Living with diverticulitis means paying careful attention to what you eat. Symptom management will largely revolve around lifestyle changes to your diet. The diverticulitis diet is intended to address key diet issues related to this specific disease. Let us take a closer look at what it entails and how to implement it effectively.
What Is Diverticulitis?
Diverticulitis fits under the broader umbrella term of diverticular disease.
Diverticulitis is a common digestive tract disease that can be extremely painful and disabling. It can be chronic, meaning it frequently flares up repeatedly, or an acute case involving just one or a couple of attacks before the issue is resolved with treatment.
Diverticulitis begins as the intestines, most commonly the large intestine (colon,) develops weakened areas that develop under pressure and strain. This is termed diverticulosis.
These weakened areas create small pouch-like areas that bulge out from the walls of your colon (diverticula). If these diverticula areas tear, they commonly become inflamed and/or infected, which is then termed diverticulitis.
Complications, such as a fistula, peritonitis, bowel blockages, and so forth, occur in about 25 percent of all diverticulitis cases.
Why Is Diet So Important To Diverticulitis?
Once formed, diverticula do not go away. Without surgical intervention, they remain in their location and are prone to episodes, often called flare-ups, of chronic diverticulitis. This is why diet is so pivotal in the management of diverticular disease.
A diverticulitis diet plan is primarily aimed at a balance of food avoidance and promotion. Certain foods are known to irritate the colon and diverticula, which can lead to the tearing and inflammation process of diverticulitis. Meanwhile, other foods may help manage symptoms. Most people with a diverticular disease can benefit from a diverticulitis diet.
The Basic Premise Of The Diverticulitis Diet
There are established guidelines on good and bad food groups within the diverticulitis diet. Most nutrition experts recommend that you take these guidelines into account as you pay close attention to how each food you eat impacts your digestion and bowel symptoms. This systematic approach allows you to customize the diverticulitis diet to your own body since different foods may affect different people different ways.
A food diary will help you keep track of your foods and symptoms. It will also make it easier to discuss your food triggers with a nutritionist or your primary care doctor, who can help you further tailor the diverticulitis diet to your body.
As with any lifestyle change, this new way of eating will take time to adapt to and dedication to maintain long-term consistency. Of course, if your diverticulitis is acute, you can simply use the diet temporarily to help you get through the symptoms.
Benefits Of A Diverticulitis Diet
First of all, you should know that you can use this diet to help prevent diverticulitis and/or manage it. In the case of prevention, this is particularly useful for those with a history of other gut diseases or a family history of diverticulitis.
Treatment with diet has great appeal because it is something that the suffer can self-analyze and control on a daily basis. Of course, it is also non-pharmaceutical and non-invasive.
While doctors commonly recommend dietary changes once any gut disease is identified, science is still working to understand just how specific foods relate to diverticular disease. There is a great deal of debate.
Dietary fiber is a good example. On one hand, avoiding fibrous foods can help relieve diverticulitis symptoms. Yet, research also shows that high-fiber diets may decrease the risk for diverticulitis to begin with when eaten regularly.
None the less, we know that food has an impact on gut diseases because dietary adjustments have a long-standing history of mitigating reoccurrence. That’s not to say that diet is a magic cure, particularly if your lifestyle involves other factors like tobacco use or alcohol consumption that contribute to inflammation.
The goal of this diet is simply to avoid foods that add to the inflammatory process, create unhealthy bowel habits, and/or create unpleasant gut symptoms:
• Proactive Bowel Health
The health of your bowels greatly influences its susceptibility to diverticulitis, but doctors remain unsure why the diverticula patches develop. One hypothesis is that a low fiber diet makes bowel movements more difficult, which then makes the colon’s walls more prone to weakened spots. This is mainly supported by research showing that the majority of diverticular disease sufferers engage in a low fiber Western diet and suffer frequent bouts of constipation before developing the disease.
Diets with high insoluble fiber promote bowel habit regularity that may help prevent or lessen symptoms and allow gut healing during diverticulitis flares.
How much fiber do you need? The Academy of Nutrition and Dietetics recommends women and men respectively get 25 grams and 38 grams of fiber per day.
• Control Inflammation
Since inflammation is the primary villain to diverticula, the diverticulitis diet aims to reduce consumption of inflammation-causing foods and promote the consumption of anti-inflammatory foods.
• Avoid Symptom-Causing Foods
This is the part where your food diary comes into play to identify the foods that cause you distress. Of course, this does not eliminate the disease, but it can help avoid aggravating diverticula and mitigate painful symptoms of GI upset.
Guidelines For Diverticulitis Diet
The following are general guidelines to start a diverticulitis diet. Keep in mind that none of these components are written in stone. Each element is designed to be tailored around what your body tells you as you eat. For example, one food on this list may not effect you at all, but another food not on the list may cause you severe gastric symptoms. Use the list as a guide, but ultimately listen to your body, not the list.
Let us look at some of the components of a diverticular disease diet:
1. Adjust For Competing Medical Conditions
If you have other pathologies, such as kidney disease, IBS, or diabetes, you’ll need to work closely with your nutrition expert to develop a plan that accommodates both your gut and other nutritional limitations or demands. For example, adding fiber is counterproductive if you also have IBS.
2. Adjust For Your Unique Situation
The diverticulitis diet is geared toward generally accepted and available food choices. However, if your finances, beliefs, or other personal factors are a consideration, you should make your healthcare team aware as soon as possible. They are not there to judge you or dictate to you. Their sole purpose is to help you design a nutrition lifestyle that’s wholistic to you as an individual.
3. Add Fiber
It’s important to understand that boosting fiber in even the most sound gut can cause upset. That is why it’s slowly and methodically added just a little at a time. Gradually work up the amount to the recommended serving size as your body tolerates it. This will help minimize gas and bloating side effects.
Remember that every single body is unique. Recommended amounts may be too much or too little based on your age, absorption abilities, and/or presence of other pathologies. This is why it’s recommended to work with a nutritionist to help guide you in listening to your body as it responds to added fiber.
Allow your symptoms and disease progression or remission to guide you on how long you adhere to a high fiber diet. It may be a long-term diet change that you wish to keep for gut health.
Foods high in fiber will be trial and error to your tastes and gut reaction, but here are some high fiber foods to get your list started:
- Whole grains
- Brown rice
- Fleshy fruits – apples and pears
- Root veggies – broccoli, carrots, turnips
4. Add Anti-Inflammatory Foods
Certain foods have properties that help mitigate inflammation. Here are some foods to get your list started:
- Berries – packed with fiber and anthocyanins
- Fatty fish – packed with EPA and DHA.
- Avocados – packed with cytokines and chemokines.
- Green tea – contains epigallocatechin-3-gallate
- Diverticulitis Tea + Probiotic – Calming Blends mix of chamomile, peppermint, and marshmallow leaves with wild yam root.
- Mushrooms – eat them raw for maximum polysaccharides, terpenoids, and phenolic compounds.
Try anti-inflammatory spices in moderation and with caution. While spices like the following can either be soothing to the gastrointestinal tract or have anti-inflammation properties, heavy seasoning can irritate acute cases of diverticulitis:
- Black pepper
5. Avoid Foods Associated With Inflammation
Doctors once commonly recommended that diverticulitis patients automatically avoid small foodstuffs, such as nuts, seeds, and popcorn, that could potentially get trapped in the pockets and lead to inflammation/infection. Research isn’t supporting this line of thought, however. Today, doctors commonly advise diverticulitis patients to eat these with caution to determine effect. If no harm, then you may want to add them to your diet since they are actually good sources of fiber not known to promote inflammation. With that said, certain foods are known to promote inflammation, including:
- Saturated fats
- Trans fats
- Refined carbohydrates
- Red meat
- Processed meats
- Margarine and lard
- Omega 6s
- Full-fat dairy
6. Use The Elimination Diet
As you first begin managing diverticular disease, your nutritionist or doctor may suggest an elimination diet. How does it work?
You will begin with one food or food good at a time. You slowly reduce it within your diet until it has been eliminated. For the next few days or weeks you’ll keep track of how you feel without it in your diet. It is then reintroduced to your diet to see if it causes any unwanted symptoms or impact to your diverticular disease.
If you find a particular food has a negative impact, be sure to let your nutrition expert know so that they can help you formulate a plan to replace any necessary vitamins or minerals with an alternative food choice or supplement.
For example, if yogurt happens to be trigger for you, then you can use a probiotic supplement. In the case of Calming Blends, you can even pair your probiotic with diverticulitis tea blends.
7. Adjust For Flares
During and after flare-ups you’ll need to give your gut time to rest. Fibrous foods are more difficult to digest and may be put on hold until your colon has had time to heal.
Do keep in mind that fibrous foods are often more filling than low-fiber foods. If you have accustomed yourself to eating fibrous foods, you may be unsatisfied when you’re adjusting your diet to low fiber for flares.
Some physicians may recommend temporarily adopting a liquid diet for a few days following a severe flare-up. This is not intended to be a long-term eating habit. It is simply to give the gut a short break.
A liquid diet involves foods that are liquid or turn to liquid at room temperature, including:
- Soup broth
- Ice cream and popsicles
- Fruit sauces
Keep in mind that many of the items on a liquid diet are high in sugar. Choices may be further restricted if you have diabetes.
As you transition back to a regular or diverticulitis diet, slowly reintegrate certain food groups back into your diet. Here are some post-flare tips:
- Fresh fruits with high fiber, such as bananas and apples.
- Start with lower lactose/ fat products, such as cottage cheese and skim milk, that are easier to digest.
- Unless you are a diabetic, go with white over brown starches, which are lower fiber, until your flare up symptoms subside.
- Restart protein with lean ground meat, nut butters, and eggs.
- Put the fibrous root veggies on hold until symptoms subside.
- Stay hydrated with waters and teas and avoid coffee and alcohol.
8. Plan Meals Ahead
Most people with digestive disorders do better with smaller, more frequent meals verses three large portions at dedicated meal times. How often you eat and in what amount will be a trial and error process.
Meal planning ahead can be difficult since your gut’s symptoms may impact what you feel you can tolerate from day-to-day. If you find you have a lot of inconsistencies, you may want to stick to varying up the recipes for friendlier food choices.
Do not forget to factor in snacks and hydration. Healthline offers some tips to stay hydrated, such as setting a daily goal with a dedicated water bottle.
9. How You Cook It Matters
In prepping your foods, keep in mind that many diverticulitis sufferers are troubled by the skins of veggies and fruits. Try removing them before eating. Chopping and cooking a food only changes fiber a minuscule, if any, amount. However, removing the seeds and skin will go a long way in reducing fiber. It is something you can easily adjust to when you feel well verses suffer a flare.
Go with broiled and grilled methods over frying and get your produce at least fork-tender.
Life is not stagnant. Certain changes may influence your nutritional needs and/or limitations. Adopting an exercise plan, for example, will increase your nutritional and hydration needs. If you are limited in what your gut can tolerate and moderating even healthy fats, this may be a problem you should discuss with your nutrition expert. Illness, injury, surgery, pregnancy, and such changes certainly merit an appointment with your health care team to assess any necessary diet modifications.
11. Take Support
Your first line of support is your healthcare team. They will be instrumental in ensuring that your diverticulitis diet is safe and efficient. The doctors, nutritionists, and nurses will also be able to point you toward local and national support groups, educational materials, recipes, meal planning guides, and all sorts of other helpful resources.
Many suffering from life-altering pathologies need such resources to openly discuss their challenges, accomplishments, and missteps with knowledgeable and like-minded peers.
Once you understand your diverticular disease and how it impacts your diet, the next step is to have a conversation with friends, family, and coworkers. It can be particularly difficult to balance one person’s dietary needs against the rest of the family eating at-will. It may be helpful to bring family with you to a nutritionist appointment so they can better understand what you face.
12. Ask If You Need Supplements
Due to dietary restrictions, you may need to replace essential vitamins and minerals with supplements. There are also supplements, such as probiotics, that are designed to support gut health. Joining a club enables you to buy in bulk and often at a discounted rate. Ask your doctor if a supplement is right for you.
13. Be Aware Of Side Effects
Fiber, in particular, is a precarious thing. Too much, too fast, and you suffer unwanted bloating, cramping, and stomach discomfort. But, if you are accustomed to that daily high fiber, then your gut often responds to cutbacks with constipation. If you cut back on fiber during flares, you may want to proactively ask your doctor for a non-fiber laxative or stool softener recommendation.
Another consideration is the lack of energy you may experience during flares if you find it necessary to severely limit your food choices or temporarily adopt a liquid diet. Be sure to pair such gut rest diets with physical rest.
How Does The Diverticulitis Diet Differ From Other Diet Choices?
A diverticulitis diet is specifically geared toward the facets of diverticular disease. However, there are other diets that can be used for chronic inflammatory bowel diseases. They are all very much akin to the type of diet a surgeon will suggest after any gastrointestinal surgery. The most common two are the BRAT diet and the low-FODMAP diet:
1. Low-FODMAP Diet
This diet is also commonly recommended for people with IBS. It’s a three-step diet that swaps high FODMAP foods for low FODMAP foods for two to six weeks, reintroduces those dismissed foods one-by-one every three days over a 12-week period, and then evaluates what was tolerated verses what wasn’t tolerated.
Yes, it’s very similar to an elimination diet, but the choices are much more precise and based on serving size and register on the FODMAP food chart. This does correlate to diverticular disease because the high- FODMAP foods are those that commonly cause cramps, gas, and bloating.
2. BRAT Diet
This diet is multi-functional. It is used for viral stomach bugs and basically any condition that causes nausea, vomiting, or upset stomach. Its name is the acronym for acceptable foods following a 24 hour period of the liquid diet. BRAT – bananas, rice, apples, and toast.
Other “bland “ foods, such as crackers and cooked cereals, are slowly introduced as tolerated until the stomach is once again able to tolerate its normal diet. Like the liquid diet, this diet is not intended as a long-term plan, but it is quite useful to follow during diverticular flares.
Is A Diverticular Diet Right For You?
In closing, we suggest speaking with your health care team before adopting any diet. If highly restrictive, we also recommend speaking with your health care team about appropriate supplements. Remember, the above diverticulitis diet is not intended to be a one-size-fits-all solution. It will take time and trial and error to determine what facets and foods work best for your unique body and pathologies.