Diverticulitis

Colonic diverticulitis, which stems from diverticulosis (an asymptomatic condition affecting the intestines), can be a very painful condition that affects the sufferer’s enjoyment of life, both during a flare-up of the worst symptoms and day-to-day.  Tiredness and discomfort may be frequent symptoms, and sufferers have been found to be more prone to depression and anxiety.  But there are things that you can do to feel healthier.  Let’s take a look at these ailments in more detail and 12 things that you can do to help your gut if you experience them.

The wall of the intestine can form ‘pockets’ called diverticula when strained, for example when passing hard stools.  Many people who have formed diverticula will not have any symptoms – a condition called diverticulosis.  However, in other people the diverticula can become inflamed or infected causing pain and discomfort.  This is diverticulitis (‘itis’ meaning ‘inflammation of’).

The inflammation or infection may be due to a wedged stool or undigested food becoming trapped in the diverticula, resulting in a build-up of bacteria.

Symptoms of diverticulitis can include:

• constant abdominal pain most often on the left side of your body, although the right side may be more painful for individuals of Asian descent
• nausea and vomiting
• pain after eating that eases when you pass a stool or trump
• fever
• constipation (although some people may experience diarrhoea)
• mucus or blood in your stool.

It is important to consult your GP if you experience these symptoms.

As with many health conditions, there is not necessarily a singular cause but there are several nutrition and lifestyle features that may contribute to the problem.

Smoking appears to increase the risk of developing the disease, and may increase the risk of complications.  While the relationship is not yet fully understood, it may be caused by nicotine’s effect on the intestinal muscle.  Nicotine is associated with relaxation of the muscles and reduce muscular tone, which reduces the movement of the stool through the colon.  If this is the case, it suggests caution when using vapes also.

Red meat
Studies have found that a diet high in red meat was associated with an increased risk of diverticulitis.  This includes unprocessed red meat (many other health warnings around meat concentrate mainly on processed meats).  It is thought that diets high in red meat contribute to inflammation and affect the gut microbiome.

Fibre
Insufficient fibre in the diet has been associated with the condition.  Fibre

• aids the passage of food through the digestive system
• supports the removal of waste products so less effort is needed to push stools out of the body
• helps us absorb nutrients
• supports the gut microbiome.

Alcohol
While research did not find a link between alcohol and an increased risk of developing diverticulitis, there was evidence that the risk of diverticular bleeding may be increased.

Magnesium
A diet low in vitamins and minerals, including magnesium, may contribute to the problem.  While no direct link has been identified between magnesium and diverticulitis, magnesium may be helpful in reducing the risk of developing diverticula through its influence on digestion and the gut.  Magnesium can help the movement of stools through the intestinal tract, and attracts water into the intestines helping to soften the stools.

Vitamin D has a role in maintaining the health of the gut walls and the regulation of gut inflammation.  Studies have found that individuals with low levels of this vitamin are at greater risk of developing diverticulitis.

Although not directly attributable to the development of diverticulitis, stress is often a trigger for flare-ups.

Stress may contribute to the condition indirectly by:

• compounding the problem of a low magnesium intake. Stress can increase magnesium excretion from the body and a deficiency, or depletion, can increase the body’s stress reaction.  It’s a double-whammy!
• contributing to digestion issues. Through its potential influence on stomach acid production and the release of bile, stress may contribute to slower movement through the large intestine reducing the ability to absorb nutrients and water. Digestion may have also been affected by an imbalance of the microbiome as a result of poor diet and stress (which in turn may affect the body’s stress response!).
• contributing to chronic inflammation throughout the body due to interactions between the immune and nervous systems.

A former client of mine suffered with diverticulitis and had identified their triggers for flare-ups before we met.  The client was doing well with their day-to-day management of the condition but wanted additional advice regarding this and other health concerns.  Stress, smoking and poor diet were all known triggers for the client.  Unfortunately, during our time working together the client experienced a highly stressful situation and turned to smoking and poor diet in response.  This resulted in a significant flare-up.  It was clear that reviewing their resilience and response to stressful situations was going to be an important part of their long-term health strategy.

Being aware of your stress responses is important if you are to manage them.  Of course, we don’t always think rationally in stressful situations so take time to think about your responses and alternative behaviours before you need them.  It is also helpful to take steps to build your resilience to help reduce your feelings of stress.  The mental health charity MIND include advice around this on their website.

If you experience the symptoms of diverticular disease it is important that you consult your GP.  Your GP can confirm the diagnosis and/or check for other conditions with similar symptoms.  Medication or other medical interventions such as surgery may be required to alleviate your symptoms.  If you have already received a diagnosis, follow any advice you have received regarding ongoing management of symptoms.

The general advice for individuals living with diverticulosis and diverticulitis has changed over the last few years.  It is no longer recommended that tough fibres such as seeds, nuts or fruit skins are avoided.  If you have received this advice from your doctor, it is always worth checking with them before changing your diet to ensure there is no specific reason that you received this advice.

12 things you can do day-to-day to help

• Identify what triggers your flare-ups. What foods, activities or events make your problem worse?  Keeping a diary or journal can help identify patterns.
• If you smoke – stop! Your doctor or pharmacist may be able to help you identify a method of quitting that works for you.
• Ensure you get regular physical activity.
• Manage your stress levels – identify how to reduce your exposure to stresses and/or to manage them (see the above link to MIND. Also meditation, yoga, reflexology or acupuncture may be useful).
• Ensure you get sufficient good quality sleep each night to help manage stress and support healthier eating patterns.
• Take time to eat and chew your food properly.
• Enjoy a diet rich in a variety of whole foods to help maximise your nutrient intake from food. Include wholegrain cereals, and aim for at least 7 portions of fruit and vegetables per day (2 fruit and 5 vegetables) and/or 30 portions of different plant foods per week.
• If you eat meat, limit your intake of red meat in favour of poultry and fish. Aim for two portions of oily fish, such as salmon, per week to help your body manage inflammation.  If you do not eat fish, algal oil supplements are available (it is recommended that you discuss taking these with a suitably qualified practitioner especially if you take medication).
• Add milled flax/linseeds to porridge, salads, smoothies and fruit. Milling seeds helps us to extract the nutrients (including magnesium) from them as whole seeds can pass through the digestive system unchanged.
• Add turmeric to your food. This contains curcumin which is believed to help the body reduce inflammation – its availability can be enhanced by adding black pepper to the dishes.  Ways to enjoy turmeric include turmeric tea/golden tea, added to rice dishes, added to egg dishes such as scrambled eggs and omelettes, in soups.
• Ensure you drink sufficient non-alcoholic fluids in the day to help you stay hydrated and keep your stools soft. To help you, keep an eye on your wee which should be a pale straw colour: dark coloured urine suggests you may need to drink more; colourless indicates that you are well hydrated (take care not to overhydrate by drinking large amounts of fluids in a short period of time). A urine colour chart is available from the NHS: https://www.nhsinform.scot/campaigns/hydration/
• Ensure you are getting enough vitamin D. In the UK, we can top up our levels by exposing our skin to sunlight between April and September (take care not to burn!).  While there are a few foods that give us vitamin D, they do not contain enough to meet our daily requirements.  However, ensuring you have a reasonable intake of fat (not trans fats from fried and heavily processed foods!) can help you to absorb and utilise the vitamin.  If you think you may have low vitamin D levels, supplements are widely available but, it may be beneficial for you to get your level tested before taking them.  Vitamin D tests are available via your GP or privately.

• Role of dietary habits in the prevention of Diverticular Disease Complications: A Systematic Review (2021) – Carabotti, et al.
• Smoking and risk of colonic diverticulosis: A meta-analysis (2018) – Wijarnpreecha, et al.
• Higher serum levels of vitamin D are assoicated with reduced risk of diverticulitis (2013) – Maguire, et al.