FiberMaxxing: The Truth About Fiber, Your Gut Microbiome and Digestive Health

Podcast Transcript

Dr. Scott Steele:

Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end. Hi again, everyone, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, colorectal surgeon and president of main campus here at the Cleveland Clinic in beautiful Cleveland, Ohio. I'm absolutely pleased to welcome back our all time most frequent guest and that's Julia Zumpano, who is a dietician in Cleveland Clinic's Digestive Disease Institute. Very, very, very knowledgeable expert and guest here on Butts & Guts. Julia, welcome back.

Julia Zumpano:

Thanks so much for having me. I'm so excited to be on again today.

Dr. Scott Steele:

Well, you've been on a lot and we appreciate your time and you are some of the absolute most downloaded and listened to podcasts. So we're happy to make another one. And today we're going to talk a little bit about something of the benefits of fiber to your gut health, something near and dear to my heart as a colorectal surgeon and specifically is fiber maxing right for me. I'm so excited to hear about that. But briefly for those who have not heard you on our podcast before, give us a little bit about your background.

Julia Zumpano:

Sure. So I have been a registered dietician for 21 years. All of that time has been enjoyably spent at the Cleveland Clinic. I am focused in the Department of Preventive Cardiology, but I also am the nutrition media liaison for the Cleveland Clinic. So have had a good amount of input on the Cleveland Clinic Diet app. And I'm the co-host of the Nutrition Essentials Podcast with the Cleveland Clinic and have been a guest on several of the other podcasts. So just trying to reach as many people as I can and we can to educate on the benefits of nutrition.

Dr. Scott Steele:

Well, we are certainly glad to have you back. And as I said today, we're going to talk about a term that maybe if you're not a whole lot on social media, but certainly if you are, fiber maxing and it's been making the rounds on social media lately. And before we dive in, let's first talk about fiber and what fiber is and then maybe about fiber maxing and what that really means. And is this a legitimate nutritional approach? Is it a trend? Is it somewhere in between? What's going on here?

Julia Zumpano:

Sure. So to begin, fiber is a non-digestible, non-absorbable carbohydrate. So it creates bulk to our stool and it's minimally absorbed and digested. So it goes through your intestinal tract and out the other end. So it's very beneficial in many ways to overall health, but it is found in mainly plant-based foods. So fiber maxing is a trend, but really what it is trying to get the maximum fiber intake out of your day. And the dietary guidelines are looking at aiming for 25 to 38 grams of dietary fiber per day and the fiber maxing is trying to get to that point. But the method of getting to that is pretty quick. As we know trends go, it's just like shoving it all in as quickly as you can. And that's the part that you have to be more cautious with. It can be unsafe if you're not doing it properly.

Dr. Scott Steele:

So let's start with a little bit more basics for our listeners who maybe they know a little bit about fiber, maybe they don't, maybe they've seen it more on the commercials that are on TV. They don't think about it day-to-day and get into this. But you talked a little bit about being essential not only to your gut health, but our overall health. What does it actually do inside of the body? And then be a little bit more specific than what does it do for your gut health?

Julia Zumpano:

First of all, we know that fiber can lower bad cholesterol, LDL. And the mechanism here is that fiber binds around something called bile in our guts and bile's compost of cholesterol. So fiber removes that bile with the body's waste, therefore promoting the elimination of some cholesterol. So it can work positively there. It also can help manage blood sugars. So fiber slows down the rate of glucose going into the bloodstream. So if you're eating a fiber-rich diet, that will lead to less spikes and more balances in your blood sugar throughout the day because the opposite of fiber is considered a refined carb or a simple carbohydrate.

And that is pretty much a white carb of what most people think of. And these white carbs lack fiber. So they tend to spike the blood sugar quickly and rapidly and then drop it quickly. So that leads to irregular blood sugars or unnecessary spikes and drops in blood sugar, which overall leads to poor blood sugar management, which in the end leads to a lot of increased cravings. So often these refined carbohydrates lead to you wanting more of them. So it also can lead to over consumption of these foods, which puts us to a place where we're at as Americans is a diet very low in fiber where Americans are averaging 10 to 13 grams of fiber a day. That's less than half of what the minimum intake of fiber is.

Dr. Scott Steele:

We often hear that fiber is just fiber. Is this true? I mean, are there different categories or types of fiber? Does it matter the type of fiber that we eat? Does it matter if you take the pills, the gummies, the powder? What are your thoughts there?

Julia Zumpano:

So as a dietician, food first always, always want to get fiber through food. And the reason being is because if you're eating a fiber-rich diet, it's filling you up. It's providing control to your satiety cues. So it's helping your hunger cues say, "Okay, I'm full. My stomach feels full." Fiber expands in our belly so it takes more space in our guts. Therefore, it signals to your brain that you're full a little bit sooner than foods that don't have fiber. Also, fibrous foods are very low in calories. So specifically vegetables are the lowest calorie food group and fruits are right behind them. So when you're filling up with these fruits and vegetables, you're really minimizing your caloric intake. So that's really where some of the weight loss and weight management benefit comes in.

Now, if you're eating a standard American diet and just aiming to get your dietary fiber through a supplement, you're not getting any of the other benefits from fiber-rich foods. You're just getting the fibrous benefit. And it's still even questionable on if you're getting that fullness factor to the extent as if you would through a meal from a supplement. So I think there's many, many great benefits. One other one that I can't go without saying is that fiber-rich foods are the most nutrient dense. So you are going to pack in so much nutrition from these foods that if you're just taking a supplement and it only has fiber, you're lacking all those other vitamins and minerals, polyphenols, antioxidants, healthy fats that you would be getting if you ate it through your food.

Dr. Scott Steele:

I would like to editorialize here real quick and just say those people I never discourage as colorectal surgeon people from taking a fiber supplement. My ask is always make sure you know how much you're taking. I know a lot of people feel very good about that. That's great, but there's some supplements out there that may be only .5 grams per tablet or per pill. And man, you might as well eat the entire box, including the cardboard that comes with it in order to get just one daily thing that's out there. So read the box, see where you're at and go from there. So you mentioned veggies and fruits and all of that and as a nice way to get fiber through their diet, through a furred first approach. But can you give us maybe any standout high fiber foods or maybe some surprising ones that are easy to work into everyday meals?

Julia Zumpano:

Yeah. Avocado is a very fiber-rich food. High in soluble fiber, it's high in fat. It's very satiating. It goes well on a salad or as a dip or as a spread. I mean, so many versatile ways. I mean, we have a great recipe on our website that includes avocado and tofu and making a chocolate mousse actually. So it's great in smoothies, so many great ways. So avocados, blueberries are an excellent source of fiber, oats. And if you don't like oatmeal, there's so many different ways you can use oats.

So you can use them raw in energy balls or throw them into a smoothie. You can toast them, you can make a granola from them so many different ways. You can even grind up the oats and make it into a fine flour and use it as a baking flour. So oats are another great one. Leafy greens. So that's another easy category to throw into soups, make it as a base of the salad, put it in a sandwich, a smoothie. You can buy leafy greens frozen, which are also really good to use in a pinch adding to any meal like a stir-fry or whatever you're cooking.

Dr. Scott Steele:

Julia, as we mentioned in the beginning of this, you've done a ton of work in terms of our Cleveland Clinic diet, the app, everything that's out there. And we'll touch a little bit more information on that later. But as you're getting into this, additional practical tips or tricks for gradually building fiber into your diet without overhauling everything at once, meal timing, swabs, label reading, what advice do you give your patients?

Julia Zumpano:

Well, first thing, you got to recognize that fiber can cause some GI symptoms if you're increasing it too quickly and your stomach's not prepared for that. So I generally recommend we add fiber slowly and we add a little bit of a fiber-rich food to each meal in a small moderate amount and then gradually increase from there. So if you're more on the basis of a lower fiber diet, let's say you're only getting 10 to 15 grams a day, I usually say, "Well, let's add three gram increments to your meals." So small amounts of fiber and that might just look like a quarter of an avocado. It could look like two tablespoons of a nut butter. It might look like a half a cup of leafy greens. So it's not very much. We want to start small and then build upon there because that will help minimize any of those unnecessary GI symptoms that you might encounter with increasing fiber in a very rapid rate and getting up to a very high amount of fiber.

Tips would be just looking at a plant-based food with each meal. So looking at breakfast, am I getting a fruit or a vegetable in? Can I throw some spinach in my eggs or can I have some berries on top of my cereal? Lunch, getting a veggie in, whether it's if you're having a salad or if you're just more of a sandwich kind of person, just throw some carrot sticks as a side dish or some celery sticks. And then dinner, anything you could do to make sure you have a vegetable in. And then if you can add beans, legumes are a phenomenal source of fiber. They're a great source of protein and they pack a punch. They have so much other nutrition, vitamins and minerals, folate B vitamins. So I would say just even swapping out, when you're having rice, instead of having rice, just have rice and beans, add the beans to it, or adding some beans to a soup or a salad. So many different ways that you can incorporate more fiber in your diet.

Dr. Scott Steele:

Regarding the billing into it gradually, I always like to say you wouldn't be able to go to a gym right away and bench press 300 pounds. You got to work your way up there. And sometimes it's starting with the lower weights. And so when it comes to these fiber supplements, there's a lot of supplements out there. You go into any grocery store aisle or pharmacy and you'll see psyllium, methylcellulose, gummies, all sorts of forms that we talked about before are some better than others. And when is a supplement appropriate versus just focusing on whole food sources, even if you're really going after it? I know you said food first approach, but when do you got to go a little bit more?

Julia Zumpano:

I usually take it case by case. So if you're looking at your fiber intake and you're just not able to meet your needs, whether it be there's certain foods that you don't tolerate well or you just don't have the access to the foods, then I would say supplementing is a great option. First and foremost, I like to use whole food as supplements first. So ground flax seeds, chia seeds. Chia seeds have a ton of fiber, about 10 grams of fiber. So you really can get a huge amount from just real food supplementation, chia and flax. Psyllium husk is another favorite of mine because there's a lot of good research with the use of psyllium in lowering LDL cholesterol. So that's very simply found. When you get into the pills, when you get into the gummies is where I try to caution and really encourage people to utilize some powder forms that are more whole food-based versus the gummies or the pills.

Because as you mentioned, the serving size for some of those pills are six to eight pills a day, capsules, whatever it may be coming in, that's a lot. And really we can easily get that amount of fiber through a slice of whole grain bread has three grams of fiber. So there's easy ways we can build it in. And then the gummies can contain some artificial color. They can include a lot of sugar, artificial sweeteners. None of those are really supportive of overall health. So just even some prunes are a great source of fiber dates, our excellent source of fiber, a handful of almonds. You can get more fiber through those foods than you can from a gummy or two.

Dr. Scott Steele:

So we talked a little bit about fiber maxing and really just going for the gusto there. It may sound great in theory, but is it right for everyone? Are there groups of people that maybe have certain digestive conditions that maybe should approach high fiber eating with more caution or maybe even avoid it?

Julia Zumpano:

Yes, absolutely. I mean, Dr. Steele, you'd know better than me, but we're looking at patients with IBS, with Crohn's, ulcerative colitis, with any type of diverticulitis. So you're looking at any GI disorders that may not be well managed. Again, you want to always check with your physician, your healthcare provider to see, but those are the ones that we really want to caution with if you suffer from diarrhea, if you suffer from abdominal pain and cramping. So a high fiber diet maximizing your fiber intake can really worsen your symptoms. And that's the last thing we want to do here really.

Dr. Scott Steele:

Yeah. So one of the things I say to my patients all the time, and a common question I get asked is when you have an inflammatory bout or something like about a diverticulitis or getting over that or you're having a flare associated with it, think about the analogy of lifting weights. In the long-term lifting weights may be great for you, but you're not going to have a pulled bicep and then go do bicep curls with that. And so fiber may be the same way is that if you're having a flare, you want to have a low fiber diet, give your gut a little bit of a rest, but long-term it might be the good thing for you. So make sure you understand the context of which the advice is given to you. So Julia, beyond digestive and gut health, you mentioned the broader health benefits that are associated with high fiber diet. What about weight management or even colorectal cancer risk? What is fiber's role with these?

Julia Zumpano:

Absolutely such a great role. So from a weight management standpoint, I alluded to this a little bit in the beginning of the podcast, educating here on the benefits of what fiber can do to your appetite, to your satiety cues. It fills you up, it controls your appetite, it controls blood sugar. All of those lead to better weight management. It also can control your intake. So as I mentioned, fiber expands in your belly. You tend to eat less volume if you're eating more fiber-rich foods. And lastly, the fiber-rich foods are the lowest calorie foods. So they tend to be lower in calorie and very nutrient dense. So if you're following a very heavily plant-based diet, most people don't need to measure, weigh, control their portions. It's a little bit self-controlling, which I love about what whole foods can do. And then from a colorectal cancer perspective, we do know a high fiber diet can reduce your risk.

I think about it, Dr. Lee told me this analogy and I love it. I love it. She says, think about the trash you have. When your trash is sitting for a long time, it ferments, it smells, you can't wait to take it out. You got to take your trash out every day and that's what fiber does to your colon. It clears out your colon. It takes the trash out every day. You got to get that trash out. All that food sitting in your GI tract can ferment and create more bacteria and that bacteria can wreak havoc on your digestive system. And then if you have something like leaky gut, it can leak into your bloodstream and wreak even more havoc in your whole system. So I love the taking out the trash analogy, but really fiber helps you take out the trash every day.

Dr. Scott Steele:

So speaking of bacteria, it's hard to do a digestive health podcast without talking about the gut microbiome and fiber and that gut microbiome, as you said, oftentimes go hand in hand. So explain a little bit more about that relationship. Does it feed the microbiome and why can it do everything from affecting immunity to affecting mood?

Julia Zumpano:

Yeah. So our gut is full of billions and trillions of microbes. We have this whole system in our guts and these bacteria and these probiotics work in tandem in the whole body. So it helps improve mood and reduces anxiety and depression. It helps your immune system. So there's so many benefits and some we don't even know of yet, but the fiber, we do know fiber is a prebiotic. It's a natural prebiotic. And prebiotic is what feeds those probiotics, which are those good guys, those good bugs that live in our guts and in our systems. And if those thrive, then our system thrives. So that does really help feed that good bacteria and then overall helps you really head to toe.

Dr. Scott Steele:

So now it's time for our quick hitters, a chance to get to know you a little bit better. And I had to try to think of some other ones since you've answered this traditional one so often. So typical night, would you prefer to eat out or stay home?

Julia Zumpano:

Oh, stay home for sure.

Dr. Scott Steele:

You're going on a vacation, mountain or beach?

Julia Zumpano:

Beach.

Dr. Scott Steele:

What is a book that you would like to read?

Julia Zumpano:

That's a good one. Well, right now I'm reading the Bible and that's a book I would like to complete.

Dr. Scott Steele:

Fantastic. And then finally, you're going out on date night, you're going to a movie. Are you going rom-com or scary movie?

Julia Zumpano:

Oh, rom-com.

Dr. Scott Steele:

Fantastic. So for any of the listeners who might want to start fiber maxing today, maybe what's the single most impactful change that they could make and what's your final take-home message about this topic?

Julia Zumpano:

Fiber has so many benefits. So try to aim to consume your fiber through food first, go slow. There's so many nutrient-dense foods you can incorporate into your meals. So just start with one fiber-rich food per day and then build upon there.

Dr. Scott Steele:

Fantastic advice. And so to learn more about nutrition therapy here at the Cleveland Clinic, please visit clevelandclinic.org/nutrition. That's clevelandclinic.org/nutrition. You can also call 216.444.3046. That's 216.444.3046. Julia, thanks again for joining us another time on Butts & Guts.

Julia Zumpano:

Thank you so much for having me.

Dr. Scott Steele:

That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.