What you eat can play a role both in the prevention of diverticular disease and in the treatment of flare-ups of diverticulitis. In diverticular disease, the large intestine (colon) develops small bulges, or sacs, called diverticula. It may have no symptoms. When diverticula become infected or inflamed, the condition is called diverticulitis.
Depending if you have diverticulosis (no flares) or are experiencing a diverticulitis flare-up, your diet recommendations will be different. For instance, while a high-fiber diet may help prevent diverticulitis, a low-fiber diet is often recommended during flare-ups.
This article reviews foods to eat during a flare-up of diverticulitis and what to eat to help prevent future flares.
Liquid Diet for Diverticulitis
If you are experiencing a severe flare-up of diverticulitis, a healthcare provider may recommend a liquid diet. You might start on a clear liquid diet. As your symptoms improve, you may gradually progress to a full liquid diet and then to a low-fiber diet.
A liquid diet is not recommended long-term because it doesn’t provide all the nutrients your body needs.
On a clear liquid diet, you can eat:
- Clear broth
- Clear, pulp-free juice (such as apple and cranberry juice)
- Gelatin without any fruit pieces
- Popsicles (ice pops) without any fruit pieces
A full liquid diet includes all of the above and:
- Cream soups that have been strained
- Fruit juices, including those with pulp
- Pudding and custard
- Ice cream and frozen yogurt without any fruit pieces, candy, nuts, or other solids
- Nutritional supplement drinks
Low-Fiber Diet During Flare-Ups
For less severe cases of diverticulitis, a healthcare provider may recommend a low-fiber diet. A low-fiber diet limits the amount of fiber you eat. This may be between 8 and 12 grams of fiber per day, depending on the severity of the flare-up.
High-fiber foods to avoid include whole grains, nuts, seeds, popcorn, beans, and fruits and vegetables (especially those with seeds and/or skins on).
Low-fiber foods include:
- Lean cuts of meat
- Poultry, fish, and shellfish
- Low-fat dairy products
- Breads, cereals, and grains made with refined grains
- Potatoes without the skin
- Soft-cooked fruit without seeds or skin
- Fruit juices without pulp
- Plain broth or strained cream soups
Foods to Avoid in Diverticulitis
Aside from avoiding high-fiber foods during flare-ups, there are other foods to avoid when alleviating your symptoms.
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a group of carbohydrates that aren’t easily absorbed in the gut. In some people, FODMAPs can trigger symptoms such as stomach upset, abdominal pain, bloating, gas, constipation, and/or diarrhea.
The low-FODMAP diet was developed to help people with irritable bowel syndrome (IBS). However, some experts suggest that it may help people with diverticulitis by decreasing or preventing high pressure in the colon.
FODMAPs are in foods such as:
- Vegetables: Onion, garlic, mushrooms, peas, asparagus, cauliflower, artichoke, Brussels sprouts
- Dairy: Cow’s milk, ice cream, yogurt, custard, pudding, evaporated milk, soy milk made from whole soybeans
- Fruit: Apples, cherries, plums, pears, dried fruit, mangoes, peaches, watermelon
- Grains: Wheat-, rye-, or barley-based breads, breakfast cereals, baked goods, and snack products
- Nuts and legumes: Most legumes and pulses (beans, peas, lentils, chickpeas), cashews, pistachios
- Sweeteners: Honey, high-fructose corn syrup, sugar-alcohols (i.e. xylitol, maltitol, sorbitol, mannitol)
Sugar and Fat
The standard American diet (SAD), or Western diet, is often low in fruits and vegetables and high in foods that contain a lot of saturated fat, sodium (sodium), and added sugars. This low-fiber diet, coupled with high fat, sugar, and salt, may increase the risk of diverticulitis.
A 2017 study following more than 46,000 men for over 25 years indicated that a standard Western dietary pattern was associated with an increased risk of developing diverticulitis. (Note that when citing research or health authorities, the terms for gender or sex from those sources are used.)
Foods high in sugar and fat include:
- Sugar-sweetened beverages
- Fried foods
- Butter, full-fat dairy, and cheese
- Processed meats
- Fatty cuts of red meat
- Dessert foods, such as ice cream, cookies, pastries, candy, chocolate, etc.
Processed and Red Meat
Research suggests that a diet high in red meat, in conjunction with a low-fiber diet may increase the risk of developing diverticulitis.
A 2020 review of diet and diverticulosis found that higher consumption of red meat was associated with a mild increase in the risk of acute (short-term) diverticulitis. A 2021 review of studies suggested high red meat consumption was associated with an increased risk of diverticulitis.
On the other hand, protein foods such as poultry and fish were not associated with diverticulitis. A high-fiber diet rich in vegetables, fruits, and whole grains may be protective against diverticulitis.
When Can I Return to a Normal Diet After Diverticulitis?
A liquid or low-fiber diet is not meant to be eaten long-term. A liquid diet is meant to allow your bowels to rest and heal. It is generally recommended to follow a liquid or low-fiber diet only until your diverticulitis symptoms improve.
Afterward, you may gradually add solid foods back into your diet along with slowly increasing your fiber intake. It’s important to do this over several days to weeks to avoid gastrointestinal (GI) upset, including bloating and constipation.
High-Fiber Diet Prevents Flare-Ups
Eating foods high in fiber and eating less red meat may lower your risk of developing diverticulitis.
Foods high in fiber include:
- Whole wheat bread, pasta, and tortillas
- Whole grains, such as brown rice, quinoa, barley, teff, corn, buckwheat, spelt, and rye
- Oats and whole grain cereals
- Beans and lentils
- Nuts and seeds
Recommended Daily Fiber Intake
In healthy adults, the recommended amount of fiber is about 14 grams of fiber for every 1,000 calories consumed per day.
This equates to around 22 to 28 grams per day for adult females and 28 to 34 grams per day for adult males.
Other Dietary Considerations
Other aspects of your diet to be mindful of are hydration and alcohol intake.
Whether you have diverticular disease or not, staying hydrated is beneficial. Drinking plenty of water prevents dehydration and supports your overall gut health.
You can get some fluids from the foods you eat—especially foods with high water content, such as most fruits and vegetables. Water is the best beverage choice to stay hydrated. Avoid or limit sugar-sweetened beverages, including regular soda, fruit drinks, sports drinks, energy drinks, and sweetened coffee and tea.
High alcohol intake may increase the risk of diverticulitis.
Researchers found a slight association between high alcohol intake and diverticulosis in a 2020 review of studies. Another 2021 review study found that high alcohol intake may be associated with diverticular bleeding, though not with diverticulitis that occurs often or diverticular complications.
However, a 2017 meta-analysis study found no significant association between regular alcohol intake and increased risk of diverticulosis (the formation of the bulging pouches) or diverticular bleeding.
In general, it’s best to avoid alcohol during a flare-up of diverticulitis. During times of non-flares if you choose to drink alcohol, do so in moderation.
Your healthcare provider may recommend probiotics (supplements of friendly gut bacteria) to help treat chronic symptoms of diverticular disease. However, there is not sufficient research to draw conclusions on whether probiotics are useful in the management of diverticular disease.
One study found that taking probiotics didn’t result in fewer diverticulitis flare-ups, but people did report less pain, bloating, and fevers.
Some other herbs and dietary supplements have been suggested for diverticular disease, particularly those with anti-inflammatory effects. These include vitamin D,flaxseed, garlic, ginger, green tea, marshmallow root, licorice, and turmeric. However, there has not been much, if any, research done on these supplements in relation to diverticular disease.
Always talk with your healthcare provider before using probiotics or any other dietary supplements.
Creating a Long-Term Food Plan With Your Healthcare Provider
A diet high in fiber and low in red meat may lower your risk of diverticulitis. If you currently do not eat a lot of fiber, increase your intake slowly over the course of several days or weeks. Be sure to also drink plenty of water to avoid constipation and other GI upset.
Your healthcare provider may recommend an anti-inflammatory diet.
A 2020 study followed more than 46,000 men over 28 years, evaluating their diet and risk of diverticulitis. The researchers found that a reduced risk of diverticulitis may be associated with an anti-inflammatory diet that includes higher amounts of leafy green vegetables, dark yellow vegetables, coffee, and tea, and lower amounts of red meat, processed meat, refined grains, and sugar-sweetened beverages.
Work with a healthcare provider or registered dietitian to create a long-term diverticular disease meal plan that suits your lifestyle.
During flare-ups of diverticulitis, it may be beneficial to follow a liquid or low-fiber diet until your symptoms improve. It may be helpful to avoid high-FODMAP foods, alcohol, processed and red meats, and foods high in fat and sugar during diverticulitis flare-ups.
During times of remission (no flares) it’s recommended to include high-fiber foods in your diet and limit consumption of red meat. Staying hydrated and following an anti-inflammatory diet may help prevent flare-ups.
Probiotics and other herbs and dietary supplements may be recommended, though more research is needed to determine effectiveness in diverticular disease. Always talk to a healthcare provider before trying probiotics or supplements.