Medical News Today: What are the best foods for diverticulitis?

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Diverticulitis is a condition where small pouches in the intestine called diverticula become inflamed or infected. Symptoms of diverticulitis can include abdominal pain, nausea and vomiting, fever, constipation, and diarrhea.

If a person has these pouches that are not inflamed or infected, they have diverticulosis and usually have no symptoms. According to current estimates, less than 5% of people with diverticulosis will develop diverticulitis.

A 2018 review suggested that risk factors for developing diverticulitis include aging, increased fat around the abdomen, inactive lifestyles, and poor diet.

The review concluded that there is not enough quality research to identify which diets are beneficial for an acute attack of diverticulitis. They did, however, suggest that following a high fiber diet after recovery from acute diverticulitis might reduce the risk of another episode.

Serious complications of diverticulitis might include:

• an abscess or perforation in the colon
• peritonitis, which is inflammation or infection in the abdominal lining
• a fistula, which is an uncharacteristic tunnel linking two organs or an organ and the outside of the body
• a blockage of the movement of food or stool through the intestines

Keep reading for more information about which foods to eat and avoid when a person has diverticulitis.

One study on men suggests that a diet high in fruits, vegetables, and whole grains has associations with a decreased risk of diverticulitis.

Fiber-rich foods

Traditionally, doctors have recommended that people who are experiencing a flare of acute diverticulitis should follow a clear liquid diet. They should then progress to a low fiber diet until their symptoms have improved. Once a person’s symptoms are better, some sources recommend they follow a high fiber diet.

The Dietary Guidelines for Americans 2015–2020 recommends a dietary fiber intake of 14 grams (g) per 1,000 calories. High fiber foods include:

• high fiber ready-to-eat bran cereal
• beans and pulses, including navy beans, chickpeas, split peas, and lentils
• fruits, including pear, avocado, apple, and prunes
• vegetables, including green peas, potatoes, squash, and parsnips
• grains, including bulgur, quinoa, barley, and whole wheat

If any foods aggravate symptoms, then a person should speak to their doctor. The University of California, San Francisco (UCSF) note that some doctors may suggest a person takes a fiber supplement, such as methylcellulose (Citrucel) or psyllium (Metamucil).

Probiotics

Probiotics are beneficial bacteria that help the gut stay healthy. A 2013 study suggested that probiotics can be effective in treating symptomatic diverticular disease, especially when combined with medication.

People can take probiotics as a supplement, but they also occur naturally in some foods. These foods include natural yogurt and fermented foods, such as:

• sauerkraut
• kefir
• tempeh
• miso

People who have been taking antibiotics might consider adding these foods to their diet to help repopulate the gut with good bacteria.

A 2019 review of the health benefits of fermented foods suggested that the potential probiotic effects can support a healthy digestive system and may help symptoms of irritable bowel syndrome (IBS). However, there is insufficient evidence to determine their impact.

A typical Western diet is high in red meat and refined grains, and has a lower fiber content. A 2017 study associated this type of diet with an increased risk of diverticulitis.

The UCSF note that it is safe for people with diverticulitis to eat nuts, popcorn, and seeds, including pumpkin and sesame seeds. Experts also say that it is OK to eat the seeds in tomatoes, zucchini, cucumbers, strawberries, and raspberries. In the past, doctors may have advised people to remove these foods from their diets.

However, each person is different, and some may find that particular foods worsen their symptoms. Anyone who notices that a certain food causes pain or a change in symptoms should eliminate that food and talk to their doctor or healthcare provider.

High FODMAP foods

FODMAP is an abbreviation for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrate foods that research suggests can cause digestive symptoms, such as bloating, gas, and diarrhea.

In Dietary Patterns and Whole Plant Food in Aging and Disease, the author comments that low intake of FODMAP foods may help to lower the risk and alleviate symptoms of diverticular disease.

A 2016 hypothesis suggests that a high fiber diet, when combined with FODMAP foods, may cause excess gas, which could contribute to diverticulitis symptoms.

Some high FODMAP foods include:

• onions, mushrooms, cauliflower, and garlic
• apples, apricots, dried fruit, pears, peaches
• dairy foods, including milk, yogurts, and cheeses
• legumes and pulses
• bread and cereals
• sugars and sweeteners

As some of these foods also contain beneficial fiber, it is important to discuss food choices and elimination with a healthcare professional. Each person will have different dietary needs and sensitivities, so doctors recommend individualized professional guidance.

Red Meat

Research has linked higher intakes of red meat and processed meat to diverticulitis. One 2017 study found that if people stick to a healthful diet and lifestyle, it might be possible to prevent 50% of diverticulitis cases. Recommendations include consuming no more than 51 grams (g) of red meat per day, eating about 23 g of dietary fiber daily, doing at least 2 hours of vigorous exercise each week, maintaining a healthy weight, and never smoking.

Another study published in the journal Gut looked at males in the U.S. The study found that higher intakes of red meat, particularly unprocessed red meat, was associated with an increased risk of diverticulitis. They suggest that substituting red meat with poultry or fish may reduce risk.

Diet and other lifestyle factors play an essential part in the development of diverticulitis. Research indicates that obesity, physical inactivity, and smoking may all play a role in its development.

Research has linked several medications with an increased risk of diverticulitis. Regularly using non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, corticosteroids, such as prednisolone, or opioid analgesics, may also increase a person’s risk.

Estimates suggest that genes account for about 50% of a person’s susceptibility to the condition, though research is yet to identify genetic markers. There may be more risk if a person has a family history of diverticulitis.

The review also linked low levels of vitamin D, which people mainly obtain through exposure to sunshine, with diverticulitis.

Researchers need to conduct more studies to determine which foods are beneficial for people with diverticulitis.

Currently, researchers are looking at how beneficial gut bacteria can support general health, and this may show promising results for diverticulitis also. However, at the moment, there is not enough good quality evidence to make recommendations.

Fiber intake seems to be a vital component. Consuming a high fiber diet may reduce the risk of diverticulitis and improve digestive health in general. However, people experiencing a flare-up may be better off avoiding high fiber foods.

Limiting red and processed meat may also reduce risk and symptoms. Replacing them with poultry, fish, and plenty of fruits, vegetables, whole grains, and legumes may be a sensible approach.

Leading a healthy lifestyle and being active, eating a healthful diet, reducing alcohol intake, and stopping smoking can support overall health and minimize a person’s risk of obesity and disease.

A person with diverticulitis should always consult their healthcare provider or a registered dietitian nutritionist to discuss how best to manage their symptoms through diet and lifestyle changes.