Diverticular Disease (Diverticulosis & Diverticulitis)

Small pouches bulging from your colon wall, occasional bleeding, and the constant worry of when inflammation might strike aren't just normal aging—they're signs of diverticular disease, a condition affecting over 50% of adults over age 60 in Western countries. Research shows dramatic geographic differences in this "Western disease," with rates 10-50 times higher in developed countries compared to Asia and Africa, highlighting the crucial role of diet, lifestyle, and gut health in both prevention and management. Our comprehensive approach addresses the root causes while providing targeted treatment for both asymptomatic diverticulosis and acute diverticulitis episodes.
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What Exactly Is Diverticular Disease?

Diverticular disease encompasses a spectrum of conditions involving small, sac-like protrusions (diverticula) that develop in weak areas of the colon wall. Diverticulosis refers to the presence of these pouches without symptoms, while diverticulitis occurs when they become inflamed or infected. This "Western disease" primarily affects the sigmoid colon in European and American populations, but involves the right colon in Asian populations, suggesting genetic and dietary factors play crucial roles. Effective management requires understanding the underlying mechanisms—including increased colonic pressure, wall weakness, altered motility, and microbiome imbalances—rather than simply managing acute episodes.

Types of Diverticular Disease and Their Characteristics

Diverticular disease exists on a continuum from asymptomatic pouches to life-threatening complications, each requiring specific management approaches and prevention strategies.

Type Primary Characteristics Common Symptoms Considerations
Asymptomatic Diverticulosis Silent pouches without inflammation Usually no symptoms Found incidentally; 75% remain asymptomatic
Symptomatic Uncomplicated Diverticular Disease (SUDD) Chronic symptoms without acute inflammation Abdominal pain, bloating, altered bowel habits Often involves chronic low-grade inflammation and microbiome changes
Uncomplicated Diverticulitis Acute inflammation without complications Severe left lower abdominal pain, fever, nausea 80% respond to conservative treatment
Complicated Diverticulitis Inflammation with abscess, perforation, or obstruction Severe pain, high fever, signs of complications May require hospitalization, antibiotics, or surgery

Why Diverticular Disease Impacts More Than Digestion

Diverticular disease affects multiple body systems due to chronic inflammation, altered gut microbiome composition, and the potential for serious complications. Research shows that people with diverticular disease have decreased beneficial bacteria that produce short-chain fatty acids, leading to compromised gut barrier function and systemic inflammation. This can contribute to immune dysfunction, increased infection risk, and poor nutrient absorption. Additionally, the chronic pain and unpredictability of diverticulitis episodes can significantly impact mental health, sleep quality, and overall quality of life, while the fear of complications affects dietary choices and social activities.
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Common Signs of Diverticular Disease Include:

Diverticulosis (Often Asymptomatic):

  • Usually no symptoms in 75% of people
  • Mild abdominal cramping or discomfort
  • Occasional bloating or constipation
  • Rare rectal bleeding (usually painless, can be significant)

Symptomatic Uncomplicated Diverticular Disease:

  • Chronic left lower abdominal pain (right-sided in Asian populations)
  • Intermittent bloating and distension
  • Altered bowel habits (constipation or diarrhea)
  • Feeling of incomplete evacuation
  • Food intolerances or sensitivities

Diverticulitis:

  • Severe, constant left lower abdominal pain
  • Fever and chills
  • Nausea and vomiting
  • Changes in bowel habits
  • Abdominal tenderness
  • Loss of appetite
  • Urinary symptoms (if affecting adjacent structures)

Diagnostic Options at Whole Gut Health

Comprehensive diverticular disease evaluation involves both acute assessment and long-term prevention strategies. At Whole Gut Health, we use advanced diagnostics to assess disease severity, identify complications, and develop personalized management plans.

Testing options may include:

CT Scan with Contrast - The gold standard for diagnosing diverticulitis and assessing complications like abscesses or perforation.

Colonoscopy - Performed 4-6 weeks after acute episode resolution to evaluate extent of disease and rule out other conditions.

Comprehensive Stool Analysis to assess gut microbiome composition, inflammation markers, and digestive function.

Food Sensitivity Testing to identify dietary triggers that may contribute to inflammation or symptoms.

Inflammatory Markers including C-reactive protein and complete blood count to assess acute inflammation.

Functional Lab Work including nutrient assessments, immune function evaluation, and metabolic markers.

Specialized Imaging such as CT colonography for ongoing surveillance and prevention planning.

We customize diagnostic protocols based on your presentation, disease history, and risk factors to ensure comprehensive evaluation and optimal management planning.

Our SIBO Treatment Approach

Our Three-Phase SIBO Protocol Includes:

1. Assessment and Risk Stratification

  • Comprehensive evaluation of disease type, severity, and complications
  • Detailed analysis of dietary, lifestyle, and genetic risk factors
  • Assessment of contributing factors including:
    • Gut microbiome imbalances and inflammatory patterns
    • Dietary triggers and fiber intake patterns
    • Medication effects (NSAIDs, opioids, steroids)
    • Underlying conditions affecting colon health
    • Family history and genetic predisposition
    • Lifestyle factors (exercise, smoking, stress)

2. Targeted Intervention

  • Acute Management: Anti-inflammatory protocols, targeted antimicrobials when indicated, and symptom relief strategies
  • Dietary Optimization: Personalized fiber recommendations, anti-inflammatory nutrition, and trigger food elimination
  • Gut Microbiome Restoration: Targeted probiotics and prebiotics to restore beneficial bacteria and reduce inflammation
  • Lifestyle Modifications: Exercise protocols, stress management, and smoking cessation support
  • Medication Review: Assessment and modification of medications that increase diverticular disease risk

3. Rebuilding and Prevention

  • Comprehensive Prevention Strategies: Sustained dietary modifications and lifestyle optimization to prevent recurrence
  • Ongoing Microbiome Support: Long-term protocols to maintain healthy gut bacteria composition
  • Regular Monitoring: Surveillance strategies and early intervention protocols for symptom changes
  • Complication Prevention: Education and support to recognize warning signs and prevent serious complications
  • Quality of Life Optimization: Strategies to manage chronic symptoms and maintain active lifestyle
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Expert-Led, Patient-Centered Care

Dr. Alexandra Shustina, NYC’s and Miami’s premier gut health specialist doctor is a board-certified gastroenterologist and internist. She is a gut health specialist with training in conventional gastroenterology and functional gut health. She is an expert in the gut microbiome and its role in health and wellness.

At Whole Gut Health, our care is led by experienced functional medicine clinicians with a deep understanding of the gut microbiome and advanced diagnostics. We combine evidence-based strategies from conventional gastroenterology with a functional and integrative lens to give you the clarity and support needed for long-term healing.

Frequently Asked Questions

Diverticular disease encompasses a spectrum of conditions involving small, sac-like protrusions (diverticula) in the colon wall. Diverticulosis refers to the presence of these pouches without symptoms, while diverticulitis occurs when they become inflamed or infected. The disease exists on a continuum from asymptomatic pouches to potentially life-threatening complications.

Asymptomatic Diverticulosis

  • Primary characteristics: Silent pouches without inflammation
  • Common symptoms: Usually no symptoms
  • Found incidentally; 75% remain asymptomatic

Symptomatic Uncomplicated Diverticular Disease (SUDD)

  • Primary characteristics: Chronic symptoms without acute inflammation
  • Common symptoms: Abdominal pain, bloating, altered bowel habits
  • Often involves chronic low-grade inflammation and microbiome changes

Uncomplicated Diverticulitis

  • Primary characteristics: Acute inflammation without complications
  • Common symptoms: Severe left lower abdominal pain, fever, nausea
  • 80% respond to conservative treatment

Complicated Diverticulitis

  • Primary characteristics: Inflammation with abscess, perforation, or obstruction
  • Common symptoms: Severe pain, high fever, signs of complications
  • May require hospitalization, antibiotics, or surgery

Diverticulosis: Usually no symptoms in 75% of people, mild abdominal cramping, occasional bloating, rare rectal bleeding

Symptomatic Uncomplicated Disease: Chronic left lower abdominal pain, intermittent bloating, altered bowel habits, feeling of incomplete evacuation, food intolerances

Diverticulitis: Severe constant left lower abdominal pain, fever and chills, nausea and vomiting, changes in bowel habits, abdominal tenderness, loss of appetite

Comprehensive evaluation involves multiple approaches depending on presentation:

CT Scan with Contrast

  • Gold standard for diagnosing diverticulitis
  • Assesses complications like abscesses or perforation

Colonoscopy

  • Performed 4-6 weeks after acute episode resolution
  • Evaluates extent of disease and rules out other conditions

Comprehensive Stool Analysis

  • Assesses gut microbiome composition and inflammation markers

Food Sensitivity Testing

  • Identifies dietary triggers contributing to inflammation

Inflammatory Markers

  • Including C-reactive protein and complete blood count

Diagnostic protocols are customized based on presentation and disease history.

 

Our comprehensive three-phase protocol includes:

Phase 1: Assessment and Risk Stratification

  • Comprehensive evaluation of disease type, severity, and complications
  • Detailed analysis of dietary, lifestyle, and genetic risk factors
  • Assessment of contributing factors including gut microbiome imbalances, dietary triggers, medication effects, and lifestyle factors

Phase 2: Targeted Intervention

  • Acute management with anti-inflammatory protocols and symptom relief
  • Dietary optimization with personalized fiber recommendations and anti-inflammatory nutrition
  • Gut microbiome restoration with targeted probiotics and prebiotics
  • Lifestyle modifications including exercise protocols and stress management
  • Medication review and modification when appropriate

Phase 3: Long-Term Prevention and Maintenance

  • Comprehensive prevention strategies with sustained dietary and lifestyle modifications
  • Ongoing microbiome support to maintain healthy gut bacteria
  • Regular monitoring and surveillance strategies
  • Complication prevention education and early intervention protocols
  • Quality of life optimization strategies

Different types require different management approaches:

  • Asymptomatic diverticulosis focuses on prevention strategies
  • SUDD requires microbiome restoration and anti-inflammatory approaches
  • Uncomplicated diverticulitis needs acute management and recurrence prevention
  • Complicated diverticulitis may require immediate medical intervention and long-term monitoring

 

Yes, many cases can be effectively managed through comprehensive lifestyle approaches including:

  • Anti-inflammatory dietary modifications
  • Gut microbiome optimization
  • Regular exercise and stress management
  • Smoking cessation and medication review However, acute diverticulitis may require medical treatment, and our approach focuses on reducing the need for long-term medications through root-cause management.

At Whole Gut Health, we address both acute management and long-term prevention through:

  • Comprehensive assessment of underlying causes and risk factors
  • Integration of conventional gastroenterology with functional medicine approaches
  • Gut microbiome restoration and anti-inflammatory protocols
  • Personalized dietary and lifestyle optimization
  • Focus on preventing complications and recurrence rather than just managing acute episodes

Dr. Alexandra Shustina is a board-certified gastroenterologist and internist who serves as NYC's and Miami's premier gut health specialist. She has training in both conventional gastroenterology and functional gut health, with expertise in the gut microbiome and its role in health and wellness.

The first step is scheduling a comprehensive consultation where we'll:

  • Review your symptoms, medical history, and any previous diverticular episodes
  • Determine the most appropriate diagnostic and treatment strategy for your case
  • Develop a personalized management plan focused on both immediate needs and long-term prevention

Contact our office to schedule your initial consultation and begin your comprehensive approach to diverticular disease management and prevention.

Locations

New York

PHONE

(212) 634 4233

ADDRESS

635 Madison Ave.
New York, NY 10022

BUSINESS HOURS

Monday - Friday
9:00am - 5:00pm
Saturday - Sunday - Closed

BUSINESS HOURS

Monday - Friday
9:00am - 5:00pm
Saturday - Sunday - Closed

Miami

PHONE

(212) 634 4233

ADDRESS

407 Lincoln Rd Suite 10B
Miami Beach, FL 33139

BUSINESS HOURS

Monday - Friday
9:00am - 5:00pm
Saturday - Sunday - Closed

BUSINESS HOURS

Monday - Friday
9:00am - 5:00pm
Saturday - Sunday - Closed

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