A common cause of irritable bowel syndrome and diverticulitis: chronic distal colon distention from sedentary behavior and excessive dietary fiber

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Date: July 2013
Publisher: Expert Reviews Ltd.
Document Type: Report
Length: 5,127 words
Lexile Measure: 1530L

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Author(s): Steven E Robbins [*] 1

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descending colon; dietary fiber; distention; diverticulitis; diverticulosis; historical diets; irritable bowel syndrome; sedentary

Attention has recently been focused on expanding the analysis of health problems beyond the arbitrary traditional boundaries imposed by subspecialties and even traditional health sciences through a multidisciplinary approach. By expanding the pool of relevant verified reports, it has been hoped that new insight could be gained, particularly in areas that have stagnated. Certainly, our understanding of the cause or causes of irritable bowel syndrome (IBS) and diverticular formation and subsequent diverticulitis (DFSD) seems particularly suited for this approach, since it remains as obscure as it was when these conditions were first identified ages ago.

The cause or causes of IBS and DFSD may be related. They affect mainly the distal descending and sigmoid colon [1-5] . Both are similar in prevalence, although they commence at differing ages - IBS usually beginning in late adolescence, whereas DFSD incidence begins to rise in middle age [1-5] . There are regional disparities in the incidence of DFSD, and perhaps IBS, that are poorly explained by differences in dietary fiber consumption. The incidence of DFSD and perhaps IBS is highest in the western industrialized countries and lower in Asia [6,7] . The incidence of both may have increased [6-8] . Diverticulitis commences at a younger age now compared with decades ago, and IBS and perhaps DFSD are more common in sedentary individuals [9] . Since the majority of the population have at least modest symptoms of IBS, most sufferers of DFSD probably suffered from IBS symptoms earlier in life. This suggests that over time, IBS might lead to DFSD.

Prevention of IBS and DFSD is not possible since successful interventions require understanding of cause, and no plausible causal mechanisms have been advanced for either, let alone one that explains both [1-5] . Contemporary standards of proof of causality of a disorder require both a statistical association between disorder and proposed cause together with a plausible (best proven) causal mechanism [10] . Proof of causality is further advanced when it satisfies the principle of 'parsimony' (referred to sometimes as 'Ockham's razor'), which, in the present context, is considered a single causal hypothesis which explains both IBS and DFSD [10] . It would be further strengthened if it also explained other related issues [10] , such as why the incidence of both IBS and DFSD appears to be increasing [8] , why augmenting dietary fiber has failed to prevent and perhaps exacerbated both conditions [8] , regional disparities in DFSD [6,7] , why DFSD incidence is increasing in a younger age group [9] and why IBS is more prevalent in sedentary individuals [11] .

Dietary fiber consists of cellulose, which humans digest poorly. Diets rich in fiber were introduced for the management of IBS and DFSD decades ago [12,13] without any scientific reports that meet high standards supporting their effectiveness in preventing and managing those conditions [12] . They continue to be recommended despite reports indicating that augmenting dietary fiber fails to prevent DFSD and is less effective than prunes in dealing with...

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Gale Document Number: GALE|A339495925