What To Eat When You Have Diverticular Disease

A diagnosis of diverticular disease might bring up a lot of questions and concerns. What are you allowed to eat? Are there foods you should avoid? Will your symptoms go away on their own, or will you feel this way forever?

Searching for answers can be just as confusing. With a lot of misinformation and myths around the differences between diverticulosis and diverticulitis, where do you even begin?

According to registered dietitian Anna Taylor, RD, LD, you want to focus your diverticulitis diet on reducing inflammation and severity of symptoms whenever you’re caught in the middle of a flare-up. But you also want to be preventive when you’re not having a flare-up by building out an eating plan that works for you and your digestive tract.

Taylor clears up the confusion about how to manage both halves of the diverticular disease equation and provides answers about what foods you may or may not want to eat if you’re dealing with these conditions.

Dietary differences between diverticulosis and diverticulitis

When you have diverticulosis, little pouches or pockets form on the inside lining of your intestines and your colon. These pockets, called diverticula, are relatively harmless on their own. You can think of them as freckles or skin tags. They’re usually not a problem unless they get irritated or infected — and when this happens, it’s called diverticulitis.

When these pockets become infected or injured, it can cause inflammation to build up inside those pockets that can then spread to other areas of your colon. During these flare-ups, you’ll likely experience:

• Abdominal cramping.
• Pain or tenderness in the area.
• Swelling.
• Bloating.
• Constipation or diarrhea.

It’s possible to have diverticulosis without ever developing diverticulitis. So, the key to preventing flare-ups is making sure your diet doesn’t cause any additional inflammation or injury when you have diverticulosis. And when you’re having a flare-up because of diverticulitis, your diet should change to decrease the severity of your symptoms and allow your intestines to recover.

What to eat during a diverticulitis flare-up

“When you have diverticulitis, those pockets in your intestinal wall are upset, inflamed and maybe even infected. So, we want to reduce traffic in your gastrointestinal tract so that nothing else irritates them,” explains Taylor. “Decreasing the fiber in your diet helps with that.”

During a diverticulitis flare-up, your provider may recommend rest, antibiotics and either a clear liquid or low-fiber diet so your colon can rest and recover until the flare-up has passed.

Clear liquid diet for diverticulitis

If a diverticulitis flare-up is severe or requires surgery, your doctor may recommend a clear liquid diet. “After a day or two, you progress from clear liquids to a low-fiber diet,” says Taylor. “Even if your pain doesn’t subside, you still move toward regular food. You can’t be on a liquid diet long term because you can become malnourished.”

On a clear liquid diet, you can eat:

• Clear broths (not soup).
• Coffee and tea without milk or nondairy creamer.
• Clear, pulp-free juices like apple and cranberry juice.
• Clear sports drinks or sodas like ginger ale or lemon-lime soda.
• Jell-O®.
• Popsicles.
• Plain water or pulp-free flavored water.

Low-fiber diet for diverticulitis

For milder cases of diverticulitis flares, eat a low-fiber or GI soft diet. A low-fiber diet limits fiber intake to between 8 and 12 grams of fiber, depending on the severity of the flare-up.

Good low-fiber food options include:

• Grains: Lovers of white pasta and white bread, rejoice! These are good low-fiber options, along with white rice and white crackers.
• Low-fiber starches: Get your peeler out. Potatoes without skin can be on the menu. Mash, roast or bake them. Certain low-fiber cereals also get a thumbs-up, including cornflakes and puffed rice cereal.
• Proteins: Choose eggs and egg whites, tofu, and meat or seafood. “It should be tender, so shredded chicken, lean ground turkey and soft baked fish work best,” Taylor recommends.
• Fruits: Use caution, as fruits have lots of fiber. Good options include canned fruits such as peaches or pears, applesauce, ripe bananas, and soft, ripe cantaloupe and honeydew. “It’s not a lot of fiber because you’re not eating the skin,” clarifies Taylor. “The skins are the source of insoluble fiber, which can irritate inflamed diverticula.”
• Dairy: “Cottage cheese and Greek yogurt are real winners if you’re recovering from a flare-up. They’re high in protein, calcium and other nutrients and don’t have any fiber,” says Taylor. “They’re also soft, moist and easier to get down if you’re not feeling well.” You can also have milk and cheese.

Foods to avoid with diverticulitis include high-fiber options such as:

• Whole grains.
• Fruits and vegetables with the skin and seeds.
• Nuts and seeds.
• Beans.
• Popcorn.

You’ll want to follow this low-fiber diet until your diverticulitis symptoms subside. “Usually, someone starts to improve after several days of being on antibiotics,” Taylor says.

If you do, your provider will have you gradually increase your fiber intake over several days to weeks to avoid constipation and bloating.

“The goal is getting back to a high-fiber diet to decrease your risk for future bouts of diverticulitis,” she adds. “But if you’re not feeling better within a few days, talk to your provider.”

How to follow a diverticulosis eating plan

But what if you’re not having a flare-up of diverticulitis? What can you do to prevent flare-ups from happening in the future? Constipation often contributes to the development of diverticula. Hard, stuck stools may also irritate or injure those pockets lining the walls of your colon, which can cause flare-ups to reoccur over time.

“People develop diverticula due to years of excessive muscular contractions as the body attempts to move small, hard stools,” explains Taylor. A high-fiber diet helps fight constipation by softening stool, which then moves through your gastrointestinal (GI) tract more comfortably and easily. There’s also less pressure against those pockets, which helps prevent diverticulitis flare-ups.

A high-fiber diet typically includes 25 to 35 grams of fiber per day. You can work that into your nutritional plan by choosing minimally processed plant foods such as:

• Whole grains.
• Fruits.
• Vegetables.
• Beans.
• Legumes, including lentils and nuts.

Years ago, doctors thought that if you ate corn, popcorn, nuts and seeds, those tiny components could get caught inside the pockets along your intestines, causing them to become inflamed so that you developed diverticulitis. But there’s no research to support that theory.

“It’s safe to eat these types of foods, including tomatoes and strawberries with seeds,” Taylor notes. “All that normal roughage and fiber is fine.”

To get the most out of a high-fiber diet, she also recommends:

• Drinking at least 64 ounces of water a day — more if you’re active.
• Exercising regularly (it helps propel waste through your system).
• Eating a variety of food groups, including five or more servings of fruits and vegetables, three of whole grains and a serving of nuts or beans each day.
• Limiting red meat, processed foods and foods that are high in saturated fat.

“Diverticular disease may be common in Western societies because our diets are so low in fiber,” Taylor says. “Americans, on average, eat around 14 grams each day — about half of what’s recommended.”

Are there any foods you should avoid?

If you’re not having a flare-up or experiencing any symptoms, you should limit low-fiber foods, red meat and other food triggers that cause you GI upset.

If you’re having a flare-up and are experiencing symptoms, you should avoid high-fiber foods until your symptoms subside or your healthcare provider gives you the all-clear.

It may sound confusing on the surface, but it’s two sides to the same coin. Once you’re more in tune with how your body reacts to certain foods, and you’re able to identify your food triggers, living with diverticular disease becomes much more manageable. Keeping a food journal might help track your symptoms and triggers. But you’ll also want to talk to your doctor about a long-term plan.

And if you’ve recently been diagnosed with diverticular disease, meet with a dietitian to learn practical and sustainable ways to get more fiber into your diet.

“Dietitians can also give you more specific recommendations to feel better during a diverticulitis flare-up,” encourages Taylor.