A quick search on TikTok and Instagram of hashtags like #ibs and #ibstok yields endless videos with combined views in the billions. Chelsea McCallum, an accredited practicing dietitian and frequent TikToker based in Brisbane, Australia, has seen firsthand the growing interest in IBS-related content over the past two years. McCallum, who not only specializes in IBS but was diagnosed with IBS herself in 2017 (her social handle is ibs_dietitian on Instagram and TikTok), posts quick videos offering educational and often humorous takes on topics like what IBS symptoms feel like and how to manage the condition. “In May 2020, I had about 6,000 followers on Instagram, and I’ve just cracked 70,000 as of April 2022,” she says. “In almost two years, I’ve grown 65,000 followers, and it just continues to encourage me to keep going, because obviously there is a huge need for education and support that isn’t necessarily being filled by primary doctors or gastroenterologists. “People are going online and looking for more help, and I’m glad that I can be online and provide that help in a way that maybe people don’t have access to otherwise,” she continued. And McCallum’s content is certainly resonating with her followers. Many of her videos have gone viral, racking up more than a million views. McCallum spoke about how her own gut troubles inspired her to work in the IBS field. She also described some common misconceptions about the disorder and the questions she’s most frequently asked about how to manage IBS. What drew you to become a dietitian and specialize in IBS? I always wanted to study nutrition and became a dietitian because I had a passion for science and I really loved cooking. I grew up around a few people living with type 1 diabetes, so I was interested in learning about how diet affects that as well. For me, it was a really obvious path to go down the route of studying nutrition and dietetics. After I got my degree and started applying for jobs, it was an extremely stressful period. I moved away from home and away from my boyfriend at the time to work elsewhere. I started to notice some uncomfortable gut symptoms, and I sort of brushed it off. At the same time, I was seeing patients with diabetes or for weight loss, and noticed they were also experiencing gut symptoms and brushing them off. I realized there is a great need for a dietitian to address GI issues. When I was diagnosed with IBS, that’s when I really found my niche, because I realized how managing symptoms of IBS can dramatically change your life. Many people struggle with these issues and need help acknowledging it, like I had. As someone who has IBS, do you feel more connected to the people you treat and work with, and does that help them feel more comfortable discussing their symptoms with you? Absolutely. I will say, though, that one person’s IBS is so different from another’s. Symptoms and triggers, although they can overlap, usually are completely different. But I am confident that it makes my client feel more comfortable because they know that it’s something that I’ve experienced before. They sort of know that nothing is off-limits. They can tell me the good, the bad, and the ugly when it comes to their symptoms. What have you found to be some of the biggest misconceptions about IBS? I think one really frustrating component is that some people think IBS is just about bloating or having trouble going to the bathroom. If you’ve ever had really bad food poisoning, like a week’s worth of food poisoning, then you might understand how much of an impact IBS can have on someone’s life. IBS can affect your social life. Going out to an event or eating out at a restaurant can be challenging. People with IBS often want to leave parties or social gatherings early because they may have uncomfortable GI symptoms. They might turn down travel plans because they’re not sure about the food that’s going to be available. Or they might turn down a walk with a friend because they don’t know where the closest restroom will be. It really impacts your social life and your relationships, whether it be platonic or intimate. Studies show that IBS can worsen mood symptoms and zap energy levels, which can interfere with work and reduce the desire to exercise. Another misconception is that IBS sufferers are fussy eaters. A lot of my clients will come to me and say, “My family thinks I’m a fussy eater because I can’t have onion or garlic or cauliflower or asparagus. But these foods really hurt me.” These are people who have very strict food rules because they have really unpredictable and urgent bowel movements. Are you surprised that your social media posts and videos have gained so much traction? Do you think people are becoming more comfortable talking about their gut problems? It’s interesting, because you look at statistics and the numbers suggest that 10 to 15 percent of the population has irritable bowel syndrome. It’s a big chunk of people. But it still surprises me that 70,000 people follow me. Not many people want to talk about their bowel habits or bloating or any gut symptoms. So often I find people will message me, but they don’t actually follow my account. There is still work to be done with awareness and addressing the stigma around gut disorders, but it’s certainly moving in the right direction. I’m not the only dietitian online that’s working in the IBS space. There’s quite a few of us now, which obviously helps build awareness, breaks the stigma down, and helps patients advocate for their health. What topics or questions do you get asked about the most? I get such a diverse range depending on how long someone has been struggling with issues. I’ve heard from people who’ve had some funky poops for the last six months, they’re diagnosed with IBS and told to start the low-FODMAP diet. They come to me totally confused, asking me, what is this acronym? Then there are those who have dabbled with the low-FODMAP diet and have done a lot of research, but they might not understand the concept of FODMAP stacking, or they might not understand which probiotic to take. So, there is a wide range of questions that I get asked. Since we’re on the topic, could you explain the low-FODMAP diet and how it might help with IBS symptoms? Of course. So FODMAP is an acronym, and there’s a good reason why it’s an acronym. It stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Anything that ends in “saccharide” is a carbohydrate or sugar, and a polyol is a sugar alcohol. These are just small components in foods that are unfortunately poorly digested and not well absorbed, which can result in rapid fermentation when these FODMAPs are broken down, drawing fluid into the gut. Because of this, people with IBS may experience bloating, abdominal pain, constipation, or diarrhea, depending on the type of FODMAP. FODMAPs are found in really healthy foods as well, which is one of the most frustrating elements of the diet. They’re found in things like avocados and cauliflower, broccolini, onions, garlic, asparagus, mushrooms, apples, cashews, pistachios, just to name a few. The low FODMAP diet includes three phases. The first is the elimination phase, which takes no more than six weeks and involves removing as many FODMAPs as possible. Eliminating FODMAPs is designed to get your gut under control and alleviate symptoms. Once we’ve done that, we move to the reintroduction phase, adding FODMAPs one by one to figure out which FODMAP groups or FODMAP combinations are a trigger for a particular patient. Usually patients have two, maybe three triggers, and the rest are completely fine. For the final phase, which involves personalizing the diet, we slowly bring back food that didn’t cause any symptoms. To address particular FODMAP intolerances, I recommend taking digestive enzymes or probiotic supplements to help nurture the gut microbiome. Research shows specific digestive enzymes can help break down the FODMAPs (carbohydrates) into single molecules (sugars) which are more easily absorbed in the small and large intestine. That sounds like it can be quite challenging. What kind of support do you provide your clients to help them successfully get through this process? If you have a clear plan, it isn’t necessarily hard to take out FODMAPs during the elimination phase. For example, typical button mushrooms, the small mushrooms that you’d see most often at the supermarket, are extremely high FODMAP. But oyster mushrooms, which are low FODMAP and not always found on supermarket shelves, can be found in farmers’ markets and some specialty markets. We know that a direct swap for many foods can be easy. The most challenging part is the motivation to keep going and actually persevere through the reintroduction phase. That’s where we’ll spend the most time, because that’s the testing phase where we figure out what is triggering your gut. A dietitian can help you execute a plan, so that’s always my first piece of advice to anyone who has an IBS diagnosis: If you can see a dietitian, someone who is trained in IBS and the low FODMAP diet, that is really going to fast-track your success. And you can complete it in as little as 12 weeks. That’s usually the shortest amount of time that I suggest my clients can finish the low-FODMAP diet. But it can certainly be a lot longer if they feel stuck at any point throughout the process. It can be helpful to have that support to get you on the right track, help ensure that you’re doing the right thing, and have someone to hold your hand and encourage you throughout the process so that you can persevere and get it done. In addition to diet, are there other lifestyle tips that can be beneficial in managing IBS? We know that irritable bowel syndrome is a disorder of the gut-brain axis. Communication between the gut and the brain gets jumbled up. Stress can play a really big role. For many of my clients, symptoms are brought on 50 percent of the time by stress and 50 percent of the time by food. Managing stress is really important. Studies show that it can be done in many different ways, from cognitive behavioral therapy to gut-directed hypnotherapy, or getting more sleep and exercising — all these lifestyle factors can have a positive impact on stress. There’s a lot that we can do. And it certainly is an important part of the process, and it needs to be considered when putting together that comprehensive plan. What message would you like to get across to readers about IBS? Just know that there is so much that can be done for someone struggling with IBS. So many people are told when they’re diagnosed, well, it’s just IBS, or thank goodness it’s just IBS, because of course, it’s not colon cancer or celiac disease or Crohn’s disease. But oftentimes people aren’t given a treatment plan. They’re not even encouraged to see a dietitian. Just know that there is so much that a dietitian can help you with. We can look at implementing the low FODMAP diet if it’s going to be the right route or help manage a client’s stress and energy levels. I guess the message that I always drill home is to seek support and help, and if you can, work with a dietitian, someone trained in IBS and FODMAPs, whether it’s someone online like myself, or someone you can see face-to-face.
