Diverticulosis and Diverticular Disease
Dietary and Lifestyle Considerations
Plant-Based, Fiber-Rich Diet
Plant-based diets that are high in fiber may protect against diverticular disease. The study of fiber as it relates to diverticular disease often focuses on fiber’s role in promoting bowel regularity (Collins 2015). However, fiber may also influence the risk of diverticular disease via its role as a prebiotic, meaning it provides fuel for beneficial probiotic organisms. Also, fiber promotes the formation of short-chain fatty acids, notably butyrate, which are essential for colonic health. In fact, butyrate has been studied as a treatment for diverticular disease (Slavin 2013; Krokowicz, Stojcev 2014).
In a study that monitored over 47 000 men and women for an average of 11.6 years, vegetarians had a 31% lower risk and vegans had a 72% lower risk of diverticular disease compared with meat eaters. This study also noted a link between increased dietary fiber and lower risk of diverticular disease in both meat eaters and non-meat eaters (Crowe 2011). And in a study in more than 43 000 people, the risk of symptomatic diverticular disease was reduced by 45% in those with the highest intake of insoluble fiber, compared with those who had the lowest intake (Aldoori 1998).
Some, though not all, trials have found a beneficial effect of a high-fiber diet or fiber supplements on diverticular disease symptoms (Unlu 2012), and many practice guidelines call for a high fiber intake or fiber supplementation for the prevention and treatment of symptomatic diverticular disease (Cuomo 2014; Andersen 2012; Thaha 2015).
Note: A low-fiber, low-residue diet is often recommended during the initial healing phase after an episode of acute diverticulitis (Mayo Clinic 2014b; Saul 2015; Thaha 2015). People recovering from an episode of acute diverticulitis should ask their healthcare provider about consuming fiber.
Nuts, Corn, and Popcorn
Historically, diverticular disease management has included the avoidance of foods with large indigestible pieces such as nuts, seeds, corn, and popcorn. The belief behind this recommendation was that fragments of these foods could become trapped in diverticula and cause inflammation and infection. However, a study in over 47 000 American male health professionals found no association between consumption of these foods and diverticulitis risk. In fact, this study found that men who ate nuts or popcorn two or more times per week had 20% and 28% reduced risk of diverticulitis, respectively, compared with men who ate those foods less than once per month (Strate 2008).
Physical Activity and Weight Management
Physical activity and maintaining a healthy weight may reduce the incidence of diverticular disease and its complications. In an 18-year study in over 47 000 American male health professionals, those who reported exercising the most were 25% less likely to develop diverticular disease and 46% less likely to have diverticular bleeding than those who reported exercising the least. Vigorous activity was especially correlated with a significantly lower risk of diverticular disease and bleeding (Strate, Liu, Aldoori, Giovannucci 2009). A study in over 36 500 women found that those who reported low levels of exercise—30 minutes or less per day—had a 53% higher risk of diverticular disease compared with women who exercised more than 30 minutes per day (Hjern 2012). Another study that followed more than 10 000 joggers aged 50 or older for 7.7 years found that more running was associated with less diverticular disease, and more vigorous and longer runs were more protective (Williams 2009).
Also, excess weight, especially when carried around the abdomen, appears to be a risk factor for diverticular disease and its complications. A study in over 47 000 male US health professionals found that, compared with normal-weight men, obese men had a greater than 1.7-fold higher risk of diverticulitis and a 3.1-fold higher risk of diverticular bleeding; men with the largest waist circumference, compared with those with the lowest, had a greater than 1.5-fold higher risk of diverticulitis and greater than 1.9-fold higher risk of diverticular bleeding (Strate, Liu, Aldoori, Syngal 2009). Another study in women found that overweight and obese women had a 29% and 33% increased risk, respectively, of diverticular disease compared with normal-weight women; and obese women had double the risk for complicated diverticular disease (Hjern 2012).