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

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.

PPIs and H2 blockersBlock 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.

Underlying cause of Acid RefluxConventional• 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.

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

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

Fermentation Potential (FP) Formula

GI = Glycemic IndexNC = Net Carbs (g)DF = Dietary Fiber (g)SA = Sugar Alcohols (g)

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

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

How about modern Foods?

Comparing Rices for FPFood (GI) Servin

g 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

Comparing Fruits for FPFood Servin

g 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

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

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

Comparing vegies for FPFood Servin

g 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

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

Comparing drinks for FPFood Servin

g 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

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

Clinical study of Fast Tract Diet heartburn symptoms

Clinical study of Fast Tract Diet

gas related symptoms

References1. 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.

 

References6. 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

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