Myths and Misconceptions

Reviewed by: HU Medical Review Board | Last Reviewed: January 2018.

There are many myths when it comes to inflammatory bowel diseases (IBD) like Crohn's and ulcerative colitis. Unfortunately, many people do not understand the conditions, leading to misconceptions. We're here to break it down.

Myth #1: IBD is the same as IBS

Some of the common symptoms of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) overlap. For example, both conditions can cause diarrhea, constipation, and abdominal pain. Both conditions are often diagnosed in young adults. However, they are not the same condition.1

Crohn’s disease and ulcerative colitis are the two main types of IBD. As the name suggests, these diseases involve inflammation in the digestive tract.1 Signs of inflammation can be seen with colonoscopy. Inflammation leads to serious complications, including abscesses and fistulas. People with IBD are at increased risk of other digestive diseases, such as colon cancer and gallbladder disease.

In contrast, IBS is a functional gastrointestinal disorder.1 It causes discomfort and emotional distress. However, it does not damage the intestine. The digestive tract looks normal during a colonoscopy. People with IBS rarely need to be hospitalized, although they frequently miss work.

Treatment of IBD is very different from treatment of IBS.1 IBD is treated with medications that reduce inflammation. Surgery is often necessary to treat complications of IBD. In contrast, IBS is treated by avoiding irritating triggers. People with IBS have unusually sensitive nerve endings in the bowel. There are numerous potential triggers, including certain foods, stress, hormone changes, and medications.1 Education, therapy, developing coping techniques, and sometimes medications can help treat IBS.

Myth #2: Following a special diet will cure Crohn's or colitis

The fact is that diet alone does not cause inflammatory bowel diseases like Crohn’s disease or ulcerative colitis. It also cannot cure it.

Experts believe that IBD develops due to the combination of certain genes with certain environmental factors. This means that a person may have genes that make the immune system prone to an abnormal reaction. Contact with certain environmental factors may cause the immune system to overreact, leading to IBD.2 To date, no one knows what environmental factors have a role in IBD.

Diet may seem like an obvious environmental factor. Crohn’s disease and ulcerative colitis are more common in people who live a Westernized lifestyle. It is a disorder of the digestive tract. Diet affects the type of bacteria that you have in your gut. Nevertheless, research into the role of diet in Crohn’s disease is inconclusive.3

To date, no one has proven that any particular food or nutrient causes IBD. For each study that has connected a dietary factor with IBD, there are other studies showing no connection.4

The only diet that causes remission in IBD is exclusive tube feeds (enteral nutrition). Tube feeding can be done by inserting a thin, hollow tube from your nose into your stomach or small intestine. A nutrient-rich formula flows through the tube. Tube feeding decreases inflammation and help patients—especially children—recover during active Crohn’s disease or ulcerative colitis.5,6

The discovery that exclusive tube feeding can treat IBD is exciting, but no one knows why it works.2 Therefore, there is currently no normal diet of whole foods that treats IBD. Many people living with IBD come up with their own diets, usually based on avoiding foods that make their symptoms worse. But so far, nothing you can eat—or avoid—has been proven to reduce inflammation and heal the gut.2

Myth #3: Does stress cause Crohn's disease or ulcerative colitis?

"Stress causes inflammatory bowel disease. You just need to relax and be more positive." This is a myth that many people with and without IBD believe.7 However, the idea that psychological factors cause Crohn’s disease and ulcerative colitis has been outdated since the 1990s.8 Recent studies provide little evidence that stress, life events, or mental illness cause IBD.7,8

What is true is that the stress of having a chronic illness can be a risk factor for depression and anxiety.8 Indeed, these psychiatric disorders are common in people with IBD. One estimate is that about a quarter of people with Crohn’s disease also have depression, and nearly 40% have anxiety.9 For comparison, in the US, about 16% of the general population have depression and 11% have anxiety.

It is also true that stress is linked to increased symptoms. However, a recent study showed that feeling stressed is not related to an increase in inflammation.10 More research is needed to explain these interesting results.

Can reducing stress help? It might improve your quality of life, but it does not reduce disease activity or prevent relapse. A small study was done with 56 patients with Crohn’s disease and 58 patients with ulcerative colitis.11 Participants were randomly assigned to usual treatment of stress management therapy. Stress management therapy improved quality of life for the people with ulcerative colitis, but not Crohn’s disease.

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