From the Guidelines
Seeds and nuts do not cause diverticulitis, and a high-fiber diet that includes these foods may actually help prevent diverticular disease. Diverticulitis is an inflammation or infection of small pouches (diverticula) that can form in the digestive tract, particularly in the colon. Traditionally, doctors advised patients with diverticular disease to avoid seeds, nuts, popcorn, and other high-fiber foods based on the theory that these particles could get trapped in the diverticula and cause inflammation. However, current evidence, including a 2021 study published in Gastroenterology 1, shows no connection between consuming these foods and developing diverticulitis flares. In fact, a high-fiber diet that includes nuts and seeds may actually help prevent diverticular disease by promoting regular bowel movements and reducing pressure in the colon.
The American Gastroenterological Association (AGA) suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts, and popcorn 1. This recommendation is based on very low-quality evidence, but it is unlikely to pose a substantial risk to patients. A high-fiber diet or fiber supplementation is suggested in patients with a history of acute diverticulitis, although the certainty and magnitude of benefit are difficult to ascertain based on very low-quality evidence 1.
Some key points to consider include:
- 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.
- Nut, corn, and popcorn consumption is not associated with an increased risk of diverticulitis 1.
- Consuming fruits with small seeds, such as strawberries and blueberries, is not associated with diverticulitis risk 1.
- Physical activity, particularly vigorous activity, decreases the risk of diverticulitis 1.
If you have diverticular disease, you generally don't need to avoid seeds and nuts unless you've personally noticed they trigger symptoms. Most gastroenterologists now recommend a diet rich in fiber, including whole grains, fruits, and vegetables, to help manage and prevent diverticular disease.
From the Research
Seeds and Nuts in Diverticulitis
- The relationship between seeds, nuts, and diverticulitis has been debated, with some suggesting that avoiding these foods can help prevent episodes of diverticulitis 2.
- However, modern data has debunked the myth that eating nuts, corn, popcorn, and seeds can cause diverticulitis 2.
- A survey of colon and rectal surgeons found that half of those surveyed believed avoidance of seeds and nuts was of no value in preventing diverticulitis 3.
- A prospective cohort study of women found that intake of peanuts, nuts, and seeds was not associated with incident diverticulitis 4.
- Healthy diets, such as the Dietary Approaches to Stop Hypertension diet and the Healthy Eating Index, were associated with a reduced risk for incident diverticulitis in women, but consumption of nuts and seeds was not found to be a risk factor 4.
Dietary Recommendations
- A high fiber diet appears to decrease the likelihood of symptomatic diverticulitis 2.
- Recommendations for "diverticulitis diets" mirror those made for overall healthy lifestyle, with a focus on whole grains, fruits, and vegetables 2.
- There is no evidence to support the routine avoidance of seeds and nuts in patients with diverticulitis 2, 3, 4.