For more than 50 years, doctors have been telling patients with diverticulosis--a condition that forms pouches in a weakened intestinal wall--to avoid nuts, seeds and corn in their diet. New studies show, however, that such advice is not evidence-based.
Prevention and Treatment of Diverticulitis
Diverticulosis is a condition associated with a diet high in refined foods, low in plant fibers and chronic constipation. Over time, with increasing age and depending on lifestyle factors, one-third of people will develop some form of diverticulosis by age 60, although they might not have symptoms. Two-thirds of people age 85 and older have the condition.
The problem occurs when pouches become inflamed and infected, and a disease known as diverticulitis occurs. Because of increased pressure and straining of constipation, the bowel forms pockets, or diverticuli, that can become infected, resulting in abdominal pain, inflammation and sometimes bleeding.
For many years, it was thought that small seeds, nuts and popcorn could become trapped and cause irritation on their way through the bowels, contributing to diverticulitis and mucosal bleeding. Doctors advised a high-fiber but seed-free diet, suggesting that even berries and tomatoes posed a risk to those with a history of diverticulitis.
Researchers at the University of Washington School of Medicine in Seattle found that of 47,000 healthy men, 801 developed diverticulitis and 383 cases were complicated by bleeding of the diverticuli. Long-term studies of men's dietary habits did not correlate eating seeds, nuts and corn with the development of either diverticulitis or diverticuli bleeding. In fact, the men who ate nuts and popcorn at least twice a week had the lowest incidence of diverticulitis.
Researchers in the study, which was completed in 2008, pointed out that although their sample was large, it was a broad study and that more investigation is warranted. It is clear, however, that the prevention of diverticulitis in healthy men, and probably women, can be achieved by increasing dietary fiber, including nuts, seeds and popcorn. Men who ate popcorn at least twice a week had a 28 percent lower risk of diverticulitis than those who ate the snack infrequently.
For people who have a history of diverticulitis, with or without bleeding, dietary restrictions should be based on individual needs. There are many anecdotal reports of patients who benefit from eliminating seeds, nuts and popcorn. A flareup of pain and inflammation that seems related to a trip to the movie theater and a box of popcorn might indicate a need to forgo such snacks in the future. The researchers in the Washington study explained that people who experience pain and inflammation after ingesting seeds, nuts, corn and popcorn should not eat them. But dietary restrictions do not need to be so strict as to avoid all seeds, such as tomatoes and strawberries.
Increasing the amount of fresh dark green leafy vegetables such as spinach, romaine lettuce, parsley and kale should reduce inflammation and add bulk to stools. Celery, carrots, red bell peppers, beets and squash are other vegetables to include in a healthy high-fiber diet. Whole grains such as steamed brown rice, quinoa and oatmeal are filling and add fiber. Soft, ground corn, such as that used in tortillas, corn breads and batters, is perfectly safe and should not be eliminated from the diet. Plenty of fresh pure water is important to help the fiber make its way smoothly through the digestive tract, and moderate exercise, such as daily walking or yoga, stimulates the peristaltic action of the bowels.
A no nuts, seeds or corn diet can be tailored to individual needs. It is no longer appropriate advice for people with diverticulosis and can be modified to restrict only those foods with troublesome hulls that bother some individuals with a history of related symptoms.
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