Food allergies have become very common, and the trend is up.1 Most medical practitioners are facing this problem on a daily basis more and more. A recent public survey in the UK has shown that almost half the population report that they have an “allergy” to one or more foods.2 However, the official figures for a “true allergy to food” are around 1 percent of the population in most developed countries.1
The reason for this confusion is that the majority of food reactions, allergies, and intolerances do not produce a typical allergy test profile—raised IgE or IgG with positive prick test or positive RAST test. Physicians have made several attempts to classify this group: as “type B food allergy,” “metabolic food intolerance” or simply “food intolerance,” rather than a “true” allergy.3 People who do not test positive to standard allergy tests may nevertheless react to many different foods or combinations of foods. Quite often the person is not sure which food produces the reaction because the reaction may be immediate or delayed—a day, a few days or even a week later. As these delayed reactions overlap each other, patients can never be sure exactly what they are reacting to on any given day.1,3
In addition, physicians often encounter a masking phenomenon, in which reactions to regularly consumed foods run into each other— the new reaction begins when the previous has not yet finished—so the connection with a food and the symptoms it triggers is not apparent.4
Food allergy or intolerance can produce every symptom under the sun, from migraines, fatigue, PMS, painful joints and itchy skin to depression, hyperactivity, hallucinations, obsessions and other psychiatric and neurological manifestations. However, the most immediate and common symptoms in the vast majority of patients are digestive problems: pain, diarrhea or constipation, urgency, bloating and indigestion.3,5,6
Naturally, many people try to identify which foods they react to. As a result many forms of testing have appeared on the market, from blood tests to electronic skin tests. Many experienced practitioners get disillusioned with most of these tests, as they produce too many false positives and false negatives.6 Furthermore, these tests lead physicians to the simplistic conclusion that removing the “positive” foods from the diet will solve the problem. Indeed, in some cases, elimination of a trigger food can help. However, this help is rarely permanent; the patients usually find that as they eliminate some foods, they start reacting to others to which they did not seem to react before. The patient finishes up with virtually nothing left to eat, and every new test finds reactions to new foods. The majority of experienced practitioners come to the same conclusion: the simplistic idea of “just don’t eat foods you are allergic to!” does not address the root of the problem.3,6 We need to look deeper into the causes of these food intolerances.
A CASE HISTORY
In order to understand the root cause of food allergies, I would like to share a case history of one of my patients. Stephanie S., thirty-five years old, asked for my help in “sorting out her food allergies.” A very pale, malnourished looking lady, (weight 99 pounds with height five feet, three inches) with low energy levels, chronic cystitis, abdominal pains, bloating and chronic constipation. She was consistently diagnosed as anemic all her life.
As to her family background, she was born naturally from a mother with digestive problems and migraines. Her sister suffered from severe eczema and her brother from gastro-intestinal problems. She did not have information on her father’s health.
She was not breast fed as a baby and at the age of three months contracted her first urinary infection, treated with the first course of antibiotics. Since that time, the urinary infections became a regular part of her life, usually treated by antibiotics; when she saw me she was suffering from chronic interstitial cystitis.
Throughout her childhood she was very thin, always finding it difficult to put any weight on, but otherwise she considered her health to be “OK”—she completed school and played sports. At fourteen years of age her menstruation stopped, having started a year before. She was put on a contraceptive pill, which seemed to regulate her menstrual periods.
Around age sixteen she was put on a long course of antibiotics for acne, after which she developed lactose intolerance with severe constipation and bloating. She was advised to stop consuming dairy products at age eighteen, which helped with constipation for a while, but her other symptoms remained. She developed progressively lower levels of energy, abdominal cramps, dizzy spells, very low body weight and very dry skin.
Following numerous medical consultations and food allergy testing, she started removing different foods from her diet, but was never sure whether this made much difference. Some symptoms seemed to improve, others did not and new symptoms appeared. She became sensitive to loud sounds and local pollution, her shampoo and make-up and some domestic cleaning chemicals. Her cystitis became chronic and was pronounced psychosomatic by her doctor. Her diet at the time of the consultation was very limited: she seemed to tolerate (but was not entirely sure) breakfast cereals, sheep’s yogurt, soy milk, some varieties of cheese, a few vegetables and rarely fish. Following several food allergy tests she removed all meats, eggs, nuts, all fruit, whole grains and many vegetables from her diet.
This example is very common and demonstrates clearly that just removing “offending” foods from the diet does not solve the problem. We have to look deeper and find the cause of the patient’s malady. In order to do that we have to examine Stephanie’s health history.
INFANCY
Stephanie was born from a mother with digestive problems and Stephanie was not breast fed. What does that tell us? We know that unborn babies have a sterile gut.7 At the time of birth, the baby swallows mouthfuls of microbes, which live in the mother’s birth canal.8 These microbes take about twenty days to establish themselves in the baby’s virgin digestive system and become the baby’s gut flora.7,8
Where does the vaginal flora come from? Medical science shows that the flora in the vagina largely comes from the gut. What lives in the woman’s bowel will live in her vagina.9,10 Stephanie’s mother suffered from digestive problems, which indicates that she had abnormal gut flora as well, which she passed to her daughter at birth.
Baby Stephanie was not breast fed. Breast milk, particularly colostrum in the first days after birth, is vital for appropriate population of the baby’s digestive system with healthy microbial flora.9,10,11 We know that bottle-fed babies develop completely different gut flora than breast fed babies. 11 That flora later on predisposes bottle-fed babies to asthma, eczema, other allergies and other health problems.12 But the most important abnormalities develop in the digestive system, of course, as that is where these microbes make their home. Having acquired abnormal gut flora from her mother at birth, Stephanie’s was compromised further by bottle feeding.
CHRONIC CYSTITIS
In the first few weeks of life, in addition to the gut lining, other mucous membranes and baby’s skin get populated by their own flora, which play a crucial role in protecting those surfaces from pathogens and toxins.13 As baby Stephanie acquired abnormal flora in her gut, her groin and vagina got abnormal flora too, as this flora normally comes from the gut.10 At the same time, the urethra and the urinary bladder get populated with flora similar to that of the vagina. In a normal situation, the uretha and bladder should be predominated by lactobacteria, largely L. crispatus and L. jensenii.14 This flora produces hydrogen peroxide, reducing the pH in the area. In these acidic conditions, pathogens cannot adhere.15 When the urethra and bladder are unprotected by good flora and a low pH, they fall prey to pathogenic microbes, causing urinary tract infections (UTI). The most common pathogens that cause UTIs, are E.coli,Pseudomonas aeruginosa and Staphylococcus saprophyticuscoming from the bowel and the groin.15
Urine is one of the venues of toxin elimination from the body.16 In gut dysbiosis, large amounts of various toxins are produced by pathogens in the gut and then absorbed into the bloodstream through the damaged gut wall.16,17Many of these toxins leave the body in urine; accumulating in the bladder, this toxic urine comes into contact with the bladder lining. The beneficial bacteria in the bladder and urethra maintain what is called a GAG layer—a protective mucous barrier, largely made from sulphated glucosaminoglycans, produced by the cells of the bladder lining.17 As the GAG layer gets damaged, toxic substances in urine get through to the bladder wall causing inflammation and leading to chronic cystitis.18
And that is what happened to Stephanie: at the age of three months she got her first urinary infection. As her gut flora, vaginal flora and the flora of urethra and the bladder were not corrected, she suffered from urinary infections all her life and eventually developed chronic cystitis.
FURTHER DAMAGE TO GUT FLORA
Because of regular urinary tract infections, Stephanie had regular courses of antibiotics through her entire life, starting from infancy. Every course of antibiotics damages the beneficial species of bacteria in the gut, leaving it open to invasion by pathogens that are increasingly resistant to antibiotics.10,19 Even when the course of antibiotic is short and the dose is low, it takes the various beneficial bacteria in the gut a long time to recover: physiological E.coli takes one to two weeks; bifidobacteria and veillonelli take two to three weeks; lactobacilli, bacteroids, peptostreptococci take one month.10,20 During this period, if the gut flora is subjected to another damaging factor, then gut dysbiosis may well start in earnest.21
After many short courses of antibiotics Stephanie took a long course for acne at the age of sixteen. That is when she got pronounced digestive problems: constipation, bloating, abdominal pain and lactose intolerance, indicating that her gut flora was seriously compromised. From the age of fourteen Stephanie had been taking the contraceptive pill. Contraceptives have a serious damaging effect on the composition of gut flora, leading to allergies and other problems related to gut dysbiosis.22,23
MALNUTRITION
Stephanie suffered from malnutrition all her life despite the fact that her family always cooked fresh wholesome meals and Stephanie ate well. She was always pale, very thin and small, and could never put any weight on. This is not surprising considering the state of her gut right from birth. The microbial layer on the absorptive surface of the GI tract not only protects it from invaders and toxins, but maintains its integrity.20,21 The epithelial cells, called enterocytes, which coat the villi, are the very cells that complete the digestive process and absorb the nutrients from food.24These cells only live a few days as the cell turnover in the gut wall is very active. These enterocytes are constantly born in the depth of the crypts. Then they slowly travel to the top of the villi, doing their job of digestion and absorption and getting more and more mature on the way. As they reach the top of the villi, they get shed off. This way the intestinal epithelium gets constantly renewed to insure its ability to do its work well.24
Animal experiments involving sterilization of the gut found that when the beneficial bacteria living on the intestinal epithelium are removed, this process of cell renewal gets completely out of order.10 The time of cell travel from crypts to the top of the villi becomes a few times longer, which upsets the maturation process of these absorptive cells and often turns them cancerous. The mitotic activity in the crypts gets significantly suppressed, which means that far fewer cells will be born there and decreased numbers of them will be born healthy and able to do their job properly. The state of the cells themselves becomes abnormal.9,25That is what happens in a laboratory animal with a sterilized gut.
In a human body, the absence of good bacteria always results in pathogenic bacteria getting out of control, which makes the whole situation much worse. While under attack from pathogenic flora, and without the care of beneficial bacteria, the gut epithelium degenerates and becomes unable to digest and absorb food properly, leading to malabsorption, nutritional deficiencies and food intolerances.19,21,25
Apart from keeping the gut wall in good shape, the healthy gut flora populating this wall are programmed to take an active part in the very process of digestion and absorption,19,21 so much so that the normal digestion and absorption of food is probably impossible without well-balanced gut flora. It has an ability to disassemble proteins, ferment carbohydrates, break down lipids and digest fiber. By-products of bacterial activity in the gut are very important in transporting minerals, vitamins, water, gases and many other nutrients through the gut wall into the bloodstream.10
If the gut flora is damaged, the best foods and supplements in the world may not have a good chance of being broken down and absorbed. A good example is dietary fiber, which is one of the natural habitats for beneficial bacteria in the gut.25 They feed on it, producing a whole host of good nutrition for the gut wall and the whole body; they engage it in absorbing toxins; they activate it to take part in water and electrolyte metabolism; and they help recycle bile acids and cholesterol, among many other functions. It is the bacterial action on dietary fiber that allows it to fulfil all those good functions in the body.20,21 And when these good bacteria are damaged and are not able to “work” the fiber, dietary fiber itself can become dangerous for the digestive system, providing a good habitat for bad pathogenic bacteria and aggravating inflammation in the gut wall. This is when gastroenterologists have to recommend a low-fiber diet.19Consequently, dietary fiber alone without the beneficial bacteria present in the gut can end up not being all that good for us.
Stephanie also found that she became lactose intolerant after the long course of antibiotics prescribed for her acne. And indeed lactose is one of those substances which most of us would not be able to digest without well functioning gut flora.25 The explanation science has offered us so far is that after early childhood, the majority of us lack an enzyme called lactase to digest lactose.26 If we are not meant to digest lactose, then why do some people seem to manage it perfectly well? The answer is that these people have the right bacteria in their gut.
One of the major lactose-digesting bacteria in the human gut is E.coli.10 It comes as a surprise to many people that physiological strains of E.coli are essential inhabitants of a healthy digestive tract. They appear in the gut of a healthy baby in the first days after birth in huge numbers—107 – 109 Colony Forming Units per gram—and remain in these high numbers throughout life, providing that they do not get destroyed by antibiotics and other environmental influences.9,19
Apart from digesting lactose, physiological strains of E.coliproduce vitamin K and vitamins B1, B2, B6, B12; they produce antibiotic-like substances, called colicins; and they control other members of their own family which can cause disease. In fact, having your gut populated by the physiological strains of E.coli is the best way to protect yourself from pathogenic species of E.coli.21 Unfortunately, this group of beneficial bacteria is very vulnerable to broad spectrum antibiotics, particularly aminoglycosides (Gentamycin, Kanamycin) and macrolides (Erythromycin, etc.).9,10
Apart from E.coli, other beneficial bacteria in the healthy gut flora—bifidobacteria, lactobacteria, beneficial yeasts and other organisms— will not only ensure appropriate absorption of nutrients from food but also actively synthesize various nutrients: vitamin K, pantothenic acid, folic acid, thiamin (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pyridoxine (vitamin B6), cyanocobalamin (vitamin B12), various amino acids and other active substances.9,10,25 Nature has made sure that when the food supply is sparse, we humans don’t die from vitamin and amino acid deficiencies. Nature has provided us with our own factory for making these substances— our healthy gut flora. And when this gut flora is damaged despite adequate nutrition, we develop vitamin deficiencies. Every tested child or adult with gut dysbiosis shows deficiencies in the very vitamins that their gut flora is supposed to produce.25 Restoring the beneficial bacteria in their gut is the best way to deal with those deficiencies, particularly vitamin B deficiencies. 10,19,21
Through testing over the years, Stephanie consistently showed deficiencies in most B vitamins, fat soluble vitamins, magnesium, zinc, selenium, manganese, sulphur, iron and some fatty acids.
ANEMIA
Another consequence of gut dysbiosis is anemia. Stephanie suffered from anemia all her life, unsuccessfully treated by courses of iron tablets. The majority of patients with gut dysbiosis look pale and pasty, and their blood tests often show changes typical for anemia.21 The anemia is not surprising as those with gut dysbiosis not only cannot absorb essential vitamins and minerals from food, but their own production of these vitamins is damaged. In addition, people with damaged gut flora often have a particular group of pathogenic bacteria growing in their gut, which are iron-loving bacteria—Actinomyces spp., Mycobacterium spp., pathogenic strains of E.coli, Corynebacterium spp. and many others. 13,25 These organisms consume dietary iron, leaving the person deficient. Unfortunately, supplementing iron makes these bacteria proliferate, bringing unpleasant digestive problems, and does not remedy anemia. To have healthy blood, the body needs other minerals, a whole host of vitamins: B1, B2, B3, B6, B12, C, A, D, folic acid, pantothenic acid and some amino acids.24,10 It has been shown in a large number of studies all over the world, that just supplementing iron does not do much for anemia.27
PATHOGENS IN THE GUT
The most studied pathogens, those that overgrow after numerous courses of antibiotics, are clostridia and yeasts, which normally belong to the opportunistic group of gut microbes.28 The opportunistic gut flora consists of a large group of various microbes, the number and combinations of which can be quite individual—so far around four hundred different species of them have been found in the human gut.25 The most common are bacteroids, peptococci, staphylococci, streptococci, bacilli, clostridia, yeasts, enterobacteria (proteus, klebsielli, citrobacteria, etc.), fuzobacteria, eubacteria, spirochaetaceae, spirillaceae, and catenobacteria, along with several viruses.13 Interestingly, in small numbers and well controlled by beneficial bacteria, many of these opportunistic bacteria actually fulfill some beneficial functions in the gut, like taking part in the digestion of food and breaking down lipids and bile acids. In a healthy gut, their numbers are limited and tightly controlled by the beneficial flora.20 But when this beneficial flora is weakened and damaged, they get out of control.
Each of these microbes is capable of causing various health problems.29 The best known is the fungus Candida albicans, which causes untold misery to millions of people.31 There is an abundance of literature published about candida infection. However, in my experience, much that is described as candida syndrome is in effect a result of gut dysbiosis, which includes lots of other opportunistic and pathogenic microbes.
Candida albicans is never alone in the human body. Its activity and ability to survive and cause disease depends on the state of trillions of its neighbours—different bacteria, viruses, protozoa, other yeasts and many other microcreatures. 9,19,31 In a healthy body, candida and many other disease-causing microbes are very well controlled by the beneficial flora.
Unfortunately, the era of antibiotics gave candida a special opportunity. The usual broad-spectrum antibiotics kill a lot of different microbes in the body—the bad and the good. But they have no effect on candida. So, after every course of antibiotics, candida is left without anything to control it, so it grows and thrives.30,31 Stephanie had many symptoms of candida overgrowth in her body: low energy levels, dry skin, recurrent vaginal thrush and cystitis, bloating, constipation, foggy brain and lethargy.
The clostridia family was given a special opportunity by the era of antibiotics as well, because clostridia are also resistant to them.34 About one hundred members of this family have been discovered so far, and they all can cause serious disease. Many of them are found as opportunists in a healthy human gut flora.25,33 As long as they are controlled by the beneficial microbes in the gut, they normally do us no harm. Unfortunately, every course of broad-spectrum antibiotics removes the good bacteria, which leaves clostridia uncontrolled and allows it to grow. Different species of clostridia cause severe inflammation of the digestive system and damage its integrity, leading to many digestive problems and food intolerances.32,33
Food “Allergies ” and Intolerances
Normal gut flora maintains gut wall integrity by protecting it, feeding it and insuring normal cell turnover. When the beneficial bacteria in the gut are greatly reduced, the gut wall degenerates. 9,10,21,25 At the same time, various opportunists, when not controlled by good bacteria, get access to the gut wall and damage its integrity, making it porous and “leaky.”6,28,29 For example, microbiologists have observed how common opportunistic gut bacteria from the spirochaetaceae and spirillaceae families have an ability to push apart intestinal cells with their spiral shape, breaking down the integrity of the intestinal wall and allowing substances to pass through which normally should not get through.13,25
Candida albicans has this ability as well. Its cells attach themselves to the gut lining, literally putting “roots” through it and making it “leaky.”31 Many worms and parasites have that ability as well.9,10,35 Partially digested food gets through the damaged “leaky” gut wall into the blood stream, where the immune system recognizes them as foreign and reacts to them.36,37.38 This is how food allergies or intolerances develop.
So there is nothing wrong with the food. What is happening is that foods do not get a chance to be digested properly before they are absorbed through the damaged gut wall. Thus, in order to eliminate food allergies, it is not the foods we need to concentrate on, but the gut wall. In my clinical experience, when the gut wall is healed, many food intolerances disappear.
Healing the Gut Wall : The Diet
How do we heal the gut wall? We need to replace the pathogens in the gut with the beneficial bacteria, so effective probiotics are an essential part of the treatment. However, the most important intervention is the appropriate diet.
There is no need to re-invent the wheel when it comes to designing a diet for digestive disorders. A very effective diet was described over sixty years ago, which has an excellent record of helping people with all sorts of digestive disorders, including such devastating ones as Crohn’s disease and ulcerative colitis. This diet is called the Specific Carbohydrate Diet or SCD for short.
SCD was invented by a renowned American pediatrician, Dr. Sidney Valentine Haas, in the first half of the twentieth century.39 Those were the good old days, when doctors treated their patients with diet and natural remedies. Carrying on the work of his colleagues, Drs. L. Emmett Holt, Cristian Herter and John Howland, Dr. Haas spent many years researching the effects of diet on celiac disease and other digestive disorders. He and his colleagues found that patients with digestive disorders could tolerate dietary proteins and fats fairly well. But complex carbohydrates from grains and starchy vegetables made the problem worse. Sucrose, lactose and other double sugars also had to be excluded from the diet. However, certain fruits and vegetables were not only well tolerated by his patients, but improved their physical status. Dr. Haas treated over six hundred patients with excellent results—after following his dietary regimen for at least a year there was “complete recovery with no relapses, no deaths, no crisis, no pulmonary involvement and no stunting of growth.”
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 honored for his pioneering work in the field of pediatrics.
In those days celiac disease was not very clearly defined. A great number of various conditions of the gut were included into the diagnosis of celiac disease and all those conditions were treatable by the SCD very effectively.
Unfortunately, a “happy ending” does not happen in human history too often. In the decades that followed, something terrible happened. Celiac disease was eventually defined as a gluten intolerance or gluten enteropathy, which excluded a great number of various other gut problems from this diagnosis. As the “gluten free diet” was pronounced to be effective for celiac disease, the SCD diet was forgotten as outdated information. And all those other gut diseases, which didn’t fit into the category of true celiac disease, were forgotten as well. True celiac disease is rare, so the “forgotten” gut conditions constituted a very large group of patients, which used to be diagnosed as celiac and which do not respond to treatment with a gluten-free diet. Incidentally, a lot of “true” celiac patients do not get better on the gluten-free diet either. All these conditions respond very well to the SCD diet, developed by Dr. Haas.39
Following the whole controversy about celiac disease, the Specific Carbohydrate Diet would have been completely forgotten were it not for—you guessed it—a parent! Elaine Gottschall, desperate to help her little daughter, who suffered from severe ulcerative colitis and neurological problems, went to see Dr. Haas in 1958. After two years on SCD her daughter was completely free of symptoms, an energetic and thriving little girl. Following the success of the SCD with her daughter, Elaine Gottschall helped thousands of people suffering from Crohn’s disease, ulcerative colitis, celiac disease, diverticulitis and various types of chronic diarrhea over the years. She reported very dramatic and fast recoveries in young children, who in addition to digestive problems suffered from serious behavioral abnormalities such as autism, hyperactivity and night terrors. She devoted years of research into the biochemical and biological basis of the diet and published a book called Breaking the Vicious Cycle. Intestinal Health Through Diet.39 This book—reprinted numerous times—has become a true savior for thousands of children and adults across the world. Many websites and web groups have been set up to share SCD recipes and experiences.
I have been using the SCD for many years in my clinic and can say with confidence that it is the diet for food allergies. As my practice mostly involves children with learning disabilities, such as autism, ADHD, dyslexia and dyspraxia, I refer to this cluster of symptoms as the Gut And Psychology Syndrome or GAPS.40 I had to adapt some aspects of SCD for these patients, so we call the diet the GAPS diet. Over the years I have developed a GAPS Introduction Diet for the severe end of the spectrum (www.gapsdiet.com). I find that the GAPS Introduction Diet is particularly effective in food allergies, as it allows the gut wall to heal quickly.
Stephanie had to follow the GAPS Introduction Diet for seven months before she started putting weight on and feeling stronger. By the time she moved to the full GAPS Diet, she had normal stools, no bloating and no cystitis symptoms; and her energy levels were much improved, though she still looked slightly pale. In about a year from the start of the treatment we lost track of her for eighteen months, but then she emailed me with an update. She was doing well, her energy level was good, she had no symptoms of cystitis and her GI function was good. She had gained weight, although she was still quite slim, but within the normal range. In the last two months she started eating some foods not allowed on the diet and found that she can tolerate them on an occasional basis, including pasta, chocolate and some goods from the local bakery.
Healing the Gut Wall : Probiotics
In addition to the appropriate diet, in order to heal the gut wall we need to replace the pathogenic microbes in the gut with the beneficial ones. The fermented foods in the diet will provide some probiotic microbes in food form, which is the best. However, an effective probiotic supplement is essential. The benefits of probiotic supplementation for most digestive disorders as well as for many other health problems have been demonstrated.41-47
The marketplace is full of probiotics in the form of drinks, foods, powders, capsules and tablets. The majority of them are prophylactic, which means that they are designed for fairly healthy people, not to make a real difference in a person with a digestive disorder and a leaky gut. These people need a therapeutic-strength probiotic with well-chosen powerful species of probiotic bacteria.
There is a growing number of good quality multi-strain probiotics on the market and every practitioner usually has his or her own favorite formula. A therapeutic multi-stain probiotic will produce a so-called “die-off” reaction—the probiotic bacteria kill the pathogens in the gut, and when these pathogens die, they release toxins. As these are the toxins that give the patient his or her unique symptoms, their release makes these symptoms temporarily worse. This reaction can be quite serious and must be controlled. That is why I recommend starting the therapeutic probiotic with a very small dose, then build the dose very gradually up to the therapeutic level. Once on that level, the patient needs to stay on it for a few months—how long depends on the severity of the condition. Once the symptoms of the disease are largely gone, the patient can start gradually reducing the daily dose to the maintenance level or can stop altogether.
Stephanie took a multi-strain therapeutic probiotic. She took one capsule per day (two billion live cells) for a week, then increased to two capsules per day. On this dose her skin became itchy, she got loose stools and her cystitis symptoms got slightly worse. She understood it to be a die-off so stayed on this dose for as long as it took for these symptoms to subside—about two and one-half weeks. Then she increased her dose to three capsules a day. This increase produced another die-off reaction, so she had to stay on the three capsules per day for a month before she could move on. In this manner she gradually increased the dosage to eight capsules a day—her therapeutic dose.
I recommended that she stay on this dose for six months. In this period, all of her main symptoms subsided and some began to disappear. After six months, she decided to stay on the therapeutic dose for longer, as she felt well on it. After another four months on eight capsules per day, she felt strong enough to start reducing the dose. She gradually reduced it to four capsules a day—her maintenance dose. After about two years on this dose she found that she could discontinue the probiotic (as it is expensive) and only take it occasionally, when she was under unusual stress. At this stage just regular consumption of fermented foods provided her with all the probiotic bacteria she needed.
SIDEBAR
THE GAPS INTRODUCTION DIET
The GAPS Introduction Diet is structured in stages. Unless there is a dangerous (anaphylactic type) allergy to a particular food, I recommend my patients ignore the results of their food intolerance testing and follow the stages one by one. The GAPS Introduction Diet in its first stages serves the gut lining in three ways:
1. It removes fiber. With a damaged gut wall fiber irritates the gut lining and provides food for the pathogenic microbes in the gut. This means no nuts, no beans, no fruit and no raw vegetables. Only well-cooked vegetables (soups and stews) are allowed with particularly fibrous parts of the vegetable removed. No starch is allowed on the GAPS diet, which means no grains and no starchy vegetables.
2. It provides nourishment for the gut lining: amino acids, minerals, gelatin, glucosamines, collagens, fat soluble vitamins, etc. These substances come from homemade meat and fish stocks, gelatinous parts of meats well-cooked in water, organ meats, egg yolks and plenty of natural animal fats on meats.
3. It provides probiotic bacteria in the form of fermented foods. The patients are taught to ferment their own yogurt, kefir, vegetables and other foods at home. These foods are introduced gradually in order to avoid a “die-off” reaction.
In the first two stages of the GAPS Introduction Diet, most severe digestive symptoms, such as diarrhea and abdominal pain disappear quite quickly. At that point the patient can move through the next stages, when other foods are gradually introduced. As the gut wall starts healing, the patients find that they can gradually introduce foods, which they could not tolerate before. When the GAPS Introduction Diet is completed, the patient moves to the Full GAPS Diet. I recommend adhering to the Full Diet for two years on average in order to restore normal gut flora and GI function. Depending on the severity of the condition, different people take varying amounts of time to recover. Children usually recover more quickly than adults. For further informatin on the GAPS Introduction Diet see www.gaps.me.
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This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2010.