DIVERTICULITIS


 

DIVERTICULITIS

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Diverticulitis is an inflammation of the diverticula or outpouches of the large intestine. The presence of these outpouches is very common. When there is no inflammation, these outpouches, also known as diverticulosis, are not painful or bothersome; they are benign abnormal pouches in the lining of the intestinal wall.

The acute or inflamed state is called diverticulitis, which is caused by fecal matter accumulating in these outpouches. Symptoms include abdominal cramping, painful muscle spasms, distention, nausea, and fever.

When inflammation occurs, bowel rest often is prescribed. Following a diet that is low in fiber gives the bowel inflammation a chance to resolve. A low-fiber diet eliminates foods that contribute to fecal bulk. By decreasing the amount of stool produced, the bowel is better able to rest and recover.

Usually a mild condition, diverticulitis responds well to medication, and only severe cases require surgical intervention. The diet for diverticulitis generally begins with a clear-liquid diet, advances to a full-liquid diet, and then progresses to a low-fiber diet. When symptoms disappear, a high-fiber diet with plenty of water generally is recommended.

Clear-liquid diet

  • Apple juice, punch, juice blends, and fruit and vegetable juices with no pulp
  • Coffee and tea
  • Broth
  • Gelatin
  • Ice pops

Full-liquid diet

  • Juice
  • Milk
  • Milk shakes
  • Broth
  • Coffee and tea
  • Carbonated beverages
  • Creamed soups
  • Liquid meal replacements
  • Yogurt
  • Pureed soups (use blender)
  • Margarine, butter, and oil
  • Pudding
  • Gelatin
  • Ice cream
  • Fruit puree
  • Custards

  Low-fiber diet

  • Refined white bread, buns, and English muffins
  • Cereal, including cornflakes, puffed rice, Kellogg’s® Special K®, and Cheerios®
  • Biscuits, including arrowroot biscuits and water crackers
  • White rice
  • Refined pasta and noodles
  • Cottage cheese
  • Cream cheese
  • Mild cheeses
  • Any fruit and vegetable juice, except prune juice
  • Melons
  • Grapes
  • Ripe banana
  • Applesauce
  • Citrus fruit sections
  • Pureed fruits
  • Canned fruit salad
  • Stone fruits (fruits with pits, such as cherries, nectarines, and plums)
  • Potatoes with no skin
  • Alfalfa sprouts
  • Beets
  • Green beans
  • Carrots
  • Celery
  • Cucumber
  • Eggplant
  • Lettuce
  • Mushrooms
  • Peppers
  • Squash
  • Zucchini
  • Pureed vegetables
  • Well-cooked meat, fish, and eggs

Foods to avoid on a low-fiber diet

  • Tough, fibrous meats
  • Raw vegetables
  • Whole-grain breads, wheat or rye bran
  • Whole-grain cereals
  • Whole-grain flours
  • Popcorn
  • Nuts
  • Seeds

After symptoms subside and a high-fiber diet is initiated, you may begin reintroducing all of the foods on the low-fiber diet. It is important to consume water with high-fiber foods to aid the fecal matter in passing through the gastrointestinal tract. Regular exercise is recommended to promote normal bowel function and to reduce pressure inside the colon.

Diverticulitis: Progressing From a Low- to High-Fiber Diet

This advice will help you progress from a low-fiber diet to a high-fiber diet following a bout of diverticulitis.

Follow your physician’s instructions

Do not advance to a high-fiber diet until your physician tells you that it is OK to do so.

Drink fluids

Make sure to drink at least 8 cups of fluid each day while increasing your fiber intake.

Start slowly

Increase your fiber intake gradually.

Mix your cereal

Mix a small amount of high-fiber cereal, such as raisin bran or oatmeal, into a lower-fiber cereal, such as corn flakes or rice puffs. Slowly increase the proportion of high-fiber cereal every few days.

Eat fresh fruits and vegetables

Start by trying to have two servings of fresh fruits and one serving of fresh vegetables each day. Slowly advance from canned fruits to eating mostly fresh fruits and vegetables by adding one serving/day every week as tolerated. You may want to mix some fresh fruit into canned fruit at the beginning.

Remember that we now know that you do not need to avoid seeds, such as those found in strawberries. Your final goal is to consume at least 2 C of fresh fruit and 2½ C of fresh vegetables each day.

Consume beans, peas, or lentils

Once you are tolerating high-fiber cereal and fresh produce, try to eat a ½ C of dried beans, peas, or lentils each day. If you cannot tolerate this, try to eat them at least two times a week and gradually increase your intake.

Add some wheat germ

Try sprinkling a small amount of wheat germ into your yogurt, cereal, or fruit salad.

Eat whole-wheat bread

Eat one slice of whole-wheat bread each day. Once you are tolerating this, progress to eating two or three slices each day.

Include nuts in your diet

Eat several small servings of nuts each week.

Go half and half with your pasta

Make half of your pasta whole grain.

Use some whole-wheat flour

Replace one third of the all-purpose flour called for in recipes with whole-wheat flour.

Consider using a psyllium-based fiber product

Once you have adjusted to the high-fiber diet, you may want to add a serving of a psyllium-based fiber product, such as Metamucil®, into your daily menu.

Prevent flares of diverticulitis

Eating a high-fiber diet when you have diverticulosis prevents flares of diverticulitits. 

Think about probiotics

Some people with diverticulosis have had positive results from consuming probiotic-enriched foods occasionally. Look for yogurt that is labeled “contains live and active cultures.”

References and recommended readings

Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available to subscribers at: http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=84460. Accessed October 25, 2011.

Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:635-636.

National Digestive Diseases Information Clearinghouse (NDDIC). Diverticulosis and diverticulitis. Available at: https://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/. Accessed October 25, 2011.

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