Understanding diverticular disease

Digestive health can be a complicated subject, and one area that often causes confusion is diverticular disease. You might have been told that you or a related has diverticulosis, diverticular disease or diverticulitis - all related conditions affecting the large intestines.  So, what's the difference?

What are diverticula?  

Diverticula are small pouches or bulges that form in the lining of the bowel wall.

• Diverticulosis means that these pouches are there, but not causing any symptoms.
• Diverticular disease refers to diverticula that are causing problems such as pain or altered bowel function.
• Diverticulitis occurs when the diverticula become inflamed or infected, which can be more serious and may require medical treatment.

Many people with diverticulosis will never experience symptoms, but for others, flare-ups can be uncomfortable and disruptive.

Symptoms of diverticulosis to look out for

The symptoms below can vary in severity but are often persistent enough to interfere with daily life.

Common signs include:

• cramping or abdominal pain (often in the lower left side)
• bloating and excess wind
• changes in bowel habits, so you can see how it can be confused or misdiagnosed with other digestive conditions

Why does diverticular disease develop?

The exact cause isn't fully known, but it is pretty clear that one of the strongest risk factors is a low-fibre diet. The modern Western diet - often high in processed foods and low in whole plant foods - seems to increase the likelihood of developing diverticula.  And fibre, found in whole plant foods, is critical in protecting the gut lining and supporting the microbiome in the following ways:

•  Gut bacteria ferment certain fibres, producing short-chain fatty acids, which are the main fuel for our intestinal cells. This process helps protect against inflammation and keeps the bowel wall healthy.
• Soluble fibres, such as those from oats, can also help regulate cholesterol levels and support detoxification.

Without enough fibre, the bowel has to work harder to move waste along, which may contribute to the formation of diverticula over time.

How much fibre do we need?

Public health guidelines of fibre intake have shifted in recent years, as research now shows we need more than previously thought. Most adults in the UK still fall short of this target, often because most of us eat refined grains and too much low-fibre processed food. Meeting the daily requirement is not as difficult as it sounds when you build your meals around foods containing fibre.

The recommended 30g of fibre per day can usually be achieved by:

• increasing fruit and vegetable intake
• switching from white, refined carbohydrates to wholegrain options (e.g. brown rice, wholemeal bread, wholegrain cereals such as sugar-free muesli)
• including legumes, nuts and seeds regularly.

And yes, you can eat nuts and seeds. Advice to avoid nuts and seeds is now considered outdated, and research has shown that these foods do not increase the risk of diverticulitis and may even be protective.

Practical strategies for managing diverticular disease

The good news is that lifestyle factors play a major role in diverticular disease prevention and management.  Even small consistent changes can improve your digestion and reduce any pain or symptoms you experience, and may reduce the risk of complications.

Practical strategies include:

• Eating a Mediterranean-style diet rich in vegetables, legumes, fruits, nuts, seeds, fish and olive oil.
• Prioritise fibre, aiming for 25-30 grams daily from a variety of whole foods.
• Stay hydrated by drinking water and herbal teas to prevent constipation.
• Exercise or build movement into your daily routine to support bowel motility and reduce the risk of flare-ups.
• Support your gut bacteria with the above, but also by including fermented and prebiotic foods that feed the beneficial gut bacteria inside you. 

Natural and herbal approaches to diverticular health

In addition to food, certain natural compounds show promise for diverticular health.  These can help reduce inflammation, modulate gut bacteria and provide antioxidant support. As always, you should seek advice before starting on any natural compounds such as curcumin, green tea (or matcha) or other compounds, such as pomegranate husk extract.

For best results, a personalised approach would be my recommendation in order to monitor your response to dietary, lifestyle and supplement recommendations by taking a step-by-step approach so as not to overload your gut and digestive system.