The Healthy Gut Podcast Episode 18

Dr Norm Robillard

The Healthy Gut Podcast Episode 18

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The Fast Tract Diet

Knowing why your body is reacting to certain foods, with symptoms such as acid reflux and bloating, is key to your journey to digestive health. This week Rebecca speaks to Dr Norm Robillard Ph.D. Dr Robillard is the founder of The Digestive Health Institute, a gut expert, microbiologist, author of the Fast Tract Diet book series and the Fast Tract Diet app. The Fast Tract Diet, which has been used successfully by many people with SIBO to calm their digestive symptoms. Dr Robillard had his own gastric issues with acid reflux and this is what led him to start to explore the issues with carbohydrates and fermentation. Rebecca and Dr Robillard delve into the Fast Tract Diet, and talk at what gut health benefits can be achieved by lowering the fermentation of the foods that you are consuming.

In today’s episode

In Episode 18 of The Healthy Gut Podcast, we discuss:

✓ The core principles of the Fast Tract Diet (FTD) and how to use it

✓ The difference between the FTD and other SIBO diets

✓ How to find your personal fermentation potential (FP)  threshold

✓ Reintroducing higher FP foods and what to do in a flare

✓ Treating SIBO without using drugs such as antibiotics

✓ Making good nutritional choices to ensure long term good gut health

Resources mentioned in today’s podcast

Connect with Dr Norm Robillard

Dr Norm Robillard bio

Norman Robillard, Ph.D., Founder of the Digestive Health Institute is a leading gut health expert. He is a microbiologist, the author of Fast Tract Digestion book series and publisher of the Fast Tract Diet mobile app. He is the creator of the drug and antibiotics free Fast Tract Diet for functional gastrointestinal disorders, SIBO and related conditions. The Fast Tract Diet has been endorsed by the New York Times Best Seller Co-author, Dr. Michael Eades, GI Surgeon, Dr. Alan Hu, many certified nutritionists and healthcare providers.

The Digestive Health Institute website

Dr Norm Robillard

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About the host

Rebecca Coomes

Rebecca Coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

Read more about Rebecca >>

Podcast transcript

REBECCA: Dr Norm Robillard it is an absolute pleasure to have you on the healthy gut podcast today welcome to the show.

DR. ROBILLARD: Thanks for having me Rebecca.

REBECCA: One of the reasons I’ve got you on the show is you are the creator of the fast track diet which is a really wonderful system and can be so beneficial to people suffering from small intestinal bacterial overgrowth or SIBO or SYBO depending on where you are in the world and how you pronounce it. I’d love for you to talk about how you came to be the creator of this diet protocol that many people now follow and have great success with?

DR. ROBILLARD: Yes, my journey did start some years ago, about 14 years ago actually. I was living in Southern California loving life I worked for the largest bio tech company in the world on life saving medicines. I had just bought a house and everything was great except for one nagging problem. I had this chronic acid reflux, I’d had it for many years. I was taking a number of different things for it toms, and even proton-pump inhibitors, not really solving the problem and it was just a complete fluke. This digestive health was not my field. But my older son, who was an athletic trainer at the time, talked me into buying a treadmill and going on a low carbohydrate diet and 2 days into the diet I stopped thinking about the treadmill or losing weight because my chronic acid reflux went away. I bought the book Protein Power by Doctors Michael and Mary Dan Eades, great book by the way, and somehow when I really reduced my carbohydrates my acid reflux had gone away and I just felt so curious about that because I got online and talk to Dr Google immediately and other people were saying the same thing they were on a low carb diet and the acid reflux was much better and there was a small study at the time by William Yancy and Eric Westman and others, their associates down at Duke University, Just a small pilot study but they had the same answer. Cutting carbs out seemed to reduce reflux but for me that wasn’t enough, I really got curious about this. Did carbohydrates somehow cause acid reflux and so I started doing some research, I wanted to get to the bottom of this question because the prevailing theory was completely different it was saying that these muscles at the top of our stomach, the lower esophageal sphincter muscles were relaxing and that was the problem and trigger foods cause that and that had been the prevailing idea for 60 years and nobody had ever challenge it and I started thinking about digestion, I said let me just walk through the digestive process of these three food groups, fats and proteins and then this carbohydrate that seems to be causing my problem and as I walked through the digestive process when I got to the intestines a light bulb went off in my head. My own background is microbiology, I worked for many years in the laboratory growing bacteria and many of those strains that I worked on were gut bacteria like bacteroides fragilis e coli, and I knew two things about gut bacteria they most of them are sacrolitic, that means they prefer to eat carbohydrates, and most of them produce a lot of gas and write them a new way of looking at acid reflux popped into my head.   I thought what if on my high carbohydrate diet, the SAD diet so to speak, I was consuming so many carbohydrates that many of them were not being fully digested and absorbed and instead these excess carbs were feeding blooms of gas producing bacteria in my small intestines and this gas pressure was building up and it was translating into my stomach intragastric pressure and it was actually driving this acid reflux like you might imagine you drop a mentos candy into a bottle of Coke.   It was that simple and since then I’ve done a lot of research and there is actually a lot of evidence that this is actually what is going on and that the LAS laxation theory is wrong and so that is what I talked about in my books.

Initially I wrote a book called ‘Heartburn Cured’ because I was just so passionate about this idea. I wrote it late at night working at this company, self published it, but I sent a copy to this Doctor Mike Eades, the co-author of protein power, the book that I had read, because he mentioned using low carb diets for his patients with heartburn and so I wrote to him thinking well maybe he’ll read my letter and being the kind of guy Mike is he agreed to meet this cold calling microbiologist and luckily he lived nearby in Santa Barbara I was in Thousand Oaks at the time, And over time we became pretty good friends we talked about this idea he bought into it fully but he still probed it in a number of ways, asking a lot of questions and one key question he asked me was ‘is it all carbs or are some carbs easier to digest and not a problem’ and this to me was a piercing question. So I ended up working for several more years to figure out which are these hard to digest carbs and how can you easily quantify those in any food in other words how can I make a diet out of this that works only on the problematic carbs and so I was lucky to have people like Mike Eedes helping me and also Gary Taubes, the author of ‘Good Calories, Bad Calories’, and his new book ‘The case against sugar’, help me out greatly because he helped me understand the limitations observational studies are having to do with dietary fibre because I was looking at fibre and thinking could that be part of the problem too. So long story short I came up with this fast track diet and when I started reading along the way Doctor Mockpenantals work and Professor John Hunters work on sibo and irritable bowel syndrome I realised that what I had been proposing was essentially the same. That is, SIBO is the cause for acid reflux. So many years later I have now published two books, ‘Fast Tracked Digestion’, ‘Heart Burn’, ‘Fast Tracked Digestion IBS’ and it can all be traced back to that one observation and just kind of doing my homework afterwards and trying to understand it.

REBECCA: And there are so many people that are so grateful and thankful for you having that experience and doing everything that you’ve done and it’s so interesting and I look at just how many people out there experience heartburn and all you need to do is look on the television to see how many ads they are constantly running for heartburn tablets and drinks and medication…

DR. ROBILLARD: I cringe every time I see that…..

REBECCA: So do I and I think …..

DR. ROBILLARD: While you’re on that topic though about those commercials have you noticed when they’re selling prilosec they always show somebody eating either a slice of bacon or a turkey drumstick and I think the message is once you’re on this drug you’ll be able to eat these drumsticks and bacon without any problems. Well, those are the problems to begin with…

REBECCA: Definitely it really gets my goat and I just looked around me and my immediate circle so my friends my family people that are close to me and it seems like so many of them are chomping down on these medications and I think it’s so easy to do something about this you just need to look at what’s going into your digestive system and the first place that’s causing this pain. Don’t mask it with a pharmaceutical medication but I could do a whole podcast with me ranting about that….

DR. ROBILLARD: Right and luckily I think the tables are turning because every year something new comes out for instance with these acid reducing medicines especially Proton pump inhibitors kidney problems you can’t absorb B12, anaemia you can’t absorb calcium and magnesium, problem after problem it’s bad for your heart it’s bad for your bones it’s just bad for you. So more and more people are now actually reaching out to us to find a better way.

REBECCA: Which is great and I hope that anybody that is listening to today’s podcast who is taking any antacid or Proton pump inhibitor type medication, I hope that this Interview really helps them in terms of having more of a understanding where they can look elsewhere for some options that might be a little more natural in helping car that pain because heartburn can be excruciatingly painful. I used to experience it quite frequently prior to getting my SIBO diagnosis subsequently getting rid of my SIBO and now I never experienced it and got it so much better now.

DR. ROBILLARD: Interesting….I didn’t know that….you’re one of us…

REBECCA: It used to be so painful.

DR. ROBILLARD: That’s terrible And it’s hard to carry on your life when you just feel that miserable it really does impact your quality of life.

REBECCA: Well the thing is I didn’t know I felt that miserable until I stopped feeling like that. To me that was my norm and I’d have flare ups and I know that, I’ve been gluten free for on and off for 10 years prior to my SIBO diagnosis, and I knew that if I ate a lot of, if I slipped and started eating gluten I knew that was pretty and immediate trigger for heartburn. But also if I ate a lot of gluten free products, you know those major frankenfoods that have been made by factories where it’s blending all sorts of other kinds of products that don’t contain gluten, and I would actually get worse heartburn eating that type of food so if I had gluten-free pasta for dinner, I would sit there rubbing my chest going ooohh I feel miserable and there I was going but what caused it I have eaten gluten free I shouldn’t be in pain it was very interesting. So for those listeners who haven’t heard of the fast track diet, can you explain to me what it is and how it works?

DR. ROBILLARD: Sure be glad to. So the fast track diet it’s a dietary system that addresses SIBO, which as you know, is involved in a whole variety of conditions, so we talked about acid reflux and irritable bowel syndrome but also rosacea a whole wide variety of autoimmune diseases, celiac, rheumatoid arthritis, sjogren’s, Hashimoto’s, and other conditions such as fibromyalgia, interstitial cystitis, Crohn’s, cirrhosis, people with pancreatitis, and Cystic Fibrosis, and that list is far from complete. So, there’s a lot of people so even if you can’t solve the problem, you can’t change somebody’s genes who has cystic fibrosis or Crohn’s but you can certainly help support the SIBO part of it with a diet that limits these fermentable carbs so that’s a second point about what the diet is. The fast track diet limits but doesn’t eliminate, a lot of people write to me ‘ am I starving my microbiota’ ‘ no you’re not starving your microbiota’, but it does limit the full range of fermentable carbohydrates.

REBECCA: And I think that’s a really interesting Point around the complete elimination not the reduction and there’s a lot of here around what are we doing to all of those little bugs that are living in our digestive system and am I doing more damage, so I think that’s really interesting that point you’ve just made about reducing rather than ….

DR. ROBILLARD: Exactly and you know we should make sure we come, let’s come back to that one because I think that’s really an important point. So it limits these fermentable carbohydrates and it does so with a calculation called the fermentation potential. So essentially every serving of food depends on the type of food it is, you get this FP value so it’s really like a Weight Watchers program but instead of calories you have these FP points and if you can control those everyday then you should really start feeling a lot better. The other thing that, there is two more components in the approach. First of all it really stresses a variety of gut friendly behaviours and practices. A lot of people don’t realise that in selecting the food, cooking or preparing the food, and how you consume the food, all three of those are really critical in determining how well they will be broken down and digested because when it comes to carbs you don’t want too many of them persisting if you’re susceptible to these overgrowths, and then the last point I want to make about the fast track diet is it has a very detailed section on how to identify and address the variety of potential underlying causes. So you put it together and it’s kind of like, it’s a three pronged approach, limit these actual FP points, employees gut friendly behaviours, and then really take a deep booked for other underlying causes.

REBECCA: And how important do you believe addressing or identifying the underlying cause to be in these successful treatment of SIBO?

DR. ROBILLARD: Well I think, and by the way whether you’re on a diet for whether you take some herbs or antibiotics, whatever you’re doing you do need to really become cognisant of what these underlying causes could be. There is a whole variety of those that you need to be aware of. For instance, the one you hear about all the time is motility, but now something new on the horizon is with the ileocecal valve, the valve between your large and small intestine. There was a study done just a year or so ago that people with SIBO had low ileocecal valve pressure. Of Cools anything to do with surgery or structural abnormalities, testinal scarring, inflammation, either from the SIBO itself or from a GI infection, deficiency in digestive enzymes, lactose intolerant, or you might have a deficiency in pancreatic enzymes, loss of stomach acid, that’s the big one you hear about all the time even though it tends to be a minor calls in most people, immunological deficiencies, alcohol or any liver problems, it’s huge because the liver works with the bacteria in your gut to regulate a bile acid pool, so that’s a big factor. A whole variety of underlying genetic conditions, we talked about celiac and Crohn’s for instance, cystic fibrosis, and then one that usually doesn’t make most people’s list that I add to my list for underlying causes and that is quite simply the over consumption of fermentable carbohydrates. I really think that some people that’s the problem. For me that was the problem, as you get older your digestive tract might not function quite as well as it did when you were 20 and you just might not be able to tolerate has many carbs as you once were used to eating and so in those cases if you just get used to not over doing these fermentable carbs that might be all it takes.

REBECCA: And can you clarify what a fermentable carb is to the listeners in case somebody listening thinks I’m not exactly sure what they are?

DR. ROBILLARD: Sure. There is a whole bunch of different carbohydrates, right, but some of them are either simple carbs and they are easy to digest and or absolute such as dextrose or glucose, that sugar, it’s a single sugar so there’s no digestion, but it’s absorbed very very quickly from the small intestine into the bloodstream. Your body actually spends energy to get that glucose into the bloodstream. So that’s when it’s relatively easy to absorb and why we do recommend that as one of the sweeteners on the fast track diet because it’s less likely to drive these kinds of SIBO reactions. Of course if you have a lot or if you do have all kinds of problems in your small intestine or you have a lot of bacteria growing up into the early part of your small intestine, even a simple sugar like glucose might be a problem and if you want proof of that just look at the fact that many hospitals still use glucose to do SIBO testing with. So it’s not a perfect system but something like glucose is easier to absorb and less likely to be a problem and the same thing holds true ironically enough with the large very complex carb, it’s a starch called Amylopectin, so rices like Japanese sushi rice and Jasmine Rice are mostly amylopectin starch, it’s a light fluffy starch with a lot of branch points and so amylase enzyme is able to gobble it away from all of these different ends and so it breaks down to glucose very quickly and that’s why those rices have a very high glycemic index, but they also have a low fermentation potential because the digestion absorbed relatively quickly, if you look at a different type of rice say basmati rice which has a much higher percentage of a hard to digest starch called amylose which is a more linear type of molecule, and the amylase enzyme need to kind of nip of the ends, there’s not as many ends to start digesting it from and so it’s slow to digest and that why ricers have high amylose have a lower glycemic index like basmati rice I think it’s in the 50’s somewhere compared to Jasmine Rice is which is 98, there are a couple of different values for it but it still up around 90%. So the basmati and the Uncle Ben’s rice Prices are down in the fifties so you can see it’s not going to digest as quickly so if you don’t have any SIBO or any problems with fermentable carbs, go and have some, but if you do you might want to have a smaller serving size of that type of rice or switch to a Jasmine or sushi rice.

REBECCA: And that’s why people would, can often find that rice can be problematic for them but it’s the kind of rice there eating rather than rice as a whole group of rice.

DR. ROBILLARD: It is, but also how you cook it, make sure you use enough water and make it how you want to cook it preferably in a rice cooker so it’s light and fluffy. Soon as rice starts to get dried, you know everybody’s gone to a Thai restaurant where they’ve had rice that was probably from yesterday and it’s been refrigerated, that builds up resistance starch, been dried out ads to resistance. It’s also how it’s prepared and then you want to eat smaller amounts, maybe half a cup, not a whole cup and you want to eat really slowly and do really well because one thing we’ve learnt in recent years is people differ widely in how many gene copies they have for that enzyme amylase in your saliva and you might be a person who has only one or two gene copies and not have all that much amylase and so you have to eat slow and chew really well to use the amylase you do have whereas somebody else may have 9 gene copies, 60% of the saliva is amylase and just go through the stuff like nothing and they digest and absorb it really well.

REBECCA: Is there a way that people can find out how much amylase they have, can you test for that?

DR. ROBILLARD: Unfortunately to my knowledge that’s really still a lab test that’s not available commercially for people to just go and see what they have. It would be great, I’d probably take it myself.

REBECCA: What a bummer it would be great to know that. It’s really interesting talking to you about rice in particular because when I was going through my SIBO journey, having being gluten free for years it was such a staple and I was vegetarian for 7 years so I ate a lot of grains, vegetarian grains, I should say sorry gluten free grains, and as soon as I commenced my SIBO treatment and I stripped out a lot of those foods I found it really difficult to re-introduce and I was following the biphasic diet by Dr Nirala Jacobi, that worked well for me and I actually hadn’t heard of your diet because I hadn’t heard of SIBO I was like what is this thing I was a complete novice to all of this and it took me a long time to re-introduce rice back into my diet and I found it so peculiar because I had lived off it for so many years and yet as soon as I started addressing this issue that was going on in my gut, my gut said no we are not coping with this, this does not work with us at this point in time and I was eating basmati rice and now I know that it had a higher fermentation potential, so that that gives me an explanation. So thank you for answering that question that I’ve had sitting in the back of my mind all this time, why was right so problematic.

DR. ROBILLARD: You know overtime so if you are diligent with your diet and your small intestines heels and gets better you can tolerate more larger volumes and sum of these higher FP rices. I have a good friend, his wife is Indian and she makes the most beautiful spread of food and the centerpiece is always a big bowl of basmati rice. So these days I can eat a little bit more but I don’t eat too much and I do eat really well and eat slowly but the first night I ever went over to their house I said I know this is going to end badly, and at 2 in the morning there I woke up with terrible acid reflux but I had a big smile on my face because it’s confirmed my theory but you know, you do have to be careful for a while. In terms of re-introducing foods I think that’s a good question in itself and I think it’s one where a lot of people make a mistake and so I think of it as 4 steps. First of all you need to be very restricted upfront. Your diet should be restricted even if you have to cut out, maybe you have to cut out even the simple easy to digest rice, until your symptoms are really under control. If you don’t then you can follow these behaviours and use the lower FB rice is fine but some people might have to cut it out completely. Whatever you have to do you, there is a troubleshooting section in the book that walks you through this but you might even have to go on a ketogenic diet for a while and really cut back all these carbs until you’re getting better and then at some point you can start to re-introduce these foods but you should do it very gradually and one food group at a time like we talked about starches but you can make the same argument for increasing the fibre, foods that contain fibre, lactose, again with lactose you can take a lactase that can help. But you might try for instance half of one of those little red potatoes, those are actually low FP foods they have higher glycemic index with a lower FP and try half, instead of like a Russet which has a higher FP and they are bigger potatoes or a half a cup of Jasmine Rice over the same serving size of Basmati as we talked about. And if you have a flare and you start to have symptoms you’ve gone too far and you really have to back off and then as we mentioned don’t forget to really embrace all of these gut friendly behaviours and practices when introducing these foods especially starches. I mean it’s a common mistake to re-introduce too many fermentable carbs too fast and you know I’ve heard people say things like OK I’m going on a low FODMAP diet for two weeks and then I really need to ramp up the fibre, that’s a terrible idea and it’s probably not going to work.

REBECCA: Yeah, definitely and I think though the reintroduction phase can be fraught with anxiety because it’s moving into a zone where you’re not sure what’s going to happen. I know for me after 6 months of the pretty restricted diet when I started re-introducing foods there was a little bit of fear that I experienced around it. I was worried that I was going to experience painful symptoms again. I was kinda scared by that and there was safety in what I knew which was this restricted diet. I knew how I felt. I felt great on it and I didn’t want to stop feeling great and so there was definitely trepidation. Do you see that with people that there is trepidation around adding in a highest FP food and the fear around what that might do to them?

DR. ROBILLARD: I do, I mean I know it’s different for different people. Some people I think that the sicker they were to begin with, probably the more they are concerned about they don’t want to end up back there so they are more cautious but some people just throw caution to the wind and they know this is a long term thing but if at least, if you can convince people that they have a tool belt, that the diet with these behaviours and practices and causes, all these different pieces come together and it’s essentially, if you can figure out ok I did it and it works I’m symptom free you gotta a tool belt there, and so I don’t think you have to worry so much if you fall off the wagon especially around holidays, it happens to me sometimes, but if you trust your toolkit you know ok look, next Monday I’m going to just cut it out and I know I’ll be feeling better. But I understand that concern I mean at the height of my reflux problems I was beginning to suffer with an aspiration reflux and I mean that scare you out of your wits in the middle of the night you can’t breath, there is acid in your lungs and you think I really did wake up one night, I was half dreaming but I thought to myself I’m dying, this is what is feels like to die. Woke up and started coughing and realise it was just a bad case of aspirating acid reflux into my lungs.

REBECCA: That sounds really painful. That just sounds, that sounds really painful.

DR. ROBILLARD: I know. Those days are long behind me and I’m just very thankful that I don’t have to feel that way any more so. Like you I want to help other people build the toolkit and show them that it works and then they can go off and it’s easier with time. You know people that are on the fast track diet for a while, they don’t count points anymore, they know which foods are what they know what they can eat and about how much and they know what to do if they have some symptoms so it does get more relaxed in time and also your sensitivity is reduced, everyday you can control your symptoms your gut is healing.

REBECCA: Yep, that’s a really great points and I’m interested in the reintroduction phase in terms of stepping up the FP level of foods, in what time frame do you suggest that people do that, do they do something everyday, do they do something once and then wait a few days and then add something else in, what’s your advice around that?

DR. ROBILLARD: Well for most people they do spend, as I mentioned, a lot of time being a little more stringent, 20-25 points a day. You know, and in the books and also in the fast track diet mobile app, which is a new app out this year, it does go into how you set those points and so forth and it is by the severity of your symptoms and where you fit on that continuum and so you can look at the same graph in terms of when you should increase the points, hey you know my symptoms are really kind of mild or almost gone, ok you can start to increase them gradually but I’d rather hear you say they are gone, that be the safest thing, but I think the good thing about the diet is that there is no reason you can’t just back off again if it starts, if you’ve gone a little too far. So I don’t worry about it too much but honestly, you know how it works in these consultation programs, I end up being the coach most of the time and saying no, no you went too far back off a little bit, maybe not, because most people want to jump the gun and they tend to get ahead of themselves a little bit. So I think when you consult with people you end up being a bit of a coach to moderate.

REBECCA: Yeah, I think people also know when they have stepped over the line when you ask them those questions they’re like, yeah, yep I went too far. I went out and I went crazy and I ate an entire burger and or you know, I had all of these foods that I’d just been dreaming about for so long and I just went and ate them and I really paid the price for it.

DR. ROBILLARD: You know I work with people on like what are you favourite foods, maybe we can come up with a strategy so that you can include those and you can give up something else. My own love is an IPA beer, I just love it, a light beer has much fewer points only has 3 or 4 points. An IPA can have a lot more and of course if you have three of them forget about it. Sometimes I’m willing to have a couple of IPAs and cut back on on something else.

REBECCA: So with regard to the fermentation potential threshold, how do people know where to start, does everybody start at the same level or can one person start at one point and another person be able to tolerate a higher amount each day?

DR. ROBILLARD: Yeah, sure we’ll let’s talk about that and by the way I think I haven’t covered this, so real quick how do we get this FP value, let’s just go through that real quick, you know, this is a calculation I created using the glycemic index and nutritional facts and a serving size for any food and the glycemic index is you know measures how quickly the carbohydrates in a food go into your bloodstream and so it’s really quite simple. I turn the equation around to measure how many carbohydrates for a specific food and serving size of persisting in the small intestine so, you know, but I mean I’m not the sharpest knife in the drawer so it took me 2 years to do this but the bottom line is it’s a way to use the glycemic index which theres thousands of these values for these different foods to actually measure the FP by turning it around so that’s what the calculation is. As far as the threshold, as I mentioned there are guidelines in the book and the app and your limits will initially be set by your own symptoms so essentially it’s like do I have mild or almost none, just a few symptoms, then your limit might be way up near 40 or 45 FP but chances are most of the people people that will spend 8 bucks on the app, they’re not mild they’re having more problems than they want and they will need something that’s more strict so in that case they might be 25 to 30 points a day and people with real severe symptoms I’d say 20 or even less, and again go right into troubleshooting sections because you may have to do some additional things and maybe some supplements, some digestive enzymes, could be a stomach acid issue betaine so you might have to go to the troubleshooting section but the most significant your symptoms are the more you need to cut these FP points, in a nutshell.

REBECCA: And is it easy for people to determine the FP potential of a food like how would they go about doing it. I had put a call out to my community to say that you were coming on the show and did they have any questions and I had a lovely guy from Brazil reach out and say to me there’s a lot of foods here that I don’t I don’t know how to calculate these, we don’t have a lot of nutritional information on our foods here how do I go about calculating that. Would be great if you’re able to answer that question on how to calculate FP potential?

DR. ROBILLARD: Sure, well the mobile app does a built-in calculator for FP and there’s also a free calculator on digestive health Institute dot org website so effective you just Google FB calculator and you go right there and so you can plug there values in yourself but you will need the serving size and you’ll need the nutritional facts. So you need the total carbs you how much dietary fibre is there and if there are any added sugar alcohols and certain sugar free ice cream for instance, you need to plug those in and then you need to plug in the glycemic index value and you calculate and get the FP. Now in some cases you will have a food that hasn’t been tested for the glycemic index and so what do you do there. So there’s a couple things you can do. For foods that are low carb foods, so green any kind of green leafy vegetables, you know the app has like 150 vegetables listed and their FP values listed anyway, but if you find a vegetable it’s not on there and it’s a lower carb vegetable you can use the average glycemic index for these vegetables which is about 50-55 something like that, or just use 50, and it’s not that critical because first of all that’s the average for vegetables but also the glycemic index matters less when that’s fewer carbohydrates there. So if you wanted to do that with a starch and that’s why you put values in for many different potatoes and rices and all these different starches because when you have a high carb starch that glycemic index value is important. It’s important to know whether it’s 85 or 45 because that will change the FP significantly so if you have starch that’s not in there you can you can try putting in 50 just to be a little on the conservative side and then at that point you might have to just experiment yourself and try some. Use all the pro digestion practices that we talked about and then see how you feel. So your symptoms will become your own barometer at some point.

REBECCA: And once you start becoming in tune with your body it’s amazing how quickly our bodies give us signals. It’s quite incredible. I was never in tune with my body and then when I started to really listen to it, I was like oh, you tell for what you feel when I do a certain thing, great ok and now I have a barometer for this.

DR. ROBILLARD: I know it’s great and I think as we get older we do that more often probably because when we’re young we’re just so strong and healthy, nothing bothers us, we can take a lot of abuse.

REBECCA: Exactly and other things you never knew were actually symptomatic of the food you were consuming, things like aches and pains or headaches or things that don’t involve the digestive area were really interesting to me. I could see that I would get a dull ache in my head with certain foods which I only started to notice when I was dealing with my SIBO and I realised that, or I might get a bit congested in my sinuses and I was like oh my gosh this is totally related to what I’m eating and I could then narrow it down to ok it’s this specific item that I have consumed that is causing that problem which is fascinating because I’d never felt that before.

DR. ROBILLARD: In fact it reminds me when you said sinuses that, you know, there’s a lot of people these days that are struggling with Laryngopharyngeal reflux LPR, they get these symptoms, throat breathing sinuses, eustachian tubes, lump in the throat, hard time swallowing and they go to the doctor who will say ‘well what I’m concluding at this point is you have LPR so I’m writing you a script for proton pump inhibitor’ and these PPI’s neutralize, not neutralize, they stop your stomach from actually making any stomach acid. But there have been some studies, and I just published a blog on LPR and why proton pump inhibitors don’t work, recently. It turns out that a number of studies and even some fairly complex matter analysis and PPI’s don’t work at all for LPR and so what does work though is if you can stop reflux itself and it’s the same situation with asthma. They did huge studies, thousand kids, hospitals all over the US, called the Sara study to look at home Nexium would help kids with asthma because they knew it was related to reflux. That’s well established, 80% of kids with asthma have chronic acid reflux so they figured, hey we have another market for Nexium let’s go for it. Big study did not help one single bit and they concluded from that study, over 100 authors on that paper, they concluded that therefore acid reflux is not a cause or a contributing factor to asthma and that conclusion is completely wrong and here’s why, if you give people a fundoplication operation, I’m not recommending this, because there are a lot of other issues with that procedure, but you tighten up the LES, this set of muscles on top of your stomach surgically, that doesn’t prove asthma and so it is something in the reflex but it not at the acid component. But there’s also bial, there’s bacteria, there’s enzymes, pepsins and pancreatic enzymes so but but Nexium isn’t the answer because acid is not the only problem so everywhere I turn I feel like there’s a new book I need to write, fast tract diet for asthma, because the secret isn’t stopping the reflux and I just wish you know that message would ring clear because it’s based in the science. Why would a fundoplication operation help if the reflux wasn’t a problem, why did 80% of kids with asthma have acid reflux. Is the asthma causing the acid reflux? No, it’s the other way around.

REBECCA: I can see many many more books coming out of you in the future years, and I look forward to all for them. Just backtracking a little bit around the FP for a food and the difference that the value is depending on the way that the food is so say in it’s raw state versus a cooked state versus a puree state or a juiced state, does it change according to how that food is prepared and what state it’s in?

DR. ROBILLARD: Thank you for asking this question because so many people ask this question so the better I can get this answer out there the easier it will be. Ok, cooking, when you measure out raw veggies the FP will either be the same or slightly lower when you cook it. It will never be higher that’s one point, and here’s an example, it’s in the book, 1 cup of raw carrots, who would eat a whole cup of raw carrots, nobody but, that’s our example, 1 cup of raw carrots, has 11 FP points raw, if you cook them it’s 9 FP points. So not a big difference right but it a little bit less when you cook them, now here’s where it gets a little complicated, not real complicated but just a little bit more, how about leafy green vegetables. When you cook those they condense quite a bit, right. Take a cup of spinach and cook it doesn’t look like much right, and so that’s confused a lot of people. One cup of cooked spinach so if you cook it and then measure your cup full, that has 5 FP points but if you take one cup of raw spinach it’s only 1 FB and that’s because in a cup of cooked spinach, you have five times as much spinach there and that’s the reason that I included some examples of cooked veggies in the book and the app because I wanted people to see the difference. As long as you measure everything raw you’re good to go but if you want to measure some things cooked you can look at some of those examples. It will change for the vegetables that get a lot more condensed. Does that make sense?

REBECCA: That’s great, yeah it does totally, and so if someone was to do, you know, green smoothies or green juices are all the rage at the moment, and everyone’s like ‘oh I had my green juice coz it’s so healthy’, if someone is wanting to or feels that they need to include a green juice into their diet is your recommendation at they measure out the the raw vegetables, work out the FP for them and then they juice them and then they know what that is or does the process of juicing change the FP?

DR. ROBILLARD: Yeah, what you said. I think to be on the safe side select the vegetables and or fruit you are going to put in your juice, add up the FP’s, that’s you’re FP. Now when you use a juicer, some of the insoluble fibre will end up not in the juice, so there’s a little bit of FP there but a lot of the fermentable carbs are going to be in the soluble fibre fraction and they will be in the juice, so my advice is as you said, it’s just to count the FP and recognise that the actual FB might be slightly less. Now let me qualify that for a minute, but something about turning vegetables into juice, for me at least, gives me a stronger reaction and I’m not sure why but when I, I’m not a big juice and I don’t really care for the taste, but if somebody makes juice and I have more than a shot I’ll get loose stools so for me it has a very powerful effect and other people they might be fine but it’s just something to keep in mind, my out of one observation there.

REBECCA: Well I can add to that there’s an observation of 2 because I feel exactly the same. It really has a very powerful impact. I feel a very immediate impact on my blood sugar, I feel like I’m very sensitive to sugar as I can feel them hit my bloodstream and so even the sugars from vegetables, even if I’m not using much fruit or any fruit at all, I can feel quite zooped up from what’s come through because my system obviously must absorb it pretty quickly and it can have a pretty powerful impact on my, it can cause me diarrhoea as well and if I was just to eat those vegetables in their whole form rather than their juices form I wouldn’t have that experience with them so it is, there is something in that process that has an impact.

DR. ROBILLARD: Yeah, in a way you’re skipping part of the digestive process by juicing them, you know, the stomach churning things around, your skipping some of that, and so it’s going to present differently but rule of thumb for now just add up the FP values and hey you’ll know if you have a bad reaction.

REBECCA: Yeah, and I think that the message that’s really coming through it that, working out what works for you as an individual rather than looking at you know what’s my favourite blogger talking, green smoothies or juices, but really determining what your system is happy with at this point in time, what makes you feel good, rather than what you’re being told in the media that you should be doing and really tailoring it to your own personal needs.

DR. ROBILLARD: I couldn’t agree more and the other rule of thumb that I really live by is less is more, especially with the marketing machine that’s out there, we need more of everything according to these adds and people are trying to sell stuff, I get it, but really less is more. There was this study out by Christina Remley in Austria a few years ago, and she found that people fasting, when they fasted the gut microbiota become more diverse, which is interesting, you always think of the mantra, no you need more prebiotics and more fiber or these poor bacteria are going to die. I really think a diverse diet and that’s why we, we have a protocol built around fresh herbs and fresh low FP vegetables and low FP lacto fermented vegetables so were not adding a lot of fermentable material but we’re still challenging many different microbes because different microbes participate whenever new molecules come along and so these, you have plenty of microbes in your gut that might be kicking along at very low numbers, maybe a couple hundred to one thousand cells but they’re there when they’re needed, when they’re called into action and by diversifying your diet I think you can really help with that. Another reason I have a nice organic garden every summer, I try to eat a lot of low FP lower carb green leafy vegetables to keep challenging my microbiota but not overdo it so, that’s the less is more thing.

REBECCA: It’s really interesting you talk about fasting because since coming through SIBO, once I tested negative for it I started and I was very interested in fasting and done a lot of reading on it. I’ve got a whole podcast just on fasting intermittent fasting coming up and I have started fasting two days a week and also just reducing the load, reducing my meal sizes being really careful of the types of food that I eat so organic where possible pasture fed or grass fed meat, hormone free, all of that stuff and I have learnt I don’t need to eat nearly as much as I thought I used to and I can often go, I can go, I’m on a fast day today actually and I’m absolutely fine and in fact I feel incredible for it and on the days that I’ve fasted I have so much energy and I feel amazing and it seems counterintuitive you feel that you should be weak and lethargic but I have done some of my best sort of movement in exercise sessions at the end of a fast day, and I feel such great mental clarity and my gut feels great even though it feels good these days but it feels even better so it’s a really, it’s so interesting and I’m fascinated about fasting anyway.

DR. ROBILLARD: I would expect your gut to feel better, just curious so how long do you fast for?

REBECCA: So I have dinner, so I fast on Mondays and Wednesdays, I have dinner on a Sunday night which is a protein and vegetable meal, I don’t use any rice or any carbohydrates cause I find that if I do, fasting is very difficult the next day, it is really impacts my blood sugar levels. So I’ll have say chicken or some fish or some red meat and a big nice green leafy salad on the Sunday night. I then don’t eat again other than consuming water and maybe some herbal tea, and I won’t eat again until dinner on the Monday night and then on the Tuesday I often don’t eat again till lunchtime. I train in the morning do quite a heavy and intense training session and then I’ll have a really healthy protein and vegetables lunch on Tuesday. I’ll have dinner on Tuesday and then I won’t eat again until Wednesday dinner and that’s my routine and I feel awesome for it. It’s been quite incredible how much of a difference it has had on me and my partner does the same. He feels great on it, so we’ve kind of got this little routine going now and every now and then you might have a day where fasting becomes a little difficult, especially if you’re in an environment where there’s a lot of food around, if somebody’s bought delicious looking food and eating it next to you and you like oh, just looks so good, but we use each other as support and I’ll text him and say help I’m really hungry.

DR. ROBILLARD: I should try that, I’m halfway there I generally never eat breakfast. Most days I won’t eat anything until lunch except for maybe a small handful of nuts that’s every day but I’ve never really tried these long fasts I don’t know how I’d do, I guess try it and see

REBECCA: Well I used to be a constant grazer, I could not go more than 2 to 3 hours without eating something. I had terrible blood sugar highs and lows even though I wasn’t eating what I considered a high sugar diet but I had carbohydrates in my diet and rice and things like that and I just would get so shaky and weak and I feel awful but when I move to a more green veg and lots vegetables and protein and good quality animal fats, and plant based fats, nuts and seeds, I moved to that way of eating, my gosh you know, my blood sugar really stabilized and I now have, I can now do it and the other thing that was really interesting to me was that I stopped getting hangry, I used to be a terrible angry hungry person and now the only thing I feel is it my stomach just feels empty but it doesn’t even feel that hungry. I can often get to dinner time and think I don’t necessarily need to eat this meal I’m doing it because I’ve chosen to be and one day I will go for a full day and then do a fast for a full day and just see how that feels, I’m very interested in the longer term fast.

DR. ROBILLARD: Sound like you’re some what fat adapted, which is the way I like to live as well, I think that’s an easy way to avoid feeling very hungry if you consume good healthy fats along the way.

REBECCA: Yeah, definitely, moving on, in terms of just the food’s and this is something that I know causes a lot of confusion with people that you do have some foods on your list that seem to cause unnecessary anger with people, things like chocolate bars, people are like, why is that listed, that shouldn’t be on there oh my god what am I doing I’m supposed to be eating healthily. Can you explain why some of those foods have appeared on your list?

DR. ROBILLARD: I can. Somebody just asked me a question the other day about skittles, so yes, lets jump into that. So here’s why I did that, right, the FP tables they include foods that are on the market and these are the food’s people eat and I want them to have the data, but I also want people to know that many of these foods in addition to being bad for you, they may contribute to you daily FP limits, and it’s one more reason not to eat them. But you mention chocolate, who can resistant an occasional piece of chocolate I can’t. I’d like to know the FP. So where do you draw the line and say, you know, hey we’re not putting anything on here unless it passes our test for what’s a healthy diet. That’s not, I try not to be judgmental. I wanted to develop this diet, I don’t decide what the FP value are, it’s a calculation, I try to do a good representation of food that’s in the market. I want people to know, I want them to have the information and so if somebody thinks I’m unhealthy because a snickers bar is in the table, get over it. I wouldn’t eat a snicker bar but it has a lot of FP points and people might need to know that.

REBECCA: Exactly, and I think that’s a great explanation that it’s food that’s commonly available and commonly eaten and it’s great to know your FP values, whatever the food is. You use the fast track diet with SIBO and I’d love for you to talk about your experience of how it works for people with SIBO and some of the results that you see.

DR. ROBILLARD: You know I personally have been eating this way for about 5 years and as you know, I told you my story, 14 years ago I learned about a low carb diet and now I’m eating essentially according to the fast tract diet, 5 years, and it completely controls my symptoms of acid reflux as well as occasional bloating and cramping, but that’s me, you know, it’s my book I’m going to say that anyway. But what I’m really interested in is what other people are saying so we use a customised version of the fast track dieting and a consultation program, with a major focus on these behaviours and the underlying causes so we’ve had good success, but you need to look at the reviews. There’s a lot of reviews on digestive health institute dot org the website, but also amazon reviews and reviews for the iTunes and Google app so people can read that and then I just saw something interesting there’s a video review of somebody that went on the fast track diet for a year with no drugs, no antibiotics, it’s on the SIBO support group on Facebook so if people want to join that group they can check out that video. I think that was really interesting and worth watching and of course when your on Facebook don’t forget to join the fast track diet Facebook group.

REBECCA: Exactly, I saw that video very recently and that was that was interesting. One of the things that also causes quite a lot of confusion and angst amongst some of the SIBO’ers is when they compare food’s on the fast track diet to other diets that are commonly used with SIBO such as the low FODMAP diet, or the biphasic diet, or the SIBO diet. Can you talk to those people that are going ‘but on this diet it is low, and on this diet it is saying to avoid, what do I do, I’m so confused’ what’s your advice to those people?

DR. ROBILLARD: Great question. So many of the diets out there for SIBO are more along the lines of an elimination diet, hey this food has FODMAPs in it, you better just avoid it, OK I’m going to avoid it. But again the fast track diet is a different approach based on this point system, so it’s not an elimination diet and no food is illegal but it’s quantitative and each food is rated based on the amount of fermentable carbs per serving so let’s look at some of these examples that come up. A lot of people type of garlic and onions, let’s look at garlic. Both of these foods, garlic and onions, contain FODMAP in the form of fructose oligosaccharide and that’s a soluble fibre, considered a prebiotic so I get it, it’s a FODMAP you know, you’ve got to be careful with this but I look at how much you’re going to be using. If you use a few cloves of garlic in your stir fry, a few cloves of garlic only come to about 8-10 grams and then when you actually ask how much of that is fructose oligosaccharide, it’s only a couple of grams, so it’s a couple of FP points and so that’s what it is that’s what it is my calculation and that’s what I published. If somebody feels that it doesn’t matter, I literally can’t have garlic, ok, you don’t have to have it but the FP value for a few cloves of garlic is between 2 and 3, if that, closer to 2 I think. So if you want to eat a whole garlic bulb yourself, it’s going to add more FP. So it’s really how much of it are you consuming so our diet is moving in a different direction and it’s really a quantitative approach where nothing is off limits but it’s very important to control your overall daily FP points.

REBECCA: I was doing an interview just earlier this week with Dr Jason Clop who’s based in Vancouver, Canada, and we were talking around the psychology of the classifications of foods on some of these diets with terms like illegal and band and avoid which when I look at them as a word are very strong powerful words and negative words and we were discussing what impact does that have psychologically around the perception of food because, I’m with you, I don’t think that any one food is bad, it’s just we might not be able to tolerate it at the moment, or we might have another condition that means that we really aren’t very good at digesting it or we’re got a disease like coeliac disease and from a health perspective we need to avoid gluten. But I think that I really like what you say about it’s no food is band that it’s just around the amount that you eat and how much you can tolerate and I think that it’s important that anyone in the health space, and the food space, is thinking about the psychological impact we’re having about when we’re talking about food and how we’re describing it to people because food is our nourishing life support without food were not here.

DR. ROBILLARD: Absolutely, adequate nutrition is a key to a long healthy life, but a lot of people trying things in these diets, I think what happens is sometimes they save tid-bits from one diet, or several different diets, or they go on a hybrid diet because they know that this and that bothers them but what happens is that can lead to orthorexia in some people where they are literally not getting adequate nutrition. Some of the stories it’s a little frightening, you know, hey I can only eat cooked lettuce and bone broth. Oh-oh, that’s concerning. So what is adequate nutrition, my view is, first of all the western diet contains way too many carbs which our body doesn’t even need, and the other problem is this global fat phobia, phobia that others have covered but I mean it’s fuel by this Ancel Keys diet hypothesis which favours seed oils over saturated fat cholesterol, in fact I’m actually reading the ‘Big Fat Surprise’ by Nina Teicholz right now, which is just eye opening as well as the work of Gary Taubes, Mick Eedes, Richard Fireman these are the people that have helped educate me a little bit in this area, but in terms of gut health there’s just no question in my mind, there’s too many fermentable carbs are overfeeding our gut microbiota leading to these huge numbers were talking about, with functional gastrointestinal disorders, and the other list of SIBO related conditions, if you add all those up, and Allison Siebecker, your friend Allison, had done that at one point, I think she came up to something like 100 or 150 million, and I get a similar number. That’s just the US, so there’s a lot of people hurting and I really feel this marketing mantra for more fibre and more pre-biotics, it’s hurting not helping.

REBECCA: It is, and us marketers, I’m a marketer by trade it’s what I went to university and studied, 20 years ago, and marketers of the world over have a lot to answer for on their promotions of these messages, that haven’t been helpful for us so I apologize on behalf of marketers for what they have done.

DR. ROBILLARD: They’re not usually in charge.

REBECCA: One question I get asked a lot by people is can diet alone cure SIBO and I’d love to know your thoughts on that, or whether we do need to be using antibiotics or herbs or supplements in conjunction with diet?

DR. ROBILLARD: Yeah, it a good question and by the way, I just wrote blog on that last week’s it’s called ‘SIBO treatments antibiotics vs diet’, it’s on the digestive health institute dot org site, so people can read that, but couple …

REBECCA: And I’ve got links to all of the things we’ve talked about today in the show notes so just head there and I’ll put the links there for everybody.

DR. ROBILLARD: So couple points, whether you use antibiotics or diet or some combination of that, I mean, you do need to look at identifying and address any specific underlying causes that might be relevant for you. So that’s, I think, no matter what you do, that you’re going to have to look at that, and antibiotics, I’m not against them, believe it or not, I have worked in the pharmaceutical industry for 20 years and one of my jobs for many years was developing new antibiotics. I worked on the development of cipro, I’ve studied antibiotic resistance in bacteria in the lab. For many years, that was all I did, and I loved it and these antibiotics saved lives and they are wonderful, and even for SIBO there are cases where they’re appropriate. If you have a significant issue with SIBO where are you suffering from, oh I don’t know, the inability to digest fats, everything else has failed, you have uncontrolled weight loss, failure to thrive, anaemia, all of these things can occur, bone pain, or even fractures, autoimmune reactions, an antibiotic could be at some point appropriate but even in those situations I really do think diet should be a part of the solution. But let’s just look at antibiotics for one second, whether it’s herbal, synthetic, fungal, or bacterial, right, our first antibiotics can from funga, remember the penicillin story, bacteria producing herbs, or you can make them in the lab, but they’re all the same in one regard right, these are a quick fix for SIBO, you pop the pill and some people notice an improvement in symptoms, others don’t. But when you look at some of the larger well controlled studies, for instance, the target studies that we’re used to register or facter some in with the FDA for IBS, 42 people 42% of people responded, sounds good right, compared to 30 people in the placebo group so there’s a 10% in that response, and the other problem with antibiotics is there’s no evidence that the response is durable, they haven’t studied them long enough, there’s just no evidence for it, and now many people require retreatment with a success rate, and there was a target 1, 2, and 3 study done so you look at all 3 of those, retreatment the success rate drops to 33% vs 25% placebo, so again it’s not super great. I’d encourage people to read that article, where I get into that a little bit more, on top of that significant potential side effects and health risks particularly for some antibiotics, Neil Myson is a favourite one people have now for a methane predominate SIBO but that can be a dangerous antibiotic, you have to be careful, bacterial resistance, huge problem, I’ve spent a lot of time working on this on, it’s out of control right now things like methicillin-resistant, staphylococcus, carporpenan, penan resistant enterobacteriaceae like a pathogenic e coli, eclipciola, there’s a million infections of the US every year from bacteria that are resistant to these antibiotics, resulting in 23,000 deaths and it’s getting worse. The last point about antibiotics is there’s a shotgun approach, the killer inhibit the good as well as the bad bacteria, there is no doubt, they don’t just kill the bad ones, and they deplete the protected strains, increasing susceptibility to various other gut pathogens, C diff every antibiotic carries the risk of C diff, and there’s a rationale for that too because here you are killing off all of your resident bacteria, and they normally foment the carbs, right, so they’re going away and meanwhile if you don’t change your diet, in fact some people are eating more carbs when they do this, there’s more carbohydrates and they have more pathogens like salmonella, clostridia difficile to become established so I really think they should reserve those for when there’s a more serious form of SIBO. On the other hand, dietary changes, they do provide a durable response. There’s been studies on lactose intolerance, avoiding lactose is durable even when they looked 5 years out and there’s no resistance, a study on fructose intolerance showed avoiding fructose was durable after a year, they looked out a year, so there’s a durable response, here’s the only issue I see with a lot of the diets, we’re still working to really fully refine these diets, I think the biggest problem is that these diets are not restricting the full range of fermentable carbohydrates, that’s what we identify in the fast track diet, and believe it or not, it is supported by the textbook of primary and acute care medicine, this is a textbook used to train doctors, page 11, 92, look it up at an library. It’s a chapter on intestinal gas complaints, right, and that’s what’s driving these problems, and I quote, dietary alterations to reduce intestinal gas require elimination, we use reduction, they say elimination, of most of the foods in table 1. What are those foods in table 1, sugar, alcohols, fructose, …, resistant starch, fibre and lactose. There it is. I predict that one day, hopefully not too long in the future, science based diets that limit fermentable carbohydrates, will be the first line of therapy for treating SIBO honestly believe it.

REBECCA: Yeah, I think that there is so much we can do around our nutrition rather than popping a pill, and eating for health. I really hope that eating for health, like you say, becomes the new way of treatment rather than taking a few drugs here and there and hoping for the best and not changing anything else. A final question I have is around weight loss and weight gain. People seem to experience one or the other when it comes to SIBO. They either become very thin and quite under nourished or they find, and I was this person, they find that they’re gaining weight so rapidly and finding it very difficult to take off. Do you see anything with that, with the fast track diet, with people that are following the diet around what happens with their weight?

DR. ROBILLARD: We do get both groups of people, and I do track weight when we work with people, but for every person I have that has a problem losing weight, I probably have 3 that have trouble maintaining weight, so I think that’s where the biggest problem is. In fact I just, I guess I had a rush of blogs, I just did a blog about a week or so ago on how to maintain weight when you have SIBO, so again it’s on the same site, people can find that, and read it.

REBECCA: Wonderful, and it’s distressing, anyone that is either losing weight rapidly or they are gaining weight rapidly, whatever end of the spectrum you’re in, it’s very demoralizing because you’re thinking I’m not eating anything that should be making me fat or, you know, superskinny, what’s happening, this is so unfair and particularly around the weight gain side of things and so much pressure particularly for women around how to look, and you must be thin, and you must you look a certain way, and so when suddenly you put on 2, or 3, or 4 dress sizes in a matter of weeks, it is such a psychological blow.

DR. ROBILLARD: And some of that can be bloating, extensions of course, I think that’s one of the first things that usually improves when you control SIBO.

REBECCA: Now you are an absolute prolific writer, what’s coming up, what’s next for you, it sounds like you could definitely be writing a whole bunch of new books that we’ve talked about today.

DR. ROBILLARD: I did have some pretty significant plans for book writing but, to get things done I’ve had to set up a project schedule and limit myself to what’s going on, so we are involved in some collaborative work in the clinic, I have another book that will are working on, further development on the mobile app, and we are working on some kind of online program, so there’s a lot going on but on a lighter note, we will be traveling to Japan for business and vacation in early April, so I’m looking forward to that.

REBECCA: Wonderful, Japan is great, I love that country so, so I hope you have a wonderful time there. Dr. Norm Robillard, it has been such an honour and a pleasure to have you on the healthy gut podcast today. I have learnt a lot and I’m sure my listeners have as well. We have mentioned your website many times, but just again, anyone that missed it what’s the best way for someone to reach out and connect with you or follow the work that you’re doing?

DR. ROBILLARD: Yes, digestive health Institute dot org and they can visit us at the fast track diet official Facebook group on Facebook.

REBECCA: Wonderful, once again thanks so much for coming on the show it’s been an absolute joy to have you here today.

DR. ROBILLARD: Thank you for having me Rebecca.

Dr Norm Robillard

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