What are effective methods to prevent diverticulitis (inflammation of diverticula) flares?

From the Guidelines

To prevent diverticulitis flares, patients should consume a high-quality diet, achieve or maintain a normal body mass index, routinely be physically active, and not smoke. This approach is based on the most recent and highest quality study available, which emphasizes the importance of lifestyle modifications in reducing the risk of recurrence 1.

Key Recommendations

• Consume a high-quality diet rich in fiber from fruits, vegetables, whole grains, and legumes, and low in red meat and sweets, as it is associated with decreased risk of incident diverticulitis 1
• Engage in regular physical activity, particularly vigorous activity, to decrease the risk of diverticulitis, as suggested by observational studies 1
• Maintain a healthy weight, as obesity is a risk factor for diverticulitis, and avoid smoking, which increases inflammation throughout the body 1
• Avoid or limit foods that may trigger symptoms, including processed foods and spicy items, and manage stress through techniques like meditation or deep breathing exercises, as stress can worsen digestive issues

Additional Considerations

• While fiber supplements may be beneficial, they should not replace a high-quality diet, and patients should be aware that approximately 50% of the risk for diverticulitis is attributable to genetic factors 1
• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of diverticulitis, and patients should avoid them when possible, opting for alternative pain management strategies instead 1

From the Research

Prevention Measures

To prevent diverticulitis flares, several measures can be taken:

• Consuming a high-quality diet rich in fruits, vegetables, whole grains, and legumes 2
• Limiting red meat and sweets intake 2
• Achieving or maintaining a body mass index of 18 to 25 kg per m2 2
• Being physically active 2
• Avoiding tobacco and long-term nonsteroidal anti-inflammatory drugs 2
• Eating a fiber-rich diet (25-40 g/day) 3
• Drinking an appropriate amount of water 3
• Excluding products that decrease colonic transit time from the diet 3

Dietary Fiber Intake

Dietary fiber intake plays a crucial role in preventing diverticulitis:

• High dietary fiber intake is associated with a lower risk of diverticulitis 4, 5
• Fiber from fruits and cereals, but not vegetables, is associated with a decreased risk of diverticulitis 5
• Intake of total whole fruit, especially apples/pears and prunes, is associated with reduced risk of diverticulitis 5

Medication and Supplements

Certain medications and supplements may also be beneficial:

• Rifaximin, a poorly absorbed antibiotic, has been shown to be effective in soothing symptoms and preventing diverticulitis when used in combination with fiber supplementation 6
• Probiotics may be effective in dietary management during the remission process 3