Who Says You Can't Eat Nuts?

Conflicting advice regarding nuts and diverticular disease ends with results from large study!

There is good news for individuals with diverticular disease who are longing to eat garden ripe strawberries and blueberries, munch on popcorn at the movies, and get their share of the healthy oils in walnuts. While we have been telling diverticular disease patients that you can still eat these delicious and nutritious foods, some dietary advice offered by others has continued to encourage the avoidance of nuts and seeds. Surprisingly, despite a lack of evidence to support this dietary restriction, a study published about ten years ago revealed that 47% of colorectal surgeons were advising patients with diverticular disease to avoid nuts and seeds.

A recent study published in the Journal of the American Medical Association examined the relationship between nuts, corn, and popcorn consumption and the risk of diverticular disease complications. The researchers used data from the Health Professionals Follow-up Study (HPFS), where health professional men (dentists, pharmacists, optometrists, osteopathic physicians, podiatrists, and veterinarians) completed a series of questionnaires every two years, providing information as to newly diagnosed conditions and disease risk factors, and every four years, providing specific diet information. After eliminating data for individuals who had diverticular disease, inflammatory bowel disease, and some cancers at the beginning of the data collection period, study candidates numbered 47,228 men between the ages of 40 and 75. Data collected over the course of 18 years from 1986-2004 revealed that there were 801 new cases of diverticulitis and 383 of diverticular bleeding during this time.

To eliminate other potential risk factors, the study authors also looked at a number of variables including diet (e.g., consumption of red meat and dietary fibre intake), lifestyle (e.g., level of physical activity), body mass index, as well as a number of medical analyses, including reviewing colonoscopy results, to confirm their findings. Even before adjusting for these factors, there was no increased correlation between the consumption of nuts, corn, and popcorn and diverticulitis/diverticular bleeding. After adjusting for other risk factors, these results held true. Surprisingly, the study revealed that those who ate the most seeds and nuts actually had a lower risk of developing diverticular disease. While it is early yet to draw any conclusions regarding the health benefits of nuts and corn in disease prevention, this study shows that even those who have diverticular disease do not need to avoid munching on popcorn and nuts. (Just pay attention to the amount of fat and salt you are eating with these foods.)

They found no correlation between nut, corn, and popcorn consumption and uncomplicated diverticular disease. Additionally, while they could not specifically measure seed intake, they noted no significant association between the intake of blueberries and strawberries (which contain small seeds) and diverticular complications, so there should be no need for dietary avoidance of small seeds.

The authors note that because the records examined were of an older, male population, they cannot statistically generalize to include women or younger populations in their findings. However, given that there are no significant gender differences in the disorder, it is likely that nuts, corn, popcorn, and small seeds may be safe for all individuals with diverticular disease and for those who wish to avoid onset of the condition.


Diverticular Disease

Diverticular disease and diverticulosis are interchangeable terms meaning the presence of diverticula in the colon. Diverticula are small sac-like out-pouchings of the inner bowel lining that push through the outer bowel wall. Diverticulitis occurs when the diverticula become inflamed. Around 30% of the population greater than 60 years of age and close to 60% of those over the age of 85 have diverticular disease.

Although a high-fibre diet is ideal for diverticular disease, your healthcare professional may direct you to follow a low-fibre diet as a temporary measure during a flare-up (diverticulitis), and you might also receive antibiotic treatment. Most often, a high fibre diet should be resumed once symptoms such as fever and abdominal pain subside.


Want to learn more about diverticular disease?

We have several related articles that may be helpful:

First published in the Inside Tract® newsletter issue 172 – 2009
Health Professionals Follow-up Study. Harvard School of Public Health. Available from: www.hsph.harvard.edu/hpfs/ Accessed July 15, 2009.
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