Have you been told by your doctor that you have diverticulosis or diverticulitis? Diverticular diseases are very common in Western countries; in Canada, the prevalence of diverticulosis affects about 40% of people by 75 years, and about 50% of people aged >80 years.
In about 80% of people with diverticular disease, they do not have any symptoms, while 20% of patients develop abdominal symptoms and, eventually, about 4% of patients develop complications such as bouts of diverticulitis flare up or bleeding. A recurrence of diverticulitis flare up after the first episode has been reported to occur in 15%–30% of these patients.
If you have been diagnosed with a diverticular disease, don’t panic; you can make dietary and lifestyle changes to prevent your diverticulosis from worsening. The main goals are to reduce abdominal symptoms and to prevent development of acute diverticulitis.
Read on to find out how you can manage a flare up episode and what you can do to prevent future diverticulitis flare ups.
Diverticulosis vs diverticulitis - which one is it?
Diverticular disease is a condition that occurs mainly in the large intestine (colon). There are two forms of diverticular disease: diverticulosis and diverticulitis.
Diverticulosis occurs as a result of pressure inside the colon, leading to some parts of it forming small bulging pouches. You may not know that you have either condition unless you have symptoms, which may have prompted you to visit your doctor in the first place.
When these pouches become infected due to stools blocking the pouches, or when these pouches tear or are filled with pus, you may end up with diverticulitis – an inflammation or infection of these pouches (diverticula). In this case, you may have sudden onset of cramps (usually in the left lower abdomen), diarrhea or constipation, nausea, vomiting, fever and chills.
Some symptoms, such as bloating and constipation, could be related to other gut conditions, such as irritable bowel syndrome (IBS). Your doctor may run additional tests, such as blood tests, ultrasound, CT scan and/or colonoscopy, to rule out other medical causes and to confirm your diagnosis.
Can diverticulitis be cured?
95% of an uncomplicated diverticulitis flare up will resolve on its own within a week. 5% of flare up may require hospital stay and medication treatments (ie. antibiotics), depending on the severity of symptoms and if there are any complications.
Foods to avoid during a diverticulitis flare up
You may need a liquid diet or a low fiber diet (10 to 15g of fiber per day) temporarily for a few days for your gut to rest. Once your symptoms improve, you’d want to return to a normal diet and gradually return to a high fiber diet to prevent future flare ups.
Keep in mind that you may be sensitive to certain foods that could trigger flare-ups. The foods that give you unpleasant symptoms may differ from others who have the same condition. Speak with one of our gut health registered dietitians to discuss an individualized plan that meets your needs.
5 steps to prevent diverticulitis flare-ups
1. Include foods with fiber
A diet low in dietary fiber may be one of the risk factors for diverticular disease.
When there is little fiber in the stools, your gut needs to work harder to move the stools along your digestive tract. Over time, this creates pressure within the colon that causes weak spots to develop, resulting in diverticulosis. Eating foods with fiber will not make the existing small pouches go away. The good news, though, is that they may prevent new pouches from forming and decrease the severity of your symptoms.
How much fiber you need is dependent on your age gender and calorie needs, ranging from 25 to 38 grams for women and men under 50 years of age, respectively, and from 21 to 30 grams for those who are over 50 years old. Calculate how much fiber you need with our Macro calculator!
To meet your daily fiber needs, try the following:
Include at least half a plate of vegetables and fruits
Vegetables and fruits are not only sources of dietary fiber; they are also packed with nutrients that provide many health benefits. Browse our library of recipes on how you can include vegetables and fruits in your meals.
Choose whole grain foods
Whole grains are more nutritious than refined grains, where the former has the entire kernel staying intact. In contrast, the latter have parts of the kernel, including the fiber, removed during processing, leaving them a less nutritious choice.
Examples of whole grains include whole oats, barley, buckwheat, rye, quinoa, brown and wild rice. To know whether a food product is made primarily with whole grains, look for words, “whole [name of grain],” listed as the first ingredient on the ingredients list. Check out our blog on how to choose a high fiber cereal.
Add in a fiber supplement
If you’re having trouble getting enough fiber through diet alone, you can consider adding in a fiber supplement for reducing the occurrence of diverticulitis. Some fiber supplements to consider include : methylcellulose, psyllium, bran, and glucomannan.
When you first start adding fiber to your diet, don’t overdo it. Overeating it may cause bloating and cramps, so add slowly and in small amounts.
2. Choose lean and plant-based proteins more often
Research suggests that eating too much red meat may raise the risk of diverticular disease. This may be due to undigested proteins from large meat portions reaching the colon where they are available for fermentation by the colonic microbiota.
Choosing lean meats such as fish and poultry and plant-based proteins, such as tofu, lentils, beans, peas, nuts, and seeds more often would be beneficial to your gut and overall health. Additionally, plant-based proteins, like beans, lentils, nuts and seeds, are also sources of fiber. Aim to include one-quarter of your plate with these foods. Visit our blog for some easy plant-based meal ideas for busy people.
3. Eat a variety of foods
Eating foods from all food groups promotes optimal health. Most people with diverticulitis have uncomplicated cases and do not need to avoid certain foods. Observational data suggests that including berry seeds, nuts, corn and popcorn does not increase the risk of diverticulitis, diverticular bleeding or uncomplicated diverticulosis; in contrast, nuts and popcorn may be protective against diverticulitis because of their high fiber content.
4. Drink plenty of water
Water and dietary fiber are a perfect duo to keep your colon healthy by making your stools soft and easier to pass through the system. When you do not drink enough water, despite eating fiber, your stools will become hard. This state could lead to putting pressure on your colon, worsening your condition and symptoms over time.
Aim to drink at least 6 to 8 cups (1.5 to 2.0 litres) of plain water every day.
5. Exercise regularly
Regular physical activity may help reduce the risk of diverticular disease through mechanisms such as reducing overweight and obesity, reducing transit time and/or decreasing intra-gastric pressure. Activities such as running and jogging have been shown in research to decrease pressure inside the colon, allowing food to move more quickly through the digestive tract.
Set a goal to be active for at least 150 minutes every week. Include a mix of cardio and strength-building exercises in your plan. Cardio activities, such as running, jogging, swimming, skiing and dancing, make you sweat, breathe harder, and heart rate go up. Engaging in weight lifting exercises at least twice a week is also recommended.
Conclusion
You can make small, incremental diet and lifestyle changes to prevent diverticulitis flare-ups. Connect with one of our gut health dietitians today to find out how we can support you.
References
- Role of Fiber in Symptomatic Uncomplicated Diverticular Disease: A Systematic Review – PMC (nih.gov). Accessed Apr 13th 2024.
- Nut, corn and popcorn consumption and the incidence of diverticular disease – PMC (nih.gov). Accessed Apr 13th 2024.
- Eating Guidelines for Diverticular Disease (pennutrition.com) Accessed Apr 13th 2024.
- Diverticular disease and diverticulitis: Treating acute diverticulitis – InformedHealth.org – NCBI Bookshelf (nih.gov) Accessed Apr 13th 2024.
- Canadian 24-Hour Movement Guidelines: An Integration of Physical Activity, Sedentary Behaviour, and Sleep.
- 24-Hour Movement Guidelines – Canadian 24-Hour Movement Guidelines (csepguidelines.ca) Accessed on November 12, 2021.
- Diverticular Disease: An Update on Pathogenesis and Management. https://pubmed.ncbi.nlm.nih.gov/28494576/. Accessed on November 11, 2021.
- Diverticulitis. https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758. Accessed on November 11, 2021.
- Eating, Diet & Nutrition for Diverticular Disease. https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/eating-diet-nutrition. Accessed on November 11, 2021.
- Physical activity decreases diverticular complications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144158/. Accessed on November 12, 2021.
- Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002463/. Accessed on November 11, 2021.
- Western Dietary Pattern Increases, and Prudent Dietary Pattern Decreases, Risk of Incident Diverticulitis in a Prospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/28065788/. Accessed on November 11, 2021.
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