0 The GAPS Diet

I first wrote about Natasha Campbell-McBride and the GAPS diet many years ago, commenting on what an excellent public speaker Campbell-McBride is.  She speaks with a tremendous amount of confidence and fervor.  You are convinced, after hearing her speak, that she really knows something and is eager to bring it to those in need.  But these good intentions and good impressions aside, most find the GAPS diet to be woefully ineffective.  For some, like a young girl who recently contacted me after what seems to be some electrolyte-related heart troubles caused in part by her GAPS experience, it can do a lot of damage.

So what, in my assessment, is the good, bad, and ugly of GAPS (with an emphasis on bad and ugly as everyone else only talks about the good)?  As always, I bring this up and give my honest appraisal of it for discussion.  I have no doubt the discussions will be lively.  Enjoy this primer, as I plan to discuss this in much greater detail in an upcoming live GAPS podcast with Josh and Jeanne Rubin on April 30^th…

For those of you unfamiliar with GAPS, it stems mostly from concepts that led to the development of the Specific Carbohydrate Diet (SCD) decades ago.  The concept was that larger carbohydrate molecules cannot be broken down by an unhealthy digestive tract, and merely cause a great deal of irritation.  Thus, the carbohydrates you “specifically” eat are simpler carbohydrates – while avoiding complex polysaccharides such as those found in starchy foods.

The idea behind the GAPS diet, for simplicity’s sake, is to undergo a prolonged healing period in which the villi of the large intestine, the gut wall, and the bacterial flora of the gut can be healed and properly reestablished.  Proponents of the diet say it can take years to heal the gut.  On the diet, meats and fats are championed, as are many well-cooked vegetables.  For carbohydrates, honey and some fruits and nuts are allowed, but not necessarily emphasized.  Bone broths and probiotic supplementation are highly encouraged and considered mandatory.  Gluten and casein are restricted, but with the hope that they can one day be reintroduced after the gut has undergone its healing.  The diet is recommended for those with autism, schizophrenia, and other psychological disorders among a wide range of other illnesses – from constipation to food allergies.

I’m very thankful for having encountered Campbell-McBride, as it was her that got me thinking beyond the simple concept of what is and is not healthy – and thinking instead of targeted strategies to overcome specific problems.  It was this mindset that led me to identify low metabolism/body temperature as a specific problem – later developing a strategy for addressing it.

But that doesn’t mean I’m supportive of the GAPS diet.  In all honesty, I think it’s a pretty poor strategy that applies to only a rare few, and the system itself lacks a great deal of understanding about the collective functioning of the entire human organism – such as the ties between metabolic rate and countless digestive processes.

Take for example constipation.  When we take a broad look at the processes involved with transit time, stool moisture and volume, and other factors – we can see that it’s certainly not just a matter of what takes place with gut flora and the villi.  There are many factors that contribute, much more dominant factors at that, many of them being inseparably tied to rate of metabolism.

To keep this post from being book length, let me briefly point out the metabolism-digestion link.  Keep in mind that diets low in carbohydrates, or even diets that are overly restrictive and monotonous, which GAPS usually ends up being – can be highly detrimental to metabolic rate – my main criticism of basically all diets and other “health” interventions.

Metabolism controls the strength of the gastric secretions.  How well you digest your food – and how well it is broken down during the early stages of digestion depend on metabolic rate, gastrin secretion (governed in large part by thyroid), etc.  Thus, the first step of digestion is very metabolic.

How long food sits in your stomach depends upon metabolism too.  Delayed stomach emptying, or gastroparesis, is a frequent result of a slow metabolism.  You might see other apertures remaining open, allowing stomach acid to flow up the esophagus as in acid reflux/GERD when metabolism is low.  I experienced this phenomenon myself on several different diets, and even had this problem spring up from doing excessive hiking.  It didn’t matter what I ate.  Until I raised my metabolic rate, it did not go away.  It has been gone for many years now, except for brief periods when it has reemerged due to doing something metabolically stupid.

Metabolism largely controls the rate at which food passes through the digestive tract as well.  The mammal with the lowest metabolic rate also happens to have the longest bowel transit time (sloth).  When food travels through the digestive tract more slowly, fibers and sugars ferment excessively.  This can lead to gas, bloating, bacterial overgrowth of the small intestine/SIBO (presumed to be the cause of most cases of IBS thanks to the work of Mark Pimentel at the gastroenterology department at Cedars-Sinai), constipation, changes in bacterial flora, diverticulosis, and disorders attributable to straining at stool time – anal fissures, hemorrhoids, and perhaps even varicose veins.

Metabolism even seems to have some direct impact on gut permeability (leaky gut) and the strength of the gut wall.  As was observed in prolonged calorie-restriction…

“There is reason to believe that the epithelial lining of the gastrointestinal tract becomes more permeable to microorganisms in severe undernutrition.  The morphological changes in the intestinal tract would strongly suggest this.”

It’s well known that the rate in which new tissues are regenerated, as in wound healing, goes up and down with the rate of metabolism.  I even suspect that rebuilding the strength of the gut wall and repairing a damaged gut can be accelerated by metabolic increase – making more headway in a shorter period of time than with the use of other isolated approaches.  Like GAPS for example.

Overall GAPS is a speculative approach to fixing an isolated area.  One who follows the diet takes it on faith that the diet is performing healing work, but there’s no real way of knowing if this is actually occurring or not.  It seems more like a story to me, one that is partly true but may be riddled with far too much fiction.  A Santa Claus story if you will.

I understand that there can be many short-term symptom improvements in many health problems, but this is probably not too different from the honeymoon period one can find on any number of new eating regimes – from raw foodism to fasting to juicing to veganism to Paleo to carb restriction to removing various allergenic foods, all of which are fraught with danger from a long-term metabolic standpoint.

If decreasing metabolic rate is capable of contributing to heartburn, gastroparesis, gas, bloating, diverticulosis, hemorrhoids, constipation, IBS, gut permeability, and more – and the GAPS diet really does lower metabolic rate as often as my personal communications with others suggest, then I suspect the diet probably causes more digestive problems than it heals.  This says nothing of the barbaric restrictiveness and social crippling provided by the diet.  And it speaks nothing about the Santa-length list of health problems outside of the digestive tract that can surface as metabolism falls (problems with fertility, sex drive, menstruation, sexual function, sleep, anxiety, and so forth).

There is no diet or program or health pursuit that doesn’t have both positive and negative outcomes for those testing ‘em out.  There are successes and failures in every arena.  It is fair to recognize and discuss openly what those failures are, and why they occur.  Don’t get too swept away and infatuated with the idea that a few hard years of GAPS is going to deliver the health you are looking for.  You might totally ruin your health working so hard to get healthy.  There are real risks and real downsides to the approach.

I would be cautious about probiotic supplementation as well.  Many digestive problems stem from “probiotics” inhabiting portions of the digestive tract that should be sterile.  Mark Pimentel at Cedars Sinai certainly doesn’t use them – noting his belief that they can be fuel on the fire, and even the Rubins – who I will be discussing the GAPS diet with in an upcoming podcast, have noted that even people who have been taking antibiotics for long periods of time still show adequate or even excessive amounts of these “healthy bacteria” in the gut.

Anyway, in closing I will share with you what someone wanted to be shared with those blindly following GAPS without any clue as to the potential negatives.  This is not necessarily something to attribute directly to GAPS as it is low carbohydrate consumption and excessive fluid intake, but low-carbohydrate consumption happens by default on the diet, as does fluid intake with the broth-o-philia.  I would pay particular attention to this if low-carbohydrate or overly-restricted eating has resulted in frequent, clear urination (polyuria) or muscle cramping. You’ll notice many of the common themes in her symptomology that lots of people can experience with carbohydrate and/or calorie restriction – most of it metabolic in origin…