Small Intestinal Bacterial Overgrowth (SIBO) Diets – Digestive Health

SIBOSince releasing my first book in the Fast Tract Digestion series on Heartburn which linked chronic acid reflux to Small Intestinal Bacterial Overgrowth (SIBO), I have received several inquiries about using the Fast Tract Diet to treat other SIBO-related conditions such as IBS (update: Fast Tract Digestion IBS now available) and celiac disease. To answer this question, I am going to review several other diets that may be applicable to treating SIBO along with the Fast Tract Diet.

What is SIBO?

In healthy people, the small intestine contains low levels of friendly bacteria such as Lactobacillus acidophilus, especially in the upper part of the small intestine where our own critical digestion takes place. SIBO involves the invasion of the small intestine with much greater numbers of bacteria from the large intestine. The official definition of SIBO is “the presence of an abnormally high number of bacteria (more than 100,000 bacteria per milliliter) in the upper part of the small intestine”. At this level, the normally harmless bacteria that live in our gut can become harmful. They produce toxins, enzymes, and intestinal gases, including hydrogen, methane, and carbon dioxide that can disrupt digestion, cause intense physical discomfort and even damage the small intestine.

The symptoms of SIBO include abdominal pain or cramps, diarrhea, constipation, gas, bloating, acid reflux, flatulence, nausea, dehydration and fatigue. More severe symptoms related to SIBO can include weight loss and “failure to thrive,” steatorrhea (the body’s failure to digest fats), anemia, bleeding or bruising, night blindness, bone pain and fractures, leaky gut syndrome, and autoimmune reactions, among others.

There is an abundance of scientific research linking SIBO to a growing number of digestive (and even systemic) conditions. The list continues to grow but already includes:

  • IBS
  • Diverticulosis
  • Celiac disease
  • Crohns disease
  • Chronic acid reflux (based on the first book in the Fast Tract Digestion series)
  • Asthma
  • Fibromyalgia
  • Rosacea
  • Autoimmune disorders
  • Cystic fibrosis

SIBO has many underlying causes, but here some that stand out:

  • Slowed peristalsis – how well food moves through the intestine
  • Low stomach acidity
  • Immune deficiency
  • Antibiotic usage
  • Food poisoning
  • Carbohydrate malabsorption (key for dietary control)

Though each of these issues could increase your chances of having SIBO, the driving force behind SIBO is always poorly absorbed carbohydrates. That’s because gut bacteria consume mostly carbs for energy. For this reason, the best way to control SIBO is to deny gut bacteria the fuel they need to overrun the small intestine by limiting the consumption of certain carbohydrates. The worst offenders are the hard-to-digest carbohydrates including lactose, fructose, resistant starch, fiber and sugar alcohols. Fast Tract Digestion considers these hard-to-digest carbs as having “fermentation potential” or FP. Limiting FP, as opposed to overall carbs, is the secret of lasting symptoms relief.

SIBO Diets

Back to the question, “Can the Fast Tract Diet be used to treat other SIBO-related conditions?” The answer is yes, although specific conditions may have additional requirements. For instance, any diet for celiac disease would require all gluten (even small amounts) to be removed. With this in mind, the Fast Tract Diet is specifically designed to treat SIBO by limiting the carbohydrates (listed above) that drive bacterial overgrowth.  Other diets have also been used to treat SIBO-related conditions. These include the Paleo Diet, Elemental Diet, Specific Carbohydrate Diet (and the related GAPS Diet), Low Starch Diet, Low Carb Diet and the FODMAP approach. These diets all limit carbohydrate malabsorption to varying degrees. Let’s take a closer look at each.

The Paleo Diet

Paleo diet experts make a rational case that eating like our ancestors ate is healthier.  The reason is, our bodies evolved in balance with the foods that were available before we learned to cultivate grains.

You hear different opinions on the details as no one knows for sure what paleolithic humans ate or what their diets were like locally. More fruits would be available in tropical areas. People near lakes, rivers or the ocean relied more heavily on aquatic foods. Hunting was a common thread as supported by fossil records. Foods tended to be uncooked and many foods we tend to dismiss in the modern Western world (i.e. insects) were likely part of the caveman diet.

I have gained a general view of Paleo diet foods from reading some great books including, The Paleo Solution, by Rob Wolf, The Primal Blueprint by Mark Sisson, and Perfect Health Diet by Paul snd Shu-Ching Jaminet.  Other excellent sources of information on Paleo eating include Danny Alber’s Blog, Primal North (for real deal, hard core Paleo) and the web site, Paleohacks.com. I also attended the two most recent Ancestral Health Symposia (you can see my ASH2013 presentation here). My take away message is this.

”Modern Paleo diets are based on food types that were available and consumed during our evolution.”

Included:

  • Fish, meats; including organs, fowl and eggs
  • Green vegetables, fruits, nuts, seeds, and herbs
  • Insects

Limited:

  • Cassava, Sweet Potatoes, Yams, Wild rice, Taro

Off Limits:

  • Most grains (though Mark’s plan allows some wild rice and Paul Jaminet’s Perfect Health Diet allows more starch including white rice)
  • Beans and pulses
  • Dairy and foods containing dairy
  • PUFA-containing oils except olive and coconut oil
  • Processed foods containing sugars and trans fats, nitrates and other additives.

Clearly, this diet is a big step in the right direction for gut health! The Paleo diet removes or limits many difficult-to-digest carbohydrates that are tied to SIBO. Let’s take a closer look at Paleo diet foods to see if some might give Mark’s caveman, Grok, a little indigestion.

Removing most grains, beans, pulses, dairy, and processed sugars should make a big improvement in reducing SIBO-related symptoms. But, I would advise caution on some of the other “acceptable” food choices when experiencing symptoms.

Some white rices (basmati and Uncle Ben’s for example) are known to contain significant amounts of resistant starch and should be limited. Wild rice likely contains significant amounts of resistant starch, though I can’t confirm this as fact without a GI  value and I don’t believe wild rice has been tested.

I would recommend jasmine rice with a known Fermentation Potential (FP) value of zero. But, don’t eat too much if you have high blood sugar or insulin resistance.

How about fruit? Many fruits contain high amounts of fructose. Because fructose is a single sugar, it requires no digestion, but it’s absorbed slowly into the bloodstream. This makes it more available for excessive fermentation in the gut. There are many studies liking fructose consumption to gut problems, especially IBS symptoms. Apples, pears, cherries, grapes, plums, are examples of fruits containing a lot of fructose.

Another fruit that can create issues is bananas. Bananas have a lot of resistant starch, especially under-ripe bananas. Resistant starch, like all difficult to digest carbs, hangs around providing gas-producing bacteria fuel.

What about dairy? Dairy is restricted on the Paleo diet because it wasn’t an available food source throughout our evolution. For gut health, the major issue is lactose. I agree that high lactose dairy such as milk and ice cream (there is lactose-free ice cream available) should be avoided. I don’t see the benefit of excluding a number of other low lactose or  fermented dairy foods discussed in my book. I personally can’t imagine life without them.

Of particular interest are tubers and root vegetables, which are allowed on most Paleo diets. These include potatoes, sweet potatoes, parsnips, celery root, carrots, beets, daikon, yams, and turnip. Some contain significant amounts of resistant starch and should be limited.  See my recommendations at the end of the article for safe choices.

The Elemental Diet

The Elemental diet consists of foods that are essentially “predigested.” The foods contain fatty acids rather than fats, amino acids rather than proteins, and glucose instead of carbohydrates. The diet formula also includes water and micronutrients — vitamins and minerals. Elemental diet product such as Nestle’s Vivonex can be delivered orally or enterally (by tube). Elemental diets are designed to ensure full absorption and have been used to treat a broad range of digestive conditions including: Crohn’s and celiac disease, lactose intolerance, malabsorption, diarrhea, constipation, diabetes, cystic fibrosis, abdominal distention, and short bowel syndrome. Note that all of these conditions have a connection to SIBO. Some limitations of the elemental diet approach include high cost, unappealing (predigested) food products, and the need for medical supervision.

The Specific Carbohydrate Diet

The book Breaking the Vicious Cycle by Elaine Gottschall describes her experiences with Drs. Sidney and Merrill Haas, who successfully treated celiac disease with a diet that allowed only specific sugars and starches. The Specific Carbohydrate Diet limits disaccharide or double sugars as well as grains and starch, but allows simple sugars like glucose.

In general, this dietary approach is on the right track, but some carbohydrates potentially contributing to SIBO-related illness are not limited. For example, honey is used extensively in the recipes even though honey has just as much fructose as table sugar (sucrose is made of equal parts glucose and fructose). And the diet allows a large variety of fruits and fruit juices that also contain large quantities of fructose, which is now recognized as a major contributor to the development of SIBO.

Finally, the SCD does not allow any grains or foods containing starch. It incorrectly identifies amylose starch as easy to digest and amylopectin starch as difficult to digest, suggesting that amylopectin and not amylose is more likely to cause problems. The reverse is actually true.

Note: The GAPS Diet (Gut and Psychology Syndrome) created by Dr. Natasha Campbell-McBride is based on the Specific Carbohydrate Diet but also includes detoxification, and supplementation.

The Low Starch Diet

Carol Sinclair popularized the Low Starch Diet in her book The IBS Low-Starch Diet. Sinclair discovered that reducing starch in her diet improved her IBS symptoms. She also collaborated with Dr. Alan Ebringer, a professor of immunology at Kings College in London, UK, who found that the diet could improve painful symptoms of ankylosing spondylitis (AS). Dr. Ebringer has made the connection between the autoimmune disease AS, intestinal overgrowth of the bacterium Klebsiella pneumonia, and controlling the bacteria’s growth through a low-starch diet. Sinclair’s book limits all starches as well as sucrose, lactose and maltose.

Like the Specific Carbohydrate Diet, the Low Starch Diet unnecessarily limits all starch, yet does not limit fructose, thus limiting the effectiveness in treating SIBO.

The Low Carb Diet

The book Protein Power by Drs. Mike and Mary Dan Eades documented how low-carb dieting helped people with heartburn. Clinical studies have also shown that strict (ketogenic) low-carb dieting can improve IBS and GERD, two conditions associated with SIBO.[i] Despite impressive results (as documented in my first book, Heartburn Cured), not everyone gets complete symptom relief from a low carb diet. One possible explanation for the variations in results is that the low-carb diets don’t restrict fiber or sugar alcohols — known contributors to SIBO-related digestive illness. Another reason might be a simple failure to stick with the diet.

The FODMAP Approach

Susan Shepherd and Peter Gibson developed the FODMAP Diet at Monash University in Victoria, Australia.[ii] The acronym FODMAP represents four classes of fermentable sugars/sugar alcohols:  Fermentable Oligo-, Di-, and Monosaccharides, And Polyols.[iii] The FODMAP approach limits fructose, fructans, lactose, galactans and sugar alcohols.

While the approach makes sense and has helped people with IBS and other SIBO-related conditions, the FODMAP diet includes sucrose in many low FODMAP recipes, and does not restrict resistant starch and fiber found in sweet potatoes, certain rices, corn, gluten free pasta, gluten free breads, cereals and bananas for example. Sucrose, because it’s half fructose, and resistant starch are both significant contributors to malabsorption and excessive fermentation. The FODMAP diet actually calls for adding more resistant starch. As a recent article on the diet stated, “Part of dietary counseling is to ensure continuing adequate intake of resistant starch.”[iv]

The Fast Tract Diet – New Way to Treat SIBO

The Fast Tract Diet limits all difficult-to-digest carbohydrates including fructose, lactose, fiber, resistant starch and sugar alcohols. But the diet uses a special method called Fermentation Potential (FP) to calculate the potential for any food containing carbohydrates to cause symptoms. Mathematically derived FP values (they are listed in 15-16 tables in the books but can also be calculated) for each food help identify and restrict difficult-to-digest carbohydrates without having to know what specific carb types are in each food. So you don’t need the help of a medical professional or dietician.

Unlike a strictly low-carb diet, the Fast Tract Diet limits fiber, but can include some higher-carb foods as long as they don’t contain too many difficult-to-digest carbohydrates. For instance, sushi rice, which contains little resistant starch, is acceptable, but basmati rice, which contains more resistant starch, is not. The Fast Tract Digestion book series also explains and addresses the other underlying problems listed above that can contribute to SIBO.

In addition to the overall recommendations in the book, here are five recommendations that are missing in some of the other diets to control SIBO and limit symptoms:

  1. Limit high amylose rices – high FP. There are lower amylose rice available that are safe for gut issues.
  2. Limit high amylose tubers – high FP. There are other low FP tubers such as parsnips, and several potato varieties available.
  3. Limit sucrose and high fructose fruits – high FP. These can be substituted with many Low FP fruits such as strawberries, cantaloupe, and others. Consume other (high FP) fruits, such as apples and bananas as small wedges or single slices. Switch out high FP sucrose with Low FP sweeteners such as dextrose, erythritol (the one safe sugar alcohol) etc.
  4. Limit dairy with excess lactose – high FP. Acceptable alternatives include cream and a variety of fermented dairy products.
  5. Limit fiber and sugar alcohols (except erythritol) which are poorly digested yet fermentable potentially driving SIBO and symptoms.

Note: Some low FP starchy vegetables, while gut friendly, are higher in carbs. Use your judgment and limit your overall carb levels to avoid metabolic complications from high blood sugar, such as diabetes, obesity and cardiovascular health.

Question: What foods cause you digestive problems?

Fast Tract Digestion books

References


[i]Yancy WS Jr, Provenzale D, Westman EC. Improvement of gastroesophageal reflux 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. Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR, Westman EC, Yancy WS Jr, Drossman DA. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009 Jun;7(6):706-708.

[iv] Peter R Gibson, Susan J Shepherd. Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach. J Gastroenterol Hepatol. 2010;25(2):252-258.

About Norm Robillard

Norman Robillard, Ph.D., is a microbiologist and researcher who spent 20 years in the pharmaceutical industry before founding the Digestive Health Institute. His goal is to develop holistic treatments for digestive illnesses based on a clear understanding of the underlying causes of disease. Norm was the first to recognize a connection between bacteria in our intestines, nutritional malabsorption and the symptoms of acid reflux. Based on his extensive research, he created the clinically proven Fast Tract Diet, a safe and effective alternative to proton pump inhibitor (PPI) and H2 blocking drugs. Fast Tract Digestion books are now available for Heartburn and IBS on the books page. Bacterial overgrowth fueled by nutritional malabsorption is a factor in several other digestive health conditions. Research in this area is the main focus of the DHI. Additional versions of Fast Tract Digestion are in the works for a number of these conditions. Norm received his Ph.D. at the University of Massachusetts, Amherst and completed post-doctoral training at Tufts University.
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424 Responses to Small Intestinal Bacterial Overgrowth (SIBO) Diets – Digestive Health

  1. Sarah says:

    Hi Norm, love your work! I am one of the folks that while on a low carb diet my heartburn/reflux gets worse. I have SIBO and know to stay away from fiber, sugar alcohols, etc. What do you think about Paul Jaminet’s (Perfect Health Diet) suggestion that the bacteria feed not just on excess carbs, but also on ketones when on a low carb diet? Would love your opinion!

  2. Hi Sarah,
    Thanks for writing and for your kind remarks. I had not heard of this diet, so thanks for bringing it to my attention. First off, Paul lumps together all rice and potatoes. This is wrong for people with SIBO as some rice and potato varieties have lots of resistant starch, others have little or none.

    On the idea of gut bacteria using ketones, I have never heard of this concept before. Let me dig into this and get back to you.

  3. kripal says:

    Hi Norm, I went through your book it is a wonderful book that gave me a lot of new informations regarding SIBO. Before reading this book I was planning to go absolute cereal free which I thought would be the toughest thing to do, but now I have some options thanks to you. Well I have a few questions for you.
    1. as I have read in Breaking the vicious cycle, apple and banana are listed in legal foods. what is your view?
    2. can I drink pure glucose as a substitute for cereals?
    3. what is your opinion on taking pysallium husk?

    • Hi Kripal,
      Thanks for writing and your positive remarks.
      As for your questions:
      1. As I discuss in Fast Tract Digestion, Breaking the Vicious Cycle does not limit fructose and there is lots of fructose in apples and bananas. Bananas also have quite a bit of resistant starch. I would go by the Fermentation Potential tables. A 120 gram serving (4.2 Oz) of apple has an FP equal to 12 grams. A whole apple is about 180 grams for a total FP equal to 15 grams. That’s considered high – having significant symptom potential. You might consider having a one quarter of an apple and evaluate your symptoms. Bananas have an FP of 15 (ripe) to 18 (green) grams which is high. Again, you could try 1/3 of a banana once your symptoms are under control.
      2. Glucose drinks should be avoided for a couple of days as you start the diet. Once SIBO and symptoms are reduced, glucose drinks should not trigger symptoms. Just keep in mind that foods that raise blood sugar quickly and significantly, in the absence of exercise, are not particularly healthy and can lead to other problems like obesity, diabetes, etc. over time.
      3. I don’t think fiber, above what you get from green stalked and leafy vegetables, is needed. In many people, fiber supplements make symptoms worse. Also, some fiber supplements contain lots of sugar which contains lots of fructose which can also lead to symptoms. Lastly the FDA has warned of choking and intestinal blockage risks associated with fiber supplements. I don’t recommend these supplements, but if you try them, drink lots of water.

      You might be interested in the three part article I wrote called “I thought fiber was good for me“.

  4. Cecilia Fannon says:

    Hello, Norm,
    A year ago, I was diagnosed with SIBO at Cedars-Sinai. I also have gastritis/esophagitis and asthma. Five years ago, I started on PPIs (before gut symptoms and worsening asthma). My husband and I have been reading about bacteriotherapy and its successful use in treating IBS, Crohn’s, etc. I mentioned this to my gastro doc and he said, “No, no, only for C-Diff.” Yet you, too, mention the possibility in your new book. 1) Can you recommend a gastroenterologist who might be more open to such therapy? 2) Do you recommend Apple Cider Vinegar or baking soda for reflux? (I’m reducing the PPIs.)

    • Hi Cecilia,
      Your doctor is right – The primary use of this procedure currently is C diff infection. However, some work has been done on IBS.

      You might try writing to the master of this technique, Thomas Borody (thomas.borody@cdd.com.au) to see who he recommends in the US. Dr. Pimentel may have a suggestion as well. Also check out Brorody’s excellent review (Borody TJ, Khoruts A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol. 2011 Dec 20;9(2):88-96. doi: 10.1038/nrgastro.2011.244.). Specifically, look at references 46 and 47.

      Many people swear by cider vinegar for low stomach acid, but the most important way to improve acidity is to work with your doctor to wean yourself off the PPIs. Of course, if you’re still refluxing, you will experience heartburn and other symptoms. I recommend the Fast Tract Digestion Diet as your are reducing the PPIs. Using antacids can help with breakthrough symptoms. At least you will only be reducing acidity on a temporary basis which is better than 24/7.

      • Cecilia Fannon says:

        Thank you very much for getting back to me so rapidly. I’ll follow up on the links you sent re: bacteriotherapy.

        Have you, perchance, read Gary Taubes’ books, Why We Get Fat and Good Calories, Bad Calories? (I am thin — 108 pounds, 5’5″, but find an echoing theme of yours — carbs reduction. His prescribed diet, though, is draconian, in that he eliminates all carbohydrates.) I’m wondering what your opinion of either his books or Wheat Belly, by William Davis is.

        • I have read Gary’s book Good Calories Bad Calories and agree with Gary on the health benefits of low carb dieting. I personally restrict carbs though not generally on the very low carb end. Low carb generally works well for gut / SIBO issues as well. But there are some unrestricted food types on low carb such as fiber and sugar alcohols that can cause gut problems. I am reading Wheat Belly currently after meeting William earlier this year. I find his research fascinating, though, its very clear to me that wheat alone is not responsible for digestive issues.

          • Cecilia Fannon says:

            Again, thank you for getting back to me.

            I’m wondering if I might BUY hard copies of your book. I’d like to give one to my Primary Doctor and another to my brother-in-law, Garrison Bliss, M.D., a well-known internist in Seattle who pioneered affordable concierge medical care. He still sees many patients and would undoubtedly be fascinated by your own research.

          • Thanks for your interest in sharing the book. You can find it on the “buy books” tab on this site. I was just reading your brother in law’s blog on Direct primary care medical homes on the Huffington Post. He has some great ideas. Please let him know that I would very much enjoy receiving his thoughts on the ideas in the book.

  5. Cecilia Fannon says:

    FYI. I wanted to let you know that the Oct. 22 edition of the New Yorker has a fascinating article called “Germs Are Us” by Michael Specter. A point it makes is that antibiotics are herbicides for humans. That while medically necessary, they change the ecology of our bodies in unimaginable and unhappy ways.

    But you already know that.

  6. Mandy says:

    Hi, I have just ordered the Fast Tract Digestion Heartburn book and was wondering if the diet is safe during pregnancy? I am 9 weeks pregnant and having a terrible time with GERD, which I have had for 20 years ( I had Barrett’s oesophagus when I was 21). I have been on a PPI for the past 10 years but I went off it when I found out I was pregnant. Now I can’t eat without getting terrible reflux and I have trouble sleeping due to bad stomach pains. I eat a small meal and feel like I have eaten a 5 course banquet. I have cut out acidic foods but it doesn’t make much difference, I still get reflux all the time. I’m really worried about how I’m going to cope with the increased intra-abdominal pressure that will come later in my pregnancy…

    • Hi Mandy,
      I feel for you as the PPI rebound effect can be quite considerable when you first stop. The diet will help minimize this temporary problem. Also, the Fast Tract Diet is based on whole healthy foods and should be fine for pregnancy. Just don’t overdue it with the carbs as gestational diabetes can sometimes arise half way into your pregnancy. But that shouldn’t be too much trouble as the daily carb count of the Fast Tract Diet meal plans is approximately 75 grams per day.

      • Mandy says:

        Thanks very much Norm, I think I’ll try going paleo with the inclusion of your 4 recommendations above, hopefully thst will give me some relief until I understand more. Thanks again :)

  7. Joey says:

    Dr. Robillard:

    I have been researching Gerd for about 5,000 hours over the last 2 and a half years. I just ordered fast tract digestion and am thrilled to receive it soon. I weaned myself off proton pump inhibitors and adopted a low carbohydrate lifestyle. I am happy to say that I have experienced almost zero reflux in the past 2 weeks. 1 question for you: Although I am experiencing little to no reflux symptoms anymore, I feel very confident that your method works. My LES valve is still open 24/7. I believe the valve to be controlled autonomically, and am curious if the valve will eventually close on it’s own? Should I consider taking HCL tablets? I feel I have cured the reflux, but not the low acid/and LES valve problem. Thank you for all of your work. I can’t thank you enough.
    -Joey in Portland, OR

  8. Joey says:

    I apologize for the grammatical errors above. I should have opted for a full computer screen instead of a smart phone haha. One thing I think would be pertinent to mention is that I was using 20 mg of omeprazole for 2.5 months. Prior to that, I was using organic apple cider vinegar before each meal and felt the valve close. My belching sounds hollow now. It’s quite strange. Thanks again!

  9. Hi Joey,
    Didn’t notice any grammar errors. Probably why I need an editor for my own writings. In a nutshell, if your reflux is under control and your off PPIs, I would say congratulations, you’re done. I would not recommend any other changes such as supplementing with vinegar or HCL. Now that your refluxing is controlled, the tone of your LES should improve over the coming months.

    • Joey says:

      Brilliant! That makes sense. My fingers are crossed. I really hope my acid levels return, and that valve closes. Patience I guess :) I have been on aspirin therapy for an acute stroke I had about 10 years ago. It is also enteric coated. From my understanding, the aspirin dissolves in the small intestine when enteric coated. I’m not sure if you have come across anything about the harmful long term side effects of aspirin therapy in your work? I have not found conclusive evidence that it will prevent or stop another stoke/heart attack from occuring. I plan on working with some naturopaths to implement other herbs and fish oil to keep my blood from clotting instead of using aspirin. I feel that perhaps this could be a factor in my issues as well? Thank you again for all of your work. You’re my hero! I can’t wait to show your book to my gastro and the surgeons I was speaking to.

      • Thanks Joey. If you were talking about statins for cholesterol, I might agree. But if I was in your situation and my doctor told me to take enteric coated aspirin, I would do it. You can have a discussion about long term risks of aspirin therapy (likely dose related) with your doctor, but I think the benefit of aspirin for preventing stroke is pretty solid.

  10. Marlis Jannis says:

    I came across your website during my search for an answer regarding SIBO and diet. I am glad you made the differences in the prevalent diets clear. I am definitely going to get your book. There is one remaining question I have. I’d love to use cream, dairy and yoghurt but I tested positive for lactose intolerance first (taking Lactase now). When that didn’t help with my symptoms, I had a test for SIBO and tested positive. Now, the question is: what comes first: SIBO causing lactose intolerance or lactose intolerance causing SIBO. How will I deal with the dairy etc. that you suggest using in your recipes?
    I definitely want to use your diet to help ease and hopefully correct my digestive tract problems. I have been on and off antibiotics since December 2009 for various reasons.
    I am looking forward to your response.

    • Hi Marlis,
      Great question. This is absolutely a classic “chicken and egg” question. The truth is both. Lactose intolerance can lead to SIBO and conditions involving SIBO can lead to lactose intolerance. The evidence is clear and described in the book. Lactose is included in the fermentation potential formula (because of its effect on the glycemic index of lactose-containing foods). Following the diet program should take care of symptoms as it significantly limits lactose. If you have severe lactose intolerance and continue to consume too much lactose, you might benefit from continuing lactase supplements. Lactose intolerance is the easiest to treat because you have the option – limit lactose or take lactase. You don’t get that choice with fructose intolerance, for example.

      • Marlis Jannis says:

        Thank you for your quick response. I am now waiting for your book to arrive – which should be on it’s way from Amazon.

  11. CM says:

    Hello,

    Thanks so much for a great article explaining current trends in SIBO treatment and comparing the pros and cons. I was wondering if you could elaborate a little bit on this statement: “Finally, the SCD does not allow any grains or foods containing starch. It wrongly identifies amylose starch as easy to digest and amylopectin starch as difficult to digest, suggesting that amylopectin and not amylose is more likely to cause problems. The reverse is actually true.”

    Could you explain a bit more about what this means? What foods are high in amylopectin, and yet still safe to eat, and which would you say contain a lot of amylose and should be avoided?

    Thanks in advance for your help.

    • Hi Christina,
      The book has several examples but here are a couple. Basmati rice is higher in amylose and more likely to cause symptoms than short grain glutinous (nothing to do with gluten) or sushi rice which is 100 percent amylopectin with no amylose and least likely to cause gut symptoms.

      • CM says:

        Thank you very much for replying. I am planning on buying your book today.

        I was curious, where does coconut flour fit in (if at all) in the Fast Tract plan? I have read that it is high in fiber and protein. Do you know if it has a high FP? It’s something of a staple in Paleo cooking and is permitted on SCD, which is why I ask.

        Thanks again!

        • Great question CM. I have actually been looking into coconut flour. The numbers vary quite a bit as to the amount of fiber in coconut flour but range as high as 60 g fiber per 100 grams of flour. Coconut fiber is also fermentable by gut microbes, but the question is how fermentable? If it’s fermentability is closer to the toughest fiber, cellulose, it might not be too bad, but the amount of fiber is cause for caution. In the absence of more research, I would recommend first getting your symptoms under control with the Fast Tract Low FP approach. Then in a more controlled fashion, try consuming some foods made with coconut flour to see how much you can eat before getting symptoms. Then report back to us!

          • CM says:

            Thanks again for responding so faithfully. I ordered your book today and am going to follow the recommendations. I appreciated hearing your thoughts on coconut flour—I suspect it may be pretty fermentable b/c I seem to have symptoms after eating it in breakfast items.

            I’ll report back and let you know how things are going after following the plan in your book.

          • I hear you CM. I have yet to try foods made with coconut flour, but too many macaroons (made with unsweetened coconut flakes and Splenda) leads to some gut growls for me.

            I look forward to hearing from you.

      • CM says:

        Still waiting on the book to arrive, so I hope you don’t mind another question. I was doing some reading about resistant starches and came upon this article saying that some food’s resistant starch content is increased by chilling: http://www.livestrong.com/article/307427-list-of-foods-that-are-a-resistant-starch/

        I haven’t heard much about how chilling affects how food is digested except in the case of Dreamfields pasta, which apparently loses its “special” properties (lower glycemic index/less impact on blood sugar levels) when it has been refrigerated.

        Could you comment on whether those of us battling GERD need to worry about refrigerating and eating leftovers of foods that are otherwise low FP. For example, is jasmine rice that has been chilled and reheated more problematic than freshly cooked? Likewise, or maybe conversely, does cooking foods that contain a lot of resistant starch (such as bananas) make them at all easier/harder to digest?

        Interested to hear your thoughts. Thanks!

  12. Ruth Elder says:

    Dear Norm, I came across the reference to your book from Michael Eades site, and what a great find! I have been struggling to get ulcerative proctitis under control for 6 years and I have tried most of the diets that you mention above. I started with paleo 12 months ago, as described by Loren Cordain, but found that I was often tired. I do crossfit and play a lot of golf. I thought perhaps I should get more carbs, so I tried the SCD with no change to symptoms or feelings of tiredness, and then the FODMAPS, which also seemed to make no difference. I also upped the fat content, mainly through increased dairy, although no milk, and I also ate quite a bit of 85% chocolate. The increased fat did seem to make a difference to my experience of tiredness, but not much in terms of UP symptoms. Since I have stopped the chocolate and nuts, as well as many of the fruits you mention (I live in Brisbane, Australia so tropcial fruits tended to be a staple) I find that my symptoms have been negligible. I hope eventually that I will be able to stop also the small dose of mercaptopurine I take daily. Thanks for a diet that seems to work and a wonderful book – I’ve recommended it to my friends who have GERD and I look forward to the future additions on digestive disorders.
    Regards, Ruth

  13. Reye Kenney says:

    Hi, I had Roux-en-y gastric bypass in Sept 2004, everything went fine and I have continued to keep the weight off (100 lbs). I’m 5’9″ and 165 lbs (sz 8 or 10) and exercise 4 days a week. About 2 years ago (2011) all the sudden I noticed I was lactose intolerant, I would bloat up like a balloon and have terrible gas if I drank 1 glass of milk. So I gave up lactose for the most part, still would notice terrible bloating and gas a lot so went to surgeon who said it was most likely SIBO as result of surgery and not uncommon. Had breath test at GI and sure enough it was positive so about every 3 months I go on a 2x per day 550mg 10 days of xifaxan which usually bloats me more by day 8 but than it get’s better. My questions are: do you recommend probiotics after xifaxan, if so what kind? New ailment as of 5 months ago is nighttime acid reflux, especially if I’m laying on my stomach, the burning will wake me up – uncomfortable but not painful and not every night. Dr put me on Omeprazole 20 mg to take 1 every morning and I’ve done this for a month and it hasn’t changed anything so I hate to take something everyday if it’s not doing anything, thoughts? Also, considering my gastric bypass my intestines system is different than everyone elses, what diet do you think would work best for me? One more thing, do you believe in having an internal yeast problem? I get frequent UTI’s lately too and on top of all that gyno says I have mild case of Lichen sclerosus, kept thinking I had yeast infection but it’s LS. For 6 years after surgery I was fine, no issue at all with the exception of anemia, now since I have SIBO, all kinds of weird things happening to me…thinning hair, brain fog, extreme bloating, gas, lactose intolerent, rosacea, insomnia, hypothyroid (I’m on 1/2 grain armour) wet cough in the morning for an hour, hands fall asleep easily at night if laying wrong, feet fall asleep if sit to long or especially on fit ball, body odor, increased calluses on my feet, and I smell a weird odor sometimes like stale smoke (like what you used to smell like after going out before the smoking ban), meralgia paraesthetica in right thigh (could be due to Pilates). Feel like a hypercondriac last 2 years when before I went to dr for my yearly physical and that’s it! I just want to have 1 size of clothes cuz when I’m bloated I’m a whole size bigger and it’s depressing. I should keep a food journal and try to determine what bloats me but it’s so inconsistent. Thanks!

    • Hi,
      I can’t speak to all your symptoms but I sure feel for you. The good news is that this condition can absolutely be reversed. An overgrowth of yeast can arise from treating SIBO with antibiotics. The best approach might be to deal with the confirmed issue of SIBO which has connections to so many other problems, some of which you mention like rosacea. I think it would be helpful for you to read Fast Tract Digestion Heartburn which addresses many of the issues you raise including probiotics, antibiotics and specific intolerances. Another good source of information is the next book in the Fast Tract series on IBS coming out soon. This book has a whole chapter on antibiotics. Both books have an extensive chapter on other factors that can promote SIBO. To sum it up, I would recommend the low FP diet in Fast Tract and drop the antibiotics and PPI drugs (consult your own doctor on this) as a first course of action. The Fast Tract Diet approach deprives microbes of fuel they need for overgrowth so it should be just as effective for yeast as it is for bacteria. This is one big advantage over antibiotics. There are many more.

    • mysha says:

      hi, I understand what you’re going through, I have had all of the symptoms that you have mentioned. to naturally treat SIBO you can buy GSE which is Grapefruit Seed Extract, its worth a try. you can buy it on amazon.com for about 15 dollars which includes the shipping. I hope that helps :)

  14. Robert says:

    I’ve been on the low FP diet for several weeks now, and although I’ve had a great improvement in GERD symptoms, have stopped using PPIs, and no longer feel the need for antacids, I’m still not feeling well all of the time. I still burp quite often (although they sound more like croaks now).
    I have calculated that my FP consumption is only about 25-30g/ day — well within the limits suggested in Fast Tract Digestion. My diet includes: chicken, eggs, lactose-free milk, homemade yogurt, corn flakes, pineapples, cantaloupe, strawberries, jasmine rice, and a few sorts of cooked vegetables — usually potatoes (Russet variety), eggplant, or zucchini.
    I’ve noticed that even though I stay within FP guidelines, several of the foods I eat do violate the following guidelines:

    Limit tubers containing amylose starch – high FP. There are other low FP tubers such as parsnips, Pontiac potatoes, celery root and daikon.

    Limit high fructose fruits – high FP. Low FP fruits include watermelon, strawberries, blueberries, etc. Consume other fruits, such as melon, pineapple, pears, peaches, apples, lemon, lime and oranges as single slices or small wedges.

    Is it possible that these low-FP foods — Russet potatoes, corn flakes, pineapples, and cantaloupe — could still cause me burping and unease? How can they be considered gut-friendly foods if they still contain lots of amylose (in the case of the Russet potato and corn flakes) or lots of fructose (in the case of pineapple and cantaloupe)?

    • Hi Robert,
      Good to hear you are getting into the diet. You might consider cutting back a bit on the lactose-free milk (milk also contains oligosaccharides), corn flakes, potatoes and pineapple. As for potatoes, some have less amylose than others. That’s why I identify some varieties with low amylose and low FP. For fruits, just stick to the FP limits and consume less when in doubt or if you still have symptoms.

  15. Shelby says:

    Are red and Yukon potatoes ok to eat? I didn’t see them listed in your book but these types, and along with russet, are the only ones available here.

    It excites me to have starch again…. With candida and klebsiella, and starch is basicallya big no. Are u sure it is ok with these strains?

    • Potatoes other than those with solid references for GI results can be tricky. I saw a reference for red skin potatoes having a GI of 58 but haven’t confirmed the result, nor am I sure they are what you are referring to, but if so, that would give a relatively high FP. I can’t find a reference for Yukons. One work around is to get your symptoms under control with foods that have known GIs and FPs and then experiment using the techniques outlined in the book (cooking ripe potatoes well and eating slowly and chewing well, etc.). See if you get symptoms from then while limiting other changes in your diet. Let us know what you learn!

  16. Lazza says:

    Dr. Robillard, I recently downloaded your book and found it very interesting. I have been doing an SCD-type of diet for the past year or so. This helped me clear my IBS symptoms (..I had suffered with it for several years). Clearing an H. pylori infection was instrumental too. Yet about two years ago I started to suffer with acid reflux (burning throat, mouth). HCL tablets and TUMS made it survivable but it was hardly an optimal solution. About a month ago I went a low-ish carb diet (perhaps 50 grams/day), mostly by cutting back on fructose, and it has worked wonders. Yet I have been denying myself rice and potatoes for so long I am tempted to reintroduce them into my diet, using the low FP varieties you list in your book.

    However, and maybe I’m just too stuck into the SCD mindset, is a chance rice/potatoes could reignite my IBS? That would be nightmare worth avoiding. I would hope the carbs in the low FP rice/potatoes would be digested before any mischief would develop in the lower part of my intestines.

    Oh and if I may, one more question. I understand having both IBS and acid reflux is not at all uncommon, especially for someone my age (56). Yet I have seemingly been cured of one problem but not the other. Might this be because bacterial/fungal issues in the lower part of my intestines been cleared out courtesy of SCD and H. pylori eradication but the upper part still has SIBO? Or might the case be we are talking about different bacteria, one that causes IBS and another acid reflux??

    Thanks for your help!

    • Hi Lazza,
      Thanks for a couple of great questions. I see your concern with reintroducing rice and potatoes. I would start with the low FP rice varies mentioned in the book as they are more of a sure bet for the absence of resistant starch – amylose. The potatoes are perhaps a bit less black and white as there are so many varieties and all contain some level of resistant starch. You can try them a bit later when you feel your symptoms are fully under control.

      Your thoughts on IBS/GERD (SIBO in lower small intestine and even the large intestine – LIBO- might be more likely to bring on IBS symptoms while SIBO in upper small intestine might be more likely to increase GERD symptoms) make sense to me, though I am not aware of proof in this matter.

      The best bet is to try the diet for a while keeping FP really low and, based on symptoms improvement, gradually increase FP.

      • Lazza says:

        Dr. Roubillard:

        Thank you for such a fast and informative response. Yeah, I think trying out low FP rice might be best (I love sticky Asian rice). I can easily be satisfied with rice for a LONG time before attempting potatoes.

        And yes, I forgot about LIBO. I suppose years of eating resistant starch is the perfect recipe for LIBO. However it’s somewhat curious that I developed IBS some five years before developing SIBO. But what might have happened is that in my attempt to control IBS my carb intake swung from starchy veggies/grains to fruit, and I can see where I over-indulged on fruit (.. I just love bananas). As your book points out overeating high FP fruit can fuel small intestinal bacteria into a frenzy.

        Thanks again. Although I would LOVE to go back to the good old days and eat anything and everything, and maybe that day will come, at least your book points out that one can overcome SIBO and still enjoy some good food. One just has to be mindful FP.

        _Lazza

      • Shelby says:

        How low carb do u recommend to “starve” bad gut bugs? (like percent of cals)?

        • This is covered in my books Shelby. Putting the bad bugs on a diet can be done with the low FP approach (Fast Tract Digestion) where the number of total daily carbs is irrelevant or by controlling total carbs (Heartburn Cured). On the later approach, a good starting point is less than 25 grams per day then follow the plan.

  17. Jowy says:

    Dr. Robillard

    Thank you again for all of your research and saving me from a Nissen Fundoplication! I was experiencing some strange sounding belches like the individual that commented above. I stuck to the diet, and my belching sounds normal now. I can’t believe it! It took about a month and a half, but sticking to the diet really worked. I sincerely appreciate what you are doing and have recommended your book to several family, friends, and co-workers. Your book should be mandatory reading for anyone suffering from digestive illness. I am not overweight, but have suffered from chronic acid reflux for 2 and a half years. I am 32 years old. My reflux has now completely disappeared. After changing my diet I realized I had been bloated after eating certain carbohydrates for the last 10 years or so. I thought it was normal! Boy was I wrong! haha. My girlfriend first brought it to my attention about 2 years ago when I looked 4 months pregnant after dinner. I am skinny enough that most people never noticed it. I would usually just throw a sweatshirt on after I ate out. I feel stupid for not recognizing the symptoms sooner! I want to tell everyone I know how I feel now. I have read many forums where people are borderline suicidal dealing with reflux and ibs. It really saddens me. I hope more and more people discover your book before they allow doctors to just cut them open. I hope your book changes their lives too. Now that reflux is a thing of the past for me :) I started researching if there is a cure for SIBO. The only symptom I have now is bloating if I stray from my diet. Most websites say there is no cure, while some have indicated a 1 to 3 year period until a person can eat normal again. I was also humoring the idea of only getting my carbs through jasmine rice each day instead of specific, ripe fruit and lactose free ice cream, vegetables etc(because of it’s negative fermentative potential)? I wonder if any research has been done to see how long it would take to starve the bacteria off near completely? Maybe a silly thought…could be that I missed that section in the book, or it could just be that I’m Polish (haha) but…If there isn’t a way to completely cure this condition today, I bet we can’t be that far off?!?!

    • Hi Joseph,
      I am happy to see that the Fast Tract approach gave you such positive results. I don’t think you need to worry about wiping out all your bugs. They’re healthy and useful for digestion as long as they are kept in check in the small intestine. It sounds like yours are.

  18. Joey says:

    I typed a “w” instead of an “e”. oops. It’s Joey haha.

  19. Joey says:

    I accidentally erased my last comment somehow, so I will give it another shot. Your diet absolutely cured my reflux! I also experienced strange sounding belching as the gentleman described above. I never though it would stop. I stuck with the diet for a month and a half, and now I am back to normal! I am so grateful for my restored health! I have recommended your book to coworkers, friends, and family. I can’t stop talking about it. This book should be mandatory reading from anyone suffering from any digestive problems. I am 32 years old, and not overweight. Chronic reflux started 2 and a half years ago. I researched daily for a cure. Your book saved me from a Nissen Fundoplication. I can’t thank you enough. It saddens me to see people in forums suffering from reflux and ibs sounding near suicidal. I hope they all learn of your book.

    2 years ago my girlfriend said I looked 4 months pregnant. I always thought it was normal because I could usually just suck my gut it in or throw on a sweatshirt. Boy, was I wrong. I was skinny enough that no one seemed to notice. Completely cured of my reflux these days :) I only get bloated if I stray from the diet. I get my carbs from green leaf lettuce, some greek yogurt, ripe fruit, and lactose free ice cream, etc. I also really enjoy the jasmine rice. Gastroenterologists feed us pills to treat our symptoms, but don’t address the cause. Your diet truly addresses the cause. I have researched a lot more trying to find out if I will ever be able to eat the same way again. I should say…at least eat some of the things(carbs). Most people say there is no cure, while others say it can take 1 to 3 years to cure this. I have also read that probiotics can help make symptoms better or worse. I have been using Dr. Ohhira’s and think they help. Curious if anyone has ever tried to near-completely starve out the not so friendly gut inhabitants? For example, getting your carbohydrate intake specifically from jasmine rice each day(because of it’s negative fermentative potential)? I wonder if there is in fact a way to cure this stuff permanently by sticking to this type of diet? If there isn’t, we surely can’t be far off?!?! Also curious if the servings of jasmine rice in the book are based on a ‘cooked’ or uncooked serving size? Thank you again for changing my life and for giving me hope.

  20. Kate says:

    Hi. Love the ftd book so far and am excited to see if it works for my crabby gut. :-)

    Quick questions: a lot of paleo recipes use coconut flour. What’s the fp on this? Also, what is the FP on brown rice protein powder like sun warrior and garden of life? Since most of the starch is removed and it is mostly protein, am I sage to assume that it is in the low Category?

    Thanks

    • In the absence of a glycemic index value (maybe it’s been tested and you can find one online) I would assume an GI = 50. Then calculate FP making sure to add grams of fiber. Below is a reply to another inquiry about coconut flour with some general thoughts on symptom potential.
      Below is a reply to another inquiry about coconut flour. On the brown rice protein powder, it’s likely zero if there are not carbs. Check the label so see if carbs are present.

      “Great question CM. I have actually been looking into coconut flour. The numbers vary quite a bit as to the amount of fiber in coconut flour but range as high as 60 g fiber per 100 grams of flour. Coconut fiber is also fermentable by gut microbes, but the question is how fermentable? If it’s fermentability is closer to the toughest fiber, cellulose, it might not be too bad, but the amount of fiber is cause for caution. In the absence of more research, I would recommend first getting your symptoms under control with the Fast Tract Low FP approach. Then in a more controlled fashion, try consuming some foods made with coconut flour to see how much you can eat before getting symptoms. Then report back to us!”

      • Kate says:

        Most recipes for pancakes call for approx 2 tablespoons of coconut flour, so is that a safe amount.? Also, some recipes call for like 1TB psyllium as a binder (or chia, but the former seems to work best)

        How are psyllium, coconut flour and chia in those amounts and ione sserving of a recipe (2tbs Co flour, 1TB psyllium)?

        • I recommend doing you best to stay in the FP limits per meal and per day remembering to add the fiber grams. Once you are symptom free, you can experiment in a controlled fashion to add less well characterized foods to see if they invoke symptoms. Chances are, a little psyllium and coconut flour won’ hurt once SIBO is under control as the fiber types in these foods are the least fermentable types of carbs.

          • Kate says:

            What makes a carb less fermentable?

            It’s hard to know when sibo is “gone”… Does it ever leave or are some people more prone to it and thus always need to follow a modified diet? Or is it more along the lines of once u have it, u always have it, just in varying degrees dependingon diet and such? That would not be cool.. I want to get rid of it entirely and not have to be so strict with carbs.

          • Fast Tract Digestion goes into all of these issues. As for your last question, when SIBO is under control, you won’t have to be as strict with your diet, but you will most likely always have the potential to develop SIBO again if you revert to the same behaviors or consume the same foods that led to the problem to begin with, or if you have any of a number of underlying factors / conditions that promote SIBO. These are described in chapter 6.

  21. Kate says:

    Also, how can hummus be low fp but chickpeas be high fp? What brand of hummus is usually safest? And Lastly, would homemade hummus be high fp or low?

    And was the fps for the legume list on dry, or cooked? How would soaking and/sprouting affect the fp?

    Thanks

    • Notice in the FP tables that the serving size referenced for chick peas is 5 times larger than the serving size for the hummus. That accounts for the difference in FP. Unless specified as “dry”, most FPs are listed for “hydrated” or “prepared” foods. Soaking likely won’t change FP much, but sprouting would. The question to ask is what is happening to the carbs during the process (can you get a net carb number for the sprouted product?), be it sprouting or fermenting, etc.

  22. Kate says:

    Don’t yell at me if this is described in the book… I’m still reading it but I have suggested it to many friends and one asked me this question, which I wanted to ask u before she bought the book, in case it didn’t work for her:v

    Does the diet address OTHER pathogens besides just sibo? Many people have other types of gut pathogens besides bacterial, like yeast fungus parasites etc. How would this diet address those types of pathogens… Wouldn’t carbs of any type feed those pathogens, especially the more refined ones that have a low fp bc they digest to sugar more readily?

    Thanks

    • WHAT, YOU DIDN’T READ THE BOOK? Ok, just kidding. The books and site are getting more popular, which is what we want. Now my challenge is to answer as many questions as I can until I enlist another moderator to help, or until more dialog picks up between people who have read the book and people who haven’t.

      The concept of both the FP and Low carb approach is to create a condition of more limited gut nutrients to reduce microbe counts overall (including various types of bacteria and yeast). In this state, the human body is more able to work it’s magic to allow the good guys to stay and expel or kill the bad guys. The lower the FP, the more likely the carbs are fully digested entering the blood stream instead of persisting in the intestine.

      • Kate says:

        HAHA..Im in the process fo reading it and am so excited by the concept that Im recommending it to a lot of my friends…however, we are skeptical bc everything out there says NO carbs with candida, klebsiella, and other major bugs, so we are trying to wrap our brains around this theory.

        So basically, low FP allows u to eat certain carbs and these carbs will NOT feed yeasts and starch-eating microbes at all?

        WOuldn’t food combining need to play into this as well….for instance, eating carbs with meats can cause the carbs to not digest properly or vice versa bc the starch requires a more alakine environment and the pro requires more acidic environment. Also, pro digest slower than carbs and thus can hold up the carb digestion and thus ferment. Any thought on this?

        • Nothing is absolute. Bacteria and yeast prefer to ferment carbohydrates (different species and strains have different abilities to ferment different carbs), but can also ferment proteins and amino acids. The idea isn’t to truly starve all your microbes, just limit the amount of fermentable material available.

          Yes, different foods will affect the digestibility of carbs, but you’re still better off with low FP carbs all other things remaining constant. It sound’s like you are looking to take it to the next level with controlling food mixing -go for it and report back.

  23. daniel says:

    Hi Norm,

    I have been using your book for a few days now, after 5 years of dealing with heartburn. I had a couple questions: 1) What is the best way to wean off of PPI’s while on the diet, and 2) Can I use DGL Licorice while on the diet?

    Thank you!

    • Hi Daniel,
      Once on the diet, many people just go cold turkey without symptoms. A more gradual approach is to wean off over a period of two weeks – with your doctor in the loop.
      Lastly, I don’t recommend DGL due to the sugar alcohols used in the product.

      • daniel says:

        Wow, thank for the fast response.

        After 5 years of constant struggles – I have no idea how its been so long – I’ve finally found an explanation that makes sense. I told all of my Dr’s that it followed a strong course of antibiotics at age 24, but none of them had any insight. I have daily symptoms despite 40MG Prilosec so I doubt I’ll have no symptoms cold-turkey. But I’ve tried many, many things and this is the first that has my unbound optimism.

        You are the best Norm. I wish I would have tried this 5 years ago (I know you posted on a GERD forum I write on back then). I know you have helped many selflessly. I have contacted your email for a phone consult and hope to have the opportunity.

      • CM says:

        Similar question: assuming the DGL is unsweetened capsules rather than the chewable wafers, do you think a small amount of rice flour or cellulose in the tablets (like these: http://www.vitacost.com/productResults.aspx?NttSR=1&ss=1&x=0&y=0&ntk=products&Ntt=DGL%20capsules) poses a problem?

  24. Wow, thanks Danial. But the pleasure is all mine. I started as a long term GERD sufferer. My research and writing has been a very pleasurable 7 year journey. Seeing things through a new lens (new theory) is very rewarding. Everything you read looks different.

    You might be right. Tapering in your case makes sense.

  25. daniel says:

    Thank you.

    Is it safe to assume that some people have GERD as a result of something other than SIBO? I am afraid of the cancer risk of GERD, and so I am curious if being off the PPI’s long-term would be a great idea. If someone still had symptoms while off the medication, would you recommend they stay off of it? If 2 months of the Fast Track diet and being off PPI medication didn’t help, would you tell that person to go back on the PPI’s because they might have non-SIBO related GERD? I am just curious.

    For those of us focused on esophageal health and using things that are supposed to be good against esophageal cancer, like fish oil pills, turmeric (and mustard), brocolli sprouts, etc., is there anything we may be consuming that we should not while on Fast Track?

    Thanks again!

    • The only reason I can imagine someone having GERD symptoms other than SIBO is having a lower esophageal sphincter that is extremely weak or damaged easily allowing stomach contents to spill into the esophagus. I see SIBO is the driver of acid reflux in every other case. if you still were to have symptoms after being on the Fast Tract diet or other dietary approaches we discuss through DHI counseling, I would no longer advise against PPIs until the symptoms were under better control. But one thing to remember; PPIs don’t stop reflux and do not appear to provide protection against esophageal cancer or lung problems such as asthma and other respiratory complications from GERD.

  26. CM says:

    I finally received the book and have been enjoying reading it and trying to implement the principles in my lower-carb diet. I am still having quite a few symptoms and, beginning today, am trying to measure more carefully how many grams of FP I consume daily. Until now I’d just been eating foods considered lower-FP without really tracking overall consumption.

    A few questions I hope you’ll have time for:

    1) Any guess as to the FP of plain 24-hr.-fermented/SCD yogurt (http://www.breakingtheviciouscycle.info/legal/detail/homemade-yogurt/)? I make my own yogurt and let it ferment for at least 24 hrs., which theoretically gives the cultures enough time to completely break down all the lactose into simpler sugars. Would the FP be lower than the 7 grams listed for (presumably) commercial yogurt?

    I’ve also read that carb counts on even commercial yogurt are slightly misleading because they don’t account for the cultures converting the lactose, but instead measure the carbs in the milk pre-fermentation. (http://www.carbsmart.com/greatyogurt.html) With that in mind, do you think it’s fair to use the 4g carbs/cup of yogurt estimate to recalculate the FP for plain yogurt?

    2) In the book and in your post, you mention that lactose-free milk is acceptable. I’ve looked all over the internet trying to find a GI for Lactaid (either 2% or whole), and it doesn’t seem to exist. Do you have an educated guess as to the FP of lactose-free milk? I would guess it’s less than the 8g listed in the book for regular whole or 2% milk. Is lactose-free milk still something heartburn sufferers should try to limit or count toward daily FP targets?

    3) Brown rice pasta looks like an attractive occasional alternative to jasmine rice. Do you recall which brand you calculated FP for? I picked up a bag that turns out to have added bran, which strikes me as a no-no considering fiber’s potential fermentation.

    4) Most varieties of potatoes available in stores, even organic or specialty stores, are sold unlabeled. Is there a good source for the low-FP potatoes mentioned in the book (Desiree, Pontiac, Sebago)? Also, have you thought about whether aging tubers/potatoes impacts their FP? I’d read somewhere that refrigerating potatoes isn’t generally advised because it encourages them to convert start to sugar—which might actually be beneficial in terms of lowering FP, no? I also heard somewhere that McDonald’s stores their potatoes until the starches convert and they become sweeter, which makes for more addictive fries. Just curious whether this might be a factor to consider, just as we have to think twice about refrigerating cooked starches.

    Thank you, and keep up the good work!

    • Great post Christina,
      The student becomes the master. Your questions are amazing. I don’t have all the answers, but I love the questions.

      Your thought and link on yogurt is really interesting. I will look into this because wouldn’t it be nice if yogurt was even more gut friendly than we thought.

      Lactose-free milk is most definitely lower FP than lactose-containing milk, but I suspect they add sugar back for the same taste. Another mini research project.

      On the brown rice pasta and the various types of potatoes, all I can say is that I sourced all my data (for calculation of FP) from the public domain glycemic index tables. I removed many foods due to the fact that they would not be recognized in the US. Still many of the foods in the tables are Australian as much GI work has been done there. Now I will need to rely on well informed curious readers like your self to learn more about the availability of the less well recognized foods in the tables.

      This whole idea is new and there is still much to be learned.

      Thanks for adding your keen insights!

      • SherryL says:

        On the FP tables, I wanted to see if you could clarify….

        What is the difference between rice cakes and puffed rice cakes? The only ones I have found are Quaker Oats rice cakes would these be considered puffed rice?

        Also, the peanut butter listed doesnt specify whether it is typical peanut butter or natural peanut butter=only ingredient being peanuts. Which one are you referring to?

        Also, is the Almond milk on table, sweetened or unsweetened?

        I have read your IBS book but need to fine tune the details.

        Thanks for your help.

        • Hi Sherry,
          Thanks for reading. Puffed rice cakes are made with “puffed rice”. They look fat and round and very light. Likely the same as the Quaker Oats rice cakes you mentioned. Peanut butters likely won’t vary much in FP since peanuts are the main carb ingredient that registers in the glycemic index test. The almond milk / drink is unsweetened. Good luck with the diet!

    • daniel says:

      Hi CM,

      Do you have a link to how you make this yoghurt? Thanks!

      • CM says:

        Here’s my approximate “recipe”:

        Heat 8 cups 2% or whole milk to 180F (just at a simmer) and transfer to a large Tupperware you’ve just cleaned with very hot water and dish soap. Cover with plastic wrap and monitor the temperature until it drops to around 110-115F (you can use ice packs or a water bath under your bowl to cool down the milk more quickly). When the milk reaches 115F, whisk in 2-3 Tbsp. of your favorite yogurt that contains live cultures (I like using Liberte vanilla or Stoneyfield organic). Whisk well. Cover your container with its lid (discard the plastic wrap), wrap it in a towel, and stick it in the oven that you have very briefly preheated to warm it up slightly (like you might for proofing bread dough). Turn the oven light on. Note the time—your yogurt will be ready in 24 hrs. Every 6-8 hrs., if you can remember, it’s helpful to very briefly turn your oven back on just to warm it slightly (just don’t forget or you’ll overheat and kill your yogurt). At the end of 24 hrs. you’ll have a tart, thick yogurt—almost Greek yogurt style. It will also firm up further once you refrigerate it. You can also use a heating pad (I’ve done this using a styrofoam cooler for insulation) instead of the oven.

        • daniel says:

          Thanks! Really appreciate you taking the time to write that out.

          • CM says:

            No problem. The higher the fat content, the thicker your yogurt will be. If you want to use fat-free milk, you’ll need to whisk about 1 c. of dry milk powder into the hot milk to help augment the thickness—not sure how that might affect the FP (perhaps in a bad way). My normal breakfast is about 1 c. of this yogurt with some sliced strawberries (it’s less sweet than the commercial stuff, but you get used to it).

            Also, regarding your other post about heartburn being up and down, that’s definitely been my experience. I don’t think you can assume that whatever you ate immediately prior to symptoms is what caused them (e.g., chicken). The impression I have from the book is that you can sometimes experience symptoms 2 or 3 days out from something you at earlier (which is why the diet has you reintroduce wheat and other potential allergens slowly and separated by several days to monitor for symptoms). You might be able to keep chicken, after all ;)

  27. daniel says:

    Does this mean that after some time on the diet that one could eat within an hour of sleeping without heartburn, and not have to sleep on an incline?

    • That is the goal – get SIBO and reflux under control so there is less intragastric pressure and the LES tension can improve over time. I would keep the technique on your GERD tool belt in case you ever have breakthrough symptoms.

  28. daniel says:

    Thanks Norm!

    I have weaned from 40mg Prilosec to 20MG Prilosec and am doing much better symptom-wise since starting the diet despite the lower dosage. Although I eat basically the same thing every day, yesterday I did get a lot of heartburn after days of doing very well. I guess it is just how it goes – ups and downs without any real logic, with a long-term trend of improvement.

    I did eat chicken, which I thought would be fine, but perhaps the seasonings do come into play and can cause heartburn even if the protein and fat do not. But I will leave chicken out of my diet for a while though and go back to what I’ve been restricting myself to so far.

    Thanks!

  29. Marty Gerace says:

    My chiro just sent me this link. I have been having reflux since October, and off and on for 3+ years. I am celiac and hypothyroid (Hashi’s). I am a vegetarian (since ’76). I am 5’2 and weigh 103#. I am concerned if I cannot eat some of the sweets (mostly pumpkin muffins and other gluten free products). These are made locally, so did not have the stuff that no one should be eating. This might cause more weight loss than I can afford. I have been following an Ayurvedic diet, which excludes brown rice, soy and all nightshades. I have been using Basmati rice which I will change to Jasmine. Since doing the Ayuredic diet, I have had no IBS bowel issues, but do have the reflux. Part of it may be caused by constant back spasms (overuse of computer/work) which impacts the nerves in the esophagus and irritates. I also have a small sliding hiatal hernia. I also use Aloe and DGL and drink lots of water. Any thoughts/suggestions? I did have the breath test for h pylori years ago which was negative. Thank you for your time.

    • Hi Marty,
      If you need to add some sweets you can prepare them with Splenda, dextrose or even maltose, though I would watch the latter two until your symptoms are under control. One of the problems with gluten free diets is that they have too much resistant starch because they only limit starches from wheat, barley and rye. Many celiacs therefor are consuming too much resistant starch in the form of corn, certain potatoes and rices and even bananas. I would stop the DGL as most brands contain sugar alcohols.

      If you would like more specific help with what to eat, feel free to drop us a line under the counseling tab.

      • Marty Gerace says:

        Thanks for your reply. I do not eat corn products, except polenta at times, no bananas. I eat Jasmine rice, no potatoes, except sweet potatoes. Having been a baker most of my life, I found making gluten free to challenging and never tasted as I remember those receipes tasting, so I no longer bake, so that creates problems with the “sweets”. The DGL that I use is Fructose Free and Sugarless. I will look where you directed me. I believe Gluten Free diets are not healthy. Choices are limited though better than 8 years ago. You have to read labels really carefully.

  30. Angela says:

    when will your hardcover IBS be available. Will that have the list of foods and there fermentability? I am curious about garlic and onions on this plan. These are major triggers for me.

  31. Kate says:

    How do purple potatoes, Yukon potatoes, and jewel and garnet yams fall in the fp?

    • Sorry Kate. I don’t have info on the specifics of these potato varieties at the moment. For the time being, you could look up the carb counts and assume a glycemic index (unless someone tested these foods) of 48 (conservative for potatoes based on sweet potatoes). That will allow you to calculate a rough FP. Remember, there are potato choices with known lower FPs such as Pontiac, Sebago or Russet.

  32. Angela says:

    thanks, am looking forward to that.

  33. Joe sabet says:

    Hi. I just took antibiotics for sibo. I’m overwhelmed knowing that I have to drastically change my diet. In the past few months I’ve been eating cookies, scones at Starbucks, big bowls of oatmeal, etc. Now it seems like I have to eat meats and some veggies or just starve. Here’s my questions:
    1) is there any kind of oatmeal or wheat bran or some type of grain I can eat a lot of by simply adding hot water and honey? I don’t like cooking
    2) what kind of sweetener is ok for my coffee? Splenda, stevia, organic raw honey or what?
    3) have you tried that new sweetener made by Splenda, which is mostly monk fruit? Is it safe for sebo?

    Thanks for your time. I am going to get the book people keep mentioning in these posts

    • I hear you Joe. We all wish we could eat like we did as teenagers. But I think you will be surprised by the recipes in the Fast Tract Digestion books. For instance, the sticky rice cereal is easy to make, delicious and creamy, and you can sweeten either with Splenda, dextrose or even maltose (better not to use honey). I have not tried this new Splenda sweetener based on monk fruit, but I am very curious now that you mention it.

  34. Kyra says:

    Hi… I’m not sure if this has been addressed, but does the “fast tract digestion” diet help with yeast/fungal/mold overgrowth and parasites in the gut? I had a recent Metametrix stool test that showed these results. There are many variations of the “anti candida diet”… Some say that brown rice, starchy veg, and even some fruits and beans are ok… Other limit just some of those foods or are very strict and promote lots of meats eggs veg and fats.

    How low carb and fp would be beneficial for me to go? How high fat? Are there any particular foods I should avoid based on these infections?

    Lastly, do u feel that the natural antimicrobials like oil of oregano and grapefruit seed extract are helpful? Probiotics?

    Thanks for being such a great resource

    • Hi Kyra,
      I can’t give you a very detailed answer with out more information about your situation, but here are a few thoughts. The Fast Tract Diet limits the amount of (carbohydrate) fuel that supports the growth of all intestinal microorganisms including yeast and other fungi as well as many parasites. In your case, knowing what specific organisms are causing the problem would be very helpful. Parasitic microorganisms can be tough to get rid of because they have well developed virulence factors that allow them to attach, feed and reproduce in the digestive tract. Many of these specific parasites or fungi may require powerful antiparasitic or antifungal drugs to dislodge them.

      If you choose to try the general approach of “starving them out”, you can’t go too low on carbs or too low on Fermentation potential. I would focus more on limiting carbs than fats or proteins. You should avoid high carb or high FP foods. I don’t think the herbs and extracts will be of much help in your case, but that’s just my opinion. In the case of probiotics, it wouldn’t hurt to try it.

      I recommend you discuss any ideas on this site with your own health care provider to arrive at a comprehensive diagnostic and treatment strategy tailored to your specific situation.

      • Kyra says:

        Thanks norm!!!

        I wish i knew the strains. The test couldn’t id them, but my yeast/fungus level was the highest possible at 4+. I have bad uc and gerd. Low carb is hard for me bc i get constipation, which flares the uc. I’ve been trying to go low carb the last few days (no fruits only some squash, peas, and veg for carbs… Eggs, chicken/fish for pro… Coconut oil for fat) but it’s caused my stools to become gluey/tarry and constipated with some incontience (sorry for the tmi) … I’m also craving fruit badly and i dont feel satiated.

        Any advice, based on what I wrote above?

        What would be a good general macronutrient ratio? I’m not used to eating low carb, so idk how low my grams/percent should be, nor hw high fat.

        Lastly, any tips to prevent these sticky stools and constipation?

        • Don’t worry, never tmi on this site. Your diet sounds pretty reasonable. Fast Tract Digestion IBS- coming soon- has lots of information on constipation including a detailed section on the four basic types of laxative. Here are a few suggestions. Go on the Fast Tract Diet because constipation has been linked to a particular type of SIBO. Loose the legumes which can make matters worse. Add more green leafy veggies. Drink lots of water. Consume more olive oil. If you use laxatives, don’t over do it as that can create a dependency. Antacids and some pain medicines such as Tylenol 1, 2, 3 and 4, which contain codeine, can cause constipation. I don’t worry about macronutrient ratios because there are so many low carb vegetables and I eat plenty of fat and protein.

          • Kyra says:

            Cant wait for the book to come out!!! :)

            I’m not eating legumes…. Aren’t green peas a veggie? I would be really sad to cut them out bc i make a good sauce with them. It’s the only way I can tolerate meat (i am normally a vegetarian)

            I don’t use any meds. I am trying hcl and digestive enzynes. But Idk if these are making things worse?

            I’m all about the natural aporoach

            I worry abt macros bc i want to eat balanced.

            Also, I’m getting hypoglycemic and feel “imbalanced” eating low carb. So, having macronutrient parameters helps. Any advice on the physical symptoms?

  35. Yes, peas are a legume, but not quite as symptom provoking as beans. A 2.8 ounce serving has an FP value of 8 grams. Just keep daily FP grams under 40 (25-30 might be even better if your symptoms are persistent).

    The enzymes should be OK to try. I wouldn’t recommend the HCl unless you are over 50 years old or have had a test showing you have low acid.

    On low carb, the human body easily adjusts making blood sugar from protein. Hypoglycemia should not be an issue. But the Fast Tract Diet is flexible for people who want more carbs. Just focus on reducing high FP carbs.

    • Kyra says:

      Thanks so much norm… U are more helpful than any practitioner I’ve seen

      I read in another post regarding someone with candida and how u said that refined carbs won’t feed candida as easily as whole/natural carbs. Can u explain this bc my understanding was that yeast thrives off of refined grains/sugars moreso than refined ones

      Lastly, what would then approximate fp be for this product?

      http://www.foodforlife.com/product/tortillas/brown-rice-tortillas

      And would it be “safe” to eat daily for someone with my gut infection?

      Ps, imI’m also prone to klebsiella pneumoniae…. It is supposedly gone now, but i dont want that bugger to come back!!

      • Yeast would love to consume refined carbs, but these are also the carbs preferentially absorbed leaving few available for yeast or other gut microbes. The brown rice tortillas have an estimated FP of about 12 grams. BTW, K. pneumonia overgrowth responds favorably to low starch (Dr. Alan Ebringer’s work) and should respond even more to low FP.

  36. Amy says:

    Speaking of candida and yeast, isn’t it important to go on a low sulfur diet if u have candida bc sulfur feed the yeast (and can also be bad if u have mercury toxicities)?

    How would a person do a low fp, anti candida, low sulfur diet?

    • I have also read a few posts about low sulfur for Candida. I don’t understand this approach as sulfur-containing compounds inhibit yeast so foods such as garlic and onions are recommended because they contain sulfur compounds. Just don’t eat too much garlic and onion because they also contain difficult to digest but easy to ferment fructose oligosaccharides. The best overall approach is low FP, low carb, low starch type diets while addressing any existing immune system deficiency that can allow yeast (Candida) to become established. Also avoid antibiotics, hormone treatments and other drugs that can promote yeast overgrowth wherever possible. It might not hurt to try a probiotic containing Lactobacillus acidophilus though there is little information on the effectiveness of this approach.

      Mercury toxicity is a much more serious condition that goes way beyond candida overgrowth.

  37. Olga says:

    Dear Norm,
    First of all I would like to express my deep gratitude for your great insights and research! I got an electronic version of your book through Amazon, read it the same day and was ecstatic to find something that actually explained the problem behind GERD and presenting such a brilliant solution for it!
    I have been experiencing severe GERD symptoms for about 3 months, it started abruptly and seemed to never end. By the end of the 3d month, my esophagus was so bad that I had trouble breathing.
    My physician put me on PPI and told me that my problem was weak LES and that it was genetic. I felt so hopeless. I then discovered a Candida diet and tried a strict candida diet for 4 days. I ate exclusively vegetables (onion, cauliflower, broccoli, kale, artichoke) and eggs for those 4 days, my vegetable portion was quite low (about 150 grams per meal 3 times a day). I had a horrible acid reflux all those 4 days. The worst one was after dinner of one boiled artichoke and one boiled egg.
    I discovered your book and eliminated all veggies (all fiber) and instantly within a day felt like a human being again. I have been on your diet for 3 days now and have not had a single acid reflux episode!! It is just like a miracle! 
    I do have a couple of questions for you though
    1. On a diet of just veggies and eggs I had a bad heartburn still, although the FP of those veggies was not great. I probably was having FP of about 10 per day. My question is, are there certain vegetables that are not very safe to eat with SIBO even if they have low FP?
    2. I have heard of ways of lowering GI of a meal or food by adding vinegar, fat or eating it with protein. Rice for sushi is always seasoned with vinegar for example; I always put butter or ghee in my rice and often eat it with protein of some kind. Does that mean that the FP of a meal gets higher in this case with GI being lower?
    Thank you so much for you work and for your time!!
    Olga

    • Hi Olga,
      I really appreciate your comments. I like the way you embrace the scientific approach and question everything. I am not sure why your last diet did not work, despite the fact that the veggies were of the low FP variety. But I am glad the Fast Tract Diet is working. I can comment on one thing. Even though eggs have zero FP by definition and overall appear to be a very safe food for heartburn, once in a great while, I get heartburn after eating them. I can’t explain it except perhaps relating it to a slowly fermentable fiber that I may have consumed the previous day. When I assess which foods may have caused my very infrequent reflux, I look back for the last full 24 hours to see if I can identify foods that may have contributed.

      Also, you bring up a good point about the affect of vinegar, fats of protein. While some foods will lower the GI (and hence raise the FP) of other foods, the FP system just compares foods to one another without adjusting for these affects. I figure if you start with the safest foods, even some influence from things like vinegar, fats and proteins on the FP will be less significant compared to high FP foods. I recommend using your observation as an additional tool to pull out when and if you have any breakthrough symptoms.

      • Amy says:

        May I chime in?

        Olga, are u still eating eggs or did u cut them out? What exactly is ur diet like now?

        The diet u ate was very high sukfur. Some people have a genetic sulfur clearance issue with the cbs gene. If so, then a low sukfur/thiol diet would suit u best until u clear this pathway. Supps like molybdenum can help, but only take small doses, like 30mg. Test ur sulfate level with quantofix sulfur strip. It should be <400. As u clear sulfur, ur levels may rise very high, but if u stick to a low thiol/sulfur diet and use the molybdenum, it should clear in approx 10wks. Addingyucca and bbutyrate supps can help clear excess ammonia too,which often goes hand in hand wwith cbs issues. Sprinkle yucca capsules over any food that has animal pro (1/3-1/2cap)

        Sulfur is essential to live, so don't go completely sulfur free… But u may need to watch ur intake for a short while. Bad gut hugs can influence this sukfur intolerance issue, and if u have other genetic polymorphisms (snps), these might influence ur ability to methylated, detox, and tolerate certain foods

        Hope this helps

        • Olga says:

          Dear Amy,
          Thank you so much for you input!
          I do still eat eggs on this diet, about 2-3 a day and since I eliminated all veggies I have not had an incident of heartburn which tells me that my reaction while on Candida diet was probably to fiber in vegetables. Of course by eliminating sulfur containing veggies I did cut down on sulfur a bit but I still do not think that I have a sulfur issue also due to the fact that ironically, about 4-5 days ago I also started to take organic sulfur crystals(after reading about importance of sulfur for detoxing), about 4 gr per day dissolved in water and Alpha lipoic acid(both rich in thiols) and I have not noticed any worsening of my symptoms and still have not had a bad reaction. Or maybe there has not passed enough time yet and all the hell will fall on me in two or three days?  I hope not.
          I am curious though about this issue and would like to test myself for my sulfate level. Where can one get quantofix sulfur strips? Also, is this condition genetic or it can also develop with age? I used to have no trouble with sulfur rich foods before, at least I thought so
          As for my diet I try to take it slow and eat mostly animal protein, animal fats and a little bit of sticky rice. I am cautious to introduce anything else at this point since the diet I am on is working now. I will be introducing other things gradually in the future and see what my reaction is. Sulfur issue is definitely worth exploring more which what I will definitely do.
          Thank you very much for your advice and new insight into my problem

          • Amy says:

            U can get ur genes tested thru 23andme. Cbs is a gene that can make people sensitive to sulfur if it is activated. Taking small doses of molybdenum can help (like 30mcg and working up), in addition to avoiding foods that cause issues (look up foods high in thiols).

            Hope this helps. Sorry for the delay

      • Lynn_M says:

        I wonder if the occasional problem with eggs could be related to what the egg-laying chicken has been fed. If the chicken was fed GMO soy and corn, I suspect her egg could be problematic, whereas an egg from a hen allowed to eat free-range might not cause any issues.

        Norm, I found you from your interview on oneradionetwork.com. Thanks for being on that show.

        • Hi Lynn,
          Thanks for catching the show. On eggs you never know. I recently was having almost immediate diarrhea right after eating eggs. But (like an idiot?) thought that if I hard boiled them they might not make me sick. When I put them in a pan of water, they all bobbed in the water – full of gas, a sure indication that they had become contaminated with bacteria. I bought new eggs which sank to the bottom of the pan and the problem was solved.

  38. Olga says:

    Dear Norm,
    Thank you so much for your quick response! I absolutely agree with you , sometimes something that has been eaten a while ago may still have an effect and one should always examine the foods consumed at least within 24 hour period. I used to get bad heartburn in the mornings after drinking a glass of water on an empty stomach. I even told my doctor that I had heartburn from everything even water.
    I think in my case I should be careful with eating any vegetables even low FP ones. Apparently bacteria in my gut love vegetables even more than I do.
    I have not had any problems with eggs before, although I did stumble upon an article about egg whites being difficult to digest by people with compromised digestion, due to having protein inhibitors and anti nutrients in them. http://paleodietlifestyle.com/an-egg-yolk-a-day-keeps-the-doctor-away/
    The author of this article also writes about nightshades and them being not so great for people with gut problems. http://paleodietlifestyle.com/you-and-your-gut-flora/
    I used to eat tons of nightshade veggies because I love them but now I feel very cautious about trying to eat them again. I am curious about your thoughts on nightshade vegetables. I wonder if any of your patients ever had bad reaction to them.
    Thank you so much for your time and expertise!
    Olga

  39. Jon says:

    I’ve purchased your book and am so excited — dietary recommendations for my “IBS” that finally make sense! Thank you… this will be well-recommended to a number of people I know who are suffering. I had a couple questions I was wondering if you’d be able to give your thoughts on…

    I’ve been spending a year and half with unexplained digestive issues — after trying to quit smoking and getting *badly* backed up while being under a lot of other stress. The primary issue is extreme gas, which has been continuing to build and build. My intestines fill with gas 24/7 at this point. Every hour (sometimes every 10 minutes) I’m forced to assume uncomfortable positions to emit extreme volumes of gas, sometimes it’ll trap terribly, while other times I’ll be attacked by an hour+ of huge, violent, swaths of non-stop gas and still be left bloated & constantly gassy afterwards. It’s not as if I’m intolerant to anything specific, severely constipated, or eating an extreme amount of carbohydrates or fiber. I am already underweight, and a high school teacher, and have not been able to cut out carbs completely, however. Other than that I’ve tried it all from fiber therapy to probiotics to FODMAPS (though definitely still too much sugar, and moreso resistant starch & fiber methinks…) and have had every test done on me. Tested negative for SIBO but know false negatives are common, and figure my problems lie farther down the tract as I suffer no real upper GI complaints. Currently ‘fighting candida’ with a naturopath. Had a comprehensive stool analysis done that showed “friendly” +3 bacteroides fragilis +3 e coli, +2 bifido, +1 lacto / “commensal” +1 of klebsiella pneumoniae ssp pneumoniae , +1 Gamme hemolytic strep, +1 alpha hemolytic strep / “yeast” candida +2 / and then the “potential parasite” blastocystis. I don’t know how accurate/informative any of that is. Blastocystis has shown up before and docs have offered to give me Flagyl, with the caveat that it would likely make my situation worse. Is the culprit of this extreme flatulence a general overgrowth, the wrong bacteria, blastocystis, or some unfound parasite?? Thoughts?

    I’ve purchased your book & have started following the diet… but obviously with the extent of my gas despite previous dietary experimentation, things won’t resolve overnight. The gas has become so extremely horrible and controlling that I am becoming severely depressed. Now both my naturopath and GP say I should give Flagyl (250mg TID) a try. I’m worried it could result in making the candida thrive, and possibly the klebsiella or blastocystis as well (to eliminate blasto they usually prescribe 3 times as much), or maybe even c.diff :o? I feel good in terms of elimination, there’s no odor to speak of, and I worry about making things worse than they already are. I can’t remember ever having taken antibiotics before. That said, I’m in pain all day, unable to sleep, and barely holding onto my job. Any advice at all on whether to take the antibiotics and use the diet during/after, or to focus on pushing myself diet wise, i.e. carb elimination? Any thoughts would be awesome… I’m a bit lost!

    Also, the more fiber I cut the more constipated I seem to become… quite a catch-22 in my current situation. What’s worse in terms of feeding those buggers… constipation or fiber? Any recommendations there? (I had a transit time test & everything was moving fine– while I was intaking a ~22g of fiber a day & GASSSy– and worry that I’ll be compounding the situation by getting constipated again.) Any thoughts on enemas/colonics?

    Thanks a ton. I know there aren’t any easy answers to any of my questions… but I really love the book & you seem to be one of the wisest individuals I’ve come across in terms of your digestive advice

    • Jon says:

      Oops… forgot: -NG Eneterococcus spp. // +2 Clostridium spp….. :)

      And how reliable/informative are these stool tests anyway?

      • I assuming you mean that the test (no growth) was negative for Enterococcus species and positive for 2 Clostridium species. I would not worry about the results unless specific pathogenic (disease-causing) organisms are present. Both Enterococcus and Clostridium species are normal parts of most people intestinal flora. If you were positive for C. diff, that would be a red flag.

  40. Hi Jon and thanks for writing. Based on the information you provide, I suspect you are experiencing a general dysbiosis, as you suspected – an imbalance in gut microbes likely involving the latter part of the small intestine and large intestine. For some reason your diet is feeding this dysbiosis. I recommend following the Fast Tract Diet and drinking lots of water. If you are worried about constipation read the two sections dealing with this topic. Make sure you have salad and lots of olive oil daily.
    Of course consult your own doctor, but I do not recommend taking any other drugs, probiotics, antibiotics, colonics or enemas until you give the Fast Tract approach a chance. As far as stool analysis, more information can’t hurt. You could find out that you have a specific pathogenic organism present, etc. But first give the diet a try. You should know straight away if it’s going to help. We offer coaching if you need some concentrated help on your specific situation.

  41. Andy says:

    Dr. Robillard,

    Just going over your book on IBS and SIBO, and had a few questions about the dietary recommendations. Can you help me make sense of these? I saw that brown rice has a high FP, but brown rice pasta is low? Similarly, rice crackers are low, but I assumed this to mean white rice crackers, not brown? Can you clarify? Also, I saw that a corn muffin was listed as low FP. Does this mean making baked items from cornmeal would also be low FP? One last thing, not sure how much luck I will have finding the varieties of potato you mention as low FP (Desiree or Pontiac). Any other low FP types of potato?

    Thanks so much! Really enjoying the book!
    Andy

    • Hi Andy,
      Good questions. There are several varieties of brown rice listed with FPs between 8-19 grams for a 5.3 ounce serving. The brown rice pasta does have a lower FP of 5 grams for a similar serving size. I can’t say whether this is due to the manufacturing process or inherent in the type of rice used. I just don’t have that information. The rice crackers have an FP of 2 grams per 1 ounce serving. If you multiply that by 5 for a similar serving size as that reported for rice in the tables, you get 10 g (similar to some varieties of rice). Again, I don’t know what the type of rice was used to make the crackers. The corn muffin with a low FP is listed as a “low amylose” corn muffin which explains the low FP. To duplicate this low FP muffin, you would need to acquire some low amylose flour. If you find some, please let me know where you found it! Lastly, I can’t help you find these varieties of potatoes. I suggest you do the best you can to find some of the lower FP potato varieties, cook them well and consume them in a controlled manner to identify a variety you can tolerate.

  42. Val says:

    Hi.im a french canadien And im not good in english but i like so much your web site. I have a diagnostic of sibo since 2 weeks. Before That, a lot of doctor said That it was just stress And That i CAN eat everything. I start antibiotic (cipro and metronidazole because we cant take rifaxin in Canada)but i Will Try That just one Time. i buy your book. I Will Try to understand all the Words in english! I Will probably have some questions for you!

    • Hi Val, Thanks for writing. Check with your doctor, but I recommend that you try the Fast Tract Diet first, before you take antibiotics (Cipro and Metronidazole). You don’t want to kill your good bacteria!

    • Amy says:

      I agree with norm… Avoid antibiotics. Especially the flurorquinolones like cipro. They can cause longterm damage… I’m living proof of it. I’m a nurse and the dangers of flurorquinolones are too great to justify their usage, unless in dire, life or death situations. Try dietary, herbals, and probiotics and fermented foods before using cipro

      • Val says:

        Thanks for your reply. Its stress me because a already start for 5 days but now i dont have secondary effects. My doctor gave me That because i lost Weight because i lost lipid. So Maby he thinks That it was urgent to kill the bacteriA!. But its the first Time That i take antibiotic during all m’y Life. Its scares me That you think That its so dangerous!

        • Val says:

          And i just Want to sais That probiotic makes me realy worst so i just Want to said to take care with probiotics but it Maby help some person . But herbal and the dietary Yess i Will do and Try to do the best That i can but it Will be difficult in restaurant.

        • Amy says:

          I dont mean to scare u, and it does sound like u need the cipro if ur symptoms are so severe

          Just make sure to do plenty of joint strengthening exercises (start low and slow) once u feel better, as cipro can affect the joints of some people. I hope ur gut gets better asap :)

          • Val says:

            I will follow your Advice when i Will have more energy to do exercises. :). I hope i Will have more energy one day!.i Will write my evolution here after the antibiotic and a diet if you Want!.i hope That the good bacteriA Will be able to coming back without probiotics.

          • Hi Val,
            Don’t worry too much about Candida. Please do post on your progress.

  43. Val says:

    Where i live, nobody believe That candida is a problem in bowel and i don’t believe in That to. Should i believe in candida ??

  44. Val says:

    Thanks Norm, i Will post on m’y progress. what do you think about taking grapefruit seed extract with the diet in the beggining?

    • Amy says:

      Oil of oregano is better. Gfse has a toxin in it that can cause side effects. Your stool test should show what supplements to take

    • Val, I would beware of this product as there have been many adulterated (with chemical preservatives) grapefruit seed extract products found on the market. The pure product reportedly does not contain antimicrobial compounds as claimed by marketers of this product.

  45. Angela says:

    Hello, I hope this question has not been asked already. I am wanting to make an extra amount of sticky rice to have in the fridge to use for the next day, as I am trying to portion my carbs out. Will the rice become resistant starch the next day after heating up again? Thanks in advance for any answers.
    Angela

    • Hi Angela,
      A good approach is to wrap one half cup portions of rice air tight in plastic wrap while its still warm being careful not to squish or mash it. You want it to stay fluffy. Then refrigerate or freeze it. You can microwave it in the plastic wrap before eating. Be sure to reheat well to reduce any resistant starch tha may have formed during storage. Use the prodigestion behaviors discussed in the Fast Tract books to help minimize starch malabsorption.

      If you have symptoms from eating reheated rice, I recommend going back to freshly prepared rice or reducing the serving size. Once symptoms subside, you could try again.

  46. Afshin says:

    Hi Norm and thanks,
    I learned a lot from your view about resistant starch. I had problem with basmati rice especially when it is cold or even reheated and i didn’t know it. I think it’s good that i buy your book about ibs in future. (I have IBS.)
    question: I wonder how watermelon can be a safe fruit, because watermelon has a lot of fructose and (fructose/glucose) ratio is bigger than 1 and has polyol. In fodmap diet this fruit is forbidden.
    forgive me about mistakes in writing in english. (I am Iranian)

    • Hi Afshin,
      I am glad you liked the resistant starch article. As described in my books watermelon has a relatively low FP (based both on it’s relatively high GI). That means that the fructose levels are likely not as high as you may think. Also, the FODMAP diet is qualitative, while the Fast tract diet is quantitative. I did not include a value for polyol or sugar alcohol in the FP table for watermelon because I didn’t have any value for this content. Can you provide a source for the amount of polyol? If significant, I will revisit the table and update if needed.

  47. Kim Rongey says:

    Your book has been a godsend since I was diagnosed with H Pylori and then SIBO. I am much better than I was by following your diet. Since I had the SIBO and was nauseated a fair amount of the time, I ended up losing weight (I am under 100 pounds). Occasionally I drink Ensure Clear. Can you tell me if this is okay to drink or what the FP is on this (I only drink at most once a day)? Thank you again.

    • Hi Kim and glad you liked the book. Ensure Clear (10 ounce serving) has 35 grams net carbs of which 18 grams are sugar. I estimate the FP value at approximately 14-16 grams. You might consider cutting the serving size in half or trying a different product.

      • Bee says:

        Kim, u could try making ur own nutritional shake for easy to absorb cals…..

        Raw organic whey protein (healthy plant makes one)
        Coconut oil
        Based in coconut water, almond milk, coconut milk
        U can add dates for carbs (low fp fruit, but high cals)

        • Jon says:

          Rice protein powder might be worth considering too, as I know some can’t do whey…

          Or Kim, if fat is bothering you (Ensure Clear is fat free), try making some kind of drink using dextrose?

          • Kim Rongey says:

            Dr. Robillard, Compared to others I feel very lucky since my only real complaint is the nausea that I still get on occasion. I will stop drinking the Ensure Clear and see if I can make some other type of nutrional drink. I know I need the calories so that is why I tried it. I keep reading about low stomach acid. Would that cause nausea? I sincerely appreciate all of the help!

      • Kim,
        I think the chances are slim that low stomach acid is causing your nausea. I can’t speculate on the cause without investigating your specific situation. Please feel free to contact the institute if the problem persists.

  48. Angela says:

    I was wondering if anyone has ever heard of digestive enzymes (Now brand Super enzymes) causing massive bloat and pain. Tried them yesterday and could not sleep all night because the burning bloat. And it has not gotten any better. All my food was fine, no changes other than one enzyme with each meal yesterday. Pain and bloat came on half an hour after taking the enzyme each meal. I am ready to stop them and I bought 2 bottles. Please if someone knows anything let me know!

    • Bloating is often linked to probiotics as opposed to digestive enzymes, but the burning is likely due to the betaine in the product. I recommend evaluating carefully if you even have a need for this supplement.

  49. Lana says:

    I am thrilled to have found your site doing a google search for amylose/Specific Carbohydrate Diet. I was confused at Elaine Gottschall’s position on this.
    I have since purchased your book and am getting so much out of it. Thank you.

    I do have a question I am hoping you can clarify… It was my confusion regarding amylose vs. amylopectin that lead me to this site. My research showed that amylopectin is the starch that is easily digested and this is confirmed in your research. The only place I found an alternate position was with Elaine Gottschall. However, I have since stumbled onto the research of Dr. Ebringer who says that it is amylopectin that feeds the organism that causes Crohn’s and ankylosing spondylitis.

    I’m perlexed!

    A quote from his book Ankylosing Spondylitis and Klebsiella states: “Amylose is a linear polymer consisting of α-(1→4) links between glucose residues and these can be readily hydrolysed by amylases present in digestive enzymes. Amylopectin, however, is a branched polymer consisting of linear sequences of amylose like chains linked by α-(1→6) side chain giving rise to a branched structure. The problem is that digestive enzymes cannot break down the α-(1→6) links present in amylopectin… ending up with a “hard starch”… which is available for the growth and propagation of gut bacteria…”

    This seems to parallel the position of Elaine Gottschall. In looking a little further into this I found an anecdotal claim stating “…deprivation of amylopectin starch can cause the disease (AS) to go into remission. In my case, my blood values are all back to normal.” However I have found similar claims from Ankylosing Spondylitis suffers that have limited AMYLOSE and relied on AMYLOPECTIN starch. Confusing!

    Most research shows that Amylopectin is more easily digested. Your theory of applying the GI is brilliant and shows that indeed, amylopectin starch is more easily digested. What gives with the above research?! And how odd that followers of both camps are having success??

    • Hi Lana,
      Good work researching this issue. I have become pen-pals with Dr. Ebringer over the years. His research findings on AS are absolutely outstanding. We only disagree on this one point. I think he learned about starches from Elaine. Amylose is most definitely the one that is difficult to digest. There is no question.

  50. Lana says:

    Hi Norm,

    Thanks so much for your confirmation. It certainly makes sense.

    I will share a few food items that I have discovered…

    The first is sweet rice flour – this flour is made with sticky rice. When used on it’s own, the texture of baked goods is rather moist and dense. I’m going to play around with additions to alter the texture a little. That being said, I think it will work really well for some items – shortbread cookies, brownies., pastry. It’s a great thickener as well.
    Like sticky rice, it is pretty much 100% amylopectin.

    The other item is similar. It is a Japanese rice cake made by cooking and pounding a sticky rice called mochigome which is characterized by its lack of amylose. “The protein concentration of the rice is a bit higher than normal short-grain rice and the two also differ in amylose content. In mochi rice, the amylose content is negligible which results in the soft gel consistency of mochi.” http://en.wikipedia.org/wiki/Mochi

    Here’s a cute YouTube video of how to make mochi pizza. I’d nix the ketchup (yuck!) and use a real pizza sauce http://www.youtube.com/watch?v=e59erF1YiFA

  51. Lana says:

    Hi Norm,
    Industrious :) That’s my food science background… I was a Home Ec teacher in a former life.
    Yes, Mochi is made from Mochigome rice. This rice is a type of sticky rice. At one point in the pizza video, when he’s eating it, there’s a long strand of what looks like melted cheese. He points at it and says ‘Mochi!’
    Here’s an article on Insulin and Glucose responses to different rice. They state that Mochi gome rice has 0% amylose and 100% amylopectin. The insulin response is as expected for this rice. http://ajcn.nutrition.org/content/39/3/388.full.pdf
    I wonder if the GI for the Mochi Rice Balls was skewed due to other ingredients? When I did a google search for Mochi Rice Balls it seemed to highlight different recipes – some sweet, some savory. Maybe that’s what they were testing? It doesn’t seem right for this type of rice. When you were in Japan, were you told that Mochi isn’t made from Mochigome rice? I’m going to try to get down to our Japanese food store today to see if they carry this. I haven’t tried it yet. I’ll see what the ingredient list looks like!

    • In Japan, they just said “it wasn’t regular sticky rice, i.e., sushi rice” but I have now confirmed that you are correct, it’s called mochigome rice (in Japanese, mochi means rice cake and gome means rice). However, I had not been able to confirm the amylose/amylopectin ratio or GI. I really appreciate your research into this matter. I wonder if there is sufficient data in that paper you cited to calculate the actual GI?
      I have eaten mochico fried chicken made with mochico (flour made from mochigome rice) that was delicious – and did not lead to symptoms, but i was unsure about amylopectin/amylose content of GI, so was concerned with publishing on it. Your research has encouraged us to experiment more with this flour.
      Thanks again, and keep up the great work!

  52. Lana says:

    Glad the research was useful. I’m making fried fish using sweet rice flour tonight. Even those without issues say it’s a superior flour for this purpose. Looking forward to trying it!
    Norm, I’m new at this and am very leary to eat out in restaurants. Any tips in that regard?

  53. We are doing the same but with chicken.. We should compare notes later. It can be a challenge at restaurants for sure. I find that most restaurants are willing to make you what you want so I often times give that a try. Rib eye steak loaded with sauteed mushrooms and veggies is a favorite. Other common dishes include broiled seafood or mixed skewers over jasmine rice. Antipasto salad is one of my go to dishes as is a Greek salad with either grilled chicken or gyro meat on top. And of course you can eat at a sushi restaurant and eat most of the foods with the except udon noodles. Also vermicelli (hard to know if wheat is used) and not sure if soba noodles are low FP either.

  54. Lana says:

    I wonder where we could get a hold of these potatoes?!
    http://www.avebe.com/News/DiscoverELIANE/tabid/1110/Default.aspx

    Had to postpone fish to tonight. Will let you know how it turns out. Hope the chicken was good!

    • Lana says:

      By the way, thanks for the dining out tips – they’re helpful. Our favorite cuisines are East Indian and Chinese. I’ll have to decipher the typical sauces and see how they pan out.

    • Good find. The US distributor is Ingredion. I sent for a sample. I may need your advice for some baked goods.

      We actually went out last night so didn’t make the chicken. We ate Indian, including basmati rice. I had to use some proabsorption techniques to avoid symptoms. A bit of gas but no reflux. Mission accomplished.

      • Lana says:

        Well, the fish wasn’t as crispy as I was hoping. Have to work on it some more. Great find getting the US distributor for the potato starch! I think I’ll have to order a sample too :)
        Now to find the potato itself…
        You might have some luck with another product I found:
        http://www.hiwtc.com/products/jasmine-rice-noodle-8206-42766.htm
        I wonder what the minimum order is. If you order a container, put me down for a few cases :)
        I’m thinking the reason that the GI for Rice Vermicelli and Rice Paper is low might be due to additional ingredients. It took me awhile to find vermicelli and rice paper made just with rice. Most have added tapioca and/or potato starch.
        Whenever I make salad rolls I can’t help thinking the rice used must be sticky rice as they’re so stretchy and glue onto everything. The ones I’m using come from Thailand.

        • Yes, the mochiko chicken we make is also not particularly crispy, but it’s still moist chicken and delicious. We serve it with a mayo / chili sauce mixture. Let us know if you find a way to make it more crispy. Thanks for posting your resourceful finds. Jasmine noodles – perfect. I will have to check it out and see if I can get some. I am also on the look out for rice paper confirmed to be made from a low amylose rice.

  55. Heidi says:

    Hi Dr. Robillard,

    In an effort to control my long-standing symptoms of gas, bloating and reflux, I started a GAPS diet a couple of weeks ago. Although I experienced alleviation of symptoms within a few days, I found that I also had plummeting energy levels and other signs of ketosis, due to such low carb intake. I am very physically active (in both work and play) and have very low body fat (5′ 10″; 125 lbs). I DO NOT want a ketogenic diet nor do I want to lose weight! To increase energy levels and carbs, I added more fruit and some sprouted lentils, with unhappy results (as you can imagine).

    Through continued web research, I found your diet program and am thrilled about the potential of adding some carbs back in. (Also thrilled that heavy cream is acceptable–coffee without it is just not the same!). I also appreciate the mechanistic explanation/theory behind the fermentation potential–it makes a lot of sense to my scientifically-trained brain. I will certainly be turning toward your diet recommendations as the next step in my dietary experimentation. A couple questions for you: 1) Will I be able to consume enough carbs to keep myself out of ketosis, yet still restrict the food source for bacteria? 2) Does the analysis of fermentation potential hold for fungal species as well as bacterial? I have had problems with yeast overgrowths in the past, and am wondering if your diet recommendations will help control fungal populations as well as bacterial.

    Thanks for the work you’re doing on this!

    Heidi

    • Hello Heidi,
      Thanks for trying the Fast Tract Diet. You can consume plenty of carbs if desired. In the recipes, we kept the overall carb counts to less than 100 grams per day. You can consume more as long as the FP levels are maintained. For instance, jasmine rice has an FP of zero so there is technically no limit to serving size. We recommend limiting servings size to 1/2 cup initially – for the first week or so. We do that in case people have advanced SIBO where bacteria are present in the earliest part of the small intestine. In those cases, even the simplest / most easy to digest and absorb carbs might feed these bacteria. By limiting both FP and the total amount of carbs early on, your control systems (stomach acid, motility, immunity, etc.) can clear out the bacteria.
      As for your second question, the diet should also be effective for any fungi involved as these organisms also feed on malabsorbed carbohydrates.

  56. Natalie says:

    Hi Dr Robillard,

    I have both gastritis (infection H. pylori) and IBS-C. Currently I am taking antibiotics to get H.pylori out of the way. After that my doctor wants to do the breathing test for SIBO (but I am sure I have the condition since using Xifaxan in the past keeps my bloating and excess gas away but as soon as I am off of the medication the symptoms comes back). Will you kindly take some time to answer some questions that might help me using your diet?

    I have bought your book Fast Tract Digestion (IBS); should I wait for the antibiotics to finish before starting your diet?

    I suffer from IBS-C and use Flaxeed (in different forms) to fight constipation. How much Flaxseed can I take while in your diet? Can I take extra fiber (if so what kind)?

    The recipes in the book are excellent but they use a lot of dairy products. I am lactose intolerant. Can I substitute the deserts with heavy cream/cheese with other things for the first two weeks?

    Also what do you think about using Coconut cream?
    In advance, I thank you for your time and all your efforts.

    Best, Natalie

    • Hi Natalie,
      I am really sorry to hear that you have had more than your share of gut issues lately. The diet will definitely help. I would not wait to finish the meds. Go ahead and start the diet. You can talk to your doctor about it, but it shouldn’t be a problem. I recommend that you discontinue the flax seed as you begin the diet. If you continue to used it, include the FP – which is basically the fiber in this case. The book does use dairy, but only cream and fermented dairy including yogurt and cheese – all in controlled quantities and all relatively low in lactose. Milk is usually the biggest problem. You can substitute if needed as long as you include the FP in your daily allowance. The coconut cream needs to be used in moderation given the overall carbs and fiber counts. try calculating the FP for the serving size you use for this product (use a glycemic index of 50). If you have problems, contact me.

  57. Melinda says:

    Very helpful website. I’ve been suffering from what I assume is SIBO for two months, though I didn’t test positively for it. I just ordered your book and plan to start your diet. But one question while I wait for it to come. I drink wine, which mitigates the SIBO symptoms, but I assume you would say I should not drink alcohol?

  58. Lana says:

    Hello Norm,

    Hope your summer is going well. I thought I would check in with you to see if you received the sample of potato starch from Ingredion. I haven’t ordered a sample yet. Let me know if you like it! I find sweet rice flour has a particular flavor – it would be nice to have an alternative.
    Being the researchaholic that I am, I keep a folder with all the tidbits I find. I was just going through it to clear it out and came up with this piece of info that I thought you might be interested in. http://www.thefoodcoach.com.au/food/?W=1&Action=Print&FoodID=524 It gives the GI of rice paper as greater than 70. It’s the only place I found a GI rating for it.
    I like rice paper and it seems to like me… :)

  59. Hi Lana,
    This summer is exciting but going by too fast. I am presenting a talk called “Did Cavemen Get Heartburn” at the Ancestral Health Symposium this week in Atlanta. It should be fun and I will post the video when available.

    Thanks for the link on the GI of rice paper. I won’t be able to officially use is as there is not reference for the information. Still, it’s interesting and 70 sounds about right. Also, those don’t weight much so likely have a pretty low FP is you don’t eat too many.

    We tried making some crepes with the Ingredion Elaine 100 – pure amylopectin potato starch. No heartburn and they weren’t too bad – but the recipe still needs some work. They sent me a whole bunch so if you email me your address (normjr1@gmail.com), I will mail you some of my batch for you to fool around with.

  60. Shel says:

    Rob, have u studied sea salt much in terms of how it relates to health and food reactions and digestion? I notice that if i load my good with sea salt, i digest better and I don’t get as bad of reactions…. Sans salt, i get major histamine issues (headachey, spacey, dizzy, and craving to eat sugar). Also, i dont feel as anxious. I recently added salt in my diet and noticed these positive changes. My anxiety is less too.

    Can an imbalance of sodium/potassium cause these issues? Is high potassium linked to anxiety, insomnia, food reactions, edema, low thirst, water retention, and sugar cravings?

    Also, does mold toxicity cause a greater need for sodium?

    Thanks a bunch

  61. tom says:

    Any tips to stop losing weight? I can’t seem to stop losing .5-1 lb a week. I don’t know whether to have more carbs or less carbs.

    • More low FP starches should help. Also, more animal fat may help as well. When ever you reduce carbs, you will typically loose some weight the first week or so, but that should stabilize if you are already lean.

  62. Melinda says:

    Thanks, Norm. I’ve been on your diet for 6 weeks and am doing much better (though I found when I “cheated” on vacation I had a major IBS relapse so I’ve learned that lesson). My question: as you no doubt know, Elaine Gottshall “forbids” stone fruits, including avocados. And Stanford backs heroon that:

    http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP-Diet-Handout.pdf

    I really don’t want to limit peaches, avocados, etc. You list them as “low” fermenting in your latest book. What are your thoughts on eating them?

  63. tom says:

    Isn’t it only soluble fiber that’s the problem?

    • Good question Tom. Put another way, which fiber type is more fermentable? That would be the biggest problem. I believe that soluble fiber is more fermentable (so you would be at least partly right), but since I don’t completely have my arms around which types of fiber are soluble and which are insoluble, it’s still a bit of an open question for me. More thoughts on this would be welcome.

  64. M Z says:

    Hi. I’m not sure why my comment didn’t post so I’ll try again.

    There is a product called “waxy maize” which the manufacturer describes as “a complex starch derived from Non-GMO corn that is naturally high in amylopectin, a high molecular weight, highly branched polysaccharide…. contains 90% amylopectin. Amylopectin is slowly absorbed by the body, and then easily assimilated by muscle tissue, where it is converted into glycogen. Glycogen can then provide a sustained source of glucose for energy. Unlike maltodextrin or dextrose, Waxy Maize supports glycogen resynthesis well after you are finished working out and sustains energy levels throughout the day.*

    This sounds like the opposite of what you’ve said about amylopectin being quickly digested. Is this information wrong?

    • Hi MZ,
      There is an inaccuracy in the above statement. Amylopectin is quickly digested and absorbed. That’s why foods such as Asian sticky rice (100% amylopectin) have a glycemic index of 98.

      • mary says:

        Not if they are eaten raw, which is how “waxy maize” is intended to be eaten. Waxy maize is a type of corn that is almost entirely amylopectin. It is useful if used raw, (put in smoothies, for example). Raw amylopectin has not been altered by heat, the way the amolypectin in sticky rice has. Please get your facts straight.

      • mary says:

        There are studies proving that amylopectin, for example waxy maize, eaten uncooked is entirely different in effect on blood sugar than if eaten cooked.

        The confusion by sites like yours stems from a study using waxy maize that was cooked with water into a paste – it had the same glycemic impact as glucose does. BUT previous studies on amylopectin, that used it uncooked, showed no such increase in blood sugar or insulin.

  65. Alana says:

    Hi Norm,

    I am looking forward to your work on leaky gut syndome. Do you think you will eventually write a book on this subject?

    My last blood test 4 months ago showed slightly elevated thyroid antibodies (Hashimoto’s). I could tell that my thyroid was slightly sluggish but the antibodies surprized me. Gluten/Gliadin antibodies were negative, and I have never felt bothered by gluten. It doesn’t bloat me or cause any gas or upset as long as I stick to the low FP items you describe in your book. Yet, there must be somewhat of a leaky gut if thyroid antibodies were present. This may have come from antibiotics prescribed in the past, but of course I can’t say for sure.

    My question to you is this: Can high FP foods (foods that cause me to have bloating or gas/acid reflux – like legumes, fruits, or certain whole grains – even gluten-free grains) exacerbate or cause the problem? In other words, if leaky gut is the issue, if I keep the FP down low, can that allow my gut to heal, thus allowing the thyroid to heal through the removal of antibodies?

    Thanks so much for your GREAT, GREAT work!

    Alana

  66. Kes says:

    Hi,

    I bought your Fast Tract Digestion IBS book and have a few questions:

    1) Is it possible to get rid of SIBO eating raw vegetables and following the books FP guidelines.
    2) Are raw vegetable smoothies permissible if they adhere to FP guidelines.
    3) Do u know what helps to how to cure Gastroparesis. I did the Heidelberg stomach acid test and it shows that I have excess acid but yet i have NEVER felt heart burn. However, when i eat, I immediately feel extreme distension likely due to extremely slow gastric/stomach emptying. I believe I HAD SIBO but not any more. I just started taking Iberogast a week ago to see if it could help. I eat absolutely no processed foods. What do u think can help?

    Thanks

    Kes

    • Hi Kes,
      Glad you are reading the book and trying the diet. The answer to 1 and 2 is yes. Gastroparesis has symptom overlap which GERD, IBS and SIBO. I recommend staying the course with any of your current doctors recommendations for your condition while implementing the Fast Tract Diet and see how your symptoms respond. We may be able to help further through our counseling program if you continue to have issues.

  67. steven evans says:

    Hi Norm.

    Firstly thank you for the great advice you give, its comforting to know that someone really knows their stuff on the subject. I shall be buying your book ASAP.
    I’ve recently been diagnosed with SIBO and after a ten day course of antibiotics and a thirty day cycle of Probiotics my symptoms improved but came back again after a week. So this process was done again, same thing happened the second time around.
    Last week i was put on a three month course of a changing cycle of antibiotics the first being Augmentin (625mg) twice daily coupled with the use of multibionta with probiotic. I was also advised to change my diet to a high fat low carb diet with the ability eat all dairy providing they are high in fat. I was also told to eat some carbs but haven’t due to the amount being so small. As yet certain aspects have improved but the churning sound in my small intestine seems ever present. Would you recommend sticking to this diet or swapping it, as it appears that i’m eating meat virtually every meal. Also looking at what you have written i see that antibiotics are common in the cause of SIBO, though when i asked my specialist he suggested it wasn’t a factor even though my symptoms all came after a course of antibiotics treating an infected wisdom tooth, how likely was this to be the cause of the onset of SIBO. And one last question how long does a sufferer of SIBO usually have the condition once diagnosed and how manageable can it be if a lifetime condition.

    regards, steve.

    • Hi Steve,
      You will find the answers in Fast Tract Digestion. I recommend the IBS volume. Antibiotics (or an intestinal infection) can absolutely trigger SIBO/dysbiosis and the symptoms you are experiencing. High fat/low carbs is a good starting point. The Fast Tract Diet has some definite advantages to other diet. For instance, dairy can be a problem in terms on oligosaccharides and lactose and must be limited. You can control SIBO with diet and cure it completely if you address any other underlying factors present – the book explains what these are and how to address them.

  68. Mark says:

    Hi Norm,

    so do you think the Fast Track Diet also adresses psychological issues like the GAPS. If so, are there any adjustments you suggests (like more strict amount of FP, etc).

    Thank you.

    • Hi Mark,
      That’s a good question. I have been doing some work on other SIBO related conditions. Psychological, gut / brain related problems have been a lower priority because I think they are less likely to be tied to SIBO, compared to autoimmune diseases, etc. But it’s certainly possible. Sorry I can’t be of more help on this currently. Given the good results we are seeing using the Fast Tract Diet with other SIBO-related problems, it can’t hurt to try it.

  69. Sarah says:

    Hi Norm-
    So glad I found your website. I was researching resistant starch and was getting ready to try to increase it in my diet thinking that it might help feed my good gut bacteria-but I was nervous because of my history of gut issues. Good thing I happened on your website!
    I have MS and have been paleo-esque for 5 yrs since diagnosis. I never eat gluten grains and do not eat much non-gluten grains either, am low dairy, no legumes, etc. I do include rice and potatoes but not too much. I have growing children to cook for and had to make the diet fit so I wasn’t cooking differently for everyone.
    I have done extremely well with my MS for 5 yrs. and rarely have issues with the GERD that troubled me before cleaning up my diet. I definitely have trouble with fiber-twice after eating some coconut flakes I thought I would have to be taken to the hospital I was in so much pain. On the occasions that I eat gluten free breads it seems like it takes a long time to digest and I need to drink lots of water. When I used to eat oats I would get severely constipated which still causes me problems. Magnesium really helps me in that regard. I do get gas from fruit-especially the high FP ones you mention. I feel like this info may be another piece to my puzzle. I have had an improvement in my rosacea (no more flushing-this actually stopped when I stopped taking melatonin at night) and a reduction in pimples but still have quite badly clogged pores especially on my chin.
    My questions:
    which volume should I order?
    Is it your opinion that most people with MS suffer from SIBO?
    does leaky gut cause SIBO or SIBO cause leaky gut?
    splenda makes me nervous-is stevia a problem w/SIBO?
    what do you think of soil based probiotics such as Prescript-Assist for SIBO?
    Thank-you so much for writing this book I have spent 5 yrs researching and trying to fine tune my diet-I have learned so much but am sometimes stymied by my limited scientific knowledge.

    • Hi Sarah, I really enjoy hearing from such well informed readers who stand up and fight back by learning as much as possible about their own health issues and reaching out for healthy solutions. I have not seen a lot of info on the connection between MS and SIBO, but I am not surprised due to the fact that some 70% of people with MS have digestive complaints, particularly around motility issues. Motility is a major driver of SIBO and must be addressed to fully resolve SIBO. Every thing you said leads me to believe that the low FP approach would work well for you. I would suggest the IBS volume of Fast Tract Digestion as the sections on gut motility are more extensive. As for your chicken and egg question, SIBO causes leaky gut, not the other way around. If you like Stevia, used the liquid version that is (sugar) alcohol free. Splenda can also be replaced with dextrose (powdered glucose) or maltose (a little harder to find, try brewers supply shop). I am not familiar with Prescript-assist, but please feel to post what you learn here.

  70. bogdan says:

    Hi Norm.I am suffering for 5 years of bloating nausea gerd(silent reflux) but the worst thing is the fatigue.

    5 years ago i used to weight train heavy and took a lot of suplements whey protein vitamins minerals creatine glutamine and i had a stressfull period 4 months in wich i developed erosive esophagitis with after gastro endoscopy but my biggest problem was that i couldn’t eat protein anymore(whey chicken beef ) after i eat it i get belching bloating (burping meat taste) and nasuea fatigue.dr gave me PPi but this made things worse.
    I am a pharmacist student and this gerd slowly destroyed my energy focus levels and i do not know what to do and what to eat.i tried all the suplements under the sun for this until i discover rifaximin wich made the symptoms better(i can eat some protein no more fatigue and energy is comming back) but i cannot rely on rifaximin all my life.So i am living in romania i cannot buy ur book but maybe u have the kindness to guide me with sime hints about what u think i might have.I know is related somehow with SIBO.

    also simple sugars are ok (rice is a no no ) also mashed potatoes are ok.i do not know what do eat anymore the only time i feel good is when i am fasting but i get tired and fatigue with no nutrients in me.training is hell because of the lack of protein in my body.i also get gerd from drinking water it is hell,i am eating only small bites of everything to feel ok.how can i combine foods to cure myself?

    enzymes HCL is a total No for me they make things worse also probiotics and yoghurt are not ok.i think is something related wih fermentation..

    • Hi Bogdan,
      Thanks for writing and truly sorry to hear of your struggles. While it’s possible that you can have some symptoms from excess protein fermentation in your gut, it’s more likely that your bloating, reflux and esophagitis are being caused by carbohydrates in your diet. Some types of rice (jasmine, for example) is OK, others (Uncle Bens, Basmati) are not. The same goes for potatoes. You might not feel symptoms until much later after eating these or other carbohydrates, so its hard to know exactly what food caused it. You should be able to buy the ebook – Fast Tract Digestion Heartburn on Amazon. If you can’t get it from Amazon, write to me at normjr1@gmail.com and we can arrange to have a bound book sent to you.

    • Christina says:

      Hi Bogdan,

      I have read the book, and it’s really helped me. Maybe I can offer you some tips since you can’t get a copy where you are.

      Just email me, ChristinaEMason at hotmail dot com

      Norm may be able to give you some pointers, too.

      Christina

  71. Bogdan says:

    Tks so much Norm.
    i e-mailed Christina for some meal examples is she has the time and i wnt to ask you

    Norm if it’s ok to eat just meat at one meal and how many meals/day are ok in the healing period?

    Sorry,i have some idiot questions but these things i ran into every day when i eat.

    should i combine small quantity of carbs with meat?

    Whey protein isolate is ok to take or cassein?(i do not know the FP of whey)
    i am afraid from so much protein of acidosis also my urine is concentrated fro 2 years now like i am dehydrated or something.

    TKS A MILLION NORM!

    • Angela says:

      Small amount of carbs with every meal is best, do not have a large meal of carbs unless they are really fast acting carbs like Jasmine rice. Casein protein is terrible for anyone having digestive disorders. Isolate is always best, no time for it to ferment! Use some lemon juice to help with acidosis. The Inuit do not worry about acidosis, I would not put too much fear and worry into that. Good luck.

  72. Bogdan says:

    Tks so much Angela.

    Could u give ma a small example of ur meal for 1 day?how many hours before sleep u stop eating an how big are ur portions at one sitting?(i do not have the book)

    i have the bad habbit of now chewing verry well the food and i think it’s a big mistake.correct me if i m wrong.

  73. bogdan says:

    The worst part about having this illness is after i eat i ted to get verry lazy(i think low dopamine) tired no motivation a generally bad mood and when i fast for 5 hours my energy levels come back and only when i am on empty stomach i feel good.

    I tred melatonin 6mg before bed for 2 weeks in wich time i felt great my muscles were fuller ,hydrated but i developed anxiety and joint pain so i stopped.

    of course the symtoms returned.

    i stopped also yesterday the rifaximin after 3 weeks and i feel BAAD.i do not know why but feel bad.

    maybe i should’n eat nothing for 2 days..

    also i get this from vitamins tablets or capsule(i can tolarate liquid forms)

    PLS PLS some hints…

    • Angela says:

      Sounds like you get high blood sugar after a meal. I do not have the book either, but have experimented alot. Keep a food diary. I am not the best to give my menu as I do not tolerate greens at all. I have big problems with salads and anything fiberous and raw. My veggies consist of cooked carrots and some peppers and cucumbers (peeled). I react to all the FODMAPS (I believe Norm has some info on this). I do not tolerate garlic or onion of any kind. Make sure you are taking pro-biotics that do NOT have any pre-biotics(like inulin, chicory,or FOS). Ones with high Bifido are best for me. I eat lots of protein(there is no problem with meat without additives. I eat sushi rice, some hot potatoe(do not eat cold), home made kefir. Keep a food log, I eat right before bed and about % times through out the day. I take melatonin as well and fish oils.

  74. bogdan says:

    I also cannot eat vegetables or onion garlic but also i cannot eat meat bio or not it’s the same and i simply cannot understand also i have bad breath after meat alone..probiotics i use chewable kind because in my country the ones that are in capsules give me bad nausea..i get bloating belching even from water

  75. bogdan says:

    Hi Norm.

    I tried to send u an e mail but you’re adress is incorrect so please maybe u can give me the e-mail again.

  76. bogdan says:

    Hi Norm.

    I tried the e mail adress but an message came back like this

    Sorry, we were unable to deliver your message to the following address.

    :
    Remote host said: 550 Requested action not taken: mailbox unavailable

    Basicly i wanted to ask you for a e-book copy of the book ,i am so desperate and i can’t get the book from amazon(politisc stupid bull..)so with all the shame in the world if anyone can help me with an e-book copy i’ll be verry gratefull….it’s not about the money it’s about i can’t find it anywhere and when i did find it the romanian bank that i have visa told me that i cannot make the tanzaction!

  77. tom says:

    Does amaranth have a really low fp? Livestrong says its glycemic index is 97. I figure 40 grams of carbs worth is an fp of 5.

  78. Christina says:

    Bodgan,

    If Norm was willing, maybe he could mail you a hard copy of the book by post. You could reimburse him through Paypal or something?

  79. bogdan says:

    Tks Norm,Christina.

    i tried this method and i didn’t got any answer from kindle.

    Pls tell me can i drink free lactose milk(it seems i am k with it) and eat small amounts of peanuts throu or eggs.gh the day?

    free lactose milk is more ok for me than whey protein isolate and meat or eggs wich gives nausea.

    and i have 3 days now with no wheat potatoes legumes bread rice but i eat small amounts of sugar (chocolates or glucose) and i am feeling better.

    can i drink sweet beverages like fanta coca cola or sprite?

    i can’t go zero carbs so i’m looking for something to eat with simple sugars ..any hints?

  80. Maria says:

    Hi, I’ve had the book on ibs for a while. I haven’t been able to fully implement the diet, although I’m sure it would help me (my main symptom, which is bloating, improves on a low-FODMAPs diet, but doesn’t completely disappear. By reading your book, I realized that there are low-FODMAPs foods with high FP).

    My issue with the diet is the following: I cannot eat meat and fish a minimum of two times a day, as the sample menus require. I’m not vegetarian, but for different reasons I think I do best if at least one of my main meals is vegetarian. I’ve seen comments by Norman stating that it’s possible to implement a vegetarian version of the diet, but I haven’t been able to figure out how. Has anybody been able to come up with a full day vegetarian menu that is filling but with FP below 30? I’d really appreciate some suggestions.

    • Hi Maria,
      Sorry for missing your question first time around. I am not an expert in vegetarian matters, but here are a few thoughts that others might be able to add to. Most vegetables are low FP. So you can add them pretty much at will. Just avoid the higher FP starchy vegetables in favor of the low FP starches including jasmine or sushi rice, certain potatoes, etc. But you need to find a way to include complete proteins as rices are deficient in certain essential amino acids. Legumes are the go to protein vegetables, but are relatively high in FP. I suggest including some hummus, yogurt if permissible, and nuts. That should cover you for protein. Also include olive or coconut oils for healthy fats.

  81. Mark says:

    Hi Norm,

    do you suggest to use a sugar and sugar alcohol free tooth paste? Is gum as an ingredient okay?

  82. Jean says:

    Hello, I recently purchased your book and it’s been an enlightening read. You mention hypochlorhydria, but finding doctors to perform the test might not be easy. What is the test for hypochlorhydria and how do you get tested? Thank you.

  83. Andy says:

    Thanks for all the great resources on this site! Have you heard of SIBO causing upper abdominal discomfort? I mean the actual stomach area (I know people use stomach to refer to the whole abdomen sometimes, but I am talking about below the sternum but above navel). How might SIBO be experienced differently from another stomach issue such as peptic ulcers in terms of symptom presentation? I have been diagnosed with SIBO but have more upper GI symptoms than lower. Thanks!

    • Hi Andy,
      Do you have acid reflux? This can cause a number of symptoms including nausea and stomach discomfort.

      • Andy says:

        Hi Norm,

        Thanks for the reply. No acid reflux as far as I know. I have discomfort below the ribs, but no burning sensation in the chest area or throat and never any acidic taste in the mouth or other feelings of regurgitation. Pretty steady nausea is a problem as well as a dull ache in upper abdomen.

        Thanks!

  84. bogdan says:

    Hi Norm.the nausea is present also in my case although i run 2 weeks on 2 antibiotics bismuth and zantac for H pylori with no succes eliminating the nausea and the fatigue.

    i don’t know what kind of gerd i have but 5 years ago when i did an endoscopy they said i have erosive esophagitis so i follwed PPi treatment with really bad side ffects

    the thing is i don’t have acid reflux i have silent relfux with bad dyspepsia (foods sits in my stomach toooo long 6 hours ) and i feel fatigued almost all the time maybe because i am malnourished.

    and maybe ur opinion on why meat as soon as i swallow it, i burp meat like taste and sits too long in my stomach..

    i have ur book and i started the diet but is verry hard.i also weight train( do u think i should stop?)

    i try to stay away from all carbs but the protein is the big problem for me..also i get nausea from eggs too.please tell me u have an answer because all the dr i talked to said they never heard problems with protein…what should i eat ,i mean i am looking for a “perfect foods” that does’t sits too long in my stomach and has low g.i.

    or maybe i need serotonin treatment?

  85. Hi Bogdan,
    You can reduce your meat/eggs and protein levels in general a fair amount without a problem. You can make up your calories with medium chain triglycerides (coconut oil) if you tolerate them (they are generally easy to absorb) as well by adding some low FP starches.
    I recommend staying away from serotonin modulation and drugs in general if you possibly can.

  86. bogdanthat's why i am so desperate to eat protein to says:

    Tks good Dr.

    one thing i do not understand though,i tried in the past eating only carbs like swets grape juice rice potatoes with no animal protein,i felt ok no more bad breath fatigue depression nausea but still bloating and gaining weight and water retention that’s why is so difficult for me to give up protein is because i gain weight verry fast from carbs,

    i must keep insulin at bay..that’s why i am desperate to eat protein with some low g.i carbs but these meals gve me the most unbereable side effects..one thing i can digest is dilluted free lactose milk but i get attention defficit from it and it’s not ok for my studies(hyperactivity relestless leg etc) i do not know why..

    so i follwed ur boook and Christina advice and began eating smoked salmon,it is ok but i read it contains nitrites and other not healthy stuff but i keep going,it’s better that cooked meat.

    also i want to try biftec tartar..maybe u can help me with some ideea how to keep insulin at bay but also have some proteins in my system(weight training)??peanuts are ok??

    Tks a lott

  87. Brady Shackelford says:

    I read about Lactobacillus plantarum 299v (Lp299v) and how it can colonize the small intestine, thus preventing other bacteria from adhering to the intestinal wall, so I started drinking Goodbelly, which has 20 billion Lp299v in it. Would drinking Goodbelly — which also contains concentrated fruit juices and evaporated cane sugar — help my SIBO or hurt it? If it hurts it, would taking Lv299v it in conjunction with your diet help or hurt my SIBO?

    • Brady Shackelford says:

      Sorry, but I meant to say would taking Lv299v alone without the Goodbelly in conjunction with your diet help or hurt my SIBO?

    • Hi Brady,
      As you likely suspect, the fruit juice concentrates and sugar will exacerbate, not help control SIBO. Taking L. plantarum alone will likely not hurt but there are a couple of relevant points. Since we have a complex population of gut microbes – even in the small intestine, taking a single strain might alter the more balanced natural population that can generally be achieved with diet. Also while most lactic acid bacteria don’t make gas from carbohydrates, L plantarum under certain circumstances can produce carbon dioxide gas (malic acid fermentation, for instance). Taking the supplement alone will probably be fine and who know, might even help, but if you can balance your diet using low FP foods without supplementation, that would be the best bet.

      • Brady Shackelford says:

        If the L. plantarum can throw off my gut flora, then what about other probiotics? For example, would drinking Lifeway’s Kefir be beneficial? It is 99% lactose free and has 12 different cultures.

        • The most important thing is to be sure the carbs/FP are inline with the Fast Tract Diet. If so, it should be fine. Just note that many probiotic strains can make gas from carbs (the term is “heterofermentative). That’s why some people report bloating symptoms after taking probiotics. The least troublesome pair is lactobacillus and bifidobacteria.

  88. Brady Shackelford says:

    Does Candida play any role in SIBO? If yes, would your diet help that as well??

    • Hi Brady,
      Some suspect that Candida or other fungi may contribute to SIBO, but to date there is little data supporting this idea. The good news is Candida, like bacteria, dines on fermentable carbohydrates which are limited in the Fast Tract Diet. So the Fast Tract Diet should limit yeast growth as well.

  89. Emily says:

    I thoroughly enjoyed your post and look forward to reading your book. As a SIBO sufferer in the past, I have had complete relief of symptoms and tested negative after following the SCD diet for over a year and going through 2 rounds of rifaximin (at the beginning). I also think the addition of herbal antibiotics, ginger and orange peel oil for motility, and digestive enzymes have played a large role in recovery as well. Something this SCD diet does well, is the fermented dairy. I make my own yogurt using gut issue friendly strains and I think that makes a huge different in recolonizing the gut. I have now successfully added back some of the starches you mention being unnecessarily restricted (certain tubers and rice) and other sweeteners that you also discussed. I have experimented with my own personal fructose tolerance level, and find it is quite high. I am enjoyed more variety in my diet but will never go back to the Standard American Diet. Anyway, in my personal journey and professional one (I am a health educator) I have learned a great deal and am always thrilled to find others conducting research in these areas. Have you heard about the SIBO symposium in January? If not, I think you would love it! I will attend via live webinar and am very much looking forward to hearing the presenters – Doctors Pimentel, Siebecker, Wienstock, and Sandburg-Lewis – all SIBO experts, as you well know. http://sibosymposium.com/

    • Hi Emily,
      I’m happy you enjoyed the article. Thanks for sharing what you have learned on the SCD. The supplements you mentiond are very interesting. I hadn’t heard of using ginger and orange peel oil for motility issues. I need to remember that one.

      I will definitely be tuning in to the SIBO symposium this January. I met Dr. Siebecker at the Ancestral Health Symposium last August. She is so knowledgeable and dedicated to helping people struggling with SIBO. Her talk was excellent.

  90. Brady Shackelford says:

    What are your thoughts on tap water? Is the chlorine good or bad for people with SIBO??

  91. Brady Shackelford says:

    I am going to buy your book. Before it arrives, would you please tell me what the FPs are for mushrooms, onions, and garlic? Also, are all onions created equal? There are yellow, red, white, and sweet/Vidalia onions, so I would think that their FPs would be different as well.

    • The FP for 2.8 ounce servings of mushrooms or onions is 3 and 5 grams respectively. I didn’t do a calculation for garlic as of yet, but since a clove has so few total carbohydrates, I wouldn’t worry about it.

  92. chris busby says:

    Hi Norm,
    bought your new book,just working through it now.
    2 questions
    whats your take on barley malt and or Rice syrup as sweeteners.
    and I have psoriasis which many say can be gut related,have you come across any such link in your work?
    thanks
    Chris

    • Hi Chris,
      Barley malt and rice syrup make good sweeteners. Use them sparingly at first and see how you tolerate them.

      I have not seen too much on psoriasis and SIBO/dysbiosis, but will be doing some work on this early next spring. You might want to check back then. I will tell you this much. I had psoriasis through out the nineties and it abruptly went in to remission in 2004 (never to return) when I started low carb dieting. But that’s just an N=1 story. The great thing about the Fast Tract Diet or low carb diet is you can always try it to see if it works with no downside risk.

    • Mark says:

      Hi,

      I have seborrhoeic eczema and I found out that it gets worse on carbohydrates. Now the carbs with low fermented potential described in Fast Track Diet indeed don’t exacerbate the eczema and overall my skin is much better but the excema isn’t gone (yet – hopefully).
      On the other side I am not sure if I have SIBO because besides excema I don’t get sudden symptoms on carbohydrates except that I have extreme cravings which regularly lead to overeating.

      Norm, do you think that eating FTD will restore the colon flora as well?

  93. The diet won’t add lost organisms. They need to repopulate as they are reintroduced from the environment and diet over time. But the diet should provide a healthy / competitive atmosphere for the organisms as they are reintroduced.

  94. chris busby says:

    Hi Norm
    thanks very much for your reply.
    thats very interesting and inspiring that you had psoriasis and it retracted on the low carb.will keep you posted as I’ve had P for 38 years and only chinese medicine cleared it for about 18 months .
    this is a great site especially as you engage with your readers so well.
    thanks again
    Chris

  95. My pleasure Chris. I learn a lot myself from all the thought-provoking posts on this site. Its funny, I never gave a thought about my own psoriasis until you asked this question. I never made the connection. I had forgotten about it entirely. I hope yours goes into full remission for good.

  96. Chris says:

    Thanks Norm.
    Im a little confused as i looked up jasmine rice as ive never used this
    And it said its less sticky as it contains less amylopectin yet i thought
    It contained more because of less amylose?
    Could you clarify please
    Regards
    Chris

  97. Chris says:

    It was a wilkapedia site, 1st site that came up, reading others it seems
    that its misleading. Just bought some to try.first day of the regime.
    Chris

    • Hi Chris,
      Not sure what you read, but jasmine rice contains very little amylose, hence the very high GI / low FP. I am not sure why it does not have the sticky nature of sticky rice, but it does contain mostly amylopectin starch.

  98. Chris says:

    Hi Norm
    Thanks for the clarification. Just for the record, this is the link to
    The wilki site which was a bit misleading,
    http://en.m.wikipedia.org/wiki/Jasmine_rice

    Regime going well so far, love your book
    Cheers
    Chris

  99. Thanks for the link Chris. Actually, it’s technically accurate. Jasmine rice does have less amylopectin than short grain sticky rice (which is 100% amylopectin) and a bit of amylose. But that’s still a lot less amylose than high FP varieties such as Uncle Bens.

  100. Chris says:

    Hi Norm,
    Thanks for that. In your book the jasmin rice has a 0 fp yet the stick rice has 100 amylopectin and a rating of 3 fp, is this because the sticky rice has 2 asca fibre score compared to 0 for the jasmin ?
    Chris

    • Yes, the reported fiber value is one reason the FPs are different. But GI measurement is not a perfect science. There is some degree of variability based on test methodology, which lab and analyst does the test, individual differences in the test subjects (people) and finally differences in food source and preparation method. Helping to even out this variability is repeat testing. Many of the GI values used to calculate FP come from several GI test results that are averaged.

  101. Loretta says:

    I just ordered your Fast Track IBS. Should I have read your first book too? I am suffering from abdominal pain for 7 years which just turned into severe constipation. All the doctor’s theories have proved wrong They told me initially that my pancreas was inflamed, not they say I never had pancreatitis. So confused and so sick. It does seem that all my healthy high fiber foods and PPIs have exacerbated my condition. Help.

    • Hi Loretta,
      There is no guarantee that your symptoms are caused only by IBS, but reading the sections on constipation and underlying conditions should help. I recommend trying the diet, talking to your doctor about weaning off PPIs, and losing the fiber. Let me know how you make out.

      • Loretta says:

        The book arrived and it is very helpful. Recent colonoscopy ruled out anything that might have contributed to constipation. I have experienced tremendous relief following your protocol. The recipes are a little involved for me but I find that recipes on other SIBO diet sites disagree with your guidelines. Does your first book have additional recipes or can you recommend a source?

        • Hi Loretta, Great to here that your constipation has responded to the Fast Tract Diet. Some recipes are more involved than others, but you can always use the basic low FP foods from the recipes and prepare them your own way. The Fast Tract recipes differ from other SIBO recipe sites because they are based on my novel formula for evaluating the symptom potential of different foods.

          In terms of additional recipes, The Fast Tract Digestion IBS and Heartburn books both have many unique recipes, so having both books will provide more variety for sure. You can also make your own recipes simply by choosing low FP foods from the tables in the appendices. Also check out the recipe section on this blog, though some of these may appear in the books.

  102. Chris says:

    Are Miso and use Japanese plum sauce useful as anti bacterial condiments,
    Macrobiotics considered them highly?

    • I am not sure Chris. I do know that wasabi has antimicrobial properties. But my real effort has been focused on limiting the overfeeding of gut microbes, not inhibiting their growth by chemical or natural antibiotics. Fermented foods in general, including miso, fit this strategy.

  103. Brady Shackelford says:

    I want to buy some sugar-free gum. Which brand do you recommend for people with SIBO? BTW, I just bought your book and am in the process of reading it. VERY informative!!!

    • Hey Brady,
      Good question. All that I could find have either sugar alcohols or sugar. Even Stevia-sweetened gum has sugar alcohols. The best bet might be regular sugar sweetened gum that has 2 grams of sugar, some of which is dextrose, so the FP would be below 1 gram per piece. Let us know if you find a better solution.

  104. Brady Shackelford says:

    Once your diet eliminates my SIBO, how long, in your opinion, will it take the inflammation in my small intestine to heal? I ask because my antidepressant medication, which I take for a serotonin deficiency due to chronic back & neck pain, became ineffective after my SIBO arose, which I deduce was due to inflammation reducing how much medication got absorbed..

    • How long depends on the extent of intestinal damage as well as how effectively SIBO / dysbiosis or various underlying conditions driving the problem are addressed. Most people with GERD (including me) and IBS begin feeling much better in a matter of days. More extensive damage from Celiac Disease, for instance, can take months or even years to fully heal.

  105. Michele Sheaff says:

    Hi Dr. Robillard,

    I just ordered your book yesterday and am looking forward to reading it. I feel it’s essential to address the cause and not just the effects, and I have a gut feeling (pardon the pun) SIBO is my problem.

    For years I simply avoided the worst offenders (rice, potatoes, bananas) but it got worse as my health declined, so I tried Carol Sinclair’s starch-free diet. But that just made matters worse because it made me eat more of other foods that were even more problematic (according to her, honey is the best thing ever, but it was the worst for me.) Once I had completely cut out absolutely all starch and my symptoms were just as bad, I finally found out about the low-Fodmap diet. I added that to the starch-free diet, but not only is it prohibitively restrictive (I also have outright food allergies to contend with), it hasn’t solved the problem. As soon as I add any of the supposedly starch-free low-fodmap fruits or vegetables, symptoms return (including an unbearably itchy rash on my abdomen and lower back.) It may just be after all the high fodmap food I ate on the starch-free diet, the bacteria have overgrown so much I cannot even tolerate small amounts. But I’m hoping your diet will provide me with more information that can help me eat at least some fruits and vegetables (I would be in heaven if I could eat certain kinds of potatoes and rice after all these years!) Malnutrition and weight loss are becoming a problem. It probably won’t be a perfect fit for me (I react badly to watermelon but seem to tolerate sugar–I drink a lot of ginger ale for nausea without problem) but maybe by mixing and matching I can tailor something to my own individual idiosyncrasies.

    Speaking of malnutrition, I’m trying to take vitamins while I sort this out, but all of them seem to contain cellulose. Do you know if that’s a problem for SIBO?

    A few things that may be of interest to you: my IBS started when I was prescribed megadoses of iron for anemia about 15 years ago. I thought the problems would go away when I stopped taking the iron but they never did. I’ve been told iron fuels bad bacteria in the gut. But prior infections probably made me vulnerable. Before that I had a couple bouts of amoebic dysentery while working in Central America. And it has now been confirmed via biopsies I have a chronic enteroviral infection which causes IBS amongst many other problems. (I was infected at age 8 by my father, a microbiologist handling enteroviral-infected fecal samples, and lax about washing his hands.) Dr. John Chia at the Enterovirus Foundation did the tests; he is spearheading research into chronic enteroviral infections. http://enterovirusfoundation.org/index.shtml

    Another contributory problem in my case is fatty liver. Because my common bile duct is clogged with fatty “stones,” enzymes from my pancreas don’t get through as well, carbs go undigested, you know the rest (you came up with the theory :) ). I have done many liver flushes and flushed out ridiculous quantities of “stones,” and in the few days or weeks afterward before more fat clumps have descended to block the CBD again, my IBS completely goes away as do my food allergies. I’m unfortunately too sick at the moment to keep doing the liver flushes. So I’m hoping a more gentle and gradual approach through diet will bring the SIBO numbers down for starters. I haven’t read your book yet, but my understanding so far, in a nutshell, is: too many bacteria, not enough enzymes. So I’ll start by decreasing the bacteria, then increase the enzymes when I can.

    Thank you!

    • Your book is in the mail. Give it a read and try the diet without worrying too much about all the other things you’ve heard. You may find you don’t actually have many food allergies once you are controlling FP. Bacteria do sequester iron to live, but they also need fuel (mostly carbs) to grow. Also don’t worry about cellulose in your vitamins. The amount is small and cellulose is the least offensive fiber type.

      • Michele Sheaff says:

        Thank you for the reply. It’s good to know I can keep taking the vitamins while I sort this out. It’s all very complicated and confusing, with so far things only half-helping or making things worse. I look forward to reading your book and I’ll clean the slate and try the diet as you suggest.

  106. Mark says:

    Hi Norm,

    I’ve got a few questions if you don’t mind.

    a) I read somewhere that you now recommend 7FP per meal as low (I think some presentation slides). In my book version it is still 10. Do you have written an article recently which points out the new guidelines for those who bought the old version?

    b) How much does fat influence the FP because I read that combining foods with fat can reduce the GI by a third. So that would turn a slice of baguette (30g, GI 95, 1FP) with butter to around 6FP (with GI 65 if I calculated right).

    c) I have IBS-C with strong malaise, dizziness, burning mucous membranes throughout the body after eating especially from fatty, sour, spicy foods. Carbohydrates I actually do tolerate quite well except that I crave them a lot which leads to overeating frequently which makes my situation worse over and over again. Since FTD approved foods usually being high glycemic it became even harder to withstand the cravings.
    Diagnosis couldn’t find anything except a tissue example from colonoscopy recently showed “focally accented eosinophile in the colon mucosa”. I don’t have allergies so I don’t know how to connect this to anything which could make sense. Do you have a guess?

    d) I think my constipation was triggered by antidepressants and 5htp I took for several years. I skipped them four years ago, but my constipation is as bad as ever. Have you come across some informations that this is plausible and what might I do about it?

    Thanks and all the best
    Mark

    • Hi Mark, I am not in a position to comment on “d.” We did revise downward slightly the cut-off for low FP meals, but how you feel in terms of symptoms is a far more important determinant. You should find your own cut off as you try the diet. This cutoff may increase overtime. Fat’s and other factors can influence GI and hence FP. But all carb-containing foods will be affected, so it still makes sense consume lower FP foods. If you are reacting to fatty foods in the absence of carbs, you may have another type of problem / complication beyond carbohydrate malabsorption – such as lipase deficiency /gallbladder issues, etc. You may need to explore further to see what is driving this reaction to fat. I am afraid I can’t comment on your colonoscopy results.

  107. Angela says:

    Dear Norm,
    I ordered your book 2 days ago and am really looking forward to reading it… the information on SIBO is so conflicting! I’m not totally sure that’s what I have but my intuition and symptoms indicate so. I”ve literally had the runs for 5 months on and off and i’m an a long distance bike rider!! Imagine how that gets in the way! last year after feeling bloating and gas in my stomach after eating I had an endoscopy and colonoscopy all coming out normal and the GI dr said he did biopsies…not sure of what… but all was normal and he said I had IBS… literally because he didn’t know(he admitted this to me) … Anyway i’ve been on a low carb diet for a long long time and have eaten pretty healthy…. wine and cocktails are my downfall, however recently i’ve stopped those too. My Naturopath and I have finally gotten to me doing the SIBO antibiotic protocol… Im on my 6th day of metronidaziole and neomycin and it’s been difficult. Today is the first day i felt better. After reading so many articles and your blog i’m realizing that the veggies i’ve been eating are feeding the bacteria….like lots of broccoli and cabbage family veggies. I’ve been mostly gluten free for several months also. i was hoping to be done with this very soon but from what i’m reading it sounds like this is a long process…. I want my life back!!! so here’s my questions and i’m sure some of this will be answered in your book but i can’t wait i feel so limited in what to eat!!

    1.Can i have lettuce ? Like a ceasars salad? no croutons or gluten free ones?
    2.Also you seem to support he Paleo diet and they say this bone broth is really really nutritious for the gut.. what’s your feeling on that?

    And I’m hoping your book will fly quickly across this ocean to me…

    Thank you for your time…
    Angela from Kauai

    • Hi Angela,
      Yes, your questions are covered in the book which contains a recipe for Ceasar salad (there is also a recipe for Caesar salad on this site). Bone broth is wonderful stuff and fully supportive for SIBO.

  108. Brady Shackelford says:

    The FP tables in your book don’t mention lactose-free milk, so what is the FP of lactose-free milk?

    • Great question Brady. I have not found a published glycemic index for lactose-free milk. Clearly lactose-free milk will have a lower FP than regular since the lactose is broken down to two much easier to digest sugars, but you still have other oligosaccharides to deal with. Let me give this one a bit more thought.

  109. Ray says:

    Hi,
    Can you explain your reasoning as to why you think resistant starch are bad for a SIBO suffering patient?
    I am currently on low FODMAP diet and I find to be able to handle resistant starch just fine.. and I was diagnosed with SIBO last year.

    • Hi Ray,
      Thanks for your question and comment. This article gives my general rational. Also, my own reflux symptoms act up when I include starches (other than low amylose / high amylopectin starches) in my diet. What else in foods like potato and pasta would be driving my symptoms, I can’t imagine. Did you add the RS after your symptoms were under control on FODMAP or jump right in? One possibility is that some people can tolerate certain types of carbs better than others. But your case does make me curious.

  110. Angela says:

    Hi Norm,
    I’m stil waiting for your book to arrive so I need to ask this question. I’m a long distance bike rider and have been using hammer nutrition Heet as my electolyte nutritional drink. it has 2g of sugar..xylitol.. and 25 grams complex carbos…not sure what they are… it hasn’t bothered me in the past like creating gas or anything but i’m not sure. i need to have something to replenish and i discovered that their plain electrolyte tabs have tiny amounts of sorbitol and stevia… any suggestions? are they ok or just eliminate completely?
    also what is “femented cheese”?

    thank you…

    I made the bone broth..it’s a little greasy…

    aloha, Angela

    • Hi Angela,
      I would consider any drink with xylitol and can complex carbs to have relatively high symptom potential. But if it hasn’t bothered you who am I to tell you to stop. But somethings things you consume now will bother you later. Proceed with caution. All cheeses are fermented, that’s why they contain only small amounts of sugar – because bacteria used in the fermentation have consumed most of the carbs. Cheese would be a good snack on your trip as would be the recipe “Anne’s recipe for Jasmine Energy Balls” on the Consultation tab.

  111. Angela says:

    Norm,

    Thank you so much for your prompt reply… i am truly impressed with your commitment to help people!!!!! I actually saw those and sounds good for training. the electrolytes I have have sorbitol.. it’s a tablet I just put in water.. is it okay or do you have another suggestion for an electrolyte drink?

    thank you so much and Aloha,
    Angela

  112. DINA says:

    I JUST PURCHASED BOTH BOOKS ON AMAZON AND GOT A POSITIVE BREATH TEST FOR SIBO, MY DOCTOR IS PERSCRIBING 20 DAYS OF NEOMYACIN 500 MG 2X DAY AND XIFAZON 550 MG 3X DAY AND THEN 50 MG ERTHROMYACIN FOR 3 MONTHS AS YOU CAN IMAGINE I AM REALLY FREAKED OUT ABOUT ALL THE ANTIBIOTICS . I GENERALLY GO WITH A MORE NATURAL METHOD FOR TREATING THINGS. I WAS IN ANTIBIOTICS BACK IN MAY FOR DENTAL WORK. DID NOT HAVE ANY OBVIOUS PROBLEMS ATTHE TIME , I HAVE HAD ACIS REFLUX FOR 3 YEARS BUT DO NOT TAKE MEDS JUST WATCH DIET. IT SEEMS THAT WHEN I STARTED TAKING A PROBIOTIC CALLED LACTINEX THAT THE PROBLEMS REALLY STARTE WITH THE SIBO OR AT LEAST THE PAIN AND BLOATING . CAN YOU SHED ANY LIGHT ON WHY A PROBIOTIC WOULD MAKE THIS WORSE OR BRING THE CONDITION ON IF IT WAS UNDERLYING ANS ALSO DO YOU THINK I SHOILD START THE MEDS OR WAIT FOR THE BOOK TO GETHERE AND CAN THIS BE CURED WITHOUT MEDS . PLEASE HELP I AM DESPERATE, I DONT KNOW WHATTO DO OR WHAT I CAN EAT . PLEASE PLEASE HELP

    THANKS DINA

    • Hi Dina,
      Your doctor is in the best position to help you make critical decisions about your health. On this particular matter, I suggest you bring the books to share with him or her and ask about the possibility of trying the diet before you take any antibiotics. You can find the rational for giving the diet a try first in Fast Tract Digestion IBS, Chapter 5. And also in a blog article entitled “Antibiotics for my IBS” on this site.

      Also, I recommend stopping the probiotics for now as well. Some probiotic bacteria make gas from carbs causing bloating. And taking a small number of probiotic strains don’t do much to rebuild your gut microbiome which is comprised of hundreds of different species. If you really wanted to take a probiotic, you could try a simple lactobacillus probiotic – this strain makes no gas and does produce healthy lactic acid. But with or without a probiotic, your gut microbe diversity should gradually improve over time as long as you are following the Fast Tact Diet and staying healthy overall including good hydration and a multivitamin with minerals until you recover. Avoiding antibiotics (unless you are very sick, then they can save your life) is one of the most gut-healthy things you can do.

  113. DINA says:

    ALSO FORGOT TO ASK IS ORGANIC YACON SYRUP ALRIGHT TO USE . THANKS DINA

  114. No!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Just kidding, but no, it’s the opposite of good and has high Fermentation Potential (FP). The same goes for Agave – with lots of sugar alcohols. Dextrose is a much better choice. Barley malt syrup is another alternative if you don’t have gluten sensitivity.

  115. Cheryl says:

    Hi dr, I am excited to find this post. I have been dealing with SIBO for a year and am a patient of dr seibeckers. She is wonderful.

    You don’t mention the migrating motor complex and its role (buying ur book Today so perhaps I will be reading about it in the book?). I was under the impression that SIBO could never be healed because what is broken is the migrating motor complex and therefore even if you get rid of the bacteria, eventually it will buildup again because the MMC is not working. What are your thoughts on this? Can the mmc ever be inner gated again?

    We just found out that my daughter who is five years old, is positive for SIBO. She’s been having symptoms for a long while and I just feel awful but she has to go through life being so limited. I really didn’t mind my limits but for my baby, it is heartbreaking. Any thoughts on recovery for children? I guess I’m just hoping to hear that children are better able to recover from this because from what I am experiencing and reading adults don’t usually seem to recover for very long.

    What are your thoughts on lyme disease linked with SIBO? We were both just diagnosed with Lyme disease and because I did not think SIB was genetic or contagious I just can’t see how my daughter and I both have this without there being a link to lyme disease. Also do you think treating Lyme disease will help sibo?

    Also where are you located and can I make an appointment with you?

    • Hi Cheryl,
      Glad to here you have been working with Dr. Seibecker, a real expert in this area. I do address motility issues in Fast Tract Digestion though I don’t refer to these issues as the MMC. Some forms of dysmotility, such as those caused by surgery or scarring, may be permanent, but others are more likely temporary based on your bodies reactions to food, nutrients or other factors. Regardless, modifying diet by reducing high FP foods is a supportive measure I highly recommend for SIBO-related conditions.

      I have not given much thought to a connection between Lyme disease and SIBO, though I am aware of anecdotal reports of a connection. Have you taken antibiotic for the Lyme and if so, have you noticed any improvement in SIBO symptoms?

      You can find our contact information on the Consultation tab on this site. We offer consultation by phone, so our location (Watertown, MA) won’t be a factor.

  116. Terry says:

    Hello Dr. Robillard,
    Very happy to come across this site and I am going to try and find your book today. I am being treated for SIBO by Seibecker’s collegue Dr. Steven Sandberg-Lewis at the SIBO Clinic. I am following Seibeckers diet plan which combines SCD and Low Fodmap. My biggest issue with this diet is due to all the conflicting information given by very knowledgeable experts on what is “legal” and ‘illegal”. It’s interesting for example that you say Jasmin rice is a low FP yet and allowable, yet Seibecker does not allow for any grain. Also she says bone broth soup is ok in limited quantities because it contains polysaccharides. This diet is challenging enough and it’s easy to feel isolated, but the great challenge too is trying to discern who is correct on any given foods. I would give anything to eat Jasmine rice, but can I? It’s the inconsistency that is most troubling. Please try to understand how for some of us, this diet very difficult and to me, perhaps potentially unhealthy given the fact that so many important fruits and vegetables are not allowed.
    Thank you for your thoughtful consideration. Diets that are too restrictive have the most failure rate among those with even the best intention of following it.
    Terry

    • Hi Terry. All I can say is please read the book and have a look at the various blogs and comments on this site. The rational is very clear as to why jasmine rice is allowed and the tables in the back of the book will show you which friuts are safe and which ones you should consume in limited quantities based on the FP system. Also check out the SIBO diet comparison here. I am not aware of polysaccharides in bone broth and can’t imagine this being a problem.

  117. Terry says:

    Dr. R,
    Just one last thing, I see that you know Seibecker and her collegue Sinclair Lewis. Are you familiar with her SCD and Low FODMAP chart? She also says no garlic or onions and allows 2 tbls of honey at at time. What are your thoughts here? You mention not to worry about garlic because it has such low carbs.
    Terry

  118. Tom83 says:

    Hi Norm,

    I’ve been suffering from GERD for several years now (and also systemic Candida probably due to or at least much worse due to PPI usage) and have tried a number of dietary approaches with different results. While I am inclined to agree with you about the connection with SIBO and carbohydrate malabsorption, for me personally fructose (from fruits) does not seem to pose a problem.
    A while ago I went through a raw vegan period where I would eat nothing but fresh raw fruits and vegetables, with often more than 10 bananas a day. I did not exclude certain types of fruit or anything like that. While I couldn’t keep up with such a restricted diet for more than 2 weeks at a time, my acid (and pepsin) reflux did go away completely while on the diet and my Candida overgrowth (thrush, balanitis) also improved greatly. In fact, I had no digestive problems whatsoever and could leave the PPIs behind. When I quit the diet it all came back (gradually).

    Might you have some insight as to why this is? I am convinced that I have SIBO (or SIFO?) and whenever I increase my consumption of grains I get more bloated. When the holidays are over I’d like to start with your Fast Tract Diet plan, but I am somewhat unsure as to what to do with fruits. I would like to incorporate them as they don’t seem to cause me any trouble.

    I would love to hear your thoughts on this. Thanks for reading!

    • Hey Tom,
      You might be right and fructose is not a problem for you. Not everyone malabsorbs fructose. It won’t hurt to try the Fast Tract Diet without limiting fruit. If it doesn’t work, you can always double back and restrict the highest FP fruits.
      Cheers

  119. Brady Shackelford says:

    Your book doesn’t mention whether or not the fillers and fibers in multivitamins are good for people with SIBO. I’ve been checking out the ingredients for several multivitamins, and all of the ones at Wal-Mart have some sort of fiber in them. Which multivitamin do you recommend for people with SIBO?

    • Hi Brady,
      A couple of points. The amount of fiber in vitamins is so small (less than a gram), it should not present a problem. Also, cellulose, commonly included, is the least fermentable fiber type. So I wouldn’t worry about.

  120. Shari says:

    Dr. Robillard,

    I was recently diagnosed with SIBO and currently on Xifaxan ( for a second time) at a dosage of 1650mg daily in three divided doses. I’m also on a PPI, oh what a surprise …..
    I am very concerned because I also have been battling chronic urticaria with mad histamine releases for about one year, which are hardly controllable on daily antihistamines plus an H2 blocker as needed. I am being considered for Xolair injections by my physician at MGH in Boston to help with this raging urticaria.
    What are your thoughts?

    • Hi Shari,
      Really sorry to hear about your current condition. SIBO and allergic reactions together sound challenging. It’s possible they are related (via leaky gut / food allergens). If you have not tried the Fast Tract Approach, I would recommend this as a starting point. You might also read my article on antibiotics for IBS. We do offer counseling if you wanted to delve deeper.

  121. LK says:

    Greetings, Norm and fellow readers! Thanks so very much, Norm, for your terrific work. I’ve been on a “fast tract” regarding educating myself about SIBO, IBS, and slow motility… more than 5 years of symptoms are starting to make sense. Food glorious food has been ‘ the enemy’ for so long …! I’m looking forward to trying a new approach through your ideas and your book.

    I have a couple of questions. I was put on Xifran for a 2-week period, but I lasted for only 1 week – my symptoms seemed to be getting worse and worse. I have heard about a “shedding” phenomenon when the gut bacteria are starved … can symptoms be exacerbated by antibiotics…? Just as a happenstance, when treated with Doxycycline for another issue, my intestinal symptoms dramatically improved… for a short while. Is it worth rummaging around in the antibiotic cabinet for one that offers some symptoms relief, while shifting to the dietary focus?

    Second question …. I’m sure you address this in your book (I’m ordering it tonight!!)… my biggest problem is keeping up a calorie intake daily. Eating causes so much pain that I’ve reduced my food intake to 1 egg, a bit of brown-rice based (non-yeast) tortilla (GF) that I can tolerate, stewed tomatoes, occasional small slices of avocado, and occasional kelp or spinach. That’s about it. I tried eating salmon and had a terrible reaction. I can tolerate sardines… almost every food except eggs seems to give me problems. So, I’m losing weight and down to the ‘don’t go lower’ zone… at 5’2″ and 97 lbs. I’m wondering if I should ask an M.D. to explore any types of liquid nutrition, etc. – I’m concerned about the weight loss and just can’t eat.

    The issue that I wonder about overall with a number of carb reduction diets is how to maintain a healthy weight. Perhaps I’m simply remarkably under-educated about nutrition (this may certainly be so…) but it’s a tough battle to keep the calories coming in.

    Sorry for such a long post..!!!

    All best to everybody here… may your symptoms resolve soon and permanently!

    Thanks, Norm, you’re really so kind to respond to these inquiries and make yourself available for dialogue here. It’s above and beyond the call of duty…!

    LK

    • HI LK,
      Thanks for visiting the site. I am glad you are getting the book as it contains the answers you’re looking for. The most likely reason xifaxin is not working is because your gut is colonized with bacteria that are resistant to this antibiotic. Please read the book before searching for additional antibiotics which negatively impact the diversity of your entire gut microbiome. We also offer individual counseling for a variety of specific issues such as ways to control excessive weight loss.

  122. Alexandra says:

    Hello Dr. Robillard!
    I’m now following the Fast Tract Digestion-GERD plan, trying to manage my health issues. Your books are great and shoking and fresh! I beleive that you provide a real answer for many health problems. I hope that this type of diet will help me to solve my issues too (bile and acid reflux, bile gastritis).
    I’m just one day of strict counting FP of all the day meals , so i am at the very beginning of the story.
    What is your opinion about Fast Tract diet effectiveness in the case of biliary reflux?

    Sincerely,
    Alexandra K.

    • Hi Alexandra,
      When studies have examined refluxate, they have found bile. So I imagine anyone who has acid reflux has a bile component as well as acid, digestive enzymes and bacteria. The key is controlling the reflux. Once you accomplish that you should have no trouble.

  123. Doug says:

    Hi Norm, trying to calculate the FP of buckwheat but have some questions. How much does preparation factor into the equation? I cooked groats in the pressure cooker then then blended them into a creamy porridge. But the numbers I found on the Internet were based on the groats or sometimes the flour. I came up with 16 for FP, which is way higher than I’d like, but this may vary greatly based on preparation method . What do you think? Getting tired of just jasmine rice so wanted some other low FP breakfast and snacks options.

    Thanks

    Doug

    • Hi Doug,
      I can’t answer that without knowing the serving size. I get an FP of 13 grams for a (dry) serving of 1.1 ounces. Hope that helps.

      Also, you might consider cream and glutinous rice.

  124. Angela says:

    Hi Norm,

    i was wondering about coconut water… I couldn’t find anything about it in your book?
    It has a lot of electrolytes and would be good for me bike riding… Also I had a bad reaction to watermelon… ??? Is it the sugar in there?

    thank you and much Aloha, Angela

    • Hi Angela,
      Then FP for coconut water is 9 grams for an 8.8 ounce serving. A dextrose-based electrolyte drink would be better.

      As stated in the tables, the FP for watermelon is very low – based on GI testing in healthy individuals. But some of the sugar in watermelon is fructose which could be giving you symptoms. But make sure watermelon is not getting the blame for symptoms caused by something else you ate before. Foods with a lot of fiber may cause delayed symptoms for example.

      • Angela says:

        THank you so much for your prompt replies…. you are awesome.. I guess I will have to do more searching to find me an elcetrolyte drink….Also in the book you say that carbs will increase x3 if cooled and then eaten. So I made those Jasmine rice balls for a long ride i’m doing later today. they are in the frig. are they going to be ok?… i’m doing much better BTW…. Just trying to figure out how to implement into my current lifestyle.

        thank you thank you…..And aloha, Angela

    • rewinj says:

      Pretty sure watermelon is high in fructose as well as fructans and/or polyols. I think the Chinese use it as their go-to constipation cure for this reason (like we do Prunes?). Combining the Fast Tract diet with the FODMAPS diet might help you? This is all based on random stuff I’ve read over the past couple years, but it might be worth investigating….

  125. Alana Sugar says:

    Hi Norm,
    Just thought I would touch base with you again. I wanted to let you know that I found out that my particular issue with acid reflux (which I control beautifully with your program) comes from having fructose malabsorption. I learned this from a breath test I recently took. I have always suspected fruit and legumes to be problematic, far more so than grains for me. So, I did some research online and discovered there is a digestive enzyme product called Digest Spectrum, made by Enzymedica, that is useful for the treatment of fructose malabsorption. Many people swear by it! So I bought some from Whole Foods to see if it would help me, too, if I over indulged in black-eyed peas for New Year’s day, or ate a whole pear or an apple. It really did seem to help greatly. Normally I would have been very uncomfortable after eating legumes and fruit, but not when I took the enzyme. So, I am hopeful and wanted to pass this on to you and your readers. You may already be aware of the product. I know it contains an enzyme called Xylanase that may be helpful to some people. Wishing you all the BEST! Thanks for everything you do for all of us!

    • Interesting. Let me know how it works for you. Not sure what xylanase would do for fructose malabsorption, but it might help with the breakdown of fiber: “Xylanase is an enzyme that catalyzes the hydrolysis of 1,4-beta-D-xylosidic linkages in xylans that are constituents of hemicellulose, a structural component of plant cell walls.”

      • Alana Sugar says:

        As far as I know there is no enzyme out there for aiding fructose digestion, although I think I read somewhere that they are working on such a thing in Europe… (also, I am not sure how that would work since fructose is a single sugar). Perhaps it helps through the breakdown of fibers that often come with fructose in whole foods? Still, I decided to search in case there was something new I didn’t know about and I did find people who had really good results with this product, so I decided to try it, too.

  126. james harless says:

    I have your two books. I been ill following a heart stent 4-23, bloating, constipation, upper GI and lower. I use Linzess pill and 2 gram glycerine to have bowels move. But I need to use diet liquid drinks for one meal a day, did you evaluate any for short carbs or Low carb fermentation for carbs in say Glucerna 11 oz hunger shake? or for the sugar in this diet drink, Is it fructose or part fructose? what, with regard to SIBO, is best or most healthy diet liquid drink sold in stores, as I use one or sometimes two daily with one regular meal? cityjimmy@yahoo.com

    • Hi James,
      The Glucerna shakes include fructose, fiber and other carbs and have 16 grams total carbs for an 11.5 oz serving. I calculate the FP to be approximatley 12 grams for that serving size. I haven’t fully researched “meal replacement” shakes and can’t assess your nutritional requirements for this liquid meal based on this short exchange, but strictly from a low FP stance, something like the Atkins Advantage shake has an FP value of under 2 grams.

  127. DINA says:

    Hi Norm just wondering of chewing gum made with sugar was Ok and whar about condiments like mayo . ketchup i guess is best avoided because of sugar , mustard ok i would assume and once you get SIBO under control canyou have ann occasional day or meal where you eat what ever you want as long as you get right back on track and what if you cheat onthe diet how long does it take to recover from it there have been a few times where i have caved and had a piece of cake or chips and salsa , how much damage have i done if I get right back on track ? Looking forward to the next book Thanks !!

    • Hi Dina, Chewing gum has sugar, but it’s not much if you don’t over do it. Ketchup also has some sugar, but again just don’t over do it. Mustard is fine. We all cheat once in a while but once your symptoms are under control, you will find you are more tolerant to these periodic indulgences.Then just get back to low FP and all will be great.

  128. LK says:

    Greetings, Dr. Robillard and fellow readers! Thank you for your Fast Tract
    publication and all of the very detailed and comprehensive research involved.
    I also wanted to mention that I am so deeply impressed by the fact that when
    readers bring up other ‘plans’ and questions about these, that you are extremely
    open to looking into other researchers’ work and examining the approaches as
    these compare to your own. This adds tremendously to the knowledge base
    for fellow SIBO people and very much applauded.
    -
    I wanted to mention to readers / Dr. Robillard – transitioning to essentially
    ‘home cooked’ food to make sure there are no additives, I recently made
    almond milk, sunflower seed milk, and cashew milk. These are so very
    easy and satisfying to make, by simply soaking the nuts/ seeds overnight,
    straining, putting in a blender with fresh water (about 2/3 seeds or nuts,
    and 1/3 water) and blend on high speed. Voila! Looks just like cow’s milk
    and tastes very refreshing. And NO additives!!
    -
    Also, eating the ‘lower FP’ foods such as jasmine rice (great also to
    make in the evening, blend it in the morning on high speed for
    ‘rice puree cereal’ – and also such veggies as bok choy – these changes
    add to the incremental healing process for SIBO – the results I am
    experiencing are just a few days of a healthier, lower FP approach,
    and already there is symptom reduction.
    -
    I am a very cautious person by nature – slow to take on experiments
    and changes! These changes are incremental, they are non-threatening (!)
    they do *not* result in pain… one can introduce a new low FP and then
    see the results in the next 24 – 48 hours. It’s a very thoughtfully presented
    process in Dr. Robillard’s work. One understands not just the “how” but
    the “why” – this is essential!!

    Thank you, Dr. Robillard!

    Reporting from ‘the field’ – i.e. – the kitchen!!

    All best, LK

    • Wow, I hardly know what to say LK. Thank you, and thanks for sharing some of your great ideas on the site! Your kitchen sounds like a fun place. I need to try cashew milk. Do you keep the water they were soaked in as part of the milk?

  129. LK says:

    Hi, Dr. Robillard – thanks for your note! I don’t keep the soaking water, as I’ve thought that if there’s anything that might be fairly ‘concentrated’ (I have no idea what) in terms of the soaking, that I should ‘start fresh’ with the water. The ‘how to make nut and seed milk’ advice online is to use fresh water. Perhaps there’s a reason…! Or it’s the ‘folk wisdom’ and it will be shown to have a reason…!

    I have read regarding making jasmine rice to first rinse the rice to ‘rinse off extra starch…’ (?) I’ve followed that advice… but don’t know if is logical..?

    Logic, folk wisdom, laboratory analysis, clinical evidence, plus trial-and-error… there must be an acronym in there (somewhere!)..!

    : ) LK.

  130. Makes sense LK. I always rinse rice too, especially glutinous rice.

  131. Torsten says:

    Hello, I am on day 1 of my elemental diet and have a question. Since Jasmin Rice is fully absorbed, can I eat small amounts of Rice occasionally during the diet? Also, is it okay to drink one or two cups of green tea during my day. And last, is it okay to sweeten my shake with dextrose? Thank you for your time and for writing the book Dr. Robillard

  132. Jean Arnold says:

    Hi Norm,
    I just got the IBS book & am looking forward to integrating the info! I recently realized I have SIBO-D, then I was fortunate to learn of the SIBO Conference, which I attended via internet. You mentioned you would be, also. So I am wondering what takeaways & impressions you have from it — whether you would comment here or create a new page about it. I learned a great deal & am glad I had the opportunity to attend.
    Thanks, Jean

    • Hi Jean,
      Great you got the book and also participated in the SIBO Conference. Unfortunately, I was not able to view the live event and will have to take a look at the recorded talks when I have a chance. I would love to hear your thoughts. I have seen Allison Siebecker speak in the past and most enjoyed her lecture.

  133. Jean Arnold says:

    I would have so much to say about it! A biggie for me is that there is a sense that this is a serious, lifelong disorder that must be managed with diet & treatment — and Dr. Pimental presented research that indicates autoimmune involvement.

    Since I relapsed repeatedly on SCD, and did poorly when I tried a straight low fiber/residue diet & also straight FODMAPs — it will be interesting to see how I will do by combining yours w/ those diets. Right now, I’m on a very restrictive diet, and will add foods back in one at a time. I’ll keep you posted, but it might be a while before I know.

    There was a sense by all that the conference was a real breakthrough event & they plan to hold it again next year. Maybe you could present at next years!

  134. Brady Shackelford says:

    I found this scholarly article about Splenda that you might be interested in reading. It makes me want to eliminate it from the Fast Tract Diet. http://www.ncbi.nlm.nih.gov/pubmed/18800291

    • Hey Brady,
      I am aware of this study which was later acknowledged to be funded by the sugar industry – who doesn’t like Splenda much. Personally, I am not overly concerned with these marginal (when you have 20 million bacteria, a drop to 50 to 80 percent of the control is still 10 million to 16 million bacteria – does it matter?) or inconsistent (weight gain was higher at a lower level, then decreased at a higher level, then increased again at an even higher level of Splenda) results. And since it was done with rats, is it relevant in people?

      But no one knows for sure. Despite extensive testing, FDA approval and use by so many people around the world for quite a few years, there could always arise some problem that no one expected. I certainly respect your decision to remove it from your diet if you think it could be a problem for you. In that case, dextrose or alcohol-free Stevia are low FP alternatives.

  135. Angela says:

    Hi Norm…. miss aloha here…
    I’m really trying to get better on this diet. Can I do a green drink it’s organic powder and has no additives.. just greens and a little ground flax seeds. I did it for years once a day then stopped to see if it was creating the symptoms but didn’t make a difference. i’m just having trouble with vegetables.. and I love vegetables.. Also for all your readers that work out and are athletes I found an electolite powder drink with no sugar…! it’s made by the same co that makes emeg C….
    thank you for your time and integrity….
    Aloha, Angela

  136. LK says:

    Greetings Dr. Robillard and fellow readers!

    I thought I’d report a few ‘successes’ regarding dietary changes. I had been putting soy milk in my morning coffee, and found soy was definitely a problem for me (perhaps not for others). I switched to homemade almond milk, and found it was ‘too oily’ for my digestion. I have found that homemade cashew milk, which is very easy to make, works perfectly well in coffee and has the consistency of milk.
    -
    I’ve also switched from broccoli (and even spinach and kale) to bok choy -just the leaves, very well steamed. This seems to alleviate symptoms associated with some cruciferous vegetables. I’ve been reading about soluble and insoluble fiber. Tomatoes, for example, have a combination of both. If you tolerate soluble but not insoluble, or vice versa, this can make a big difference on types of veggies/ fruit that can be eaten.
    -
    I’ve purchased some ‘pure beef gelatin’ powder – it has a whopping 9g of protein per tablespoon, and is used as a natural thickening agent. It can be put in liquids, added to soups or smoothies, etc. I am about to try it (it’s not supposed to be difficult if you have IBS-C or etc.) but will use caution. If it is a successful experiment (or even if not) I’ll report back here. For those of you struggling with nutrition and weight loss, or who simply need more protein, the pure beef gelatin may be helpful as it’s not a solid and still delivers significant protein. We’ll see… jury is out on this as of yet..!
    -
    Small changes…. these seem very good. A writer, Marge Piercy, wrote a book entitled Small Changes. A second writer, Grace Paley, wrote a book entitled Enormous Changes at the Last Minute.
    -
    Hm. Both exist in life… I think the small changes are for SIBO / IBS, we are the experimental subjects we read about!
    -
    Also, as Mark Twain once wrote “you can die of a misprint…” – so in anything I post here.. caveats abound!

    All best, LK

  137. Andy says:

    HELP! I am writing this in utter frustration and confusion about what’s gone wrong. So I have been told I have SIBO (though did not have breath test, only stool culture), as well as yeast overgrowth, mild adrenal imbalances, and a genetic issue called Gilbert’s Syndrome. Over the past two weeks I started a cleanse where I eliminated alcohol, sugar, dairy, etc. I was having protein shakes for breakfast with ground flax and either hemp or pea powder. I got horrific constipation, so I have switched to the Body Ecology plan for the past week, but now I have awful gas. Like, clear the room type gas. Been eating an apple for breakfast, followed by nuts an hour later or an egg. Lots of veggies, buckwheat groats, cultured veggies like kim chi, still no alcohol, dairy, or sugar, as I am trying to knock out the bad critters. Any ideas what I may be doing wrong? Would you see this SIBO approach being a better fit and if so, why? Does SIBO also address candida? I am SO frustrated!!!
    Thank you so much for all that you do! Andy

    • Hi Andy, Sorry to hear that. SIBO symptoms can be miserable. I don’t make it a habit of critiquing other author’s specific diet, but your symptoms don’t surprise me given a few of the foods you mention that have high fermentation potentials. I think think Fast Tract Digestion IBS is a book you should read and implement ASAP. (unless you also have heartburn, then read FTD Heartburn). The diet limits all the hard-to-digest but fermentable carbs that drive SIBO and all the symptoms you mention. Since yeast feed on carbs also and make gas, the same principle applies, i.e., the diet will help with yeast as well. We also offer counseling if you want to jump start the process.
      *We are starting a special, today I believe, where you get a free book if you sign up for counseling. Write to us on the consultation tab if you are interested.

      • Andy says:

        Thanks for the quick reply, Norm! I had downloaded the book some time ago (and am kicking myself for not trying this out sooner), but had a question based on some of the general info I have read. It’s my understanding that by limiting foods that are not easily digestible, you remove foods that sit around in the gut and feed the bad guys. However, does this not mean that you are eating more foods that enter the blood stream quickly, spike insulin levels, and then trigger medical issues associated with higher blood sugar? I also can’t get the standard message of “eat more fiber” out of my head. Can you address the blood sugar question and the fiber issue briefly?
        Thanks again! Much appreciated! And I will look at the counseling tab for more info.

        • Hey Andy,
          Low FP carb choices will be either lower in carbs or higher in GI. To strike a balance while controlling FP, the meal plans in FTD books contain approximately 75 g of carbs per day, in line with the recently updated ADA recommendations for diabetics. Basically you’re limiting blood sugar by carb level as opposed to eating slightly more carbs having a low GI. Having said that, people with diabetes or metabolic disorders may want to consume even fewer carbs per day, but anyone with gut issues should not be choosing high carb/low GI foods IMO.

          I know the fiber message is deeply in”grained”. But fiber simply did not live up to the claims either in terms of general health benefits or GI symptom improvement. Most types of fiber will make IBS, GERD and constipation symptoms worse.

  138. Angela says:

    hi Norm…
    Also wondering about Chia seeds as i have IBS -D.. and they absorb water… am i thinking properly?
    thank you….
    Angela

    • Angela,
      If you want to try some and see, just be sure to add the fiber grams to your daily FP levels, because while the fiber might absorb some water, the more important consideration is it’s fermentability. If you go over the recommended FP levels, all bets are off.

  139. Stella says:

    are sweet potatoes in or out? and what are your thoughts on eco coconut kefir probiotics and bone marrow broths?
    and I may be doing a sugar detox and eliminating all forms of sugar including fruit.

    • Good direct questions Stella. Let’s not waste time : ) Sweet potatoes within the FP limits, kefir, probiotics and marrow broths Ok. Let us know how your sugar detox goes.

      • Stella says:

        Thank you. Im soo glad I found you. I just researched yesterday that fructose could be causing digestive illnesses says WebMD. That’s why I wasn’t getting better and my stomach felt like it would digest bricks, even when I was dairy and gluten free. Cutting out fruit will be challenging but sure worth it I believe, and my inner guidance system tells me this is what I have to do.

        • Happy to be in touch Stella. And you don’t need to cut out fruit, just stick to lower FP fruits or smaller portions of the higher ones. We just had a great breakfast with some cubes of cantaloupe on the side. Delicious!

  140. Shebeeste says:

    Parsnips, celery root, carrots, beets, daikon, and turnip are not tubers. They’re roots.

  141. Frank of Denmark says:

    Hi Norm!
    I am very happy to finally arrive at diet that alleviates my symptoms through almost 20 years (African parasites, waves of penicillin cures, IBS alternating btw. moderate and severe symptoms, classical story sadly). Your ebook is just the kind of scientifically reasoned narrative translating into a quite easy to use dietary instruction I (plus the rest of the world I guess) needed. Even the logic of the program is simple, that a layperson as me had no problems of picking it up instantly. Thank you from the bottom of my heart. Symptoms are gone within a week, which is nothing but amazing. Still on the diet, of course.
    Now my question is: I feel an intense weariness (in no way unpleasant, like when having symptoms in the old days a week ago, though, but at kind of comfortable sleepiness, that does not go away with sleep). Is this a known phase in the diet (perhaps stemming from an impaired uptake of nutrients, energy, vitamins/minerals or what have you?)
    Further, I have ordered betain HCL from Sweden, plus enzymes, all Thorne. At least plan to go with the HCL. My thinking is low stomach acid as I experience some burping after meals and traces of undigested foods in the stools.
    Do you have any thoughts on the weariness, respectively HCL/enzymes? Anything would be highly appreciated.

    • Hi Frank,
      Very happy to hear your GI symptoms have improved on the diet. As for feeling weary, that’s a question I rarely encounter from people on the diet. To fully address this, I would need to have more information about your situation. We have a consultation program if needed, but here are a couple of ideas. One possibility is that you came down with some kind of viral illness and it will pass. Next, I would look at the ratio of fats, carbs and proteins and possibly try a few adjustments. The Fast Tract Diet does not limit the actual levels of overall carbs, proteins or fats. So those parameters can be adjusted still keeping to a low FP diet. Sometimes when people go on a diet, they limit calories from one food group but don’t increase calories from another and end up with a calorie deficit.

      You could also try adding a vitamin/mineral supplement if you suspect you are not fully absorbing nutrients- undigested food is a sign of some level of malabsorption. This may be from residual gut damage from all the years you had symptoms- it should heal in time if this is the case. As for stomach acid, you could try betain HCL if you suspect that, but generally that’s not an issue for healthy people (but a possibility in elderly or certain H. pylori positive or people taking PPI or H2 blocker meds). Getting tested would not hurt.

  142. chris says:

    Norm, this hitting nail on the head and timely. I just had multiple testsvto reveal a nasty strep ba
    Bacteria infection, yeast issues (was dominant on gets but present) , major gluten intolerances, dairy allergies, etc. I am wondering if is sibo I am dealing with? Symptoms are similar to Candida but I don’t have heartburn, just bloating, bad gas, among myriad of other symptoms related to overall 5.8 body pH. How do I start? Will buy the book but may need some more hand holding. BTW, I don’t do many carbs now, but I do eat brown rice bread (yikes) and I did eat a lot of carbs in the past. This stuff happens for a reason – finding you!

  143. chris says:

    I was also very low in good gut bacteria. Some of them reported as NO GROWTH! Strong allergies to Gluten, casein, dairy, milk

  144. Joel says:

    Norm, thanks so much for all your guidance. I’m just getting my 5-year-old son started. He has severe GERD. Of course, sweeteners help a lot, so I was wondering if Barley Malt Syrup is a good choice since it’s mostly maltose?

    • Good question Joel, The FP is based on 75% maltose (GI 100), 16% glucose (GI 100), 6% sucrose (GI 59), and 2% fructose (GI 20). I get about half a gram of FP for a 14 gram (about two teaspoons) serving. Not too bad at all.

      • Joel says:

        Great. Thanks so much, Norm!

        • Joel says:

          Hi again, Norm,

          I’m wondering about tapioca starch. We got a gluten-free white rice bread (Ener-G brand) that has white rice as the first ingredient and then tapioca starch. My son has been eating very low FP for the past few days and is still having bad acid reflux, so I’m trying to figure out what’s causing it. Also, if a product says white rice, does that usually mean white Jasmine? We’re also trying Trader Joe’s brand of Rice Crispies, but maybe that was a mistake. Thanks!

  145. Joel,
    Unfortunately, most processed rice products are made with long grain rice with too much amylose. Often times the FP is relatively low due to the extensive processing, but you’re still better off with jasmine or sticky rice which can also be used to make a creamed cereal. Also, limit the quantity if symptoms persist. Pudding from tapioca is also not a bad choice.

    • Joel says:

      Ok. We’ll cut out the packaged rice bread and cereal and see how that works. Thanks again, Norm – I really appreciate your book and your help!

  146. Lou says:

    Hi Norm,

    Just want to thank you for an outstanding job on this Low Fermentation regime. I’ve been struggling with a flare of IBS/SIBO (the ibs had been in remission for some twenty years) for a couple of years now, and did not find much consistent relief with the SCD, FODMAP or GAPS diet. The often painful distension, bloating and chronic C drove me nuts, yet I couldn’t control it. Just 36 hours into this regime, and the worst of the bloating and all of the pain have subsided (hope this remains!). I also want to commend you for running such an excellent blog, responding to questions, etc. Much appreciated. If I could get this thing under control, finally, life would be much better (one can’t help but worry about underlying issues constantly, as bloating and pain may indicate more maligne ilness, too).

    Regards,
    Lou

    • Thanks Lou,
      Very happy to your condition is improving on the diet! Stay in touch. Reducing FP should help greatly with IBS C as methane-producing organisms, which are generally to blame, rely on hydrogen for fuel. Therefore reducing hydrogen with the Fast Tract Diet should reduce overall methane gas and help alleviate constipation. If you should have any more issues with this, please consider our consultation program. We have a variety of tools to deal with this issue.

  147. lu says:

    Hi Norm, I have some questions for you. I dont know exactly what my diagnosis is because I havent been to the doctors but Ill explain my symptoms.
    I have to start with the fact that I was prescribed 1 benzo and 2 atypical antidepressants for insomnia, I understand that a lot of benzo receptors are in the gut, thus my gut was compromised.
    I became severely constipated, fast forward to quitting the pills and trying to heal my body with nutrition that included lots of fiber, especially during orthodox lent, eating beans that were not cooked/ prepared correctly, eating lots of nuts, back then wasnt aware of the anti-nutrients contained in these 2..
    So my current situation is that I can not tolerate fiber, I get extremely bloated, have lots of flatulence and belching. Used to have cramps also but found relief with activated charcoal.

    Its not a clear pattern also, sometimes I get cramps from eating say raspberry, other times I dont, but generally cant tolerate green beans, beans, cabbage, broccoli, cauliflower, garlic is absolute no no, seem to tolerate just fine potatoes, rice, pasta, avocado, meats, eggs, fats, dairy.

    Tried gluten free and grain free, saw no improvement, actually maybe even worse.
    Can not eat vegetables without bloating and can not lose weight either, I came to the conclusion that the 2 are somehow linked.

    Now, I dont know what exactly is wrong with me, is it sibo/libo or what, and can I find it in the book?
    It seems also like bloating runs in the family…my mother and her sisters couldnt eat salads without bloating and gas seems to run in the family as well.
    I too had moderate bloating and gas in the past that became much much worse after the pills and the excessive nut consumption.

    I am better off eating refined carbohydrates, I want to eat a healthy diet but my gut just cant take it.
    Also, dont have problems with milk, be it pasteurized or raw.
    Also used to spice my food with lots of black pepper, now Im trying to reduce it although I love it.
    Thanks.

    • Hi Lu,
      I feel for you. I can’t address your specific situation in these comments, but the symptoms you are describing are consistent with SIBO/dysbiosis and some of the foods you list can make things worse for sure. Fast Tract Digestion IBS will answer many of your questions. If you need more info, feel free to contact us via the consultation tab and also check out the forum on this site.

      • lu says:

        Thx for your reply, If my situation is illustrated in the book I’ll buy it..I just dont want to see again avoid gluten and/or grains because gluten/grains do not create problems for me.

    • Angela says:

      Lu- Your situation sounds pretty much like mine. I struggle with mostly constipation with massive bloating and intestinal burning. Started just as a fiber intolerance, morphed into a fruit and veggie intolerance, then went into slow starch intolerance as well. You should look up FODMAPS, because this will go from your large intestine up to your small intestine and develop into SIBO. I follow FODMAP and SIBO diet together.
      God bless.

      • lu says:

        Thx for your reply, Angela.
        I checked the diets you recommended and I agree partially with them..I am so confused because I have no symptoms from dairy so dont know if its a good idea to avoid it since I dont get problems from it, same for grains..its tough.
        Do you have improvement on your diet?
        God bless!

        • High lactose dairy avoidance or supplementation with the enzyme lactase is recommended for people who are lactose intolerant. Sound’s like this won’t apply to you, but many other foods have potential to induce excessive fermentation by gut bacteria. The book uses a new system called Fermentation Potential to get excessive fermentation (and symptoms) under control.

  148. jana Nalbandian says:

    Agree with most of your recommendation, I have used SCD, GAPs and FODMAP diet for many patients. I have always know that all starches are not created equal and resistant starches are recommended for those individuals with blood sugar issues. That being said, I am a little shocked that you would even recommend splenda as a sweetener alterative with studies indicating a negative effect on gut flora, gut pH (by increasing) amongst other side effects. Could you please explain your rationale. I only recommend stevia if a patient really needs to add something sweet.

  149. Jayne says:

    Hello, great work on your book FTD IBS. I bought your book and am implementing suggestions to my diet. After 8 years now of suffering with GERD I have tried countless diets and varying treatments. A 2nd trip to ER with terrible *D* attack – landed me with a gastro at Cedars that treated me for SIBO with Pimentel regime. The good news with the antibiotic treatment is that it allowed me to finally get off PPI’s – but 3 years later I am still suffering with IBS-C mostly.
    I believe I now may have candida as well and recently switched enzymes to Bitters since I read that may help and it does seem to be helping. But a try at probiotics only brought back those SIBO symptoms again! Now I am back on a berberine (Goldenseal does wonders for me). Will have to get off that soon and what I am afraid off is all the symptoms coming back slowly as they have in the past.
    I feel it’s true what has already been said that SIBO won’t stay away unless you can control 2 things. Enough acid (if your problem is you don’t have enough) that may be my problem – and you tackle MMC because most us SIBO suffers struggle with that. For me I am going to switch enzymes to see if one with HCL will help a bit more than bitters but I am stumped on help with constipation (probably caused by slow MMC). Currently am using flax seed in my gf cereal and I read above that you constantly suggest doing away with any fiber. What are your suggestions for a possible transition? After only one day off of flax and I constipate badly. Have you heard of Triphala? The FP restriction alone does not seem to be helping in this area.
    Thanks so much for your great book and time.

  150. Bogdan says:

    Hi Dr.Norm.
    Finally i got you’re book and read it,started the diet and i do not understand the nausea on low carb diet.I can get past the tiredness the brain fog poor focus and motivation but the nausea is baddd.i read that on low carb many people experience nausea and bloating belching,well i am one of them.

    So Dr.Norm my question is did in you;re experience did u noticed nausea on low carb?and should i stay on the diet and “fight” this nausea?i can do that but please tell me it’s gonna end someday.I am on low fat also i try to keep protein up(lean chiken breast) and some veggies fro you re book.jasmine rice for now is a no no,also dextrose(i weight train) i keep low!!what o u think?

    • Hi Bogdan,
      While I can’t comment specifically on your situation without more information via our consultation program, I can provide some general feedback. The Fast Tract Diet is not high carb or low carb per se. But rather a way of eating that limits harder to digest carbs that can be fermented by gut bacteria as that process is the biggest single driver of IBS/GERD and other functional gut symptoms. That being said, higher carb low glycemic index carbs have a higher fermentation potential and should be limited (not eliminated). If you choose to minimize lower FP (but higher GI) carbs (for instance rice, dextrose, etc.), the calories need to be made up (typically by healthy fats). People who limit both carbs and fats get into a bind because eating excessive amounts of protein is not the answer. You end up not consuming enough calories which could cause a variety of symptoms including weight loss.

      PS: Bloating is almost always the direct result of gut bacteria fermenting high FP carbs.

    • tam says:

      If you’re getting cold hands and bad sleep, maybe you should eat more food.

  151. Carson says:

    Norm,

    Ive started reading your book in relation to SIBO, it is a fantastic find I think it really gets to the root of the problem everbody else misses and that is that anything that does not digest fully quickly and smoothly could cause problems even if they are considered healthy (beans broccoli etc.)

    I also read “Fiber Menace” you might have heard of it…but that book changed my life and following that eye opening info I really improved lots of my symptoms.

    Your book has just given me even a little more knowledge in the ongoing battle Thank you!

    I want to also point out to you and all commenters on here that I was tested for stomach acid levels a while back and I was diagnosed with mild case of hypochloridia (low stomach acid) and ever since I started correcting this issue(use of betaine hcl and raising Sodium, correcting zinc and iodine defficiencys) my stomach acid levels are improving and so are all my symptoms!! better than ever!!.

    Through much research and even talking to my GI specialist we both agree that a majority people that have any digestive issues have this low stomach acid problems! He sees it in Countless patients.

    Again Thanks for the insightful book!!

    • Thanks Carson for sharing some important insights. Keep reading. There is a section that discusses low stomach acid and other underlying conditions that can predispose one to SIBO.

    • Jayne says:

      Hello Carson,
      I was curious what test did you get for stomach acid ? I asked my GI for something like that and he shrugged it off and said that he doesn’t test for such things – it’s more Naturopathic.
      I am going to seek out another GI in hopes of finding a more integrative Dr – but it sure is difficult.
      Getting this SIBO under control has been the most difficult thing I have tackled thus far.

  152. Stacy says:

    What is your opinion of coconut milk, coconut butter, and coconut milk kefir (dairy freee)?

    Do u think fermented foods like coconut milk kefir, Raw kraut, and Apple cider vinegar can help heal sibo/parasites/dysbiosis, or do u feel it makes it worse? I’d love your take on this, as there is a lot of conflicting info

    Thanks for all u do!

    • Christina says:

      Hi Stacy,

      I’m chiming in to say that in my experience, fermented foods and probiotics are key to repairing and rebalancing the gut. I don’t think following the low FP diet alone does enough. However, by following the Fast Tract diet, eating cultured foods, and taking probiotic supplements, I’ve been able to completely stop taking PPIs and acid reducers, eliminated reflux, and have much better digestion and health overall. This is one area I hope Dr. Robillard will research further and add to future additions of the Fast Tract series. You not only need to starve out the “bad” bacteria by reducing fermentables; it also helps to consume “good” bacteria that will out-compete the baddies for resources, so the excess die off. Look for foods and probiotics rich in various strains of lactobacilli, Saccharomyces Boulardii, Bifidobacterium infantis.

      But hey, don’t my word for it. See what some others say:

      http://chriskresser.com/beyond-paleo-6
      http://www.simplywoman.com/probiotic-superfoods-that-can-change-your-life/
      http://www.mindbodygreen.com/1-9331-1/top-10-probiotic-foods-to-add-to-your-diet.html
      http://balancedbites.com/2011/03/bites-i-love-fresh-raw-sauerkraut-a-probiotic-food.html
      http://www.amazon.com/dp/0553384198/ref=pe_385040_30332190_TE_M3T1_ST1_dp_3

      • Stacy says:

        Thanks Christina!

        The controversy I’ve seen has been that if there is an overgrowth of bacteria in the wrong place, that probiotics/ferments can contribute to this imbalance by not going to where they need to go (ie, due to MMC issues, or colonizing where the overgrowth is, etc). Also, they can also be a food source to any underlying parasitic/dysbiotic situation, thus making the infections worse

        Also, many people with dysbiosis have a hard time tolerating histamine foods like ferments

        A hallmark sign of sibo/dysbiosis is not tolerating probiotics or ferments

        However, I’ve also seen the sources u’ve sited and others whom feel ferments and probiotics are key.

        Some say leaky gut is healed with probiotics and ferments… Others say it can make it worse….

        So, it’s hard to know what to do!

        Did u have issues tolerating ferments and probiotics at first, or did u experience relief right away? I’d love to see what ur daily diet/meals look like too and how much/what fermented foods u eat. I’m thrilled u are seeing results, so any examples u can share would be helpful indeed. Also, how low carb/high fat are u?

  153. Christina says:

    Hi Stacy,

    I didn’t have any trouble tolerating fermented foods or probiotics right from the start. In fact, around the time I started Fast Tract and transitioned off of PPIs, I also started taking Nature’s Way “Reuteri” blend probiotic capsules, which I called my “anti-heartburn pills” because they seemed to help taken on-demand when I was having symptoms. They actually contain a small amount of prebiotics (fermentables) to feed the probiotics, but they seemed to help rather than hurt overall despite this. I’ve also taken MegaFoods brand probiotics, which don’t contain any fermentables, but I ended up switching back becuase they don’t seem to be entertic coated (which helps the probiotics get past stomach acid unharmed).

    Many people say that fermented foods are more effective than pills; I’m not sure, so I do a bit of both. It’s not always easy to remember to include them in your diet, and they can be expensive if you aren’t making them yourself. Kefir is especially good because all the lactose has been fermented out of it, and 24-hr. (“SCD”) homemade yogurt is great for the same reason. I eat those with low FP fruits (strawberries, melon) or make smoothies (avoiding bananas and other high-FP fruits except occasionally). I started eating kimchi and sauerkraut with eggs, meats, even homemade fried rice. Foods like miso paste, pickled green beans, cultured beets, sour pickles, cultured cheeses (camembert) etc. are easy and delicious to work into the diet here and there. You can even ferment your own foods with Caldwell’s starter and a Primal Kitchen Boss Pickler jar – it’s simple and kind of fun: http://primalkitchencompany.com/index.php?route=product/product&path=77_69&product_id=64

    http://www.picklemetoo.com/2013/08/02/review-and-giveaway-the-boss-pickler-from-primal-kitchen/

    A continuous brew of homemade kombucha is cheap and healthy, too. It contains B vitamins and other nutrients that help with digestion and support the liver, gut repair, etc. It’s fizzy and the sour taste grows on you. I like sour beers for the same reason, although you do have to be careful about FP; don’t go there until you’re feeling better.

    You asked about diet. When I first started Fast Tract, I followed the dietary recommendations pretty closely. I am a big home cook and didn’t end up using the recipes much, nor did I measure/weigh foods for FP religiously. I just tried to eliminate high-FP foods, strictly limit the moderates, and make the bulk of my diet low FP foods. Now that I have GERD under control, I still try to eat low-carb/low-FP, but I’m not strict about it. Jasmine rice is my main starch, but I’ll occasionally have a bowl of pasta, a noodle bowl with rice noodles, or a hunk of baguette or crackers with cheese. I drink more beer than I should…and sometimes I pay for it with heartburn. It’s a trade-off, but at least now the symptoms are under control and I understand what sets them off.

    Hope this helps!

  154. Bogdan says:

    The thing is i really need calories because i weight traing and i train preety hard so yes i will try to get them from good fats.The thing is fats makes me even more nausea i think my gallbladder is meesed up(it runs in family).

    After gym i take some dextrose and whey protein and have some chiken breast thorugh the day with some green salad and cooked peeled carots.

    So if u have some ideeas of fat i mean i know olive oil is ok for gallbladder.I tried some raw fish but i get headaches and it’s not ok.

    I am tired of waking up with brain fog,i think that is my biggest problem of all and that is why i started this diet and bought the book.I really need to be focus on my studies and exams so i cannot afford brain fog poor memory focus and flu like symptoms next day after weight training.I know these symptoms are all relating to bad fermenting bacteria but it was verry hard for me to give up te carbs.

    So i am on this road and the “die off” is really bad like i need to be strapped to my bed,craving for sweets and big meals , killing me also the depression and fatigue..

    I wait for a sign of impovement…If u have other ideas of simple meals ok for gallbladder post it ,it would be great!!

    • Pompadur says:

      Hi Bogdan!
      Maybe a coconut oil can be an option for you? It doesn’;t need bile to be absorbed, so it doesn’t affect gallbladder.

      I have problems with gallbladder too (“lazy gallbladder”, low function) and i have GERD. It seems that coconut oil doesn;t bother me much but i am not sure though…

  155. Bogdan says:

    Maybe i should lay off the meat for a while or eat maybe 2 or 3 times per week.But i don’t know with what to replace the protein if there is no more meat.

    I can tolerate maybe 2 eggs per day and i use wehy protein isolate i ask Norm if that is ok with this diet.

    When i first got this stupid gerd thing i eat a lot of meat per day maybe 1 kilo chiken breast plus 2 protein shakes and as a carb i used brown rice and some dextrose and raisins.so it was preety clean diet for 3 years and i always keep asking myself how in the world i got this terrible disease that i can get rid of anymore.

    Maybe it was the stress in my life at that time or the suplements(i took many suplements like creatine vitamins glutamine testosterone natural enhancers etc).

    So maybe there are a few over here that lay off the meat as a protein source and the question is should i?the effects after eating meat are burping meat like taste imediatly after eating,belchind and after 4 hours u cand still find meat in my stomach..

    It’s ugly..
    I thought it was hypochlorhydria but i took betaine HCl made things worse..
    So i must gut up and be strict on this diet as long as i can( like a warrior :))) );

    • Hi Bogdan. I feel bad for you as I know all too well how challenging GERD symptoms can be. You may need individual consultation allowing someone can evaluate the specifics of your diet. In general, you can lower your overall protein levels. Body builders often consume quite a bit. Typical protein levels can vary quite a bit (15-35% of calories). You might try lowering your protein levels and also switch out some meats for fish, aged cheese or even plant-based proteins such as tofu for example (noting that some people have concerns about soy-based foods). You would make up the calories with low FP carbs and fats, perhaps leaning towards healthy fats more than carbs.

  156. Ren says:

    Hi can you give me some guidance – I have sibo caused though surgery and radiotherapy. I also have a stoma and borderline short bowel so I have been told to follow a low fibre high fat high protein diet. I have to take in a lot of calories and do this by having a lot of fats carbs and sugary foods. I’m sure this is worsening my symptoms but I’m so confused what I shd eat that will provide enough calories and be nutritious. So far taking metronizadole which really helps with wind and bloating. I’m now starting to try Prescript Assist broad spectrum probiotic . I don’t understand the term FP either thank you.

    • Hi Ren, Sorry to hear about your current challenges, but there is much you can do to improve your situation. FP stands for fermentation potential. The Fast Tract Diet is consistent with the advice you have received, but low fiber doesn’t go far enough. I suggest you read Fast Tract Digestion IBS that explains how to limit gut fermentation while upping your calories. You can also get more individualized support under the consultation tab and connect with others in the forum.

  157. Ren says:

    Hi thanks so much ill get the book and give it a try. Best wishes

  158. Thanks Ren. I hope you find it helpful.

  159. lynne says:

    i was told i have sibo and wondering if untreated what are the side effects other than feeling crappy and bloated ;) like, malabsorption….?
    and what if i become pregnant and have not treated the sibo yet…….
    i do plan on getting our book, but i just stumbled upon this site 10 min ago ;)

    • In addition to what you mentioned, SIBO can cause altered bowel habits (diarrhea / constipation), acid reflux, and malabsorption of various vitamins, nutrients and minerals that can have a significant impact on your overall health. Better to get it resolved before getting pregnant from a nutritional point of view.

  160. Kim says:

    Hi, I came across this site while searching for information about IBS because I think my nine month old suffers from it. I realize this information is geared toward adults but I am hoping it could help with my son’s issues. He has had issues with constipation and obvious distress/discomfort with bowel movements for months. The advice I get from the doctor is to give juice (pear or prune) and fruits etc. which helped initially, but he would go right back to having issues. Now I am thinking all the fruit and juice (and increase in fiber) is the opposite of what he needs. Recently he was on Amoxicillin for an ear infection and by the end of the ten day course he was having regular easy bowel movements and was happier than I had seen him in a long time. As soon as the antibiotics were finished he went right back to having issues and a more cranky state. Now he is on Lactulose for the constipation (which also worked initially but doesn’t seem to be making that much of a difference), but should he be taking that if he has SIBO? He is already on a limited diet being nine months old, should he be eating the rice and oatmeal baby cereals? I can’t stand seeing him having so much trouble, I really appreciate any help or advice I can get.

    • Hi Kim,
      I think your suspicions are correct in that hard-to-digest fermentable carbs could be a big part of the problem. The same goes for modified formulas and cereals. As for lactulose, it’s 100% malabsorbed and can absolutely exacerbate overgrowth and symptoms. You can share the Fast Tract approach with your pediatrician to come up with a lower FP strategy.

  161. Marilyn says:

    I have had stomach issues pretty much all my life, however the last 4 years have been the worst. I’ve suffered from acid reflux, hear burn, flatulence, bloating, pain, nausea…diverticulitis..you name it I experience it! I tried I low fiber diet…but with my low bowl, its hard. I did the FOD diet, but didn’t see much improvement.. was gluten free and dairy free, but then I became constipated.
    Now, I eat dairy and wheat in moderation, plus I eat root vegetables, hardly any fruit or sugar… coffee one a day, I feel a bit better, however… I’m still bloated and uncomfortable. I ate fries the first time in years… and a week later I’m still suffering. So mo fried food.
    I think your finding is correct…
    But in.my case what should I do? To be able to loose weight..and feel healthy.
    So many gastro doctors just prescribe drugs for acid reflux, that’s just a bandage! I’m afraid of a leaky gut… and what’s going to happen when I age? I’m only 40!
    I feel frustrated and alone.
    Marilyn

    • I really feel for you Marylyn. Just one of the these painful conditions can be challenging, but when you have two or more issues going on together, it can be too much to bear. Good that you are under the care of a doctor to rule out any serious (non dietary problem). So many people suffer with functional gut disorders from following typical Western dietary guidelines. I recommend that you read Fast Tract Digestion Heartburn and follow the dietary and behavioral recommendations. You may also want to read chapter 6 carefully on underlying conditions that can contribute to SIBO and share this information with your doctor. If we can help please contact us under the consultation tab on this site.

  162. miss emily says:

    hi..let me tell u my symptoms first :
    diarrhea, acid reflux, skin problem, anal fissure, pain at pelvic area on and off, flank area on and off, pain at the left n right abdomen (on and off) , mucus in stool, indigestion.gas, bad breath.
    i’ ve met specialist, he diagnosed I have Ibs, he only did colonoscopy, we didn’t analysis stool, breath, urine, blood and etc… I consumed all the medicine he gave, but after 3 days consumed those medicine, my symptoms get worsen..vomits, very frequent diarhhea, gas, headache, fatigue, lack of water.. after that I stop took those medicine.. and about the my pelvic pain, urine test showed its clean.also my blood pressure.it means my kidney healthy right? I’m really mad to the doc.. he wasted my money, all those medicine is quite expensive, im only a student! ever since, i never believe to doc.. I did research by my own, i really think I have SIBO.. I consumed supplements; peppermint-ginger plus shaklee, energizing soy product esp shaklee, my symptoms improved.. but till now, i still having skin problem, gas..my diarhhea had stopped, but sometimes constipate ( on and off ), sometimes I got anal fissure. I was about to take natural remedies to cure it like apple cider vinegar..it is ok? please help..im still studying.. I’m dying everyday.. I suspected my SIBO because of food poisoning untreated well 4 month ago.. and i never have ellergy before, i can tolerate all kind of food..i also have g6pd deficiency..what shoud I do?

    • Hi Emily,
      Sorry to hear about your challenging symptoms. If you do have IBS / SIBO I recommend that you read and implement Fast Tract Digestion IBS. That’s a cheap and easy way to impact any SIBO-realated symptoms. In order for me to get involved with your individual situation, you will have to enter the consultation program.

  163. Amy says:

    Hello Norm,

    I just came across your website and am so glad to have found it. I ordered your book this morning but am a little desperate for some help in the mean time. I was diagnosed with SIBO last week, specifically a heavy overgrowth of Citrobacter Braakii (and another species). I am on day 5 of the GAPS Intro diet, and am now concerned that some of the vegetables I’ve been eating (carrots, butternut squash and zucchini) might actually contribute to the pathogenic bacteria. Can you tell me which vegetables would be the best to consume given my situation?

    Thanks so much! I look forward to reading your book when it arrives.

    Amy

    • Amy says:

      Also, if you have any supplement suggestions (I’m considering taking berberine), please let me know.

      Thanks again!

  164. Kathy says:

    Just discovered your book and plan to order it. I have a couple of questions I hope you can help me with in the mean time.
    Been constipated for 30 years. Had my first painful attack 6 years ago in the upper right quadrant of my abdomen. After many attacks and many doses of Cipro, which stopped working, my doctor diagnosed diverticulitis. He removed a 6 inch section of my lower left bowel. Felt great until I started eating again after surgery. That’s when I realized it was food related. I cut out gluten which made me feel better. Been gluten free a year. I did some research and decided I probably had candida and bad bacteria in my colon so I began taking oil of oregano, garlic and thyme supplements along with probiotics. Also cleaned up my eating habits. Worked fine until 2 months ago. I started to feel like I did before any surgery and supplements. Pain is back, I feel irritated in the bowel region, have enlarged lymph nodes and I’ve had flu-like symptoms for a month. More research sent me to this website. I suspect SIBO.
    My questions: I have been drinking a smoothie of almond milk (unsweetened) and a scoop of Garden of Life Raw Meal every morning for many months. Is that ok? Can you give me your opinion on the Raw Meal? It seemed to be ideal for getting extra nutrients into me. Should I continue it?
    Also, I have been reading about biofilm in the small intestine. The theory is that that’s a good reason the bad bacteria still looms as it’s “protected” from my supplements. Should I begin taking supplements to dissolve the biofilms? Should I continue with probiotics?
    Thank you.

  165. Hi Kathy,
    Gluten free is a good idea to try. I would skip the Raw Meal meal replacement. The FP (fermentation potential) for one serving (two scoops) is about 25 grams – too much. Current probiotics are not that great. You can try them, but I really think you would benefit by reading Fast Tract Digestion to tie it all together. Diverticulitis is also linked to SIBO.

  166. Carolyn says:

    Norm, I had an initial consult with you in January. I spoke to you about my long term problems with severe die-off symptoms and enquired about the lack of discussion about die-off in your book. You said that you would write something about die-off and post on your website. However, I have looked numerous times and cannot find anything. I have you written about die-off. It continues to be a major problem for me when ever I try probiotics, peppermint oil, or other herbal anti-bacterials. (I have been on your low FP diet for about a year.)

  167. Hi Carolyn,
    I do recall discussing this with you, but I don’t recall saying that I would definitively write something on this (sorry if I gave you that impression : ( ). As far as I know, there is very little hard science on this theoretical phenomenon (correct me if I’m wrong). While dietary changes involving fermentable carbs will alter bacterial populations over time, I am not aware of any findings demonstrating a sudden massive die-off invoking symptoms after dietary alterations, though it’s theoretically possible. Even if this did occur, I would imagine that a new equilibrium would soon be established with bacteria that can ferment the new dietary fermentable substrates becoming established. After the new equilibrium is reached, if you don’t change your diet (in a significant manner) again, why would this continue to be a problem?
    PS: I feel bad that you are still having some GI issues. I took another look around and did multiple searches on the PubMed data base with the terms: bacterial die-off, herxheimer reaction, and herxheimer diet, etc. I literally can’t find a thing on this, though symptoms that could relate to die offs following broad spectrum antibiotics are reasonably well documented. I wonder if trying to stabilize your diet and making changes gradually might help if this is happening. Alternatively, something else might be going on.

  168. Carolyn says:

    Dr Robillard,
    Guess that I was not clear. I do NOT have die-off when I change my diet. The nausea, extreme sleepiness, headaches, chills, cold feet, and flushing that put me in bed and prevent me from going to work for 3 to 4 days come within hours after I have tried to take any brand of probiotics, or non-prescription herbals such as peppermint oil, grape seed extract, berberine etc. Again, not related to change in foods.

    These Herxheimer or die-off reactions are discussed in medical literature in the treatment of Lyme disease, syphilis, typhoid fever, and a few other diseases that involve the toxic reaction to killing of bacteria and release of endotoxins. Several of my medical doctors acknowledge that this is reported somewhat frequently with patients who appear to have SIBO and try to treat with probiotics and/or herbals and/or Rx antibiotics.

    I would appreciate any comments that you have and/or suggestions regarding this reaction. Give up on probiotics and/or herbals?

    • J says:

      Carolyn, it may be worth investigating histamine and salicylate intolerance (which can stem from SIBO and increased gut permeability) and can often be mistaken for die-off symptoms.

      Most of the herbal remedies you mentioned are high in salicylates. And the probiotics you are taking may contain histamine-producing strains. (D-lactate producing strains can also make one feel worse – see Dr de Meirleir’s research.)

      You could try making your own yoghurt from non-histamine/d-lactate producing bacterial strains.

  169. I see Caroline. Yes, I am aware of reported Herxheimer reactions associated with antibiotics, but not with probiotics or herbals. But if you (and your medical doctors) think that’s a possibility, perhaps it would wise to stop using them for a while and see what happens.

  170. Kathy says:

    Thanks for the rapid reply. I ordered your book and am looking forward to reading it. Hasn’t shipped yet from Amazon. In the mean time, I have been consuming ginger kombucha daily. Without having your book yet to consult, I am wondering if I should continue this.

  171. Kathy, Do you have the nutritional facts for this drink? If so, what are the total and net carbs and dietary fiber?

  172. Kathy says:

    30 calories /serving
    7 g carbohydrates
    2 g sugar
    0 protein

  173. Assuming there is no fiber or sugar alcohol present, a rough estimate of FP is 3.5 grams.

  174. Laura says:

    Greetings, Dr. Robillard and fellow readers. I have confirmed SIBO, IBS, and also slow motility… bad combination!! I have worked on dietary issues for many months. I thought I’d share a few ideas: I’ve found that high fiber is a definite “no-no” and there are ways around that. I also don’t eat anything w/ lactose – with various ‘workarounds.’ I was struggling with how to keep up nutrition each day and losing too much weight. I started to make chicken ‘gel’ – boiling chicken on the stove in a ‘fast boil’ for 2 hours, and refrigerating the chicken/ broth overnight. With that approach, a thick gel forms, which is enormously ‘soothing’ to the stomach and also a great source nutritionally. Also, I make cashew nut milk, specifically, as it is the lowest fiber of the nut milks. And… a product to mention (no affiliation whatsoever) is Cabot Cheese (VT-made) – there is no lactose in the cheese making process, and I am able to tolerate the cheese. Additionally, ‘beef gel’ that can be purchased in powdered form has a very high protein content and easy to digest. This, plus eggs, and steamed tomatoes (w/ skin peeled off) are staples of my diet. I’ve discovered taking the skin off most foods that I can eat (e.g. Idaho potatoes, blueberries, tomatoes etc.) helps as the IBS doesn’t get triggered. Overall, it is one food at a time and see how it goes. I’m sure most of the readers can relate to that idea!! Trial and error, within the limits of low fermentation potential, low fiber, and high nutritional value. One exception to ‘no skin’ is that chicken skin (boiled) is enormously soothing to the stomach and seems easy to digest. Of course- everybody is different – that’s the beauty of human life- and the glitch! :)
    All best, Laura

    • Hi Laura,
      Thank you so much for sharing your research and experience on the Fast Tract Diet. Very helpful indeed! I may have to experiment with skinless veggies myself.

  175. Mhyrr Ben says:

    Hi. I’ve been off PPI for about 8 yrs. now, I have them sent with meds every month.
    Lots of ER visits with chest pain, all ruled out and pointing at stomach, first with h. pylori in ’98 . . . currently all symptoms point to severe water brash (excessive salivation) caused by GERD, constantly spitting out saliva to point of frustration. Little food, no stamps or cash, living on olive oil, eggs, challah, one chicken/wk and what is donated in wkly. box from JKshrOrg. On eve. meds for ImmDis; started PPI again today, out of desperation. Alone in Queens, NY. 1 cup of coffee in am, green tea rest of day. I think I might benefit from GERD surgery, female over 50, etc . . . nausea from eve meds, flatline all day —

  176. Megan says:

    Hi there! So happy to have found your website with all the great information. I had a question about SIBO for anyone. Do you have a lot of abdominal pain with it? I feel like I have this gnawing feeling around my belly button all the time. When I wake up in the morning it isn’t there until I eat and later in the day its so bad I’ve had to go to emergency a few times. Im 24 years old and never leave bed, they still can’t figure out whats wrong and they put me on hydromorphones for the pain. I am waiting to get a breath test and a smart pill at the end of July. I talked to my GI doctor today and she said she hasn’t heard of anyone having abdominal pain so bad they had to go to the ER with SIBO so I was curious if anyone can relate to me or knows that this pain can be associated with a severe case! I am so desperate for answers as to why I am hurting so badly and having so much trouble eating. Thank you so much for any responses.

  177. Bessie says:

    Hi Norm
    I stated your diet in January, I believe.
    Definitely I feels better than before, when heartburn ruled and reigned over me. The problem still when I eat cheese, yogurt, cream and even lactose free milk. Can I use any substitute for milk, dairy is not for me.
    I can not eat even the fruits that you recommend nor squash either. Sushi rice occasionally is more less okay.
    Thank you, I’m thankful for your books.

  178. Christina says:

    Hi Megan,

    The pain you describe is exactly how my reflux started. I would get this searing pain in my stomach, in the area around my belly button and where the ribs meet at the bottom. It was so severe I had to leave work several days. OTC acid reducers didn’t do much; Prilosec helped a little. I had an endoscopy showing a mild case of gastritis and some irritation. Prescription Prevacid helped quite a bit, but symptoms would flare, especially during periods of stress, and I’d get desperate and have to double up my dose. It was awful. And whenever I forgot to take my Prevacid? Searing stomach pain and (new-t0-me) acid reflux/GERD. It sucked.

    Then, when I tried to get OFF of Prevacid because of some of the health risks of long-term use (brittle bones, pregnancy dangers), I had full blown GERD and even silent reflux (where you feel like you have constant post-nasal drip). Horrible rebound reflux–and I bet the PPIs had helped exacerbate the SIBO by eliminating my stomach acid.

    The Fast Tract diet was the solution for me. It took a while, but the diet protocol combined with probiotic supplements and probiotic foods has gotten my reflux under control and completely eliminated the stomach pain.

    How can I be sure? When I cheat too much and eat or drink too many fermentables, the symptoms come back. Let’s just say I am regretting the carby meals and beers I’ve been drinking lately!

    • Pamela Gray says:

      Hi Christina
      How long does it generally take for your symptoms of GERD to calm back down? I have been on the diet for a bit over a month, stopped taking ppi when I started tbe diet. It was going mostly ok, but about a week ago i had a flare up. It is still hanging around, despite being very careful with my diet……. Any advise/anecdotes welcome.

  179. Bea says:

    Hi Dr. Robillard. I just discovered I have SIBO — both kinds of bacterial overgrowth in very high counts. Its possible I have had this problem since I was a small infant. I developed pneumonia and severe gluten intolerance at age 4 months to the point I stopped growing. At the hospital they put me in isolation and discovered about the gluten problem thankfully. More than likely I was given antibiotics. I was also given gamma globulin to beef up my immune system. Of course no probiotics. This was after all nearly 65 years ago! when no one knew about the dangers of antibiotics.

    I discovered years later I had been exposed to radiation from the Green Run at Hanford nuclear power plant coincident to my first getting so ill — and was exposed to another run of radiation when I was two years old plus likely plutonium from drinking boiled river water (my parents were working as archaeologists there in Washington State not that far from Hanford).

    I was put back onto gluten by the time I was 5 since by then while being on wheat I was finally able to grow. After that I was ill a lot and often had this brain fog–but no one thought anything of it.

    My abdomen seems like it has always been distended even though I am not otherwise heavy. Plus my sinuses are even now nearly always stuffed up despite whatever I have tried to do to remedy the condition. And I have also had more migraines than I’d care to recount. Even though I now eat a low histamine diet and use detox herbs pretty regularly I still get the migraines, though certainly not as often. I discovered last Fall Wormwood really helps my digestion, which was the beginning of my realizing that I had pinworms since the wormwood eventually brought the critters out.

    Going off grains recently after getting rid of parasites seems to finally make my abdomen look more normal. So I finally suspected that I had SIBO and I was right.

    Even though I do not have IBS or GERD etc. I have had very low energy and am an inveterate night owl. White tongue etc. RLS and jumpy nerves especially at night. Itchy Fragile scaly skin in my nether region and ears — though it has been getting better, especially since I got treated for seemingly intractable pinworms.

    My question was why is it so hard to get rid of the critters?? The answer seems to be this SIBO. I do seem to need to use fiber however otherwise I experience constipation. But after seeing what you describe about the Fast Track, I am intrigued. Maybe it would work for me.

    I was on a modified paleo/SCD diet since neither diet by itself worked for me that well. Honey and cheese etc. put me into a completely altered not very happy space. But combining the diets creatively seemed to be OK–though I used sunflower seeds rather than almonds (I seem to be sensitive to all nuts).

    My doctor wants me to go on a SCD diet again now we have discovered I have SIBO.

    But two years ago I discovered I have extreme sensitivity to Histamine/Amines. This makes going on a diet without white beans (my one reliable food) and eating bone broth and 24 hour yogurt instead problematical–though store bought plain organic yogurt is fine (for two days after opening the container).

    However I am hoping that by taking refraxamin I will become a little less histamine sensitive and can thus eat more chicken. I will also be using antibacterial herbs — which should agree with me since herbs actually do agree with me very much and I had been taking one form or another of them for years due to my kidney sensitivity. I lost half of one kidney due to nephritis, likely due to the gluten I was eating plus having had a hobby years ago making wine. I have been using h for 40 years minus two years I thought I had salicylate sensitivity. The herbs in fact saved my life since otherwise I would have had to take antibiotics continuously for my kidney problem. As is, I almost never have a problem with them. Maybe once every ten years or so I get a run in with it. The last was when I was testing out my gluten sensitivity and discovered I had zero tolerance for gluten from the wheat family.

    Already now I can eat fresh (and then quick frozen to stop the amines) chicken more often than I could previously due to having killed off most of the parasites. Using antihistamine herbs such as basil and rosemary and ginger really helps me tolerate the chicken better too. Cucumbers also help.

    Interestingly, during the two weeks prior to my SIBO breath test I started eating rice again since I figured I needed to be able to eat something more than chicken once every other day, ditto with an egg–both of which I am sensitive to due to the high amines. Previously I had stopped eating rice for a while due to killing off the parasites protocol. I had no fiber supplements (or any supplements at all for that matter) those two weeks preparing for the SIBO test and was not constipated. So your theory seems to be very possibly true. Especially at the last when I was eating white rice.

    So I want to buy your book and discuss it with my doctor. It seems so antithetical to everything I have believed about diet all these years, but who am I to go against true observation??

    I was after all on a self imposed SCD/Paleo diet for two years following taking ciprofloxasin for what turned out to be simply a skin condition rather than an actual infection in my ears. I had terrible diarrhea every half hour for a month after the cipro. This was back in the Fall of 2009. To survive I used my herbal knowledge and drank olive leaf tea and lived on 24 hour yogurt for two months. Such fun and games. After that I went on the SCD/paleo diet for two years as mentioned previously. The itchy condition continued however.

    Finally I thought I had salicylate sensitivity but in the end it turned out to be this histamine problem instead. I am grateful for the comparatively improved diet! Going on a partial GAPS diet helped me discover my histamine problem. Eating home made sauerkraut really brought out the histamine sensitivity to its utmost! But while I thought I had the sal sensitivity I was just eating the white rather than the brown rice…. And it was OK. Hmmmm!! So yes I want to buy your book and see what my naturopathic/acupuncturist/TCM doctor and I come up with. Any comments you might have for someone a little outside the box of the usual IBS GERD would be helpful.

  180. Christina says:

    Hi Pamela,

    I think it was about 2 1/2-3 mos. of following the diet, taking probiotic supplements (Nature’s Way Reuteri or MegaFoods MegaFlora) and eating probiotic foods before I felt like the reflux and stomach pain were really fully under control. Definitely be strict with yourself and try to identify any “slips” that trigger indigestion. I never measured FP strictly because I tried to stick to low FP foods, but you may need to exercise portion control if you eat in the moderate and high range. I suggest avoiding them entirely as long as you can stand it.

    And definitely explore whether probiotics might help you. Just looks out because some contain prebiotics (fermentables) that might cause problems. The Nature’s Way Reuteri actually contains some oligosaccharides (I think), but somehow never really caused me trouble.

  181. Jan says:

    Hi Norm! I feel like I know you! I’ve been following your blogs, podcasts, RS exchanges with TaterTot and Richard (love the civility and respect in these debates!), and I have just ordered the IBS book for me, and the Gerd one for my brother. I have been diagnosed with both SIBO (hydrogen type) and candida overgrowth in colon, so it’s challenging to determine proper diet, whether probiotics are best (apparently, good for candida, not good for SIBO), and whether I should tackle the SIBO first or the candida.
    Ae you still against the raw potato starch idea? I’m really at a loss. Your diet sounds good for SIBO, but not so good for candida. Any thoughts? Thanks in advance! Your willingness to personally respond to all these strangers is pretty darn impressive!

    • Ha Jan. A great beach day and then your wonderful comment. Can life get any better? Probiotics have a mixed track record for both IBS and GERD which will likely improve as new / better strain combos are developed and tested. My general thoughts on SIBO and yeast is that both bacteria (SIBO) and fungi (yeast) ferment undigested carbs and produce symptom-causing gas. Theoretically either type of overgrowth should respond well to limiting fermentable carbs. So I don’t recommend raw potato starch to begin with. I recommend that people that want to experiment with prebiotics do so after they get symptomatic relief on the Fast Tract Diet. Thanks for following my stuff.

  182. Kristie says:

    I have been thinking on your book for a while. This discussion is definitely helpful to me. Thank you Dr. Robillard! I have overcome alot of health problems (some of my story is here: http://www.familyhomehealth.blogspot.com/2014/06/food-as-medicine-for-incurable.html) Digestion and food intolerance is the one thing that I feel still needs some work. I seem to be sensitive to histamines, and have trouble with fermented foods or slow cooked beef broth (bad bloating/buzzing in extremities/insomnia). I also recently ate alot of white beans as an experiment and had bloating/heartburn/sinus drainage for about a day afterward. Actually it seemed worse the next day after I had been eating the beans. I was diagnosed with a mild case of SIBO recently through a breath test. I was told by my previous doctor that I had yeast overgrowth (which does seem to correspond with mercury poisoning which used to be an issue but many of those symptoms are gone). I was wondering what your recommendation would be. I have considered taking black walnut or maybe goldenseal. Although a previous commentor mentioned that goldenseal might be high in histamine. Would you say do the fast tract diet and then take some kind of herbs later? I have been reading recommendations to take the herbal “killers” first and then do something like the scd diet. I read that the scd diet can make the bacteria “hide” so it is best to hit it with the antimicrobials first and then do the diet. But my experiment with the navy bean makes me think that your diet might be more appropriate for me than the scd. Also probiotics are tricky with histamine intolerance. I was wondering what would I need to do to heal my intolerances completely. I took out dairy around 4 years ago, but would love to try some butter again but was waiting for my last symptoms to be gone before bringing foods back. Basically, how can I get my good bacteria to win all the time, and therefore not have problems with histamines or other foods?

  183. Megan says:

    Hi everyone! I have had all the symptoms of SIBO and I recently had a breath test, still awaiting the results but I was wondering what is considered positive breath test. Many websites say anything above 20, is this true?

  184. Heather says:

    Hello! I just finished your IBS book and found it very informative. I have dealt with IBS for almost 25 years (I am now 43). Two years ago I was diagnosed with SIBO. I received the diagnosis without the breath test because the hospital where I had to have it done had never heard of the test before.

    I have read through the other postings, and the symptoms list in your book, but neither are exactly what I am experiencing. Here is what happens to me during an “episode” (and I apologize in advance for the level of TMI in the description):

    • I belch a sulphur taste and then immediately suffer intense fatigue.
    • Over the next 4-5 hours the sulphur taste intensifies to an unbearable level, and flatulence is very frequent.
    • Then the diarrhea starts – 15-30 minute intervals of constant flushing – pure liquid and the strong sulphur taste.
    • Usually during this time the vomiting begins.
    • This will continue anywhere from 5-20 hours.

    These “episodes” occur anywhere from once in 6 weeks, to 3 times a week. I’m starting to worry about keeping my job with all the sick days I’ve had to take.
    I tried a low-fat diet, a high-fiber diet, and finally a wheat-free diet. None have worked (in fact I agree with your conclusion that the high-fiber diet made things worse). I am going to begin a modified version of your Fast Track diet tomorrow. Modified because I am still staying away from certain foods so I am going to use your tables to keep my FP 20-30 grams a day, to start. I am crossing my fingers that it will help.

    Have you ever heard of these episodic symptoms linked to SIBO?

  185. Hi Heather,
    Given the significance of your symptoms including bouts of vomiting, it’s important that you are under the care of a physician. There is lots of research going on concerning the role of sulfate-reducing-bacteria (SRBs) in gut health and chronic fatigue. Limiting hydrogen gas formation on the Fast Tract Diet should help control overgrowth of these types of bacteria. If you want some help delving into this deeper, please contact us under the consultation tab.

  186. aneta says:

    hi norm,
    I want to ask whether it is possible to SIBO caused a histamine intolerance. I have been diagnosed with histamine intolerance, lactose intolerance, and I suspect for SIBO. it, however, I have not yet been tested.
    Thank you for your response.
    aneta

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