Diverticulitis and nutrition

No more nuts and seeds?

Diverticulosis is small pouches in the muscular wall of the bowel. The older you get, the more likely you are to have it, with 65% of people over 70 years having it. Whether you get symptoms from it (diverticular disease/diverticulitis) can be the luck of the draw, but there are some things that put you more at risk of having ‘a flare’.

Having low physical activity, being overweight and having a low fibre/highly processed diet, or being on NSAIDs (non-steroidal anti-inflammatories), steroids or opiate pain relief increases your risk of experiencing pain in your lower abdomen due to diverticulitis.

Traditionally people with diverticulitis were told to avoid nuts and seeds, and follow a low fibre or low residue diet. Recent evidence increasingly points towards diverticulitis being an inflammatory and immune-mediated condition, rather than one of infection and too much fibre. Randomised controlled trials have shown no benefit from antibiotics and low fibre in uncomplicated diverticulitis, but the onset of symptoms can trigger altered gut motility, and dysfunctional gut-brain interactions that can keep annoying symptoms going. This makes diagnosis of acute diverticulitis inflammation challenging.

So what does that actually mean?

Medical and diet treatment of abdominal pain should depend on the presenting symptoms – a registered Dietitian will want to thoroughly understand your specific symptoms, severity of symptoms and will understand how they are impacted by gut function and the food you are eating. We also need to understand your medical history and background, as these are taken into account with any suggested dietary changes.

Medical management includes using laboratory tests to check inflammatory markers, and helps to differentiate between uncomplicated and complicated diverticulitis.

From a diet point of view, we often need to increase fibre to help switch off inflammation. By modifying the type of fibres we can do this while ensuring an adequate amount of nutrients as well as a reduction in gut symptoms.

The commonly held belief that nuts, seeds, corns, grains and raw vegetables fibres should be avoided has been consistently unsupported by research since the 1970s. A trial which included 42,000 men demonstrated that not only was there no association between these foods on risk of diverticulitis, but there was a protective effect of including them in the diet.

Dietary modification for managing medical conditions, or even general health, benefits from an early consultation with a specialised dietitian. And in the meantime, ask yourself – how many handfuls of vegetables have I had today?

Anna Sloan and Ashleigh Share | NZ Registered Dietitians www.nutritionconnection.nz