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For all patients, but particularly those with chronic constipation and constipation‐predominant IBS, it is important to initiate any fiber therapy gradually. Therefore, it is important for nurse practitioners to understand the mechanisms that drive a laxative effect, and to recognize which fibers have clinical evidence of a clinically meaningful laxative effect (e.g., psyllium, coarse wheat bran), versus which fibers can be constipating (e.g., wheat dextrin, finely ground wheat bran). Two fibers (soluble/fermented wheat dextrin and finely ground insoluble wheat bran) have actually been shown to decrease stool water content, resulting in a constipating effect (van den Heuvel et al., 2004, 2005; McRorie & Chey, 2016). Methylcellulose (chemically altered wood pulp) has an over‐the‐counter (OTC) indication for relief of constipation, but there are no well‐controlled clinical studies in constipated patients to support efficacy versus placebo. Fermented fibers (e.g., inulin, polydextrose, guar gum) increase flatulence but do not provide a laxative effect/regularity benefit (McRorie & Chey, 2016). For an isolated fiber to exert a laxative effect/regularity benefit, it must resist fermentation to remain intact throughout the large intestine, and it must increase stool water content, which is the primary mechanism for both stool bulking and stool softening (McRorie & McKeown, 2016). One patient may strain to pass a small, hard, “marble‐like,” stool every day (e.g., 7 BMs/week), while another may produce bulky/soft/easy‐to‐pass stools every other day (e.g., 3–4 BMs/week). Not all fibers provide a laxative effect or regularity benefit, and some can even be constipating. The studies show that psyllium lowers LDL cholesterol 6–24% and total cholesterol 2–20%, with the greatest reductions in studies with unrestricted diets and patients with high baseline cholesterol concentrations. 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