Diverticulosis vs Diverticulitis, what is the difference?

Both Diverticulosis and Diverticulitis are disorders that effect a portion of the gastrointestinal tract called the colon. Diverticulosis is the simple presence of mucosal herniations called Diverticula (small pockets form and protrude from the lining of the colon), this is common in many of the unknowing population because it has no symptoms.

Whereas Diverticulitis is a disorder primarily characterized by inflammation of the formed diverticula[1,2].

This disease is surprisingly common, however it still only largely effects the elderly. The latest statistic suggested that between one third and a half of people will develop diverticula in their lifetime. This chance increases as years go by [2,4]. However 85% will never experience symptoms and 15% will develop serious symptoms of Diverticulitis.

What is the difference?

The name Diverticulosis comes from the latin “Diverticulum” which means “to branch”. Our colon is made up of multiple layers, the protrusion occurs when a hole is made in the outer layer of the colon and the inner layer protrudes through. Diverticulitis can be hugely serious when bacteria form in the protrusions and colonise. This causes inflammation, pain and bleeding amongst other symptoms.

Diverticulosis is the formation of Diverticula (pouches) from the wall of the colon. Whereas Diverticulitis is the infection and inflammation of said pouches. There are two kinds of chronic Diverticulitis, these are:

• SUDD- Symptomatic uncomplicated Diverticular disease.
• SCAD- Symptomatic colitis associated with Diverticulitis[4].

What is the cause of the disease?

In some people this disease can be prevented and it’s all down to the diet. There has been a mild increase in the consumption of fibrous wholegrains, fruits and vegetables recently, however it is still not sufficient. As of 2015 the new guidelines for fibre were put in place. It is now suggested that we consume 32g/day, on average the UK barely reached 18g. Increasingly most westernised nations are eating less fibre than recommended which leads to chronic constipation and more pressure on our colon. Increased pressure leads to weakness in the colon, holes and protrusions. Increasing fibre may be the answer to decreasing our chances of unknowingly producing Diverticula [3]. In addition, sedentary lifestyle, smoking, obesity and an increased use of NSAIDs (non-steroidal anti-inflammatory drugs) can lead to a weakened structure within the large intestine [4].

On the other hand, some people are genetically predisposed to developing Diverticulitis. They have a faulty gene for the production of T-cell receptor, TNFSF15. T-cells are involved in the immune and inflammatory responses, a sort of stress signal. This faulty receptor means there is an ‘overreaction’ thus creating the classical inflammatory symptoms of Diverticulitis [1].

What are the symptoms of Diverticulitis?

Diverticulosis is simply the presence of Diverticula, it tends to be asymptomatic. Whereas Diverticulitis is quite the opposite. SUDD is characterised by bloating, left abdominal pain, constipation or diarrhoea and a clinically raised white blood cell count. SCAD is more serious and only occurs in 0.3 to 1% of people. The symptoms of this are rectal bleeding, pain located in the abdomen, fever like symptoms and diarrhoea [4].

How can you treat Diverticulosis and Diverticulitis?

If you have Diverticulosis there are many things you can do to prevent more forming, or for it to develop to Diverticulitis. These include:

• Increase your daily fibre. The new recommended amount for fibre is 32g in the UK and this should be the aim. Dietary Fibre can be increased by switching to wholegrain and brown options (bread, pasta, rice). You can also boost your fibre by leaving skins on vegetables, increasing your legume, nut and dried fruit consumption.
• Take Probiotics. A probiotic is a live micro-organism that is introduced to the gastrointestinal tract to encourage growth of natural intestinal bacteria. This will provide important health benefits and reduce colonisation by foreign bacteria[1].
• A beneficial step may be to convert to a plant based diet, this easily increases dietary fibre.

If you have developed Diverticulitis the advice is quite different:

• Eat soft and low fibre foods that are easy to digest. Fibre should only be added back in when inflammation begins to decrease.
• Ensure that protein rich foods are consumed in abundance. Please be careful that if you are vegetarian you do not consume fibre rich proteins such as chickpeas and lentils.
• Ensure iron levels are also adequate. During inflammation of the Diverticula they may rupture which will cause bleeding. Internal bleeding can drastically reduce iron concentration in the body, in very serious cases this can lead to anaemia. Iron rich foods include red meats, dark chocolate, and spinach. Majority of iron sources (beans, legumes, fortified cereals and dark leafy vegetables) are fibre rich so these must be eaten in moderation.
• Contact a doctor as a course of antibiotics will be required to fight the bacterial infection [1].

Natural Supplements you could try...

As previously mentioned Probiotics are hugely effective in repopulating the colon with good and beneficial bacteria. Lactobacillus makes up between 20 and 60% of the bacteria found in the gut. Taking a Probiotic such as Lactobacillus Acidophillus can be hugely beneficial in to gut health [5]. One study showed that after taking Probiotics (Lactobacillus acidophilus, Lactobacillus Planatarum and Bifidobacteria) they were more likely to stay free of Diverticulitis symptoms after one year than when treating with anti-inflammatory drugs. If you struggle to eat Iron rich source from you food you could try supplementing it. Iron is one of the most popular supplements on the health market [6].