What is diverticulitis?
Diverticulitis is one of the most common conditions found during a colonoscopy and describes alterations in the gut that can lead to digestive health symptoms.
The symptoms of diverticulitis include:
- Abdominal pain, commonly in the lower left of the abdomen
- Fever
- Nausea or vomiting
- Constipation
- Diarrhoea
This is a digestive condition where alterations in the gut lining are seen in the form of ‘pockets’ in the gut wall. These abnormal pockets are described as diverticula and their condition is diverticulosis.
However, it is only when these become inflamed that the condition is described as diverticulitis. [Source: PubMed]
The presence of these pockets increases with age with studies indicating that by the age of 60 50% of the population has diverticulosis and by the age of 80 the percentage increases to 70%. Diverticulitis is also understood to be more common in females.
The presence of diverticula in the colon can be without symptoms and it is often only when these become inflamed, and diverticulitis presents that there is an issue. [Source: PubMed]
There are several risk factors associated and linked with this gut health condition.
These risk factors for diverticulitis include:
- Smoking
- Non-steroidal anti-inflammatory medications (NSAIDs)
- Low fibre diet
- Obesity
- Genetics
- Opiates [Source: PubMed]
Is Diverticulitis the same as Diverticulosis?
While diverticulitis and diverticulosis may sound and look similar, they do describe different digestive conditions.
- Diverticulosis is the presence of diverticula which can be without symptoms.
- Diverticular disease is the clinically significant presentation of symptoms.
- Active diverticulitis is active inflammation of the diverticular.
Diverticular disease and diverticulitis can be explained further using more specific terms and medical definitions.
Asymptomatic uncomplicated diverticular disease is the presence of diverticulosis without any symptoms or complications of the disease. Most often this is noted incidentally on colonoscopy.
Symptomatic uncomplicated diverticular disease (SUDD) is where symptoms are attributed to diverticulosis in the absence of any visible inflammation or diverticulitis. Commonly this will present as an episode of abdominal pain but without evidence of inflammation. In most cases the pain with come and go but in some patients, the pain can be ongoing in nature.
As with IBS, it is common for symptoms associated with symptomatic uncomplicated diverticular disease to be relieved with flatus or bowel movements. Further symptoms, as also commonly seen in typical IBS patients include abdominal pain, bloating, constipation, and diarrhoea.
Recurrent symptomatic uncomplicated diverticular disease is the same as symptomatic uncomplicated diverticular disease (mentioned above). However, here the symptoms occur multiple times during a year. [Source: PubMed]
What Causes Diverticulitis?
Several factors are understood to influence the development of diverticular conditions and diverticulitis. These include factors relating to genetics, diet, inflammation, alterations in the gut microbiome and changes in bowel motility.
While fibre intake has not been linked with a reduction in the occurrence of diverticular, it is associated with a reduction in the development of diverticular disease. Additionally, those eating a higher-fibre diet also have a reduced risk of complications if they do develop diverticular disease. [Source: PubMed]
Part of the understanding related to the age-related decline in the strength of the gut lining combined with slower transit time and increased pressure within the gut. The combination of the weakened walls of the gut plus the higher level of pressure may then contribute to the development of the pockets of diverticula in the gut lining.
Specific genes (TNFSF15 SNP rs7848647) have been associated with the development of diverticulitis and complications from this condition. This can increase the risk of developing diverticulitis. However, other factors are required for the condition to develop, even if there is a genetic susceptibility. [Source: PubMed]
Poor bowel motility is indicated to contribute to the development of diverticulitis. This is related to age-related degradation in nerve function in the digestive tract. This reduction in nerve signalling may then contribute to altered bowel motility via a reduction in the contractions in the muscles along the gut. The result of this is increased pressure on the gut wall, which if weakened can lead to the formation of diverticular pockets.
Gut Bacteria, Microbiota and Diverticulitis
Alterations in the gut microbiome have been associated with many digestive conditions such as IBS (irritable bowel syndrome), IBD (inflammatory bowel disease) as well as diverticulitis.
These alterations are associated with long-term dietary patterns (particularly a low-fibre diet), the use of medications such as antibiotics, as well as inflammation in the gut. [Source: PubMed]
In diverticulitis, a theory around the development of the digestive condition is how constipation can contribute. This is due to the stool remaining in the colon for an extended period of time which leads to changes and imbalances in the gut microbiome, described as dysbiosis. These changes may then further contribute to constipation, altered bowel function as well as increased inflammation in the gut.
It is also possible for alterations in the gut microbiome to first impact bowel motility. In turn, this can create a cycle of imbalances leading to constipation leading to further imbalances.
When the profile of the gut microbiome has been studied, those with diverticulitis had an increase in the ratio of Firmicutes/Bacteroidetes as well as higher levels of the proinflammatory organisms, Proteobacteria. [Source: PubMed]
Do I need to avoid nuts and seeds with Diverticulitis?
Due to the development of pockets (diverticular) in the gut walls of those with this condition, it was long suggested that certain foods needed to be avoided. These were foods that may cause an issue by getting stuck in these pockets, then leading to inflammation (diverticulitis) as well as an increase in symptoms or bleeding.
However, a large-scale study in 2008 found that eating nuts, corn and seeds were not associated with an increase in diverticulitis or bleeding. [Source: PubMed]
Diverticulitis Symptoms
The symptoms of this gut health condition can vary between individuals. This variation in the symptoms of diverticulitis can depend on factors such as the level of inflammation, food sensitivities and the degree of irritation to the gut lining.
In the acute form, diverticulitis will often display as pain that can vary between mild and intermittent to chronic pain that is unrelenting. Alongside this, there may also be changes in bowel patterns, nausea and vomiting. [Source: PubMed]
Constipation is the most common symptom relating to bowel motility which is experienced by up to 50% of those with acute diverticulitis. Diarrhoea has been indicated to be present in between 25-35% of those with acute diverticulitis.
This inflammatory response in the bowel can also present as more systemic symptoms such as a fever. [Source: PubMed]
What foods trigger diverticulitis?
Long-term studies into digestive conditions, gut health and diverticulitis have assessed food intake and the rates of diverticular disease. A long-term research project which monitors a cohort of men over a 26-year period resulted in specific findings.
This resulted in the understanding that a Western-style diet, consisting of a high intake of red meat, refined grains, and high amounts of processed fat increased the risk of developing diverticulitis. Where a diet rich in fruit, vegetables, whole grains and fish reduced the risk of developing diverticulitis.
This leads the researchers to conclude that rather than a single food being the culprit, the overall dietary pattern deserves the focus. [Source: PubMed]
It has also been theorised by some that a low FODMAP diet may be appropriate for diverticulitis. The low FODMAP diet is commonly used for IBS, however, even those these 2 conditions are different from one another, they share common features such as microbiome alterations, a low-level inflammatory response and increases sensitivity in the gut lining.
It has also been theorised that reducing the amount of gas produced via the fermentation of FODMAP foods, may reduce the pressure on the gut wall, thus reducing the further development of diverticulitis. However, this is not conclusive and does not take into consideration other factors that can improve or balance the fermentation process, to reduce how reactive individuals may be to fibres with higher fermentable capacity. [Source: PubMed]
Also Read: Foods To Avoid With Diverticulitis
Are probiotics helpful for diverticulitis?
Probiotics are strains of beneficial bacteria that are taken in supplement form. These have been shown to be helpful in diverticulitis to either improve symptoms or to move someone towards a state of disease remission.
This is likely due to the beneficial effect of probiotics to support and balance the gut microbiome which is commonly disturbed in those with diverticular conditions. Probiotics can also reduce inflammation, another common factor involved with diverticular diseases such as diverticulitis.
In the majority of these studies Lactobacillus strain of probiotics supplements we commonly used. [Source: PubMed]
Is Sodium butyrate/Butyric acid helpful for diverticulitis?
Sodium butyrate is a compound that has been shown to be helpful in diverticular diseases. Sodium butyrate is produced naturally within the gut via the fermentation of dietary fibres. This compound is used by the cells that line the digestive tract to support the integrity of the gut lining, reduce inflammation, support cell regeneration and modulate the immune response.
In certain disease states, there may be an increased requirement for sodium butyrate. This has been found in studies showing the benefit of sodium butyrate in IBS, inflammatory bowel disease, functional diarrhoea and malabsorption syndromes. [Source: PubMed]
Is curcumin helpful for diverticulitis?
A central aspect of diverticulitis is increased inflammation in the large intestine. This has led researchers to investigate the use of herbal anti-inflammatory medications to support anti-inflammatory processes. This has particularly focussed on 2 herbal supplements, Curcumin and Boswellia.
It is understood that the anti-inflammatory effects of these herbs can support the anti-inflammatory processes within the gut. In addition to this, the use of curcumin has been shown to improve other areas of gut health that can contribute to the improvement in symptoms seen when using these supplements.
This can be due to curcumins ability to:
- Support a balanced gut microbiome
- Reduce intestinal permeability (leaky gut)
- Reduce inflammation
- Reduce oxidative stress
When supporting the gut microbiome, curcumin has been found to increase the levels of beneficial species such as Bifidobacteria and Lactobacilli, and additionally increase butyrate-producing bacteria.
In contrast to this, it also reduces the abundance of less beneficial species such as Prevotellaceae, Coriobacteriaceae, Enterobacteria, and Enterococci. [Source: PubMed]
Gut Health Treatment
Working to address the underlying issues in the gut is a key consideration to resolve digestive issues. This can involve dietary support, targeted and research-based supplements as well as lifestyle factors.
Often, rather than a single element being required, a combination of these factors can be most beneficial and act as a holistic approach to support gut health and overall well-being.
Working with a registered gut health practitioner can guide you through these steps to address the root cause and underlying issue in the gut that is contributing to the symptoms of diverticulitis.
