January 19, 2018 at 5:10 pm #1083Raquel MartinParticipant
I have a 67 year old female client with regular flare ups of abdominal pain (lower left side), loose stools and flatulence, which also cause fatigue, for 1-2 days. She has been diagnosed with diverticulosis but not diverticulitis (i.e. the diverticula are seemingly not inflamed). I did a stool test which showed dysbiotic flora (4+ citrobacter and proteus). We have done several rounds of antimicrobials (those that came up high in the sensitivity section) but she still gets the flare ups and the two bacteria are still there, at 4+. In the last round she took four antimicrobials at the same time, at high dosage, but no result! She is also doing vitamin C flushes regularly. I am puzzled.
Could it be that the bacteria are difficult to eliminate because of the diverticula? Could the above dysbiotic bacteria alone be causing those symptoms? If so, any ideas as to how to eliminate it?
Or could it be something else related to her diverticular disease? A breath test was negative for SIBO and she is also on a gluten and dairy free diet and a few other foods that she came up as sensitive in a food intolerance test. She does eat some nuts and seeds (chia seeds). She is a vegetarian but eats fish. We have previously tried restricting the vegetables that she eats to low fodmaps and peeling them initially but the flare ups still happened.
She has also taken probiotics and immune strengthening supplements.
The trigger to the start of her symptoms seems to be a very stressful period that she had around 2-3 years ago.
Your help will be much appreciated (I have read previous cases posted where diverticular disease was mentioned but could not find a similar case to the above).
Posted By Raquel Martin 19/1/2018
March 6, 2019 at 5:36 pm #1084Christine BaileyModerator
Many thanks for your question regarding your client suffering with diverticular disease. You mentioned that the symptoms appear to worsen after a period of stress and certainly this could well have played a key role in her ongoing symptoms. It may be the case that more attention is needed to support her innate immune system and provide beneficial probiotics rather than using anti-microbials at this point. In addition, supporting the gut barrier health and the production of short chain fatty acids may be helpful.
Diverticula are small pouches or pockets in the wall of the digestive system, most often the large intestine. When these pouches become inflamed, this characterizes diverticular disease. Diverticula are quite common in older individuals, and often do not cause symptoms.
A person who has diverticula without inflammation or any associated symptoms is said to have diverticulosis, a term that simply denotes the presence of diverticula in the large intestine. Diverticula form as a result of a complex interaction of age, diet, and structural and functional changes in the nerves and muscles of the colon wall. These factors may contribute to weakness of and increased pressure on the colon wall. It used to be thought that mechanical obstruction of diverticula by fecal matter or undigested food particles caused diverticular disease, but newer research suggests that changes in the microbial composition of the intestinal tract (which can create a pro-inflammatory environment) and changes in colon motility are important contributors – therefore the current dysbiotic changes seen may be relevant.
Peery AF, Sandler RS. Diverticular disease: reconsidering conventional wisdom. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. Dec 2013;11(12):1532-1537. https://tinyurl.com/ydf9pr77
Acute diverticulitis causes pain in the lower left abdomen that tends to worsen with movement which interestingly she appears to be suffering with although you mention that at present the GP does not think there is inflammation of the diverticula. However, it does appear there is irritation of the bowel. Often when there is a flare up it is recommended to switch to a low residue diet. Some people also find that a few days of liquid diets such as soups etc can also be helpful to reduce the irritation.
It is difficult to ascertain whether her current symptoms are actually due to the presence of the dysbiotic bacteria. However, you can look at addressing dysbiosis and introducing interventions to calm irritation and reduce symptoms at this stage.
Probiotics. By helping restore the balance of intestinal flora and reduce inflammation in the colon, probiotic supplementation may be of benefit in both acute and chronic diverticular problems.
Boynton W, Floch M. New strategies for the management of diverticular disease: insights for the clinician. Therapeutic advances in gastroenterology. May 2013;6(3):205-213. https://tinyurl.com/zlpdjdq
In an open-label trial, a combination of Lactobacillus acidophilus 145 and Bifidobacterium species 420 was found to be effective for preventing disease recurrence in people with symptomatic uncomplicated diverticular disease (SUDD).
Lamiki P, Tsuchiya J, Pathak S, Okura R, Solimene U, Jain S, . . . Marotta F. Probiotics in diverticular disease of the colon: an open label study. Journal of gastrointestinal and liver diseases : JGLD. Mar 2010;19(1):31-36. https://tinyurl.com/ychkk3m9
Butyrate: Butyrate is a short-chain fatty acid produced in humans by intestinal bacteria that digest and metabolize fiber. Butyrate is critical to colonic mucosal health; is the preferred fuel of the cells that line the interior of the colon; helps maintain the intestinal barrier; has anti-inflammatory and anti-cancer effects; and helps regulate colonic motility.
In a randomized clinical trial of sodium butyrate in 52 people with diverticular disease, less than 7% of those in the butyrate group experienced diverticulitis symptoms compared with slightly more than 31% in the placebo group.
Krokowicz L, Stojcev Z, Kaczmarek BF, Kociemba W, Kaczmarek E, Walkowiak J, . . . Banasiewicz T. Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis–a prospective randomized study. International journal of colorectal disease. Mar 2014;29(3):387-393. https://tinyurl.com/y8wrojur
Fibre: Initially I would start on a low residue diet and then gradually increase fibre until consumption reaches 20–30 g of fibre daily which has been recommended by some diverticular disease researchers. Supplemental fibre in a form like ground psyllium seed or apple pectin fibre can help increase total daily fibre intake.
Slavin J. Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients. 2013;5(4):1417-1435. https://tinyurl.com/yad7bbde
Fish oil may be helpful to alleviate inflammation together with nutrients such as curcumin.
Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon. Hepato-gastroenterology. May-Jun 2008;55(84):916-920. https://tinyurl.com/y76a74pc
Your client may find benefit in mucilage herbs. Mucilages are complex sugars found in many plants that form a thick, gel-like film when mixed with water. Psyllium seed husk, flaxseed, slippery elm and marshmallow root are examples.
When ingested, mucilages are believed to form a barrier or lining on the intestinal mucosa, protecting against infection and injury, soothing irritation, and promoting tissue healing.
Another option is colostrum which may help with support the gut barrier and modulating the immune response – clearly if the client is sensitive to dairy this may not be appropriate.
If you feel that ongoing stress is still a problem for this client, then I would focus on supporting her adrenal health in addition.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
GI Flora (ARG) – take 1 twice daily – contains 4 beneficial probiotic bacteria: Lactobacillus acidophilus, L. rhamnosus, L. casei, and Bifidobacterium longum. https://tinyurl.com/zrbvo8g
Saccharomyces boulardii (ARG) – take 1 at each meal (to calm bowel movements) – https://tinyurl.com/z27sdwn
Buytrate (Body Bio) – take 2 capsules with each meal (store in fridge to reduce odour)
Vitamin D3 Complete (ARG) – take 1 daily – https://tinyurl.com/jqx3ttt – innate immune system support
KappArest (BRC) – take 2 at each meal – https://tinyurl.com/jms9v3n
Phospholipid Colostrum (ARG) – take 1tbsp twice daily – https://tinyurl.com/zwty66b
I hope this helps answer your question
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