Causes and risk factors of diverticulitis gas zauberberg 1

From a historical standpoint, diverticular diseases were first identified in the United States in the early 1900s. This is around the same time that processed foods were first being introduced into the American diet, shifting our intake from milled flours, which are high in fiber, to refined flour, which is low in fiber.

Today, the increased intake of red meat, hydrogenated fats, and processed foods have created a veritable epidemic of diverticular disease in industrialized countries such as the United States, England, and Australia, where the rate of diverticulosis hovers at around 50 percent.

By contrast, diverticular diseases are rare in Asia and Africa, where people tend to eat less red meat and more fiber-rich vegetables, fruits, and whole grains. As a result, the rate of diverticulosis in these regions is less than 0.5 percent.

In 1971, surgeons Denis Burkitt and Neil Painter proposed the theory that a "low-residual diet" high in sugar and low in fiber was responsible for the rise of diverticulitis in Western hemisphere countries. It was a theory that would end up directing the course of treatment for the next 40 years, with doctors routinely prescribing a high-fiber diet as the primary facet of treatment and prevention.

In 2012, researchers with the University of North Carolina School of Medicine reported that, among 2,104 patients examined by colonoscopy, high fiber intake and frequent bowel movement actually increased the risk of diverticulosis, challenging the long-held belief that low fiber is the primary trigger for disease development.

On the other hand, the bulk of evidence does suggest that a high-fiber diet can prevent some of the more serious complications of diverticulitis. A 2012 study from the Oxford University, which retrospectively analyzed the health records of more than 15,000 older adults, reported that a high-fiber diet was associated with a 41 percent decrease in the number of hospitalizations and deaths from the diverticular illness.

While the conflicting research does nothing to undermine the benefits of a high-fiber diet, it does suggest that diet is less effective in preventing the onset of diverticular diseases and more effective in avoiding the long-term complications. Other Risk Factors

Age plays a major role in the formation of diverticula, with more than half of the cases occurring in people over 60. While diverticulosis is uncommon in people under 40, the risk can steadily rise the older you get. By age 80, between 50 percent and 60 percent of adults will have developed diverticulosis. Of these, as many as one in four will have diverticulitis.

Obesity is also a major risk factor. A 2009 study from the University of Washington School of Medicine, which tracked the health records of more than 47,000 men over a period of 18 years, concluded that obesity—defined as a body mass index (BMI) of over 30—nearly doubled the risk of diverticulitis and tripled the risk of diverticular bleeding compared to men with a BMI under 21.

Sm oking is, perhaps not surprisingly, a concern, too. The habit is known to contribute to inflammation that can increase one’s risk of a number of health issues, and it can contribute to diverticulitis by promoting inflammation that undermines already compromised tissues, increasing the risk of abscesses, fistula, and intestinal perforation. The risk appears to be greatest in people who smoke over 10 cigarettes per day, according to research from Imperial College London.

Nonsteroidal anti-inflammatory drugs (NSAIDs) is also closely linked to diverticulitis and diverticular bleeding. While aspirin has long been considered the prime suspect, it has since been shown that all NSAIDs have the same potential for harm. They include such popular, over-the-counter brands as Aleve (naproxen) and Advil (ibuprofen).

Crowe, F.; Appleby, P.; Allen, N. et al. " Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): a prospective study of British vegetarians and non-vegetarians." BMJ. 2011; 343: d4131. DOI: 10.1136/bmj.d4131.