DIVERTICULOSIS

IMAGINE SQUEEZING A SMALL balloon with your hand and watching parts of it protrude between your fingers. That's similar to what happens in the colon (large bowel) of a person with diverticulosis. Little pockets form as a result of consuming a low-fibre diet, straining for bowel movements or having a weakness in the colon or large intestine wall. These pockets, or diverticula, are somewhat common in anyone over age 40. They occur in as many as 40 per cent of people over age 50 and in almost all people over age 90. Diverticula might produce no symptoms, but they can divert digestive contents. If intestinal contents remain inside them, the result is inflammation, infection, bleeding and pain - a condition known as diverticulitis.

If inflammation in these pockets progresses, infection can develop, producing fever, nausea, vomiting, painful bloating, rectal bleeding and severe abdominal tenderness, especially in the lower left side. Diverticulitis has much in common with appendicitis - eitper can cause a surgical emergency if a rupture occurs. For this reason, it is crucial that diverticulitis be evaluated by a doctor.

DRUG TREATMENT

Antispasmodics

Hyoscine butylbromide (Buscopan), dicyclomine hydrochloride (Merbentyl), atropine sulphate. Function: block the action of acetylcholine, a chemical involved in bowel cramping. Side effects: dry mouth, nausea, blurry vision, dizziness, difficulty with urination, constipation.

Anti-Inflammatories

Aspirin, ibuprofen, naproxen, indometacin. Function: relieve the pain that accompanies inflamed diverticula. Side effects: allergic reactions, bleeding stomach ulcers, fluid retention.

Antibiotics

Cefalexin (Ceporex, Keflex), cefadroxil (Baxan), ciprofloxacin (Ciproxin), ofloxacin (Tarivid). Function: kill a broad spectrum of infectious bacteria, indicated when elevated white blood cells or fever is present. Side effects: allergic reactions, diarrhoea.

EATING FOR DIGESTIVE HEALTH

To prevent diverticulosis, there's one simple change you can make: eat more fibre. It prevents constipation and the resultant straining to produce a bowel movement, which weakens the bowel walls and creates these painful pockets. The best sources of dietary fibre are whole grains, legumes, crisp vegetables and fruits with the skins on.

Once diverticulosis begins to cause symptoms, however, you'll want to avoid specific types of fibre in your diet. Insoluble fibre - the kind that does not dissolve in water - can still be beneficial, but it is also more prone to collect in the narrow necks of diverticuli. Examples of insoluble fibre are nuts, seeds, corn, and the skins of apples, cucumbers and tomatoes.

Soluble fibre dissolves in water to form a soft gel and is less likely to plug up diverticuli. This type of fibre is found in oat bran, flaxseed meal, barley malt, gelatin, peeled apples, brown rice and psyllium seed husks. Such fibres are an essential part of the diet to prevent recurrent attacks of diverticulitis.

Because poor digestion aggravates symptoms, chew your food thoroughly. Some people find it very helpful to supplement their diets with digestive enzymes, such as bromelain from pineapple stem and papain from papaya (follow manufacturer's recommended dosages). Caffeine and alcohol can irritate the digestive tract, so avoid them whenever possible.

HERBAL REMEDIES

Psyllium (Plantago ovata)

Cultivated in Iran and India, this plant has seed husks rich in mucilage, the soluble fibres similar to those found in oat bran, flaxseed meal and guar gum. The husks have a long history of use by both herbalists and medical doctors to treat constipation and diverticulosis. Typical dosage: up to 1 teaspoon of the husks or 2 teaspoons of ground husks stirred into a glass of water per day (drink immediately because the mixture thickens rapidly); or up to six 660­milligram capsules with one full glass of water per day. Psyllium is also available in commercially produced energy bars. Caution: may cause wind, bloating and diarrhoea; avoid by starting with lower doses and building up slowly. Allergic reactions occur in some people.

Peppermint (Mentha x piperita)

This menthol-containing herb has many benefits, including relieving pain, cooling inflammation, and fighting yeasts and other microbes. Most important, it has potent antispasmodic properties that make peppermint useful for alleviating cramps. In using peppermint for this purpose, take an enteric-coated capsule so the active ingredient is released in the intestines and not the stomach. Typical dosage: I to

2 capsules containing 0.2 millilitre of the oil two or three times per day as needed. To apply topically to relieve stomach discomfort, dilute peppermint essential oil with an equal quantity of vegetable oil, such as olive, sesame or almond, and apply directly above the painful spot. Peppermint can be used topically and internally at the same time. Caution: some people are very sensitive to peppermint oil and experience a burning sensation in the rectum after ingesting It; allergic reactions to topical use of the oil are rare but possible.

Aloe Vera (Aloe barbadensis)

The gel from inside the leaves of this plant has benefits appreciated by anyone who has used it to treat sunburn. Aloe gel as a topical application has anti-inflammatory effects soothing to the intestinal wall and mild antibacterial activity. (Be aware that only the gel is useful for this condition; the yellow substance from the outside of the leaves is a potent cathartic that can cause diarrhoea.) Oral preparations of aloe are increasingly being used by physicians to treat a wide variety of gastrointestinal ailments, including diverticulosis. Typical dosage: 2 to 8 capsules per day; or 60 to 120 millilitres of reconstituted juice four times per day (use a product specifically intended for oral use and with a guaranteed amount of aloe vera mucopolysaccharide). Caution: some people have allergic reactions to aloe juice.

Cat's Claw (Uncaria tomentosa)

This picturesquely named herb has a

long history of use as part of South American folk medicine. It was used to treat infections, arthritis and a wide range of intestinal disorders, including diverticulosis and diverticulitis. Despite its popularity, there are no good medical studies that confirm its effectiveness. But cat's claw is reasonably safe to use, so it may well be worth a try. Typical dosage: 20 to 60 milligrams of standardised extract per day; or 15 drops of tincture two to three times

per day; or 3 cups of tea per day (simmer 1 tablespoon of root bark in Y4 litre of water for 10 to 15 minutes; cool and strain). Caution: may interfere with fertility or lower blood pressure. Do not use if pregnant or breastfeeding.

Wild Yam (Dioscorea villosa)

This tuber is known by pharmacists as the source of raw materials used to make numerous hormones, such as progesterone. Without chemical processing, wild yam has little hormonal activity, but it does possess antispasmodic and anti-inflammatory effects that make it very useful for diverticulosis. Typical dosage: I to 2 dropperfuls of tincture three or four times per day; or 1 to 2 capsules or tablets of powdered root three times per day. Caution: some people experience mild nausea at the high end of the dosage range.