Diverticular Disease - Acute and Preventative Management

A large portion of people who see naturopathic doctors come with a chief concern of digestive issues. After months of scopes and bloodwork, they are often left without answers from their medical doctor and seek a new perspective. Other times, their diagnostic imaging tests reveal something significant, yet the medical system is still at a loss for treatment options.

Diverticulosis is a common concern that causes significant gastrointestinal discomfort, but only few pharmaceutical interventions are available. This condition affects the large intestine, which is responsible for reabsorbing fluids into the body and creating stool. It houses a major portion of the body’s bacteria and relies on a system of nerve signals and muscle contractions to move substances without our conscious effort. The large intestine is shaped like a series of connected pouches, similar to a chain of sausages. The walls of the intestine are comprised of many layers including connective tissue to maintain the shape, vascular tissue for blood supply, and neuromuscular connections for movement.^[1] The health of the large intestine is maintained by the delicate balance of bacteria, as well as the stool that moves through the intestine, carrying away waste products as it passes through.

While the pathogenesis of diverticula is still not fully understood, essentially the walls of the large intestine become weakened and create smaller pouches bulging out of the intestinal wall. At this point, an individual may be diagnosed with diverticulosis upon completing a colonoscopy and may not notice any aggravating symptoms at this time. The real problems arise when small particles of food and digestive matter get stuck in the small pouches and become a huge risk for infection by bacteria. A person may experience severe lower-left abdominal pain, cramping, as well as fever, and even notice blood in the stool. These episodes can last weeks, and antibiotics are necessary to prevent the spread of infection; however, once the acute phase is passed, patients are often left confused as to how they developed a diverticula and ways to prevent a future episode.

So, let’s consider who is at greatest risk for diverticular disease. According to a study in 2015, the uncontrollable risk factors include age, sex, and genetics.^[2] Only 13% of people under 50 developed diverticular disease, but this percentage continues to rise with age, and the prevalence increases up to 66% for people over the age of 85. As we age, the connective tissue in all parts of our bodies tends to lose its strength and elasticity, making it easier for diverticula to form. Similarly, certain genetic connective tissue disorders were also linked with higher incidences of diverticular disease, including Marfan syndrome and Ehlers-Danlos syndrome. The rest of this study confirmed several things that naturopathic doctors have practiced for decades. The controllable risk factors include dietary fibre, red-meat consumption, smoking, alcohol, body weight, and physical activity level. Essentially, with proper individualized diet and lifestyle counseling, acute flares of diverticulitis can be minimized and even prevented!

How to Manage an Acute Flare

If you have ever had an episode of diverticulitis before, you will know exactly when another flare is about to hit. The lower-left abdomen becomes sore and achy, and you may feel warmth around the left side of the pelvis and experience fever, nausea, and vomiting. If you notice a large amount of bright red blood in the stool, please see your doctor right away. Outside of the large intestine, symptoms can also include frequent, urgent and burning urination.^[3]

If it has been more than two days of this pain, antibiotics are likely needed to manage an infection. It is wise to consume only bland soups, bone broths, or pureed foods. In this stage, low-fibre foods can help soothe the intestines and prevent the digestive tract from overworking and creating more inflammation. If a patient is open to taking a herbal support, consider a herbal tincture containing goldenseal, myrrh, turmeric, and echinacea. At the same time, slippery elm and marshmallow root powder can be mixed with water to create a protective mucilage layer around the intestines and allow them to heal. Nuts, grains, seeds, popcorn, and fibrous fruits should be avoided at all costs, as they can be easily lodged in pouches and worsen infection. Additionally, Epsom salt baths and castor oil heat packs can soothe the abdominal muscles and reduce discomfort. Depending on the severity of the flare, the patient may be on bone broths for over a week, but must carefully follow a graded diet plan to get them back to eating whole foods again.^[4]

Bone Broths and Bland Soups During an Acute Flare

When the pain has subsided, and the antibiotics are underway, consider bone broths with steamed or pureed vegetables. Once the antibiotics are finished, the pain is gone, and the patient is working towards preventing a future episode, add in quinoa, rice, and other grains. By this stage, the individual should be in full prevention mode, aiming for 25–30 g of fibre per day, and adding one new food every 3–4 days. Sweet potatoes, oats, and root vegetables are okay to be added at this point. It may take over a month to reach this stage.

How to Prevent a Future Episode

We are well aware that our standard North American diet is rich in simple carbohydrates and unhealthy fats, but poor in fibrous vegetables. We tend to drink caffeine instead of water to quench our thirst and spend too many hours being sedentary. Our digestive tract becomes accustomed to dealing with dehydration and slows down the movement, sometimes leaving us constipated or having bowel movements that are incomplete or uncomfortable. Preventing a future episode of diverticulitis or preventing the formation of a diverticula often include the same lifestyle habits.

Once an individual is in remission from a flare, an anti-inflammatory diet or food-sensitivity test should be considered to identify triggers of an active immune system. Helping the patient understand what they can and can’t eat creates an individualized treatment plan that often increases compliance over standard diet plans. Enforce the importance of eating slowly, chewing food properly, and avoiding foods that are cold and raw. Consider the use of a digestive enzyme and sublingual vitamin B12, vitamin D, and magnesium to support the digestive process and prevent nutrient deficiencies.

Create a water-drinking routine. Start slow and increase every week if needed, but water absolutely must be part of a diverticular disease plan. Set alarms and reminders on computers and cell phones, bring a large bottle to work in the day, or add lemon and berries for flavour. Whatever the issues are around drinking water in the day, identify them and create solutions to overcome them. Caffeinated, sugary, and alcoholic drinks should be minimized, and the requirement for water increases when these beverages are consumed.

Exercise every day and vary the intensity of your training. Movement increases circulation and regulates our sleep and digestive cycles. A moderate-intensity workout might include a run with intermittent sprints, a spin class, or a dance program, and should be done 1–2 times per week. The rest of the week can follow a lower-intensity routine, such as yoga, walking, or tai chi to help restore the body, lower stress hormones, and promote digestion.

Stress management is key. Yes, the brain-gut connection is real, and though your daily stress may seem outside of your body, it has very real effects on your body. When the stress hormone, cortisol, flows through your bloodstream in higher amounts, increased intestinal permeability, indigestion, and leaky gut ensue.^[5] It increases whole-body inflammation, makes us crave unhealthy foods, and lowers our immune response. Whether it be taking five minutes to meditate every morning, exercising daily after work, or sleeping 30 minutes earlier, every little bit helps to lower stress and reduce the production of cortisol in the body.

When managing diverticular disease, the most important takeaway is to be patient. Of course, this is the most difficult thing to do when you are in pain and can’t hold any foods down. The intestinal lining will heal itself without intervention, but this process can take months, and introducing high-fibre foods too early can set you back a couple steps. Please see your naturopathic doctor for the best tools available to manage in the acute phase, make the antibiotics more effective, and prevent further damage to the intestines.