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Diverticular Disease - Dr. Emily Kane, ND, LAc

Diverticula are pouch-like projections from the inner wall of the large intestine. They are caused by slow-moving stools which increase pressure within the colon, requiring more vigorous muscular contraction (peristalsis) to expel fecal matter. Approximately 40% of people over age 40 have them, 60% over age 60 and 90% over age 90. They are more common in men than in women. Often, they aren’t a problem at all. But they are also the cause of one of the most common bowel disorders, called Diverticulosis. This disease occurs when fecal matter becomes lodged in the diverticula, making them subject to inflammation, ulceration, bleeding, or more seriously, fistulas. A fistula is an abnormal tunnel, in this case through the intestine wall, which can release fecal matter into the abdominal cavity. This causes peritonitis, which, like appendicitis, requires urgent medical attention. The most common symptoms of diverticular disease are pain in the left lower part of the abdomen, blood in the stools, and irregular bowel habits mimicking irritable bowel syndrome, which presents as mostly constipation alternating with bouts of diarrhea. Pain can also be present on the lower right portion of the abdomen, or associated with other pelvic organs. For example, if inflamed diverticula are adhering to the bladder, urination may be painful. Many people only find out they have diverticula with abdominal imaging, such as barium enema and x-ray, colonoscopy, or bowel surgery. Generally, asymptomatic diverticula do not cause problems. However, the likelihood of diverticula becoming irritated then inflamed increases with age. This is mostly because diverticulosis is entirely a disorder of faulty food choices, and the major offender is refined starches. Smoking and high stress are other known factors in creating inflamed diverticula.

For an acute episode of diverticular disease, a liquid diet may be indicated for several days, along with natural anti-inflammatories, to allow the colon wall to heal. Then, a high-fiber diet must be slowly introduced, and maintained, to prevent further episodes. The following remedies are useful in maintaining good bowel health after the acute phase is resolved.

Oat Bran (Avena sativa)

The very best treatment for early diverticulosis, and for prevention of the disease, is oat bran. Wheat bran provides bulk, but does not lower cholesterol, an additional benefit of oat bran. Oat is hypoallergenic, whereas many people have wheat sensitivities. It doesn’t matter so much whether the fiber is soluble (such as from fruit pectins and legumes) or insoluble (such as bran and cellulose, such as from celery) but that you get a variety of fibrous foods in your diet daily. Fiber’s purpose in the gut is primarily to hold water, which makes the stools softer and easier to pass. This is particularly important as we age and the gut walls become less elastic. Adequate fiber intake may also help prevent conditions such as gallbladder disease, colitis, colon cancer and high cholesterol. Beware of “fiber-enriched” refined grain foods, especially breads; some contain harsh sawdust products. One note of caution: fiber can interfere with mineral absorption and should be taken several hours away from supplements. Take 2-3 tablespoons daily stirred into yogurt, oatmeal, soups or juices.

Flaxseeds (Linum usitatissimum)

This amazing food not only provides a good source of fiber, but is also the only vegetable food high in the healing Omega-3 essential fatty acids, alpha-linolenic acid. Omega-3 fatty acid are necessary for proper infant brain development, and have been implicated in healing a wide variety of disease such as hypoglycemia, arthritis, asthma, allergies, eczema, cancer and bowel disorders. It has potent anti-inflammatory properties as well as providing an exceptionally nutritious source of fiber, which, when finely ground, will gently clean out any pouches that trap bacteria in the gastro-intestinal tract. It also acts as a lubricant for the GI tract because it holds 3-4 times its bulk in water. Golden flax is far superior to the brown flax seeds, which are grown primarily for the paint and solvent industries. Golden flaxseed is a hybrid specifically intended for food and medicinal use due to its higher Omega-3 content. Take 2-3 ground tablespoons daily, in water is fine, but my favorite is in pineapple juice.

Why have I not mentioned psyllium seed husk? Glad you asked. Psyllium is considerably harsher than flaxseed or oat bran and can actually, with long-term use, scrub away the absorptive surface of the small intestine. Nutrient absorption happens through the villi (fingerlike projections) which line the upper intestine. Long-term use of psyllium (such as Metamucil) can severely compromise a person’s nutritional status; particularly an elderly person. Please let your parents and grandparents know that oat bran and flax seeds are much safer. It’s fine to use psyllium seed husks for “cleansing diets” up to 6 weeks during a year. Just don’t make a habit of it...

Bifido Bacterium

Most of you are familiar with L. acidophilus, the “healthy” intestinal microbe that helps with digestion and maintaining an optimal “microflora” in the gut. Acidophilus is great for the upper small intestine, but as the pH of the gut rises as it moves along towards the colon (becoming more alkaline) different species of beneficial flora optimally live along the gut lining. The most important species for the large intestine, where diverticula occur, is the Bifido species, namely B. bidifum, B. infantis, and B. longum. These should be included in your probiotic blend, or taken separately if you already have a good acidophilus product, for a total of 500-1000 mg (depending on your weight) of healthy microflora (so-called “probiotics”) daily. Bifido bacterium will not only help with proper bowel function, it will help to heal infected diverticula. A good probiotic blend should always be taken in the case of needing antibiotic therapy, for at least 10 days beyond the course of antibiotics.

B-Vitamin Complex

All the B vitamins are critical for proper functioning of the enzyme systems that allow for optimal digestion. These complex biochemical pathways which turn your food into the building blocks for tissue repair are universally dependent on B vitamins. Even if you have a particular need for one B vitamin, it’s best to take a B-complex along with that particular nutrient. In the case of diverticular disease, functional digestion is critical, so that fecal matter will not become impacted in the colon. Please take a good B multi that delivers in the range of 100 mg of each of the main Bs (B1, B2, B3, B5 and B6) as well as 500-1000 mcg of B12 and 400-500 mcg of folic acid. When you are in the first phase of treatment for diverticular disease, you should consider taking this high-potency B multi 3 times daily for several months. Don’t take B vitamins too close to bedtime as they can slightly stimulate the central nervous system. B6, in particular, can give vivid dreams. B vitamins are water-soluble, so can be taken away from food, but are better absorbed taken with a meal. The B2 (riboflavin) will turn your urine yellow.

Enzymes

Enzymes are tiny protein units found in live food including fungi, which catalyze all the biochemical pathways in the body. High heat, thus most cooking methods, destroys enzymes. While gently cooked food is easier to digest than raw food, I recommend some raw food (apple, sprouts, carrot stick) every day, even in the winter, to keep enzyme levels high in the body.

When extra help is needed with digestion, such as with diverticular disease, supplemental enzymes are required. If you seem to have trouble with protein digestion (sharply malodorous gas – sulfurous, or egg-smelling) then pancreatic enzymes are your best bet. Look for a product that contains Pancreatin USP (6X concentrate) which gives about 150 mg per serving, and take that with each meal for several months. Ideally the pancreatic enzyme supplement would also contain ox bile extract, since bile helps digest not only fat, but protein. You can increase the flow of your own bile by regularly eating steamed, organic beets. The other critical nutrient for protein digestion is hydrochloric acid. Contrary to popular medical belief, most people have insufficient stomach acid. It is very rare that stomach acid needs to be reduced (i.e. with TUMS or Tagamet or Protonix). Much more usual is to have low stomach acid – you can ask your nutritionally oriented doctor or naturopathic physician to help you evaluate your stomach acid levels. It is generally safe to say most people will be helped with acidifying the stomach at meal times. You can either can an enzyme product that has HCl (hydrochloric acid) about 300 mg per serving, with the pancreatic enzymes, or you can squeeze a half lemon into a small amount of water and take just before main meals. If you seem to have trouble with digestion in general, you might try a multi-enzyme complex (protease, lipase, amylase plus pancreatin) with meals for several months. Most enzyme products will have clear directions on the label as to how many caps to take with meals. If you feel a “burning” in your stomach after taking enzymes, reduce the dose slightly.

Besides the five major remedies discussed above, there are a few more items for helping diverticular disease. One is good old garlic, a potent anti-microbial agent which will get rid of unwanted parasites and bacteria while promoting healthy digestion. Add lots of garlic to your cooking (3-5 cloves daily) or take a yeast-free formula, 2 caps with each meal. According to Bernard Jensen, chiropractor and natural health pioneer, believed that the only needed remedy for many bowel disturbances is alfalfa sprouts. They provide bulk, chlorophyll to oxygenate the tissues and magnesium to relax colicky intestines. A small handful daily, or start with less if they produce gas, should soon help produce regular and normal bowel movements. Another important nutrients for the cells of the gut wall is L-Glutamine, which is critical for fat and sugar metabolism as well as being an important brain detox agent (for ammonia, in particular). L-Glutamine is best taken on an empty stomach, 500 mg twice daily with water or juice (not milk) and combines well with B-vitamins. If protein digestion is still a problem even with extra enzymes and stomach acid, you may benefit from taking free-form amino acids in powder form for awhile until your digestive function improves.

Well-absorbed protein is critical for cell healing. Consider also the spice turmeric (Curcuma longa), which turns rice and stews an attractive golden color. This east Indian spice has been used for centuries as a potent anti-inflammatory, and it is especially effective in combination with enzymes. Sprinkle turmeric liberally in your home-cooked soups and stews, and also sprinkle some on all savory meals – keep a shaker full at the table.

Bibliography
Balch JF, Balch PA, Prescription for Nutritional Healing, Avery Publishing, 1997, pp 234-236.
Carlson KJ, Eisenstat, SA, Ziporyn T, The Harvard Guide to Women’s Health, Harvard University Press, 1996, pp 213-214.
Doress-Worters PB, Siegal DL, The New Ourselves, Growing Older, Simon & Schuster, 1994, pp 58-59.
Gerras,C, Hanna JE, Feltman J, Bingham J, Golant J, Moyer A, The Encyclopedia of Common Diseases, Rodale Press 1976, pp 494-500.
Jensen B, Tissue Cleansing through Bowel Management, (self published), Escondido CA, 1981, pp 103-104.
Murray M, Pizzorno J, Encyclopedia of Natural Medicine, Prima Publishing, 1998, pp 142-143.