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Diverticulosis vs. Diverticulitis: What’s the Difference and How to Manage Both

by Valerie Polley | Oct 29, 2025 | 0 comments

Many people are diagnosed with diverticulosis during a routine colonoscopy and are unsure what it means. While the terms sound similar, diverticulosis and diverticulitis are very different. While both conditions involve the colon, they differ in inflammation and symptom severity.

This blog post will clear up the confusion about the two conditions, explain management strategies, and address common myths about these common digestive conditions.

Diverticulosis vs. Diverticulitis—What's the Difference?

Before diving into myths and management strategies, it's important to understand the difference between diverticulosis and diverticulitis.

Diverticulosis

Diverticulosis is a term used to describe small pouches (called diverticula) that form in the lining of the colon. They're usually asymptomatic and are often discovered incidentally (such as during a routine colonoscopy).

The incidence of diverticulosis tends to increase with age and can affect over 70% of adults over 80. While it may present with mild symptoms like bloating, irregular bowel habits, and mild discomfort, in general, it doesn't cause too many issues.

Diverticulitis

Diverticulitis describes when one or more diverticula become inflamed or infected. Unlike diverticulosis, which tends to have mild or no symptoms, diverticulitis can manifest as abdominal pain (often on the lower left side), fever, nausea, and changes in bowel habits. 

Fewer than 5% of people who have diverticulosis will develop diverticulitis. Interestingly, the prevalence of diverticulitis by sex changes with age. While more men than women under 50 get diverticulitis, after age 50, diverticulitis is more prevalent in women.

Diverticulitis requires medical attention and sometimes antibiotics or hospitalization. Common complications of diverticulitis include:

  • Diverticular bleeding (when a small blood vessel in the diverticulum pouch bursts). This may be severe and life-threatening.
  • Abscess formation
  • Fistula formation (when an abnormal passage forms between the colon and another part of the body)
  • Blockage of the intestine
  • Colon perforation
  • Infection of the abdominal cavity lining (called peritonitis)

It's important to note that diverticulitis is a complication of diverticulosis, not a separate disease entirely.

What Causes Diverticula to Form?

There are many potential causes of diverticula formation, including:

  • A low fiber diet leading to constipation and higher colon pressure (from straining to have a bowel movement)
  • Aging and weakening of the intestinal walls
  • Smoking
  • Possibly changes in the gut microbiome and inflammation in the colon

In addition, genetics and lifestyle factors (such as inadequate physical activity or obesity) may also contribute. While we can't change age or genetics, diet and lifestyle can play a key role in preventing and managing diverticulosis.

Managing Diverticulosis

The goal of diverticulosis management is to prevent flare-ups and reduce the risk of diverticulitis occuring. Here are some tips I often share with my clients:

    • Eat a high fiber diet: Fruits, vegetables, whole grains, and legumes all provide fiber, which supports the microbiome and reduces the risk of constipation.
    • Stay hydrated to help fiber move through the intestines smoothly.
    • Exercise regularly to support a healthy body weight and bowel motility (the movement of waste through the bowels).
    • Avoid straining during bowel movements, as this can increase pressure in the colon and potentially lead to diverticula formation.

If you're currently following a low FODMAP diet (for IBS management) or other digestive health plan, it's important to increase your fiber intake slowly to avoid digestive symptoms like gas and bloating.

Managing Diverticulitis

Diverticulitis management depends on the severity of your symptoms. Mild cases can be managed at home with a combination of antibiotics, rest, and a temporary low-fiber or clear liquid diet to give your digestive system time to heal. More severe cases, especially those involving fever, significant pain, or complications like abscesses or bleeding, may require hospitalization, IV antibiotics, and, in rare cases, surgery to remove the damaged portion of the colon.

As your symptoms improve, it's important to gradually reintroduce fiber to support long-term gut health and reduce the risk of another flare. This typically happens in stages:

Clear liquids → low-fiber foods → high-fiber diet over time

During the clear liquid stage, stick with broths, clear juices, gelatin, and electrolyte drinks to stay hydrated and maintain energy. Once tolerated, transition to low-fiber foods such as white rice, plain pasta, white bread, canned peaches or pears, potatoes without skin, and lactose-free yogurt. Once you're feeling better, begin adding high fiber foods like oats, fruits, vegetables, beans, and whole grains—slowly, and with plenty of fluids.

Following up with your doctor and dietitian is key to preventing future episodes. They can help you develop a plan that balances fiber intake, supports regular digestion, and fits your personal tolerance.

Sample Diverticulitis Recovery Meal Plan

Everyone recovers at a different pace, so think of this as a gentle framework rather than a strict plan. Always follow your doctor or dietitian's guidance for your specific case.

Phase 1: Clear Liquids (1-2 days)

This phase gives your digestive system a rest while keeping you hydrated. Examples of foods to include are:

  • Clear broth or strained soups (chicken, vegetable, or bone broth)
  • Gelatin
  • Electrolyte drinks
  • Water, herbal tea, or diluted fruit juice (without pulp)
  • Popsicles made from pulp-free fruit juice

Dietitian Tip: Sip slowly throughout the day. The goal here is to keep you hydrated.

Phase 2: Low-Fiber, Soft Foods (2-4 days)

Once symptoms like pain and nausea subside, start to introduce easy-to-digest, low-fiber foods to help your body transition back to solids. Here are some foods to try:

  • White rice or plain pasta
  • Scrambled or poached eggs
  • Mashed potatoes (without the skin)
  • Canned peaches or pears in juice
  • Lactose-free yogurt or cottage cheese
  • White toast

Dietitian Tip: Stick to small, frequent meals every 3 to 4 hours to avoid overwhelming your gut.

Phase 3: Gradual Fiber Reintroduction (ongoing)

As you feel stronger, slowly reintroduce high-fiber foods to support long-term gut health and reduce the risk of recurrence. Try adding the following foods:

  • Oats, quinoa, or brown rice
  • Soft-cooked vegetables (carrots, zucchini)
  • Peeled apples or ripe bananas
  • Lentils or beans (in small portions at first)
  • Whole-grain bread and cereals

Dietitian Tip: Add one new fiber-rich food at a time and monitor your symptoms. Pair fiber with plenty of fluids, as water helps fiber move smoothly through your digestive system.

Common Myths About Diverticular Disease

 

Myth

Fact

You should avoid nuts, corn, and popcorn

Research shows no link between these foods and diverticulitis risk

Once you have diverticulosis, it always becomes diverticulitis

Only about 5% of people with diverticulosis develop inflammation

Fiber worsens diverticulitis

During a flare, a low-fiber diet is recommended, but long-term, fiber protects the colon

It's caused by spicy foods or stress

While stress can affect digestion (such as worsening constipation), diverticulitis is primarily linked to inflammation and pressure, not spicy foods

When to See a Doctor or Dietitian

If you experience persistent abdominal pain, fever, blood in your stool, or unintentional weight loss, it's important to see your doctor to rule out other causes of your symptoms, like inflammatory bowel disease (IBD) or colorectal cancer.

 If you're struggling with diet and lifestyle, a dietitian can help:

  • Gradually increase fiber safely
  • Build a personalized meal plan for symptom prevention
  • Support post-flare recovery and gut microbiome health

Remember, early intervention and professional guidance can reduce the recurrence of diverticulitis and improve overall quality of life.

Final Thoughts

Diverticulosis and diverticulitis are connected, but not the same. Diverticulosis refers to small pouches in the colon, while diverticulitis refers to the inflammation of these pouches. The key to preventing flare-ups lies in eating enough fiber, hydrating regularly, and getting adequate physical activity. With the right approach, you can live comfortably and confidently—without fear of flare-ups or outdated myths holding you back.

If you're struggling with making lifestyle changes to support a healthy gut, consider reaching out to us at Blue Tree Nutrition to schedule an introductory call. 

Our gut microbiome (the community of trillions of microbes that live in our gut) plays a key role in maintaining metabolic and immune health. Gut dysbiosis occurs when the composition and diversity of our gut microbiome shift. This could include overgrowth of harmful bacteria or a decrease in beneficial bacteria. Gut dysbiosis has been linked to a wide range of negative health outcomes, including increased levels of inflammation and changes in metabolism.

Many people switch to non-nutritive sweeteners like sucralose, aspartame, and stevia for health reasons, and for decades, we've believed that they pass through our bodies without affecting us. But emerging research shows that these compounds interact directly with our gut microbiome and may have potential negative effects on our health. 

This article will review what we currently know about the relationship between non-nutritive sweeteners (including artificial sweeteners and calorie-free natural sweeteners) and the gut microbiome, plus practical advice for navigating sweeteners.

Sucralose

Sucralose (Splenda) is an artificial sweetener commonly used in baked goods, gums, and sugar-free beverages and is approximately 600 times sweeter than sucrose (table sugar). However, recent research has linked it to adverse health effects such as systemic inflammation, metabolic disease, and gut dysbiosis. For example, a 2022 study found that sucralose consumption increased harmful bacteria and reduced beneficial bacteria, which was associated with changes in insulin and glucose levels.

Additionally, a 2025 randomized controlled trial examining the effects of replacing added sugars with sucralose found that people with type 2 diabetes who consumed sucralose experienced reductions in both alpha diversity (the number and types of species present in a single person) and beta diversity (differences in microbial composition between people). Interestingly, the people with overweight and obesity without type 2 diabetes did not experience the same changes.

Overall, animal studies and limited human studies suggest that sucralose may trigger intestinal inflammation, likely through its effects on the gut microbiome. However, since most of the evidence we have comes from test tube or animal studies, these results should be interpreted cautiously.

Aspartame

Aspartame is another commonly used artificial sweetener that is about 200 times as sweet as sucrose. While it does contain some calories, because you don't need much of it to reach the same sweetness levels as sucrose, these calories are negligible.

Like sucralose, most of the research into the gut effects of aspartame has been done in animals. However, we do have some very small human studies. A 2022 randomized controlled trial (RCT) involving 20 healthy adults found that participants taking aspartame showed changes in both probiotic (beneficial) and pathogenic (harmful) bacteria, but the changes were specific to each individual. 

Why the differences? It's likely due to the "responder vs. non-responder" phenomenon. We all have differences in our "baseline" microbiome. While certain bacterial species are common in healthy populations, our microbiome is as unique as a fingerprint. Whether an artificial sweetener has positive or negative effects on our microbiome may depend on which species are already present in our gut, as well as on our habitual diet. This difference in responses makes it very challenging to draw firm conclusions about whether artificial sweeteners are harmful.

Stevia

Many people choose stevia because it's a "natural" zero-calorie sweetener. Studies have shown mixed results regarding the effects of stevia on the gut microbiome. For example, while some in vitro (test tube) and in vivo (animal) studies have reported potentially harmful effects of stevia on the gut microbiome, others have found no impact, and some even reported beneficial effects through inhibition of inflammatory pathways.

Additionally, a 2024 human study found that stevia had no significant effect on the gut microbiome. This highlights the importance of not forming conclusions based solely on test tube and animal studies. Overall, it appears that stevia is a potentially less-harmful alternative to artificial sweeteners like sucralose and aspartame.

Practical Advice for Navigating Sweeteners

Since the research on artificial sweeteners is still evolving, the decision to include or avoid them comes down to personal preference. Here are some tips for including them in your diet in moderation:

  • Try gradually reducing the amount you use: If you typically use two packets of sweetener in your coffee or tea, try gradually reducing to one packet. Our taste buds are highly adaptable, and you may find that one packet is sweet enough once you get used to it.
  • Check your labels: Low- or no-calorie sweeteners (such as sucralose, aspartame, and sugar alcohols like erythritol) are often hidden in low-sugar foods like protein bars, yogurt, and diet sodas. Awareness is the first step to reducing your intake.
  • Rotate your sources: If you do use artificial sweeteners, try switching up the types you use. Since different sweeteners may affect your gut microbiome in different ways, this may reduce the concentrated impact on your gut.
  • Switch to stevia: While animal and test-tube studies show mixed findings, human research indicates that stevia has a limited effect on the gut microbiome, making it a better choice for people seeking to support their gut health.

Another way to support your gut if you regularly use artificial sweeteners is to rebuild gut diversity with fiber and fermented foods, while focusing on whole-food sweeteners.

  • High fiber prebiotic foods (like legumes, whole grains, garlic, onions, asparagus, and under-ripe bananas) act as "fuel" for your healthy gut microbes. Aim to include a variety of these foods in your diet to support the microbes already in your gut.
  • Add fermented foods, like unpasteurized sauerkraut and kimchi, kefir, or kombucha, to your diet. Some fermented foods contain live, beneficial bacterial cultures, while others are rich in "postbiotics" (beneficial compounds like short-chain fatty acids, which are produced when bacteria break down prebiotics).
  • Try using whole-food sweeteners instead of artificial ones. For example, sweeten plain yogurt with vanilla extract and berries or add dates to smoothies or homemade energy bites.

Final Thoughts

Emerging research suggests that certain low- or no-calorie sweeteners, including sucralose and aspartame, may affect the gut microbiome, whereas stevia appears to have a less negative effect. While individual responses can vary with a person's unique baseline microbiome, certain artificial sweeteners may increase inflammation or reduce gut microbiome diversity.

If you need personalized support navigating sweeteners or supporting your gut health, Blue Tree Nutrition can help. Click here to get in touch!

 

 

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Hello, I am

Valerie

My name is Valerie Polley. I am a Indianapolis-based registered dietitian and owner of Blue Tree Nutrition. I consult with clients both local and far away.
I have a bachelor’s degree in nutrition from Purdue University and I have been practicing for 20 years.
I thoroughly enjoy helping clients through their gut health journey. I see a range of GI issues including, but not limited to celiac disease, IBS and SIBO. I also specialize in the FODMAP elimination diet.

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