Conventional wisdom for decades has been to avoid nuts and seeds if you have diverticulosis; however official Gastroenterology literature now says otherwise. Actually, it has for some time, but old habits die hard, and anecdotal rumors still heavily cloud the discussion both in the medical community and among lay people. While it’s not surprising that patients’ impressions may be skewed by rampant Reddit forums on the subject, doctors should be aware of the change in recs, seeing that literally hundreds of studies (more than 300 in the past decade) exist evaluating a variety of dietary effects on diverticular disease. Many of those specifically focused on seed and nuts, and none of them showed any increased harm or risk. The one diet that was affiliated with diverticulitis bouts? No surprise here: “Standard American Fare.” (fried foods, red/processed meats, heavily refined grains, sweets and high fat dairy products). I personally think a big reason why those are correlated with worse outcomes in diverticulosis is that they are all so constipating; and avoiding straining and incorporating fiber and hydration into your diet has long been known to be beneficial (both for diverticulosis as well as in people w/o it).

Now speaking of trying to turn the cruise liner that is diverticulitis management…. Antibiotics. The American Gastroenterology Association has had data out for years showing that we only started treating diverticulitis with antibiotics because “that’s what they always did.” When docs first started doling out Cipro/Flagyl to everyone, it wasn’t based on any scientific trials or evidence, it came more from a logical, hypothetical theory and resultant trial and error approach, and then got passed down from generation to generation. But we now have actual research data showing that uncomplicated diverticulitis in an otherwise healthy patient is more of an InFLAMMatory process, not an InFECTious one, and therefore treatment should include anti-inflammatories, not antimicrobials. Myself being a huge proponent of antibiotic stewardship, I love this change in practice, but it has been pulling teeth to get patients to accept it, and even to change the minds of my fellow colleagues; many of whom say “yeah, I heard about that literature, but I still cover them.” (meaning they prescribe them antibiotics) …  Cut to 4 days later when I see the patient back for their even worse diarrhea due to the antibiotic side effect. Now certain patients and certain cases (i.e. those w abscesses or perforations), still do need antibiotics, but your run-of-the-mill mild case, those do not.

I know many of you will have a hard time *stomaching* this news, so here is a high-quality source for you to check out and verify that I’m not blowing smoke up your behind (sorry couldn’t resist two GI tract puns) just copy this into your search bar:  10.1053/j.gastro.2020.09.059