Popcorn, nuts may not cause diverticular disease

Washington -- Popcorn, corn, seeds and nuts, long banished from the diets of people with diverticular disease, were absolved of blame by research presented at Digestive Disease Week, held May 19-24 in Washington, D.C.

Patients with the condition traditionally have been advised to avoid such foods. It was suspected that the indigestible fiber they contain could make its way to the colon, lodge in the diverticula and cause inflammation and infection. Researchers from the University of Washington in Seattle and a number of Boston hospitals decided to test that theory.

What they found was that the opposite seemed to be the case, said lead author Lisa L. Strate, MD, MPH, acting assistant professor in the division of gastroenterology at the University of Washington. "We observed a statistically inverse association between frequent consumption of nuts and popcorn and the development of diverticulitis."

Diverticular disease is common. About a third of Americans develop diverticulosis by age 60 and two thirds by age 85. Although most cases are asymptomatic, 10% to 30% will result in complications that can include pain, fever, nausea, constipation and diarrhea. Less common symptoms include vomiting and bleeding.

For their study, Dr. Strate and colleagues selected 47,228 men who participated in the Health Professionals Follow-up Study and were, in 1986, free of diverticular disease, gastrointestinal cancer and inflammatory bowel disease. The men were between 40 and 75 years old.

Participants responded to medical questionnaires sent to them every two years from 1986 to 2004. Those reporting newly diagnosed diverticulosis or diverticular complications were sent a 131-item dietary questionnaire, which was mailed every four years, said Dr. Strate.

During 18 years of follow-up, researchers identified 383 cases of diverticular bleeding and 801 cases of diverticulitis. No associations were seen between the consumption of nuts, corn or popcorn and diverticular disease, she said.

Popcorn's reputation is enhanced

Instead, researchers found that men who ate popcorn at least twice a week had a 28% decrease in the risk for diverticulitis, and men who consumed nuts frequently had a 20% reduced risk compared with men who ate those foods less than once a month.

"So in this large prospective cohort, we found that these foods are not associated with diverticular complications, challenging a very long held belief," said Dr. Strate.

Diverticular disease is one of a number of very common diseases that come under the umbrella of inflammatory bowel disease, noted Maria Abreu, MD, associate professor of medicine and director of the Inflammatory Bowel Center at Mount Sinai School of Medicine in New York City. More attention is being devoted to studying people with these debilitating diseases and finding effective treatments, she added.

In addition to Dr. Strate's study, findings were presented indicating that stem cells grown from a patient's own fat cells helped heal complex perianal fistula. The study was conducted at three hospitals in Madrid, Spain.

Limited treatments exist for the condition, noted the researchers, who compared the effectiveness of fibrin glue -- a biological product that can stimulate wound healing -- used alone or with stem cells.

They evaluated healing at eight weeks and found that 71% of the 49 adult patients studied had made improvements as compared with 16% of those treated with fibrin glue alone.

Researchers from the Netherlands found that hypnotherapy was an effective treatment for children who have abdominal pain or irritable bowel syndrome. IBS in childhood is among the most common reasons for seeing a pediatrician, they said. Despite a range of treatments that include education, reassurance and dietary advice -- generally to eat more fiber -- 25% to 66% of patients continue to experience symptoms, they noted.

For the trial, researchers randomized 53 patients ages 8 to 18 with long-standing complaints of either abdominal pain or IBS to a course of hypnotherapy or to standard medical care.

They found that, after treatment, hypnotherapy resulted in a cure rate -- defined as a greater than 80% improvement in pain scores -- of 59% compared to 12% of those in the control group.