Patients may receive an ileostomy as either destination therapy (such as in proctocolectomy) or as a temporary diversion prior to anastomosis. While the formation of an ileostomy is often quite beneficial for the patient, it can be complicated by dehydration, electrolyte losses, malnutrition, and undesirable stool consistency. To combat these issues, physicians and nutritionists alike employ a variety of measures. One of the more controversial strategies utilized is fiber supplementation with an intention to increase ileostomy effluent viscosity, slow transit time, and reduce water and micronutrient losses. Despite its commonality, there is surprisingly minimal literature on this topic. Nonetheless, the predicted physiologic benefits of fiber in patients with an ileostomy are not matched in both observational studies and randomized controlled clinical trials.