Diverticulitis is a digestive condition where pouches called diverticula form in the wall of the colon. When these pouches become inflamed, it results in abdominal pain, fever, chills, nausea, vomiting, and a change in bowel habits. While mild cases can be treated with rest, antibiotics, and a modified diet, severe cases may require hospitalization and surgery. Knowing which foods to avoid during a diverticulitis flare-up is important to help manage symptoms and prevent future attacks.
High Fiber Foods
During an acute diverticulitis attack, high fiber foods should be avoided to give the colon a chance to rest and heal. Fiber can scrape and irritate the inflamed pouches in the colon. Once symptoms have resolved, high fiber foods can gradually be reintroduced to help prevent constipation and future diverticulitis flares. Examples of high fiber foods to restrict during an active bout of diverticulitis include:
- Whole grains like whole wheat bread, brown rice, quinoa, barley, and oatmeal
- Fruits like berries, pears, apples, dried fruit, and fruit with seeds or skin
- Vegetables like broccoli, carrots, celery, artichokes, and squash
- Legumes like beans, lentils, split peas, and soybeans
- Nuts and seeds like flaxseeds, chia seeds, almonds, and peanuts
Potential substitutes during a flare-up can include white bread, white rice, noodles, yogurt, eggs, skinless chicken, fish, pureed vegetables, and canned or cooked fruits without skins or seeds.
Greasy, Fatty Foods
Foods high in saturated fat can also irritate the gastrointestinal tract and potentially worsen diverticulitis symptoms. Examples of high fat foods to avoid include:
- Red meat like beef, pork, veal, and lamb
- Butter and cream
- Ice cream
- Baked goods like cakes, cookies, donuts, and pastries
- Fried foods like french fries, hash browns, and potato chips
- Fast food like burgers, pizza, tacos, and hot dogs
- High fat dairy like whole milk, cream cheese, sour cream, and cheese
- Oils like coconut oil, palm oil, and lard
Lower fat alternatives can include skinless chicken, fish, eggs, low-fat dairy, olive oil, avocados, nuts, and seeds. Portion sizes of fats should also be monitored.
Popcorn, Nuts, and Seeds
Foods that contain small, hard pieces like popcorn, nuts, and seeds can get lodged in diverticula and cause infection or perforation. It’s best to avoid:
- All nuts including peanuts, almonds, walnuts, cashews, pine nuts, etc.
- All seeds like poppy, sesame, sunflower, chia, flax, etc.
- Popcorn
- Foods that may contain seed pieces like strawberries, tomatoes, cucumbers, and raspberries
Instead, choose seedless jams, cooked fruits and vegetables, nut butters smoothed into a sauce or dressing, and well-cooked grains like cream of wheat or rice porridge.
Certain Raw Fruits and Vegetables
Raw fruits and vegetables should also be limited during an acute diverticulitis flare. Raw produce is more likely to have seeds, tough skins, and fibrous parts that can aggravate diverticula. Raw veggies also tend to cause more gas. Examples to avoid include:
- Corn
- Cucumbers
- Tomatoes
- Zucchini
- Bell peppers
- Broccoli
- Cabbage
- Cauliflower
- Brussels sprouts
- Asparagus
- Onions
- Carrots
Some fruits and vegetables may be tolerated if they are skinned, seeded, cooked thoroughly, or processed into smooth purees or juices. Examples include cooked carrots, cooked spinach, canned pears, applesauce, banana, melon, berry purees, and vegetable juices.
Alcohol
Alcohol consumption is generally discouraged during an acute diverticulitis flare. Alcohol can irritate the digestive tract, promote inflammation, impair the immune system, and interfere with medications. It’s best to avoid:
- Beer
- Wine
- Liquor
- Mixed alcoholic drinks
After symptoms have subsided, modest amounts of certain alcohols like red wine may be tolerated by some individuals with diverticulosis. However, alcohol intake should be discussed with a doctor.
Sugar-Sweetened Beverages
Beverages sweetened with high fructose corn syrup or added sugars can promote inflammation and may worsen symptoms of diverticulitis. Examples of sweetened drinks to avoid include:
- Soda
- Fruit juice
- Sweet tea
- Lemonade
- Sports drinks
- Sweetened coffee drinks
- Alcohol mixers like margarita mix, daiquiris, etc.
Opt for water, unsweetened tea, coffee, sparkling water, or diluted fruit juice instead. Staying hydrated with non-sweetened, non-caffeinated beverages can help ease constipation and prevent diverticulitis attacks.
Spicy Foods
Spicy foods seasoned with hot peppers or spices can irritate the intestines and may exacerbate diverticular inflammation. It’s best to avoid:
- Hot sauce
- Chili peppers
- Chili powder
- Horseradish
- Black pepper
- Onion
- Garlic
Milder spices like small amounts of black pepper, cinnamon, ginger, and oregano may be better tolerated. Other flavor additions like lemon, herbs, broths, and vinegars can provide flavor without irritation.
Gas-Producing Foods
Certain foods can produce intestinal gas, which can cause bloating, distention, and discomfort when diverticula are inflamed. It’s helpful to limit:
- Beans
- Lentils
- Soybeans
- Cruciferous veggies like broccoli, cauliflower, cabbage, Brussels sprouts
- Onions
- Carbonated beverages
- Sugar alcohols like xylitol, maltitol, and sorbitol
Low gas options include eggs, rice, fruits, fish, chicken, yogurt, cooked carrots, spinach, bananas, and melon.
Acidic and Spicy Foods
Acidic foods like citrus fruits, juices, and tomatoes can increase stomach acid production and gastric motility. This can potentially worsen symptoms in some people with diverticulitis. Limiting spicy foods seasoned with hot peppers or spices can help reduce irritation and inflammation.
To help prevent digestive upset, it’s best to avoid:
- Oranges
- Grapefruits
- Lemons
- Limes
- Tomatoes
- Peppers
- Onions
- Garlic
- Horseradish
- Black pepper
- Chili powder
- Hot sauce
Better tolerated options include banana, cantaloupe, honeydew, watermelon, mango, berries, cooked carrots, cucumber, lettuce, boiled potatoes, rice, oatmeal, eggs, and chicken.
Caffeine
Beverages containing caffeine like coffee, tea, soda, and energy drinks can stimulate intestinal motility and gastric acid secretion. Caffeine on an empty stomach may be particularly bothersome. It’s best to limit intake of:
- Coffee
- Espresso
- Black tea
- Green tea
- Cola
- Energy drinks
Substituting herbal tea, caffeine-free coffee, warmed milk, or decaffeinated soda may help reduce symptoms.
Carbonation and Sugar Alcohols
The bubbles and gas produced by carbonated beverages can cause bloating, gas, and abdominal discomfort when diverticula are inflamed. Sugar alcohols like xylitol, maltitol, and sorbitol found in sugar-free foods can also produce intestinal gas.
It’s best to avoid:
- Soda
- Beer
- Sparkling water
- Sugar free gum/candy
- Quest bars
- Halo Top ice cream
Choose plain water, decaffeinated tea, broths, or dilute fruit juices instead. Read ingredient labels and limit items with sugar alcohols.
Dairy
Some individuals with diverticulitis may have difficulty digesting lactose, a naturally occurring sugar in most dairy products. Limiting high lactose foods can help reduce gas, bloating, and cramping.
It’s best to restrict:
- Milk
- Ice cream
- Custard
- Soft cheeses like ricotta, cottage, brie
- Sour cream
- Whipped cream
- Chocolate
- Lasagna, souffles
- Cream sauces
Lower lactose alternatives include lactose-free milk, hard cheeses like cheddar and swiss, plain yogurt, kefir, soy milk, almond milk, rice milk, and coconut milk.
Fibrous Vegetables
Raw fibrous vegetables can be difficult to digest and may aggravate diverticulitis symptoms. Fiber provides roughage that can scrape and irritate inflamed intestinal pouches. Cooking helps soften fiber and make it easier to tolerate.
Avoid raw:
- Lettuce
- Spinach
- Broccoli
- Cabbage
- Brussels sprouts
- Asparagus
- Corn
- Carrots
- Celery
- Cauliflower
Opt for well-cooked versions and pureed vegetables like soups, stews, steamed spinach, boiled carrots, mashed potatoes, roasted butternut squash, and canned pumpkin. Remove skins and seeds when possible.
Refined Carbohydrates
Limiting refined grain products like white bread, rice, pasta, and baked goods may help manage diverticulitis symptoms. Refined carbs can feed bad gut bacteria and promote inflammation and constipation.
It’s best to avoid:
- White rice
- White bread
- Bagels
- Pasta
- Crackers
- Cereals
- Muffins
- Cookies
- Cakes
Choose whole grain options like brown rice, quinoa, oats, barley, whole wheat bread and pasta, and sprouted grain products. Stick to small portions.
Fried and High Fat Foods
Fried foods cooked in oil or lard and other high fat foods can be difficult to digest. They take longer to move through the colon and can aggravate inflammation and diarrhea. It’s best to limit intake of:
- Fried chicken
- Fried fish
- French fries
- Potato chips
- Donuts
- Pastries
- Cream sauces
- Pizza
Healthier fat options include olive oil, avocado oil, nuts, seeds, fatty fish, and coconut products. Avoid deep fried foods.
Commercially Processed Meats
Heavily processed meats like bacon, sausage, bologna, salami, and hot dogs are often high in fat and sodium. Nitrates used to cure meats may also promote inflammation and irritation.
It’s best to limit:
- Bacon
- Sausage
- Pepperoni
- Salami
- Bologna
- Hot dogs
- Corned beef
- Ham
- Spam
Choose fresh poultry, fish, eggs, or small portions of lean grass-fed meats instead. Canned and pre-packed meats should also be avoided.
Conclusion
Following a modified diet can help ease symptoms during an acute diverticulitis flare-up. Work closely with your doctor and registered dietitian to determine food triggers and an appropriate meal plan based on your specific case. As symptoms resolve, fiber can be gradually added back to aid digestion and prevent constipation. With proper management, diverticulitis can often be treated through diet and medication, without needing surgery.
