Preventing diverticular disease and diverticulitis

Eating a high-fibre diet may help prevent diverticular disease, and should improve your symptoms.

Your diet should be balanced and include at least five portions of fruit and vegetables a day, plus whole grains. Adults should aim to eat 18g (0.6oz) to 30g (1.05oz) of fibre a day, depending on their height and weight. Your GP can provide a more specific target, based on your individual height and weight.

It's recommended that you gradually increase your fibre intake over the course of a few weeks. This will help prevent side effects associated with a high-fibre diet, such as bloating and flatulence (wind). Drinking plenty of fluids will also help prevent side effects.

If you have established diverticular disease, it may be suggested that you avoid eating nuts, corn and seeds due to the possibility that they could block the diverticular openings and cause diverticulitis. People usually find out themselves if these foods cause symptoms. Probiotics have also been recommended, but evidence is lacking. Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease.

Sources of fibre

Good sources of fibre include

• fruit
• vegetables
• nuts
• breakfast cereals – but check fibre content as some are very low
• starchy foods – such as brown bread, rice and pasta

Once you have reached your fibre target, stick to it for the rest of your life, if possible.

More detailed information on sources of fibre is provided below.

Fresh fruit

Good sources of fibre in fresh fruit (plus the amount of fibre that is found in typical portions) include:

• avocado pear – a medium-sized avocado pear contains 4.9g of fibre
• pear (with skin) – a medium-sized pear contains 3.7g of fibre
• orange – a medium-sized orange contains 2.7g of fibre
• apple (with skin) – a medium-sized apple contains 2g of fibre
• raspberries – two handfuls of raspberries (80g) contain 2g of fibre
• banana – a medium-sized banana contains 1.7g of fibre
• tomato juice – one small glass of tomato juice (200ml) contains 1.2g of fibre

Dried fruit

Good sources of fibre in dried fruit (plus the amount of fibre found in typical portions) include:

• apricots – three whole apricots contain 5g of fibre
• prunes – three whole prunes contain 4.6g of fibre

Vegetables

Good sources of fibre in vegetables (plus the amount of fibre found in typical portions) include:

• baked beans (in tomato sauce) – a half can of baked beans (200g) contains 7.4g of fibre
• red kidney beans (boiled) – three tablespoons of red kidney beans contain 5.4g of fibre
• peas (boiled) – three heaped tablespoons of peas contain 3.6g of fibre
• French beans (boiled) – four heaped tablespoons of French beans contain 3.3g of fibre
• Brussel sprouts (boiled) – eight Brussel sprouts contain 2.5g of fibre
• potatoes (old, boiled) – one medium-sized potato contains 2.4g of fibre
• spring greens (boiled) – four heaped tablespoons of Spring greens contain 2.1g of fibre
• carrots (boiled, sliced) – three heaped tablespoons of carrots contain 2g of fibre

Nuts

Good sources of fibre in nuts (plus the amount of fibre found in typical portions) include:

• almonds – 20 almonds contain 2.4g of fibre
• peanuts (plain) – a tablespoon of peanuts contains 1.6g of fibre
• mixed nuts – a tablespoon of mixed nuts contains 1.5g of fibre
• Brazil nuts – 10 Brazil nuts contain 1.4g of fibre

Breakfast cereals

Good sources of fibre in breakfast cereals (plus the amount of fibre found in typical portions) include:

• All-Bran – a medium-sized bowl of All-Bran contains 9.8g of fibre
• Shredded Wheat – two pieces of Shredded wheat contain 4.3g of fibre
• Bran Flakes – one medium-sized bowl of Bran flakes contains 3.9g of fibre
• Weetabix – two Weetabix contain 3.6g of fibre
• muesli (no added sugar) – one medium-sized bowl of muesli contains 3.4g of fibre
• porridge (milk or water) – one medium-sized bowl of porridge contains 2.3g of fibre

Note – the "own-brand" equivalents of the cereals mentioned above should contain similar levels of fibre. 

Starchy foods

Good sources of fibre in starchy food (plus the amount found in typical portions) include:

• crispbread – four crispbreads contain 4.2g of fibre
• pitta bread (wholemeal) – one piece (75g) contains 3.9g of fibre
• pasta (plain, fresh-cooked) – one medium portion of pasta (200g) contains 3.8g of fibre
• wholemeal bread – two slices of wholemeal bread contain 3.5g of fibre
• naan bread – one piece of naan bread contains 3.2g of fibre
• brown bread – two slices of brown bread contain 2.5g of fibre
• brown rice (boiled) – one medium portion of brown rice (200g) contains 1.6g of fibre

Fibre supplements – usually in the form of sachets of powder you mix with water – are also available from pharmacists and health food shops. Some contain sweetener. A tablespoon of fibre supplement contains around 2.5g of fibre. If you require long-term fibre supplements, your GP can prescribe them.

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Diverticulitis and diverticulosis - discharge

You were in the hospital because you have diverticulitis. This is an infection of an abnormal pouch (called a diverticulum) in your intestinal wall.

You may have had a CT scan or other tests that helped your doctor check your colon. You may have received fluids and drugs that fight infections through an intravenous (IV) tube in your vein. You were probably on a special diet to help your colon rest and heal.

If your diverticulitis was very bad, or a repeat of past swelling, you may need surgery.

Your health care provider may also recommend that you have further tests to look at your colon (large intestine) such as colonoscopy. It is important to follow up with these tests.

What to Expect at Home
Your pain and other symptoms should go away after a few days of treatment. If they do not get better, or if they get worse, you will need to call the provider.

Once these pouches have formed, you have them for life. If you make a few simple changes in your lifestyle, you may not have diverticulitis again.

Self-care
Your provider may have given you antibiotics to treat any infection. Take them as you were told you to. Make sure you finish the whole prescription. Call your provider if you have any side effects.

DO NOT put off having a bowel movement. This can lead to a firmer stool, which will make you use more force to pass it.

Eat a healthy, well-balanced diet. Exercise regularly.

Diet
When you first go home or after an attack, your provider may ask you to drink liquids only at first, then slowly increase your diet. In the beginning, you may need to avoid whole-grain foods, fruits, and vegetables. This will help your colon rest.

After you are better, your provider will suggest that you add more fiber to your diet and avoid certain foods. Eating more fiber may help prevent future attacks. If you have bloating or gas, cut down the amount of fiber you eat for a few days.

High fiber foods include:

• Fruits, such as tangerines, prunes, apples, bananas, peaches, and pears
• Tender cooked vegetables, such as asparagus, beets, mushrooms, turnips, pumpkin, broccoli, artichokes, lima beans, squash, carrots, and sweet potatoes
• Lettuce and peeled potatoes
• Vegetable juices
• High-fiber cereals (such as shredded wheat) and muffins
• Hot cereals, such as oatmeal, farina, and cream of wheat
• Whole-grain breads (whole wheat or whole rye)

When to Call the Doctor
Call your health care provider if you have:

Blood in your stools
Fever above 100.4°F (38°C) that does not go away
Nausea, vomiting, or chills
Sudden belly or back pain, or pain that gets worse or is very severe
Alternate Names
Diverticular disease - discharge

References
Fox JM, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 117.

Prather C. Inflammatory and anatomic diseases of the intestine, peritoneum, mesentery, and omentum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 144.

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DIVERTICULOSIS

Diverticulosis, otherwise known as pockets or pouches of the colon, is very common. You can access a full description of this condition at Diverticulosis. The condition is almost certainly caused by a low fiber intake over a lifetime. This results in high pressures in the colon, which very, very slowly, over many years, cause ballooning of tiny weak points in the colon wall resulting in diverticuli. When these pockets become infected, diverticulitis occurs, a painful and, at times, serious condition. Rural Africans who consume 50 or more grams of fiber a day over a lifetime do not get diverticulosis. Yet, they do when they eat a Western diet with low fiber. Low fiber intake can result in small, thin and/or hard pellet stools, which usually means high pressure within the colon. Again, this high pressure is what causes these pockets to balloon out forming diverticuli.

These are dietary recommendations for people with diverticulosis. However, specific advice will depend on the stage of diverticulosis. Is it early diverticulosis? Is it advanced with fixed changes in the colon? Are there symptoms? Or is it acute diverticulitis where the colon is recovering from infection around these pockets?

Stages of Diverticulosis

Diverticulitis – Diverticulitis means that one or more of these weak-walled diverticuli has become infected and inflamed. At this point, the physician will want to put the bowel and even the patient at rest. Early on, a diet consisting of clear liquids is often prescribed to ensure maximum bowel rest. As recovery proceeds, the diet is advanced to a Low Fiber Diet, progressing gradually to a High Fiber Diet when recovery is complete.

Quiet, early and moderate diverticulosis – This is where most people are. The physician may have discovered a few or a moderate number of diverticuli on colonoscopy as an incidental finding when screening for colon cancer. Because it is just mentioned in passing, not too much importance may be attached to it. This is a mistake, as now is the time that something can really be done. Remember, it is the increased pressures that the colon can exert within itself that causes diverticulosis. A bulky stool helps prevent this. Plant fiber, especially the insoluble fiber, is the best. These are the fibers that do not produce colon gas. The easiest to take are wheat bran, amaranth, barley and others as listed in Fiber Content of Foods.

Quiet but advanced, fixed and/or narrowed diverticulosis – In many older folks, the diverticulosis has become so severe that the colon, just above the rectum, becomes fixed, twisted or gnarled by fibrous tissue within the bowel wall. At this stage, the colon is less likely to be massaged back to its normal size. The dilemma here is that large stools can seldom be produced, as the only thing that can get through this narrowed portion of the colon is smaller, even pellet-like stool. Still, it is worth trying small doses of extra food fiber or supplements to see what can be accomplished.

Go to High Fiber Diet for full details. The goal is to increase the daily fiber to 20, 30 or even 40 grams per day. You do not want to do this all at once, and, especially with excessive amounts of soluble fiber as this fiber is the one that, if taken to excess, promotes the bacterial production of harmless colon gas and flatus.

Insoluble Fiber

This fiber, also known as roughage or bulk, does not dissolve in water but paradoxically hangs onto water in the large bowel. This creates a large, soft and bulky stool. It promotes regularity and seems to be associated with a reduced chance of getting colon polyps and colon cancer, as we believe cancer inciting agents are swept through the bowel in a more rapid manner. In addition, it may promote weight loss and it can enhance diabetic control. Foods that are high in insoluble fiber are:

• whole wheat bread and baked goods
• wheat bran
• whole grain breads
• vegetables and fruits, especially the skins
• peanuts
• Brazil nuts
• popcorn
• brown rice
• The section, Fiber Content of Foods, provides detailed information on the insoluble fiber content of many foods.

Soluble Fiber

This plant fiber does dissolve in water. In the colon, it provides food for the enormous number of bacteria that thrive there and, in so doing, provides many health benefits. Soluble fibers also promote regularity by increasing growth of the colon bacteria. Foods that are high in soluble fibers are:

• oats in any form – cereal, muffins, etc.
• apples, oranges, grapefruit, peaches, concord grapes
• prunes, pears, cranberries
• beans
• beets
• carrots
• sesame seeds
• psyllium found in dietary supplements and cereals

The section, Fiber Content of Foods, provides information on the soluble fiber content of many foods.

Nuts, Seeds and Popcorn

From time immemorial, physicians have been advising patients with diverticulosis to avoid these items. Didn’t it just make sense that these could get inside colon pockets, rattle around and injure the colon wall? It was just like dried seeds inside a gourd that you can hear rattling around when you shake it. I have never agreed with this. I have never heard a patient rattling after eating these things. Furthermore, all of these items become digested or totally sodden and soft by the time they reach the colon. Most important of all, they contain excellent amounts of fiber, which is exactly what the colon wants. So, I have always recommended nuts, seeds and popcorn for diverticulosis patients. Now, I have been supported in this recommendation by a 2007 study where a large number of diverticulosis patients who took these foods were matched against those who did not. You guessed it. The ones eating nuts, seeds and popcorn had less diverticulosis problems than those who did not.

Prebiotics

Prebiotics are the relatively newly discovered types of plant fiber that have been shown to promote beneficial changes in the colon. These are present in certain plant foods as well as in our prebiotic products. In diverticulosis, all the soluble fiber foods and supplements can be a healthy addition. However, if too much is taken, then excessive colon gas can occur. If it is trapped behind a narrowed diverticular colon, there may be cramps and bloating. The advice is to take these healthy fibers in small, but increasing amounts and see if symptoms develop.

Summary

Diverticulosis is a disorder of the Western diet which has occurred along with the ingestion of large amounts of animal products and small amounts of beneficial plant food and their beneficial fiber. At any stage, but particularly in the early one, increasing fiber intake will be very helpful. Reducing high pressure in the colon and a more regular, softer bowel pattern may be the observed benefit. The unseen one, in the long term, is the large number of positive health benefits that dietary fibers, especially the prebiotic ones, can confer on future health.

Author: Frank W. Jackson, M.D.

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Diverticulitis diet

Definition

A diverticulitis diet is something your doctor might recommend as part of a treatment plan for a mild case of acute diverticulitis.

Diverticulitis occurs when small, bulging pouches (diverticula) in your digestive tract become infected and inflamed. Mild cases are usually treated with antibiotics and a diverticulitis diet, which includes clear liquids and low-fiber foods. More severe cases typically require hospitalization.

Purpose

A diverticulitis diet can't treat or prevent diverticulitis. Rather, it's intended to give your digestive system a chance to rest. A diverticulitis diet is typically recommended along with antibiotics for mild or uncomplicated cases of diverticulitis.

Diet details

A diverticulitis diet starts with only clear liquids for a few days. Examples of beverages allowed on a clear liquid diet include:

• Broth
• Fruit juices without pulp, such as apple juice
• Ice chips
• Ice pops without bits of fruit or fruit pulp
• Gelatin
• Water
• Tea or coffee without cream

As you start feeling better, your doctor will recommend that you slowly add low-fiber foods. Examples of low-fiber foods include:

• Canned or cooked fruits without skin or seeds
• Canned or cooked vegetables such as green beans, peas and potatoes (without the skin)
• Eggs, fish and poultry
• Refined white bread
• Fruit juice with little or no pulp
• Low-fiber cereals
• Milk, yogurt and cheese
• White rice, pasta and noodles

Results

You should feel better within two or three days of starting the diet and antibiotics.

If you haven't started feeling better by then, call your doctor. You should also contact your doctor if:

• You develop a fever
• Your abdominal pain is worsening
• You're unable to keep clear liquids down

These may indicate a complication that requires hospitalization.

Risks

The diverticulitis diet has few risks. However, continuing a clear liquid diet for more than a few days can lead to weakness and other complications, since it doesn't provide enough of the nutrients your body needs. For this reason, your doctor will want you to transition back to a normal diet as soon as you can tolerate it.

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The Diverticulitis Diet

Will a high-fiber diet prevent diverticulitis?

For those with diverticular disease, preventing painful inflammation of diverticula — small bulges that form along the digestive tract — is of the utmost importance.

While there is no sure-fire way to keep inflammation from occurring, some doctors believe that eating a high-fiber diet may help.

Fiber and Diverticulitis

Many researchers believe that the primary cause of diverticula is too little fiber in the diet. Studies have shown that people in Africa and Asia, where high-fiber diets are common, rarely suffer from diverticular disease.

Fiber, or plant material, serves an important role in the digestive process, softening stool and helping it move more smoothly through the colon. A lack of fiber can cause constipation, which makes stools harder and more difficult to pass, putting stress on the muscles of the colon.

And since diverticula typically form in areas where digestive muscles are strained or weakened, constipation may make the development of diverticula more likely.

Because constipation causes pressure to build up in the colon, it may also lead to inflammation or infection of diverticula that are already present in the colon, causing the painful condition known as diverticulitis.

The Diverticulitis Diet

It should be noted that there have also been studies that suggest eating too much fiber may lead to diverticular disease by causing more frequent bowel movements.

The recommended amount of dietary fiber is 20 to 35 grams per day. There are two kinds of fiber found naturally in the foods you eat:

• Soluble fiber
• Insoluble fiber

Soluble fiber dissolves in water, forming a gel-like material that makes stools softer and larger, allowing them to pass easily through the intestine. Insoluble fiber helps move waste through the digestive system by absorbing water and adding bulk to stools.

Most plant-based foods contain both soluble and insoluble fiber. However, some foods contain more of one kind of fiber than the other.

To ensure you're getting enough of each, consume a wide variety of high-fiber foods, including:

• Cereals: shredded wheat and corn bran
• Grains: bran flakes, whole wheat pasta, pearled barley, oatmeal, brown rice
• Baked goods: bran muffins, whole wheat bread
• Legumes: split peas, lentils, black beans, lima beans
• Vegetables: artichokes, peas, broccoli, brussels sprouts, carrots
• Fruit: raspberries, blackberries, avocados, pears, and apples (with skin)
• Dried fruit: prunes, raisins
• Nuts and seeds: peanuts, popcorn

Because foods that are high in fiber are typically also high in vitamins and other nutrients, it's best to get the fiber you need from food. \

But if dietary restrictions prevent you from consuming all the fiber you need at meals, your doctor may recommend fiber supplements.

Psyllium, which is present in supplements like Metamucil and Konsyl, is one fiber option. This supplement may be sold as a powder or liquid, in granules, capsules, or as a wafer.

Methylcellulose-based supplements, like Citrucel, are typically sold in powder or granular form.

For many years, doctors advised people with diverticulosis not to eat nuts, seeds, or popcorn, which they believed could block the openings of diverticula and lead to flare-ups of diverticulitis.

However, research has never proven that eating these foods increases the risk of developing diverticulitis, and doctors no longer make this recommendation.

Preventing Diverticular Disease

There are several other ways you can maintain good digestive health and prevent diverticula from forming:

• Avoid overconsumption of red meat
• Avoid fatty foods, which may lead to intestinal blockage and worsen symptoms of diverticulitis
• Exercise regularly
• Quit smoking (smokers are at a higher risk of developing complications from diverticulitis)
• Avoid the use of non-steroidal anti-inflammatory drugs (NSAIDs)
• Drink plenty of fluids
• Maintain a healthy body weight
• Respond to bowel urges

NSAIDs such as aspirin, naproxen, and ibuprofen have been linked to increased instances of diverticular bleeding.

High-fiber diets need water to function properly. If you don't drink enough water, you can put yourself at greater risk of constipation.

Finally, delaying bowel movements can lead to hard stools and increased strain on the muscles of the colon, which may lead to diverticular disease.

Sources

N. Painter & D. Burkitt. "Diverticular Disease of the Colon: A Deficiency Disease of Western Civilization." May 1971. BMJ.

A. Peery, et al. "Constipation and a low-fiber diet are not associated with diverticulosis." December 2013. Clinical Gastroenterology and Hepatology.

Diverticulitis: Lifestyle and home remedies. Mayo Clinic.

Diverticulitis Diet. Mayo Clinic.

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Diet For Diverticulitis

Sometimes, especially as they get older, people can develop little bulging pouches in the lining of the large intestine. These are called diverticula, and the condition is known as diverticulosis.

When the pouches become inflamed or infected, it leads to a sometimes very painful condition called diverticulitis. In addition to having abdominal pain, people with diverticulitis may experience nausea, vomiting, bloating, fever, constipation, or diarrhea.

Many experts believe that a low-fiber diet can lead to diverticulosis and diverticulitis. This may be why people in Asia and Africa, where the diet tends to be higher in fiber, have a very low incidence of the condition.

Diverticulosis usually causes no or few symptoms; leaving many people unaware that they even have diverticula present.

Diverticulitis may need to be treated with antibiotics or, in severe cases, surgery.

Diet for Diverticulitis

If you're experiencing severe symptoms from diverticulitis, your doctor may recommend a liquid diverticulitis diet as part of your treatment, which can include:

• Water
• Fruit juices
• Broth
• Ice pops

Gradually you can ease back into a regular diet. Your doctor may advise you to start with low-fiber foods (white bread, meat, poultry, fish, eggs, and dairy products) before introducing high-fiber foods.

Fiber softens and adds bulk to stools, helping them pass more easily through the colon. It also reduces pressure in the digestive tract.

Many studies show that eating fiber-rich foods can help control diverticular symptoms. Try to eat at least 25-35 grams of fiber a day.

Here are a few fiber-rich foods to include in meals:

• Whole-grain breads, pastas, and cereals
• Beans (kidney beans and black beans, for example)
• Fresh fruits (apples, pears, prunes)
• Vegetables (squash, potatoes, peas, spinach)

If you're having difficulty structuring a diet on your own, consult your doctor or a dietitian. They can set up a meal plan that works for you.

Your doctor may also recommend a fiber supplement, such as psyllium (Metamucil) or methylcellulose (Citrucel) one to three times a day. Drinking enough water and other fluids throughout the day will also help prevent constipation.

Foods to Avoid With Diverticulitis

In the past, doctors had recommended that people with diverticular disease (diverticulosis or diverticulitis) avoid hard-to-digest foods such as nuts, corn, popcorn, and seeds, for fear that these foods would get stuck in the diverticula and lead to inflammation. However, recent research has noted that there is no real scientific evidence to back up this recommendation.

In fact, nuts and seeds are components of many high-fiber foods, which are recommended for people with diverticular disease.

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