Diverticulosis is a common condition, especially in older adults, where small pouches called diverticula form in the wall of the colon. These pouches can become inflamed, leading to abdominal pain, cramps, bloating, and changes in bowel habits. Certain foods may aggravate diverticulosis symptoms, while others can help prevent flare-ups. Understanding which foods to choose and avoid can help manage this condition.
What is diverticulosis?
Diverticulosis occurs when small bulges or pockets, called diverticula, push outward through weak spots in the colon wall. This colon condition becomes more common with age, affecting over half of all people over age 60 (1).
The diverticula themselves are harmless and cause no problems unless they become infected or inflamed. This painful condition is called diverticulitis. Symptoms of diverticulitis include (2):
– Left lower abdominal pain
– Bloating and gas
– Diarrhea or constipation
– Fever
– Nausea or vomiting
Chronic, mild diverticulitis may cause intermittent abdominal discomfort, bloating, and irregular bowel movements. Flare-ups of diverticulitis are often triggered by hard stool, which can lodge in the diverticula and cause infection and inflammation.
How do foods impact diverticulosis?
Diet and lifestyle factors appear to play a role in managing diverticular disease. Increased pressure in the colon from a low-fiber diet has been associated with developing diverticula pockets. Straining during bowel movements can worsen symptoms (3).
Certain foods may also irritate the colon lining and provoke inflammation in pre-existing diverticula. Foods implicated in flare-ups of diverticular disease include (4, 5):
– Nuts and seeds
– Red meat
– Processed meats like hot dogs or bacon
– Refined grains like white bread
– Certain raw vegetables
On the other hand, diets high in fiber can help make stools softer and easier to pass. This may lower pressure in the colon and reduce irritation of diverticula. Foods high in fiber like fruits, vegetables, whole grains, and beans are recommended for managing diverticular disease.
Foods to avoid with diverticulosis
Nuts and seeds
For many years, people with diverticulosis were told to avoid nuts, seeds, corn, and popcorn because they could get lodged in diverticula and cause infection. Research in the past decade has failed to find evidence that eating nuts and seeds increases flare-ups (6).
However, some gastroenterologists still recommend caution with nuts, seeds, and popcorn, especially during symptomatic episodes of diverticulitis. When diverticula are already inflamed, these small hard foods could theoretically aggravate symptoms.
Red meat
Several large studies have linked frequent red meat consumption to an increased risk of diverticulitis complications and diverticulitis-related hospitalizations (7, 8).
Possible reasons why red meat may irritate diverticulosis include (9):
– Saturated fat and cholesterol in red meat may negatively impact gut health.
– Heme iron in red meat may contribute to oxidative stress and colonic inflammation.
– Cooking red meat at high temperatures may create carcinogenic compounds.
– Processed red meats contain added sodium and preservatives like nitrates.
To limit potential problems, it’s recommended to avoid or reduce intake of red and processed meats like beef, pork, lamb, hot dogs, sausage, and deli meats. Poultry, fish, eggs, beans, and nuts are healthier protein alternatives.
Refined grains
Refined grains like white rice, bread, pasta, and baked goods offer very little fiber compared to whole grains. A low-fiber diet is linked to the development of diverticulosis because of increased colon pressure.
Consuming refined grains can also lead to harder, dryer stools, which may block or get stuck in diverticula. Whole grains like brown rice, quinoa, oats, and whole wheat provide important fiber and nutrients that support colon health.
Certain raw vegetables
Raw vegetables are normally an excellent food choice, but some healthcare providers advise avoiding or limiting specific raw vegetables if you have diverticulosis. Vegetables like cabbage, broccoli, cauliflower, spinach, and celery contain indigestible fibers that may be difficult to pass and irritate sensitive colon tissue. People with diverticular disease may find that cooking these vegetables makes them easier to digest.
| Foods to Limit with Diverticulosis |
|---|
| Nuts and seeds |
| Red meat |
| Processed meat |
| Refined grains |
| Raw cabbage |
| Raw broccoli |
| Raw cauliflower |
| Raw spinach |
| Raw celery |
Foods that help diverticulosis
A diet centered on fiber-rich fruits, vegetables, whole grains, and legumes may promote colon health and prevent diverticulosis symptoms. These foods add bulk to stool and may lower pressure within the colon.
Fruits and vegetables
Fruits and vegetables are naturally high in fiber, with skin-on varieties providing the most gut-healthy fiber. Aim for 25-30 grams of fiber daily from fruits and vegetables. Excellent choices include (10):
– Raspberries
– Pears
– Apples
– Artichokes
– Green peas
– Split peas, lentils, beans
– Potatoes with skin
– Carrots
– Squash
– Greens like spinach, kale
Whole grains
Substituting whole grain products for refined grains significantly boosts fiber intake. Look for the term “whole” as the first ingredient on food labels. Great whole grain options are (11):
– Whole wheat or multigrain bread
– Brown rice
– Quinoa
– Oatmeal
– Whole grain cereal
– Popcorn
– Whole wheat pasta
Nuts and seeds
Despite conventional advice to avoid nuts and seeds, numerous studies demonstrate that eating nuts and seeds does not increase diverticulosis problems. In fact, the fiber, vitamins, minerals, and phytochemicals in nuts and seeds offer nutritional benefits for intestinal health (6).
To reduce risk of symptoms, chew nuts and seeds thoroughly or incorporate them into smoothies. It’s also prudent to limit portion sizes to 1-2 ounces per day. Good choices include almonds, pistachios, flaxseeds, chia seeds, sunflower seeds, and walnuts.
Legumes
Beans, lentils, and chickpeas are excellent plant-based protein sources that provide about 16 grams of fiber per cup cooked (12). The soluble fiber in legumes helps thicken stool and eases its passage through the colon. Try incorporating legumes like:
– Split peas, black beans, pinto beans, kidney beans
– Lentils
– Chickpeas, hummus
– Soybeans, tofu, edamame
| Foods Recommended for Diverticulosis |
|---|
| High-fiber fruits – berries, pears, apples, plums |
| Vegetables with skin – potatoes, carrots, squash, okra |
| Greens – spinach, kale, lettuce |
| Whole grains – oats, brown rice, whole wheat bread |
| Nuts and seeds – almonds, walnuts, flaxseeds |
| Legumes – lentils, beans, chickpeas |
Lifestyle recommendations
Beyond diet, other lifestyle factors can help manage diverticular disease:
Increase physical activity
Getting regular exercise encourages more frequent bowel movements and decreases pressure in the colon. Aim for 30 minutes per day of moderate activity like brisk walking. Yoga positions and abdominal exercises also aid digestion (13).
Drink fluids
Proper hydration is vital for preventing constipation and keeping stools soft. Water and other fluids add fluid volume to the colon and bulk to stool. Adults should drink about 2 liters of total fluids daily. Avoid excess alcohol, which causes dehydration (14).
Avoid medications that constipate
Medications like narcotics, antacids, diuretics, antidepressants, and iron supplements commonly cause constipation. Discuss alternative medications or laxatives with your doctor if bowel function changes. Never abruptly stop prescribed medications.
Practice stress management
Stress and anxiety can manifest in the digestive system, causing abdominal pain and irregularity. Make time for relaxing activities like therapy, massage, meditation, yoga, or mindfulness. Getting quality sleep also helps combat stress.
Stop smoking
Smoking is clearly linked to worse outcomes in diverticular disease, including development of complications like abscesses, perforations, strictures, and fistulas. Quitting smoking improves outcomes in this condition (15).
Foods to eat during a diverticulitis flare-up
Periodically, diverticula may become inflamed or infected, resulting in a condition known as acute diverticulitis. Attacks of diverticulitis cause severe abdominal pain, fever, chills, and bowel changes. Treatment involves antibiotics and resting the colon with limited solid foods.
As symptoms start improving, the diet can be expanded to include low fiber, easily digestible choices that won’t irritate inflamed colon tissue. Well-tolerated foods during diverticulitis flares include (16):
– White bread or crackers
– Pasta, noodles, white rice
– Chicken breast without skin or bones
– Eggs
– Low fiber cereals like cream of wheat, cornflakes, puffed rice
– Canned fruits like peaches, pears, fruit cocktail
– Vegetable juice
– Milk, milk alternatives like almond milk
– Smooth peanut butter
– Applesauce
– Tea, coffee, clear broths, water
Avoid raw fruits and vegetables, whole grains, nuts, seeds, legumes, tough meats, alcohol, and caffeinated drinks until diverticulitis symptoms have fully resolved. After symptoms improve, high fiber foods can gradually be added back to the diet.
Foods to avoid in later stages of diverticular disease
For the majority of patients, diverticular disease remains chronic but manageable. However, an estimated 10-25% of patients experience complicated diverticulitis at some point (17). This means the condition progresses with complications like:
– Abscesses around diverticula
– Perforations or tears in the colon wall
– Bowel obstruction due to scar tissue
– Fistulas connecting the colon to other organs
In severe or complicated cases, the affected portion of colon may need to be surgically removed. After surgery or complications, some people will be advised to continue restricting or avoiding specific foods that may be difficult to digest. These may include (18):
– Tough meats with gristle
– Raw fruits and vegetables
– Whole nuts, seeds, corn
– Whole grains
– Fried or greasy foods
– Carbonated beverages
– Alcohol
A low-fiber, low-residue diet is often recommended after complications from diverticulitis. This eliminates small particles that could block or pass through surgical anastomoses where sections of the colon have been removed and reconnected.
Supplements for diverticulosis
While no supplements have been proven to treat or cure diverticulosis, some complementary medicines may provide symptom relief. Commonly used supplements include:
Probiotics
Probiotic supplements contain live bacteria that help repopulate the digestive tract with beneficial microorganisms for improved gut health and immunity. Evidence suggests probiotics may reduce inflammation and prevent diverticulitis complications (19).
Digestive enzymes
Plant-derived digestive enzymes like bromelain, papain, and lipase help break down proteins, fats, fiber, and carbohydrates in food for better absorption. Enzymes may alleviate gas, bloating, and post-meal discomfort.
Aloe vera
Aloe vera juice is traditionally used to heal irritation or inflammation in the GI tract. Aloe is rich in anti-inflammatory compounds and offers soothing gastrointestinal relief.
Curcumin
Curcumin, the active compound in turmeric, has potent anti-inflammatory properties that may calm diverticular inflammation and prevent complications. However, absorption of turmeric’s beneficial curcumin is very poor (20). Combining turmeric with piperine-rich black pepper or lipid carriers like oil may enhance curcumin absorption.
Garlic
Multiple research studies demonstrate the antimicrobial effects of garlic against gut pathogens like bacteria, viruses, and yeast (21). Garlic may prevent infection of diverticula and associated diverticulitis flares.
As with any supplement, consult your physician before taking complementary medicines to avoid interactions with prescribed medications or health conditions. Supplements are not a substitute for standard diverticulitis treatment.
When to seek medical care
Most people with diverticulosis have no symptoms and only need routine colonoscopy screening. However, prompt medical attention is indicated for:
– Persistent or severe abdominal pain
– Rectal bleeding
– Ongoing constipation and diarrhea
– Constant feelings of rectal fullness or pressure
– Fever over 101 F
– Nausea and vomiting that prevents eating or drinking
– Changes in bowel habits lasting more than a few days
These signs may indicate an attack of acute diverticulitis that requires urgent evaluation and treatment with antibiotics to prevent complications. Recurrent episodes of diverticulitis that progress in severity also warrant medical care to discuss potential surgical options.
Conclusion
A diet high in fiber from fruits, vegetables, whole grains, nuts, seeds, and legumes may help prevent complications of diverticular disease. Limiting or avoiding red meat, refined grains, and certain raw vegetables can help manage diverticulosis symptoms. Lifestyle measures like regular exercise, plenty of fluids, and practices that ease constipation are also beneficial.
Although most people with diverticulosis do not have serious issues, abdominal pain, bleeding, fever, or bowel changes should prompt medical evaluation to rule out acute diverticulitis. With proper, ongoing care and diet modifications that avoid irritating foods, many patients can achieve satisfactory control of their diverticular disease.
