Dr. Keith Roach

DEAR DR. ROACH: I have been advised by my sports medicine doctor to never take nonsteroidal anti-inflammatory drugs because they are detrimental to my health. I think this is unfortunate because NSAIDs do actually work to reduce pain. Do you agree with this advice, or is there some way to take them safely? — R.K.
ANSWER: There are some people who shouldn’t take NSAIDs, such as ibuprofen, because they have a history of allergy with it; a serious reaction (ibuprofen can rarely cause these, including inflammation of the lining of the brain); or moderate to severe kidney disease, which is often worsened by NSAIDs.
Most people can take NSAIDs, but should be careful. NSAIDs are potentially detrimental to our health in several ways. One way is that, as most people know, it can cause stomach upset and even ulcers. This is particularly likely in older people and in women more than men. NSAIDs raise blood pressure a bit in people with high blood pressure and can even cause kidney failure. The heart can also be affected, with an increased risk of heart attack and heart failure. In addition, there are rare adverse effects on bone marrow.
With all of these (and more still that I don’t have space to print), one might understand why your sports medicine doctor advises against NSAIDs. But the risk of these bad events in an otherwise healthy person is small, and they do have real benefits. In my opinion, the risk of a low-dose NSAID, like ibuprofen, is small enough that I do not recommend against it, unless a person is at an otherwise high risk for one or more of these specific adverse effects, or has already experienced a bad side effect.
DEAR DR. ROACH: I have severe diverticulosis with several pouches throughout my colon. I have been hospitalized twice and received antibiotics through an IV. The last two gastroenterologists have told me that research does not 100% prove that an attack is brought on by eating seeds, nuts, etc., that get caught in pouches, which ends up causing infection. Do you believe this to be true? Does the size of the seed or the number of nuts matter? What about tiny seeds like those in tomatoes, cucumbers and “seedless” watermelons? — R.H.S.
ANSWER: Diverticula are, just as you say, small pouches in the wall of the colon, most common in the sigmoid colon, which is the last part of the colon before the rectum. We certainly used to think that seeds or nuts could block the diverticula, causing inflammation called diverticulitis. Unfortunately, this misinformation is still out there.
Times have changed, and your two gastroenterologists are correct that this traditional wisdom isn’t thought to be true. However, I am even more definitive about this, as research shows that eating nuts and seeds somewhat decreases the risk of a diverticulitis attack. Still, it’s prudent to listen to one’s own body. If you get a diverticulitis attack any time you eat a certain food, avoid it.
Other factors that reduce the risk of diverticulitis include regular exercise (especially vigorous exercise); regular fiber intake (per one study, at least 23 grams a day from diet or supplements); fewer than 4 servings per week of red meat; and avoiding smoking. Heavy alcohol use increases diverticulitis risk, but it isn’t clear whether it is moderate or occasional use that increases risk.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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