I’ve worked in a gastroenterology practice for the better part of a decade and, with each passing year, I see patients arrive at my doorstep on ever-growing lists of evermore expensive designer supplements to help manage their digestive woes. Call me old-fashioned, but I still find there’s one humble, low-tech, no-frills supplement that helps the largest number of my patients with the widest variety of their issues: fiber.
[See: Pharmacist Recommended Vitamins and Supplements.]
Fiber won’t fix everything. In fact, inflammatory digestive conditions like Crohn’s and colitis feel worse — not better — on supplemental fiber. Still, fiber can have a magical effect on a multitude of symptoms that impede quality of life for so many people. The trick is choosing the right fiber for your problem. Here’s how:
1. Choose soluble fiber if …
You are dealing with non-inflammatory diarrhea, alternating diarrhea with constipation, bowel urgency, too-frequent bowel movements or incomplete soft stools. My top picks are Citrucel (methylcellulose), Benefiber (wheat dextrin) and oat bran.
Soluble fiber absorbs water like a sponge, creating a formed, viscous mass that slows down the transit time through your gut. I describe it to my patients as “poo glue,” since it helps create soft, formed stools that consolidate straggling soft little pieces into a complete, log-like specimen. People prone to occasional constipation get nervous when they hear of this “slowing effect,” but rest assured, it really shouldn’t constipate. After all, it’s still fiber. And since it holds water so well, stools won’t become dried out while making their way to the exit. I like the types of fiber listed above because they’re among the least gassy options available.
Taken in the evening, soluble fiber works wonders for people with irritable bowel syndrome who typically spend their mornings running back and forth to the bathroom for hours. It’s also great for people who’ve had intestinal surgeries, weak rectal muscle tone or radiation-related inflammation and who experience watery, urgent stools or even fecal incontinence. A bulky, formed stool is a lot harder to slip out than a watery one, after all! Take one dose once per day with adequate water to start; you can increase up to three times daily if needed.
An increasingly popular source of soluble fiber is glucomannan, which is derived from the roots of the konjac plant. While it seems to be effective in regulating bowel movements, I steer patients away from it due to safety concerns: Its super-thick gelling capacity makes it more of a choking hazard than other soluble fiber options.
2. Choose insoluble fiber if …
You’re experiencing constipation, whether it’s opioid-induced or not. My go-to choices include Fibercon (calcium polycarbophil) and ground flaxseeds.
Insoluble fiber has the exact opposite effect of soluble fiber: It speeds up transit time of matter passing through the gut. It’s the type of coarse fiber in leafy greens, popcorn, fruit and vegetable skins, bran and seed hulls that can’t absorb water. It comes out pretty much how it looked going in. If you just need more bulky stimulation to get that poop moving through a sluggish gut, insoluble fiber is the best man for the job.
[See: What to Eat, Drink and Do to Relieve Constipation.]
If your constipation results from dysfunction of the pelvic floor muscles, fiber supplements will likely make things worse, not better. If you move your bowels only once per week or less, it’s best to check out this possibility with your doctor before taking extra fiber.
3. Choose psyllium husk fiber if …
You are aiming to lower your cholesterol. I like Konsyl and generic psyllium husk capsules or powder. Metamucil is another popular brand of psyllium husk fiber, but it’s quite high in sugar. You can look for sugar-free (artificially sweetened) and lower-sugar options, though.
Psyllium comes from a herb in the Plantago family whose seeds are known for their gelling properties. Its fiber content is about two-thirds soluble and one-third insoluble, which makes it helpful in steadying irregular bowel patterns — like those of people who swing back and forth between diarrhea and constipation. It may be a bit gassier than the pure soluble fiber supplements described above, though.
Where psyllium shines brightest is in its ability to help lower cholesterol. Its viscous, gooey texture traps both dietary cholesterol and a key building block of cholesterol in the gut so they can’t be absorbed. This forces your body to remove cholesterol from the blood to meet its needs. Research has shown regular use of psyllium husk can help reduce total cholesterol and bad “LDL” cholesterol by about 4 to 7 percent. Not too shabby!
4. Be careful of sugar content.
Flavored fiber supplements — like powders and gummies — can contain an appalling amount of sugar. One very popular brand of psyllium husk fiber contains 16 grams of sugar per dose — that’s equivalent to 4 teaspoons! You can avoid all that extra sugar by opting for sugar-free versions of powders (these will be artificially sweetened, though), pill forms instead of powders or completely unflavored products.
5. Avoid “prebiotic” ingredients if …
“Prebiotics” are types of fiber that are highly fermentable by specific types of gut bacteria, which in turn produce byproducts beneficial for gut health. Objectively speaking, prebiotics are health-promoting. Subjectively speaking, they can be very uncomfortable for some due to the large amount of gas that they can generate. Examples of prebiotic fibers include inulin (a.k.a. chicory root fiber and Jerusalem artichoke flour) and fructo-oligosaccharides (a.k.a. “FOS”). If you suffer from constipation or are already plagued with more gas than you can handle, you may want to steer clear of products that contain prebiotics.
6. Be aware of the fiber source.
Some fibers are derived from natural ingredients and others are synthetic. While there isn’t a functional advantage of one versus another, you may have a philosophical preference. Some fibers are derived from wheat and therefore are not suitable for people with celiac disease.
[See: 10 Weird Things That Can Make You Poop.]
7. Consider the cost.
Fiber should not be expensive. It’s cheap for companies to source, and you’re just going to poop it out, anyway. I’ve seen patients spend a fortune on designer, proprietary formulas sold by profit-seeking health practitioners. It’s overkill. I’d put my money on a store-brand version of any of the go-to products I described above in a head-to-head competition with the fanciest of newfangled fibers.
More from U.S. News
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How to Choose a Fiber Supplement originally appeared on usnews.com
