Diverticulitis Diet – What is The Best and Worst Foods

Diverticulitis is a medical condition that causes inflamed pouches in the intestine. For some people, diet can affect the symptoms of diverticulitis.

Doctors and dietitians no longer recommend specific diets for diverticulitis. That said, some people find that eating and avoiding certain foods can help ease their symptoms.

A diverticulitis diet is something your doctor might recommend as part of a short-term treatment plan for acute diverticulitis.

While newly-diagnosed people often feel overwhelmed by the limitations of a diverticulitis diet, the good news is that you don’t need to be overly restrictive with what you eat. There are a few  “golden rules” when it comes to choosing safe foods for diverticulitis that can make it easy to keep your stomach happy.

Diverticula are small, bulging pouches that can form in the lining of the digestive system. They’re found most often in the lower part of the large intestine (colon). This condition is called diverticulosis.

In some cases, one or more of the pouches become inflamed or infected. This is known as diverticulitis.

Mild cases of diverticulitis are usually treated with antibiotics and a low-fiber diet, or treatment may start with a period of rest where you eat nothing by mouth, then start with clear liquids and then move to a low-fiber diet until your condition improves. More-severe cases typically require hospitalization.

Doctors may recommend that people follow a clear liquid diet during an acute flare-up of diverticulitis. Some research suggests that dietary changes — such as eating more fiber and probiotics while avoiding certain carbohydrates and red meat — could help some people with diverticulitis symptoms.

The goal of a diverticulitis diet is to avoid foods that could further irritate the pouches (diverticula) in your large intestine. If you develop diverticulitis, changing how you eat can help control symptoms and may help prevent complications from the condition, such as bleeding and bowel obstructions.

The general guidelines of a diverticulitis diet are a good place to begin, but you should also start paying attention to how what you eat makes you feel. You may notice connections between your bowel symptoms and certain foods—information you and your doctor or nutritionist can use to individually tailor your eating plan.

What is Diverticulitis?

Diverticulitis is a condition that affects the digestive tract. It causes inflamed pouches in the lining of the intestine. These pouches are called diverticula.

Diverticula develop when weak spots in the intestinal wall give way under pressure, causing sections to bulge out.

When diverticula develop, the person has diverticulosis. When the diverticula become inflamed or infected, this is called diverticulitis.

Diverticulosis becomes more common as you age, occurring in around 58% of Americans over age 60. Fewer than 5% of people with diverticulosis will develop diverticulitis.

Diverticulitis may lead to health problems or complications, including:

• nausea
• fever
• severe abdominal pain
• bloody bowel movements
• an abscess, or an inflamed pocket of tissue
• fistula

Can Diverticulitis Diet Help?

Diverticulitis is a condition where small pouches in the intestine called diverticula become inflamed or infected. Symptoms of diverticulitis can include abdominal pain, nausea and vomiting, fever, constipation, and diarrhea.

If a person has these pouches that are not inflamed or infected, they have diverticulosis and usually have no symptoms. According to current estimates, less than 5% of people with diverticulosis will develop diverticulitis.

A 2018 review suggested that risk factors for developing diverticulitis include aging, increased fat around the abdomen, inactive lifestyles, and poor diet.

The review concluded that there is not enough quality research to identify which diverticulitis diet are beneficial for an acute attack of diverticulitis. They did, however, suggest that following a high fiber diet after recovery from acute diverticulitis might reduce the risk of another episode.

Serious complications of diverticulitis might include:

• an abscess or perforation in the colon
• peritonitis, which is inflammation or infection in the abdominal lining
• a fistula, which is an uncharacteristic tunnel linking two organs or an organ and the outside of the body
• a blockage of the movement of food or stool through the intestines

A Healthy Diet for Diverticulitis

Liquid Diet

First, if you are experiencing severe abdominal pain, your doctor may order blood work and a CT scan to check for “complicated acute diverticulitis”, manifested as an abscess or a perforation of the colon. This is a medical emergency. However, if you are experiencing “uncomplicated acute diverticulitis”, manifested as fever, less severe abdominal pain, vomiting, or a change in bowel habits that is affecting your ability to live a normal life or you are becoming dehydrated, your doctor will initially recommend a clear liquid diet.

Here are a few clear liquids you can consume daily to manage your symptoms and ensure you remain hydrated:

• Pedialyte/Gatorade
• Fruit Juice with no added sugar
• Broth
• Ice popsicles

You should avoid eating any foods until you and your doctor believe the diverticulitis is under control. Then, you can advance to a full liquid diet then gradually add solid foods back into your diverticulitis diet.

Fiber-Rich Foods

Traditionally, doctors have recommended that people who are experiencing a flare of acute diverticulitis should follow a clear liquid diet. They may then progress to a low fiber diet until their symptoms have improved. Once a person’s symptoms are better, some sources recommend they follow a high fiber diet for your diverticulitis diet.

The Dietary Guidelines for Americans 2015–2020 recommends a dietary fiber intake of 14 grams (g) per 1,000 calories. High fiber foods include:

• high fiber ready-to-eat bran cereal
• beans and pulses, including navy beans, chickpeas, split peas, and lentils
• fruits, including pear, avocado, apple, and prunes
• vegetables, including green peas, potatoes, squash, and parsnips
• grains, including bulgur, quinoa, barley, and whole wheat
• If any foods aggravate symptoms, then a person may wish to speak to their doctor. The University of California, San Francisco (UCSF) note that some doctors may suggest a person takes a fiber supplement, such as methylcellulose (Citrucel) or psyllium (Metamucil).

Probiotics

Probiotics are beneficial bacteria that help the gut stay healthy. A 2013 study suggested that probiotics can be effective in treating symptomatic diverticular disease, especially when combined with medication.

People can take probiotics as a supplement, but they also occur naturally in some foods. These foods include natural yogurt and fermented foods, such as:

• sauerkraut
• kefir
• tempeh
• miso
• People who have been taking antibiotics might consider adding these foods to their diverticulitis diet to help repopulate the gut with good bacteria.

A 2019 review of the health benefits of fermented foods suggested that the potential probiotic effects can support a healthy digestive system and may help symptoms of irritable bowel syndrome (IBS). However, there is insufficient evidence to determine their impact.

Since what affects someone’s diverticulitis can be, to an extent, personal, there is no scripted plan that is sure to help you. There are basics that can guide recommendations, but some of this may prove to be trial and error.

Taking Vitamins or Supplements

Fiber supplements are powerful for managing symptoms of diverticulitis, largely because it keeps stool moving through the colon. “If you keep stool soft, you can prevent the clogging of the diverticula,” explains Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in California. “In general, if you can manage to avoid constipation, it may prevent flare-ups.” A high-fiber diet—as long as it includes high-fiber foods that don’t irritate your system—can also be beneficial.

He also suggests taking magnesium, which can strengthen the intestinal muscles and keep stools soft and regular. It’s been shown, says Dr. Farhadi, that foods rich in magnesium can prevent the progression of diverticulosis—but be aware that some of these foods are nuts, and you may be limited in eating them if they’re a trigger food for you.

As far as other vitamins, some patients with diverticulitis wonder about vitamin D. Some studies have shown that people with higher vitamin D levels are less likely to develop diverticulitis. However, there’s not much research here, and a 2020 controlled trial looking at the link found no difference among diverticulitis hospitalizations between people who supplemented with vitamin D and those who didn’t.

Foods to Avoid

High FODMAP foods

Following a low FODMAP diet has benefits for people with irritable bowel syndrome (IBS), and it might also help some people with diverticulitis.

FODMAPs are a type of carbohydrate. It stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

Some research suggests that a low FODMAP diet could prevent high pressure in the colon, which, in theory, could help people avoid or correct diverticulitis.

In this diverticulitis diet, people avoid foods that are high in FODMAPS. Examples of foods to avoid include:

• certain fruits, such as apples, pears, and plums
• dairy foods, such as milk, yogurt, and ice cream
• fermented foods, such as sauerkraut or kimchi
• beans
• cabbage
• Brussels sprouts
• onions and garlic

Red Meat

Research has linked higher intakes of red meat and processed meat to diverticulitis. One 2017 study found that if people stick to a healthful diverticulitis diet and lifestyle, it might be possible to prevent 50% of diverticulitis cases.

Recommendations include consuming no more than 51 grams (g) of red meat per day, eating about 23 g of dietary fiber daily, doing at least 2 hours of vigorous exercise each week, maintaining a healthy weight, and never smoking.

Another study published in the journal Gut looked at males in the U.S. The study found that higher intakes of red meat, particularly unprocessed red meat, was associated with an increased risk of diverticulitis. They suggest that substituting red meat with poultry or fish may reduce risk.

You may be able to eat these foods, eat them carefully or infrequently, or eat them in small amounts—or they may pose too much of a trigger for your colon. If that’s the case, you’re in good company; these are the foods most likely to cause a diverticulitis flare-up.

• Hard-to-chew foods: Hard foods that are difficult to break down are more likely to get trapped in the pockets of your colon.
• Medium-sized seeds or nuts: Sunflower seeds, for example, may be difficult on your digestion; strawberries seeds usually aren’t (though they could still bother you!).
• Popcorn and corn on the cob: Because you tend to eat these foods quickly—rather than taking time to fully chew them—they are more likely to cause issues.

Foods High in Sugar and Fat

A standard Western diet high in fat and sugar and low in fiber may be linked with an increased incidence of diverticulitis.

Research suggests that avoiding the following foods may help prevent diverticulitis or reduce its symptoms:

• red meat
• refined grains
• full fat dairy
• fried foods

Some Simple Steps to Help Prevent Diverticulitis

Other than diet, there are several other ways you can maintain good digestive health and prevent diverticula from forming, including avoiding eating too much red meat, avoiding fatty foods, and drinking plenty of fluids.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, Aleve (naproxen), and Advil or Motrin (ibuprofen) have been linked to increased instances of diverticular bleeding.

High-fiber diets need water to function properly. If you don’t drink enough water, you can put yourself at greater risk of constipation.

Finally, delaying bowel movements can lead to hard stools and increased strain on the muscles of the colon, which may lead to diverticular disease.

Here are some habits to practice to avoid diverticulitis:

• Exercise regularly
• Quit smoking (smokers are at a higher risk of developing complications from diverticulitis)
• Avoid the use of NSAIDs
• Drink plenty of fluids
• Maintain a healthy body weight
• Respond to bowel urges
• Moderate red meat intake

Read more What is Celiac Disease? What to Know about Celiac Disease