Latest / The Antisocial Doctors Podcast / Episode 18: Is Fibermaxxing Worth It?

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Episode 18: Is Fibermaxxing Worth It? · The Antisocial Doctors Podcast

• 1:27
  Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
• 1:38
  Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
• 1:43
  Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
• 1:48
  Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
• 1:56
  Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
• 1:58
  Rebecca Berens MD: Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion that comes from social media's messaging around health.
• 2:05
  Rebecca Berens MD: In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.
• 2:12
  Sonia Singh MD: This is not your average debunking podcast.
• 2:14
  Sonia Singh MD: We wanna explore not just what is trending on social media, but why?
• 2:18
  Sonia Singh MD: Why are so many people drawn to this?
• 2:20
  Sonia Singh MD: What is the nugget of truth here?
• 2:21
  Sonia Singh MD: What are the facts?
• 2:23
  Sonia Singh MD: What can we learn from this as patients and doctors?
• 2:25
  Sonia Singh MD: No shame.
• 2:26
  Sonia Singh MD: No blame, no snark.
• 2:27
  Rebecca Berens MD: We're so glad you're here.
• 2:42
  Speaker 3: All right.
• 2:43
  Speaker 3: Hi Rebecca.
• 2:44
  Rebecca Berens MD: Hi Sonia.
• 2:46
  Speaker 3: So you just told me this was fun.
• 2:48
  Speaker 3: This episode.
• 2:48
  Rebecca Berens MD: Episode.
• 2:48
  Rebecca Berens MD: It was so fun.
• 2:49
  Rebecca Berens MD: Research.
• 2:51
  Rebecca Berens MD: It had so much fun.
• 2:52
  Speaker 3: Seemed like a fun topic, but honestly, I do love fiber.
• 2:55
  Speaker 3: I've always
• 2:55
  Rebecca Berens MD: been, I love fiber too, and that's why I was like, why we gotta make it a thing and destroy it, with this trend.
• 3:02
  Rebecca Berens MD: But anyway, we'll get into it.
• 3:04
  Speaker 3: Okay, tell us about the patient story that led us to cover this topic today.
• 3:08
  Rebecca Berens MD: Okay, so I have so there's a patient with a history of OCD and also Orthorexia.
• 3:13
  Rebecca Berens MD: So orthorexia is not an official diagnostic term, but it's basically, anorexia, but there's a specific preoccupation around the health cont content of foods, like nutrient content, clean ingredients, quote unquote, all of that.
• 3:26
  Rebecca Berens MD: Very common.
• 3:27
  Rebecca Berens MD: And it actually, particularly in people who have OCD but anyway, this patient was.
• 3:32
  Rebecca Berens MD: Is in recovery and, nutritionally restoring and all of that, but is eating such high fiber content at all of their meals that they're actually not able to get in enough calories.
• 3:42
  Rebecca Berens MD: And so this is not necessarily someone who is fiber maxing in the sense of the social media trend, although I'm sure that content probably influences them in some way.
• 3:52
  Rebecca Berens MD: But it is an example of one of the potential concerns I might have with fiber maxing.
• 3:57
  Rebecca Berens MD: I.
• 3:58
  Speaker 3: I actually had a story from just this past week of a, or maybe two weeks ago, a patient messaged me saying she saw, some study had just come out about the benefits of fiber and fiber goals for women in perimenopause and menopause.
• 4:11
  Speaker 3: And she was like, I saw that and I was like, I'm gonna get, 35 grams tomorrow.
• 4:15
  Speaker 3: And she immediately upped her fiber intake and she texted me because she was feeling terrible.
• 4:21
  Speaker 3: Yeah, this is a, this is fi, fiber is having a moment for sure, and I'm hearing about it a lot.
• 4:26
  Speaker 3: What is the claim around this specific fiber maxing trend?
• 4:30
  Speaker 3: Tell us more about that.
• 4:31
  Rebecca Berens MD: Yeah, so I think that the whole trend is, just fiber's so important, which okay, true.
• 4:36
  Rebecca Berens MD: And it, this is a way of making it a trendy, cool thing to do by giving it this fun name, fiber maxing.
• 4:43
  Rebecca Berens MD: Dramatically increasing your fiber intake.
• 4:46
  Rebecca Berens MD: And often it's even beyond the standard recommendations.
• 4:49
  Rebecca Berens MD: They'll say things like more fiber means better gut health.
• 4:52
  Rebecca Berens MD: Fiber will help you stay full and so it can help you lose weight.
• 4:54
  Rebecca Berens MD: And then most people are fiber deficient, so you really can't go wrong.
• 4:58
  Rebecca Berens MD: You need more, everyone needs more.
• 5:00
  Rebecca Berens MD: And then, adding.
• 5:01
  Rebecca Berens MD: Fiber to everything.
• 5:02
  Rebecca Berens MD: There's fiber soda, there's fiber powder you can mix into your current drinks that will turn your sugar into fiber.
• 5:09
  Rebecca Berens MD: There's all sorts of fun fiber products that you can buy that I've gotten targeted ads for since I started researching this episode.
• 5:15
  Rebecca Berens MD: So it's just like this sort of preoccupation with adding as much fiber as possible to meals and that it has all these health benefits and not really getting into the nuance of.
• 5:27
  Rebecca Berens MD: What that might actually mean.
• 5:30
  Sonia Singh MD: Okay.
• 5:30
  Sonia Singh MD: I'm really curious about this magical thing that turns sugar into fiber.
• 5:35
  Sonia Singh MD: I wanna hear more about, put a pin in that for sure.
• 5:38
  Rebecca Berens MD: Yeah.
• 5:38
  Speaker 3: Okay.
• 5:39
  Speaker 3: So why do you think that fiber is having a moment now?
• 5:43
  Speaker 3: Why is this particular trend so viral?
• 5:46
  Rebecca Berens MD: I think we managed to make every other, nutrient group.
• 5:51
  Rebecca Berens MD: An extreme version.
• 5:52
  Rebecca Berens MD: And so this was the last one that we hadn't done yet, right?
• 5:55
  Rebecca Berens MD: We've done low carb, we've done low fat, we've done keto, we've done carnivore, we've had done all these things.
• 6:00
  Rebecca Berens MD: And now it's okay, how can we make fiber into a disordered relationship with food?
• 6:06
  Rebecca Berens MD: And that's how we've managed to get there.
• 6:08
  Rebecca Berens MD: So thank you.
• 6:09
  Rebecca Berens MD: Fiber maxing for making fiber disordered.
• 6:11
  Rebecca Berens MD: And I think also, as we come back to, with all of these ways that things go viral is this is a thing you can sell, right?
• 6:18
  Rebecca Berens MD: You can sell fiber products to people, and so by creating a movement around increasing fiber, you can then sell this solution to that problem.
• 6:26
  Rebecca Berens MD: It's hard to eat enough fiber.
• 6:28
  Rebecca Berens MD: Here's the solution, buy this thing.
• 6:30
  Rebecca Berens MD: Buy this magical powder that turns sugar into fiber.
• 6:33
  Rebecca Berens MD: Buy this fiber soda, buy this thing and it will fix it.
• 6:35
  Rebecca Berens MD: And I think that messaging sells really well.
• 6:37
  Rebecca Berens MD: And it's in targeted ads.
• 6:39
  Rebecca Berens MD: Influencers are using these products, being sent these products to promote.
• 6:43
  Rebecca Berens MD: And so that just increases the visibility of fiber in people's social media feeds.
• 6:49
  Sonia Singh MD: Yeah, I think the general increased awareness around ultra processed foods and, this movement towards, as our HHS secretary says, eating real food I think there's increased awareness now that we don't get enough fiber.
• 7:04
  Sonia Singh MD: Which is good.
• 7:04
  Sonia Singh MD: I'm glad people are thinking about that because that is a true thing.
• 7:07
  Sonia Singh MD: I have been frustrated for many years by people becoming obsessed with protein when many of those people are probably getting adequate protein.
• 7:14
  Sonia Singh MD: I'm always like you should be a little bit more obsessed with your fiber.
• 7:17
  Rebecca Berens MD: Yeah.
• 7:18
  Sonia Singh MD: So I think, I think some of the virality is probably positive and warranted because, our diets as Americans have become much higher in ultra processed foods, which are typically low in fiber.
• 7:31
  Sonia Singh MD: So we're probably consuming historically.
• 7:33
  Sonia Singh MD: You can tell me, I don't know if you looked at this, but we're probably consuming historically low amounts.
• 7:38
  Sonia Singh MD: Prior to this trend.
• 7:39
  Rebecca Berens MD: Oh, absolutely.
• 7:40
  Rebecca Berens MD: Absolutely.
• 7:40
  Rebecca Berens MD: And I think, it is absolutely true that most people do not eat enough fiber.
• 7:44
  Rebecca Berens MD: That's true.
• 7:45
  Rebecca Berens MD: We'll get into the stats, but I think I think the thing that I find so interesting about fiber maxing and it's interesting that you say that about the nutrition guidelines because if you look at the new upside down pyramid.
• 7:54
  Rebecca Berens MD: The fiber's not really up there either.
• 7:57
  Speaker 3: Oh, interesting.
• 7:58
  Speaker 3: Okay.
• 7:59
  Rebecca Berens MD: I'm like, are beans on there?
• 8:00
  Rebecca Berens MD: I don't see them.
• 8:01
  Rebecca Berens MD: That's,
• 8:01
  Speaker 3: I know beans I see the beans
• 8:03
  Rebecca Berens MD: on.
• 8:03
  Rebecca Berens MD: It's it's interesting because it's yes we do lack fiber.
• 8:07
  Rebecca Berens MD: The problem with processed food is not that the ingredients are toxic, it's that a lot of the food matrix, which is a concept that we'll get into in this episode, has been removed.
• 8:15
  Rebecca Berens MD: And by food matrix, I mean the actual, scaffolding other pa are the parts of the food, right?
• 8:20
  Rebecca Berens MD: It's not just okay, there's X amount of sugar and X amount of fat and X amount of protein, and you put it in a drink, and now it's the same as that food.
• 8:26
  Rebecca Berens MD: It's not the way that it is arranged.
• 8:29
  Rebecca Berens MD: In the chemical structure of the food and the way that it is digested actually influences how you absorb those nutrients.
• 8:35
  Rebecca Berens MD: So it's not like you can get a sandwich and then recreate those macros in a drink and it's equivalent.
• 8:41
  Rebecca Berens MD: It's not even if it has the exact same macro content.
• 8:44
  Rebecca Berens MD: And so I think the, that's the interesting piece of this is we, we've started to realize the food matrix is important and rather than responding by.
• 8:57
  Rebecca Berens MD: A more natural food matrix.
• 8:58
  Rebecca Berens MD: It's buy this other product that's been engineered to add fiber to it.
• 9:03
  Sonia Singh MD: It's always about the shortcut or the hack.
• 9:05
  Sonia Singh MD: Yes.
• 9:05
  Sonia Singh MD: Like we're in the era of hacks and so basically, companies and influencers have looked at okay what are people, oh, they're, they realize that they're not getting enough fiber and they wanna get more fiber like.
• 9:16
  Sonia Singh MD: How can we create a immediate clickable short term, not even short term.
• 9:21
  Sonia Singh MD: It's not even a solution really, I think.
• 9:23
  Sonia Singh MD: But
• 9:23
  Rebecca Berens MD: yeah.
• 9:23
  Sonia Singh MD: How can we appease that desire with something we can sell them, basically.
• 9:27
  Sonia Singh MD: So I guess we're getting into this already, but.
• 9:29
  Sonia Singh MD: Can you talk about what you think the nugget of truth is in this obsession with fiber?
• 9:35
  Rebecca Berens MD: Yeah, so it is absolutely true that fiber is very important for our health and that most Americans do not eat enough of it.
• 9:41
  Rebecca Berens MD: And probably also in other, industrialized nations as I'm sure it's a similar issue.
• 9:46
  Rebecca Berens MD: I'm primarily researching American things since we are both in the us.
• 9:49
  Rebecca Berens MD: But I think part of the reason for that is modern diets of quick prep, eating on the go.
• 9:55
  Rebecca Berens MD: It's not feasible always for that to be a very high in fiber diet.
• 9:59
  Rebecca Berens MD: We have more things that are pre-prepared, shelf stable, fast to make, throw in the microwave for a minute at work or whatever.
• 10:07
  Rebecca Berens MD: And so in order for something to be quick to prep and easy to eat on the go, it probably has to be chained somewhat to remove some of the fiber.
• 10:16
  Rebecca Berens MD: 'cause fiber makes it take longer to cook.
• 10:18
  Rebecca Berens MD: And it's really an issue of like modern life, why we are not getting enough fiber.
• 10:25
  Rebecca Berens MD: And so that is, true, it's an issue.
• 10:26
  Rebecca Berens MD: And it does have health implications.
• 10:28
  Rebecca Berens MD: So I think that it's, I don't want that to get lost in my making fun of fiber products in this episode.
• 10:33
  Rebecca Berens MD: I think that, that is true and it is important to talk about.
• 10:37
  Sonia Singh MD: No, that's a really important point because I'm hating on hackers and shortcuts here, but the root of that, like why are people looking for hackers and shortcuts?
• 10:45
  Sonia Singh MD: It's because.
• 10:46
  Sonia Singh MD: They do not have the ability or bandwidth or resources or time or whatever it is to do it the longer route, yeah.
• 10:54
  Sonia Singh MD: And so that's why they're looking for these solutions and in some situations that's how they're gonna achieve the goal is by relying on some of these products.
• 11:01
  Sonia Singh MD: So it's not that these products are, I don't want to vilify all the fiber.
• 11:07
  Sonia Singh MD: There's certainly a role for them, for people, but I think getting into this and putting it in context and going through the nuances of some of the stuff around fiber maxing will be helpful.
• 11:16
  Sonia Singh MD: So how much fiber do we actually need and what is the data on how much Americans are typically getting.
• 11:22
  Rebecca Berens MD: I looked at the position statement from the Academy of Nutrition and Dietetics Health Implications of Dietary Fiber.
• 11:27
  Rebecca Berens MD: This was an excellent review of lots of data about fiber.
• 11:32
  Rebecca Berens MD: And what they reported is that populations that consume more dietary fiber have less chronic disease.
• 11:37
  Rebecca Berens MD: Should be surprising to no one.
• 11:39
  Rebecca Berens MD: Higher intake of dietary fiber reduces the risk of developing several chronic diseases including cardiovascular disease, type two diabetes, some cancers.
• 11:46
  Rebecca Berens MD: Adequate fiber intake is considered about 14 grams of total fiber per thousand calories.
• 11:53
  Rebecca Berens MD: So estimated needs of about 25 grams for an adult woman and 38 grams for an adult man.
• 11:57
  Rebecca Berens MD: And of course, this is an average, this is gonna vary depending on specific populations.
• 12:02
  Rebecca Berens MD: And so it's it's important to, that's just the baseline line amount that you need to get.
• 12:08
  Rebecca Berens MD: But then the mean intake of dietary fiber in the US is 17 grams a day and only 5% of the population is actually meeting the adequate intake.
• 12:18
  Rebecca Berens MD: So that's quite below the recommendations.
• 12:21
  Sonia Singh MD: Yeah.
• 12:21
  Sonia Singh MD: 5%.
• 12:23
  Rebecca Berens MD: Yeah.
• 12:24
  Rebecca Berens MD: I think I think there's all this buzz about ultra processed food and how it's so toxic.
• 12:27
  Rebecca Berens MD: I don't think it's that the food is toxic.
• 12:29
  Rebecca Berens MD: I think it's that we're not getting this very helpful component in our food.
• 12:34
  Rebecca Berens MD: And so it's not that the food is bad, it's just that we're missing a piece.
• 12:37
  Rebecca Berens MD: And again, that's where I think the food matrix is really important.
• 12:40
  Rebecca Berens MD: And as we said, vilifying the products is not helpful, but we have to find ways to get that stuff back into our diet because it has a lot of health implications.
• 12:50
  Speaker 3: Yeah.
• 12:50
  Speaker 3: And somebody might look at this study and say, oh my gosh, more dietary fiber, less chronic disease.
• 12:54
  Speaker 3: So let's just put it in a pill or a drink or shake and make sure we're getting enough, but that suffers from the same problem that you're describing with, ultra processed foods and thinking of it more about the individual toxic ingredients.
• 13:05
  Speaker 3: It's nutrition is not really about individual ingredients, oftentimes.
• 13:09
  Speaker 3: Yeah.
• 13:09
  Speaker 3: It's really about the entire diet or the entire food So anyway okay.
• 13:13
  Speaker 3: You have some other studies on fiber and the benefits of fiber, so
• 13:18
  Rebecca Berens MD: yeah, so I wanted to run down and just explain the three main types of fiber that we are talking about when we talk about fiber,'cause all fiber is not equal, and then how each of those types of fiber benefits us.
• 13:30
  Rebecca Berens MD: Because I think that's important to, to understand.
• 13:32
  Rebecca Berens MD: 'cause part of the issue is that even I, prior to researching this, I knew some of this, but I think I did not know in as much detail as I learned in my doing my research.
• 13:40
  Rebecca Berens MD: And I definitely think the average person doesn't necessarily know that there's a difference between different types of fiber or where those fibers are sourced from and what they do.
• 13:50
  Rebecca Berens MD: So first I just wanna run down with this and all of this data I got from, a a really great article that was a good read is called Understanding the Physics of Functional Fibers in the Gastrointestinal Tract, an evidence-based approach to Resolving Enduring misconceptions about insoluble fiber.
• 14:04
  Rebecca Berens MD: And so this, they, this was summarizing lots of data.
• 14:07
  Sonia Singh MD (2): They're basically like, fiber is so misunderstood
• 14:10
  Rebecca Berens MD: and it is, it's so misunderstood.
• 14:13
  Rebecca Berens MD: And they did, they explained it very well.
• 14:14
  Rebecca Berens MD: Okay, so first Type of fiber that I'm gonna talk about is insoluble fiber.
• 14:18
  Rebecca Berens MD: And so insoluble fiber natural sources would include whole grains, leafy green vegetables, skins of vegetables and fruits and then nuts and seeds.
• 14:29
  Rebecca Berens MD: And then supplemental forms would include cellulose based forms or mixed fiber products.
• 14:34
  Rebecca Berens MD: And the way that insoluble fiber is helpful is primarily for.
• 14:39
  Rebecca Berens MD: Increasing bowel regularity.
• 14:40
  Rebecca Berens MD: And the way that it does that is actually the larger particles of the insoluble fiber, irritate mechanically the lining of the large intestine and that stimulates more release of water and mucus to make the stool.
• 14:52
  Rebecca Berens MD: Slipperier and move through the intestines nicely.
• 14:55
  Rebecca Berens MD: If you grind it up too small and the particles are really small, it actually can have the opposite effect.
• 15:00
  Rebecca Berens MD: 'cause you get more bulk added to the stool, but it doesn't irritate the lighting the same way.
• 15:05
  Rebecca Berens MD: So it actually can be constipating.
• 15:07
  Rebecca Berens MD: So this is, I think, one of the reasons that people always talk about you can overdo it with fiber and especially if you're not thinking about the types correctly, adding a bunch of fiber in the wrong way could actually make you feel worse.
• 15:17
  Rebecca Berens MD: So that's one piece to it.
• 15:18
  Rebecca Berens MD: And then the other piece is with satiety.
• 15:20
  Rebecca Berens MD: So of course if you eat a larger volume of food, because fibrous foods are larger in volume, they take up physical space in your stomach.
• 15:28
  Rebecca Berens MD: That is going to stretch your stomach, you're gonna feel fuller.
• 15:31
  Rebecca Berens MD: And so it can result in lower overall calorie intake, which can have influence on, management of chronic diseases such as diabetes.
• 15:40
  Rebecca Berens MD: And then also just avoiding overeating because you're feeling more satiated and full after your meals.
• 15:47
  Sonia Singh MD: Okay, that makes sense.
• 15:48
  Rebecca Berens MD: Okay, so that's insoluble fiber.
• 15:50
  Rebecca Berens MD: The next one I'm gonna talk about is soluble fiber.
• 15:53
  Rebecca Berens MD: So natural sources of soluble fiber include oats and oat bran.
• 15:56
  Rebecca Berens MD: Legumes like beans, lentils, peas, edamame, fruits, like the flesh part of the fruits, berries especially vegetables.
• 16:03
  Rebecca Berens MD: And some other nuts and seeds and barley as well are awesome examples.
• 16:08
  Rebecca Berens MD: And then the supplements are highly viscous, soluble fibers that form a gel.
• 16:13
  Rebecca Berens MD: And so that is the important part about the soluble fiber.
• 16:15
  Rebecca Berens MD: When it gets into your gut and mixes with water, it forms a gel like substance.
• 16:20
  Rebecca Berens MD: And so the primary supplements that are useful for this would be cilium, Gugu, and beta glucan.
• 16:27
  Rebecca Berens MD: Okay?
• 16:27
  Rebecca Berens MD: And so this is what I think.
• 16:30
  Rebecca Berens MD: Most of us think about when we talk about fiber in terms of the benefits of it.
• 16:34
  Rebecca Berens MD: But again, this is a specific soluble fiber benefit.
• 16:37
  Rebecca Berens MD: And the reason that this is important is because it does have to be this like gel forming type of fiber.
• 16:45
  Rebecca Berens MD: Because when it mixes in your intestines with the, intestinal juices and water and all of that, and it forms that gel, it actually affects the mechanisms by which we absorb sugar and also traps cholesterol and eliminates bile from the stool.
• 16:59
  Rebecca Berens MD: And so in doing that, it.
• 17:00
  Rebecca Berens MD: Lowers serum cholesterol and it means we don't get as pronounced glucose spikes after meals.
• 17:06
  Rebecca Berens MD: So it improves our, ability to process glucose.
• 17:10
  Rebecca Berens MD: We have less of an insulin spike reduces high insulin responses.
• 17:13
  Rebecca Berens MD: And so it has an effect on glucose regulation as well.
• 17:17
  Rebecca Berens MD: So that's where the actual structure of the food is very important.
• 17:21
  Rebecca Berens MD: 'cause there has to be that viscous gel formed.
• 17:24
  Rebecca Berens MD: And not every fiber does that.
• 17:26
  Rebecca Berens MD: Only these specific soluble fibers do that.
• 17:29
  Sonia Singh MD: Wait, so you're saying all soluble fibers will do the make the gel or you're s.
• 17:33
  Sonia Singh MD: Specific.
• 17:33
  Rebecca Berens MD: So these specific supplemental ones do, and then not all soluble fibers do, but a lot of the fibers that are in the things that I mentioned, the soluble fibers will have a similar gel.
• 17:42
  Rebecca Berens MD: But when I'm talking about supplements, yes, it has to be those specific types that fall, that form the gel.
• 17:48
  Rebecca Berens MD: Other
• 17:48
  Sonia Singh MD: supplements may be insoluble fiber, and those would not have the same,
• 17:51
  Rebecca Berens MD: they may be insoluble fiber or they may be a prebiotic fiber, which I'm gonna get into next because there are some soluble, there's some fibers that.
• 17:59
  Rebecca Berens MD: Are what we call prebiotic.
• 18:02
  Rebecca Berens MD: And the prebiotic fibers are digested by the gut bacteria, so they actually don't stay in a gel form throughout the entire colon because they're getting digested by gut bacteria and so they can be beneficial in terms of supporting growth of healthy gut bacteria.
• 18:19
  Rebecca Berens MD: But they don't have these, the same gel-like formation that affects the absorption of nutrients and removal of cholesterol.
• 18:26
  Rebecca Berens MD: And so when I'm talking about these prebiotic fibers this would be things that come from natural sources like chicory root, Jerusalem artichokes, garlic, onions, leaks, asparagus and then the the supplemental ones are like the fiber gummies, the fiber sodas, the other fun fiber products.
• 18:42
  Rebecca Berens MD: They're all pretty much using these prebiotic fermentable fibers.
• 18:46
  Rebecca Berens MD: Often it's inulin, which is a polysaccharide known as a fructan, and then that fun turn your sugar into water or sorry, you're turning your sugar into fiber supplement that I talked about is an enzyme that turns sucrose into, levin fiber, which is another prebiotic fiber.
• 19:02
  Rebecca Berens MD: And so again, most of these fun products are talking about this kind of fiber.
• 19:07
  Rebecca Berens MD: And so the benefits in terms of the metabolic health benefits and the bowel regularity is not the same with these.
• 19:14
  Rebecca Berens MD: Now do they feed your gut bacteria?
• 19:15
  Rebecca Berens MD: Yes, but not necessarily in a way that actually has any tangible health benefits for you, especially at the doses that they are in The fun products like the sodas.
• 19:26
  Rebecca Berens MD: Interesting.
• 19:27
  Rebecca Berens MD: And so in order for a fiber to be useful for either bowel regularity or.
• 19:32
  Rebecca Berens MD: Metabolic health, it has to pass the whole way through.
• 19:36
  Rebecca Berens MD: And so if it's getting fermented, digested, turned into whatever by the gut bacteria, it's not passing the whole way through.
• 19:41
  Rebecca Berens MD: So it's not doing all of those things for you.
• 19:44
  Sonia Singh MD: Interesting.
• 19:45
  Sonia Singh MD: Okay.
• 19:46
  Rebecca Berens MD: But what it is doing is producing a lot of gas.
• 19:48
  Sonia Singh MD: Okay.
• 19:49
  Sonia Singh MD: So basically the big health benefits that often people are after, like lowering cholesterol.
• 19:55
  Sonia Singh MD: And lowering blood sugar.
• 19:57
  Sonia Singh MD: The, those benefits are mainly seen for soluble fiber.
• 20:01
  Rebecca Berens MD: Correct.
• 20:01
  Rebecca Berens MD: And things like increasing satiety and improving bowel regulation are mostly from insoluble fiber.
• 20:07
  Rebecca Berens MD: And so these prebiotic fermentable fibers, feed the gut bacteria.
• 20:12
  Rebecca Berens MD: That is true.
• 20:13
  Rebecca Berens MD: But
• 20:14
  Sonia Singh MD: You have some studies here looking at the benefits of the prebiotic fi fiber.
• 20:18
  Sonia Singh MD: So tell us about that.
• 20:22
  Rebecca Berens MD: There was a review a meta-analysis of 14 randomized, well-controlled clinical trials that show that none of the fructans, which is like the inulin and like these prebiotics soluble fibers I'm talking about showed evidence of improved glycemic control versus placebo.
• 20:37
  Sonia Singh MD: Oh,
• 20:38
  Rebecca Berens MD: and they also have no effect on stool output or stool softening.
• 20:43
  Rebecca Berens MD: So again, they're not doing.
• 20:46
  Rebecca Berens MD: Why, what we want fiber to do.
• 20:48
  Rebecca Berens MD: I think the other thing that was really interesting when I was researching about the, there's actually a couple of class action lawsuits against some of the popular fiber sodas.
• 20:56
  Rebecca Berens MD: So one of them against Poppy was filed in May of 2024 and settled in 2025.
• 21:01
  Rebecca Berens MD: This was in California, and they agreed to pay$8.9 million to resolve claims that it falsely advertised at.
• 21:07
  Rebecca Berens MD: Sodas as containing prebiotics for a healthy gut.
• 21:09
  Rebecca Berens MD: And then there was actually one filed in December of last year against OP in New York for the same thing.
• 21:15
  Rebecca Berens MD: And so that one's still ongoing.
• 21:16
  Rebecca Berens MD: But essentially the crux of both of these class action lawsuits is that the amount of prebiotic fiber in there is very low.
• 21:24
  Rebecca Berens MD: And so you would have to drink multiple of the sodas a day.
• 21:27
  Rebecca Berens MD: To even get a clinically relevant amount of the fiber into your gut and then also the amount of sugar that you would then drink in drinking that many sodas in a day would probably counteract any of the benefits that you might get from the fiber being there.
• 21:41
  Rebecca Berens MD: And then also the type of fiber that's in there is not the type of fiber that is doing the things that we want fiber to do for us in terms of our metabolic health and our bowel regularity.
• 21:51
  Sonia Singh MD: So, are there studies looking at just prebiotic fiber and benefits for.
• 21:57
  Sonia Singh MD: Gut health, which is like totally a, who knows what that phrase really means, but I don't know, changes in the microbiome related to that.
• 22:04
  Rebecca Berens MD: Yeah, that, that's the primary thing that they see is there can be stimulation of healthy bacteria growth in the gut, but again, the downstream effects of that does not result in improved stool output in stool, improved bowel regularity, or improved glycemic control or improved cholesterol.
• 22:20
  Rebecca Berens MD: So yes, they do increase the bacteria.
• 22:23
  Sonia Singh MD: Yes.
• 22:24
  Rebecca Berens MD: They don't necessarily do all these other things.
• 22:27
  Sonia Singh MD: Right, and the argument in these cases was that even though it has that prebiotic fiber, it's such a minuscule amount that the argument that drinking these sodas gives you a, improves your gut health is.
• 22:42
  Rebecca Berens MD: Yes.
• 22:42
  Sonia Singh MD: Okay.
• 22:44
  Sonia Singh MD: Yeah, that, it's, this feels like very intuitive to me'cause I'm like, when you think about what it's like to eat a carrot or an apple or a sweet potato or whatever, and then you think about drinking a poppy soda, I'm like, how can that possibly to do the same thing in your body?
• 23:00
  Sonia Singh MD: It's just a totally different.
• 23:03
  Sonia Singh MD: Experience, like you're chewing something that has some bulk and some it's some work versus you're drinking this clear, carbonated substance that just on some level I'm just like, yeah this checks out.
• 23:15
  Sonia Singh MD: That makes sense to me.
• 23:17
  Rebecca Berens MD: Yeah.
• 23:18
  Sonia Singh MD: Okay.
• 23:18
  Sonia Singh MD: Yeah,
• 23:18
  Rebecca Berens MD: so it just, it doesn't, it's just not the same thing.
• 23:20
  Rebecca Berens MD: It's not doing the same thing at all.
• 23:22
  Rebecca Berens MD: And what I did wanna talk about was as we talked about earlier in this episode.
• 23:26
  Rebecca Berens MD: We don't get enough fiber in our diets and a lot of that it has to do with just the time and ability to prep food and eat food on the go.
• 23:33
  Rebecca Berens MD: And so I did wanna talk a little bit about some things that people actually can do to add supplemental fiber that would be evidence-based and beneficial if they really can't get enough in their food.
• 23:43
  Rebecca Berens MD: And the things that have been studied to show.
• 23:45
  Rebecca Berens MD: Benefits are primarily, again, those soluble gel forming fibers.
• 23:50
  Rebecca Berens MD: And the important thing with this is the structure of that fiber ma matters.
• 23:54
  Rebecca Berens MD: And again, this comes down to the food matrix.
• 23:56
  Rebecca Berens MD: So if you, the more you change that fiber in the processing of the food, even by baking it, for example, versus mixing it in water, versus having it naturally occurring in the raw food.
• 24:10
  Rebecca Berens MD: It changes the physiologic effects on the blood sugar and cholesterol response that you get from that.
• 24:16
  Rebecca Berens MD: So there was a study called cholesterol lowering effect of beta glucan from OAT brand and mild mildly hypercholesterolemia patients may decrease when beta glucan is incorporated into bread and cookies.
• 24:26
  Rebecca Berens MD: And they had just 48 subjects.
• 24:28
  Rebecca Berens MD: It was a small study and they had three weeks of control eating bread and cookies, rich and wheat fiber.
• 24:33
  Rebecca Berens MD: And then for the next four weeks, by random assignment, they had 23 of them.
• 24:37
  Rebecca Berens MD: So about half continued the control products and 25 received rich and beta glucan bread and cookies.
• 24:44
  Rebecca Berens MD: And the total fiber intake didn't differ significantly between the groups.
• 24:49
  Rebecca Berens MD: But.
• 24:50
  Rebecca Berens MD: The structure of the fiber was different..
• 24:53
  Rebecca Berens MD: And then they at the end randomly assigned the subjects to consume orange juice containing either wheat fiber or beta-glucan.
• 25:01
  Rebecca Berens MD: And what they saw was the ones that were taking the drink with beta-glucan had.
• 25:07
  Rebecca Berens MD: Decreased cholesterol compared with the other drink that contained wheat fiber.
• 25:12
  Rebecca Berens MD: So those different types of fibers.
• 25:14
  Rebecca Berens MD: And so again, the way that the fibers are processed and the way that they then form the structure chemically in the intestines actually affects the way that you, that they impact the absorption of cholesterol and sugar.
• 25:29
  Sonia Singh MD: Okay.
• 25:30
  Sonia Singh MD: So basically all fibers are not equal.
• 25:32
  Sonia Singh MD: Correct.
• 25:32
  Sonia Singh MD: The type really matters.
• 25:33
  Sonia Singh MD: And even among the same type, the way it's been processed in the form that you're consuming it in really matters.
• 25:40
  Rebecca Berens MD: Correct?
• 25:40
  Rebecca Berens MD: Yeah.
• 25:41
  Rebecca Berens MD: And then I think that the takeaway from that for me is like.
• 25:45
  Rebecca Berens MD: High fiber food is important, but you need to look at where did the fiber come from?
• 25:49
  Rebecca Berens MD: Look at the actual label and the most common added one that's a prebiotic fiber is inulin.
• 25:54
  Rebecca Berens MD: So inulin is commonly added to increase fiber and get the label that says high fiber or excellent source of fiber.
• 26:01
  Rebecca Berens MD: But if it's primarily inulin, that's the fiber.
• 26:05
  Rebecca Berens MD: You're not actually getting a lot of those benefits that you would be getting if it was more of like the whole food fiber.
• 26:12
  Rebecca Berens MD: I'm
• 26:12
  Sonia Singh MD: curious about that original study that you talked about that showed reduced chronic disease in patients that were consuming more higher levels of fiber.
• 26:20
  Sonia Singh MD: I'm curious if they did a breakdown of what types,'cause I would wonder if now in like the current landscape, so many people are like, yeah, I'm getting the 35 grams.
• 26:27
  Sonia Singh MD: 'cause they're eating a bar or like a bunch of things that have inulin added to them.
• 26:31
  Sonia Singh MD: But maybe if you look at those outcomes, they're not gonna be as you would expect, based on the previous study.
• 26:37
  Sonia Singh MD: 'cause I would imagine it.
• 26:38
  Sonia Singh MD: There weren't as many fiber products in the marketplace, and so people were probably consuming.
• 26:43
  Sonia Singh MD: Other soluble and insoluble fibers.
• 26:45
  Rebecca Berens MD: Yeah.
• 26:46
  Rebecca Berens MD: So a lot of these studies were going back to the seventies, so yeah.
• 26:49
  Rebecca Berens MD: I think the point is that when they have studied it, it is different.
• 26:53
  Rebecca Berens MD: Yes.
• 26:53
  Rebecca Berens MD: And so it does matter.
• 26:54
  Rebecca Berens MD: But the one thing that's consistent is cilium fiber is one of the best study type of fibers.
• 27:00
  Rebecca Berens MD: And this is the one that's in the regular, over the counter, powder that you mix.
• 27:03
  Rebecca Berens MD: I'm gonna call out a brand here, Metamucil, just'cause everyone's heard of it.
• 27:06
  Rebecca Berens MD: But it doesn't have to be Metamucil brand, cilium fiber is what's important.
• 27:10
  Rebecca Berens MD: And that one is one of those ones that forms that gel.
• 27:13
  Rebecca Berens MD: Yeah.
• 27:13
  Rebecca Berens MD: And actually has more of an influence on absorption.
• 27:16
  Rebecca Berens MD: And then also is helpful for bowel regularity too.
• 27:19
  Rebecca Berens MD: Because of the way that it's holding water in the stool.
• 27:22
  Rebecca Berens MD: So if you're gonna add a fiber supplement because you can't get enough in your food, that would be the one I would add.
• 27:29
  Rebecca Berens MD: And that one is very cheap.
• 27:32
  Rebecca Berens MD: And it doesn't come in a trendy can or gummy, but it actually works.
• 27:37
  Rebecca Berens MD: But still primarily the best place to get it is from food.
• 27:40
  Rebecca Berens MD: And the concept of the food matrix is important.
• 27:42
  Rebecca Berens MD: And I think that's something that societally we need to be thinking about and like, how can we improve our access to high fiber foods and actually eating real fiber containing foods instead of having to do a bunch of supplemental stuff.
• 27:55
  Sonia Singh MD: Yeah.
• 27:56
  Sonia Singh MD: I have very savvy patients and so I've had this conversation with people about Metamucil and then they're like, but which one?
• 28:01
  Sonia Singh MD: And then I looked once and there's so many different types of Metamucil now'cause I think the original, the OG Metamucil, I think has sugar in it.
• 28:09
  Sonia Singh MD: And so then I.
• 28:11
  Sonia Singh MD: Artificial sweetener version of Metamucil, and then they had a no sweeteners at all.
• 28:15
  Sonia Singh MD: But I think that one is like really unpalatable.
• 28:18
  Sonia Singh MD: Yeah.
• 28:19
  Sonia Singh MD: It's hard to drink, but yeah, if you find yourself going down that rabbit hole where you're just like, I don't wanna drink any of these, then don't go back to looking at the food and seeing how that happened.
• 28:28
  Sonia Singh MD: But, yeah.
• 28:29
  Sonia Singh MD: So the shortcuts always come at some cost, so Price.
• 28:32
  Rebecca Berens MD: Absolutely.
• 28:33
  Rebecca Berens MD: Yeah.
• 28:33
  Rebecca Berens MD: And I think that, the, I've heard that also that complaint.
• 28:37
  Rebecca Berens MD: They're like, but I don't wanna have one that has sugar.
• 28:39
  Rebecca Berens MD: And I'm like, a little bit of sugar to make the Metamucil not taste terrible.
• 28:42
  Rebecca Berens MD: Yeah.
• 28:42
  Rebecca Berens MD: Is really not the end of the world.
• 28:44
  Rebecca Berens MD: I, I would probably prefer that to an artificial sugar.
• 28:47
  Rebecca Berens MD: 'cause a lot of people don't tolerate they all those very well, and those can have issues for your gut bacteria too.
• 28:51
  Rebecca Berens MD: So I'm just like, I'm less worried about that'cause you're getting a ton of fiber with it.
• 28:56
  Rebecca Berens MD: You do have to drink a significant quantity of it for it to be useful, and I think that's a big barrier for people.
• 29:01
  Rebecca Berens MD: And so again yes, as a supplement, I think it's great, but ideally we are looking at ways to increase the fiber in our foods and getting, if you can get a fiber fortified food that has.
• 29:11
  Rebecca Berens MD: Some type of non just prebiotic fiber in it.
• 29:15
  Rebecca Berens MD: That is also added.
• 29:17
  Rebecca Berens MD: I think that's a more beneficial way to increase your fiber.
• 29:21
  Sonia Singh MD: So we've covered ways that you can get a little bit more fiber in your diet if you're concerned about your fiber intake.
• 29:26
  Sonia Singh MD: But what is the flip side of that, of going too extreme and getting too much fiber or excessive supplemental fiber in your diet?
• 29:35
  Rebecca Berens MD: Yeah, so I think part of the reason that this trend has also exploded is there's not a lot of harm to it.
• 29:42
  Rebecca Berens MD: The main side effect is GI upset as we've alluded to.
• 29:46
  Rebecca Berens MD: So if you go from very little fiber to a lot of fiber very quickly, your body does not have a chance to adjust and you are going to be very uncomfortable.
• 29:53
  Rebecca Berens MD: You also have to make sure you're drinking enough fluid because the way that fiber helps move stool through your GI tract requires water.
• 30:01
  Rebecca Berens MD: And so if you.
• 30:02
  Rebecca Berens MD: Don't drink a lot of fluid and add a ton of fiber, you are probably just gonna make yourself feel more constipated and bloated, uncomfortable.
• 30:09
  Rebecca Berens MD: And then if you're adding specifically a lot of those prebiotic fibers, as I said, those produce gas as the part of the fermentation progress process.
• 30:17
  Rebecca Berens MD: And I just have to tell this really.
• 30:19
  Rebecca Berens MD: TMI.
• 30:19
  Rebecca Berens MD: But funny story.
• 30:20
  Rebecca Berens MD: So when I was at my first job, there was one of my colleagues that had a garden, and she brought me one day a bag of Jerusalem artichokes from her garden, which I had never had before.
• 30:32
  Rebecca Berens MD: I didn't know, really know what they're also called sunchokes.
• 30:35
  Sonia Singh MD: Oh, okay.
• 30:36
  Sonia Singh MD: Yes.
• 30:36
  Rebecca Berens MD: Okay.
• 30:36
  Rebecca Berens MD: So they're a little root vegetable looking thing and they look and taste like root vegetables and they're delicious.
• 30:41
  Rebecca Berens MD: And so anyway, my husband and I were so excited and so we like roasted them and we had them with dinner.
• 30:46
  Rebecca Berens MD: And Jerusalem, our chokes are a very powerful source of prebiotic fiber and we didn't really know that about them.
• 30:55
  Rebecca Berens MD: And we ate both a full serving.
• 30:58
  Rebecca Berens MD: Or more of Jerusalem artichokes, which I don't think is how they're designed to be eaten.
• 31:01
  Rebecca Berens MD: I think you're supposed to eat small amounts of them for exactly residue.
• 31:05
  Rebecca Berens MD: 'cause we were in so much pain, like for days like so uncomfortable.
• 31:10
  Rebecca Berens MD: 'cause yeah, I mean it pro produce produces a lot of gas and it can create a lot of.
• 31:15
  Rebecca Berens MD: GI discomfort and distress and changes in your stools and it's just very unpleasant.
• 31:20
  Rebecca Berens MD: And so again, I think if you're consuming a lot of fiber, particularly these like mostly prebiotics, supplemental fibers, you're probably gonna be pretty uncomfortable.
• 31:31
  Sonia Singh MD: It happens to the best of us.
• 31:33
  Rebecca Berens MD: Yeah.
• 31:33
  Rebecca Berens MD: So that is the main sort of Side effect, I guess I would say that could happen from fiber.
• 31:37
  Rebecca Berens MD: The other harms though, I think are important to consider and I think are maybe less well understood.
• 31:43
  Rebecca Berens MD: So as I mentioned with my patient story at the beginning, you can eat so much fiber that you're not eating enough other food.
• 31:50
  Rebecca Berens MD: And I do think this happens quite a bit in patients with orthorexia who are very like clean eating focused because they're typically eating very low calorie.
• 31:58
  Rebecca Berens MD: Other things.
• 31:59
  Rebecca Berens MD: And then they're having a lot of fiber foods, which again, there's most of these foods are lower in calories.
• 32:04
  Rebecca Berens MD: And it's also volume wise, quite dense.
• 32:06
  Rebecca Berens MD: And so their stomach is filled.
• 32:08
  Rebecca Berens MD: There's actually just not enough room to get the other calories in.
• 32:12
  Rebecca Berens MD: And so you really can crowd.
• 32:15
  Rebecca Berens MD: The other foods that you need, if you're eating too much fiber and miss out on other important nutrients, like enough carbs, enough fat, enough protein.
• 32:23
  Rebecca Berens MD: So it is possible to do that.
• 32:25
  Rebecca Berens MD: And then I think the la last thing I would say from like a harm perspective is I think the focus on fiber maxing is really promoting, buying a lot of supplemental products because it is difficult to do with food.
• 32:34
  Rebecca Berens MD: And so that's then resulting in people spending money.
• 32:37
  Rebecca Berens MD: On products that actually don't have the health benefits they claim to have or suggest that they have.
• 32:43
  Rebecca Berens MD: And that's probably displacing funds that could be spent on cheaper and more nutritious foods.
• 32:49
  Sonia Singh MD: Or food preparation services.
• 32:51
  Sonia Singh MD: Yeah.
• 32:51
  Sonia Singh MD: That, is actually going to make it possible for the full, the whole food to get into a person's mouth.
• 32:57
  Rebecca Berens MD: Yes.
• 32:57
  Sonia Singh MD: Yeah, that's an important point about the harms.
• 33:00
  Sonia Singh MD: Okay, so what can we learn from this as doctors and humans?
• 33:04
  Rebecca Berens MD: So I think the main thing I would take away from this is all fiber is not equal and there can be too much of a good thing.
• 33:09
  Rebecca Berens MD: And so when we're talking about increasing fiber, it's important.
• 33:12
  Rebecca Berens MD: We should probably all be thinking about it, but we wanna try to be thinking about it from food first.
• 33:19
  Rebecca Berens MD: And and the, there's really not a quick and easy solution for this.
• 33:23
  Rebecca Berens MD: And so it is more of a systemic issue that we need to solve of how to make.
• 33:29
  Rebecca Berens MD: Foods that are actual whole foods that are higher in fiber and more close to their original form with the original food matrix accessible to everyone.
• 33:39
  Rebecca Berens MD: And possible for people to slow down and actually prepare and eat real food instead of just work, work all day as our current habit.
• 33:48
  Sonia Singh MD: Yeah.
• 33:50
  Sonia Singh MD: The take home point for me is like you said, all fiber is not equal and that oftentimes the products that we perceive as shortcuts are not even the same type of fiber that has been more extensively studied as being beneficial.
• 34:01
  Sonia Singh MD: And so you may not be guaranteeing yourself really anything by having that sort.
• 34:06
  Sonia Singh MD: Safety net having an extra bar or shake or something that has that extra fiber.
• 34:12
  Sonia Singh MD: And how would you talk about this with your patients?
• 34:15
  Sonia Singh MD: Somebody who comes to you and is worried about their fiber intake or interested in fiber maxing?
• 34:19
  Rebecca Berens MD: Yeah, so in general.
• 34:22
  Rebecca Berens MD: Anything with the word maxing in it or two xs in it, it's probably not a thing that I would be recommending.
• 34:27
  Rebecca Berens MD: I think that if you're wanting to work on metabolic health, like I already do, talk to people about fiber and like, how much fiber are you eating?
• 34:34
  Rebecca Berens MD: Are you eating some fiber with each meal?
• 34:37
  Rebecca Berens MD: How, what are some ways that we could introduce a fiber rich food?
• 34:40
  Rebecca Berens MD: And like fruit for example, is really much more portable and easy way to add fiber to your meals.
• 34:46
  Rebecca Berens MD: So talking about increasing fiber slowly and gradually, adding a little bit to each meal, ensuring that you're drinking enough water for sure.
• 34:54
  Rebecca Berens MD: And then not wasting money on those fiber products.
• 34:58
  Rebecca Berens MD: Because the food sources are best.
• 34:59
  Rebecca Berens MD: Let's focus on.
• 35:00
  Rebecca Berens MD: How can we use the resources you have to get nutritious food and get it prepared and easily accessible for you to be able to eat when you need to.
• 35:09
  Rebecca Berens MD: And then if you do decide to use a supplement, the cheap stuff works the best anyway, buy the cheap supplement and I don't care if it has a little bit of sugar in it.
• 35:16
  Rebecca Berens MD: I would rather you have that because I know that it actually does something for you.
• 35:20
  Rebecca Berens MD: And I'm not convinced all this expensive stuff really does anything of any benefit.
• 35:23
  Rebecca Berens MD: There's not really clear data that it does other than make your stomach upset.
• 35:28
  Rebecca Berens MD: Yeah.
• 35:29
  Rebecca Berens MD: Okay, cool.
• 35:30
  Rebecca Berens MD: Where can people go for more info?
• 35:32
  Rebecca Berens MD: Yeah, we'll in, I'll include in the show notes a few.
• 35:35
  Rebecca Berens MD: The, of the GI dietician and nutrition experts that I love for this.
• 35:39
  Rebecca Berens MD: And all of the resources and references that I referenced today.
• 35:43
  Rebecca Berens MD: Okay, perfect.
• 35:44
  Rebecca Berens MD: Thanks Rebecca.
• 35:46
  Rebecca Berens MD: Yeah, thanks Sonya.
• 35:48
  Sonia Singh MD: Hey guys.
• 35:49
  Sonia Singh MD: Last but not least, we have a very important disclaimer.
• 35:53
  Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
• 35:57
  Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation diagnosis.
• 36:10
  Sonia Singh MD: Or treatment.
• 36:11
  Sonia Singh MD: Listening to this podcast does not establish a physician patient relationship between you and the hosts.
• 36:17
  Sonia Singh MD: We are doctors, but not your doctors.
• 36:19
  Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
• 36:26
  Sonia Singh MD: Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health, medical conditions, or treatment options.
• 36:34
  Sonia Singh MD: Never disregard or delay medical advice because of something you've heard on this podcast.
• 36:39
  Sonia Singh MD: While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated, although we do our best to stay up to date.
• 36:52
  Sonia Singh MD: Please note that this podcast includes discussion of.
• 36:55
  Sonia Singh MD: Emerging research, evolving medical concepts and differing professional opinions.
• 36:59
  Sonia Singh MD: Medicine is not static and information may change over time.
• 37:03
  Sonia Singh MD: We, the hosts make no guarantees about the accuracy completely, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors podcast, you have agreed to these terms.
• 37:19
  Sonia Singh MD: Thanks again for joining us.