Dietary Fiber: Tackling Constipation on GLP-1s

Like many medications, GLP 1 drugs come with side effects and one of the most common (and bothersome!) among them is constipation. Even if you're not taking anti-obesity medication, constipation remains a common problem for many, which is not only uncomfortable, but also detrimental to your well-being. 

In this episode, I’m looking at the pivotal role fiber plays, not only in combating this side effect, but also in your overall health and weight management. We’ll dive into the practical ways you can increase your fiber intake and explore some of the other benefits of a high-fiber diet, including its positive impact on the gut microbiome.

References

If you want to learn about the role of fiber in a lot more detail and have the opportunity to ask me questions, take a look at my mini course: Optimizing Fat Loss and Maintaining Muscle While on a GLP 1

This course is perfect for you if you are going to start a GLP 1 or you're already on one and want to fine tune your approach and get the most out of your GLP 1 medication. 

Audio Stamps

00:53 - Even if you're not on an anti-obesity medication, fiber is an important topic because a lot of people struggle with constipation.

01:43 - If you want to dig even deeper into this topic, Dr. Rentea encourages us to listen to her mini course: Optimizing Fat Loss and Maintaining Muscle While on a GLP-1. One of the modules there is all about getting enough fiber.

04:55 - We find out why we should care about dietary fiber.

05:37 - Dr. Rentea explains how you know if you’ve got constipation.

06:51 - We hear some practical advice about what will help constipation.

08:05 -  Dr. Rentea digs into how we can get more fiber into our diet.

10:45 - Dr. Rentea runs through some specific examples of high fiber foods.

14:22 - If you're still struggling with constipation despite making dietary changes, it's always worth getting an opinion from your doctor about what can be changed.

15:46 -  We discover the importance of fiber for helping to keep our gut microbiome healthy.

Quotes

“If we can get ahead of a problem, it's always better than waiting for you to have this crippling constipation and you not wanting to take the medication.” - Matthea Rentea MD

“In the same way that we're looking with every meal or snack if protein is involved, we're going to want to look as well if fiber is involved.” - Matthea Rentea MD

“Remember, with fiber, it's a slow game. We don't go from where you are to all the way up overnight.” - Matthea Rentea MD

“We know that to support the gut microbiome in the direction that we want it to be, you need to get that fiber.” - Matthea Rentea MD

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Transcript

0:29

Welcome back to another episode of the podcast. Today is going to be another one of those heavy hitter episodes, because we did a few weeks ago an episode on protein, and so many of you told me how much you enjoyed that episode. And I think that there are some topics that are just hard for people, and it's getting enough protein. It's getting enough fiber. It's getting that strength training in and navigating certain side effects if you are on the anti obesity medications. Now, this topic is relevant even if you're not on a medication because a lot of people struggle with constipation. I know, having come from a primary care background, there are certain things that you pretty much cannot go a day without managing multiple times. And those types of things include things like constipation, mental health, things like depression, musculoskeletal, things like back pain. So constipation is something that if you have a clinician that has spent any time in primary care or any time sort of in GI health or obesity medicine, all of those intersections Most of us all day long are dealing with constipation and also any other field, right? Because I always say it's the same patient that is being dealt with everywhere. So let's have a moment here. Number one, whenever it comes to constipation, again, everything here is for general educational purposes and always please talk to your doctor. We're going to talk about a few things in general. The one thing that I really want to encourage you though is that if you like these kind of topics and these kind of deep dives and sort of if you want even more information compared to what I sort of briefly talk about on here really getting into the details. I have a mini course now and it's called optimizing fat loss and maintaining muscle while on a GLP 1. And part of what I dig into there is getting enough fiber. That's actually one of the modules that I go through. And in addition to that, I've thrown in a bonus, a bonus here that was part of my blood sugar mastermind. When I. did a whole hour where I had two experts. They are both my sisters that are in the medical field. And I had them come in and talk about both over the counter medications as well as more supplements and different things we could eat. And so we really went in depth and I stuck that bonus into that mini course. So if you're someone that you want to learn in a whole, whole lot more detail. You also want to have handouts where it's like, Hey, these are the high fiber foods in all these different categories. Try all these different things. Let's try this, try that. There are all these different things you could think about. You will get a lot. I'm calling it a mini course just because it's not, you know, 50 hours worth of listening, but who even wants that anymore? So Part of this mini course is going to be on constipation. So again, we have some handouts in there. And the one unique thing, if you don't know about this course that I have yet, this mini course, it's really meant for someone that either is going to start a GLP 1 or you're already on one, you want to fine tune things. What's really unique about this course is that you can leave questions and I will answer them either in a monthly Q and A call or I will make a little video response to the question and kind of what my thoughts are for the answer and there's a question answer video bank that you can go through and that will accumulate over time. So while you're in there for a year, there's always going to be a lot of questions that people are asking and you'll continue to learn things as we go because everyone has a unique scenario. I'll give you an example. I'll sometimes have people say, I just really don't like to eat veggies. What do I do in that scenario? And so. Either me or my dietitians, we can kind of walk you through what our answers would be. Okay, so that the link for that is in the show notes here. If you ever have any questions about that for this episode in particular, you can go to rentiaclinic. com forward slash blog and when you see this episode about fiber, you can look. We always have a blog post that really writes out a lot of the different points that I make in the episodes and it'll have a link to this specific course. I'm really in love with the course. It's funny, all my patients that come in, I'm like, start with this course because it in the most succinct way possible breaks it down for them. It's what I always wish that everybody knew. And what's funny is, my first visit with patients are an hour and that's on top of, sorry, we're going to go left field for a second. Cause this helps you understand how important this course is. They already, prior to seeing me fill out about 16 pages worth of intake paperwork, right? So I've already reviewed all that. I'm meeting them, I've met them in a meeting group before, so I know all of that. We still in the first visit, I couldn't get to all these kind of points that I wanted them to know. And so I go over maybe the risks and the benefits of the medication, things like that, but I can't get into the nitty gritty. And so I literally have my patients listen to this course. Okay, so not to overstate the benefit, let's get into talking a little bit about fiber today. Okay. So. Why are we going to care about fiber? Number one, we're only going to care more about your dietary fiber. If you're someone that either already has constipation as a challenge or you are starting to increase medications and you're noticing it's a problem for you. Oftentimes if there's not a problem, we don't need to create a problem. I'm going to give you an example that some people don't struggle with constipation, but if you really do a dietary audit on them. They're actually already incorporating a lot of things that make it such that they don't have constipation. So I don't want you to think that some people are more privileged than others. Yes, genetics can either influence you or not to the gut being a little bit more stopped up compared to others, but also some people just are gravitating toward things that support their gut health more or not. So by the way, how do you even know if you have constipation? Constipation is a clinical diagnosis means that it's something that you tell the physician that it's not just that you don't go for a day or two. In fact, only 80 percent of people will go, will go to the bathroom about movement daily, but about one out of five, you might go two or three days in between. And again, you know, up to a few days, that's actually not a problem. Constipation is when you find that you are maybe getting. lower abdominal pain. Maybe you're getting cramping because your body wants to move this stuff along, but it can't. Maybe when you're on the toilet, you need to strain really hard. That's called Valsalva. Maybe you see little stars. Maybe it's painful when it comes out. Maybe you get some bleeding because you're getting hemorrhoids and fissures. So that is when we really start to think about constipation. So it's when it causes a challenge for you. It's when it causes a problem. So, let's say that this is a challenge for you, or you know that you might be starting on one of these anti obesity medications, the ones where I see the constipation happening the most, they're in that GLP 1 family, so whether that be daily Sexenda, weekly Wagovia, or Ozempic, or weekly Menjaro or Zep bound now. So again, it's within that class that I'm seeing the most constipation and it makes sense because the gut motility is slowed down. So stuff is sticking around more. So what are things that we can do that can help that out more? So when we're thinking about constipation, it's things like making sure there's enough water that people are moving. And one of the other things that we really think about our fiber. And again, I go through a lot of this in more detail within the course that I'm doing, but when we think about fiber, so just in general, we, I'm just going to talk to women for a second because women are majority of who's listening to me right now, for women, we want about 25 grams is great, but 30 is better. So you can start out again. You guys know how much I'm a fan of you all doing a nutrition audit and it's not in the name of being restrictive or feeling like we're on Weight Watchers and counting points. That's the opposite of what we're doing, but we're just trying to get a little assessment of where you're at. So I would just see on average, so do three days up to seven days, whatever you can handle. And I, when you average it out, dividing by how many days there were, what's the amount of fiber that you get? What's really interesting is most of my patients that come in are around 15 grams of fiber, one five. What's interesting about this is they inevitably, if they're at that amount, they're going to end up getting constipation as we either put them on a medication or increase. If we can get ahead of a problem, it's always better than waiting for you to have this crippling constipation and you not wanting to take the medication. Okay. So now that you know, you figured out. How do I figure out if I need, if I need, to be even worried about this, you know, symptom wise, what, how can I assess kind of where I'm at? And then, you know, maybe where you want to get to. The question always becomes, okay, how do I get this fiber? And again, I can only on this podcast do so much in these, in these topics. So again, That bonus call goes through so much of this, okay? Like literally the mechanics of all of this, but the point is there are different ways to get fiber and the the Challenging and frustrating thing is that everybody responds differently. So let's just go through a few of these So number one people think of things like fiber gummies Okay, I don't necessarily have a problem with you using these. I just don't see people getting amazing results. The other problem with fiber gummies is if you look at sort of how they produce these, they put the fiber and all of this together in the mixing process, and you really don't know when you're getting the gummy, if it has the amount of fiber or not, because a lot of that might have fallen to the bottom of the gelatinous material that they use. And so there's not. a guarantee, and this is with all supplements, they're, unless you really know the company and what they're doing behind the scenes, how often they're testing, you really can't guarantee that that gummy actually has it in it. So you end up basically just having like a glorified candy experience, and it's not really doing much for your stool. So I'm actually not such a big fan of the fiber gummies. The next area I think about are supplements over the counter like Betafiber and Metamucil. Those can work in some scenarios for people. And then I like to think more about fiber coming from fruits, veggies, legumes, things like beans, whole grains, and then again some other little random categories. How I like to do this to keep this easy with people, if someone is either headed into a GLP 1 or they're struggling with this, I like to start with, are you getting enough water? And then number two, are you getting some type of a fiber source with every meal or snack? So I don't care if that is That with breakfast you normally like to have eggs and now you're like, all right I'll stick some green beans or a little bit of cucumber next to it or half an avocado, right? Whatever you need to do to get some fiber next to that and again It's gonna change the way you're eating a little bit if you're just not used to maybe you like to do a yogurt in The morning, but it just doesn't have any fiber So in the same way that we're looking with every meal or snack is protein involved, we're going to, we're going to want to look as well is fiber involved. So that's my main thing. Most people, if they're doing that, again, they don't end up having challenges. Now, let's say that you're doing that. You're like, but I still have challenges. So you've looked at your audit and you're figuring out how much more to get. And honestly, the biggest struggle is what do I pick? People just don't know what's high in fiber. So I'm going to give you again, just like a few ideas here today. But there's no way that I can go over all of this because it's just so extensive. And so, again, I'm always going to recommend that this be an area where you meet with a skilled, either registered dietitian or if you know a nutritionist that really has an area that supports this. Again, it depends on their level of expertise and what they can provide, but they can go over for your particular taste palette and preferences, how could you get this in. But when I think about fruits, I think about things like apples pears are another really good source. Pears are not something that I'm hearing people eat all the time, right? They're not, they're not the darling favorite, but they have a very good amount of fiber. When I'm thinking about veggies, I'm thinking about things like broccoli. When I'm thinking about things like legumes or beans, I mean really any beans can do this. Some people really like chickpeas. Again, some of these sources, the reason that some people don't eat them as often is they're really worried about the carbohydrate content in them. But remember, whenever we're combining fiber and protein, with that carbohydrate, the glycemic load, meaning how much our sugar goes up, it is greatly reduced down how high that blood sugar curve is. So that's why I really encourage my patients to not shy away from things like, like chickpeas, because they tend to be something that actually gives a great source of carb, but also we're getting that protein and fiber. I also think about avocados. So avocados are an interesting one. Avocados have 10 grams of fiber. Maybe you don't eat the whole avocado, right? It can be quite calorie dense. However, even if you're having half of an avocado, it really gets you a far way to your goal. And, let's see, what else do I have on here? Of course, there are things like, like hemp hearts and chia seeds and, you know, different whole grain products. Something else that people can consider with fiber, and this works for some people and doesn't work for others. That's why it's not, like, a hundred percent. You have to go do this. But there are some products that they are processed. So definitely a company has sat down and said, look, we want to get the protein and the fiber in there, but they can still taste really good. One of my most recent obsessions here, I've probably talked about it on the protein episode are these they're called the better bagel and they have 25 grams of protein and it's over 30 grams of fiber and things like that. It's like you might not even need to eat a whole one. Maybe you eat a half of one, right? Because it's like too much for you at one time. It makes your stomach hurt. Remember, with fiber, it's a slow game. We don't go from where you are to all the way up overnight, and again, I go through much more of this in the course, kind of what my, what my thoughts are there. Because all of these things sound easy, but executed in the right way, you get amazing results. And if you do it, In a way that doesn't make sense, it, it, it ends up where you feel like, oh, that, that didn't work for me. But it's really because you either did it too quickly, like you jumped 10 levels higher when you should have started with one. So let's see here. So coming back to, coming back to kind of everything that I had on here. So once you have your water and you consider, am I going to be doing, either a fiber gummy, Benafiber Metamucil, am I going to get those veggies in? Other things to consider for, if we're talking about constipation that might be developing would be things like Miralax Magnesium, things like that. Again, I go over all of that within my course and I just, it's just one of those scenarios where I feel like it needs to have enough due diligence behind it for me to talk about it without out. It's just one of those scenarios where I feel like if you want to hear those details, that's a good place to come. Alright, so let's just talk about, in general, let's say you're doing all these things and they're not working out for you. Talk to your doctor. It's not just about upping this fiber content for you to get the results that you want. Sometimes it matters. There's a concept of soluble and insoluble fiber. And again, I'm not a dietician, so I'm not going to. go all the way down this rabbit hole. But I know enough to tell you that if you're struggling with this, it's 100 percent worth getting an opinion on this of what can be changed. Because often it's just a matter of switching up what you're eating, how you're eating it, all those kind of things for you to get better results. So I hope that this gives you some ideas for fiber. Maybe you hadn't thought of, oh yeah, whole grains count, or this counts, or that counts. And often this is where You know, it's helpful to look at the nutrition labels on things and while I'm not a fan of tracking all day long and sort of making this an overly involved process because it just doesn't last long term, but I think a period of education to figure out, oh yeah, that, that I could do this or I could do that. I think that these are Good ideas to kind of lock away. So I hope you got some great ideas today. Again, if you want to learn in a lot more detail and kind of be able to ask me stuff or have a few more handouts, kind of just have a little bit of a deeper level here. I think that would be a really great time to do that mini course. So we'll have the link down below for that optimal fat loss and maintaining your muscle on a GLP one. And this is what it's part of the one last thing that I didn't. touch on with us getting enough fiber, because I think I got so distracted by the constipation side, which is what I see so often, is that fiber helps to keep our gut microbiome healthy. And so if you have not heard this concept before, we need to do a whole podcast episode on it, but I want to Bring on an expert that can talk more about this so that that's to come in this year That's on my list because it's something that we talked a lot about in this blood sugar mastermind that I did recently. I did a little Members only podcast for them on it and it was it's fascinating how our gut microbiome works So if you've never heard about our gut microbiome before we have in our gut Millions. I think actually billions of bacteria. And so it's not that food just aimlessly comes in and out. These bacteria are actually processing our food in certain ways and doing different things. And what's interesting is the higher the weight set point, the more off the ratio is, meaning it's actually opposite the gut bacteria. And so no one knows is it that the gut bacteria is off and so you gain weight or does that cause the weight gain or does the weight gain cause it the other weight? Who knows, but we know that to support the gut microbiome in the direction that we want it to be, you need to get that fiber, so the prebiotic, the probiotic, all these type of things that are coming into the gut microbiome matter. So meaning, what are these bacteria feasting on? it might be very different if they're getting a processed food, not as helpful. If they are getting some of these whole foods, they act very differently. And so this is one of the reasons why when people come into work with me, everyone is so obsessed with calories in and calories out, and you just can't make a soundbite that's long enough online to explain to people the intersection of all of these concepts, right? That it's actually that If your gut microbiome is off, you're actually absorbing calories at a different rate. That's scary, right? To think that you compared to the person next to you, maybe they've never struggled with their weight. You are literally eating the same amounts and you are absorbing more of the calories because Because your gut microbiome is not doing great. And so a lot of what I work with my patients on is making sure that they nutritionally are supporting themselves in a way that we, at this moment, think to be helpful. And it's something that, of course, it's always going to change. I mean, this stuff's always evolving. I'm doing continuing medical education every week, right? You can never know enough. And if you have a clinician that thinks they know everything, that's problem number one. So, so this field is always evolving. But how you're eating, it really matters, and so I don't want you to give up on that. Continued learning and experimentation with what works in your body and how do you feel and so sometimes if your gut microbiome is really rocking and rolling along you're not having as much gas and bloating and you just feel better, you're not constantly sitting there with a stomach ache, things like that. So I'm gonna leave it here because we've gone in so many different directions today. Hopefully you got a few ideas for what to look for, how to either look if you even need more fiber, Ideas for how to go about that and different things you could look into if you have questions for me. Again, the best way here going forward is gonna be for you to be in that mini course to ask me underneath the video so I can make a really great answer for you so that it makes sense and it's cohesive for you. All right, I hope you all have a great rest of the week and we'll talk soon.