After a diverticulitis episode, dietary diligence will help you avoid recurrence. Your gastroenterologist wants you to remain healthy. With this earnest intent, here’s expert advice for preventing future flare-ups.

Pocket Snapshot

First, let’s briefly review diverticular disease. With aging, it’s common to develop weak areas in the muscles of your large intestine or “colon.” Constipation and straining to pass stools exert pressure against these vulnerable spots. As a result, sac-like pockets form, bulging outward through the colon wall, known as “diverticula.”

Having such pockets constitutes diverticulosis. When feces and bacteria get trapped within diverticula, they can become infected or inflamed. This pathology is called “diverticulitis.” Diverticular disease refers to having either stable or inflamed diverticula.

Broom and Sponge

With regular, comfortable bowel movements, further bouts of diverticulitis are less likely. To maintain regularity, after the colon has healed, gastroenterologists advocate a high-fiber diet.

Fiber helps to form and soften stools, so you can pass them without straining. It also lowers intestinal pressure. Two types of fiber are involved, insoluble and soluble. Both kinds are plant residues we don’t fully digest since we lack the required enzymes.

Insoluble fiber or “roughage” is mostly impervious to water. By staying intact, it builds stool volume. Then, as roughage contacts your intestinal muscles, it nudges them to contract, pushing stool toward your rectum. Toxins are ushered along, as well.

In this way, roughage is like an intestinal broom, speeding evacuation. Examples of insoluble fiber are whole grains and most vegetables.

Soluble fiber consists of plant parts that absorb water, forming a spongy mass and a gel-like substance that lubricates your colon. Plant flesh provides soluble fiber.

This dynamic fiber duo, working like a broom and sponge, keeps food from clogging your colon.

Friendly Flora

Also vital in your diet are friendly bacteria, known as “probiotics” and “good flora.” These microorganisms are naturally present in your large intestine. A healthy colon averages between 100 billion and 1,000 billion probiotics per milliliter, roughly 1/5 of a teaspoon!

Likewise residing in the digestive tract are harmful bacteria, fungi, and yeasts. However, when good flora predominate by 85 percent, they shield you from infection.

Probiotics crowd out pathogens by competing for attachment sites in your colon. They also sustain immune cells that combat illness. In fact, up to 80 percent of your defensive power lies within your digestive tract, as immunologic proteins, cells, tissues, and organs.

Additionally, friendly bacteria release natural peroxides that kill germs. By fortifying your colon lining, good flora block pathogens from entering your bloodstream.

Probiotics also help digest your food through “fermentation,” dividing plant particles into smaller molecules. Good flora synthesize Vitamins B and K and aid nutrient assimilation.

Do you know what feeds these friendly beings? If your answer is “fiber,” you’re right! What probiotics especially like is the soluble, spongy kind.

Optimal Foods

photo of raw sweet potatoes on wooden background closeupTo easily pass stools, eat both types of fiber. Delicious forms of the soluble kind are cherries, oranges, figs, apples, papayas, beans, lentils, oats, and sweet potatoes.

Whole grains are rich in roughage. Vary your sources, such as wholegrain bread, bran cereal, quinoa, and wholegrain pasta.

Most vegetables provide insoluble fiber. Generous donors are asparagus, carrots, beets, kale, parsnips, potatoes, winter squash, and broccoli rabe. Here’s a nifty shopping tip – the darker the vegetable, the more fiber it has!

With legumes, you get both kinds of fiber, plus substantial protein. Try to eat three half-cup servings per week. To improve digestibility, soak beans overnight before cooking. Or, rinse canned beans in a colander for one minute. Legumes with the highest fiber counts are kidney, navy, black, pinto, and lima beans, along with lentils and black-eyed peas.

Nuts, Seeds, Corn?

Years ago, when physicians first treated diverticulitis, they advised against eating nuts, corn, popcorn, and foods with tiny, edible seeds, such as strawberries, raspberries, tomatoes, cucumbers, and sesame seeds. At the time, doctors feared that the small food particles might lodge in diverticula, triggering infection and inflammation.

However, research hasn’t supported this cautionary measure. Your gastroenterologist will give you specific dietary advice for your case.

Fiber Goals

Are you wondering how much fiber to eat? The Institute of Medicine suggests the following daily aims:

  • women age 51+ – 21 grams
  • women ages 18 to 50 – 25 grams
  • men age 51+ – 30 grams
  • men to age 50 – 38 grams

There are no recommendations for soluble and insoluble fiber. However, most fruits, vegetables, and whole grains have a mixture of both. So, just eat a wide variety of whole foods. However, to reach your daily goal, try to get familiar with the average fiber counts for common foods. Here’s a chart to help you.

If you’re below the ideal quota, go slow with increasing fiber. Your digestive system needs time to adapt. Too much at once will give you gas, bloating, cramps, and constipation, the very problem we want to avoid.

So, incrementally raise fiber by 5 grams each day, until your goal is reached. Include fibrous foods in each meal and snacks. If your doctor recommends a fiber supplement, include the dose in your daily total.

Vital Water

For broom and spongy fibers to do their digestive work, they need water. To calculate the amount to drink each day, divide your weight in half, and convert the pounds to fluid ounces.

For instance, over the course of each day, a person weighing 160 pounds should gradually sip 80 ounces or 10 cups of water. Note that, on average, kidneys can filter no more than four cups of water per hour.

What to Avoid

Try to minimize your intake of processed sugar. Skip the white forms of rice, pasta, and bread, which are constipating. Likewise, nix soda and fatty meats.

Greasy and fast foods are inflammatory. Fiber-fortified foods often have too much isolated fiber, along with sugar and artificial ingredients. Your best fiber options are whole foods, packed with antioxidants, vitamins, enzymes, and minerals.

Restoring Your Flora

photo of small bowl of plain yogurtAfter antibiotic treatment of diverticulitis, your probiotics need replenishing. When it comes to bacteria, antibiotics kill both the harmful and friendly ones.

Cultured foods will reinstate your good flora. If lactose isn’t a problem, have a daily serving of yogurt or kefir. On product labels, look for the words “live active cultures” or “probiotics.”

Dairy-free options are cultured almond yogurt, kombucha tea, soybean cakes called “tempeh,” raw sauerkraut, and kimchi, a Korean fermented cabbage dish. Again, vary your choices daily since cultured products contain different bacterial strains, each with specific health merits.

Also, take a probiotic supplement. This ensures that you replenish the strains proven to aid intestinal health and immune strength.

At a minimum, your supplement should have these five strains – Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus casei, Saccharomyces boulardii, and Bifidobacterium bifidum. Even better is a product that includes Bifidobacterium breve and longum, for a defensive boost.

For maximal effectiveness, each dose should supply at least 15 billion colony-forming units or “CFUs.” Probiotics need an advanced delivery system, protecting them from stomach acid, so they arrive at your colon alive. Also, make sure the bacteria are guaranteed viable through the end of shelf life, not just at the time of manufacture. Follow the storage instructions for the product.

Take your supplement daily on an empty stomach. A digestive delay will kill the bacteria before getting to your intestine.

FODMAPs

After recovering from diverticulitis, stay in touch with your gastroenterologist. If judiciously adding fiber is causing digestive upset, you may be sensitive to certain carbs and sugar alcohols called “FODMAPs.” Examples are fructose, lactose, fructans, sorbitol, maltitol, and fructooligosaccharides.

Symptoms of FODMAP sensitivity include gas, bloating, abdominal pain, nausea, diarrhea, lethargy, and even difficulty concentrating. To pinpoint the source of these problems, your doctor may recommend a low-FODMAP diet.

What you’ll do is eliminate suspect foods for two months, while consuming easily digested options from an extensive list. Then, you’ll try one serving of a questionable food you typically enjoy eating. If it triggers no symptoms within four days, try another from the FODMAP list. If discomfort arises after sampling a given food, wait two weeks before testing another suspect.

Fear Not

Experiencing diverticulitis can make you anxious about future episodes. However, don’t worry! By maintaining a high-fiber diet and your probiotic population, you substantially lower the risk.

Plus, our staff is committed to your ongoing digestive health. If any concerns arise, make an appointment with Digestive Care Physicians. If you’d like, our dietician can offer nutritional guidance and meal ideas.

For your convenience, we have four North Atlanta offices, in Lawrenceville, Cumming, Johns Creek, and Alpharetta. We also care for residents from Duluth, Suwanee, Roswell, Milton, Marietta, Dunwoody, Sandy Springs, and Canton.

We’re so relieved that you’ve healed from diverticulitis. Let us help you stay that way!

Note – This blog is meant to help those with diverticulosis but cannot replace professional medical care. For any gastrointestinal problems affecting you and those you love, contact Digestive Care Physicians.

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