Diverticulitis is a gastrointestinal disorder that cripples the guts of more than 200,000 patients in the United States per year.

Traditionally, diverticulitis is treated with antibiotics based on the assumption of bacterial etiology. 

Thanks to the meticulous efforts of researchers and scientists, major paradigm shifts occurred in the understanding of diverticulitis and its treatments.

This article will explore these paradigm shifts and how probiotics come into play in diverticulitis.

What is diverticulitis?

Diverticulitis refers to inflammation of the diverticula.

Diverticula are small sac-like protrusions in your bowel wall, especially in your colon. About 50% of Westerners have those pockets by the age of 60. They are mostly asymptomatic. However, if one or more of these pouches become inflamed or infected, it is called diverticulitis.

Diverticulitis can present with severe abdominal pain, especially in the left lower abdomen, bloating, nausea, vomiting, altered bowel habits, fever, and chills.

What causes diverticulitis?

The old theory was that diverticula are great hideouts for bacteria. When a chunk of stool or undigested food such as seed gets trapped in one of the pouches, bacteria are happy to multiply and spread, triggering infection and inflammation.

The new thinking is that diverticulitis is predominantly an inflammatory process, and may not always be associated with infection. 

This led to new pathogenic theories in diverticulitis: chronic inflammation and alterations in the gut microbiome.

What do probiotics do for diverticulitis? 

The new concept of linking diverticulitis to the gut microbiome and chronic inflammation makes probiotics a substantial therapeutic approach in diverticulitis.

Probiotics are good bacteria that confer health benefits when consumed in adequate amounts.

• They promote the growth of beneficial bacteria and restore balance to your altered microbiome. 

• Probiotic bacteria feed on dietary fiber ( prebiotics ) and produce short-chain fatty acids. In addition to supplying energy for colonic epithelial cells, short-chain fatty acids produce mucus and antimicrobial substances and protect intestinal mucosa from harmful substances.

• They defeat pathogenic microbes and maintain a healthy gut environment.

• They alleviate inflammation by stimulating the regulator cells of the immune system and reducing the production of pro-inflammatory molecules.

Taking probiotics for diverticulitis: evidence-based?

A 2021 review paper from PubMed Central analyzed all the research articles published in the last ten years, screened 1017 papers, and concluded that Limosilactobacillus Reuteri, one of the lactobacillus probiotics, is effective in acute uncomplicated diverticulitis, with a reduction of bloating and abdominal pain.

Debunking the myths 

• Probiotics ameliorate flare-ups of diverticulitis. But they may not permanently stop diverticulitis from recurring. 

• Probiotics do not cure already-existing diverticula in your gut, called diverticulosis. But by maintaining a healthy balance of good bacteria in the gut and supporting digestive health, they may play a role in preventing new diverticula.

• There is solid evidence that nuts and seeds do not increase the risk of diverticulitis. The British Society of Gastroenterology encourages people with diverticular disease to eat a healthy diet to create a healthy gut environment. You can also check my previous article: how to improve gut health.

Should diverticulitis patients take probiotics?

Although current scientific data are not overwhelmingly positive, the outcomes of taking probiotics in symptomatic uncomplicated diverticulitis are remarkable.

From my perspective, a well-researched probiotic is worth adding to the conventional treatments of diverticulitis in selected patients, considering potential benefits and a good safety profile.

Is it ok to take probiotics during a diverticulitis flare-up?

Yes, there is no evidence that taking probiotics during a diverticulitis flare-up cause any harm. However, you should always consult your doctor for control of symptoms rather than relying on probiotics alone.

Best probiotic strains for diverticulitis according to research

According to research, the following probiotic strains showed the most promise in diverticulitis.

Limosilactobacillus Reuteri and Lactobacillus rhamnosus GG shows a reduction in symptoms such as bloating and abdominal pain and a shorter duration of hospital stay in patients with acute uncomplicated diverticulitis.

Lactobacillus salivarius Ls33 facilitates the recovery of the inflamed gut in animal studies by diminishing the production of inflammatory mediators such as TNF-alpha. 

Lactobacillus Acidophillus and Bifidobacterium lactis are effective in acute diverticulitis, especially in patients with constipation-predominant features.

Lactobacillus casei is effective in maintaining remission of diverticulitis, especially when given together with mesalazine.

What are the best probiotics to take with diverticulitis?

Optibac Probiotics Every Day – Digestive Probiotic

I particularly like this product because it has just about right amount in terms of dose and strains involved. It has gut calming strains such as L rhamnosus, acidophillus and Bifidobacterium longum and so on with a total of 5 billion CFUs.

The reason I say right amount for everything is that I finds 5-10 Billion CFU is the most suitable for most of my patients and around 5-10 strains of microbiomes to be most tolerable.

Culturelle Digestive Daily Probiotics Capsules

Culturelle Digestive Daily Probiotics Capsule is more of a specialized product containing Lactobacillus rhamnosus GG for gut-related symptoms such as bloating, gas, and diarrhea.

L rhamnosus combined with inulin ( prebiotics) helps calm bowel inflammation and thus helps mainly with symptom control related to inflammation and also regulates good bowel habits which are very important for people with diverticular diseases.

I recommend this product, especially for those who can not tolerate multiple strains of products with very high CFUs.

Why I recommend

• CFU 10 Billion
• Combined L rhamnosus with Inulin
• Gluten-free, sugar-free, soy-free
• Vegan probiotics

Why I would not recommend

• CFU count is fairly low for most people

• single strain probiotics

VSL 3 for Inflammatory Bowel

VSL 3 for Inflammatory Bowel Probiotics is a premium product with multiple strains of microbiomes and very high amounts CFUs.

This is particularly for those who want a high-quality product with a shotgun approach.

This product contains the most promising strains from Lactobacillus, Bifidobacterium, and Streptococcus ( three major groups of gut microorganisms) aiming to reduce inflammation associated with infection, or autoimmune such as inflammatory bowel diseases.

Some people might find it difficult to tolerate, especially in the first month of taking it but most people will find significant improvement of symptoms and most of the side effects are usually tolerable for most of my patients and goes away after taking it for few days.

Why I recommend

• High CFU
• Very good profile for the strain of probiotics
• Proven outcomes

Why I would not recommend

• Difficult to tolerate in the first month
• higher price than the average

Dr formulated probiotics

Dr. Formulated Probiotics is manufactured by Garden of Life, well known due to the use of high-quality raw materials. I chose this product at the top of the list because it has a decent amount of CFU – 50 billion, and contains all of the species known to have a good effect on Gastrointestinal symptoms such as bloating, pain, and gas.

This is more of an all-in-one approach product with a reasonable price including almost all of best performing Lactobacillus and Bifidobacterium species combined with Prebiotic fibres.

Why I would recommend

It is dairy free, vegan, and free from any genetically modified ingredients.

• CFU – 50 Billion
• Resistant to stomach acid
• Excellent micro bacterial diversity
• Dairy-free, gluten-free, soy-free
• No refrigeration required
• Once a day formula

Why I would not recommend

• high CFU and too many strains can be difficult to tolerate for some people
• not include Strep strain and little prebiotics content for better bowel movement

They also have a separate product for women – Dr. Formulated Probiotics for Women

Balance one probiotic

Balanceone probiotics come with 15 Billion CFU, arguably one of the lowest doses however this particular brand has special tech in the capsule called “ timed release:” which means microbiomes are only released in the intestinal giving its maximum effect.

It does come with various strains of Lactobacillus including L acidophilus, L casei, Bifidobacterium including Brevis which will help to create an optimal bacterial environment to reduce inflammation, and repair intestinal epithelium.

Similar to Garden of Life, it also has some the prebiotics such as Guar Gum, turmeric, etc.

• Contains prebiotics
• 15 Billion CFUs Of Probiotic Bacteria
• 12 Proven Strains
• Shelf-Stable
• Time-Release Tablets – released slowly over 8-10 hours
• Prebiotic Included
• Tablets form which has been tested to show more resistance against stomach acid

Portion Master Gastrointestinal Support Probiotics Plus

Apart from the usual gut microbiomes, Portion Master Probiotics also comes with Bifidobacterium longum which has immune regulating properties showing benefits in conditions such as allergies, and eczema.

It has a decent 30 billion CFU which is just about the right dose for gastrointestinal conditions.

Miracle Green Probiotics

Miracle Green is a budget-friendly product that covers all the basics such as a good bacterial profile, has 50billion CFU, and stomach acid resistance.

The company has a reputation for the high standard of manufacturing processes in the UK, ensuring that quality is guaranteed.