By Matt Stone
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 30th…
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…
“After eating strictly Weston A. Price food and being gluten free for 2 years I decided to try GAPS diet by Dr. Natasha Campbell-McBride since my food intolerances seemed to be getting worse. Milk, Wheat, and then corn and nuts. I ‘fixed’ the milk intolerance by drinking raw and fermented milk. I assumed the other intolerances were due to my few years of vegetarianism and excessive sugar intake, lost digestive enzymes and probiotics and overabundance of “bad bacteria”.
I did GAPS introdiet for 3 weeks, lost 10 lbs to look like a skeleton and felt awful. I assumed it was bad bacteria “die-off” or sugar addiction withdrawal. I ignored these symptoms only to find myself in the hospital with deadly low blood levels of potassium (an electrolyte), a nearly stopped heart, and what doctors call a‘heart attack’. I was 26 years old, 130lbs, tall, thin, athletic, nonsmoker, nondrinker, and perplexed. For the entire time of my GAPS trial, I wrote down everything I ate and exactly how I felt. My diet was not lacking in potassium. I did more research and found many articles linking low potassium with blood clots, stroke, and heart failure. I also found a community of people warning of diets because of a young girls’ death from a‘heart attack’ while on a low carb diet. This case also had low potassium, and some think that potassium was lost because when a body is lacking in dietary carbs, it uses its stores of glycogen, which are bound to water. This process unbinds water and a person will experience excessive urination (and weight loss), which results in electrolyte imbalances. But who would listen to that? Of course, the doctors attribute the heart attacks to being overweight, having high cholesterol and eating a lot of protein. There were no categories I fell into that doctors could blame. At first they thought I was bulimic because apparently there is a correlation with vomiting, loss of fluids and electrolytes, and heart attacks. They even looked at my arteries and found them to be “squeaky-clean” with no cholesterol buildup.
With my symptoms and information I think that eating a lowcarb diet, with diuretics (Dandelion root, kombucha, etc.) and laxatives recommended can be really dangerous for some since all of these things can result in dropped potassium levels with symptoms that mimic what the book calls“die-off” and normal to the experience. Some symptoms I experienced included: very painful cramps in my calves at night, headaches, chills, waking up to go to the bathroom 1-3 times a night, standing up and feeling dizzy, constipation, excessive hunger/thirst and dry mouth, craving oatmeal and potatoes.
I realize that I am not a doctor, and my case probably involved many factors since there is a whole community of people who have successful ‘GAPS’ stories. However, I do not understand why laxatives/enemas are recommended to be given on a daily basis with this diet when the author herself verified that potassium levels are kept in check by a hormone called aldosterone and can become dangerously low when this hormone is absent OR when it is lost through the gut(vomit/diarrhea) or kidneys (urine).
Here’s more details on the numbers and medical tests:
I did not have this low aldosterone hormone. I entered the hospital with chest pain, chills, anxiety, and limp weakness. They ran a bunch of ‘heart attack’ checks but did not see anything. The X-rays and dopler scans did not show blood clots or cholesterol blocks. However, my blood tests showed high levels of CK-Total, CK-MB, Myoglobin and Troponin, which are all heart attack indicators. My potassium was at 2.9 mEq/L, glucose at 111 mg/dL. I stayed overnight and the next morning received a cardiac cathederization (tiny camera into arteries) where they found a tiny tiny dissolving bloodclot in the “distal obtuse maeginal branch”. I do have Factor V Leiden blood , which is associated with blood clots in veins, and MTHFR (inability to convert folic acid) but my doctors said that this blood clot was in an artery. Factor V was associated with leg clots that would have had to travel through my lung and brain to get to my heart. At this time, after the episode, my cholesterol was taken and it showed to be 205, 68 HDL, 131 LDL with a 1.93 LDL/HDL ratio. I also had slightly low white blood cell count. The camera in my artery showed no sign of corrosion, scarring, or cholesterol buildup. I was released from the hospital and told that there was no reason that this should have happened. It was not related to potassium or my diet or my blood clotting factor.
But they did offer me statins and gave me a pill used for heart stent patients to thin my blood and open my heart, and sheet of paper that said I should avoid fried foods, creams, butter, whole milk, bacon, sausage, organ meats, egg yolks, tropical oils and only eat low-fat foods including “whole wheat, vegetables without salt or butter, skim milk, soy milk, nonfat yoghurt and cheese, lean cuts of meat, skinless poultry, fish, meat alternatives with soy or textured vegetable protein, egg whites or substitutes, unsaturated oils (olive, peanut, soy, sunflower, canola), soft or liquid margarine, and vegetable oil spreads, seeds, nuts, avocados.”
It has now been a year since this episode and I continue to have food sensitivities, intolerance to cold, midnight anxiety, no body heat, hypoglycemia, and really sensitive to sugar and alcohol. I also had really low blood pressure (95/60) and low heart rate (60 bpm) for a while after hospitalization.”