Which foods to include in your diverticulitis diet depends very much on whether you're having a flare up or you're trying to prevent one.
As discussed in the previous page on Diverticulitis Symptoms, diverticular disease can manifests itself in two ways:
- Diverticulosis is the presence of pouches or saclike protrusions (called diverticula) mainly in the sigmoid colon, and you may not even be aware they're there.
- Diverticulitis is when these pouches become inflamed and painful and that's when most people become aware of their presence.
It should be fairly easy to work out which foods to include in your diverticulitis diet once you realize what the underlying cause of diverticula formation is: constipation.
The same thing that cures and prevents constipation is also considered the key to combating this digestive disorder: high-fibre foods.
In fact, lack of fibre in the diet can cause a lot of straining during bowel movements, which, in turn, tends to expand the tiny diverticula along the muscle walls of the colon, causing discomfort.
For nearly fifty years, doctors treated diverticular disease with a low-fibre diet. Their theory was that "roughage irritates the gut".
Ironically, this misguided practice was a cause, not a cure for the problem, says the man who helped change it all, Neil S. Painter, a surgeon at Manor House Hospital in London.
Dr. Painter released his landmark study in a 1971 issue of the British Medical Journal showing that diverticulosis was caused by a fibre-deficient diet.
Knowing that such patients ate only half as much fibre as people with healthy colons, he persuaded 70 diverticulosis sufferers to go on a high-fibre diet.
It was a near total success. After a twenty-two-month follow-up period, he found that the diet had alleviated or abolished the symptoms (pain, nausea, flatulence, distension, constipation, etc.) associated with diverticular disease - in 89% of them! Bowel habits were normalized; all but a few gave up laxatives.
What did they eat? One-hundred percent whole-wheat bread, cereals high in bran, plenty of fruits and vegetables.
They also added "miller's bran" (unprocessed wheat bran) to every meal and gradually upped the dose until they passed one or two soft stools a day without straining. This bran has about five times the fibre of ordinary whole wheat, says Dr. Painter.
How much bran they needed was determined by trial and error. Dr. Painter pointed out there was no single correct "dose" of bran to help such bowel problems.
It varied greatly, ranging from a mere one dessert spoon daily (3 grams) to three tablespoons three times a day (12 to 14 grams)!
"Most required two teaspoons of bran three times a day, to render the stools soft and easy to pass" he said.
Dr. Painter's advice: Start with two teaspoons of unprocessed bran three times a day. After two weeks increase (or decrease) this dose if necessary and until you can move your bowels once or twice a day without straining.
Since the bran is difficult to eat dry, Dr. Painter's subjects sprinkled it on cereal, mixed it with porridge, added it to soup or took it with milk or water. A few patients were able to overcome their symptoms simply by eating processed bran cereals, such as All-Bran, instead of miller's bran.
Dr. Painter explains that a deficiency of dietary fibre alters the consistency of the stool so that the sigmoid part of the colon has to generate more pressure to more vigorously propel the stools. This causes the herniation of the walls of the colon, characteristic of diverticular disease.
If you're recovering from a flare up of diverticulitis, begin with a soft-fibre diet. Cook vegetables until fairly soft, eat cooked fruits, use easy-to-digest grains like oatmeal, and make vegetables soups with tofu.
Once you're feeling well, gradually increase the high-fibre foods in your diet. Focus on fruits, vegetables, whole grains and legumes. If that is not sufficient to give you regular bowel movements, introduce bran in your diverticulitis diet, a little at a time.
Meat, poultry, and dairy products contain zero fibre and need to be eaten in moderation.
Psyllium seeds are a good fibre supplement choice because they're non-irritating.
It may take you some time to get accustomed to a high-fiber, low-fat diet, but it'll be worth the effort.
The benefits reach even further than your digestive tract, lowering your risk factors for cancer, heart disease and diabetes.
Aim for 25 to 35 grams of fibre per day. Here's an example of how you can achieve that amount of fibre:
For years, doctors suspected that nuts and seeds could lodge in the pouches and actually promote inflammation and infection.
So for a long time, experts cautioned people with diverticulosis against eating nuts and foods with seeds and hull, such as tomatoes, strawberries, raspberries, poppy seeds, sesame seeds, pumpkin seeds and popcorn, and many still do.
But in actuality, such pips and seeds are not much of a worry, many experts now say, and have reversed their ban on them.
So do keep off them while the inflammation is active, because they could further irritate your already inflamed colon, but you can eat them regularly after that.
First of all, you need to make sure whether you really don't tolerate wheat bran or whether it's just the adding of the fibre to your diet that causes you to have problems. If you're not used to it, this in itself can create a lot of digestive discomfort (i.e. bloating, cramping, pain, etc.).
Start with a small amount of wheat bran. If after 2 weeks you're still having problems, wheat bran might not be for you.
Recent studies indicate that rice bran may be even more effective than wheat bran in relieving constipation. So follow the same advice that Dr. Painter gave to his patients but using rice bran instead.
Another alternative is to supplement your diet with a bulk product and/or a stool softener that contains methylcellulose or psyllium, since these don't promote as much gas formation in the colon as other sources of fibre, especially wheat bran.
And I've found that adding Linwoods flaxseed to my diet has made a huge difference to my intestinal transit! See what works for you.
Foods That Relieve Constipation and Constipation Prevention - Discussing the importance of fiber and water in the diet.
High Fiber Diet Plan - Explaining how fiber works to keep you regular.
Benefits of Fiber and High Fiber Foods in Your Diet - Increasing fiber in your diet can help preventing and treating many conditions.
Best Fiber Supplement - Why is Lepicol the best fiber supplement?
Best Foods for Constipation (Part 1) - Discussing apples, beans, berries, flaxseed and dried fruits.
Best Foods for Constipation (Part 2) - Discussing dark leafy greens, ginger, honey, rhubarb, squash and coffee.
Carper, J., (1993) Food Your Miracle Medicine: How Food Can Prevent and Treat Over 100 Symptoms and Problems, New York: HarperCollins Publishers Inc.
Lipski, E., Ph.D., CCN, (2005) Digestive Wellness, Fourth Edition: Strengthen the Immune System and Prevent Disease Through Healthy Digestion, New York: McGraw-Hill.
NEIL S. PAINTER, DENIS P. BURKITT, British Medical journal, 1971, 2, 450-454 Diverticular Disease of the Colon: A Deficiency Disease of Western CivilizationWait, M., (2007) Food Cures: Breakthrough Nutritional Prescriptions for Everything from Colds to Cancer, New York: The Reader's Digest Association, Inc.