Bloated from all that fiber? You added it too fast.

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Social media says to spike your fiber intake as fast as you can. That is where the bloating starts. Lisa Talamini is a registered dietitian nutritionist and senior vice president of clinical solutions at Wondr Health. This episode is based on her article “How to eat more fiber without the bloating,” published on KevinMD. You will hear why fibermaxxing with pills, powders, and fortified bars tends to bring gas, bloating, and sometimes diarrhea while delivering few of the nutrients whole food carries. Lisa explains fiberlayering instead, adding one small whole food at a time to meals you already eat, and why water decides whether the fiber you add helps or hurts. You will also hear the roughly 25 grams a day she works from, why the Mediterranean pattern is layering in practice, and how to raise the subject in the few minutes a primary care visit leaves for nutrition. She closes on the red flags to watch for in the next fiber video, and the case for the middle ground over the maximum.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Lisa Talamini. She’s a registered dietitian and health care executive. Today’s KevinMD article is “How to eat more fiber without the bloating.” Lisa, welcome to the show.

Lisa Talamini: Well, thank you for having me.

Kevin Pho: All right, so before we talk about your article, let’s briefly share your story and then talk about why you decided to share this particular article on KevinMD.

Lisa Talamini: Well, first of all, you mentioned I’m a registered dietitian. This is true. I started out in the clinical setting. I actually started out in pediatric dialysis and transplant, but made the switch. For many, many years now, I have spent my career at this intersection between nutrition and physical activity and stress and sleep, and the behavioral strategies that really drive weight management and disease prevention. And today, I’m senior VP of clinical solutions at Wondr Health, where my role is to ensure the integrity of the program.

Kevin Pho: And your article specifically talks about fiber. It’s titled “How to eat more fiber without the bloating.” Before talking about the article itself, why did you decide to share this particular article on KevinMD?

Lisa Talamini: Well, because fiber is trending so much now, but there’s a lot of noise out there. There’s a lot of misinformation out there, and I wanted to try to cut through some of that social media buzz that was going around about fiber maxing. This idea of pushing high fiber overnight, usually using supplements and highly fortified, very processed foods, which besides not having a lot of nutrition benefit, can end up with a lot of additional side effects. Unwanted side effects, we’ll just put it that way, right?

And instead, I wanted to advocate for the idea of fiber layering. The idea of being a little more steady, slow, taking a more moderate approach, but also working in real foods like fruits and vegetables and whole grains and beans and healthy fats, nuts, into your usual pattern, so that you’re doing something that is usual for you as well, that is comfortable for you.

I think the other thing that’s really fun about this is the idea that when you are adding in more fiber, you’re also adding in more flavor. So when you add in those fiber-rich foods, you’re adding more color, you’re adding more texture, you’re adding more taste. It’s a much more enjoyable way to eat. And then beyond all that, we know that by including all of these whole foods in your regular eating patterns, you’re going to improve your heart health, you’re reducing your risk for other health conditions, and overall you’re improving your gut health.

Kevin Pho: So obviously, as a primary care physician, I’ve learned about the benefits of fiber, and of course everything that you had just said about the health benefits of fiber. Now, I’m actually not that familiar with what’s going on on social media regarding fiber maxing. So for a lot of our patients on TikTok and Instagram, what exactly are they seeing on social media regarding fiber?

Lisa Talamini: Well, again, it’s the idea of just maxing out as quick as you can, as rapidly as you can, with this idea that you’re building a healthier gut. Sometimes people are trying to use it as a weight management strategy. It’s really about that whole maxing concept, which again isn’t very sustainable, number one, but also is not very comfortable, and can set people up for real side effects, the bloating, the gas. Sometimes it works too well and you end up with diarrhea. So it’s not an optimal physiologic way to eat.

Kevin Pho: And in terms of these influencers, are they suggesting these fiber supplements? How are they recommending people max out their fiber? What are patients seeing on TikTok in terms of ways to maximize their fiber?

Lisa Talamini: I think we’re seeing a combination of things being recommended. Sometimes it’s about pills, sometimes it’s about adding powders. It’s a variety of different additives, I’ll call it, for lack of a better word.

Kevin Pho: So you mentioned some of the side effects of too much fiber, bloating, diarrhea. Are those the major ones? What else do we need to be worried about if we take too much fiber and go on that extreme side of the spectrum?

Lisa Talamini: Well, the other piece around adding all this maximum fiber is that you have to be sure that you’re matching it with hydration, right? So if you don’t get enough water, if you don’t get enough fluids to turn that fiber into a gel, to help push that fiber through the GI tract, not only will it not be effective, not only do we have side effects, but we get concerned a little bit about going so far as having impaction, right? And again, that’s very rare. I don’t mean to be extremist about it, but it really does run the range.

And I think that’s why it’s really important if you are in primary care and your patients are asking you about these supplements. And sometimes people have trouble meeting their fiber goals. We see a lot of people, for instance, who are on GLP-1s who are struggling to meet their fiber goals because they’re struggling to eat a lot of food in general, right? So they’re missing out on fiber. So it’s not to say that you shouldn’t use them at all, but to use them judiciously, the way that they’re recommended on the label, the way that you would recommend them in primary care to help them deal with acute issues, or just to help bring people up to par.

But again, remembering that grams of fiber doesn’t mean grams of nutrients per se, right? So you have to try to find ways to bring in all those other whole foods so that you are getting that full array of vitamins and minerals, phytonutrients, all those things that can’t happen in a little pill or in a spoon of supplement.

Kevin Pho: And all fiber is not created equal, right? Of course, the fiber that you get from whole foods may not necessarily be the same as the fiber that you’re getting in some type of powder, right?

Lisa Talamini: Exactly. Exactly. So again, there’s soluble fiber, there’s insoluble fiber, and we know that by having that combination of multiple types of fiber from multiple types of foods, especially when you think about those fruits and vegetables and that entire array, the spectrum to choose from, you’re going to get so much more nutrition from those whole foods than you are from that little pill that may have isolated one or two types of fibers from one or two particular ingredients, whether that’s psyllium or oat. There are a variety of fibers that are out there, but oftentimes they’re a single fiber. Whereas when you’re looking at having that varied meal pattern, you’re going to get a lot of different types of fiber.

Kevin Pho: So before we talk about fiber layering, which you mentioned earlier, just give us what the official recommendation is in terms of how much fiber is currently recommended that we take.

Lisa Talamini: We recommend about 25 grams of fiber per day on average. And again, getting it through whole foods primarily. And then again, ensuring that you’re having adequate hydration with it.

Kevin Pho: And you mentioned the term fiber layering in contrast to fiber maxing. So tell us more about what you mean by that.

Lisa Talamini: Well, layering is really about looking at how you’re eating right now, and finding ways to just layer in a little bit of extra whole foods that are fiber-rich. So if you think about it, it’s simple things. It’s like adding roasted red peppers and spinach to your scrambled eggs in the morning. It’s maybe throwing a few nuts and berries on your oatmeal. It’s trading out quinoa for white rice at dinner. So they’re all really easy ways to layer into what you’re already eating.

And they’re also, again, ways to really add some real pleasure to eating. I think that’s a lot more enjoyable, a lot more sustainable than simply having a highly fortified bar with fiber, or other types of supplements that are out there.

Kevin Pho: So you mentioned the variety of fiber, right? So the different types of food. You mentioned things like red peppers. You mentioned things like quinoa. Give us a differentiation. Sometimes we see terms like soluble versus insoluble fiber. So when patients see that, what exactly does that mean?

Lisa Talamini: Well, again, I would focus more on the mix, but if you want to separate them out, the soluble fibers are the ones you find in apples and beans. And when liquid is added to them, they form a gel. Insoluble fiber is more like what we find in vegetables and in whole grains, and those really help promote regularity. Those really help push things through the intestine. And again, the beauty is to combine both, and when you’re eating a healthy meal plan, you’re getting both, so you’re getting both of those benefits.

Kevin Pho: In your KevinMD article, you talk about the overlap between the fiber layering approach that you’re mentioning and the Mediterranean diet, right?

Lisa Talamini: Yes. Yes, absolutely. I mean, if there was a plan that was about fiber layering, it would be the Mediterranean pattern, because again, it’s plant forward. It includes all of those foods we were just talking about, the big focus on fruits and vegetables, and whole grains, and beans, and legumes, as well as lean proteins and healthy fats. So that plan has been so proven through the research to be beneficial, not just in disease prevention, but it supports weight management as well. And you can imagine, because it’s high in fiber, it’s low in energy density, so you’re going to eat less food or fewer calories in total, but have as much or more volume, so you feel more satisfied in the process.

Kevin Pho: So in the primary care office, when I’m talking to patients about improving their fiber intake, I only have a few minutes with them to talk about nutrition, if that. What are some high-yield tips that I can share with patients that you find more successful?

Lisa Talamini: Again, it’s about layering what they’re already doing, and it’s making one small change. One or two small changes. We talk a lot at Wondr about SMART goals and setting one or two so they’re realistic. So it might be saying, “So what are you having for breakfast? Would you consider adding a fruit?” “What are you having for lunch? Can you add an extra slice of tomato?” It’s adding these things on in a really slow, mindful way that is most effective for people, and it can help them feel successful and want to continue to experiment with more.

Kevin Pho: So I’m going to put you on the spot here. Can you give us a case study or a success story of successful fiber layering? It could even be a hypothetical patient. What exactly does that practically look like?

Lisa Talamini: I think that it probably looks like what I just described, in ways where someone was probably just having some toast for breakfast or just some yogurt for breakfast, and then saying, “Well, let’s throw some berries on top.” So they started throwing berries on top. And then they do that, they try that for a couple of weeks, and then they might try adding some nuts the next time around, and they really enjoyed that, and they found that not only was it delicious and satisfying, but it was easy. Because that’s the other piece. This has to be easy for people to implement.

And so from there, the next time we have a follow-up, we say, “How is that going? What’s going on for lunch and dinner?” So again, it’s like giving people ideas for adding meal by meal, because we eat meal by meal, right? Until they build a day that’s higher in fiber. And again, you may need to work with supplements on an acute basis, if someone has an acute need. But overall, this layering in with foods that they enjoy and foods that are easy to add in is really the most sustainable way to go.

Kevin Pho: Early on in our conversation, you talked about the importance of hydration in relation to fiber. So talk a little bit about that relationship, hydration and fiber.

Lisa Talamini: Absolutely. I think that people forget about that. They think about just adding the food. The good news again about fruits and vegetables is that they’re anywhere between 60 and 80 percent water, so you’ll get some hydration just by eating those foods. But if you’re eating other foods like whole grains, for instance, you’re not getting so much fluid. So it’s just important to be drinking throughout the day.

We talk a lot at Wondr about having hydration at the very beginning of the day, because sometimes you wake up and you think you’re hungry, but you’re not even really hungry. You’re just thirsty, and you mistake one for the other. So it’s drinking at least, we have a sort of ballpark of 64 ounces, 60 to 64 ounces in a day, and spreading that out throughout the day. Especially if you’re eating high-fiber foods, you’re spreading that out to match those foods that you’re eating.

Kevin Pho: So for those who didn’t get a chance to read your article, what are some of the other key points that you don’t want them to miss?

Lisa Talamini: I think what’s really important, sort of from a primary care standpoint, we were talking about this a little bit more, but when patients come in, they’re excited about what they read, and you’re going to hear them talking about wanting to add more, and the idea that more is not necessarily better. And I think that this fiber maxing really is sort of a reflection of the fact that we’re doing a lot of maxing out there right now.

And so I think when people start talking about fiber maxing, it might be good to ask some questions about other things they’re doing that they might be maxing out on. Versus taking more, you could take a layered approach to their entire lifestyle. Because it’s about making those small shifts, small changes one by one. Those are more sustainable. They’re easier for you to remember. They’re easier to build habits with. They’re easier for you to maintain. So I think that’s a really important piece.

Kevin Pho: Now, for the patients who may be listening to us during this conversation, of course, they’re on social media. Just tell us the things that they need to be looking out for that would raise red flags in their minds. What are some specific things they should look out for in the next TikTok video they see about these diet influencers that should raise concerns?

Lisa Talamini: I think just to sort of moderate the information. If someone’s telling you to do something that’s extreme, ask yourself, is that really necessary? And then maybe you could do a version of that that’s just pulled back a little bit more, just a little bit more moderate an approach. But when people are promoting extreme things and they’re promoting instant results from them, that usually isn’t how it works in a beneficial way.

Kevin Pho: We’re talking to Lisa Talamini. She is a registered dietitian and health care executive. Today’s KevinMD article is “How to eat more fiber without the bloating.” Lisa, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Lisa Talamini: I think again, the idea of health optimization is a beautiful concept, but again, it shouldn’t be a pursuit of perfection. And it’s not about those extremes, it’s about finding the middle ground for you that works for you in the long term.

Kevin Pho: Lisa, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Lisa Talamini: Thanks for having me.

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