ash13 norm robillard — did cavemen get heartburn?
DESCRIPTION
A new theory suggests that acid reflux is caused by carbohydrate malabsorption, small intestinal bacterial overgrowth (SIBO) and microbe-induced gas pressure. The pressure drives acid reflux much like dropping a Mentos in a bottle of coke. Difficult-to-digest Carbohydrates lactose, fructose, resistant starch, fiber and sugar alcohols are most likely to cause malabsorption and symptoms of SIBO-related conditions such as GERD and IBS. A novel calculation called fermentation potential (FP) can measure the gut symptom potential of any food. The low FP approach was successfully tested in a small clinical study in the Boston area.TRANSCRIPT
Did Cavemen Get Heartburn?Norm Robillard Ph.D.Founder, Digestive Health Institute
What is heartburn & GERD?GERD: Chronic acid reflux.Acid Reflux: When stomach contents escape past the LES – causes irritation.Reflux Symptoms: Heartburn, cough, sour/bitter taste, sore throat, hoarseness, sinus irritation, gas, bloating, nausea, LPR. Long Term Health Risks: Esophagitis, Barrett's esophagus, esophageal cancer.
PPIs and H2 blockersBlock the production of stomach acid
• Inhibit the absorption of vitamins, minerals and nutrients
• Lead to weakened bones and fractures of hip, wrist and spine – osteoporosis, calcium absorption hindered in the absence of acid
• Linked to pneumonia
• Linked to C diff (Clostridium difficile)
• Cause and perpetuate SIBO
• Cause dangerously low magnesium blood levels (hypomagnesaemia) - FDA warning
• Don’t address the underlying cause.
Underlying cause of Acid RefluxConventional• Relaxation of LES from alcohol, trigger foods
(TLESRs)
New concept • Carbohydrate malabsorption promotes small
intestinal bacterial overgrowth (SIBO - >106 bacteria per mL)
• Bacteria produce gas (Hydrogen, Carbon Dioxide, Methane) and intragastric pressure
• Drives reflux – like Mentos in Coke bottle
• LES is “forced” open.
Evidence SIBO causes Reflux
Restricting the growth of intestinal bacteria reduces the symptoms of reflux1,2,3
Reflux can be created experimentally with FOS (Gas, TLESRs, Symptoms)4
Reflux is associated with increased gas pressure in the stomach (and fundo side effects)5,6
Health conditions associated with malabsorption and SIBO are linked to Reflux7,8,9
SIBO has been detected in GERD patients10
Worst offenders for SIBO Fructose Lactose Fiber Sugar alcohols Amylose starch (resistant starch)
Fermentation Potential (FP) Formula
GI = Glycemic IndexNC = Net Carbs (g)DF = Dietary Fiber (g)SA = Sugar Alcohols (g)
FP Recommendations
FP recommendation for single meal◦0 to 7 grams - low◦8 to 15 grams - moderate◦ > 15 grams - high
FP recommendation for single day◦20 to 30 grams – low◦30 to 45 grams – moderate◦> 45 grams - High
Did Cavemen get Heartburn?
Occasionally◦Lots of plants - some high in fructose, fiber
and RS◦Periodic food poisoning likely
Protective◦Adapted to diet – unlike the “everything all
the time” (SAD diet), balanced microbiome◦No antibiotics or preservatives (more
diverse microbiome)◦Periodic fasting - gut healthy, prevents SIBO◦Seasonal diet
How about modern Foods?
Comparing Rices for FPFood (GI) Servin
g Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Jasmine Rice 5 0 Low
Glutinous Rice
5 3 Low
Basmati Rice
5 17 High
Brown Rice 5 19 High
Uncle Bens Rice
5 20 High
Comparing Fruits for FPFood Servin
g Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Watermelon 4 2 Low
Cantaloupe 4 4 Low
Grapes 4 11 Moderate
Banana, ripe 4 15 High
Banana, green
4 18 High
Dates 2 4 Low
Apricots 2 23 High
Comparing Tubers for FP
Food Serving Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Pontiac Potato
5 4 Low
Parsnip 5 5 Low
Taro 5 6 Low
Russet Potato
5 7 Low
Ontario Potato
5 13 Moderate
Sweet Potato
5 21 High
Comparing Dairy for FP
Food Serving Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Mozz cheese 2 1 Low
Plain Yogurt 8 7 Low
Sweet Yogurt
8 23 High
Cream 8 2 Low
Whole milk 8 8 Moderate
Chocolate milk
8 18 High
Comparing vegies for FPFood Servin
g Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Spinach 3 2 Low
Tomatoes 3 3 Low
Broccoli 3 4 Low
Avocado 3 6 Low
Squash 3 6 Low
Corn 3 9 Moderate
Plantain 3 16 High
FP values for Grains / Legumes
Food Serving Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Pasta (rice) 6 5 Low
Pasta (wheat)
6 28 High
French baguette
1 1 Low
7 grain bread
1 9 Moderate
Course Rye 1 14 Moderate
Soy beans 5 11 Moderate
Kidney beans
5 31 High
Comparing drinks for FPFood Servin
g Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Coconut milk
9 0 Low
Rum, whiskey, vodka, gin, etc.
1 0 Low
Lite beer, dry wine
12, 7 2 Low
Non lite beer
12 6 Low
Orange juice 9 14 Moderate
Apple juice 9 18 High
FP values for meats, fats and seafood
Food Serving Size (Oz)
Ferm. Potent. (G)
Symptom Potential
Beef, pork, chicken, etc.
6 0 Low
Fish, shellfish 6 0 Low
Lard, talow, ghee, butter, oils
3 0 Low
Clinical study of Fast Tract Diet heartburn symptoms
Clinical study of Fast Tract Diet
gas related symptoms
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disease after initiation of a low-carbohydrate diet: five brief cased reports. Altern Ther health med. 2001. Nov-Dec; 7(6):120,116-119. Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12.
2. Pennathur A, Tran A, Cioppi M, Fayad J, Sieren GL, Little AG. Erythromycin strengthens the defective lower esophageal sphincter in patients with gastroesophageal reflux disease. Am J Surg. 1994 Jan;167(1):169-173. Pehl C, Pfeiffer A, Wendl B, Stellwag B, Kaess H. Effect of erythromycin on postprandial gastroesophageal reflux in reflux esophagitis. Dis Esophagus. 1997 Jan;10(1):34-37.
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4. Piche T, des Varannes SB, Sacher-Huvelin S, Holst JJ, Cuber JC, Galmiche JP. Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. Gastroenterology. 2003 Apr;124(4):894-902.
5. Dodds WJ, Dent J, Hogan WK, Helm JF, Hauser R, Patel GK, Egide MS, Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N. Engl J Med. 1982. Dec 16;307(25):1547-52. Lin M, Triadafilopoulos G. Belching: dyspepsia or gastroesophageal reflux disease? Am J Gastroenterol. 2003 Oct;98(10):2139-45.
References6. Vakil N, Shaw M, Kirby R. Clinical effectiveness of laparoscopic fundoplication in a US
community. Am J Med. 2003 Jan;114(1):1-5. Klaus A, Hinder RA, DeVault KR, Achem SR. Bowel dysfunction after laparoscopic anti reflux surgery: incidence, severity, and clinical course. Am J Med. 2003 Jan;114(1):6-9. Beldi G, Gláttli A. Long-term gastrointestinal symptoms after laparoscopic Nissen fundoplication. Surg Laparosc Endosc Percutan Tech. 2002 Oct;12(5):316-9.
7. Ledson MJ, Tran J, Walshaw MJ. Prevalence and mechanisms of gastro-oesophageal reflux in adult cystic fibrosis patients. J R Soc Med. 1998 Jan;91(1):7-9. Vic P, Tassin E, Turck D, Gottrand F, Launay V, Farriaux JP. Frequency of gastroesophageal reflux in infants and in young children with cystic fibrosis. Arch Pediatr. 1995 Aug;2(8):742-6. Fridge JL, Conrad C, Gerson L, Castillo RO, Cox K. Risk factors for small bowel bacterial overgrowth in cystic fibrosis. J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):212-8.
8. Lisowska A, Wójtowicz J, Walkowiak J. Small intestine bacterial overgrowth is frequent in cystic fibrosis: combined hydrogen and methane measurements are required for its detection. Acta Biochim Pol. 2009;56(4):631-4.
9. Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M. Studying the overlap between IBS and GERD: a systematic review of the literature. Dig Dis Sci. 2006. Dec;51(12):2113-20.
10. Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010 Jun;8(6):504-8
“No Disease That Can Be Treated By Diet Should Be Treated With any Other Means.” -Maimonides