From the Guidelines
Fiber supplementation is generally safe and beneficial for patients with a history of diverticulitis, as suggested by the American Gastroenterological Association institute guideline 1. When considering fiber supplementation for patients with a history of diverticulitis, it's essential to weigh the potential benefits against the risks. The current evidence, although of very low quality, suggests that a high-fiber diet or fiber supplementation is unlikely to pose a substantial risk to patients 1. Some key points to consider when recommending fiber supplementation include:
- Starting with a low dose (3-5 grams daily) and gradually increasing over 1-2 weeks to avoid gas and bloating
- Recommending products like psyllium (Metamucil), methylcellulose (Citrucel), or wheat dextrin (Benefiber) if dietary sources are insufficient
- Ensuring adequate fluid intake (at least 8 glasses of water daily) to prevent constipation
- Temporarily restricting fiber during an acute flare of diverticulitis and reintroducing it gradually after symptoms resolve It's crucial to consider patient preferences and potential side effects, such as abdominal bloating, when counseling patients about fiber supplementation 1. Overall, the benefits of fiber supplementation in patients with a history of diverticulitis, including promoting regular bowel movements and supporting a healthy gut microbiome, make it a worthwhile consideration for most patients.
From the Research
Safety of Fiber Supplementation in Patients with a History of Diverticulitis
- The safety and efficacy of fiber supplementation in patients with a history of diverticulitis have been studied in several research papers 2, 3, 4, 5, 6.
- A study published in the journal Digestion in 2006 found that fiber supplementation is indicated in symptomatic diverticulosis to get symptom relief and prevent acute diverticulitis 2.
- Another study published in the journal Nutrients in 2018 conditionally recommends the use of liberalized diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis, and strongly recommends a high dietary fiber diet after the acute episode has resolved 3.
- A systematic review published in the International Journal of Colorectal Disease in 2012 found that high-fiber diet can improve symptoms and/or prevent complications of diverticular disease, but high-quality evidence is lacking 4.
- A review published in the International Journal of Colorectal Disease in 2021 updates the reader on modern evidence-based treatment strategies for acute diverticulitis, including the role of fiber supplementation 5.
- A prospective study published in The American Journal of Gastroenterology in 2019 found that higher intake of dietary fiber, especially from fruits and cereals, is associated with a lower risk of diverticulitis in women 6.
Key Findings
- Fiber supplementation is safe and effective in preventing acute diverticulitis in patients with symptomatic diverticulosis 2.
- High dietary fiber intake is recommended after an acute episode of diverticulitis to improve symptoms and reduce recurrence 3.
- Fiber from fruits and cereals, but not vegetables, is associated with a decreased risk of diverticulitis 6.
- Whole fruit intake, especially apples/pears and prunes, is associated with reduced risk of diverticulitis 6.