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Stage Progression

Healing Crisis

A healing crisis usually occurs in stage one on day two or three.  During the first few days in implementing the GAPS protocol, the body begins cleaning up its toxins.  The healing crisis occurs when the pathogenic microbes die off and release their toxins.  These toxins are the cause of the GAPS patient’s mental health characteristics and a regression is usually presented.  Whatever symptoms the child or adult has such as self harming or obsessive compulsive disorder, these symptoms may get worse before they get better.  The body needs time to detoxify before this gets better and this could take weeks or months.  Many of the symptoms include headaches (migraines), vomiting, nausea, muscle aches, depression, bloating, constipation, diarrhoea, extreme fatigue, listlessness or an increase in any symptom the person may have experienced in the past.  Read more about the Healing Crisis and what to expect here

Stage Progression Indicators

Stage progression is dependent upon the individual.  Some people may remain in stage one and two for a few days and others may take several weeks before moving onto the next.  Your patient may be able to move through the Introduction Diet faster or slower depending on two factors: typical symptoms and stool changes.  Generally if you are constipated, you will move faster through the first 2 stages and rest at stage 3 for a week or so until you have managed to introduce the food in each step comfortably.  If you have profuse watery diarrhoea, you will need to stay in the 1st and 2nd stage longer and this could be weeks.  Some people have to take vegetables out all together for a while until diarrhoea clears.  Please refer to ‘the GAPS Companion’ for a more in-depth discussion on Stage progression indicators and specific modifications for the diet.

Typical Symptoms

The first indicator identifies when the healing crisis subsides and other typical symptoms improve.  These symptoms could range from anything that you noticed that got worse during the healing crisis like a specific behaviour (obsessions, irritability, crying etc) or noticeable reactions like headache, bloating or rashes.  It becomes a personal observation for the individual; however each stage should not be rushed or you run a risk of returning to that stage. 

The GAPS patient’s stool needs to have firmed up to either a 3 or 4 on the Bristol Stool Chart.  The general rule is: do not move on until diarrhoea has improved and the stool has become more solid.  Do not be mistaken by stools that have squeezed out of an excess fecal compaction which greatly increases toxicity in the body – this is when the stool shape has a slightly jiggered edge or unusual  appearance instead of a stool that presents with smooth round sides.  Constipation and an overflow squeezing through fecal compaction is very toxic for the whole body.  An enema will assist in resolving this problem and Dr Natasha advises that no child should be left constipated for more than 36 hours.   

The Bristol Stool Chart

The Bristol Stool Scale or Bristol Stool Chart is a medical aid designed to classify the form of human stools into seven groups.  It was developed by Heaton and Lewis at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997.  The form of the stool depends on the time it spends in the colon

GAPS Australia

Type 1 has spent the longest time in the colon and type 7 has spent the least.  Stools at the lumpy end of the scale are hard to pass and often require a lot of straining.  Stools at the loose or liquid end of the spectrum can be too easy to pass – the need to pass them is urgent and accidents can happen.  The ideal stools are types 3 and 4, especially type 4, as they are most likely to glide out without any fuss.

What type of stool is best?

  • The feeling you need to go is definite but not irresistible  
  • Once you sit down on the toilet there is no delay  
  • No conscious effort or straining is needed  
  • The stool glides out smoothly and comfortably
  • Afterwards there is only a pleasant feeling of relief
  • All this is most likely if the stool is Bristol Stool Form Scale, type 4


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