Even if you’re not a nutritionist, you’ve probably scratched your head at social posts promising miracles if you just eat this food, cut this food, do this cleanse, or drink your meal through a straw while upside down at 1:01 pm.

While some of these recommendations are easy to spot because they fly in the face of science and common sense, many still trip people up. We are all attracted to the promise of feeling better and finding shortcuts. We can all be influenced by peers and people we admire.

Part of my work as an IBD dietitian is to help people learn about IBD nutrition and implement scientifically supported dietary therapies to improve their IBD and overall quality of life. This includes challenging ideas that are unsupported, unhelpful, outdated or dangerous.

Because it’s more of a niche topic, the world of IBD escapes some of the wilder dietary crazes. But it’s still rife with misinformation, which is why I’ve created this two-part series on IBD nutrition myths. Last time, I focused on persistent myths in the IBD community that may even be shared by medical professionals. This time, I tackle myths you’re likely to find on social media. So let’s clear them up!

Social Media Myth #1: You should test for food sensitivities if you have Crohn’s or Ulcerative Colitis

It is true that people with Inflammatory Bowel Disease can react to certain foods, especially when they have active inflammation. Inflammation impacts overall functioning of the gastrointestinal (GI) tract. It makes sense that intolerances or symptoms after eating arise during these times.

GI doctors and nutritionists have frequently recommended that IBD patients track and temporarily remove these foods, called “triggers,” while the intestine is healing. Nutrition counseling is not this simple, and we now know that strategies to promote tolerance, such as texture modification of food, is a better approach.

Food reactions in those with Crohn’s and ulcerative colitis related to inflammation probably account for a popular misunderstanding that food sensitivities can be behind IBD. If you can test for and eliminate foods you’re sensitive to — the thinking goes — you can improve your IBD.

There’s a germ of truth here. First, it is tempting to remove foods when they cause adverse symptoms. This is a natural result of IBD symptoms and inflammation. Decrease in food intake decreases symptoms. This is a slippery slope and can lead to nutrient deficiencies, weight loss and malnutrition. Second, because there are some foods (like gluten and dairy, as I discuss below) that can worsen IBD symptoms when other conditions (like celiac disease or lactose intolerance) are present.

However, these are unrelated to “food sensitivities” and may not be picked up on a food sensitivity test. Also known as immunoglobulin G (IgG) panels, these lab-drawn or at-home kits measure IgG antibodies that your body has made based on exposure and tolerance to food. IgG antibodies are not the same as immunoglobulin E (IgE) antibodies that mediate allergic and anaphylactic responses to foods — as in, say, a classic peanut allergy. In fact, we don’t fully know what IgG antibodies mean, except that they seem to be a normal human response to exposure (and perhaps tolerance) to foods.¹ They frequently have a high false-positive rate, and may not be elevated in those with true IgE-mediated allergy.² They do not mean certain foods are damaging your intestines or contributing to your disease.

IgG food sensitivity tests are not an effective way to approach IBD nutrition. Neither the American Academy of Allergy, Asthma and Immunology, nor the American Academy of Nutrition and Dietetics endorse the use of IgG food tests to treat any condition, including IBD. Further, these tests are not covered by insurance because there’s no evidence they’re useful.

Relying on food sensitivity tests may cause you to cut out a large list of foods (in addition to those already removed), limiting your diet, causing nutritional deficiencies, and complicating your life for no reason.

Here’s the truth:

While IgG food sensitivity tests have no place in managing IBD nutrition, tracking your intolerances can offer some help. I frequently recommend keeping a food log. Look back on your day to see if you had GI upset after eating certain foods. This is a much more reliable indicator of what foods you may need to temporarily modify, limit or avoid. Many individuals find they cannot see a pattern in the foods they eat and their symptoms. This is due to the nature of IBD inflammation as mentioned above — the simple act of eating can wreak havoc. In this case, tracking foods may not be helpful. This is why working with an IBD dietitian is so important.

It’s important to know that, as your IBD improves, you’ll likely be able to tolerate a much wider range of foods again.

Social Media Myth #2: If you have IBD, you need pancreatic enzymes

The pancreas is an expert digestive gland, secreting up to 2 L (WOW) of fluid into the duodenum daily. This fluid contains digestive enzymes that break down proteins, fats and carbohydrates for digestion and absorption.

In conditions that impact the pancreas, like chronic pancreatitis, people can develop Exocrine Pancreatic Insufficiency (EPI) requiring enzyme supplementation. Your doctor may order tests, such as fecal fat excretion and fecal elastase as part of the evaluation for EPI. If your doctor has told you to take enzymes, please continue.

EPI is a distinct condition from IBD. So why do people suggest taking pancreatic enzyme supplements if you have IBD? I think there are several reasons.

1. People can be confused about malabsorption. Those with active IBD frequently experience malabsorption of macronutrients, such as fats, and micronutrients, such as vitamin D — and they can experience similar symptoms seen with EPI. However, the malabsorption typically results from intestinal inflammation and damage, not from insufficient pancreatic enzymes to break down foods.³
2. There may be confusion over enzymes. There are specialized enzymes produced by cells (known as enterocytes) on the intestinal border that break down specific sugars and proteins. When people experience active inflammation from IBD, this digestive process can be impaired. A common example is impairment of lactase, the enzyme that digests lactose. If your body is unable to make lactase, either temporarily or permanently, taking it in supplement form can help you better tolerate dairy. Lactase is not a pancreatic enzyme.
3. Those with IBD may be at higher risk for complications involving the pancreas.⁴⁵ However, neither the definitive IOIBD⁶ or ESPEN⁷ guidelines indicate pancreatic enzymes as a treatment for Crohn’s or Ulcerative Colitis.
4. People may think pancreatic enzymes can break down roughage. However, most roughage consists of cellulose, which human bodies aren’t built to break down at all. Pancreatic enzymes won’t help this.

Here’s the truth:

Pancreatic enzymes can be expensive and unnecessary most of the time. The main goal is to treat the underlying cause/s of intestinal malabsorption and ensure adequate nutrition — not to try to add additional enzymes in the hope of further breaking down foods. That being said, there are specific situations that require work-up by your gastroenterologist noted above to assess if pancreatic enzymes are necessary. Anecdotally, some people say they find pancreatic enzymes helpful during periods of malabsorption, but this is not evidence-based and mostly individual.

Social Media Myth #3: You just need THIS probiotic for your Crohn’s or Ulcerative Colitis

Probiotics have been an area of great excitement in the last few decades, and research continues. However, instead of finding magic bullet probiotic strains that treat specific problems, for the most part, we’re finding that it’s not that simple. And while we know that the microbiome is involved in Inflammatory Bowel Disease, our best expert bodies agree that there is little evidence that probiotics are helpful at this time.

In fact, in 2020, the American College of Gastroenterology released a position paper which says they do not recommend the use of probiotics for either adults or children with Crohn’s or Ulcerative Colitis except in the context of a clinical trial.⁸

And the 2023 ESPEN Guidelines also agree that there is no evidence for probiotics in the prevention or treatment of relapse in Crohn’s Disease. However, they do offer a low grade recommendation that those with Ulcerative Colitis may use “selected probiotics or probiotics-containing preparations…as an alternative to 5-aminosalicylic acid (5-ASA) standard therapy if 5-ASA is not tolerated for the treatment of mild or moderate active disease.” They also mention there is enough evidence (although weak and inconsistent) to conclude multi-strain probiotics may help prevent pouchitis.⁷

So these aren’t exactly glowing recommendations for probiotics at this time and we need more clinical trials.

Here’s the truth:

The impacts of probiotics on disease management in IBD aren’t fully researched. You’re better off feeding your microbiome through a healthy, whole foods diet including fermented foods and fiber, in whatever form you best tolerate.

Social Media Myth #4: Because I have IBD, I have to avoid gluten

Not true! But not always false, either. In this case, I refer you to my comprehensive post: Gluten and Inflammatory Bowel Disease: Who Should Eat It and Who Should Avoid It.

Social Media Myth #5: Gut cleanses and detox diets can help your IBD

Social posts promoting gut cleanses and liquid or detox diets may claim they work for IBD by removing toxic buildup from the bowels or body.

Those touting gut cleanses may recommend fasting, enemas, and herbs, supplements or teas that have a laxative effect.

For detox diets, they may also promote fasting, herbs or supplements, along with a very low calorie or liquid diet.

Not only do we have no reputable evidence that these practices are effective for IBD — or any other condition — we have no plausible mechanism for how they would even work.⁹ Our kidneys and livers are highly effective at neutralizing and removing toxins, and we can also remove some toxins through our sweat and even our breath. We can support our natural detoxification pathways by getting good nutrition, adequate sleep and exercise. We do not need to take enemas or resort to a green juice cleanse.

In addition to being unproven, these recommendations can cause a lot of harm. Gut cleanses and detox diets can lead to electrolyte imbalances, weight loss, diarrhea, blood sugar imbalances, inadequate fiber intake, microbiome alterations, and increased transit time, while they worsen malnutrition or nutrient deficiencies already challenging those with IBD. In addition, unregulated detox supplements and teas may contain bogus, unneeded, and even dangerous ingredients.¹⁰ (Here’s more info for you on supplements in IBD.)

On a related note: People with IBD often need repeated colonoscopies and the necessary bowel prep to clean them out beforehand. Typically these are prescribed with care to maintain electrolyte balance, and are chosen from among preparations found to be safest in those with IBD.¹¹

Here’s the truth:

Please don’t fall for the gut-cleanse and detox diet hype. Honestly, the last thing most of my clients with IBD need to do is poop more, and many need to build up their nutrition, not restrict it further.

Your body was already built to detox. You can support it with a healthy diet and lifestyle. For the best “cleanse” prioritize whole foods (food in its most basic form), limit ultra-processed foods and food additives, and avoid tobacco and excessive alcohol.

And if you’re really looking to detox, you might cut back your social media to only the most trusted resources.

Ready for more myth busting?

Check out my last post, IBD Nutrition Myths Debunked.

1. https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Tools%20for%20the%20Public/Conditions%20Library/Library%20-%20Allergies/eacci-igg4-2010.pdf[↩]
2. Matarese, L. E., Mullin, G. E., & Tappenden, K. A. (Eds.). (2022). Health Professional’s Guide to Gastrointestinal Nutrition (2nd ed.). Academy of Nutrition and Dietetics.[↩]
3. Zuvarox T, Belletieri C. Malabsorption Syndromes. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553106/[↩]
4. Fousekis, F. S., Theopistos, V. I., Katsanos, K. H., & Christodoulou, D. K. (2018). Pancreatic involvement in inflammatory bowel disease: a review. Journal of Clinical Medicine Research, 10(10), 743.[↩]
5. Rogler, G., Singh, A., Kavanaugh, A., & Rubin, D. T. (2021). Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disease management. Gastroenterology, 161(4), 1118-1132.[↩]
6. 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.[↩]
7. 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.[↩][↩]
8. Su, G. L., Ko, C. W., Bercik, P., Falck-Ytter, Y., Sultan, S., Weizman, A. V., & Morgan, R. L. (2020). AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology, 159(2), 697-705.[↩]
9. Tahreem, A., Rakha, A., Rabail, R., Nazir, A., Socol, C. T., Maerescu, C. M., & Aadil, R. M. (2022). Fad Diets: Facts and Fiction. Frontiers in nutrition, 9, 960922. https://doi.org/10.3389/fnut.2022.960922[↩]
10. Ibid.[↩]
11. Restellini, S., Kherad, O., Bessissow, T., Ménard, C., Martel, M., Taheri Tanjani, M., Lakatos, P. L., & Barkun, A. N. (2017). Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease. World journal of gastroenterology, 23(32), 5994–6002. https://doi.org/10.3748/wjg.v23.i32.5994[↩]