More than two-thirds of Americans over age 60 have diverticulosis, but it was nearly unknown a century ago, and remained extremely rare among populations eating whole food plant-based diets.
Diverticulosis: When Our Most Common Gut Disorder Hardly Existed
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Diverticula are outpouchings 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. Nine out of ten people who 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 become small and firm, and so our intestines really have to squeeze hard to move them along, and this buildup of pressure may force out those bulges. And eventually, a low-fiber diet can sometimes lead to the colon literally “rupturing” itself.
If this theory is true, then populations who 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 50s 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 2,000 autopsies; 2 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.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- Singal R, Gupta S, Airon A. Giant and multiple jejunal diverticula presenting as peritonitis a significant challenging disorder. J Med Life. 2012;5(3):308-10.
- Fujii T, Nakabayashi T, Hashimoto S, Kuwano H. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis. Case Rep Gastroenterol. 2007 Oct 12;1(1):116-22.
- A F Peery, R S Sandler, D J Ahnen, J A Galanko, A N Holm, A Shaukat, L A Mott, E L Barry, D A Fried, J A Baron. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol. 2013 Dec;11(12):1622-7. doi: 10.1016/j.cgh.2013.06.033.
- D P Burkitt, J L Clements Jr, S B Eaton. Prevalence of diverticular disease, hiatus hernia, and pelvic phleboliths in black and white Americans. Lancet. 1985 Oct 19;2(8460):880-1.
- D P Burkitt. Two blind spots in medical knowledge. Nurs Times. 1976 Jan 1-8;72(1):24-7.
- N S Painter, D P Burkitt. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971 May 22;2(5759):450-4.
- W H M Telling, O C Gruner. Acquired diverticula, diverticulitis, and peridiverticulitis of the large intestine. Brit J Surg. 4:468-530, 1917.
- J Chapman, M Davies, B Wolff, E Dozois, D Tessier, J Harrington, D Larson. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005 Oct;242(4):576-81; discussion 581-3.
- N S Painter. Diverticular disease of the colon. The first of the Western diseases shown to be due to a deficiency of dietary fibre. S Afr Med J. 1982 Jun 26;61(26):1016-20.
- J Y Wick. Diverticular disease: eat your fiber! Consult Pharm. 2012 Sep;27(9):613-8. doi: 10.4140/TCP.n.2012.613.
Diverticula are outpouchings 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. Nine out of ten people who 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 become small and firm, and so our intestines really have to squeeze hard to move them along, and this buildup of pressure may force out those bulges. And eventually, a low-fiber diet can sometimes lead to the colon literally “rupturing” itself.
If this theory is true, then populations who 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 50s 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 2,000 autopsies; 2 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.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- Singal R, Gupta S, Airon A. Giant and multiple jejunal diverticula presenting as peritonitis a significant challenging disorder. J Med Life. 2012;5(3):308-10.
- Fujii T, Nakabayashi T, Hashimoto S, Kuwano H. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis. Case Rep Gastroenterol. 2007 Oct 12;1(1):116-22.
- A F Peery, R S Sandler, D J Ahnen, J A Galanko, A N Holm, A Shaukat, L A Mott, E L Barry, D A Fried, J A Baron. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol. 2013 Dec;11(12):1622-7. doi: 10.1016/j.cgh.2013.06.033.
- D P Burkitt, J L Clements Jr, S B Eaton. Prevalence of diverticular disease, hiatus hernia, and pelvic phleboliths in black and white Americans. Lancet. 1985 Oct 19;2(8460):880-1.
- D P Burkitt. Two blind spots in medical knowledge. Nurs Times. 1976 Jan 1-8;72(1):24-7.
- N S Painter, D P Burkitt. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971 May 22;2(5759):450-4.
- W H M Telling, O C Gruner. Acquired diverticula, diverticulitis, and peridiverticulitis of the large intestine. Brit J Surg. 4:468-530, 1917.
- J Chapman, M Davies, B Wolff, E Dozois, D Tessier, J Harrington, D Larson. Complicated diverticulitis: is it time to rethink the rules? Ann Surg. 2005 Oct;242(4):576-81; discussion 581-3.
- N S Painter. Diverticular disease of the colon. The first of the Western diseases shown to be due to a deficiency of dietary fibre. S Afr Med J. 1982 Jun 26;61(26):1016-20.
- J Y Wick. Diverticular disease: eat your fiber! Consult Pharm. 2012 Sep;27(9):613-8. doi: 10.4140/TCP.n.2012.613.
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Diverticulosis: When Our Most Common Gut Disorder Hardly Existed
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Content URLDoctor's Note
Just in the last few weeks I’ve come out with a few videos on this similar theme of bowel health:
- Diet and Hiatal Hernia
- How Many Bowel Movements Should You Have Every Day?
- Should You Sit, Squat, or Lean During a Bowel Movement?
What if your doctor tells you that you shouldn’t eat healthy foods like nuts and popcorn because of your diverticulosis? Share with them my video Diverticulosis & Nuts.
Sorry for the cliff-hanger, but I’m really trying to be good about limiting how long my videos get. Stay tuned for Does Fiber Really Prevent Diverticulosis?
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