Abdominal Pain, Bloating, Cramps and Nausea: Could it be Diverticulitis?

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I've got a two-part show. First, I'm going to be talking about diverticulitis, diverticulosis, and diverticular disease, and that will be followed by a short interview with my sponsor for this episode, Gut Gardens founder Lily Lopez, who will be talking about her gut health journey, how she turned her gut health around, and supplements that she designed to help others turn around their gut health. But before I get started, if you haven't yet followed or subscribed to the show, please be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet called Finding Your Root Cause Through Stool and Organic Acids Testing when you sign up. Now on to the show. Today we're going to be doing somewhat of a deep dive into the world of diverticulitis, diverticulosis, and diverticular disease. While people tend to use all these terms interchangeably, there are distinctions between them. Diverticulosis simply means that there are pouches that are present in the large intestine. And if you haven't heard of this before, you may just wanna Google a picture of what that looks like. The presence of the pouches alone isn't necessarily a problem, but when these pouches become inflamed or infected, that's called diverticulitis. And then diverticular disease is a broad name of all the symptoms that can be experienced due to the pouches forming. And that's in fact super common as we age, with over 50% of people over the age of 60 and 60% of people over the age of 80 having colonic diverticula. But let's back up a bit and talk about what exactly diverticular disease is in case you haven't heard of it. If you're diagnosed with diverticular disease, it means that there are these pouches, known as diverticula, in your colon or large intestine. And they're like bubbles or bulges in the weaker areas of the wall of the colon. So just having them is called diverticulosis. Most people with diverticulosis are asymptomatic. So that alone isn't cause for concern. However, when those diverticula become inflamed or infected by bacteria, this is called diverticulitis, which is estimated to happen in around 10 to 25% of people, although more recent estimates are around 5% of people with diverticulosis. Diverticulitis can be accompanied by fever, chills, tenderness over the affected area, nausea or vomiting, leukocytosis, or an increase in the number of your white blood cells, cramps, rectal bleeding, and pretty severe discomfort in the lower left part of the abdomen. The pain will often be bad enough to necessitate, necessitate significant lifestyle changes or even a trip to the hospital. About 25% of those suffering from this illness will see complications such as perforations, peritonitis, or inflammation of the peritoneum or lining of the abdominal cavity, abscesses or collections of pus from bacterial infections, colonic fistula, which is when a diverticular abscess extends or ruptures into an adjacent organ such as the bladder, vagina, or small intestine, or an intestinal obstruction. So if you have consistent pain on the lower left side of your abdomen, which may get worse over the course of several days, you should definitely see a doctor and determine if diverticular disease is at play. But I should also mention that there are some case studies of attacks of diverticulitis that mimic the symptoms of appendicitis if the infected diverticula are on the right side in the cecum, which is another part of your large intestine. Something that makes this disease complex is that it's difficult to know when to seek medical help and it's even somewhat difficult for doctors to diagnose. It's usually when a person has an acute attack of diverticulitis that they'll receive a diagnosis, which requires a CT scan. Short of that, a blood test to reveal a high white blood cell count, a stool sample to check for abnormal bacteria, or a digital rectal exam may be done. Other possible tests that may be warranted include a barium enema with X-rays, a sigmoidoscopy, which is like a colonoscopy but of your sigmoid colon where most diverticula form, or a full colonoscopy. One thing I learned while researching this is that diverticular disease is frequently accompanied by irritable bowel syndrome, which may be coincidental, but there is also evidence to support diverticular disease leading to the development of IBS. In one study of acute uncomplicated diverticulitis, one year after the attack of diverticulitis, 45% of the participants reported abdominal pain and 30% had altered bowel habits. Another study found an almost fivefold increase of a diagnosis of IBS following an attack of acute diverticulitis. Of course, what they may be seeing in these studies is an infection with pathogenic bacteria, which causes both the attack of diverticulitis as well as the subsequent symptoms of IBS. So what causes diverticulosis and diverticulitis? Well, I'll be honest to tell you that I picked this topic today because it wasn't one that I knew a lot about, but when researching it, some of the preconceptions I had were changed. For example, I found out the surprising fact that in two cross-sectional studies involving a total of over 2,000 participants who had colonoscopies, Constipation was not found to be a risk factor. In fact, compared to people who had fewer than 7 bowel movements a week, those with more than 15 bowel movements a week had a greater risk for diverticulosis. Some of the most agreed-upon risk factors for diverticulosis and diverticulitis include aging, obesity, smoking, use of NSAIDs or nonsteroidal anti-inflammatory drugs or aspirin, opioids, and a sedentary lifestyle. The more disputed claims are that a diet that is very high in red meat but very low in fiber is to blame. The two cross-sectional studies I mentioned above did not support that claim, as there was no correlation between those factors and diverticulosis, as confirmed with colonoscopies. And then the author also criticized the methodology of the studies that did support it. But I'm still a little bit on the fence after reviewing all the studies. The author also found that those with hard stools had reduced odds of diverticulosis. Another theory is that the seated position of defecation in Western societies on a toilet leads to a lack of support of the colon, incomplete evacuation, and backup in the sigmoid colon where most diverticula occur due to ongoing pressure on this part of the colon. So squatting while defecating like other primates do might alleviate this problem. Another popular theory that emerged in the past was that diverticular disease could be the result of eating nuts, corn, popcorn, and seeds. However, there's been studies that have nullified this theory completely. So how do you treat diverticulitis? In the allopathic medical world, the common treatment for an attack of diverticulitis is antibiotics. In severe or recurrent cases, laparoscopic lavage to wash out the diverticula or surgeries like bowel resections and colostomies may be necessary. Of course, this depends on the type and severity of your symptoms, and somebody dealing with a mild case would most likely just be prescribed antibiotics, including Rifaximin, which is an antibiotic commonly used for SIBO. So how can you prevent or reverse diverticular disease? So there's some controversy around this recommendation, but I would think that it certainly wouldn't hurt to start by trying to gradually add more fiber from fruit and vegetables to your diet, as this is helpful for health overall and gut health in particular. A study of almost 48,000 men found that those who ate the most fiber, which is more than 32 grams a day, had a 42% lower risk of developing diverticulitis than those who ate the lowest amount of fiber. The risk was also higher in men who had a higher intake of fat and red meat along with low fiber. But I want you to take that in context, right? So knowing what we do about how ketogenic diets, which are super high in fat and also tend to be high in meat and often red meat, we know that those diets produce butyrate naturally in the colon and often help people resolve bowel issues. So I wouldn't want you to lump a ketogenic diet into the category of the kind of diet that they studied because I'm, I'm I'm seriously doubting that's what they were studying. I'm assuming the people in the study were consuming a typical low-fiber, high-fat, high red meat diet that resembles a standard American diet where the fat was coming from processed seed oils used for deep frying the fries that went along with the burgers and the white buns and, you know, probably not grass-fed, high-quality red meat prepared at home and accompanied by healthy oils like avocados or avocado oil or extra virgin olive oil, ideally atop a nice big salad with a healthy carb like sweet potato or winter squash accompanying it. So anyway, all this makes sense to me because in the end, to have an infection in the diverticula, you may need an overgrowth of pathogenic bacteria, and pathogenic bacteria are kept in check by commensals, which feed on healthy food that are high in fiber. By commensals, I mean good bacteria. Historically, as I mentioned before, a common recommendation for people with diverticulitis was to avoid nuts, seeds, popcorn, and corn, but this was debunked, at least for corn, popcorn, and nuts, in the Health Professionals Follow-Up Study that I mentioned before with the 48,000 men. And in fact, popcorn and nuts were actually found to be beneficial. As always though, you should take your time when you eat and chew your food well, especially if you are eating nuts and seeds. And other dietary approaches you can take include eating more probiotic foods, again, to continue providing beneficial bacteria to your system to outnumber the pathogenic ones, drinking bone broth, which provides many healing nutrients to your intestines, and eating an anti-inflammatory diet, which for my personal bias tends more towards a paleo diet. Also, reducing alcohol consumption is a solid recommendation, not just for your general health, but also because one study did show a 2.2 times greater risk of developing diverticulosis in drinkers versus non-drinkers. And then some supplements that may be helpful in soothing the gut lining include slippery elm, aloe vera, marshmallow root extract, and DGL, or deglycerinated licorice root extract. There's a supplement with those four combined that I often recommend to folks with H. pylori called DGL Plus, made by Pure Encapsulations. You can find that in my Fullscript or Wellivate dispensaries, which are linked in the show notes. And I checked, and my new favorite supplement, butyrate, also has evidence supporting its use for diverticulitis, which makes sense because it helps feed and heal your gut colonocytes, or the cells lining your large intestine, especially when you're using forms of it like tributyrin that definitely get down to the large intestine, which we were talking about in my last podcast. In one study of 52 patients with diverticulosis, patients in the experimental group who received 300 milligrams of sodium butyrate a day, which is a pretty low dose in my experience, had significantly fewer episodes of diverticulitis than those in the control group. And while I don't personally have diverticulosis to my knowledge, I take butyrate for other reasons, including great stool quality, and currently take 2 to 3 500mg pills a day of Tributrin-X. Now, if you're constipated, you should only start with 1 pill every 3 days, just a warning. You can check out my last podcast or the blog transcript version for more details on the dosing and all that. Those links are all gonna be in the show notes. So I hope that was helpful for you who are suffering from diverticular disease. As always, if you're suffering from that or any other gut health issue, you can set up a free 30-minute breakthrough session with me by going to the link in the show notes. So stay tuned for a short interview with my sponsor for this episode, Gut Gardens founder Lily Lopez. Did you know that over 40% of women that are eventually diagnosed with serious autoimmune disease have at one point been told by a doctor that their symptoms are all in their head? Lily López was one of those women. She suffered from uncomfortable digestion and bloating for more than 10 years. Time and again, she was dismissed as a hypochondriac by the medical community. Even an eventual diagnosis of IBS did little to relieve her symptoms. A desperate visit to a functional medicine doctor finally yielded the treatment and results that she'd been searching for. In the end, happy to have reclaimed her health, Lily was left wondering why it took so long, and why didn't more people know about functional medicine and the 5R approach to gut health? She founded Gut Garden in 2016 in response to this experience. Gut Garden's 5-supplement Good Gut program is designed to rebuild and restore gut health long-term. They provide a roadmap with easy-to-follow instructions and a suggested schedule to help users incorporate the program into their daily lifestyle. Welcome to the show, Lily.

Thanks, Lindsey Parsons. I'm excited to be here.

Yeah, I'm happy to have you. So can you start by telling me about your gut healing journey?

I spent about a decade feeling pretty sick and it all started, I can trace it back to right when I finished a course of antibiotics for a kidney infection, actually. And just about the exact time when I took the last pill, I suddenly had this really heavy, bloated feeling and I was constipated and I blew up like a balloon. I proceeded to feel like that for about 10 years. I sought help. I saw multiple GI doctors and everybody was referring me all over the place to different specialists, gynecologists, nephrologists. I mean, they're looking at my kidneys and my ovaries. I mean, you name it. I had multiple colonoscopies. And after a while, they couldn't find anything wrong with me. And they're just telling me, you know, must be in your head and you should consider seeing a psychologist. It's frustrating. You feel unwell and you're doing everything you can to try to heal yourself. And nothing was working. Nobody can find anything wrong with you. After a while, it just kind of becomes your new normal. I lived with that feeling for years. What I know now, and I did not know then, is that what happens in your gut eventually does not stay in the gut. And eventually it had a cascading effect on the rest of my body. You know, I had brain fog and really bad fatigue to the point where I would come home from work at 6 o'clock and go right to bed at 30 years old. And I had prediabetes, I had nutrient deficiencies, and my hormones were all over the place. So at this point, I went back to doctors and I did have these markers of ill health that I didn't have before. I'm being told, "Not you should see a psychologist, but, you know, you're just getting older, so you're just going to have to be on medication." And at this point, I'm 30, you know, 31, 32 years old.

Older? Oh my goodness.

Yeah. You know, it's, it's crazy. So it was just So frustrating. And eventually, just really out of desperation, I went to— made an appointment with a functional medicine doctor. And that's really when everything changed for me. That was the first time that I worked with a doctor that, A, believed me that I didn't feel well, and B, just really had a protocol and a way to help me get better that worked.

How did you find functional medicine?

Lots of late nights Googling, spending a lot of time just trying to figure out other avenues after conventional medicine. Medicine really failed me. I was a skeptic. It took me a long time to get there. I wish I had come around sooner, for sure.

So the Good Gut Program includes all 5 of your products. How did you come up with that system?

What the functional medicine doctor introduced me to was the concept of the 5R program. I guess I wouldn't call it a program, but the 5R approach to, to healing your gut. Some people call it the 4R approach. Which is something that's widely used by healthcare practitioners, but not very well known to the general public. And it's a supplement protocol that we based the Good Gut Program on. And the 4 Rs stand for remove, replace, repopulate, repair. We're Gut Garden, so we've rebranded it and changed it to clean, prepare, plant, feed, protect. But what we really wanted to do was bring this 4R approach direct to consumer. It was really something that I wish existed when I was sick all of those years, and finding this information was life-changing for me.

So you provide a sample schedule with the Good Gut Program. Can you talk about the recommended times to take each supplement and what—

Yeah, sure. So the first supplement is charcoal, and we call it Clean, and it's really to help remove Charcoal is highly absorbent, so it sets the stage for healing to absorb and, and remove toxins and any kind of unwanted materials through the digestive tract and out of the body. So that's the first one, that's charcoal. We suggest that you take that just for the first 5 days or so, just to kind of set the stage for healing and clear everything out. And then moving on from that, we've got digestive enzymes. That helps replace any— your digestive functions that may have been depleted or compromised over time while your gut was disrupted. And the digestive enzymes you want to take with meals, especially any meals high in protein and fat. So we'll take a couple digestive enzymes with each meal. And then the next thing is a high-quality probiotic. Just to make it easy, we just have you taking that first thing in the morning when you wake up or whenever you take any of your medications. And then the fourth product is our resistant starch prebiotic. A prebiotic is a preferred food for your probiotics. It's actually a combination of fibers that help feed the healthy bacteria to help them thrive. And this product is a powder that you can mix into water or smoothie. We suggest people just make it easy, take it alongside your probiotic whenever you take the probiotic. And then lastly is collagen peptides, which are all over the internet, are all over Instagram for their benefits for hair, skin, and nails and beautiful skin. But what's less well known is that collagen is really phenomenal for strengthening the lining of the gut. And collagen is actually one of my favorites because it's so versatile. You can mix it into cold or hot beverages. And it's totally tasteless and it dissolves perfectly. So I like to just put it in my coffee and you forget it's even in there. You can bake with it. It's really a great, a great product.

Are you taking those all at the same time or other than that, the charcoal first?

Mm-hmm. Yeah, it's a 30-day supply of each product and you can take the 4 products, you know, outside of the charcoal in the first 5 days, you can take each product every day.

And so who can benefit from the Good Gut Program?

The Good Gut Program, that is a great question. As I said, what happens in the gut does not stay in the gut. So obviously, if you're experiencing digestive issues like bloating, gas, constipation, diarrhea, a Good Gut Program will certainly help to resolve your symptoms. If you're further down the road of gut stuff and you've been dealing with it for a while, before long you might start having seemingly unrelated symptoms. You might be diagnosed with an autoimmune disease, mood and mental health, depression, anxiety, brain fog, skin issues can be related to the gut, acne, rosacea, hives, any food allergies or intolerances, trouble sleeping. I mean, you name it, things that can be traced back to the gut is every day. It's something else being discovered.

So you take them for 30 days. What happens after that 30 days? Is it recommended to keep going with those 5 products for longer or—

Mm-hmm.

Yeah.

So we've got a number of customers that subscribe to the Good Gut Program and just take it month after month. A lot of people will find after the first 30 days they feel great and maybe they don't need the enzymes anymore. Maybe they don't need the charcoal anymore, but they really want to keep taking a really high quality probiotic and collagen supplement. So the products are available individually and it really kind of depends on the person.

So if people want to try these products, there's a link in the show notes and I believe there's a discount code for my listeners, right? Mm-hmm.

Yep. Just enter the coupon code PERFECTSTOOL at checkout for 15% off all products.

Wonderful. And is that a one-time use or does that repeat?

You can keep using it.

Okay, well, thank you so much for sharing about all this stuff with my listeners. I'm sure that there are many people who could benefit from this.

Definitely, definitely. I'm excited for you guys to try it. You're gonna feel great.

Great. Well, thanks so much.

Thank you.

Nice to find another gut health warrior. We need a lot of folks in this community to help all the suffering people out there, so I hope her supplements will be helpful to some of you. If you'd like to connect with me online, you can follow my High Desert Health Facebook page join my gut healing Facebook group or join my newsletter list at highdeserthealthcoaching.com. And while I'm not terribly active in other forms of social media, you can also find me on Twitter, Instagram, and Pinterest, and links for all that are in the show notes. Thanks for joining me today. Here's wishing you all the perfect stool.