Muscle tone varies throughout the length of the gastrointestinal tract, with weakness often occurring in the later sections of the colon; typically the result of blood vessels making connections through the muscular tissue. It's at these sites (or weak spots) that little pouches, known as diverticula, can form.1
Never heard of diverticular disease? It's extremely common over the age of 50, but many of us don't realize we have it until those little pouches become infected and inflamed. This is when diverticular disease becomes diverticulitis.
If you have diverticulitis, the symptoms are often hard to ignore: it may cause abdominal pain and tenderness, a bloated or distended abdomen, in addition to diarrhea, chills and fever. These symptoms occur as a result of inflammation brought on by an immune response. Your body is trying to fight off the infection, often caused by waste trapped in the diverticula.
The most common treatment for diverticulitis is antibiotics to counter the infection. However, in some more severe cases, tears in the bowel wall can occur, causing a systemic infection that requires hospitalization. In Canada alone, over 3000 surgeries are performed each year to manage diverticulitis.2 Rates of this disease are on the rise, and affecting younger adults as well.1 The widespread prevalence of the disease and the necessary hospitalization (if disease progression occurs) makes the diverticulitis a burden on both the health care system and our quality of life. So, it’s worth asking… why do diverticula form?
A Closer Look at Diverticulitis
The prevailing thought about what causes diverticula to form is that high pressure in the sigmoid colon - which is located at the end of the digestive tract - is to blame.1 A high-pressure environment makes it more likely that pouches will form in the weakest areas of the colon. The culprit behind that increased pressure is the bowel working to eject hard to pass stools most often brought about by a low fibre diet. Looking to constipation as a culprit makes sense considering that diverticular disease is most common in countries with more ‘Westernized’ dietary habits; a trend we're seeing mirrored around the world with the global dietary transition to a hyper-processed diet.1
However, as our understanding of the disease increases, we are uncovering new factors at play, although whether they occur as a result of the disease or are part of the cause is still unknown. The first has to do with the ‘second brain’ nature of the gut; inflammation can alter the nervous system within the digestive tract, which could lead to higher contractile pressure and experience of pain1. It also appears that microscopic inflammation plays a role in disease severity, flare up recurrence, and response to treatment1. Levels of fecal calprotectin, a marker of gut-level inflammation, are typically elevated in symptomatic disease1.
Research on the role of gut bacteria in diverticulitis is in its early stages, and it will be interesting to see what conclusions will be drawn, especially around inflammation and infection. A recent trial found bacterial differences between inflamed and non-inflamed tissue in diverticular disease, including a type of bacteria known to release destructive enzymes and methane-producing organisms commonly associated with constipation3.
Living Well with Diverticular Disease
Without complications, diverticular disease can have IBS-like flare-ups that make it difficult to diagnose1. When talking to your doctor about your digestive health, especially if you are over the age of 40, consider diverticular disease alongside irritable bowel syndrome; often diagnostic tools like CT scans and ultrasound can be used to spot the presence of diverticula.
If you are diagnosed with diverticular disease (barring complications), it would be wise to take a ‘food as medicine’ approach. While the research base is surprisingly minimal to guide nutrition interventions, a high fibre dietary pattern is generally agreed to be the best course of action. Begin swapping out low fibre, hyper-processed food stuffs such as pastries and fast foods for whole food options. Consume smaller portions of red meat and eat more plant proteins, poultry and fish. Put a bounty of high fibre whole grains, legumes, fruits and vegetables on your plate as a high fibre, plant-centred diet is thought to decrease your risk of acute disease1. Women should aim for at least 25 grams of fibre per day while men need 38 grams.
If your first hint of diverticular disease was a flare up, antibiotics and a clear liquid diet is usually necessary to fight infection and let the inflammation subside. Once the infection has been successfully treated with antibiotics, gradual adoption of a high fibre diet is recommended to improve gut health and decrease the risk of relapse1. However, the challenge is navigating bowel tolerance to such a diet. Traditionally, we have recommended the avoidance of corn, seeds and nuts thinking they could become caught in the diverticula; however, this is not supported by modern research. Which makes sense, when you think about it: as the disease typically occurs in the distal sections of the digestive tract, adequate chewing should lead to digestion and absorption of the foods in question. The key phrase here is adequate chewing. Many of us rush through our meals and do not use our teeth to grind down plant foods, so they are digested properly. Take your time at meals and thoroughly chew until food is a uniform pulp before swallowing.
That said, there are a few exceptions to the above. For example, whole flax seeds almost always pass through undigested and can be consumed only in ground form. And some hardier plant foods, including things like popcorn, may simply be irritating to a sensitive post-flare gut. In fact, in the early stages of as adjusting to life post flare, eating blended forms of harder to digest foods, such as nut butter, hummus or blending seeds into smoothies, is an excellent strategy for better nourishment and tolerance, as the blender does the work of chewing for you.
Fibre, Bacteria, and a Healthier Gut
Post-flare-up, moving through a soft, low fibre diet before gradually working up to more high fibre plant foods takes time, particularly after severe flares (although everyone is unique). Fibre adds bulk to the stool, making it easier to pass, and helps feed beneficial bacteria in the gut. Start with the addition of ground psyllium; a uniquely soluble and low fermentation fibre as the first choice for less irritation. Also take a high-quality probiotic like Bio-K+ as part of the healing process. Bio-K+ is clinically proven to help prevent the side effects of antibiotic use, such as antibiotic-associated diarrhea. The established guidelines for use with antibiotics is as follows: take one Bio-K+ (either our 50 billion capsules or drinkable products), 2 hours after one of your daily antibiotic doses, every day of antibiotic therapy plus five days after.
In practice, I also tend to recommend continued use of Bio-K+ for at least 12 weeks during the healing stage. The reason for this is that probiotics are well-established in their role to support the growth of beneficial bacteria that fight infection and help moderate inflammation within the gut, making them a wise choice in diverticular disease. Research on the role of probiotics specifically in diverticular disease is in early stages, so we have a lot more to learn about specific strains but there are some preliminary trials suggesting their benefit4,5. Probiotics are, in fact, commonly recommended by healthcare professionals to improve digestive health in diverticular disease.
Any digestive disease requires a holistic, individualized approach as the gastrointestinal tract lies at the intersection of digestive, immune and nervous system health. Gentle exercise is critical for improving wellbeing and managing inflammation, as well as encouraging regular elimination. Managing stress is also an essential part of the equation; given the deep brain-gut connection, stress can increase sensations of pain and even trigger flare-ups.
Although many of us may not be currently suffering from diverticular disease, knowing how common is means taking a preventative mindset critical. Given what we currently know about the disease, consuming plenty of high fibre plants and a daily probiotic is a simple strategy to help keep your colon healthy. If you find yourself diagnosed with diverticular disease, a dietitian can help you restore better digestive health.
If you have any other questions about the health of your gut, ask us in comments below. If you are looking to stock up on Bio-K+, head to our store locator. For more information on Bio-K+ probiotic drinks and digestive health, contact us, find us on Facebook and Instagram or join our community.