What Doctors Don't Tell YouI have been experiencing extreme tenderness in my lower left abdomen for some time now. My doctor has diagnosed diverticulitis and has given me a course of antibiotics. He says that in extreme cases, if the antibiotics fail to deal with the infection, surgery is required to drain the infected material from the coon. Is there anything I can do to help the healing process? WM, Bristol…..
Diverticular disease affects the colon, the flexible tube like organ responsible for removing water from the contents of the intestine. A normal colon is strong and relatively smooth; one affected by diverticulosis has weak spots in the walls. These defects allow the development of hernia like sacs or pouches. These pouches, called diverticulae, appear when the inner intestinal lining has pushed through weakened areas of the colon wall. When these pouches become infected or rupture, it is a sign that the condition has progressed to diverticulitis.
Development of diverticular disease is not an inevitable part of growing older. The colons of older people living in developing countries show a virtual absence of the disease. For many years it was also unheard of in Japan, though the more this country adopts a Western diet, the more prevalent the disease becomes (Am J Clin Nutri, 1983; 38: 115-21). But while it is relatively unknown in these countries, it has reached alarming proportions in the West. For example, in the US it affects 10 per cent of those over 40, and a frightening 50 per cent of those over age 60.
The most common symptoms are no symptoms at all. In fact, the first most people know about it is when the pouches become infected or ruptured, causing extreme pain, or when they experience large amounts of rectal bleeding. Other common symptoms include bloating, cramping, nausea, fever and constipation, followed by diarrhoea. Approximately 20 per cent of those with diverticulosis go on to develop diverticulitis (J Clin Gastroenterol, 1999; 29: 241-52).
Many medics are unsure of the causes of diverticulosis, but it seems to be in part related to an increase in pressure within the colon. The wall thickens, occasionally unevenly, as we age, and when it contracts, it causes increased pressure, which facilitates the formation of diverticulae. There has been some suggestion that early weaning (before two years of age) may prevent the colon from growing evenly and to its full thickness (Clin Gastroenterol, 1985; 14: 829-46). The most likely theory is that it is the result of a poor diet.
Poor nutrition can affect the colon in several ways. For instance, lack of fibre means that it must work harder to pass faecal material. In a person on a low fibre diet, greatly increased pressure is required to force small amounts of hard, dry stool through the bowel. Lack of essential nutrients can also weaken the wall of the colon, making the eruption of these small pouches more likely.
Amazingly, some medical advisers still prescribe a bland, refined diet of dairy, meat, white flour products, and soft vegetables for this condition, when one composed of whole foods and fresh produce would be much more effective.
The first thing you must do is introduce water soluble fibre into your diet. Wheat fibre is more irritating on the gut. A high fibre diet rich in vegetables will regularly expand the colon, improving elasticity, and help to reduce pressure on the colon wall. So opt for oats, rice and barley and plenty of fresh fruits and vegetables. If your gut is initially unable to deal with raw produce, then lightly steam vegetables and cook fruits. A fibre rich diet may prevent diverticula from forming; it can also prevent constipation and subsequent irritation of existing pouches.
In one study, more than 47,000 men were followed for four years to observe the influence of diet on the development of diverticular problems. The researchers found that those who had the highest intake of dietary fibre were the least likely to develop the disease. This inverse association was primarily related to the intake of fruit and vegetable fibre. Men on a high fat, low fibre diet had more than twice the risk of developing diverticular disease. For men who consumed a diet high in red meats, the relative risk of developing the disease was more than three times greater (Am J Clin Nutri, 1994; 60: 757-64).
Including fibre in your diet may also prevent you from needing surgery. When a group of 72 patients with diverticular disease were followed over a 10 year period, researchers found that those who did increase fibre intake were significantly less likely to need surgery and experienced fewer uncomfortable symptoms than those who did not (Ann R Coll Surg Eng, 1985; 67: 173-4).
Try also to include steamed or grilled fish, especially oily fish such as salmon, mackerel and herring. While some doctors still recommend avoiding foods like popcorn, nuts and seeds, on the basis that they might become lodged in the diverticula and trigger inflammation, there is no real basis for such a recommendation. Nuts and seeds are a rich source of minerals and essential fats known to contribute to the healing process.
If you are at all worried, though, consider grinding up a mixture of seeds to put on salads and breakfast cereals. While there is no research directly relating the intake of EFAs to the prevention of diverticular disease, EFAs have been shown to be important to colon health, especially in relation to the development of colon cancer (J Gastroenterol, 1998; 33: 206-12; Br J Cancer, 1998; 77: 731-8). Your optimum dose should be between 2 and 3 tablespoons of high quality oils (such as flax seed oil) per day.
Little is known about which supplements may best help prevent or treat diverticular disease. However, when one study analysed fecal samples from those with irritable bowel syndrome and diverticular disease, it found that the stool composition of the latter group contained significantly less magnesium, potassium and calcium (Am Clin Nutri, 1976; 29: 1480-4).
Adequate vitamin C is also important not only to strengthen the wall of the colon, but also to fight infection. Your daily minimum should be 1g. If you are recovering from infection, consider between 2 and 3 grams daily.
There is now reasonable evidence to support the use of probiotics in supporting gastrointestinal health. The newest class of probiotic Lactobacillus GG (LGG) has been shown to alleviate intestinal inflammation and strengthen the intestine. Lactobacilli also produce a variety of factors which inhibit or antagonise unfriendly bacteria, so they may help deal with the infection in your colon.
One of the newest fields of research into gut health surrounds the use of soil based probiotics (SBOs) (Townsend Letter for Docs, 1997; 169/70: 85-90, 92).
Soil based organisms have all the most favourable characteristics of an effective probiotic. They were first discovered in Asia in 1978 when a scientist named Peter Smith discovered some mounds on the ground that he recognised as soil, based organisms of an unusual nature. Tests over the next few years concluded that these organisms were as beneficial and useful to humans and animals as they were to plants and soil.
Soil based microorganisms are more resistant to stomach acid than traditional probiotics and are thought to have a greater affinity for the intestinal walls. They can be taken in capsule form and become active when they come into contact with the watery environment in the gut.
SBOs have been shown to help establish a healthy colon, correct problems of malabsorption, help with the breakdown of food, stimulate the immune system and regulate cellular repair.
There are two other causes of diverticular disease, which should be considered. Firstly, it has been shown to be a disease of a sedentary lifestyle. When one study looked at the levels of physical activity of nearly 48,000 men, and the effects this had on the development of diverticular disease, it found that overall physical activity was inversely associated with the development of the disease the more exercise you did, the less likely you were to develop this condition. Aerobic exercise, such as running and jogging, had the greatest protective effect (Gut, 1995; 36: 276-82).
The overuse of non steroidal anti inflammatory drugs (NSAIDs) and the drug acetaminophen can be another cause. Use of such drugs is high among the elderly. In one US study, more than 35,000 male health professionals between the ages of 40 and 75 were studied over four years to determine just how risky taking such drugs is.
What the researchers found was that regular users of NSAIDs had more than twice the risk of developing severe, bleeding diverticular disease than non users. Regular use of acetaminophen was associated with nearly twice the risk, when compared with the risk of non users (Arch Fam Med, 1998; 7: 262-3).
Certain herbal remedies may also be of benefit in the treatment of diverticular disease. Goldenseal is active against bacteria in the gut, and its berberine content has also been shown to increase the tone and movement of the gastrointestinal tract (Daniel B Mowrey, The Scientific Validation of Herbs, Keats,). A simple tea made from fresh ginger may help to reduce the flatulence which accompanies diverticulitis. Some practitioners recommend that slippery elm which can be purchased in health food shops as a tablet or liquid will help reduce inflammation.
Daniel Redwood DC
Tom Ferguson MD
