Probiotics and Diverticulitis

Probiotics and Diverticulitis Video


Many people have diverticulosis. Some have experienced an infection called diverticulitis. There is new information on how probiotics, the balance of gut bacteria, and the integrity of the gut immune system can help with prevention and treatment.


Many people after having had a screening colonoscopy were told that “weak spots” or “pockets” called diverticulosis in the colon. Some have had diverticulitis before and many know of someone who has had diverticulitis. The colon is not just a solid tube of muscle but has a lot of structure and openings to allow blood vessels to deliver oxygen. These less covered areas may bulge out with pressure or straining to have bowel movements and those who have had constipation at some point in their life may have these weaker areas bulge out and form pockets called diverticulosis.   It occurs in only 5% of the Western adult population younger than forty years of age, but it rises sharply to occur in at least 50% of those who are older than fifty and 75% of those older than seventy-nine.


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When they are inflamed or infected the condition is called diverticulitis. People who have diverticulitis usually seek medical help because they experience symptoms such as intense abdominal pain, bleeding, bloating, nausea, or fever. In some rare instances, fistulae, bowel obstruction, and lower intestinal hemorrhage occur, or a diverticulum can perforate, causing a localized abscess.

The traditional treatment is for “bowel rest” stopping food for 1-2 days drinking more fluids, and starting antibiotics.  Antibiotics has been shown to cause a lot of problems with the balance of good and bad bacteria. Bad bacteria such as clostridium Difficile are more resistant to antibiotics and may overgrow like weeds.  After about 10 days of antibiotics fiber is gradually increased.

After recovery people are recommended to be on a high fiber diet of over 45 grams. The fiber need to ramped up slowly as too much fiber and the wrong bacteria can produce a lot of uncomfortable gas.

People that have had diverticulitis usually never want to experience another episode if they can possible avoid it. Traditionally they have been told to avoid small seeds and nuts, have at least 45 grams of fiber, and drink at least 64 ounce of water.  While fiber may be helpful to add bulk to keep regularity and serve as a prebiotic for beneficial bacteria, avoiding small seeds and nuts have not been proven to prevent an episode of diverticulitis. Recent evidence have suggested benefits to probiotics as treatment for mild colon inflammation, diverticulitis, and possibly to decrease the recurrence of diverticulitis.


New Thoughts and Directions


An Italian study by Andrea Piccioni et al  “Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance” compiled PubMed research articles. Keywords in their search were  “probiotics”, “gut microbiota”, “probiotics and gut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics mechanism of action”, “gut immunology and probiotics”.

Several articles were reviewed. Among many of the findings, the review showed how microbiotia, specifically bacteria, influence intestinal health and overall health. For example, certain species of bacterial like E. Coli can be protective for pancreatic cancer if found in abundance in one area but prove to increase risk of colorectal or liver tumors if found in other areas. It was observed that Bifidobacterium adolescentis, Lactobacillus, Phascolarctobacterium, Akkermansia muciniphila are all reduced in patients with intestinal inflammation.

The microbial species associated with diverticular disease are Enterobacteriaceae, Streptococcus and Bacteroides, while reduced amount of “good” bacteria, such Bifidobacteria and Lactobacilli are found.  Using probiotics can provide similar positive effects to antibiotics, in reducing pathogens, but at the same time avoiding many of the side effects. Probiotics have been used with different degrees of success in patients suffering from IBS, gastroenteritis and even in C. difficile-associated diarrhea.

Lactobacilli have been demonstrated to reduce symptomatic uncomplicated diverticular disease, particularly in reducing bloating and abdominal pain, while Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium lactis have proven effective in managing acute diverticulitis. Lactobacillus is a transient intestinal microbe meaning it doesn’t colonize to stay long term. Therefore it needs to be “seeded” or better yet attracted to come habitate the intestine with specific prebiotics. Prebiotics are nutrients or fibers that feed and attract specific bacteria.

“Basically, stasis of faecal material within diverticula can be favoured by a prolonged colonic transit, which in turn predisposes to altered microflora and bacterial overgrowth. Mucosal barrier function can be consequently impaired and provoke an inflammatory reaction by means of cytokine release; a low-grade, localised microscopic colitis may result, which can evolve towards microperforation and show the clinical features of acute diverticulitis.”

“Probiotics may be able to modify the localised and persistent inflammation, present in some patients who are between acute bouts of diverticulitis. Acting on inflammation they may also act on symptom development, in individuals affected by uncomplicated diverticular disease.”

“Recognising that overgrowth and alteration of gut microbiota can play a role in the development of inflammation related to diverticular disease, there is a clear rationale for administering probiotics with the aim to restore a healthy microenvironment in the colon. Different mechanisms have been discussed, such as a decrease in bacterial translocation, competitive inhibition of pathogenic and proinflammatory bacterial strains overgrowth, down-regulation of inflammatory cytokines, together with an improvement in mucosal defence, due to enhanced tight junction integrity”

“Indeed, concerning therapy with probiotics, there are no established protocols defining which strain, what dosage and for how long to use them, and this reflects the absence of reliable meta-analyses in this regard.”




We have successfully used a combination of nutraceuticals to suppress  or reduce “bad” inflammatory strains of bacteria like Enterobacteriaceae, Streptococcus and Bacteroides and prebiotics and probiotics to enhance and promote Bifidobacteria and Lactobacilli.  We also use nutraceuticals and peptides to decrease inflammatory cytokines, enhance mucosal defense and restore tight junction integrity.  Please see the list of nutraceuticals below that we’ve used with success.  Please contact us for more information. Take care and Stay Healthy.


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Jeffrey Mark, M.D.


Optimal Probiotic for prevention and active diverticulitis with maximum of 18 beneficial strains: Probio 350

Essential Probiotic for prevention and active diverticulitis with beneficial strains: Probio PlusProBio 100ProBio 30 SB Probio Daily, ProBio Rainbow

Prebiotic to with butyric acid, attracts lactobacillus to make short chain fatty acids, reduces yeast overgrowth: PomBioX

Nutraceutical to suppress or reduce “bad” inflammatory strains of bacteria: Florabalance

Nutraceuticals to decrease inflammatory cytokines, enhance mucosal defense and restore tight junction integrity: Z-complex , IgX, IgG Dairy Free, Biotransform

Peptides: personalized selection and based on availability

Jeffrey Mark, M.D.


Helping clients with compassionate and comprehensive medical care for over 25 years with 5 board certifications in functional medicine, gastroenterology, internal medicine, anti-aging/ regenerative medicine, and obesity medicine . IFMCP, ABIM Gastroenterology, NPAS Internal Medicine, ABAARM, ABOM.