Sometimes we can’t blame an autoimmune disease or an allergy for our gastrointestinal discomfort. Sometimes the walls of the intestine grow weak and develop pouches. This is known as diverticular disease. If these pouches become inflamed or infected, you have diverticulitis. Read on to develop a better understanding of this potentially serious condition.
- What Is Diverticulitis?
- Diverticulitis vs Diverticulosis
- What Causes Diverticulitis?
- Primary Risk Factors
- Diverticulosis Symptoms
- Diverticulitis Symptoms
- How Is Diverticulitis Diagnosed?
- Diverticulosis and Diverticulitis Treatment
- Diverticular Disease Diet
- The Gluten-Free Diet and Diverticular Disease
- Diverticulitis Surgery
- What You Need to Know
What Is Diverticulitis?
A relatively common disease of the intestine, diverticulitis occurs when pouches form along the wall of the small or large intestine. These pouches are called diverticula, and they occur more often in the large intestine, or colon. If one or more of these pouches become inflamed, you develop diverticulitis.
Diverticulitis vs Diverticulosis
I’ve seen many online sources confuse the terms diverticulosis and diverticulitis. But they are not interchangeable. When you develop pouches along your intestinal wall, you have diverticulosis. When these pouches become inflamed or infected, you have diverticulitis. Having the pouches — diverticula — alone is not diverticulitis.
Diverticulosis and diverticulitis are together referred to as diverticular disease.
As a quick summary:
Diverticulum: A single pouch formed in the wall of your intestine.
Diverticula: The plural of diverticulum, meaning multiple pouches
Diverticulosis: The condition of having diverticula.
Diverticulitis: When the diverticula become inflamed or infected.
What Causes Diverticulitis?
In all people, the muscles along the wall of the intestine become thicker and less supple with age. While we don’t know why this happens, we have theories for why these muscles may grow thicker more quickly in some situations than others. The main theory is that, as we age, the pressure required to move and eliminate feces increases. If anything in your diet makes feces harder to eliminate, over time you increase your risk for developing diverticulosis.
As the colon experiences increased pressure over time, the inner-most muscles along the intestinal wall begin to push outward through weaker patches of outer-most muscles. This process is called herniation. This process results in the pouches or sacs in the intestinal wall we call diverticula.
While we don’t know for certain that low fiber diets cause diverticula, there is a high correlation between societies that eat a low fiber diet and societies with high frequencies of diverticula. This suggests that a low fiber diet may increase the risk for developing diverticula.
Primary Risk Factors
The primary risk factors for developing diverticular disease, and in particular for developing diverticulitis, include aging, low activity levels (lack of exercise), low fiber diet, obesity and smoking. We can’t control aging, so take a long hard look at the fiber in your diet, your exercise routine (or lack thereof), your weight and if applicable, a smoking habit.
Addressing these risk factors can have synergistic benefits. Increasing fiber in your diet and improving your exercise routine will help you lose weight, and when you’ve lost weight by improving these habits, you significantly reduce your overall risk for diverticulitis. Addressing these risk factors may also help you slow the one risk factor we can’t fully control: aging.
Most diverticulosis patients are asymptomatic. This means they don’t experience tangible symptoms. Some people, however, may experience intestinal bloating, cramps and constipation.
When symptoms do occur, they dovetail with the symptoms of many other gastrointestinal problems, including Crohn’s disease, ulcerative colitis and gluten intolerance symptoms, so experiencing these symptoms doesn’t mean you have diverticulosis.
Diverticulitis is a serious condition. If the diverticulum are inflamed but not infected, symptoms may be less severe. But if they are infected, symptoms may become acute. The most common symptoms include:
- Abdominal pain or tenderness in the lower left abdomen
- Constipation or diarrhea (constipation is more common)
Diverticulitis symptoms tend to grow more severe over time if the condition is not identified and treated. In fact, symptoms my quickly grow severe, even during a single day.
How Is Diverticulitis Diagnosed?
Diagnosis begins with identifying symptoms and excluding other conditions. Tests are performed to identify inflamed, infected or ruptured diverticula. Depending on the severity and urgency of the condition, different tests may be used.
Barium X-rays, sigmoidoscopies, colonoscopies, ultrasounds and CT scans (computerized tomography scans) are among the different tests doctors will use to identify and diagnose your condition.
Diverticulosis and Diverticulitis Treatment
A diet with normal, healthy levels of fiber may help prevent constipation and the worsening of diverticular disease. In some cases, doctors may prescribe an anti-spasmodic medication like hyoscyamine (Levsin).
Inflammation usually occurs around the edge of diverticula, indicating the presence of infammation-inducing bacteria. For this reason, some researchers speculate that gut bacteria may contribute to the creation and rupture of diverticula. One new hypothesis suggests modulating gut bacteria with probiotic supplements may help reduce the risk for diverticulosis or help treat existing diverticulosis to minimize the risk of diverticulitis. However, this is just a hypothesis without clinical evidence to support it… yet.
In my opinion, certain probiotics known to improve stool consistency may help manage diverticulosis, and thus minimize the risk of diverticulitis. In particular, a specific bifidobacteria, B. infantis, has been shown to improve irritable bowel syndrome (IBS) symptoms, especially in women. Currently, researchers believe this is because (1) it alters the population of gas-producing bacteria in the gut and (2) it helps maintain a consistency of feces that is less likely to cause irritation along the walls of the colon.
In addition, we know that the population of this bacteria in the gut decreases as humans age. The risk for diverticulosis and diverticulitis increases as age, so we can correlate that as the population of B. infantis in our guts decrease, our risk for diverticulosis increases.
This is all my own conjecture, and I admit it is based on correlations, not established causation. However, I believe patients seeking to take a pro-active approach to relieving their symptoms should at least consider a probiotic supplement with Bifidobacterium infantis. Try to take one with an enteric coating to help the live bacteria survive your stomach acids. To further manage the growth of good and bad bacteria in your gut, you might consider a FODMAPs diet or a low fructose diet.
Treating diverticulitis is a different and more immediate issue. If you are diagnosed with diverticulitis you will be prescribed antibiotics. In early treatment or mild cases oral antibiotics — along with a temporary liquid diet — are usually enough to curb diverticulitis. However, in more severe cases, hospitalization and intravenous antibiotics may be required.
Diverticular Disease Diet
While in the past some doctors advised diverticulosis patients to avoid nuts and seeds, lack of evidence to support this approach has caused this practice to fall out of favor. If you can enjoy nutritional diversity without consuming nuts and seeds, you might still try to avoid them if you’re struggling to find relief from symptoms.
However, some evidence suggests nuts and seeds may help treat diverticulosis in adult males. If you are not allergic to them, nuts and seeds provide an excellent range of nutrients for people on a gluten-free diet, so only eliminate them from your diet if you are still looking for relief.
If you have been diagnosed with diverticulitis, you may be moved to a liquid diet or a low fiber diet. This is a temporary diet implemented to avoid acute attacks while antibiotics are administered to eliminate the infection and minimize the inflammation. While the evidence is sparse, the theory most doctors follow at this point is that reducing the total material passing by the inflamed diverticulum will reduce the risk for acute attacks.
Again, keep in mind this is a temporary diet for diverticulitis, not a permanent diet for treating diverticulosis. For long-term treatment, a healthy diet with plenty of fiber should be sufficient to minimize the risk of diverticulitis.
The Gluten-Free Diet and Diverticular Disease
It is important to note that if you are new to a gluten-free diet, you need to make sure you get enough fiber in your diet. Many people rely on gluten-containing foods to fulfill their daily fiber requirement, then after they remove gluten they don’t compensate for this lost source of fiber.
According to the American Dietetic Association, most people new to a gluten-free diet don’t get enough fiber in their diet. You need plenty of fiber to keep your bowel strong, healthy and regular, especially as you grow older. I recommend fulfilling your fiber requirements with vegetables, but certified gluten-free grains can help as well.
It will depend on your gender, age and weight, but somewhere in the range of 25 grams of fiber each day will be the general range to target. If you go from 5 grams to 25 grams in just one day, expect to experience some degree of bloating and gas. I recommend gradually increasing your fiber intake until you are in your target range.
In some rare cases when diverticulitis does not respond to intravenous antibiotics and a liquid diet, diverticulitis surgery may be required. Surgical procedures can vary depending on each case. Sometimes pus is drained from infected diverticulum, but sometimes surgical removal of parts of the colon (resection) may be required.
Surgery may also be recommended for chronic bleeding of diverticulum. Identifying the exact location of the bleeding is important as chronic internal bleeding can lead to a wide range of health concerns and complications.
What You Need to Know
A healthy, low inflammation diet that incorporates plenty of fiber should help you minimize your risk for diverticular disease. In addition, get plenty of exercise, keep yourself well-hydrated (drink plenty of water), and watch your weight. But if you know you’ve already developed diverticular disease, don’t hesitate to head to the hospital if you begin to experience significant symptoms.
Once you develop diverticular disease, there is no cure. You will need to learn to manage your condition and avoid acute attacks. I recommend a healthy diet, plenty of exercise and an enteric-coated probiotic supplement with the strain called B. infantis.
Diverticulosis is not directly related to gluten consumption. Little evidence correlates gluten intolerance with diverticulosis. However, in my opinion, when a body is weakened by a long-undiagnosed case of gluten intolerance and the intestine is weakened by the damage done by gluten in people with celiac disease or a non-celiac gluten sensitivity (NCGS), you will likely experience increased risk for diverticular disease.
Remember, if you are new to a gluten-free diet, be mindful of your daily intake of fiber. Many people new to a gluten-free lifestyle don’t get enough fiber in their diet. You need fiber to help keep your intestine strong and regular to minimize your risk for diverticular disease.
Diverticulosis is something we should all better understand as we grow older and the smooth muscle lining along the intestinal wall grows weaker and more susceptible to inflammation and infection.