When a new field takes off running, it’s never long before a pack of myths is chasing after. It seems the more we learn about the benefits of nutrition therapies for treating inflammatory bowel disease (IBD), the more questions and misperceptions that arise.

As a researcher and provider using tailored nutrition therapy frequently in IBD, I’d like to address the 5 myths I hear the most often about IBD Nutrition. I’ll share what we know and don’t know, and point providers to additional research if they’d like to dig in further. If you’re a person with IBD and want a better scientific understanding, this post is for you, too! But, stay tuned…next time, I’m going after common myths that patients hear on the internet and social. Let’s get busting!

IBD Nutrition Myth #1: Diet Has No Effect on IBD

While there is no silver-bullet IBD Diet for every person with Crohn’s Disease (CD) or Ulcerative Colitis (UC), diet does impact inflammatory bowel disease.

For a long time, we’ve known that people with IBD can react to perceived trigger foods that increase their symptoms. When their disease is active, a person’s reactions may be stronger, especially to fried/high-fat, spicy, raw fruits/vegetables and high-lactose foods. These triggers often subside when the inflammation is treated.

One pillar of my 3D-Dietary® Approach to IBD is detecting and minimizing these triggers, which helps reduce symptoms while still supporting a nutritionally complete eating plan. As a person’s condition improves, we reintroduce eliminated foods as much as possible to increase the diversity of their diet.

But beyond triggers, overall eating patterns can also play a role in the intestinal inflammation that is seen in IBD. Researchers investigating dietary therapies in IBD measure participants’ inflammation levels as compared to other treatments such as corticosteroids. We have a growing number of studies that show certain nutrition therapies, especially Exclusive Enteral Nutrition (EEN), are able to reduce inflammation and symptoms, and even promote mucosal healing.¹ For instance, a landmark study comparing EEN alone to corticosteroids alone found that a 10-week course of EEN was  more effective in inducing mucosal healing in children with CD.²

This demonstrates that by intentionally modifying what a person with IBD eats and doesn’t eat, we are often able to measurably improve their IBD. We also know that diet impacts overall health for all individuals and other chronic illnesses, not just those with IBD. Those with IBD are equally at risk for cardiovascular disease, type II diabetes and other comorbidities.

In addition, there is sufficient evidence to recommend including increased whole foods (fruits, vegetables, legumes, whole grains) and removing ultra-processed foods across the board for those with IBD. The 2020 guidelines from the International Organization For the Study of Inflammatory Bowel Disease review the evidence on diet and conclude:

1. Dietary therapies that exclude certain foods and replace them with nutritional formulas or other foods may lead to remission in CD.
2. In UC some dietary components have been linked to flares.
3. Those with CD should consider eating more fruits and vegetables, possibly because fiber can increase beneficial fatty acid production, preserve protective mucus, and reduce inflammation in the intestine.
4. Individuals with UC should reduce saturated and trans fats and increase omega-3 fatty acids (preferably in the form of food).
5. Those with IBD should avoid ultra-processed foods that include artificial sweeteners, maltodextrins, emulsifiers and thickeners, carrageenans, titanium dioxide and other nanoparticles.³

Similarly, the 2023 ESPEN guidelines on Clinical Nutrition in Inflammatory Bowel Disease conclude that ultra-processed foods and dietary emulsifiers may increase the risk of IBD — and that excluding them may help with IBD prevention. In addition, they recommend an individualized nutrition approach in general and the Crohn’s Disease Exclusion Diet (which includes some specific foods and eliminates others) can be considered as an alternative to exclusive enteral nutrition for both children and adults with mild-to-moderate active CD to achieve remission.⁴

Choosing the best nutrition approach for IBD is highly individual and should be done in consultation with a patient’s care team. However, it’s certainly safe to bust Myth #1 right here and now. Diet is important in IBD — at the level of individual reactions to specific foods and in terms of overall eating patterns that affect symptoms and risk.

(Wondering if gluten plays a role? Check out my article on Gluten and Inflammatory Bowel Disease for more.)

IBD Nutrition Myth #2: Diet Causes IBD

It’s one thing to say that diet has an effect on inflammatory bowel disease. It’s another thing entirely to say that what a person ate caused their IBD. We need to be careful about this for a couple of reasons.

First, we just don’t know the full picture yet. Both genes and environment play a role in IBD, and we have some good evidence that gut bacteria and diet are significant contributors⁵. Even though we now have studies suggesting that ultra-processed foods may be contributing to the rise in IBD we see in countries with Westernized diets⁶, this is not to say that everyone who eats ultra-processed foods is at risk of IBD. Nor is it to say that someone with IBD who has eaten many ultra-processed foods got IBD because of their diet. It’s rarely, if ever ever that simple.

Second, Myth #2 smacks of blame and can lead to a cycle of shame in those already struggling with a painful disease. This is known as healthism. It also implies that everyone has equal access to adequate amounts of whole, unprocessed foods — which is not the case. I find it helpful to look forward, not backward. We DO know that diet and lifestyle changes can improve the health for everyone with or without IBD, so I like to help my clients focus on how their eating patterns can help them now and going forward.

IBD Nutrition Myth #3: You Must be on a Low Fiber Diet

This myth is as tough as an old string bean and just as hard to swallow. It’s just not the case — but not everyone has gotten the news.

Decades back, the thinking was that those with IBD couldn’t tolerate fiber and that it would irritate an already inflamed gut.⁷ So patients were advised to avoid residue or fiber to “rest” their intestines.

However, these recommendations have fallen out of favor as we’ve learned how vitally important fiber is for intestinal health. We now know that there is little evidence that a low-residue or low-fiber diet helps⁸ outside of certain short-term cases, and that Nutrition Therapies (SCD, IBD-AID, AIP, CDED, etc) that include fiber-containing foods in various textures and types are proving effective in reducing symptoms and even inducing remission.

Fiber is critical for feeding a healthy microbiome, increasing production of beneficial fatty acids⁹, reducing inflammation⁸, and even prolonging remission¹⁰ in those with IBD. It is important to note that not all fiber is equal. There are two main types – soluble and insoluble – and fiber reduction is frequently recommended in the name of symptom management, without long-term guidance on how to use fiber to help the bowels with active symptoms and as symptoms subside. Insoluble and soluble fiber can help with both loose/frequent bowel movements and in cases of constipation.

For those who struggle to tolerate fiber or are curious about how to incorporate fibrous foods in their whole form or at all, there are many strategies to help you benefit from fiber in a tolerated form — and I outline some of them in my post on Legumes.

IBD Nutrition Myth #4: Nutrition Therapies Cause Disordered Eating

This is a hot topic in the IBD world — and for valid reasons as there is a lot of gray area where research is needed. Research has shown that those with diet-related chronic illnesses are more likely to have negative body images and disordered eating.¹¹ And rates of depression, anxiety¹², and eating disorders¹¹ may be higher among the IBD population than in the general population, especially when disease is active.

However, the jury is still out on the causes of this relationship. Patients with IBD face a variety of challenges that impact their experience of food and their bodies including but not limited to:

• impaired digestion, absorption and metabolism,
• fluctuations in body shape and weight because of their disease or treatments,
• decreased appetite and changes in their hunger cues,
• alterations in the gut microbiome (also found in the general population of eating disorders)⁸
• and negative associations with foods perceived to trigger their symptoms, especially with active disease,
• frequent weight checks during clinic visits,
• nutrition or diet recommendations without complete, individualized guidance,
• numerous reports of or influencers online who talk about treating or curing disease with various supplements,
• dialogue on weight or body changes from well meaning family and friends,

We also know that up to 40% of IBD patients have attempted various diet therapies – often without the careful assistance of a physician or dietitian.¹³ We still need to understand the relationship between a person’s individual risk factors (such as a history of trauma or family history), their disease-related factors, and their eating choices in response to their disease.

We need to understand the differences between patients self-restricting their diets and patients undertaking well-researched nutrition therapies with the support of an IBD dietitian and a multidisciplinary care team (especially a mental health provider). We don’t have the data yet, but I suspect that outcomes may differ.

For one thing, we know in practice that when people self-restrict foods, they tend to over-restrict. This can be due to need for some control over food when illness can feel out of control, desperation to feel better, or what they have read online. In combination with their existing disease, this can contribute to nutrient deficiencies and microbiome disturbances — both of which can interact with mental health.¹⁴¹⁵ Screening for mental health disorders, including disordered eating risk, when appropriate, is important early in the IBD journey with gentle check-ins regarding relationship with food and mental health as agreed upon by the individual.

In my experience as an IBD dietitian, using an evidence-based eating plan as a guide can actually expand the diets of many who have tried eliminations on their own. I suspect this is due to education and close supervision, guidance and support knowing when we need to change direction. And we also have some tantalizing evidence that nutrition therapy can improve Food-Related Quality of Life (FRQoL) with a good support system. For example, one small pilot study on the Autoimmune Protocol Diet (AIP) concluded, “dietary modification can improve quality of life as early as week 3 in patients with active IBD.”¹⁶ Of note, patients in this study received detailed diet and lifestyle education and support by a certified health coach AND IBD dietitians provided one-to-one feedback as well as resources and community support via a Facebook group for easy, frequent communication. To my knowledge, education level and socioeconomic status (SES) were not mentioned in this study.

In my practice, we focus on empowerment through education and shared decision-making as well as reducing symptoms and inflammation through nutrition. Not everyone is a good fit for nutrition therapy and factors such as IBD status/diagnosis, personal history, anxiety levels, family and peer support, SES, food access, insurance reimbursement and other high risk factors, etc., need to be weighed to set a patient up for success. Many of these same factors play into medical therapy decision making and adherence, they are not unique to nutrition therapy. Since many aspects go into this decision, patients deserve to know ALL the options for their treatment plan — and they deserve professional support in carrying out their plan. One of the most common comments from patients and parents I see is “I wish I would have known about these nutrition options at the time of diagnosis. Why were we not told?”

We do not have enough information to conclude that Nutrition Therapies lead to eating disorders at this time and it is not black and white.

For more information, see my post on IBD and Disordered Eating.

IBD Nutrition Myth #5: Nutrition Therapy is Too Hard

This is a myth with a grain of truth. Because, yes, it can be hard for people to make diet and lifestyle changes. On the other hand, Crohn’s and Ulcerative Colitis are also hard in themselves, and the relationship with food can be complex. Approaches like nutrition therapy that can reduce symptoms and potentially induce remission as part of one’s overall medical plan can improve quality of life over the long run.

Everyone’s hard is different. It doesn’t have to be all or nothing, and there is almost always something a person can and is willing to do to feel better using an individualized approach and not necessarily a set diet structure. Providers can start by encouraging general healthy eating patterns and suggest some of the guidelines above, such as reducing reliance on ultra-processed foods and finding ways to incorporate fiber as tolerated. This is where IBD RDs are crucial for their individual nutrition assessment, which includes evaluation of one’s access to foods, personal goals and benefit to be gained, and ability to make diet and lifestyle changes.

Sometimes nutrition therapy is the best option given an individual’s disease state, nutrition status, medication response or access to viable medication options.

It is our job as providers to share all of the evidence and set expectations around what nutrition therapy can look like. We need to outline the potential pitfalls and describe what an ideal support system looks like, so that any diet change has the best chance of success. In the end, it’s up to an individual or family to make the choice that’s best for them with the evidence given.

Ready for your tailored nutrition plan to support your IBD? If you’re a patient or family looking for guidance, I encourage you to get started here. If you’re a provider looking to expand your IBD nutrition knowledge and offerings, please check out my resources for professionals and programs for health organizations.

1. Suskind, D.L., Cohen, S.A., Brittnacher, M.J., Wahbeh, G., Lee, D., Shaffer, M.L., Braly, K., Hayden, H.S., Klein, J., Gold, B. and Giefer, M. (2018). Clinical and fecal microbial changes with diet therapy in active inflammatory bowel disease. Journal of clinical gastroenterology, 52(2), 155.[↩]
2. Borrelli, O., Cordischi, L., Cirulli, M., Paganelli, M., Labalestra, V., Uccini, S., … & Cucchiara, S. (2006). Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clinical gastroenterology and hepatology, 4(6), 744-753.[↩]
3. Levine, A., Rhodes, J. M., Lindsay, J. O., Abreu, M. T., Kamm, M. A., Gibson, P. R., … & Lewis, J. D. (2020). Dietary guidance from the international organization for the study of inflammatory bowel diseases. Clinical Gastroenterology and Hepatology, 18(6), 1381-1392.[↩]
4. Bischoff, S. C., Bager, P., Escher, J., Forbes, A., Hébuterne, X., Hvas, C. L, et.al. (2023). ESPEN guideline on Clinical Nutrition in Inflammatory Bowel Disease. Clinical Nutrition.[↩]
5. Lewis J. D. (2016). The Role of Diet in Inflammatory Bowel Disease. Gastroenterology & hepatology, 12(1), 51–53.[↩]
6. Narula, N., Wong, E. C., Dehghan, M., Mente, A., Rangarajan, S., Lanas, F., … & Yusuf, S. (2021). Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. Bmj, 374.[↩]
7. Shah, N. D. (2015). Low residue vs. low fiber diets in inflammatory bowel disease: evidence to support vs. habit?. Practical Gastroenterology, 39(7), 48-57. [↩]
8. Ibid [↩][↩][↩]
9. Armstrong, H., Mander, I., Zhang, Z., Armstrong, D., & Wine, E. (2021). Not All Fibers Are Born Equal; Variable Response to Dietary Fiber Subtypes in IBD. Frontiers in Pediatrics, 8, 620189.[↩]
10. Pituch-Zdanowska, A., Banaszkiewicz, A., & Albrecht, P. (2015). The role of dietary fibre in inflammatory bowel disease. Gastroenterology Review/Przegląd Gastroenterologiczny, 10(3), 135-141.[↩]
11. Satherley R, Howard R, Higgs S. Disordered eating practices in gastrointestinal disorders. Appetite. 2015 Jan;84:240-50. doi: 10.1016/j.appet.2014.10.006. Epub 2014 Oct 13. PMID: 25312748. [↩][↩]
12. Tarar, Z. I., Zafar, M. U., Farooq, U., Ghous, G., Aslam, A., Inayat, F., & Ghouri, Y. A. (2022). Burden of depression and anxiety among patients with inflammatory bowel disease: results of a nationwide analysis. International Journal of Colorectal Disease, 1-9. [↩]
13. Guadagnoli L, Mutlu EA, Doerfler B, Ibrahim A, Brenner D, Taft TH. Food-related quality of life in patients with inflammatory bowel disease and irritable bowel syndrome. Qual Life Res. 2019 Aug;28(8):2195-2205. doi: 10.1007/s11136-019-02170-4. Epub 2019 Mar 21. PMID: 30900206; PMCID: PMC6625837. [↩]
14. Lakhan, S. E., & Vieira, K. F. (2008). Nutritional therapies for mental disorders. Nutrition journal, 7, 2. https://doi.org/10.1186/1475-2891-7-2 [↩]
15. Kuźnicki, P., & Neubauer, K. (2021). Emerging comorbidities in inflammatory bowel disease: eating disorders, alcohol and narcotics misuse. Journal of Clinical Medicine, 10(19), 4623. [↩]
16. Chandrasekaran, A., Groven, S., Lewis, J. D., Levy, S. S., Diamant, C., Singh, E., & Konijeti, G. G. (2019). An autoimmune protocol diet improves patient-reported quality of life in inflammatory bowel disease. Crohn’s & Colitis 360, 1(3), otz019. [↩]