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Dealing with Diverticulitis
Living with Diverticulosis can be really challenging, especially during flare-ups. Life can be made a little easier with the right nutrition.
Diverticulosis is a condition in which weak areas of the colon form pouches, or “diverticula”. It’s believed these diverticula are formed when high pressures occur in the colon. High pressures occur from straining to pass a bowel movement. Diverticulitis occurs when these pouches get inflamed, which is caused by fecal matter getting trapped in the diverticula. Symptoms of diverticular disease include constipation, diarrhea, tenderness in the abdomen and even mild bleeding from the rectum. It’s important to know that diverticulosis can be asymptomatic as well (1). An episode of diverticulitis can include a variety of complications including abscess formation and bleeding. It’s estimated that at least 5% of people with diverticulosis experience episodes of diverticulitis (1).
So how are these conditions managed with diet? The basic rules of thumb are:
During a Flare-Up
Eating less fiber and sometimes even bowel rest is recommended to avoid aggravating the colon while it is inflamed. Doctors often prescribe a clear-liquid diet during a flare up in order to continue to promote rest. This can include liquids such as water, broth, ice chips, and tea with no cream added. Next, low fiber foods should be slowly introduced, and small meals should be consumed (about the size of your hand) to avoid aggravating your system. An example of low fiber foods are white bread, chicken, yogurt and white bread. This plan may need to be followed for several weeks before increasing fiber intake (2).
Once inflammation resolves, following a high fiber diet along with adequate hydration (2 liters or more for most people) is important for promoting regular bowel movements. A “high-fiber diet”includes plenty of insoluble (roughage) fiber such as whole grains, legumes, fruits, vegetables, nuts, and seeds. It is recommended that men consume 38 grams per day and women consume 25 grams per day according to the US Dietary Guidelines. Another way of recommending fiber intake is consuming 14 grams for every 1,000 calories consumed (3). There is now strong evidence to show that foods such as nuts and seeds do not contribute to acute flares of diverticulitis, and are a safe source of fiber for those with diverticulosis (4).
Adding more Fiber to your Diet
Doing so slowly and gradually is your best bet. Increasing by 2 to 3 grams, seeing how you tolerate the increase, and then increasing further is an easy way to start. Consuming a lot of fiber all too quickly can cause discomfort, bloating, GI discomfort, and flatulence (5). As always, a varied and balanced diet will provide multiple sources of fiber along with the nutrients you need. Luckily for you, there are many recipes containing these fiber-filled foods here on The-Sage.org!
Regular Bowel Movements
Passing bowel movements regularly means less chance of fecal matter getting trapped in the diverticula, and less chance of getting another inflammatory episode. Medications can affect frequency and consistency of bowel movements, so always discuss possible side effects with your physician or primary care provider if they are occurring. Some simple ways to promote regularity if constipation is
occurring include taking regular walks or running and consuming enough water and fiber as mentioned above. Even consuming yogurt, which contains bacteria that is beneficial to the gut has shown to have a positive effect on regularity (6).
Because episodes of diverticulitis vary among each individual with diverticulosis, each person faces specific challenges in determining the best foods to consume during and between flares. At The Sage,
we always encourage nutritious eating; most importantly, we encourage working closely with a registered dietitian to navigate this condition in order to optimize your daily nutrition and reduce flares.
Kamran Ahmad, MS, RDN, LDN