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.

I have struggled with digestive problems pain in the lower abdomen, wind, hard stools, diarrhoea and smelly stools, nausea, vomiting and weight loss.

When my GP realised my rather dramatic weight loss, he arranged for me to have every possible test at the hospital. This took months. In the meantime, they found an obstruction where the stomach joins the gut. “Might be a tumour,” said the GP. I lived with that on my mind for a further six weeks until an investigation revealed a hiatus hernia. The other tests showed cysts in the liver, polyps in the stomach and diverticulitus in the gut.

The gastroenterologist suggested antispasmodics, but I declined the painkillers. I then began taking Fibogel, Isogel or Lepicol but, after weeks of this, I found that it was not really helping and stopped all of these remedies. In the meantime, I started on a gluten free regime, which

I found rather expensive. But now, after about six weeks, I think I am beginning to feel the benefits.

Thank you for the comprehensive article. I have found much of interest to me and shall try out some of the herbal remedies. No one has ever even hinted at the possibility of any relief of the diverticular condition, nor have I received any suggestions as to how to deal with the hernia. I seem to recall that, many years ago, an accquaintance suffered from this and was given strengthing exercises to do. I have tried deep breathing and exhaling in a controlled way no results yet! Mrs H. Hyde, Thorpe Bay, Essex……..

WDDTY replies: See our issue on hiatus hernia (WDDTY vol 8 no 1, Q&A) for ideas about how to relieve that problem.

My doctors have recommended that I have about a foot of my descending colon removed. They say that my descending colon is weakened due to all the scanning that I have undergone and that, if I do not have the operation, I risk a ruptured bowel, peritonitis and a colostomy. They have not told me what the risk is or how large a risk I take if I do not have the operation. They have also said that it will take three months to recover, but there will be no side effects. I find this hard to believe as the bowel has to do with water regulation as well as elimination of waste.

I would like to know if there are any alternative treatments worth pursuing and where I can go to find out more about the risks involved in this operation, whether I can discuss this with other people who have had this operation and where I can find out about any research on it.

I think the examinations showed that a section of my bowel had reduced its diameter to 10 cm, but I do not have a copy of the letter and my GP would not give me one or allow me to get a second opinion. JH, Reading……..

A-As is so often the case, it sounds as though your doctors are trying to kill a flea with a sledgehammer.

It is true that you may be getting these repeated infections from a hole in your bowel. Sometimes, the colon can form tiny sinuses, or abscesses, through which bacteria and waste from the faeces can leak out. If the bowel rests against the bladder, these bacteria can also cause a little hole in the bladder and drain into it. As your doctors say, these little abscesses can come and go, so it may be difficult to find them in a test or on scans.

It is also possible that your bladder infections are completely unrelated to such a hole and that these many infections are, in fact, just one infection. A common cause of bladder infection for men and women is the bacteria Escherichia coli. However, it is estimated that, in the USA, about 40 per cent of the strains of E. coli are now resistant to trimethoprim sulphamethoxazole, the antibiotic of choice for bladder infections. So, it may be a case of the same infection repeatedly manifesting itself because the E. coli haven’t been completely eliminated.

Or you could simply have an irritated bladder. Any one of a number of foods can cause irritation these include all forms of caffeine, such as coffee, tea and carbonated beverages, and any foods containing tomatoes. Artificial sweeteners are also a secret culprit. You might also wish to avoid foods high in the amino acids phenylalanine, tryptophan, tyrosine and tyramine. These would include, in particular, citrus fruits, pineapple, cranberries, avocados, figs, yogurt and chocolate, and all wines other than those which do not undergo malolactic fermentation (Goldberg B, ed, Alternative Medicine, The Definitive Guide, Tiburon, CA: Future Medical Publishing, 1999).

The point is that it may be unusual but not impossible for men to have chronic bladder infection.

According to Dr Larrian Gillespie, an American specialist in cystitis at the Women’s Clinic for Interstitial Cystitis in Beverly Hills, California, chronic bladder infection usually has more to do with bacteria being trapped in a bladder and not being able to get out, usually because the bladder isn’t efficiently expelling all of its contents during urination. This was aptly illustrated in one study where medical students consented to having faeces was placed in their bladders. By the second time they urinated, no bacteria remained in their bladders.

So the problem may lie with something in your urinary system that is preventing your bladder from voiding completely. As Dr Gillespie says, “If you can move dirt on the pavement with your stream, instead of ‘tinkling’ drops out, you will not get a bladder infection.”

We are surprised that your urologist has not investigated whether the problem lies with any prostate problems. The actual basis for repeated infection may lie in a slightly enlarged prostate, which will impede a fast and efficient flow of urine.

Usually, when doctors start poking and prodding and doing tests, they will unearth something and, in your case, they have come up with diverticulitis, which can be related to the problem of sinus formation and constant bladder infection. Diverticulosis is a condition where the walls of the intestine balloon out like a bubble of chewing gum. Diverticulitis results when these little pockets become infected. Diverticulosis undoubtedly is linked to the Western diet of processed, low fibre food, but it can

sometimes develop in people who have some genetic weakness, just as varicose veins can develop in those predisposed to it.

We spoke to our panel member Harald Gaier, who tells us that, although scar tissue will form because of these sinuses, it will not be large enough to cause such a narrowing of the bowel or diverticulosis, which is a weakness in the bowel, not a narrowing of it.

Even assuming it is, chopping out a huge chunk of your bowel seems a drastic measure. They’ve warned you that you risk a ruptured bowel, peritonitis and a colostomy without the surgery. But have they warned you that you risk all three with the surgery as well? And nobody, not even the most confident surgeon, can claim that there will be no side effects. There may be, but there may not be. Our mail bag is full of letters from people whose health was wrecked by a doctor who assured them that there were no risks with his procedure.

As you have consulted with a surgeon, he is naturally going to favour surgery. And as your GP is so unforthcoming, it might be prudent to seek a private consultation with a gastroenterologist. Since he does not make his money from surgery, he might be able to suggest alternatives and confirm whether you do need surgery.

In the meantime, there are several alternatives you can try to firm up the diverticular pockets and avoid infection there. Although it’s difficult to completely reverse diverticular pockets, Boiron, the French homoeopathic company, produces a suppository called Rectobyl, which has a good track record for firming up these pockets and making sure they don’t become larger.

Other homoeopathic remedies like Colosynthis or Belladonna at low potencies have much anecdotal evidence of success.

Besides homoeopathic remedies, you can try certain herbal remedies, which have solid evidence of treating diverticulitis. Dr David Mowrey recommends that you take a combination herbal of goldenseal (Hydrastis canadensis), liquorice root (Glycyrrhiza glabra), gentian root (Gentiana lutea) papaya leaf (Carica papaya), myrrh gum (Commiphora myrrha), Irish moss (Chondrus crispus), fenugreek seeds (Trigonella foenum graecum) and ginger root (Zingiber officinale) (The Scientific Validation of Herbal Medicine, New Canaan, Connecticut: Keats Publishing, 1966). This combination is known to soothe and heal a variety of problems of the gastrointestinal tract, including diverticulitis and ulcers. Any competent herbalist can have such a formula made up for you.

You might also try drinking liquorice tea, which soothes the gut.

Once your bowel has narrowed, the condition is likely to stay with you. However, you can follow a diet that will avoid impacted bulk, which is likely to lead to infection or cause blockages, says Dr Gaier.

This means avoiding foods such as wheat and other gluten containing grains, which cause gas, distention and bulked up stools. You’ll also want to cut down on your consumption of meat and dairy products, sugar and refined carbohydrates.

You may also wish to try an elimination diet to determine if you are allergic to any foods or find certain foods difficult to digest. Both types of foods can cause gas and distention or even result in firm, hard stools. Eat plenty of fish, fruits, rice and vegetables, which are easy on digestion. Also, make sure to have enough to drink.

Fibre, those elements of food that remain undigested by the time they reach your large intestine, are vital in getting food to move more efficiently through the intestinal tract. Fibre allows the stool to bind with large amounts of water, which allows easier and more rapid passage through the intestine. Indeed, the problem is that any gastroenterologist is likely to push bran on you to increase fibre. Avoid bran or any gluten containing fibres like the plague. Instead, you can try flaxmeal or psyllium. You should also avoid eating small seeds.

Diverticula are small sac like herniations of the mucosal lining of the colon though the muscular wall. They are found in 30-40% of people over the age of 50. When they become inflamed the condition is called diverticulitis. It is thought that a highly refined low-fibre diet is a primary cause. The characteristic signs and symptoms include pain and tenderness associated with constipation that alternates with diarrhea. Fever is often observed. Differential diagnosis is very important to rule out colon carcinoma.

Actions indicated for the processes behind this disease

Anti-spasmodics will help relieve pain caused by abdominal cramping around the diverticula.

Anti-inflammatories to ease a generalized inflammatory response within the colon.

Anti-microbials are the basis for helping the body deal with any infection that might occur.

Carminatives will help discomfort due to flatulence.

Nervines will ease the stress involved, which may be causal or the result of the condition.

System Support:

Problems of the large bowel of this kind will be effecting elimination in general so support for the liver and kidneys are especially called for. In addition there may be a need to help the nervous system. However this problem is often associated with the aging process and can be linked to a whole range of health issues, from diseases to drug side effects.

Specific Remedies:

The Wild Yam is a very useful specific here. It is a good anti-spasmodic and anti-inflammatory but has a quite specific impact upon this condition.Care has to be taken to not induce constipation through over use of astringent herbs.

One possible prescription

Wild Yam – 2 parts

Valerian – 1 part

Cramp Bark – 1 part

Peppermint – 1 part of tincture to 5ml in total 3 times a day

This supplies the range of actions needed as well as specific help:

• Anti-spasmodics (Wild Yam, Cramp Bark, Peppermint)

• Anti-inflammatories (Wild Yam, Peppermint)

• Anti-microbials (Garlic)

• Carminatives (Valerian, Peppermint)

• Nervines (Valerian, Peppermint)
  

Diverticular disease appears to be associated with a low fibre diet and there is little doubt that most patients gain some relief from their symptoms when on a high-fibre diet. The underlying bowel abnormality remains but it does not cause the same degree of problems. However when the symptoms are acute and severe, an initially low fibre diet is called for to ensure not physical irritation from the roughage. This is especially the case where the person is not used to a high fibre content. As soon as the discomfort is brought under control, the proportion of fibre can be increase gradually to that of a high fibre diet.

The commonest cause of constipation in Western cultures is a lack of dietary fibre. However there are some important less common causes which must be borne in mind by the practitioner, but a detailed discussion of these goes beyond the range of this book. Examples range from conditions such as irritable bowel syndrome, diverticular disease, serious infection of the abdomen (e.g. appendicitis) to painful anal conditions that make the person afraid to open their bowels. Other causes might be drugs that effect bowel motility, long periods of immobility, stress or depression.

There are many herbs that will alleviate the discomfort of constipation and rather than knowing all of the individual species, we can generalize about relevant actions. Laxative remedies are obviously relevant, but others must be considered. Because of their general
stimulation of the digestive process, bitters may be very helpful. Where stress or depression are involved the relaxing nervine, anti-spasmodic and anti-depressant herbs should be considered.

A number of different varieties of laxative may be used. The bulk laxatives are fibre rich foods and herbs that are the only truly safe long term treatments. They act slowly and gently and are best used through a gradual increase in dose morning and evening until a softer, bulkier stool results. Secretory laxatives promote bowel movement through stimulation of bile production in the liver. Hepatics act as secretory laxatives. Stimulant laxative are anthraquinone containing herbs that stimulate peristaltic movement directly via an impact on the nerve ganglioa of the gut. Carminatives may ease the pain and discomfort that is associated with constipation.

A treatment suggestion

As with many other functional problems in the digestive system, there are many specific herbs used in different cultures and by different herbalist’s. As constipation is a symptom, there cannot be any true specifics. Commonly use defective herbs include Yellow Dock and
Psyllium seed.

Yellow Dock – 2 parts

Dandelion root – 2 parts

Aniseed – 1 part tincture to 5 ml 3 times a day

Sometimes, though, the intestinal pouches become inflamed, in which case the condition is called diverticulitis.

Many older persons have diverticulosis. The digestive system becomes sluggish as a person ages. Things that increase the risk for diverticulosis include:

• Not eating enough dietary fiber. Diverticulosis is common in nations where fiber intake is low.
  
• Continual use of medicines that slow bowel action. (Examples: Painkillers and anti-depressants).
  
• Overuse of laxatives.
  
• Having family members who have diverticulosis.
  
• Having gallbladder disease.
  
• Being obese.
  

In most cases, diverticulosis causes no discomfort. When there are symptoms they are usually:

• Tenderness, mild cramping or a bloated feeling usually on the lower left side of the abdomen.
  
• Sometimes constipation or diarrhea.
  
• Occasionally, bright red blood in the stools.
  

Diverticular disease can’t be cured, but you can reduce the discomfort, and prevent complications. Eat a diet high in fiber throughout life. You can add more fiber to your diet with fresh fruits and vegetables, and whole-grain foods. Check with your doctor about adding wheat bran to your diet. These pass through the system quickly, decreasing pressure in the intestines. Do, however, avoid corn, seeds, and foods with seeds like figs. These are easily trapped in the troublesome pouches.

You should also drink 1-1/2 to 2 quarts of water every day. Avoid the regular use of laxatives that make your bowel muscles contract such as Ex-Lax. In fact, you should consult your doctor before taking any laxatives. If you are not able to eat a high-fiber diet, ask your doctor about taking bulk-producing laxatives like Metamucil. These are not habit-forming. Try, too, not to strain when you have bowel movements. Finally, get regular exercise.