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The Gut and Psychology/Physiology Syndrome (GAPS) protocol is a one- to two-year program that incorporates diet, lifestyle, and supplementation in order to heal the seat of wellness and immunity – the digestive system, or gut. It was designed to reverse mental and physical conditions rooted in gut health, addressing their underlying causes rather than simply managing symptoms.
GAPS contains extremely useful elements that can be implemented by any person desiring to achieve better health. By eating more whole, nutrient-dense, properly prepared foods; reducing the amount of toxic substances in the living environment; and utilizing high-quality supplementation, anyone can enjoy improved health and vitality. You can strengthen your digestion, alleviate long-term fatigue, gain more energy, cut sugar cravings, and experience healthier skin and better overall structural alignment, along with many other physical and mental benefits.
This article is a primer for how to bring components of the GAPS protocol into your daily life, even if it is not your current goal to integrate GAPS in its entirety. You can create a strong foundation for long-term health by taking some effective, easy-to-follow steps. These will enable you to heal damage in your digestive system created by maldigestion, nutrient deficiency, and microflora imbalance, and to eventually reverse excessive intestinal permeability, sometimes known as leaky gut. “Healing and sealing” the “leakiness” of the digestive system through our food and way of life is imperative to experience vibrant health.
Origin of GAPS
The term GAP Syndrome was coined by Dr. Natasha Campbell-McBride, a medical doctor with postgraduate degrees in neurology and nutrition, as a way to designate the multiple conditions she witnessed in her medical practice. Many of the adolescent patients seen by Dr. Campbell-McBride not only were on the autism spectrum but also presented with several other seemingly unrelated but overlapping conditions, including ADD/ADHD, dyspraxia, dyslexia, allergies, asthma, eczema, and severe food and environmental allergies. She also noticed that almost all these patients had varying degrees of digestive problems and extremely fussy eating habits.
Upon noticing this pattern in her patients, she concluded that these illnesses were, in fact, related. They were all rooted in the digestive system. The term GAPS refers to the connection that she observed between the health of the gut and that of the brain and body, and encompasses various mental illnesses, chronic fatigue, ulcerative colitis, Crohn’s disease, irritable bowel syndrome, and autoimmune conditions.
Peer-reviewed research, paired with the clinical observations of Dr. Campbell-McBride, as well as other doctors and practitioners, has shown that almost all GAPS patients have digestive problems that create a cascade of dysfunction. Eventually, these problems lead to the development of leaky Applying GAPS Principles for gut, eliciting an exaggerated immune and inflammatory response, which results in a breach of the blood/brain barrier in the case of psychological illness, or abnormal autoimmunity in many cases of physiological illness.
The GAPS protocol
Dr. Campbell-McBride primarily based the GAPS protocol on the Specific Carbohydrate Diet (SCD) created by Dr. Sidney Haas, which limits the use of foods containing complex carbohydrates.
His findings and successful treatment of over 600 patients were discussed in his medical textbook The Management of Celiac Disease. SCD eventually fell out of common knowledge, overshadowed by the much less restrictive gluten-free diet, but enthusiasm for it was reignited by Elaine Gottschall and her book Breaking the Vicious Cycle: Intestinal Health Through Diet. GAPS differs from SCD in some significant ways, such as the emphasis on nutrient-dense foods, and was introduced in Dr. Campbell-McBride’s book Gut and Psychology Syndrome.
While the GAPS diet focuses on the addition of whole foods, it also requires the elimination of foods that promote inflammation.
The GAPS protocol has two main goals: to create an optimally functioning digestive system through the healing of the digestive tract and the restoration of balanced gut flora; and to remove from the body any stored toxins, usually resulting from years of improper diet and maldigestion. To achieve these goals, the protocol includes:
- a specific diet consisting of properly prepared, nutrient-dense, whole foods
- high-quality supplementation, as needed
- lifestyle changes that promote appropriate detoxification
The GAPS dietary program is divided into two phases: the Introduction Diet and the Full GAPS Diet. The Introduction Diet is a restrictive plan designed to quickly heal and seal the gut wall and determine to which foods one is allergic or intolerant. When implementing the entire GAPS protocol, one normally completes the Introduction Diet before beginning the less-restrictive Full GAPS Diet. However, incorporating parts of the Full GAPS Diet into your current diet is a great way to begin taking steps toward better health.
The Full GAPS Diet includes grassfed meats, organ meats, wild-caught fresh fish, and homemade, short-cooked meat stocks. It also allows fermented, probiotic-rich vegetables, as well as homemade cultured dairy products and dairy products that contain little or no lactose, such as high-quality ghee and organic butter. Pastured eggs; nonstarchy fresh vegetables; fresh fruits; nuts and seeds; some beans; raw honey; fresh, nonpasteurized organic juices; unadulterated fats, including saturated fats; and unrefined sea salt round out the diet.
While the GAPS diet focuses on the addition of whole foods, it also requires the elimination of foods that promote inflammation. Grains, most starchy vegetables, refined sugars, starchy beans, processed vegetable oils, and nonfermented dairy products that contain lactose are the main foods to avoid while on the GAPS protocol. All processed foods and food additives, as well as alcohol, are also avoided.
So, where to start?
First, omit the glutenous grains – wheat, rye, barley, and triticale – with the goal of eventually omitting all grains from the diet. This first step can feel like a huge undertaking for some people, so set a timeline. Choose a date on which to start, and hold yourself to it.
Second, eliminate dairy. Commercial milk products are not only great fodder for any opportunistic flora overgrowth in the gut, they are also a common allergen. After 40 days without dairy, gradually bring homemade ghee; then organic, pastured butter; and finally homemade ferments (ideally made with raw, whole dairy) back into the diet and notice any symptoms that may return.
Next, remove refined sugars, processed oils (produced using high heat and chemical solvents), and other processed foods from the diet. Be aware that sugar may be labeled as agave nectar, barley malt, brown rice syrup, cane juice crystals, carob syrup, or one of over fifty other names. You can use raw, local honey as an enzyme-rich, whole-food alternative. Small amounts of dried fruits, such as dates, figs, and raisins, can also be added to recipes as sweeteners.
Processed oils are found in most prepackaged foods, and some, such as partially hydrogenated trans fats, may be hidden. In 2014, the CDC found that most foods that contain trans fat don’t list it on the label. Thus, the elimination of sugars and processed oils means avoiding almost any food that comes in a package.
Some processed oils, such as canola and grape seed, are incorrectly touted as healthy cooking oils. They are highly refined, and canola oil is likely to be genetically modified. Organic, pastured butter and ghee, coconut oil, and pastured animal fats such as duck fat, lard, and tallow are appropriate for cooking. Extra-virgin domestic olive oil and cold-pressed sesame oil are great for homemade salad dressings and can be added to already-cooked foods.
It’s best to eliminate common irritants and allergens from your diet. These can include nuts, seeds, eggs, nightshades, and citrus. While these foods are allowed on the Full GAPS Diet, they can create an inflammatory response in some people.
The most important food to add to your diet is short-cooked meat stock and/or long-cooked bone broth, a daily staple of the GAPS diet, ideally consumed at every meal. Stocks provide the elements the gut needs in order to heal, including gelatin, amino acids, vitamins, minerals, and fats. Dr. Campbell-McBride notes that the more broth and healthy fats consumed, the faster one will heal.
Begin by making a short-cooked meat stock once per week, adding it to your daily diet in casseroles or soups, or using it to cook nonglutenous grains. Meat stock is made by simmering the raw meat, bones, and connective tissue of poultry, beef, lamb, pork, or cold- and deep-water fish such as salmon or fresh sardines for up to eight hours.
After you’ve mastered meat stock, you may benefit from making a longer-cooked bone broth. This is different from meat stock in that only the bones and some attached meat and connective tissue are used, and it is cooked on very low for up to 48 hours, with an acid such as vinegar or fresh lemon juice added to draw the minerals out of the bones.
However, bone broth is not for everyone. Some GAPS patients cannot properly metabolize the high amount of the amino acid glutamine in bone broth, and therefore need to start by consuming meat stock instead, until their systems are able to tolerate the broth. Those with glutamine sensitivity may include people with severe gut dysfunction, MSG sensitivity, certain genetic variances, and metal toxicity. Others may react to the higher amounts of histamine present in longer-cooked broths.
While meat stock or bone broth is optimal, vegetarians can substitute vegetable broth. You can make vegetable stock by cooking all types of nonstarchy vegetables overnight and straining the mixture. Cook the resulting stock with more vegetables to make soup, and add lots of butter and an egg yolk to every bowl.
Animal fats – including those found in meat, eggs, and dairy, and those rendered from meat – should constitute the majority of fats consumed on the GAPS diet. Healthy fats provide us with a source of long-burning energy and contribute to a sense of satiety. They also play important roles in blood sugar regulation and the creation of healthy cell membranes, and they are required for the absorption of the fat-soluble vitamins, A, D, E, and K. Other fatty acids necessary for healing, provided by fish and nut/seed oils, are discussed in the supplementation section later in this article.
In a GAPS patient, the gut microbiome is imbalanced, with too many opportunistic or detrimental microflora and not enough beneficial ones, negatively impacting the integrity of the intestinal wall. If you have taken antibiotics, overconsumed sugar and white flour, or been exposed to toxic chemicals, including ones found in many body care products, your gut flora may be out of balance.
The combination of fat and protein in a GAPS Milkshake promotes blood sugar balance, and the drink acts as a gentle chelator of toxic metals.
To address this imbalance, begin consumption of homemade fermented foods, such as sauerkraut, beet kvass, and raw, whole milk yogurt. A bit of sauerkraut is delicious with meat dishes and is a great addition to salads. Homemade yogurt or kefir gives a creamy texture and taste to cold soups.
These foods contain many naturally occurring probiotics. While making your own fermented foods with local inoculants is ideal, you can also find raw fermented vegetables in the refrigerated section of most natural food stores.
Juicing and the GAPS milkshake
Drinking freshly extracted juices of raw vegetables and fruits on an empty stomach provides the body with a concentration of easy-to-digest minerals, vitamins, and amino acids that assist the body’s detoxification processes. These juices can be made into a GAPS Milkshake, a tasty substitute for a morning smoothie. A blend of 50 percent therapeutic vegetables, such as celery or cucumber, mixed with 50 percent delicious fruits, such as apple, pineapple, or orange, blended with one or two raw eggs and a few tablespoons of any whole fat, such as coconut oil, olive oil, or homemade sour cream or yogurt, makes a surprisingly delicious shake. The combination of fat and protein in a GAPS Milkshake promotes blood sugar balance, and the drink acts as a gentle chelator of toxic metals.
The use of high-quality supplements, as needed, is an integral part of the GAPS protocol. While you are beginning the initial dietary steps, however, it’s important to keep supplementation to a minimum in order to observe the changes that come only from diet and lifestyle. Over time, adding supplements that correlate with your individual needs can make a positive change in health outcomes.
Digestive aids are extremely important in the GAPS protocol. They are needed by most people, due to long-term unhealthy eating habits. Insufficient stomach acid is extremely common, and it impairs the entire digestive process. An easy home remedy from which almost everyone can benefit is the consumption of a tablespoon of raw apple cider vinegar with six ounces of water ten minutes before eating. This stimulates stomach acid production.
Alternatively, many people will benefit from supplementing with betaine hydrochloride with added pepsin and/or other digestive enzymes. This can help ready the body for the digestive process, assist in the breakdown of food, and enhance nutrient absorption. Improvements in digestion, such as less burping, bloating, and gas, as well as relief from constipation and/or diarrhea, have been reported with the supplementation of hydrochloric acid. Other benefits may include physical and mental improvements, such as increased energy, clearer skin, and better mood. Consult your healthcare practitioner before beginning betaine hydrochloride if you have experienced any severe digestive disorder, such as Crohn’s disease or ulcerative colitis, or if you are currently taking or have taken any anti-inflammatory medication, such as corticosteroids or aspirin.
Essential fatty acids, or EFAs, cannot be made by our bodies, so we must get them from food or supplements. Those wishing to use EFAs therapeutically should take them in the easily assimilated supplement forms EPA and DHA, both of which are omega-3 fatty acids; and GLA, which is an omega-6 fatty acid. Recommended sources of EFAs also include a nut/seed oil blend with a 2:1 ratio of omega-3 to omega-6; high-quality cod liver oil, which will supply EPA, DHA, and the fat-soluble vitamins A and D; and fish oil that contains a high ratio of EPA to DHA. According to Dr. Campbell-McBride, cod liver oil should not be taken by those with epilepsy or involuntary movements.
Probiotics increase the number of friendly microflora in the digestive tract, thereby helping to restore the integrity of the gut wall. They are best taken away from food or other digestive supplements, such as betaine hydrochloride, unless the label specifies otherwise. Start with a very small dose of a probiotic and build to a therapeutic dose that is appropriate for your body. Find a product with many different types of bacteria, including a mixture of strains from the genuses Lactobacillus and Bifidobacterium, as well as soil bacteria such as Baccillus subtilis. Your probiotic should have at least 8 billion viable bacteria per gram.
Other supplements used by those on the GAPS protocol, based on individual needs, may include liquid iodine, high-quality minerals and vitamins, and additional digestive support, such as bile support products, pancreatic enzymes, and specific amino acids. Dr. Campbell-McBride stresses the importance of keeping supplementation to a minimum, allowing nourishing food, fresh air, and sunshine to heal the body as much as possible.
Another important component of the GAPS protocol is reduction of the general toxic load. People in need of the protocol generally have poorly functioning detoxification systems, allowing for the buildup of both environmental and metabolic toxins. The GAPS diet reduces the presence of improperly digested foods, which feed pathogenic bacteria and create metabolic toxicity. The addition of healthy fats, proteins, minerals, and enzymes to your diet, particularly in GAPS Milkshakes, greatly aids the body in expelling accumulated toxins.
Lifestyle changes can also play an important role by minimizing exposure to toxins from the environment. Environmental toxicity can contribute greatly to chronic illness, and research indicates a link between various toxins and cancer. To minimize your toxic load, avoid carcinogens and other chemicals that off-gas from new furniture, mattresses, carpets, cars, and paint, as well as those found in many cleaning products, air fresheners, and body care products, including cosmetics and toiletries.
Also avoid chlorine, commonly found in tap water and swimming pools; and food and beverage contact with styrofoam and plastics. Reduce mercury exposure by using alternatives to dental amalgam, and do not consume fish known to be high in mercury.
Daily, short-term exposure to sunlight is also essential for optimal health. Full body exposure, or as close to that as possible, aids detoxification and boosts immunity.
Many GAPS-related resources have become available as the protocol has gained popularity. Websites such as www.gaps.me, Dr. Campbell- McBride’s official site; www.gapsdiet.com, which supports her book Gut and Psychology Syndrome; and various professional blog sites focused on recipes and other relevant topics are easily found online. Social media forums, such as Pinterest, are an excellent place to find GAPS-friendly recipes.
It is highly recommended that those using the GAPS protocol to recover from chronic illness read and become familiar with Gut and Psychology Syndrome, and find a GAPS group or certified GAPS Practitioner who can provide individualized guidance. A list of certified GAPS Practitioners can be found at www.gaps.me.
About the Authors
Hilary Moshman holds a master of public health degree from Emory University and is currently pursuing training with the Nutritional Therapy Association to be a Nutritional Therapy Practitioner. She plans to become a certified GAPS Practitioner and wishes to assist those with gut-related health issues, particularly mental illness. She may be contacted at [email protected]
Victoria LaFont is a certified Nutritional Therapy Practitioner and certified GAPS Practitioner. She holds a bachelor of arts degree from Murray State University, with an emphasis in medical anthropology and professional writing. Victoria has a private practice in Northern California and is currently pursuing a master’s degree in human nutrition and functional medicine. Her website is www.victorialafont.com.
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- Morrell SF, Daniel KT. Nourishing Broth: An Old-Fashioned Remedy for the Modern World. New York, NY: Grand Central Life & Style; 2014.
Published in the Price-Pottenger Journal of Health and Healing
Spring 2015 | Volume 39, Number 1
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