For many of us, the gut is something of a black box. Food goes in, waste comes out, and we rarely discuss or even try to understand what happens in between.
“We don’t talk about gut health enough,” said Dr. Morgan Sendzischew Shane, a gastroenterologist at the University of Miami Miller School of Medicine. “It’s not prim and proper” to discuss digestion, gas or bowel habits, she added.
And people may feel shy about bringing up certain issues with their doctors, she said, which can allow old gut health myths to persist and new sources of misinformation to spread.
We asked 10 experts in gastroenterology and the microbiome about the myths they most wanted to set straight. Here’s what they said.
Myth 1: You must ‘go’ every day.
People often worry that if they don’t have a bowel movement every day, something must be wrong, said Dr. Folasade P. May, a gastroenterologist at the David Geffen School of Medicine at U.C.L.A.
But it can be normal to go anywhere from three times per day to three times per week, she said. More important is how consistent your bowel movements are, and how your stool looks (not too hard, lumpy or watery) and how it feels to pass (not too painful or difficult), Dr. May added.
If you’re regularly straining, having pain, needing more than 10 minutes on the toilet, or feeling as though you can’t evacuate your bowels completely, you may benefit from seeing a doctor. This is especially important if you have blood in your stool, sudden changes in the frequency or appearance of your bowel movements, or unexplained weight loss. These could be signs of serious conditions including inflammatory bowel disease, celiac disease or colorectal cancer, she said.
Myth 2: Elimination diets can help cure gut symptoms.
Tamara Duker Freuman is a dietitian at New York Gastroenterology Associates in New York City. When she sees patients who have issues like bloating or constipation, they often think that cutting out various combinations of food — like grains, legumes, dairy, eggs and soy — will help calm inflammation and heal their gut.
But there’s nothing inherently inflammatory about these foods, Ms. Freuman said. And elimination diets may worsen your gut health, which is usually best supported by consuming a variety of plant-based foods like whole grains, fruits, vegetables and legumes. Following restrictive diets may also lead to nutrient deficiencies or disordered eating, she said.
If you have regular gut issues, a health care provider can help figure out the cause. It may be that you still need to abstain from certain foods — for example, if you have celiac disease and must avoid gluten — but you shouldn’t need to cut entire food groups from your diet.
Myth 3: You can diagnose food sensitivities with a simple test.
Various companies sell at-home or lab-based tests, called food sensitivity tests, which claim that by analyzing your blood or a few strands of hair, they can identify the foods that may be causing issues like bloating, abdominal pain and indigestion.
Kate Mintz, a dietitian at U.C.L.A. Health who specializes in gut health, said that it could be “enticing” to take a simple test in the hopes of getting clear-cut answers.
But food sensitivity tests, including those administered at home and by certain alternative medicine providers, have not been rigorously evaluated, Ms. Mintz said. And their results often suggest that people avoid a long list of foods — sometimes ones that they’ve never had issues with — which can be confusing or can prompt them to follow unnecessarily restrictive diets, Ms. Mintz said.
Instead, see a dietitian who can help figure out what, if any, foods are causing your symptoms. This can take time, Ms. Mintz said, but it’s likely to yield better results.
Myth 4: Stress can cause ulcers.
Doctors used to think that peptic ulcers — open sores in the stomach’s lining or the first section of the small intestine — were caused by stress or other lifestyle factors, like eating spicy foods.
That thinking was overturned in the 1980s, when scientists discovered that Helicobacter pylori, a bacterium that bores into the protective lining of the stomach, caused many peptic ulcers, said Dr. William D. Chey, chief of gastroenterology at Michigan Medicine. Frequent use of nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen and naproxen can also cause them.
Failing to treat the “root cause” of ulcers — with antibiotics if they’re caused by H. pylori or by reducing the use of NSAIDS if they’re the culprit, for example — can allow them to recur, Dr. Chey said.
Recurrent ulcers can increase the risk of bleeding, or a blockage or a hole forming in the stomach or small intestine. Untreated H. pylori infections can also increase the risk of stomach cancer.
Myth 5: Juice cleanses and fasts can heal your gut.
It’s a popular idea: Make a juice from various ingredients you would find in the produce aisle — oranges, pineapple, lemon, cucumber, ginger, turmeric — and consume it every day for better digestion, less bloating and a healthier gut.
If you enjoy making these elixirs (or buying them at the store), it’s fine to drink them in moderation, Dr. Shane said. But some juice drinks can be high in sugar, she said, and they’re “really not helping to clean anything.”
In fact, juicing fruits and vegetables removes their fiber, which feeds your beneficial gut microbes and regulates bowel movements. You’re better off blending produce into a smoothie, which doesn’t remove the fiber, or making a salad, Dr. Shane said.
The extreme version of this myth is the juice cleanse, in which people consume only juice for several days. This is not beneficial or sustainable, Dr. Shane added, and it’s dangerous to promote the idea “that your body needs to be deprived of food in order to be clean and healthy.”
Myth 6: Colorectal cancer mainly affects older people.
In medical school in the early 2000s, Dr. May was taught that colorectal cancer was a disease of older adults. But its rates have climbed in younger people, and it’s now the leading cause of cancer-related deaths among men under 50 and the second most common among women in that age group.
Today, Dr. May tells medical students that when adults have changes in their bowel habits, unexplained weight loss or blood in their stool, colorectal cancer should be on their list to rule out.
Because the early stages of colorectal cancer often don’t have symptoms, everyone should get screened — with a colonoscopy or an at-home stool test — starting at age 45, or sooner if you have certain risk factors, Dr. May said.
Myth 7: Eating nuts and popcorn can cause diverticulitis.
Diverticulitis occurs when small pouches in the wall of the colon become inflamed, causing abdominal pain, nausea, vomiting, constipation, cramping or fever.
Doctors used to say that if you’re prone to diverticulitis, you should avoid eating nuts, seeds and popcorn, thinking they might get stuck in the colon wall and cause inflammation, said Dr. Nitin K. Ahuja, a gastroenterologist at the University of Pennsylvania.
But that turned out to be wrong, Dr. Ahuja said. In fact, some research suggests that people who consume nuts or popcorn are actually less likely to develop diverticulitis than those who don’t. These foods contain fiber, which is associated with a reduced risk of diverticulitis.
Myth 8: Eating beans and other lectin-containing foods can cause a ‘leaky’ gut.
Some influencers claim that certain foods that contain chemicals called lectins — including beans, grains and some vegetables — cause inflammation and a “leakier” intestinal lining, which can allow microbes and toxic substances to pass from the gut to other parts of the body.
All plants contain lectins, and they’re particularly high in beans; that’s why eating raw or undercooked beans can cause gastrointestinal distress. But most lectins are destroyed by cooking, so you don’t need to worry about their levels in cooked beans, grains or other foods, said Justin Sonnenburg, a professor of microbiology and immunology at Stanford University.
And although some vegetables that you might eat raw — like tomatoes, bell peppers and snap peas — do contain lectins, they are present in far lower concentrations than in dry beans and haven’t been linked with digestive symptoms.
Swearing off lectin-containing plant foods because of this myth won’t help your gut, Dr. Sonnenburg said. In fact, it might hurt it. Avoiding plant foods may rob your beneficial gut microbes of enough fiber, he said. When that happens, they can start to eat the protective mucus lining of the gut — which itself can lead to a “leaky” gut and inflammation, he added.
Myth 9: I.B.S. is ‘all in your head.’
Abdominal pain, bloating, diarrhea, constipation — the symptoms of I.B.S. are real and can be debilitating. But the condition has historically come with some stigma, in part because it doesn’t have a diagnostic test, scientists don’t fully understand its cause, and certain mental health conditions like anxiety and depression can worsen it.
Even today, some health providers may not take the condition seriously, leaving many patients feeling dismissed as “crazy,” said Dr. Baha Moshiree, a gastroenterologist at Atrium Health Wake Forest in Charlotte, N.C.
I.B.S. is a disorder of the gut-brain interaction, she said. Some nerves in the gut — such as those that sense pain, for example — can be extra sensitive, which can cause even normal digestive functions to feel painful.
Even though mental health can play a role in I.B.S., that doesn’t make the condition any less real or worth treating, Dr. Moshiree said.
Myth 10: Everyone should take probiotics for gut health.
While some people may benefit from taking probiotic supplements, there’s little quality evidence suggesting that most people need them, said Dr. Brian Lacy, a gastroenterologist and professor of medicine at the Mayo Clinic in Jacksonville, Fla.
Thousands of microbial species live in your gut, he said, so it’s unlikely that a small capsule containing just one or a few living strains would do much to improve it.
And for some people, probiotics can make symptoms worse. Those with constipation, for example, may have increased gas, bloating and nausea after taking a probiotic, said Kayla Hopkins, a dietitian at Atrium Health Gastroenterology and Hepatology in Charlotte, N.C. Instead, she recommended consuming fermented foods like yogurt, kefir, kimchi or sauerkraut, in addition to a variety of plant-based foods.
“An optimal gut,” Ms. Hopkins said, “doesn’t start with lots of pills and lots of potions if you can help it. It just starts with balanced nutrition and variety.”
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