What is the best diet for diverticulosis (diverticular disease)?

From the Guidelines

The best diet for diverticulosis is a high-fiber diet that includes plenty of fruits, vegetables, whole grains, and legumes, as supported by the most recent and highest quality study 1. This dietary approach is recommended because it can help reduce the risk of diverticulitis and promote overall gut health.

• Aim for 25-35 grams of fiber daily, gradually increasing your intake to avoid gas and bloating.
• Specific foods to emphasize include:
  • Fruits: apples, pears, berries
  • Vegetables: broccoli, carrots
  • Whole grains: brown rice, oatmeal, quinoa
  • Legumes: beans, lentils
• Stay well-hydrated by drinking at least 8 cups of water daily to help the fiber work effectively.
• Limit red meat, processed foods, and fatty items which can increase inflammation.
• Contrary to outdated advice, you don't need to avoid nuts, seeds, or popcorn as research shows these don't cause diverticulitis flares 1.
• During acute flares of diverticulitis, follow your doctor's advice which may include a temporary liquid or low-fiber diet until inflammation subsides. This high-fiber approach works because fiber adds bulk to stool, making it easier to pass and reducing pressure in the colon that can create or worsen diverticular pouches.
• Fiber also promotes healthy gut bacteria which may reduce inflammation in the digestive tract 1.
• Regular physical activity complements this dietary approach by promoting healthy bowel function. The benefits of a high-fiber diet for diverticulosis are supported by the American Gastroenterological Association (AGA) 1, which suggests a fiber-rich diet or fiber supplementation in patients with a history of acute diverticulitis. However, it's essential to note that the quality of evidence for these recommendations is very low, and patient preferences and side effects of fiber should be considered when counseling a patient 1. Overall, a high-fiber diet is a safe and effective way to manage diverticulosis and reduce the risk of diverticulitis, and it should be recommended as the first line of treatment 1.

From the Research

Diet and Diverticulosis

The relationship between diet and diverticulosis is complex, with various studies yielding conflicting results.

• A high-fibre diet is widely accepted as a potential preventative measure for diverticulosis, although the evidence is not conclusive 2.
• Some studies suggest that a high-fibre diet may not protect against asymptomatic diverticulosis, and may even increase the risk 3.
• Other studies have found that a high intake of red meat and low intake of dietary fibre are associated with an increased risk of diverticulitis, a complication of diverticulosis 4, 5.

Specific Dietary Components

Certain dietary components have been investigated for their potential role in diverticulosis:

• High-fibre intake: may reduce the risk of diverticular disease, with a 23%, 41%, and 58% reduction in risk for an intake of 20,30, and 40 g/day, respectively, compared to 7.5 g/day 6.
• Red meat consumption: may increase the risk of acute diverticulitis, especially when consumed as unprocessed red meat 5.
• Fish intake: may be associated with a reduced risk of diverticulitis, although the evidence is not conclusive 5.
• Alcohol intake: may be associated with an increased risk of diverticulosis, although alcohol dependence may show a lower risk of in-hospital mortality due to acute diverticulitis 5.

Dietary Patterns

The role of dietary patterns in diverticulosis is still not well understood:

• No association has been seen between nut, corn, or popcorn consumption and the occurrence of diverticulosis, diverticular disease, and acute diverticulitis 5.
• The evidence for the role of dietary pattern on the occurrence of colonic diverticulosis, diverticular disease, and acute diverticulitis is still conflicting 5.