Care, commerce, and conflict: A multimodal discourse analysis of dietary guidance for gastrointestinal cancer survivors on Xiaohongshu

Gastrointestinal cancer patients face significant dietary challenges, compounded in China by competing recommendations from Western clinical nutrition and Traditional Chinese Medicine (TCM). As family caregivers increasingly turn to social media for guidance, the quality and nature of dietary content remains largely unexplored. This study employed multimodal critical discourse analysis to examine 370 posts on Xiaohongshu, a Chinese social media platform with over 200 million monthly active users. Analysis revealed a complex information ecology characterized by four patterns. First, family caregivers dominated the discourse, constructing “experiential authority” through accumulated practice while health professionals remained peripheral. Second, a “nutritional double bind” emerged from tensions between clinical nutrition and TCM dietary principles, with caregivers navigating contradictory guidance through selective adherence or syncretic formulations. Third, “aestheticized care labor” transformed everyday cooking into performative visual displays, establishing aspirational standards that may exclude caregivers with fewer resources. Fourth, “Trojan Horse marketing” characterized commercial accounts that appropriated authentic caregiving conventions to embed promotional content within seemingly personal narratives. These findings highlight that dietary discourse on social media is deeply entangled with cultural values, emotional labor, and economic interests, with implications for health communication, digital health literacy, and platform governance.