let's call it "Pouchitis" because diverticula is too hard!

So you’ve had a colonoscopy and your surgeon told you that you have diverticulosis. And now you’re really worried and every time you have a bit of a tummy ache, or bloating or a stomach cramp you’re nervous? Well, put your concerns to bed. For two reasons:

1. Your surgeon probably said diverticulosis NOT diverticulitis. It’s annoying that these two disease states have such similar names…because they are very different.

2. Now you think that you have something wrong in your digestive tract you’re going to worry and end up thinking about it too much and that WILL cause trouble with your digestive tract!

So….let’s cast some light on this deep dark corner of your body.

First, some definitions: diverticula are little pouches that form in the lining of the digestive system, mostly in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems.

If you’ve got diverticula you have diverticulosis (die-vur-tik-yoo-LOE-sis) – from now on “pouchitis!”. In industrialised countries most of us will get it. Most of us will also never know it!

When one or more of the pouches become inflamed, and in some cases infected, that condition is known as diverticulitis (die-vur-tik-yoo-LIE-tis). Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits.

Pouchitis (diverticulosis) is a very common condition and most people who have it never really have any symptoms; in fact most of us only know we’ve got it because we’ve had a colonoscopy and the surgeon has said it was seen while they poking around in your colon. It’s estimated that 60% of people over 60 have diverticulosis and that this number rises up to 70% by 80 years of age. Most who have it will never even know it.

Interestingly, prevalence is lower in non-Western countries. (Ed's Note: where they eat less junk food and more plants! - the related research is currently underway)

It is estimated that only two percent of people with diverticulosis will go on to have the serious disease of diverticulitis.

There’s a growing use of the term SUDD (Symptomatic Uncomplicated Diverticular Disease) to describe people with abdominal symptoms but don’t have any overt inflammation, so physical

ly there is no indication that they have diverticulitis. But if you think about how common abdominal systems are (IBS for example) and how common diverticulosis is, it’s often hard to discern what exactly is causing the symptoms.

However, in the US and the UK (I’m not sure here in Australia) gastroenterologists believe that unless a patient has a history of diverticulitis (the bad inflammatory disease) it’s unlikely that the diverticulosis will cause symptoms.

According to the American Society for Gastrointestinal Endoscopy (see link to podcast) it’s really hard to know if those two are related…it’s really hard to know if the diverticulosis is causing the symptoms”.

What they’re saying is, unless you’ve had a diagnosed flare up of diverticulitis, in is very unlikely that your tummy pain comes from diverticulosis – it will more likely be plain old constipation which is the most common cause of bowel and stomach problems in the Western world.

Research hasn’t yet shown why the pouches (diverticula) are more prevalent in industrialised counties –

originally it was thought it was a lack of fibre in diet, however more recent research implicates connective tissue in the colon. It appears that there’s a genetic component and some people who develop diverticulosis have some difference in their connective tissue that makes it more lax so the mucosa can poke through the circular and longitudinal muscles in the colon. However, this is where it comes back to food; while fibre might not be the root cause of the problem, it’s possible that the lack of fibre has epigenetically expressed or “turned on” the diverticulosis gene. So, back to square one. Eat more plants.

Smoking and overweight are known to play a large role.

PREVENTING DIVERTICULITIS

Even though you may have diverticulosis, this doesn’t mean that its going to escalate to painful diverticulitis.

So how do you stop that happening?

First, stay the right weight and don't smoke. Then...plants for fibre. There are two reasons for this – even though

fibre no longer seems to be linked to the development of the symptoms itself, it is very important in staving it off and managing it. A high-fibre diet is protective. Fibre-rich foods help maintain regular bowel movements and reduce the risk of stool becoming trapped in the diverticula, which could lead to inflammation and infection. Additionally, fibre supports a healthy gut microbiome, which plays a role in overall gut health.

This is potentially the most important element and is very new science. The gut microbiome lives on fibre and as the fibre is digested and fermented by the bugs in your gut (the microbiota) it produces very important elements called “Short Chain Fatty Acids” which play a huge role in protecting the mucous layer and the cells of the colon.

So, it makes sense that if you protect the lining of the gut, it won’t get problems.

Vegetables and fruit, legumes, beans, nuts, seeds and grains. Eat them all! The bugs will thank you and build a strong colon lining.

PS. It’s an old wives tale that seeds will give you diverticulosis (or diverticulitis) – eat them, they’re good for you.

WHAT TO DO IF YOU DO HAVE DIVERTICULITIS FLARE UP

If you are among the two per cent that does suffer from diverticulitis, and you get a flare up, see a doctor.

You may be given antibiotics or treated with a food plan.

If for some reason you don’t want to see a medical practitioner (!) then you will need to go onto a broth diet for several days, followed by introducing soluble fibre (oats, chia – plants that partly dissolve) - this is the type of fibre that the bugs want. Don’t introduce insoluble fibre until the flare up has subsided (things like leafy greens etc) but these are very important for future “motility” – that is, making the colon work well and allowing you to poo easily!