From the Guidelines
Patients with diverticulitis can use psyllium fiber supplements during remission periods, but should avoid them during acute flare-ups, as the most recent and highest quality study suggests a fiber-rich diet or fiber supplementation may be beneficial in preventing future episodes 1. When considering the use of psyllium fiber supplements, it's essential to differentiate between acute and remission phases of diverticulitis. During an active diverticulitis episode, the inflamed pouches in the colon need rest, and fiber supplements may irritate the condition and potentially worsen symptoms. Once the acute inflammation has resolved, typically after antibiotic treatment and following a doctor's guidance, gradually introducing psyllium fiber supplements can be beneficial. The American Gastroenterological Association suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis, although the quality of evidence is very low 1. A prudent approach would be to start with a low dose of 3-5 grams daily and slowly increase to 20-30 grams of total daily fiber (from both supplements and diet) while drinking plenty of water (at least 8 glasses daily). Psyllium works by adding bulk to stool, promoting regular bowel movements, and reducing pressure in the colon that can lead to diverticular formation, which may help maintain colon health and reduce the risk of recurrent diverticulitis. It's crucial to consult a healthcare provider before starting any supplement regimen, especially for patients with a history of diverticular disease. Additionally, a high-quality diet with plenty of fruits, vegetables, whole grains, and legumes, and low in red meat and sweets, is recommended, as it may decrease the risk of incident diverticulitis 1. Regular physical activity, particularly vigorous exercise, and avoiding obesity, smoking, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) can also help reduce the risk of diverticulitis. Genetic factors play a significant role in determining the risk of diverticulitis, with approximately 50% of the risk attributable to genetic factors 1. However, the use of fiber supplements, such as psyllium, should be individualized and guided by a healthcare provider, taking into account the patient's specific needs and medical history.
From the Research
Psyllium (Polycarbophil) Fiber Supplements in Diverticulitis
- Patients with diverticulitis can use psyllium (Polycarbophil) fiber supplements, as suggested by studies 2, 3.
- A low-fiber diet is often recommended during symptomatic periods, but once the acute episode or highly symptomatic period resolves, patients can gradually increase dietary fiber to 20 to 30 grams daily or take dietary fiber in the form of bulk stimulants like psyllium 2.
- Fiber supplementation may prevent progression to symptomatic disease or improve symptoms in patients without inflammation 3.
- The use of high dietary fiber diet, with or without dietary fiber supplementation, is conditionally recommended after the acute episode has resolved 4.
- Some studies suggest that fibers, both dietary and supplemental, could be beneficial in symptomatic uncomplicated diverticular disease (SUDD), although the quality of evidence is very low 5.
Key Findings
- A systematic review found "very low" quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms, and reoccurrence 4.
- A study found that patients with diverticulitis who received rifaximin plus fibre supplementation had a lower incidence of recurrences compared to those receiving fibres alone 6.
- The benefits of dietary or supplemental fiber in SUDD patients still need to be established due to substantial methodological limitations and heterogeneity of therapeutic regimens employed 5.