The Best Diet for Diverticulitis: Splitting Fact From Fiction With Over 20 Studies

[Last Updated 15th May, 2017]

Diverticulitis is an extremely unpleasant digestive disease.

Those diagnosed know it’s worth taking measures to avoid future episodes. Unfortunately, 1 in 5 will have another flare up within five years (1).

This is a research-driven look at what diet changes may help treat diverticulitis, as well as some common myths about foods to avoid.

What is Diverticulitis?

Diverticulitis occurs when small pockets in the wall of the large intestine (colon) become inflamed or infected.

These small pockets or sacs – called diverticula – are formed when the muscles of the colon become too weak in certain areas. This causes them to push outward and form a “pocket,” which is common in the lower part of the colon.

Diverticulosis and Diverticulitis

Diverticulitis becomes extremely painful during a flare up. Even immediate surgery can be required to treat a severe case.

Diverticulitis vs Diverticulosis

Diverticulosis refers to having diverticula that have not yet become infected and painful.

This means diverticulosis always occurs before diverticulitis.

‘Osis’ refers to a medical condition, while ‘Itis’ typically refers to inflammation or infection.

The risk of diverticulosis increases as we grow older, to about 70% of people aged 80 and above. Fortunately, it only progresses to diverticulitis about 4% of the time (2, 3).

What is Diverticular Disease?

Together, diverticulitis and diverticulosis are often referred to as diverticular disease.

The cause of this disease is complex and still poorly understood. Researchers suspect it to be a combination of numerous dietary habits, aging and genetic predisposition (4).




Summary: Diverticulitis occurs when small pockets in the lining of the colon become irritated and inflamed. Diverticulosis is simply the presence of these small pockets. Diverticular disease refers to either condition.

Diverticulitis Symptoms

Diverticulitis SymptomsMost are unaware they have diverticulosis until it becomes infected and painful (diverticulitis).

Symptoms can vary between individuals, but the most common are:

Diagnosis is based on a history of symptoms in addition to some medical tests.

This can include blood tests, a colonoscopy or radiology as determined by your doctor.

Summary: Diverticulosis is usually symptom-free, however diverticulitis symptoms are typically severe and painful.

Diverticulitis and Antibiotics

Diverticulitis and AntibioticsIn severe cases of diverticulitis, surgery and regular antibiotic use are required to overcome the infection (5).

However, recent research suggests that aggressive antibiotic treatment is overused, particularly in less severe cases (6).

This is where nutrition therapy comes into play.

Summary: Antibiotics are definitely warranted in severe cases, but less so otherwise.

Diverticulitis and Probiotics

Diverticulitis and ProbioticsProbiotics are bacteria we eat for health benefits.

Studies show that a variety of different probiotic strains are effective in reducing symptoms of diverticulitis. Particularly those of Lactobacillus casei and Lactobacillus paracasei (7, 8, 9).

In this chart, you can see that a high-fiber diet plus the probiotic Flortec appeared especially useful for short-term abdominal pain (8):

probiotics and diverticulitis for treatment

Probiotics have also been successfully combined with the anti-inflammatory drug Mesalamine to help reduce symptoms of diverticulitis. However, it’s uncertain if they reduce the risk of recurrence (10, 11).

Probiotic Sources

The best food sources of probiotics are fermented foods, such as yogurt, quark, Yakult, sauerkraut, kefir, kimchi, tempeh, and miso.

Probiotic supplements are also a great option, but recommended strains and dosage have yet to be determined. Always buy probiotic supplements (as with any supplement) from a reputable and trusted source.




Summary: Research suggests a variety of probiotic strains are effective in managing diverticulitis symptoms. Both fermented foods and supplements are useful sources.

Diverticulitis and Fiber

Diverticulitis and FiberFiber is an indigestible carbohydrate we get from plant foods.

It was always thought diverticulosis was caused by inadequate fiber intake. However, newer studies suggest it probably doesn’t prevent the diverticula forming in the first place (12, 13).

That said, it most likely does help prevent diverticula becoming symptomatic (diverticulitis).

One observational study found those who ate 25 grams or more of fiber per day had a 41% lower risk of being hospitalized for diverticulitis compared to those who ate less than 14 grams per day (14).

Another study that followed more than 690,000 women without diverticular disease found that each additional 5 grams of fiber per day was associated with a 15% reduction in risk of diverticulitis (15).

fiber intake and diverticulitis

Considering that fiber has numerous other known benefits for the health, particularly in maintaining a healthy gut bacteria, it makes sense to recommend a high fiber diet.

Unfortunately, today most people only consume half of the recommended amount. Women should aim to get at least 25 grams per day, while the average man should have at least 38 grams per day (1617).

Fiber supplements are an option, but whole food sources of fiber are best. This includes legumes, vegetables, fruits, nuts and seeds.

Summary: A high fiber diet is strongly associated with a reduced risk of developing diverticulitis. Considering the additional health benefits, and overall inadequate intake, additional fiber is beneficial for most everyone.

Diverticulitis and Vitamin D

Diverticulitis and Vitamin DVitamin D is a critical nutrient for human health, best known as the “sunshine vitamin”.

There is increasing evidence that our vitamin D status may influence risk of gastrointestinal diseases such as Irritable Bowel Syndrome, Irritable Bowel Disease (including Crohn’s disease) and diverticulitis (18).

A recent study in those with diverticulosis found those with the lowest vitamin D levels were significantly more likely to experience a diverticulitis flare up (19).

So it’s important to have your vitamin D levels checked with your doctor, particularly if you don’t get much regular sunlight exposure.

Unfortunately, natural food sources of vitamin D are not very useful if you have a deficiency. This is one of the few instances where supplementation is far superior to food.

Summary: Low vitamin D levels are linked to increased risk of diverticulitis. Get screened for a deficiency with your doctor.

Are Nuts and Seeds Really Foods to Avoid with Diverticulitis?

Nuts and Seeds DiverticulitisA simple search for “foods to avoid with diverticulitis” or “what not to eat for diverticulitis” will show you nuts and seeds, corn and popcorn.

In fact, for years we’ve been taught these foods can literally get stuck in diverticula, causing irritation and eventually diverticulitis.

But this theory has never been proven, and research actually shows no link.

A large study in 47,228 men found no associations with nut, corn, or popcorn consumption and diverticulitis, after 18 years of follow-up (20, 21).

If anything, these foods are more likely to be protective of diverticulitis because they tend to be high in fiber.

Summary: Nuts, seeds, corn, and popcorn are safe to eat with diverticular disease.

What About Red Meat and Diverticulitis?

Meat and DiverticulitisThe idea that red meat intake increases diverticulitis risk is unproven.

It was formed on the back of observational studies that found vegetarians were much less likely to develop diverticular disease than average person.

But the reason vegetarian and vegan diets are advantageous is because they’re almost always higher in fiber than the typical Western diet. Additionally, non-meat eaters tend to be more health-conscious than the average person (22, 23, 24).

So it’s considerably more likely the benefits lie in eating more fiber, rather than cutting meat or animal foods.

That means you should follow whatever eating pattern will help you to eat more vegetables, nuts, seeds and other high fiber foods. If going vegetarian will help you achieve this, and is something you can do long-term, then do that.




Summary: The idea that red meat increases risk is unproven. Vegetarian diets appear protective because they are typically higher in fiber.

Video Explanation of This Article

Summary: Treating Diverticulitis with Diet and Food

While a high fiber eating pattern may not prevent diverticula from forming, it most likely helps prevent the occurrence or recurrence of diverticulitis.

That is, a diet rich in whole vegetables, legumes, fruit, nuts and seeds.

So whichever eating pattern helps you to eat more of these foods – that you still see yourself following in 5 or 10 years – is a great choice.

There is good evidence that probiotics (particularly some strains of lactobacilli) are useful for treating symptoms. However, researchers are unsure they help prevent recurrence. Also consider vitamin D supplementation if you have low levels.

Lastly, there is no evidence that cutting meat or nuts and seeds from your diet is beneficial. If anything, nuts and seeds are more likely protective.

Remember that diverticulitis is a disease influenced by many other factors too, including obesity, physical activity levels, and smoking status.



This article takes an evidence-based look at what diet changes help to manage diverticulitis, as well as some common myths about foods to avoid. Learn more here: http://www.DietvsDisease.org/diverticulitis-diet/

Comments

  1. I’ve heard that psyllium husk is a good way to get your fiber and help with Diverticulitis. is this true?

    • Yes Roy psyllium husk is good: https://www.dietvsdisease.org/best-fiber-supplement.

      And higher fiber appears beneficial for this condition.

    • I WAS WONDERING IS IT OK TO EAT CHICKEN AND RICE WITH HAVING Diverticulosis and Diverticulitis

      • Greg Kerlin says:

        Dear Barbara, I had my first “attack” a few weeks ago, and have been trying to create a diet ever since. I am a chef and foodie so it has been challenging. I find that chicken and rice works great for me. I put thighs, bone-in ones, that I trim of fat, then I sear skin side down in a non stick pan. After that I put them in a crockpot wit a bit of garlic, a bit of unfiltered cider vinegar, some broth and pitted prunes (which for me gives me the fiber …but if you are experiencing other issues, you may wish to avoid this.) Bay leaves, thyme too, seem to work fine. This dish is delicious with white rice, like Jasmine. Other chicken and rice dishes should work too. Oregano, and ginger may have medicinal qualities, and could add nice flavors, not together)…personally am trying to avoid anything too spicy for a while. Roasted hard squash cubes like butternut are great too as a side flavor. I use Himalayan pink salt as my only seasoning, too. Organic coconut oil, when needed.

        • Greg, I am wondering if rice would be able to be chewed enough to go through the digestive tract without getting into one of the pockets of colon wall?

          • Rice getting stuck in the pockets has not been proven. The benifits of fiber are pretty clear. Remember, if concerned you can blend food and to make cream style soups. In my experience blended soups will require seasoning (like oregano) to add flavor.

        • Just got out of th er with diverticulitis and uti diagnosis. Clear diet sounds daunting but I will do it. Greg, do you have other recipes? I need inspiration. Feeling really down.

          • I am in hospital with my first flareup of diverticulitis. I feel totally confused with the dietary advice – high fibre or low fibre?? Meat or no meat? Broccoli or not??

            • I too was in the same situation as you about a month ago. My dr. didnt bother to tell me after having a liquid diet for a few days to switch to a low fiber diet for a couple weeks and work up to a high fiber diet. I am vegetarian and have since gone vegan. For me it feels the only way I can get enough fiber. Good luck!

  2. Sometimes I think, in my case, it is stress as stress for me goes directly to my gut.

    • Stress is a huge risk factor and trigger. Mind-gut connection is very real thing

      • Thanks. I asked my doctor about this and she said it had no impact. I have had two attacks in 4 months and I am under tremendous stree.

        • I’ve had two diverticulitis attacks, last one was on two antibiotics for 10 days. I can tell you in my case, mine is caused by STRESS. Too much of it. If something ‘scares’ me, even a little, I feel my gut spasm. A direct connection. They don’t call your gut you 2nd brain for no reason.

  3. Please give me some advice on rice and grains such as quinoa as I am thinking they are harder to chew well and might end up going through digestive trace whole and get stuck in the pouches? I know I need to increase fiber and avoid some vegetables with skins. Thank you

    • (I think this post is right on, except if you are doing the liquid diet for a few days.)
      “For me, I have to avoid raw dense vegetables such as broccoli, cauliflower, carrots and any fruit with skin such as apples. I’ve had several flare-ups thst landed me in the hospital and its always been the raw veggies. So now I cook them to soften them and they don’t bother me. Nuts, seeds and popcorn have never been an issue for me.”
      (I don’t think raw Vegetables are something I would recommend unless they were blended. Fruits without skin are probably fine. Also cream style soups can be easily made using a blender. Even canned soups like “progresso” brand and such can be blended. These will require some seasoning like oregano and such to add flavor.)

  4. Hi Joe

    In the midst of recovery from a nasty flare up with fever, diagnosed late 2015 with Pan Diverticular Disease following an initial acute episode, hospitalisation, IV antibiotics etc.
    My regular diet is high in fibre, fish, chicken occasionally, almost never red meat, love nuts and seeds.
    My question is regarding the recovery diet following a flare up. In this flare up, I have only taken clear fluids for 24 hrs, added dry rye toast when taking antibiotics, ( metronidazole/Augmentin Forte) miso, herbal teas.
    Would value your input regarding progressive steps in the recovery diet.
    Cheers Sandi

  5. Hi Joe

    In the midst of recovery from a nasty flare up with fever, diagnosed late 2015 with Pan Diverticular Disease following an initial acute episode, hospitalisation, IV antibiotics etc.
    My regular diet is high in fibre, fish, chicken occasionally, almost never red meat, love nuts and seeds.
    My question is regarding the recovery diet following a flare up. In this flare up, I have only taken clear fluids for 24 hrs, added dry rye toast when taking antibiotics, ( metronidazole/Augmentin Forte) miso, herbal teas.
    Would value your input regarding progressive steps in the recovery diet.
    Cheers Sandi

  6. For me, I have to avoid raw dense vegetables such as broccoli, cauliflower, carrots and any fruit with skin such as apples. I’ve had several flare-ups thst landed me in the hospital and its always been the raw veggies. So now I cook them to soften them and they don’t bother me. Nuts, seeds and popcorn have never been an issue for me.

  7. Hello,

    I’ve been searching for a list of the best things to eat after being on a liquid diet for a while. The symptoms have subsided and I’m nervous about reintroducing food. I’ve been existing on bone broth, herbal tea and lemon water. I’ve gotten so many conflicting views on what to eat and what not to eat that I’ve worked myself into a bit of a paralysis.

    • I had a flare up 3 weeks ago. Since then I have been on 2 antibiotics, Cipro and Flagyl. I also was told to do the liquid diet for 3 days and then a low-residue diet for a week. So that consists of the white rice, applesauce, bananas, jello, no caffeine, broth and saltines. I have tried to reintroduce higher fiber foods over the last few days and some are agreeing with me and some aren’t. It seems like any processed foods, ie Uncle Ben’s long grain and wild rice are not agreeing with me where as cooked veges are ok. Last night I roasted some beets. I only had like 2 bites, cause I am afraid too.
      Best wishes! I am glad I found a blog because there is not a whole lot of info out there on our disease.

  8. Hey Joe!

    Great post, great to see large study cohorts and plenty of references where possible. I will definitely be arranging to come visit you for one on one consult if I ever develop Diverticulitis (as Diverticulosis I probably won’t have any symptoms just yet ^_^ ).

    Keep up the great work!

    Marlo Sarah Elms

  9. POSITIVE GIRL says:

    i am currently going through flare up taking antibiotics. i have battled stomach problems since i was a child., seeds i don’t eat cause they cause a flare up., what has help me a great deal to only have a flare up maybe 1 a year is green juice., nappa cabbage, kale. celery. cucumber carrots, apples., has help me a great deal. also listen to your body. you start feeling pressure on left side at least a week before a flare thats letting you know to eat less binding foods and you may even need to take stool softener to get things to move out. when it gets to stress remind yourself of this, you cant control things in your life, and if you are sick or need surgery, then you will wont be able to get anything done. so take care of yourself 1st cause if you are sick you cant take care of anything else. also i don’t really eat meat, what i am eating now flare up is trader joe organic chicken broth, i water down a bit add trader joe water crackers or sour dough bread to make it soft mushy., and in a few days i will grind up kale. cabbage. carrots, celery, cilantro and let it cook for hours and then strain it and have that. this is a crappy disease, but there are more worse illness out there. the positive to this is to listen to your body a week before you have a flare up you get pressure in left side and spams,that come and go, that’s letting you know your intestine is tired and needs a break.

  10. I have been suffering with this now for the last 10 months, I was in hospital for 2 weeks and not able to eat for 5 days with antibiotics fed into my veins. I have found so many conflicting information, it’s hard to know what to do for the best.
    What I have found is I now drink at least 1 large carton of PEACH JUCIE every day (yeah Peach Juice) and since I have been my symptoms have really calmed down. I tried different fiber supplements and everything seems to make me worse, I came across this by pure chance but it seems to have done the trick for me and I can almost eat as normal. I am no longer in pain when I go to the bathroom, and I don’t get spasms or pains as often. My diet I try to stick to foods that are not fatty or greasy and stay away from drinks that have bubbles.

    I think you just have to find what works for you, but it tricky and I have been in so much pain spending at least 1 hour on the toilet per day. I still have to go to the bathroom a lot but since the Peach Juice I am able to go and not be in pain.

  11. Lanita Ledbetter says:

    This is a great website. I love the chicken and rice recipe, of sorts. I think I will try that. I guess I was thinking of diverticulitis as a condition and not as disease. I really need to focus on diet and overall health. I was surprised to read about the possible role that a vitamin D deficiency might contribute to this disease.

  12. All questions and answers were so helpful. Doctors do not explain and help enough. Terrible.

  13. I was just diagnosed with Diverticulitis and UTI two weeks ago. I was discharged without any dietary instructions. I came home and did my own research b/c I was afraid to eat. I put myself on a low residue diet for a week and then each day introduced some type of regular food back in my diet. Homemade hummus one day, seemed fine. Cheese pizza slice and a soda, seemed ok. Next day I had a half of a quesadilla with chicken, cheese, black beans, pickled jalapeños nbut without the seeds and only 3. Later that night I was back in severe pain and at the doctors office first thing in the morning. Now I’m back on the antibiotics and left with very mixed messages on what is ok to eat. I’ve heard the Fodmap diet is good for IBS but there are foods on that list I question. I don’t want to suffer through flare ups that are so painful over and over again. On one hand we think the seeds from strawberries, raspberries, nuts and popcorn would get stuck in the pouches then you read it’s ok to have it. It doesn’t make sense to me.

  14. Patricia Summers says:

    Hi, I just want to tell you a fairly new miraculous remedy that has kept me from getting a full-blown attack & having to go on antibiotics. It is a mixture of 1 Tbsp Bragg’s Apple Cider Vinegar & 1 Tbsp of raw honey mixed in a glass of water. Drink this at least 2x a day. I have also been taking the brand 1MD Complete Probiotics Platinum, DrTobias GutMeister PreforPro Ultimate Pre-biotic, Zenwise Labs Advanced Digestive Enzymes, and Digestive Freedom Plus by Patriot Health Alliance. These supplements are not cheap & even though I’m living on Social Security disability I sacrifice in order to be able to take them as they have proven themselves to be mighty in my goal to remain as free as I can from the painful episodes of full-blown attacks. As far as my diet I am still learning & figuring it all out. I know for sure that some things I just cannot risk eating. The fiber I added is Acacia Fiber as it is gentle & the psyllium fiber hurt me. I also drink a lot of Peppermint tea especially after meals & if I’m having spasms. My doctor prescribes a drug Bentyl 20 mg & this helps enormously! When having the spasms it relaxes the gut so this is very beneficial for me anyway. Though I will give first credits to the Raw, unfiltered Apple Cider Vinegar & the Raw honey! Truly blessed to find!

  15. I was diagnosed with Diverticulitis the end of March. I was on Cipro an Flagyl three times. I am still having trouble eating anything even with taking a pill for nausea. Nothing wants to stay down. I am drinking keifer and Boost. At this point I don’t even want to try to eat.

  16. Elizabeth Cody says:

    I was diagnosed with this disease 4 Years ago…and, I just had a flare up a week ago..I try and stay clear of popcorn,and, anything with seeds,,and, Yes, they DO cause a flare up,as, in my case here…and, here I sit taking antibiotics,and, still having issues…YES, there are certain things I CAN’T eat…but, SOME times I eat the heck out of them…I fins, Pizza,Nuts. Popcorn..are the main culprits for me…and, last week it was tortilla chips and salsa..UGH….this disease is Horrible,and, HURTS tremendously…

  17. rd with severe stomach pain–dx was DV. Thanks for being here! So i have had liquid diet – bone broths and well-cooked veggie or chicken soup. Sun night, i added chicken that had been soaked in Nepalese herbs from local Nepali restaurant. Ayurvedic doc says to eat ghee in my soups and 1/2 tsp dried ginger with warm water after meals. My liquid poop is beginning to become liquid mush – looking forward to being more like cow-pies (yep, as in a field of cows). 1) i am under stress, 2) in 2 days,I meet my boyfriend in Lisbon for a 12-day fun (can be slow-paced) trip (16 hour flight-I live in SFBay area, CA) – So should I go on trip or stay here and continue to add to my diet. And, what to add next to diet? and when to add…had/have a v healthy diet and lifestyle. ,

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