GutTok check: Behind the wellness trend exploiting the mysterious nature of IBS

For better or worse, TikTok and Instagram have become spaces where health information is not only exchanged, but also a place to sell and promote specific health regimens. Lately, the conversations in digital health spaces have been predominantly about “gut health.” Just search #GutTok on TikTok and you’ll uncover a range of people sharing tips on how to “heal your gut.”

Taking a deeper look, it’s not only videos of unsolicited health advice, but also tangible solutions,which unsurprisingly incorporates a wide range of supplements. From bovine colostrum to probiotics to prebiotics, many of these supplements are being sold under the guise of improving a person’s microbiome, the colonies of beneficial germs that live inside us, which will relieve people of physical symptoms like bloating (in other words, a flat stomach). 

As Derek Beres, co-host of the Conspirituality Podcast, previously told Salon, he fears the digital world of gut health is intersecting with diet culture in a toxic way. 

“It is the new frontier of grifting, selling not only probiotics, but this whole range of supplements, along with further promoting eating disorders,” Beres said. He added that when supplements come to market claiming to promote the “good bacteria” in a person’s intestines, he’s concerned it pushes rhetoric promoting orthorexia, or the obsession with eating healthy food, usually featuring dangerous overfixation on the quality of food and not the quantity.

But like many of the nuances in the supplement and wellness space, the rise in interest in gut health didn’t come out of nowhere. Instead, it’s possible that there’s another reason behind the increased focus on gut health: a gut disorder that remains somewhat difficult to diagnose and treat —  irritable bowel syndrome (IBS).  

As IBS has become increasingly more prevalent, doctors are still catching up on the science of it all. According to the American College of Gastroenterology, an estimated 10 to 15 percent of adults in the U.S. are affected by IBS. However, only 5 to 7 percent of people have been diagnosed. Worldwide, more developed countries appear to be more affected by IBS than developing ones. But recent research has shown that the more developed countries become, the more prevalent IBS is in society.

Notably, IBS is more common in women than men which may explain why it’s mostly women discussing it online — and why supplements focused on “gut health” are mostly targeting women. Indeed, while there isn’t a straightforward diagnosis or treatment for IBS, it’s left room for a cottage industry focused on gut health to take hold.

“There are a lot of marketing tools to get you to use these products,” Gastroenterologist Dr. Mark Pimentel told Salon in an interview. “But what we need is the evidence.”

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But what’s the truth about IBS, and why is it still somewhat difficult to treat and manage? First, it might be best to start with the symptoms of IBS. Pimentel told Salon IBS, by definition, is abdominal discomfort, bloating — usually after meals — and a spectrum of bowel patterns. On the extreme end, it can be constipation. For others, diarrhea. He estimates that one-third of people are somewhere in between swaying back and forth between the extremes throughout their life.

“But what people who don't have IBS should know is that the symptoms are unpredictable, which makes them extremely miserable,” Pimentel said. “So you could be getting ready to get on an airplane and all of a sudden you have to go to the bathroom, you're doubled over in pain, and when you go to the bathroom, it's not like two minutes, you spend time there — and that creates a lot of distress.”

The diagnosis process for IBS isn’t straightforward either. Traditionally, it’s been a “diagnosis of exclusion,” he said, which means doctors perform a series of tests to rule out other conditions. Once this happens, a person can be diagnosed with IBS. At Cedars-Sinai, Pimentel and his colleagues created a diagnostic blood test to diagnose IBS. While he said it’s not a definitive diagnosis, it can provide one with more than 90% certainty.

This is in part because of a rise in research showing a clear link between food poisoning and IBS — a less talked about cause of IBS and “gut health” on #guttok. Pimentel said it’s estimated that food poisoning triggers at least 60 percent of all IBS on the “diarrhea-mixed side.” In this kind of situation, a person may have gone on a trip and got food poisoning. If their bowel movements never return to normal, that’s IBS. Researchers have identified a toxin that’s responsible for that type of IBS, and antibodies that are created from the toxin. 

“What we believe is happening is there's a change in the microbiome, because of the damage that these antibodies do to the gut flow, and that's the bacterial overgrowth connection to IBS,” he said, adding that 60 percent of IBS is “bacterial buildup in the small bowel.”

For the other people who don’t get IBS from food poisoning, Pimentel said it could be that food sensitivities are the driver behind it. Mast cells, which are special cells that are part of the allergic system of the gut, tend to be higher in some IBS patients. 

“And then some patients just have naturally sensitive guts,” he said. “That's called visceral hyperalgesia.” 

Since doctors don’t know exactly what is causing each person’s case of IBS, the best course of action is symptom management: to make the diarrhea or constipation go away, he said. Most of the drugs for IBS that are approved by the FDA are meant to manage the symptoms. When asked if supplements work, Pimentel said some have the properties that you’d expect to work, but the science just isn’t there. He added many supplements have “antibacterial properties,” like garlic, peppermint, berberine and probiotics, which could treat bacterial overgrowth, but don't have the scientific evidence to support them. 

“The challenge we have is separating those things that work from those things that we don't know. And you need good studies for these things, and they're not they're not there,” he said. “With probiotics, there was just another probiotic study that came out that was positive, but there's also, you know, many probiotic studies that are negative in treating IBS.”

Online, there is a lot of chatter about the “gut-brain” connection, which is why many people promote mindfulness and even hypnotherapy as a treatment for IBS. Pimentel said it’s true that bacteria in the gut can influence nerves in the gut and even track that to the brain. However, he emphasized while stress affects a lot of functions, it’s not necessarily the cause. For example, he said he has patients with IBS who still have IBS when they are on vacation.

Part of the mystery around IBS and why science is a bit behind, he said, is because it’s difficult to study every area of the gut. 

“The problem with the microbiome is there are parts of the gut that we’ve never been able to properly characterize until now," he said. “So science is continuing to emerge.”