Diverticulitis, an infection of small pockets (diverticula) in the intestinal lining, can cause fever, abdominal pain, nausea, and changes in bowel movements. Managing this condition often involves dietary adjustments, with the low-FODMAP diet emerging as a potential strategy. This article explores the connection between the low-FODMAP diet and diverticulitis, providing insights and practical tips for a healthier life.
Understanding Diverticular Disease and Diverticulitis
Diverticular disease involves the formation of small pouches (diverticula) in the colon wall. While the exact cause is not fully understood, dietary habits, particularly low-fiber diets, play a significant role. Diverticulitis occurs when these pouches become inflamed or infected, leading to painful symptoms.
What are FODMAPs?
FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are types of carbohydrates (sugars) found in certain foods. FODMAPs are osmotic, meaning they draw water into the intestinal tract. They may not be digested or absorbed well and can be fermented by bacteria in the intestinal tract when eaten in excess.
Types of FODMAPs
- Fructose: Found in fruits, honey, and high fructose corn syrup (HFCS).
- Lactose: Found in dairy products.
- Fructans/Inulin: Found in wheat, onion, and garlic.
- Galactans: Found in beans, lentils, legumes, and soy.
- Polyols: Found in sweeteners containing sorbitol, mannitol, xylitol, maltitol, and stone fruits such as avocado, apricots, and cherries.
The Low-FODMAP Diet: An Overview
The low-FODMAP diet is often used in those with irritable bowel syndrome (IBS). The diet also has potential use in those with similar symptoms arising from other digestive disorders such as inflammatory bowel disease and diverticulitis.
How the Low-FODMAP Diet Works
The low-FODMAP diet temporarily restricts carbohydrates that are difficult for some people to digest. This can relieve uncomfortable symptoms and give the digestive system a rest. Removing irritants gives the gut lining a chance to repair itself and can help restore a healthy balance of gut flora.
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Phases of the Low-FODMAP Diet
- Elimination Phase: Avoid all high-FODMAP foods for 4-6 weeks.
- Reintroduction Phase: After 4-6 weeks, add high-FODMAP foods back into your diet one at a time and in small amounts to identify potential “trigger” foods.
- Maintenance Phase: Limit foods that trigger your symptoms.
Low-FODMAP Diet and Diverticulitis: Is There a Connection?
Some research suggests that a low-FODMAP diet could prevent high pressure in the colon, which, in theory, could help people avoid or correct diverticulitis.
Potential Benefits
- Reducing Colon Pressure: By limiting FODMAPs, the diet may reduce fermentation and gas production in the colon, potentially lowering intraluminal pressure. A high-fiber diet may be linked with IBS symptoms. This idea is based upon the theory of “segmentation hypothesis” that was first put forth by Painter, in which he described the colon obstructed at both ends as an enclosed space that acts as a series of “little bladders”.
- Alleviating Symptoms: Symptoms of gas, bloating, cramping, diarrhea and/or constipation may occur in those who could be sensitive to the effects of FODMAPs. A low FODMAP diet may help reduce symptoms, as it limits foods high in fructose, lactose, fructans, galactans and polyols.
- Gut Lining Repair: Removing irritants gives your gut lining a chance to repair itself and can help restore a healthy balance of gut flora.
Important Considerations
- Nutritional Deficiencies: The low FODMAP diet is not recommended long term as it risks nutritional deficiencies. When following a low FODMAP diet plan, it’s important you still get enough nutrition from other foods.
- Individual Triggers: The point of the diet is not to deprive you of “bad” foods but to find out if your symptoms are related to FODMAPs or not - and if they are, which ones. Some people may not improve at all on the elimination phase. If you don't, there’s no reason to follow through to the next phase. Many people find in the end that it’s only one or two of the FODMAP food groups that bother them.
- Expert Guidance: Cutting out groups of food isn’t recommended without expert guidance. Advice needs to be practical and to fit into your life.
Foods to Include and Avoid on a Low-FODMAP Diet
Certain fruits, vegetables, grains, and proteins are higher and lower in FODMAPs. Some are OK to eat in limited amounts but will bother you in larger amounts. Portion sizes of low FODMAP foods is extremely important for a diverticulitis diet, so please make sure you are not exceeding the recommendations.
Low-FODMAP Foods
- Fruits: Grapes, strawberries, pineapples, some berries (blueberries, raspberries).
- Vegetables: Yellow squash, zucchini, pumpkin (without skin or seeds), cooked spinach, beets, carrots, asparagus, potatoes (no skin).
- Grains: Gluten-free grains made with potato, quinoa, rice, or corn.
- Proteins: Plain-cooked meats, tofu, eggs.
- Dairy: Lactose-free dairy products.
High-FODMAP Foods to Limit or Avoid
- Fruits: Apples, watermelon, stone fruits, ripe bananas.
- Vegetables: Onion, garlic, beans/lentils.
- Grains: Wheat products.
- Sweeteners: Honey, high fructose corn syrup, sweeteners containing sorbitol, mannitol, xylitol, maltitol.
- Dairy: Products containing lactose.
Other Dietary Considerations for Diverticulitis
Fiber Intake
The relationship between fiber and diverticulitis is complex. A high-fiber diet is strongly associated with a reduced risk of developing diverticulitis.
- High-Fiber Diet: A diet high in fruits, vegetables, and whole grains may decrease the risk of developing diverticulitis. Since fiber can soften your body’s waste material, softer stool passes through your intestines and colon more quickly and easily. This reduces the pressure in your digestive system, which helps prevent the formation of diverticula. Adults are generally recommended to get 25 to 30 g of fiber in their diet per day.
- Low-Fiber Diet: However, if you’re having an acute attack of diverticulitis, your doctor may suggest either a low fiber diet or a clear liquid diet temporarily to help relieve your symptoms and reduce the increased colon contractions that fiber can cause. Low fiber foods to consider eating if you have symptoms of diverticulitis include: white rice, white bread, or white pasta (but avoid foods that contain gluten if you’re intolerant), dry, low fiber cereals, processed fruits, such as applesauce or canned peaches, cooked animal proteins, such as fish, poultry, or eggs, olive oil or other oils, yellow squash, zucchini, or pumpkin without skin or seeds, cooked spinach, beets, carrots, or asparagus, potatoes with no skin, fruit and vegetable juices.
- Gradual Increase: When adding fiber to your diet, be sure to drink plenty of water to avoid constipation.
Clear Liquid Diet
A clear liquid diet is a more restrictive approach to relieving diverticulitis symptoms. Your doctor may suggest it for a short period of time. A clear liquid diet usually consists of: water, ice chips, soup broth or stock, gelatin, such as Jell-O, tea or coffee without any creams, flavors, or sweeteners, clear electrolyte drinks.
Foods to Limit
- Red and Processed Meats: Eating a diet high in red and processed meats could increase your risk of developing diverticulitis. Red meat is linked to inflammation in certain organs, and it’s best to avoid excessive consumption to prevent health issues.
- Refined Grains: Foods made with white flour, such as white bread and pastries, lack fiber and can contribute to digestive issues, making them less ideal for those with diverticulitis (except during a flare!).
- Fat and Sugar: Diverticulitis flare-ups can be avoided by eating less fat and sugar, but doing so requires plenty of willpower, and additional help might be necessary.
- Nuts and Seeds: Nuts, seeds, corn, popcorn and fruits and vegetables with seeds may be safe to eat with diverticular disease, but the current scientific evidence clashes with patient reports.
Lifestyle Factors for Managing Diverticulitis
- Hydration: It’s essential to drink plenty of water to complement your high fibre diet. Adequate hydration ensures that the stools are softened to prevent constipation. Make sure to drink at least 2.7 to 3.7 liters of water daily, and you'll take a crucial step in diverticulitis prevention.
- Regular Exercise: Physical activity can promote regular bowel movements and reduce pressure in the colon.
- Weight Management: Maintaining a healthy weight can reduce the risk of diverticular disease and related complications.
- Stress Management: Stress can exacerbate digestive issues.
The Importance of Consulting Professionals
It’s always a good idea to consult a medical professional before making large dietary changes. Working with a gastroenterologist and dietitian can help you safely incorporate fiber into your diet.
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