The presence of these pouches is called diverticulosis, a condition that is not in itself a cause for alarm. But if pressure erodes and thins the wall of a diverticulum, tiny perforations can appear, allowing bacteria from the colon to escape through the holes and infect the surrounding tissue. This development is called diverticulitis, a potentially serious condition that can require surgery if it’s not caught and treated in time. (2,3) “You have to have diverticulosis to get diverticulitis,” says Albert Kim, MD, MPH, a gastroenterologist and clinical assistant professor at the University of Michigan Medical School in Ann Arbor. “Then, once you have these saclike pouches on the wall of the colon, they can develop inflammation, followed by either a small or a large perforation that then leads to infection. It’s all part of the same process — these things can happen at the same time.” Diverticulosis is fairly common in the United States. A study suggests that about 35 percent of American adults age 50 and younger have these pouches, while the figure for people older than 60 is closer to 60 percent. (4) About 5 percent of people with diverticulosis will go on to have diverticulitis. (5) The most common sign of diverticulitis is abdominal pain, particularly in the left lower abdomen, where the sigmoid colon is located, Dr. Kim says. He notes that there are racial and geographical differences in where the pain manifests — while pain in the lower left abdomen is most common in Western countries, in Asian countries the pain usually comes from the right side of the abdomen, but why this is the case is not known. The pain may be accompanied by nausea and vomiting, he adds. (6)
The Relationship Between Fiber and Diverticulitis
The reason fiber is so important is that plant fiber binds water and salt, resulting in larger bowel movements. (7) This eases the transit of stool through the colon, reducing the pressure on the colonic wall that causes diverticula to become inflamed and infected, says Ira Shafran, MD, a gastroenterology research specialist in Winter Park, Florida. (8) He recommends eating high-fiber foods, such as fruits and vegetables, as well as supplementing your diet with added fiber products like psyllium husk if needed, particularly if diverticulosis is already present. It was once common wisdom that a high-fiber diet prevented the formation of diverticula in the first place. (9) But a 2015 study found that while fiber can prevent symptoms and complications of diverticulitis, it has only a limited impact on the development of diverticulosis. (10) That doesn’t mean you should skimp on fiber, as odds are that if you have diverticulosis, you don’t know it. “Eighty percent of the patients I see with diverticula are asymptomatic; they don’t know they have diverticulosis until we see it on a colonoscopy,” says Dr. Shafran, emphasizing the importance of a proper diet regardless of whether you present symptoms of diverticulitis.
Risk Factors Linked With Diverticulitis
Besides a diet low in fiber, the following risk factors are also associated with diverticulitis: Consuming too much red meat: That includes pork, Kim notes, despite the marketing of pork as white meat. (11) Eating a diet high in saturated fats: This can cause constipation, creating opportunities for food and waste particles to become trapped in and inflame the diverticula, Shafran says. (12) Your genes: Although genetics are a known risk factor for diverticulitis, what genes are involved and who is most at risk is still unclear. (7) The presence of polycystic kidney disease: The development of diverticula and diverticulitis are more common in people with polycystic kidney disease, suggesting that diverticulitis is one manifestation of the disease. (7,14) Being overweight or obese: Obesity is linked with chronic intestinal inflammation, as well as the presence of more harmful gut bacteria. (15) Taking corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs): (7) These drugs have been found to cause injury to the gastrointestinal tract, and NSAIDs may also prevent the formation of a compound that maintains intestinal tissue. (16)
Can Eating Nuts and Seeds Put You at a Higher Risk for Diverticulitis?
Kim also notes that in the past, physicians had advised patients to avoid eating seeds and nuts, as it was thought that these contribute to diverticulitis, but this is no longer the case. It was thought that small seeds, such as the ones found in tomatoes, cucumbers, and strawberries, or even the sesame seeds on a hamburger bun, could get lodged in the diverticula and inflame them. (17) But no scientific evidence has been found to support this fear, and eaten in moderation as part of a high-fiber diet, such foods can actually help prevent diverticulitis. (18) RELATED: Seriously Bloated? Warning Signs You Shouldn’t Ignore Not getting enough exercise: Besides contributing to weight loss, physical activity, particularly jogging and running, have been associated with faster transit of stool through the colon. Overall cardiorespiratory fitness is also associated with reduced diverticulitis risk. (19) Drinking too much alcohol: While the research is inconsistent in linking alcohol to diverticulitis, some studies suggest that alcohol can impair the motility of the colon, increasing the pressure within the colon. (20) Smoking cigarettes: Smoking impairs the blood supply to the colon and can increase pressure within the colon as well, potentially leading to perforation. (21)
How Knowing the Causes of Diverticulitis Can Help You Prevent the Disease and Related Conditions
The good news is, even if you already have diverticulosis, following the above advice can reduce your risk of developing diverticulitis by up to 50 percent, Kim says. “Exercise, eat your fiber, avoid red meat, don’t smoke. If you do all the good stuff, you can significantly reduce your risk of getting diverticulitis.” RELATED: The Best and Worst Ways to Quit Smoking Research has shown that higher levels of vitamin D are associated with a reduced risk of diverticulitis as well, so consider getting some of that exercise outside in the sun, or supplementing with vitamin D if your doctor thinks that’s appropriate. (22) That’s good news indeed, as diverticulitis can lead to complications serious enough to require surgery, including abscesses, or pockets of pus that can form inside of the diverticula; and fistulas, abnormal tunnels between the colon and adjacent organs, Kim and Shafran warn. (23) Peritonitis, which occurs when an infected pouch ruptures and spills the contents of the intestine into the abdominal cavity, is also a possible complication, one that requires immediate medical attention. Complications, including abscesses, fistulas, obstruction, and perforation, occur in about 25 percent of people with diverticulitis. Finally, Shafran and Kim point out that diverticulosis becomes increasingly common with age, making it all the more important to do what Kim calls “the good stuff” as you get older. Follow the simple guidelines laid out above. Your gut will thank you.
