A 4th Macronutrient: The key to health that 95% of people lack

If all of society’s health problems could be boiled down to one single ingredient, don’t you think we should focus on it?

I hope your answer is a clear yes like mine is. Now hang with me while we explore the root cause of the health epidemic in our world today, along with the simple, foolproof way of getting your body on a healing path.

What do you eat?

We are all familiar with the three basic macronutrients – fat, protein, and carbohydrates. Every single food can be broken down into these essential elements that the body uses to create cellular energy. In addition to carbs, fat, and protein, there are of course the vitamins, minerals, and other constituents that are derived from the earth itself!

One caveat; a lot of food these days is actually not food. You heard me right. Most of the middle of the grocery store is filled with food like substances. Look at any ingredient list and you will probably find some familiar food names (i.e. plants that grow in the ground). But, chances are you will also find unfamiliar items such as nitrites, benzoates, bromates, artificial colors, artificial flavoring, emulsifiers, and MSG, just to name a few. This doesn’t even include any of the tens of thousands of chemicals that are used in the farming food processing process itself. Let’s be clear that these items are not food. As such, we can agree that we should do our best to avoid such ingredients to the best of our ability. Most of the time, what this means is avoiding any processed or packaged foods and sticking to whole foods in their unadulterated form.

This simple, common sense recommendation will take a lot of people very far in their healing and wellness journey. Michael Pollan said it best. “Eat food. Not too much. Mostly plants.”

These days, we like to make things complicated. One such way is counting macronutrients. Moderating dietary fat, protein, or carbohydrates is the basic formula for any of the trendy diets that have risen to fame over the last few decades. As mentioned above, keep in mind that as long as we “eat food, not too much, and mostly plants,” we will probably be doing just fine, regardless of where macronutrients land. It is practically impossible to become fat deficient, carbohydrate deficient, or protein deficient if we approximately stick to an FDA recommended 2,000 calorie diet. That said, let’s take a quick look at the recommended dietary allowance (RDA) for these three macronutrients:

Fat – 20-35%

Carbs – 45-65%

Protein – 10-35%

As you can see, lots of wiggle room. Additionally, note that even individuals on long-term diets such as 90% carbs, 5% fat, and 5% protein do not develop any symptoms of fat or protein deficiency. In fact, many health conditions are prevented and reversed under low fat, low protein diets that focus on real, whole foods.

The 4th macronutrient: FIBER

Enough on fats, proteins, and carbohydrates.

 The reason I am writing this article is to inform you (or remind you) of a 4th macronutrient. OK, FIBER is actually not technically a macronutrient. Macronutrients are technically nutrients that can provide fuel for the body. While FIBER does not directly provide fuel for the body, it actually does provide fuel for the microorganisms inside of the body, specifically the gut (more on this in a bit). On the nutrition label, fiber is found under the heading of carbohydrates. Like all carbohydrates, fiber also comes from plants. It is known as being “indigestible” plant matter.

Because of its direct impact on the microbiota of the gut, fiber is sometimes referred to as ‘prebiotics’ or ‘microbiota-accessible carbohydrates (MACs).’

There is overwhelming research showing fiber intake inversely proportional with numerous disease (more fiber, less disease), I think it’s about time we take this long-neglected nutritional line item much more seriously. 

Personally, I’m a bit tired of the popular nutrition scene these days – keto this, low carb that. Protein bars, powders, and drinks. Vegan donuts washed down with a green juice. Lately, I choose to ignore all of it. I keep my head down, my chin up, and my mouth open to eat real food, and focus on getting as much fiber into my body as humanly possible!

Now, I’m going to tell you why you should also consider shifting your focus from counting carbs, fat, and protein to FIBER. 

More than roughage

There are many classifications of fiber, and it can actually get a bit confusing. That said, it’s easy to break fiber down (hah!) into being either soluble or insoluble, as these different types of fiber have different impacts on the body/gut.


Insoluble fibers such as cellulose and hemicellulose have a fecal bulking effect. As they reach the colon, they are not broken down and digested by bacteria, but mainly remain intact to bulk the stool. Insoluble fiber tends to draw water into the bowels which make for healthy, regular bowel movements.


Soluble fibers do not contribute to fecal bulking so much, but are fermented by the gut bacteria and thus give rise to metabolites such as short-chain fatty acids (SCFAs). Soluble fibers can also form a gel structure inside the intestines that can be beneficial for a number of reasons. More on this in a bit!

How Fiberful are you? 

The RDA for fiber is a measly 25-35 grams (depending on male vs female).  What’s more pathetic is that the vast majority of the population does not reach this daily recommendation. The US average fiber intake is reported at 15 grams! Only about HALF of the recommended allowance! To me, that is truly sad. 

Fiber has definitely taken a backseat on the nutrition stage. I hear things to the effect of…

“Eh, it’s just fiber.”

“You poop it out anyways.”

“It’s just for constipated old men.”

The reality is that fiber is extremely important for a number of reasons. Now, it is time for me to convince you to pay more attention to fiber, and hopefully, start consuming more of it!

Pass the fiber, please!

Now time to dive into the magical ingredient that gets flushed down the toilet at least a couple times per day (hopefully!).

Below I’ve listed out the top 5 most powerful benefits of eating a high fiber diet, however, please keep in mind the benefits of eating fiber extend for beyond what I am focusing on in these points below.

1. Microbiome benefits

The gut microbiome is all the rage these days. Probiotic foods, drinks, and supplements have become mainstream as awareness of the relationship between gut ecosystem to health and disease is enhanced. Put simply, what we put into our mouths doesn’t only feed and fuel the cells of our body, but also the bacteria cells within, which actually outnumber our human cells. This naturally begs the questions, “what am I, really?” and “who am I actually feeding?”

Our bodies are actually amazingly flexible and dynamic, able to metabolize almost anything to create cellular energy, from a ham and cheese omelet to a jelly-filled donut, to a carrot stick. When it comes to the microbes within, they are not quite as dynamic. Gut bacteria require a specific form of food. Can you guess what it is? FIBER!

Different types of soluble fiber from plants make their way into the intestines where they are broken down by bacteria – the good ones! When these bacteria break down the soluble fiber, they create short-chain fatty acids (SCFAs) (propionate and butyrate) which in turn fuel the cells that line the colon. Having optimal SCFA producing bacteria and subsequent SCFA levels in the colon has been shown to be crucial not only for gut and colon health, but also the prevention of numerous diseases like, inflammatory bowel disease (IBD), diabetes, obesity, cancer, allergies, autoimmune conditions, and cardiovascular disease, just to name a few (1).

We need good sources of fiber to keep the microbiome healthy and diverse. And, what’s really concerning is that a diet that is chronically low in fiber (i.e. standard American diet) may irreversibly lead to diminished microbial diversity and the extinction of various beneficial bacterial species in the gut (2). 

2. Blood sugar control

Have you ever cut a piece of raw okra to find it slimy on the inside? Or have you ever made a “flax egg” by mixing flax seeds with water? What about using the gel within an aloe vera leaf to soothe a sunburn?

Soluble fiber creates a gel-like matrix within the intestinal tract, much like what is observed in the above examples. Why would you want a gooey gel in your intestines?

When it comes to blood sugar, this gel-like substance in the gut delays the absorption of glucose, which can have a very profound and beneficial impact on blood sugar control. The presence of the gel matrix from soluble fiber prevents sudden surges in blood sugar that would otherwise be seen after a low fiber meal with processed and refined carbohydrates, fats, and protein (3).

The long-term consequence of elevated blood sugar is of course diabetes. Plenty of epidemiological data continues to show us that type 2 diabetes is strongly correlated with a low fiber diet, and subsequent diminished levels of fiber-degrading bacteria (4).

3. Cholesterol management

Recently, I saw a popular nutrition blogger post a photo of his blood work (I don’t want to mention any names here). He claimed to be on a ketogenic diet for the last couple of years, and he was boasting about his “normal” lab values. His total cholesterol was 190-something and his LDL was about 115 as I recall. Not only was his LDL abnormally high, out of the reference range, his total cholesterol was borderline. This might be “normal” in the sense that it is about average (or maybe even a little better than average) as far as the general population goes. I don’t know about you, but in a world where heart disease has been the leading cause of death  for 80+ years, and still claims the equivalent of 3 jumbo jets full of people every single day, I don’t want to be “normal.”

Somehow in popular nutrition these days, cholesterol is all of the sudden “off the hook” with regards to its role as a risk factor in cardiovascular disease, which is still the number 1 killer in this US. Maybe it’s due to narrowing in on the many different types of cholesterol molecules, particle size, etc. Nevertheless, managing cholesterol levels (naturally) should remain a primary goal for overall health and heart disease prevention. Analysis shows that pharmaceutical management of cholesterol, while lowering total cholesterol numbers, may be ineffective in preventing heart disease and stroke (5). What’s more is the list of side effects associated with statin therapy, and the list of iatrogenic conditions to which patients are predisposed. 

A diet that is replete with soluble fiber reduces cholesterol absorption via the formation of the gel-like matrix in the intestines. Increased fiber intake also helps to increase bile acid synthesis, which in turn directly lowers cholesterol levels in the blood (6).

4. GI health

By this point you are probably saying to yourself, “DUH! Of course eating fiber is beneficial for gut health.” Great. I’m glad you are on board. Now to dive in just a little bit for a deeper understanding.

Studies show that diets higher in soluble fibers can be effective in correcting gut dysbiosis (SIBO) and decreasing intestinal permeability (7). This is really important stuff! Intestinal permeability, i.e. leaky guy, has been a hot topic for some time. Many see this issue as a root cause of the development of allergies, autoimmune conditions, and even cancer!

Of course soluble fiber intake, as mentioned before, has a direct soothing effect on the gut lining. The gel of these soluble fibers coats the intestines to maintain a strong and healthy interface with the outside world. A resilient gut lining plus optimal microbiota diversity can make chronic GI conditions like IBS, SIBO, candida, and inflammatory bowel disease a thing of the past! Additionally, given that colorectal cancer, the 5th most common type of cancer is strongly associated with a high meat, low fiber diet, increasing dietary fiber is a key component for prevention (8).

5. Weight management

A study following 120,877 non-obese individuals showed that long-term weight gain was inversely correlated with dietary fiber (more fiber, less body weight) (9). Additional epidemiological data is consistent. The bottom line is that, for a number of reasons, individuals who tend to maintain a healthy weight are also much less likely to acquire chronic disease (10). 

There may be many reasons why adequate fiber intake is important to maintain a healthy weight and prevent diseases associated with obesity. I want to mention just two.

The first reason brings us back to the microbiome. Again, high fiber diets are associated with increased gut microbial diversity and lower long-term weight gain (11). 

The second reason brings us to the topic of nutritional density. Maybe you’ve heard the saying that Americans are “overfed and undernourished.” This is true. And has led to Dr. Joel Fuhrman’s work, coining the term, “nutritarian.” Essentially, he says to focus on getting as many nutrients into the body per calorie. He even created a little equation to guide us – “Health = nutrients/calories.”

I love this stuff. And, I think there is one piece missing.

One major reason for the obesity epidemic is food addiction and compulsive eating. Studies show that food addiction has a prevalence of just around 5% of the population, however based on numerous conversations with people, I can’t help but think that the numbers are most likely much higher than this. I think it’s true that many of us have an “insatiable appetite” which may have deeper, psychospiritual implications. Nevertheless, it is important to address food addiction and compulsive eating. One excellent and healthy way to do this is to fill the body with fiber.

Look at an 8-ounce steak next to an 8-ounce sweet potato. The steak has about 650 calories of pure fat and protein, not the optimal fuel for your cells. The potato has about 200 calories, >90% of which are complex carbohydrates, the optimal fuel for your cells. The steak has zero grams fiber and the potato has about 8 grams. Eating the potato probably won’t fill you up, but if you have 3 potatoes (which is something I do often!), chances are you’ll be pretty full (I know I am)! And, you will have gotten much more vitamins, minerals, and FIBER, while consuming fewer calories. Your body knows exactly what to do with these nutrients, which will help you to feel energized and content. 

How to bulk your bowels

If you go from 15 grams of fiber right up to 70 or 80 grams (a healthy goal) you will likely encounter some trouble!

Not only will you be faced with a mountain of food that may appear impossible to consume, but you may also overwhelm the microbes in the gut, leading to some short-term gas and bloating.

It’s like bringing a big tray of veggies and a couple tubs of hummus to a party.

If your friends at the party are busy consuming the cheese and crackers, the wonderful hummus and those delicious fresh veggies will just sit out in the open, and eventually go bad. An unfortunate event! 

If you bring the same big beautiful platter to another party where there are more of your friends who enjoy hummus and veggies, your platter will be thoroughly enjoyed (and, you will be very appreciated for your generous offering)!

The friends at the party are your microbiome and the hummus and veggies are, well, the hummus and veggies, i.e. fiber. If you don’t have an adequately diversified microbiome to digest the soluble fiber, you may overwhelm the microbes and cause some symptoms of gas and bloating. 

Many individuals find that they need to slowly bulk their diet with a diverse array of fiber sources. Think back to the hummus and veggies at the party. You can’t expect to just convert all of your friends into hummus lovers all at once. The hummus conversion is most likely a slow and steady event, with more and more people coming to enjoy the treat. 

I hear many people say “I just can’t do beans.” To me, what this really means is that, “I need beans, but I just don’t have the microbiota in place to help me digest them yet.” The answer to this is to simply increase fiber in the diet slowly, and from different sources. Have just a few garbanzo beans one night, some black beans the next night, and maybe some pintos the next. Have some sweet potatoes one night, an artichoke the next, and some onions or leeks the next. 

There is no right way to eat fiber, but there is a wrong way. The wrong way to eat fiber is to not eat fiber. 

In summary

“Eat food, not too much, mostly plants (fiber).”

I don’t like focusing in on any one particular thing. Doing so is the definition of reductionism. However, given that we are indeed in a world that appreciates reductionistic data, let’s at least focus on what matters most.

Breaking down food into the nutritional headings of fats, proteins, and carbohydrates is incomplete and does not support people in achieving health goals. Acquiring these basic macronutrients through the diet is never an issue in today’s world.

What is an issue is the adequate intake of fiber. In fact, fiber intake might be seen as the number one most important nutritional marker for overall health and longevity. Quite simply, this is because the more fiber a person has in their diet, the more whole plant foods they consume.

With a focus on consuming the most amounts of whole plant foods as possible, we can rest assured that nutritional deficiencies will be largely obsolete and rates of chronic, lifestyle-based disease will decline. By connecting with real food in this way, more people will experience a connection with their optimal health and their human potential in this life. 

Blessings of Health,

Dr. Benjamin Alter


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