From the Guidelines
Yes, a patient with diverticulosis should take dietary fiber, as a high-fiber diet is associated with a decreased risk of incident diverticulitis and may help manage symptoms. According to the most recent and highest quality study, a prudent dietary pattern high in fiber from fruits, vegetables, whole grains, and legumes is recommended 1. Increasing dietary fiber intake can help add bulk to stool, prevent constipation, and reduce pressure in the colon that can worsen diverticulosis.
Key points to consider when recommending dietary fiber for a patient with diverticulosis include:
- Aiming for 25-35 grams of fiber daily, gradually increasing intake to avoid gas and bloating
- Good sources of fiber include fruits, vegetables, whole grains, and legumes
- If dietary changes are difficult, fiber supplements like psyllium (Metamucil), methylcellulose (Citrucel), or wheat dextrin (Benefiber) can be helpful, starting with a small dose and slowly increasing while maintaining adequate fluid intake
- Adequate hydration is essential when increasing fiber intake, with a recommendation of at least 8 glasses of water daily to help the fiber work effectively
It's also important to note that while fiber supplements can be helpful, they are not a replacement for a high-quality diet 1. Additionally, patient preferences and potential side effects of fiber, such as abdominal bloating, should be considered when counseling a patient, as the certainty and magnitude of benefit of fiber in patients with acute uncomplicated diverticulitis are difficult to ascertain based on very low-quality evidence 1.
From the FDA Drug Label
As your body adjusts to increased fiber intake, you may experience changes in bowel habits or minor bloating. The patient with diverticulosis can take dietary fiber, such as psyllium, but should start with 1 dose per day and gradually increase to 3 doses per day as necessary to allow their body to adjust to the increased fiber intake 2.
- Key considerations:
- Increased fiber intake may cause changes in bowel habits or minor bloating
- Gradual increase in fiber intake is recommended
- Patients should follow the directions for use and consult a doctor if necessary
From the Research
Dietary Fiber Intake in Diverticulosis
- Patients with asymptomatic diverticulosis can be recommended to consume a fiber-rich diet to reduce intraluminal pressure and slow down the worsening of the disease 3.
- Fiber supplementation is also indicated in symptomatic diverticulosis to get symptom relief and prevent acute diverticulitis 3.
- A high-fiber diet is commonly suggested for patients with symptomatic uncomplicated diverticular disease (SUDD) to reduce symptoms and prevent acute diverticulitis 4, 5.
Benefits of High-Fiber Diet
- A high-fiber diet may help reduce symptoms in SUDD patients and prevent acute diverticulitis 4, 5.
- Some studies suggest that a high-fiber diet can improve symptoms and/or prevent complications of diverticular disease of the sigmoid colon 5.
- A high-fiber diet is recommended in several guidelines for the treatment of diverticular disease, despite lacking high-quality evidence 5.
Recommendations for Fiber Intake
- Patients with diverticulosis can gradually increase dietary fiber to 20 to 30 grams daily or take dietary fiber in the form of bulk stimulants like psyllium once the acute episode or highly symptomatic period resolves or chronic disease is managed 6.
- A combination of soluble fiber, like glucomannan, and poorly absorbed antibiotics, like rifaximin, may also be beneficial in symptomatic diverticulosis 3.