What are the lifestyle management strategies for diverticulitis?

Lifestyle Management for Diverticulitis

To reduce the risk of recurrent diverticulitis, patients should consume a high-quality diet rich in fiber from fruits, vegetables, whole grains, and legumes while maintaining a normal body mass index, engaging in regular physical activity (particularly vigorous exercise), avoiding smoking, and limiting NSAID use. 1

Dietary Modifications

High-Quality Diet Pattern

• Adopt a prudent dietary pattern that is high in fiber from fruits, vegetables, whole grains, and legumes, while being low in red meat and sweets. 1
• A vegetarian diet is also associated with decreased risk of incident diverticulitis. 1
• Fiber from fruits appears to have a stronger protective association against diverticular disease compared to fiber from other sources. 2

Fiber Supplementation

• Fiber supplements can be beneficial but are not a replacement for a high-quality diet—they should complement, not substitute, whole food sources of fiber. 1, 2
• For patients experiencing bloating with increased fiber, start with lower amounts and gradually increase to improve tolerance. 2

Foods That Do NOT Need to Be Avoided

• Contrary to traditional advice, consumption of nuts, corn, popcorn, and small-seeded fruits (strawberries, blueberries) is NOT associated with increased risk of diverticulitis and should not be restricted. 1, 2
• This is a critical point to communicate to patients, as unnecessarily restrictive diets may reduce overall fiber intake and quality of life. 2

Physical Activity and Weight Management

• Regular physical activity, particularly vigorous exercise, decreases the risk of diverticulitis. 1
• Achieving or maintaining a normal body mass index is essential, as obesity (particularly central obesity) and weight gain are established risk factors. 1, 2

Smoking Cessation

• Smoking is a risk factor for diverticulitis and should be avoided. 1, 2

Medication Considerations

NSAIDs and Other Medications to Avoid

• Regular use of NSAIDs increases the risk of diverticulitis, with non-aspirin NSAIDs carrying greater risk than aspirin. 1
• Patients should avoid NSAIDs when possible, though aspirin prescribed for secondary prevention of cardiovascular disease can be continued. 1
• Opiate analgesics are associated with diverticulitis and perforation and should be avoided when possible. 1, 2
• Corticosteroid use is a risk factor for diverticulitis and may contribute to complications including perforation and death. 1

Medications NOT Recommended for Prevention

• Patients with a history of diverticulitis should NOT be treated with 5-aminosalicylic acid (mesalamine), probiotics, or rifaximin to prevent recurrent diverticulitis, as there is no proven benefit. 1, 3

Alcohol Consumption

• Alcoholism (but not moderate alcohol consumption by itself) increases the risk of diverticulitis. 1

Understanding Genetic Risk

• Patients should understand that approximately 40-50% of the risk for diverticulitis is attributable to genetic factors, which cannot be modified through lifestyle changes. 1
• The risk is three times higher for siblings of cases versus the general population. 1
• This information helps set realistic expectations about the effectiveness of lifestyle modifications. 1

Common Pitfalls to Avoid

• Do not recommend unnecessarily restrictive diets (avoiding nuts, seeds, popcorn), as this is not supported by evidence and may reduce overall fiber intake. 1, 2
• Do not rely solely on fiber supplements without improving overall diet quality—supplements should complement, not replace, a high-quality diet. 1, 4
• Do not fail to warn patients about potential temporary bloating when starting a high-fiber regimen, as this may affect adherence. 2
• Do not assume that lifestyle modifications alone will prevent all recurrences, given the substantial genetic component of disease risk. 1