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GAPS

 

Gut and Psychology Syndrome (GAP Syndrome or GAPS)

By Dr. N. Campbell-McBride

We live in the world of unfolding epidemics. Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder (ADHD/ADD), schizophrenia, dyslexia, dyspraxia, depression, obsessive –compulsive disorder, bi-polar disorder and other neuro-psychological and psychiatric problems in children and young adults are becoming more and more common.

In clinical practice these conditions more often than not overlap with each other. A child with autism often is hyperactive and dyspraxic. There is about 50% overlap between dyslexia and dyspraxia and 25-50% overlap between hyperactivity and dyslexia and dyspraxia. Children with these conditions are often diagnosed as being depressed and as they grow up they are more prone to substance abuse or alcoholism than their typically developing peers. A young adult diagnosed with schizophrenia would often suffer from dyslexia, dyspraxia or/and ADHD/ADD in childhood. Schizophrenia and bi-polar disorder are often described as two sides of one coin. We have created different diagnostic boxes to fit our patients in. But a modern patient does not fit into any one of them neatly. The modern patient in most cases fits into a rather lumpy picture of overlapping neurological and psychiatric conditions.

When we examine these patients in a clinical setting, we find that apart from so-called mental problems, they are also physically very ill. Digestive disorders, malnourishment, allergies, asthma, eczema, chronic cystitis, thrush and fussy eating habits are a consistent part of the picture.

What is a typical scenario we see in clinical practice?

Before examining the patient it is very important to look at the health history of the parents. Whenever the parents are mentioned people immediately think about genetics. However, apart of genetics there is something very important the parents, mother in particular, pass to their child: their unique gut micro-flora. Not many people know that an adult on average carries 2 kg of bacteria in the gut. There are more cells in that microbial mass than there are cells in an entire human body. It is a highly organised micro-world, where certain species of bacteria have to predominate to keep us healthy physically and mentally. Their role in our health is so monumental, that we simply cannot afford to ignore them. We will talk in detail about the child’s gut flora later. Now let us come back to the source of the child’s gut flora – the parents.

After studying hundreds of cases or neurological and psychiatric conditions in children, a typical health picture of these children’s mums has emerged. A typical modern mother was probably not breast fed when she was a baby, because she was born in 60s or 70s when breast-feeding went out of fashion. Why

is it important? Because it is well known that bottle fed babies develop completely different gut flora to the breast fed babies. This compromised gut flora in a bottle fed baby later on predisposes her to many health problems. Having acquired compromised gut flora from the start, a typical modern mum had quite a few courses of antibiotics in her childhood and youth for various infections. It is a well known fact that antibiotics have a serious damaging effect on the gut flora, because they wipe out the beneficial strains of bacteria in the gut. At the age of 16 and sometimes even earlier the modern mum was put on a contraceptive pill, which she took for quite a few years before starting a family. Contraceptive pills have a devastating effect on the beneficial(good) bacteria in the gut. One of the major functions of the good bacteria in the gut flora is controlling about 500 different known to science species of pathogenic (bad) and opportunistic microbes. When the beneficial bacteria get destroyed the opportunists get a special opportunity to grow into large colonies and occupy large areas of the digestive tract. A modern diet of processed and fast foods provides perfect nourishment for these pathogens and that is a typical diet a modern mum had as a child and a young adult. As a result of all these factors a modern mum has seriously compromised gut flora by the time she is ready to have children. And indeed clinical signs of gut dysbiosis (abnormal gut flora) are present in almost 100% of mothers of children with neurological and psychiatric conditions. The most common health problems in mothers are digestive abnormalities, allergies, auto-immunity, PMS, chronic fatigue, headaches and skin problems.

A baby is born with a sterile gut. In the first 20 or so days of life the baby’s virgin gut surface gets populated by a mixture of microbes. This is the child’s gut flora, which will have a tremendous effect on this child’s health for the rest of his/her life. Where does this gut flora come from? Mainly from the mother. So, whatever microbial flora the mother has she would pass to her new-born child.

Gut flora is something we do not think much about. And yet the number of functions the gut flora fulfils is so vital for us that if some day our digestive tract got sterilised we probably would not survive.

The first and very important function is appropriate digestion and absorption of food. If a child does not acquire normal balanced gut flora, then the child will not digest and absorb foods properly, developing multiple nutritional deficiencies. And that is what we commonly see in children and adults with learning disabilities, psychiatric problems and allergies. Many of these patients are malnourished. Even in the cases where the child may grow well, testing reveals some typical nutritional deficiencies in many important minerals, vitamins, essential fats, many amino-acids and other nutrients. The most common deficiencies, recorded in these patients, are in magnesium, zinc, selenium, copper, calcium, manganese, sulphur, phosphorus, iron, potassium, vanadium, boron, vitamins B1, B2, B3, B6, B12, C, A, D, folic acid, pantothenic acid, omega-3, 6, 9 fatty acids, taurine, alpha-ketoglutaric acid, glutathione and many other amino-acids. This usual list of nutritional deficiencies includes some most important nutrients for normal

development and function of the child’s brain, immune system and the rest of the body.

Apart of normal digestion and absorption of food healthy gut flora actively synthesises various nutrients: vitamin K, pantothenic acid, folic acid, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pyridoxine (vitamin B6), ciancobalamine (vitamin B12), various amino-acids and proteins. Indeed, when tested people with gut dysbiosis always present with deficiencies of these nutrients. Clinical experience shows that restoring the beneficial bacteria in their gut is the best way to deal with these deficiencies.

The majority of children and adults with neurological and psychiatric conditions look pale and pasty. When tested they show various stages of anaemia, which is not surprising. To have a healthy blood we require many different nutrients: vitamins (B1, B2, B3, B6, B12, K, A, D, etc), minerals (Fe, Ca, Mg, Zn, Co, Se, boron, etc.), essential amino-acids and fats. These patients not only cannot absorb these nutrients from food, but their own production of many of them in the body is damaged. On top of that people with damaged gut flora often have particular groups of pathogenic bacteria growing in their gut, which are iron-loving bacteria (Actinomyces spp., Mycobacterium spp., pathogenic strains of E.Coli, Coryne bacterium spp. and many others). They consume whatever iron the person gets from the diet, leaving that person deficient in iron. Unfortunately, supplementing iron only makes these bacteria grow stronger and does not remedy anaemia. To treat anaemia the person requires all the nutrients we have mentioned, many of which healthy gut flora supplies.

Apart from taking a direct part in nourishing the body, beneficial bacteria in the gut act as the housekeepers for the digestive tract. They coat the entire surface of the gut protecting it from invaders and toxins by providing a natural barrier and producing a lot of anti-bacterial, anti-viraland anti-fungal substances. At the same time they provide the gut lining with nourishment. It is estimated that 60 – 70% of energy, the gut lining derives, is from the activity of bacteria, which live on it. So, it is no surprise that when the gut flora is abnormal the digestive tract itself cannot be healthy. Indeed most children and adults with learning disabilities, psychiatric disorders and allergies present with digestive problems. In many cases these problems are so severe, that the patients (or their parents) talk about them first. In some cases they may not be very severe, but when asked direct questions the parents describe that their child never had normal stool, that their child suffered from colic as a baby and that tummy pains, bloating and flatulence are a common part of the picture. Adult sufferers describe the same kind of symptoms. In those cases where these children and adults have been examined by gastro-enterologists inflammatory process in the gut was found along with faecal compaction and an over-spill syndrome. Dr. Andrew Wakefield and his team at the RoyalFree Hospital in London in the late 90s found an inflammatory condition in the bowel of autistic children, which they have named Autistic Enterocolitis. Schizophrenic patients were always known to have serious digestive problems. Dr. Curtis Dohan,

MD has devoted many years to researching digestive abnormalities in schizophrenia. He found a lot of similarities between coeliac disease and the state of the digestive tract in schizophrenics. Indeed, in my clinical practice long before these patients develop psychotic symptoms they suffer from digestive problems and all other typical symptoms of gut dysbiosis pretty much from the start of their lives. Children and young adults with ADHD/ADD, OCD, depression and other neuro-psychological problems are very often reported to suffer from digestive abnormalities.

What other symptoms of gut dysbiosis do we know?

Well-functioning gut flora is the right hand of our immune system. The beneficial bacteria in the gut ensure appropriate production of different immune cells, immunoglobulins and other parts of the immunity. But most importantly they keep the immune system in the right balance. What typically happens in a person with gut dysbiosis is that two major arms of their immune system Th1 and Th2 get out of balance with underactiveTh1 and overactive Th2. As a result the immune system starts reacting to most environmental stimuli in an allergic or atopic kind of way. A baby is born with an immature immune system. Establishment of healthy balanced gut flora in the first few days of life plays a crucialrole in appropriate maturation of the immune system. If the baby does not acquire appropriate gut flora then the baby is left immune compromised. The result is lots of infections followed by lots of courses of antibiotics, which damage the child’s gut flora and immune system even further. The most common infections in the first two years of life in the children with neurological, psychological and atopic disorders are ear infections, chest infections, sore throats and impetigo. At the same time in the first two years of life the child receives a lot of vaccinations. A child with compromised immune system does not react to vaccinations in a predicted way. In most cases vaccines deepen the damage to the immune system and provide a source of chronic persistent viral infections and autoimmune problems in these children. There has been a considerable amount of research published into the state of the immune system in children and adults with learning disabilities and psychiatric problems. The research shows deep abnormalities in all major cell groups and immunoglobulins in these patients. The most common autoantibodies found are to myelin basic protein (MBP) and neuron-axon filament protein (NSFP). These antibodies attack the person’s brain and the rest of the nervous system.

So, the modern patient (child or adult), who we are talking about, did not get normal gut flora from the start and then got it damaged even further by repeated courses of antibiotics and vaccinations. As a result these children and adults commonly suffer from digestive problems, allergies, asthma and eczema. But apart from that in people who then go on to develop neurological and psychiatric problems something even more terrible happens. Without control of the beneficial bacteria different opportunistic and pathogenic bacteria, viruses and fungi have a good chance to occupy large territories in the digestive tract of the patient and

grow large colonies. Two particular groups which are most commonly found on testing are yeasts (including Candida species) and Clostridia family. These pathogenic microbes start digesting food in their own way producing large amounts of various toxic substances, which get absorbed into the blood stream, carried to the brain and cross the blood – brain barrier. The number and mixture of toxins can be very individual, causing different neurological and psychiatric symptoms. Due to the absence or greatly reduced numbers of beneficial bacteria in the gut flora, the person’s digestive system instead of being a source of nourishment becomes a major source of toxicity in the body.

So, what kind of toxins are we talking about?

There are many toxins, which we have not studied very well yet. But some toxins have received a considerable amount of research. Let us have a look at them.

Acetaldehyde & Alcohol

The most common pathogenic microbes shown to overgrow in the digestive systems of children and adults with neuro-psychiatric conditions are yeasts, particularly Candida species. Yeasts ferment dietary carbohydrates with production of alcohol and its by-product acetaldehyde. Let us see what does a constant exposure to alcohol and acetaldehyde do to the body.

Liver damage with reduced ability to detoxify drugs, pollutants and other toxins.

Pancreas degeneration with reduced ability to produce pancreatic enzymes, which would impair digestion.

Reduced ability of the stomach wall to produce stomach acid.

Damage to immune system.

Brain damage with lack of self-control, impaired co-ordination, impaired speech development, aggression, mental retardation, loss of memory and stupor.

Peripheral nerve damage with altered senses and muscle weakness.

Direct muscle tissue damage with altered ability to contract and relax and muscle weakness.

Nutritional deficiencies from damaging effect on digestion and absorption of most vitamins, minerals and amino acids. Deficiencies in B and A vitamins are particularly common.

Alcohol has an ability to enhance toxicity of most common drugs, pollutants and other toxins.

Alteration of metabolism of proteins, carbohydrates and lipids in the body.

Inability of the liver to dispose of old neurotransmitters, hormones and other by-products of normal metabolism. As a result these substances accumulate in the body, causing behavioural abnormalities and many other problems.

Acetaldehyde is considered to be the most toxic of alcohol by-products. It is the chemical, which gives us the feeling of hangover. Anybody who experienced a hangover would tell you how dreadful he or she felt. Children, who acquire abnormal gut flora with a lot of yeast from the start, may never know any other feeling. Acetaldehyde has a large variety of toxic influences on the body. One of the most devastating influences of this chemical is its ability to alter the structure of proteins. Acetaldehyde – altered proteins are thought to be responsible for many autoimmune reactions. Children and adults with neuro-psychiatric problems are commonly found to have antibodies against their own tissues.

Clostridia Neurotoxins

There are about 100 different Clostridia species known so far. They are present in the stools of people with autism, schizophrenia, psychosis, severe depression, muscle paralysis and muscle tonus abnormalities and some other neurological and psychiatric conditions. Many Clostridia species are normal inhabitants of a human gut. For example Clostridium tetani is routinely found in the gut of healthy humans and animals. Everybody knows that tetanus is a deadly disease, due to an extremely powerful neurotoxin Clostridium tetani produces. Clostridium tetani, which lives in the gut, is normally controlled by the beneficial bacteria and does us no harm, because its toxin cannot get through the healthy gut wall. Unfortunately, patients, which we are talking about, do not have a healthy gut wall. In gut dysbiosis this powerful neurotoxin can get through the damaged gut lining and then cross the blood-brain barrier affecting the person’s mental development. Many other species of Clostridia (perfringens, novyi, septicum, histolyticum, sordelli, aerofoetidum, tertium, sporogenes, etc) produce toxins similar to tetanus toxin as well as many other toxins. Dr. William Shaw at Great Plains Laboratories describes in detail number of autistic children, who showed serious improvements in their development and biochemical tests while on anti-Clostridia medication. Unfortunately, as soon as the medication was stopped the children slipped back into autism, because these children do not have healthy gut flora to control Clostridia and not to allow their toxins through the gut lining into the bloodstream. In many cases Clostridia were not identified in the stools of these children, because Clostridia are strict anaerobes and are very difficult to study. We need to come up with some better ways of testing for these potent pathogens.

Yeasts and Clostridia have been given a special opportunity by the era of antibiotics. Broad-spectrum antibiotics do not touch them while killing the beneficial bacteria in the gut, which are supposed to control the yeasts and Clostridia. So, after every course of antibiotics these two pathogenic groups get out of control and overgrow. The patients that we are talking about usually are exposed to numerous courses of antibiotics pretty much from the beginning of their lives.

Gluteomorphins & Casomorphins or opiates from gluten and casein.

Gluten is a protein present in grains, mainly wheat, rye, oats, barley. Casein is a milk protein, present in cow, goat, sheep, human and all other milk and milk

products. In the bodies of children and adults with autism and schizophrenia these proteins do not get digested properly due to the fact that their digestive systems are full of abnormal microbial flora and hence unhealthy. As a result of misdigestion gluten and casein turn into substances with similar chemical structure of opiates, like morphine and heroin. There has been quite a substantial amount of research done in this area by Dohan, Reichelt, Shattock, Cade and others, where gluten and casein peptides, called gluteomorphins and casomorphins, were detected in the urine of schizophrenic patients and autistic children. Incidentally, these substances were also found in patients with depression and rheumatoid arthritis. These opiates from wheat and milk get through the blood-brain barrier and block certain areas of the brain, just like morphine or heroin would do, causing various neurological and psychiatric symptoms. Based on this research the gluten and casein free diet(GFCF diet) has been developed.

Dermorphin & Deltorphin

These are two frightening toxic substances with opiate structure, which have been found in autistic children by a biochemist Alan Friedman, PhD. Dermorphin and deltorphin were first identified on the skin of a poison dart frog in South America. Native people used to dip their darts into the mucous on these frogs in order to paralyse their enemy, because deltorphin and dermorphin are extremely potent neurotoxins. Dr Friedman believes that it is not the frog that produces these neurotoxins, but a fungus, which grows on the skin of this frog. It is possible that this fungus grows in the gut of autistic children, supplying their bodies with dermorphin and deltorphin.

Organic Acid Testing available now in many laboratories around the world identify various metabolites of microbial activity in the gut, which get absorbed and finish up in the patient’s urine. Many of these metabolites are highly poisonous substances.

Low Serum Sulphate is a common picture in these patients, which is an indirect indication of toxicity in the body, because sulphates are essential for many detoxification processes and normalmetabolism of brain neurotransmitters. In many cases the person may be getting plenty of sulphates through the diet, but they all get consumed by the detox pathways struggling with the river of toxicity, which is constantly coming from the person’s gut. At the same time another large group of bacteria, which commonly overgrow in the gut dysbiosis situation are sulphate-reducing bacteria, which make sulphur unavailable for the body to use. These bacteria metabolise sulphate coming from food into sulphites, many of which are toxic like hydrogen sulphide for example, which is the gas with rotten egg smell. Some parents of autistic, hyperactive and other children tell me that their child’s stool has this characteristic smell.

The mixture of toxicity in each child or adult can be quite individual and different. But what they all have in common is gut dysbiosis. The toxicity, which is produced by the abnormal microbial mass in these people, establishes a link between the gut

and the brain. That is why I have grouped these disorders together and gave them a name: the Gut and Psychology Syndrome (GAP Syndrome). The GAPS children and adults can present with symptoms of autism, ADHD, ADD, OCD, dyslexia, dyspraxia, schizophrenia, depression, sleep disorders, allergies, asthma and eczema in any possible combination. These are the patients who fall in the gap in our medical knowledge. Any child or adult with a learning disability, neurological or psychiatric problems should be thoroughly examined for gut dysbiosis. Re-establishing normal gut flora and treating the digestive system of the patient has to be the number one treatment for these disorders, before considering any other treatments with drugs or otherwise.

Gut And Psychology Syndrome (GAP Syndrome or GAPS) establishes the connection between the state of the patient’s gut and the functioning of the brain. This connection has been known by medics for a very long time. The father of modern psychiatry French psychiatrist Phillipe Pinel (1745–1828), after working with mental patients for many years, concluded in 1807: "The primary seat of insanity generally is in the region of the stomach and intestines." Long before him Hippocrates (460-370 BC), the father of modern medicine has said: "All diseases begin in the gut!" The more we learn with our modern scientific tools, the more we realise just how right they were!

The Full GAPS Diet

By Dr Natasha Campbell-McBride

Your patient needs to carry on completely avoiding starches and sugar for two years at least. It means avoiding all grains, sugar, potatoes, parsnips, yams, sweet potato and anything made out of them. The flour in your cooking and baking can be replaced with ground almonds (or any other nuts or sunflower or pumpkin seeds ground into flour). In about 1 – 1.5 years you may be able to introduce new potatoes, fermented buckwheat, millet and quinoa, starting from very small amounts and observing any reaction. Wheat, sugar, processed foods and all additives will have to be out of the diet for much longer.

Slowly increase the amounts of fermented foods. You can ferment vegetables, fruit, milk and fish (please look in the recipe section). I would also recommend reading a wonderful book by Sally Fallon "Nourishing Traditions", it will provide you with a lot of good recipes. Eating fermented foods with every meal will help your patient to digest the meal without using supplements or digestive enzymes. Make sure to introduce all new fermented foods into the diet very gradually starting from 1-2 teaspoons a day.

The best foods for the GAPS person are eggs, meats and fish (bought fresh or frozen, not smoked or canned, and cooked at home), shellfish, fresh vegetables and fruit, nuts and seeds, garlic and olive oil. As well as eating the vegetables cooked it is important to have them raw in the form of salads and sticks. In this form they will provide your patient with valuable enzymes and detoxifying substances, which

will help in digesting meats. Raw fruit should be eaten on their own, not with meals, as they have a very different digestion pattern and can make the work harder for the stomach. At that stage let your patient to have fruit as a snack between meals. Remember, that about 85% of everything your patient eats on a daily basis should be savoury – made out of meats, fish, eggs, vegetables and natural fats. Sweet baking and fruit should be snacks between meals in limited amounts.

It is very important for a GAPS person to have plenty of natural fats in every meal from meats, butter, ghee, coconut and cold pressed olive oil. The fat content of the meal will regulate the blood sugar level and control cravings for carbohydrates.

If your patient gets a tummy bug or any other form of diarrhoea go back to the low fibre diet for a few days: remove all nuts, raw vegetables and raw fruit out of the diet; go back to meats cooked in water and meat stock, fish, eggs, fermented dairy and cooked vegetables (skinned, de-seeded and well cooked with meats as soups and stews) until diarrhoea completely clears. After the stools stay normal for a week introduce raw vegetables slowly, one at a time and starting from small amounts. When vegetables are introduced, try to introduce nuts, seeds and fruit gradually.

It is important for your GAPS patient to balance the meals so that his or her body pH stays normal. All protein foods, such as meats, fish, eggs and cheese leave an acid ash in the body, which may aggravate his or her condition. Vegetables are alkalising, so you need to combine meats, fish and eggs with good amount of vegetables cooked and/or raw. Raw fruit, vegetables and greens have particularly strong alkalising ability. Apple cider vinegar is very alkalising, it is good to have it every day: just add one teaspoon of cider vinegar into every glass of water your patient drinks. Hot water with cider vinegar will makes an excellent warming and alkalising drink. Fermented foods are also alkalising.

It is very important to avoid processed foods (any packet or tinned foods). They are stripped from most nutrients that were present in the fresh ingredients used for making these foods. They are a hard work for the digestive system and they damage the healthy gut flora balance. On top of that they usually contain a lot of artificial chemicals, detrimental to health, like preservatives, colorants, E-numbers, etc. Try to buy foods in the form that nature made them, as fresh as possible.

Do not use a microwave oven, as it destroys food. Cook and warm up food using conventional oven and stove.

The 6 introduction stages to the GAPS Nutrition Protocol provide individuals with a kick start to healing.

Gut and Psychology Syndrome

Introduction Diet

The Introduction Diet has been designed for people with serious digestive problems, persistent diarrhoea, food allergies and intolerances. These individuals should follow the Introduction Diet before progressing into the full GAPS diet. People who experience constipation during the introduction stages should strongly consider implementing an enema as described in the GAPS book. An individuals body can become very toxic if constipation is left too long and bowls do not move for more than 36 hours. Please refer to page 225 in the GAPS book for more information before you commence with the introduction stages because the detox is a low fibre diet.

*Note: Those who start with the Introduction Diet will introduce dairy earlier than those who go right into the full GAPS diet. Always do a sensitivity test prior to introducing dairy.

IMPLEMENTING THE DIET

Provided by Dr. Natasha Campbell-McBride

1. Introduction Diet 2. The Full GAPS Diet with the typical menu

INTRODUCTION DIET

I recommend that most GAPS patients follow the Introduction Diet before going into the Full GAPS diet. Depending on the severity of your patient’s condition he or she can move through this program as fast or as slow as his/her condition will permit: for example you may move through the First Stage in one or two days and then spend longer on the Second Stage. Following the Introduction Diet fully is essential for people with diarrhea or severe constipation: it reduces symptoms quickly and speeds up the healing process in the digestive system. Even for healthy people, if you or your child gets a ‘tummy bug’ or any other profuse diarrhea, following the Introduction Diet for a few days will clear the symptoms quickly and permanently without needing any medication.

Those without severe digestive problems can move through the Introduction Diet quite quickly. However, please do not be tempted to skip the Introduction Diet and go straight into the Full GAPS Diet, because the Introduction Diet will give your patient the best chance to optimize the healing process in the gut and the rest of the body. I see many cases where skipping the Introduction Diet leads to long-term lingering problems, difficult to deal with.

EVERY MORNING

Start the day with a cup of still mineral or filtered water. Give your patient the probiotic. Make sure that the water is warm or room temperature, not cold, as cold will aggravate his or her condition.

Only foods listed are allowed: your patient must not have anything else. On the First Stage the most drastic symptoms of abdominal pain, diarrhea and constipation will quickly subside. If, when you introduce a new food, your patient gets back diarrhea, pain or any other digestive symptoms then he/she is not ready for that food to be introduced. Wait for a week and try again.

If you suspect an allergy to any particular food, before introducing it do the Sensitivity Test.

SENSITIVITY TEST

Take a drop of the food in question (if the food is solid, mash and mix with a bit of water) and place it on the inside of the wrist of the patient. Do it at bedtime. Let the drop dry on the skin, then let your patient go to sleep. In the morning check the spot: if there is an angry red reaction, then avoid that food for a few weeks, and then try again. If there is no reaction, then go ahead and introduce it gradually starting from a small amount.

6 Introduction Stages

STAGE 1 Homemade meat or fish stock. Meat and fish stocks provide building blocks for the rapidly growing cells of the gut lining and they have a soothing effect on any areas of inflammation in the gut. That is why they aid digestion and have been known for centuries as healing folk remedies for the digestive tract. Do not use commercially available soup stock granules or bullion cubes, they are highly processed and are full of detrimental ingredients. Chicken stock is particularly gentle on the stomach and is very good to start from. To make good meat stock you need joints, bones, a piece of meat on the bone, a whole chicken, giblets from chicken, goose or duck, whole pigeons, pheasants or other inexpensive meats. It is essential to use bones and joints, as they provide the healing substances, not so much the muscle meats. Ask the butcher to cut in half the large tubular bones, so you can get the bone marrow out of them after cooking. Put the bones, joints and meats into a large pan and fill it with water, add natural unprocessed salt to your taste at the beginning of cooking and about a teaspoon of black peppercorns, roughly crushed. Bring to boil, cover and simmer on a low heat for 2.5-3 hours. You can make fish stock the same way using a whole fish or fish fins, bones and heads. After cooking take the bones and meats out and sieve the stock to remove small bones and peppercorns. Strip off all the soft tissues from the bones as best as you can to later add to soups or encourage your patient to eat all the soft tissues on the bones. Extract the bone marrow out of large tubular bones while they are still warm: to do that bang the bone on a thick wooden chopping board. The gelatinous soft tissues around the bones and the bone marrow provide some of the best healing remedies for the gut lining and the

immune system; your patient needs to consume them with every meal. Take off all the soft tissues from fish bones and heads and reserve for adding to soups later. The meat or fish stock will keep well in the fridge for at least 7 days or it can be frozen. Keep giving your patient warm meat stock as a drink all day with his meals and between meals. Do not use microwaves for warming up the stock, use conventional stove (microwaves destroy food). It is very important for your patient to consume all the fat in the stock and off the bones as these fats are essential for the healing process. Add some probiotic food into every cup of stock (the details about introducing probiotic food follow).

Homemade soup with your homemade meat or fish stock. Please look for some recipe ideas in the recipe section of the book. Here we will go through some details, specific for the Introduction Diet. Bring some of the meat stock to boil, add chopped or sliced vegetables: onions, carrots, broccoli, leeks, cauliflower, courgettes, marrow, squash, pumpkin, etc. and simmer for 25-35 minutes. You can choose any combination of available vegetables avoiding very fibrous ones, such as all varieties of cabbage and celery. All particularly fibrous parts of vegetables need to be removed, such as skin and seeds on pumpkins, marrows and squashes, stalk of broccoli and cauliflower and any other parts that look too fibrous. Cook the vegetables well, so they are really soft. When vegetables are well cooked, add 1-2 tablespoons of chopped garlic, bring to boil and turn the heat off. Give your patient this soup with the bone marrow and meats and other soft tissues, which you cut off the bones. You can blend the soup using a soup blender or serve it as it is. Add some probiotic food into every bowl of soup (the details about introducing probiotic foods follow). Your patient should eat these soups with boiled meat and other soft tissues off the bones as often as he/she wants to all day.

Probiotic foods are essential to introduce right from the beginning. These can be dairy based or vegetable based. To avoid any reactions introduce probiotic foods gradually, starting from 1-2 teaspoons a day for 2-5 days, then 3-4 teaspoons a day for 2-5 days and so on until you can add a few teaspoons of the probiotic food into every cup of meat stock and every bowl of soup. If your patient is ready to introduce dairy, then use your homemade yogurt or kefir. If dairy is still out [by results of sensitivity test or negative reaction when introducing it], then into every cup of meat stock or soup add juice from your homemade sauerkraut, fermented vegetables or vegetable medley (please look in the recipe section of the book). Make sure that the food is not too hot when adding the probiotic foods, as the heat would destroy the beneficial probiotic bacteria.

Ginger tea with a little honey between meals. To make ginger tea, grate some fresh ginger root (about a teaspoonful) into your teapot and pour some boiling water over it, cover and leave for 3-5 minutes. Pour through a small sieve and add honey to taste (optional).

STAGE 2

Continue with Stage 1. Keep giving your patient the soups with bone marrow, boiled meats or fish and other soft tissues off the bones. He or she should keep drinking the meat stock and ginger tea. Keep adding some probiotic food into every cup of meat stock and every bowl of soup: juices from sauerkraut, fermented vegetables or vegetable medley, or homemade kefir/yogurt.

Add raw organic egg yolks. It is best to have egg yolks raw added to every bowl of soup and every cup of meat stock. Start from 1 egg yolk a day and gradually increase until your patient has an egg yolk with every bowl of soup. When egg yolks are well tolerated add soft-boiled eggs to the soups (the whites cooked and the yolks still runny). If you have any concerns about egg allergy, do the sensitivity test first. There is no need to limit number of egg yolks per day, as they absorb quickly almost without needing any digestion and will provide your patient with wonderful and most needed nutrition. Get your eggs from a source you trust: fresh, free range and organic.

Add stews and casseroles made with meats and vegetables. Avoid spices at this stage; just make the stew with salt and fresh herbs (look for a recipe of Italian Casserole in the recipe section of the book). The fat content of these meals must be quite high: the more fresh animal fats your patient consumes, the quicker he or she will recover. Add some probiotic food into every serving.

Increase daily amount of homemade yogurt and kefir, if introduced. Increase the amount of juice from sauerkraut, fermented vegetables or vegetable medley.

Introduce fermented fish, starting from one piece a day and gradually increasing. Look for recipes in recipe section.

Introduce homemade ghee, starting from 1 teaspoon a day and gradually increasing. Look for recipe in recipe section.

STAGE 3 Carry on with all the previous foods.

Add ripe avocado mashed into soups, starting from 1-3 teaspoons and gradually increasing the amount.

Add pancakes, starting from one pancake a day and gradually increasing the amount. Make these pancakes with three ingredients: 1) organic nut butter (almond, walnut, peanut, etc); 2) eggs; 3) a piece of fresh winter squash, marrow or courgette (peeled, de-seeded and well blended in a food processor). Fry small thin pancakes using ghee, goose fat or duck fat. Make sure not to burn them.

Egg scrambled with plenty of ghee, goose fat or duck fat. Serve it with avocado (if well tolerated) and cooked vegetables. Cooked onion is particularly good for the digestive system and the immune system: melt 3

tablespoons of duck fat or ghee in the pan, add sliced large white onion, cover and cook for 20-30 minutes on low heat.

Introduce the sauerkraut and your fermented vegetables (your patient has been drinking the juices from them for a while now). Start from a small amount, gradually increasing to 1-2 tablespoons of sauerkraut or fermented vegetables per every meal.

STAGE 4

Carry on with all previous foods.

Gradually add meats cooked by roasting and grilling (but not barbecued or fried yet). Avoid bits, which are burned or too brown. Let your patient eat the meat with cooked vegetables and sauerkraut (or other fermented vegetables).

Start adding cold pressed olive oil to the meals, starting from a few drops per meal and gradually increasing the amount to 1-2 tablespoons per meal.

Introduce freshly pressed juices, starting from a few spoonfuls of carrot juice. Make sure that the juice is clear, filter it well. Let your patient drink it slowly or diluted with warm water or mixed with some homemade yogurt. If well tolerated gradually increase to a full cua a day. When a full cup of carrot juice is well tolerated try to add to it juice from celery, lettuce and fresh mint leaves. Your patient should drink the juice on an empty stomach, so first thing in the morning and middle of afternoon are good times.

Try to bake bread with ground almonds or any other nut and seeds ground into flour. The recipe (please look in recipe section of the book) requires only four ingredients: 1) nut flour; 2) eggs; 3) piece of fresh winter squash, marrow or courgette (peeled, de-seeded and finely sliced); 4) some natural fat (ghee, butter, goose or duck fat) and some salt to taste. Your patient should start from a small piece of bread per day and gradually increase the amount.

STAGE 5

If all the previous foods are well tolerated try to add cooked apple as an apple pure. Peel and core ripe cooking apples and stew them with a bit of water until soft. When cooked add some shee to it and mash with a potato masher. If ghee has not bee introduced yet add duck or goose fat. Start from a few spoonfuls a day. Watch for any reaction. If there is none gradually increase the amount.

Add raw vegetables starting from softer parts of lettuce and peeled cucumber. Watch your patient’s stool. Again start from a small amount and gradually increase if well tolerated. After those two vegetables are well tolerated gradually add other raw vegetables: carrot, tomato, onion, cabbage, etc.

If the juice made from carrot, celery, lettuce and mint is well tolerated, start adding fruit to it: apple, pineapple and mango. Avoid citrus fruit at this stage.

STAGE 6

If all the introduced foods are well tolerated try some peeled raw apple. Gradually introduce raw fruit and more honey.

Gradually introduce baking cakes and other sweet things allowed on the diet. Use dried fruit as a sweetener in the baking.

As I mentioned before, your patient may be able to move through the Introduction Diet faster or slower depending on the stool changes: let the diarrhea start clearing before moving to the next stage. You may have to introduce some foods later than in the program depending on his/her sensitivities. Make sure that you carry on with the soups and meat stock after your patient has completed the Introduction Diet at least once a day.

After the Introduction Diet is completed and when your patient has more or less normal stools move into the Full GAPS Diet.

THE FULL GAPS DIET

A Typical Menu: Start the day with a glass of still mineral water or filtered water with a slice of lemon. It can be warm or cold to personal preference.

If you have a juicer your patient can start the day with a glass of freshly pressed fruit/vegetable juice diluted with water. A good juice to start the day is 40% apple + 50% carrot + 10% beetroot (all raw of course). You can make all sorts of juice mixes, but generally try to have 50% of therapeutic ingredients: carrot, small amount of beetroot (no more than 5-10% of juice mixture), celery, cabbage, lettuce, greens (spinach, parsley, dill, basil, fresh nettle leaves, beet tops, carrot tops), white and red cabbage, and 50% of some tasty ingredients to disguise the taste of therapeutic ingredients: pineapple, apple, orange, grapefruit, grapes, mango, etc. Your patient can have these juices as they are, with some yogurt or diluted with water.

Every day our bodies go through a 24 hour cycle of activity and rest, feeding and cleaning up (detoxifying). From about 4 am till about 10 am the body is in the cleaning up or detoxification mode. Drinking water and freshly pressed juices will assist in this process. Loading the body with food at that time interferes with the detoxification. That is why many of us do not feel hungry first thing in the morning. It is better to have breakfast around 10 am when your body has completed the detox stage and is ready for feeding. At that stage we usually start feeling hungry. Children may be ready for their breakfast earlier than adults.

BREAKFAST CHOICES

A variation of English breakfast: eggs cooked to personal liking and served with sausages and vegetables, some cooked, some fresh as a salad (tomato, cucumber, onions, celery, and fresh salad greens, etc.) and/or avocado and/or meat. The yolks

are best uncooked that the whites cooked. Use plenty of cold pressed olive oil as a dressing on the salad and eggs. Mix a tablespoon of pre-soaked or sprouted sunflower and/or sesame and/or pumpkin seeds with the salad. Sausages (full fat) should be made of pure minced meat with only salt and pepper added. Make sure that there are no commercial seasonings or MSG (Monosodium Glutamate) in the sausages. I recommend finding a local butcher, who would make pure meat sausages for you on order

Avocado with meat, fish or shellfish, vegetables raw and cooked, lemon and cold pressed olive oil. Serve a cup of warm meat stock as a drink with food.

Pancakes made with ground nuts. These pancakes are delicious with some butter with honey, or as a savory snack. If you blend some fresh or defrosted berries with honey, it will make a delicious jam to have with pancakes. Weak tea with lemon, ginger tea or mint tea.

Any of the home baked goods: muffins, fruit cake and bread.

LUNCH CHOICES

Homemade vegetable soup or stew in a homemade meat stock.

Avocado with meat, fish, shellfish and raw and/or cooked vegetables. Use olive oil with some lemon squeezed over it as a dressing. Serve a cup of warm homemade meat stock as a drink.

Any meat/fish dish with vegetables.

DINNER CHOICES

One of the dishes from the lunch or breakfast choices.

There are many recipes found in the book. You can also take old recipes and give them your own GAPS diet update.

GAPS List of Allowable and Non Allowable foods can be located in the GAPS book, along with the GAPS recipes.

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