stools move slowly, research has shown that it may affect the flora of the colon causing inflammation as the gut bacteria act as barriers. Including both probiotic and prebiotic foods can turn out to be beneficial. Fibre is the best prebiotic for our gut as it forms the base for the bacteria to thrive on. Probiotics are found abundantly in fermented foods. One of the best sources of probiotics is dahi or yogurt. Apart from this, khamiri roti, fermented idli and dosa batter are some other common foods that you may add to your diet.
Exercise helps reduce the intra colonic pressure and also helps prevent constipation, so keep a daily schedule. Exercise also helps manage weight, which is a risk factor for diverticulitis.
Medical nutrition therapy for diverticulitis depends on the severity and stage of treatment. If the symptoms are severe, you may need clear liquids; liquids that do not leave any residue like clear soups, green tea, and fresh coconut water etc. This is followed by a full liquid diet comprising chaas, tea, diluted milk and maybe supplements. From here, a soft diet which is low in residue is added. Typically this will have soft dals like arhar, moong, masur, khichdi, ghiya, tori, and carrots to start with and your clinical nutritionist will work with you to bring you up to a normal diet depending on your treatment, symptoms and how you are coping with your diet changes.
Diverticulum isn't so common in Asia as compared to the western world, but with all of us moving towards high-fat, low-fibre, ready-to-cook, ready-to-eat processed foods and away from our traditional lifestyles, we need to take precautionary measures.
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About Rupali DattaRupali Datta is a Clinical Nutritionist and has worked in leading corporate hospitals. She has created and lead teams of professionals to deliver clinical solutions for patients across all medical specialties including critical care. She is a member of the Indian Dietetic Association and Indian Association of Parenteral and Enteral Nutrition.