What should the diet be like for diverticulosis?

Diet Recommendations for Diverticulosis

A high-fiber diet (25-35 grams daily) is strongly recommended for patients with diverticulosis to reduce the risk of complications and recurrence. 1

Key Dietary Components

Fiber Intake

• Aim for 25-35 grams of fiber daily as recommended by the American Gastroenterological Association 1
• Fiber sources should include:
  • Fruits and vegetables
  • Whole grain products
  • Psyllium fiber supplements (15g daily) can be used to augment dietary fiber intake 1, 2
  • For new users of fiber supplements: start with 1 dose per day and gradually increase to 3 doses as necessary to avoid bloating 2

Hydration

• Drink at least 8 ounces (a full glass) of water with each fiber supplement 2
• Maintain adequate hydration throughout the day to help fiber work effectively 1

Foods to Include

• Diet rich in fruits and vegetables 1, 3
• Whole grain products 3, 4
• Seeds and nuts (contrary to previous myths, these do not increase risk and may actually have a protective effect) 5, 4

Foods to Limit

• Diets high in sweets should be avoided 1
• Avoid foods that decrease colonic transit time 3

Implementation Strategy

During Acute Flares

• Clear liquid diet is advised during the acute phase of uncomplicated diverticulitis 1
• Gradually advance to a regular high-fiber diet within 3-5 days as symptoms improve 1

Long-term Management

• Maintain consistent fiber intake daily
• Consider fiber supplements if dietary intake is insufficient:
  • Psyllium (Metamucil): 1 packet in 8 oz of liquid, up to 3 times daily 2
  • Wheat bran, flax seed, or sugar-beet fiber can be useful 6
  • Methylcellulose has shown benefit in some studies 7

Additional Lifestyle Recommendations

• Regular vigorous exercise 1
• Maintain normal body mass index (BMI) 1
• Avoid smoking 1
• Limit non-aspirin NSAIDs and opioid analgesics 1

Managing Constipation

• Osmotic laxatives like polyethylene glycol (17g daily) can be used as first-line treatment for constipation 1
• Stimulant laxatives can be added if there is inadequate response to first-line treatment 1

Cautions and Monitoring

• As your body adjusts to increased fiber intake, you may experience changes in bowel habits or minor bloating 2
• Consult a doctor before increasing fiber if you have:
  • Abdominal pain, nausea, or vomiting
  • Sudden change in bowel habits persisting for 2 weeks 2
• Colonoscopy is recommended 6-8 weeks after resolution of acute symptoms if not performed within the past year 1

The evidence supporting high-fiber diets for diverticulosis is consistent across multiple guidelines, although the quality of evidence is moderate. While older studies questioned the effectiveness of fiber, more recent guidelines strongly support its use for both prevention and management of diverticular disease 1, 3, 6, 7.