Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood about why diverticulitis occurs.
The blue arrows highlight small outpouchings in the colon wall, which are called diverticula.
Diet has long been implicated in the formation of these diverticula which can eventually become inflamed leading to diverticulitis (the condition of just having the pockets without an associated infection/inflammation is called diverticulosis). We know thatdiverticular disease is rare in countries where fiber intake is high, and we know that when populations change to a more westernized diet (poor in fiber/rich in protein, fat and processed sugars) the rate of diverticular disease rises accordingly. So if fiber is protective against developing diverticular disease in the first place, does it stand to reason that supplementing fiber when one already has diverticulosis will help prevent future complications?
The answer to the above question is unknown, but because fiber is a mostly harmless supplement and has other health benefits, we often recommend fiber supplementation to patients after they are diagnosed with diverticulosis or diverticulitis. But what about the common advice of avoiding seeds, nuts, corn, and popcorn that is readily doled out by some doctors and most family members/friends as soon as they hear the words diverticulosis or diverticulitis? One can reason that it makes common sense to try to avoid having sharp, hard, indigestible seeds getting stuck in a diverticulum and causing an abrasion or perforation which may lead to infection and other nastiness. But does this recommendation have any valid scientific reasoning behind it?
While I’m not sure when or where this recommendation started, it probably belongs more under the category of “old wives’ tale” rather than scientific fact. Let me explain my reasoning for this:
Red arrows denote stool impacted in diverticula.
It is very commonly observed during colonoscopy that patients with diverticulosis are found to have a small ball of stool impacted in each and every diverticulum. Presumably, this is the natural state of affairs in the colon of the patient with diverticulosis. So if small hard pellets of stool (mostly composed of indigestible waste and bacterial mass) do not cause an infection, why would a small seed or nut cause a problem? Nevertheless, people still take great pains to avoid seeds, nuts, and corn, causing themselves a fair amount of grief when it comes to meal options. Is this all worth it?
I would reason that it is not necessary to avoid seed and nuts if you have diverticular disease.Probably the best evidence we have that seeds, nuts, corn, and popcorn do not cause complications in patients with diverticular disease comes from a study published inJAMA in 2008showing that not only was intake of nuts, seeds, popcorn, and corn NOT associated with developing diverticulitis, but in fact the opposite was true. Eating more seeds, nuts, corn, and popcorn actually seemed to be associated with LESS of a chance of developing diverticulitis! These foods are thought to be somewhat anti-inflammatory, and therefore may protect against diverticulitis.
So what is the ideal diet to prevent development of diverticular disease? I think it is pretty obvious that a high-fiber diet is king in preventing the development of diverticulosis. But what if you are late to the high-fiber party but still want to make some changes to prevent that next attack of diverticulitis? Starting a high-fiber diet later in life may still help to reduce the progression of more diverticula, but unfortunately, there is no way to reverse the existing diverticula (besides surgical resection of the diseased segment of colon). However, there are still diet changes you can make that might help.
It seems thatdiets high in red meat are also associated with the development of diverticulitis. This is independent of the effect of fiber, as red-meat eaters develop diverticulitis more often than their vegetarian counterparts even after controlling for fiber intake between the groups. What is more interesting is that researchers found that the recent diet for the past 1-4 years before developing diverticulitis seemed to shape the risk more than the lifelong diet habits. That means that changing to a high-fiber, low-red-meat diet now can still lessen your chance of developing diverticulitis in the near future. But look at the bright side — at least you can eat all the seeds, nuts, corn, and popcorn you want!
Frederick Gandolfo is a gastroenterologistwhoblogs atRetroflexions.
Image credit:Shutterstock.com
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FAQs
When the diverticula aren't inflamed, they usually don't cause symptoms. In the past, people with diverticula were told not to eat nuts, seeds and popcorn. It was thought that these foods could lodge in diverticula and inflame them, causing diverticulitis. But there's no proof that these foods cause diverticulitis.
Are seeds and nuts bad for diverticulitis? ›
Pay attention to symptoms and follow a healthy lifestyle.
"You don't have to worry about eating nuts, seeds, or popcorn. The evidence does not show a higher risk of diverticulitis in people who eat a lot of those foods, compared with people who don't," says gastroenterologist Dr.
Can you eat sesame seeds if you have diverticulitis? ›
Avoidance of nuts, popcorn, and sunflower, pumpkin, caraway, and sesame seeds has been recommended by physicians out of fear that food particles could enter, block, or irritate the diverticula. However, no scientific data support this treatment measure.
What is the new treatment for diverticulitis? ›
Probiotics combined with mesalazine have also emerged as an alternative potential therapeutic strategy in preventing recurrent attacks of diverticulitis. One series reported that treatment with mesalazine and/or lactobacillus casei induced remission in 88% of their patients at a median follow-up of 2 years.
Is popcorn ok to eat if you have diverticulitis? ›
In the past, people with diverticula were told not to eat nuts, seeds and popcorn. It was thought that these foods could lodge in diverticula and inflame them, causing diverticulitis. But there's no proof that these foods cause diverticulitis.
Is popcorn bad for my colon? ›
Popcorn is a whole grain that contains fiber. Eating popcorn and other fiber-rich foods can help keep the bowels regular and prevent constipation. Experts recommend that people exercise regularly and drink plenty of fluids to help the fiber work.
Are bananas bad for diverticulitis? ›
Good options include canned fruits such as peaches or pears, applesauce, ripe bananas, and soft, ripe cantaloupe and honeydew. “It's not a lot of fiber because you're not eating the skin,” clarifies Taylor. “The skins are the source of insoluble fiber, which can irritate inflamed diverticula.”
What not to drink with diverticulitis? ›
You can get some fluids from the foods you eat—especially foods with high water content, such as most fruits and vegetables. Water is the best beverage choice to stay hydrated. Avoid or limit sugar-sweetened beverages, including regular soda, fruit drinks, sports drinks, energy drinks, and sweetened coffee and tea.
What calms diverticulosis? ›
Summary. Using a heating pad, taking Tylenol (acetaminophen), and resting are all strategies you can employ at home to soothe diverticulitis pain fast—or at least faster. Most home remedies for diverticulitis aim to improve symptoms over the long term and prevent future attacks.
Can I eat scrambled eggs with diverticulitis? ›
Your healthcare provider may advise a liquid diet. This gives your bowel a chance to rest so that it can recover. Include these foods: flake cereal, mashed potatoes, pancakes, waffles, pasta, white bread, rice, applesauce, bananas, eggs, fish, poultry, tofu, and well-cooked vegetables.
Foods To Avoid If You Have Diverticulitis
- certain fruits, such as pears, apples and plums.
- dairy foods, such as milk, yogurt, and ice cream.
- Fermented foods, including sauerkraut and kimchi.
- Cabbage.
- beans.
- onions and garlic.
- Brussels sprouts.
You should keep a liquid-based diet should be followed for the first 24 hours. As symptoms improve, you can incorporate some pureed fruits, like vegetable soups (pumpkin, celery, and yam), boiled vegetables (zucchini or aubergine), and shredded chicken.
How do you flush out diverticulosis? ›
Mild cases of diverticulitis are usually treated with antibiotics and a low-fiber diet, or treatment may start with a period of rest where you eat nothing by mouth, then start with clear liquids and then move to a low-fiber diet until your condition improves. More-severe cases typically require hospitalization.
Is salad bad for diverticulitis? ›
It's also best to avoid raw foods, especially salads, and opt for soft or cooked vegetables and fruit instead. As inflammation eases, you'll be advised to gradually wean yourself back onto a higher fibre intake to help make your bowel movements more comfortable and prevent constipation and more pouches from developing.
Why am I so tired with diverticulitis? ›
Diverticulitis is an intestinal disease that can cause fatigue in some people. The fatigue may be caused by infection, inflammation, or sleep disruption due to pain. It could also be related to nutritional deficiencies such as anemia, dehydration, medication side effects, or surgery.
Why do nuts and seeds hurt my stomach? ›
Why Does My Stomach Hurt After Eating Nuts? Raw nuts contain phytates and tannins that can be hard for some people to tolerate or digest, causing stomach pain or bloating. 4 Cooked nuts have much lower levels of phytates and tannins so they may be better tolerated.
What foods should you avoid if you have diverticulitis? ›
During an episode of acute diverticulitis, your appetite may be poor. It is also recommended to avoid foods which are poorly digested or high in fibre, such as onions, nuts, seeds, fruit and vegetable skins, wholegrain cereals etc. Try to stick to plain foods which do not irritate your bowel.
What desserts are ok with diverticulitis? ›
Liquid Diet:
Milkshakes. Ice cream or ice pops- no fruit or chocolate chips! Tea. Pudding.
Can nuts cause bowel problems? ›
Like many other nuts, pecans contain a high percentage of fat and can lead to diarrhea if too many are eaten in a short amount of time. Over-consumption may also lead to digestive issues like gas and bloating.
