Your patient needs to carry on completely avoiding starches and sugar for two years at least. It means avoiding all grains, sugar, potatoes, parsnips, yams, sweet potato and anything made out of them. The flour in your cooking and baking can be replaced with ground almonds (or any other nuts or sunflower or pumpkin seeds ground into flour). In about 1 – 1.5 years you may be able to introduce new potatoes, fermented buckwheat, millet and quinoa, starting from very small amounts and observing any reaction. Wheat, sugar, processed foods and all additives will have to be out of the diet for much longer.
Slowly increase the amounts of fermented foods. You can ferment vegetables, fruit, milk and fish (please look in the recipe section). I would also recommend reading a wonderful book by Sally Fallon “Nourishing Traditions”, it will provide you with a lot of good recipes. Eating fermented foods with every meal will help your patient to digest the meal without using supplements or digestive enzymes. Make sure to introduce all new fermented foods into the diet very gradually starting from 1-2 teaspoons a day.
The best foods for the GAPS person are eggs, meats and fish (bought fresh or frozen, not smoked or canned, and cooked at home), shellfish, fresh vegetables and fruit, nuts and seeds, garlic and olive oil. As well as eating the vegetables cooked it is important to have them raw in the form of salads and sticks. In this form they will provide your patient with valuable enzymes and detoxifying substances, which will help in digesting meats. Raw fruit should be eaten on their own, not with meals, as they have a very different digestion pattern and can make the work harder for the stomach. At that stage let your patient to have fruit as a snack between meals. Remember, that about 85% of everything your patient eats on a daily basis should be savoury – made out of meats, fish, eggs, vegetables and natural fats. Sweet baking and fruit should be snacks between meals in limited amounts.
It is very important for a GAPS person to have plenty of natural fats in every meal from meats, butter, ghee, coconut and cold pressed olive oil. The fat content of the meal will regulate the blood sugar level and control cravings for carbohydrates.
If your patient gets a tummy bug or any other form of diarrhoea go back to the low fibre diet for a few days: remove all nuts, raw vegetables and raw fruit out of the diet; go back to meats cooked in water and meat stock, fish, eggs, fermented dairy and cooked vegetables (skinned, de-seeded and well cooked with meats as soups and stews) until diarrhoea completely clears. After the stools stay normal for a week introduce raw vegetables slowly, one at a time and starting from small amounts. When vegetables are introduced, try to introduce nuts, seeds and fruit gradually.
It is important for your GAPS patient to balance the meals so that his or her body pH stays normal. All protein foods, such as meats, fish, eggs and cheese leave an acid ash in the body, which may aggravate his or her condition. Vegetables are alkalising, so you need to combine meats, fish and eggs with good amount of vegetables cooked and/or raw. Raw fruit, vegetables and greens have particularly strong alkalising ability. Apple cider vinegar is very alkalising, it is good to have it every day: just add one teaspoon of cider vinegar into every glass of water your patient drinks. Hot water with cider vinegar will makes an excellent warming and alkalising drink. Fermented foods are also alkalising.
It is very important to avoid processed foods (any packet or tinned foods). They are stripped from most nutrients that were present in the fresh ingredients used for making these foods. They are a hard work for the digestive system and they damage the healthy gut flora balance. On top of that they usually contain a lot of artificial chemicals, detrimental to health, like preservatives, colorants, E-numbers, etc. Try to buy foods in the form that nature made them, as fresh as possible.
Do not use a microwave oven, as it destroys food. Cook and warm up food using conventional oven and stove.
The 6 introduction stages to the GAPS Nutrition Protocol provide individuals with a kick start to healing.
The Introduction Diet has been designed for people with serious digestive problems, persistent diarrhoea, food allergies and intolerances. These individuals should follow the Introduction Diet before progressing into the full GAPS diet. People who experience constipation during the introduction stages should strongly consider implementing an enema as described in the GAPS book. An individuals body can become very toxic if constipation is left too long and bowls do not move for more than 36 hours. Please refer to page 225 in the GAPS book for more information before you commence with the introduction stages because the detox is a low fibre diet.
*Note: Those who start with the Introduction Diet will introduce dairy earlier than those who go right into the full GAPS diet. Always do a sensitivity test prior to introducing dairy.
1. Introduction Diet
2. The Full GAPS Diet with the typical menu
I recommend that most GAPS patients follow the Introduction Diet before going into the Full GAPS diet. Depending on the severity of your patient’s condition he or she can move through this program as fast or as slow as his/her condition will permit: for example you may move through the First Stage in one or two days and then spend longer on the Second Stage. Following the Introduction Diet fully is essential for people with diarrhea or severe constipation: it reduces symptoms quickly and speeds up the healing process in the digestive system. Even for healthy people, if you or your child gets a ‘tummy bug’ or any other profuse diarrhea, following the Introduction Diet for a few days will clear the symptoms quickly and permanently without needing any medication.
Those without severe digestive problems can move through the Introduction Diet quite quickly. However, please do not be tempted to skip the Introduction Diet and go straight into the Full GAPS Diet, because the Introduction Diet will give your patient the best chance to optimize the healing process in the gut and the rest of the body. I see many cases where skipping the Introduction Diet leads to long-term lingering problems, difficult to deal with.
Start the day with a cup of still mineral or filtered water. Give your patient the probiotic. Make sure that the water is warm or room temperature, not cold, as cold will aggravate his or her condition.
Only foods listed are allowed: your patient must not have anything else. On the First Stage the most drastic symptoms of abdominal pain, diarrhea and constipation will quickly subside. If, when you introduce a new food, your patient gets back diarrhea, pain or any other digestive symptoms then he/she is not ready for that food to be introduced. Wait for a week and try again.
If you suspect an allergy to any particular food, before introducing it do the Sensitivity Test.
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.
Homemade meat or fish stock.
Meat and fish stocks provide building blocks for the rapidly growing cells of the gut lining and they have a soothing effect on any areas of inflammation in the gut. That is why they aid digestion and have been known for centuries as healing folk remedies for the digestive tract. Do not use commercially available soup stock granules or bullion cubes, they are highly processed and are full of detrimental ingredients. Chicken stock is particularly gentle on the stomach and is very good to start from. To make good meat stock you need joints, bones, a piece of meat on the bone, a whole chicken, giblets from chicken, goose or duck, whole pigeons, pheasants or other inexpensive meats. It is essential to use bones and joints, as they provide the healing substances, not so much the muscle meats. Ask the butcher to cut in half the large tubular bones, so you can get the bone marrow out of them after cooking. Put the bones, joints and meats into a large pan and fill it with water, add natural unprocessed salt to your taste at the beginning of cooking and about a teaspoon of black peppercorns, roughly crushed. Bring to boil, cover and simmer on a low heat for 2.5-3 hours. You can make fish stock the same way using a whole fish or fish fins, bones and heads. After cooking take the bones and meats out and sieve the stock to remove small bones and peppercorns. Strip off all the soft tissues from the bones as best as you can to later add to soups or encourage your patient to eat all the soft tissues on the bones. Extract the bone marrow out of large tubular bones while they are still warm: to do that bang the bone on a thick wooden chopping board. The gelatinous soft tissues around the bones and the bone marrow provide some of the best healing remedies for the gut lining and the immune system; your patient needs to consume them with every meal. Take off all the soft tissues from fish bones and heads and reserve for adding to soups later. The meat or fish stock will keep well in the fridge for at least 7 days or it can be frozen. Keep giving your patient warm meat stock as a drink all day with his meals and between meals. Do not use microwaves for warming up the stock, use conventional stove (microwaves destroy food). It is very important for your patient to consume all the fat in the stock and off the bones as these fats are essential for the healing process. Add some probiotic food into every cup of stock (the details about introducing probiotic food follow).
Homemade soup with your homemade meat or fish stock.
Please look for some recipe ideas in the recipe section of the book. Here we will go through some details, specific for the Introduction Diet. Bring some of the meat stock to boil, add chopped or sliced vegetables: onions, carrots, broccoli, leeks, cauliflower, courgettes, marrow, squash, pumpkin, etc. and simmer for 25-35 minutes. You can choose any combination of available vegetables avoiding very fibrous ones, such as all varieties of cabbage and celery. All particularly fibrous parts of vegetables need to be removed, such as skin and seeds on pumpkins, marrows and squashes, stalk of broccoli and cauliflower and any other parts that look too fibrous. Cook the vegetables well, so they are really soft. When vegetables are well cooked, add 1-2 tablespoons of chopped garlic, bring to boil and turn the heat off. Give your patient this soup with the bone marrow and meats and other soft tissues, which you cut off the bones. You can blend the soup using a soup blender or serve it as it is. Add some probiotic food into every bowl of soup (the details about introducing probiotic foods follow). Your patient should eat these soups with boiled meat and other soft tissues off the bones as often as he/she wants to all day.
Probiotic foods are essential to introduce right from the beginning.
These can be dairy based or vegetable based. To avoid any reactions introduce probiotic foods gradually, starting from 1-2 teaspoons a day for 2-5 days, then 3-4 teaspoons a day for 2-5 days and so on until you can add a few teaspoons of the probiotic food into every cup of meat stock and every bowl of soup. If your patient is ready to introduce dairy, then use your homemade yogurt or kefir. If dairy is still out [by results of sensitivity test or negative reaction when introducing it], then into every cup of meat stock or soup add juice from your homemade sauerkraut, fermented vegetables or vegetable medley (please look in the recipe section of the book). Make sure that the food is not too hot when adding the probiotic foods, as the heat would destroy the beneficial probiotic bacteria.
Ginger tea with a little honey between meals.
To make ginger tea, grate some fresh ginger root (about a teaspoonful) into your teapot and pour some boiling water over it, cover and leave for 3-5 minutes. Pour through a small sieve and add honey to taste (optional).
Continue with Stage 1.
Keep giving your patient the soups with bone marrow, boiled meats or fish and other soft tissues off the bones. He or she should keep drinking the meat stock and ginger tea. Keep adding some probiotic food into every cup of meat stock and every bowl of soup: juices from sauerkraut, fermented vegetables or vegetable medley, or homemade kefir/yogurt.
Add raw organic egg yolks.
It is best to have egg yolks raw added to every bowl of soup and every cup of meat stock. Start from 1 egg yolk a day and gradually increase until your patient has an egg yolk with every bowl of soup. When egg yolks are well tolerated add soft-boiled eggs to the soups (the whites cooked and the yolks still runny). If you have any concerns about egg allergy, do the sensitivity test first. There is no need to limit number of egg yolks per day, as they absorb quickly almost without needing any digestion and will provide your patient with wonderful and most needed nutrition. Get your eggs from a source you trust: fresh, free range and organic.
Add stews and casseroles made with meats and vegetables.
Avoid spices at this stage; just make the stew with salt and fresh herbs (look for a recipe of Italian Casserole in the recipe section of the book). The fat content of these meals must be quite high: the more fresh animal fats your patient consumes, the quicker he or she will recover. Add some probiotic food into every serving.
Increase daily amount of homemade yogurt and kefir, if introduced. Increase the amount of juice from sauerkraut, fermented vegetables or vegetable medley.
Introduce fermented fish, starting from one piece a day and gradually increasing. Look for recipes in recipe section.
Introduce homemade ghee, starting from 1 teaspoon a day and gradually increasing. Look for recipe in recipe section.
Carry on with all the previous foods.
Add ripe avocado mashed into soups, starting from 1-3 teaspoons and gradually increasing the amount.
Add pancakes, starting from one pancake a day and gradually increasing the amount.
Make these pancakes with three ingredients: 1) organic nut butter (almond, walnut, peanut, etc); 2) eggs; 3) a piece of fresh winter squash, marrow or courgette (peeled, de-seeded and well blended in a food processor). Fry small thin pancakes using ghee, goose fat or duck fat. Make sure not to burn them.
Egg scrambled with plenty of ghee, goose fat or duck fat.
Serve it with avocado (if well tolerated) and cooked vegetables. Cooked onion is particularly good for the digestive system and the immune system: melt 3 tablespoons of duck fat or ghee in the pan, add sliced large white onion, cover and cook for 20-30 minutes on low heat.
Introduce the sauerkraut and your fermented vegetables (your patient has been drinking the juices from them for a while now).
Start from a small amount, gradually increasing to 1-2 tablespoons of sauerkraut or fermented vegetables per every meal.
Carry on with all previous foods.
Gradually add meats cooked by roasting and grilling (but not barbecued or fried yet).
Avoid bits, which are burned or too brown. Let your patient eat the meat with cooked vegetables and sauerkraut (or other fermented vegetables).
Start adding cold pressed olive oil to the meals, starting from a few drops per meal and gradually increasing the amount to 1-2 tablespoons per meal.
Introduce freshly pressed juices, starting from a few spoonfuls of carrot juice.
Make sure that the juice is clear, filter it well. Let your patient drink it slowly or diluted with warm water or mixed with some homemade yogurt. If well tolerated gradually increase to a full cua a day. When a full cup of carrot juice is well tolerated try to add to it juice from celery, lettuce and fresh mint leaves. Your patient should drink the juice on an empty stomach, so first thing in the morning and middle of afternoon are good times.
Try to bake bread with ground almonds or any other nut and seeds ground into flour.
The recipe (please look in recipe section of the book) requires only four ingredients: 1) nut flour; 2) eggs; 3) piece of fresh winter squash, marrow or courgette (peeled, de-seeded and finely sliced); 4) some natural fat (ghee, butter, goose or duck fat) and some salt to taste. Your patient should start from a small piece of bread per day and gradually increase the amount.
If all the previous foods are well tolerated try to add cooked apple as an apple pure.
Peel and core ripe cooking apples and stew them with a bit of water until soft. When cooked add some shee to it and mash with a potato masher. If ghee has not bee introduced yet add duck or goose fat. Start from a few spoonfuls a day. Watch for any reaction. If there is none gradually increase the amount.
Add raw vegetables starting from softer parts of lettuce and peeled cucumber.
Watch your patient’s stool. Again start from a small amount and gradually increase if well tolerated. After those two vegetables are well tolerated gradually add other raw vegetables: carrot, tomato, onion, cabbage, etc.
If the juice made from carrot, celery, lettuce and mint is well tolerated, start adding fruit to it: apple, pineapple and mango. Avoid citrus fruit at this stage.
If all the introduced foods are well tolerated try some peeled raw apple. Gradually introduce raw fruit and more honey.
Gradually introduce baking cakes and other sweet things allowed on the diet. Use dried fruit as a sweetener in the baking.
As I mentioned before, your patient may be able to move through the Introduction Diet faster or slower depending on the stool changes: let the diarrhea start clearing before moving to the next stage. You may have to introduce some foods later than in the program depending on his/her sensitivities. Make sure that you carry on with the soups and meat stock after your patient has completed the Introduction Diet at least once a day.
After the Introduction Diet is completed and when your patient has more or less normal stools move into the Full GAPS Diet.
A Typical Menu:
Start the day with a glass of still mineral water or filtered water with a slice of lemon. It can be warm or cold to personal preference.
If you have a juicer your patient can start the day with a glass of freshly pressed fruit/vegetable juice diluted with water.
A good juice to start the day is 40% apple + 50% carrot + 10% beetroot (all raw of course). You can make all sorts of juice mixes, but generally try to have 50% of therapeutic ingredients: carrot, small amount of beetroot (no more than 5-10% of juice mixture), celery, cabbage, lettuce, greens (spinach, parsley, dill, basil, fresh nettle leaves, beet tops, carrot tops), white and red cabbage, and 50% of some tasty ingredients to disguise the taste of therapeutic ingredients: pineapple, apple, orange, grapefruit, grapes, mango, etc. Your patient can have these juices as they are, with some yogurt or diluted with water.
Every day our bodies go through a 24 hour cycle of activity and rest, feeding and cleaning up (detoxifying). From about 4 am till about 10 am the body is in the cleaning up or detoxification mode. Drinking water and freshly pressed juices will assist in this process. Loading the body with food at that time interferes with the detoxification. That is why many of us do not feel hungry first thing in the morning. It is better to have breakfast around 10 am when your body has completed the detox stage and is ready for feeding. At that stage we usually start feeling hungry. Children may be ready for their breakfast earlier than adults.
A variation of English breakfast: eggs cooked to personal liking and served with sausages and vegetables, some cooked, some fresh as a salad (tomato, cucumber, onions, celery, and fresh salad greens, etc.) and/or avocado and/or meat. The yolks are best uncooked that the whites cooked. Use plenty of cold pressed olive oil as a dressing on the salad and eggs. Mix a tablespoon of pre-soaked or sprouted sunflower and/or sesame and/or pumpkin seeds with the salad. Sausages (full fat) should be made of pure minced meat with only salt and pepper added. Make sure that there are no commercial seasonings or MSG (Monosodium Glutamate) in the sausages. I recommend finding a local butcher, who would make pure meat sausages for you on order
Avocado with meat, fish or shellfish, vegetables raw and cooked, lemon and cold pressed olive oil. Serve a cup of warm meat stock as a drink with food.
Pancakes made with ground nuts. These pancakes are delicious with some butter with honey, or as a savory snack. If you blend some fresh or defrosted berries with honey, it will make a delicious jam to have with pancakes. Weak tea with lemon, ginger tea or mint tea.
Any of the home baked goods: muffins, fruit cake and bread.
Homemade vegetable soup or stew in a homemade meat stock.
Avocado with meat, fish, shellfish and raw and/or cooked vegetables. Use olive oil with some lemon squeezed over it as a dressing. Serve a cup of warm homemade meat stock as a drink.
Any meat/fish dish with vegetables.
One of the dishes from the lunch or breakfast choices.
There are many recipes found in the book. You can also take old recipes and give them your own GAPS diet update.
GAPS List of Allowable and Non Allowable foods can be located in the GAPS book, along with the GAPS recipes.
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Tags:digestive problems, Dr Natasha Campbell-McBride, food allergies, Gut and Psychology Syndrome, Introduction Diet, persistent diarrhoea, The Full GAPS Diet