Diverticulitis - What is it and What can be done about it? Added July 8/2006

 Diverticuli are tiny "pockets" of weakness in the wall of the large intestine. This condition is called diverticulosis, and a third of the people over age 50 in the United States have it. Some have just a few diverticuli, while others may have 20 or more. Most people have no symptoms and only find out that they have diverticulosis when they have a colonoscopy.

What Causes Diverticular Disease?

Doctors believe a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900's. At about the same time, processed foods were introduced to the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.

Diverticular disease is common in developed or industrialized countries--particularly the United States, England, and Australia--where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets.

Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation.

Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure causes the weak spots in the colon to bulge out and become diverticula.

Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.

What Are The Symptoms?

Diverticulosis

Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your doctor if you have these troubling symptoms.

Diverticulitis

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.

Are There Complications?

Diverticulitis can lead to complications such as infections, perforations or tears, blockages, or bleeding. These complications always require treatment to prevent them from progressing and causing serious illness.

Bleeding

Bleeding from diverticula is a rare complication. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. Doctors believe bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.

Abscess, Perforation and Peritonitis

The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition gets worse, an abscess may form in the colon.

An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes, the infected diverticula may develop small holes, called perforations. These perforations allow pus to leak out of the colon into the abdominal area. If the abscess is small and remains in the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it.

To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin and drains the fluid through the catheter. This procedure is called "percutaneous catheter drainage." Sometimes surgery is needed to clean the abscess and, if necessary, remove part of the colon.

A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal.

Fistula

A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula forms. When diverticulitis-related infection spreads outside the colon, the colon's tissue may stick to nearby tissues. The most common organs involved are the urinary bladder, small intestine, and skin.

The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.

Intestinal Obstruction

The scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.

How Does The Doctor Diagnose Diverticular Disease?

To diagnose diverticular disease, the doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment.

The above information is provided by the National Institutes of Health

Diverticulitis is infection/inflammation of the diverticuli. In other words, a person with diverticulosis may get diverticulitis when stool gets caught in one or more of these “pockets,” and they become inflamed or infected. This typically causes fever, pain and tenderness in the abdomen. The two major signs of diverticular disease are bleeding and infection.

Diverticulitis usually clears up within a week with antibiotics and a liquid or soft diet. (A soft diet includes anything that does not require a lot of chewing: soup, mashed potatoes, cooked or pureed vegetables, bananas, Jell-O and pudding fit this category.) After the acute infection clears up, patients should eat a high-fiber diet including nuts, seeds, whole grains, fruits and vegetables. They should drink plenty of fluids and avoid constipation at all costs, even if that requires taking Metamucil (psyllium seed) or other fiber products daily. Hard stools or straining will cause more diverticuli to appear or the existing ones to enlarge.

What is the treatment for diverticulosis?

Okay to Eat Seeds and Nuts
The National Digestive Diseases Information Clearinghouse clearly states: "Until recently, many doctors suggested avoiding foods with small seeds such as tomatoes or strawberries because they believed that particles could lodge in the diverticula and cause inflammation. However, this now a controversial point and no evidence supports this recommendation."

Benson T. Massey, MD, Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at the Medical College of Wisconsin, specializes in gastroenterology. According to him there is NO evidence to suggest that such foods worsen diverticulosis. To the contrary, eating high fiber foods is the ONLY treatment for diverticulosis. He says that how diverticulitis develops is a mystery. It could be from hard stool or bacteria alone, but it is probably not from a nut getting lodged in a pocket.

Everyone should eat a diet high in fiber, but especially people with diverticulosis. Nuts are a good source of fiber and protein.  With a strong family history for colon cancer, it's all the more reason to eat plenty of high fiber foods.

David Crawford is a UK nutritionist who specialises in using natural foods to treat such problems. He says it is correct that you need a high fibre diet (this is what most sufferers are told) but stresses that there is an even greater risk to your health if you eat the wrong type of fibre. You need, for example, to avoid all the mucous-forming grains, including wheat, rye, and dairy, since these will exacerbate the problem. Instead, look for fibre from chickpea or soya flours, from fruit and vegetables and from oatbran and sprouted grains.

Diverticular disease is the usually the result of a long, slow build-up of dietary mucous against the walls of the intestine. Over time, these deposits solidify, narrowing the passage through which the faeces must pass. The intestine responds by trying to expand to maintain normal functioning and it is in the weakened areas of the intestinal walls that the first diverticular pouches appear. A clever nutritionist will know how you can dissolve this build-up of waste matter without resorting to more invasive techniques such as colonic irrigation, where, if the intestinal wall has been damaged, there could be further risks.

David Crawford’s treatment plan for this condition, for example, includes a tailor-made juicing regimen, likely to include carrot and apple juice in the mornings, carrot and celery in the evenings and a combination of carrot, beetroot and cucumber. An excellent tip for maintaining good digestive health for everyone is to drink a cup of warm water with the juice of half a lemon when you get up in the mornings.

If you are suffering the milder symptoms of this disease, eat more pineapple and papaya - both of which contain potent digestive enzymes that will help reduce inflammation. This is one condition where it is crucial to treat the underlying cause. Psyllium husks, which make up the fibrogels that are often recommended, can help alleviate the symptoms but do not attack the cause. If left untreated, these conditions can lead to more serious even carcinogenic conditions. This is because, after digestion, the residue of bile salts can react with any putrifying food, especially meat, which has become trapped in the pouches to create cancer-causing metabolites. This is a risk, not an unavoidable prognosis but it highlights the importance of tackling the root cause of any digestive disturbance.

* David Crawford can be contacted by telephone on 0208-898 0670.

The Most Effective Natural Remedies for Diverticulitis

A good nutritional programme is essential - please contact HealthSmart Nutrition's Metabolic Bio Typing advisors for an appropriate eating protacol.  Use Digestive Enzymes, and Wild Yam also.

Acidophilus Ultra promotes the healthy environment in the intestinal tract that is at the base of all good health.   

Powdered Barley Grass Juice has potent nutrition and health restorative benefits.  It is a nutritious, alkaline powder made from young barley grass juice which contains perhaps the most balanced nutrient profile of all green plants with a natural balance and abundance of vitamins, minerals, antioxidants, amino acids, proteins, active enzymes, and chlorophyll, it is an exceptional superfood.

Daily consumption of powdered barley grass juice will help provide your body with essential nutrients that promote health and vitality. After taking powdered barley grass juice daily for as little as one week, many people report an increase in energy, better looking hair, skin, and nails, and increased regularity - all signs of good nutrition.  

If you eat cooked food Digestive Enzymes are definitely required to help maintain health. Digestive enzymes are present in raw food, but destroyed by cooking, in order to digest and absorb food, the body has to work hard.   Typically by the time we reach our 40's our internal glands and organs are beginning to fail to produce enough enzymes because of the lack of nutrients in the food we eat.   Simply put, this results in poor health or outright disease.    To help reverse these diseases and move towards optimum health we need to supplement with digestive enzymes. The only other way to protect ourselves is to eat a 90 to 100% raw diet which would provide the nessessary enzymes also.

 MSM can be effective for gastrointestinal problems. It may reduce the inflammation of mucus membranes and promote healing of mouth ulcers, stomach ulcers and various inflammatory diseases such as colitis and diverticulitis.

Wild Yam helps to maintain a balance of hormones in the body and is a perfect example of the old saying  'Let your food be your medicine' (Hippocrates, 'the father of medicine')

The Trobiand islanders, who attribute much of their radiant health to its regular consumption, regard it with reverence.   Yam has a long tradition as a natural remedy in herbal medicine.

• Nervine & anti-spasmodic
• Anti-neuralgic effects
• Alleviating pains in the urinary tract
• Treating cramps and nausea during pregnancy
• Intestinal colic
• Period problems
• Rheumatoid arthritis
• Aids liver and bowel function

However, its range of action far exceeds its traditional herbal role. Scientific research and clinical trials suggest that yam is a "super-food" - a food capable of improving the health and well-being of the majority of people and in some individuals proving tremendous in its health and elevating effects

Alan Tillotson a medical herbalist with a busy private practice said the following about Diverticulosis "Diverticulosis, a condition characterized by sacs or pockets in the colon with no inflammation, is a disease seen most frequently in elderly patients.  It affects up to 20% of the population by the age of retirement, and two-thirds by the age of 85. A.R.P. Walker pioneered the research into the association between food, gut function and disease patterns.  He recognized that South African blacks have a very low incidence of colonic problems such as diverticulitis, adenomatous polyps and carcinoma.  Consequently, he postulated that the traditional high-fiber African diet was important for maintaining colonic health (O’Keefe, 1995), with follow-up studies showing disease symptoms could be substantially improved with a diet high in fiber-containing whole-wheat bread, cereals with bran, vegetables and fruits (Painter, 1985). While I agree that fiber is of therapeutic importance, we must also consider the other factors discussed throughout this section, especially long-term neglected constipation. Also, any of the digestive system can create a condition of increased intestinal permeability, allowing toxins to enter the bloodstream and disturb the immune system.

We can treat diverticulosis and intestinal permeability conservatively but effectively with a high-fiber diet, accompanied by membrane- strengthening herbs like tien chi root, licorice root, gotu kola, and liquid chlorophyll, or mucilagenous herbs that coat like slippery elm bark. Carotenoid rich carrot juice is also often helpful.  According to tolerance ginseng root or white atractylodes can be gradually added to strengthen the internal energy. Basic vitamins and minerals are also important.

Diverticulitis is a progression of diverticulosis, caused by inflammation and subsequent perforation of one or more of the sacs in the colon. Milder forms of diverticulitis begin with gradually increasing symptoms emanating from the lower left quadrant of the abdomen.  Cases of acute complicated disease present with dramatic onset of abdominal pain, followed by fever. Chronic diverticulitis can be debilitating. The treatment is the same as described, but often requires more sophisticated formula changes over a long period of time, along with the addition of anti-inflammatory herbs like scute root, coptis rhizome, dandelion root, persica seed (tao ren or Prunus persica), red peony root, and boswellia gum. These must be prescibed by a competent practitioner, and only in conjunction with appropriated membrane strengthening strategies. The Ayurvedic bowel tonic Triphala is also quite helpful for long term treatment.

Nai-shing has noticed that there is often internal bowel tension contributing to this problem, which accords with both TAM correlation of bowel dysfunction with neurological disturbance (Vata), and the Western clinical observation that antispasmodics of clinical use with this disease (Lux et al., 1998). If there are signs of tension along with the pain, kava root or ashwaghanda root can be added to your formula. Peppermint oil or stoneroot tincture can be used independently. Use of omega-3 oils like flaxseed or fish oils are also of benefit to lubricate and reduce inflammation.

BENEFICIAL HERBS

• Alfalfa aids digestion and the leaves of alfalfa are rich in minerals and nutrients, including chlorophyll, which aids in detoxifying the body. It can be taken in liquid or tablet form.
• Herbs that help constipation include rhubarb, psyllium, and senna leaves.
• Pau d’arco promotes good digestion, cures fungal infections, and helps fight parasitic infections
• Goldenseal, papaya (the dried latex of the papaya is marketed under the names papayotin, papain or papoid), red clover, and yarrow are beneficial for diverticulitis. Caution: Do not take goldenseal on a daily basis for more than a week at a time, and do not use during pregnancy. Do not give goldenseal to children under two. Do not use goldenseal without consulting a physician if you have had heart disease, diabetes, glaucoma, a stroke, or high blood pressure.
• Caraway and peppermint teas are excellent digestive aids (recommend drinking peppermint tea after meals).
• Basil is an effective remedy for a variety of digestive disorders and promotes normal bowel function
• Chamomile tea at bedtime is gentle and calming Caution: Do not use chamomile on an ongoing basis, as ragweed allergy may result. Avoid it completely if you are allergic to ragweed.