How can I prevent diverticulitis?

Dr. Michael Roizen, MD
Internal Medicine
Diverticula are small outpouchings (pockets) in the intestine that are filled with waste. By age eighty, all of us have them, and by age sixty, 50 percent of us have them. However, in the Nurse's Health Study, the subjects (most of them were women) who consumed the greatest amounts of insoluble fiber a day had 50 percent less diverticular disease than those who consumed the least amounts of fiber.
Patricia Raymond, MD
The suggestion to prevent diverticulitis is to eat a diet high in fiber, and that includes high-fiber whole grains, fruits, vegetables, nuts, and seeds. I’m aware that some gastroenterologists say to avoid all seeds and nuts, so some of you are nuts enough to wash tomato seeds from slices and pick free poppy seeds from buns. Think that’s a tad ... insane. Carefully try consuming the various seeds and nuts that you’ve excluded from your diet, and add back those that you tolerate -- after all, seeds and nuts are a high-fiber diet. My personal diverticula don’t favor sunflower seeds, so I avoid them.
William B. Salt II., MD

Risk of this complication of diverticulosis may be reduced with diet and avoidance of two drugs.

About one of every three Americans will develop small pouches (diverticula) of the colon (diverticulosis) by age 60, and two of every three will have diverticulosis by age 85. Most people with diverticulosis don't have any symptoms from the condition unless they develop one of two complications: either rectal bleeding or inflammation, called diverticulitis. The main symptom of diverticulitis is pain, usually located in the left lower abdomen.

Doctors used to advise people with diverticulosis to avoid nuts, seeds, corn, and popcorn, since it was thought that they could get stuck in the diverticula and cause diverticulitis. However, there is no scientific evidence that this is true. Furthermore, a study published in the August 27, 2008 issue of the Journal of the American Medical Association led by researcher Lisa L. Strate, MD, found that these fiber-containing foods may actually lower the risk of developing diverticulitis.

I advise patients with diverticulosis that there is not only no evidence of harm from eating these fiber-containing foods, there is scientific evidence of benefit of ingesting these foods and dietary fiber. Still, some believe that nuts, seeds, corn, and popcorn trigger their attacks of diverticulitis, so they should avoid them and try to get enough dietary fiber from other sources.

Researchers, again led by Dr. Lisa L. Strate, report in the May, 2011 issue of the medical journal, Gastroenterology that the use of aspirin and NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen) raise the risk for both diverticulitis and diverticular bleeding. The risk of diverticulitis increased as the frequency and dosing of the drug rose (so the higher the dose and/or the greater number of times the drug is taken, the higher the risk of developing diverticulitis).

Mesalamine is a drug used to treat inflammatory bowel disease, or IBD (ulcerative colitis and Crohn's disease). Mesalamine is currently undergoing phase III research for prevention of diverticulitis in people with diverticulosis but without inflammatory bowel disease.

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