What lifestyle changes can help manage diverticulitis?

Lifestyle Changes for Managing Diverticulitis

To effectively manage diverticulitis, patients should adopt a high-quality diet rich in fiber from fruits, vegetables, whole grains, and legumes, maintain a normal body mass index, engage in regular physical activity, and avoid smoking. 1

Dietary Recommendations

• Consume a high-fiber diet or use fiber supplementation to reduce the risk of recurrent diverticulitis 1
• Focus on a prudent dietary pattern that is high in fiber from fruits, vegetables, whole grains, and legumes, while limiting red meat and sweets 1
• Advance diet gradually during acute episodes - start with clear liquids during the acute phase and advance as symptoms improve 1
• Contrary to traditional beliefs, there is no need to avoid nuts, popcorn, or fruits with small seeds (like strawberries and blueberries) as these are not associated with increased risk of diverticulitis 1
• A fiber supplement alone is not a replacement for a high-quality overall diet 1

Physical Activity and Weight Management

• Engage in regular physical activity, particularly vigorous exercise, as this decreases the risk of diverticulitis 1
• Aim for approximately 2 hours of vigorous physical activity weekly 2
• Achieve or maintain a normal body mass index (BMI) between 18.5-24.9 kg/m² 1, 2
• Avoid central obesity and weight gain, which are risk factors for diverticulitis 1

Medication Considerations

• Avoid regular use of non-aspirin NSAIDs when possible, as these increase the risk of diverticulitis 1
• Aspirin use does not need to be avoided in patients with a history of diverticulitis 1
• Avoid opioid analgesics and corticosteroids when possible, as these are associated with diverticulitis and perforation 1
• Do not use 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrent diverticulitis, as evidence does not support their effectiveness 1

Management During Acute Episodes

• Follow a clear liquid diet during the acute phase of uncomplicated diverticulitis for patient comfort 1
• Advance diet as symptoms improve, typically within 3-5 days 1
• If unable to advance diet after 3-5 days, follow up immediately with healthcare provider 1
• For ongoing abdominal pain after an episode, consider treatment with a low to modest dose of a tricyclic antidepressant if visceral hypersensitivity is suspected 1

Understanding Risk Factors

• Recognize that approximately 50% of the risk for diverticulitis is attributable to genetic factors 1
• Alcoholism (not moderate alcohol consumption) increases risk of diverticulitis 1
• Complications from diverticulitis most often occur with the first presentation rather than with recurrences 1
• Ongoing gastrointestinal symptoms are common after an episode of acute diverticulitis, affecting approximately 45% of patients at 1-year follow-up 1

Common Pitfalls to Avoid

• Do not restrict nuts, corn, popcorn, or small-seeded fruits, as these restrictions are based on outdated beliefs 1
• Avoid the misconception that a fiber supplement alone is sufficient - focus on overall dietary quality 1
• Do not rely on medications like 5-aminosalicylic acid, probiotics, or rifaximin to prevent recurrence, as evidence does not support their use 1
• Be aware that ongoing symptoms after diverticulitis may be due to visceral hypersensitivity rather than active inflammation 1

By implementing these lifestyle changes, patients can significantly reduce their risk of recurrent diverticulitis. The evidence suggests that adherence to a low-risk lifestyle combining dietary changes, physical activity, weight management, and smoking cessation could prevent up to 50% of incident diverticulitis cases 2.