Diverticular disease is a common condition, particularly as we age. It occurs when small pouches, known as diverticula, form in the lining of the colon. While many people live with diverticula without any issues – a condition called diverticulosis – problems arise when these pouches become inflamed or infected, leading to diverticulitis. Managing diverticulitis often involves dietary adjustments, especially during a flare-up. Understanding what foods to avoid is crucial for recovery and preventing future episodes. This guide, informed by NHS principles, will outline key dietary recommendations.
Understanding Diverticulitis and Diet
Diverticulitis symptoms can range from persistent abdominal pain and fever to nausea, changes in bowel habits (constipation or diarrhea), and rectal bleeding. These symptoms are not exclusive to diverticulitis and warrant medical consultation to rule out other conditions.
Historically, a low-residue diet, which restricted foods like nuts, seeds, and fruit and vegetable skins, was advised to prevent these foods from lodging in diverticula and causing inflammation. However, current NHS guidance and expert consensus have shifted away from this restrictive approach for long-term management. A high-fiber diet is now generally recommended to promote healthy bowel function and prevent diverticulosis progression.
However, during an active diverticulitis flare-up, the focus temporarily shifts to easing bowel irritation and allowing the colon to heal. This often involves a temporary reduction in fiber intake and avoiding certain foods that can exacerbate symptoms.
7 Food Categories to Limit or Avoid During a Diverticulitis Flare-Up
While individual tolerance varies, certain food categories are commonly recommended to limit or avoid during a diverticulitis flare-up to minimize bowel irritation and promote healing. It’s important to note that this is for the acute phase and a gradual return to a balanced, high-fiber diet is crucial for long-term health.
-
Nuts and Seeds: Previously restricted due to concerns about getting trapped in diverticula, nuts and seeds are now understood to be less problematic than once thought for general diverticular disease management. However, during a flare-up, their indigestible nature might still cause irritation for some individuals. It’s generally advised to avoid whole nuts and seeds during acute diverticulitis. This includes:
- Walnuts
- Almonds
- Sunflower seeds
- Pumpkin seeds
- Chia seeds
- Flax seeds
-
Popcorn: Similar to nuts and seeds, popcorn kernels are not fully digestible and can be a source of irritation during a diverticulitis flare. The hulls, in particular, can be difficult to digest and might worsen symptoms.
-
Corn: While corn itself is digestible, corn kernels and corn on the cob contain a significant amount of cellulose, which is a type of fiber that can be harder to digest, especially when the bowel is inflamed. It’s often recommended to limit corn during a flare-up.
-
Fruit and Vegetable Skins and Seeds: The skins and seeds of many fruits and vegetables are high in insoluble fiber. While beneficial for regular bowel function in the long term, these can be difficult to digest during a diverticulitis flare. Examples to limit include:
- Tomatoes with skin and seeds
- Cucumbers with skin and seeds
- Peppers with skin and seeds
- Berries with seeds (strawberries, raspberries, blackberries)
- Apples and pears with skin
It’s generally better to opt for peeled fruits and vegetables and those without seeds during a flare. Cooked fruits and vegetables are also easier to digest.
-
Tough Meats: Red meats and processed meats, which are often tougher and higher in fat, can be harder to digest and may exacerbate inflammation in the gut. Opting for leaner protein sources and ensuring meat is tender and well-cooked during a flare-up is advisable.
-
High-Fat Fried Foods: Fried and fatty foods can be difficult to digest and may promote inflammation. These foods can also contribute to general digestive discomfort, which is best avoided during a diverticulitis episode. Examples include:
- Deep-fried foods
- Fatty fast foods
- Rich sauces and gravies
-
Certain Dairy Products: While not universally problematic, some individuals find that dairy products, particularly those high in lactose or fat, can worsen diverticulitis symptoms. This might be due to lactose intolerance or the inflammatory nature of high-fat dairy in some people. Monitor your tolerance to dairy and consider lower-fat options or lactose-free alternatives during a flare-up if you suspect dairy sensitivity.
What to Eat During a Diverticulitis Flare-Up
During an acute diverticulitis episode, the focus is on a low-fiber diet to rest the bowel. This typically involves easily digestible foods such as:
- White bread, pasta, and rice: These are lower in fiber than their whole-grain counterparts.
- Cooked, peeled vegetables: Potatoes (without skin), carrots, and squash are good options.
- Canned or cooked fruits without skin or seeds: Applesauce, canned peaches (drained), and cooked pears are suitable.
- Lean protein: Chicken, fish, and eggs are easily digestible protein sources.
- Clear broths and soups: These help maintain hydration and provide electrolytes.
Reintroducing Fiber and Long-Term Diet
Once your diverticulitis symptoms subside, it’s crucial to gradually reintroduce fiber into your diet. A high-fiber diet is key for long-term management of diverticular disease and preventing future flare-ups. This helps to create softer, bulkier stools, reducing pressure on the colon and minimizing the risk of diverticula formation and inflammation.
Good sources of fiber to gradually incorporate include:
- Whole grains: Whole wheat bread, brown rice, oats, and quinoa.
- Fruits and vegetables with skin (when tolerated): Apples, pears, berries, broccoli, and carrots.
- Legumes: Lentils, beans, and peas.
Remember to increase fiber intake slowly to avoid gas and bloating. Drinking plenty of fluids (6-8 glasses a day) is also essential when increasing fiber intake.
Consulting with Healthcare Professionals
Dietary advice for diverticulitis is not one-size-fits-all. It’s crucial to consult with your doctor or a registered dietitian for personalized recommendations. They can help you create a dietary plan tailored to your individual needs, medical history, and tolerance levels. If you experience persistent or severe diverticulitis symptoms, always seek medical advice.
References
Manual of dietetic practice (4th Ed) 2005, Thomas B and Bishop J
Tarleton S and DiBaise J. Low residue diet in diverticular disease: putting an end to the myth. Nutrition in clinical practice 2011; 26:2 137-142
Rocco A, Compare D, Caruso F, Nardone G. Treatment options for uncomplicated diverticular disease of the colon. Journal of Clinical Gastroenterology 2009: 43: 9: 803-808
Ravikoff J and Korzenik J. The role of fibre in diverticular disease. Journal of Clinical Gastroenterology 2011: 45:S1: S7-S11
