Managing Diverticular Disease

Diverticular disease is common throughout the world and especially in industrial countries like the United States. About thirty-five percent of American adults develop diverticulosis by age 50 years and fifty-eight percent of adults over 60 years. Most cases are asymptomatic, and more recent research suggests that less than five percent of persons with diverticulosis develop diverticulitis.

Although the exact mechanism of diverticular disease is poorly understood, it is thought to be related to complex interactions of colon structure, intestinal motility, diet and genetics. In the past, avoidance of nuts and popcorn as well as seeds, including those in fruits and vegetables, has been recommended as a form of treatment.

A study published in 2008 in the Journal of the American Medical Association questioned the recommendation that people with diverticular disease should avoid these foods. In this study it was noted that nut, corn, and popcorn consumption was not associated with an increased risk of complicated diverticular disease. Instead the researchers observed inverse relationships between nut and popcorn consumption and the risk of diverticulitis.

Current guidance for diverticular disease focuses on increasing fiber intake gradually, since a high-fiber diet may help to reduce symptoms. Adequate fluid intake is also encouraged and supplementation with probiotics and prebiotics may be recommended.

Eliminating specific foods is not necessary, unless symptoms worsen or an acute diverticulitis episode occurs. Then nothing by mouth may be prescribed, followed by a low-fiber diet until the inflammation subsides.

Assessing a patient’s tolerance to foods is important when customizing a meal plan for individuals with diverticular disease. Having clients keep a food diary can help to identify what foods may cause symptoms. Obesity and a lack of physical activity are also thought to be factors which may influence diverticular disease. Registered dietitian nutritionists can assist patients and clients with incorporating healthful lifestyle behaviors while managing these diverticular conditions.

References:

• Piscopo N, Ellul P. Diverticular Disease: A Review on Pathophysiology and Recent Evidence. Ulster Med J. 2020;89(2):83-88.
• Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300:907-914.
• National Institute of Diabetes and Digestive and Kidney Diseases. Diverticular Disease. Accessed May 25, 2021.
• Academy of Nutrition and Dietetics. Nutrition Care Manual. Gastrointestinal Disease, Diverticular Conditions. Accessed May 25, 2021.