What diet is recommended for someone with diverticulitis?

Dietary Recommendations for Diverticulitis

A clear liquid diet is recommended during the acute phase of uncomplicated diverticulitis, with gradual advancement to a high-fiber diet as symptoms improve. 1

Acute Phase Management

• Clear liquid diet is advised during the acute phase of uncomplicated diverticulitis 1

  • Provides comfort for patients experiencing anorexia and malaise
  • Helps manage potential mechanical obstruction or inflammation
  • Diet should advance as symptoms improve
  • If unable to advance diet after 3-5 days, immediate follow-up is necessary

• Progression of diet:

  • Clear liquids → Fiber-free liquid diet → Low-fiber solids → High-fiber diet
  • Advancement should be based on symptom improvement 1, 2
  • Some patients may advance their diet more quickly based on comfort level

Recovery and Maintenance Phase

• High-fiber diet is strongly recommended after the acute episode has resolved 1, 3, 4

  • Includes fruits, vegetables, whole grains, and legumes
  • Target 25-35 grams of fiber daily
  • Gradually increase fiber intake to avoid bloating and gas

• Specific foods to include:

  • Fruits (including those with small seeds like berries)
  • Vegetables
  • Whole grains
  • Legumes (beans, lentils)

• Foods that do NOT need to be avoided (contrary to outdated recommendations):

  • Nuts
  • Popcorn
  • Small-seeded fruits like berries
  • Seeds 1, 3

• Fiber supplements can be used to augment dietary fiber intake:

  • Psyllium (Metamucil)
  • Methylcellulose 5
  • Should complement, not replace, a high-quality diet

Important Dietary Considerations

• Limit consumption of:

  • Red meat
  • Processed foods
  • Sweets 3

• Hydration:

  • Maintain adequate fluid intake, especially when increasing fiber consumption
  • Helps prevent constipation and supports overall digestive health

Supporting Lifestyle Modifications

• Regular physical activity is recommended 3

  • Particularly vigorous exercise
  • Helps maintain bowel regularity and overall health

• Weight management:

  • Achieve or maintain healthy body mass index
  • Central obesity is a risk factor for diverticulitis 3

• Medications to avoid if possible:

  • Non-aspirin NSAIDs
  • Opioid analgesics 3

Common Pitfalls to Avoid

1. Unnecessarily restrictive diets during recovery phase

   • Prolonged dietary restrictions may extend hospital stays 6
   • No evidence supports avoiding seeds, nuts, or small-seeded fruits 3

2. Inadequate fiber intake during maintenance phase

   • Despite inconsistent evidence, high-fiber diet remains the standard recommendation 5
   • Insufficient fiber may contribute to constipation and increased pressure in the colon

3. Ignoring persistent symptoms

   • Ongoing gastrointestinal symptoms are common (45% report periodic abdominal pain at 1-year follow-up) 1
   • If symptoms persist, evaluation for ongoing inflammation, stricture, fistula, or alternative diagnoses is warranted

The evidence supporting high-fiber diets for diverticulitis is of "very low" quality according to GRADE assessment, but it remains the standard recommendation due to its safety profile and potential benefits for overall digestive health 4, 5.