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GERD diet that works without drugs

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GERD diet that works without drugs

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This is the final article of a four part series on acid reflux and GERD. Read the first article on the underlying cause, the second article on the myths of H. pylori and low stomach acid being the major causes and the third article on the main stream medical treatments.

Online dietary advice for GERD is often characterized by the following statement:

“Avoid fatty or fried foods, coffee, tea, alcohol, spicy foods, oranges and other citrus fruits, tomatoes, onions, carbonated beverages, chocolate and mint.”

This anecdotal advice is based on the idea that there is a link between specific “trigger foods” and acid reflux. Yet a common thread that explains how and why trigger foods cause symptoms has proved elusive. Even worse, diets that limit trigger foods have proven ineffective resulting in soaring sales of acid-reducing medicines.

Throwing the baby out with the bathwater

The American Medical Association’s Continuing Medical Education (CME) program for doctors and gastroenterologists no longer supports any type of dietary intervention for treating GERD.[1] Here’s a quote:

“Routine global elimination of food that can trigger reflux is not recommended in the treatment of GERD.”

This is a recommendation published in 2013 based on a systematic review of lifestyle modifications for GERD in 2006. This review was an evaluation of clinical studies conducted from 1975 through 2004. Their conclusions:

“There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.”

The fact that trigger food diets didn’t work doesn’t mean that dietary intervention won’t work, but it does mean going back to the drawing board.

Why trigger food diets failed?

While the American Medical Association no longer recommends dietary modification for GERD, people recognize that there is a connection between GERD and diet. But two challenges have hampered a refinement of the trigger food approach, which made the cause and effect relationship difficult to identify.

1st challenge: There is a delay between when a food is consumed and the onset of symptoms.

Was your heartburn and other reflux-related symptoms caused by something you ate one hour ago, or 10 hours ago?

2nd challenge: People seldom consume individual foods in isolation.

Most meals and snacks combine different food types belonging to all three food groups:

  • Proteins
  • Fats
  • Carbohydrates

If you got heartburn from pizza, was it the peperoni, tomato sauce or wheat flour dough?

I believe uncertainty from these two challenges has plagued diet studies on GERD and presented a roadblock in identifying exactly which foods cause symptoms. And like a bad murder investigation, if you can’t figure out who the murderer is, it’s tempting to build your case around any suspect who happened to be near the scene of the crime.

Some of the best examples of innocent bystanders involve coffee, alcohol, fatty or fried foods, and spicy foods. I want to take a closer look at these examples, but I want to do so looking through a different lens.

A new lens for dietary GERD treatment

In my first article, I talked about making a connection between carbohydrates and my own GERD symptoms. After confirming my own observations with clinical proof, I proposed a novel, evidence-based mechanism of acid reflux and developed a dietary solution, Fast Tract Diet described in the Fast Tract Digestion Heartburn book

The premise is:

Specific types of carbohydrate such as lactose, fructose, resistant starch, fiber and sugar alcohols are difficult to digest and absorb into the bloodstream. As a result, they can build up in the small intestine and over-feed intestinal bacteria.

Over-fed bacteria grow and produce excessive amount of gas including hydrogen, carbon dioxide and methane. These gases drive acid reflux because they create pressure in the small intestine and stomach, which forces the lower esophageal sphincter (LES) to open allowing stomach contents to enter the esophagus. I.e. Mentos in a coke bottle.

The defining feature of the book is a mathematical formula to measure symptom potential in every day foods. This formula is called Fermentation Potential (FP). The lower the FP points, the lower the symptom potential. The book includes 16 tables with the FP values for over 350 foods, so that you do not have to do the math yourself. Also, you can use the Free Online FP Calculator for foods that are not listed in the book.

Also, the Fast Tract Diet was presented at Digestive Disease Week in 2013 to provide gastroenterologists a new dietary solution for GERD and Small Intestinal Bacterial Overgrowth (SIBO) related conditions.

Debunking trigger food diet myths

In light of this new theory and the Fermentation Potential (FP) calculation, let’s take a look at some examples of trigger foods and see if we can spot the real culprits (difficult-to-digest carbohydrates).

Fried or fatty foods: I agree that many fried foods can cause acid reflux, but not because of oil or fats in the foods, or used to fry the foods.

Clear evidence now exists in the scientific literature that fats themselves do not cause reflux,[2],[3],[4] and there is no factual basis for clinicians recommending a low fat diet for people with GERD.[5]

Where I would focus instead is the wheat or corn flour-based batter often used to coat fried foods. Wheat flour or corn flour contain lots of resistant starch which in my opinion, is more likely to cause symptoms than fats, oils or butter in fried foods. Depending on the type of flour, one ounce can present some 8 to 10 grams of fermentable carbohydrate to gut bacteria. To put this in perspective, gut bacteria can turn 30 grams of carbohydrate into 10 liters of intestinal gas. That means that 10 grams of unabsorbed carbohydrates can yield approximately 3 liters of symptom-causing gas. Imagine three balloons filled with gas in your intestines.

Alcohol: Though many studies have been done on the role of alcohol in GERD symptoms, the results are conflicting.[6]

A large case control study involving 3153 people concluded that alcohol “did not seem to be risk factor for reflux”.[7]

All alcoholic drinks are not created equal. A shot of whiskey, vodka, rum, gin, etc. has no carbohydrates and is not likely to drive symptoms. But many mixed drinks (or sweet wines) contain lots of sucrose which is one half fructose. Fructose is hard to absorb and has a high FP value. And non-light beer has lots of resistant starch. According to this theory, sugar in sweet drinks and resistant starch in non-light beer are more likely than the alcohol to drive symptoms. Check out this article on SIBO and Alcohol.

Coffee: Many people report GERD symptoms from coffee but in the study cited above,[8] the authors concluded that neither coffee nor tea was a risk factor for GERD. Though coffee contains a small amount of soluble fiber, I would first suspect the lactose-containing milk, or the sugar often added to coffee. Milk also contains hard-to-digest oligosaccharides (short sugar chains) which may also drive symptoms.

Pizza: I can’t tell you how many times people have told me that peperoni, spices and tomato sauce on pizza gives them heartburn. While commercial tomato sauce does have some added sugar, I think the chief suspect is the wheat-based pizza crust which contains lots of resistant starch. An average slice of pizza has an FP value of 11 grams mostly due to the crust. An FP of 11 is considered moderate, but if you have two slices, the FP jumps to 22 grams which is considered high and likely to cause symptoms. If you add a can of regular coke, the total FP jumps to 36 grams.

Spicy foods: There is no clear evidence that spicy foods exacerbate GERD,[9] yet many people report a connection. One explanation I can think of is that some spicy foods may irritate the esophagus creating a burning sensation which mimics symptoms of acid reflux.

There are three basic issues limiting the effectiveness of trigger-food diets

  1. They fail to limit all of the difficult-to-digest carbohydrates that I believe are the real triggers for GERD.
  2. They limit innocent bystander foods that don’t cause symptoms such as coffee, alcohol, spices and fats.
  3. Trigger food diets don’t include practices and techniques that minimize carbohydrate malabsorption.

Holistic dietary strategy for GERD

Dr. Norm's consultation for digestive healthBased on my research over the years, I developed a 3 Pillar Strategy outlined in the Fast Tract Digestion series for reliving symptoms without drugs:

Diet: limit foods containing the most difficult to digest carbohydrates such as lactose, fructose, resistant starch, fiber and sugar alcohols.

Behavioral modification: select fully ripened fruits and vegetables, cook starchy foods well and consume them fresh, employ pro-digestion strategies for starches such as eating slowly and chewing well for maximum salivary amylase function.

Identify and address any additional underlying causes of small intestinal bacterial overgrowth (SIBO) or dysbiosis: lactose intolerance, celiac disease, low stomach acid, etc. (case by case).

In addition, you may also want to examine your medications and / or supplements for side effects and / or symptom causing ingredients. I have seen many clients who are on certain medications and / or taking supplements, which end up being the source of their symptoms.

With your doctor’s consent, wean yourself off of acid reducing medicines ASAP while reducing fermentable carbohydrates in your diet. Many people have successfully weaned off PPIs and 2H blockers with the Fast Tract Diet.

Ready to start the Fast Tract Diet?

1. Read the Fast Tract Digestion Hearburn book

2. Get the Fast Tract Diet Mobile App for Android or iPhone/iPad

3. Call for individual consultation at 844-495-1151 US or send an e-mail to rhea.tanaka@digestivehealthinstitute.org

Fast Tract Digestion Heartburn - GERD diet that works without drugs               Fast Tract Diet App for Gut Health

Not sure if the Fast Tract Diet is for you?

Read the professional reviews and genuine experiences  | testimonials of the Fast Tract Dieters and decide for yourself.

Looking for a community of Fast Tract Dieters?

Fast Tract Diet Group on FacebookJoin the Fast Tract Diet Discussion Group on Facebook for questions, support and inspiration. Great recipes are also posted there.

 

Your comments and questions are welcome.

Read the first article, “What Really Causes Acid Reflux and GERD?”. 

Read the second article,Is GERD caused by H. pylori & Low Stomach Acid?”.

Read the third article,GERD – Why standard treatments are ineffective“.

_____________________________________________________________________

[1] Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28; quiz 329.

[2] Penagini R, Mangano M, Bianchi PA. Effect of increasing the fat content but not the energy load of a meal on gastro-oesophageal reflux and lower oesophageal sphincter motor function. Gut. 1998 Mar;42(3):330-3.

[3] Pehl C, Waizenhoefer A, Wendl B, Schmidt T, Schepp W, Pfeiffer A. Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects. Am J Gastroenterol. 1999 May;94(5):1192-6.

[4] Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey. Ann Epidemiol. 1999 Oct;9(7):424-35.

[5] Penagini R. Fat and gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1343-5.

[6] Chen SH, Wang JW, Li YM. Is alcohol consumption associated with gastroesophageal reflux disease? J Zhejiang Univ Sci B. 2010 Jun;11(6):423-8.

[7] Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J.Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut. 2004 Dec;53(12):1730-5.

[8] Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J.Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut. 2004 Dec;53(12):1730-5.

[9] Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006 May 8;166(9):965-71.

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.

69 Comments

  1. Bill September 20, 2014 at 12:12 pm

    My question is whether this approach will starve the commensal as well as the pathological gut microbes. Could there be a potential for harm here, given the critical role commensal microbes play in immune system modulation and so many other functions still being discovered and understood?

    • Norm Robillard October 15, 2014 at 3:07 pm

      Hi Bill,
      This is a great question which strikes at the basic issue: “Are we underfeeding or overfeeding our gut microbes?” I won’t be able to do this question true justice here (I’m working on a blog article on this topic), but in general, I believe that typical Western diets overfeed our microbiota. I base this opinion on a variety of things that I will explore in the article, but here are a few that come to mind:
      1. Agricultural success has provided for an abundance of grain based foods, most of which contain high levels of resistant starch and fiber. These foods and snacks are within easy reach and I believe we over indulge in them. You can add to the grains bigger, more fructose-laden fruits available all year, not just seasonally as well as a huge variety of lactose-containing diary products. Just use the FP tool to add up the fermentable carb points for a typical day on the Standard American Diet (SAD). You will find this diet actually contains 100 to 150 daily grams of fermentable / hard to digest carbs.
      2. It’s hard to process all of these fermentable carbs with a gut microbe population that has been depleted from a variety of factors some behavioral (cooking foods, finely grinding grains) and some based on modern science (preservatives and antibiotics). Can we reverse course by consuming more unprocessed foods? Perhaps, but we still have the overabundance of grains, other starches, fruits and diary to contend with that were not as readily available during our evolution.
      3. The clinical success of diets that limit fermentable carbs for treating functional gut disorders including IBS, GERD, Crohn’s, Celiac disease (gluten free versions) and many others. These diets include low carb, low starch, low FODMAP, and elemental diets. The Fast Tract Diet seeks to optimize this strategy. Where are the studies that show clinical improvement by adding fiber, starch, lactose, fructose, and other fermentable carbs?
      4. Our gut microbes help keep us healthy (vitamins, immune function, compete with pathogens, etc.), but the main reason we co-evolved with gut microbes was to survive starvation. Why then would these organisms succumb to the very thing they evolved to solve – starvation? That idea makes no sense to me and I have not found any evidence that supports the idea that these bacteria are eliminated by moderating food intake or reducing specific carbs – of course the populations will adjust to our diet. Our own body also nourishes these microbes by feeding them (especially the most critical ones that adhere to the gut lining) with mucous – glycopeptides (sugars stuck to proteins). By the way, these microbes also feed on a variety of fermentable substrates from animal-based food – collagen, glycoprotiens, etc.

      In a nutshell, Weed, seed and feed might make conceptual sense, but I believe we need to learn much more about the weed and seed part of the equation and embrace diets that don’t overfeed.

      More on this later but thanks for a great and piercing question.

  2. Jim Small September 22, 2014 at 6:43 pm

    My anecdotal experience is that going Atkins Low Carb cured my GERD and my snoring (interesting…) in about two weeks. Eric Westman MD did a small study a number of years ago that showed significant improvement in several GERD measures, including some rather objective ones–look it up! And as a scotch drinker, I’m delighted to hear that it is not associated with GERD although I must admit I get minor symptoms, still, from a nice scotch sometimes (I think…)

    • Norm Robillard October 15, 2014 at 3:20 pm

      Thanks Jim. My journey that lead to my theory on what causes GERD and the Fast Tact Diet also began with the same experience – finding low carb was effective for GERD. I cite Westman/Yancy’s and other’s work on this in my first book, Heartburn Cured and in the Fast Tract Diet books as well. I also love Scotch, though I my usual drink is Irish Whiskey. I don’t get symptoms from the amounts I consume, but I do suspect there must be some sugar in both Scotch and Irish based on what my taste buds tell me. However, I can’t find any nutritional facts to back up my suspicion.

  3. Alexandra September 23, 2014 at 4:53 pm

    I’ve been on the diet for almost 4 weeks now and noticed some positive changes but also am not ‘better’ which I had hoped for. I have GERD/IBS symptoms and have been on medication for them for years. I switched from PPIs to H2 blockers last summer and experienced almost 4 MONTHS of very bad reflux which resolved, suddenly, one day – so weird – as long as I took Pepcid which only ‘sort of’ works. Was taking Pepcid from that point until about a week ago. Right now I don’t feel terrible – miraculously – but I also don’t feel great. I basically have pressure in my sternum, a fair amount of burping and some very minor (comparatively) bloating. But the pressure feeling is completely chronic, no let up at all unless I’m exercising (not sure what that’s about) unless I take a Tums or something (which I’m trying to avoid).

    In the book, Dr. Robillard talks positively about the folks whose symptoms resolve in 1-3 days. I get that my situation is probably different, and to be fair, my IBS symptoms other than constipation and bloating (other than above) have evaporated much to my delight – AND, I just went off the Pepcid so I’m sure some ‘rebound’ is natural, but I guess I would love to hear some encouragement about people in my position – those of us who were on medication for a long time, ARE having symptoms despite being very religious about the diet, etc. and are not feeling great. Will I ever feel better? Were there test subjects who found that after 2, 3, 6 months they were feeling better? Because reading how fast the improvement was for people, followed by a chapter of bigger problems (motility, cancer, etc.) that would cause symptoms NOT to resolve quickly makes me doubt what I’m doing. Do I give it more time or am I wasting my time because if not better by this point I can glean that SIBO was not my problem?

    • Brian September 27, 2014 at 8:54 pm

      Alexandra,

      Your situation sounds very similar to mine. I eventually had to avoid all starch, even jasmine rice, further limit lactose and replace them with low-FP fruits and vegetables. Recently I have also reduced the overall size of my meals to reduce the pressure on the LES, which has helped too.

      Also if you drink coffee I would recommend adding half-half to make it more drinkable and less acidic on the way down. These changes helped me get start seeing some real progress.

      Hope this helps

      Brian

  4. Norm Robillard October 15, 2014 at 3:26 pm

    Hi Alexandra, Brian’s advice makes perfect sense to me. One of the troubleshooting methods in the book for persistent symptoms (in addition to digging deeper on other potential underlying conditions that you eluded to) is to cut fermentable carbs even more and even limiting or eliminating starches completely for a period of time. The reason is that damaged digestion / enzyme deficiency, etc., or advance SIBO all can result in even simple starches and even glucose becoming food for gut bacteria. Hopefully, in time you can begin to add these back as your symptoms improve.

  5. Eric Selle November 7, 2014 at 5:40 pm

    First off – this information is great! I’m excited to learn more about it, as I’ve begun suffering from GERD and consequently have developed voice problems. I found a very useful list of the Fermentation Potential of certain foods compiled by Allison Siebecker that places ALL potatoes as having high FP and should be avoided. A list by Norman Robillard places pontiac and russet potatoes as having low FP. Other contradictions include bananas (Siebecker lists fresh bananas as low FP, Robillard places fresh bananas as high FP) dairy (Siebecker lists cream and “commercial yogurt” as high, Robillard lists cream and yogurt as low). Why the differences?

    What about goat’s milk and cheese? Oatmeal (particularly if you soak it first to reduce the phytic acid)? Cranberries? (and cranberry juice?) Kombucha? Tumeric Root?

    When I first started realizing I had an acid reflux problem I thought I was going to have to give up eating EVERYTHING (spicy foods, citrus, tomatoes, dairy, raw vegetables, everything!). This info by Robillard makes a lot of sense and also seems to be more manageable!

    Thanks so much for your help!
    Eric <

    • Norm Robillard November 12, 2014 at 4:50 pm

      Hi Eric,
      The Fast Tract Diet is the only diet that focuses on Fermentation Potential (FP). Other food lists often rate foods by the presence of FODMAPs which don’t include dietary fiber or resistant starch. Another difference is that the FODMAP approach is qualitative (either a food has FODMAPs or it doesn’t), while the Fast Tract Diet is quantitative – the FP value is a calculation that gives the actual amount of fermentable carbs per serving in grams. This is why some potatoes are higher in FP than others. Bananas and some potato and rice varieties have high FPs due to the presence of resistant starch. Oatmeal is both high in resistant starch and fiber.

  6. PollyDick November 26, 2014 at 9:56 am

    I found your website and bought your first book a few months ago and thought you’d like some feedback.
    I am 70 and have been visiting my GP on and off for various conditions for the last 8 years – stomach pain, malaise, fatigue, poor sleep, back and joint pains and stiffness. These conditions although intermittent, I felt were linked. At their worst I was confined to bed & unable to function. I also had other less bothersome conditions: rosacea, legs cramps at night and these all led to depression.
    I had blood tests and was prescribed Vitamin D which helped my energy levels a bit. I had an endoscopy and no problems were detected. I was prescribed CoCodamol & paracetamol for joint pains and Ranitadine for stomach problems. They helped but had side effects [mainly hives] but i was taking them every day and tempted to up the recommended dosage.
    After going as far as i was prepared with drugs, i decided to try altering my lifestyle/food/sleep regime. I now walk a few miles everyday, I do Pilates once a week, and i follow the rules of ‘sleep hygiene’ recommended by the nhs. These changes really helped my chronic back pain and improved my sleep pattern. But I was still having recurrent bouts of stomach pain – keeping me awake at night – malaise, arthritic pain and fatigue. I ate what i thought was a healthy mainly vegetarian diet: low fat dairy, whole grains, plenty of nuts and dried fruit, masses of spinach and avoided red meat.
    To cut a long story short: I came across your FT diet and immediately my stomach pains disappeared. After a couple of weeks on the full FT diet however, I started to feel uncomfortably full and was constipated for the first time in my life. I now moderate your diet: I eat full fat dairy, white bread and fewer pulses, dried fruit and nuts. [it is a diet i much prefer anyway and feels natural for me] I can now manage my symptoms and am free of all those debilitating conditions and feel full of energy. As a bonus i am sleeping much better, have not had rosacea, have lost 7lb and maintain a healthy weight and my leg cramps seem to have gone.
    I really appreciate your careful research and thank you for improving the quality of my life.

    • Norm Robillard November 26, 2014 at 1:15 pm

      Hi Pollydick,
      Thanks for sharing your story. I’m happy to hear you have found relief from many of the problems you were experiencing. When you say you have modified the diet, I’m not sure exactly how, given that the book allows most of the foods you say you now eat, as long as overall FP points are controlled and to eat “only until you’re comfortably full”. Dried fruits do tend to be higher in FP, but if some dried fruit helps alleviate constipation for you, it seems reasonable to add some into your diet. For some people, too much dried fruit might present a problem, given its high sugar and fiber content and high overall FP. A recent study showed that low or now fiber diets were much more effective than high fiber diets for constipation (Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012 Sep 7;18(33):4593-6).

  7. Philip Frey December 2, 2014 at 7:03 pm

    Thank you for the information. I have been suffering for some time from GERD symptoms (an almost constant burning in the esophagus, from the sternum up to the throat). I just tested negative for H. Pylori and am about to take the breath test for SIBO. I wondering if there are other tests I should have done to rule out other possibilities? Thank you!

    • Norm Robillard December 20, 2014 at 1:09 am

      A breath test is a good place to start Philip. Please do give the diet a try regardless of the results.

  8. Porter Rockwell December 6, 2014 at 8:05 pm

    Any insight into Gluten?

    • Norm Robillard December 6, 2014 at 10:15 pm

      Hi Porter, Thanks for a good question.
      Short answer: If you don’t have celiac disease, I would worry about fermentable carbs more than gluten.

      Here’s a few additional thoughts on Gluten. Celiac disease is linked to GERD which makes sense to me since they’re both linked to SIBO. Celiac disease, and by all reports the autoimmune response to gluten (perhaps high FP diets lead to SIBO, leaky gut and increase the systemic immune exposure to gluten to begin with), leads to villus atrophy, malabsorption and cycles of SIBO, more damage, leaky gut, more gluten release, etc.). There is good evidence that reflux improves in celiacs on a gluten free diet (http://gut.bmj.com/content/52/4/514.full). It all makes sense. What I am not at all sure about is how bad gluten would be in the absence of leaky gut (do you know of any studies where only dietary gluten was removed or even added back without altering the carbohydrate balance in the diet? And why do 30% of celiacs fail to get well on a gluten free diet?) which may be triggered more by excess dietary fermentable carbs than by gluten alone.

  9. Joe Cobin December 19, 2014 at 10:57 pm

    It’s been about 6 months since I first read your book Norman and since then I’ve not had more than 2 or 3 episodes of bad GERD. And when I do, it’s because I’ve sucumbed to cake, pie or icecream or all three. Also I find it best if I don’t eat baguettes more than a couple of days at a time.

    When I pondered the idea that fermentation was causing the bloating, wind and subequent GERD, it all sort of fell into place. After following your diet or, more accurately, being more mindful of a food item’s FP, I was pretty quickly able to come off of the PPIs. So a great big thank you.

    Now the next big step is to find a way of killing the critters that are producing all the wind. Any plans on a protocol to heal SIBO?

  10. Norm Robillard December 20, 2014 at 1:14 am

    Thanks Joe. Great news that your are off the PPIs and doing better! The Fast Tract Diet does target SIBO. It does so with low FP food choices, pro-absorption behaviors and identifying and addressing other underlying causes should they exist. That is the recipe to heal SIBO and prevent it’s recurrence.

  11. Joe Cobin December 21, 2014 at 12:49 pm

    Norm, I find that on my diet, which tends to be low carb to low FB cycling, the symptoms die down but don’t completely disappear–I still get a grumbling gut and a degree of fartage, but no upper tract wind accumulation causing reflux. Maybe my measures of low FB are too high or I’m eating something that is giving sustenance to these bacteria. And when I do visit someone, slip an eat some cake or something, bang it’s all back.

    Anyway, if what you say is true then a period on the low FB heals SIBO (I’m taking that to mean the bacteria are eliminated from the small intestine, then you would expect a person could then eat his pre-SIBO diet (some food with high FB) without GERD. That’s just my reasoning, I don’t mean to contradict you and I certainly don’t have any qualification to do so, I’m just trying to understand this condition.

    • Norm Robillard December 21, 2014 at 2:11 pm

      Joe, As we get older, we often become less able to tolerate excessive fermentable carb loads which lead to bacterial overgrowth / dysbiosis and symptoms. Like me, you will likely need to moderate your diet for the rest of your life.

      Over time, following the “low FP food choices, behavior modification, identifying and addressing underlying causes” advice in Fast Tract Digestion should leave you will few or no symptoms and more resistance to periodic digressions. After ten years of living this approach, I can slip up for a number of days before my reflux symptoms begin to re-emerge. I can live with that, especially knowing what I need to do to correct things.

  12. bearsmom December 21, 2014 at 2:16 pm

    Hi Joe
    From what I have seen (and I have pretty much read every single post on this site (LOL) and recently joined a SIBO Facebook group and have been reading Dr. Seibecker’s webstie siboinfo.com, once you have SIBO, you are always going to be prone to it. Especially if you have an underlying motility issue that is idiopathic (unknown). Basically, kind of a slow gut. Sorry, that is just the truth. I plan to follow Norm’s diet the rest of my life, as I wish to experience health and vitality and a pain-free life, rather than eat the Cr*p that my friends and family eat LOL. It looks like as things improve you can occasionally “cheat” a bit on the diet. At this point, I had to use the troubleshooting section of the Fast Track Digestion:IBS book and completely elimiate jasmine rice, fruit, nuts to get my FP numbers very low for a few months and help my body sweep out the bad bacteria. I hope to re-introduce those foods soon. Of all of the “SIBO” diets out there, Norm’s makes the most sense and is more accessible.

    As for the minor continuing symptoms of grumbling and gas, this is SIBO related (although I am not totally sure about the gas-that may more likely have to do with dysbiosis in the LARGE intestine which also accompanies SIBO). It may help to be sure you are following the diet very closely (are you eating apples for example, because you said you are “low carb” and sometimes there are problem foods on “low carb” diets). Come over to the forum and post questions for more support. Look twice at his trouble shooting chapter, and consider a consult with him, as I am doing. It does take time for some people. Dr. Seibecker said that with diet alone, it can take up to a YEAR to resolve SIBO. My preference is not to use prokenetics and antibiotics to resolve this, so I am sticking with diet for now. Best of luck!

  13. bearsmom December 21, 2014 at 2:37 pm

    Dr. Robillard,

    Could you please comment on this idea of SIVO (small intestine VIRAL overgrowth). What do viruses feed on? How do we know if we might have those too, along with the bacteria? Do the virus issues, if any, resolve with the bacterial overgrowth? Are the symptoms different? Have you come up against this in your consultation practice?

    The second part of my question is related: In a recent talk, Dr. Seibecker noted that only about 1/4 of her patients have candida overgrowth, along with the SIBO. (Lucky me, I am one of them). And so she sometimes has to treat that also, and sometimes it just clears up with the SIBO treatment. (MINE IS!) But something that Candida doctors have long insisted on (Not Seibecker, but other candida-focused practitioners), is this idea that it is important to avoid pork, because of the risk of contracting viruses from the pork that people with compromised immunity are prone to. The Westin A. Price Foundation has looked at this issue and determined that traditional practices such as curing the meat with salt or vinegar, may minimize the risk of exposure to these viruses, but I think the whole thing is poorly understood. I also think pastured pork may be superior, if available. My thinking is that candida diets contain a LOT of foods that are high in fermentation potential (fruits are not limited, and brown rice and other whole grains are often allowed) and if one has SIBO, this is not the best diet to follow. If one has SIBO, then a diet high in FP might allow the body to hold onto viruses, thereby making pork consumption riskier which is why candida docs just say “limit” it because SIBO is still so poorly understood by “candida”-focused doctors.

    The Fast Track Diet does not limit pork, and my hope is that, maybe there is no need to? (Bring on the Bacon!). I have long been confused as to why the Paleo community says enjoy pork with abandon, and my holistic doctor (who is very candida focused) says “AVOID”. Can you please comment on this? Much appreciated and Happy Holidays!

  14. shir January 3, 2015 at 6:23 pm

    Hi Norm,
    I’ve been following an extremely low carb diet for the past 2 weeks and i do see a big improvement, however i’m still nauseous when i wake up in the morning and then also my hernia appears (only in the morning when i get up). Can this diet eliminates it over time or hernias can only treated with surgery or is there another option ?

    • Norm Robillard January 3, 2015 at 7:34 pm

      Hi Shir, Since the diet reduces bacterial fermentation in the intestines leading to reduced gas and gas pressure, it should greatly help even with a hernia.

  15. shir January 3, 2015 at 8:00 pm

    Thank you for the quick response. So do you think it will get better over time ? are there certain supplements that also can help ? i’m currently taking HCL and digestive enzymes which seems to help a bit but not solving the hernia thing.

  16. bearsmom January 4, 2015 at 9:41 pm

    Shir, give the diet a good month. These things don’t happen overnight. You are on the right path! If you are not getting improvements, review the trouble shooting tips in the IBS book and post questions in the forum. The forum participants are very helpful!

  17. bearsmom January 4, 2015 at 9:45 pm

    Shir, also
    If you have continued issues with hernia, it is also helpful to look at your aligment (NOT posture, but how you align your bones). Poor aligment (in addition to gases created by microbes) is a big contributor to intra-abdominal pressure creating unwanted forces on the pelvic floor, and up towards the chest, putting one at risk for hernia. Visit http://www.katysays.com and restorativeexercise.com and consider joining the Facebook group called All About Alignment. You can post questions there, they are very helpful.

  18. shir January 5, 2015 at 7:59 am

    Sounds good, thanx so much for answering and giving me a relevant information.
    Regarding the diet, since i’m eating very low carb now i’m eating eggs and avocado’s also and i heard they can be a bit gassy (?), what do you think about that ?. should i continue with it or decrease the amount ?

  19. bearsmom January 5, 2015 at 2:40 pm

    Hi Shir, I would consult the fermentation tables in Fast Track Digestion: IBS. And come post your questions in diet section of the forum. I think avocado has the potential to cause fermentation, but here is the thing: A small quantity may be fine when you are calculating your overal FP foods for a day. You are trying in the intro diet to keep your Fermentation Potential foods quite low, but there may be room for avocado. When using FODMAP as a guide, the question is a qualitative one: Is this type of food likely to cause symptoms? (Yes/no). Whereas, Dr. Robillard’s approach is quantitative, so the amounts of food are more relevant. I hope you read the book! As for eggs, they can be fine for some, whereas they bother others. Only way to know is to follow the intro diet, and get to a good baseline and then add foods in.

  20. 49barefoot February 18, 2015 at 2:37 pm

    Finally think I’ve found the missing piece: histamine sensitivity! I had a lot of improvement on the fasttrack diet, but still couldn’t eat any tomatoes, and a couple of weeks ago, started feeling worse even though I was careful with the diet. I had taken a trip, and ate a lot of canned sardines, hard cheese, and some kefir.
    My research when I got back come up with the histamine sensitivity, and all of those items are very high in histamine! And on all the symptom sites for histamines, acid reflux is listed. Apparently histamine sensitivity can be created or exacerbated by SIBO, and maybe the reverse is true. The challenge now is to combine the fast track diet with a low histamine diet — not impossible, but difficult, as many nuts, tofu, hard cheeses, among other items are high in histamines.
    The histamine sensitivity sites also list ALL fermented foods as high in histamines, and some sites say there are very few probiotics that don’t make the histamine sensitivity worse.

    • Vania October 11, 2016 at 8:27 pm

      Yep….that is my conclusion as well. I have had histamine intolerance for the past 3 years…when GERD hit…I had been off of my anti-histamine for about 4 months. Feeling a lot better after getting back on Claritin and eating a low histamine diet.

  21. Jenni February 28, 2015 at 7:59 pm

    Hi Norm! I have chronic GERD and LPR, but I do not feel the gas and bloating that you talk about. I do not belch frequently. Can you comment on that? And thanks so much for your work!!!

    • Norm Robillard February 28, 2015 at 10:36 pm

      Hi Jenni,
      I think it may be possible to reflux vapors without noticeable belching, regurgitation or obvious acid reflux. The term silent reflux comes to mind. I recommend people with LPR symptoms, even in the absence of more obvious symptoms such as heartburn or excessive belching, try limiting fermentable carbs and see if it helps.

  22. Elizabeth May 21, 2015 at 4:50 pm

    I’ve found your book very helpful. I am wondering if you, or your readers, have advice about recurrent laryngitis as a result of GERD? While my SIBO symptoms are (mostly) improving, I am having laryngitis for the 6th time in 6 months (brought on by a cold). I take Betaine HCl and pro-kinetics in addition to following the diet.

  23. Marko Goreta June 11, 2015 at 2:22 am

    Thanks Norm, what about already fermented food. Could already fermented food be refermented? Would it produce gas?

  24. Eric June 16, 2015 at 6:14 pm

    Do you REALLY believe that coffee does not contribute or at least lead to reflux symptoms? I control my diet 100% and whenever I drink a black coffee I have reflux within 3 hours. Thoughts?

    • Norm Robillard June 17, 2015 at 4:49 pm

      Hi Eric, When you say you control your diet 100%, what does that mean. What kind of a diet are you on?

  25. Ellen July 29, 2015 at 6:49 pm

    Dr. Robillard,

    I read your first book and started doing the low-carb diet, restricting my diet to about 30g/ day last week and I thought it was getting a little better possibly until I ruined it eating a slice of pizza. I started again this week, but I was eating Atkins bars every day because of their low net carb count (high sugar alcohols). I’m a little confused because of the newer diet, the Fast Tract, low FP one. I’m reading that sugar alcohols are actually pretty bad. Would you recommend I try the Fast Tract Diet instead? I realize they supplement each other but there are some differences and I want to be consistent!! I’m only 22 years old and ready for my reflux to go away!

    Also, what are your thoughts on wine? I know it has a low carb count but I have found that it causes really bad reflux and I’m not sure why if its truly the sugar/carbs that cause my reflux. Is it because it weakens the LES?

    Thanks! Ellen

    • Norm Robillard July 30, 2015 at 12:05 am

      Hi Ellen, I hear you reflux is not something anyone should have! The two approaches are quite different and it’s entirely possible that sugar alcohols or higher fiber acceptable on LC diet could be contributing to symptoms. To read about the newer Fast Tract Diet which focuses on fermentation potential instead of carbohydrates content, check out the free ebook on the home page. Wine is both low carb and low FP, but some people do report symptoms with wine. Usually, further cutting carbs or FP points often resolves the problem.

  26. Nick Quintero August 16, 2015 at 12:46 pm

    Hi Dr. Robillard,

    I have been reading all of your articles and have found it to make a lot of sense. (I’ve read articles on acid reducing diets, etc but things dont seem to fully click) I’m a 26 yr old male, in good shape. I began exhibiting really bad acid reflux at the beginning of this year.

    I started taking proton inhibitors and going to the doctor. They gave me the usual spiel about trigger foods and sent me on my way. My situation worsened and I went to a Gastroenterologist, I had an endoscopy and everything looked normal except for an old healed ulcer. After biopsy results returned, I was diagnosed with an H. Pylori infection to which I had a very involved antibiotic treatment all while taking Dexilant. Fast forward a couple months later and I felt less acid reflux. However, I was having a lot of stomach pains after eating. Below the ribs, around my stomach in different areas but with no acid reflux.

    Now a week ago, I had a weekend of eating unhealthy foods (fast heavy foods) and lots of drinking and I started experiencing a lot of reflux again. I started taking Ranitidine (GE had recommended after endoscopy) but it seems to have made things worse. My question is, could it be that I have a different digestive system issue? Or if its all due to bacteria overgrowth, how could it all have gone back after the antibiotics treatment? Side note: I will start going on a low carb / low acidic diet.

    Thanks in advance!
    Nick

    • Norm Robillard August 16, 2015 at 2:03 pm

      Cutting carbs makes good sense to me Nick, or try the Fast Tract Diet and focus specifically on low FP. I would not be surprised if antibiotics helped in the short turn as they will inhibit not only H. pylori, but potentially SIBO bacteria as well. But as many people with SIBO/IBS find, without getting at the underlying drivers of SIBO, it comes back soon after antibiotics are discontinued. If you continue to have symptoms with proper dietary changes (carbs/FP), feel free to contact us for help figuring out if anything else is going on.

  27. Alyssa August 22, 2015 at 6:45 am

    Hi Dr Robillard,
    I feel very fortunate to have stumbled on your website tonight as I am seeking answers to my digestive woes and I feel I have come closer to an approach to begin the healing process! I began to experience a burning sensation lower in my torso (lower small intestine?) around 6 months ago, and over time this sensation has ‘risen’ to my chest but I have never experienced what I understand to be the ‘classic’ symptoms of burning reflux in my oesophagus. With the passage of time, however, I am now wondering if I do in fact have GERD in its early stages of development? In addition to the burning sensation, I also experienced some IBS symptoms earlier in the year which prompted me to follow a low FODMAP diet. This helped immensely with the IBS symptoms but did not alleviate the burning (which is not excruciating but is there around 70% of each day). I tested negative to a H. Pylori breathtest and a Gastroscopy/Colonoscopy proved all was fine, however the parasite Dientamoeba fragilis was detected (apparently the detection of this parasite causes contention amongst the medical community as to whether it causes IBS symptoms and whether it needs to be treated, as some people have the parasite but are ‘asymptomatic’ whilst others may exhibit symptoms). Due to this, I took a course of Doxycycline and it was eradicated (for now!). I am wondering if you are familiar with cases such as mine where GERD is contained to just the chest (and if so, I am assuming your approach will be ideal?) and if you may have any light to shed regarding this parasite and the impact its presence may have had!
    My many thanks! Alicia

    • Norm Robillard September 23, 2015 at 12:30 pm

      Hi Alyssa,
      I agree on Dientamoeba fragilis. Typically treatment would only be warranted when symptoms are present. Given the information you shared, I would expect the Fast Tract Diet to be worth a try since it quantitatively limits fermentable carbohydrates that can drive both GERD and IBS symptoms.

  28. George September 23, 2015 at 12:15 pm

    Hello Dr. Robillard, I want to start from the beginning when i went to my regular MD for my physical 3 years ago and i mentioned to my Dr. that i coughed when i ate supper,and he said it is probably just allergys so take zertec, and you will be fine.A year later my coughing got so bad that every time i even looked at food i would cough, but really from the time i took my first bite, until after i was finished eating, i would cough profusely.I went back to my MD.and insisted that he do something NOW.I had a chest ex-ray and a cat scan and it showed some scarring on my left lung, and almost nothing on my right lung.My Pulmonary doctor said, do you sleep on your left side ,and i said yes,so he surmised that re-flux was seeping out of my stomach and directly into my left lung.He also told me to take Prilosec and i have been taking it for 2 years with alot of improvement .I am reading alot about the extended use of drugs like Prilosec and i was wondering if your diet would help me,, so i could eventually be able to stop the drug taking, and the other symptoms i still have. .I still clear my throat alot and cough periodically and have some hoarseness which are all symptoms of re-flux.My Yale Pulmonary Dr,.Dr. Herzog said that she could not definitively rule out re-flux as the cause of my scarring.I would greatly appreciate your input .Thanks George!

    • Norm Robillard September 23, 2015 at 12:46 pm

      Hi George,
      This study (http://www.ncbi.nlm.nih.gov/pubmed/8071510?dopt=Abstract)showed that lying on the left side (not the right side) resulted in shorter reflux times and better acid clearance. But reflux can occur in either position, so your doctor may have a point in terms of acid entering the left lung when sleeping on the left side.

      But the best solution is completely controlling reflux even during sleep. The Fast Tract Diet was designed to control acid reflux without the use of drugs, as opposed to reducing stomach acid to reduce symptoms. As you have been learning, acid reflux can cause cough, respiratory illness and LPR. I am a firm advocate of this diet which modulates intestinal bacterial overgrowth over drugs.

      Please refer to our consultation page if you are interested in help transitioning to a diet-based approach.

  29. Kate October 15, 2015 at 2:34 am

    Hello, my five year old daughter has complained of stomach discomfort after eating for about two weeks. She belches and burps alot. Today our GP diagnosed her with reflux. Do you make suggestion in your book for treatment of children. GP suggested removing ‘trigger’ foods from her diet ie tomatoes, garlic, spicy foods, onions.

    • Norm Robillard October 15, 2015 at 8:10 am

      Hi Kate, Here is a response we posted on the Fast Tract Diet Q&A recently concerning this issue:
      Of course, it’s always a good idea to discuss your child’s diet with your pediatrician. But since the Fast Tract Diet consists of healthy fats, carbohydrates and proteins from a variety of plant and animal sources, it should be absolutely fine for your child.

      It will also help reinforce good decision making on snack and junk foods as many are high in FP points and should be limited.

  30. Christina November 17, 2015 at 2:11 am

    Hi Dr. Robillard, thank you very much for sharing your research! I am trying to solve my Layrngitis Reflux symptoms and was feeling flustered regarding all of the contradicting information coming from my ears nose and throat doctor and the internet so this is refreshing. I recently weaned off of the PPI I”d been taking for approximately a month and a half and am feeling a surge in symptoms, as you’d expect. I have shortness in breath as well as a lot of acidic saliva (i guess it’s mucus, but I’m not sure) going in my mouth and making it difficult to speak. I recently switched to a vegan diet which, I suppose will help me, but I’m wondering how long it will take for my surge in symptoms to go away… (i’ve been off of the PPIs for about 2 weeks now. Based on your research, would you say a vegan diet supports a healthy digestive tract? Also, I’m wondering whether or not eating tomatoes close to bed time is increasing my reflux symptoms. Thank you, I would greatly appreciate any feedback!

    • Norm Robillard November 17, 2015 at 8:27 am

      Hi Christina, Thanks for your interest in our work. A vegan diet presents unique challenges for people susceptible to SIBO/dysbiosis. The reason is that plant-based diets require a tremendous amount of microbial activity to help break down the larger quantities of complex sugars in plants that our own body cannot digest. Reading Fast Tract Digestion Heartburn is a good place to start. Our consultation program also includes vegetarian-based strategies for LPR and other SIBO-related conditions.

  31. Michael January 16, 2016 at 12:41 am

    Norm,

    Hello. I offer my case history to help you in your research. I think it has some valuable insight. I moved to Taiwan in 2010. Before coming here, like many I developed gas after eating oats or beans and some kinds of bread (plus sesame, olive oil, and a host of other foods) but it was never a real issue. When I came to Taiwan I got many of the flus that people here have. This is a common and unpleasant adjustment for many foreigners. The typical course of action for doctors here, is to prescribe a bag of antibiotics when one has a cold or flu. I noticed on two ocassions after taking antibiotics that my gas cuased from morning oatmeal was greatly rediced. About a year ago I developed GERD and went to get endoscopy. Small sore in my esophagus. Nexium was prescribed which I refused, deciding to just drink more water and adjust my diet. During the last year of GERD I have had two flus. On both times, I did not go to a doctor (no antibiotics) and on both times my gas and GERD were almost nothing. In the past year, I changed my diet to completely eliminate most gas producing foods. I find that when I do have gas, my GERD is worse. I recently went to the doctor because the gas was worse and she gave me Domperidone. Like magic, the GERD and (most of the) gas disappeared within two days and my stomach and intestines feel normal. I think there is a strong connection between the bacteria in our bowels and GERD and probably many other ailments. I think the gas backs things up. Also, I think stress weakens the LES (and stressed individuals might be more suceptible to bacterial overgrowth) so the combination is probably what causes problems. Why else would the Domperidone help? It doesn’t inhibit acid but strengthens and helps the system move properly. The doctor also did a helicobacter test and the result was positive, so I will take the antibiotic course. During that time I will eat some foods that I haven’t for a long time, to see what happens and also see how my GERD is affected. On another note, I think PPI and H2 blockers can also exacerbate things…should only be used for ulcers that need a neutral ph environement to heal…otherwise the neutral ph can lead to more bacterial overgrowth or other fungal issues.

  32. Dennis Durost January 31, 2016 at 4:41 pm

    Dr. ROBILLARD: Enjoyed the articles. Was a little disappointed you didn’t delve a little more into LPR or “silent” reflux. I am currently dealing with LPR. My only symptom is a horse voice. I have been intrigued and somewhat perplexed by the notion that acid can affect your throat without any typical GERD symptoms. But after reading your material I have come up with a theory. Rather than refluxing acid, LPR sufferers are probably refluxing less caustic (to the esopagus) pepsin and bile salts. What would be your take on that idea? I also have low stomach acid and have just started experimenting with HCL capsules. Currently I’m taking three capsules with no adverse symptoms. Finally, your low carb diet. My doctor was perplexed when I told him I can go for long periods (months) without any horseness. Based on your articles I now know why. I periodically go on low cab diets to lose weight!

    • Norm Robillard January 31, 2016 at 5:59 pm

      Hi Dennis, Happy that you enjoyed the article and I accept your point. I should have included LPR as I often have done in other venues/interview, etc. But supplementing with a HCl makes sense if you know our stomach acid is low – also checking H. pylori status would be good if this is the case. But stopping reflux itself is critical and the best way to do it is with either LC or Low FP (FTD). And give it a good three months to be sure since LPR symptom improvement takes longer than simple heartburn

      Best Regards,
      Norm

  33. Tom March 7, 2016 at 3:54 pm

    Hi Dr Norm,
    Your work is very interesting to me as I have been on PPI drugs for the past 12 years. I started experiencing GERD, and then I had some tests performed years ago, not sure what the name of the test was, but the interesting part was that I was asked to drink a liquid that would “cause” me to reflux. Thing was, I didn’t reflux at all, but shortly after I was diagnosed by the doctor with Acid Reflux, placed on a PPI. I have been taking 20 mg of omeprazole everyday since then. 2 years later (10 years ago) I had a bad bought with ISB, though that was eliminated after a round of antibiotics. The IBS symptoms have never really returned. When I stop taking the PPI (accidently run out), I immediately suffer heartburn, so I am nervous when not taking them. What is my best approach to your program? Just dive right in? Any special instructions for someone who has taken PPI for as long as I have?
    Thanks so much for your help!
    Tom

    • Norm Robillard March 7, 2016 at 4:09 pm

      Hi Tom, Thanks for reading and telling your story. Reminds me of some of my own experiences. We have developed a program that encompasses diet, behaviors and supplements to help people in your situation. The course of action depends on your specific situation. Please contact us via the consultation tab and we will send you the information.

  34. angeli alvares March 13, 2016 at 1:51 am

    In all the responses and detailed coverage of this symptom you have forgotten the MAIN cause of GERD, which is prolonged exposure to negative information (everything is wrong with the planet) and the stress we all feel because of constantly being bombarded with it.. I find that relaxing with some pleasant music with great harmonies and lyrics of songs from my past while lying still on the couch immediately stopped the burningI was feeing when stressed and agitated. So maybe you should do some research on music therapy. We are sadly so stressed out. Told the meat we eat is from tortured animals, vegetables are full of additives etc etc and this info works on the mind and eventually on the body. There is no escape unless we find a way out of propaganda or try to grow our own food. Food phobias and obsessions with what we eat, only exacerbate the problem, for fear of anything is bad for you, causes stress, brings out the bile and brings you back to zero. A good friend of mine in her mid eighties, parties everyday, eats everything but IN MODERATION.. Go to the book “I Claudius” and take his advice “:When you sit down to eat, stop eating when you feel you can eat one more bite comfortably”. Then you never will suffer from the hell of reflux pain.
    In naturopathic medicine the advice is “Never eat when you are stressed out, as then even the most healthy or perfect food will turn TOXIC from the bitter bile that will be released”

  35. Kristy April 14, 2016 at 10:47 am

    Hi,
    I came across your article and have a different dilemma I have never seen addressed. I am struggling with symptoms of GERD – burning in stomach, esophagus area, lump in throat, belching, general stomach discomfort. I read about carbs and sugar, etc, maybe being the issue. This is where I am different. I am anorexic, eat very little (I am not a purger – do not induce vomiting, so this is not the cause) and yet I have this issue. Why? I am already low carb, no meat, mostly applesauce person. Mostly I am starving with occasional fruit (applesauce or pears and maybe a few crackers). My doctor has started me on ensure drinks and boiled eggs and I have recently begun high dose PPIs and H2s, non of which are helping me at all. I already have bone loss which is bad for me to be on these drugs. So how can diet be my issue?

  36. Neil harding June 29, 2016 at 9:21 am

    Hi Norm,
    Really intersting site, I have just ordered your “Acid” book and downloaded the mobile APP. I suffer with LPR(silent reflux) which symptoms include bloating and discomfort, breathlessness, burning occationally in lungs not oesophagus. Originally given asthma meds but tests proved negative so I’m on Omeprazole(3x months so far)). I had a Upper GI Endoscopy which showed Barret’s Oesophagus(small) but no other problems with biopsies. So I am going back to GP to discuss ways in which I can manage the condition without PPI’s long term. I may need to have my airway and larynx checked out by ENT consultant which I may push for. I am wondering as I have just started to use the mobile app before the book arrives, what is a high score for daily FP and what is the score I am aiming to achieve? Many thanks.
    Neil (51)

    • Norm Robillard June 29, 2016 at 10:42 am

      Hi Neil, Thanks for your interest in the Fast Tract Diet. Most people aim for the more aggressive FP range of between 20 and 25 points per day, at least when starting out on the diet.

  37. Chris Davies August 2, 2016 at 5:09 pm

    I don’t eat virtually any fermentable carbs. Yet I still get chronic reguritation. Probiotics always make this worse too. I think my meds may be the cause. I’m on an antispasmodic, clonazepam and amitriptyline plus sleeping tablet. In my experience Ppis do very little if anything for the regurgitaton.

    I eat very little solid food so don’t know if that’s a contributing factor also.

  38. Beki August 4, 2016 at 11:13 am

    Hello! I’m Beki, I just ordered your Fast Tract diet book & I’m so excited to receive it & start my transformation. I suffer mostly from LPR, I have it really bad & on top of it I have anxious tendencies, which I assume might worsen the sensations & fixation on symptoms experienced. I haven’t gotten a chance to review your specific recommendations on foods I can and can’t eat, but from what I’ve read online, it seems beans are out. I am a vegetarian & beans are a huge part of my diet. And I am a major cooking lover, so the idea of no onions is so sad! Are these things prohibited in order to get max results? How would you recommend a vegetarian get sufficient protein? My bad if this is covered in the book, it’s still going to be another 10 days before I get it but I wanted to sort of get started on the diet, so if you could give me some insight that would be awesome. Thank you so much for addressing & working to resolve a condition that has had little to no medical success in treating, & that is often never even acknowledged. I’m most appreciative & am really excited to try your program, hoping for the best. Hope to hear back! In the future I would love to schedule an appointment to talk with you directly. Thanks again & have a great day!

  39. Deepak Madan August 15, 2016 at 5:22 am

    I am a big fan of your posts about GERD. I am a GERD patient and I am also having symptoms of eosonophilic esophagitis. I am from India. I am facing the problem of chronic acid refluxe since past 3 years. I have met many doctor in India but no one advised me a low carb diet. They always say that PPI is the only way-out for treating acid reflux. Sir I am a vegetarian and In India we majorly dependent on wheat products as a main source of energy. After reading your posts about low carb diet for GERD treatment I started finding low carb products, but I found a very few alternatives. Can you help me finding with a vegetarian low carb diet. I shall be very thankful to you.
    Deepak Madan
    Indian
    PH. 9813097272
    Email deepak.madan28@gmail.com

  40. Brigette Keating September 20, 2016 at 6:20 pm

    Hi Dr. Norm,
    Thank you for this truly interesting article. I’ve just recently been suffering with GERD, but it started after I had a very bad cold. During that time I consumed gallons of orange juice. Some time after, (but not immediately) came horrible GERD. My doctor has put me on Nexium and has advised me to refrain from citrus, caffeine and alcohol along with every other food that is in my diet (tomatoes, onions, spices). The symptoms are still there regardless. The scary thing is that I forgot to take a Nexium one day and the GERD came back full force.

    So in saying all this, when I start on your program, how long do you think it will be before I am able to stay off of the Nexium for good?

    Thanks very much in advance,
    Brigette Keating

    • Norm Robillard September 20, 2016 at 7:51 pm

      Thanks Brigette, The timing of the cold and GERD may be a coincidence, but orange juice is a huge trigger. You have received standard dietary advice for GERD which is known not to be effective. Give the FTD approach a shot. You should see improvement in a matter of days without any Nexium. For the first couple weeks keep total carb grams as low as possible.

  41. june October 10, 2016 at 4:33 pm

    Hi Dr Norm l have just recently had a gastrocopy and colonoscopy.my doctor diagnosed osphageal dysmotility
    .This she mentioned was a muscle not working properly , l also had some polyps in the bowel which she has removed for biopsy. my syptoms have been reflux repeatedly clearing my throatcoughing belching and slight pain when having bowel movements.. l don’t want to go on medication. .
    l would like to know if you think k your diet would help in my case
    Thanking you june

    • Norm Robillard October 18, 2016 at 11:13 pm

      Hi June, Symptoms including reflux, throat/coughing, belching are indicative of GERD / LPR. I think the diet would help indeed.

  42. inf3rno October 20, 2016 at 5:14 am

    Actually fructose is not hard to absorb, it has a dedicated transporter: https://en.wikipedia.org/wiki/GLUT5 It still is not healthy in processed foods, since it can cause fatty liver and diabetes if you don’t eat it with enough antioxidants. http://advances.nutrition.org/content/4/2/226.full I can more or less support this fermentation theory, dietary fibers e.g. whole grain flour products worsen my reflux symptoms. Whole grain flour pizza is much worse than white flour pizza. Spicy foods are okay, it may even ease the symptoms, but horseradish with vinegar totally kills me… I am not sure whether a simple theory can explain this disease, health problems are usually very complex and it is hard to find the causes. I am waiting for more evidence.

    • Norm Robillard October 20, 2016 at 7:24 am

      Yes, glut5 transports fructose (facilitated diffusion), but this is much less efficient compared to the transport of glucose via several transporters including glut1 using an energy (ATP) – dependent “active” transport mechanism that spends energy to move glucose rapidly from the intestinal lumen into the blood stream. These mechanistic differences help explain the results of numerous studies documenting fructose malabsorption.

  43. Yann October 27, 2016 at 12:58 pm

    Hi Norm,

    For me, the FT diet worked a wonder. Removing honey / apples from my daily diet was crucial.

    What concerns me is the fact that pathogens (or good bacteria overgrowth for that matter) may hide in a biofilm which helps them survive starvation or antibiotics treatments. This biofilm builds up over time. At some point, it becomes so important that any attempt to curb bacteria overgrowth will be met with a nasty rebound in bacteria growth (some kind of negative feedback). This may explain why many antibiotics treatment are followed with a fierce relapse or why your symptoms come back with a revenge as soon as you stop your diet (hence the diet has to be followed for your entire life).

    At this point, wouldn’t it be better to tackle this biofilm issue as well ? What about the use of biofilm enzymes and n-acetyl cysteine to destroy the biofilm ? One strategy is to combine a low carb diet and to weaken the biofilm with the use of enzymes and bactericides (plants and mushrooms based).

    I think also there’s a missing element in the overall picture you describe : this element is iron.

    Bacteria, Cancer cells, virus, pathogens, thrive on iron rich environment. Iron builds up as we age, making it easier for bacteria to grow. Since the body cannot dump excess iron, most of the population has excess iron stored everywhere in the body. Iron accumulation in the intestines leads to oxidative stress which can in turn lead to cancer. This explain maybe why eating red meat is so dreadful for many health practitioners, because the heme iron in meat is highly bio-available and may lead to iron accumulation and then cancer.

    So, I wonder if iron overload (which occurs in the 40’s/50’s) is not fueling SIBO as well as fibers and carbs.

    In that case, removing iron with chelators or through a low iron diet could be helpful as well. It’s important to note that dairy actually decrease iron absorption (through calcium competition with iron and lactoferrin) and in country with large dairy consumption, it’s shown that there’s less cancer (Scandinavians). I’m not advocating for milk or industrial dairy, but organic fermented milk is probably a good idea, since it reduces iron and provide good bacteria.

    I would also like to point out the fact that from an evolutionary perspective,15% of humans have evolved to digest lactose probably 15,000 years ago to help them survive starvation periods. Which makes pretty much the case for dairy to be included in a paleo diet. So before eliminating dairy I would check my DNA first. In my case I have the mutation and don’t feel any reflux with dairy. The same goes for my wife who’s not lactose tolerant but can eat fermented milk like kefir, since most of the lactose is eaten by bacteria.

    One last point : I found a study pointing its finger on pepsin rather than acid to explain LPR / (extra-oesophagal reflux). A pepsin test is available in UK to determine if LPR is caused by pepsin rather than acid reflux. Pepsin can reach the airways, lungs and sinus, and do serious damages when the Ph drops below 4.5. This would explain why some people feel burnt when they drink acidic juice or ACV and why some GERD sufferers are not.

    Thank you for your input on those topics !

    Pardon my english (my primary language is french)

    Best Regards

  44. Pete April 30, 2017 at 10:11 am

    Hi Norm,

    At 60, I’m new to the world of acid reflux, and I’m wondering if the healthy changes I made to my diet beginning in November are actually causing my issues. For years I enjoyed a single dirty martini at night with cheese and crackers. I also looked forward to two large cups of coffee in the morning with International Delight. I decided one day that the martinis probably weren’t good for someone my age and gave them up. I also increased water intake and added a bowl of plain oatmeal and banana to my diet.

    In January, just two months later, I developed the lump in my throat, for which the doctor prescribed heavy duty Omeprazole (40 mg, twice a day). After reading about the risk for dementia, I stopped the Omeprazole. Within days, I landed in the hospital with esophageal spasms (masking as a heart attack). While in the hospital, in addition to the lump, I developed heavy acid reflux, which I’d never had before in my life.

    Reading internet articles, I cut out the coffee, all sugar, chocolate, soda, etc., and started eating plain chicken broth with broccoli, cauliflower, beans, and asparagus. If anything, my reflux has gotten worse. Because I’m eating so little, I took Metamucil last night, which was apparently a really bad idea.

    And today I came across your site, which, in many ways, contradicts others. In addition, everyone is discussing foods that I’ve never heard of, like jasmine rice and special red potatoes. I can barely tell the difference between a potato and a zucchini! Is there a one-meal, simple, easy-access diet that I could try for a day that would let me try out your plan to see if it works for me?

    I’d really appreciate the information.

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