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The Functional Medicine Approach to Diverticulitis

The statement that it takes 15 years for research to influence clinical practice is true. I have had quite a few patients come to see me in the past month asking if there are alternatives to the standard treatment of diverticulitis which is, of course, ANTIBIOTICS! One particular patient called her doctor to tell him that she was having left-sided abdominal pain and had a temperature elevation to 99.9 degrees Fahrenheit and the immediate response was that antibiotics would be prescribed for FOURTEEN days! She followed his advice, began having side effects from the two antibiotics, and then wisely discontinued these on her own accord.

Fortunately, more and more people are becoming aware of the detrimental effects of pharmaceutical antibiotics--not the least of which is the devastating effect on the microbial ecosystem in the gut. It's like leveling a rain forest. Thankfully, we have data to help guide us--it just needs to be incorporated into every day clinical practice. This recent research indicates that antibiotics do NOT hasten the recovery from diverticulitis, they do NOT influence the need for surgery, and they do NOT prevent complications related to diverticulitis (See studies cited below). Other research studies suggest that a big part of diverticular disease is related to a microbiome that's out-of-balance. Finally! Some research to back up what we as integrative/functional medicine doctors have been saying for years.

So what should you do if you develop left lower quadrant pain and a low-grade temperature elevation? I always urge my patients to be evaluated and examined by a licensed practitioner with appropriate credentials. If you're diagnosed with diverticulitis and have been prescribed antibiotics, it's reasonable to get another opinion from an integrative/functional medicine MD to see what he or she would recommend. I treat many of my patients with an elemental diet until their pain improves and then gradually ramp up their soluble fiber intake. Many times I get more data about their condition through a CT scan and/or a comprehensive stool analysis to evaluate their colonic microbiome and level of gut inflammation. When the acute process clears, a colonoscopy may well be in order. I always recommend treatment to improve the gut microbiome, strengthen the colonic mucosal lining, and decrease inflammation. Though we don't have randomized controlled trials that statistically prove effectiveness, my clinical experience demands this conclusion: It works! And it's much more proactive than current recommendations from the American College of Gastroenterology or American Society of Colon and Rectal Surgeons.

So if you have or have had diverticulitis here's the bottom line:

1. Avoid antibiotics if possible.

2. Consider an opinion from a Integrative/Functional MD properly credentialed

3. No matter what, get checked out and intervene early so that the process can be arrested, you can get your gut healthy, and you can get back to your life!

Here are the main studies that show that antibiotics are not necessary in most cases of uncomplicated diverticulitis:

1. Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688. Epub 2012 Jan 30. PMID: 22290281.

2. Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017 Jan;104(1):52-61. doi: 10.1002/bjs.10309. Epub 2016 Sep 30. PMID: 27686365

Here is just one a several studies that implicate dysbiosis (an out-of-balance microbiome) as a major factor in diverticulitis:

Tursi A, Mastromarino P, Capobianco D, Elisei W, Miccheli A, Capuani G, Tomassini A, Campagna G, Picchio M, Giorgetti G, Fabiocchi F, Brandimarte G. Assessment of Fecal Microbiota and Fecal Metabolome in Symptomatic Uncomplicated Diverticular Disease of the Colon. J Clin Gastroenterol. 2016 Oct;50 Suppl 1:S9-S12. doi: 10.1097/MCG.0000000000000626. PMID: 27622378.


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