My question is, could this happen again? I try to consume the recommended amount of fiber, and I drink plenty of water. Your thoughts, please.

DEAR READER: Diverticula are small sacs or pockets in one or more areas of the colon, more commonly in the sigmoid colon. People with diverticula present are diagnosed with diverticulosis. Should bacteria or waste get trapped in these pouches, inflammation and infection can result. When this occurs, the condition is then known as diverticulitis. Both conditions together make up diverticular disease. A diet low in fiber appears to be the main cause of diverticular disease, which can lead to constipation and strain during evacuation. It’s the straining that could cause diverticula to form in the colon.

Even though you had surgical repair, you could conceivably get diverticulitis again had you not taken positive steps. By modifying your diet to include more fiber, you have gone a long way toward eliminating the problems you had in the past. Whole grains such as found in multigrain or whole wheat breads, fresh fruits such as apples, pears and peaches and vegetables such as broccoli, Brussels sprouts, squash, potatoes and legumes should provide adequate fiber. Between 20 and 35 grams of fiber per day are recommended for a healthful diet. Avoid constipation. Maintain good bowel habits. Drink adequate liquids. Exercise regularly. Obtain adequate sleep.

Diverticulosis is common as a person ages. By the time a person reaches the age of 60, it will occur in almost 50 percent of the population.

People without symptoms will probably not require treatment; however, they should be on a high-fiber diet to ensure they are taking all possible precautions. When symptoms do present (constipation, diarrhea, fever, chills), diagnosis can be made through X-ray, CT, ultrasound, sigmoidoscopy or colonoscopy.

Complications of diverticulitis can include intestinal blockage, abscesses and peritonitis (infection of the abdominal cavity). You appear to have presented with a classic case. Abscesses were discovered and drained. Surgery removed the damaged portion of the colon. You formed a fistula that was surgically removed. And you’re pain free.

To give you related information, I am sending you a copy of my Health Report “Diverticular Disease.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.

One day while chewing gum that contained an artificial sweetener, I felt mild GI distress. Later that day I drank some diet soda and again experienced the same distress. About that time the light went on. STOP the artificial sweeteners! I did and it’s been almost a year now without any flare-ups, complications or symptoms from my diverticulitis. What a blessing!

True diverticulitis is probably not caused (or affected) by artificial sweeteners, but it’s worth a try. By listening to my body I’ve been able to avoid surgery.

DEAR READER:
Diverticulitis can occur in individuals with diverticulosis. Diverticulosis is generally a harmless condition of the colon that causes small pouches to bulge outward in weakened areas. It is estimated that about 10% of adult Americans over 40 have diverticulosis. That number jumps to more than 50% in those over 60.
Diverticulitis occurs when some or all of the pouches become infected or inflamed. This condition is relatively uncommon affecting only about 10-25% of individuals with diverticulosis.

Because most people with diverticulosis do not have any symptoms, they go undiagnosed. Some may experience mild cramping, constipation and bloating. If you experience any of these symptoms, see your doctor to rule out other conditions such as irritable bowel syndrome, stomach ulcers and more.

Symptoms of diverticulitis include abdominal pain or tenderness (often on the lower left side). If the cause is infection, vomiting, cramping, constipation, chills, nausea and fever may be present. If inflammation is the cause, fever, chills and vomiting are generally not present. If you have these symptoms see your doctor immediately. He or she will most likely prescribe antibiotics, bed rest and pain medication for severe cases.

Your case is more complicated. To the best of my knowledge, diverticular disease is not caused by artificial sweeteners. However, you were positively diagnosed with diverticulosis by MRI. I believe that this may be an inconsequential finding in your situation. Antibiotics did not seem to help when you were having flare-ups every nine weeks.

In my opinion, you are one of the unfortunate individuals who experiences gastrointestinal upset and distress from artificial sweeteners and sugar alcohols. From your brief note and apparent remission of the condition with the cessation of non-sugar sweeteners, your symptoms were not caused by diverticulitis.

According to an article entitled “Artificial Sweeteners” (written by B. Kovacs, MS, RD and edited by W.C. Shiel, Jr., MD, FACP, FACR) all artificial sweeteners and sugar alcohols can cause gastrointestinal upset. While reading the article, it also became apparent to me that despite claims made by thousands of consumers, the FDA has failed to follow up these claims with more scientific research. Furthermore, most of the substances in the sweeteners are unhealthful and in some cases, known cancer-causing agents. The author goes on to say that since sweeteners are not necessary for bodily health, they only serve to please our sweet tooth.

For those who would like to read the article I mentioned I direct you to www.MedicineNet.com. This website is part of the WebMD network which is produced by more than 70 US board certified physicians. These physicians have also partnered with Webster’s to write the “Webster’s New World™ Medical Dictionary”.

I applaud your ability to find the cause of your symptoms and take responsibility for your own health. Most individuals do not have such profound symptoms and sweeteners, when used in moderation are considered to be safe. However, for those who do not wish to use them but don’t want to use sugar either, there are several options. Fructose is natural fruit sugar. It is as sweet as table sugar but is not detrimental to diets. Over-ripe fruit and dried fruits are abundant in fructose. Try making a “syrup” by blending hot water, dried figs, dates and/or raisins to pour over hot cereal, French toast or other items. It provides all the sweetness of sugar without the guilt!

To give you related information, I am sending you copies of my Health Reports “Diverticular Disease” and “Constipation and Diarrhea”. Other readers w ho would like a copy should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

After my diagnosis, I went online to learn as much as I could about this condition. After reviewing several websites, such as the Mayo Clinic and “WebMD”, I began to notice a trend in their recommendations about diet. The majority of them ended with similar statements. “Your doctor may recommend no nuts, seeds or corn, but there has been no evidence to suggest that these foods actually contribute to this condition.”

Have I stumbled upon one of these “our practices have not caught up with the science” findings or is there still legitimate rational for this restriction? Are we still preaching something that we no longer need to preach?

DEAR READER: Many gastroenterologists have changed their opinions about a diet for diverticulitis (infected diverticula). Your quote seems to sum up the latest recommendation. I am not aware of any recent studies about seeds (and the like) causing diverticulitis.

There is one way to help prevent diverticulitis and diverticula (intestinal out-pouches caused by weak spots and pressure): a high fiber diet. Diverticulitis is rarely present in areas of the world that regularly consume this type of diet. In fact, it was almost unheard of until the invention of steel-grind mills which remove most of the fiber from rice and wheat to make flour.

Diverticula do not usually cause problems and are most often found by accident during routine screening tests for colon cancer and other intestinal disorders. Diverticulitis, however, is generally diagnosed during an acute attack. Common symptoms include left lower abdominal pain, fever, nausea, constipation or diarrhea and abdominal tenderness. Less common symptoms are vomiting, rectal bleeding, frequent or painful/difficult urination, bloating and abdominal tenderness while wearing a belt or bending.

Treatment options vary. For mild to moderate attacks, home care is often recommended and includes a low-fiber or liquid diet, rest for the duration of the attack and oral antibiotics. Once the attack has subsided, fruits, vegetables and whole grains can be (slowly) introduced back into the diet. Severe cases or individuals who have recurrent infections or are at high risk of complications such as peritonitis (abdominal inflammation due to intestinal rupture), bleeding, intestinal blockage, abscess or fistula (abnormal passage between intestine and abdominal cavity, bladder or vagina), that should be treated in hospital with IV antibiotics and special diets. Some individuals with complications or frequent attacks may benefit from surgery to remove the diseased section of the colon and repair damage, such as fistulas.

It is important to see a doctor as soon as possible if you think you are having an attack of diverticulitis. It can mimic other disorders such as appendicitis. The sooner treatment is begun, the shorter the attack will be.

To give you related information, I am sending you a copy of my Health Report “Diverticular Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.