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What to do when the GAPS diet fails

Montana Whole Health / Children's health tips  / Children's health conditions  / ADHD  / What to do when the GAPS diet fails

What to do when the GAPS diet fails

What to do when the GAPS diet fails

A decade ago Dr. Natasha Campbell-McBride published her now-famous book titled Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia. A few years ago I started noticing a huge trend in parents trying the GAPS diet on their own, either after reading the book or getting advice from friends or other health or mom bloggers.  I have recommended the GAPS diet (or more commonly, the Specific Carbohydrate Diet) to some families as well.

But what happens when the GAPS diet fails?

This blog post will address some of the most common reasons why the GAPS diet doesn’t work.

So first, a little background behind GAPS.  The diet originated with the Specific Carbohydrate Diet, popularized by Elaine Gottschall in her book Breaking the Vicious Cycle.  (For more information, I highly recommend reading the whole book: Breaking the Vicious Cycle: Intestinal Health Through Diet.)  Dr. Campbell-McBride slightly modified the SCD diet, further restricting certain foods and focusing on healing nutrients.  The aim of the GAPS diet is to reduce intestinal dysbiosis, limit carbohydrates or starches that feed gut dysbiosis, and simultaneously provide gut-healing nutrients.  Her experience has been that healing the gut provides beneficial effects in the nervous system, which reduces symptoms of autism, ADHD, depression and schizphrenia.  (I second that experience – I have seen many patients where healing their intestines helps significantly with some of these other psychological symptoms.)

I should pause here a little bit and give a side note.  The GAPS diet has never been scientifically validated for “curing” schizophrenics, autistic children, depressed patients, or those with ADHD.  There are many doctors concerned about the GAPS diet, saying it lacks certain essential nutrients, and that it is not a long-term healthy diet.

I agree.

So why do I recommend a non-scientifically validated therapy that requires an incredible amount of work? Because when it does work it can have hugely beneficial effects.

Remember: the goal of a Naturopathic Physician like myself is to uncover the underlying cause of why someone is ill. For many children with ADHD, autism, depression, etc, the underlying cause is malabsorption, gut dysbiosis, leaky gut syndrome, or intestinal inflammation.  This may be the underlying cause for many children, but not for all!

The purpose of the GAPS diet is not to replace a normal diet.  The GAPS diet, I believe, should be used for a short to moderate amount of time (usually 1- 6 months, sometimes longer), to eliminate gut dysbiosis and inflammation and stimulate healing of enterocytes (the intestinal cells).   The goal is to completely heal the gut, discover which food allergens/sensitivities are a problem, and then progress to a long-term well-rounded diet.  (I highly recommend the anti-inflammatory diet as a long-term dietary strategy.  A lot of research has supported long-term anti-inflammatory diets like the mediterranean diet for disease prevention and health promotion.)

When the GAPS diet fails one of a few things may have happened: 1) the gastrointestinal system was not the underlying cause, or 2) the GAPS diet failed to address the gastrointestinal problem.

If the GAPS diet fails because of #1, parents and physicians need to spend quite a bit of time investigating other options.  (See my blog post about ADHD evaluation and treatment for more ideas. This can be helpful for other conditions, including autism, depression and anxiety).  I highly recommend seeing a competent physician who can order basic blood tests, including a whole-blood lead test (every child should be screened at least once in their lifetime), complete blood count (to screen for anemia), ferritin to check for low iron, thyroid, and vitamin D.

If the GAPS diet fails because of #2 – then we need to talk.

There are a lot of things I really love about  the Gut and Psychology Syndrome book.  Dr. Campbell-McBride does a great job of explaining basic anatomy and physiology of the gastrointestinal system.  She explains how enzymes work to digest our food, insulin and blood sugar, the role of the immune system in the gut, and the role of beneficial bacteria in the intestines.

There are a few things, though, that I don’t like so much about the book.

First and foremost – that it claims to be a cure-all for children with autism and other neurological disorders.  Not only does this sometimes lead to false hopes, but it also perpetuates Mom Guilt if the diet does fail.  (And you all know how much I hate Mom Guilt.)

The GAPS diet CAN work – but as I mentioned earlier, it does not work for all kids.  When trying the GAPS diet I tell parents that they should think of it as a therapeutic trial – if leaky gut and malabsorption is the cause of their child’s condition, then the GAPS diet will improve their symptoms.  If their symptoms do not improve then we need to look elsewhere.  Autism, ADHD, depression, schizophrenia, anxiety – all of these are multifactorial diseases and disorders – it is unrealistic to expect that all people will be cured with the GAPS diet.

Secondly, there are a few things that I don’t agree with in the book.  One is the idea that putting a small amount of food on the skin (she recommends the wrist) is an accurate test for food sensitivities.  There is no research to support this.  If a patient does have a skin reaction it is quite likely they will have an intestinal reaction (almost undoubtedly). But the opposite is not true at all: the absence of a skin reaction does not mean there is no food allergy.   There are several other small points in the book that I disagree with too (using aspirin for fevers, length of the diet, etc., etc), but I won’t get nit-picky here, I just want to remind readers that one book is not the be-all-end-all for health.

So here are the most common reasons I see the GAPS diet fail:

1. Failure to identify food allergens/sensitivities.  Many of my patients (if not most) do not tolerate dairy in any form, whether fermented or not.  Similarly, many patients have coconut, egg, tomato, potato or tree nut sensitivities. Some even have beef allergies! Imagine using beef broth for these patients! When these patients start adding these foods on the GAPS diet they sometimes forget to go slow and add foods one at a time.  If the symptoms do not resolve in the elimination phase (bone broth only), then something is wrong.

2. Including fermented products. What Dr. Erika???  I would say about 50% of my patients cannot tolerate any amount of fermented products, even homemade.  Obviously they are incredibly beneficial, but I believe it may be the product of fermentation – the alcohols and acids, possibly other compounds, that aggravate many patients.  Instead I use a FOS-free probiotic for my patients (my favorite is Klaire Labs SCD compliant probiotic, no affiliation).

3. Coffee, wine and vinegar. Dr. Campbell-McBride says that weak freshly-brewed coffee is okay, as is potato vodka and some wines.  I disagree.  Most of my patients do not tolerate these beverages as they seem to irritate the gut lining.  Vinegar is often better tolerated, but for some sensitive patients they just cannot handle it, at least initially.

4. Too many animal fats.  This is by far the biggest limitation of the GAPS diet for long-term health.  Animal fats are helpful in that they contain vitamin K2 and provide a much-needed source of calories on the GAPS diet.  They also provide a barrier by coating the intestinal cells to protect against many gastrointestinal irritants.  However, animal fats tend to be inflammatory. I know the Weston A. Price folks disagree with me on this one, but so far all the research still suggests that animal fats are pro-inflammatory. Granted, grass-fed and free-range beef are significantly less inflammatory (perhaps even bordering on anti-inflammatory?) than their grain-fed counterparts.  Nevertheless, I have many hesitations in recommending a long-term GAPS diet because of the high amount of animal fats.   All of the best researched and referenced diets in scientific literature are low in animal proteins and incredibly high in colorful fruits and vegetables. Remember that historically humans have consumed high amounts of foraged vegetables, and feasted on animals only when meat was available (rarely).  The Mediterranean diet, which I consider to be the best-referenced, best-researched all-purpose diet, is low in animal meats but high in vegetables and fatty fish.

For patients who do not respond to the traditional bone-broth introduction, OR have documented oxidative stress (tested through something like Genova’s Oxidative Stress 2.0 test) OR have inflammatory conditions like Crohn’s, Colitis, hypertension, atherosclerosis, asthma, thyroiditis, any other autoimmune condition (like rheumatoid arthritis, lupus, etc.) I recommend a modified GAPS introduction using vegetable juices in lieu of the bone broth.  Organic, fresh-pressed juices using copious green leafy vegetables and only a small amount of sweetener (like a 1/2 apple, one carrot, or some beets) are suggested.  Foods can be added back in according to the GAPS introduction diet, though of course there will not exactly be a “soup” to add them to.

5. Failure to add anti-microbials.  I believe this is the number one cause for GAPS-diet failure.  When I have a patient who has been on the GAPS diet and either improved only slightly or improved and then regressed I always look for gut dysbiosis.  Yeast overgrowth, overgrowth of pathogenic bacteria, or Small Intestinal Bacterial Overgrowth (SIBO) are incredibly common conditions in our era of frequent antibiotic-use and stress.

The GAPS diet is definitely designed to eliminate gut dysbiosis by “starving” bad bacteria and providing good bacteria from fermented foods.  But for people with incredibly high bacterial/yeast loads the GAPS diet simply isn’t going to be enough.  Remember, even if a patient is completely fasting there will still be some food supply for the microorganisms just from the sloughing off of dead intestinal cells.  In other words, starving out bacteria usually isn’t good enough.  (Unless you do actually starve, and I don’t recommend that!)  Even bone broth, though it is low in fermentable sugars, does contain a very small amount of food which can be just enough for dysbiotic flora to live in.

If you have improved on the GAPS diet in the past but then gotten worse as you introduced new foods or returned to a semi-normal diet I highly recommend checking for gut dysbiosis.  Naturopathic doctors often have stool culture kits in their office to check for a variety of organisms, not just the standard Clostridium difficile that most medical doctors are looking for.  Bacteria, yeast and parasites may all be present, and it is usually necessary to do more than 1 stool sample (an O&Px3 is standard for parasites, for example – meaning it checks for ova & parasites three times).

If that ends up negative and you still have gastrointestinal symptoms, especially symptoms of pain shortly after eating or significant gas and bloating with a distended abdomen then I recommend doing a test for Small Intestinal Bacterial Overgrowth (or “SIBO”).

Whether SIBO or another type of gut dysbiosis is detected there are several different antimicrobials that can be added to the GAPS regimen to help speed up the elimination of the organisms.  Though I usually use herbal antimicrobials, sometimes it may even be necessary to add in prescription antibiotics, anti-fungals or anti-parasitics if there is a very high microbial load.  This should be done carefully, obviously, so as to not cause more dysbiosis.  This blog post seems to be getting really long, so if you want another entire blog post about natural antimicrobials please request it!

Once the pathogens have been eliminated most patients will fully recover, and the GAPS diet can be resumed (if paused during treatment) to fully restore proper gut health.

Well – I hope this helps clear up some confusion about the GAPS diet.

What were your experiences with the GAPS diet? Did it work for you? Was this post helpful?

photo credit: cheeseslave via photopin creative commons license

Comments:

  • Pingback: Diet | Zeal for Life Wellness Drink
    April 14, 2014 at 8:18 pm
  • Kristin
    April 15, 2014 at 2:50 pm

    Yes please to the post on natural anti-microbials .

    • diana sampedro
      February 2, 2017 at 11:04 am

      Hi,

      My son is two years old. I’ve been doing the GAPS diet for almost 6 months.
      In certain way I noticed improvement on bowels, stool consistency and behavior , I’m doing my own sauerkraut , organic food, coconut milk yogurt , water kefir , but, I he’s kind of in he middle now.
      He is focused sometimes, his spinning had stopped, he is on the autism spectrum , but he had instead been taking other habits such us playing with Sticks ,he likes to tap his chin with his hand to
      Make his teeth tap together . He’s hyper, and he is obsessed with the iPad. He’s not interested
      In puzzles or activities we used to do together. He does make lots of noises but not signs of speech
      I’m not sure if GAPS is working. We are seeing a wholistic doctor now and are on a antifungal medication, soon we will be doing stool and urinalysis trstings. I hope that will bring some light .

      What’s your experience when it comes to autism and behavioral issues with kids in GAPS diet? E

  • julie hill
    April 26, 2014 at 1:09 am

    Such a timely article for me! My daughter (two year old) and I have been stuck on GAPS intro for months, and keep returning to stage one. It seems more foods are becoming an issue each day. Slowly I’ve found that we can’t tolerate any dairy, any ferments, or bone broth. Now the fermented cod liver oil is a problem, but it is also really helping. I realized today that eggs and ghee are a problem still. Nuts and honey are also problematic. it seems like all the foods we need for healing are off limits. Now my daughter is not even interested in eating the stews that she used to gobble up, although I’ve never been able to get much broth in her. I keep trying to figure out what the number one thing is that we need to do to seal the gut so we can move onto the next stage and add variety – some convenience foods like nuts or fruits or raw veggies would be nice. I understand that GAPS unmasks underlying food sensitivities, but after 6 months shouldn’t our guts be healed more than this – allowing us to tolerate oxalates or histamines? Maybe getting a higher dose of Biokult (we are only at “2 tips of a knife”)? Or maybe I try carrot juice again to help detoxify? I’m pretty sure I have SIBO because during my daily enema I am seeing long stands of a substance that I know I haven’t ingested. My guess is that it’s candida. But I haven’t seen any of this in my daughter’s diapers, so why isn’t she progressing? I am humbled and scared by my experience with this diet. I don’t know if I can keep it up, yet I know I have to because even the supposedly easily tolerated foods give us reactions. I feel like we were led to this healing protocol by God, so I’m trying to trust that it is right for us. But I am open to anything you could tell me that would point me in the right direction. I wonder if natural anti microbials are something I need to look into. There are just so many avenues to try and each trial is so stressful and seems so slow. Each time all my hopes are hinging on “this” being the thing that finally helps us move on, and then the disappointment is heartbreaking when I realize they we can’t tolerate it. Apparently Dr. McBride and I have a different definition of the word “quickly”! 😉

  • Suresh
    June 6, 2014 at 6:17 pm

    Great insights and comparisons..I definitely think anti-microbials need to be discussed at length. Does turmeric act as an anti-microbial or just an anti-inflammatory? I’ve read Berberine, Licorice and Haritaki are good too..any thoughts?

  • quianna
    September 23, 2014 at 1:43 pm

    Thanks for the article even tho it makes me doubt my choice to pursue this diet. I put my two year old son on it and we are on day 14 stage three without any dairy. He has eczema and really poor digestion. We saw a naturopathic Dr and had stool analysis and IgG testing done. His stools are always loose with undigested foods and his stool analysis showed inflammation and not enough enzymes. He was allergic/sensitive to almost 30 different foods all of which are the most common foods we eat. She said he has leaky gut and told us to avoid the foods he tested positive for and gave us a few supplements. I decided to do something else about it and that is why we are on gaps now. His skin and digestion have neither gotten better and our gaps practitioner says that it is a long journey to see improvements sometimes. I’m feeling so lost on what to do next. It’s hard to know if any foods are affecting him since he never clears up. Any thoughts on what to do next?

    • Julie Hill
      October 5, 2014 at 8:49 pm

      Quianna I really feel for you. This past year doing the GAPS diet with my daughter has been the worst year of my life! I developed allergies and problems that I don’t hink I had before. We don’t have any parasites but do have issues with genetic mutations which makes us unable to clear the die-off from our bodies. Some people with these problems are following MTHFR protocols like fredd’s using methylB12 and Methylfolate if you want to look into that area. It seems to be simular to GAPS only they use supplements insted of relying just on food, which makes some sense because of how depleted our food is I think it’s impossible to get all the nutrition we need through just food these days. But reading the comments it seems like people have been treating their issues for years and are still struggling (just like GAPS). The GAPS diet is supposed to be temporary but from what I’ve seen, it’s not if you want it to keep working. My daughter and I have both quit the GAPS diet, although it’s been about a month and some of her symptoms are slowly coming back. I think I am on to something though since I’ve discovered Dr. Abram Hoffer’s Orthomolecular Medicine – especially niacin and vitamin C. When you take niacin in regular amounts it helps with depression by correcting the tryptophan pathway. But when you take much more than your body needs it changes the niacin into a substance called NAD which allows the cells to heal themselves (even for things like arthritis and PTSD). If you’re interested in looking into this I recommend the book “Niacin The Real Story” by Dr. Abram Hoffer. Also “Orthomolecular Medicine” by Hoffer and Dr. Andrew Saul. It’s just vitamins, but explains which ones you may need and how to take them for them to really work. Also Dr. Saul’s book “Doctor Youself” has been helpful. When you read about vitamin C you are gonna be amazed! In the right doses it nuetralizes toxins, cures viruses and bacterial infections and a lot more. Maybe look into it for your problems.

      • Nissa
        January 5, 2018 at 5:14 am

        Thank you Julie, I you don’t mind me asking, what have you noticed while doing the Niacin and Vitamin C? My family and I have just started the GAPS diet and on stage 2 with total 3 days. We are all very cranky and snappy and my son has diarrhea now. I am feeling nervous now because he never had diarrhea before.

  • Kim Gomez
    December 5, 2014 at 10:53 pm

    What do you think of Lauricidin as an antimicrobial? I would like to do a parasite cleanse for my 14 yr old–we are all on the GAPS diet, to help our gut after years of toxic mold and lyme disease, but I have been concerned that the herbs will be too strong and counter what the diet is trying to accomplish. I don’t want her to lose more weight and she does not detox die-off/toxins well. Is it better to kill the parasites and then go back and continue healing the gut? My 14 yr old is having trouble gaining weight and keeping it on. She is underweight right now at 5’7 1/2″ and 105 lbs. She keeps fluctuating between 102 and 105. She has seen improvement on the diet except for her chronic, daily headache that is a 6 1/2 on a 1-10 scale.
    Thanks for this article. I constantly have to wonder if this diet is enough for lyme disease/mold and as sick as my girls have been for years. Their guts need to be in a better state before continuing with any treatment, I do know that, but the diet may not be all they need.
    Thank you for any guidance or ideas. This has been a long, rough road.

  • Kim Oliver
    January 12, 2015 at 12:31 am

    Dr. Erika, I began the Gaps diet several weeks ago. I was diagnosed with severe, chronic psoriasis on both my palms and both of the soles of my feet. My skin keeps cracking, dead skin that pulls off in large sheets, and stinging problems. I keep moisturizing as my dermatologist suggests, but, it seems like my skin begins to improve a little, then once again, my skin dries out and the peeling on my feet has deepened. I have been dealing with this issue for 4 months now. My father passed away several months ago and Im sure the stress hasnt helped. I believe I have systemic candida which is causing this painful condition. Some days I cant walk or hold anything. My dermatologist is going to start me on Enbrel this week for severe psoriasis. I was using oil of oregano but my rashes got worse. I also take probiotics and plant based enzymes before eating to help heal the gut. I believe I may be experiencing leaky gut. Im 56, have been menopausal for 4 yrs, and noticed I kept having vaginal infections alot. This is why I feel the candida is contributing to my skin disorder. I keep noticing small, tiny red dots underneath the skin on my feet. Do you think my skin condition is mostly fungal from candida or/and from leaky gut syndrome? I ‘ve never had any type of rashes in my past. What advice can you give concerning my problem?

    • Anna H
      February 19, 2015 at 1:18 pm

      Hi Kim – I am starting the GAPS diet and researching the benefits and I came across your comment and have a suggestion that may possibly help you the way it helped me.
      I have always had gut issues but after working in a lab 12 years ago, I developed awful eczema on my hands that nothing could cure. In January, I got fed up after wearing heavy duty moisturizers under nitrile gloves for three straight days and still experiencing no relief, and so I spent a lot of time on Pub Med and other health-related sites trying to find a solution. One of the most intriguing things I found is that researchers are now discovering that a skin specific genus of fungi called Malassezia may be associated with different skin issues including eczema, dandruff, and possibly psoriasis.
      I researched methods of killing fungus that are available at the drug store. Among other possible solutions, I found papers describing how iodine can work synergistically with hydrogen peroxide to kill bacteria and fungi (these papers were not in the context of skin though). I came up with a protocol that actually worked to give me soft hands for the first time in a dozen years.
      Here’s the protocol: I smeared my hands in povidone iodine and waited five minutes (to allow some iodine to penetrate the skin). I then applied multiple successive rinses with hydrogen peroxide. For these rinses, I would douse my hands in hydrogen peroxide, and then wait about minute without shaking it off or otherwise removing it, then douse and wait again, and repeat this again. After the third hydrogen peroxide rinse, I reapplied the povidone iodine, and then repeated the hydrogen peroxide douse-and-wait cycle three more times. It was painful, but eventually the pain subsided and small white “pods,” for lack of a better word, appeared on my hands, and in some places where I suffered the worst, the skin actually burst open into painless wounds (I imagined it was the fungus or whatever self destructing). My skin was immediately softer. I tried the treatment three days in a row. The improvement of the first day was so dramatic that the second day offered little additional relief, and the third day was unnecessary.
      This wasn’t permanent, sadly. About a month later, after eating a lot of sugar, my skin started getting dry again, but thankfully, it has not returned to anywhere near as bad as its former state. Although this wasn’t the permanent cure I had hope for, it was the best relief I’d had in a dozen years. The return of the dryness definitely seemed to be related to my diet and consuming too much sugar and grains, which is part of the reason I want to start the GAPS diet.
      For experimental purposes, I tried soaking my hand in hydrogen peroxide alone without the iodine, and it did not work and only succeeded in inflaming my skin, and I tried iodine without the hydrogen peroxide, which seemed to have little effect, so I believe that the combination is necessary.
      Also, my boyfriend let me experiment on a dermatitis patch that has bothered him for years. Just to see, I tried comparing OTC antifungals (made for athlete’s foot) to the iodine-hydrogen peroxide treatment. For him, his skin had thickened so much that it first required lactic acid as a keratolytic agent to soften the skin so the treatment could actually reach anything. The antifungals had no effect, but the iodine-hydrogen peroxide had an immediate effect. It was painful for him too though. It doesn’t seem to be painful for healthy, intact skin, and isn’t painful after the damaged skin has improved.
      I have no idea if it will work for you, but it’s worth a try. If your skin has thickened or hardened, you need a keratolytic agent like 12% ammonium lactate or 40% urea (better) which you can get on Amazon. I think strong salicylic acid also serves the same purpose, but I have no experience with that. Povidone-iodine (Betadine) is available at the drug store, and I just used standard drug store 3% hydrogen peroxide. The iodine will make your hands red but it washes off.
      One final note – hydrogen peroxide oxidizes your skin so it’s a good idea to protect your skin with anti-oxidants. Internal Vitamin C is good and does reach your skin, but topical Vitamin C is even better. For skin protection, Vitamin C works synergistically with Vitamin E, so internal/topical application of both might be a good defense before and after this treatment.
      Scientists are working on some special synthetic peptides to kill Malassezia but they aren’t available yet and who knows when they will be.
      Sorry for this insanely long response – I don’t know if it will help you, but it’s cheap and easy and worth a try. I tried a LOT of things before this and nothing ever worked, and it was so horribly frustrating, not to mention painful (I thought it was just a condition of life to suffer intense pain after getting lemon juice, or vinegar, or salt, on one’s hands – now I know that’s not true, and is just a symptom of compromised skin), and I would be happy if my experiments could help someone else.

  • Rick
    January 13, 2015 at 2:57 pm

    Hi Dr. Erika,

    Just curious if you’ve ever had patients react poorly to the bone broth phase of the GAPS diet? I have recently heard other practitioners mention that when the patient presents with severe increased intestinal permeability broths made with lots of cartilage can trigger an inflammatory response – have you ever experienced this in your practice? Could this be the difference between a low-protein bone-only broth and a bone broth with lots of cartilage & some meat maybe, and these proteins upregulate cytokines in the context of a severely leaky gut?
    Thanks for any insights you may have to offer, Rick

      • josh hunter
        July 24, 2018 at 4:19 am

        Arachidonic acid is entirely needed by the gut, you are barking up the wrong tree here
        https://www.westonaprice.org/health-topics/know-your-fats/good-fats-bad-fats-separating-fact-from-fiction/
        “Despite these sensational claims, arachidonic acid is not inherently inflammatory. Its deficiency, in fact, produces a number of inflammatory symptoms, including dandruff, hair loss, infertility and irritated, red, sore, swollen, and scaly skin.26,27 Inhibiting supposedly “inflammatory” products made from arachidonic acid such as prostaglandin E2 using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can produce a number of inflammatory outcomes. These drugs induce intestinal pathologies that closely resemble celiac disease in laboratory animals in response to gluten or even egg white,28,29 and they interfere with the resolution of autoimmune conditions.30

        Although it is true that our bodies use arachidonic acid to initiate inflammation—a vital process if we want to survive to adulthood without being wiped out by pathogenic microbes —our bodies also use this fatty acid to suppress inflammation or to resolve inflammation once it has run its course. We use arachidonic acid to make cell-to-cell junctions that form physical barriers against toxins and pathogens,31-33 to create a unique environment in the gut that causes our immune system to react to food proteins with tolerance instead of intolerance,34 and to make important molecules called lipoxins that help resolve existing inflammation.30,35 We even use arachidonic acid to signal the conversion of omega-3 fatty acids to resolvins, another class of molecules that help resolve inflammation.30 It makes little sense to characterize this fatty acid as singularly inflammatory in nature when it has so many anti-inflammatory functions, and when it is present in so many traditional foods consumed by populations free of inflammatory diseases.”

  • Rick
    January 14, 2015 at 9:14 am

    Hi Dr. Erika,

    Thank you very much for your rapid reply! Yes, I’m now remembering I’ve heard Allison Siebecker say that cartilage broth is highly fermentable and this would aggravate SIBO. Nice talking with you and best regards, Rick

  • Mrs. Mac
    February 19, 2015 at 9:12 am

    My 18 year old son has been on GAPs diet for about three months. His colon ruptured at birth due to Hirschprung’s disease. Had a colon resection leaving small intestine and transverse portion of large intestine. For many years his white blood count was dangerously low (1200), headaches, low grade fevers, etc. Drs tested for leukemia and diagnosed him with leukopenia. He once had horrible (room clearing) gas! Two years ago I started eliminating certain foods and wbc went up .. fevers subsided. Now on GAPS gas, headaches, eczema, seborrhea dermatitis and blepharitis are greatly reduced. He was on intro diet for only one week .. then we progressed to full diet slowly. It’s easy to ‘try’ a new food and watch for reactions just by monitoring eczema redness and moodiness. BTW, he’s got Down syndrome and limited speech. Oh .. speech has improved .. less stuttering! Not sure how long to keep him on this diet .. but in a few months I may introduce a single carb. He’s able to tolerate a little fermented buttermilk and aged cheese. So far I am pleased with his progress on this diet.

  • Noemi
    March 20, 2015 at 1:08 pm

    Hi,
    I’m considering trying the GAPS diet to reverse my Hashimoto’s and leaky gut (haven’t been tested yet but I have a lot of GI problems). I have been vegan/vegetarian for years, so it’s a quite a transition for me to start this diet. I actually started craving some animal foods a while ago so I intuitively started adding some meat and eggs back to my diet but nowhere near in the quantities required by this diet. I’m so glad about your advice about animal fats not being so healthy. I cooked a trial chicken soup just to see how I like it, but after 2 days of eating it, I really miss veggies and fresh juices. I know now (after reading Izabella Wentz’s Hashimoto book) that I do need some animal foods to heal from Hashimoto (I guess this is why I didnt heal while vegan), but GAPS just seems too much.
    How would you alter the GAPS diet with the juices? Would you do Intro with only green juices and then add the foods one by one? Do you think smoothies are also okay or should I stick to juices? You mentioned you had a patient replacing the broth with juices, but would the juices provide enough energy/calorie? And wouldn’t they result in severy diarrhea?
    Or shouldn’t I just try another diet? Anything that you could recommend?
    Thanks a lot!

  • Christyn
    August 25, 2015 at 11:50 am

    Hi, Dr. Erika!

    Can you elaborate on why berberine can not be used while nursing? I am having a hard to finding a solid answer other than the uterine contractions during pregnancy. I have done GAPS with my 21 month old with some progress, but lingering eczema issues for both of us. I would like to try berberine, but he is still nursing two to three times per day. Thanks!

  • Caroline Carlson
    September 2, 2015 at 2:39 am

    I think the reason gaps isn’t working for some people is that they are not giving it enough time. You said you thought that it should be used only for about six months. For many people this is not enough time. I’ve been doing gaps for two years and figure I am going to be on it for another two years. I was in my early 40s when I started and have been sick all of my life. At six months I was just starting to see an improvement. My progress has not been the fastest but has been steady. I’ve been researching cures for myself for decades and honestly trying different diets diligently but with limited success or no success. I even got a master degree in acupuncture and Chinese medicine in my quest. Gaps needs to be done methodically and for an extended period of time especially if one has been chronically sick for years. Advocating it’s use for six months is not supported by Dr Campbell-McBrides years and years of research and hundreds of documented cases of healed patients.

      • Isabel
        November 21, 2015 at 9:12 pm

        It doesn’t make sense that the “Mediterranean Diet” is a One Size Fits All — even for people who are not Mediterranean. Many peoples have thrived without access to a Mediterranean climate and foods.

        Dr. Cambell-McBride encourages “cheating” on her diet if your body is giving you a (natural) craving and points out that no scientist or doctor is as intelligent as your BODY. Here – http://www.doctor-natasha.com/one-mans-meat-another-mans-poison.php – she discusses the many cycles our bodies experience day to day, moment by moment, and how different foods are required depending on your body’s unique needs.

        The take away is learn to listen to your body’s inner intelligence through your SENSES – taste, smell, etc. You may have to retrain your senses by eliminating processed foods and harmful chemicals, but essentially your body knows best what it needs in any given moment. No diet or “studies” should be your rule book.

  • Alicia
    September 11, 2015 at 9:41 am

    Hi!
    Very interesting article, thanks for your perspective. 🙂

    I just wanted to correct one error that you have made here, and that the GAPS diet begins with a stage where you just consume bone broth. This is incorrect. Stage one of GAPS Intro includes MEAT STOCK which is very different than bone broth. Meat stock is made from meat and bones, along with veggies, and simmer for a short time, about 2-3 hours. Bone broth is made from the bones or carcass of an animal and simmered for 24-72 hours. It is much higher in histamines and glutamate and is not recommended early on the GAPS diet for this reason. Also, on the first stage of GAPS Intro, you are able to have this meat stock along with many meats and veggies cooked in the stock, tea, and a little honey. Coconut oil is also permitted. So it’s definitely different than “bone broth only”. Just wanted to clear this up!

    • Lyn
      February 11, 2016 at 8:47 am

      Thank you Alicia. This may make a difference. 🙂

  • Amanda
    October 8, 2015 at 8:27 am

    my brother-in-law has been on various mess for scheziphrenia for 20 years – since his breakdown at age 17. If he became interested in trying a GAPS protocol what kind of supervision, blood work, etc do you foresee he would need due to the meds he is on. Would you recommend a naturopath or a functional medical doctor? I’ve been discussing this a little with my MIL and feel like I need some practical answers before they could make any steps in this direction. Thanks

  • Fred Cory
    November 8, 2015 at 4:58 pm

    It was certainly good to point out that the problem may not be gut dysbiosis and to screen for lead etc.. But some of your criticism about animal fats is flawed. For many traditional cultures animal fat and protein were the primary foods such as the Northwest natives who ate mainly seafood and seafood oils such as Oolican grease; The Massai of Kenya who are dairy and meat, especially blood; the Inuit, and many others. You noted studies where high animal protein were not well tolerated. The above cultures also knew this and cherished fat above all else. A study that does not control for these two separate nutrients is confounded from the start. The GAPS diets may not be an absolute cure but that doesn’t mean it should be abandoned if results are not forthcoming with in 6 months. Because a low-carb diet promotes blood sugar and systemic homeostasis it would certainly be at least supportive to the recovery of almost almost health problem that could arise.

  • Tara
    November 23, 2015 at 1:49 pm

    Hi Dr. Krumbeck,

    I’ve been following the autoimmune paleo diet for about a week now, to help sure what I believe is a leaky gut that is exacerbating adrenal fatigue. I’ve tried many things to heal the AF, and have improved somewhat, but believe that my system is still getting stressed because of leaky gut, and so now am working to heal that instead of the AF.

    1) Out of either AIP, SCD or GAPS, do you think one is a better diet in general for healing leaky gut? I chose AIP as it seemed the most “successful” when I researched it (anecdotally), but wondering what a professional opinion is?

    2) I started this diet and just found out I am pregnant-is it safe to continue AIP? Is there anything else I should know about trying to heal your gut while pregnant?

    Thank you!

  • Sarah
    January 19, 2016 at 3:16 pm

    My doctor thinks that my 11 month old’s eczema is indicative of internal inflammation (along with a single incidence of bloody stool) that could be the cause of his failure to grow (17 lbs). The only true allergy he has is eggs. His only idea was to try the predigested formulas and pump for a few weeks to keep up my milk supply to see if that works. Any resources you’re aware of on how to heal inflammation in a baby who isn’t having any major allergens firsthand, and no wheat, dairy, soy, or eggs secondhand? Elimination diets haven’t yielded any results that we can see. My doctor is very amenable to doing what I think is best for him.

      • Sarah
        January 21, 2016 at 7:05 am

        I was, but reading further, it is recommended that nursing mothers only do full GAPS. I think introducing major allergens through dairy and eggs would just muddy the waters of trying to figure out what is wrong. I want to heal his inflammation, but I can’t figure out how to go about it. The elimination diet hasn’t yielded any results, but the fact that he isn’t growing has put a bit of a time crunch on figuring out what is wrong.

  • Kim Tisor
    March 19, 2016 at 12:22 am

    Dr. Erika, would you please consider moving to northern Alabama? We need you down here! 🙂

  • Sandy
    July 27, 2016 at 12:17 am

    Hi Dr Erika,

    I’d like to request the full blog on natural antimicrobials you mentioned in this blog. Where can I get it?

    Thanks.

  • Rachel
    August 9, 2016 at 11:51 pm

    Hi Dr. Krumbeck,
    I have been following the GAPS diet for a week now to help alleviate some symptoms of my Crohn’s disease. I am currently on Remicade for that because getting off of it can lead to severe allergic reactions were I to need to start again later. My question is this: how normal is it to feel very ‘dry’ on the diet? My lips, mouth, and hands have all been very dry and in addition I have been urinating pretty frequently. My functional medicine Doctor says this could be the inflammation starting to ease and releasing water or the fact that I’m not eating starches which trap water. Does this sound about right? Also, have you ever heard of Stevia having a diuretic affect? That is in one of the supplements (alpha lactalbumin- Serplus is the brand name) I’m taking now and I wondered. Any insight you might have would be great. Thank you!

  • Melissa
    August 16, 2016 at 10:49 am

    My son has all kinds of behavioral and developmental problems at 18 months old and has since birth. While I am on a waitlist for testing and evaluation at a behavioral development center, I am trying to do all I can to help him on my own. A few friends pointed me towards the GAPS diet, but we are all vegetarians. I am not opposed to cooking meat if it truly helps him, but before I dive into a completely different food culture for our family, I am wondering where you would recommend someone start with all this if you don’t know what kind of gut problems you may have and cannot afford a naturopathic doctor. I do not know in fact if food is the underlying problem, but I do notice his behavior is worse and more intense if he eats certain foods like soy, gluten and brown rice. Sometimes it seems like he is allergic to everything, and other times nothing. When he was a baby only eating breast milk, I was on constant elimination diets, and now I am struggling to figure out what triggers his behavior. The “mom guilt” factor is huge since he seems to have really digressed in a short time- both vision speech and balance since he had a mystery virus, then chickenpox, and then in a moment of panic I went for his first vaccination. I feel very alone and doctor appointments and specialists have so much waiting time. I want to help him but I have no idea how I can start to piece together the whole gut health issue, and it sounds like there is a possibility of him being more damaged by this diet than being helped, and of him losing his interest in food, which at the moment is not the case. he loves food, veggies, beans, pasta, rice, dairy, fruit, smoothies, everything! but his behavior is really troubling and even dangerous to himself. I have always had a hunch it was his gut health since he is at his worst when he wakes up from nap or in the night. He seems to be in pain and he shows over-the-top aggravation with not being able to nurse as long as I used to let him. I tried to wean and I just gave up because the tantrums were so bad. So this hope for recovery is not only for him, its for me!

  • Ewa
    August 17, 2016 at 4:52 am

    Hi, My friend is on the gaps diet for her hashimoto disease, and she feels great, but she just did her blood test, and her results are much worse then before the diet (3 months) and her cholesterol is getting really high. Would it be possible that she will get worse before she gets better, or should she stop the diet?

  • Nicole Platte
    October 10, 2016 at 9:38 am

    My experience with GAPS/WAP diet was exceedingly negative. I tell a little of my story in this blog post: https://leadstohealth.com/ten-reasons-the-gaps-diet-may-not-be-for-you/

  • kati
    February 14, 2017 at 12:06 pm

    The two concerns I have about the Gaps diet is (1) Eating high amounts of animal fat if a person is not producing sufficient bile to digest the fats, and (2) snacking on a mixture of coconut oil and honey, when fat can interfere with insulin working properly and make it difficult for our bodies to use up sugar, leading to high blood sugar.

  • Lisa Greene
    April 4, 2017 at 8:26 am

    Hi Dr. Erika,
    My daughter is 21 and 2 years ago she was diagnosed with Mono. About 4 days after diagnosis she began hallucinating and hearing voices. We are now 2 years in and the symptoms have never went away. (Add: my daughter also has Cerebral Palsy). Our Psych NP recently recommended this diet to try. Any ideas or suggestions if you agree on how is the best way to start?

  • Amanda
    May 23, 2017 at 10:17 am

    Hi Dr. Erika,

    I found this post because my son has been on GAPS Intro for almost two years. Initially, it was because he had horrible, bloody eczema from ankle to knee. We saw immediate results after 6 weeks on GAPS and after 15 months, he was completely eczema free. Inflammation, however, has not gone away. His stool tests have come back with extremely elevated inflammation markers time after time. He hasn’t slept through the night – ever (he’s four). I’m now talking with our orthomolecular practitioner about “what’s next” after GAPS and the info you posted was extremely helpful. I think I’ve been terrified to go off GAPS and add new foods in. This gave me the courage to try!

  • Joel Henry
    July 17, 2017 at 9:29 am

    In most of these cases an underlying mineral deficiency/imbalance is occurring and needs to be part of the equation/conversation.

  • Katie
    November 24, 2017 at 9:36 am

    The problem with all of this is that nothing is clear enough on what to do, including the original GAPSbook. And once you start, which is a considerable time and financial investment, unexpected things come up constantly. My autsistic son improved, but as we introduced almond meal, my typical daughter regressed. Setbacks are part of doing this and if you don’t go in ready to accept anything like being in intro stage two for a year, then you’re going to ‘fail’. We also had a hard time bc we can’t have dairy which meant we caouldnt do the yoghurt. I didn’t understand the initial change from going to using carbs for energy to using fats so my kids got sick for about three weeks and I was afraid I was killing them. We had a doctor overseeing everything which helped put my mind at ease, and once we got through this initial time my son started coming out of the autism. But!!!! We went through a week of horrible constipation I wasn’t prepared for. We had to squirt coconut oil into my son’s rectum. I just was not aware this was possible and I had to fight w my spouse to keep moving forward all while being terrified that I was harming my son rather than helping. By 6 months, the doc had us doing so many supplements and b12 shots, costing us so much money, and effecting my sleep (long story). I was ordering our food from an Amish farm and going more and more in debt, but it’s worth it when it’s your kid, right? But then I hit burn out. I wasn’t able to follow the diet bc I never got through the initial discomfort. I was isolated and exhausted by my life and the diet. This diet works. I’ve seen it work even when it ‘fails’, but with an already failing marriage, my undiagnosed adhd, depression, feeling like a failure as a mother, being isolated bc we lived far from family, etc, I strong recommend getting your life in order before undertaking this diet. No there is no perfect situation and your kids health and wellness is worth sacrifice, but you have to take care of yourself and have a support system. Doing gaps is hard to explain to nonbelievers and can make you have to be aggressive every where you go w strangers who hand your child a goldfish cracker. Research! Find like mind people who have been successful w this, get a support group, prepare your mind, get clear and why you’re doing it and make it fun for your kids w rewards. I took TV away fro two weeks then started the diet. They could only watch tv if they were drinking broth. You will be amazed what kids will do for screen time. I am looking for another opportunity to start again. It’s worth it.

    • Mary Lawton
      December 23, 2017 at 11:05 am

      Good for you, Katie. Keep going. It takes time and effort. Two steps forward, one step back. But, its worth it in the end. I admire your focus and tenacity. It will pay off in the end. I have seen it happen many tines.

  • Diana Allen
    March 2, 2018 at 9:36 am

    This is an excellent post, thank you!

  • Fannie
    May 8, 2018 at 5:51 am

    I stopped GAPS after 3 months, because it made me feel so sick. After an initial improvement with less brain fog and more energy that I assume was due to the clean diet, my symptoms have gotten worse, I had no energy, and constant joint and muscle pain. I developed acne on my previously clear skin, and my period had disappeared. The latter was a strong signal that my body wasn’t doing well on this diet, so I added more carbohydrates and decreased protein consumption. During a recent test where inflammation and leaky gut was confirmed, they’ve also found really high levels of Enterobacter species in my gut, which is as far as I know mainly metabolises fat and protein. So with the GAPS I basically fed the Enterobacter and starved my beneficial bacteria (of which I had very low levels). As there was also a lot of histamin in my stool I was advised a low histamin diet, probiotics and gut lining strengtheners. I’m wondering however if the overgrowth of Enterobacter should somehow be tackled directly with ntimicrobials.

  • Claudia
    August 4, 2018 at 2:04 pm

    Dear Erika, what do you think about the GAPs certification training that Dr Natasha C. Runs online?

  • Robin
    August 5, 2018 at 8:16 pm

    We’ve been on Gaps intro for a while with amazing results. I’ve now reached a place where i’m wondering if it’s done and time to move on. This was a very helpful post. The only thing I wanted to point out is that you refer to the bone broth intro. To clarify, on GAPS bone broth is a VERY advanced and difficult to digest food. Intro diet consists of short cooked meat stocks. It’s a common misunderstanding and people who are not ready for bone broth who become sick on it may prematurely rule out GAPS as a diet that might help them, when even just preparing the broth correctly could help. Thanks for this post.

  • Kimberly Morris
    March 12, 2020 at 11:34 am

    Please send me more information on antimicrobials!

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