Diet after diverticulitis

May 3, 2013 10:58 AM

A couple of days ago, I got a CT scan looking for for diverticulitis, and later that day got a phone call telling me I had a positive diagnosis. It's being treated with drugs (I was actually already feeling improved by the time I got the diagnosis). Today I saw the PA who ordered the CT scan, basically so that she could tell me not to eat corn or seeds…ever. Now I'm wondering.

My wife did some research, and found the following on the Mayo Clinic website: "In the past, doctors thought that nuts, seeds, popcorn and corn played a role in causing diverticulitis by getting trapped in the diverticula. However, research has shown that these foods aren't associated with an increased risk of diverticulitis."

My only risk factors are age (I'm over 40) and family history.

So: are those jokers at the Mayo Clinic putting me on, or is my PA passing on outdated medical advice?

posted by adamrice to Health & Fitness (13 answers total)

I know nothing about the medical information, just that my grandmother had this and didn't eat nuts/seeds in 1990-2000.

However, the Mayo statement says nuts/seeds don't cause diverticulitis or increase your likelihood to get it. Your doctor says you already have diverticulitis, and nuts/seeds cause inflammation (or something?) in anyone who has it. Those statements do not necessarily conflict.
posted by aimedwander at 11:04 AM on May 3, 2013 [1 favorite]

Your PA is giving outdated advice, although keep in mind there is an enormous amount of subjectivity in medicine - it is more of an art than a science in many respects - and your PA is probably acting on their experience and perception of outcomes of their other patients.

Sounds like Mayo got their language from uptodate (MD reference site) which says,

"Seeds and nuts — Patients with diverticular disease have historically been advised to avoid whole pieces of fiber (such as seeds, corn, and nuts) because of concern that these foods could cause an episode of diverticulitis. However, this belief is completely unproven. We do not suggest that patients with diverticulosis avoid seeds, corn, or nuts."


And in fact, most clinicians recommend a high-fiber diet for diverticular disease, and seeds, corn, and nuts can be a healthy part of a high-fiber diet. Diverticular disease is much more common in the first world and there is a strong theoretical link between low-fiber first world diets and this problem.
posted by latkes at 11:14 AM on May 3, 2013 [1 favorite]

Best data suggests that the primary dietary modification to prevent recurrence would be increasing fiber intake. The seed/nut thing is a long-standing controversy. The original recommendations were based on theory more than anything else, and the medical community is still somewhat divided on this recommendation. Evidence-based purists have yet to find any conclusive evidence that seeds/nuts or other poorly digest small particulates actually do lodge in diverticula and cause diverticulitis. Anecdotally, GI docs and surgeons essentially never find the smoking gun (or smoking seed/nut, as it were) when they have to go in and directly take a look at or cut out regions of intestine affected by diverticulitis.
posted by drpynchon at 11:18 AM on May 3, 2013 [2 favorites]

Relatively recent research appears to suggest that nuts are safe even if you already have the disease. (IANAD and TINMA, obviously.)
posted by wachhundfisch at 11:20 AM on May 3, 2013

Diverticulitis runs in my family; I'm just biding time until it's my problem too. The nuts & seeds thing is totally case-by-case for us. We think (not a single doctor among us) it has more to do with processing & acidity than the seeds themselves (e.g., my mother can eat most whole tomatoes with seeds but reacts strongly to tomato sauces and dried tomatoes with or without seeds). Most effective has been a kind of elimination diet approach to foods by each person, and rechecking things as responses to those foods change. Fiber is a biggie too.
posted by headnsouth at 11:23 AM on May 3, 2013

This from the Physician's Committee for Responsible Medicine: A report in the Journal of the American Medical Association And, this article may be a good start for research into diet and diverticulitis.
posted by partner at 11:38 AM on May 3, 2013

My references are telling me that advice to avoid corn, nuts, etc. is indeed outdated. They say to follow the average recommendations for a healthy diet, include high-fibre foods, drink enough water, and get enough exericse. If you want a fact sheet, memail me your email address.
posted by Ouisch at 11:43 AM on May 3, 2013

Actually, be careful with fiber:

"The claim that a lack of dietary fiber, particularly non-soluble fiber (also known in older parlance as "roughage") predisposes individuals to diverticular disease was long accepted within the medical literature.[1][2] However, the first study to specifically test the theory has found that "A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis."[3]"

A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis

"Conclusions

A high-fiber diet and increased frequency of bowel movements are associated with greater, rather than lower, prevalence of diverticulosis. Hypotheses regarding risk factors for asymptomatic diverticulosis should be reconsidered."
posted by VikingSword at 12:35 PM on May 3, 2013

A disenting opinion regarding fiber consumption. Full disclosure: I do not have diverticulitis, and I have not read the book, only this synopsis.
posted by vignettist at 4:44 PM on May 3, 2013

You have diverticulosis - meaning you already have the "pockets" and they're there to stay. Pretty standard for anyone over the age of 40. Diverticulitis is when those pockets are irritated and inflamed - you don't feel well at all and your bowels aren't working as they should - you're miserable. You're stuck with the d-osis, but the d-itis you can learn to keep under control. I used to eat high-fiber bread with lots of nuts and seeds and I also took fiber supplements - and I had a continuous bellyache and was rapidly becoming one of "those old people who are always focused on their bowel movements." When they finally did a scan and found the diverticulosis (or diverticula - meaning more than one diverticulum/pouch) my doctor suggested I avoid seeds and nuts for the simple reason that they do pack into those pouches and irritate them - makes sense to me. I went to a bread that has only a few nuts in it and no seeds (it's called Oat Nut bread) and once the bellyache went away, it's stayed away - and I no longer have any elimination difficulties, either. I don't take any fiber supplements, either, but try to eat a little bit of fruit each week - seems to work for me.
posted by aryma at 5:03 PM on May 3, 2013

Anecdata: I have diverticular disease (the pockets) but have not had diverticulitis. I eat corn, nuts and seeds all the time. My GP at the time I was diagnosed advised me to avoid these but as they had never caused me any discomfort or distress, I decided to take a rain check on that particular advice. If I developed inflammation or had an episode of diverticulitis, I'd reconsider. I remember looking it up at the time and there seemed to be two opposite schools of thought: eat nuts and seeds, nothing will happen vs never eat nuts and seeds, they will get caught in the pockets and cause inflammation. The latter doesn't seem to be the case for me - YMMV.
posted by t0astie at 7:35 PM on May 3, 2013 [1 favorite]

More anecdata: I was diagnosed with diverticulosis about five years ago (following a rather alarming rectal bleeding episode, yikes) and I have been eating seeds, nuts etc. since then with no obvious problems. I try to make sure I chew them before I swallow but I'm not even sure that's necessary. That said, I've never been an especially big eater of those things so perhaps that helps.
posted by Decani at 12:29 AM on May 4, 2013

Other anecdata: my father died of complications from diverticulitis. He had, over several years, I think three surgeries for it, until the final surgery failed because his intestine just couldn't hold the sutures anymore. He had been told pretty much what you were told, and the doctors said his intestine was full of corn when they operated on him. He'd been fine for a long time, even managed to come back from lung cancer, but a week before having some time to actually get to know his new daughter-in-law, he had a big meal full of things he'd been told to avoid.

Maybe you'll be fine, but ask yourself, are seeds and corn really that important, on the off chance that you won't be okay?
posted by Ghidorah at 5:04 AM on May 7, 2013