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Health Protocols

Diverticulosis and Diverticular Disease

Causes and Risk Factors


Factors currently known to increase risk of diverticulosis include advancing age, obesity (especially central or visceral obesity), and smoking (Comstock 2014; Nagata 2014; Spiller 2015; Medina-Fernandez 2015; Nagata 2013).

Diverticular Disease

Several factors increase the risk of progression from diverticulosis to diverticular disease (Peery 2013; von Rahden 2012):

Low-fiber diet. In a study of 47 033 healthy adults followed for an average of 11.6 years, those with the highest dietary fiber intake (>25 g daily) were 41% less likely to be hospitalized for diverticular disease compared with those with the lowest intake (<14 g daily) (Crowe 2011). A four-year study in over 43 000 participants found that those with the highest intake of insoluble fiber had an approximately 40% lower risk of diverticular disease (Aldoori 1998).

Sedentary lifestyle. Several studies have found that increased physical activity appears to be protective against diverticular disease (Aldoori, Giovannucci, Rimm, Ascherio 1995; Williams 2009).

Obesity. Most studies show that higher body mass index, obesity, and abdominal obesity increase the risk of diverticular disease and its complications (Spiller 2015; Bose 2013; Dobbins 2006; Strate, Liu, Aldoori, Syngal 2009; Sorser 2009).

Smoking. Most studies suggest smokers are at increased risk of complications of diverticular disease, particularly perforation, but also abscess and hospitalization (Turunen 2010; Papagrigoriadis 1999; Collins 2015; Hjern 2011; Aldoori, Giovannucci, Rimm, Wing 1995).

Alcohol. Research into alcohol consumption and risk of diverticular disease has been inconclusive (Aldoori 2002; Strate 2012), though a study that included 23 people under age 50 found that in that age group, chronic alcohol consumption was associated with greater than three-fold odds of having an episode of acute diverticulitis (Pisanu 2013).

Non-steroidal anti-inflammatory drugs (NSAIDs), pain relievers, and steroids. The use of aspirin and other NSAIDs such as ibuprofen; opioid pain relievers such as codeine; and corticosteroids, especially inhaled steroids used to treat asthma, appear to increase the risk of diverticulitis and its complications (Hjern 2015; Kvasnovsky 2014; Strate 2011).