There is a noticeable rise in the prevalence of diverticulosis, especially in the Western hemisphere and in countries that have adopted a more Westernized lifestyle. I, myself, have noticed a rise in the number of hospital patients I see with either a history of diverticulosis or with an active diverticular flare. Research shows the prevalence is age-dependent increasing from less than 20 percent at age 40 to 60 percent by age 60. Similarly, the incidence of diverticulitis also is increasing.
When I see these patients the majority of them make it clear that there are certain foods they avoid. The list usually includes nuts, seeds, corn, popcorn, strawberries, blackberries and even rice. Patients tell me they do not want those foods to “get stuck in the pockets.” Well, when I proceed to explain that this dietary recommendation is no longer valid, I often get a not-so-subtle rolling of the eyes. Yet, I continue to assure and encourage them that dietary fiber is important for GI health.
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What is the good news in all of this? Patients are listening to their Physicians. The bad news? The message they’re receiving is inconsistent and may be based on outdated guidelines. So how can we clear this up? Let’s take a look at what the most recent research tells us about how environmental and lifestyle factors play a role in both the prevention and management of diverticular disease.
Fiber
While research is conflicting in determining the role fiber plays in the development of diverticulosis, it appears that a diet high in fiber – as well as a vegetarian diet – may reduce the incidence of symptomatic diverticular disease. This is because dietary fiber reduces intestinal inflammation and promotes a healthy gut flora.
Recommendation: Encourage patients to increase their dietary fiber intake by choosing whole grains, and whole fruits and vegetables, while reducing their intake of processed, refined foods.
Dietary Fat
A traditional westernized lifestyle tends to be high in dietary fat, often in the form red meat. Unfortunately, research shows that there is an increased risk of developing diverticular disease in those with diets low in fiber and high in total fat or red meat.
Recommendation: Encourage patients to choose heart healthy fats, such as olive oil and avocado, instead of butter and margarine. In addition, opt for lean protein sources, such as chicken, turkey, fish and even meatless sources, such as beans, lentils and tofu.
Nuts and Seeds
There is solid research showing that consuming seeds and nuts does not lead to an increased risk for diverticulosis, diverticulitis and diverticular bleeding. The Health Professionals Follow-up Study, which included more than 47,000 men from 40 to 75 years, found an inverse association between the amount of nut and popcorn consumption and the risk of diverticulitis. Furthermore, no association was found between consumption of corn and diverticulitis or between nut, popcorn or corn consumption and diverticular bleeding or uncomplicated diverticulosis.
Recommendation: Nuts and seeds are a great source of heart healthy, anti-inflammatory fats. Suggest to patients that choose a handful of nuts and seeds each day as a healthy snack. In addition, they should not be afraid to choose fruits with seeds, like strawberries and blackberries. They’re nourishing and filled with cancer-fighting antioxidants.
Physical Activity and Obesity
Both physical activity and obesity play a role in diverticular disease. Vigorous activity – such as jogging or running – appears to reduce the risk of diverticulitis and diverticular bleeding. However, it is unclear if a lack of vigorous activity is a risk factor for the disease. Obesity also is associated with an increased risk of both diverticulitis and diverticular bleeding.
Recommendation: Encourage patients to achieve or maintain a healthy weight with both exercise and healthy eating. If they’re new to exercise, they can begin simply by walking or riding a stationary bike 2 – 3 times per week.
Erin DeMito, RD, LDN works as a clinical dietitian with the Crozer Keystone Health System and Lower Bucks Hospital in Philadelphia, Pennsylvania. She also provides nutrition counseling and education to private clients, and is a contributing nutrition writer for the Crozer Keystone Healthbeat and Healthy Bites blogs.
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