Diverticulosis: The discreet presence of bubbles in the intestine
Visit diverticulosis simply describes the condition of a person with diverticula. Diverticula resemble tiny pouches, which form along the inner layers of the colon (the mucosa and submucosa) most often towards the terminal phase of the large intestine (5)(6)(14).
It's important to understand that diverticulosis is generally not a disease. The vast majority of people with diverticulosis live without symptoms. They are often unaware of their presence, and diverticulosis is frequently discovered by chance during medical examinations carried out for other reasons.
Diverticulitis: When inflammation sets in
Visit main cause of diverticulitis is the perforation of a diverticulum (16). This perforation, however small, allows bacteria and faeces to escape into the colon wall and surrounding tissues, triggering an inflammatory reaction. In the most severe cases, this inflammation can spread, leading to the formation of abscesses (collections of pus) or fistulas (abnormal connections between the colon and other organs) (6).
Diverticulitis is the inflammation of one or more of these diverticula. This inflammation triggers an immune system response and typically manifests as a trio of symptoms (11):
- Pain: Often intense and localized in the lower left abdomen;
- Fever: Sign of an inflammatory reaction and potentially of an infection;
- Leukocytosis: An abnormal increase in the number of white blood cells in the blood, indicating that the body is fighting a major infection or inflammation.
Treatment of acute crisis
Acute diverticulitis requires prompt medical attention, usually in hospital. Treatment is usually based on antibiotics to fight the infection and analgesics to relieve pain. During the active phase inflammation, a liquid and/or residue-free diet is often recommended, on a temporary basis, to rest the colon (5)(11). It is crucial to consult a nutritionist for a proper and balanced application of this plan.
Following this active phase, the integration of solid and liquid foods gradual increase fibers are desirable.
Preventing diverticulitis: The role of diet
Recurrence of diverticulitis is a common concern, affecting around 20-30 % of people who have already suffered an attack (16). Although there is no "miracle diet" to prevent the initial onset of diverticulitis, the adoption of certain dietary habits appears to play a crucial role in the prevention of recurrence. prevention diverticulitis attacks.
Current scientific data highlight several important aspects:
Dietary fibre: a protective ally
Numerous studies have linked high consumption of dietary fibers a reduced risk of diverticulitis (16). Fiber, whether soluble or insoluble insolublecontribute to intestinal health by regulating transit and promoting a healthy colonic (intestinal) environment (16).
The Western diet: a risk factor
A typical Western diet, rich in red and processed meats, ultra-processed foods, refined cereals, sweets and saturated fats, is associated with an increased risk of diverticulitis (2)(16).
Red meat: eat in moderation
High consumption of red meat also appears to increase the risk of diverticulitis (4). Substituting poultry or fish for red meat could be a beneficial strategy (4).
Alcohol: uncertain links
Studies on the impact of alcohol consumption on diverticular complications are contradictory (16). However, according to the Canadian Alcohol Guidelines, any reduction in alcohol consumption is beneficial to health (1).
Contrary to popular belief, there is no scientific evidence that eating hard, sharp foods, pits or seeds can perforate a diverticulum and trigger diverticulitis (4)(10). So there's no need to avoid fruits and vegetables with grains, such as raspberries, strawberries, tomatoes and cucumbers. On the contrary, these fibers are actually beneficial to digestive and overall health.
Raspberries are a good ally for intestinal transit because of their insoluble fibre content (9) :
Per 125 ml serving (½ t., 84 g)
4.6 g total fibre
1.3 g soluble fibre
3.3, g insoluble fibre
For people who have avoided these foods for yearsIf you've always been told that these foods are off-limits, you may have developed a chronic fear (e.g., food-related anxiety) that can lead to functional abdominal pain via the via. Indeed, if we've always been told that these foods are to be avoided, we may have developed a chronic fear (e.g. food-related anxiety) that can lead to functional abdominal pain via the gut-brain axis, as observed in irritable bowel syndrome (IBS) (7). This phenomenon, known as psychosomatic pain, could be addressed in consultation with a health professional, as could the subject of individual hypersensitivities.
The intestinal microbiota: An underestimated key player?
The intestinal microbiota, the huge community of microorganisms that reside in the gut, is emerging as a potentially important player in the pathology of diverticulitis. Although research is still ongoingseveral mechanisms suggest a link:
Chronic low-grade inflammation
A few studies have highlighted specific alterations in microbial composition in patients with diverticulitis, causing an imbalance in the intestinal microbiota (dysbiosis) (12). This may contribute to the maintenance of the inflammatory state (13).
Increased intestinal permeability
Dysbiosis can alter the intestinal barrier, making it more permeable. These bacterial "leaks" could expose the colonic wall to bacterial substances, exacerbating inflammation (13).
Production of metabolites
Intestinal bacteria produce various metabolites that influence inflammation and intestinal function (12)(17). An imbalance in this production, such as a reduction in butyrate-producing bacteria (short-chain fatty acids with anti-inflammatory properties), has been observed in patients with diverticular disease and could potentially promote inflammation (3).
Immune response
The microbiota interacts closely with the intestinal immune system (8)(16). Dysbiosis could disrupt this interaction, contributing to an inappropriate inflammatory response in diverticulitis (12).
It is crucial to stress that research into the precise role of microbiota in diverticulitis is still in its infancy. still in progress. Identifying the specific bacterial species involved and understanding the exact mechanisms require further study.
If you have any questions or would like to optimize your digestive health following diverticulitis, it's important to ask your treating physician about your situation and to make sure you have personalized nutritional support. Taking care of your intestine means investing in your overall well-being.
To remember
- Diverticulosis is frequent and often silent.
- A diet rich in fiber, low in red meat and rich in variety may protect against diverticulitis.
- All nuts and fruits, including those with small seeds, are not to be avoided - on the contrary!
- The intestinal microbiota is a key player in digestive health.
- Personalized support from a nutrition professional is recommended for any adjustment to your diet.
References
(1) Canadian Mental Health Association. Consumer summary of Canada's benchmarks on alcohol and health: Drinking less is better [Internet]. Ottawa (ON): Government of Canada; [cited 2025 May 21]. Available from: https://www.ccsa.ca/fr/resume-grand-public-des-reperes-canadiens-sur-lalcool-et-la-sante-boire-moins-cest-mieux
(2) Astudillo AA, Mayrovitz HN. The Gut Microbiome and Cardiovascular Disease. Cureus. 2021 Apr 16;13(4):e14519. https://pubmed.ncbi.nlm.nih.gov/34007770/
(3) Cameron R, Duncanson K, Hoedt EC, Eslick GD, Burns GL, Nieva C, Keely S, Walker MM, Talley NJ. Does the microbiome play a role in the pathogenesis of colonic diverticular disease? A systematic review. J Gastroenterol Hepatol. 2023;38(7):1028-1039. https://pubmed.ncbi.nlm.nih.gov/36775316/
(4) Carabotti M, Falangone F, Cuomo R, Annibale B. Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review. Nutrients. 2021 Apr 14;13(4):1288. https://pubmed.ncbi.nlm.nih.gov/33919755/
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(6) Centre hospitalier de l'Université de Montréal. Diverticulitis [Internet]. Montreal (QC): Centre hospitalier de l'Université de Montréal; [cited 2025 May 21]. Available from: https://www.chumontreal.qc.ca/sites/default/files/2023-11/994-1-diverticulite.pdf
(7) Drossman DA, Hasler WL. Rome IV-functional GI disorders: Disorders of gut-brain interaction. Gastroenterology. 2016;150:1257–61. https://pubmed.ncbi.nlm.nih.gov/27147121/
(8) Gibson GR, Hutkins R, Sanders ME, Prescott SL, Reimer RA, Salminen SJ, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8). https://pubmed.ncbi.nlm.nih.gov/28611480/
(9) Government of Canada. Canadian nutrient file (CNF) [Internet]. Ottawa (ON): Government of Canada; 2019 [cited 2025 May 21]. Available from: https://aliments-nutrition.canada.ca/cnf-fce/?lang=fre
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(12) Piccioni A, Franza L, Vaccaro V, Saviano A, Zanza C, Candelli M, et al. Microbiota and Probiotics: The Role of Limosilactobacillus Reuteri in Diverticulitis. Medicina (Kaunas). 2021;57(8):802. https://pubmed.ncbi.nlm.nih.gov/34441008/
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(14) Sante SagLac. Diverticulitis [Internet]. Saguenay (QC): Sante SagLac; 2019 Nov [cited 2025 May 21]. Available from: https://santesaglac.gouv.qc.ca/medias/2019/11/DSM_diverticulite_20-02-19.pdf
(15) Schultz JK, Azhar N, Binda GA, Barbara G, Biondo S, Boermeester MA, et al. European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020;22 Suppl 2:5-28. https://pubmed.ncbi.nlm.nih.gov/32638537/
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