Diet and Diverticula - Which Foods to Choose?

The so-called "diet for diverticulitis" is not a system for treating diverticular mattia, but a method aimed at preventing its inflammatory evolution.

Even if through a correct diet we cannot eliminate intestinal diverticula, we therefore have the possibility of preventing their inflammation.

Diet and Diverticula - Which Foods to Choose?

What is Diverticulitis?

Diverticulitis is a gastrointestinal disease that affects the large portion of the intestine.
This disease can only affect those with so-called diverticulosis.
Diverticulosis means "presence of diverticula".

Diverticula are real anatomical alterations of the colon which, based on the pathological nature and the level of severity, can be of two different types.

  • Less problematic diverticula are characterized by mucosal and sub-mucosal protrusions that tend to invaginate within loci of least resistance of the wall, such as the points of penetration of the arteries through the smooth muscle layer.
  • The most serious diverticula, ie the "real" (less frequent) ones, are instead formed by an extroflexion of all the layers of the intestinal wall.

Diverticulitis occurs when diverticula become infected / inflamed and give rise to an acute disorder. However, if these remain healthy and asymptomatic, the condition is simply referred to as diverticulosis.

To avoid continually distinguishing the two phases, especially in subjects who get sick frequently, we speak of diverticular disease.

Who Affects and Why?

Diverticulosis can be identified with specific investigations, such as abdominal ultrasound, computed tomography and rectolonoscopy.

The diagnostic finding can be justified by a specific symptomatology of diverticulitis or be a random finding, during the investigation of other disorders of the large intestine.
It is not easy to establish the incidence of diverticulosis, as it is not certain that those who have one or more diverticula will fall ill with diverticulitis. On the other hand, it is much easier to define the epidemiological importance of acute conditions, which affects about 10% of those over 40 and 50% from 60 onwards.
Diverticulitis mostly affects the left side and is exceptional in children, rare in adults under 40 and quite frequent in over sixty.

With these data in hand, the first question that arises spontaneously is: "Do diverticula tend to form more with the progress of time, or do they simply become more delicate?". Probably, both solutions can be considered valid and significant.

Risk factors

Diverticula could be the consequence of an intrinsic weakness of the muscular walls of the large intestine, which is why the progressive weakening of the same with old age would explain the greater incidence in the elderly.

In addition to age, the other statistically relevant factor is one low-fiber diet and water typical of western countries, where the incidence of diverticulitis is greater than in the east.

This happens for a very specific reason: the scarce presence of fibers and water is associated with an increase in intraluminal pressure which, by exerting a push from the inside out, forces the protrusions to invaginate in the points of greatest weakness.

Symptoms and Therapy

When present, the symptoms of uncomplicated or mildly activated diverticular disease are quite general and sometimes overlap with those of irritable bowel.

The most frequent are: spontaneous or provoked pain, especially in the left iliac fossa, meteorism and alternate alvus with prevalence of constipation.

On the contrary, diverticulitis becomes explicitly symptomatic when it enters a phase of severe acuity, that is in the case in which they occur:

  • Obstruction of the diverticular ostium, due to stagnation of feces inside the pocket and relative appearance of inflammatory phenomena
  • Perforation of the diverticular ostium, with perivisceral abscess formation associated with circumscribed or generalized peritonitis
  • Bleeding, due to erosion of the underlying vessels and, sometimes, consequent haemorrhage.

Diverticulitis often presents with localized pain, closed sore, fever and chills, increased inflammation and rectal bleeding (expulsion of blood which, if not associated with other symptoms, almost always translates to diverticular hemorrhage).
Complicated diverticulitis cannot be treated with nutrition and therapy includes: parenteral administration of antibiotic drugs, complete intestinal rest (fasting), and sometimes surgery.
On the contrary, in the event that the generic symptoms already described appear or there is awareness of the presence of diverticulosis, it is possible to adopt a preventive diet; this, which some refer to as a diet for diverticulitis, is very similar to the diet recommended in the case of irritable colon.

Prevent Diverticulitis with Diet

As anticipated, diverticulitis (especially complicated diverticulitis) requires total fasting and parenteral nutrition associated with antibiotics; only in some cases, surgery is necessary.
La diet to prevent diverticulitis instead, it is a well-known dietary therapy and intervenes with two distinct but complementary mechanisms:

  • Reduction of the possibility of diverticula formation
  • Reduction of the possibility of infection / inflammation of the diverticula.

The diet to prevent diverticulitis is not much based on calorie intake or nutritional breakdown, but on the composition of fibers, probiotics and prebiotics.
The basic rules (for an adult) are:

  • Fiber intake that corresponds at least to the amount suggested for a healthy person (30g / day)
  • Water intake that corresponds at least to the amount suggested for a healthy person (1 ml per kcal taken), of which a good part during the meal
  • Increase the percentage of soluble fibers at the expense of insoluble ones; remember that some soluble fibers, such as inulin, also exert a very important prebiotic action
  • Integrate with dietary foods or probiotic supplements or medications
  • Periodically carry out cycles of intestinal disinfectants (questionable)
  • Avoid foods that are difficult to chew such as, for example, oil seeds (walnuts, hazelnuts, almonds, pistachios, pine nuts, peanuts, sesame, poppy seeds, hemp seeds, flax seeds, etc.)
  • Avoid foods containing non-digestible portions such as peel and internal seeds (tomato, aubergine, figs, cucumbers, kiwi, watermelon, grapes, pomegranate, etc.).

Let's go into more detail.
As anticipated, the presence of soluble fibers and water mainly serves to reduce intraluminal pressure and facilitate the transit of stools. This avoids both the onset / worsening of diverticula and the stagnation of fecal material.
Some fibers are also considered prebiotic elements, that is, they nourish the intestinal bacterial flora favoring its trophism. This device is extremely useful to maintain a balance between the internal strains and to guarantee the nourishment of the enterocytes.

In addition to protecting the tissues from possible external aggressions, the bacterial flora reduces the fecal pH and produces vitamins and molecules very useful for the health of intestinal cells (butyric acid and polyamines).
In addition to feeding them, it can be very useful to increase the exogenous introduction of these microorganisms. In this case, the use of probiotic products containing Lactobacilli, Bifidobacteria and Eubacteria becomes desirable.

The use of disinfectants is still a questionable recommendation today. This means that not all specialists agree on the relevance or otherwise of this practice. The positive aspect is undoubtedly that of reducing the total bacterial load, including the potentially pathological one; the negative aspect consists in the reduction of the physiological microbial population.

As we have already said, the latter is extremely beneficial for the organism, but cases of infection (acute) caused by them are not rare; generally, these are cases in which the diverticula are very deep or concomitant with significant alterations in intestinal transit (severe constipation).

Even the exclusion of foods that can leave indigestible waste represents a recommendation that has aroused many controversies; it is believed that certain products do not need to be excluded by ensuring optimal functioning of the colon.

Some may ask: "Why take the risk?".

The answer is quite simple. Many of the foods that should be eliminated from the diet against diverticulitis belong to the group of vegetables and fruits; in addition to providing excellent quantities of fiber (with a higher percentage of the solubles compared to cereals), necessary for the health of the colon and bacterial flora, these foods are an irreplaceable source of: vitamin C, vitamin A, folic acid, potassium, phenolic antioxidants etc.

Their exclusion from the diet is not easy to compensate and the use of tools that filter the seeds and the peel necessarily requires reduction to a puree, with consequent poor palatability.

On the contrary, as far as oilseeds are concerned, it is possible to completely eliminate them from habit and compensate for their deficiency by using the relative (or other) extraction oils.

This is because the most important nutrients that characterize oil seeds are lipidic in nature (essential fatty acids and vitamin E) and therefore are easily isolated by pressing and filtration.

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