Digestive Health Institute

09/01/2025

🔬 PPIs and SIBO: What the latest, 2025 meta-analysis shows

Many of us here have used proton pump inhibitors (PPIs), such as omeprazole, esomeprazole, or pantoprazole, for reflux, whether for a short course or over a longer period. A new analysis of 29 studies found:

- Higher SIBO risk on PPIs: About 2× higher odds of SIBO vs. non-users; pooled prevalence 36.8% in PPI users vs 19.9% in controls.

- Time matters: Each additional month of PPI therapy was linked to a ~4.3% absolute increase in SIBO risk, the highest risk after >6 months (OR ≈ 4.23).

- Consistent across test types: The association shows up whether SIBO is assessed by glucose or lactulose breath tests or aspirate culture.

Source: 2025 systematic review & meta-analysis on PPI duration and SIBO risk (Journal of Clinical Medicine): https://www.mdpi.com/2077-0383/14/13/4702

🔎 Why PPIs may increase SIBO risk

- Less stomach acid → more bacteria survive: PPIs reduce gastric acid, the body’s natural defense against ingested microbes.

- Bacteria migrate downstream: With reduced acid, oral and upper-GI bacteria are more likely to persist and colonize the small intestine.

- Over time → higher risk: The longer PPIs are used, the more this imbalance can develop into small intestinal bacterial overgrowth (SIBO).

💡 How the Fast Tract Diet can help (reflux, SIBO, and other dysbiosis)

- Medication strategy: With your doctor's consent, if prescribed, weaning off PPIs is part of the Fast Tract Diet strategy.

- Lower fermentation load: Use the FP system to select lower-FP foods and portions to reduce gas pressure, reflux, and dysbiosis.

- Gut-friendly behaviors and practices: Eat slowly and chew well, use meal spacing, maintain adequate hydration, practice regular, appropriate exercise, get adequate sleep, and more.

- Identify and address root causes specific to your case: There are 30–40+ potential contributors to functional GI disorders and gut dysbiosis. Based on your profile, targeted, evidence-based supplementation may be appropriate.

- Everything above is explained in detail in the Fast Tract Digestion books, the Fast Tract Diet app, and Dr. Norm Robillard’s YouTube videos combined.

✅ Bottom line: PPIs may help in the short term, but long-term use raises SIBO and other risks. Use the Fast Tract Diet to reduce fermentation and, with your doctor’s consent if prescribed, consider a PPI step-down while you track symptoms and progress.

08/31/2025

💊 GLP-1 Weight-Loss Meds & Your Gut: The Good, the Bad, and the Ugly

Many people managing digestive issues are focused on maintaining or gaining weight, while others are working on weight loss.

Medications like Ozempic, Wegovy, Victoza, Trulicity, and Mounjaro are part of a newer drug class called GLP-1 receptor agonists. They were designed for type 2 diabetes, but now they’re also widely used for weight loss.

🔬 How they work (the good):
- Boost insulin after meals → better blood sugar control.

- Act on the brain’s satiety centers → reduced appetite.

- Slow stomach emptying → you feel full longer → often leads to weight loss.

⚠️ Side effects (the bad):
- Nausea, vomiting, bloating, and feeling overly full are common.

- By slowing stomach emptying, they can mimic or worsen gastroparesis (stomach paralysis).

- They can complicate medical testing and even increase the risk of aspiration (food entering the lungs) during surgery or endoscopy.

❗ Unresolved concerns (the ugly):

- In some people, stomach problems don’t improve after stopping the drug.

- Doctors are still figuring out how long these medications should be stopped before stomach-emptying tests or procedures—
sometimes it could be weeks.

- People with existing gut motility problems may be especially sensitive.

💡 In short:
GLP-1 receptor agonists are powerful tools for diabetes and obesity management, but their effect on stomach emptying creates new diagnostic and safety challenges.

Doctors, patients, and medical staff must balance the clear benefits against the risk of nausea, delayed gastric emptying, and complications during diagnostic tests or surgery.

https://tech.snmjournals.org/content/52/1/3

08/28/2025

☕🧬 Coffee & Gut Health: The Surprising Science

For individuals addressing IBS, SIBO, reflux, gas, bloating, or abdominal pain, coffee can be both a welcome ritual and a potential digestive wildcard.

Because the key isn’t just whether coffee is caffeinated, acidic, or decaf, it’s how coffee interacts with your gut environment that matters most.

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🔍 Coffee and Whole-Body Health

Moderate coffee consumption (3–4 cups per day) has been linked to a range of health benefits, including: 1,2,3,4,5

- Reduced risk of heart disease, type 2 diabetes, Parkinson’s, and liver disease

- Protection against certain cancers (breast, colorectal, endometrial)

- Anti-inflammatory and antioxidant effects

- Improved metabolic and cognitive function


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☕ Coffee and Gut Health

Coffee promotes digestive health through several mechanisms: 6,7

- Digestive secretions: It enhances the production of gastric acid, bile, and pancreatic enzymes, supporting digestion and potentially speeding up intestinal transit.

- Bowel motility: Coffee can stimulate the colon, occasionally leading to the urge to have a bowel movement shortly after drinking it.

- Gallstone prevention: Regular coffee consumption is associated with a lower risk of developing gallstones.


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🦠 Impact on Gut Microbiota

Emerging research highlights coffee’s positive influence on the gut microbiome: 8,9,10,11,12,13

- Microbial diversity: Moderate coffee intake is associated with greater overall gut microbial diversity, including an increase in beneficial strains like Bifidobacterium.

- Bacterial balance: Coffee has been linked to higher levels of health-supporting bacteria such as Bacteroides and Lawsonibacter asaccharolyticus, along with a reduction in potentially harmful Enterobacteria.

- Prebiotic effects: The polyphenols and fibers (not listed on nutrition facts label, but documented in studies) found in coffee and its by-products may act as prebiotics, feeding beneficial gut bacteria and supporting microbiome balance. Although these effects sound beneficial, they may be the very reason coffee triggers your symptoms.

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⚠️ What About Reflux?

A couple of studies suggested coffee can lower the pressure of the lower esophageal sphincter (LES).14,15 This may increase reflux symptoms for sensitive individuals.

But here’s what the broader science (and my clients) shows: 16,17,18,19,20,21,22,23

- Most studies show no consistent link between coffee and GERD in the general population

- Individual tolerance varies widely

- Decaf or dewaxed coffee may be easier on the gut for some

If you love coffee but are dealing with reflux or bloating, there’s no need to give it up entirely. You just need the right strategy.


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🧠 Why the Fast Tract Diet Helps

Reflux (either acid or silent, LPR), IBS, and SIBO often stem from excess fermentation in the gut. When bacteria ferment unabsorbed carbs, gas is produced, raising pressure, driving reflux, and fueling dysbiosis.

The Fast Tract Diet addresses this root cause by helping you select foods based on their Fermentation Potential (FP), a science-based system for reducing symptoms for relief and recovery.


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📚 Essential Reading because the Fast Tract Diet is a system

To truly understand how the Fast Tract Diet works and apply it with confidence for real results, these books are your essential guide.

- Fast Tract Digestion: Heartburn – A root-cause approach for reflux, GERD, and silent reflux (LPR), also addressing underlying gut dysbiosis.

- Fast Tract Digestion: IBS – A non-antibiotic, science-based solution for IBS, SIBO, and IMO rooted in controlling fermentation and restoring gut balance.

👉 If you reside outside the U.S., please visit Amazon in your country to find these titles.


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📲 Fast Tract Diet Support

The Fast Tract Diet app puts the science into action with practical tools to help you manage symptoms day by day, including:

- A curated list of low-FP foods, including coffee and alternatives

- FP values for over a thousand foods

- Tools to track diet and symptoms in real time

- A dashboard that gives you a clear view of your progress

- The ability to add your unique foods and recipes, complete with FP calculations

- Space to log daily notes in the Tracker

👉 Get the app now: https://www.fasttractdiet.com/


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🔬 Personalized Gut Health Strategies

If you’re ready to take control of reflux, IBS, SIBO, and other forms of gut dysbiosis and want a personalized plan built on the following 4 pillars, schedule your pre-consult appointment today.


- Root Cause Analysis – Identify and address the underlying factors driving your unique condition

- Dietary Modulation – Align your diet with your digestive capability to optimize nutrient absorption

- Targeted Supplementation – Use root cause analysis to remove unnecessary products and add proven, science-based supplements for relief and recovery

- Behavioral & Lifestyle Strategies – Adopt practical daily habits and evidence-based lifestyle changes that support long-term digestive health and overall well-being


👉 Book a pre-consult appointment here: https://calendly.com/drnorm/pre-consult-appointment-20-minutes

For international clients, please email rhea@digestivehealthinstitute.org

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References:

1. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes
2. Coffee, Caffeine, and Health Outcomes: An Umbrella Review
3. Coffee for Cardioprotection and Longevity
4. Coffee consumption, health benefits and side effects: a narrative review and update for dietitians and nutritionists
5. Health Benefits of Coffee Consumption for Cancer and Other Diseases and Mechanisms of Action
6. Effects of Coffee on the Gastro-Intestinal Tract: A Narrative Review and Literature Update
7. The impact of consumed coffee on the digestive system - review of the latest research
8. Effects of Coffee on Gut Microbiota and Bowel Functions in Health and Diseases: A Literature Review
9. Long-Term Coffee Consumption is Associated with F***l Microbial Composition in Humans
10. Impact of coffee consumption on the gut microbiota: a human volunteer study
11. Coffee consumption is associated with intestinal Lawsonibacter asaccharolyticus abundance and prevalence across multiple cohorts
12. Coffee by-products: An underexplored source of prebiotic ingredients
13. Health Effects of Coffee: Mechanism Unraveled?
14. Inhibitory effect of coffee on lower esophageal sphincter pressure
15. Effect of caffeine on lower esophageal sphincter pressure in Thai healthy volunteers
16. Association between coffee intake and gastroesophageal reflux disease: a meta-analysis
17. No Association of Coffee Consumption with Gastric Ulcer, Duodenal Ulcer, Reflux Esophagitis, and Non-Erosive Reflux Disease: A Cross-Sectional Study of 8,013 Healthy Subjects in Japan
18. The role of tea and coffee in the development of gastroesophageal reflux disease
19. Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux
20. Effect of coffee on gastro-oesophageal reflux in patients with reflux disease and healthy controls
21. Effect of Dewaxed Coffee on Gastroesophageal Symptoms in Patients with GERD: A Randomized Pilot Study
22. The effect of decaffeination of coffee on gastro-oesophageal reflux in patients with reflux disease
23. Effect of decaffeination of coffee or tea on gastro-oesophageal reflux

08/21/2025

📌 Acidic Foods, LPR, and the Fast Tract Diet – Key Points
Many members ask how acidic foods fit into reflux management, especially for those with laryngopharyngeal reflux (LPR). Here’s an overview based on Dropping Acid principles and Dr. Norm’s Fast Tract Diet approach.

🔬 Why Acidic Foods Matter in LPR
Pepsin activation: Reflux can carry pepsin from the stomach into the esophagus or throat.
Reactivation risk: Once present, pepsin can remain inactive until exposed to acidic foods or drinks, which can reactivate it and irritate tissues.

🥗 Short-Term Dietary Approach
While the long-term goal is to stop reflux entirely—preventing pepsin from leaving the stomach—reducing acidic foods can help manage symptoms in the interim:

- Avoid high-acid foods such as lemon, lime, vinegar, and tomato sauce/products.

- Use caution with fermented dairy (e.g., yogurt). It is generally less acidic but may still cause symptoms in sensitive individuals.

- If acidic foods are consumed, sipping alkaline water after every few bites is generally recommended to help neutralize acid.

⚠️ Important Limitations of the Low-Acid Approach
While this approach makes rational sense, it does not directly control or stop reflux—it only addresses the acid component after reflux has occurred.

Reflux contains more than just pepsin. It may also include:
- Acid
- Bile
- Other digestive enzymes
- Bacteria and their end products

These additional elements are not neutralized or mitigated by a low-acid diet.

💡 Dr. Norm’s Perspective
The low-acid approach can be useful as a short-term strategy during active reflux. The primary objective is to eliminate reflux episodes entirely, not simply to neutralize acid after the fact, and this is what the Fast Tract Diet is designed to do.

📝 Next Steps
- Track your symptom triggers.
- Continue applying the Fast Tract Diet to address the root cause, put gut-friendly practices into action, and reduce reflux events at their source.

For more information, read How To Fix LPR – LPR Diet That Stops Reflux below and testimonials: https://digestivehealthinstitute.org/testimonials-fast-tract-diet/

What is the most effective LPR diet? Why medications are ineffective for LPR, and trigger and low acid foods are examined by Dr. Robillard.

08/20/2025

🍬 Could sugar intolerance be part of your digestive issues?
I often see people say “no sugar” when dealing with gut issues. That makes sense, because sugar (sucrose) is not only difficult to digest for some people. It’s also made of glucose + fructose, and fructose itself is one of the fermentable carbs limited on the Fast Tract Diet. Beyond digestion, excess sugar in general is linked to weight gain, blood sugar spikes, and a higher risk of metabolic disease.

Normally, the enzyme sucrase breaks sucrose into glucose and fructose so your body can absorb it. But if you don’t make enough sucrase, either from Congenital Sucrase-Isomaltase Deficiency (CSID) or reduced enzyme activity, sucrose isn’t digested properly.

👉 Instead, it becomes fuel for microbes in the small intestine. For people with SIBO, SIFO, IBS, or reflux, this can lead to gas, bloating, diarrhea or constipation, abdominal pain, and reflux symptoms.

💊 The standard treatment is either avoiding sugar and sugar-containing foods, or a prescription enzyme called sacrosidase (Sucraid®), but it’s extremely expensive. A recent study* suggests that invertase (a yeast-derived enzyme that does the same job) may be a more effective and affordable alternative.

⚠️ Keep in mind: Enzymes like invertase only help with sucrose digestion. This approach does not address other fermentable carbs, including fructose on its own, starches, fibers, or sugar alcohols. It’s not just about sugar. All fermentable carbs add up. That’s why the Fast Tract Diet looks at the overall balance of fermentable carbs in your diet.

✨ Takeaway: If sugar makes your symptoms worse, it may be due to sucrase deficiency leading to undigested sucrose. Enzyme support like invertase can help with sucrose, but long-term relief comes from managing all fermentable carbs with a structured approach such as the Fast Tract Diet.

For more information about the Fast Tract Diet, check out the Fast Tract Digestion book series on Amazon.
Ready to put the Fast Tract Diet into practice? Try the Fast Tract Diet app: www.fasttractdiet.com

* https://adc.bmj.com/content/110/9/717?rss=1

08/19/2025

🍽️ Digestibility of Fermentable Carbs and Symptom Timing
It’s easy to blame the most recent food when you experience digestive symptoms, assuming that what you just ate must be the culprit. But digestion doesn’t work that way. The digestibility of each food—and what it’s made of—is unique. The key factor is how much fermentable carbohydrate it contains and how long it takes to break down.

For example:

If you had ice cream and developed diarrhea within 30–60 minutes, lactose (a simple sugar) is a likely cause because it is quickly fermented when not absorbed. Casein (milk protein) may also play a role in some cases.

If you ate grilled chicken and sautéed bok choy and experienced a reaction hours later, it’s unlikely due to the protein or vegetables themselves (unless food contamination or a rare allergy is involved). Instead, what you ate 12–24 hours earlier may be the actual driver of your symptoms, such as a bowl of oatmeal with banana or a serving of guacamole.

⚖️ Digestibility of Fermentable Carbohydrates
Here’s a simplified overview of how quickly different carbohydrate types that the Fast Tract Diet limits can ferment and trigger symptoms:

🥛 Lactose (dairy sugar): within 30 minutes – 2 hours*
🍯 Fructose (fruit, honey, sweeteners): 1 – 6 hours (estimated)
🍬 Sugar alcohols (sorbitol, xylitol, etc.): 1 – 6 hours (estimated)
🍌 Resistant starch (underripe banana, legumes, cooled potatoes/rice): 6 - 24 + hours** (estimated)
🌾 Fibers (inulin, FOS, oligosaccharides): 6 – 24+ hours***

🌙 Important Note
Sleep does not erase what you eat. Food remains in your gut overnight, and fermentation continues as long as fermentable carbohydrates are present. Because digestion and gut motility naturally slow down at night, fermentation may persist into the morning. This means that symptoms like bloating, reflux, gas, diarrhea, or even constipation experienced the next day can often be traced back to meals eaten the day before.

📖 Reference:
“Healthy humans have normal bowel motility during the day … with minimal activity during the night.”
(PMCID: PMC7147411)

✅ What To Do if Symptoms Persist
If your symptoms are mid-severe or not improving as you hoped, please:

- Read one of the Fast Tract Digestion books for a deeper understanding. (https://digestivehealthinstitute.org/shop/ or Amazon)
- Refer to the Fast Tract Diet app chapters for troubleshooting guidance. (https://www.fasttractdiet.com/)
- Identify and address underlying causes that are specific to you, and practice gut-friendly behaviors as part of the Fast Tract Diet system.

* https://shorturl.at/IYPVD
** https://pubmed.ncbi.nlm.nih.gov/11427691/
*** https://shorturl.at/mDSHN

08/12/2025

🔍 Understanding GERD Through the Lens of SIBO, other forms of gut dysbiosis, and Carbohydrate Fermentation

In this article*, physician and New York Times bestselling co-author Dr. Michael Eades described a pattern he observed repeatedly in his patients: when they reduced carbohydrates, their GERD symptoms often disappeared.

At first, he couldn’t explain the connection — until he learned about Dr. Norm Robillard’s theory. Dr. Norm's research suggests that in many cases, GERD may be driven by small intestinal bacterial overgrowth (SIBO) and other forms of gut dysbiosis.

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🧪 How This Works
Fermentable carbohydrates feed bacteria in the gut.
As these bacteria ferment the carbs, they produce gas.
This gas increases intra-abdominal pressure, which can push stomach contents — including acid — through the lower esophageal sphincter (LES) into the esophagus.

This mechanism was first described by Dr. Norm Robillard in his 2005 book Heartburn Cured.

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⏳ Why Symptoms Can Return Slowly
Some people notice a delayed return of symptoms after reintroducing carbs. It takes time for carb-loving bacteria to recolonize to the point of producing enough gas to trigger reflux.

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📊 Fermentation Potential (FP)
To help people make informed dietary choices, Dr. Norm developed the concept of Fermentation Potential (FP) — a measure of how much a food can fuel this gas-producing process. By choosing lower-FP foods or reducing total carbohydrate intake, many people can lower gut pressure and reduce reflux episodes. Remember, 30 g of unabsorbed carbohydrates can allow bacteria to produce more than ten liters of hydrogen gas.

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🌱 The Fast Tract Diet System
Built on this science, the Fast Tract Diet is structured around three key pillars:

🥗 Dietary modification – reducing high-FP foods to lower fermentation and gut pressure.
🧭 Identifying and addressing your specific underlying causes – tailoring the approach to your unique situation.
💡 Gut-friendly behaviors and practices – supporting digestive health beyond diet alone.

The Fast Tract Digestion: Heartburn book (https://shorturl.at/WCwpC) is the essential guide to understanding and applying this system.

The Fast Tract Diet app (https://www.fasttractdiet.com/) is where the rubber meets the road — turning the FP system into daily action so you can plan meals, track foods, and make real-time changes for relief and recovery.

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📚 Scientific References
Primary source on the Fermentation Potential (FP) system:
Robillard, Norman J. The Fast Tract Digestion Series (2012–2013). This two-book series outlines the FP system in detail and cites over 100 scientific references supporting his theory and approach.

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💭 Key Takeaway
For those managing GERD, this offers another perspective: rather than focusing only on acid suppression, we can address gut microbial balance, dietary triggers, and everyday habits that influence reflux.

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*Read Dr. Eades’ full article here: GERD — Treat With a Low- or High-Carb Diet?

Want to know what GERD is? What the symptoms are? And how to treat it nutritionally with either a low-carb or a high-carb diet. Here is the explanation.

06/18/2025

Are Your Protein Powders Gut-Friendly?

For individuals addressing IBS, SIBO, reflux (acid and non-acid, LPR), gas, bloating, or abdominal pain, protein powders can be either a convenient source of nutrition or an unexpected trigger.

From a microbiome-centered perspective, such as the Fast Tract Diet (https://digestivehealthinstitute.org/fast-tract-diet/), the key concern isn’t just protein quality. It’s a food’s Fermentation Potential (FP) that matters most.

What Is Fermentation Potential (FP)?

Fermentation Potential is a science-based metric that estimates how likely a food is to ferment in the gut and cause symptoms.

Key aspects of FP:
- Each food is assigned a specific FP value
- Lower FP = lower symptom potential
- Calculated based on the full spectrum of fermentable carbohydrate content and portion size
- Adaptable across dietary needs and cultural preferences

This system empowers individuals to make informed, symptom-conscious food choices without compromising variety or nutrition.

Protein Powders: What to Watch For

Many protein powders marketed as “clean” or “healthy” contain fermentable additives such as inulin, chicory root, acacia fiber, sugar alcohols, and gums.

These ingredients can feed gas-producing microbes in the small intestine, worsening symptoms in conditions like SIBO, IBS, and reflux.

Some blends contain over 15 grams of carbohydrates and up to 7 grams of fiber per serving, a significant fermentable load that can aggravate digestive symptoms instead of relieving them.

Better Protein Powder Choices

Rather than focusing on brands, evaluate each product label for:
- Low total carbohydrate and fiber content
- Minimal ingredients beyond the source of protein
- No added prebiotics, sugar alcohols, or emulsifiers
- Examples that typically meet these criteria include whey isolate, single-ingredient pea protein isolates, collagen peptides, and egg white–based powders.

These options are generally low in FP and better tolerated by individuals with sensitive digestion.

Why It Matters

Just 30 grams of unabsorbed carbohydrates can fuel the production of over 10 liters of hydrogen gas in the gut. In SIBO, this gas:

- Feeds methanogenic archaea, contributing to methane-dominant overgrowth (IMO)
Feeds hydrogen sulfide–producing bacteria, linked to H₂S-dominant SIBO
- In reflux—both acid and silent (LPR)—this gas increases intra-abdominal pressure, pushing stomach contents upward and intensifying symptoms.

Fast Tract Support

To make smart choices easier, the Fast Tract Diet app (https://www.fasttractdiet.com/) includes a curated list of low-FP protein powders, plus FP values for over a thousand foods.
Whether you’re managing SIBO, IBS, reflux, or general gut sensitivity, this tool can help guide your recovery.

Discover Low-FP Foods in the App (https://www.fasttractdiet.com/)

Essential Reading

To truly understand the science behind the Fast Tract Diet and apply it with confidence for relief and long-term recovery, reading the books is key:

- Fast Tract Digestion: Heartburn – A science-based, novel solution for stopping reflux at its source. This book addresses acid reflux, GERD, silent reflux (LPR), as well as SIBO and other forms of gut dysbiosis.

- Fast Tract Digestion: IBS – An integrative, science-based solution for IBS, SIBO, IMO, and other forms of gut dysbiosis that does not rely on antibiotics.

Both books offer a deep dive into the Fermentation Potential (FP) system and provide clear strategies to help reduce symptoms, rebalance the gut, and support lasting digestive health.

If you reside outside of the U.S., please visit Amazon for your country of residence to find these titles.

Dr. Norm Robillard’s latest email update
To subscribe and receive his free eBook, visit: https://digestivehealthinstitute.org/

05/06/2025

Fiber and Gut Health: Rethinking the Rules

Not all fiber supports digestion. Discover why fermentability matters more than solubility—especially for SIBO, IBS, and reflux.

04/30/2025

Diets for (acid and silent) reflux: trigger food, low acid, FTD (Fast Tract Diet)

What is the best dietary strategies for reflux? Trigger food, low acid or Fast Tract Diet?

04/29/2025

Pros and Cons of Elemental Diet for Digestive Health

Clinical studies show elemental diet helps short term. See where it falls short—and how the Fast Tract Diet offers lasting relief.

04/23/2025

Tried Rifaximin or Antimicrobials for SIBO—Now What?

Explore SIBO treatment beyond rifaximin and herbal antimicrobials with a 4-pillar strategy focused on root causes, digestion, and gut health.