Fiber Deficiency Syndrome

poop emoji

How could I possibly resist starting a post about fiber without putting up the infamous pile of poop emoji? That is not to say that what I’m about to relate is a bunch of crap, mind you! πŸ™‚

So, I’ve been listening to some of the speakers at the Food Revolution Summit. On Saturday Dr. Michael Greger talked about foods that you should be eating, but probably are not. This morning Dr. David Perlmutter had a fascinating talk about the importance of the gut microbiome and it’s link to neurological health including Alzheimer’s, Parkinson’s and even autism. Seriously cool stuff. All of the talks at the Food Revolution Summit are free, just sign up and listen within 21 hours of them being broadcast. Not surprisingly, there is an option to purchase, but for the casual listeners the free option is groovy.

The much maligned 2015–2020 US Dietary Guidelines (see numerous previous posts if you’re confused about how I feel about them)Β  recommended 25–30 grams of fiber per day for adults. Studies have shown that few adults get more than 15 grams of fiber per day, which leads to a number of problems that I detailed in a previous post about constipation. In Dr. Greger’s talk he said that fiber was the #2 dietary deficiency in the United States (potassium being #1). He claimed that 92% of Americans are fiber deficient. I had never considered it in that context. Flipping the script, so to speak, from recommending supplementation as a way to meet a minimum standard to considering a low fiber diet as a disease state. While interesting, I thought it might be a stretch. To my surprise, chagrin, and amazement, I was missing a big part of the story that was filled in by Dr. Perlmutter’s talk.

It turns out that there is large and growing compendium of information regarding the previously unknown importance of what’s happening on the surface and inside our bodies and the emerging understanding of the incredible symbiosis between us and our bacteria. Really fascinating stuff with far reaching implications (beyond antibiotic use and the over-prevalence of hand sanitizers). A couple of highlights:

  1. Rice has more genes than humans. About 15,000–20,000 more. While the reason for this has been debated since it was discovered in 2002, there is an emerging belief that we humans have elected to “off load” some of our genetic programming to our symbiotic bacteria, who are much better suited to making quick changes as necessary. Just ask any physician who’s tried to treat a multiply resistant organism in a sick patient how quickly bacteria can adapt. This is considered to be similar to our current “cloud” technology (i.e. your iPhone stores your pictures in the cloud, not on your phone because it’s a more secure system (at least from loss)).
  2. There is an association between autism and C-section that has been pretty clearly described. Please note, this DOES NOT mean that C-sections CAUSE autism, just that researchers have noted that children born by C-section are statistically more likely to develop autism than vaginally delivered children. May turn out to be a statistical quirk and then again, it may not. The vagina is certainly not a sterile environment. Passage through “the birth canal” is now thought to help inoculate the newborns gut. Supporting evidence is that children with Austism Spectrum Disorder have a different gut biome than children without. This is the basis for a new realm of treatments including probiotics and possibly fecal transplant to help treat ASD. Crazy Stuff!
  3. Best quote: “Getting dietary advice from your physician is almost malpractice” Dr. Greger

The other interesting part, at least to me, is how hard it is to be a practicing physician and keep up with this stuff. It speaks volumes toΒ  how misplaced our priorities have become that it took retirement from clinical practice for me to begin to understand the error of my, and my colleagues, ways. I’m not sure how to fix that. One of the big, big problems is that knowing your patients are fiber deficient and encouraging them to correct it doesn’t really pay. It’s definitely the right thing to do, but it’s time consuming and docs are generally financially penalized for taking time to talk to patients. Moreover, as I have discussed previously, pretty much no physician asks their patients what they eat, at least not in detail.

Last, but not least, is the critical and usually disregarded method of increasing fiber in the diet. In classic Western Reductionist thinking, most docs who recommend increasing fiber recommend adding it as a supplement, Metamucil or something like that. I was very guilty of that as a physician. My bad, though. Docs, learn from my mistake. If your patients need more fiber (and they do, I promise) make them get it the old fashioned way. Beans, legumes, whole grains, fresh fruits and vegetables. We all took the Hippocratic oath when we graduated medical school, but I bet your school forgot to pass along what was probably the most helpful thing you should have learned from Hippocrates:

β€œLet food be thy medicine and medicine be thy food.”
― Hippocrates

 

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