Current treatment of diverticulitis involves a modified diet, bowel rest, antibiotics, and/or pain management. However, patients who have suffered 3 or more earlier cases have about an 80% chance of another recurrence, raising the chance of complications. Some 15-25% of patients with a first episode of acute diverticulitis require surgery, and 22% of those are likely to suffer a future attack post-surgery.
As diverticulitis is an often underlooked disease with limited research regarding treatment options, researchers are investigating compounds with direct anti-inflammatory effects, anti-microbial action, and modulation of the intestinal microbiome to potentially improve patient outcomes and prevent future attacks.
Currently under investigation are the natural herbal treatments, curcumin and coptis. These compounds both show potent anti-inflammatory activities and have both been found to improve microbial health and gut immunity with the potential to guard against infection.
Coptis Chinensis for Diverticulitis
Coptis chinensis is one of the rare sacred herbs for ‘damp heat’ conditions in Traditional Chinese Medicine. Used widely to drain fire and relieve toxicity associated with symptoms of Diverticulitis, Coptis promotes balance in the microbiome, boosts gut immunity, and guards against future infection.
Coptis is a natural anti-microbial herb containing several bioactive compounds reported to be beneficial for infectious and inflammatory disorders, including the alkaloids berberine, palmatine, and jatrorrhizine.
Berberine for Diverticulitis
Berberine is the main biologically active compound found in coptis. The compound has been found to exert protective effects against digestive diseases by inhibiting toxins and bacteria and fortifying the intestinal mucosa.
Berberine exerts broad-spectrum antibiotic activity and increases the production of butyrate, a vital short-chain fatty acid that regulates the intestinal environment, keeps mucosal inflammation at bay, and has been found to lower the recurrence of diverticulitis.
Berberine exerts anti-inflammatory activities by reducing the expression of TNF-α. TNFα is a pro-inflammatory cytokine found to be overexpressed in patients with Symptomatic Uncomplicated Diverticular Disease (SUDD), with mucosal TNFα levels decreasing during remission. SUDD patients with visceral hypersensitivity may also benefit from berberine, as it alleviates visceral hypersensitivity.
Berberine additionally inhibits the activation of the NF-κB-MLCK pathway, increasing the expression of tight junction proteins and repairing epithelial barrier damage. This may benefit SUDD patients as it is theorized that the prolonged chronic immune activation driving disease progression may be caused by the translocation of intestinal microbes and products from the gut lumen through the mucosa.
Palmatine & Jatrorrhizine
Two other main active components of Coptis are palmatine and jatrorrhizine, which both contribute to the anti-bacterial, anti-viral, and anti-inflammatory properties of Coptis.
Palmatine suppresses inflammatory and oxidative damage and exerts anti-bacterial and anti-viral properties. Likewise, jatrorrhizine exerts strong anti-inflammatory and antimicrobial activities and has been found to regulate intestinal contractions and promote gut bacteria balance.
Curcumin for Diverticulitis
Curcumin is a potent curative compound extracted from turmeric currently used to manage a wide range of conditions due to its beneficial anti-inflammatory, antioxidant, and neuroprotective properties.
Curcumin can benefit those with acute diverticulitis, as these patients show significant signs of mucosal inflammation due to immune system activation. One of the markers is an increased expression of TNFα in acute diverticulitis, which drops when patients enter periods of remission. Studies have shown curcumin can inhibit tumor necrosis factor-alpha, one of the inflammatory chemical messengers associated with acute diverticulitis.
Moreover, curcumin has the ability to restore dysbiosis, meaning an imbalance of the gut microbiome. Diveriticilus has been associated with alterations in gut bacteria, as diverticula pockets may encourage certain microbe communities that influence inflammation and lead to the progression of SUDD or diverticulitis. Therefore it is suggested that curcumin may have a preventive effect for diverticulitis by modulating gut bacterial balance.
Curcumin supplementation has also been found to neutralize the decrease of butyric acid-producing bacteria. This has a beneficial impact on those with diverticulitis as butyrate is a short-chain fatty acid that improves tight junction expression, which, as mentioned above, plays an important role in symptomatic uncomplicated diverticular disease (SUDD). Whether by preventing low levels of butyrate or by other mechanisms, curcumin has the ability to restore impaired intestinal permeability by preventing tight junction protein disruption.
Additionally, curcumin can enrich beneficial bacteria such as Bifidobacteria and Lactobacilli and reduce pathogenic bacteria associated with the onset of systemic diseases.
A prospective randomized study investigated the preventative effect of butyrate in diverticulosis patients with at least one episode of mild or moderate diverticulitis requiring treatment. During the 12-month course of treatment, there was a decrease in the number of diverticulitis episodes, acute pain, fever, hospitalization, and surgery in comparison to the control group, as well as reports of improved quality of life.
The study demonstrated that a butyrate regimen can result in a significant reduction of clinical diverticulitis incidence.
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