African schoolchildren 33 English schoolboys 70
This is not the result of a rugby match but the start of the revolution in the treatment of diverticular disease (DD) in the 1970s. The figures are the average times in hours for food to pass through the digestive system (1) a measurement known as ‘transit time’ The difference in the two figures was attributed to the amount of fibre in the children’s diets. Researchers then tested this theory in adults, for example, adding fibre to a standard diet of five healthy young men reduced the mean transit time from 2.4 days to 1.6 days(2). People with DD had very little fibre in their diets and long transit times (3) (this was the medical treatment at the time so this finding was not surprising) Thus the fibre theory of cause, prevention and treatment of DD was born and dietary fibre has become an institution which has spread throughout medical research. As Dr le Fanu pointed out (4) it has never been demonstrated that those who get diseases eat more or less fibre than those who don’t, nor has it been demonstrated that eating more fibre will prevent diseases.
There is another way of reducing transit time. In 10 healthy volunteers, moderate exercise reduced transit time from an average of 51.2 hours to 36.6 hours with 1 hour cycling per day or to 34.0 hours with 1 hour jogging per day (5). A 13 week training programme by 7 healthy, older men reduced mean transit time from 41 hours to 20 hours (6). Exercise in dogs initiated the powerful colon movements which were followed by defaecation. In healthy people the transit time was greater in women than men (7) and ageing had more effect on women than men in slowing transit (9). Is this a possible explanation of greater incidence of DD in women where the dietary fibre theory fails?
There is no doubt that increasing dietary fibre can reduce transit time and give softer, bulkier stools with less straining for many people with or without DD and constipation can be a particular problem in older people. An excess of fibre can produce urgency, diarrhoea and accidents. Similar effects are found in distance runners with cramps, nausea, vomiting and occasional rectal bleeding also (10). Physical activity could alter gastrointestinal blood flow, nerves and hormones or have a purely mechanical effect (11).
How fibre intake and exercise interact for people with DD has been demonstrated by Aldoori et al (12) They had been following the lifestyle and health of 47,678 American men aged 40 to 75 years. During a set 4 year period, 382 men were diagnosed with DD because of symptoms .They gave people in this group with a high dietary fibre intake and high levels of physical activity a relative risk value of 1.0. Diet and exercise interacted so that when both were low, symptomatic DD was more than two and a half times more likely. This is illustrated in Diagram 1.
DIAGRAM 1 The effect of fibre and exercise on the relative risk of DD symptoms. Adapted from Aldoori et al (12). Men having a low fibre intake with low physical activity levels were two and a half times more likely to have symptoms leading to DD diagnosis than those with high fibre/high activity
| HIGH FIBRE INTAKE | MEDIUM FIBRE INTAKE | LOW FIBRE INTAKE | |
| HIGH ACTIVITY | 1.0 | 1.21 | 0.85 |
| MEDIUM ACTIVITY | 0.80 | 1.43 | 1.81 |
| LOW ACTIVITY | 1.20 | 1.55 | 2.56 |
Exercise moves along gas responsible for abdominal symptoms (13) and gas is claimed to be a major factor in DD (14). There is also the contribution of exercise to weight reduction and excess weight has been linked to more serious problems with DD (15) and their surgical correction (16).
Not everybody with DD is capable of doing much exercise. Arthritis and other complaints and the pain of DD do not encourage exercise, but every little helps. When resting or in bed, deep diaphragm breathing pushing out the stomach is a relaxation technique which moves the colon. The bowels can be squashed by bad posture. Massaging the abdomen in a clockwise circular direction can also keep the colon moving. There is a report of a mechanical kneading device applied to the abdomen of long- term care patients (17). This reduced colon transit time and helped to relieve severe constipation without any observed side effects.
Perhaps the researchers in Africa in the 1960s and 1970s were somewhat selective in deciding that fibre in the diet accounted for all the differences between African and English schoolchildren. Parasitic infections and dysentery as well as exercise probably played their part. The colon is part of the whole person and not affected just by what is passing through it. In exercise and movement we have another potential means of reducing problems with DD and its impact on quality of life.
Keeping moving will keep the bowels moving.
©Mary Griffiths 2006
REFERENCES
- The Royal College of Physicians ‘Medical aspects of dietary fibre’ Pitman Medical 1980 Chap 7
- Cummings JH, Jenkins DJA and Wiggins HS Measurement of the mean transit time of dietary residues through the human gut. Gut 1976, 17, 210
- Brodribb AJM & Humphreys DM Diverticular disease: three studies. Br Med J 1976, i, 424
- Dr James Le Fanu ‘Eat your heart out. The fallacy of the healthy diet’ Macmillan London 1987, Chap 7
- Oettle GJ Effect of moderate exercise on bowel habit. Gut 1991, 32, 941
- Koffler KH et al Strength training accelerates gastrointestinal transit in middle- aged and older men Med Sci Sports Exerc 1992, 24, 415
- Dapoigny M & Sarna SK Effect of physical exercise on colonic motor activity Am J Physiol 1991, 260(4 pt 1) G646
- Sadik R, Abrahamsson H & Stotzer PO Gender differences in gut transit shown with a newly developed radiological procedure Scand J Gastroenterol 2003,38,36
- Graff J, Brinch K & Madsen JL Gastrointestinal mean transit times in young and middle-aged healthy subjects. Clin Physiol 2001, 21, 253
- Sullivan SN & Wong C Runner’s diarrhoea. Different patterns and associated factors J Clin Gastroenterol 1992, 14,101
- Simren M Physical activity and the gastrointestinal tract. Europ J Gastroenterol Hepatol. 2002, 14, 1053
- Aldoori WH et al Prospective study of physical activity and the risk of symptomatic diverticular disease in men Gut 1995, 36, 276
- Azpiroz F & Serra J Treatment of excessive intestinal gas Curr Treat Options Gastroenterol 2004,7, 299
- Wynne-Jones G Flatus retention is the major factor in diverticular disease Lancet 1975, 2(7927), 211
- Dobbins C et al The relationship of obesity to the complications of diverticular disease Colorectal Dis 2006, 8, 37
- Pessaux P et al Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicentre multivariate analysis of 582 patients World J Surg 2004, 28, 92
- Mimidis K et al Use of a device that applies external kneading- like force on the abdomen for trearment of constipation World J Gastroenterol 2005, 11, 1971
- The Royal College of Physicians ‘Medical aspects of dietary fibre’ Pitman Medical 1980 Chap 7
- Cummings JH, Jenkins DJA and Wiggins HS Measurement of the mean transit time of dietary residues through the human gut. Gut 1976, 17, 210
- Brodribb AJM & Humphreys DM Diverticular disease: three studies. Br Med J 1976, i, 424
- Dr James Le Fanu ‘Eat your heart out. The fallacy of the healthy diet’ Macmillan London 1987, Chap 7
- Oettle GJ Effect of moderate exercise on bowel habit. Gut 1991, 32, 941
- Koffler KH et al Strength training accelerates gastrointestinal transit in middle- aged and older men Med Sci Sports Exerc 1992, 24, 415
- Dapoigny M & Sarna SK Effect of physical exercise on colonic motor activity Am J Physiol 1991, 260(4 pt 1) G646
- Sadik R, Abrahamsson H & Stotzer PO Gender differences in gut transit shown with a newly developed radiological procedure Scand J Gastroenterol 2003,38,36
- Graff J, Brinch K & Madsen JL Gastrointestinal mean transit times in young and middle-aged healthy subjects. Clin Physiol 2001, 21, 253
- Sullivan SN & Wong C Runner’s diarrhoea. Different patterns and associated factors J Clin Gastroenterol 1992, 14,101
- Simren M Physical activity and the gastrointestinal tract. Europ J Gastroenterol Hepatol. 2002, 14, 1053
- Aldoori WH et al Prospective study of physical activity and the risk of symptomatic diverticular disease in men Gut 1995, 36, 276
- Azpiroz F & Serra J Treatment of excessive intestinal gas Curr Treat Options Gastroenterol 2004,7, 299
- Wynne-Jones G Flatus retention is the major factor in diverticular disease Lancet 1975, 2(7927), 211
- Dobbins C et al The relationship of obesity to the complications of diverticular disease Colorectal Dis 2006, 8, 37
- Pessaux P et al Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicentre multivariate analysis of 582 patients World J Surg 2004, 28, 92
- Mimidis K et al Use of a device that applies external kneading- like force on the abdomen for trearment of constipation World J Gastroenterol 2005, 11, 1971
Note The 2006 Spring/Summer issue of Incontact magazine contained this article
Tags: Bowel gas, Exercise, Faeces, Fibre, Transit time