From the Guidelines
For patients with diverticulitis, a clear liquid diet is initially recommended during the acute phase to rest the bowel, as advised by the most recent guidelines 1. This approach is based on the principle of reducing mechanical and chemical stimulation of the inflamed colon during the acute phase.
Key Components of the Diet
- The clear liquid diet should include water, broth, clear juices, gelatin, and tea without milk.
- As symptoms improve, usually within 2-3 days, patients can gradually transition to a low-fiber diet (less than 15 grams of fiber daily).
- Foods like nuts, seeds, popcorn, and raw vegetables were traditionally thought to aggravate the condition, but recent evidence suggests that they do not increase the risk of diverticulitis 1.
Transition to High-Fiber Diet
- After the acute episode resolves, typically within 1-2 weeks, patients should transition to a high-fiber diet (25-35 grams daily) including whole grains, fruits, vegetables, and legumes to prevent recurrence, as suggested by the american gastroenterological association institute guideline 1.
- Adequate hydration with at least 8 cups of fluid daily is essential throughout all phases.
Rationale
The dietary progression works by initially reducing mechanical and chemical stimulation of the inflamed colon during the acute phase, then gradually reintroducing fiber to promote regular bowel movements and prevent constipation, which can increase pressure in the colon and potentially lead to more diverticular complications.
Considerations
- Patient preferences and side effects of fiber, such as abdominal bloating, should be considered when counseling a patient 1.
- A prudent dietary pattern, high in fiber from fruits, vegetables, whole grains, and legumes, and low in red meat and sweets, is associated with decreased risk of incident diverticulitis 1.
From the Research
Dietary Recommendations for Diverticulitis
- A liberalised diet is conditionally recommended for adults with acute, uncomplicated diverticulitis, as opposed to dietary restrictions 2.
- A high dietary fibre diet, aligning with dietary guidelines, is strongly recommended after the acute episode has resolved, with or without dietary fibre supplementation 2.
- Early enteral nutrition with an oral fibre-free liquid diet may be feasible and not harmful in complicated acute colonic diverticulitis, and may reduce hospitalisation time and treatment cost 3.
- A fibre-rich diet (25-40 g/day) plays an important role in the prevention and nonpharmacological treatment of uncomplicated diverticular disease 4.
- A well-balanced diet or fibre supplements intake can achieve successful therapy goals, and the use of probiotics may be effective in dietary management during the remission process 4.
Key Considerations
- The quality of evidence for comparing different dietary approaches is generally low 2.
- Further studies are needed to confirm the safety and efficacy of early enteral nutrition in complicated acute colonic diverticulitis 3.
- A high dietary fibre diet should be introduced after the acute episode has resolved, rather than during the acute phase 2.
- Adequate water intake and exclusion of products that decrease colonic transit time should also be considered in the dietary management of diverticular disease 4.