Diet in Diverticular Disease

It is linked to ageing of the bowel wall, constipation and straining, and a low-fibre diet. Other risk factors are obesity, smoking, lack of physical activity, a diet high in red and processed meat, and regular use of non-steroidal anti-inflammatory painkillers (NSAIDs such as ibuprofen or diclofenac). Genetics also play a role.

Diverticulosis becomes more common with age and is found in a large share of older adults in Western countries; it is increasingly seen in younger adults as well. Only a minority of people with diverticula ever develop diverticulitis (commonly quoted as roughly 1 to 4 in 100 over some years).

Refined white bread and rice dominate many meals, so swapping part of them for whole wheat bread, brown rice, bulgur, freekeh, ful and lentils is a practical step. Salads, vegetable stews and fruit after meals add fibre. Drink more water in the hot months. During Ramadan, people with uncomplicated diverticular disease can usually fast; include fibre-rich foods and water between iftar and suhoor to prevent constipation, and speak to your doctor if you are recovering from an attack or have complications.

Diverticulosis is often found by chance at colonoscopy or CT. Diverticulitis is diagnosed from symptoms, examination, blood tests (inflammation markers) and usually a CT scan. A colonoscopy is often advised some weeks after an attack, particularly if complications occurred or if you have not had a recent colonoscopy, to be sure no tumour is hidden.

Lifestyle changes that also protect your heart and weight help the bowel too.

• Be active: aim for about 150 minutes of brisk activity a week, such as walking.

• Aim for a healthy weight; excess belly fat is linked to a higher risk of diverticulitis.

• Stop smoking.

• Avoid regular use of ibuprofen, diclofenac and similar painkillers unless your doctor advises; low-dose aspirin for the heart should not be stopped without medical advice.

• Do not strain on the toilet and do not ignore the urge to go.

Between attacks, aim for a fibre-rich diet; during an attack, follow your doctor’s advice and widen your diet as symptoms ease.

• Build up to about 25 to 30 grams of fibre a day (your dietitian can set a target). Increase slowly over several weeks to limit gas and bloating, and drink enough fluids (roughly 6 to 8 cups of water or unsweetened drinks daily unless your doctor limits fluids).

• Good fibre sources: oats, whole wheat bread, brown rice, bulgur, barley, lentils, chickpeas, beans (ful), fruit with skin where tolerated, vegetables, and dates in moderate portions.

• You do not need to avoid nuts, seeds, popcorn or fruit skins to prevent diverticulitis.

• Eat less red and processed meat (for example, sausage, luncheon meat); choose fish, poultry and legumes more often.

• During an acute attack: your doctor may suggest clear fluids for a short time, then a low-fibre (low-residue) diet, and then a gradual return to a high-fibre diet after you recover. Do not stay on a low-fibre diet long-term.

• If you cannot reach enough fibre from food or it causes symptoms, a bulk-forming fibre supplement (such as psyllium) can be discussed with your doctor.

If you have a bowel stricture, inflammatory bowel disease or have had bowel surgery, your fibre advice may be different. Ask your specialist.

Medicines are chosen by your doctor depending on whether you have symptoms or an acute attack.

• Bulk-forming laxatives can help if constipation persists despite diet.

• Simple pain relief such as paracetamol is preferred; avoid NSAIDs and opioids unless prescribed.

• Antibiotics are used for more severe, complicated or higher-risk diverticulitis, and are not always needed for mild attacks in otherwise healthy people.

• Mesalamine and rifaximin are not recommended routinely to prevent attacks; probiotics have not been shown to help.

Procedures are for complications or repeated severe attacks.

• Colonoscopy a few weeks after an attack to check the bowel.

• Drainage of an abscess through the skin guided by a scan, or in hospital with IV antibiotics.

• Surgery to remove the diseased section is considered for perforation, fistula, blockage, or after repeated attacks, based on your individual situation rather than the number of attacks alone.

• Endoscopic or interventional treatment for diverticular bleeding when it does not stop on its own.

The AGA clinical practice guideline and clinical practice update on diverticulitis (2021), the ASCRS guideline (2020) and NICE guideline NG147 (2019) advise a diet rich in fruit, vegetables, whole grains and legumes, regular exercise, healthy weight, stopping smoking and avoiding regular NSAIDs. Nuts, corn, popcorn and seeds do not need to be avoided: a large cohort study of US men found no increased risk and possibly lower risk. High intake of red meat is associated with higher risk. Honestly, most evidence on diet comes from observational studies; randomised trials showing that extra fibre cures symptoms or prevents attacks are limited, and NICE noted weak evidence. Antibiotics are no longer routine for mild uncomplicated attacks in selected patients, and a clear-liquid diet is often used briefly but strong evidence for it is lacking.

Most people with diverticulosis never have serious problems. Most attacks of diverticulitis settle with simple treatment, though some people have repeat attacks and a few need surgery. A healthy diet and lifestyle may lower the chance of problems, but they cannot guarantee that attacks will not return.

• How much fibre should I aim for, and how fast should I increase it?

• Which foods, if any, should I avoid?

• Do I need a colonoscopy after my attack?

• Is it safe to use my pain medicines (NSAIDs, aspirin)?

• When would surgery be considered for me?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.