Dietary Modifications for Diverticulosis
A high-fiber diet is the primary recommended dietary modification for managing diverticulosis, with a target of increasing both dietary fiber and possibly fiber supplementation. 1
Recommended Dietary Approach
High-Fiber Diet
- The American Gastroenterological Association (AGA) suggests a fiber-rich diet or fiber supplementation for patients with a history of diverticulitis (conditional recommendation, very low quality of evidence) 1
- Target foods to include:
- Fruits and vegetables
- Whole grains
- Legumes
- Low in red meat and sweets 1
Fiber Supplementation
- Psyllium fiber supplements can be used to augment dietary fiber intake
- Dosing: Start with 1 dose per day and gradually increase to 3 doses per day as necessary 2
- Each dose should be mixed with at least 8 ounces of water 2
- Note: Fiber supplements are not a replacement for a high-quality diet 1
Foods That Do NOT Need to Be Avoided
- Nuts, seeds, popcorn, and corn do NOT need to be avoided 1
- The AGA specifically recommends against routinely advising patients to avoid these foods (conditional recommendation, very low quality of evidence) 1
- Fruits with small seeds (strawberries, blueberries) are not associated with increased diverticulitis risk 1
Additional Lifestyle Recommendations
Physical Activity
- The AGA suggests advising patients with diverticular disease to consider vigorous physical activity (conditional recommendation, very low quality of evidence) 1
- Vigorous physical activity has been shown to decrease risk of diverticulitis 1
Weight Management
- Achieve or maintain a normal body mass index 1
- Obesity, particularly central obesity, and weight gain are risk factors for diverticulitis 1
Smoking Cessation
- Patients with a history of diverticulitis should not smoke 1
Medication Considerations
Medications to Avoid When Possible
- The AGA suggests advising patients with a history of diverticulitis to avoid non-aspirin NSAIDs if possible (conditional recommendation, very low quality of evidence) 1
- Opioid analgesics are also associated with increased risk of diverticulitis 1
Medications That May Be Used
- The AGA suggests against routinely advising patients to avoid aspirin (conditional recommendation, low quality of evidence) 1
Acute Phase Management
During an acute episode of diverticulitis:
- A clear liquid diet is advised during the acute phase
- Diet should advance as symptoms improve 1
- Most patients report greater comfort on a clear liquid diet during acute episodes 1
Common Pitfalls and Caveats
Outdated Recommendations: The traditional advice to avoid nuts, seeds, and popcorn has been debunked by modern evidence 3. These foods do not need to be restricted.
Fiber Supplementation Side Effects: As the body adjusts to increased fiber intake, patients may experience changes in bowel habits or minor bloating 2. Start with lower doses and gradually increase.
Inconsistent Evidence: Despite widespread recommendations for high-fiber diets, high-quality evidence supporting this approach is lacking 4. Most recommendations are based on inconsistent level 2 and mostly level 3 evidence.
Contradictory Research: Some research has challenged the traditional view that high-fiber diets prevent diverticulosis. A 2012 study found that high fiber intake was actually associated with a greater prevalence of diverticulosis 5. However, this study focused on asymptomatic diverticulosis rather than symptomatic disease or diverticulitis prevention.
Fiber Tolerance: When counseling patients about fiber intake, consider individual preferences and potential side effects such as abdominal bloating 1.
Despite some contradictory evidence, the most current clinical practice guidelines from the AGA continue to recommend high-fiber diets for patients with diverticulosis, particularly for those with a history of diverticulitis, as this approach is unlikely to pose substantial risk and may provide benefit for overall digestive health.