GUEST BLOG - Diverticulitis and Diverticulosis

Produced by Matthew Rigoni

Dietitian, Sports Nutritionist, founder of R.E.A.L

Welcome to our Guest Blog Series! This entry was written by Mattew Rigoni - Dietitian, Sports Nutritionist, and founder of R.E.A.L. shared here with permission. Join us as we explore a wealth of knowledge and insights from experts in various health and wellness fields.

What is it? 3,5

There are 3 stages/ categories of the disease.

• Diverticulosis is a very common condition where small pouches or pockets form in the wall of your large intestine/ bowel.

  • -  This is the physical structural difference from a disease free bowel.

  • -  It is usually asymptomatic (does not cause any symptoms and you can’t tell it is there

    unless tested for)

• Diverticular Disease is when Diverticulosis causes symptoms such as

  • -  Mild cramps or lower stomach pain that may come and go

  • -  Bloating

  • -  Inconsistent or irregular bowels

• Diverticulitis is when the small pouches of diverticulosis “flares up”, becomes irritated and/or is infected. This may commonly lead to one or multiple of the following:

  • -  Significant sharp & intense pain and/ or cramping in lower stomach/ abdomen

  • -  Fever

  • -  Nausea &/ or vomiting

  • -  Loss of appetite

  • -  Constipation or diarrhoea

  • -  Blood in stool

What causes diverticulosis and diverticulitis? 3,5

Diverticulitis is a multifactorial disease, meaning that multiple things appear to contribute to its development. It’s primary influence is low fibre intake (meaning low vegetable, fruit and legume intake) and dehydration in the diet over many years. Additional contributors can be:

• -  Reduced physical activity & exercise

• -  Pushing when going to the toilet and chronic/ long term

  constipation.

• -  Obesity

• -  Smoking

• -  General “wear and tear” of our bowels as we age

How is it treated?

Once a diagnosis has been confirmed via your Doctor, treatment may depend on the severity/ stage of the disease or if there are complications present.

-  Diverticulosis: For a large portion of cases, dietary intervention of higher fibre intake should be sufficient in preventing progression or flare-ups to Diverticulitis.

-  Diverticulitis (flare-up): For more severe &/ or frequent cases, A bowel rest diet may be begun including 2-3 days of clear fluids (no solids and no fluids that are not transparent), followed by an easy-to-chew and soft foods diet until pain improves.

Once pain improves, resuming a higher-fibre diet is recommended. If you’re looking for further support, a Dietitian is a nutrition expert and can assist with meeting your requirements.

Your Doctor may recommend medicines or surgery (colectomy) to support your quality of life if severe enough

How common is it?

Diverticular disease is a very common disease in Australia and globally.

-  1 In 3 Australians over the age of 45 have diverticular disease

-  1 in 2 people over 80 have the disease.

-  A large portion of cases are asymptomatic and unnoticeable in daily life

When should you see a Doctor?

See your doctor if you have:

-  Cramps or lower abdominal (tummy) pain

-  Irregular bowel habits — alternating episodes of constipation and diarrhoea

-  Blood in your stool (poo)

When should you see a Dietitian?

For personal assistance with modifying your diet because of diverticular disease, contact an Accredited Practising Dietitian (APD).

We recommend seeing a dietitian if you:

• Have been diagnosed with diverticular disease and want some support on dietary management of this condition

• Would like to optimise the healing rate of diverticula

• Are struggling with any of the symptoms of diverticular disease

• Need nutritional advice to help ensure you're meeting your individual nutrient requirements

• Would like advice on ways to have more high-fibre foods in your diet

• Would like personalised advice and support from a professional.

Accredited Practising Dietitians (APDs) are university-trained nutrition experts. They can help you with personalised, easy-to-follow and evidence-based advice.

Frequently asked questions and common misconceptions

1. Can I eat seeds, corn and peas with diverticulosis/ diverticulitis?

a. It was previously thought that small and hard food items such as seeds, corn, nuts and

popcorn would get stuck in the small pockets/ pouches in diverticular disease. There is currently no evidence supporting these claims and, in fact, it appears that consuming these foods may actually reduce the risk of diverticulitis/ fare ups. 8

2. Will probiotics reduce the risk of a diverticulitis flare-up?

a. No. There is currently no evidence that supports the use of probiotics to prevent flare

ups.

3. My Doctor told me I should go on a low-fibre diet until my pain gets better.

a. Currently, there is very poor evidence for either low fibre or high fibre diets while a flare up is active. Usually, this decision should be made on a case-by-case basis and taking into account the complexity of your condition/ situation.1

4. If a high-fibre diet is recommended, can I just get all my fibre from a supplement such as psyllium husk instead of whole foods?

a. No. While the current evidence for supporting dietary fibre intake is not completely conclusive, we at R.E.A.L conclude that the wide micronutrient intake that accompanies high-fibre foods may assist with the healing process (and reduce the occurrence of additional chronic disease) in combination with the fibre int the food, which you do not achieve with the supplemental form alone.

5. What foods should be avoided if I have diverticulitis?

a. Generally, it’s not the foods that you should avoid, it’s the foods that you should be getting. A high-fibre diet with plenty of fruit, vegetables and legumes may reduce the occurrence of diverticulitis and by extension, support health in many other areas.

6. Is exercise necessary?

a. If your goal is to reduce the risk of a flare-up/ diverticulitis as

much as possible, then yes. There is strong evidence to support that physical activity

decreases the occurrence of diverticulitis. 7

7. Does stress cause diverticulitis?

a. While there is no specific link, chronic muscle tightness and contractions, colonic pressure and systemic inflammation all theoretically have roles in the development of diverticulosis.

We are excited to present this engaging blog post produced by Matthew Rigoni, a Dietitian and Sports Nutritionist, and founder of R.E.A.L. Located in Melbourne, Victoria, his practice offers tailored nutrition and lifestyle strategies.

For more details or to schedule a consultation, visit R.E.A.L at their Melbourne location, email admin@realnutrition.com.au, call +61 468 872 138, or explore their offerings online at Recovery, Exercise, and Lifestyle.

R.E.A.L is dedicated to providing individualized care and addressing a wide range of health and wellness needs. With a focus on sports nutrition and lifestyle management, they are committed to supporting your health journey. Their doors are open Monday through Friday from 8:00 AM to 7:00 PM, and Saturdays from 8:30 AM to 1:00 PM, ready to welcome you and provide the expert care you need.

References:

Dahl, C., Crichton, M., Jenkins, J., Nucera, R., Mahoney, S., Marx, W., & Marshall, S. (2018). Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review. Nutrients, 10(2), 137. https://doi.org/10.3390/nu10020137 1

Dietitians Australia. Diverticular disease, Dietitians Australia. Available at: https://dietitiansaustralia.org.au/health-advice/diverticular-disease (Accessed: 20 January 2025). 2

Health Direct Diverticular disease - diverticulitis and diverticulosis, healthdirect. Available at: https://www.healthdirect.gov.au/diverticular-disease-and-diverticulitis (Accessed: 20 January 2025).

3

MacKee, N. Uncomplicated diverticulitis: Putting antibiotics on hold, InSight+. Available at: https://insightplus.mja.com.au/2019/29/uncomplicated-diverticulitis-putting-antibiotics-on-hold/ (Accessed: 20 January 2025). 4

NIDDK Diverticular Disease - NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis- diverticulitis (Accessed: 20 January 2025). 5

Piccin, A. et al. (2023) Diverticular disease and Rifaximin: An evidence-based review, MDPI. Available at: https://www.mdpi.com/2079-6382/12/3/443 (Accessed: 20 January 2025). 6

Strate, L.L. et al. (2009) ‘Physical activity decreases diverticular complications’, The American Journal of Gastroenterology, 104(5), pp. 1221–1230. doi:10.1038/ajg.2009.121 7

Weisberger, L., & Jamieson, B. (2009). Clinical inquiries: How can you help prevent a recurrence of diverticulitis?. The Journal of family practice, 58(7), 381–382. https://pubmed.ncbi.nlm.nih.gov/19607778/ 8