From Popcorn to Nuts in Diverticulosis: Good-bye to an Old Chestnut

December 1, 2008

A patient comes to her physician for instructions consequent to the discovery of diverticular disease. She is cautioned to avoid high-residue foods, such as nuts, seeds, popcorn, and corn either on or off the cob, because the by-products of these foods might lead to trauma or obstruction at the diverticular opening in the colon, resulting in brisk bleeding or infection.

What evidence supports the recommendation that patients with diverticulosis avoid nuts, popcorn, and other high-residue foods?

A patient comes to her physician for instructions consequent to the discovery of diverticular disease. She is cautioned to avoid high-residue foods, such as nuts, seeds, popcorn, and corn either on or off the cob, because the by-products of these foods might lead to trauma or obstruction at the diverticular opening in the colon, resulting in brisk bleeding or infection.

For a long time, this clinical scenario has represented common practice. The problem is that the recommendation to avoid high-residue foods may seem rational at first glance, but it lacks empiric proof. In addition, one of the proscribed foods, nuts, actually has a number of health benefits.1

A REVERSAL OF A LONG-ACCEPTED PRACTICE

A cohort study of 18 years’ duration that included 47,228 men, aged 40 to 75 years, addressed the practice of advising patients with diverticular disease to avoid high-residue foods.1 At the outset of the study, all participants were free of diverticula. During follow-up, there were 801 cases of diverticulitis and 383 episodes of diverticular bleeding in those enrolled.

The surprising finding in this study was that there was an inverse association between the consumption of nuts and popcorn and the risk of diverticulitis. Compared with men who had the lowest intake of these foods, those with the highest intake of nuts had about a 20% decrease in the risk of diverticulitis and those with the highest intake of popcorn had about a 28% decrease. Corn, either on or off the cob, neither increased nor decreased the risk of diverticulitis. Finally, there was no association between any of the high-residue foods and diverticular bleeding.

WHAT TO TELL PATIENTS

Tell patients with diverticular disease that nuts and popcorn actually decrease the likelihood of diverticulitis and that nuts have a number of other health benefits. For most patients with this common malady, this will be welcome news.

References:

REFERENCE:


1

. Strate LL, Liu YL, Syngal S, et al. Nut, corn, and popcornconsumption and the incidence of diverticular disease.

JAMA

. 2008;300:907-914.