Nutty or Just Gone to Seed? Nuts, Corn, Popcorn and Diverticular Disease
Abstract & Commentary
By Malcolm Robinson MD, FACP, FACG, AGAF, Emeritus Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City. Dr. Robinson reports no financial relationship to this field of study.
Synopsis: A very large prospective study found no evidence that nuts, corn, popcorn, or seeds increased diverticular disease or its complications.
Source: Strate LL, et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA 2008; 300:907-914.
The authors evaluated findings from the health Professionals Follow-Up Study that began in 1986 with prospective data up to 2004. Self-administered and validated questionnaires included biennial medical data as well as detailed dietary data collected every four years. The study included 47,228 men aged 40-75 years at entry, none having any previous diagnosis of diverticular disease, inflammatory bowel disease, or cancer. Main outcome measures were incident diverticulitis and diverticular bleeding. There were 801 incident cases of documented diverticulitis and 383 cases of diverticular bleeding. Not only were nuts and popcorn not found to be provocative of diverticular disease complications, but there were statistically significant trends for protection associated with the consumption of these dietary items. The authors speculated about possible protective mechanisms involving anti-inflammatory properties of nuts, their high mineral content (zinc and magnesium), and the presence of both low levels of magnesium and lutein in popcorn. Although no data were available concerning all seeds that might have been consumed by the study participants, strawberry and blueberry consumption had no effect on the development of diverticular disease complications. Corn was likewise found to be innocuous. The authors carefully assessed possible roles of confounding factors such as NSAIDs, red meat consumption, and total fiber consumption. None of these played any role in modifying or obscuring the primary findings of the study. Although diverticular disease was not directly assessed at baseline, it was felt likely that a large number of these middle-aged and elderly individuals would have had this finding on study entry if assessments had been undertaken. The authors state that current widespread recommendations regarding the avoidance of nuts, popcorn, corn, and seeds should be carefully reconsidered.
Commentary
I love this study! Diverticular disease is extremely common, probably occurring in most adults by age 85. Complications of diverticular disease are also very prevalent, affecting a third or more of patients who have diverticulosis (and costing billions of dollars annually). For more years than I can count, physicians have speculated that foods such as nuts, popcorn, berries, corn, and seeds might be important (probably as intra-diverticular irritants) in the pathogenesis of diverticulitis and diverticular hemorrhage. In one survey, almost half of colorectal surgeons subscribed to this notion; and it is widespread in physicians of all specialties (sadly, including gastroenterology). To my knowledge, there has never been a shred of scientific evidence to support any relationship between any of these potentially "scratchy" foods and the various complications of diverticular disease. Indeed, dozens of studies have supported the health benefits of a high-fiber diet in preventing many colonic disorders, including the development of diverticular disease itself. Despite the weight of scientific evidence, the idea that patients with diverticular disease should avoid nuts, berries, corn, popcorn, and other similar foods has flourished. Although this article may not immediately change this long-held dogma, there should be a big chink in the wall. I urge our readers to accept modernity and to stop telling patients with diverticular disease that such draconian dietary maneuvers are useful or desirable.
A very large prospective study found no evidence that nuts, corn, popcorn, or seeds increased diverticular disease or its complications.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content