Book Review: Coping with Heartburn, GERD, SIBO, and IBS

Coping with Heartburn, GERD, SIBO, and IBS
Fast Tract Digestion by Norman Robillard
Reviewed by Rosalind Michahelles, Certified Holistic Health Counselor

For anyone puzzled about GERD (Gastro-esophageal reflux disease) or SIBO (small intestinal bacterial overgrowth) or IBS (irritable bowel syndrome) – puzzled despite reading books and seeing doctors, Fast Tract Digestion by Norman Robillard may help.

This ‘alphabet soup’ of digestive ailments is very likely one brew connecting different symptoms that vary according to where you feel the distress. Excessive and painful belching oresophagus is called GERD. If the symptoms are intestinal cramps, diarrhea, constipation, bloating, and flatulence – it may be either SIBO or IBS. (N.B., IBS differs from IBD, inflammatory bowel disease, in that IBD is considered an autoimmune disease and a more serious problem.)

Robillard maintains that GERD stems not so much from the stomach as from the small intestine when there is overgrowth of bacteria normally only found in the large intestine. When e-coli, clostridium, and other bacteria not associated with the small intestine manage to migrate upstream past the ileocecal valve, they cause troublesome fermentation. These very same bacteria in the large intestine may not be problematic; but they don’t belong further up. This “premature” fermentation produces a lot of gas which then forces its way up into the stomach or down into the colon, causing distress in either case: belching and reflux or bloating, cramps, and flatulence, as the case may be.

How to avoid this inappropriate fermentation? Avoid resistant starch and sugar alcohols. What is resistant starch? It is starch in the form of amylase, found abundantly in some carbohydrates. The book helps identify them, as it does with the sugar alcohols, aka polyols, often used as non-carbohydrate sweeteners in processed food, including supplements, toothpaste, chewing gum, etc. In trying to avoid sugar and fructose, manufacturers have turned to polyols with names like sorbitol, mannitol, and xylitol.

Naturally, with such a list of unfamiliar elements, it’s hard to imagine what’s OK to eat and what isn’t. Fast Tract Digestion does include food lists at the end, though they are not exhaustive. Here’s what the author says is safe: meat, fish, cheese, eggs, nuts, fats and oils. It’s in the fruit and

an acidic return of food from the stomach to the

vegetable realm that the going gets tricky. Robillard describes how to identify the “fermentable potential” of food, but it doesn’t seem easy to do. It’s not enough to look at the carbohydrate content because some carbs – e.g., glucose – is absorbed in the stomach and never gets to the small intestine.

A small irony in following Robillard’s lead here is that high glycemic food, that is food that turns quickly into blood sugar, may be easier for those with SIBO for the very reason that its carbohydrates are digested quicker and therefore aren’t lingering long enough in the digestive tract to cause trouble. So the white rice many abandoned in favor of the ‘healthier’ whole grain brown variety may, in fact be better for you. If you have secretly preferred white rice, here’s an opportunity to rejoice – if you have SIBO.

A positive note in this sea of possibilities is that there is potential for reversibility if the intestines heal and if enzymes needed to break down the difficult carbohydrates flourish again. Can supplements help? The author recommends probiotics, those that should be dominant in the small intestine: lactobacillus acidophilus, and bifidobacterium bifidum in particular as they “are very efficient at breaking down oligoaaccharides such as lactose, sucrose, raffinose, stachyose ….in the small intestine.” A diet ample in fermented vegetables and in yogurt with active cultures should also help in this department.

Chapter 8 takes on the competition – other dietary approaches to heartburn and GERD and IBS. There are two that most resemble the Fast Tract diet. One is the Specific Carbohydrate Diet published by Elaine Gottschall in her book Breaking the Vicious Cycle. This differs in allowing honey and a number of high-fructose fruits and in eliminating all starches, whereas Fast Tract eliminates as much fructose as possible and distinguishes among starches. (The GAPS diet developed by Dr. Natasha Campbell-McBride takes the SC diet a bit further.) The other similar approach has the odd acronym FODMAPS: fermentable oligo-, di-, and monosaccharides and polyols. Based on the research behind this, Patsy Catsos has published IBS-Free At Last. This diet limits lactose, fructose fructans like wheat and onions, polyols from apples and plums etc., and galactans like legumes and some members of the cabbage family. However, according to Robillard, it is deficient in failing to take resistant starch into account.

How should a sufferer tackle this conundrum? One is to buy the Robillard book and use his three appendices to help you navigate. The first includes meal plans and recipes. For more individualistic people who want to make up their own combinations, Appendix B provides 30 pages of common kinds of food and their fermentable potential. The last appendix is a template for

a food journal to track what food produced what results. Here is a rough idea of what to expect:

MEAT & FISH – allLEGUMES – noneSOUPS – miso, brothCRACKERS – rice cakes, crackers COOKIES – shortbread

FLOUR – buckwheat (i.e., no bread)RICE – jasmine, Asian stickyPOTATO – waxy, Yukon goldVEGETABLES – all leaves and stalks, no rootsDAIRY – cream, yogurt, some cheeses: ricotta, cream cheese, brie, Gouda

NUTS – almonds, cashews, walnuts FRUIT – stick with berriesSUGAR, HONEY, etc. — none

The more drastic approach is to consider what all of the books mentioned above recommend and then eliminate all potential hazards before slowly testing different ones by adding them to your diet for a few days. The basic diet would thus have no grains or added sugars, no starchy vegetables (think roots), nothing in the onion or cabbage families, nothing with dairy in it, no legumes. For a couple of weeks, your diet would resemble the Atkins diet – meat, fish, eggs, fat and oils, leafy vegetables, and the occasional berry. Tea and coffee, if taken black, would be OK. This is a tall order! But the research will pay off if you can avoid what makes you sick and even heal your intestines, to boot. Pharmaceutical alternatives tend to have side effects, which tailoring your diet to your own requirements would not have. Be brave! You deserve to feel well.

References:Breaking the Vicious Cycle, Elaine Gottschall, Kirkton Press, 1994. Fast Tract Digestion, Norman Robillard, Self Help Publishing, 2012.Gut and Psychology Syndrome, Natasha Campbell-McBride, Medinform Publishing 2004.IBS-Free At Last, Patsy Catsos, Pond Cove Press, 2008.

Rosalind Michahelles is a Certified Holistic Health Counselor in Cambridge. For questions about this essay or related issues please call 617-491-3239 or visit