Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Consumption of Nuts, Corn and Popcorn Not Associated with Diverticular Disease

Backpackers and other outdoor travelers sometimes subsist on less-than-ideal diets, including "junk food," and items that are easy to carry because of their packaging. Some favorite foods include nuts (along or contained in "GORP"), corn nuts, and popcorn. Nuts are actually quite nutritious, containing excellent protein, fiber, vitamins, minerals, and other micronutrients.

Diverticular disease (diverticulosis) can convert to diverticulitis and/or diverticular bleeding. Here is a bit of information on diverticulitis:

Diverticula are small outpouchings that develop at weak points along the wall of the colon (large bowel), probably because of high pressures associated with muscle contractions during the passage of stool. When these sacs become obstructed and/or inflamed (most frequently in middle-aged or elderly individuals), they enlarge and create pain and fever, known as diverticulitis. Usually, the left lower quadrant is involved, because diverticula tend to form in the left-side portion of the colon (descending colon) more frequently than in the right-side portion (ascending colon) or horizontal connecting section (transverse colon). A ruptured diverticulum can cause a clinical picture much like that of a ruptured appendix, with pain in the left side of the abdomen instead of the right side. The victim should seek medical attention, and his diet be limited to clear fluids. Antibiotics (metronidazole combined with doxycycline, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, metronidazole, cefixime, ciprofloxacin, or cefpodoxime) should be administered if help is more than 24 hours away.

As pointed out in an article in the August 17, 2008 issue of the Journal of the American Medical Association, entitled "Nut, Corn, and Popcorn Consumption and the Incidence of Diverticular Disease," by Lisa Strate, M.D. and colleagues, doctors have historically advised persons with known diverticular disease (e.g., the presence of diverticuli) to avoid eating nuts, seeds, popcorn, corn, and other high-residue foods. This is on the presumption that as these food products pass through the bowel partially or completely nondigested, they may either cause trauma to the diverticuli or lodge in them, causing them to become obstructed and inflamed. This recommendation has been around for as long as I have been practicing medicine, and has always been presumed to be true, reinforced by anecdotes. I've been as guilty as the next person in this regard, citing for evidence a patient that I remember who had a watermelon seed pop out of an abscess in his flank, presumably the result of retention within a diverticulum, obstruction, diverticulitis and abscess formation, and erosion to the skin surface.

In the study reported by Dr. Strate, 47,228 men aged 40 to 75 years without known diverticulosis or diverticulitis completed a self-administered questionnaire about medical and dietary information. If any of the men reported newly diagnosed diverticulosis or diverticulitis, they were asked to complete a supplemental questionnaire. During 18 years of follow-up, there were 801 cases of diverticulitis and 383 cases of diverticular bleeding identified. There was no association seen (e.g., no increased risk) for those who ate nuts, popcorn, or corn with new-onset diverticulitis or diverticular bleeding.

This was a good study, and the discussion took into account any behavioral changes, gender, and age. It appears from this evaluation that one may eat a "backpacker's diet" without fear of inducing diverticulitis. However, if you don't eat and drink properly, you may still encounter infectious diarrhea, constipation, or other sequelae to dietary indiscretion.

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Preview the 17th Annual WMS Winter Meeting, "Wilderness & Mountain Medicine," which will be held at The Canyons in Park City, Utah, February 20-25, 2009.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.