Diverticulitis

The Problem

Antibiotics overused: recent evidence suggests uncomplicated diverticulitis without signs of infection (normal WBC, mild symptoms) may not need antibiotics—observational management with diet and pain control often sufficient (antibiotics don't reduce recurrence or complications in uncomplicated cases, cause dysbiosis, C. diff risk), but many doctors still prescribe reflexively, Outdated dietary advice: old recommendation to avoid nuts, seeds, popcorn (thought to lodge in diverticula, cause inflammation) now proven false—high-fiber diet including nuts and seeds is actually protective (but still commonly advised by doctors not updated on recent evidence), Surgery too aggressive: old guideline 'two attacks = surgery' now obsolete—individualized approach based on severity, complications, quality of life (many patients with recurrent mild attacks managed conservatively, surgery reserved for complicated disease or severe recurrent attacks affecting function), Lack of prevention focus: once diverticulosis diagnosed, conventional often says 'just increase fiber' without comprehensive approach (probiotics, omega-3, weight loss, exercise, addressing constipation, dysbiosis—all reduce diverticulitis risk but not emphasized), No microbiome support: antibiotics for acute diverticulitis devastate gut microbiome (may contribute to recurrence—dysbiosis worsens inflammation), probiotics during and after antibiotics reduce dysbiosis but rarely prescribed, No investigation of root cause: why did diverticula become inflamed? (dysbiosis, SIBO, food sensitivities, NSAIDs, low vitamin D—addressing these reduces recurrence but not investigated), Colonoscopy timing: sometimes performed too early (during acute inflammation—risk of perforation, should wait 6-8 weeks after resolution), but important to rule out colon cancer (diverticulitis can mimic cancer, colonoscopy confirms diagnosis, screens for cancer), Mesalamine (5-ASA) and rifaximin: some evidence reduces recurrence but not routinely offered (off-label use, mixed study results, worth discussing if recurrent attacks), Diet after acute attack: conventional advances diet too slowly (low-fiber diet continued weeks after resolution—should transition to high-fiber relatively quickly once symptoms resolve, typically 1-2 weeks), Many diverticulosis patients develop diverticulitis that could be prevented: high-fiber diet (25-35g/day) reduces diverticulitis risk 40-50%, most Americans fiber-deficient (10-15g/day), probiotics reduce inflammation and infection risk, omega-3 anti-inflammatory, weight loss and exercise reduce risk—comprehensive prevention approach prevents most acute attacks.