Current diet recommendations for managing diverticular disease

[Guest guest]

Hi, all-

I'm an RD and have a friend recently diagnosed with diverticulitis.

She is only 42 y.o. but has a complicated medical hx including RA, for which

she takes numerous medications.

She has been on ALL of the IV immunologics for her RA at one time or another

and is currently receiving Rituxan infusions to try to reduce the pain and

swelling associated with her disease.

Anyway, the diverticulitis is new. She's on 2 abx for this acute phase-

onset approx. 2 weeks ago.

She's seeing a Gastro w/ a good reputation and this week will F/U with him

re: results of her colonoscopy done last week in which they found and

removed " a pre-cancerous tumor " (her words).

I've talked with her about dietary tx for the acute phase of diverticulitis:

bowel rest, very low fiber, etc. in concurrence her MD's instructions.

The problem is, we are receiving conflicting results re: long-term

maintenance of diverticulitis.

We understand that she is to gradually increase her intake of fiber, esp.

soluble fiber, once the acute phase has passed, BUT I'd always been told to

instruct patients w/ diverticulosis to eat diets high in soluble fiber, but

avoid nuts and seeds in the event that they might " pocket " themselves in a

diverticulum, ferment and lead to another acute illness and infection.

Now we've both heard from various sources that the avoidance of nuts and

seeds has fallen out of favor with Gastro's.

I even went to the web site for the American College of Gastroenterology and

found the following patient information in regard to long-term diet mgmt. of

this disease:

http://www.acg.gi.org/patients/gihealth/diverticular.asp

" Can diverticulitis be prevented?

Persons with diverticulosis are sometimes instructed to avoid foods that

contain undigestible particles such as popcorn, nuts and fruits with small

seeds. The theory of such a diet is that these particles might get " caught "

in a diverticulum and precipitate diverticulitis. Proof of effectiveness for

such a diet is lacking and only anecdotal stories support this restricted

diet for patients.

I guess considering my friend's poor immunologic status, I've advised her to

err toward the cautious side and avoid nuts and seeds ..... She has no

immune system and is so vulnerable to infections anyway, it just seems wise

to avoid possible foods that might set her up for an infection.

On the other hand, she has " never met a fruit or vegetable that she really

likes " - these dietary changes won't come easily. She DOES, however, love

nuts and popcorn.

I tried looking @ ADA's web site for a position paper re: this disease, but

all I found was a position paper on the importance of fiber in the diet to

PREVENT diseases such as diverticulosis/diverticulitis from ever occurring.

Not helpful to me at this point as the disease HAS already occurred.

Years ago when I worked for a hospital, I remember giving countless " No nuts

or seeds " diet instructions to patients being discharged after a

hospitalization for IV abx to treat acute diverticulitis ....... It was

usually an afterthought on the part of the MD and I gave several

instructions to " patients' backs " as they packed their suitcases to leave

the hospital or even ON THE ELEVATOR as they were heading for the door!! Not

an ideal learning environment.

Any advice or websites including meal suggestions or shopping lists that I

could give to my friend would be greatly appreciated.

Also, if you know of an active e-group or online support group that would be

helpful, that information would be appreciated as well.

Sincere thanks,

- RD/LD

Austin, TX

angalwat@...