Diverticulosis is a medical condition of the lower portion of the intestinal tract, or colon, in which pouches start to develop.
Usually, in a healthy intestinal tract, the tissue is smooth and elastic. And it looks similar to a long tube that compresses to a small size to fit into the available space in the abdomen. This helps waste to pass through it with ease on its way out of the body.
But when specific health issues arise, the intestines’ walls become thin and fragile in some places, especially on the left side of the intestines and close to the colon. This causes pouches to form, which doctors call “diverticula.” This herniation is referred to as diverticular disease.
When is Diverticulosis Dangerous?
Having a few diverticula in the intestines doesn’t pose any problems at first. Most people aren’t even aware that they have them because there aren’t any symptoms present. But over time, if nothing is done to prevent it, the diverticula’s number tends to increase.
When this happens, each diverticulum gets larger and more pronounced. So instead of the waste being able to pass cleanly through the intestines, some of it breaks off, and it gets trapped inside the pouches.
Human waste has a lot of bacteria in it. And the walls of the intestines are very thin. In some cases, the trapped fecal matter causes inflammation, swelling, and infection to start to develop. The name of the condition then changes from “diverticulosis” to “diverticulitis.”
Diverticulitis: When the herniated pouches, or diverticula, become inflamed and/or infected. These pouches can rupture and spill the waste from the intestines into the abdominal cavity. This is a life-threatening situation that requires immediate medical attention.
Diverticular Bleeding: A second form of diverticular disease presents with bleeding instead of the more traditional symptoms of pain. Research has shown that people presenting with pain don’t often have bleeding and vice versa, which is how the two conditions were determined.
The infection in the lower intestinal pouches rarely stays localized to this region because the thin tissue allows it to pass through to other areas in the body. That means it could spread to other nearby organs once it reaches the bloodstream, leading to a severe systemic infection that is much harder to treat.
Unfortunately, there is no way to reverse the pouches once they form. So if the condition goes untreated for too long, it could worsen to the point where surgery is required to remove the section of affected intestines.
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Diverticulosis and Diverticulitis Symptoms
Once enough diverticula have formed in the lower intestines, a person may start having uncomfortable, persistent symptoms.
Some of the most common of them include:
- Pain in the lower abdomen
- Loss of appetite
Who Gets Diverticulosis the Most?
For years, doctors were unsure of what triggered this condition. But they finally figured out the leading cause of diverticulosis is diet when they noticed that people in Asia and Africa rarely develop the condition. Westerners living in the United States have the highest rate of it overall.
The difference between the world’s regions is the amount of vegetables, fruits, and whole grains eaten. Those who live in Asia and Africa consume about 50 grams of fiber a day from these foods. However, Westerners eat regular amounts of fast food, soda, and junk food daily, so they get very little fiber.
Fiber is important because it absorbs water without being broken down by the body. So as it passes through the gastrointestinal system, it holds solid waste together, which helps it pass out of the body more easily. And this prevents hardened, leftover stools from causing pouches in the first place.
Age also plays a factor. Research has shown that those who are over the age of 40 have a higher chance of developing diverticulosis than a younger person.
Men tend to get the condition more than women because they need more fiber, but they also tend to eat a primarily protein-based diet. That doesn’t mean that women aren’t at risk, though. Since women naturally crave sweet snacks more than men, they can still develop diverticulosis if they eat a sugar-laden diet with little nutritional value.
Other Risk Factors of Diverticulosis
Some of the possible risk factors for diverticulosis include:
- Drinking alcohol
According to a study from PLoS One, “alcohol consumption [is a] strong risk factor for uncomplicated colonic diverticulosis, and the risk increases in line with the amount of alcohol consumed.”
Further research in the Journal of Clinical Gastroenterology came to the same conclusion. “Alcohol use is a significant risk factor for colonic diverticulosis and may offer a partial explanation for the existing East-West paradox in disease prevalence and phenotype.”
However, the Hawai’i Journal of Medicine & Public Health ran a meta-analysis review of all current studies in 2017 and found no connection between alcohol intake and diverticulosis.
- Tobacco smoking
In a recent review of research articles that included studies with more than 130,000 participants, smoking was a significant risk factor for diverticulosis. Researchers noted that the increased risk was found in active smokers. Still, former smokers didn’t show an increased risk, which lends credence to the idea that active smoking is a cause for concern, but quitting smoking can reduce the risk of diverticulosis back to levels near non-smokers.
A second review of research, this time involving more than 380,000 participants, also showed a significant connection between smoking and the risk of developing diverticulosis. In this analysis, “there was some evidence that smoking also increases the risk of complications of diverticular disease, but the number of studies is small.”
- Obesity or high body mass index
Obesity doesn’t always correlate with higher BMI. When 1445 study participants, 328 of which were previously diagnosed with diverticulosis) underwent CT scans, abdominal obesity, even in participants with a normal BMI, was a common risk factor for diverticulosis. According to the research, “Abdominal obesity measured by CT, not BMI, is associated with colonic diverticulosis, even when body weight was normal. These findings suggest an important role for visceral fat accumulation in diverticulosis development. A high visceral fat was positively associated with the distribution of diverticula.”
It appears that waist circumference may also be an indicator of increased risk of diverticulosis. “Waist circumference, an anthropometric measure correlated with obesity and, more specifically, visceral adiposity, was also shown to be positively associated with the presence of diverticulosis. Participants whose waist circumferences were between 38–45 inches tended to be 2.4 times more likely to have diverticulosis than those who had waist circumferences below 38 inches. Additionally, participants with waist circumferences above 45 inches were 8.1 times more likely to have diverticulosis than those with waist circumference smaller than 38 inches.”
Uncontrolled hypertension, not hypertension currently controlled with medication, is a risk factor for diverticulosis, according to Therapeutic Advances in Gastroenterology. The research uncovered that “findings suggest a positive association between hypertension and diverticulosis. Participants with poorly controlled blood pressure were found to have a higher risk of asymptomatic diverticulosis.”
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First and foremost, in most cases of diverticulosis, there are no symptoms, so no treatment is necessary. However, in a small number of cases, symptoms do arise. Since the leading cause of diverticulosis is due to a diet, the best way to correct the problem is to change the way that a person eats.
The treatment for diverticulosis includes a diet that is high in fiber, low in sugar, and low in red, fatty meats. Doctors may suggest using fiber supplements if dietary intake just isn’t cutting it. Fiber supplements are generally taken one to three times daily, as determined by your healthcare provider.
Probiotic use is also growing. “Since diverticulosis is associated with low fiber diet, dysbiosis is probably common in patients with diverticular disease. Probiotics may restore the balance of gut flora by decreasing pathogenic gram-negative bacteria and have been proposed to be used in diverticular disease to prevent inflammation.”
Prescription medications are also available for the treatment of diverticular disease. For instance, medicines like mesalazine and rifaximin have been prescribed to reduce symptoms of diverticulosis. However, keep in mind that these medications and treatments do not remove the diverticula that have formed. These treatments are for symptoms, not a cure.
In patients presenting with diverticular bleeding, colon resection may be necessary. The procedure removes the affected portion of the bowel and sews the remaining ends together. If the surgeon cannot safely rejoin the two ends during the initial surgery, a temporary colostomy will be performed until a second surgery can rejoin the bowel.
Diverticulosis Diet Plan
The best diverticulosis diet plan depends on whether a person has persistent symptoms that won’t go away or a sudden attack.
A diet for diverticulosis attack is made up of clear liquids. A person shouldn’t stay on the liquid diet for more than a few days unless under the care of a healthcare provider because they wouldn’t be getting enough calories or proper nutrition.
The diet for a diverticulosis attack includes:
- Chicken or vegetable broth
Caution should be used when researching a liquid diverticulosis diet because some websites suggest juices and popsicles. But these contain a large amount of sugar that may contribute to inflammation, which could make the symptoms worse, not better.
After the liquid diet for diverticulosis or diverticulitis, there is an interim where you may be advised to eat a low-fiber diet. This gives the gut more time to heal, rest, and recover. Under your provider’s care, you will gradually add in higher-fiber foods and eventually move to a high-fiber diet to help prevent further diverticulosis attacks.
A solid diet for diverticulosis is much heartier. It contains:
- Whole grains, such as quinoa, flaxseed, oatmeal, and whole wheat
- All types of fresh fruits and vegetables
- Small portions of lean meats, such as fish and chicken
- Almond and non-dairy milk
The aim should be to consume about 14g of fiber for every 1000 calories or 28g of fiber in a 2000-calorie a day diet.
It is sometimes suggested to consume a minimum amount of dietary fiber daily without total calorie intake. In this case:
Women 19 to 50: 25g of fiber daily
Women 50+: 21g of fiber daily
Men 19 to 50: 38g of fiber daily
Men 50+: 30g of fiber daily
Not only does eating high-fiber foods help prevent diverticula from developing, but it can also help relieve or prevent symptoms of diverticulosis.
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Diverticulosis Diet Benefits
Besides preventing the onset of diverticula in the intestinal tract and reversing the inflammation and other symptoms that lead to diverticulitis, the diverticulosis diet offers some other surprising benefits, which include:
Lower Heart Disease Risk
The main reason that people develop high cholesterol and clogged arteries that increase their chances of developing coronary artery disease is because they eat a sugar-laden diet that is high in fatty foods and low in fiber.
So while a person might not intentionally be trying to improve their heart health when they go on a diverticulosis diet, they will still find that it reduces their risk of a stroke or heart attack. Current research states, “Observational studies have shown that dietary fiber intake is associated with decreased risk of cardiovascular disease.”
Lower Blood Sugar
A diverticulosis diet high in fiber helps people with diabetes who are struggling to keep their blood sugar level stable.
Fiber slows down the rate at which food is processed and absorbed in the gastrointestinal tract. And this, in turn, reduces the amount of sugar that is released into the bloodstream at a time, so the pancreas doesn’t have to release extra insulin to help bring the sugar level back down when it spikes. A 2016 study shared, “Consumption of foods containing moderate amounts of these fibers may improve glucose metabolism and lipid profile in type 2 diabetes patients.”
Eating a diverticulosis diet improves energy drastically because the body will get all the proper vitamins and minerals that it was missing while eating an unhealthy diet. All the intestines’ waste will also pass through easily, which means that there won’t be a build-up of harmful bacteria being released into the bloodstream. This alone improves how someone feels because intestinal infections cause serious lethargy.
One interesting benefit of having a healthy digestive system is that since the body can flush out waste properly, fewer toxins are in the body. And this can be directly seen in a person’s skin. “Any dietary imbalance in the form of nutritional deficiency, specific nutrient inadequacy, or excess and toxic components can disturb the equilibrium of the skin.”
Most people will notice that they have less acne and blemishes within a matter of weeks of switching to the diverticulosis diet. This benefit can be more easily achieved if a person is careful to drink at least eight glasses of water per day.
Although the main reason people go on a diverticulosis diet is to improve their intestinal health, an added bonus to following a diverticulosis diet is that a person can easily lose a few pounds.
At first, there will be a more noticeable amount of weight loss when a person steps on the scales because the extra fiber will help flush out the old waste built up in the intestinal tract. But the weight loss won’t stop there.
Since the diverticulosis diet is healthy and low in calories, at least one or two pounds can be shed per week after this, mainly if a person includes an hour of exercise a day in their new lifestyle. Exercise helps encourage the bowels to move regularly, so most doctors recommend that their patients suffering from intestinal problems perform some type of aerobic exercises regularly.
There’s also the benefit of weight loss on the chance of developing diverticulosis, at least in women. According to research, “Among men, there was no association between any measure of obesity and diverticulosis. After adjustment, women with an obese body mass index had an increased risk of any diverticulosis compared with women with a normal body mass index.”
Diverticulosis Diet Side Effects
The diverticulosis diet is safe and effective for anyone willing to make the necessary changes to the way they eat to have a healthy gastrointestinal tract.
However, it is common to experience a few side effects at the beginning of this regimen. The side effects are mostly due to the extra amount of fiber a person is eating.
It is common to experience gas, constipation and bloating until the bulky stools are passed out of the body. Cramping is common too.
These symptoms can be more severe if a person decides to take over-the-counter fiber capsules instead of following the diverticulosis diet as they should. Fiber that is found in food is much gentler on the body than the supplements most stores offer.
Beginning a solid diverticulosis diet in the middle of a diverticulitis attack can also be problematic because the intestinal tract will be too inflamed and infected to handle the increased amount of solid stools.
It is best to always follow the liquid diverticulosis diet for a few days because it will give the intestines and colon a chance to heal.
To prevent the side effects of switching from a liquid diverticulosis diet to a solid diverticulosis diet, it helps to start with only a small amount of fiber at first.
Then, build up the amount included in the diet over the course of one or two weeks.
How to Prevent Diverticulosis
According to the American Heart Association, daily fiber intake should be around 25 to 30 grams. Unfortunately, the average American consumes about half the recommended amount, which leaves much room for improvement.
Fiber intake is so important because fiber eases the movement of waste through the bowels, so there’s no straining involved in passing waste. Straining can contribute to and complicate diverticulosis.
As mentioned before, men and women have different needs when it comes to fiber. Men should have a minimum of 38 grams of it a day. Women require only 25 grams of it a day.
The amount that children need is generally about half of this, depending on whether they are boys or girls. Older senior citizens have slower digestive systems, so doctors often suggest that they eat more than the daily requirements of fiber for middle-aged adults.
However, it should be mentioned that it is possible to get too much fiber in the diet.
Occasionally, those desperate to alleviate their diverticulosis symptoms or diverticulitis consume a much more significant amount of fiber than their body needs because they think it will make them get better faster.
But in reality, it will increase the strain on the intestines. This most commonly occurs when a person takes fiber supplements while eating a high-fiber diverticulosis diet.
When someone overeats fiber, and their intestines are not healthy enough to handle it, there is a good chance that they can develop a blockage in their intestinal tract. That means the hardened stools collect in one area, which blocks the stools’ flow exiting out of the body.
This can quickly become a life-threatening condition because the only way to treat a blockage in the intestines is surgery.
Less severe problems that occur when a person doesn’t follow the doctor-recommended guidelines for fiber consumption by consuming too much fiber are constipation, bloating, and gas.
Water plays two critical roles in the prevention of diverticulosis. First, water helps lubricate the bowel so that waste can move through the system effortlessly. Secondly, as you up your fiber intake, you also have to up your water intake. Fiber requires water to form a bulk that passes through the intestine and out of the body. This bulk scours the sides of the intestine along the way – cleaning away old waste. If you up your fiber intake and you don’t increase water intake, the bulk fiber forms will be hard, and passing it will be difficult. This eventually leads to constipation or blockage.
Not only does lack of exercise increase the risk of developing diverticulosis, but exercising can improve bowel movements and gut microbiota, supporting gut health. “An increasing body of evidence suggests that gut microbiota can be modulated by different factors, such as infection, disease, diet, antibiotics, and exercise, and, in turn, these modulations can affect some diseases. Interestingly, exercise can determine changes in the gut microbial composition playing a positive role in energy homeostasis and regulation.”
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What are High-Residue and Low-Residue Diets for Diverticulosis?
A high-residue diet is a high-fiber diet. The term residue refers to the amount of substance left in the intestinal tract after digestion. High-fiber foods provide more bulk; thus, they have a higher residue. This diet is suggested for people with diverticulosis who are NOT currently in an attack.
A low-residue diet is a low-fiber diet that is much easier on the digestive tract. Low-fiber means less bulk in the intestine, giving the bowel time to heal and rest before the additional fiber is added back into the diet.
The Low-Residue Diet and Low-Residue Foods
According to the GI Society, foods that are allowed on a low-residue or low-fiber diet include:
- White bread
- White cereals
- White pasta
- White rice
- Refined grains
- Juice without seeds or pulp
- Animal proteins
- Peeled and seeded fruits
- Soft-cooked vegetables
It’s important to note that this diet plan lacks many nutrients and shouldn’t be followed long term. A low-residue diet will not combat inflammation associated with diverticulitis, but it will ease the digestive system’s stress.
The High-Residue Diet and High-Residue Foods
On the flip side is the high-residue or high-fiber foods commonly suggested for people with diverticulosis who’re not currently having symptoms. This diet is also considered helpful in preventing diverticular attacks.
High-residue foods include:
- High-fiber cereals
- High-fiber breads
- Whole grains
- High-fiber fruits and vegetables, often with the skin intact
There are plenty of fiber-enriched products on the market, like the FiberOne brand, but the body prefers to get fiber in its natural form as part of a high-residue diet.
Diverticulosis Diet Recipes
There are three diets for diverticulosis – the clear liquid diet, the low-residue diet, and the high-residue or high-fiber diet. Here are some recipes for each stage of healing.
Clear Liquid Diet Recipes
For the two to three days that you may be following the clear diet for diverticulosis, your intake is extremely limited, so recipes are limited. Your major food group will be broth, bouillon, or consomme.
- 2 pounds of beef or chicken bones
- 2 onions, peeled and halved
- 2 celery stalks, halved
- 2 carrots, peeled and halved
- 1 bunch of garlic, halved
- 3 bay leaves
- 2 tablespoons coarse salt
Throw all ingredients into a large stockpot and cover with water. Bring to a rolling boil, reduce heat to a simmer, cover and cook for up to 12 hours. You may need to add water throughout the day. A foam will appear on top of the broth, skim the foam and throw away.
Once the 12 hours are up, strain the broth through cheesecloth to remove all leftover ingredients.
Bone broth may be stored in a refrigerator for up to five days or frozen and reheated as needed.
Clear Chicken Broth
- 1 5-lb chicken, remove gizzards and liver but keep neck bones
- 4 carrots, peeled and halved
- 4 celery stalks, peeled and halved
- 1 large onion, peeled and halved
- 1 bunch of garlic, halved
- handful of thyme
- handful of rosemary
- handful of parsley
- 4 tablespoons of coarse salt
Throw all ingredients into a large stockpot and cover with water. Bring to a rolling boil, then reduce heat to a simmer. Half cover the pot with a lid and simmer for four hours. Drain your broth through cheesecloth and refrigerate for up to five days.
Low-Residue Diet Recipes
The low-residue diet is much more filling than the clear liquid diverticulosis diet. Here you can add solid foods back into your day. However, keep in mind that low-residue means low-fiber.
Honey-Herb Chicken by Johns Hopkins Medicine
- 1 pound boneless, skinless chicken breast
- 1 lime, juiced
- 2 tablespoons of coriander, chopped
- 2 tablespoons honey
In a small bowl, mix honey, lime juice, and coriander. Set aside.
Pound chicken breasts until about ½-inch thick. Coat with honey mixture and place in the refrigerator for 10-15 minutes.
While the chicken is marinating, heat grill or broiler.
Cook chicken on each side for five minutes. Use a meat thermometer to measure internal temperature. It should reach at least 165-degrees F.
Feel free to serve hot or chill and use it as part of a chicken salad or sandwich.
- 4 pitas
- 2 Roma tomatoes, peeled, seeded, sliced thin
- ½ cup fresh mozzarella cheese, shredded
- ½ cup provolone cheese, shredded
- 4 fresh basil leaves, cut in ribbons
- 1 large garlic clove, peeled and halved
Preheat your oven’s broiler on high. Place pitas on a baking sheet. Rub pitas with the cut side of the garlic clove. Sprinkle ⅛ cup of provolone cheese over each pita. Add slices of ½ a Roma tomato to each pita. Add ⅛ cup of shredded mozzarella to each. Top with fresh basil ribbons.
Broil until the cheese is melted and starting to brown. Watch carefully as this can happen quickly under a high broiler.
High-Residue Diet Recipes
Once you’ve passed through the clear liquid diet and the low-residue diet stages of healing, your healthcare provider may suggest a high-residue or high-fiber diet to stave off future attacks. Upping fiber intake is a slow process, so keep track of how much fiber you’re eating and gradually increase over time. Before starting on the high-residue diet, speak with your healthcare provider about how much fiber is a good starting point.
- ⅓ cup milk of your choice (cow, soy, almond, oat, etc.)
- ¼ cup applesauce, unsweetened
- ¼ cup old-fashioned oats
- ¼ cup plain yogurt
- ¼ cup apples, diced
- 1 teaspoon of vanilla extract
- 1 tablespoon chia seeds
- 2 tablespoons of honey or maple syrup
Mix all ingredients in a small canning jar or glass. Make sure there are no lumps. Cover tightly and place in the refrigerator for at least four hours or overnight. You may need to add additional honey to taste if you like sweeter oatmeal. This recipe makes one serving.
High-Fiber Sloppy Joes
- 2 tablespoons of olive oil
- 12 ounces lean ground beef, turkey, or chicken
- 1 cup canned black beans, rinsed
- 1 onion, peeled and chopped
- 2 cloves of garlic, peeled and chopped
- 1 teaspoon chili powder
- 1 teaspoon paprika
- 1 teaspoon cayenne pepper flakes, optional
- 1 cup tomato sauce
- 4 tablespoons ketchup
- 1 tablespoon Worcestershire sauce
- 2 teaspoons deli mustard
- 1 teaspoon brown sugar
- 4 whole-wheat buns, toasted
Heat olive oil in a large skillet over medium-high heat. Add ground burger and cook for three to four minutes, until almost cooked through. Remove from the pan, leaving drippings behind. Add onions and garlic to the pan and cook until onions are translucent. Add spices and cook for another minute or two. Add ground meat back into the pan with the remaining ingredients. Reduce to medium heat and cook for an additional five minutes. Serve piping hot on toasted whole-wheat buns.
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What is the Bottom Line on the Diverticulosis Diet?
The treatment for diverticulosis includes a diet that is high in fiber and low in fat and sugar. Since it requires particular portions and food choices, it is important to work with a healthcare provider to achieve the best menu plan.
Switching to a diverticulosis diet isn’t easy at first because a person may have to follow a liquid diet for a few days, especially if they have a diverticulosis attack. And this may be difficult to stick with because it isn’t easy to avoid solid food for that long.
If the liquid diet isn’t followed according to the diverticulosis diet instructions, a person could develop unpleasant side effects from consuming too much fiber too fast.
So it helps to slowly begin adding it in instead of attempting to take extra fiber supplements, which could cause further problems. However, it should be mentioned that not everyone needs to follow a liquid diverticulosis diet, which is why working with your healthcare provider is so critical.
The diverticulosis diet has been proven to have some amazing health benefits that could make it useful for anyone concerned about developing diverticulosis, diverticulitis, or other chronic diseases.
And, it can fit into your Noom weight-loss plan with ease. Check out Noom today!
Questions and Answers on the Diverticulosis Diet
What is a liquid diet for diverticulosis?
If a clear, liquid diet for diverticulosis is recommended, you’ll consume liquids like water, clear juices, clear sports drinks, soft drinks, and clear broth. Some liquid diets suggest popsicles, but others warn that consuming too much sugar could cause a recurrence of symptoms.
How many days do I do a liquid diet for diverticulosis?
A liquid diet for diverticulosis generally lasts two to three days, followed by a period of low-fiber intake. You’ll be asked to gradually increase your fiber intake, over time, as your gut heals.
Is a high-fiber diet good for diverticulosis?
Yes, a high-fiber diet is good for diverticulosis. Fiber helps move waste more easily out of the body, helping prevent the formation of diverticula.
Can a high-fiber diet cause diverticulosis?
If you consume too much fiber and not enough water, hard, bulky stools can form that put pressure on the bowel walls. This may result in the formation of diverticula. Fiber and water intake need to be increased simultaneously.
Does fat in the diet cause diverticulosis?
The standard Western diet that’s high in fat and sugar and lower than recommended in fiber can be an underlying cause of diverticulosis.
Is a Mediterranean diet good for diverticulosis?
The Mediterranean diet suggests many of the same dietary changes as the diverticulosis diet.
Does the Gap diet heal diverticulosis?
There is no cure for diverticulosis, so no, the Gap diet doesn’t heal the condition. However, the Gap diet does suggest eliminating foods that can cause issues in the gut, like processed foods.
Is a keto diet good for diverticulosis?
A keto diet may not be ideal for people with diverticulosis. Keto is associated with constipation due to the reduced carbohydrate intake. Fiber is a carbohydrate.
What diet is best for diverticulosis?
Uncomplicated diverticulosis responds well to a high-fiber diet. If you are having an attack or have been advised to follow a restricted diet, the two standard options are a clear liquid diet or a low-residue diet. Your healthcare provider will talk with you about which of these diets is the best place to start your healing process.