Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone, and welcome to today's episode where we are talking about fiber. This is in response to a listener question, and I am so appreciative. I have had a handful of you reaching out and sharing with me your different podcast ideas or questions that you have. And for those of you who have done that, thank you so much. I will be answering those questions or addressing those topics in the next couple of months. And that invitation continues to stand. And so if you are a listener of this podcast, which obviously are, if you are listening to me right now, but if you have been listening and thinking, oh my gosh, I cannot believe Dr. Stombaugh has not addressed this certain topic, or maybe you have a question that even feels pretty particular to you and your circumstance and you feel like in your weight loss journey, you have not been able to get that properly answered for you, please reach out. Sometimes we feel very alone in our health and weight loss journeys, but it's really fascinating because as I have conversations over and over again with patients, it's very common that we share a lot of things in similarity, these situations or experiences that we have had that we don't always often talk about because our health may be private. There's things that are often very sensitive topics and so we may not be willing to talk about them broadly, but if you have a question and you feel like you've really been struggling with your weight for some reason, you have some aspect of that that has not been well explained to you, has not been answered, I would love for you to email me. You can email us at info@sarahstambaughmd.com and let us know what is your question. I would love to address that just for you. I will record a podcast episode available for you and all of my listeners. I will not say your name. We can keep that completely confidential, but I would be so happy to help you because it's amazing even in the number of episodes we have had, there are still so many topics that I continue to think of and things I have simply missed. And fiber is exactly one of those things. This listener reached out and had some questions about fiber, and it was one of those, oh my gosh, moments. How have I not yet addressed this? So we are going to talk about fiber in today's episode. So first of all, what is fiber? It's one of those things that you hear about all the time, but what exactly is it? Fiber is a plant product, so it is part of a plant that is not broken down in the body. So this is a non-digestible part of the plant that passes through our stomach and through our intestines, really pretty unchanged. So typically we're thinking of this in the context of any type of plant-based food, fruits, vegetables, nuts, seeds, whole grains, legumes, that type of thing. We'll dive a little bit more into what it looks like. Fiber can be broken down really into two categories. We think about soluble fiber and insoluble fiber. So soluble fiber is that that dissolves in water and can form a sort of sticky gel-like substance. And so if you imagine eating oatmeal, for example, when you're finished eating oatmeal or if you're cooking oatmeal and then on the side of your bowl or the side of your cooking dish, there's kind of that clear sticky substance leftover that is soluble fiber. Insoluble fiber on the other hand does not dissolve. So this stays in the GI system, provides a bulk to the stool. So this is often part of the plant. So especially the skins of plants, for example, parts of nuts and seeds. If you think about corn for example, or if you think about, this is so gross, but I'm just going to say it. If you think about your bowel movements, when you see particles of food in there, particularly particles of vegetables for example, or nuts and that type of thing, those are often soluble or rather insoluble fibers, ones that have not been digested or broken down. So those cannot be broken down by the human body. And so with that, we have these different types of fibers and both of them play a very important role in our overall health, but then also in our weight loss journey. So in the conversation today, what I like to do is talk about that a little bit in the context of our overall health, then specifically about in our weight loss journey and weight maintenance journey, and then think a little bit about recommendations for how much fiber should we be getting and how can we work to bump that up in our diet. So let's talk about the role of fiber in our health because it does a lot of things. We think about it from our gastrointestinal health, thinking about having regular bowel movements. And this is certainly a very obvious thing that it does for us. Fiber plays a very big role in providing bulk to the stool, can be supportive and helping to reduce constipation to have regular large bowel movements, which can be helpful for our colon health and can be also healthy for our gut microbiome. So when we think about, you hear about the bacteria that live, everyone's talking about the gut microbiome these days, and we need certain types of foods, particularly fibers, in order to fuel those healthy gut bacteria. So when you hear about probiotics for example, people will also often talk about prebiotics. And prebiotics a lot of times are referring to this plant substance like fiber for example, that fuels the gut microbiome, those healthy gut bacteria. So prebiotics are important for the microbiome of our gut. So that plays a really important role in our digestive health. We also know that it plays a role in our cardiovascular health. So there is an impact on cholesterol, for example, that the fiber can be supportive in reducing cholesterol levels. And when you look at on the side of a Cheerios box for example, it says may support heart health. Those studies that talked about the support of heart health from carbohydrates are based on that role of fiber. So that is how that health claim came to be, and we won't dive into that more, certainly maybe a little bit misleading, but there is fiber and that does play a role in cardiovascular health and cholesterol reduction. We also know that fiber plays a really significant role in blood sugar control. So one of the things when we eat foods that are really rich in fiber, it creates this effect that slows down digestion. So food sort of sticks with us longer, creates more satiety. That is part of the mechanism by which fiber can be really helpful in terms of the weight loss journey as well. But its role in controlling blood sugar both contributes to, can contribute to weight loss and then also contributes to improvement in conditions like pre-diabetes or type two diabetes for example. So that fiber slows down absorption of the food and allows our body to process that energy more slowly over time, which can have that benefit, like I said, for some of these elevated blood sugar conditions like pre-diabetes, diabetes, other insulin-resistant conditions like PCOS for example, and then has this important role in weight management because of the satiety that it creates. Now, when we think about weight management, another thing that high fiber foods often have in common is that they tend to be lower in calories or especially for the volume that it provides. So when we think of foods that have very high fiber, most of them are things like fruits and vegetables and legumes and whole grains, for example. And one of the best things about eating foods in their whole form is that they can be this very large volume of food. I'm sure you've seen pictures before where there is a, let's say 500 calorie salad versus a 500 calorie sandwich. And those two things side by side and the volume of food that would be in a salad, for example. Oftentimes we could eat this just sort of gigantic mound of vegetables compared to that amount in a sandwich would look like a much smaller amount of food. And so even though the caloric content would be the same, the way that food feels in our body ends up feeling very different. So this sort of gigantic salad is able to stretch our stomach, give us that more significant feeling of satiety, all of that fiber is going to slow down digestion. Now, there's other pieces of satiety as well like protein and fats, but that fiber helps to provide that bulk that kind of slows things down and can be really important in creating satiety and in a way that is pretty low calorie because you've got this very low density of calorie food items. So low calories, but a high volume of food, which is really pretty cool. So when we think about the role too of fiber and GLP, I think that this has been a conversation. So GLP, our body naturally makes the glucagon-like peptide that everybody's been talking about recently with ozempic tirzepatide, all of them. Those are all GLP receptor agonists, meaning that they stimulate the GLP receptor in our body. So our body has GLP receptors because we already naturally make GLP and these medications stimulate those receptors further. So what happens with foods that are fiber rich for example, is because the slowing down of the digestion, our body is able to process that over a longer period of time. So we're able to sort of more effectively use our GLP or it requires more, maybe I kind of said that backwards, but it requires the GLP is made over a longer period of time in order to support that digestion. And so people talk about this as increasing our body's natural GLP. Now, one of the things that I think gets really overstated is the ability of our bodies to naturally increase GLP. When you compare that to what is happening with a medication, it's really going to be a fraction of what a medication could create in your body. And so while all of these measures are important and you hear about other herbs or supplements or things like that that can support our body's own natural GLP, I think a lot of it gets really gimmicky pretty quickly because the amount that it's actually increasing our GLP is pretty minuscule. But that being said, when we can eat fiber, it's having a lot of other benefits. We're not doing it simply for that minuscule increase in GLP that we could get. So it does impact our digestion, it does allow for our body to make more GLP because it's processing that food over a longer period of time. But it's really the rest of the benefits of fiber and the rest of the role that plays in terms of satiety, in terms of bowel health, in terms of cardiovascular health that are the most important pieces of this. Now, we know that most Americans are not getting enough fiber in their diet, and that's really not surprising when you look at the standard American diet. So the standard American diet can mean a lot of different things, but we often have very highly processed foods. So when we look at flour, for example, a traditional white flour has been very highly processed and removing a lot of the grain product removes a lot of the fiber. So when we compare even white grain to whole grain, you are taking out a lot of the fiber when you have any sort of white grain product. Similarly, sugar is very highly processed. There's no fiber in it. When we compare that and even meats, which meat can play an important role in the diet in terms of the density of protein. But there are plenty of people who are vegan, for example, who are getting their protein from plant forms. So meat is not the only way that you can get protein, but it is a very dense source of it. Meat has no fiber. There is really no fiber in meat products and animal products like dairy for example, fiber is found in plant products. So when I say plant products, I mean fruits, I mean vegetables, I mean grains, particularly grains in their whole form that have not been processed to remove the fiber. And then also in things like legumes. So across any fruit, across any vegetable whole grains, we're thinking about things like oats. We're thinking farro and barley and quinoa and brown rice in the category of legumes we're thinking about beans and chickpeas and lentils and peanuts. And then thinking about nuts and seeds are also a really phenomenal source of fiber. So all of these are foods by which we can get fiber, and then we can also get fiber in the form of supplements. So a particular cilium husk. So that is the active ingredient that is in Metamucil, for example, in inulin, in wheat dextrin. So that is the active ingredient in the fiber supplement benefiber. Those things may play an important role for certain people. It's a good idea to talk with your doctor if you need or if you should be supplementing with fiber. One of the things I will caution you, if you're trying to increase fiber in your diet, whether you're thinking about doing that in the form of supplements, whether you're thinking about doing that in the form of real foods, don't go crazy if let's say you're eating a very low fiber diet right now, if you just eat a huge amount of fiber, you will feel that in your digestive system you will be bloy and gassy and have some abdominal discomfort that comes with that. And that is a result of basically the gut bacteria and how that is interacting with the fiber in our body. And so my recommendation is to sort of build your way up to it. So wherever you're at right now, thinking about just slowly moving in the direction of your goals, you do not have to all of a sudden overhaul your diet. If you do, that is okay, but just recognize you may be gassy for a couple of weeks before your system adapts to that new change. So when we think about what is the recommended dietary allowance for fiber in our diet, and we recommend that women get about 25 grams of fiber per day and men get about 38 grams of fiber per day. And for elderly, those numbers are less. But these are really good guidelines. Now we can get more than that, but these are those recommended minimums in our day. So when we look at how we get that, if we look at a lot of different fruits and vegetables and grains in their whole form, for example, a lot of these things may have three to eight grams of fiber on average. And so thinking about if you have an apple, for example, depending on the size of that apple, that might be three to five grams of protein. If you have a couple of cups of lettuce, interestingly, a lot of lettuces like romaine or iceberg lettuce are actually pretty low in fiber, pale to more hearty lettuces like a spring mix or especially a spinach or kale may have a little bit more, but even a cup or two of that may have four to seven grams depending on which one we're talking about. Beans. Often a half a cup of cooked beans will have five to six grams. Things like whole grains may have three to four grams and about a half a cup. But when you think about adding up some of these things and having them distributed throughout the day, if you imagine as a woman, I should be getting at least 25 grams of fiber per day, and if I divide that out, let's say over three meals in a snack, so I'm dividing that out over let's say four meals. If you're trying to get 25 grams over four meals, you're thinking about getting about six grams of protein a little bit over per meal. And so even though getting, or sorry, I just said protein instead of getting fiber per meal. So you want to be thinking about dividing that out and how it sounds like, oh gosh, there's only two grams here or four grams there. But when your goals are getting 25 grams of fiber per day, if you're really trying to get only six grams of fiber per, let's say, for eating options, you're going to be able to get that. Even if you're talking about three gram options that you're having an apple paired with peanut butter or you're having a big entree salad, you might very easily hit your goals for the day when you're thinking about eating protein at dinner that you put aside of low calorie vegetables on the side of that, for example, or whole grains as well. And you can easily add up. Oftentimes, even just two of these things, eat and add each meal can be a really great way to get that fiber. In our day and throughout our day, I'm still sort of chuckling about the fact that I was saying protein because I spend so much time saying grams of protein, grams of protein. We don't always think about our grams of fiber. And that thing is so, so important and making sure that we're getting that pretty often for the sake of not just our bowel health, but our cardiovascular health and our GI and digestive health and our weight management as well. So it can be a really phenomenal tool. Like I said, start with where you're at. I think a lot of times we're really excited to embark in a new journey and that is wonderful, but sometimes a new journey can feel like a major life overhaul that can be really overwhelming. And so I like to recommend take a look at what are you doing already? What are the sources of fiber that you're getting in your diet, whether it's an apple, whether it's a bowl of oatmeal, whether it is an entree salad, or a specific vegetable that you really enjoy. What are you already doing and how can you lean into what your food preferences are already to start then increasing that slowly over time or how can you doctor certain recipes that you have to just start to bump up the fiber content. So one of my favorite foods, for example, is spinach. I think spinach is just amazing, particularly when it's cooked. I don't know how many times I will have to cook spinach and watch just a gigantic bag of spinach cooked down to a teeny tiny volume. And when you're doing that, you're not losing anything from it. You're just condensing it down into a more condensed version. So you've got all the vitamins, you've got all the minerals, you've got all of the fiber and everything that comes with that just condensed down. And so if you're making a pasta dish, for example, could you add spinach into it? If you're making an egg dish, could you add spinach into it? Certainly, like I said, I'm kind of on a spinach kick right now, and so that's on my mind. But are there things like that that you can do where you're already enjoying these foods, consuming these foods, and maybe you're just making slight modifications here and there. Even for example, if we're talking about breads, if you have a traditional white bread that you really enjoy, can you swap that out for something that is going to be more whole grain and provide you with more fiber? Maybe yes, maybe there's some really great options out there that you haven't explored yet. So play around with it a little bit. Spend some time reading labels for foods that are already pre-made to understand what is in them. Spend some time familiarizing yourself with the ingredients of certain recipes. And I don't like to go crazy, as you know with calorie counting or macro counting. And for me, fiber falls into the exact same category. I do not want you measuring your food or weighing your food or anything like that, but starting to understand, okay, let's say I have this big entree salad that provides me with 10 grams of fiber. Amazing. And I'm going to get a little bit in my breakfast and I'm going to get the rest of it in my dinner with my side of vegetables, thinking about how am I pulling in fiber to each meal? And just starting to ask yourself that question. And we can always do so. For the patients in my office, while I don't recommend calorie counting or macros or points or anything like that, what I will often do is pull data from a couple of typical days and look at maybe the calories and the macros or fiber and start to understand what's happening so that we can have a glimpse of, okay, which goal is it that we're working on adjusting over the next month? So certainly for any of my patients who are listening, I'd love to do that at a visit with you. If you are not a patient of mine, but you would like to be, I would love to help support you in your weight loss journey. This episode will go live in December, and as far as I'm concerned, December is the perfect time to lose weight. It's great. You can imagine that January is the busy season in my world, and I will have patients who join me in January, and I'm so excited to have any January joiners in the practice. But for anyone who is thinking, yeah, I'm going to think about this in the new year, I would encourage you to think about your weight loss goals in December. It's really empowering to go into the holiday season, having already started to think about this stuff, already started to make adjustments. We know that there's really good data that says a lot of people will gain a couple of pounds, especially during the holiday season each year, and that when we look at weight trajectory trends, while there are things like pregnancy or major illness for example, that can really change someone's body weight more commonly, people gain a couple of pounds per year. That slowly adds up over time, and so I'm inviting you to become a new December patient in my practice. If you are ready to work on your weight loss goals, I would love for you to reach out. I see patients in person in Charlottesville, Virginia, and throughout the state of Virginia and Illinois by telemedicine. To learn more about the practice and to work with me, you can visit www.sarahstombaughmd.com. I so would look forward to speaking with you and supporting you in your weight loss journey. Thank you to the listener who reached out to ask us about fiber. I'm so glad we got to address this topic today. A quick reminder that if you want to get something addressed, you let us know, and I would love to address that for you. I'll have the email address and our website in the show notes. Thank you so much for joining me today. I'll see you all next week. bye-bye.