Current dietary practice of South African dietitians in the treatment symptomatic uncomplicated diverticular disease.
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Introduction: There is a global rise in diverticular disease (DD) in Westernized countries although the prevalence in South Africa (SA) is unknown. This has a significant effect, not only on the quality of life but also economically as the requirement for surgical interventions and hospital admissions have increased, putting additional pressure on healthcare systems. Dietary approaches to the treatment of DD differ and are contradictory. The traditional restrictive low fiber diet approach recommends the avoidance of insoluble fiber including nuts, seeds, popcorn and corn while the International Current Consensus Guidelines (ICCG) from a number of countries such as Italy, Poland, Denmark, America, Great Britain, advocate a liberal unrestricted high fiber diet (HFD). Although the ICCG have concluded that the consumption of nuts, seeds and popcorn does not appear to exacerbate DD symptoms and complications, there has been anecdotal evidence that their inclusion may worsen symptoms and provoke attacks in some patients suffering with symptomatic uncomplicated DD (SUDD). There are also conflicting views as to whether fiber supplementation is necessary in SUDD. Aim: The aim was to determine dietary treatment methods used by registered dietitians (RDs) practicing in SA when treating SUDD and to determine their beliefs regarding the ICCG for SUDD, trigger foods and the use of fiber, prebiotic and probiotic supplements. Methods: Snowball sampling was used in this quantitative descriptive study to identify 155 RDs in SA who treated SUDD. The RDs completed a closed and open-ended self-administered questionnaire. Results: Diverticular disease was treated by 75% of dietitians in the private sector compared to 25% in the government sector. A third of the dietitians treated less than five patients per year and a third treated two or more patients per month. Their approach to treatment was not significantly different. A significant portion (77%) disagreed with the ICCG and 79% identified foods (including seeds, nuts, pips, wheat, popcorn and fruits), which they believed triggered symptoms. None supplemented with bran and only 1.3% recommended insoluble fiber. Supplementation with prebiotics was considered least beneficial (20%) compared to 74% who routinely prescribed probiotics. The main probiotic species prescribed were Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium longum, Bifidobacterium bifidum, Lactobacillus casei, Lactobacillus rhamnosous, Lactobacillus plantarum and Streptococcus thermophiles. Only 7%, however, prescribed an evidence based strain. Many RDs (74%) felt that patients responded well to their treatment with significant improvement in symptoms and had a decreased relapse rate. Conclusion: The majority of dietitians practicing in SA do not support the ICCG advocating a liberal, unrestricted HFD as the appropriate dietary approach for the treatment of SUDD. An individual treatment approach for each patient was reported throughout the study. Practice regarding the use of prebiotics and probiotics was not evidence-based.