Episode 18: Is Fibermaxxing Worth It?

In this episode, we dive into why fiber is having a viral moment on social media and what can get lost when “maxing” any nutrient becomes the goal. Using real patient stories, we review the potential downsides of going from low to high fiber too fast, the confusion created by trendy products and marketing, and why “more” isn’t always better. We also preview how we think about fiber in real life—food-first, context-aware, and focused on what’s actually practical.

00:00 Podcast mission
01:15 Why fiber maxing
01:36 Patient stories
02:58 Trend claims
04:11 Why it went viral
08:02 Nugget of truth
09:49 How much fiber
11:50 Types of fiber
16:59 Prebiotic products
21:54 Supplements that work
27:58 Too much fiber
31:32 Practical takeaways
32:45 How to counsel patients
34:03 Resources and wrap
34:21 Medical disclaimer

📖 Read the full episode summary, sources, and resources on our Substack:
 👉www.theantisocialdoctors.com

Transcript

Sonia Singh MD 0:00

You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety

Rebecca Berens MD 0:10

and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.

Sonia Singh MD 0:16

We're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.

Rebecca Berens MD 0:28

This podcast is meant to be the antidote to your doom. Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion that comes from social media's messaging around health. In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.

Sonia Singh MD 0:45

This is not your average debunking podcast. We wanna explore not just what is trending on social media, but why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.

Rebecca Berens MD 1:00

We're so glad you're here.

Speaker 3 1:15

All right. Hi Rebecca.

Rebecca Berens MD 1:17

Hi Sonia.

Speaker 3 1:19

So you just told me this was fun. This episode.

Rebecca Berens MD 1:21

Episode. It was so fun. Research. It had so much fun.

Speaker 3 1:25

Seemed like a fun topic, but honestly, I do love fiber. I've always

Rebecca Berens MD 1:28

been, I love fiber too, and that's why I was like, why we gotta make it a thing and destroy it, with this trend. But anyway, we'll get into it.

Speaker 3 1:36

Okay, tell us about the patient story that led us to cover this topic today.

Rebecca Berens MD 1:41

Okay, so I have so there's a patient with a history of OCD and also Orthorexia. So orthorexia is not an official diagnostic term, but it's basically, anorexia, but there's a specific preoccupation around the health cont content of foods, like nutrient content, clean ingredients, quote unquote, all of that. Very common. And it actually, particularly in people who have OCD but anyway, this patient was. Is in recovery and, nutritionally restoring and all of that, but is eating such high fiber content at all of their meals that they're actually not able to get in enough calories. And so this is not necessarily someone who is fiber maxing in the sense of the social media trend, although I'm sure that content probably influences them in some way. But it is an example of one of the potential concerns I might have with fiber maxing. I.

Speaker 3 2:31

I actually had a story from just this past week of a, or maybe two weeks ago, a patient messaged me saying she saw, some study had just come out about the benefits of fiber and fiber goals for women in perimenopause and menopause. And she was like, I saw that and I was like, I'm gonna get, 35 grams tomorrow. And she immediately upped her fiber intake and she texted me because she was feeling terrible. Yeah, this is a, this is fi, fiber is having a moment for sure, and I'm hearing about it a lot. What is the claim around this specific fiber maxing trend? Tell us more about that.

Rebecca Berens MD 3:04

Yeah, so I think that the whole trend is, just fiber's so important, which okay, true. And it, this is a way of making it a trendy, cool thing to do by giving it this fun name, fiber maxing. Dramatically increasing your fiber intake. And often it's even beyond the standard recommendations. They'll say things like more fiber means better gut health. Fiber will help you stay full and so it can help you lose weight. And then most people are fiber deficient, so you really can't go wrong. You need more, everyone needs more. And then, adding. Fiber to everything. There's fiber soda, there's fiber powder you can mix into your current drinks that will turn your sugar into fiber. There's all sorts of fun fiber products that you can buy that I've gotten targeted ads for since I started researching this episode. So it's just like this sort of preoccupation with adding as much fiber as possible to meals and that it has all these health benefits and not really getting into the nuance of. What that might actually mean.

Sonia Singh MD 4:03

Okay. I'm really curious about this magical thing that turns sugar into fiber. I wanna hear more about, put a pin in that for sure.

Rebecca Berens MD 4:10

Yeah.

Speaker 3 4:11

Okay. So why do you think that fiber is having a moment now? Why is this particular trend so viral?

Rebecca Berens MD 4:19

I think we managed to make every other, nutrient group. An extreme version. And so this was the last one that we hadn't done yet, right? We've done low carb, we've done low fat, we've done keto, we've done carnivore, we've had done all these things. And now it's okay, how can we make fiber into a disordered relationship with food? And that's how we've managed to get there. So thank you. Fiber maxing for making fiber disordered. And I think also, as we come back to, with all of these ways that things go viral is this is a thing you can sell, right? You can sell fiber products to people, and so by creating a movement around increasing fiber, you can then sell this solution to that problem. It's hard to eat enough fiber. Here's the solution, buy this thing. Buy this magical powder that turns sugar into fiber. Buy this fiber soda, buy this thing and it will fix it. And I think that messaging sells really well. And it's in targeted ads. Influencers are using these products, being sent these products to promote. And so that just increases the visibility of fiber in people's social media feeds.

Sonia Singh MD 5:22

Yeah, I think the general increased awareness around ultra processed foods and, this movement towards, as our HHS secretary says, eating real food I think there's increased awareness now that we don't get enough fiber. Which is good. I'm glad people are thinking about that because that is a true thing. I have been frustrated for many years by people becoming obsessed with protein when many of those people are probably getting adequate protein. I'm always like you should be a little bit more obsessed with your fiber.

Rebecca Berens MD 5:50

Yeah.

Sonia Singh MD 5:51

So I think, I think some of the virality is probably positive and warranted because, our diets as Americans have become much higher in ultra processed foods, which are typically low in fiber. So we're probably consuming historically. You can tell me, I don't know if you looked at this, but we're probably consuming historically low amounts. Prior to this trend.

Rebecca Berens MD 6:11

Oh, absolutely. Absolutely. And I think, it is absolutely true that most people do not eat enough fiber. That's true. We'll get into the stats, but I think I think the thing that I find so interesting about fiber maxing and it's interesting that you say that about the nutrition guidelines because if you look at the new upside down pyramid. The fiber's not really up there either.

Speaker 3 6:30

Oh, interesting. Okay.

Rebecca Berens MD 6:32

I'm like, are beans on there? I don't see them. That's,

Speaker 3 6:34

I know beans I see the beans

Rebecca Berens MD 6:35

on. It's it's interesting because it's yes we do lack fiber. The problem with processed food is not that the ingredients are toxic, it's that a lot of the food matrix, which is a concept that we'll get into in this episode, has been removed. And by food matrix, I mean the actual, scaffolding other pa are the parts of the food, right? It's not just okay, there's X amount of sugar and X amount of fat and X amount of protein, and you put it in a drink, and now it's the same as that food. It's not the way that it is arranged. In the chemical structure of the food and the way that it is digested actually influences how you absorb those nutrients. So it's not like you can get a sandwich and then recreate those macros in a drink and it's equivalent. It's not even if it has the exact same macro content. And so I think the, that's the interesting piece of this is we, we've started to realize the food matrix is important and rather than responding by. A more natural food matrix. It's buy this other product that's been engineered to add fiber to it.

Sonia Singh MD 7:35

It's always about the shortcut or the hack. Yes. Like we're in the era of hacks and so basically, companies and influencers have looked at okay what are people, oh, they're, they realize that they're not getting enough fiber and they wanna get more fiber like. How can we create a immediate clickable short term, not even short term. It's not even a solution really, I think. But

Rebecca Berens MD 7:56

yeah.

Sonia Singh MD 7:56

How can we appease that desire with something we can sell them, basically. So I guess we're getting into this already, but. Can you talk about what you think the nugget of truth is in this obsession with fiber?

Rebecca Berens MD 8:07

Yeah, so it is absolutely true that fiber is very important for our health and that most Americans do not eat enough of it. And probably also in other, industrialized nations as I'm sure it's a similar issue. I'm primarily researching American things since we are both in the us. But I think part of the reason for that is modern diets of quick prep, eating on the go. It's not feasible always for that to be a very high in fiber diet. We have more things that are pre-prepared, shelf stable, fast to make, throw in the microwave for a minute at work or whatever. And so in order for something to be quick to prep and easy to eat on the go, it probably has to be chained somewhat to remove some of the fiber. 'cause fiber makes it take longer to cook. And it's really an issue of like modern life, why we are not getting enough fiber. And so that is, true, it's an issue. And it does have health implications. So I think that it's, I don't want that to get lost in my making fun of fiber products in this episode. I think that, that is true and it is important to talk about.

Sonia Singh MD 9:09

No, that's a really important point because I'm hating on hackers and shortcuts here, but the root of that, like why are people looking for hackers and shortcuts? It's because. They do not have the ability or bandwidth or resources or time or whatever it is to do it the longer route, yeah. And so that's why they're looking for these solutions and in some situations that's how they're gonna achieve the goal is by relying on some of these products. So it's not that these products are, I don't want to vilify all the fiber. There's certainly a role for them, for people, but I think getting into this and putting it in context and going through the nuances of some of the stuff around fiber maxing will be helpful. So how much fiber do we actually need and what is the data on how much Americans are typically getting.

Rebecca Berens MD 9:55

I looked at the position statement from the Academy of Nutrition and Dietetics Health Implications of Dietary Fiber. This was an excellent review of lots of data about fiber. And what they reported is that populations that consume more dietary fiber have less chronic disease. Should be surprising to no one. Higher intake of dietary fiber reduces the risk of developing several chronic diseases including cardiovascular disease, type two diabetes, some cancers. Adequate fiber intake is considered about 14 grams of total fiber per thousand calories. So estimated needs of about 25 grams for an adult woman and 38 grams for an adult man. And of course, this is an average, this is gonna vary depending on specific populations. And so it's it's important to, that's just the baseline line amount that you need to get. But then the mean intake of dietary fiber in the US is 17 grams a day and only 5% of the population is actually meeting the adequate intake. So that's quite below the recommendations.

Sonia Singh MD 10:54

Yeah. 5%.

Rebecca Berens MD 10:56

Yeah. I think I think there's all this buzz about ultra processed food and how it's so toxic. I don't think it's that the food is toxic. I think it's that we're not getting this very helpful component in our food. And so it's not that the food is bad, it's just that we're missing a piece. And again, that's where I think the food matrix is really important. And as we said, vilifying the products is not helpful, but we have to find ways to get that stuff back into our diet because it has a lot of health implications.

Speaker 3 11:22

Yeah. And somebody might look at this study and say, oh my gosh, more dietary fiber, less chronic disease. So let's just put it in a pill or a drink or shake and make sure we're getting enough, but that suffers from the same problem that you're describing with, ultra processed foods and thinking of it more about the individual toxic ingredients. It's nutrition is not really about individual ingredients, oftentimes. Yeah. It's really about the entire diet or the entire food So anyway okay. You have some other studies on fiber and the benefits of fiber, so

Rebecca Berens MD 11:50

yeah, so I wanted to run down and just explain the three main types of fiber that we are talking about when we talk about fiber, 'cause all fiber is not equal, and then how each of those types of fiber benefits us. Because I think that's important to, to understand. 'cause part of the issue is that even I, prior to researching this, I knew some of this, but I think I did not know in as much detail as I learned in my doing my research. And I definitely think the average person doesn't necessarily know that there's a difference between different types of fiber or where those fibers are sourced from and what they do. So first I just wanna run down with this and all of this data I got from, a a really great article that was a good read is called Understanding the Physics of Functional Fibers in the Gastrointestinal Tract, an evidence-based approach to Resolving Enduring misconceptions about insoluble fiber. And so this, they, this was summarizing lots of data.

Sonia Singh MD (2) 12:40

They're basically like, fiber is so misunderstood

Rebecca Berens MD 12:43

and it is, it's so misunderstood. And they did, they explained it very well. Okay, so first Type of fiber that I'm gonna talk about is insoluble fiber. And so insoluble fiber natural sources would include whole grains, leafy green vegetables, skins of vegetables and fruits and then nuts and seeds. And then supplemental forms would include cellulose based forms or mixed fiber products. And the way that insoluble fiber is helpful is primarily for. Increasing bowel regularity. And the way that it does that is actually the larger particles of the insoluble fiber, irritate mechanically the lining of the large intestine and that stimulates more release of water and mucus to make the stool. Slipperier and move through the intestines nicely. If you grind it up too small and the particles are really small, it actually can have the opposite effect. 'cause you get more bulk added to the stool, but it doesn't irritate the lighting the same way. So it actually can be constipating. So this is, I think, one of the reasons that people always talk about you can overdo it with fiber and especially if you're not thinking about the types correctly, adding a bunch of fiber in the wrong way could actually make you feel worse. So that's one piece to it. And then the other piece is with satiety. So of course if you eat a larger volume of food, because fibrous foods are larger in volume, they take up physical space in your stomach. That is going to stretch your stomach, you're gonna feel fuller. And so it can result in lower overall calorie intake, which can have influence on, management of chronic diseases such as diabetes. And then also just avoiding overeating because you're feeling more satiated and full after your meals.

Sonia Singh MD 14:19

Okay, that makes sense.

Rebecca Berens MD 14:21

Okay, so that's insoluble fiber. The next one I'm gonna talk about is soluble fiber. So natural sources of soluble fiber include oats and oat bran. Legumes like beans, lentils, peas, edamame, fruits, like the flesh part of the fruits, berries especially vegetables. And some other nuts and seeds and barley as well are awesome examples. And then the supplements are highly viscous, soluble fibers that form a gel. And so that is the important part about the soluble fiber. When it gets into your gut and mixes with water, it forms a gel like substance. And so the primary supplements that are useful for this would be cilium, Gugu, and beta glucan. Okay? And so this is what I think. Most of us think about when we talk about fiber in terms of the benefits of it. But again, this is a specific soluble fiber benefit. And the reason that this is important is because it does have to be this like gel forming type of fiber. Because when it mixes in your intestines with the, intestinal juices and water and all of that, and it forms that gel, it actually affects the mechanisms by which we absorb sugar and also traps cholesterol and eliminates bile from the stool. And so in doing that, it. Lowers serum cholesterol and it means we don't get as pronounced glucose spikes after meals. So it improves our, ability to process glucose. We have less of an insulin spike reduces high insulin responses. And so it has an effect on glucose regulation as well. So that's where the actual structure of the food is very important. 'cause there has to be that viscous gel formed. And not every fiber does that. Only these specific soluble fibers do that.

Sonia Singh MD 16:01

Wait, so you're saying all soluble fibers will do the make the gel or you're s. Specific.

Rebecca Berens MD 16:06

So these specific supplemental ones do, and then not all soluble fibers do, but a lot of the fibers that are in the things that I mentioned, the soluble fibers will have a similar gel. But when I'm talking about supplements, yes, it has to be those specific types that fall, that form the gel. Other

Sonia Singh MD 16:21

supplements may be insoluble fiber, and those would not have the same,

Rebecca Berens MD 16:24

they may be insoluble fiber or they may be a prebiotic fiber, which I'm gonna get into next because there are some soluble, there's some fibers that. Are what we call prebiotic. And the prebiotic fibers are digested by the gut bacteria, so they actually don't stay in a gel form throughout the entire colon because they're getting digested by gut bacteria and so they can be beneficial in terms of supporting growth of healthy gut bacteria. But they don't have these, the same gel-like formation that affects the absorption of nutrients and removal of cholesterol. And so when I'm talking about these prebiotic fibers this would be things that come from natural sources like chicory root, Jerusalem artichokes, garlic, onions, leaks, asparagus and then the the supplemental ones are like the fiber gummies, the fiber sodas, the other fun fiber products. They're all pretty much using these prebiotic fermentable fibers. Often it's inulin, which is a polysaccharide known as a fructan, and then that fun turn your sugar into water or sorry, you're turning your sugar into fiber supplement that I talked about is an enzyme that turns sucrose into, levin fiber, which is another prebiotic fiber. And so again, most of these fun products are talking about this kind of fiber. And so the benefits in terms of the metabolic health benefits and the bowel regularity is not the same with these. Now do they feed your gut bacteria? Yes, but not necessarily in a way that actually has any tangible health benefits for you, especially at the doses that they are in The fun products like the sodas. Interesting. And so in order for a fiber to be useful for either bowel regularity or. Metabolic health, it has to pass the whole way through. And so if it's getting fermented, digested, turned into whatever by the gut bacteria, it's not passing the whole way through. So it's not doing all of those things for you.

Sonia Singh MD 18:17

Interesting. Okay.

Rebecca Berens MD 18:18

But what it is doing is producing a lot of gas.

Sonia Singh MD 18:21

Okay. So basically the big health benefits that often people are after, like lowering cholesterol. And lowering blood sugar. The, those benefits are mainly seen for soluble fiber.

Rebecca Berens MD 18:33

Correct. And things like increasing satiety and improving bowel regulation are mostly from insoluble fiber. And so these prebiotic fermentable fibers, feed the gut bacteria. That is true. But

Sonia Singh MD 18:46

You have some studies here looking at the benefits of the prebiotic fi fiber. So tell us about that.

Rebecca Berens MD 18:55

There was a review a meta-analysis of 14 randomized, well-controlled clinical trials that show that none of the fructans, which is like the inulin and like these prebiotics soluble fibers I'm talking about showed evidence of improved glycemic control versus placebo.

Sonia Singh MD 19:10

Oh,

Rebecca Berens MD 19:11

and they also have no effect on stool output or stool softening. So again, they're not doing. Why, what we want fiber to do. I think the other thing that was really interesting when I was researching about the, there's actually a couple of class action lawsuits against some of the popular fiber sodas. So one of them against Poppy was filed in May of 2024 and settled in 2025. This was in California, and they agreed to pay $8.9 million to resolve claims that it falsely advertised at. Sodas as containing prebiotics for a healthy gut. And then there was actually one filed in December of last year against OP in New York for the same thing. And so that one's still ongoing. But essentially the crux of both of these class action lawsuits is that the amount of prebiotic fiber in there is very low. And so you would have to drink multiple of the sodas a day. To even get a clinically relevant amount of the fiber into your gut and then also the amount of sugar that you would then drink in drinking that many sodas in a day would probably counteract any of the benefits that you might get from the fiber being there. And then also the type of fiber that's in there is not the type of fiber that is doing the things that we want fiber to do for us in terms of our metabolic health and our bowel regularity.

Sonia Singh MD 20:24

So, are there studies looking at just prebiotic fiber and benefits for. Gut health, which is like totally a, who knows what that phrase really means, but I don't know, changes in the microbiome related to that.

Rebecca Berens MD 20:37

Yeah, that, that's the primary thing that they see is there can be stimulation of healthy bacteria growth in the gut, but again, the downstream effects of that does not result in improved stool output in stool, improved bowel regularity, or improved glycemic control or improved cholesterol. So yes, they do increase the bacteria.

Sonia Singh MD 20:56

Yes.

Rebecca Berens MD 20:57

They don't necessarily do all these other things.

Sonia Singh MD 21:00

Right, and the argument in these cases was that even though it has that prebiotic fiber, it's such a minuscule amount that the argument that drinking these sodas gives you a, improves your gut health is.

Rebecca Berens MD 21:14

Yes.

Sonia Singh MD 21:15

Okay. Yeah, that, it's, this feels like very intuitive to me 'cause I'm like, when you think about what it's like to eat a carrot or an apple or a sweet potato or whatever, and then you think about drinking a poppy soda, I'm like, how can that possibly to do the same thing in your body? It's just a totally different. Experience, like you're chewing something that has some bulk and some it's some work versus you're drinking this clear, carbonated substance that just on some level I'm just like, yeah this checks out. That makes sense to me.

Rebecca Berens MD 21:50

Yeah.

Sonia Singh MD 21:50

Okay. Yeah,

Rebecca Berens MD 21:51

so it just, it doesn't, it's just not the same thing. It's not doing the same thing at all. And what I did wanna talk about was as we talked about earlier in this episode. We don't get enough fiber in our diets and a lot of that it has to do with just the time and ability to prep food and eat food on the go. And so I did wanna talk a little bit about some things that people actually can do to add supplemental fiber that would be evidence-based and beneficial if they really can't get enough in their food. And the things that have been studied to show. Benefits are primarily, again, those soluble gel forming fibers. And the important thing with this is the structure of that fiber ma matters. And again, this comes down to the food matrix. So if you, the more you change that fiber in the processing of the food, even by baking it, for example, versus mixing it in water, versus having it naturally occurring in the raw food. It changes the physiologic effects on the blood sugar and cholesterol response that you get from that. So there was a study called cholesterol lowering effect of beta glucan from OAT brand and mild mildly hypercholesterolemia patients may decrease when beta glucan is incorporated into bread and cookies. And they had just 48 subjects. It was a small study and they had three weeks of control eating bread and cookies, rich and wheat fiber. And then for the next four weeks, by random assignment, they had 23 of them. So about half continued the control products and 25 received rich and beta glucan bread and cookies. And the total fiber intake didn't differ significantly between the groups. But. The structure of the fiber was different.. And then they at the end randomly assigned the subjects to consume orange juice containing either wheat fiber or beta-glucan. And what they saw was the ones that were taking the drink with beta-glucan had. Decreased cholesterol compared with the other drink that contained wheat fiber. So those different types of fibers. And so again, the way that the fibers are processed and the way that they then form the structure chemically in the intestines actually affects the way that you, that they impact the absorption of cholesterol and sugar.

Sonia Singh MD 24:02

Okay. So basically all fibers are not equal. Correct. The type really matters. And even among the same type, the way it's been processed in the form that you're consuming it in really matters.

Rebecca Berens MD 24:12

Correct? Yeah. And then I think that the takeaway from that for me is like. High fiber food is important, but you need to look at where did the fiber come from? Look at the actual label and the most common added one that's a prebiotic fiber is inulin. So inulin is commonly added to increase fiber and get the label that says high fiber or excellent source of fiber. But if it's primarily inulin, that's the fiber. You're not actually getting a lot of those benefits that you would be getting if it was more of like the whole food fiber. I'm

Sonia Singh MD 24:45

curious about that original study that you talked about that showed reduced chronic disease in patients that were consuming more higher levels of fiber. I'm curious if they did a breakdown of what types, 'cause I would wonder if now in like the current landscape, so many people are like, yeah, I'm getting the 35 grams. 'cause they're eating a bar or like a bunch of things that have inulin added to them. But maybe if you look at those outcomes, they're not gonna be as you would expect, based on the previous study. 'cause I would imagine it. There weren't as many fiber products in the marketplace, and so people were probably consuming. Other soluble and insoluble fibers.

Rebecca Berens MD 25:18

Yeah. So a lot of these studies were going back to the seventies, so yeah. I think the point is that when they have studied it, it is different. Yes. And so it does matter. But the one thing that's consistent is cilium fiber is one of the best study type of fibers. And this is the one that's in the regular, over the counter, powder that you mix. I'm gonna call out a brand here, Metamucil, just 'cause everyone's heard of it. But it doesn't have to be Metamucil brand, cilium fiber is what's important. And that one is one of those ones that forms that gel. Yeah. And actually has more of an influence on absorption. And then also is helpful for bowel regularity too. Because of the way that it's holding water in the stool. So if you're gonna add a fiber supplement because you can't get enough in your food, that would be the one I would add. And that one is very cheap. And it doesn't come in a trendy can or gummy, but it actually works. But still primarily the best place to get it is from food. And the concept of the food matrix is important. And I think that's something that societally we need to be thinking about and like, how can we improve our access to high fiber foods and actually eating real fiber containing foods instead of having to do a bunch of supplemental stuff.

Sonia Singh MD 26:28

Yeah. I have very savvy patients and so I've had this conversation with people about Metamucil and then they're like, but which one? And then I looked once and there's so many different types of Metamucil now 'cause I think the original, the OG Metamucil, I think has sugar in it. And so then I. Artificial sweetener version of Metamucil, and then they had a no sweeteners at all. But I think that one is like really unpalatable. Yeah. It's hard to drink, but yeah, if you find yourself going down that rabbit hole where you're just like, I don't wanna drink any of these, then don't go back to looking at the food and seeing how that happened. But, yeah. So the shortcuts always come at some cost, so Price.

Rebecca Berens MD 27:05

Absolutely. Yeah. And I think that, the, I've heard that also that complaint. They're like, but I don't wanna have one that has sugar. And I'm like, a little bit of sugar to make the Metamucil not taste terrible. Yeah. Is really not the end of the world. I, I would probably prefer that to an artificial sugar. 'cause a lot of people don't tolerate they all those very well, and those can have issues for your gut bacteria too. So I'm just like, I'm less worried about that 'cause you're getting a ton of fiber with it. You do have to drink a significant quantity of it for it to be useful, and I think that's a big barrier for people. And so again yes, as a supplement, I think it's great, but ideally we are looking at ways to increase the fiber in our foods and getting, if you can get a fiber fortified food that has. Some type of non just prebiotic fiber in it. That is also added. I think that's a more beneficial way to increase your fiber.

Sonia Singh MD 27:54

So we've covered ways that you can get a little bit more fiber in your diet if you're concerned about your fiber intake. But what is the flip side of that, of going too extreme and getting too much fiber or excessive supplemental fiber in your diet?

Rebecca Berens MD 28:07

Yeah, so I think part of the reason that this trend has also exploded is there's not a lot of harm to it. The main side effect is GI upset as we've alluded to. So if you go from very little fiber to a lot of fiber very quickly, your body does not have a chance to adjust and you are going to be very uncomfortable. You also have to make sure you're drinking enough fluid because the way that fiber helps move stool through your GI tract requires water. And so if you. Don't drink a lot of fluid and add a ton of fiber, you are probably just gonna make yourself feel more constipated and bloated, uncomfortable. And then if you're adding specifically a lot of those prebiotic fibers, as I said, those produce gas as the part of the fermentation progress process. And I just have to tell this really. TMI. But funny story. So when I was at my first job, there was one of my colleagues that had a garden, and she brought me one day a bag of Jerusalem artichokes from her garden, which I had never had before. I didn't know, really know what they're also called sunchokes.

Sonia Singh MD 29:08

Oh, okay. Yes.

Rebecca Berens MD 29:09

Okay. So they're a little root vegetable looking thing and they look and taste like root vegetables and they're delicious. And so anyway, my husband and I were so excited and so we like roasted them and we had them with dinner. And Jerusalem, our chokes are a very powerful source of prebiotic fiber and we didn't really know that about them. And we ate both a full serving. Or more of Jerusalem artichokes, which I don't think is how they're designed to be eaten. I think you're supposed to eat small amounts of them for exactly residue. 'cause we were in so much pain, like for days like so uncomfortable. 'cause yeah, I mean it pro produce produces a lot of gas and it can create a lot of. GI discomfort and distress and changes in your stools and it's just very unpleasant. And so again, I think if you're consuming a lot of fiber, particularly these like mostly prebiotics, supplemental fibers, you're probably gonna be pretty uncomfortable.

Sonia Singh MD 30:04

It happens to the best of us.

Rebecca Berens MD 30:05

Yeah. So that is the main sort of Side effect, I guess I would say that could happen from fiber. The other harms though, I think are important to consider and I think are maybe less well understood. So as I mentioned with my patient story at the beginning, you can eat so much fiber that you're not eating enough other food. And I do think this happens quite a bit in patients with orthorexia who are very like clean eating focused because they're typically eating very low calorie. Other things. And then they're having a lot of fiber foods, which again, there's most of these foods are lower in calories. And it's also volume wise, quite dense. And so their stomach is filled. There's actually just not enough room to get the other calories in. And so you really can crowd. The other foods that you need, if you're eating too much fiber and miss out on other important nutrients, like enough carbs, enough fat, enough protein. So it is possible to do that. And then I think the la last thing I would say from like a harm perspective is I think the focus on fiber maxing is really promoting, buying a lot of supplemental products because it is difficult to do with food. And so that's then resulting in people spending money. On products that actually don't have the health benefits they claim to have or suggest that they have. And that's probably displacing funds that could be spent on cheaper and more nutritious foods.

Sonia Singh MD 31:22

Or food preparation services. Yeah. That, is actually going to make it possible for the full, the whole food to get into a person's mouth.

Rebecca Berens MD 31:29

Yes.

Sonia Singh MD 31:30

Yeah, that's an important point about the harms. Okay, so what can we learn from this as doctors and humans?

Rebecca Berens MD 31:36

So I think the main thing I would take away from this is all fiber is not equal and there can be too much of a good thing. And so when we're talking about increasing fiber, it's important. We should probably all be thinking about it, but we wanna try to be thinking about it from food first. And and the, there's really not a quick and easy solution for this. And so it is more of a systemic issue that we need to solve of how to make. Foods that are actual whole foods that are higher in fiber and more close to their original form with the original food matrix accessible to everyone. And possible for people to slow down and actually prepare and eat real food instead of just work, work all day as our current habit.

Sonia Singh MD 32:21

Yeah. The take home point for me is like you said, all fiber is not equal and that oftentimes the products that we perceive as shortcuts are not even the same type of fiber that has been more extensively studied as being beneficial. And so you may not be guaranteeing yourself really anything by having that sort. Safety net having an extra bar or shake or something that has that extra fiber. And how would you talk about this with your patients? Somebody who comes to you and is worried about their fiber intake or interested in fiber maxing?

Rebecca Berens MD 32:52

Yeah, so in general. Anything with the word maxing in it or two xs in it, it's probably not a thing that I would be recommending. I think that if you're wanting to work on metabolic health, like I already do, talk to people about fiber and like, how much fiber are you eating? Are you eating some fiber with each meal? How, what are some ways that we could introduce a fiber rich food? And like fruit for example, is really much more portable and easy way to add fiber to your meals. So talking about increasing fiber slowly and gradually, adding a little bit to each meal, ensuring that you're drinking enough water for sure. And then not wasting money on those fiber products. Because the food sources are best. Let's focus on. How can we use the resources you have to get nutritious food and get it prepared and easily accessible for you to be able to eat when you need to. And then if you do decide to use a supplement, the cheap stuff works the best anyway, buy the cheap supplement and I don't care if it has a little bit of sugar in it. I would rather you have that because I know that it actually does something for you. And I'm not convinced all this expensive stuff really does anything of any benefit. There's not really clear data that it does other than make your stomach upset. Yeah. Okay, cool. Where can people go for more info? Yeah, we'll in, I'll include in the show notes a few. The, of the GI dietician and nutrition experts that I love for this. And all of the resources and references that I referenced today. Okay, perfect. Thanks Rebecca. Yeah, thanks Sonya.

Sonia Singh MD 34:21

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