GAPS Introduction Diet

By Natasha Campbell-McBride MD, MMedSci (neurology), MMedSci (nutrition)

GAPS diet – the diet for helping with learning disabilities, psychiatric disorders and physical problems, such as autism, hyperactivity and attention deficit, dyslexia, dyspraxia, depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder, eating disorders, epilepsy and more

This website has not been designed as a replacement for the GAPS book, but as a source of additional information. Please, read the GAPS book first to understand how and why this particular diet works, why other diets are inappropriate for the GAPS patients and how to implement the appropriate diet correctly.

The GAPS diet is based on the SCD (the Specific Carbohydrate Diet). SCD has been invented by a renowned American paediatrician Dr. Sidney Valentine Haas in the first half of the 20th century. Dr. Haas and his colleagues have spent many years researching the effects of diet on celiac disease and other digestive disorders. The results of this research were published in a comprehensive medical textbook “The Management of Celiac Disease”, written by Dr. Sidney V. Haas and Merrill P. Haas in 1951. The diet, described in the book, was accepted by the medical community all over the world as a cure for celiac disease and Dr. Sidney V. Haas was honoured for his pioneer work in the field of paediatrics. Unfortunately, when celiac disease was defined as a gluten intolerance or gluten enteropathy, the SCD got forgotten as outdated information. It was brought back to life by Elaine Gottschall. Following the success of the SCD with her daughter, Elaine Gottschall over the years helped thousands of people, suffering from Crohn’s disease, ulcerative colitis, celiac disease, diverticulitis and various types of chronic diarrhoea. But the most dramatic and fast recoveries she reported in young children, who apart from digestive problems had serious behavioural abnormalities, such as autism, hyperactivity and night terrors. She devoted years of research into biochemical and biological basis of the diet and published a book, called “Breaking the Vicious Cycle. Intestinal Health Trough Diet.”

I have been using SCD in my clinic for many years. Having accumulated valuable clinical experience I had to make several adjustments in the diet appropriate for my patients with the neurological and psychiatric conditions. Through the years my patients named their dietary regime – the GAPS diet.

Implementing the GAPS Diet

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

Some of you will use the diet to treat yourselves, some of you are parents trying to help your child, some will use the diet to help a loved one or a friend. To cover all these cases, I use the term “your patient” in the text.

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 programme 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 serious digestive symptoms: diarrhoea, abdominal pain, bloating, some cases of constipation, etc. This diet will reduce the symptoms quickly and initiate the healing process in the digestive system. Even for healthy people, if you or your child gets a ‘tummy bug’ or any other form of diarrhoea, following the Introduction Diet for a few days will clear the symptoms quickly and permanently usually without needing any medication.

In cases of stubborn constipation, introduce freshly pressed juices earlier in the diet, from stage 2: start from carrot juice first thing in the morning and take your cod liver oil at the same time. The juice will stimulate bile production as many cases of persistent constipation are due to poor bile production. When there is not enough bile, the fats in the food do not digest well; instead they react with salts and form soap in the gut, causing constipation. Removing dairy may also help.

People with food allergies and intolerances should go through the Introduction Diet in order to heal and seal their gut lining. The reason for allergies and food intolerances is so-called “leaky gut” when the gut lining is damaged by abnormal micro flora. Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them. Many people try to identify, which foods they react to. However, with damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later). As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day. Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere. From my clinical experience it is best to concentrate on healing the gut wall with the Introduction Diet. Once the gut wall is healed, the foods will be digested properly before being absorbed, which will remove most food intolerances and allergies.

Those without serious digestive problems and food intolerances 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 optimise the healing process in the gut and the rest of the body. I see cases where skipping the Introduction Diet leads to long-term lingering problems, difficult to deal with.

If you have decided to go straight into the Full GAPS Diet, keep in mind that about 85% of everything your patient eats daily should be made out of meats, fish, eggs, fermented dairy and vegetables (some well-cooked, some fermented and some raw). Baking and fruit should be kept out of the diet for a few weeks, and then be limited to snacks between meals and should not replace the main meals. Homemade meat stock, soups, stews and natural fats are not optional – they should be your patient’s staples.

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: you patient must not have anything else. On the First Stage the most drastic symptoms of abdominal pain, diarrhoea and constipation will quickly subside. If, when you introduce a new food, your patient gets diarrhoea back, 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 a real allergy (which can be dangerous) to any particular food, before introducing it do the 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.

First stage:

• 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 up 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 pepper corns. 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 foods follow).

• Homemade soup with your homemade meat or fish stock. Please look for some recipe ideas in the recipe section. 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, stock 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 detail 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. Start adding juice from your homemade sauerkraut, fermented vegetables or vegetable medley (please look in the recipe section) into cups of meat stock (do not add the vegetables themselves yet, as they are too fibrous). These juices will help to restore normal stomach acid production. Make sure that the food is not too hot when adding the probiotic foods, as the heat would destroy the beneficial probiotic bacteria. In my experience a large percentage of GAPS people can tolerate well-fermented homemade whey and yoghurt right from the beginning. However, some cannot. So, before introducing dairy, do the sensitivity test. If there is no reaction on the sensitivity test, then try to introduce some whey from dripping your homemade yoghurt (dripping will remove many dairy proteins): start from 1 teaspoon of whey added to the soup or meat stock. After 3-5 days on 1 teaspoon of whey per day, increase to 2 teaspoons a day and so on, until your patient is having ½ a cup of whey per day with meals. At this stage try to add 1 teaspoon per day of homemade yoghurt (without dripping), gradually increasing the daily amount. After yoghurt introduce homemade kefir. Kefir is far more aggressive than yoghurt and usually creates a more pronounced “die-off reaction”. That is why I recommend introducing yoghurt first before starting on kefir. If your patient had no reaction to yoghurt, then you may be able to introduce kefir almost from the beginning. For those who clearly react to dairy, please look at p.95 in my book.

• Ginger tea, mint or camomile tea with a little honey between meals. Most people know how to make mint or camomile tea. 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 min. Pour through a small sieve.

In extreme cases of profuse watery diarrhoea exclude vegetables. Let your patient drink warm meat stock with probiotic foods (preferably whey or yoghurt), eat well-cooked gelatinous meats (which you made the stock with) and consider adding raw egg yolks gradually. Do not introduce vegetables until the diarrhoea starts settling down. When the gut wall is severely inflamed, no amount of fibre can be tolerated. That is why you do not rush to introduce vegetables (even very well-cooked).

Second stage:

• Keep giving your patient the soups with bone marrow, boiled meats or fish and other soft tissues off the bones (particularly gelatinous and fatty parts). 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, juices from fermented vegetables or vegetable medley, and/or homemade whey/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 the 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). 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 the daily amount of homemade yogurt or 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 the recipes in the recipe section.

• Introduce homemade ghee, starting from 1 teaspoon a day and gradually increasing.

Third stage:

• Carry on with 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). Gently fry small thin pancakes using ghee, goose fat or duck fat, make sure not to burn them.

• Egg gently fried or 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 until soft, sweet and translucent.

• 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.

Fourth stage:

• Carry on with the 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 yoghurt. If well tolerated gradually increase to a full cup 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 nuts and seeds ground into flour. The recipe (please look in the recipe section) 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.

Fifth stage:

• 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 ghee to it and mash with a potato masher. If ghee has not been 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.

Sixth stage:

• 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 diarrhoea start clearing before moving to the next stage. You may have to introduce some foods later than in this programme depending on his/her sensitivities. Make sure that you carry on with the soups and meat stock after your patient 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.