Potholes in Your Colon

Barbara is 63 years old and obsessed with her diet – no trans fat, nothing processed, all organic, 40 grams of fiber daily, tons of fruits and vegetables. So, why does she spend the better part of her day in the bathroom?

Potholes in Your Colon
Potholes in Your Colon

Barbara is 63 years old and obsessed with her diet – no trans fat, nothing processed, all organic, 40 grams of fiber daily, tons of fruits and vegetables. So, why does she spend the better part of her day in the bathroom?

Getting the stool out has become a full-time job for Barbara. The morning gets off to a pretty good start: a nice big stool right after her morning coffee. Unfortunately things deteriorate steadily after that – multiple, small, stuttering, pellet-like poops that look like rabbit droppings. A feeling of incomplete emptying after each one and then back to the bathroom 15 minutes later for more unsatisfying action. “I know exactly what’s causing all of this,” I tell her after confirming it with a colonoscopy. “Is it menopause?” she asks. “No, it’s not menopause. You’ve got potholes in your colon.” I explain to her that she’s got a condition called diverticulosis – and by the way, she’s not alone. Almost half the US population over 50 has it.


Diverticulosis is a condition where the colon develops little pockets (potholes) as a result of a diet that’s relatively low in fiber and high in animal products. The colon, particularly the lower part called the sigmoid, has to work much harder to expel the small, hard stool that is characteristic of a low-fiber diet, and over time, it develops these scooped out pockets in the wall from all the strenuous activity. Once the diverticular pockets form, stool can get stuck inside them causing an annoying sensation of incomplete emptying. Additional bacterial fermentation of the stool within the pockets results in frequent bloating. Diverticulosis refers to the presence of the pockets. Diverticulitis refers to inflammation within the pockets – which is a possible complication.

In sub-Saharan Africa and other poor parts of the world where people can’t afford animal products and eat a diet high in unprocessed fiber, they have stools as big as my head two to three times a day and virtually no diverticulosis. Despite Barbara’s current commendable 40 grams of fiber, as a child and young adult growing up in the Midwest, vegetables were considered a garnish in her household. Those formative years of meat and potatoes with very little fruit and vegetables are a clue to her current predicament.

I recommend that people eat at least 35 grams of fiber daily for optimal digestive health; many studies show that the average American eats less than 10 grams. For most of my patients with diverticulosis, I recommend 1 or 2 heaping tablespoons of ground psyllium husk to help them reach their fiber intake target goal. Fiber cleans out the colon and the colon is one of the major routes for toxins to be expelled from the body. Having a good bowel movement is really the ultimate detox.

When you reach that magic number of 35 grams, some amazing things start to happen. In addition to magnificent stools that drop effortlessly into the bowl, your risk for a lot of the other things that kill Americans – many types of cancer, heart disease, diabetes and stroke – all drop too. An apple (or two) a day really does keep the doctor away.

Your Parent Has Dementia: What to Talk to Their Doctor About

Make sure all their doctors are aware of all the medications she is taking.

Q: My mom is 94 and has dementia. She is taking a whole medicine cabinet-full of medications and I think they actually make her fuzzier. How should I talk to her various doctors about what she is taking and if she can get off some of the meds? — Gary R., Denver, Colorado

A: Many dementia patients are taking what docs call a "polypharmacy" — three or more medications that affect their central nervous system. And we really don't know how that mixture truly affects each individual person.

A new study in JAMA Network that looked at more than 1 million Medicare patients found almost 14% of them were taking a potentially harmful mix of antidepressants, antipsychotics, antiepileptics, benzodiazepines such as Valium and Ativan, nonbenzodiazepine benzodiazepine receptor agonist hypnotics such as Ambien or Sonata, and opioids. And almost a third of those folks were taking five or more such medications. The most common medication combination included an antidepressant, an antiepileptic, and an antipsychotic. Gabapentin was the most common medication — often for off-label uses, such as to ease chronic pain or treat psychiatric disorders, according to the researchers from the University of Michigan.

Keep Reading Show less