Diverticular Disease: Nutritional Considerations

Diverticular disease is associated with a fiber-poor diet, ie, a diet is low in fruits, vegetables, whole grains, and legumes, but high in animal products or refined foods. The following factors have been associated with a reduced risk of diverticular disease in epidemiologic studies:

A high-fiber diet. Fiber-poor diets result in diverticular formation and chronic inflammation that may progress to acute or chronic diverticulitis.² Fiber may protect against colonic perforation by increasing stool weight and water content, resulting in a decreased fecal transit time and reduction of colonic segmentation pressures.³ Individuals eating generous amounts of insoluble fiber (eg, wheat bran, legumes, skin of fruit, nuts and seeds) have roughly a 40% lower risk of diverticular disease, compared to those consuming little dietary fiber.⁴ Not surprisingly, omnivores have a high (33%) incidence of diverticular disease, while vegetarians have a much lower incidence by comparison (12%).⁵

Avoiding meat. Eating a diet low in fiber and high in meat is associated with a 3-fold increased risk for symptomatic diverticular disease.¹ In persons eating the largest amount of meat, the risk for right-sided diverticulosis in particular is roughly 25 times that of persons eating the least.⁶ It should be noted that fiber intake and meat intake are not entirely independent variables; like all animal products, meat contains no fiber.

During symptomatic episodes, avoiding solid foods and staying hydrated on a liquid diet may help. In patients with mild forms of diverticulitis, bowel rest using a liquid diet or intravenous fluids in combination with antibiotics is helpful.⁷

It should also be noted that high levels of physical activity may have a protective effect against diverticular disease. Constipation is a known risk factor for diverticulitis and is related to inactivity.⁸ While moderate physical activity has little protective effect, more intense activity, such as jogging or running, reduces risk by about 40%.⁹

Orders

See Basic Diet Orders chapter.

Exercise prescription.

What to Tell the Family

Diverticula are outpouchings of the lining of the gut caused by pressure building up from with the intestinal tract. This pressure appears to result from low-fiber diets and may be preventable by a high-fiber diet. In some individuals, these diverticula become infected, resulting in diverticulitis and necessitating antibiotics and bowel rest. Surgery is often required for persons who have repeat episodes of diverticulitis. This involves resection of the colon and placement of a colostomy, which often can be reversed if healing of the colon occurs without complications.