Beyond Burkitt—is diverticular disease more than just cereal fibre deficiency?

Diverticular disease is a common disorder in the Western world affecting between 30% to 55% of the population over 60 years of age.1 2 Although most diverticula remain asymptomatic, their high frequency means complications are a common clinical problem. About 6500 patients per year are admitted to British hospitals for treatment of diverticulitis,3 although the number with life threatening complications such as perforation is unknown. Furthermore, many more patients require treatment for milder disease as an outpatient and undergo investigations to confirm the diagnosis.

The most well known and substantiated theory on the aetiology of diverticular disease is that of a deficiency of dietary cereal fibre. This hypothesis was advanced by Painter and Burkitt who observed that diverticular disease was uncommon in African countries where dietary fibre consumption was high.4 They contrasted this with Western countries with a higher incidence of disease and a lower consumption of cereal fibre and stated that “the refining of flour and other cereals is the primary cause of diverticulosis”.4 …