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Why do so many people with cystic fibrosis suffer from heartburn?

Approximately eighty percent of people with cystic fibrosis (CF) suffer with chronic heartburn compared to twenty percent in the general population.

[i] Up until now, no one has been able to figure out exactly why. What is the connection between cystic fibrosis and heartburn? Fast Tract Digestion Heartburn provides an explanation for this mystery.

SIBO – CF Connection. People with CF exhibit well-documented carbohydrate malabsorption and small intestinal bacterial overgrowth (SIBO). A study of CF patients with pancreatic deficiencies showed that SIBO was diagnosed (based on hydrogen breath testing) almost three times more frequently when compared to patients without cystic fibrosis.[ii]. The cause of this condition is also known. CF patients often have blockage of the pancreatic ducts by thick mucous which blocks the release of digestive enzymes including pancreatic amylase limiting carbohydrate digestion and absorption. This condition leads to a higher level of carbohydrates available to gut bacteria. Not surprisingly, this condition results in SIBO.

SIBO – Heartburn Connection. Over the last several years, I have done a lot of research on the underlying cause of acid reflux and come to this conclusion:

  • Acid reflux is a direct result of small intestinal bacterial overgrowth (SIBO).
  • The main cause of SIBO-triggered acid reflux is the overconsumption of difficult to digest carbohydrates such as lactose, fructose, resistant starch, fiber and sugar alcohols.
  • Several health conditions can contribute to the problem. These include low motility, low stomach acid, prior antibiotics, food poisoning, immune impairment or conditions such as celiac, Crohn’s disease or cystic fibrosis which result in malabsorption. Not surprisingly, all of these issues can contribute to SIBO and heartburn.

The scenario goes like this. When too many unabsorbed carbohydrates (especially the five types listed above) persist in the intestine, gut bacteria consume these carbohydrates, overgrow and producing lots of gas (hydrogen, carbon dioxide and sometimes methane). Those interested can find the evidence in my book, Fast Tract Digestion Heartburn.

What to do about it. People who have an amylase deficiency have trouble digesting even small amounts of starch, including resistant starch (mainly amylose) and even the normally easy-to-digest starch amylopectin. An amylase enzyme supplement can greatly increase the efficiency of starch digestion for these individuals including people with cystic fibrosis or pancreas problems that affect the digestion of starches. Ninety percent of people with CF know they have difficulty digesting food and take digestive enzyme supplements including not only amylase, but also protease and lipase because the digestion of all three foods groups (carbohydrates, protein and fats) is affected. Despite the use of these supplements, people with CF could further reduce their heartburn symptoms by employing the strategies in Fast Tract Digestion Heartburn.

The treatment strategy in the Fast Tract Diet uses a mathematically derived calculation to limit the five most difficult-to-digest carbohydrates that are likely to be malabsorbed. The book also offers additional strategies to minimize carbohydrate malabsorption, SIBO and heartburn.

Do you have more ideas / solutions for kids with CF and heartburn?

[i] Ledson MJ, Tran J, Walshaw MJ. Prevalence and mechanisms of gastro-oesophageal reflux in adult cystic fibrosis patients. J R Soc Med. 1998 Jan;91(1):7-9. Vic P, Tassin E, Turck D, Gottrand F, Launay V, Farriaux JP. Frequency of gastroesophageal reflux in infants and in young children with cystic fibrosis. Arch Pediatr. 1995 Aug;2(8):742-6. Fridge JL, Conrad C, Gerson L, Castillo RO, Cox K. Risk factors for small bowel bacterial overgrowth in cystic fibrosis. J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):212-8.

[ii] Fridge JL, Conrad C, Gerson L, Castillo RO, Cox K. Risk factors for small bowel bacterial overgrowth in cystic fibrosis. J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):212-8.