Live Lean and Poop Better

Oh, and lower cholesterol, too. One thing does them all.

Note: I’m going on vacation today and I’ll be largely incommunicado for a couple of weeks, so please don’t expect a timely response if you ask a question or post a comment. HOWEVER, don’t even think about tipping off some of your hoodlum friends so they can break into my house and rob me while I’m gone because there’s a guy staying here to watch over things and he’s not really right in the head, plus I’ve got two intimidating dogs who I’ve had to scold several times for trying to eat people, not to mention that I’ve got this place rigged up far beyond what that Home Alone kid could dream up on his best day. So there.

If you were a fat epidemiologist – not an epidemiologist who’s portly, mind you, but an epidemiologist who studies obesity – you might pin part of the whole obesity epidemic on a 1977 U.S. Government publication that offered weight-loss guidelines based on the “calories in versus calories out” theory.

In short, the theory posited that energy “homeostasis,” the biological process that maintains weight stability by matching energy intake to energy expenditure over time is largely what determines how much fat a person carries. So, the theory suggests, calories are all that matters and if you eat a bunch of surplus calories, regardless of the composition of those calories (whether they came from protein, fat, or carbohydrates), you will, over time, get fatter.

Here's an example: Let’s say that the Tasmanian Devil from the Looney Tunes cartoons could eat his usual fare of tigers, lions, elephants, buffalo, donkeys, giraffes, octopi, rhinoceroses, moose, ducks, and of course, rabbits (all mostly protein sources), and this would have the same effect on his bodyfat percentage as snarfing down a calorically equivalent truck filled with say, Arby’s curly fries, or Ruffles’ Queso Cheese Flavored Potato Chips.

Acceptance of this theory caused a radical shift in the American diet, pushing citizens away from fat and towards refined carbohydrates. Sure, it made sense, at least on the surface. After all, a gram of fat has approximately 9 calories per gram while a gram of carbohydrate only has about 4. Eat less fat and replace it with carbs, so the theory suggests, and you’ll lose body fat.

But it didn’t pan out, did it?

As evidence of the effect of this calories-in, calories out theory, sneak a furtive glance at the person sitting to your right, and then another one to the person seated on your left. Chances are one or both are using their ample bellies as a cushion upon which to rest their ham-hock like forearms as they contemplate their next meal.

This is why most nutrition savvy people have adopted a relatively new theory of obesity called the “insulin imbalance” model (granted, obesity is a pretty complex problem and no one theory explains everything, but insulin imbalance seems to be a pretty big part of it). The insulin theory is based on the fact that increased consumption of refined, or processed, carbohydrate causes an elevation in insulin, which then ferries calories to be stored in fatty tissue.

But elevate insulin levels long enough, and you become insulin “resistant,” meaning your pancreas has to make more and more insulin to address the barrage of carbohydrate you’ve so rudely introduced into your blood stream. The body’s cells, particularly in the muscles, fat, and liver, then become less responsive to insulin and you get a buildup of sugar in the blood stream, for which the pancreas tries to compensate by making even more insulin, but it becomes futile and diabetes and high blood sugar and rotten cholesterol and fatness ensue.

It then stands to reason that if you decrease the intake of foods that kick insulin levels into the stratosphere and replace them with protein or healthy fats, or, alternately, take drugs or supplements that increase “insulin sensitivity” (reduce the amount of insulin needed to process whatever you just ate), you’ll drop inches and lbs.

Without going into in-depth explanations, this is partly how those GLP-1 drugs like Wegovy and Zepbound work. It’s partly how the drug metformin helps facilitate fat loss as a side effect. It’s why the Adkins diet and keto diets work. And it’s also how taking a simple dietary supplement like psyllium can help you passively (without exercise) lose body fat.

Yeah, psyllium, that mundane, inexpensive, powdery stuff in a canister of Metamucil that helps you poop.

Fat Loss for Nothin’, Chicks for Free

A recent meta-study (a study that compiles the results of a mess o’ studies) looked at the effects of regularly ingesting psyllium (the dried husks of the plant Plantago ovata) had on obese people.

On average, each of the subjects in 6 trials consumed approximately 10.8 grams of psyllium a day (a teaspoon of ground psyllium equals about 5 grams) for 5 months. All subjects took their psyllium, mixed in at least 8-10 ounces of water, twice a day before meals.

This simple modification to their diet led to an average weight loss of almost 4.5 pounds. They also reduced their waist sizes by about an inch.

Granted, that doesn’t sound like a lot, but keep in mind they made no changes to their diet or exercise. The weight loss was entirely passive in that it occurred with no additional effort by the test subjects.

Part of the weight loss probably resulted from increased satiety, i.e., the psyllium, taken before meals, swelled up and took up some space in the stomach, thereby increasing the feelings of fullness. However, it seems more likely that the psyllium increased insulin resistance (see above explanation) by improving glycemic control. What that means is that the psyllium slowed the absorption of food and thereby decreased blood glucose levels, thereby relieving the pancreas from having to dump inordinate amounts of insulin into the blood stream to counter the glucose. Over time, this increased the subjects’ insulin sensitivity and led to fat loss.

[if you really want to get into the nuts and bolts of psyllium’s effects on glycemic control, psyllium forms a viscous gel and increases the viscosity of the chyme (the slurry of food and acidic fluid), which slows the rate at which the chyme is mixed with digestive enzymes.

This may sound like it's something you might not want, but you do want it. The slowing of digestion slows the absorption of glucose, which is good. It also slows the absorption of certain nutrients, allowing them to travel farther into the distal ileum, where they're not normally found.

This unexpected delivery into the distal ileum sets off a cascade of events. Glucagon-like peptide-1 is released into the bloodstream, thus decreasing the secretion of glucagon (which slows down sugar production in the liver). Appetite is decreased, the growth of pancreatic beta-cells (cells that produce insulin) quickens, and insulin sensitivity improves.]

But as a Reminder, Psyllium Also Does Other Great Stuff

Psyllium is a 3-tool player. If it were a major league baseball player, it would command at least 10 million a year with a no-trade clause. Another one of its abilities is that it also reduces cholesterol. It does this by trapping bile, which is a substance secreted by the liver to emulsify fat particles so that they can be more easily absorbed by enzymes.

This is pretty cool because bile is usually recycled several times in a single meal, but when the bile is trapped by fiber and eliminated in the stool, the liver has to produce more bile.

This is relevant because cholesterol is a component of bile, so by forcing the liver to make more bile, a de facto reduction of cholesterol occurs. LDL cholesterol goes down without affecting HDL cholesterol.

Simple!

And now to complete our trifecta of psyllium’s beneficial effects, we come to pooping, which was psyllium’s initial claim to fame.

Some fiber supplements "cure" constipation by acting as stimulants or irritants of the colonic mucosa, thus causing the large bowel to expel the stubborn, dehydrated stool like an Irish bartender at closing time telling it that it “doesn’t have to go home, but it can’t stay here.” Psyllium, however, because of its gel-forming and fermentation resisting properties, resists dehydration so that it acts as a stool "normalizer," softening hard, constipated stools while also adding firmness to liquid or loose stools.

What about the Alleged Lead in Psyllium Products?

I use Metamucil for my psyllium needs because it tastes decent and it’s flavored, but the company was involved in multiple lawsuits regarding high levels of lead in some samples (presumably from soil contamination of fertilizers). I have no doubt this is true but lead contamination has been found in virtually all brands of psyllium.

However, it appears that Metamucil has been working to rid its product of this contamination, or at least lessen it, so I’ll take them at their word for now.

Until we’re sure, though, I would recommend taking the minimum effective dosage (one teaspoon, twice a day) which correlates nicely with the dosage used in the meta-studies involving weight loss.

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References:

Gibb, Roger, et al, Psyllium is a natural nonfermented gel-forming fiber that is effective for weight loss: A comprehensive review and meta-analysis, Journal of the American Association of Nurse Practitioners, August, 2023.

McRorie JW Jr. Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 1. Nutr Today. 2015 Mar;50(2):82-89.

McRorie JW Jr. Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2. Nutr Today. 2015 Mar;50(2):90-97.

Tucker LA. Dietary Fiber and Telomere Length in 5674 U.S. Adults: An NHANES Study of Biological Aging. Nutrients. 2018 Mar 23;10(4):400.

Luoma, TC. Luoma’s Big Damn Book of Knowledge, Harper Collins, Brooklyn, NY, 2017.