Diverticulosis: Nutrition Standpoint

I am currently working on the Gastrointestinal Surgery floor as a clinical dietitian, so GI conditions are pretty much what I live and breath. I have had a lot of co-workers/co-dietitians ask me what type of diet I recommend for diverticulosis patients. I have had so many people ask me this that I thought I should just go ahead and write a post about it! Maybe I can help some followers who may be struggling with this increasingly prevalent gastrointestinal issue.

First off, what is Diverticulosis? 

Diverticulosis of the colon is an acquired condition resulting from herniation of the mucosa through defects in the muscle layer of the bowel wall. The hypothesis is that decreased dietary fiber intake can result in diverticulosis due to the lack of fiber causing smaller size of the lumen which in turn causes the muscular contraction pressure to exert itself on the wall of the colon rather than the contents of the lumen. For a shorter explanation – the lack of fiber causes people to have a harder time passing stools which will cause strain to the colon and result in pouches in the wall of the colon. When the pressure is exerted on the colon instead of the lumen, diverticula are formed at the weak points in your colon wall (especially the sites that are penetrated by blood vessels). Diverticulosis is the term used when you have those diverticula present in your bowels, diverticulitis is when those pouches are infected, inflammed, or irritated. Causes of diverticulitis are vary and can range from a perforation of the diverticula, obstriction of the intestine,  bleeding of the diverticula, or even an abscess developing from the diverticula.

Diet Treatment: As a Registered Dietitian and a firm believer in the more fiber the better, I would recommend following a high fiber diet to prevent diverticulosis, the amount of grams of fiber needed per day would vary based on age and gender, here are the USDA dietary guidelines – 

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The daily fiber recommendations for most healthy adults:

  • Men 50 years and younger: 38 grams (g) fiber per day
  • Men 51 years and older: 30 g fiber per day
  • Women 50 years and younger: 25 g fiber per day
  • Women 51 years and older: 21 g fiber per day

HOLD ON, this is where things get confusing. I would recommend following a high fiber diet to prevent diverticulosis but what about when you already have diverticulosis and then it gets infected or irritated and becomes diverticulitis? In this case, I would then recommend following a low-fiber diet. The reasoning for the diet change is due to the fact that the bowels need to heal, providing a low fiber or sometimes even only a full liquid diet allows the bowel time to heal and avoids the risk of high fiber foods irritating the already inflammed or infected diverticula. We do not recommend following the low fiber diet for a prolonged period of time, we recommend gradually increasing fiber intake daily as you can tolerate (post infection and as your MD see’s fit) until you are back to following a high fiber diet for your overall goal in managing your diverticulosis. Unfortunately there is not set guideline on how much time you should allow yourself before beginning back on fiber containing foods, research still pending on that. I normally educate my patient to try one fiber containing food at the beginning and assess how they feel before overloading on raw vegetables and oatmeal. You know your body more than anyone, be cautious and listen to what it has to say.

*To finish up, here is a link to Today’s Dietitian Article on the “Top Fiber-Rich Foods,” so you can properly educate yourself on high fiber containing foods. Today’s Dietitian: High Fiber Foods

 

And on the other side of the spectrum, here is a short list of foods considered “Low-Fiber.” Obtained from – Low Fiber Diet

Foods that are generally allowed on a low-fiber diet include:

  • White bread without nuts and seeds
  • White rice, plain white pasta, and crackers
  • Refined hot cereals, such as Cream of Wheat, or cold cereals with less than 1 gram of fiber per serving
  • Pancakes or waffles made from white refined flour
  • Most canned or well-cooked vegetables and fruits without skins or seeds
  • Fruit and vegetable juice with little or no pulp, fruit-flavored drinks, and flavored waters
  • Tender meat, poultry, fish, eggs and tofu
  • Milk and foods made from milk — such as yogurt, pudding, ice cream, cheeses and sour cream — if tolerated
  • Butter, margarine, oils and salad dressings without seeds

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(research information obtained from pubmed database articles that have been published within the past five years, if you would like to review the research articles I used just send me a message and I will provide you with links!)

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