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
