Diverticulitis, an inflammation or infection of small pouches called diverticula in the lining of the colon, can cause significant discomfort and disrupt daily life. Understanding the condition and following appropriate dietary guidelines are crucial for managing flare-ups and preventing future occurrences. This article provides a comprehensive overview of diverticulitis, its causes, symptoms, and, most importantly, the dietary strategies to navigate this condition effectively.
Understanding Diverticulitis and Diverticulosis
To understand diverticulitis, it helps to start with diverticulosis. Diverticulosis happens when small pouches, called diverticula, form in the lining of your colon (large intestine). These pouches are quite common, especially after age 40, and often cause no symptoms - most people with them don’t even know they have them. In fact, more than half of people in the United States over the age of 60 have diverticula. Diverticulitis happens when these pouches become inflamed, typically from a tear or bacterial infection. When these symptoms happen, it’s called a flare-up.
According to David M. Manuel, MD, a gastroenterologist at Northwestern Medicine, “The incidence of diverticulitis is increasing with the largest increase in patients aged 18 to 44. Dr.
Diverticulitis Symptoms
Diverticulitis can cause stomach pain, nausea, vomiting, bloating, fever, constipation, or diarrhea.
The Role of Diet in Managing Diverticulitis
When you’re having a bout of diverticulitis, it’s helpful to give your digestive system a rest by drinking liquids and eating easy-to-digest, low-fiber foods.
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Dietary Differences Between Diverticulosis and Diverticulitis
When you have diverticulosis, little pouches or pockets form on the inside lining of your intestines and your colon. These pockets, called diverticula, are relatively harmless on their own. You can think of them as freckles or skin tags. They’re usually not a problem unless they get irritated or infected - and when this happens, it’s called diverticulitis.
When these pockets become infected or injured, it can cause inflammation to build up inside those pockets that can then spread to other areas of your colon. During these flare-ups, you’ll likely experience:
- Abdominal cramping.
- Pain or tenderness in the area.
- Swelling.
- Bloating.
- Constipation or diarrhea.
It’s possible to have diverticulosis without ever developing diverticulitis. So, the key to preventing flare-ups is making sure your diet doesn’t cause any additional inflammation or injury when you have diverticulosis. And when you’re having a flare-up because of diverticulitis, your diet should change to decrease the severity of your symptoms and allow your intestines to recover.
Dietary Guidelines During a Diverticulitis Flare-Up
During a flare-up, your care team may recommend a special diet to reduce irritation and inflammation and to help your gut heal. This can be a clear liquid or low-fiber diet. Always consult with your physician or a registered dietitian before starting any restrictive diet, especially for medical conditions.
Clear Liquid Diet
If your flare-up is severe with persistent diarrhea, fever or pain, or you need surgery, you may be placed on a clear liquid diet. “When someone is acutely flaring, they are often given the suggestion to go to a clear liquid or low-fiber diet,” says Bethany M. Doerfler, MS, RDN, a clinical research dietitian at Northwestern Medicine Digestive Health Institute.
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When your diverticulitis flares up, giving your gut a break can often help ease your symptoms. Your doctor may tell you to stop eating and drinking altogether for a short time so that your digestive system can rest and recover. This pause in eating is sometimes called a bowel rest. After this brief break, your doctor may recommend that you avoid solid food and only consume liquids for 2-3 days. Be sure to choose clear liquids.
Some good choices include:
- Clear, fat-free broth
- Fruit juice, as long as it has no pulp
- Water (plain or carbonated)
- Sports drinks
- Tea or coffee, but don’t add milk or cream
You can also chew on ice chips or eat gelatin (without fruit) or ice pops (as long as they don’t contain fruit or pulp).
Low-Fiber Diet
If your symptoms are mild or improve after a clear liquid diet, your care team may recommend foods that are soft and easy to digest. These foods may be chopped, ground, mashed or pureed to make them gentler on your digestive system. It is important to note that individual responses to food can vary. Consider keeping a food diary during a flare-up to help you and your care team identify any specific foods that trigger symptoms for you.
You should begin to feel better after a short period on an all-liquid diet. If your symptoms are improving, your doctor will probably recommend that you slowly begin eating solid foods. It’s important to choose low-fiber foods during this time. That may seem surprising if you have ever heard that eating a high-fiber diet reduces the risk for diverticulitis. That’s true, but it’s best to avoid fiber in your diet when you are having diverticulitis symptoms.
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Continue with a low-fiber diet for 2-3 days, or as long as your doctor suggests. Some low-fiber foods include:
- Eggs
- Chicken and turkey
- Fish
- White bread, rice, and pasta
- Canned or cooked fruits (be sure they have no skin or seeds)
- Canned or cooked vegetables (with no skin)
- Fruit and vegetable juice (with no pulp)
- Low-fiber cereals
- Milk, yogurt, and cheese
BRAT Diet
You may have heard or read that a meal plan called the BRAT diet can ease symptoms if you’re having a diverticulitis flare-up. BRAT stands for:
- Bananas
- Rice
- Applesauce
- Toast
These foods are bland and easy to digest, which might help diverticulitis. Other foods that may be part of the BRAT diet include saltines, oatmeal, and potatoes. The BRAT diet may be worth trying to help control a diverticulitis flare-up. But keep in mind that this meal plan is very low in nutrients, so you shouldn’t consume the BRAT diet for long. As always, it’s best to talk to your doctor about what diet makes sense for you.
Foods to Avoid During a Flare-Up
When your diverticulitis is flaring up, it’s important to let your digestive system relax and heal. That means avoiding foods that are high in fiber. Normally, it’s a good idea to include plenty of high-fiber foods in your diet, as they have many health benefits. But high-fiber foods are harder to digest, and avoiding these foods during a flare-up can help get your symptoms under control.
Some high-fiber foods to stay away from during this time include:
- Fresh fruit, especially apples, pears, and raspberries
- Vegetables (other than canned), especially green peas and broccoli
- Beans and other legumes, such as lentils
- Whole wheat and rye bread
- Oat bran muffins
- Whole wheat pasta
- Brown rice
- Popcorn
- Pistachios
Transitioning Back to a High-Fiber Diet
Once your flare-up is fully over (usually in a week or two), you should gradually return to a high-fiber diet, which can help prevent future flare-ups. A high-fiber diet keeps your poop soft, promotes regular bowel movements and reduces pressure on your colon, which is thought to lower the risk of diverticula forming and becoming inflamed. Aim for 25 to 35 grams of fiber daily, gradually increasing to avoid bloating and discomfort.
High-Fiber Food Choices
When your diverticulitis is under control and you’re not having a flare-up, eating a well-balanced diet can help prevent future attacks. Your diet should include plenty of high-fiber foods, which studies show help prevent diverticulosis, the condition that can lead to diverticulitis.
Some good high-fiber choices include:
- Whole grains, such as 100% whole wheat bread, quinoa, bran cereal, and popcorn
- Beans and other legumes
- Vegetables, especially spinach and other greens, broccoli, and carrots
- Fruit, especially berries, apples and pears (leave the skin on), and oranges
- Sunflower and pumpkin seeds
- Almonds, pistachios, and other nuts
Increasing your fiber intake can make you feel gassy and bloated, so start slowly and build your way up. Drinking plenty of water every day can help you make the transition to a high-fiber diet.
Recommended Daily Fiber Intake
Your goal for daily fiber intake depends on your sex and age:
- Women aged 50 or younger: 25 grams
- Women over 50: 21 grams
- Men aged 50 or younger: 38 grams
- Men over 50: 30 grams
Foods to Include in a Diverticulosis Eating Plan
A high-fiber diet helps fight constipation by softening stool, which then moves through your gastrointestinal (GI) tract more comfortably and easily. There’s also less pressure against those pockets, which helps prevent diverticulitis flare-ups.
A high-fiber diet typically includes 25 to 35 grams of fiber per day. You can work that into your nutritional plan by choosing minimally processed plant foods such as:
- Whole grains.
- Fruits.
- Vegetables.
- Beans.
- Legumes, including lentils and nuts.
Years ago, doctors thought that if you ate corn, popcorn, nuts and seeds, those tiny components could get caught inside the pockets along your intestines, causing them to become inflamed so that you developed diverticulitis. But there’s no research to support that theory.
“It’s safe to eat these types of foods, including tomatoes and strawberries with seeds,” Taylor notes. “All that normal roughage and fiber is fine.”
To get the most out of a high-fiber diet, she also recommends:
- Drinking at least 64 ounces of water a day - more if you’re active.
- Exercising regularly (it helps propel waste through your system).
- Eating a variety of food groups, including five or more servings of fruits and vegetables, three of whole grains and a serving of nuts or beans each day.
- Limiting red meat, processed foods and foods that are high in saturated fat.
“Diverticular disease may be common in Western societies because our diets are so low in fiber,” Taylor says. “Americans, on average, eat around 14 grams each day - about half of what’s recommended.”
Foods to Limit
If you’re not having a flare-up or experiencing any symptoms, you should limit low-fiber foods, red meat and other food triggers that cause you GI upset.
If you’re having a flare-up and are experiencing symptoms, you should avoid high-fiber foods until your symptoms subside or your healthcare provider gives you the all-clear.
Addressing Common Misconceptions
Previously it was common for medical professionals to advise patients with diverticulosis or a history of diverticulitis to avoid small, hard foods like nuts, seeds, corn and popcorn. The theory was that these foods could get stuck in the diverticula, leading to inflammation or infection and triggering a diverticulitis flare-up. However, there is no evidence about that being true. In fact, seeds, popcorn, and nuts are good sources of fiber, which appears to prevent these attacks. No other foods or beverages seem to trigger diverticulitis.
Additional Considerations
The Importance of Hydration
Adequate fluid intake is essential, especially when increasing fiber consumption. Aim for at least 8 cups of fluids per day to help prevent constipation.
Probiotics and Gut Health
Some studies suggest that probiotics may play a role in maintaining gut health and reducing inflammation. However, more research is needed to determine the specific benefits of probiotics for diverticulitis.
Lifestyle Factors
In addition to diet, other lifestyle factors can influence the risk of diverticulitis. Regular physical activity, maintaining a healthy weight, and avoiding smoking may help reduce the risk of complications.
The Worst Thing for Diverticulitis
If you’re having a diverticulitis flare-up, eating foods that are high in fiber may make it worse. During a flare-up, you should eat low-fiber foods, which are easier than high-fiber foods to digest. Giving your digestive system a chance to rest will help ease your symptoms.
Calming Inflamed Diverticulitis
To calm inflamed diverticulitis, doctors usually recommend first taking a brief pause from eating and drinking, then adopting a diet of only clear liquids for a few days. As your symptoms improve, you can gradually add low-fiber foods to your diet. When your diverticulitis symptoms are under control, you can resume your normal diet.
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