Social media influencers are a growing source of medical information, particularly advice on gut health. A recent poll by the Kaiser Family Foundation (KFF) found that over half of respondents (55%) said they use social media to find health information and advice at least occasionally, and most reported seeing health-related content in the past month. Notably, close to three quarters (72%) of those respondents saw content about weight loss, diet, or nutrition.
“I had one patient who saw a TikTok video about doing a colon cleanse, bought something over the counter to do the cleanse, and ended up in our emergency department,” American Gastroenterological Association spokesperson Shazia Siddique, MD, told Medscape Medical News.
Another recent social media fad encouraged people to drink beet juice to “eliminate up to 10 lb of waste in your body. That’s appealing to many young people whose weight isn’t where they want it to be,” Siddique added.
The KFF poll respondents reported being skeptical of the health information and advice they see on social media, with fewer than half saying they find “most” or “some” of the information trustworthy.
Nevertheless, many are following the advice of social media influencers, and the authors of a recent study in The BMJ argued that doing so can cause “psychological, physical, financial, and systemic harm — from inaccurate self-diagnosis and inappropriate treatments to unnecessary spending and higher healthcare costs.” That harm stems from four potential sources of bias in influencer statements: lack of medical expertise or relevant knowledge, industry influence, entrepreneurial interests, and personal beliefs.
Even influencers with health-related credentials can provide misleading advice. The authors of the BMJ study cite Eric Berg, a US chiropractor with 14 million YouTube subscribers who promotes high-dose supplementation while selling his own brand of supplements.
Bloated Advice
It’s easy to find product promotions on social media that could appeal to patients with gastrointestinal problems. For example, a reel on Instagram shows an influencer touting “Naturezempic” for bloating and cravings. The product is positioned as “your natural GLP-1 support.” The influencer said taking it has made her feel “lighter, more in control, and more confident.”
On TikTok, the hashtags #guttok and #guthealth “show endless videos of influencers promising ways you can ‘eliminate bloating!’ or ‘heal your gut,’” according to a recent article in The Guardian. Those solutions include olive oil, ginger shots, curcumin/turmeric supplements, prebiotic and probiotic tablets, and kombucha. The article also references a fad from a few years back called the “internal shower drink,” a mixture of water, chia seeds, and lemon juice purported to relieve constipation.
Alex Kresovich, PhD, NORC, of the University of Chicago, Chicago, and colleagues recently investigated high-engagement social media posts for three major drug classes, assessing their alignment with FDA and Federal Trade Commission oversight. “We wanted to quantify exactly how much promotional content is flying under the radar,” Kresovich told Medscape Medical News.
“The sheer scale and the profound lack of balance were striking,” he said. “We analyzed just 740 high-engagement posts, yet they had already amassed over 57.5 million views.
We found that 80.1% of posts with clear marketing elements (like ‘life-changing’ language or calls to action) lacked any clear sponsorship disclosure.” Furthermore, less than a third (32.3%) of posts touting a drug’s benefits also mentioned potential harms.
Clinicians need to be aware that many patients are entering the exam room “presold on ‘life-changing’ drugs based on one-sided content,” Kresovich said. “They have likely seen the benefits hyped without hearing the risks. You will likely have to be the one to re-introduce that ‘fair balance.’”
Real-World Stories
“Access to social media is so easy, and there’s a popular culture around it where people’s friends are seeing the same videos, with short, bite-sized pieces of information and lots of anecdotal data,” said Saddique, who is also an assistant professor at Perelman School of Medicine, University of Pennsylvania, Philadelphia. “So if one person tried beet juice and said it cleaned out their system, patients see this real-world experience that feels very different than a physician saying, ‘Here is a therapy that I recommend.’ A story is a very powerful narrative.”
In a feature linked to the BMJ study, Stephanie Santos Paulo, editorial registrar for The BMJ, highlighted patient influencers who have amassed large followings on social media by sharing personal stories of their conditions that foster a sense of authenticity and emotional connection with followers.
Therefore, clinicians “absolutely have a duty to recognize that patients are getting their health information from other sources,” Saddique said. “When we’re listening to them telling us what brought them in, we often ask ‘Have you seen another doctor? Have you tried any other medications?’ And that’s it.”
Patients often don’t say that they saw something on social media and tried that first, for fear of how the doctor might react, Saddique said. “We don’t even need to ask explicitly if that’s where they got the information. But we do need to ask something like, ‘Have you tried any therapies on your own based on recommendations from friends or elsewhere that worked or didn’t work for you?’”
Paulo quoted Liam Robertson, whose Instagram page @livingwithulcerativecolitis has 9300 followers: “I think partly people are finding social media better for answers because it’s not easy to get a hold of a medical professional. It’s almost like a strategy to [get help],” he said. “I don’t feel like they should need that, but we do.”
Be Honest
Clinicians can counteract some of the power of social media influencers by being honest and transparent when patients come in asking questions about symptoms and treatments. For example, Max Brondfield, MD, assistant clinical professor in the Division of Gastroenterology at the University of California San Francisco (UCSF), sees many patients who ask about digestive enzymes and probiotics, areas in which there are many brands, strains, ingredients and doses.
“We can help first by being transparent,” he told Medscape Medical News. “It’s impossible for clinicians to keep up with all the trends and products out there and trying to sound like you know everything doesn’t build credibility with patients.”
If Brondfield is familiar with a product, he’ll discuss it with the patient. If not, he might look for information on it during the visit. “Often, we’re doing telehealth and we can share the screen and look at the product and go over the ingredients,” he said. “I can provide a couple of caveats, but if it seems safe and like a good fit, I can say it seems reasonable to try. This kind of visit can really help patients.” He may also invite patients to share a list of supplements they have questions about, so he can review them offline.
Vivek Rudrapatna, MD, PhD, an inflammatory bowel disease specialist at UCSF, believes the rise of social media medical influencers reflects, at least in part, “some failures of medical science and or of the medical establishment — something that’s particularly true in gastroenterology, where there are few diagnostics that can help the physician confidently attribute diagnoses to symptoms.”
“Patients say, ‘I have bloating,’ and we’ll ask for more information, and then we’ll say, well, it could be A, B, or C,” he said. “What we don’t say is that it’s also possible that we’ll do a lot of tests and we still won’t know the answer. Medical science hasn’t evolved enough to help us know definitively what’s causing this.”
Taking this approach conveys that the problem is larger than the patient’s individual experience, and that going doctor shopping or taking more tests won’t solve it, Rudrapatna explained. “We have to be comfortable saying something like, ‘We’ve done these tests, and because the results are normal, they basically imply you don’t have one of the serious conditions we do worry about in many patients like you.’ Then we move forward from there to the measures we can take to help them feel better.”
Should You Become an Influencer?
Experts acknowledge that some medical influencers do provide useful health advice. Some may help debunk misinformation or, if they’re patients themselves, may offer peer support by sharing personal experiences and creating safe spaces for others to do so.
“I don’t think clinicians should feel obligated to have an online presence, which can feel like an extra task,” said Brondfield. “But it can be very valuable to have trusted voices in those spaces. So whether or not clinicians choose to make patient-facing content, it’s a good idea to be on those platforms, at least to some degree, to try to be aware of the trends and what’s out there. That can be helpful in communicating with our patients and having more familiarity with what they’re seeing.”
For those considering becoming influencers, Brondfield recommends searching for and connecting with the medical influencer communities on the major social media platforms. Connecting with them can be as simple as searching on a topic of interest such as colon cleanse or diet tips and seeing what comes up, he said.
“Vetting the sources can be a challenge, but many people include their credentials, and you can find people who are verified by the platform,” he explained. “If you find someone who is talking with people on the platform, you can watch those interactions. Then find others who are giving credible advice with their content and connect with them. That’s one of the best ways to learn.”
Medical communities on these platforms, particularly X, are “very supportive and interactive,” he added. “If you see someone whose content you like, you can directly message them and ask how you can get involved. Many are really trying to educate and do a service. They’re happy to bring other clinicians into the fold and help show how they do it.”
If you are a clinician influencer or in the process of becoming one, “Be the signal in the noise,” Kresovich added. “Embrace radical transparency. Disclose any and all ties, even if not strictly required. Differentiate yourself by rigorously presenting the risks alongside the benefits [of a product or procedure]. In an environment where 80% of content is opaque and promotional, being the objective, balanced voice is your greatest asset, and much needed.”
Kresovich, Brondfield, and Siddique declared no relevant conflicts of interest. Rudrapatna research is partially funded by grants to UCSF from the following for-profit entities: Janssen, Merck, Genentech, Alnylam, Takeda, Mitsubishi Tanabe, Stryker, and Blueprint Medicines. He reported also being a shareholder in ZebraMD and DataUnite and receiving an honorarium from Natera and Ironwood Pharma.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.