Have you been told that undigested particles from nuts and popcorn can cause complications in diverticula and that you should avoid these foods?
Rejoice, you might be able to nosh on nuts and popcorn after all!
According to an analysis of a cohort of 47,228 men who have been followed for 18 years, consuming nuts and grains does not increase the risk of diverticulitis or diverticular hemorrhage. In fact, eating nuts or popcorn at least twice a week reduced the risk by 20% and 27%, respectively! 1]
But let’s start at the beginning…
What is Diverticulosis?
Diverticulosis occurs when small, bulging pouches develop in the digestive tract, usually in the colon. These pouches, called diverticula, define the condition. Most people with diverticulosis are asymptomatic and may not even realize they have the condition until it is discovered during a routine colonoscopy or imaging study.
Causes of Diverticulosis
The formation of diverticula is primarily due to increased pressures in the colon necessary to move small, hard fecal masses, often a consequence of a low-fiber diet typical in many developed countries, particularly the United States. This diet results in small, hard stools that require more pressure to pass through the colon, leading to the formation of diverticula.
Several factors contribute to the development of diverticulosis: 2] 3]
Low-Fiber Diet: Diets low in fiber lead to constipation and increased pressure in the colon, causing the formation of diverticula. In contrast, diets high in fiber, typical in underdeveloped countries, are associated with a virtual absence of diverticular disease.
Constipation
Inadequate Hydration
Symptoms of Diverticulitis
While most people with diverticulosis are asymptomatic, when diverticula become inflamed or infected when waste, or feces, become trapped in the outpouchings, a condition known as diverticulitis can develop, leading to severe symptoms such as:
Changes in Bowel Habits: Constipation or diarrhea.
Severe abdominal pain - bloating, gas, cramping: Discomfort due to trapped gas in the diverticula. Often in the lower left side of the abdomen.
Fever and chills
Nausea and vomiting
Rectal bleeding
Diagnosing Diverticulitis
Blood tests
Stool tests
Imaging tests (ultrasound, colonoscopy, CT scan) 4]
Managing Diverticulitis
Managing diverticulosis/diverticulitis involves dietary and lifestyle changes:
Increase Fiber Intake: A high-fiber diet softens stools and reduces colon pressure. Include fruits, vegetables, whole grains, and legumes.
Limit Intake of Highly Processed Foods and Animal Products: These foods contain little to no fiber.
Adequate Hydration: Drinking water helps keep stools soft.
Regular Exercise: Promotes regular bowel movements.
Avoid Straining: Straining during bowel movements increases colon pressure.
Diverticulitis leads to significant healthcare utilization: 5]
Emergency Visits and Hospital Admissions: Approximately 371,000 emergency department visits and 200,000 inpatient admissions annually in the U.S.
Economic Impact: Annual costs of 2.1–2.6 billion dollars. In 2015, the total expenditure for diverticulosis and diverticulitis exceeded 5.4 billion dollars.
Increasing Incidence: The rate of diverticulitis is rising, contributing to growing healthcare costs.
When to Seek Medical Attention
Severe symptoms like intense abdominal pain, fever, or rectal bleeding require immediate medical attention, as they could indicate diverticulitis or other serious complications. Pain medications and antibiotics are often prescribed, and hospitalization may be necessary.
Conclusion
Diverticulosis is common and often symptomless. Although the pouches do not disappear, switching to a high-fiber, plant-based diet is the best way to prevent recurrent inflammation and infection.
References:
1] Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008;300(8):907-914. doi:10.1001/jama.300.8.907
2] Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J. 1971;2(5759):450-454. doi:10.1136/bmj.2.5759.450
3] Crowe FL, Appleby PN, Allen NE, Key TJ. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ. 2011;343:d4131. Published 2011 Jul 19. doi:10.1136/bmj.d4131
Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians - PMC (nih.gov)
4] Destigter KK, Keating DP. Imaging update: acute colonic diverticulitis. Clin Colon Rectal Surg. 2009;22(3):147-155. doi:10.1055/s-0029-1236158
5] Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021. Gastroenterology. 2022;162(2):621-644. doi:10.1053/j.gastro.2021.10.017