Understanding diverticulitis and diverticulosis

What is diverticulosis?

Diverticulosis is when small bulging pouches, called diverticula, form in the lining of the digestive tract, most often in the colon. It is common, particularly in people over 50, and usually causes no symptoms. Many people only find out they have it during routine tests, such as a colonoscopy.

What is diverticulitis?

Diverticulitis occurs when one or more diverticula become inflamed or infected. It is uncertain as to why the inflammation occurs.

Symptoms may include:

• severe abdominal pain, often on the lower left side
• fever
• nausea and vomiting
• changes in bowel habits, such as constipation or diarrhoea

Diverticulitis can be mild or severe. In some cases, hospital treatment or surgery may be needed if complications develop, such as abscesses or a perforated colon.

Why dietary advice differs

Dietary advice will vary according to whether the colon is settled or inflamed. In other words, diverticulosis can exist but the individual experiences no symptoms. Diverticulitis is a phase characterised by a symptomatic flare, and the short-term goal is to introduce a gentle eating style to allow the inflammation to subside. This is why advice can vary so much.

Where there are asymptomatic (settled) pouches, most individuals can eat a healthy balanced diet including fibre from foods such as vegetables, fruits, legumes and whole grains. The fibre helps soften the stool and stimulates the peristalsis movement of the bowel leading to regularity.

A healthy balance of fibre can contribute to a lower likelihood of symptomatic diverticular disease. Personal tolerance to certain foods also has to be considered, as foods that suit one person may not suit another. 

General dietary guidelines

The following general dietary guidelines may be helpful for some people, although individual tolerance can vary.

Chew your food thoroughly

Chewing food is a first line of defence as it ensures easy digestion and extraction of nutrients. Saliva assists in the breakdown of foods, so in effect digestion starts with the mouth.

Stay well hydrated

Hydration is also another line of defence. Lifestyle, work, climate, and medications are just some of the contributory factors that can affect how much we drink. It is always vital to ensure adequate hydration.

Listen to your symptoms

Flexibility with diet is essential, as well as acknowledging symptomatic signs at the early stages so that changes can be introduced quickly to help prevent worsening and potential infection.

Consider your tolerance to fruit skins and pips

Keep highly pipped and tough-skinned foods to a minimum during flare-ups. For example: berries, kiwis, whole peaches (e.g., skins on, stoned fruit). They are easily trapped in the pouches, which could lead to inflammation and symptoms for some people. Using tinned fruit as an alternative means the skins and pips have been removed for you, and they can still be enjoyed.

Eating nuts and seeds

In general, nuts and seeds can be eaten, and using ‘half a cup’ as a measure, this is ample per day. Provided they are chewed to a paste their nutritional value outweighs the need to exclude, particularly their fibre content. However, common sense should prevail, and any signs of discomfort would indicate they should be removed.

Review your medications

Some medications can contribute to a slowing down of colonic transit times, leading to the potential for symptoms and/or dehydration. This should always be considered when prescriptions are discussed.

Eating during a mild flare-up

Where there is a mild flare-up, the diet can be simplified to help. This can be implemented for 3-5 days.

Below are some tips to help you through a flare-up:

• use blended soups and white flour breads to rest the gut and colon
• ensure hydration is satisfactory to help prevent constipation – prune juice is an easy way to help mobilise the bowels
• use white rice and plain pasta
• avoid spices 
• avoid fried foods and fatty cuts of meats
• housekeep your stress and rest levels
• keep caffeine very low or remove completely
• if possible, increase your exercise
• avoid salad leaves including spinach, rocket, lettuces (flat leaves)
• use low-fat dairy products such as cottage cheese, quark, cream cheeses
• overcook vegetables so they are well softened and easier to digest

If the symptoms do not resolve or worsen, then consult a health professional for further guidance. Always phase fibre back in gradually.

If symptoms do flare and you are unsure of the way forward, consult a nutritionist to discuss how the diet should be adapted during this period.