What foods to avoid or favor in case of diverticula?

Diverticula are multifactorial, they appear with age (it is estimated that 10% of adults and 70% of the population over 60 years old have diverticula) and are favored by a chronic constipation reflecting low fiber intake. Fibers regulate intestinal transit; in their absence, intestinal transit is slow. Diverticula mainly form in the descending colon and the sigmoid colon (before the rectum). Therefore, sigmoid diverticulitis (or colic) is the same thing as diverticulitis, with precision on the location of the diverticula.

Diverticula are asymptomatic, we are rarely aware of their presence. In 20% of cases, pain appears, we speak of diverticulitis : inflammation or infection of a diverticulum. It is also after diverticulitis that the diagnosis is made. Once formed, the diverticulum is irreversible. Only surgery can remove it. The surgical procedure remains rare, because the complications of diverticulitis (abscesses, fistulas, perforations, peritonitis, stenosis) are also uncommon.

This guide covers the appropriate diet in case of diverticula, that is to say outside the inflammatory and painful phases.

In case of diverticula, the diet must be adapted to prevent the return of inflammatory phases. For this, the diet is close to normal. We will only avoid foods that increase the risk of inflammation: such as seeds and pips which could penetrate the diverticular sac. We also avoid as much as possible carbonated drinks, spices and strong condiments which are often poorly tolerated by the colon and cause pain. However, for the moment, no scientific or clinical study confirms the real benefit of excluding these foods; we are instead talking about personal intolerances. It's up to you to analyze your diet and find the foods that suit you. Conversely, we emphasize dietary fiber for multiple reasons:

• Fibers regulate intestinal transit. Their presence accelerates transit since they are not degraded by the body (we do not have the necessary enzymatic material). This acceleration reduces the contact time between the fecal bolus and the walls of the intestine.

• The fibers are prebiotics, that is to say they regulate the development of microorganisms, to the advantage of beneficial microorganisms and to the disadvantage of saprophytic microorganisms or harmful to health. Excessive bacterial overgrowth is also a cause of diverticulitis.

This diet must be implemented little by little, 1 to 2 months after diverticulitis so as not to increase the work of the colon too suddenly.

In short, the objective is to limit degeneration into diverticulitis while fighting against the risks of constipation and inflammation of the diverticula.

The seeds and pips have a capsule that is indigestible for the body, so they go directly to the intestine and then the colon. Due to this indigestibility, they can getting stuck in the diverticula, leading to inflammation of the latter.

We recommend you :

• to avoid consuming whole seeds: linseed, sesame seeds, chia seeds, poppy seeds, hemp seeds, etc…

• to favor very finely ground seeds.

• avoid foods that carry seeds and pips: whole-grain mustard (mustard seeds), breads with seeds, certain granolas with seeds, strawberries, raspberries, pomegranates, tomatoes, zucchini, cucumbers, watermelons, etc.

• to avoid dried fruits with seeds: dried strawberries, dried raspberries, dried figs, etc.

• remove seeds and pips when possible.

The gas causes distension of the intestinal walls, increasing intestinal discomfort and therefore potential pain.

We recommend you :

• to limit carbonated drinks: certain alcohols, sodas, sparkling mineral water, fermented drinks (kombucha, kefir, etc.), etc.

• to degass drinks if consumed.

Strong spices and condiments tend to irritate the colon, which promotes the appearance of pain.

We recommend you :

• to favor sweet spices: vanilla, star anise, turmeric, nutmeg, saffron, cardamom, etc.

• reduce the consumption of condiments and strong spices: paprika, pepper, chilli, ginger, horseradish, etc.

• to limit strong condiments: mustard, vinegary condiments, spicy, smoked, sour or acidic sauces, etc.

Foods with a high glycemic index promote a disorder inflammatory flora. THE pro-inflammatory bacteria feed mainly on carbohydrates to proliferate. In too high a dose, foods with a high glycemic index support the proliferation “bad bacteria” : a risk factor for inflammation of the diverticula.

As a precaution, we recommend you :

• consume a maximum of 50 g of simple sugar per day, which represents:

• 8 teaspoons jam, jelly or honey

• or 10 sugar cubes, or 10 teaspoons of white sugar

• or 4 to 5 glasses of soda or fruit juice

• to favor home-made cooking.

• to reduce the consumption of confectionery (candies, chocolates, fruit paste, etc.).

• not to overcook your food, cooking denatures the fibers and hydrolyzes complex carbohydrates, which increases the glycemic index.

Certain foods may be poorly tolerated by the colon, either by their irritating nature, or by their fermentable power, or by their cholecystokinetic effects, that is to say “which promotes the evacuation of bile”. These foods are usually too fatty or have a strong taste. There is no scientific consensus to exclude them from the diet, but in theory they are not recommended. It's up to you to analyze your diet and find your intolerances.

Here is a list of foods that may not be supported by the digestive system:

• foods with a strong taste: game, smoked meats, blue cheeses, cabbage and bulb vegetables (garlic, onion, etc.).

• fatty foods: cold meats, sauces, fried foods, etc.

• dairy products in case of lactose intolerance.

• fermentable foods, rich in FODMAPS: fresh bread, mushrooms, melons, peaches, asparagus, fructose and corn syrups, etc.

Whole-grain starchy foods contain more fiber than refined starchy foods. For example, for 60 g of white pasta (one serving), there are 1.8 g of fiber. While we find 2.5 g of fiber for semi-wholemeal pasta and up to 3.6g for wholemeal pasta.

Caution : before opting for complete starchy foods, do not hesitate to introduce semi-complete starchy foods first. The increase in fiber intake is done gently so as not to disrupt intestinal transit and promote a diverticular crisis.

We recommend you :

• to eat whole-grain starchy foods at each meal: whole-wheat rice, whole-wheat pasta, whole-wheat bread, whole-wheat semolina, spelt, buckwheat, whole-wheat rusks, etc.

• to favor wholemeal flours: for your culinary preparations, opt for wholemeal flours rather than refined flours, they will provide more fiber. For example: T100 wheat flours (and above), legume flours, cereal flours (spelt, buckwheat, rye, millet, etc.).

Dried vegetables provide a lot of fiber, so they naturally contribute to the proper functioning of the digestive system.

Caution : take note of your personal intolerances, dried vegetables tend to increase intestinal discomfort in certain individuals, this can cause pain. NOTdo not hesitate to introduce them gradually, always accompanied by the meal and to respect the soaking time prior to their consumption. If dried vegetables are still not digestible, it is best to avoid them.

We recommend you to eat two meals based on dried vegetables per week: lentils, flageolet beans, red beans, chickpeas, broad beans, split peas, etc. A portion of dried vegetables (60 g raw) provides 10 g of fiber.

Nuts are rich in fiber.

We recommend you :

• 15 g of nuts per day: almond, peanut, pistachio, brazil nut, macadamia nuts, cashew nuts. In 15 g of nuts, we find 1.5 g of fiber.

• avoid nuts seasoned with spices: paprika, pepper, etc.

Fruits and vegetables are sources of fiber. Considering the recommended consumption per day (600 g), these are our main fiber intakes.

We recommend you :

• minimum 3 servings of vegetables per day.

• 2 fruits per day.

• consume 25 g of dried fruits per day: dried coconut, raisins, dates, etc. 25 g of dried fruits provide 2 g of fiber.

• the plants richest in fiber: peas, salsify, cabbage, artichoke, celeriac, green beans and even carrots. For example, 100 g of peas provide around 5 g of fiber.

These three foods soften the stools, due to their extreme richness in fiber. For 100 g we find 91 g of fiber for konjac powder, 84 g of fiber for psyllium powder and 21 g of fiber for bran. They contribute to the proper functioning of intestinal transit.

As a precaution, they should not be consumed every day so as not to disrupt the intestinal flora and intestinal functioning too much. Start with low dosages, and increase gradually. In the event of abnormal pain, we recommend that you stop the treatment.

We recommend you to incorporate a course of cereal bran, psyllium or konjac when necessary.

• Regular physical activity: a sedentary lifestyle promotes the appearance of diverticula. Practicing physical activity or sport prevents the appearance of diverticula. In addition, the movements accelerate intestinal transit, which fights against constipation. As noted above, slow digestive transit promotes recurrence of inflammation.

• Have good hydration: sufficient hydration is obviously essential to participate in digestive transit, and consequently prevent the risk of diverticulitis. We recommend that you drink at least 1.5 L of still or mineral water per day. Also think about hot drinks, like coffee. Caffeine tends to accelerate intestinal transit. Or herbal teas mauve, of licorice or linden, which are laxatives.