Every year, roughly 1.7 million people in the US see a doctor because of diverticulitis. And a huge number of them walk away with different advice from different doctors — or no advice at all, leaving them to search online and land in a pile of conflicting information.
Avoid nuts and seeds. Actually, that’s outdated. Take antibiotics every time you flare. That’s not evidence-based either. Take an anti-inflammatory to reduce your recurrence risk. The trials say it doesn’t work.
The good news is that this confusion is finally being addressed. The American College of Gastroenterology (ACG) — the leading professional body for gut doctors in the US — just published its most comprehensive diverticulitis guidelines ever. They reviewed decades of evidence, decades of clinical habit, and patient experience, and put it all in writing.
And a lot of what they confirmed will surprise you.
Below is a video we made; there is also a written version underneath.
Recommendation 1: Antibiotics Are No Longer the Default
For most healthy adults experiencing a standard diverticulitis flare, antibiotics aren’t actually necessary. For decades, that’s not how it worked. A confirmed diagnosis meant a prescription, every time. That was simply the standard of care.
The new guidelines reviewed four randomized controlled trials, the gold standard in medical research, covering 1,809 patients with mild, left-sided, uncomplicated diverticulitis (1). The conclusion was consistent across every trial: antibiotics had little or no effect on reducing mortality, little or no effect on progression to complicated diverticulitis, no impact on the need for surgery, no impact on hospital readmission, and no impact on whether the condition recurred.
To be clear, this doesn’t mean nobody should ever take antibiotics. More complex cases — those with fever, elevated inflammatory markers, or other risk factors — still warrant them. But for the typical healthy adult experiencing a standard flare, the evidence no longer supports automatic antibiotic treatment.
Summary: Four randomized trials covering over 1,809 patients found that antibiotics made little to no difference in mortality, complications, surgery rates, readmissions, or recurrence for uncomplicated diverticulitis. The new ACG guidelines state antibiotics should no longer be given routinely to low-risk, otherwise healthy patients — though they still have a role in more complicated cases.
Recommendation 2: Stop Avoiding Nuts, Seeds, Corn, and Popcorn
The idea that diverticulitis means avoiding nuts, seeds, corn, and popcorn for life has circulated for decades. The theory was that small, hard food particles would get trapped in the diverticula, the small pouches that form in the colon wall, and trigger infection or inflammation.
It was a plausible-sounding theory. It was also never properly tested, yet it spread through clinical practice regardless, leading countless patients to eliminate these foods without any solid evidence behind the advice.
The ACG’s 2026 guideline now states it directly: in patients with a history of diverticulitis, they suggest against avoiding nuts, corn, seeds, or popcorn to reduce recurrence risk.
This matters beyond simply being permission to eat popcorn again. These foods offer genuine nutritional value — fiber, healthy fats, protein — when tolerated. Avoiding them unnecessarily may push people toward a less nutritious diet overall, moving them further from the foods actually associated with better gut outcomes.
That said, individual triggers are real and vary from person to person. There’s a difference between “no population-level evidence this is harmful” and “this food has no effect on you personally.” If a specific food consistently causes symptoms, you don’t have to eat it — often this comes down to individual FODMAP sensitivity rather than the food itself being inherently risky.
Summary: The long-standing advice to avoid nuts, seeds, corn, and popcorn was based on a theory that was never properly tested. The ACG now officially advises against avoiding these foods to reduce recurrence risk, since they offer real nutritional benefits. Personal food sensitivities still matter and can vary by individual, but the blanket avoidance rule is no longer supported by evidence.
Recommendation 3: The Diet That’s Actually Recommended
The ACG guidelines recommend a diet high in fruits, vegetables, whole grains, and legumes, with limited red meat, processed grains, trans fats, and sweets, to reduce recurrence risk. It’s not a groundbreaking revelation; most people already sense this is true.
The honest caveat, which the guideline itself acknowledges, is that the certainty of evidence for diet specifically preventing recurrence is rated low. There’s no large randomized trial tracking a high-fiber, plant-based diet against a control group over several years measuring flare rates. The current data comes from observational studies — useful, but not the complete picture.
What the research does suggest with more confidence is that long-term dietary patterns — the years of eating habits before diagnosis and in between flares — matter more than what you ate right before a specific flare. The conditions that allow diverticula to form, including years of low fiber intake and low physical activity, build up slowly. A single meal before a flare likely isn’t the cause.
The guidelines also note that supplemental fiber is not a substitute for a high-quality diet. Getting adequate fiber through food matters, but this is where things get tricky. Many high-fiber foods are also high in FODMAPs, which can trigger symptoms in sensitive individuals. This creates a real catch-22 for many patients: told to increase fiber while also trying to avoid symptom triggers. The right balance is highly individual and depends on current diet, personal triggers, and food preferences.
Summary: The ACG recommends a diet rich in fruits, vegetables, whole grains, and legumes, with limited red meat, processed grains, trans fats, and sweets — though the certainty of evidence specifically for preventing recurrence is low. Long-term dietary patterns matter more than any single meal before a flare, and supplemental fiber doesn’t replace a high-quality diet. Because many high-fiber foods are also high in FODMAPs, the right approach is highly individual.
If you’re just getting started, download our low FODMAP Food List Guide to get clarity on common food triggers
Tap the blue button below to download our “Eat This, Not That” list as well as additional resources for Diverticulitis (it’s free!)
Recommendation 4: Exercise and Weight Management
This recommendation is straightforward and should be a priority for anyone who has experienced one or more flares.
Research shows that high physical activity is linked to a lower risk of diverticulitis compared with low activity levels. These particular studies evaluated physical activity in relation to a first occurrence of diverticulitis rather than recurrence specifically, but the effects are very likely similar.
This pairs closely with the recommendation around weight management for those who are overweight or obese. Research suggests visceral fat — the fat stored deep around internal organs, which many people carry even without a large belly — may be a more significant risk factor for diverticulitis than overall body weight. Visceral fat is also linked to other complications, including fatty liver disease.
The key takeaway is prioritizing a sustainable eating pattern and lifestyle that includes regular exercise long-term. For many people, that means finding a structured program or committing to a consistent regimen that provides enough buy-in to stick with it through inevitable setbacks.
Summary: Higher physical activity is linked to a lower risk of diverticulitis, and visceral fat specifically, not just overall weight, appears to be a meaningful risk factor. Building a sustainable, long-term exercise and weight management routine matters more than any short-term fix.
Recommendation 5: Quit Smoking and Minimize Alcohol
This is advice that applies to nearly every health condition, but it’s worth repeating because it’s easy to dismiss.
The guidelines state that cigarette smoking increases the risk of diverticulitis, with a stronger association for complicated disease. Current smokers had a 36% higher risk of diverticular disease resulting in hospitalization or death compared with people who have never smoked.
As for alcohol, research shows that people with the highest alcohol intake had a greater risk of diverticulitis compared to non-drinkers. In the American cohort studied, high intake referred to more than two drinks per day on average. While alcohol’s impact appears less dramatic than smoking’s, minimizing intake fits naturally alongside the other lifestyle factors that reduce overall risk.
Summary: Smoking significantly raises the risk of diverticulitis, particularly complicated cases, while high alcohol intake is also linked to increased risk. Neither factor works in isolation, they compound with diet, weight, and activity level to influence overall recurrence risk.
What Should Your Next Steps Be?
If you’re feeling overwhelmed trying to apply these updated guidelines to your own situation, professional guidance can make all the difference. At Diet vs. Disease, we specialize in diverticular disease and help patients build a personalized, evidence-based approach to managing it long-term.
That’s exactly what we built our 4-SURE pathway. It’s a structured process that identifies whether you have the right eating pattern in place, whether the right tests have been done, and what your actual next step is based on your specific situation.
To learn more about our integrated approach, I invite you to apply for a nutrition assessment call with us. We’ll help you make sense of what’s really happening and map out the next steps to get you feeling confident again — not just temporarily avoiding symptoms, but addressing the root cause and fixing your gut issues for good.
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