Why You're So Bloated on Ozempic

**Dr. Gabrielle Lyon** (0:00)
Only about 5% to 6% of American adults meet the adequate fiber intake. That means roughly 94% of this country is falling short. There was a recent 2025 case of a 45-year-old woman eating an enormous amount of pears and developing a complete small bowel obstruction requiring a surgical removal. She had no risk factors other than the sheer volume of fiber and pears that she ate.
Nearly half of patients discontinue GLP-1 therapy within one year, with GI side effects being the primary driver. And when you use a medication that delays gastric emptying on top of that, your stomach is essentially like a big traffic jam. Food sits there longer, gas accumulates, bloating intensifies, and nausea worsens. So this is the same pathophysiology we see in something called gastroparesis, or stomach paralysis. But the reality is, GLP-1 receptor agonists and dietary fiber are not opponents, they're partners. But these partners need to learn how to dance better. With all this talk about fiber, this brings us to what I think is the most underappreciated consequence of the GLP-1 revolution. Do I think we should fiber max or fiber min? I think we...
Our prediction is fiber will be the protein of 2027
I remember when Metamucil was the only talked about fiber supplement, and now the Arnold Schwarzenegger Pump Club also includes, you guessed it, fiber. There's a trend online right now called fiber maxing, and it's exactly what it sounds like. Creators pushing 40, 60, sometimes even more grounds of fiber a day to control appetite, support gut health, and drive weight loss. You've probably seen the version of this, where someone masses out on a large daily dose of psyllium husk for a month, and then reports dramatic weight loss. There was a recent 2025 case of a 45-year-old woman eating an enormous amount of pears and developing a complete small bowel obstruction, which means, number one, this is a medical emergency. Vowel obstruction means they cannot pass gas and they cannot go to the bathroom. All of this from a pear bezoar, which is a large ball of fiber.
Persimmons are the most usually implicated source of this phytobesor. Think of like a cat hair ball. And it's due to their high tannin content, which is a compound that somehow creates this ball. 23% of these bezoars are dissolved with Coca-Cola. So there are pros and cons to fiber and a diversity of fibers, which is what you want in the diet. But before we get into the numbers, is this fiber trend even directionally right and mechanistically sloppy? Well, your microbiome doesn't even matter. And most Americans genuinely are under eating fiber. Turning a nuanced nutrient into a single number, it's kind of like protein, to maximize it is the same mistake that we do with protein. Just to sum this up, should we be fiber maxing or should we not? Well, I'm going to let you decide, but I'm going to show you both sides. The FDA daily value for fibers, 28 grams a day, and this is based on a 2000 calorie diet. I don't know the last time it changed. This is what appears on the back of a food label. Only about five to six percent of American adults meet the adequate fiber intake.
That means roughly 94 percent or 95 percent of this country is falling short.
This is not a new problem. A 2024 New England Journal of Medicine review of the NHANES data, which is the data set that is typically quoted, found that 94 percent of Americans age one and older, basically everybody, miss the adequate intake for their life stage.
With adults 20 and older averaging just 17 grams a day, and roughly that's half of what is recommended. So the Academy of Nutrition and Dietetics found the same pattern with only about 5 percent of the population hitting the target of 14 grams per 1,000 calories. So this is a ton of words to just simply say, we are under-eating fiber. Two decades of nationally representative data and the needle has barely moved. So no, fiber is not a solved problem. But here is the reason I chose fiber maxing for this episode, the GLP-1 fiber paradox. Why the drug that needs fiber makes fiber hard to eat? And again, this is a class of drugs, the GLP-1 receptor agonist, we've all heard about somatotide, terzepotide, Ozempic, wagovi, manjourno, zepound, the list goes on, there are new emerging ones. All of these may need to start out with a fiber-mining diet. Yeah, first time you're hearing it, fiber-mining. And here's the paradox. These drugs desperately need dietary fiber to work optimally. But they also make fiber incredibly hard to tolerate. The GI side effects that make fiber hard to tolerate, and they're not rare.