Lauren Bell was stressed out and just starting her first job post-college in New York City when she realized a bout of food poisoning wasn't going away after weeks.
A doctor's appointment revealed she had irritable bowel syndrome (IBS), a surprising diagnosis -- until she learned more about the connection between mental health and gut health, as well as the prevalence of digestive problems among women.
"Working in a pretty intense environment, living in the city, and being an adult for the first time was doing a number on my body," the 27-year-old said of her diagnosis 5 years ago.
Every few months, a new TikTok about digestive problems goes viral -- the taboo topic often being brought up by women who suggest tips to reduce bloat or ease pain. Experts say it's not clear whether there is an uptick in the number of people having digestive problems or if the online conversation is leading to more appointments and diagnoses.
But doctors are seeing a pattern of more and younger people wanting to deal with their gastrointestinal distress, and they suspect anxiety related to increased isolation during the pandemic is playing a big role in the increase in visits.
"I definitely have a lot of young women in my practice," Chicago-based gastroenterologist Nina Gupta, MD, said, "but in the last few years, I am also seeing more younger men."
Making connections and sharing tips online can help, experts say, but they also want people to be careful because what might look like advice could be more like advertising if influencers are being paid to convince people to buy a product.
How Your Brain Can Affect Your Gut
It's not clear what causes IBS. Food sensitivities and gut microbes can play a role, and research indicates that issues with the nervous system can cause distress in the digestive process. Research indicates it can also be a two-way street: When your stomach is upset, that could affect your mental health.
And mental health, especially for Gen Z and younger millennials, is a major concern. While the pandemic took its toll on people of all ages, surveys have found those age groups reported higher stress and anxiety levels than other generations during and after the pandemic.
A 2023 report from the CDC that surveyed U.S. high school students during the pandemic showed teen girls' mental health was severely impacted, with nearly a third reporting that they seriously considered attempting suicide in the previous year.
Anxiety in college-age adults, especially young women, has gone "through the roof" since the early 2010s, said Jean Twenge, PhD, a Gen Z mental health expert at San Diego State University. For high schoolers, experts say the anxiety is likely a result of two things: increased isolation during a formative time and a reliance on social media to feel connected.
While changes in diet can improve IBS symptoms, Gupta said a big part of managing her patients' conditions is for them to "recognize that there's a connection between their stress or their mental health or their anxiety and their symptoms."
The Scoop on Poop
Nadya Okamoto hadn't pooped in 4 days.
"I'm very bloated," she said as she joined a Zoom interview from her home in New York City.
Okamoto, who has more than 4 million followers on TikTok, has built her platform around publicly addressing sensitive subjects. The 26-year-old is the founder of August, a period-product company, and frequently posts about her own menstrual cycle.
Some of her most popular posts over the last 3 years, though, are about her experiences with IBS. Okamoto seems to share her experiences with everything -- collecting fecal samples for colon cancer, constipation, and bloating.
"It wasn't until I started dating and being in close relationships and talking about it with my family that I realized ... it was not normal pooping three times a month," Okamoto told the Associated Press.
Seeing the hashtag "IBS" on TikTok led her to the doctor and to a diagnosis. She's been on three different medications to treat her IBS. None worked.
"From a young age, potty talk is not something that is appropriate, especially for girls," she said. "We're not incentivized to be open about it, which means that we know less about our bodies."
Misinformation on Social Media
The downside of more people talking about gut health online is an uptick in misinformation. Some of the most popular TikTok posts on IBS are from people who claim they've cured it or found a home remedy that miraculously stopped some symptoms. Others recommend unproven supplements.
A quick scroll of these influencers' accounts reveal a litany of sponsorships from probiotic or other health food companies. Gupta said viewers should be skeptical when people who aren't professionals start offering medical advice.
Okamoto and Bell, who have a master's of public health in nutrition, stick to talking about their own experiences.
Both stressed that one of the best things about the online conversation is making information more accessible. That said, in December 2023, Bell posted a TikTok video in response to someone asking if they can self-diagnose their IBS with this advice: "I'm always going to recommend you see a medical professional."
'Making People Feel Seen'
Bell, who is Black, fills a specific gap on social media.
"I felt like there weren't a lot of people who looked like me doing that type of content," she said. "It's not only white women who are hot girls with IBS."
Bell, who takes over-the-counter medications occasionally to treat her symptoms, first started posting on Instagram about her struggle with IBS – how isolating it was and how she felt like she was having to rearrange her life and diet around her food sensitivities – and sharing her diagnosis with her friends.
"It felt kind of like a secret topic that like suddenly everybody in my life had struggled with this, and once you see it, you can't unsee it," she said.
Bell sees her role as helping women of color figure out how to start having these uncomfortable conversations about their gut health.
"Gut health spans gender, age, race, and ethnicity," she said. "We all poop."