In the summer of 2020, Jaime (who asked that I use just her first name) was struggling with irritable bowel syndrome, depression, headaches, and acne. She paid a visit to the primary care physician she’d been seeing for years, who recommended an elimination diet that she said would help get to the root of all these concerns. Jaime trusted the doctor and didn’t think to question her. After reading over the elimination diet materials her doctor provided, Jaime embarked upon the recommended restrictive meal regime “wholeheartedly,” she says. She removed seven broad categories of foods, plus “anything processed,” from her diet—and kept this up strictly for about four weeks.
Jaime’s digestive issues proceeded to worsen over the course of the month that she was following the elimination diet, including “severe simultaneous diarrhea, constipation, and constant bloating,” she says. She also lost weight quite rapidly on the restrictive diet. Alarmed by the sudden change, Jaime went back to her doctor to discuss how to start reintroducing some of foods she’d eliminated and determine whether she had sensitivities to any of them. The doctor, however, told Jaime that revising the “plan” was unnecessary, and that she never needed to eat any of those foods again because she was getting “all of her required nutrition” from the restrictive diet.
That advice is a complete falsehood. In reality, even evidence-based elimination diets aren’t meant to be continued long-term—particularly if a patient’s symptoms or their relationship with food are worsened by the diet.
Jaime was 27 at the time, and she had never dieted or worried about her weight—a rarity for a woman living in diet culture. But going on the elimination diet changed all of that for her. The doctor’s recommendation to restrict and monitor her food intake so meticulously triggered two years of rigid disordered eating behaviors that Jaime only was able to let go of when she got pregnant. To this day, she says she still struggles in her relationship with her body.
Jaime’s situation is all too common, as I’ve witnessed both in my work as a dietitian who specializes in disordered eating recovery and in my personal experience seeking help for several chronic illnesses. Often, the wellness industry sells us on the idea that adhering to particular eating habits, many of which are sneakily restrictive—a diet that, for instance, vaguely promises to “balance your hormones” or “heal your gut”—is necessary for optimal health. The same goes for related pursuits, like trying to reduce inflammation through food and monitoring blood glucose in the absence of diabetes.
Today, all manner of health problems are blamed on an “unhealed” gut microbiome, an “imbalanced” hormonal state, or other immeasurable-yet-discouraging-sounding metrics—as we’re reminded every time we use social media or innocently Google a symptom. It’s easy to default to blaming a person’s diet and lifestyle for physical issues that are otherwise challenging to diagnose (especially in fields where research is still limited, like gut and hormonal health). Many corners of the wellness industry rely far too heavily on these assumed “root causes.”
The goals of “getting to the root cause” and “treating the whole person” that are so pervasive in wellness culture are understandably alluring to many people. But these concepts can be particularly appealing—and potentially damaging—to those coping with chronic health conditions. The same can be said for anyone who’s historically struggled with disordered eating and/or felt dismissed or unheard by the conventional health care system.
Yet these so-called “healthy” habits are leading many people down a dangerously unhealthy path. For one thing, these “wellness” diets generally aren’t backed by sufficient evidence for widespread use; instead, they’re often based on early-stage research in animals, cell cultures, or very small, non-randomized groups of people—not the kind of robust science that’s needed for making clinical recommendations. What’s more, the dietary changes popular in the wellness world can trigger or exacerbate disordered eating in vulnerable people, which in my experience is the majority of the population (though of course not everyone).
Why “food-first” approaches to resolving health issues can be appealing
It’s easy to see why natural-sounding, harmless-seeming, food-first approaches to wellness are so popular in a conventional health care system where many people don’t get the care they need and deserve. But eliminating entire food groups is not the panacea it’s made out to be, as Sarah-Jane Garcia learned the hard way.
Garcia is a pharmacist who struggled with binge eating for years. When she saw a doctor for help with her disordered eating, all she got was a prescription for an antidepressant, because the doctor said she had anxiety and chronic fatigue (although exactly how those were related to her bingeing was unclear).
Garcia wanted to understand the underlying reasons for her disordered eating and felt dismissed by the doctor, but she tried the meds anyway—to no avail. After trying another medication that didn’t work to stop the bingeing, Garcia was at a loss. She confided in a coworker about her issues with eating, and the colleague told her about a wellness influencer she should follow on Instagram for tips to help her with bingeing: a naturopathic doctor (not an MD) who claimed to have healed his own health problems through detoxes and certain protocols from “functional medicine” (an alternative to conventional medicine that often prescribes diets and supplements) that have little scientific backing. His content immediately resonated with Garcia. She felt hopeful, inspired.
“[The Instagram naturopath’s] story tracked so closely to mine. He went for conventional help, he couldn’t get the answers he needed, and finally he just ‘did his own research’ and found the answers in naturopathic-based medicine and other wellness components,” Garcia says. “And so I started to really buy into him.” From there, she got into Paleo diets, fasting, detoxes, herbal supplements, and more—and her binge eating only got worse.
The longer Garcia spent prioritizing these restrictive methods, the more her mistrust and wariness of the conventional health care system grew, even though she was a part of it herself as a pharmacist. Much of what Garcia was learning in wellness spaces was new to her, which made her think that her doctorate program in pharmacy hadn’t taught her “the latest research” on how to treat various conditions. She began looking to integrative and naturopathic medicine for all of her continuing education, and eventually got a certification as an integrative health practitioner—which only strengthened her distrust of conventional medicine. “I started to become a pharmacist who was anti-drugs,” Garcia says.
As Garcia’s experience reveals, problematic aspects of wellness culture such as restrictive diets and a rejection of evidence-based treatments have increasingly begun to filter into conventional health care spaces, from retail pharmacy counters to regular doctor’s offices. Jaime’s doctor had been a general practitioner at a local low-income health clinic, with a specialty in family medicine. Jaime had no idea that her longtime doctor was interested in using food restriction as a way to resolve health issues like depression until she gave her the reading materials for her prescribed elimination diet. The doctor left that clinic shortly after this, and Jaime heard it was so that she could practice functional medicine more openly in her new job.
Social media feeds into the problem
The reasons why conventional health professionals begin recommending risky approaches like restrictive diets are varied, and sometimes include preexisting disordered eating, as was the case for Garcia. But social media can also play a role, and sometimes health professionals can be just as vulnerable to online wellness misinformation as anyone else.
“A simple search for a healthy recipe quickly led me to pro-anorexia content…This persistent barrage of harmful material severely damaged my sense of self and led me towards disordered eating.
Getty / MileA
“All of my information came from these wellness groups I engaged with on social media,” Garcia says, in retrospect.Any question she had about her own health or her kids’, she asked wellness groups on Facebook—not her pediatrician or family doctor, who actually knew her and her family’s health history. “Whoever was on the other side of that computer screen and wanted to answer I would accept at face value, because they were all integrative health practitioners,” Garcia says. Unfortunately, many of the answers she got were problematic or simply wrong, leading her to try things (such as fasting and detoxes) that were ineffective, harmful, and perpetuated her binge-eating habits.
Social media platforms are rife with wellness misinformation, largely because of a central feature (or flaw) in their design: Their algorithms are designed to maximize engagement, which means to keep us on the platforms for as long as possible so that we’re served more ads. And it just so happens that what drives the most engagement is content that is novel and provokes moral outrage, presents controversy, and goes to extremes.
Wellness misinformation often hits each one of those notes. Just think about all the posts that rail against the pharmaceutical industry or medical system and then pitch some sketchy supplement as a cure, or the viral TikTok trends in which bizarre diet tips spark outraged comments and breathless reporting from mainstream media. A 2018 study found that misinformation on Twitter spread six times faster, to more people, and by more people than the truth.
Not only do social media algorithms tend to privilege misinformation, but there’s also strong evidence that they can radicalize people by exposing them to more extreme content over time, including in the realm of health and wellness. Multiple reports from 2021 found that Instagram’s algorithm was driving users—especially young girls—from general “healthy eating” and weight loss content to extreme diets and pro-eating-disorder content, and often very quickly. A recent report from tech watchdog Center for Countering Digital Hate (CCDH) found that TikTok is doing something similar: The app began recommending harmful eating disorder content within eight minutes of CCDH researchers setting up new accounts with the term “loseweight” in their usernames.
“As I read the [CCDH] results, I felt as though I was reading my own story,” says Emma Lembke, now a college sophomore and the founder of LOG OFF, a youth-led movement dedicated to helping young people rethink their social media use. Lembke started using social media at the age of 12 when she signed up for Instagram, and soon found herself inundated with harmful messaging.
“A simple search for a healthy recipe quickly led me to pro-anorexia content,” she says. “This persistent barrage of harmful material severely damaged my sense of self and led me towards disordered eating. While my experience of harm began with Instagram, this [CCDH] study affirms that this is an issue across social platforms. We must hold these companies accountable for the harm they are causing young people, especially young women, around the world.”
It’s important to remember that influencers who share unsubstantiated and/or extreme wellness information on social platforms are benefiting from spreading these harmful messages. And if it weren’t for these algorithms privileging the most novel, sensational, out-there content, our society might not be so awash in misinformation about gut health, supplements, dieting… and most other aspects of so-called “healthy” eating.
A way forward means filtering, fact-checking, and unfollowing
Occasionally, however, social media algorithms can surface information that helps pull people out of wellness traps. Take comedian Jessica Fostekew’s experience as an example. Fostekew is host of the podcast Hoovering (which is all about food and her road to recovery from disordered eating), so she tends to get an influx of pitches from diet and wellness companies in her inbox. “I’m interested in the science of how we eat and how what we eat affects us,” Fostekew says.
Approaches that promised to heal her gut microbiome were incredibly appealing to Fostekew, even after she stopped restricting and swore off diet culture. “I fully fell in with this idea that there’s some untapped thing that we’re just learning about—it felt very new and exciting,” Fostekew says of the gut-health world’s lure. But soon she began overthinking her menu and feeling guilty any time she had a meal without fruits and vegetables. She realized how problematic her mindset had become when she came across a comedian online doing a hilariously exaggerated impression of a person who’d “discovered” gut health after seeing one documentary about it: Sorry I was late, I’d only eaten 59 different plants today and I needed to track down another 12. For Fostekew, the joke hit a little too close to home.
“I was like, ‘Oh no, oh no, that is me,’” she says. “I realized that I had found another way [back into diet culture] through yet another secret backdoor. While it wasn’t necessarily obsessive control, it was another way to fill my head with to-do lists about how I’m eating and what I’m eating. And I could sense that I was becoming tiresome to the people around me. I felt like I sounded like one of my own aunts talking about ‘superfoods.’”
Garcia, too, found that social media could be an asset when used consciously and mindfully. In fact, she says the thing that finally helped her address the binge eating head-on was an approach she found online: intuitive eating.
This practice got on Garcia’s radar when she was searching for information online about how to feed her baby. Today, she uses the principles of intuitive eating to support her in a peaceful relationship with food, and she’s become a certified intuitive eating counselor. Garcia also tries to think critically about wellness culture as well as what she sees on social media, and has let go of her previous food rules. “I don’t binge anymore,” she says.
The quest for “wellness” can go from being the path to achieving purpose to feeling like the purpose itself. But wellness diets won’t guide anyone towards true meaning, joy, or connection, nor will subscribing to any one-size-fits-all approach to physical and mental health. Rather, real well-being means having social support, economic security, just and equitable treatment, purpose, and satisfaction in life. Because that’s what we all deserve.