Many Americans develop a condition known as diverticulosis in which there are small pouches in the large intestine that bulge outward from the intestinal lining. It is estimated that at least 10 percent of all Americans over the age of 40 have diverticulosis.

One-third of all Americans have diverticulosis by age 60 and two-thirds by age 85. Most of those who have diverticulosis have no symptoms of pain or discomfort, but some develop inflammation of these pouches, known as diverticulitis.

Patients with diverticulitis may develop lowed abdominal pain or discomfort. Sometimes hospitalization is indicated, but usually outpatient management is successful. To rest the GI tract, a liquid diet may be recommender for a day or two, then a low-residue, low-fiber diet is initiated. Later if all is going well, a high-fiber diet is reintroduced.

It has not been proven, but it is thought a lifelong, low-fiber diet contributes to the presence of diverticulosis, and this is a condition seen most often in industrialized countries where consumption of processed foods is most common. Diverticulosis is relatively uncommon in countries where people consume a high-fiber diet.

In the past, doctors recommended avoiding nuts and small seeds, such as tomatoes, strawberries and ucumbers, in an effort to keep their diverticulosis patients from developing diverticulitis. It was thought that small seeds could lodge in the diverticular pouches and cause inflammation or possibly diverticulitis; however, there has been no scientific evidence to support this. One study of 47,000 patients published in JAMA on Aug. 27, 2008, revealed there was an inverse relationship between the consumption of nuts, corn and popcorn and the development of diverticulitis – those who consumed these foods more than twice a week had a lower incidence of diverticulitis than those who consumed these foods less than twice a week.

That is not to say that nuts and seeds will not cause abdominal discomfort in all patients because in some individuals it does. Remember though that nuts are high in fiber, protein, polyunsaturated fats and vitamins. Nuts, corn and popcorn do not cause diverticulitis, but there are those who may sensitive to these foods and notice discomfort after eating them. Even today there are still gastroenterologists who recommend that their patients avoid those foods in an attempt to avoid future attacks of diverticulitis, but I am no longer one of them.

David Keisler is a gastroenterologist and internist in Aiken.