The so-called "diverticulitis diet" is not a system for treating diverticular mattia, but a method aimed at preventing the evolution of the disease.
Although we cannot eliminate intestinal diverticula through a correct diet, we therefore have the opportunity to prevent inflammation.
What is diverticulitis?
Diverticulitis is a gastrointestinal disorder that affects the large portion of the intestine.
This disease can only affect those presenting the so-called diverticulosis.
Diverticulosis means "presence of diverticula".
Diverticula are real anatomical alterations of the colon which, depending on the pathological nature and the level of gravity, can be of two different types.
- The less problematic diverticula are characterized by extroflexions of the mucosa and sub-mucosa that tend to become invaginated inside loci of lower resistance of the wall, such as the points of penetration of the arteries through the smooth muscular layer.
- The more serious diverticula, or rather the "real" ones (less frequent), are instead formed by an extroflexion of all the layers of the intestinal wall.
Diverticulitis occurs when diverticula becomes infectious / inflamed and gives rise to an acute disorder. However, if these remain healthy and asymptomatic, the condition is referred to as simply diverticulosis.
To avoid constantly distinguishing the two phases, especially in subjects who get sick frequently, we talk about diverticular disease.
Who Strikes and Why?
Diverticulosis can be identified with specific investigations, such as abdominal ultrasound, computerized tomography and the rectus-colonoscopy.
The diagnostic test can be justified by a specific symptomatology of diverticulitis or be a random finding, during the investigation of other disorders of the large intestine.
It is not easy to establish the incidence of diverticulosis, as it is not said that whoever possesses one or more diverticula becomes ill with diverticulitis. Instead, it is much easier to define the epidemiological importance of acute cases, which affects about 10% of the over 40 and 50% from 60 onwards.
The diverticulitis mostly affects the left portion and is exceptional in the child, rare in the adult with less than 40 years and quite frequent in the over sixties.
With this data in hand, the first question that arises is: "Do diverticula tend to form more with time, or do they simply become more delicate?". Probably, both solutions can be considered valid and meaningful.
Risk factors
The diverticula could be the consequence of an intrinsic weakness of the muscular walls of the large intestine, which is why the progressive weakening of the same with old age would explain the greater incidence in the elderly.
In addition to age, the other statistically significant factor is a diet low in fiber and water typical of Western countries, where the incidence of diverticulitis is greater than in the East.
This happens for a very precise reason: the scarce presence of fibers and water is associated with an increase in intraluminal pressure which, by exerting a thrust from the inside towards the outside, forces the extroflections to become invaginated in the points of greatest weakness.
Symptoms and Therapy
When present, the symptoms of uncomplicated or mildly activated diverticular disease are quite generic and sometimes overlapping those of the irritable bowel.
The most frequent are: spontaneous or provoked pain, especially in the left iliac fossa, meteorism and alternate alvo with prevalence of constipation.
On the contrary, diverticulitis becomes explicitly symptomatic when it enters the severe acute phase, or in the case in which they occur:
- Obstruction of the diverticular ostium, due to stagnation of feces inside the pocket and relative appearance of phlogistic phenomena
- Perforation of the diverticular ostium, with formation of perivisceral abscess associated with circumscribed or generalized peritonitis
- Bleeding, due to erosion of the underlying vessels and, sometimes, consequent bleeding.
Diverticulitis often presents with localized pains, closed alvo, fever and chills, increase in inflammation and rectorragia (expulsion of blood which, if not associated with other symptoms, almost always translates to diverticular hemorrhage).
Complicated diverticulitis cannot be treated with nutrition and therapy includes: administration of antibiotic drugs parenterally, complete intestinal rest (fasting) and sometimes surgery.
On the contrary, in the event that the aforementioned generic symptoms occur or there is an awareness of the presence of diverticulosis, it is possible to adopt a preventive diet ; this, which some call a diet for diverticulitis, is very similar to the diet recommended in case of irritable bowel.
Prevent diverticulitis with diet
As anticipated, diverticulitis (especially the complicated one) requires total fasting and a parenteral diet associated with antibiotics; only in some cases, surgery is necessary.
The diet to prevent diverticulitis, on the other hand, is a well-known dietary therapy and intervenes with two distinct but complementary mechanisms:
- Reduction of the possibility of diverticula formation
- Reduction of the possibility of infection / inflammation of diverticula.
The diet to prevent diverticulitis is not based much on the caloric intake or on the nutritional distribution, but on the fiber composition, probiotics and prebiotics.
The basic rules (for an adult) are:
- Fiber intake that corresponds at least to the suggested amount for a healthy person (30g / day)
- Water supply that corresponds at least to the suggested altitude for a healthy person (1 ml per kcal taken), of which a good part during the meal
- Increase the percentage of soluble fibers at the expense of insoluble ones; remember that some soluble fibers, such as inulin, also exert a very important prebiotic action
- Supplement with dietary foods or supplements or probiotic drugs
- Periodically perform intestinal disinfectant cycles (questionable)
- Avoid foods that are difficult to chew such as, for example, oily seeds (walnuts, hazelnuts, almonds, pistachios, pine nuts, peanuts, sesame seeds, poppy seeds, hemp seeds, flax seeds, etc.)
- Avoid foods containing non-digestible portions such as peel and internal seeds (tomatoes, aubergines, figs, cucumbers, kiwi, watermelon, grapes, pomegranate, etc.).
Let's go into more detail.
As anticipated, the presence of soluble fibers and water serves primarily to reduce intraluminal pressure and facilitate stool transit. This avoids both the onset / worsening of diverticula and the stagnation of faecal material.
Some fibers are also considered to be prebiotic elements, that is, they nourish the intestinal bacterial flora favoring trophism. This is extremely useful in maintaining a balance between the internal strains and in guaranteeing the nutrition of the enterocytes.
In addition to protecting the tissues from possible external aggressions, the bacterial flora reduces fecal pH and produces vitamins and molecules very useful for the health of intestinal cells (butyric acid and polyamines).
In addition to feeding them, it can be very useful to increase the exogenous introduction of these microorganisms. In this case, the use of probiotic products containing Lactobacilli, Bifidobacteria and Eubacteria is desirable.
The use of disinfectants is still a debatable recommendation. This means that not all specialists agree on the relevance or otherwise of this practice. The positive aspect is undoubtedly that of reducing the total bacterial load, including the potentially pathological one; the negative aspect is the reduction of the physiological microbial population.
As we have already said, the latter is extremely beneficial for the organism, but cases of infection (acute) caused by them are not rare; in general, these are cases in which the diverticula are very deep or concomitant with significant alterations of intestinal transit (severe constipation).
Even the exclusion of foods that can leave indigestible waste, is a recommendation that has raised many controversies; it is in fact believed that guaranteeing optimal colon functioning is not necessary to exclude certain products.
Some may ask, "Why risk it?"
The answer is quite simple. Many of the foods that should be eliminated from the diet against diverticulitis belong to the vegetable and fruit group; in addition to providing excellent amounts of fiber (with a higher percentage of soluble than cereals), necessary for the health of the colon and bacterial flora, these foods are an irreplaceable source of: vitamin C, vitamin A, folic acid, potassium, phenolic antioxidants etc.
Their exclusion from the diet is not easy to compensate for and the use of instruments that filter the seeds and the peel necessarily requires the reduction to puree, with consequent poor palatability.
On the contrary, as far as oilseeds are concerned, it is possible to eliminate them completely from custom and compensate for them by using the relative (or other) extraction oils.
This is because the most important nutrients that characterize oilseeds are of a lipidic nature (essential fatty acids and vit E) and therefore can be easily isolated by squeezing and filtration.
