Gluten 101.

Gluten is a protein found in wheat, rye, and barley. Its ability to stretch allows breads to rise.

A gluten-free diet eliminates all sources of gluten, including whole foods, food products, and medications containing gluten. Despite its popularity, eliminating gluten is only essential for individuals with celiac disease, wheat allergy, and non-celiac gluten sensitivity (see Who Needs to Avoid Gluten?).

If you have digestive problems you think may be related to gluten, John Leung, MD, an allergist, gastroenterologist, and director for the Center for Food Related Diseases at Tufts Medical Center, cautions against eliminating foods prior to seeing a medical professional. “There are a lot of diseases that can cause gastrointestinal distress,” he says. “It’s imperative that you consult a medical professional before putting yourself on a diet.”

Gluten-Free Risks.

There is no solid scientific evidence that following a gluten-free diet without a medical reason to do so will improve health or prevent disease. In fact, there are some potential downsides to this diet if it is not carried out with care.

➧ Higher intake of ultraprocessed foods: Most components of a healthy dietary pattern (fruits, vegetables, beans, lentils, nuts, seeds, fish/seafood, eggs, low fat and fat free dairy products, poultry, and unprocessed lean red meats) are naturally gluten free. There are many whole grains that do not contain gluten, including amaranth, buckwheat, most oats, millet, quinoa, rice, sorghum, and teff. Unfortunately, the explosion of gluten-free packaged foods has made it easy to access ultraprocessed options (see Page 4 for more on why you should limit ultraprocessed foods).

➧ Lower intake of fiber. Diets high in fiber have been associated with desirable health outcomes, including lower risk for cardiovascular disease, type 2 diabetes, diverticulitis, and colorectal cancer. Eating naturally fiber-rich foods may also help avoid weight gain by keeping you feeling full longer. Consuming a lot of ultraprocessed refined-flour products (including the many products now made with refined gluten-free flours) in place of whole grain options makes it difficult to get the recommended amount of fiber (around 25 grams a day, depending on age and sex).

➧ Potential nutrient inadequacies. Some research has suggested that individuals following a gluten-free diet for long periods of time are at greater risk of falling short on some nutrients, particularly fiber, folate, iron, and niacin. That said, there have not been reports of widespread nutrient deficiencies in people following gluten-free diets.

➧ Possible psychological and social impacts. “Some people find it more difficult to eat out and socialize on a gluten-free diet, which can increase social isolation,” says Leung. “Additionally, some people on restrictive diets develop food aversions.”

➧ High price. Numerous studies have found that gluten-free products are significantly more expensive than their gluten-containing versions.

If you don’t have a medical reason to avoid gluten, there is no real benefit to doing so. If you must avoid gluten, choose plenty of nutrient- and fiber-rich plant foods, including fruits and vegetables, beans, lentils, nuts, seeds, and minimally processed, gluten-free whole grains, and be sure you are not relying too heavily on ultraprocessed gluten-free foods.

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Your concerns are valid, but following these tips can help alleviate your fears while allowing you to enjoy the pleasures of being pampered. It’s important to go to a salon that adheres to the stringent health regulations that were required for it to be licensed. If the entire facility—including the restroom—is pristine and manicure tools are sterilized in an autoclave (a machine that looks like a microwave oven), this suggests hygienics is a priority. One way to be absolutely sure of the cleanliness of the tools is to bring your own. You can bring your own nail polish, as well, because germs can easily spread when the polish brushes touch lots of different people’s nails.

Any time your nails get wet, cut, or filed—or your cuticles are being cut—an opportunity exists for bacteria and fungi to get in under the nail. Signs of a fungal infection include new white or yellow patches and streaks, but nails can also turn brown or green. If the infection is caused by bacteria instead of a fungus, you may notice redness, swelling, pain or pus in the skin surrounding the nail. If you have any of these symptoms, make an appointment with a dermatologist. Once diagnosed with a fungal infection, you’ll need to apply a prescription-strength antifungal liquid or take an oral antifungal pill. Topical overthe- counter antifungal creams usually don’t penetrate deeply enough into the nail. If you get a nail fungal infection, you may still be able to wear nail polish, but you should not wear artificial nails because it will be hard for your doctor to monitor your improvement.

Following a routine colonoscopy, I was diagnosed with diverticulosis. I never had any symptoms—to my knowledge—to suggest I had this condition and I’m somewhat confused. How did I develop it, does my diet need to change, and am I at higher risk of developing diverticulitis?

Diverticulosis refers to the presence of small pouches called diverticula that form in the lining of the digestive tract, typically in the colon. It’s a common condition, especially in older adults, and is often asymptomatic— so it’s no surprise that it went unnoticed until your colonoscopy.

Diverticulosis is believed to result from a combination of factors, including a low-fiber diet, a sedentary lifestyle, and genetics—it tends to run in families. A diet low in fiber can lead to constipation and increased pressure within the colon, which may contribute to the formation of diverticula. The two main dietary keys to controlling diverticulosis are fiber and liquid. Fiber absorbs water as it travels through your colon, helping your stool stay soft and move smoothly. Foods high in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is important for maintaining regular bowel movements and preventing constipation. It is generally recommended to gradually increase fiber intake to allow the digestive system to adapt and minimize bloating or gas.

Consuming a high-fiber diet reduces the risk of diverticulitis, which occurs if the diverticula become inflamed. Foods that may increase the risk of diverticula becoming inflamed include seeds, nuts, popcorn, and certain fruits and vegetables with small seeds, such as strawberries.

The more you rely on a diet of high-fiber fruits, vegetables, and whole grains, and drink plenty of liquids, the greater your chances of avoiding more serious colon problems—such as diverticulitis—in the future.

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Bad Belly.

Short term bowel changes and/or abdominal (belly) pain can have a variety of causes, including food poisoning, a virus, or gas. Food allergies or an intolerance (such as lactose intolerance) and irritable bowel syndrome are possible causes of recurring incidents. But abdominal pain can also be a sign of something critical (such as appendicitis, diverticulitis, or kidney stones) or chronic (like celiac disease, inflammatory bowel disease, or irritable bowel syndrome).

How bad the pain is does not indicate how serious the disorder is. For example, gas pains can be very painful, and appendicitis may cause only a mild ache.

When to Worry.

“If your symptoms concern you, see a health-care provider to get peace of mind,” says John Leung, MD, a gastroenterologist and adjunct clinical assistant professor at the Friedman School. “Signs that definitely require looking into include unexplained weight loss, loss of appetite, persistent abdominal pain, and blood in your stool (which can be bright red or maroon or cause tarry, black stools). Additionally, if you have difficulty swallowing, you should see a doctor immediately.” If you can’t keep anything down and have been unable to have a bowel movement, have a tender or hard belly, have pain that lasts more than a day or two or is getting worse, or have diarrhea for more than five days, seek help.

“I see a lot of patients concerned about foamy or pale stools or mucous in stool,” says Leung. “Stool size, texture, color, or odor changes may worry you, but if you do not have other associated symptoms such as pain, fever, blood, weight loss, or jaundice and you feel otherwise well, it’s fine to wait and see if your stool normalizes.”

What to Do.

“It can be difficult to determine what can be dealt with at home and what cannot,” says Leung. “If your symptoms are mild, it’s fine to try some over-the-counter treatments. But if symptoms get worse or don’t get better, I suggest seeing a doctor right away.” Fiber supplements, antacids, anti-gas products, enzyme tablets that help digest dairy, and sports drinks to replace fluids lost with diarrhea and vomiting are some first-line options.

Dietary changes play a role in many short-term abdominal problems, allergies, intolerances, and food sensitivities. If you suspect ongoing issues are related to what you eat, don’t try to make major dietary changes without guidance. “I do not recommend overly restrictive or drastic diet changes,” says Leung. “These can lead to malnutrition and cause more problems long term.”

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A study that followed nearly 400,000 middle-aged individuals in the U.K. for a median of over 10 years found that, compared to individuals who reported drinking less than one cup of coffee a day, drinking four or more eight-ounce cups a day was associated with lower risk of 30 medical conditions (for reference, a Starbucks “grande” equals two cups). The most common conditions were cardiometabolic (including high blood pressure, ischemic heart disease, and diabetes) and gastrointestinal (like stomach ulcers, diverticulitis, and gallstones).

This study confirms the results of many earlier studies suggesting coffee consumption has health benefits. Coffee is a bean extract and contains a number of components that may have antioxidant and anti-inflammatory effects, including phenolic compounds. High intake of decaffeinated coffee was also associated with health benefits, although the association was somewhat weaker.

This study does not prove cause and effect. If you do not currently drink coffee, there is no recommendation to start. If you drink a lot of coffee, avoid brews with lots of added sugar and cream—otherwise, enjoy it.

Study Assesses Years of Life and Income Lost Due to Smoking

Smoking is a leading preventable cause of cancer deaths in the United States. Analysis of health and earnings data found that, among U.S adults ages 25 to 79 years, cancer deaths caused by cigarette smoking accounted for 2.2 million person-years of life lost and approximately $21 billion in lost lifetime earnings.

The analysis did not include deaths and lost earnings due to smoking-related cardiovascular diseases, which would greatly increase the estimated burdens. Still, this study puts into stark perspective how important it is for smokers to seek help quitting and for nonsmokers to avoid starting. Keep in mind that a 2019 study found that young people who vaped were four times more likely to go on to smoke traditional cigarettes than their non-vaping peers.

Dietary Vitamin C Intake (not Supplements) Associated with Better Health

A review of existing research found that dietary patterns containing the recommended amount of vitamin C from foods was associated with health benefits. Daily dietary intake of 50 to 100 milligrams (mg) of vitamin C from foods was associated with a number of positive health outcomes, including a lower risk of cardiovascular disease, cancer of the esophagus, stomach, cervix, and lung, and death from any cause. (The current recommended vitamin C intake is 90 mg for men aged 19 and older and 75 mg for women.) Dietary patterns containing foods rich in vitamin C (like fruits and vegetables) are likely also high in other health-promoting compounds, which likely contributed to this finding. Foods high in vitamin C may also have displaced less healthy food choices and contributed to the effects observed.

The same effect was not found for vitamin C supplements. Indeed, use of vitamin C supplements was associated with higher risk of breast cancer and kidney stones.

This study supports the recommendation that the emphasis should be on a healthy dietary pattern rather than individual foods or nutrients.

FDA Proposes New Definition of “Healthy” on Food Packages

The U.S. Food and Drug Administration (FDA) recently proposed new draft guidelines for food manufacturers who want to label their products as “healthy.” This term was last defined in the 1990s. According to the FDA, “our current definition permits manufacturers to use the claim ‘healthy’ on some foods that, based on the most up-to-date nutrition science and Federal dietary guidance, contain levels of nutrients that would not help consumers maintain healthy dietary practices.”

The proposed change requires foods labeled as “healthy” to contain a minimum amount of food from one of the food groups recommended by the latest Dietary Guidelines for Americans, including vegetables, fruits, grains, dairy, protein foods, and plant oils; and also to contain low levels of salt, added sugar, and saturated fat. The FDA may allow products meeting these standards to display an “FDA Healthy” icon on the front-of-package.

This proposal is aimed at helping consumers make informed choices about the foods that should form the basis of their dietary pattern. Either electronic or written comments on the proposed rule may be submitted before December 29, 2022.

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Diverticulosis develops in weak areas along the walls of the colon and is characterized by tiny sacs—diverticula—that bulge through these weak spots. Low-fiber diets, physical inactivity, and obesity are associated with diverticulosis.

Most people with diverticulosis don’t suffer symptoms, although some have constipation, bloating, and mild cramps. However, two major complications can occur: One is painless rectal bleeding, which needs to be evaluated by a doctor. The other is diverticulitis, which occurs when one or more diverticula become inflamed and, in rare cases, perforate. Diverticulitis can be very painful and may cause fever, chills, nausea, abscesses, and small tears or blockages in the colon.

About 25 percent of people with diverticulosis develop diverticulitis. One risk factor for diverticulitis is straining to pass stools when you have a bowel movement, since this puts a lot of pressure on your colon. Consuming more fiber can help protect you—this increases the weight of stools and moves them through your intestines more quickly. Fruit, vegetables, and whole grains are good sources of fiber, and your doctor also may recommend an over-the-counter fiber supplement. It’s also important to drink enough fluids, which aid in keeping stools soft and easy to pass.

I have a painful bunion on my foot that is making it difficult to walk. What does surgery to remove the bunion involve?

While bunions may look like nothing more than a bony bump on the side of the big toe, usually, they are caused by a deformity between the first and second metatarsal bones (the bones that run from the base of your toes to the middle of your foot). This makes surgery more complicated than simply removing the “bump.” If it is removed without correcting this angulation problem, the bunion will probably return.

The angulation correction involves cutting and shifting the first metatarsal bone into alignment and fixating it with a pin, screw, or plate. Additionally, the affected toe needs to be evaluated for arthritis. If you elect to proceed with the removal, your surgeon will take x-rays of your feet to assess what degree of deformity and/or arthritis you have in the big toe joint and plan the appropriate surgery. Bunion removal is followed by four to six weeks of aftercare, with gradual return to normal activity.

My doctor ordered a test for leaky gut syndrome. What is this condition, and what does the test entail?

A leaky gut syndrome test will help determine whether you have increased intestinal permeability, a condition in which the lining of your small intestine allows bacteria and undigested food particles to enter your bloodstream.

In a healthy gut, only certain nutrients and molecules can pass through the wall of your intestine. But if your intestinal lining becomes too porous, additional substances can “leak” into your bloodstream.

It is believed that increased intestinal permeability probably contributes to conditions such as irritable bowel syndrome, Crohn’s disease, and food allergies.

The standard test for leaky gut syndrome entails drinking a solution containing two sugars, lactulose and mannitol. You’ll then provide a urine sample. Because lactulose molecules are large and and cannot penetrate the intestinal wall in a healthy gut, high levels of lactulose in the urine indicates increased intestinal permeability. Mannitol molecules are smaller and easier to absorb; low levels of mannitol in urine suggest poor absorption of small molecules.

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© piotr_malczyk | Getty Images
Aim for plenty of whole grains, fruits, and vegetables and avoid overly processed foods to help support your gut.

A healthy gut can help reduce your risk of diseases, like colon polyps, colon cancer, and inflammatory bowel disease. Here are some of the best foods to include and others to limit in the quest for gut health.

Diet Affects Gut Health. When you think about gut health, you are thinking about the last part of your digestive system, called your colon. Both the foods you eat and the foods you avoid affect your gut health. These choices can help prevent colon cancer, inflammatory bowel disease, constipation, hemorrhoids, and diverticulitis. Choosing foods for gut health can also help you avoid digestive issues, like gas, diarrhea, and gut sensitivity called irritable bowel syndrome.

What About Probiotics? According to the National Institutes of Health (NIH), only vitamins and minerals are more popular as dietary supplements than probiotics. People use probiotics to add healthy bacteria to their gut. Everyone has bacteria living in their gut, but healthy bacteria are important for digestion and for the health of your immune system. People often use a probiotic supplement to maintain gut health or to restore healthy gut flora and bacteria after a bout of diarrhea.

Although using probiotics to kill bad bacteria or to restore gut health naturally seems like a good idea, researchers at NIH say no health claims for probiotics have been approved by the U.S. Food and Drug Administration, at least not yet.

Probiotics are actively being researched, and researchers are learning that probiotics are complicated. In order for them to be effective, we still need to learn which probiotics work best, and efficacy may vary from person to person. You also need to know how much to use and for how long. NIH says, if you want to try a probiotic supplement for gut health, talk to your health care provider.

Gut-Healthy Foods. There is much more agreement on gut-friendly foods than on probiotics. The NIH says the basic strategy should be to eat more fruits, vegetables, and add foods high in fiber. As for food to skip for a healthy gut, avoid red meat, processed meats, and fatty foods.

For tasty foods that help support gut health, try the following tips:

• Eat plenty of whole grains for fiber. Good gut health requires at least 25 grams of fiber every day. Gut bacteria break down fiber into nutrients that may improve immune system health. Avoid refined carbohydrates, which are stripped of their outer shell where all the nutrients are. Look for brown bread and rice as opposed to processed white rice and white bread.
• Eat lots of leafy greens (like spinach and kale). These vegetables promote healthy gut flora and they also provide vitamins B, C, K, and A.
• Eat lean proteins (like fish and poultry) and avoid red meats and fatty meats. High fat foods, especially fried foods, can make your bowel more sensitive and trigger contractions of your colon.
• If you are prone to gas or bloating, avoid high-sugar fruits like apples, pears, or mango. Try eating more berries, citrus fruits, and bananas. These fruits stimulate the good bacteria in your gut.
• Learn to love avocado. Avocado is a gut-friendly vegetable packed with fiber and potassium. Adding some avocado to your diet promotes healthy digestion and gut health.

Diet Recommendations. In combination with adding the above gut-health-enhancing foods, give the following diet recommendations a try to help reduce your risk of colon cancer and improve colon health:

• Make at least half your diet plant-based.Fill at least half your plate with foods like vegetables, fruits, nuts, seeds, beans, lentils, or whole grains.
• Limit red meat and processed meats.Processed meats include hot dogs, sausage, and lunch meats. According to the American Cancer Society (ACS), your risk of colon cancer goes up by 15 to 20 percent if you eat a hamburger or a hot dog every day. If you eat red meat, limit your serving to the size of a deck of cards and no more than three times per week.
• Avoid adding sugar or buying foods with added sugar. The natural sugar in dairy products and fruit is fine for colon health, but added sugar leads to added pounds, and obesity has been linked to colon cancer.
• Aim for at least 30 grams of fiber a day. The ACS recommends at least 30 grams from sources like whole grains, fruits, vegetables, nuts, seeds, and beans. If you have trouble eating enough fiber, consider incorporating a daily dietary fiber supplement. Fiber will help prevent constipation and may lower your risk of hemorrhoids and diverticulosis.
• At least half of your grains should be whole, and you should get three to five servings daily. Whole grains can include barley, whole wheat, wild and brown rice, oatmeal, or quinoa. You won’t get the same gut-friendly benefits of vitamins, minerals, and antioxidants from refined grains like white bread, rice, and pasta.
• A final tip is to maintain a healthy weight. If you are overweight, work with your friendly neighborhood registered dietitian to make a plan to work towards a healthier body and weight. Aim for at least 30 minutes of exercise every day. Lack of activity and obesity are bad for gut health and may increase your risk for colon cancer.

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“For most people, eating a wide variety of high-fiber plant foods, exercising, and drinking plenty of water will help with constipation,” says Colleen Webb, RDN, CDN, a registered dietitian with the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell. “However, there are situations when these interventions are not enough, and a more thorough evaluation may be required.”

Dietary Causes

Constipation may be the result of your eating habits. The typical “Western” diet is full of animal products and highly processed foods and lacks nourishing high-fiber foods, which is one reason why so many people in the U.S. suffer from constipation. Animal fats and proteins, especially in dairy foods, are common triggers for constipation.

Inadequate fluid intake is another common cause of constipation. Webb advises the average woman to aim for at least 64 ounces of water a day unless otherwise instructed by her doctor.

The Role of Fiber

Following a dietary pattern that is rich in high-fiber foods, including fruits, vegetables, legumes, nuts, seeds, beans, and whole grains, can be especially helpful in alleviating constipation.

There are two main types of dietary fiber. Soluble fiber (found in foods such as fruits, oats, barley, and legumes) allows more water to remain in the stool, which makes the stool softer and easier to pass. Insoluble fiber (found in wheat, rye, and other grains) does not dissolve in water. “It adds bulk to the stool, which will turn mild, alternating diarrhea and constipation into regular, soft stool,” explains Meira Abramowitz, MD, also with the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell.

You must drink a lot of water when eating fiber-rich foods, especially if you eat a lot of insoluble fiber, to keep the stool moving and prevent constipation.

Your Fiber Needs

For average, healthy women over age 50, Webb recommends consuming at least 25 grams of fiber daily. While some processed foods, such as cereals and granola bars, are touted for being high in fiber, Webb says they are not as effective at combating constipation as the fiber in whole foods, including fruits, vegetables, beans, and lentils.

However, there are exceptions: Certain gastrointestinal conditions, such as diverticulitis, previous abdominal surgery, or irritable bowel syndrome, might require a low-fiber diet. If you have any of these conditions, talk with your doctor about the diet that’s best for you.

Over-the-Counter Remedies

If more water and fiber in your diet don’t relieve constipation, Dr. Abramowitz says that some over-thecounter (OTC) remedies may be helpful, but they should be used only for a few days.

You can try a high-fiber supplement, such as psyllium husk. If that’s not effective, try OTC osmotic laxatives, such as polyethylene glycol (Miralax), or stimulant laxatives, such as senna or bisacodyl (Dulcolax, Correctol). “If your constipation does not improve after a short period of using OTC laxatives, you need to see a physician for evaluation,” advises Dr. Abramowitz.

Underlying Causes

If changing your diet and taking laxatives doesn’t alleviate constipation, your doctor will need to look for other possible causes. Constipation can be a symptom of low thyroid function or high calcium levels in the bloodstream. Your physician should check for both conditions with blood tests and a physical exam.

“You also need to be on the lookout for signs of possible colon cancer that may masquerade as constipation. These include unintentional weight loss, rectal bleeding, and anemia,” explains Dr. Abramowitz.

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How IBS Is Diagnosed

The official definition of IBS is recurrent abdominal pain or discomfort and a marked change in bowel habits for six months. Technically, IBS is not a disease; it is a group of symptoms, which is referred to as a “syndrome.”

Diagnosing IBS can be tricky, since the symptoms may mimic those of other conditions, including ovarian cancer, diverticulitis, and celiac disease.

“For example, if a patient has diarrhea, it could be from medications, like proton pump inhibitors; supplements, such as magnesium; or diseases, such as infectious colitis (foodborne illness) or Crohn’s disease. All of these disorders may present in a similar way, but when there is fever, blood, or weight loss, we know something serious is happening,” says Christine Frissora, MD, a gastroenterologist at Weill Cornell Medicine.

Ruling Out Other Conditions

How do doctors distinguish between IBS and other gastrointestinal conditions, such as celiac disease, gluten sensitivity, and lactose intolerance?

“We rely on a person’s medical history and a physical exam in 90 percent of cases,” says Dr. Frissora. Sometimes, tests are needed to rule out other conditions, but they’re determined on a caseby- case basis.

“For example, if there is a family history of a gastrointestinal disorder such as colon cancer, then the patient may need a colonoscopy. If someone has been suffering from diarrhea, a typical workup might include a stool test. Some people who suffer from anxiety, weight loss, and diarrhea may need to have their thyroid function and iron levels tested,” explains Dr. Frissora.

Ruling out other conditions is important. For example, someone who’s constipated may have something called pelvic floor dysfunction. “That’s when the muscles in the lower pelvis squeeze in an ineffective manner, actually holding the stool in rather than expelling it. Biofeedback and physical therapy are very helpful for this condition, and they can cure some patients with constipation,” says Dr. Frissora.

Dietary Recommendations

Many studies have shown that a diet low in “FODMAPs” can help relieve IBS symptoms. FODMAPs—fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—are found in many foods. Foods with the highest FODMAP content include garlic, onions, pears, apples, artificial sweeteners, and foods containing lactose (dairy products) and gluten (wheat, barley, and rye). FODMAPs can cause bloating because bacteria in the colon consume them, which produces gas.

Most IBS patients don’t have to avoid all FODMAPs. Once foods are eliminated from your diet, the foods can be added back into your diet one at a time to identify which ones trigger symptoms.

Medication Options

Some IBS patients don’t get complete symptom relief with dietary changes and require medication, which is chosen based on what type of IBS you have. (IBS with constipation as a primary symptom is called IBS-c, IBS with diarrhea is called IBS-d, and some patients have alternating bouts of both.) Linaclotide (Linzess) is a drug that treats IBS-c; a medical food, EnteraGam, may be used to treat IBS-d; and a gut-only antibiotic, called rifaximin (Xifaxan), may help relieve symptoms of IBS-d.

Get an Accurate Diagnosis

If you suspect you may have IBS, it’s important to have a medical evaluation to confirm your suspicions.

“You can’t rely on self-diagnosis; you may be making the wrong assumption about what’s causing your symptoms. We don’t want people to have celiac disease or colon cancer and think they have IBS,” says Dr. Frissora.

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Judith C. Thalheimer, RD, LDN, managing editor of Tufts Health & Nutrition Letter, answers: “The U.S. Food and Drug Administration (FDA) regulates the Nutrition Facts label on packaged foods and drinks. This label is required on all packaged foods, whether they are made in the U.S. or imported from other countries. It is based on the Dietary Guidelines for Americans and is designed to help you make food choices that meet your dietary needs.

“Toward that end, the label is mandated to provide information on the content of nutrients important to our health. The specific vitamins and minerals required to be listed in the lower section of the label (vitamin D, calcium, potassium, and iron) are considered ‘nutrients of public concern.’ Some adults in the U.S. don’t get enough of the first three, and iron is of concern for young children, pregnant women, and women of childbearing age.

“Vitamin C used to be on Nutrition Facts labels, but that changed in 2018 because it was determined that most people in the U.S. get plenty of vitamin C as part of their regular dietary intake. Manufacturers are welcome to include additional nutrients on their label, and many take the opportunity to highlight vitamins or minerals their products are high in.

“Each nutrient has a “% Daily Value.” The Daily Value is generally based on the amount of a nutrient that has been determined to be optimal for most healthy adults who need 2,000 calories a day. The labels can help you determine where a food fits into your healthy dietarty pattern by showing you the daily value for nutrients you want (the vitamins and minerals listed, as well as dietary fiber) and those you should minimize (saturated fat, sodium, and added sugars). Be sure to check the serving size information in the top section of the label. (This is not a recommended serving size, but rather a portion that is considered typical for that food.) If you eat twice as much, you’re getting twice the amount of each nutrient—good and bad.”

I had an attack of diverticulitis. How should I eat to prevent another?

Grace Phelan, MS, RD, nutrition support coordinator at the Frances Stern Nutrition Center and clinical instructor at the Friedman School, answers: “Sometimes little pockets or pouches (called diverticula) form in the intestinal wall. This is called diverticulosis. Diverticulitis is when the pockets get inflamed or infected, which can occur when intestinal contents get stuck in them. Diverticulitis can cause abdominal pain as well as nausea and vomiting. Treatment for diverticulitis can include bowel rest to give the intestines a chance to heal. Severe cases might require surgery.

“In periods of inflammation, we recommend keeping intake of dietary fiber to less than 10 to 15 grams (g) a day until symptoms of abdominal pain have resolved. This means avoiding fiberrich foods like whole grains, most vegetables, fruits with skins, nuts, and beans. But, once you get the all-clear, a high-fiber diet is your best bet at preventing further flare-ups. Aim for the recommended 20 g to 30 g of fiber per day from all kinds of fruits, vegetables, nuts, seeds, beans, and whole grains.

“In the past, people diagnosed with diverticulosis, and especially those who have had a diverticulitis attack, have been told to permanently avoid foods like nuts, seeds, popcorn, and fruits or vegetables (like tomatoes and blackberries) that have little seeds that could get stuck in the pouches. It’s important for people to know that a study in 2008 found no evidence for this commonly prescribed restriction. Consuming plenty of these naturally fiber-rich foods is the best way to prevent diverticulitis attacks—and stop diverticula from forming in the first place.”

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“You may notice a large amount of bright red blood in the toilet, and you should go the emergency room immediately, explains Kavya Reddy, MD, UCLA Division of Digestive Diseases. “The bleeding is usually painless, and oftentimes it will stop on its own, but if it’s significant, it may require blood transfusions, or a procedure
to stop the bleeding.”

Risk Factors for Diverticulosis

Why this condition develops is not yet fully known. Experts point to genetic predisposition as risk factor, so if your parents or siblings have it, you are more likely to develop diverticulosis. Constipation may play a role in the development of the pouches because the force of intense straining may create weak spots along intestinal walls where pouches form. Some studies have linked medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, and steroids as increasing risk for diverticulosis. Additional risk factors include obesity, smoking, and a sedentary lifestyle.

For decades, experts believed that a lack of fiber in the diet was a risk factor for diverticulitis, but that assumption is being questioned. “Historically, diverticular disease is associated with low fiber diets and diets high in animal fat; however, newer studies are showing that low fiber on its own may not increase risk as much as previously thought,” says Dr. Reddy. “High or adequate fiber
(25 to 30 grams daily) is still recommended to prevent recurrence once you have had diverticulitis and for the management of constipation.”

Progression to Diverticulitis

If the pouches become inflamed, and eventually get infected, this is
known as diverticulitis. “When this happens, you can have abdominal pain in the area of the infected diverticula, commonly in the lower left abdomen,” says Dr. Reddy. “You may also experience a fever, bloating, and a change in your bowel habits.”

A computed tomography (CT) scan of the colon is the most common
test used to diagnose diverticulitis. This scan uses a combination of x-rays and computer technology to create images of the GI tract. An x-ray technician performs the procedure in an outpatient center or a hospital. Anesthesia is not required. However, a contrast medium may be needed (a drink or an injection of a special dye). The contrast medium makes the structures easier to see.

Treatment and Prevention

When diverticulitis is mild, it’s usually treated with bowel rest (i.e., liquid diet for a few days), antibiotics, and/or pain medication. If the attack is severe, a stay in the hospital may be needed
to provide intravenous antibiotics. “In rare cases, there can be severe complications, such as an abscess (a collection of pus), that may require placement of a drain into the abdomen to remove the infection,” explains Dr. Reddy. “Also, the pouches can burst or perforate, and this can require surgery.”

The goal of treating diverticulitis is to prevent the pouches from causing problems. Although a high-fiber diet may not prevent the disease, it may help prevent recurrent attacks. The general recommendation is to be on a low-fiber diet during an acute attack of diverticulitis, and once the symptoms have resolved, fiber intake should be increased slowly to reduce the risk of developing excess gas or pain in the abdomen. Wheat bran, an insoluble fiber, may be suggested because it passes easily through the GI tract, lowering pressure in the colon. Experts are not sure if diverticular disease can be prevented since multiple factors, including genetics, diet, lifestyle, and the gut microbiome, determine your risk of developing the disease. However, Dr. Reddy says “you can do your part in potentially preventing the disease by maintaining a healthy weight, getting enough exercise, avoiding or quitting smoking, and lowering red meat intake.”

A 2018 study published in the journal Gut examined the eating habits of 46,500 men over a 26-year period and found that those with the highest red meat consumption had a 58 percent chance of developing diverticulitis.

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