Some Thoughts on Gut Health Today

Now that I have just had another bout of diverticulitis, it seems like a perfect time to talk about that issue.

Diverticulitis is an inflammation or infection of abnormal outpouchings in the colonic wall, called diverticula. With wear, time, genetics, diet and sometimes just chance, you can get these tiny herniations in the colon where blood vessels (essential to you) enter but which in the process produces a site of potential weakness in the bowel wall.

How do you know if you have diverticulitis? You might have been told you have diverticulosis – the outpouchings – on a previous colonoscopy. You might then start to feel crummy, with more bloating and abdominal tenderness, often proceeded by a change in your bowel habits, perhaps going from normal to pellety then very loose, with a cramping sensation not relieved fully by having a bowel movement. This then will steadily get worse and classically will then focus on your lower left abdomen (the opposite side where you would get appendicitis).

A note here for you history buffs – this illness has historical significance in the US Civil War, when Grant was beginning his assault on Richmond, at the battle of the North Anna River, Lee’s brilliant defensive strategy had Grant’s army separated into two, with each half being unable to come to the timely aid of the other should that become necessary. Lee had already won the battle but essentially missed the opportunity to annihilate Grant’s army, and why? It was because he was bedridden, delirious with a “severe intestinal ailment” and a high fever which almost certainly was diverticulitis.

Anyway… so what do you do to deal with diverticulitis? Start with clear liquids immediately, as bone broth will become your very best friend. Avoid all the normally healthy stuff like roughage, greens, tomatoes, beans, seeds and nuts. Now when I was a younger doctor, it was common wisdom that seeds were a common trigger by getting lodged in the diverticula then of course, modern medicine decided that this was not true. In this case, ignore what modern medicine says because each person has his or her own triggers. For me, it is clearly seeding and roughage, diagnosed actually by my astute wife after I had diverticulitis 2 years in a row, just one day apart in August. More than coincidently, this is when my garden was coming in and I (over) indulging myself with tomatoes, peppers (especially shishito peppers, where you eat the seeds too), not to mention eggplants, kale and chard. So those are my triggers. Your triggers could be similar or different.

You can look online for excellent dietary suggestions for managing diverticulitis but the concept is to (hopefully) wait until your diarrhea subsides and then slowly advance to foods with less residue, like pasta, and then something like chicken or potatoes, adding all the vegetable and fiber rich goodness last.

However, if despite doing these things you are worsening, then that is the time to seek medical attention and go on antibiotics, the sooner the better. Potentially these diverticula can rupture and lead to a generalized intestinal infection, which is not all good and which can require hospitalization or even surgery. When this is all over, think on what set this episode off and try not to do it again, easier said than done (as I know).

Get a colonoscopy after 50 (especially important with repetitive episodes of diverticulitis). Colon cancer is largely preventable but still hits 1 out of 15 folks, way too many. The fecal DNA test, the Cologuard, is good and accurate, and requires no prep but it cannot be done if you have already had a polyp and it won’t tell you if you have diverticulosis. And what about the fecal occult blood test, the Hemoccult, used heavily in the past? Now it is mostly discarded, relegated to the trash keep of previous practice, do not rely on it…

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