Skip to main content

Did Cavemen Get Heatburn?

  • Image of caveman

Did Cavemen Get Heatburn?


Leaving shortly to attend the Ancestral Health Symposium in Atlanta. Gotta love the caveman. I am presenting on Saturday – Did Cavemen Get Heartburn. A question I get all the time, ha ha. But really, there are lessons to be learned and I will talk about my theory of carbohydrates, gut microbes and GERD/ IBS. If you can make it see you there. Otherwise keep an eye out for the video.

Update: Here is the presentation.

About the Author:

Norm Robillard received his Ph.D. in microbiology from the University of Massachusetts, Amherst studying Bacillus anthracis and other Bacillus species. His post-doctoral training at Tufts University focused on antibiotic resistance and gene transfer between the gut microbes Bacteroides fragilis and E. coli. During his career in pharma / biotech, Dr. Robillard studied the genetics of antibiotic resistance, septic shock, viral illnesses and antimicrobial and antibody-based therapies prior to founding the Digestive Health Institute. Dr. Robillard is the creator of the Fast Tract Diet, author of the Fast Tract Digestion book series and publisher of the Fast Tract Diet mobile app. He was the first to propose excess intestinal fermentation as the underlying cause of acid reflux and explained the connection between intragastric pressure from gas-producing bacteria in our intestines, nutritional malabsorption and the symptoms of acid reflux. His latest book series, Fast Tract Digestion provides a safe and effective dietary tool and behavioral strategy as an alternative to proton pump inhibitors (PPIs), H2 blockers, IBS drugs or antibiotics for heartburn, acid reflux, GERD, laryngopharyngeal reflux disease (LPR), IBS and other SIBO related conditions.


  1. Tim August 28, 2013 at 5:14 pm

    I found this really cool slideshow–you should watch it!

  2. Nicky October 21, 2013 at 2:09 am

    Hi Norman
    I have purchased your ebook to get my reflux under control. I noticed the jasmine rice has a fermentation potential of -3 in the book and 0 in the slide show so that does mean there is no limit to how much rice you can eat daily if it has no fermentation value?
    Thanks Nicky

    • Norm Robillard October 21, 2013 at 1:18 pm

      Hi Nicky,
      Because the published GI for jasmine rice is greater than 100, the FP calculation gives a negative number (-3). In reality it means zero. Healthy people consuming a serving with 50 grams net carbs absorb all the jasmine rice carbs faster than glucose. However, I advise consuming only 1/2 cup per meal when people start the Fast Tract Diet because you can’t assume people suffering with SIBO/malabsorption will digest and absorb even this gut friendly starch 100 percent. In other words, the FP of jasmine rice might be higher for people with compromised digestion (though it will still be superior to other starches). Over time, that will likely improve as SIBO is addressed following the dietary and behavioral recommendations are implemented.

      • Nicky October 23, 2013 at 4:23 am

        Thanks Norman

        Do you think cooking or raw foods effect the fermentation potential of a vegetable?

        • Norm Robillard October 25, 2013 at 7:19 pm

          Hi Nicky, Interesting question. Most glycemic index determinations (that’s what I calculated FP from) are made on foods in their most common state for eating. But you raise a good point. Where the GI was determined on raw foods, it makes sense that the GI would be higher and FP lower if they were cooked. I honestly have not gone through the list specifically to find the raw foods tested for GI.

          Also, many of the vegetables listed don’t have enough carbs to test for GI. In those cases, I used an estimated conservative GI of 50 to calculate FP. That would likely go up or cooked foods. For these foods, your point is excellent. Cook when it makes sense and the FP will certainly be the lowest it can be. Just avoid cooking, cooling, reheating starchy foods where you can to avoid resistant starch formation

  3. Emily December 8, 2013 at 3:12 am

    Hi Dr. Norm,
    Just noticed from the “Caveman” presentation that coconut milk is now on the low fermentation list. I asked you earlier this year about coconut milk and you steered me away from it. So I assume there is not an issue of too much fructose and fructans? Thanks.

    • Norm Robillard December 8, 2013 at 5:03 am

      Hi Emily and thanks for a good question. It would seem there are two versions of coconut milk. One is sweetened. I am not sure if that refers to what actually comes out of a coconut, but it has 5 grams of fiber and 8 grams of sugar for an FP of around 9 grams. There is also “unsweetened” coconut milk that comes from processing the pulp that has less than one gram of carbs and no fiber for an FP of zero. Let me know if you are able to shed any more light on this. I will include both in the next update of the FP tables.

      • Michelle January 8, 2015 at 11:31 pm

        Any luck on discovering which brand of coconut milk has the zero FP?

        • Norm Robillard January 9, 2015 at 2:47 am

          Hi Michelle,
          Thanks for checking on this. I took another look. Here is what I found for 1 cup servings of two commercial brands:
          Silk unsweetened coconut milk has 7 g carbs, and no fiber for an FP = 4 grams.
          “So Delicious” unsweetened coconut milk has 2 g carbs, 1 g fiber for an FP = 2 grams.

          For the time being, I will update my tables (and eventually the next iteration of the books) with these values. The zero FP previously assigned may have been an error on my part or based on a product label I can no longer find. At some point you’ve (meaning me) got to move on. That time seems to be now.

  4. Emily December 8, 2013 at 2:09 pm

    Thanks, Dr. I’m afraid the info I have is even more confusing! Right now I’m looking at a can of Thai Kitchen organic coconut milk unsweetened. For a 1/3 cup (79 mL) serving it has 3g carb and dietary fiber 0 carb. This version is what many folks on low carb diets use (a little in coffee, etc.). Then there’s the So Delicious brand of unsweetened coconut milk that comes in a carton. For a 1 cup serving it has 2g carb and fiber 1g fiber. The sweetened version of that has 8g carb and 1g fiber (sweetened with dried cane syrup). I’m not so fond of the So Delicious as it has too much thickener (carrageenan, guar gum) for my taste – kind of gloppy 🙂 Anyway, seems like you’re saying that the unsweetened milks are okay with FP. Really appreciate your work. Hope I’m not being too nit-picky!

    • Norm Robillard December 8, 2013 at 2:25 pm

      Great work Emily. I haven’t used these products so I’m interested in what you are uncovering. Proceeding with caution and watching for symptoms seems like the best approach.

  5. Emily December 8, 2013 at 7:44 pm

    Thanks! I will do that. You mentioned an update of FP tables. Any idea when that will come out? I have the Fast Tract Heartburn e-book. Does the newer IBS book have updated tables? Thanks.

  6. Norm Robillard December 9, 2013 at 1:26 pm

    The tables in FTD IBSD do have an update. Not sure when the next one will be – maybe after publishing my next book in 2014. At that point, I will likely update the ebooks as well as the next printing of the bound books.

  7. Emily December 9, 2013 at 7:18 pm

    So do I need to also get FTD IBS to get the updated FP tables? Or is there a way to update my FTD Heartburn e-book from Amazon? Just wondering….thanks.

  8. Norm Robillard December 9, 2013 at 10:10 pm

    Emily, Sorry to say that the updates are not very extensive and would not merit buying the other book or updating the Heartburn book tables at this point. Sorry about that. Too many projects! But there is always 2014 to look forward to. One approach others have used is to put the formula into an excel spread sheet. When you see a food of interest put the values into the spreadsheet. If a GI is not available, use “50” or use the GI of the closest type of food you can find.

  9. Emily December 9, 2013 at 11:42 pm

    I will look forward to new calculations in 2014 and perhaps try the spread sheet (I’m not much of a computer person!). But I know that your existing charts are quite extensive and the formula is great – just sometimes hard to find glycemic indices…thanks again!

    • Norm Robillard December 10, 2013 at 2:44 am

      You hit the nail on the head. How do we get more GI testing done? I should keep a list of the foods without GIs that most people are interested in.

  10. Emily December 10, 2013 at 3:13 pm

    From what I’ve seen in the blogs, many (myself included) are interested in FP of gluten-free or paleo items like cocoa powder (or raw cacao powder), quinoa (FP probably similar to millet?) and the coconut products – milk, raw coconut, coconut sugar. If I think of more, I’ll report!

  11. Mark December 29, 2013 at 9:32 pm

    After about 3 years on PPI’s, I stopped my medication and started the Fast Tract diet about 10 days ago. The first weeks was great, very little or no reflux symptoms but the second week reflux is back – particularly in the afternoon and evenings, but I am ok when sleeping – and I am having trouble understanding why this is happening because my FP food intake is very low. As an example, here is my diet today.

    Breakfast – 1 cup Corn Flakes (no additional sugar), Lactose free skim milk, Coffee with Sweet and Low.
    Lunch – 2 eggs, some cheese and half an avocado.
    Snack – 1/2 a cup of 2% cottage cheese and a slice of pineapple.
    Dinner – Grilled Salmon and grilled vegetables. Cup of tea.

    Any ideas of what I might be doing wrong? or is this just a temporary result of stopping the PPI’s that I have been on for quite a while.



    • Norm Robillard December 29, 2013 at 10:20 pm

      Hi Mark,
      Hang in there Mark. It’s good that you are off the PPIs. You could still be experiencing a bit of PPI rebound, but more likely some of the carbs you’re consuming are still being fermented by residual bacterial overgrowth. Keep in mind the FP levels can be higher for people who have had SIBO so even simpler carbs might be a problem early on. Give it some time and keep limiting FP and maybe do a morning fast twice per week. The Corn Flakes (starch), avocado (fiber), pineapple (fructose) and lactose free milk (oligosaccharides) might have to be limited bit more as well.

    • Javier December 30, 2013 at 7:56 am

      I think the pineapple may be doing you in? As a life-long heartburn sufferer, raw pineapples have always caused me some of the worst heartburns I can remember… which is why I haven’t had a raw slice for years. Eating grilled or oven cooked pineapples much better. I was shocked to see pineapples had a low FP, but then saw pineapple juice had a high FP which confirmed why I will never eat those things raw again.

      Dr. Robillard, thank you so much for the work you do. I am 2 days off of Aciphex and trying to follow your FP chart to improve my condition. I have been taking a PPI for years now and every time I have attempted to come off I suffer…I’m hoping this time will be different. So far I still have routine bloating and gas going on after a meal of low PF foods but haven’t felt heartburn. I was wondering if you have an opinion on the Food Combining/Separation Diet (e.g. eating no proteins with starches) and whether you think this will help digestion.. the theory supposedly being carbs need an alkaline environment and proteins an acidic environment for enzymes to digest properly and they don’t mix well together. I have been thinking about alternating days eating high protein/little to no carbs with days of high carbs/little to no protein foods. Any thoughts whether you think this would help?

      • Norm Robillard December 30, 2013 at 2:43 pm

        Hey Javier,
        Good thought. It can’t hurt to try. You would also avoid the glycemic index blunting effects of non-carb foods on carbs (that could potentially raise the FP). I don’t recommend it specifically for these reasons: I don’t have experience with this approach. It seems like a challenging way to eat. Low FP mixed meals are effective for most people. Please do post your results if you try this approach.

  12. Mark December 30, 2013 at 6:07 pm

    Thanks for the advice, I will eliminate the pineapple and see how I do.

  13. Mark January 8, 2014 at 11:32 pm

    Still having up and down days. I am getting some symptoms later in the day and while travelling this week I obviously ate something (or several somethings) I should not have as I had very bad heartburn one night and ended up having to go out and buy some Zantac.

    I am wondering how long it takes from say having something high in sugar or carbs it takes until you get symptoms…is it hours? Just wondering why I had such a strong reaction after following a pretty strict diet over a few days and feeling pretty good.



    • Norm Robillard January 9, 2014 at 3:57 am

      Hi Mark,
      On how long it takes from having something high in sugar or carbs until you get symptoms, it might take days if you have your gut bacteria under control. If not, it could come back in hours.

      As far as UC, some anecdotal reports say low carb / elemental diets help, but the connection with SIBO is not very strong which makes sense as UC is a large intestinal condition. But it can’t hurt at least.


  14. Mark January 8, 2014 at 11:34 pm

    Oh, one more thing I forgot to mention.

    I do have UC and I am wondering if that is adding the gut bacteria problems. My GE suggested pro-biotics several years ago but I have never taken them. Is this something you suggest for people with UC and if so which brand ? thanks,


  15. Mark January 22, 2014 at 12:47 pm


    Just working on some meal variety and I wonder if you have a list of acceptable grains such as Quinoa. I did not see too much of this in the book. Thanks,


    • Norm Robillard January 22, 2014 at 7:19 pm

      Hi Mark,
      Fast Tract Digesion IBS has a table with the FP values for a variety of grains. The next update of the heartburn book will have the same. It’s possible that Quinoa could be worse than pasta for triggering symptoms. Though I can’t trace the glycemic index of quinoa to it’s original source, the site lists quinoa as having a GI of 35. If that is the case, a quarter cup of quinoa (dry) would have 28 grams net carbs and 3 grams of fiber. That would give an FP of about 18 grams. You can always try it and see how you feel – while controlling FP for other foods in your diet. If you do try it let us know what you find.

Leave A Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.