Chef Tim Says...

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Dr. Tim Says....

Diverticulitis, nuts and seeds.

I receive a lot of questions to the Ask Dr. Gourmet feature of the website about diverticulosis. Here are some examples:

“Is eating strawberries a no-no for persons with Diverticulitis?  I note that you say that the seeds in cucumbers and tomatoes are really not a problem.”

Will you please give me some information on how to eat for diverticulitis - do I really have to 'seed' a can of tomatoes? Can I still be a spontaneous cook?

People with diverticulosis have small out-pouchings of the colon. It is a very common condition with 1/3 of the population developing diverticulosis by the age of 60 and 2/3 by the time they reach 85. Oftentimes the pouches will become infected and the result can be quite serious with abscess formation, hospitalization and frequently surgery. The longstanding theory has been that the seeds might become stuck in the small diverticula (pouches) and create a setting for infection (known as diverticulitis).

Those of you who follow Dr. Gourmet commentary know how important having clear evidence about a condition is before making recommendations to patients. In the past there has been some controversy about the treatment of this problem with many doctors telling their patients with diverticulosis to not eat popcorn, seeds, nuts or foods that contain seeds, such as those found in tomatoes, cucumbers and strawberries. In the past there was never any solid research to support this, however. In the last few years good studies have disproved that a problem exists.

I have always thought the theory a bit silly but almost certainly so with strawberry seeds (those things are tiny!). Guidelines no longer make this recommendation, and I do not for my patients. The studies have shown that the only dietary change that will make a difference for those with diverticulosis is a high fiber diet (and of course, a high fiber diet is the recommendation for all of us).

One of the largest studies on this subject was published just last week. Researchers looked at more than 47,000 men over 18 years as part of the Health Professionals Follow-up Study. The most fascinating finding was that those men who ate the most nuts and popcorn actually had lower risk of infection. In short, no association was found between an increased risk of diverticulitis and eating nuts, popcorn or corn. (JAMA. 2008;300(8):907-914)

The clear answer from the research right now indicates that you don't need to worry. Eat tomatoes and do be a spontaneous cook again!

September 8, 2008


Last updated: 09/08/08