Eating & Drinking

The three-part process of ingestion, digestion, and egestion (defecation) has direct effects on healing. Our food and drink choices roll up to the final cost—whether stools are easy to pass or hard and damaging. So in a sense, foods and fluids are the currency, or medium of exchange, of fissure repair.

If food and drink are like money, then eating and drinking are like trading in the stock market. Why? Because ingesting is like investing. Once we choose to consume food or drink, our natural pipeline works to extract value, millions of participants (often called “gut flora”) want their piece of the action, and—like anything cause-and-effect—our choice results in benefit, burden, or both.

But also like financial markets, it can be hard to know what forces are swirling under the surface. Genetics, biology, and bacteria can wield unseen influence, poor ingesting can exact hidden costs when we dispose of our stock, and—sadly—one catastrophic “flash crash” can wipe out an otherwise prudent record since a single bowel movement can cause, aggravate, or re-open a fissure.

As I learned, some food and drink choices conceal their full price until you correctly spot their role in a pattern. As a case study, here’s a personal experience:

For years, I ate a granulated high-fiber cereal before strenuous physical activity. The product performed as promised, providing noticeable and sustained energy. I often followed a serving suggestion from the box—heat the cereal and milk, top with butter and salt, then eat. Seemed fine. On one occasion, though, I ate my energy meal before doing demolition at a volunteer construction site. I drank fluids throughout the day, but as the cereal passed through my GI tract, it quietly congealed into an enormous, cement-like mass. You can guess the rest.

But what really caused the problem? Was it the cereal prepared in that specific way? Or was it the cereal plus pelvic floor tension produced by hard labor, which included squatting to lift large blocks of rebar and concrete? Did I get unusually dehydrated? Deplete electrolytes? I awoke early, so did I drink too much coffee to stay alert, thereby creating an outsized diuretic effect? Did I not get enough sleep? Was it my total food consumption that day, or had I eaten badly in the days and weeks beforehand? Did travel medicines from a recent Africa trip unbalance my personal bacteria portfolio? Were other factors in play?

Unfortunately, I didn’t think carefully about fissure causation at the time, and repeated the scenario about a year later—including construction and the same energy breakfast—with even more damaging results. Having finally gotten my own attention, I started thinking back on all previous episodes of digestive distress (there was some history here), and it became clear that my ingesting style definitely played a role. In fact, I began realizing that, despite other variables, poor results could often be traced to specific foods, food combinations, and habits—including the cereal. Conducting my own self-audit yielded good insights.

As I later found, revising an ingesting style can take some experimenting. The upside is that it’s easy and fun. Some of my results are below as a sample. But first, a helpful idea when discussing diet changes: you can always go back. Why make this point?

Through conversations with family and friends, I’ve learned to appreciate how deeply certain foods—or their absence—can affect some people. What’s more, “diet” can sounds like “restriction”, which can cause an instant barrier to change.

To overcome such resistance, consider making a prototype diet. A prototype is a sample or model that demonstrates intent without being ready for full use. By its nature, a prototype prompts its users to decide whether to go forward, make changes, choose a different option, or drop the venture altogether. So when it comes to eating habits, consider experimenting with a sample diet strategy for a few weeks as a prototype, knowing that you’re just exploring options. The decision to move to a new type of eating—or not—remains firmly in your grasp. Prototyping can do wonders for product development. It might help change eating habits as well.

If you choose to launch a new nutritional venture, consider consulting a qualified nutritionist or dietitian for guidance. Here are some ideas that I found useful:

Maximize mouth mechanics. One immediately helpful investment is to ensure good mouth use. Underperforming the act of chewing means passing food disassembly to other GI tract features, which can yield poorer results. Likewise, air we gulp down into our GI tract while eating can generate intestinal gas, causing borborygmus (intestinal rumbling) and the need to release flatus. So, simple as it sounds, thoroughly chewing food with the mouth closed will allow teeth, tongue, and other features to optimize their performance.

Lead, don’t follow, your diet. The word “diet” comes from a term meaning “manner of living” or “way of life.” In my experience, our modern “diet” is often influenced less by a well-balanced meal plan than by factors such as where we are, what we’re doing, who we’re with, how we feel, available options, advertising, funds, timing, and habits. Eating better, then, may be more about making life changes than menu changes, which can be difficult. Nonetheless, I learned that it’s important to lead your eating with at least a slightly firmer hand during repair.

For example, the variety of delicious cuisines available in Silicon Valley gradually moved my palate from simpler Midwestern fare to a wonderful world of heat and spice. As a result, even during my most painful moments I failed to notice that I was consuming hot and spicy peppers, curries, sauces, and salsas as usual, but without factoring in their excretory cost. Being attentive and cutting back a bit on my spicy diet would have spared me much pain.

You need energy. By the time I reached max pain and before I got serious about my protocol, I had lost between 10–20 pounds from food avoidance. Since I tapered down my food intake in rough proportion to increasing pain, it took a while for me to notice that I was becoming easily and unusually tired, even exhausted (a condition technically known as inanition). Plus, skipping meals sometimes built up increased GI tract pressure through excess intestinal gas, which had a direct negative influence on sphincteric tension.

Food is energy, so from my experience, minimizing food intake to avoid pain was a poor strategy that did not deliver positive results. A better approach would have been to start with a well-researched energy baseline, such as the USDA’s Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level (link available in References), and then craft an eating plan that would both deliver energy and help me heal.

You need mass. To decrease pain and promote healing, I also considered trying an all-liquid diet. However, a liquid diet devoid of fiber can cause constipation, and at least one medical reference highlighted a possible risk of anal stenosis (or anal stricture, a narrowing of the anal canal) if practiced over a period of time. Plus, the rigorous attention required to get needed nutrition from a liquid diet seemed neither realistic nor sustainable. So for me, working with food combinations (details coming up) ended up being more fun, satisfying, long-lasting, and productive. Why productive?

The Bristol Stool Form Scale is a diagnostic tool that divides the shape and form of digestive output into a range of seven types, from very hard to liquid. Normal stool is described as being “like a smooth, soft sausage or snake” (their words) and is about 75% water when fresh. Stools at either end of the scale can increase risk of fissures, hemorrhoidal inflammation disease, and other anorectal issues. So though it may seem counter-intuitive, especially when fissure pain is at a peak, it’s usually most productive to foster well-formed stools with sufficient mass.

Track your investments. Since mass and energy matter, I found it helpful to make a mental note of my food and beverage choices and their effects. When eating a meal, it may not be appetizing to look at the food in front of you and consider its mass and energy content, its overall alimentary performance, or the likely size, shape, and consistency of its final disposition. But doing so is instructive, and even a little extra attention may help you rapidly design your diet for optimal repair. As an example, see some of my findings in My Food-tracking Results.

Eat fiber, drink water, both in the right amount. Similar to the difference between spending to a budget versus simply spending money, I found that staying conscious of my results helped me better understand how my food and fluid choices affected me under various conditions. That understanding, in turn, helped me act more accurately when eating fiber and drinking water.

Surprisingly, though, I discovered that achieving a good daily intake of fiber and water can be harder than it first seems. Like money management, moving beyond the basics requires a little extra setup, follow-through, and knowledge. For details, see How to Get the Right Amount of Fiber and Water.

Trying to drink the right amount of water presented an additional challenge. Once consumed, water gets expended throughout the day by respiration (250–350 mL), urination (500–1000 mL), defecation (100–200 mL) and other causes (450–1900 mL). Some water is added back in through metabolic production (about 250–350 mL), but this still results in a net loss of about 1–3 liters per day (about 1–3 quarts). Most of these basic expenses are covered by recommended daily intakes, but other environmental and personal factors—hot weather or strenuous physical activity, for example—can quickly cause a deficit. But if achieving adequate hydration increases micturition (the need to urinate), covering that debt can feel like a real burden. So what to do?

I found that the trend of carrying and sipping from a water bottle is growing for good reason. Rather than drinking whole cups at once, smaller, steady swallows throughout the day provide welcome water without feeling flooded with fluids and repeatedly resorting to a restroom. In my case, filling two liter-sized water bottles, rather than re-filling a single bottle, helped me drink an appropriate amount of water each day.

One exception is a habit I practiced for the duration of my protocol. Shortly after waking up each morning, I heated a cup or two of water for about a minute in the microwave, which made it helpfully hot without needing to sip it. Drinking it in a few gulps almost guaranteed productive GI action within 20–40 minutes.

Measure your treasure. Whether it’s for fiber, water, or other nutrients, modern food labels, portion sizing charts, and nutritional guidance can help build a balanced daily intake. However, since I wasn’t in the habit of counting calories or measuring food, I found it challenging to translate lists of numbers into practical choices. If that sounds familiar, a little experimenting with a kitchen scale and a measuring cup can do wonders. Also consider these translation tips:

• Ounces in weight (oz) are different from fluid ounces (fl oz), which measure volume. Similarly, some measurements, like a cup, can mean a liquid measure (a cup of water), a dry measure (a cup of rice), or an approximate quantity (a cup of blueberries). Likewise, some measurements, such as a US liquid cup, have customary (8 fl oz) and official metric (240 mL) definitions.
• One US cup is 240 milliliters, or about 8 fluid ounces (1 cup = 240 mL ≈ 8 fl oz).
• One milliliter of water weighs one gram (1 mL = 1 g).
• One US customary cup of water weighs approximately half a pound, which is just under 240 grams (1 cup ≈ 0.5 lb wt ≈ 240 g). An 8 fluid ounce serving weighs about 237 grams.
• You can drink one US cup of liquid by taking about 12 medium-sized swallows.
• Two US cups is a pint, or about 480 milliliters (1 pint = 16 fl oz ≈ 480 mL).
• Four cups is a quart, which is just shy of a liter (1 quart = 32 fl oz ≈ 960 mL).
• One US quarter dollar (a “quarter”) weighs about five grams.
• One ounce of weight is approximately 28 grams (1 oz ≈ 28 g).
• In general, I found that five US quarters together weigh about an ounce.
• A $10 roll of quarters (40 quarters) weighs about 200 grams, or seven ounces, which is just under half a pound.
• One pound weighs 16 oz, or just under half a kilogram (1 lb = 16 oz ≈ .45 kg).
• Together, two rolls of quarters (80 quarters) weigh just under a pound.
• Together, five rolls of quarters (200 quarters) weigh about a kilogram.
• One quart of water weighs about 2.2 pounds (1 qt ≈ 2.2 lbs).
• One liter of water weighs 1 kilogram (1 L = 1 kg).

Ensure optimal softening. It’s a key recommendation made by medical professionals for fixing fissures, and I agree based on personal experience: you must keep your stools soft. Ideally, you’ll also keep them appropriately sized and exiting your body with predictable regularity. Here’s what worked for me:

Apples. I ended up eating several apples each day. I’ll give more details about how great apples worked in Stack your snacks and Take a food tour.

Salads. I was not a big salad eater, but once I began eating them regularly, the beneficial effects were obvious and undeniable. If salad doesn’t sound attractive, I understand—my previous experiences were often bland and boring, or featured unappetizing meats, copious creamy dressings, or bizarre vegetable/fruit/nut combinations, and I was forever finding unwanted ingredients lurking under the odd leaf. But salads need not be languid, insipid, or sneaky. For an exciting alternative, see Get creative.

Coconut oil. I started eating this common cooking oil directly as food and it worked great, but there’s a minor secret you need to know: organic virgin coconut oil liquefies at around 76 ˚F (24 ˚C), but can also get rock-solid at lower temperatures. Between those two states, though, it takes on a gel-like consistency (in my experience, at around 70–76 ˚F, or 21–24 ˚C), and I found that it’s easiest to eat as a gel. I first tried spreading it on graham crackers or sprinkling it with a little sugar, but eventually I simply ate about a teaspoonful each night before bed. It tastes like an oily and somewhat despondent Mounds bar, but the effect is not unpleasant if you don’t mind the taste of coconut. And the results were fantastic; between that and the other dietary changes I made, softer stools were virtually assured. Based on current research, I wouldn’t eat it straight as a regular part of my normal diet, but I’ll still occasionally eat a teaspoonful after a heavy meal or a day of strenuous activity.

Green juice. Eating well while traveling or being very busy can be challenging, yet this is when keeping stools soft is often most critical. While following my protocol and traversing the United States by car, I took a jar of coconut oil with me, kept it cool, and ate a spoonful nightly. However, I also drank up to three pre-made juice drinks daily, which, along with solid foods, provided needed liquid, mass, and energy. The widely available Odwalla Original Superfood, Naked Juice Company’s Green Machine, and Trader Joe’s Very Green 100% Juice Smoothie worked best for me, while Bolthouse Farms’ Green Goodness, the only option I could find in some locations, also performed well.

Papaya enzyme. There are over-the-counter medicinal options that do a great job of keeping stool soft (I say more about these in Medicine & Other Modalities), but if you want to stick with a mostly plant-based solution and don’t have the desire or circumstances to try the foods listed above, I found that chewable papaya enzyme tablets also helped soften stools. Ideally, food choices and practices would promote good digestion without needing further assistance, but if part-time help is desired, papaya enzyme tablets performed well for me.

Get creative. I’m not much of a cook, but food is an easy medium with which to experiment. To spark your own creativity, here are the results of two experiments: one a success, the other a failure. My apologies in advance to those who are competent in the kitchen:

Success: The unboring salad

Here’s an exciting, easy-to-make product:

• Romaine lettuce, or a mix of lettuce types and other leafy greens, like spinach
• Sliced carrots
• Sliced zucchini
• Diced red, orange, and yellow bell peppers
• Bread-and-butter pickles, and/or pickle relish
• Sweet & spicy pecans, peanuts, cashews, and/or sunflower seeds
• Shredded cheddar or pepper jack cheese
• Croutons or tortilla strips
• Pepperoni slices
• Banana or jalapeño peppers (if you can tolerate a bit more spice)
• Dried or fresh blackberries, blueberries, raspberries, or strawberries
• Catalina or sriracha ranch dressing

The carrots, peppers, and zucchini store well in a single container while fresh, which makes them easy to add to a bowl of lettuce. Along with the other items, a meal-sized salad can be assembled in a few minutes.

Failure: The PJ

Before getting serious about my protocol, I turned to prune juice to ensure optimal softening. To offset its taste and somewhat industrial mouth feel, I tried mixing it with other fruit juices, a splash of rum, and a dash of hot sauce. At one point, fighting a cold, I even threw in an Airborne tablet for added zing (which didn’t work at all, the prune juice being far too heavy to allow for effective effervescence). Since I intended that it be consumed right before bedtime, I called my creation “the PJ,” though after hearing its ingredients, a family member suggested that I call it the “Brown Mary,” which should have tipped me off that I was heading for failure.

And failed it did: the splash of rum would quickly lose its depressive effect, which allowed the prune juice to take its own boisterous action, which woke me from sleep virtually every time. Plus, the results were fast-acting in the sense of producing urgency, but far too unpredictable; I never knew when the PJ would deliver on its promise. Conceding defeat, I soon abandoned the PJ, prune juice, and all alcohol until things were well on their way to complete resolution.

Stack your snacks. While pursuing optimal softening, I thought about the way computers sometimes process jobs linearly and developed an eating technique that has, even now, brought amazing benefits: snack stacking. Maybe it’s already obvious or well-known, but it was a new practice for me, so I’m sharing it here.

In short, snack stacking means estimating the effect that a food or drink item will have on your digestion, thinking about that item’s relative position in your GI tract (your linear “stack”), and then eating or drinking a corresponding item to offset the risk of creating sub-optimal stool.

For example, say you drank plenty of water and ate nothing but salads, quinoa, green beans, whole grains, and almonds for two days. Then you went out with friends for the evening and indulged in a large, thick, low-water, low-fiber, and somewhat sticky meal followed by a dessert of triple-layer chocolate cake paired with a scoop of chocolate fudge ice cream sprinkled with crumbled premium dark chocolate. The following day you went back to a more disciplined diet. Everything eaten prior to that evening may pass optimally, but the sticky meal, cake, ice cream, and chocolate might ball up into a hard mass, and when they reach their turn to exit, could cause real problems. Meanwhile, everything stacked up behind that meal may be soft and optimized.

You see the issue. Overall, the ingesting strategy is good, but there’s a potentially serious problem in the pipeline. Other than abstinence, how might this situation have been avoided?

The snack-stacking answer is to eat or drink items already part of your typical diet that will disrupt the effects of any risk agents, and to do so soon after eating the risky foods. So for me, on arriving home for the night, I might eat one or two small apples, or maybe eat a tablespoon of coconut oil and drink a cup of hot water. If I plan to fall asleep soon after I get home and don’t expect a lot of GI transit, I might eat a small bowl of raisin bran shortly after I get up the next morning.

Do you see the concept? You’re not drastically changing your diet (hard to do), you’re not forever abstaining (hard to do), you’re not first reaching for remedies or medicines as a bail-out (could lead to other issues over time), and you’re not just accepting the damage that may come from a potentially unwise action. Instead, you’re leveraging the positive attributes of appropriate and familiar foods and fluids at the right time to keep the dinner and dessert remnants soft!

I call the offsetting items “snacks” because it might be hard to think of apples, coconut oil, hot water, or other softening agents as part of a meal, and because in my experience they can be consumed within a few hours after the meal and still have good results. But softening agents don’t need to be consumed as snacks—I found that incorporating them directly into a meal, or immediately before or after (such as a “finishing apple”) worked just as well.

What, though, if you’re concerned that a hardened mass already in your GI tract is beyond the reach of softening foods or liquids and may be difficult to pass? Possible solutions are presented in the section Medicine & Other Modalities.

Take a food tour. I found that one of the best ways to start making dietary changes is to go on a food tour. This fun and rewarding technique simply means having an adventurous spirit, an open mind, and a willingness to try new tastes, brands, and combinations when selecting foods and fluids that can promote repair. For me, experimenting led to many delicious discoveries such as sriracha-flavored almonds, chocolate almond milk, sloppy lentils (mixing sloppy joe sauce with lentils rather than ground beef), a newfound love for cashews, a rewarding truce with grilled asparagus, and helpful exposure to a dazzling range of tasty foods—including apples.

For example, if your prior experience with apples is limited to one or two varieties, or is jaded by memories of dry, tasteless institutional apples found in school lunchrooms, you might try this: buy one or two apples of every type available at your grocery store or local farmer’s market. If you’re thinking about snack-stacking and plan to eat 1–3 apples a day, select an approximate size that you believe will work best for you (2.5 to 3-inch diameter apples worked best for me). Then wash them well and start making them part of your diet for a few days—noting taste, texture, density, convenience factor, and especially effectiveness. Make sure to eat the peels. Biting into a wormy apple is disgusting, I agree, but don’t let that risk deter you—simply use an apple slicer to get the inside story.

You see the idea. A food tour, even a simple one, helps you prototype new ideas instead of staying stuck in a digestively damaging rut. You may discover new loves or develop better ingesting strategies. And you don’t allow your fissure-free future to be hampered by taste-forming experiences from the past.

Trade well. I’m going to risk overusing the financial markets analogy for two more important points:

The first point is that small trade-offs made in the moment can have a cumulative effect. For instance, eating or drinking something for taste while ignoring the final bill can cause a bout of unhelpful constipation. But repeatedly making that same trade-off can result in chronic straining, which can cause a wide range of wear-and-tear issues beyond a fissure (such as rectocele or enterocele in women, where the rectum or small bowel pushes against the vaginal wall). Conversely, a few small helpful changes to an ingesting strategy—including the proverbial “apple a day” (or two or three)—can yield positive results down the road.

The second point is a lesser-known and hard-won truth about investing: success is as much, if not more, about managing risk than about seeking profit. Eating and drinking are necessary and healthy and can be a great source of joy, so constantly worrying about the effects of digestion and defecation sounds like a recipe for discouragement…or worse. Nonetheless, I found that giving a modest amount of thoughtful attention and discipline to my diet—even if it meant temporarily focusing on the final bill rather than on food’s taste, familiarity, or ease of acquisition—yielded great results.

My Food-tracking Results

Since every body is different, I’m sharing the following lists to demonstrate a method rather than a menu. With a small investment of energy and attention, I built a repair-friendly collection of foods simply by evaluating the entire digestive transaction—from income to outflow. A written record or app might be helpful, but I found the most usable accounting method for me was simple mental notes.

(Content describing this part of my experience is available for purchase in other formats, and includes my personal observations over time grouped into four categories: "Worked great", "Worked well...if balanced with other techniques", "Wary", and "No way". A fifth category, "Everything else", is included below.)

Everything else

The previous lists didn’t represent my entire diet…I ate plenty of other foods. But since I neither ate them often nor noticed strong positive or negative effects, I felt no need to track them, which made my results easier to remember and use.

How to Get the Right Amount of Fiber and Water

While a good daily intake of fiber and water may help fix fissures, I found that ensuring optimal softening was faster and friendlier for repair. If you’re not interested in fiber or hydration calculations, here’s a simple sample softening plan that can be worked into a larger daily menu:

• 1–2 cups hot water right after waking up
• Raisin bran cereal with almond milk (plain, vanilla, or chocolate)
• 4–5 cups tea or water, sipped throughout the day
• Almonds or mixed nuts/seeds as snack food
• 2–4 apples as snacks or with meals
• Green juice smoothies if traveling (note that some store-bought options provide liquid and energy, but not a lot of fiber, if any)
• 1 cup hot water or tea an hour or so before bedtime

That said, a lot of information I found noted various health benefits that come from consuming adequate fiber and water. But when discussing diet, it’s important to realize that “fiber” and “water” have specific meanings:

• “Dietary fiber” is not a single substance with a single effect. Fiber comes in two forms, soluble and insoluble, which produce different results: soluble fiber dissolves in water to form a thick gel-like substance that retains water, while insoluble fiber stimulates water and mucous secretion in the large intestine by mechanically irritating the mucosa. Both can contribute to soft, easy-to-pass stools and other health benefits, and some natural foods contain both types. By noticing your network and focusing on feedback, you might find that one type is more favorable for fissure repair.
• “Total water” is defined as all water derived in a day from food, beverages, drinking water, and a small amount generated by metabolic processes, so a daily intake of “water” is more than simply cups of water drank in a day. It’s important to account for losses, too, such as from dehydration through sweating. Since sweat rates are unique to each individual and are influenced by environmental factors like altitude, ambient temperature, and relative humidity, as well as personal factors like fitness level, activity intensity, and acclimatization status, compensating for sweat loss can take extra attention.

With those points clarified, notice the following numbers. According to the U.S. Food and Nutrition Board, here are daily fiber recommendations (in grams) based on gender, age, and other key personal attributes (Table 1):

What about water? To be most useful, I found that daily water takes a three-step calculation. First, using data from the U.S. Food and Nutrition Board, find your approximate daily need for total water (Table 2):

Second, determine how much liquid you’ll need to drink by subtracting the water you expect to come from the foods you eat. If you’re willing to assume that your daily water intake from food is about 900 mL (an estimate published in 1993 by the National Academy of Sciences), then here’s the approximate amount of water you’ll need to get each day from drinking (Table 3):

As you consider your recommended amount, make adjustments as needed. For example, if you feel slightly over-hydrated and you get most of your fiber from fruits and vegetables, try drinking one less cup. If you feel under-hydrated and you eat mostly drier foods, try drinking one more cup. Adequate hydration is often indicated by a substantial output of clear or lightly-colored urine every 2–4 hours, so when making adjustments, be sure to evaluate your total results.

Third, determine whether your day’s activities will lead to higher water loss and then compensate as needed. As an example, here are a few personal rules of thumb I developed with a little research.

Under normal circumstances, drink an additional cup of water:

• For every 15 minutes of strenuous physical activity. Ideally, water would be consumed about an hour beforehand to make it available for absorption in the small intestine when needed, as well as during and after the activity.
• For every 30 minutes of sweating (without exercise) in hot/humid conditions.
• For every 60 minutes of cold-, fever-, or flu-like symptoms (unless directed otherwise).

In specific situations:

• Drink a cup of water for every 15 minutes in hot, arid, desert-like conditions, intense tropical conditions, or in a high salt environment (e.g., ocean swimming or surfing).
• Drink a cup of water for every 60 minutes of air travel (though this is mostly to compensate for extra water loss through physical exertion that can come with travel; according to the World Health Organization, there is no specific internal dehydration risk from a low-humidity cabin).
• Monitor any symptoms of acute digestive distress (e.g., vomiting, diarrhea) since water loss can accelerate rapidly in severe cases. At the same time, avoid extreme overhydration, since deliberately drinking much too much water can push the body’s balance of electrolytes beyond safe limits.

Again, adjust as needed to fit your personal circumstances.

For reference, here are the fiber and water recommendations as a single table (Table 4):

If you’re confident that you’ve gained some usable ideas and you’d prefer to keep things simple, head for the next section: Strength, Power, Endurance, & Flexibility.

However, if you can tolerate more details, I discovered a deeper story that may interest you.

Since healthy eating also means managing calories, cholesterol, fats, protein, sugars, salts, vitamins, minerals, and more, achieving good balance is not always easy. Even orchestrating just three elements—fiber, water, and calories—can be complex. Why so?

One reason is that “Calories,” the common term used on Nutrition Facts labels, is a user-friendly but technically imprecise stand-in for the more accurate “kilocalories” (often abbreviated as “kcal”, since one Calorie, which is also called the large calorie, equals one kilocalorie, which is 1000 small calories). As a result, some calculating may be required when trying to match dietary guidance provided in kcal with Nutrition Facts information provided in Calories. Similarly, if it’s unclear that Calories (sometimes spelled with a capital C to hint that they’re really kilocalories) are intended to express a food serving’s energy content, then newer food labels that also measure energy in joules, or more accurately kilojoules (kJ), could further complicate unfamiliar numbers.

A second reason is the easily-forgotten fact that foods have a fiber-to-calorie ratio. Attempting to get more fiber while sticking with low-fiber foods could mean consuming more calories—perhaps a lot more—to get the right amount of fiber, which can cause unwanted weight gain. On the other hand, trying to gain needed energy by eating lots of high fiber foods could lead to a buildup of intestinal gas.

A third reason is that fiber and water recommendations need to be personalized based on individual needs, especially if health conditions impose limits on fluid or fiber intake, or if increased fiber could worsen existing conditions. Getting the right amount of fiber and water might mean consulting a healthcare professional.

For a straightforward solution, consider getting most of your daily energy from nutrient-dense foods that have little or no added saturated fat, sugars, refined starches, or sodium, and that also contain needed vitamins, minerals, and—depending on the food—dietary fiber. According to the U.S. Food and Drug Administration, nutrient-dense foods include beans and peas, fruits, unsalted nuts and seeds, vegetables, whole grains, eggs, fat-free (skim) and low-fat (1%) dairy products, lean meats, poultry, and seafood.

If you’re up for some calculating, a more definitive plan awaits. Many resources can be found online, and I’ll offer two options here: a first approach based on simple numbers, public data, and a few personal rules of thumb, and a second precision-oriented approach based on publicly available resources and tools.

Here’s the simpler approach. First, find your approximate daily fiber need using the previous fiber table.

Next, divide your daily fiber need by three and round up to the nearest whole number. Why three? A brief survey of foods in my home, cross-referenced with the USDA Food Composition Databases, suggests that if dietary fiber is available in a food, most published serving sizes will yield a range of 1–6 grams per serving. If most of your food choices can hover around 3 grams of fiber per serving, it might be easier to feel confident about getting enough fiber without a lot of mental math.

For instance, in my pantry the Nutrition Facts labels say:

• A serving of almonds is 1/4 cup and contains 3g of fiber.
• A serving of whole grain oats cereal is 1 cup and contains 3g of fiber.
• A serving of whole wheat bread is 1 slice and contains 3g of fiber.
• A serving of corn tortilla chips is about 14 chips and contains 3g of fiber.
• A medium-sized apple is one serving and contains about 3g of fiber.

For me, using the 3g rule of thumb provides easy-to-remember amounts (Table 5):

For example, here’s a day’s partial menu that includes about thirteen 3g servings:

• 6g: Two cups toasted whole grain oats cereal
• 9g: Three slices of whole wheat bread
• 3g: One ounce of corn tortilla chips
• 6g: Two medium-sized apples
• 3g: A quarter cup of almonds (plain, salted, spiced, or seasoned)
• 3g: Just under a cup of green beans (cooked, spiced, grilled, or stir-fried)
• 3g: A cup of sweet yellow corn kernels
• 3g: A slice of pumpkin pie

Standard serving sizes also help simplify food energy calculations. For each of those foods that comes in a package, the Nutrition Facts label should show the amount of energy in Calories per serving. For non-packaged foods, the USDA Food Composition Databases can provide a Calorie (kcal) estimate. Applying those numbers yields these results:

• 6g: Two cups whole grain oats cereal = 100 kcal per cup = 200 kcal
• 9g: Three slices of whole wheat bread = 90 kcal per slice = 270 kcal
• 3g: One ounce of corn tortilla chips = 140 kcal
• 6g: Two medium-sized apples = 95 kcal per apple = 190 kcal
• 3g: A quarter cup of almonds ≈ 200 kcal
• 3g: Just under a cup of green beans ≈ 30 kcal
• 3g: A cup of sweet yellow corn kernels ≈ 110 kcal
• 3g: A slice of pumpkin pie ≈ 320 kcal

The total intake generates 39g of fiber and about 1460 kcal, putting this group of choices only 540 kcal away from a 2000 Calorie diet, and only 1040 kcal away from a 2500 Calorie diet. Additional energy can be obtained from non-fiber foods or fiber-containing foods. To detect an unhelpful excess of fiber, simply notice your network and focus on feedback for signals of gas, pain, cramping, or bloating. If you choose to consume a high fiber diet indefinitely, monitor your overall health to ensure you’re absorbing sufficient vitamins and minerals.

If you’re not worried about other food elements for now (fats, cholesterol, etc.), then a similar calculation can help you build a daily fiber and energy plan from your own food preferences.

Here’s the simpler approach as a single table, which is built on the assumptions that 900 mL of of your total water comes from food each day, that you adjust your water intake as needed, and that you know your energy needs (Table 6):

However, the simpler plan stays simple because it ignores detailed energy needs and a precise fiber-to-calorie ratio. A more accurate (but involved) approach builds an eating and drinking plan around specific energy needs for your body mass index (BMI), typical activity level, and any weight loss or weight gain goals.

Here’s the precision-oriented approach, which uses publicly available resources and tools:

1. Use the USDA’s DRI Calculator for Healthcare Professionals to quickly find your Body Mass Index, Estimated Daily Caloric Needs, and Recommended Intake per Day for Total Water and various macronutrients, including total fiber, vitamins, and minerals. If you’d prefer a less detailed estimate, use the USDA’s MyPlate Checklist Calculator. For a less personal estimate, check out National Geographic’s “What the World Eats” interactive charts, and then select the option that most closely resembles your eating style.
2. (Optional) Use the U.S. Center for Disease Control’s Adult BMI Calculator or BMI Percentile Calculator for Child and Teen to check your weight status (Underweight, Normal, Overweight, or Obese) in case you want to revise your daily calorie needs up or down.
3. On USDA’s MyPlate Daily Checklist, use the Age Group/Calorie Level table to determine an appropriate mix of food groups and Calorie targets.
4. Using your MyPlate Daily Checklist, create a prototype menu for a day, perhaps by gathering up food options already available in your home. For those foods that come with a Nutrition Facts label, estimate how much you’d actually eat, and then calculate and write down the corresponding amount of energy and fiber they provide. For foods that don’t come with a label, use a measuring cup and/or food scale to estimate weight or volume, and then record those quantities as well.
5. Use the USDA Food Composition Databases to research each food in your prototype menu and fill in any missing energy, fiber, and water numbers (I use several rounded or approximate numbers in the sample table below). For best results, select the “Nutrient Search” option, and then select the nutrients “Energy (kcal)”, “Fiber, total dietary (g)”, and “Water (g).” Record each number as part of your prototype menu.
6. Sum the energy amounts, the fiber amounts, and the water amounts. If your first attempt goes as mine did, you might find it both challenging and instructive to balance all three factors for even a day’s menu. However, with a little work, you’ll gain three solid estimates that you can compare to your recommended daily needs, and you’ll see where changes may be needed. Similarly, you’ll know how many cups of liquids you’ll need to drink to get your total daily water intake. We’re almost done.
7. Decide whether you’ll lose an unusually high amount of water, such as through environmental conditions (e.g., heat and humidity), personal conditions (e.g., planned physical exertion, illness, stress), or some other circumstances. Then use suggested hydration calculations, such as those at the University of Connecticut’s Korey Stringer Institute website, as a guide to estimate your additional water replacement needs. Or perhaps just review that website’s “Fluid Replacement After Exercise” table, which provides some useful results without a lot of calculating.

Here’s what a daily plan might look like for a 2800 Calorie (kcal) pattern with a target fiber intake of 38g (thirteen 3g servings) and a target total water intake of 3.7 liters (16 total cups), organized by foods to consume rather than as a menu of meals. Not included are added herbs, spices, sauces, salts, sugars, dressings, or other seasonings. Recall that one milliliter of water weighs one gram (Table 7):

As the previous table shows, being precise doesn’t equate to being exact. Even after trying to mix and match foods different ways, my sample plan is still over the recommended fiber and water intake, and slightly under the 2800 Calorie goal. But the process of building this list provided some usable insights that can help me adjust my typical daily intake. In reality, I’d probably eat less of some foods to account for calories delivered through sugar or other flavor enhancers, which might bring my fiber intake closer to the recommended 38g amount.

Once you’ve built a prototype plan, try implementing it for a few days. If my experience with prototypes holds true, you’ll quickly discover what will and won’t work for you, and you’ll gain a clearer path to your goals. Your deep dive into the details is paying off. Congratulations.

Now that we’ve got all that worked out, let’s move on to Strength, Power, Endurance, & Flexibility.

Last revised: June 2019