Nuts, Seeds and Healthy Diet May Help Lower Risk of Diverticulitis
New research has found that nuts and seeds do not increase the risk of diverticulitis.
The findings confirmed that four key dietary patterns, including the DASH diet, help reduce the risk of diverticulitis onset.
The findings were consistent with a similar study previously conducted in males, refuting current recommendations about foods to avoid to prevent diverticulitis.
Diverticulitis develops when small pockets in the large intestine become inflamed. It causes uncomfortable digestive symptoms and often requires dietary modifications and restrictions.
Now, new research has confirmed that nuts and seeds, previously thought to trigger diverticulitis symptoms, could be back on the menu for people at risk for the gastrointestinal condition.
The study examined the effects of females with diverticulitis who followed four dietary patterns known to promote overall health:
Dietary Approaches to Stop Hypertension (DASH) diet
Healthy Eating Index (HEI)
Alternative Healthy Eating Index (aHEI)
Alternative Mediterranean diet
The participants consumed nuts and seeds, and the researchers also calculated how well they adhered to those four dietary patterns.
The results, published on May 6 in Annals of Internal Medicine, showed that females who followed these eating patterns had a reduced risk of diverticulitis.
The researchers concluded that nuts and seeds were not associated with an increased risk of the condition.
The findings are consistent with a 2008 study that found the same outcomes for males, which could lead to a shift in dietary recommendations for people at risk for the condition.
'We included fresh fruit with edible seeds (raw tomatoes and strawberries) in our analyses because patients still commonly report avoiding these nutritious foods,' the study authors wrote. 'Our findings refute the widely held belief that dietary intake of particulate matter should be avoided to prevent diverticulitis.'
Nuts, seeds not associated with diverticulitis risk
The new research included 29,916 questionnaires received from females with no previous history of diverticulitis, inflammatory bowel disease, or cancer.
The participants were enrolled in the Sister Study, a long-running project to learn more about those who are siblings of someone with breast cancer.
Of those females, 1,531 cases of diverticulitis were identified.
Beyond finding that nuts and seeds do not increase the risk of diverticulitis, the researchers also found that the healthy dietary patterns were not associated with any risk of underlying diverticulitis.
Shabnam Sarker, MD, an assistant professor of medicine in the department of gastroenterology, hepatology, and nutrition at Vanderbilt University Medical Center, said that the findings support patients and clinicians in finding the best ways to reduce the risk of symptoms. Sarker wasn't involved in the new study.
'I think this study kind of confirmed what we've been doing in our practice, or at least I've been doing in my practice for a long time,' Sarker said.
'So, I think earlier in our training, or years ago, we used to think that seeds were at risk of being trapped within diverticula… and we thought maybe that was a trigger on why some people had recurrent disease. And then through [further research] we've realized that a high fiber diet is really the best for overall colon health,' she noted.
How is diverticulitis treated?
Diverticulitis is a complication of diverticulosis, where diverticula, commonly known as pouches, develop within the colon.
When these pouches become inflamed, pain, bloating, and the potential for more serious complications like abscesses, obstructions, and perforations may occur.
Diverticulosis is common, particularly among older adults. The National Institutes of Health (NIH) estimates that around 30% of U.S. adults ages 50–59 develop diverticulitis, and more than 70% of adults 80 and older are diagnosed with the disorder.
Sometimes called 'uncomplicated diverticulitis,' diverticulosis requires minimal intervention, such as antibiotics and monitoring.
Diverticulitis, however, is much less common, affecting around 5% of people with diverticulosis. Complicated diverticulitis often leads to more intense treatment options, like surgery.
Those involved in the study were found to have 1,531 cases of diverticulitis, less than a third of which required hospitalization. Of those 1,531 cases, 14% required surgery and 58% had two or more recurrences.
Surgery is most often required when the condition creates perforations or abscesses that require intervention, much more common for those who have had diverticulitis multiple times.
Shawn Khodadadian, MD, medical director of Manhattan Gastroenterology, told Healthline there are multiple avenues to treatment for those having to manage diverticulitis symptoms. Khodadadian wasn't involved in the new study.
'Generally, outpatients can be managed with pain control and oral analgesics as well as a liquid diet in the outpatient setting for uncomplicated diverticular disease,' he said.
'Oftentimes, especially in higher-risk patients, antibiotics are prescribed when indicated. Antibiotics are not always needed to manage uncomplicated outpatient diverticulitis in otherwise healthy, stable patients, but this should be left up to your doctor after a complete evaluation,' he continued.
James Cox, MD, a gastroenterologist and assistant professor at Texas Christian University, added that it's important for people with diverticulitis to understand the limits of preventive medicine regarding the condition. Cox wasn't involved in the new study.
'There's nothing patients can do to prevent the development of the diverticuli or diverticulosis,' he told Healthline.
Diverticulitis may become severe
One of the common surgeries to treat complicated diverticulitis is a colectomy, which involves removing a segment of the intestine and sewing it back together.
In more serious cases, a temporary colostomy bag may be required to give the area time to heal before reattachment can occur.
Cox noted the most serious complications are often perforations.
'If there's a perforation, then you have colonic content in the abdominal cavity, and that's bad. That's very hard to sew right back up. Patients will often need a temporary colostomy bag for a few months, let everything calm down, and then they get hooked up.'
Sarker added that, for her patients, it can be helpful to explore options with a colorectal surgeon earlier rather than later.
'If they're interested, or would like to even speak to somebody as a consultation [like] a colorectal surgeon, I usually will set them up as a consultation. Even if they're not sure, just to have met someone and talk about the option for this, so that they feel like they're empowered, especially in a condition that seems very difficult to control,' she suggested.
Underlying causes of diverticulitis not understood
Sarker said that part of the patient-clinician relationship is building a space where conversations can flow about conditions like diverticulosis, the reason for which is largely unknown.
Future research can investigate the different risk factors for a condition in which the underlying cause is not entirely understood.
The questionnaire-based nature of the new study highlights the challenges of nutrition research. A double-blind study with a placebo, considered the gold standard in research studies, is very difficult to conduct with food.
Cox is hopeful that further research into the gut and nutrition can help shed light on why diverticulosis happens.
Khodadadian believes that more research can and should be done into the particulars of how diets can improve patients' outcomes.
Sarker said she'd like to see more research that prioritizes women and the role nutrition has on the gut.
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That is precisely what happened in 2018, when Mondelēz Global joined Pepperidge Farm in issuing a recall after being alerted to the possible salmonella contamination in the whey powder supplied by Associated Milk Producers. The suspect ingredient was used to season a range of the company's Ritz Bitz and Ritz Cracker Sandwiches. The precautionary recall took place in the U.S., as well as the U.S. Virgin Islands and Puerto Rico. Salmonella can manifest itself in a variety of ways, including diarrhea, nausea, vomiting, fever, and abdominal pain. While healthy adults usually recover without complications, the impact of the bacterial infection can be much more serious for certain individuals. For instance, children, the elderly, and people with compromised immune systems are at a particular risk, with the pathogen possibly even leading to hospitalization and death. May Flower International is a distributor of Asian food products, including snacks, pickles, sauces, seasoning, flour and rice noodles, and frozen food. In 2018, the New York-based company recalled 4.4-ounce packages of 3+2 Soda Crackers due to the risk that they could contain undeclared milk. Just like their name suggests, 3+2 Soda Crackers consist of three layers of soda crackers separated by two layers of filling. Once imported to the U.S., the 3+2 Soda Crackers were distributed nationally, making the recall more complex, as the mislabeled products could be found in grocery stores across a wide area. The presence of milk — an ingredient not listed on the packaging — was discovered after routine testing by the New York State Department of Agriculture and Markets Food Inspectors. While there were no reports of any consumers being sickened by the crackers at the time, the product could have had disastrous consequences for individuals allergic to dairy. Just some of the symptoms of a milk allergy include vomiting, diarrhea, and rash. In the worst case scenario, a severe allergic reaction to the product can even lead to anaphylactic shock. Mars Chocolate North America — which merged into Mars Wrigley Confectionery in 2017 — is best known for its Mars chocolate bars. The popular caramel, nougat, and milk chocolate confection was launched in 1932 in the U.K, and has since become a staple grocery item around the globe. The 2016 recall had nothing to do with Mars Bars, instead centering on cracker-based snacks, including Combos Cheddar Cheese Pretzel, Cheddar Cheese Cracker, Pizzeria Pretzel, Sweet and Salty Caramel Pretzel, Pepperoni Cracker, and Buffalo Pretzel. The products were pulled off the shelves due to potential contamination with peanuts, a known allergen that can trigger potentially life-threatening reactions in sensitive individuals. Mars Chocolate North America raised the alarm after one of its suppliers, Grain Craft, issued a recall of the wheat flour used in the products, warning that it was likely to contain traces of peanuts. The products had been distributed nationwide, as well as in the Bahamas, Jamaica, St. Thomas in the U.S. Virgin Islands, Antigua, Colombia, Panama, Puerto Rico, Philippines, South Korea, Taiwan, and Singapore. Unlike most other recalls, which involve product contamination or undeclared allergens, the 1998 Nabisco recall of the company's Cheese Nips CatDog crackers centered around a legal issue. Manufactured as a part of the promotion of Nickelodeon's animated TV show "CatDog," the snack featured fish-shaped Cheese Nips crackers, which Pepperidge Farm claimed looked too much like its trademarked Goldfish Crackers. Pepperidge Farm initiated a lawsuit over this similarity, claiming that Nabisco infringed on its trademark fish-shaped cracker brand. The judge sided with Pepperidge Farm, ordering Nabisco to stop production and recall any Cheese Nips CatDog crackers that may have already found their way onto grocery store shelves. The judge also instructed Pepperidge Farm to post a $3.55 million bond to safeguard Nabisco against any potential losses if the decision was overturned. While the ruling threw a wrench into Nickelodeon's promotional plan with Nabisco, the network continued its "CatDog" advertising with other partners, including Kraft Foods and Burger King. For more food and drink goodness, join The Takeout's newsletter. Get taste tests, food & drink news, deals from your favorite chains, recipes, cooking tips, and more! Read the original article on The Takeout.
