The dos and don'ts of managing diverticular disease

Stay away from nuts and seeds, and don't eat popcorn - that's what doctors said years ago if you had diverticulosis, a condition marked by tiny pouches (diverticula) that develop in the lining of the colon. The thinking was that bits of food could get stuck in those pouches and cause inflammation or infection (which is called diverticulitis).

Today, we know the advice was wrong. The evidence does not show a higher risk of diverticulitis in people who eat a lot of foods like nuts, seeds, or popcorn, compared with people who don't.

What else do we know today about coping with diverticular disease? Here are some dos and don'ts.

DON'T fret over diverticulosis

Diverticulosis is common, especially as we get older. It occurs in about 40% to 60% of people by age 60 and typically develops in the lower left side of the large intestine (the sigmoid colon). Experts think that increased pressure in the colon pushes diverticula out through weak spots in the colon wall.

Diverticulosis has no symptoms.

DO report bleeding

In about 5% of people who have diverticulosis, rectal bleeding occurs when a small blood vessel ruptures in one of the pouches. This is known as diverticular bleeding, and the cause is not clear. Bleeding sometimes is triggered by medications like nonsteroidal anti-inflammatory drugs (a common class of pain relievers that includes aspirin, ibuprofen, and naproxen), acetaminophen, or blood thinners.

Even if you have minor bleeding that stops on its own, call your primary-care provider to get it checked out. If there's a lot of bleeding and you get lightheaded or faint, you should go to the emergency department. It's important to find the cause of the bleeding and receive treatment.

DON'T strain in the bathroom

If you have diverticula, putting pressure on them - if you're constipated, for example - may cause one to rupture (perforate) and become inflamed or infected. This condition is called diverticulitis. Perforation may occur even if you're careful not to strain, but less than 5% of people with diverticulosis develop diverticulitis.

DO report pain

Diverticulitis symptoms include pain and cramps in the lower left part of the abdomen, as well as diarrhea, constipation, fever, nausea, or vomiting. Call your primary-care provider if the pain doesn't go away, if it's intense, or if you have a fever.

People with uncomplicated diverticulitis - inflamed pouches with no abscesses or perforation - usually do not require hospitalization. You may receive antibiotics, but according to the most recent guidelines, some cases of uncomplicated diverticulitis do not require antibiotic treatment.

Complicated diverticulitis indicates a severe infection requiring hospitalization and intravenous antibiotics. About a third of cases of diverticulitis are severe.

DO maintain a healthy lifestyle

Living a healthy lifestyle is good for your gut. Obesity, type 2 diabetes, a sedentary lifestyle, and smoking have all been associated with an increased risk of diverticulitis.

Research published in 2025 analyzed data from more than 175,000 participants in three large studies (Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-Up Study). The research confirmed that certain lifestyle factors were associated with an increased risk of diverticulitis:

• overweight or obesity
• smoking
• little to no physical activity
• high intake of red meat (processed and unprocessed)
• low intake of dietary fiber.

Researchers then combined these five categories into a healthy lifestyle score, giving participants one point for each healthy habit. People with the highest score (5) had only half the risk of diverticulitis, compared with people with a score of 0.

So, if you smoke, take steps to quit. Make efforts to manage your weight and reduce body fat. At least 150 minutes of moderate physical activity per week or 75 minutes of vigorous activity can reduce risk; it also is believed to support a diverse population of helpful microbes in the gut, which is thought to play a role in healthy aging and longevity.

Typical Western diets are both low in fiber and high in saturated fats, including red meat. Reducing red-meat intake and increasing fiber are also important steps for supporting heart health, reducing chronic inflammation, and helping the bowels move regularly, which helps to maintain gut health and reduce pressure against diverticula.

Drink lots of water and aim for 25 to 30 grams of dietary fiber every day from beans, whole grains, vegetables, fruits - and yes, nuts and seeds. Those very foods once thought to trigger diverticulitis are actually full of fiber and supportive of a healthy gut.

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