Diverticulitis is a condition characterized by the inflammation or infection of diverticula, which are small pouches that can form in the lining of the colon (large intestine). Understanding the role of diet in managing diverticulitis is crucial for both alleviating symptoms during a flare-up and preventing future occurrences. This article provides a comprehensive overview of dietary recommendations for individuals with diverticulitis, covering acute flare-ups, recovery, and long-term prevention.
Understanding Diverticulosis and Diverticulitis
Diverticulosis is the presence of diverticula in the colon. This condition is common, especially after the age of 40, with more than half of adults over 60 in the United States having diverticula. Most people with diverticulosis experience no symptoms and may not even know they have the condition.
Diverticulitis occurs when these pouches become inflamed or infected, often due to a tear or bacterial infection. This inflammation can lead to symptoms such as stomach pain, nausea, vomiting, bloating, fever, constipation, or diarrhea. A sudden onset of these symptoms is referred to as a flare-up.
Diet During a Diverticulitis Flare-Up
When a diverticulitis flare-up occurs, the primary goal is to rest the digestive system and reduce irritation and inflammation. This often involves a temporary shift in diet, starting with a period of bowel rest followed by a gradual reintroduction of easily digestible foods.
Bowel Rest and Clear Liquid Diet
In severe cases of diverticulitis, a doctor may recommend a period of complete bowel rest, where all food and drink are withheld for a short time to allow the digestive system to recover. After this break, a clear liquid diet is typically recommended for 2-3 days.
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Clear liquids are easily digested and leave minimal residue in the digestive tract. Suitable choices for a clear liquid diet include:
- Clear, fat-free broth
- Fruit juice without pulp (apple, cranberry, grape)
- Water (plain or carbonated)
- Sports drinks
- Tea or coffee (without milk or cream)
- Gelatin (without fruit)
- Ice pops (without fruit or pulp)
It is important to avoid solid foods during this phase to minimize strain on the inflamed colon.
Low-Fiber Diet
As symptoms improve, typically after a few days on a clear liquid diet, a transition to a low-fiber diet is recommended. Low-fiber foods are gentle on the digestive system and help to ease digestion. This phase usually lasts for 2-3 days, or as directed by a healthcare provider.
Examples of low-fiber foods include:
- Eggs
- Chicken and turkey
- Fish (lean, well-cooked)
- White bread, rice, and pasta
- Canned or cooked fruits (without skin or seeds)
- Canned or cooked vegetables (without skin)
- Fruit and vegetable juice (without pulp)
- Low-fiber cereals (Cream of Wheat, finely ground grits, cereals made from white or refined flour)
- Milk, yogurt, and cheese (fat-free, low-fat, or reduced-fat)
It is advisable to minimize foods with excess fat during this phase, as they may worsen symptoms. Additionally, chewing foods thoroughly and eating meals slowly can aid digestion.
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The BRAT Diet
The BRAT diet, consisting of bananas, rice, applesauce, and toast, is sometimes recommended to ease symptoms during a diverticulitis flare-up. These foods are bland and easy to digest. Saltines, oatmeal, and potatoes can also be included. However, due to its low nutrient content, the BRAT diet should not be followed for an extended period.
Transitioning Back to a Normal Diet
Once symptoms subside, usually within two to four days, it's important to gradually reintroduce fiber into the diet. Adding 5 to 15 grams of fiber per day is a good starting point. The goal is to eventually return to a high-fiber diet, which is crucial for preventing future flare-ups.
High-Fiber Diet for Prevention
A high-fiber diet is recommended for individuals with diverticulosis to help prevent the development of diverticulitis. Fiber softens the stool, promotes regular bowel movements, and reduces pressure on the colon, which may lower the risk of diverticula becoming inflamed.
Recommended Fiber Intake
The Dietary Guidelines for Americans, 2020-2025, recommend a dietary fiber intake of 14 grams per 1,000 calories consumed. Aiming for 25 to 35 grams of fiber daily is generally advised.
Specific daily fiber intake recommendations based on age and sex are:
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- Women aged 50 or younger: 25 grams
- Women over 50: 21 grams
- Men aged 50 or younger: 38 grams
- Men over 50: 30 grams
It is important to increase fiber intake gradually to avoid bloating, gas, and abdominal discomfort.
High-Fiber Food Choices
Good sources of fiber to include in the diet are:
- Whole grains: 100% whole wheat bread, quinoa, bran cereal, popcorn
- Beans and other legumes
- Vegetables: spinach and other greens, broccoli, carrots
- Fruits: berries, apples and pears (with skin), oranges
- Seeds: sunflower and pumpkin seeds
- Nuts: almonds, pistachios
Hydration
Adequate fluid intake is essential when consuming a high-fiber diet. Drinking at least 8 cups (64 fluid ounces) of fluid daily helps soften the stool and prevent constipation. Unsweetened beverages are preferred.
Foods to Avoid?
For many years, people with diverticulosis were advised to avoid nuts, seeds, and popcorn, based on the theory that these foods could get trapped in the diverticula and cause inflammation. However, current research suggests that these foods do not need to be avoided. In fact, nuts, seeds, and popcorn are good sources of fiber and may help prevent diverticulitis.
Other Important Considerations
- Stay active: Regular physical activity, such as water aerobics or brisk walking, is linked to gut health.
- Maintain a healthy weight: Research suggests that a diet low in fiber and high in red meat may increase the risk of diverticulitis.
- Consult with a healthcare professional: A doctor or registered dietitian can help create a personalized meal plan with the right amount of fiber.
- Keep a food diary: During a flare-up, tracking food intake can help identify specific foods that trigger symptoms.
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