What Goes In Must Come Out

Q: I was diagnosed with diverticulosis earlier this year. The doctor said to avoid nuts, seeds, and foods with seeds (tomatoes, raspberries) because they can irritate the colon. Everything I read online says something different. In YOU: The Owner's Manual, you say it's a myth. So are nuts and seeds okay, or not?
-- Debbie, Greenwich, CT

A: The myth that nuts make diverticulOSIS develop into painful diverticulITIS (it hurts, the other doesn't) just won't die. Nuts don't, but seeds may. Why? Nuts shrink when wet, but seeds may expand. The fear is that tiny bits of hard food could get trapped in tiny pouches -- called diverticula -- that can develop along the colon (picture them as small thumbs poking out the sides of the colon). If that happens, it could trigger inflammation and diverticulitis. But does it happen with nuts? It's doubtful. Not one report of nuts causing diverticulitis can be found in any peer-reviewed medical literature, and we've never heard of it actually happening.

What we know for sure is that squeezing very hard to move feces along your colon can cause diverticulosis -- the appearance of the tiny pouches. They're quite common and, by themselves, produce no symptoms. It's only when one or more of the pouches become painfully infected that trouble occurs. So if you avoid getting pouches in the first place, you won't get diverticulitis. That's why we recommend upping your fiber and water intake to prevent constipation. Preventing constipation prevents hard pushing, which prevents pouches, which prevents painful diverticulitis.

Q: I recently had my gallbladder removed, and I'm worried that without it, I won't be able to digest fat. My doctor says not to worry, but I've heard that some people have to go fat-free. Will I have to give up olive oil?
-- Scotty, El Paso, TX

A: You should be able to return to your normal diet, including healthy fats. Some people have digestive issues for the first month after a cholecystectomy (medical-speak for gallbladder removal), but ongoing problems are uncommon. Your liver still makes bile, a greenish material that dissolves fat much like soap dissolves grease. Your gallbladder, when you had one, acted as a warehouse for bile between meals and then squirted some out when you needed it. But if there's no gallbladder around to dispense bile, the liver adapts by steadily trickling bile into your intestine.

In the unlikely event that eating fat causes you ongoing discomfort, don't blame it on not having a gallbladder. It's likely sludge that's stuck in the duct; see your doc.

All that said, don't overdo fat -- but only because you shouldn't anyway. Even healthy fats are packed with calories. How do you know if you are eating too much fat? You'll see it floating in the porcelain container when you poop. (Go ahead, look. Everyone else does.)

Q: I'm a vegan, so I not only don't eat any meat, poultry, or fish, but I also don't eat eggs, milk, or cheese. I get protein mostly from tofu, take a multivitamin and calcium supplements, and drink about 3 quarts of water a day. My poop is pretty loose; could all the fluids be the cause?
-- Tonya, Riverside, CA

A: As long as you don't have diarrhea, loose poop is no big deal. Next time you go, do a few self-tests.

First, listen up. Poop should enter the water like a top Olympic diver: no splash. The sound you want to hear is a basketball-through-the-net "swish" -- not machine-gun rounds: pop-pop-pop! That's the sound of constipation, though that's obviously not likely in your case.

Next, take a look. Ideally, your feces -- loose as it is -- should be more or less S-shaped. That's the shape of your rectum as it nears your anus. While you're at it, make sure there's no blood in your stool. Just looking isn't enough. You can detect microscopic levels of blood with a home Hemoccult test, available at pharmacies. If you're over 40, do this test every year. Make it a birthday ritual and you won't forget.

Fiber and liquids, which you're getting plenty of, keep all systems moving. Can you get by with less fluid? Check the color of your urine. If it's light but very clear, cut back on the water you drink and see if the consistency of your poop changes. If it does, and your urine remains light and clear, you're good to go . . . probably less often then you do now.