Diverticulitis: Diet without residue

A diverticulum is a pocket of colonic lining that passes through the muscular layer of the colon. Quiescent for a long time, diverticulosis manifests itself by acute attacks of diverticulitis (approximately 5% of patients with diverticula will become symptomatic). Diverticulitis is a inflammation of one or more diverticula. It was thought that inflammation of a diverticulum reflected a bacterial infection of the diverticulum. However, emerging data suggests that diverticulitis is more inflammatory than infectious.

Diverticulitis causes localized pain in the left iliac fossa (lower left of the abdomen). Biologically, we observe a sharp increase in the plasma level of C-reactive protein (CRP): a marker of inflammation.

First-line treatment for diverticula is symptomatic: anti-inflammatory and residue-free diet. A food residue (or residual nutrient) is a nutrient that may not be absorbed by the intestine. The residue-free diet is essential for relieving inflammation and pain.

The role of the residue-free diet is to calm pain by resting the intestines. To do this, we remove all substances which increase intestinal work or which are aggressive for the digestive mucous membranes, such as:

• Plant fibers: plant fibers are carbohydrate polymers. We don't have the enzymatic material needed to digest and absorb fiber, so it passes through our digestive tract. Plant fibers increase fecal mass, fecal flow and are in contact with the walls of the colon (as they are not absorbed). In short, fiber can irritate the mucous membranes and/or promote digestive discomfort due to excessive fermentation.

• Resistant starches: it is a form of starch (carbohydrate) which behaves like a fermentable plant fiber (metabolized by the intestinal microbiota). Due to its particular conformation, we are unable to degrade it: it resists digestion. Thus, it reaches the colon intact, it is then a residual nutrient.

• Fibrous proteins: fibrous proteins are a subcategory of proteins. They are long, filament-shaped proteins. Given their large sizes, they are poorly digested by proteases.

• Lactose : lactose is a simple sugar in dairy products. To digest lactose, we have an enzyme called lactase. As we grow up, lactase production becomes increasingly rare. A lactase deficiency leads to lactose intolerance. Poorly digested lactose becomes a residue in the colon, causing fermentation and transit disturbances.

• Digestive irritants : some compounds are poorly digestible. They tend to irritate the digestive mucous membranes, which increases inflammation (and pain). Alcohol, capsaicin from strong spices, or even cooked fats irritate the digestive walls.

• Lipids (in excess!): fatty acids are cholecystokinetic (they promote contraction of the gallbladder), stimulate intestinal peristalsis and soften the stools. The whole thing accelerates digestive transit.

Attention, the residue-free diet is a short-term diet: maximum 10 days. It is a medical diet, prescribed by a health professional. It is one of the most restrictive diets, its consequences for health should therefore not be minimized: weight loss, nutritional deficiencies, fatigue, digestive disorders, increase in diverticulosis, etc.

As soon as the pain improves, it is essential to gradually reintroduce prohibited foods (evolution from the residue-free diet to the broad residue-free diet). In chronological order, please reintroduce all two to three days : dairy products (unless intolerance), fruits cooked without peel, soups, vegetables cooked without peel, very ripe raw fruits without peel, raw fruits, raw vegetables, fatty foods (cold meats, cheeses , fried foods), cooked fats, semi-complete cereals, dried fruits, nuts, whole cereals, dried vegetables.

When the evolution is favorable and all foods have been reintroduced, please prevent the recurrence of diverticulitis through diet: what foods to avoid or favor in case of diverticula?

If the reintroduction of food proves difficult or the pain persists, it is best to consult your doctor.

Fruits and vegetables are a source of fiber: there are 2 g of fiber in 100 g of raw fruit, and 3 g of fiber in 100 g of raw vegetables.

We recommend you :

• not to consume raw fruit, cooked fruit (except compotes listed below), raw and cooked vegetables.

• not to consume fruit juice with pulp: 1 glass of fruit juice with pulp contains 2 g of fiber.

• avoid consuming jam: 20 g of jam (one serving) contains 0.2 g of fiber.

• not to consume dried fruit: 25 g of dried fruit (one serving) provides 2.5 g of fiber.

Whole, semi-complete cereals and legumes are extremely rich in fiber. For 60 g of whole starchy foods, 4 g are made up of fiber, compared to 8 g of fiber for dried vegetables. In addition, these fibers are insoluble in nature (the most irritating to the digestive tract).

We recommend you :

• not to consume whole grains: oatmeal, quinoa, semi-whole or whole semolina, semi-whole or whole pasta, semi-whole or whole rice, etc.

• not to eat dried vegetables: lentils, chickpeas, flageolet beans, red beans, mogettes, etc.

• not to consume breakfast cereals rich in fiber.

Meats, called fatty meats, are particularly rich in collagen and elastin. Collagen and elastin are two fibrous proteins that are difficult to break down by digestive enzymes.

Without forgetting that when eaten cooked, fatty meats contribute to inflammation of the digestive mucosa through their cooked lipids.

We recommend you :

• not to consume cold meats: sausages, rillettes, pâtés, sausages, dumplings, etc.

• not to eat pieces of meat from 2th and 3th categories: collar, chest, shank, shoulder.

• to favor white meats or lean parts.

Cooked fat irritates the digestive tract, which encourages inflammation of the digestive mucous membranes.

We recommend you :

• not to eat fried foods: fries, chips, breaded chicken, breaded fish, tempura, chichis, donuts, fried onions, breaded cheese, etc.

• not to eat sauces or dishes in sauce.

• not to cook fats: butter, crème fraîche, vegetable oil or animal fats;

• to consume raw vegetable oils.

• to incorporate the fats after cooking.

These foods are rich in plant fiber. Indeed, there is an average of 2 g of fiber in 15 g of seeds or 1.5 g of fiber in 15 g of nuts.

We recommend you :

• not to consume nuts and seeds.

• not to consume products containing nuts or seeds: cereal bread, mueslis, etc.

Certain condiments or spices have significant capsaicin contents. This alkaloid irritates the epithelium of the digestive tract, contributing to inflammation.

We recommend you :

• not to consume strong spices, such as peppers and chili peppers.

• not to consume strong condiments, such as like mustard or hot sauce.

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

Alcohol encourages inflammation of the diverticula.

We recommend you :

• not to consume alcohol.

• not to consume culinary preparations containing alcohol: alcohol-based chocolate (liqueur chocolate), coq au vin, baba au rhum, wine-poached pear, flambéed bananas, original tiramisu (liqueur-based), sauce béarnaise, crepes (suzettes, with beer or rum), black forest, Savoyard fondue, certain fruit cakes, etc.

Generally speaking, it is best to exclude carbonated drinks during diverticula. The gas from drinks stretches the intestinal walls, which increases the pain.

We recommend you not to consume carbonated drinks.

Dairy products are naturally composed of lactose. In some people, lactose is poorly or not digested: this is called lactose intolerance. In this case, lactose becomes a food residue.

If you do not tolerate lactose, we recommend:

• to eliminate cow's, sheep's, goat's and mare's milk.

• to eliminate dairy products: yogurts, cottage cheese, skyr, etc.

• to consume lactose-free dairy products.

• consume a maximum of 20 g of hard cheese per day (they are lactose-free): gouda, parmesan, edam, emmental, etc.

If you tolerate lactose, we recommend:

• consume a maximum of 20 g of lactose per day. 20 g of lactose represents ½ L of cow's or sheep's milk, 30 cl of mare's milk, 60 cl of goat's milk, 6 yogurts, 200 g of condensed milk, 50 g of powdered milk, etc.

• to avoid “excesses” on foods containing lactose: milk chocolate, white chocolate, ice cream, cakes, puddings, etc.

Refined grains provide less fiber than whole grains. There are approximately 1.5 g of fiber in 60 g of white cereals. As a result, they do not irritate the digestive mucous membranes and do little to stimulate digestive transit.

Attention, It is best not to consume starchy foods the day after they are cooked. Cooling starchy foods increases their starch content resistant (a poorly digestible carbohydrate similar to a prebiotic fiber).

We recommend you :

• to eat white cereals at each meal: white bread, white pasta, white rice, semolina, white rusks, potatoes (skinless and boiled), etc.

• to choose T45 wheat flour for your culinary preparations.

• to consume your starchy foods after cooking, and not reheated or cooled.

There Vwhite meat, Pgosling and the OEggs (OPV) provide little/no collagen and elastin. They are therefore rather well digested and absorbed by the body.

White meats (also called “lean”) are: chicken, turkey, rabbit and veal.

Regarding fish, opt for oily fish thanks to their omega-3 composition. Omega-3s are anti-inflammatory, they will help reduce inflammation in the diverticula.

We recommend you :

• to consume 1 to 2 servings per day of OPV, which represents 100 to 200 g per day.

• to eat at least one fatty fish per week.

• to favor gentle cooking, such as steaming, baking, stewing, boiling, etc.

These foods are the only plants allowed in the residue-free diet. In fact, they provide so little fiber that they remain bearable for sensitive diverticula. Additionally, fiber is soluble in nature. This means that they are less aggressive for the digestive mucous membranes. There are 1 g of fiber for applesauce, 1.5 g of fiber for quince compote, around 0.1 g of fiber for fruit or vegetable juices.

Their presence in the residue-free diet is almost essential, since they make it possible to limit the deficiencies linked to the ban on fruits and vegetables.

We recommend you :

• to consume one or two apple and/or quince compote(s) per day.

• consume one to three glass(s) of fruit and/or vegetable juice per day.

• to prefer fruit and vegetable juices with extractor: they are completely free of fiber.

Uncooked, fats are allowed in the diet without residue. They help to reduce nutritional deficiencies. Be sure to favor fats known for their richness in omega-3. Omega-3 helps limit inflammation of the diverticula.

We recommend you :

• consume at least 20 g of vegetable oils rich in omega-3 per day: linseed oil, camelina oil, soya oil, Colza oil, nut oil.

• consume a maximum of 20 g of raw butter per day or 60 g of uncooked crème fraîche per day.

Lactose-free dairy products allow you to enjoy the benefits of dairy products without the inconveniences that accompany lactose intolerance. These dairy products are added to lactase, the enzyme that breaks down lactose.

Cheeses are naturally lactose-free. In fact, fermentation, draining and maturing eliminate lactose from their composition.

We recommend you :

• to consume lactose-free dairy products and milk.

• consume a maximum of 20 g of hard cheese per day: gouda, edam, emmental, parmesan.

• avoid soft cheeses. Rapid draining of these cheeses does not remove all of the lactose.

Low in fiber, vegetable drinks are authorized in the diet without residue.

We recommend you to consume plant-based drinks as a replacement or in addition to dairy products: almond milk, soy, rice, coconut, hazelnut, millet, cashew, etc.

• Be accompanied : Establishing a residue-free diet is not easy. Its demands and complexity can make meal planning difficult and distressing. Do not hesitate to consult a dietitian nutritionist or nutritionist doctor to help you with its implementation.

• Avoid overly large meals: Meals that are too large stimulate the gastrocolic reflex. This reflex causes strong contractions of the colon when new food arrives (the objective is to make room in the colon). Therefore, it is preferable to split your meals into several small meals.

• Use Tropical Basil essential oil : its analgesic, anti-inflammatory and antispasmodic properties reduce colic pain. Use the essential oil cutaneously: one drop of Tropical Basil in four drops of oily macerate of Arnica or oily macerate of St. John's Wort, 3 to 4 times a day on the painful area, until the symptoms improve.

• Take the time to chew well and eat slowly.

• Hydrate your body: it is essential to drink in sufficient quantity to ensure the vacuity of digestive transit. We recommend 1.5 to 2 L of water per day.