A new theory suggests that acid reflux is caused by carbohydrate malabsorption, small intestinal bacterial overgrowth (SIBO) and microbe-induced gas pressure. The pressure drives acid reflux much like dropping a Mentos in a bottle of coke. Difficult-to-digest Carbohydrates lactose, fructose, resistant starch, fiber and sugar alcohols are most likely to cause malabsorption and symptoms of SIBO-related conditions such as GERD and IBS. A novel calculation called fermentation potential (FP) can measure the gut symptom potential of any food. The low FP approach was successfully tested in a small clinical study in the Boston area.

1. Did Cavemen Get
Heartburn?
Norm Robillard Ph.D.
Founder, Digestive Health Institute

2. What is heartburn
& GERD?
GERD: Chronic acid reflux.
Acid Reflux: When stomach contents escape
past the LES – causes irritation.
Reflux Symptoms:
Heartburn, cough, sour/bitter taste, sore
throat, hoarseness, sinus
irritation, gas, bloating, nausea, LPR.
Long Term Health Risks:
Esophagitis, Barrett's esophagus, esophageal
cancer.

3. PPIs and H2
blockers
Block the production of stomach acid
• Inhibit the absorption of vitamins, minerals and nutrients
• Lead to weakened bones and fractures of hip, wrist and spine –
osteoporosis, calcium absorption hindered in the absence of
acid
• Linked to pneumonia
• Linked to C diff (Clostridium difficile)
• Cause and perpetuate SIBO
• Cause dangerously low magnesium blood levels
(hypomagnesaemia) - FDA warning
• Don’t address the underlying cause.

4. Underlying cause
of Acid Reflux
Conventional
• Relaxation of LES from alcohol, trigger foods (TLESRs)
New concept
• Carbohydrate malabsorption promotes small intestinal
bacterial overgrowth (SIBO - >106 bacteria per mL)
• Bacteria produce gas (Hydrogen, Carbon
Dioxide, Methane) and intragastric pressure
• Drives reflux – like Mentos in Coke bottle
• LES is “forced” open.

5. Evidence SIBO
causes Reflux
 Restricting the growth of intestinal bacteria
reduces the symptoms of reflux1,2,3
 Reflux can be created experimentally with FOS
(Gas, TLESRs, Symptoms)4
 Reflux is associated with increased gas pressure
in the stomach (and fundo side effects)5,6
 Health conditions associated with malabsorption
and SIBO are linked to Reflux7,8,9
 SIBO has been detected in GERD patients10

6. Worst offenders
for SIBO
 Fructose
 Lactose
 Fiber
 Sugar alcohols
 Amylose starch
(resistant starch)

7. Fermentation Potential
(FP) Formula
GI = Glycemic Index
NC = Net Carbs (g)
DF = Dietary Fiber (g)
SA = Sugar Alcohols (g)

8. FP Recommendations
 FP recommendation for single meal
◦ 0 to 7 grams - low
◦ 8 to 15 grams - moderate
◦ > 15 grams - high
 FP recommendation for single day
◦ 20 to 30 grams – low
◦ 30 to 45 grams – moderate
◦ > 45 grams - High

9. Did Cavemen get
Heartburn?
 Occasionally
◦ Lots of plants - some high in fructose, fiber
and RS
◦ Periodic food poisoning likely
 Protective
◦ Adapted to diet – unlike the “everything all
the time” (SAD diet), balanced microbiome
◦ No antibiotics or preservatives (more diverse
microbiome)
◦ Periodic fasting - gut healthy, prevents SIBO
◦ Seasonal diet

10. How about modern Foods?

11. Comparing Rices for FP
Food (GI) Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Jasmine Rice 5 0 Low
Glutinous
Rice
5 3 Low
Basmati Rice 5 17 High
Brown Rice 5 19 High
Uncle Bens
Rice
5 20 High

12. Comparing Fruits for FP
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Watermelon 4 2 Low
Cantaloupe 4 4 Low
Grapes 4 11 Moderate
Banana, ripe 4 15 High
Banana,
green
4 18 High
Dates 2 4 Low
Apricots 2 23 High

13. Comparing Tubers for FP
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Pontiac
Potato
5 4 Low
Parsnip 5 5 Low
Taro 5 6 Low
Russet Potato 5 7 Low
Ontario Potato 5 13 Moderate
Sweet Potato 5 21 High

14. Comparing Dairy for FP
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Mozz cheese 2 1 Low
Plain Yogurt 8 7 Low
Sweet Yogurt 8 23 High
Cream 8 2 Low
Whole milk 8 8 Moderate
Chocolate
milk
8 18 High

15. Comparing vegies for FP
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Spinach 3 2 Low
Tomatoes 3 3 Low
Broccoli 3 4 Low
Avocado 3 6 Low
Squash 3 6 Low
Corn 3 9 Moderate
Plantain 3 16 High

16. FP values for Grains / Legumes
Food Serving
Size (Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Pasta (rice) 6 5 Low
Pasta (wheat) 6 28 High
French
baguette
1 1 Low
7 grain bread 1 9 Moderate
Course Rye 1 14 Moderate
Soy beans 5 11 Moderate
Kidney beans 5 31 High

17. Comparing drinks for FP
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Coconut milk 9 0 Low
Rum, whiskey,
vodka, gin,
etc.
1 0 Low
Lite beer, dry
wine
12, 7 2 Low
Non lite beer 12 6 Low
Orange juice 9 14 Moderate
Apple juice 9 18 High

18. FP values for meats, fats and
seafood
Food Serving
Size
(Oz)
Ferm.
Potent.
(G)
Symptom
Potential
Beef, pork,
chicken, etc.
6 0 Low
Fish, shellfish 6 0 Low
Lard, talow,
ghee, butter, oils
3 0 Low

19. Clinical study of Fast Tract Diet
heartburn symptoms

20. Clinical study of Fast Tract Diet
gas related symptoms

21. References
1. 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.
2. Pennathur A, Tran A, Cioppi M, Fayad J, Sieren GL, Little AG. Erythromycin strengthens
the defective lower esophageal sphincter in patients with gastroesophageal reflux disease.
Am J Surg. 1994 Jan;167(1):169-173. Pehl C, Pfeiffer A, Wendl B, Stellwag B, Kaess H.
Effect of erythromycin on postprandial gastroesophageal reflux in reflux esophagitis. Dis
Esophagus. 1997 Jan;10(1):34-37.
3. Mertens V, Blondeau K, Pauwels A, Farre R, Vanaudenaerde B, Vos R, Verleden G, Van
Raemdonck DE, Dupont LJ, Sifrim D. Azithromycin reduces gastroesophageal reflux and
aspiration in lung transplant recipients. Dig Dis Sci. 2009 May;54(5):972-9.
4. Piche T, des Varannes SB, Sacher-Huvelin S, Holst JJ, Cuber JC, Galmiche JP. Colonic
fermentation influences lower esophageal sphincter function in gastroesophageal reflux
disease. Gastroenterology. 2003 Apr;124(4):894-902.
5. Dodds WJ, Dent J, Hogan WK, Helm JF, Hauser R, Patel GK, Egide MS, Mechanisms of
gastroesophageal reflux in patients with reflux esophagitis. N. Engl J Med. 1982. Dec
16;307(25):1547-52. Lin M, Triadafilopoulos G. Belching: dyspepsia or gastroesophageal
reflux disease? Am J Gastroenterol. 2003 Oct;98(10):2139-45.

22. References
6. Vakil N, Shaw M, Kirby R. Clinical effectiveness of laparoscopic fundoplication in a US
community. Am J Med. 2003 Jan;114(1):1-5. Klaus A, Hinder RA, DeVault KR, Achem SR.
Bowel dysfunction after laparoscopic anti reflux surgery: incidence, severity, and clinical
course. Am J Med. 2003 Jan;114(1):6-9. Beldi G, Gláttli A. Long-term gastrointestinal
symptoms after laparoscopic Nissen fundoplication. Surg Laparosc Endosc Percutan Tech.
2002 Oct;12(5):316-9.
7. Ledson MJ, Tran J, Walshaw MJ. Prevalence and mechanisms of gastro-oesophageal reflux
in adult cystic fibrosis patients. J R Soc Med. 1998 Jan;91(1):7-9. Vic P, Tassin E, Turck D,
Gottrand F, Launay V, Farriaux JP. Frequency of gastroesophageal reflux in infants and in
young children with cystic fibrosis. Arch Pediatr. 1995 Aug;2(8):742-6. Fridge JL, Conrad C,
Gerson L, Castillo RO, Cox K. Risk factors for small bowel bacterial overgrowth in cystic
fibrosis. J Pediatr Gastroenterol Nutr. 2007 Feb;44(2):212-8.
8. Lisowska A, Wójtowicz J, Walkowiak J. Small intestine bacterial overgrowth is frequent in
cystic fibrosis: combined hydrogen and methane measurements are required for its
detection. Acta Biochim Pol. 2009;56(4):631-4.
9. Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M. Studying the overlap between
IBS and GERD: a systematic review of the literature. Dig Dis Sci. 2006. Dec;51(12):2113-
20.
10. Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased incidence of small intestinal bacterial
overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2010
Jun;8(6):504-8

23. “No Disease That Can Be Treated
By Diet Should Be Treated With any
Other Means.”
-Maimonides