Diverticulitis and Diet

Understanding the "D-Words": What’s the Difference?

It’s easy to get confused by the terminology. Here is a quick breakdown to help you navigate your diagnosis:

• Diverticulum (plural: diverticula): A small, bulging pouch that forms in the lining of the digestive system (usually the colon).
• Diverticulosis: The presence of these pouches. Many people have diverticulosis and never experience symptoms.
• Diverticulitis: This occurs when those pouches become inflamed or infected. This is an acute medical condition that often requires antibiotics or medical intervention.
• Diverticular Disease: The "umbrella term" used when diverticula cause symptoms. This includes Symptomatic Uncomplicated Diverticular Disease (SUDD), where people experience chronic symptoms like bloating and pain without an active infection.

Preventing and Treating Diverticulitis

For years, the advice for diverticular disease was "avoid nuts and seeds." We now know this is a myth! Current research shows that nuts, seeds, and popcorn are not only safe and do not increase the risk of a flare, but may actually be beneficial

Prevention:

There are some simple diet and lifestyle changes that can reduce the risk of diverticulitis. This includes a vegetarian diet, a diet high in fibre with minimal red meat and processed foods, maintaining a healthy body weight and engaging in regular, vigorous physical activity.

Acute Treatment:

During an active flare of diverticulitis (infection), the goal shifts from "moving things along" to "giving the bowel a rest." Doctors typically recommend a temporary low-fibre or clear liquid diet. This reduces the volume of stool passing through the inflamed area, allowing the infection to heal.

The Low FODMAP Diet and Diverticulitis: What Does the Science Say?

There is currently no strong evidence that a low FODMAP diet prevents the initial formation of diverticula or the onset of diverticulitis. In fact, many high-fibre foods that protect the colon (like onions, garlic, and beans) are also high in FODMAPs. Restricting these unnecessarily could reduce the variety of fibre your gut needs for long-term health.

Many patients who have recovered from an acute bout of diverticulitis continue to experience "IBS-like" symptoms (bloating, abdominal pain, and altered bowel habits). This is often referred to as SUDD.

While it is possible that FODMAP restriction could help to manage IBS-like symptoms, there is no actual evidence to support this approach. People wishing to trial a low FODMAP diet for this purpose should do so under the guidance of a FODMAP-trained dietitian and implement minimal restrictions (e.g. using a FODMAP gentle approach), on a temporary basis only.

Summary:

If you have diverticular disease, your diet should change based on how you feel:

• Feeling well? Focus on a plant-based, high-fibre diet, plenty of hydration and regular exercise to prevent flares.
• Having an active flare? Follow your doctor's advice, likely for a temporary low-fibre diet.
• Struggling with chronic bloating and pain? If you're considering a low FODMAP diet, keep in mind that there is not much evidence to show it will help in this situation. If you decide to restrict FODMAP intake, do so under the guidance of a dietitian, using minimal dietary restrictions, and on a short-term basis only.

References

Williams, S., Bjarnason, I., Hayee, B., & Haji, A. (2023). Diverticular disease: update on pathophysiology, classification and management. Frontline gastroenterology, 15(1), 50–58. https://doi.org/10.1136/flgastro-2022-102361.

Kishnani, S., Ottaviano, K., Rosenberg, L., Arker, S. H., Lee, H., Schuster, M., Tadros, M., & Valerian, B. (2022). Diverticular Disease—An Updated Management Review. Gastroenterology Insights, 13(4), 326-339. https://doi.org/10.3390/gastroent13040033.

Bailey, J., Dattani, S., & Jennings, A. (2022). Diverticular Disease: Rapid Evidence Review. American family physician, 106(2), 150–156.

Carabotti, M., Falangone, F., Cuomo, R., & Annibale, B. (2021). Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review. Nutrients, 13(4), 1288. https://doi.org/10.3390/nu13041288.

Dahl, C., Crichton, M., Jenkins, J., Nucera, R., Mahoney, S., Marx, W., & Marshall, S. (2018). Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review. Nutrients, 10(2), 137. https://doi.org/10.3390/nu10020137.

Dietitians Australia. (2023, April 13). Diverticular disease | Dietitians Australia. Dietitiansaustralia.org.au. https://dietitiansaustralia.org.au/health-advice/diverticular-disease

Practitioners, T.R.A.C. of general (2017) Diverticular disease practice points, Australian Family Physician. Available at: https://www.racgp.org.au/afp/2017/november/diverticular-disease-practice-points.

Uno, Y., & van Velkinburgh, J. C. (2016). Logical hypothesis: Low FODMAP diet to prevent diverticulitis. World journal of gastrointestinal pharmacology and therapeutics, 7(4), 503–512. https://doi.org/10.4292/wjgpt.v7.i4.503