Intro: A painful disease that can severely impact lifestyles, diverticulitis is alarmingly common, affecting an estimated one in 10 adults over age 40, and about half of all people over 60. In this article, naturopath Sandi Rogers, N.D., ED.D., life member of the Australian Traditional Medicine Society, offers advice drawn from three decades of clinical experience on how to minimise the effects of this condition.
Q: I’ve been diagnosed with diverticulitis. What can I do to help ease the pain?
This lifestyle-impacting and often very painful condition mainly strikes people aged over 50, with those who experience frequent constipation most likely to fall victim. However, obesity, coronary-artery disease, gallbladder disease and genetics increase the risk of diverticulitis.
Experts believe a key contributor to diverticulitis is a diet that is low in fibre, as a lack of fibre – or roughage – can make bowel motions difficult. The excess pressure from straining can lead to certain areas of the colon becoming weakened and collapsing, producing bulging pea-sized pouches – known as diverticula – that protrude through the colon wall. These pouches, which gradually become larger, typically develop in the sigmoid and descending colon – the lower portions of the large intestine that sit just above the rectum. One reason older people are more susceptible to developing diverticula is that the walls of the large intestine tend to weaken with age.
The existence of diverticula in the intestines is known as diverticulosis, a condition you may not even realise you have as it seldom causes any problems. However, if the diverticula become infected or inflamed – possibly because waste matter becomes lodged in one of the pouches – the condition is called diverticulitis, which can be acute or chronic. Between 10 and 25 percent of people who have diverticulosis develop diverticulitis.
Fighting with fibre
In treating the condition, a natural therapist considers the entire alimentary canal from the mouth to the anus, in contrast to conventional treatment, which tends to focus only on the bowel and the colon. Ancient medical texts reveal fibre has been used to treat diverticulitis from the time of Hippocrates (b. 460BC) – and even before. It remains a recognised and effective treatment, even though at one stage doctors would warn against too much fibre believing it could irritate the diverticula, when the reverse is true.
The key is to use the right type of fibre: a soothing form of fibre rich in mucilage – a type of viscous soluble fibre present in plants that has anti-inflammatory properties. The mucilage starts to settle the diverticula because this fibre is soothing and healing.
Rolled oats are an excellent source, as are wholegrain breads and cereals. I actually suggest people consider making their own bread to ensure maximum fibre content. It’s very easy: plenty of information online or buy a bread-making machine.
The key point with fibre is that people suffering diverticulitis must ensure the fibrous foods are hydrated before bringing them in to the body rather than have this occur in the gut. So if you use rolled oats to make muesli, pre-soften the oats by soaking them overnight in apple or orange juice. If you make porridge, soak the oats overnight in water.
When you first try to settle down your diverticulitis, an old-fashioned recipe is to soak bread in low-fat custard – or make a bread-and-butter pudding. The bread provides some bulk, the fibrous content is hydrated and softened externally so it becomes a soothing applicant as it enters the body. It’s a lovely mixture to use, particularly when the diverticulitis is flaring up and everything you eat it tends to irritate you.
Vegetables and fruits
Also important is eating plenty of vegetables and fruits (work on the ratio of one fruit to three vegetables) as the fibre is hydrated due to the fluid content of the item. It’s important to eat the skin as it contains a different type of roughage called pectin, which is really beneficial for diverticulitis. However, because apple skin can irritate the bowel, you may need to grate it. So grate the whole apple, soak it in fresh orange or apple juice to soften it, and then eat it with yoghurt that contains probiotics.
We also advise clients with diverticulitis to take two teaspoons of bran twice a day with their food. Hydrate the bran first by soaking it in water for 15 minutes. Add the soaked bran to salads or soups, toss it through yoghurt, put it on top of other fibrous foods you’re having. After two weeks, decrease the amount to one teaspoon twice a day. Where a flare-up occurs, which it can when you’re under stress or eating foods you are sensitive to, go back to the two teaspoons, twice a day.
You really can’t have too much bran: there’s no such thing as a correct dose because we are all different. However, people who are wheat- or gluten-sensitive may find wheat bran and wheat-based breads and other wholegrain foods can cause a flare up. Substitute rice bran or oat bran, or psyllium, and buy gluten-free wholegrain products. Again, make sure they’re moistened externally.
Slipper elm powder
Slippery elm powder is very helpful for diverticulitis, but people generally take it incorrectly, meaning it has little effect on the condition – and that’s because it expands inside the body, when it actually needs to be hydrated externally. The correct way is to mix a teaspoon of slippery elm powder into half a glass of water and let it sit for 15 minutes to absorb the water and expand. Add some more water to the mix and drink it.
Fish over meat
Red meat should be avoided as it’s an irritant. If you can’t live without it, have it minced, e.g. a small amount in a Bolognese sauce or a mince patty, as this form is easier on the digestive tract, given the fact many people don’t chew their meat sufficiently. However, when you’re in the throes of diverticulitis-related irritation, a far better option is fish – especially fatty fish like salmon as the omega-3 oils have anti-inflammatory properties.
Another important thing with diverticulitis is to keep the body well hydrated, as this plays a key role in preventing constipation. The most effective routine is drinking water in larger doses until mid-afternoon and tapering off after that. The reason for this is that the body is working quite hard during this period and the better hydrated it is, the better it copes. The water should be sipped rather than gulped as sipping ensures the cells are properly hydrated: sip a 250ml container of water over a 15-to-20-minute period.
Following the regime of eating externally hydrated oats, bran, wholegrains, slippery elm powder, plus fresh vegetables and fruit, and fish in preference to red meat, is often enough to settle the body when the diverticulitis flares.
From there, be very careful about the foods you eat; everyone’s different, and what one person might be able to tolerate, another person won’t, it’s about identifying those foods you can tolerate. As an example, you may need to steer clear of celery and corn as they contain indigestible roughage.
The most common symptom of diverticulitis is indigestion – and this may be the only sign something’s wrong. However, many people experience multiple symptoms and quite severe pain, which tends to surface rather abruptly in the lower left side of the abdomen. Alternatively, a mild pain may manifest, and possibly increase over several days, fluctuating in intensity.
Abdominal tenderness, fever, nausea, and constipation or diarrhoea are other typical symptoms. Less common signs include vomiting; bloating; frequent urination or pain or difficulty during urination; rectal bleeding; abdominal tenderness; and blood in the stools.
Small tears or perforations can occur in an infected pouch, which may result in an infection within the abdomen leading to peritonitis. Where infection is confined to an area on the colon wall where diverticula are inflamed, an abscess may form. If you experience any of these symptoms, see your doctor as many are related to more serious bowel conditions, including cancer.
To diagnose diverticulitis, your doctor will question you about your symptoms, your bowel movements and your diet. They may conduct a rectal examination or send you for other tests such as blood and stool tests; barium enema, in which a dye is passed through a tube into your large bowel to highlight inflamed areas; a CT scan, or a colonoscopy.