Why You Need a Colon Cancer Screening Earlier Than You Think

Colon cancer is the second leading cause of cancer death in men and women in the United States. Recently, it’s been killing people at younger ages—death rates for colon cancer in adults between the ages of 20 and 54 have increased since the mid-2000s. This fact is alarming because the death rate for that same age group had been declining just a decade earlier. In addition, symptoms of colon cancer—including blood in the stool, abdominal pain, and iron deficiency anemia—usually occur at later stages in the disease. Even then, those symptoms in younger people tend to be dismissed or ascribed to less-serious conditions.

Traditionally, screening guidelines recommend that people at average risk begin colon cancer screening at age 50 (90 percent of people diagnosed with colon cancer are 50 and older). But due to the rise in colon cancer diagnoses in younger people, The American Cancer Society has changed its recommendation, urging 22 million Americans between the ages of 45 and 49 to get screened.

“It’s a deadly disease,” says gastroenterologist Dr. Maurice A. Cerulli and associate professor at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. “Without routine screening, by the time you notice symptoms, the colon cancer is in advanced stages. That’s why there’s a call to lower the screening age for everyone—to save lives.”

Catching a killer

Every year, more than 97,000 people are diagnosed with colon cancer across the country. This year, more than 50,000 people will die from the disease, according to the American Cancer Society. More than 30 percent of Americans over 50 still haven’t been screened for colon cancer.

And now experts want to start looking for this cancer at an earlier age. “Young people are getting into the prime of their lives and developing colon cancer, but because they are young, they’re writing the symptoms off as something else when they should be getting screened,” Dr. Cerulli says. In a younger person, blood in the stool, changes in bowel habits, progressive abdominal pain and unexplained weight loss may be attributed to irritable bowel syndrome. In women, iron deficiency anemia, another symptom of colon cancer, might be attributed to their menses.

Dr. Cerulli points out that colon cancer is unlike many other cancers in that screening can actually prevent the disease. “In breast, prostate or lung cancer, you’re looking for small, early-stage cancer tumors. In colon cancer, you’re screening for precancerous growths that you can treat before someone develops cancer.”

The gold standard for colon cancer screening is a colonoscopy—a scope (a flexible tube with a light and tiny TV chip at one end) is inserted through the anus and snaked through the rectum and colon. The doctor is looking for polyps—growths on the inner surface of the colon that are not cancerous, but can develop into cancer. If doctors find a polyp, they can remove it then and there with special instruments inserted through the same scope.

If you have a colonoscopy with no abnormal findings or polyps, then you don’t need another one for 10 years. But not everyone is comfortable enough with the idea of the scoping or the preparation to have one—as is evident in the low screening numbers among those 50 and older.

There are other options, Dr. Cerulli explains, but they come with their own risks and benefits.

The fecal immunochemical test, or FIT, looks for hidden blood in stool that may indicate the presence of a polyp. Your doctor can provide a kit for you to collect the stool sample. These tests can be done at home, but they must be done annually. If a test is positive, you’ll need to have a colonoscopy.

The Cologuard test detects DNA from cancer or polyps in a stool sample. Your doctor can request the test for you to use at home. It has detailed instructions for collecting and preparing the stool so the DNA can be tested. Even though it looks for DNA from polyps, it can still miss them or return false-positive tests. DNA testing should be repeated every three years.

Dr. Cerulli says that while a colonoscopy is invasive, it’s the best cancer-preventing test. FIT and Cologuard are not invasive like a colonoscopy, but they must be done more frequently and positive tests will require a colonoscopy anyway. They also have one drawback in common—“Not everyone wants to handle stool,” Dr. Cerulli says.

“In breast, prostate or lung cancer, you’re looking for small, early-stage cancer tumors. In colon cancer, you’re screening for precancerous growths that you can treat before someone develops cancer.”
Dr. Maurice A. Cerulli, gastroenterologist

Who’s most at risk?

Anal scopes and stool handling are not high on anyone’s wish lists, so just who should heed the call for earlier screening? People with a personal or family history of colon cancer or polyps (Dr. Cerulli says if a close relative has had colon cancer, you should start screening ten years before his or her age at the time of diagnosis, or at age 40), inflammatory bowel disease (including ulcerative colitis and Crohn’s disease) and certain genetic abnormalities are at higher risk for colon cancer. Heavy drinking, smoking, obesity and type 2 diabetes also increase your risk of the disease. Finally, African-Americans have a higher risk than any other ethnic group.

If you don’t have these risk factors, you may still want to consider earlier screening. Most people who develop colon cancer did not have a family history of the disease.

Ultimately, whether you should get screened before age 50 and which screening is best for you should be decided with your doctor. Take into account your risk factors, insurance coverage and personal preferences in those conversations.

Reference: https://thewell.northwell.edu/well-informed/why-you-need-colon-cancer-screening-earlier-you-think#.W1qYwRhR9NA.email



Proton pump inhibitors: Risks of long‐term use

Proton pump inhibitors are among the most commonly prescribed classes of drugs, and their use is increasing, in particular for long‐term treatment, often being over‐prescribed and used for inappropriate conditions. In recent years, considerable attention has been directed towards a wide range of adverse effects, and even when a potential underlying biological mechanism is plausible, the clinical evidence of the adverse effect is often weak. Several long‐term side effects have been investigated ranging from interaction with other drugs, increased risk of infection, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia. The most recent literature regarding these adverse effects and their association with long‐term proton pump inhibitor treatment is reviewed, and the mechanisms through which these possible complications might develop are discussed.


Proton pump inhibitors (PPIs) are among the most commonly prescribed classes of drugs, widely used to treat patients with acid‐related disorders, such as gastroesophageal reflux disease and peptic ulcer. Their use is increasing, particularly for long‐term treatment, often being over‐prescribed and used for inappropriate conditions.1 PPIs are generally considered to be effective and well tolerated, with only rare and mild side effects in short‐term use PPIs, whereas concern and evidence on the potential long‐term complications of PPI therapy are increasingly emerging. The potential adverse effects range from interaction with other drugs, increased risk of infections, reduced intestinal absorption of vitamins and minerals, and more recently kidney damage and dementia, investigated mainly by case–control and cohort studies.

We have reviewed the most recent literature reporting possible associations between long‐term PPI treatment and adverse effects and discussed the mechanisms through which these complications might develop (Table 1).

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The low FODMAP diet

There is a growing body of evidence that the low FODMAP diet is effective in improving symptoms of IBS. FODMAP stands for:

  • Fermentable
  • Oligo
  • Di
  • Mono-saccharides
  • And
  • Polyols

These are a group of short-chain carbohydrates that are not very well absorbed in the gut (small intestine). These carbohydrates are easily fermented and cause more fluid to enter the large bowel, leading to gas, bloating and diarrhea. Reducing the total amount of these fermentable sugars may improve IBS symptoms. The low FODMAP diet should be tried with the assistance of a dietician.

Gastroesophageal Reflux Disease Diet


The esophagus is the tube that carries food from the throat to the stomach.  However, it is not just a simple tube.  The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach.  It acts to prevent the reflux of the stomach into the esophagus.

Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus.  These symptoms include heartburn, chest discomfort, and bitter fluid flowing up into the mouth.  Chest discomfort can occur.  If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur.  This entire problem is called GERD (Gastroesophageal Reflux Disease).  A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.

Nutrition Facts

A diet designed to prevent or reduce acid reflux is usually easy to follow.  The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations.  So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council,  A vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, tomato, etc.

Special Considerations

The lower esophageal muscle can be weakened by factors other than food.  The following recommendations may be helpful in reducing symptoms:

  1. Stop using tobacco in all forms.  Nicotine weakens the lower esophageal muscle.
  2. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
  3. Do not lie down immediately after eating. Avoid late evening snacks.
  4. Avoid tight clothing and bending over after eating.
  5. Eat small, frequent portions of food and snack if needed.
  6. Lose weight if overweight. Obesity leads to increased reflux.
  7. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
  8. The following foods aggravate acid reflux, and should be avoided:
  • fatty or fried foods
  • peppermint and spearmint
  • whole milk
  • oils
  • chocolate
  • creamed foods or soups
  • most fast foods
  1. The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:
  • citrus fruits and juices (grapefruit, orange, pineapple, tomato)
  • coffee (regular and decaffeinated)
  • caffeinated soft drinks
  • tea
  • other caffeinated beverages
  1. Spicy or acidic foods may not be tolerated by some individuals.




Milk or Milk products skim, 1% or 2% low-fat milk;
low-fat or fat-free yogurt
whole milk (4%), chocolate milk
Vegetables all other vegetables fried or creamy style vegetables
Fruit apples, berries, melons,
bananas, peaches, pears
citrus*: such as oranges,
grapefruit, pineapple
Breads & Grains all those made with low-fat

any prepared with whole milk or high-fat 1

Meat, meat
low-fat meat, chicken, fish, turkey cold cuts, sausage, bacon, fatty meat, chicken fat/skin

Fats, Oils
none or small amounts all animal or vegetable oils
Sweets & desserts all items make with no or low fat (less than or equal to 3g fat/serving)
chocolate, desserts made with and/or fats
Beverages  decaffeinate, non-mint herbal, tea: juices (except citrus); water alcohol, coffee, (regular or decaffeinated), carbonated beverages, tea,
mint tea
Soups  fat-free or low-fat based chicken, beef, milk, or cream-based soups

**Individually determined

IBS Diet Sheet

Diet and lifestyle management can be used as a treatment for irritable bowel syndrome (IBS). When looking to treat symptoms of IBS, using a staged approach is most useful. It may be as simple as eating healthily and changing lifestyle factors, or there may be slightly stricter and more specific ways to manage symptoms.


Diet and lifestyle changes for treatment of IBS

Before making any dietary changes, keep a food and symptom diary for a week. This can be a helpful way to identify foods that may be triggering a response in your body. Record all food and drink consumed for a week and make a note of any symptoms experienced. Try to record an approximate quantity eaten and the time of day. Symptoms may not always be caused by what you eat so consider other factors that may be involved.


Step one – healthy eating and lifestyle changes

A healthy diet

This includes:

  • Plenty of fruit and vegetables.
  • Plenty of starchy carbohydrates. Examples include bread, rice, cereals, pasta, potatoes, chapattis and plantain.
  • Some milk and dairy products (2-3 portions per day). If you are lactose intolerant include dairy alternatives such as soya, rice or oat milk and yogurt that are enriched with calcium.
  • Some protein foods: meat, fish, eggs and alternatives such as beans and pulses.
  • Limited amounts of foods high in fats and sugars. Limit saturated fat that is found in animal products such as butter, ghee, cheese, meat, cakes, biscuits and pastries. Replace these with unsaturated fats found in vegetable oils such as sunflower, rapeseed and olive oil, avocados, nuts and seeds.
  • Drink plenty of fluid – at least two liters daily, such as water or herbal teas.

Lifestyle changes to improve symptoms

  • Have a regular meal pattern.
  • Take time when eating meals.
  • Try not to skip meals.
  • Sit down to eat; chew food well.
  • Try to avoid eating too late at night.
  • Exercise regularly, such as walking, cycling, or swimming. If finding time is difficult, incorporate it into your day. For example, cycle to work, get off a train a stop early and walk, and use steps instead of lifts when possible.


If you have a hectic lifestyle, stress and anxiety may also be causing IBS symptoms. There are many complex connections between the brain and the gut. Psychological factors, the nervous system, and muscle contractions in the gut all interact with each other, causing IBS symptoms. This is known as the brain-gut axis. Therefore, stress management can be effective in easing symptoms.

  • Create time for relaxation.
  • Make the most out of leisure time.
  • Try relaxation therapies such as mindfulness.
  • Exercise – try yoga or taking a walk.
  • Get enough sleep.
  • Seek support or counseling.

Step two – symptom-specific changes to the diet

Sometimes, a healthy balanced diet and lifestyle changes aren’t enough to improve symptoms. It may be that more specific changes to the diet are needed. Many people report that what they eat affects their symptoms. Therefore, modifying what you eat can help to manage symptoms.

Reduce caffeine

Caffeine can stimulate activity in the colon, which may worsen symptoms of pain and diarrhea. Limit tea and coffee to no more than three cups per day. Filter coffee contains higher amounts of caffeine (140 mg) compared to instant coffee (100 mg) and tea (75 mg). So, if filter coffee is included in your diet, you may want to limit this to two cups per day. There is also caffeine in cola and some other soft drinks, and in chocolate.

Limit alcohol and fizzy drinks

Fizzy drinks and alcohol can worsen symptoms of diarrhea. Limit your intake of these drinks to improve symptoms. Aim to have at least two alcohol-free days each week and no more than two units each day.

A unit of alcohol is:

  • One 25 ml shot of spirits.
  • Half a pint of standard-strength lager/beer (3-4% alcohol by volume).
  • One small 125 ml glass of wine (11% alcohol by volume).

Reduce intake of resistant starches

These are starches that are resistant to digestion in the gut (small intestine). Therefore, they reach the colon intact and are fermented by the germs (bacteria) in our gut. This produces gases and waste products, leading to symptoms of, bloating, wind and diarrhea. People who have IBS react to smaller doses of resistant starches than those who don’t have IBS. Reducing resistant starches may also improve symptoms of diarrhea.

Reduce intake of foods containing resistant starches

  • Processed foods such as crisps, oven chips, supermarket pizza, biscuits and cakes, breakfast cereals.
  • Foods that have been cooked and left out to cool – for example, cold potato/pasta salads.
  • Ready meals.
  • Partially baked bread – for example, garlic bread or pizza bases.
  • Whole grains, pulses, sweetcorn, green banana and muesli that contains bran.
  • Dried pasta (use fresh instead).
  • Savory snacks.

Cook fresh food whenever possible and eat food that you’ve cooked straightaway. This will help to reduce intake of resistant starches.

Modify your fiber intake

Fiber can be a confusing subject for many of those affected by IBS. For some people, reducing high-fiber foods can help to improve symptoms. For others, increasing fiber can help to improve symptoms, so it is very much dependent on the individual. Adjust fiber intake according to personal symptoms. Use a food and symptom diary and monitor any changes.

It may help to clarify what exactly dietary fiber is and how it may affect symptoms. There are two types of fiber which work differently in the body. Generally, reducing insoluble fiber may help with symptoms but if an increase in fiber is necessary, this should be from soluble fiber.

Insoluble fiber
This type of fiber does not dissolve in water and is not readily broken down, so it passes through the digestive system mostly intact. It absorbs water, adds bulk to stools (feces) and allows waste to be passed through bowels more quickly. Reducing this type of fiber may help to improve symptoms of diarrhea. Foods to reduce or avoid:

  • Skin, pith and pips of fruit and vegetables.
  • Wheat and bran.
  • Corn (maize).
  • Nuts and whole grains.

Soluble fiber
This type of fiber dissolves in water and is broken down by the natural bacteria in the bowels. It softens stools and makes them larger. Increasing this type of fiber may help to improve symptoms of constipation. Foods to include are:

  • Oats
  • Barley
  • Psyllium and ispaghula
  • Nuts and seeds
  • Fruit and vegetables
  • Beans and pulses

Whole grains (for example, wholemeal bread, brown rice and wholewheat pasta) may also help with constipation. Although increasing fiber may help to improve symptoms, it may also generate gas and cause pain and bloating. Monitoring is important to help identify this and to adjust your fiber intake according to your symptoms.

If fiber intake is suddenly increased, this can cause symptoms of wind and bloating. Introduce high-fiber foods gradually to allow the gut to become used to the extra fiber. Introduce one new food over a two- to three-day period and monitor any symptoms. For example, have porridge for breakfast on the first day; then add beans or extra vegetables to a casserole two days later; then maybe have an extra piece of fruit two to three days later.

Drink plenty

Fiber needs water, so aim to drink at least 8-10 cups of water daily or other fluids such as herbal teas or sugar-free squash. People with diarrhea will need to make sure they are replacing these lost fluids. Drinking water will also help to improve constipation.

Include golden linseeds

Including these in the diet may improve symptoms of wind, bloating, constipation and diarrhea. They are a source of insoluble and soluble fiber. They can be added to casseroles, stews, soups, porridge, cereals, yogurts and desserts. Include one tablespoon each day.

Reduce fatty foods

Some people find that fatty foods are difficult to digest and can cause symptoms of diarrhea; therefore, reducing fat in the diet may help:

  • Limit cakes, biscuits, chocolates and pastries.
  • Cut down on fatty meat products such as sausages, pies and pasties.
  • Use lower-fat dairy products – for example, low-fat yogurt, cottage cheese, semi-skimmed milk.
  • Choose tomato-based sauces rather than creamy sauces – although some tomato sauces can be oily so check the label.
  • Use small amounts of cheese (a matchbox size is a portion) – stronger-flavored cheeses may help you to use less.
  • Take care when using dressings and sauces such as mayonnaise and salad cream. Use small amounts and try the reduced-fat versions.
  • Cut off visible fat from meat and choose leaner cuts of meat.
  • Use minimal oil/butter when cooking (use an oil spray, or measure using one teaspoon of oil per person, per meal).
  • Try different cooking methods such as steaming, boiling, microwaving, grilling and poaching rather than frying.

Reduce fructose

Fructose can cause diarrhea in some people, particularly when eaten in large quantities. Sometimes fructose is not well absorbed; it can draw water from the body into the bowel, causing osmotic diarrhea. If fructose is not well absorbed, it is fermented in the colon and gases are produced, causing wind and bloating in some people with IBS.

Try limiting fruit intake to no more than three portions each day. Only have one small glass (150 ml) of fruit juice per day. Having more vegetables will help to meet the recommendation of at least five portions of fruit and vegetables each day. A portion is about 80 g, or what might fit in the palm of your hand. A portion of dried fruit is about one tablespoon.

It might be useful to limit honey, which contains fructose. Sometimes ‘high-fructose corn syrup’ or ‘corn syrup solids’ are added to processed foods, so try avoiding or limiting these. Check the labels for these ingredients.

Avoid sorbitol

Sorbitol is poorly absorbed and has a laxative effect when it enters the colon, so this can cause symptoms of bloating and diarrhea. People with IBS may be sensitive to smaller amounts of sorbitol.

Sorbitol is found in artificial sweetener, low-sugar sweets, drinks, mints and gum and often found in diabetic or slimming products. Also check the labels of these products for mannitol and xylitol, which have a similar effect.


Try probiotics

Probiotics may be useful in improving symptoms of IBS, although they do not work for everybody. Probiotics can help to balance our gut bacteria. The ‘good’ bacteria in probiotics compete with ‘bad’ bacteria for space in the gut. This means that there are fewer ‘bad’ bacteria, making it a healthier gut environment. This can help with digestion and to improve symptoms of wind, bloating and diarrhea.

There are a number of probiotic products available, including yogurts, drinks and supplements such as tablets, capsules or sachets. Some examples are Yakult®, Activia® and Actimel®. Probiotics need to be taken in the recommended dose every day for at least four weeks. Monitoring symptoms can help to identify any benefit. Other brands contain different mixtures of bacteria, so trying a different product may help if there is no success with one particular brand.

Step three – elimination diets

Some people find that even after making these dietary changes, their symptoms are still not improving. Avoidance of single foods or following elimination diets might have some benefit for people with IBS. Such dietary regimes should only be followed with the guidance of a dietician.

Food intolerance

Some people with IBS may have a food intolerance. Some food intolerances, such as lactose, can be diagnosed with a hydrogen breath test, which can be arranged by a doctor. Other food intolerances can be identified by following a diet that excludes suspected foods.

If it is thought that particular foods are causing symptoms, a dietician may advise you to exclude these foods for a certain time period. This is to monitor whether symptoms improve when these foods are taken out of the diet. After this time period (usually 2-4 weeks) the foods are gradually re-introduced to see if symptoms come back. Common intolerances include lactose (found in milk and dairy products), wheat (found in bread, cereals and pasta) and caffeine (found in tea, coffee or cola).

Gluten-Free Diet : GiCare.com


Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten sensitive enteropathy).

Celiac disease is now clearly known to be genetically determined.  In other words, if you or your close relatives have a certain gene, then it is more likely that you will get celiac disease some time in your life.  Of great concern and interest is the fact that nine out of ten people with celiac disease do not known they have it.  A simple blood test can give the physician the first clue to this disease.

In patients with celiac disease, gluten injures the lining of the small intestine. This injury can result in weight loss, bloating, diarrhea, gas, abdominal cramps, and/or vitamin and mineral deficiencies. When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal.

Gut Bacteria

The primary area of injury in celiac disease is the small bowel but there may be a relationship between what happens in the small bowel and the colon or large bowel.  There are very large numbers of bacteria in the colon. Most of these are beneficial and actually confer health benefits.  When these good bacteria thrive, they suppress the bad bacteria, which are present in the colon.  What has been found is that celiac patients, in fact anyone on a gluten-free diet, have an altered make-up of bacteria in the colon which favors the unwanted bacteria.

Prebiotic Plant Fiber

A prebiotic is not a probiotic, which are beneficial bacteria taken by mouth.  These probiotics are present in yogurt, other dairy products and pills.  Prebiotics, on the other hand, are the necessary plant fibers that contain both oligofructose and inulin.  These two fibers are the main nourishment for the good bacteria that reside in the gut.  These fibers are rich in chicory root, Jerusalem artichoke, leeks, asparagus and others.  Gluten containing wheat and barley also contain these prebiotics.

Health Benefits from Prebiotic Fibers

There is now ample information in the medical literature to indicate that a prebiotic rich diet leads to demonstrable health benefits.  These include:

  • Increased calcium absorption
  • Stronger bones and bone density
  • Enhanced immunity
  • Reduced allergies and asthma in infants and children
  • A lower blood triglyceride level
  • Appetite and weight control
  • Lower cancer factors in the gut
  • Other benefits, including an increased sense of well being

The Celiac Wheat-Prebiotic Dilemma

Nature has played a trick on celiac people.  Wheat and wheat products provide over 80% of the prebiotics that North Americans ingest.  Yet, celiac patients must carefully avoid wheat, barley and rye.  How do they then feed their good colon bacteria and get the health benefits, as outlined above?  They must favor the other vegetables and fruits, as listed in the prebiotic section below.  Additionally, they should consider a gluten free prebiotic supplement such as Prebiotin.

Special Considerations

Removing gluten from the diet is not easy.  Grains are used in the preparation of many foods.  It is often hard to tell by a food’s name what may be in it, so it is easy to eat gluten without even knowing it.  However, staying on a strict gluten-free diet can dramatically improve the patient’s condition.  Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

The person who prepares the patient’s food much fully understand the gluten-free diet.  Read food labels carefully:

  • Do not eat anything that contains the following grains: wheat, rye and barley.
  • At one time, oats were thought to contain some gluten.  It has now become apparent, however, that oats frequently were processed in machines that also processed wheat.  Most manufacturers no longer do this, although if there are any questions, a person should get reassurance from the manufacturer by mail, email or phone.
  • The following can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa.
  • Distilled white vinegar does not contain gluten.
  • Malt vinegar does contain gluten.

Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten.  The following terms found in food labels may mean that there is gluten in the product.

  • Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn
  • Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour or soy flour
  • Vegetable Protein, unless made from soy or corn
  • Malt or Malt Flavoring, unless derived from corn
  • Modified Starch or Modified Food Starch, unless arrowroot, corn, potato, tapioca, waxy maize or maize is used
  • Vegetable Gum, unless made from carob bean, locust bean, cellulose, guar, gum arabic, gum aracia, gum tragacanth, xantham or vegetable starch
  • Soy Sauce or Soy Sauce Solids, unless you know they do not contain wheat

Any of the following words on food labels often mean that a grain containing gluten has been used.

  • Stabilizer
  • Starch
  • Flavoring
  • Emulsifier
  • Hydrolyzed
  • Plant Protein

The following are lists of various foods that do not have gluten, may have gluten and do contain gluten.

Prebiotic Plant Fiber Oligofructose and Inulin

NO Gluten MAY Contain Gluten DOES Contain Gluten
Onion, garlic, leeks, Jerusalem artichokes, asparagus, chicory root, jicama, dandelion, banana, agave, jams, Prebiotin Wheat, barley, rye

Milk and Milk Products

NO Gluten MAY Contain Gluten DOES Contain Gluten
Whole, low fat, skim, dry, evaporated or condensed milk; buttermilk; cream; whipping cream; Velveeta cheese food; American cheese; all aged cheese such as Cheddar, Swiss, Edam and Parmesan Sour cream, commercial chocolate milk and drinks, non-dairy creamers, all other cheese products, yogurt Malted drinks

Meat or Meat Substitutes

NO Gluten MAY Contain Gluten DOES Contain Gluten
100% meat (no grain additives); seafood; poultry (breaded with pure cornmeal, potato flour or rice flour); peanut butter; eggs; dried beans or peas; pork Meat patties; canned meat; sausages; cold cuts; bologna; hot dogs; stew; hamburger; chili; commercial omelets, souffles, fondue; soy protein meat substitutes Croquettes, breaded fish, chicken loaves made with bread or bread crumbs, breaded or floured meats, meatloaf, meatballs, pizza, ravioli, any meat or meat substitute, rye, barley, oats, gluten stabilizers


Breads and Grains

NO Gluten MAY Contain Gluten DOES Contain Gluten
Cream of rice; cornmeal; hominy; rice; wild rice; gluten-free noodles; rice wafers; pure corn tortillas; specially prepared breads made with corn, rice, potato, soybean, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa flour Packaged rice mixes, cornbread, ready-to-eat cereals containing malt flavoring Breads, buns, rolls, biscuits, muffins, crackers and cereals containing wheat, wheat germ, oats, barley, rye, bran, graham flour, malt; kasha; bulgur; Melba toast; matzo; bread crumbs; pastry; pizza dough; regular noodles, spaghetti, macaroni and other pasta; rusks; dumplings; zwieback; pretzels; prepared mixes for waffles and pancakes; bread stuffing or filling

Fats and Oils

NO Gluten MAY Contain Gluten DOES Contain Gluten
Butter, margarine, vegetable oil, shortening, lard Salad dressings, non-dairy creamers, mayonnaise Gravy and cream sauces thickened with flour


NO Gluten MAY Contain Gluten DOES Contain Gluten
Plain, fresh, frozen, canned or dried fruit; all fruit juices Pie fillings, thickened or prepared fruit, fruit fillings None





NO Gluten MAY Contain Gluten DOES Contain Gluten
Fresh, frozen or canned vegetables; white and sweet potatoes; yams Vegetables with sauces, commercially prepared vegetables and salads, canned baked beans, pickles, marinated vegetables, commercially seasoned vegetables Creamed or breaded vegetables; those prepared with wheat, rye, oats, barley or gluten stabilizers

Snacks and Desserts

NO Gluten MAY Contain Gluten DOES Contain Gluten
Brown and white sugar, rennet, fruit whips, gelatin, jelly, jam, honey, molasses, pure cocoa, fruit ice, carob Custards, puddings, ice cream, ices, sherbet, pie fillings, candies, chocolate, chewing gum, cocoa, potato chips, popcorn Cakes, cookies, doughnuts, pastries, dumplings, ice cream cones, pies, prepared cake and cookie mixes, pretzels, bread pudding


NO Gluten MAY Contain Gluten DOES Contain Gluten
Tea, carbonated beverages (except root beer), fruit juices, mineral and carbonated waters, wines, instant or ground coffee Cocoa mixes, root beer, chocolate drinks, nutritional supplements, beverage mixes Postum™, Ovaltine™, malt-containing drinks, cocomalt, beer, ale






NO Gluten MAY Contain Gluten DOES Contain Gluten
Those made with allowed ingredients Commercially prepared soups, broths, soup mixes, boullion cubes Soups thickened with wheat flour or gluten-containing grains; soup containing barley, pasta or noodles

Thickening Agents

NO Gluten MAY Contain Gluten DOES Contain Gluten
Gelatin, arrowroot starch; corn flour germ or bran; potato flour; potato starch flour; rice bran and flour; rice polish; soy flour; tapioca, sago Commercially prepared soups, broths, soup mixes, boullion cubes Wheat starch; all flours containing wheat, oats, rye, malt, barley or graham flour; all-purpose flour; white flour; wheat flour; bran; cracker meal; durham flour; wheat germ


NO Gluten MAY Contain Gluten DOES Contain Gluten
Gluten-free soy sauce, distilled white vinegar, olives, pickles, relish, ketchup Flavoring syrups (for pancakes or ice cream), mayonnaise, horseradish, salad dressings, tomato sauces, meat sauce, mustard, taco sauce, soy sauce, chip dips


NO Gluten MAY Contain Gluten DOES Contain Gluten
Salt, pepper, herbs, flavored extracts, food coloring, cloves, ginger, nutmeg, cinnamon, bicarbonate of soda, baking powder, cream of tartar, monosodium glutamate Curry powder, seasoning mixes, meat extracts Synthetic pepper, brewer’s yeast (unless prepared with a sugar molasses base), yeast extract (contains barley)

Prescription Products

NO Gluten MAY Contain Gluten DOES Contain Gluten
All medicines – Check with pharmacist or pharmaceutical company.

Sample Menu

Breakfast Lunch Dinner
Cream of rice – 1/2 cup
Skim milk – 1 cup
Banana – 1 medium
Orange juice – 1/2 cup
Sugar – 1 tsp
Baked chicken – 3 oz
Rice – 1/2 cup
Green beans – 1/2 cup
Apple juice – 1/2 cup
Ice cream – 1/2
* Ice cream should be made
without wheat stabilizers.
Sirloin steak – 3 oz
Baked potato – 1 medium
Peas – 1/2 cup
Fruit gelatin – 1/2 cup
Butter – 1 Tbsp
Tea – 1 cup
Sugar – 1 tsp

The above sample diet provides the following: 1748 calories; 77 gm protein; 225 gm carbohydrates; 62 gm fat; 1577 gm sodium; 2934 potassium


Diverticulitis Diet


A diverticulitis diet is something your doctor might recommend as part of a short-term treatment plan for acute diverticulitis.

Diverticula are small, bulging pouches that can form in the lining of the digestive system. They’re found most often in the lower part of the large intestine (colon). This condition is called diverticulosis.

In some cases, one or more of the pouches become inflamed or infected. This is known as diverticulitis.

Mild cases of diverticulitis are usually treated with antibiotics and a diverticulitis diet, which includes clear liquids and low-fiber foods. More-severe cases typically require hospitalization.


A diverticulitis diet is a temporary measure to give your digestive system a chance to rest. Oral intake is usually reduced until bleeding and diarrhea subside.

Diet details

A diverticulitis diet starts with only clear liquids for a few days. Examples of items allowed on a clear liquid diet include:

  • Broth
  • Fruit juices without pulp, such as apple juice
  • Ice chips
  • Ice pops without bits of fruit or fruit pulp
  • Gelatin
  • Water
  • Tea or coffee without cream

As you start feeling better, your doctor will recommend that you slowly add low-fiber foods. Examples of low-fiber foods include:

  • Canned or cooked fruits without skin or seeds
  • Canned or cooked vegetables such as green beans, carrots and potatoes (without the skin)
  • Eggs, fish and poultry
  • Refined white bread
  • Fruit and vegetable juice with no pulp
  • Low-fiber cereals
  • Milk, yogurt and cheese
  • White rice, pasta and noodles


You should feel better within two or three days of starting the diet and antibiotics. If you haven’t started feeling better by then, call your doctor. Also contact your doctor if:

  • You develop a fever
  • Your abdominal pain is worsening
  • You’re unable to keep clear liquids down

These may indicate a complication that requires hospitalization.


The diverticulitis diet has few risks. However, continuing a clear liquid diet for more than a few days can lead to weakness and other complications, since it doesn’t provide enough of the nutrients your body needs. For this reason, your doctor will want you to transition back to a normal diet as soon as you can tolerate it.




Diverticulosis, otherwise known as pockets or pouches of the colon, is very common. You can access a full description of this condition at Diverticulosis. The condition is almost certainly caused by a low fiber intake over a lifetime. This results in high pressures in the colon, which very, very slowly, over many years, cause ballooning of tiny weak points in the colon wall resulting in diverticuli. When these pockets become infected, diverticulitis occurs, a painful and, at times, serious condition. Rural Africans who consume 50 or more grams of fiber a day over a lifetime do not get diverticulosis. Yet, they do when they eat a Western diet with low fiber. Low fiber intake can result in small, thin and/or hard pellet stools, which usually means high pressure within the colon. Again, this high pressure is what causes these pockets to balloon out forming diverticuli.

These are dietary recommendations for people with diverticulosis. However, specific advice will depend on the stage of diverticulosis. Is it early diverticulosis? Is it advanced with fixed changes in the colon? Are there symptoms? Or is it acute diverticulitis where the colon is recovering from infection around these pockets?

Stages of Diverticulosis

  • Diverticulitis – Diverticulitis means that one or more of these weak-walled diverticuli has become infected and inflamed. At this point, the physician will want to put the bowel and even the patient at rest. Early on, a diet consisting of clear liquids is often prescribed to ensure maximum bowel rest. As recovery proceeds, the diet is advanced to a Low Fiber Diet, progressing gradually to a High Fiber Diet when recovery is complete.
  • Quiet, early and moderate diverticulosis – This is where most people are. The physician may have discovered a few or a moderate number of diverticuli on colonoscopy as an incidental finding when screening for colon cancer. Because it is just mentioned in passing, not too much importance may be attached to it. This is a mistake, as now is the time that something can really be done. Remember, it is the increased pressures that the colon can exert within itself that causes diverticulosis. A bulky stool helps prevent this. Plant fiber, especially the insoluble fiber, is the best. These are the fibers that do not produce colon gas. The easiest to take are wheat bran, amaranth, barley and others as listed in Fiber Content of Foods.
  • Quiet but advanced, fixed and/or narrowed diverticulosis – In many older folks, the diverticulosis has become so severe that the colon, just above the rectum, becomes fixed, twisted or gnarled by fibrous tissue within the bowel wall. At this stage, the colon is less likely to be massaged back to its normal size. The dilemma here is that large stools can seldom be produced, as the only thing that can get through this narrowed portion of the colon is smaller, even pellet-like stool. Still, it is worth trying small doses of extra food fiber or supplements to see what can be accomplished.

Go to High Fiber Diet for full details. The goal is to increase the daily fiber to 20, 30 or even 40 grams per day. You do not want to do this all at once, and, especially with excessive amounts of soluble fiber as this fiber is the one that, if taken to excess, promotes the bacterial production of harmless colon gas and flatus.

Insoluble Fiber

This fiber, also known as roughage or bulk, does not dissolve in water but paradoxically hangs onto water in the large bowel. This creates a large, soft and bulky stool. It promotes regularity and seems to be associated with a reduced chance of getting colon polyps and colon cancer, as we believe cancer inciting agents are swept through the bowel in a more rapid manner. In addition, it may promote weight loss and it can enhance diabetic control. Foods that are high in insoluble fiber are:

  • whole wheat bread and baked goods
  • wheat bran
  • whole grain breads
  • vegetables and fruits, especially the skins
  • peanuts
  • Brazil nuts
  • popcorn
  • brown rice

Fiber Content of Foods, provides detailed information on the insoluble fiber content of many foods.

Soluble Fiber

This plant fiber does dissolve in water. In the colon, it provides food for the enormous number of bacteria that thrive there and, in so doing, provides many health benefits. Soluble fibers also promote regularity by increasing growth of the colon bacteria. Foods that are high in soluble fibers are:

  • oats in any form – cereal, muffins, etc.
  • apples, oranges, grapefruit, peaches, concord grapes
  • prunes, pears, cranberries
  • beans
  • beets
  • carrots
  • sesame seeds
  • psyllium found in dietary supplements and cereals

Fiber Content of Foods, provides information on the soluble fiber content of many foods.

Nuts, Seeds and Popcorn

From time immemorial, physicians have been advising patients with diverticulosis to avoid these items. Didn’t it just make sense that these could get inside colon pockets, rattle around and injure the colon wall? It was just like dried seeds inside a gourd that you can hear rattling around when you shake it. I have never agreed with this. I have never heard a patient rattling after eating these things. Furthermore, all of these items become digested or totally sodden and soft by the time they reach the colon. Most important of all, they contain excellent amounts of fiber, which is exactly what the colon wants. So, I have always recommended nuts, seeds and popcorn for diverticulosis patients. Now, I have been supported in this recommendation by a 2007 study where a large number of diverticulosis patients who took these foods were matched against those who did not. You guessed it. The ones eating nuts, seeds and popcorn had less diverticulosis problems than those who did not.


Prebiotics are the relatively newly discovered types of plant fiber that have been shown to promote beneficial changes in the colon. These are present in certain plant foods as well as in our prebiotic products. In diverticulosis, all the soluble fiber foods and supplements can be a healthy addition. However, if too much is taken, then excessive colon gas can occur. If it is trapped behind a narrowed diverticular colon, there may be cramps and bloating. The advice is to take these healthy fibers in small, but increasing amounts and see if symptoms develop.


Diverticulosis is a disorder of the Western diet which has occurred along with the ingestion of large amounts of animal products and small amounts of beneficial plant food and their beneficial fiber. At any stage, but particularly in the early one, increasing fiber intake will be very helpful. Reducing high pressure in the colon and a more regular, softer bowel pattern may be the observed benefit. The unseen one, in the long term, is the large number of positive health benefits that dietary fibers, especially the prebiotic ones, can confer on future health.