Adventures in Holistic Adult and Child Psychiatry

"One only sees what one looks for, one only looks for what one knows." - Goethe

"I did then what I knew how to do. Now that I know better, I do better." - Maya Angelou



Necessity is the mother of invention, or in this case, it was the urgent distress of my patient and her family, which drove me to seek a supplementary approach to the GAPS treatment protocol.

Keiko is an adorable, very bright, not yet 7 year old girl in treatment with me for constipation and encopresis.

The drawing above is Keiko’s rendition of the game CandyLand, which she drew during one of her very early play therapy sessions with me. Study it for a moment. What comes to mind? It reminds me of an illustration of the large intestine. At the distal end it looks like something is being explosively expelled. She informed me that the black squares found intermittently through the path are places where the pieces get stuck.

Keiko is suffering from life long IBS, primarily constipated type, which began in infancy. As a neonate she was treated with broad spectrum antibiotics for a urinary tract infection, and kept in the hospital for 10 days. At the age of 2 months, she began to go 4-5 days between bowel movements. The pediatrician reassured her worried parents that this was just a normal variant, and no cause for concern. Dr. Campbell-McBride links broad spectrum antibiotic treatment with disruption of the ecological balance of the microflora of the gut, resulting in GAPS conditions.

Keiko went on to be chronically constipated and never completely toilet trained. As is the case with so many severely constipated children, stool builds up in their bowel, and then soiling accidents occur, as liquid stool leaks around the hard, dry impacted feces. Her belly was often swollen and distended. She would become impacted and lose interest in food.

Keiko was seen at a clinic specializing in pediatric incontinence, and was prescribed laxatives and stool softeners, which worked initially, but then her body habituated to the treatment, and it was no longer effective.  At one point supplementary fiber in the form of bars and gummie bears was prescribed, which only made her condition worse. The necessity of monthly clean outs resulted in vomiting and made her feel very sick. Eventually her parents, uncomfortable with the idea of their daughter being dependent on daily laxatives, decided to seek a more holistic approach, and came to see me.

I recommended the GAPS treatment protocol to treat her constipation, and play therapy to help Keiko integrate all of the difficult experiences she has endured as a result of having this chronic troubling medical condition.

Keiko is a talented highly productive artist, and spends her hours with me drawing and creating stories about chickens laying eggs, cows being milked, and farmers having accidents.  Her work is a clear representation of her attempts to make sense of the mystery of anatomy, and all the miraculous processes that go on inside the body, as well as what goes in and what comes out.

This is the way young children communicate and process what is on their mind. They do it through play and drawing. This is technically called displacement. It can be very healing for them to express themselves in this way. It is not necessary for them to put their thoughts and feelings into words, in order for it to be very helpful to them. Keiko does not need to say to me, “I am so confused and in such despair about all I am going through with my pooping.” She can tell me about it with her play. It is as important to heal her physical digestive symptoms, as to help her psychologically metabolize all of the trauma that she has been through, and continues to endure, because of this condition.

Despite strict adherence to the GAPS protocol, with Mother tirelessly preparing all the labor intensive homemade GAPS broths, ferments, and grain free foods, Keiko’s situation has recently deteriorated significantly. Over the February school vacation her constipation became mixed with diarrhea, and she began to have frequent daily soiling accidents. With the advent of school beginning again, something needed to be done quickly.

In the context of this distressing situation, yesterday a reader wrote to me that her IBS has been much improved with a mixture of GAPS and FODMAPs. FODMAPs had been on the periphery of my awareness, but my worry about Keiko’s worsening condition prompted me to investigate it.

FODMAPs is a dietary treatment for IBS. Evidence suggests that up to 75% of patients with IBS will experience relief from symptoms following the FODMAPs diet. The list of foods which are permissible and prohibited are not the same as GAPS.

FODMAPs is an acronym for Fermentable, Oligo-, Di- and Mono-saccharides and Polyols, used to describe a group of fermentable short-chain carbohydrates. FODMAPs are prevalent in the diet and are composed of oligosaccharides (fructans, galactans), disaccharides (lactose), monosaccharides (fructose), and polyols (sugar alcohols). The total amount of fermentable sugars consumed is considered significant, rather than looking at each sugar individually. There is a threshold for the amount of global FODMAPs an individual can tolerate at one time. The fermentation of these short chain sugars produce an osmotic effect, which increases fluid delivery to the large bowel, resulting in gas, pain, diarrhea and/or constipation. Pathogenic microflora in the gut thrive on the malabsorbed sugars and create gas, resulting in abdominal bloating.

Here are some of the foods that contain FODMAPs:

Fructose: Most commonly known as fruit sugar, is also found in honey, high-fructose corn syrup (HFCS), agave, sucrose (table sugar) bound to glucose, and fructans. Fructose-containing foods with a 1:1 ratio of fructose to glucose are generally well tolerated on the FODMAPs diet. Conversely, foods with excess fructose compared with glucose, such as apples, pears, and mangoes, will likely trigger abdominal symptoms.

Fructans: These are oligosaccharides made of fructose molecule chains that are malabsorbed because the small intestine lacks hydrolases to break their fructose-fructose bond. For this reason, fructans can contribute to bloating, gas, and pain. Inulin and FOS, sources of fructans, are added to many foods to enhance their fiber content. Patsy Catsos, MS, RD, author of IBS-Free at Last wrote, “Inulin and FOS are added to foods and supplements precisely because they are fermentable fibers, meant to encourage the growth of friendly gut bacteria. While this makes sense in general, these food additives are sometimes poorly tolerated by people with IBS.”

Galactans: Oligosaccharides which contain chains of the sugar galactose are called Galactans. They can be poorly absorbed by people who lack the enzymes to hydrolyze them into digestible components. Thus galactans often contribute to gas and GI distress. Dietary sources of galactans include lentils, chickpeas, kidney beans, black-eyed peas, broccoli, and soy-based products.

Polyols: These are the sugar alcohols, which have a laxative effect on the GI tract. They are found naturally in some fruits and vegetables and added as sweeteners to sugar-free gums, mints, cough drops, and medications. Polyols produce osmotic diarrhea when consumed in amounts above an individual’s personal limit or when combined with other FODMAPs foods.

I am recommending that Keiko only consume foods which are permissible on both the GAPS as well as the FODMAPs plan. Apparently with FODMAPs, improvement should be seen in 1-2 weeks. If improvement is noted, then Keiko will continue with it for another 4 weeks, and then we can try introducing previously eliminated foods systematically, in order to determine which she can tolerate, and which effect her adversely. I am also going to try it, as I am still suffering from digestive symptoms, which have not fully responded to the GAPS approach.

In my research on FODMAPs, I found a blog by Cassandra Forsythe, which listed foods that are permissible and those to avoid on the FODMAPs plan. There are many allowed carbohydrates on the FODMAPs list, such a certain grains, starchy tubers and sugar which are not permissible on GAPS. Ms. Forsythe sensibly notes that this is not a one size fits all situation, and that each individual will need to customize their own list.

Here is the list:

It is titled Complete Food List for a Happy Gut


Excess Fructose fruit:
Nashi fruit

Excess Fructan fruit:

Excess Polyol fruit:
Nashi Fruit

Blueberries – buy organic
Boysenberry – buy organic
Star fruit
Cranberry – buy organic
Grapes – buy organic
Honeydew melon
Passion fruit
Paw paw
Raspberry – buy organic
Strawberry – buy organic

Suitable dried fruits (some people are ok with dried fruits, others are not):
Banana chips
Cranberries (often are coated in sugar – only eat if not sweetened)
Paw paw
Pineapple (often are coated in sugar – only eat if not sweetened)
Raisins (may not be suitable for everyone…)

Special notes on fruit:
Limit intake of suitable fruits to one serve per meal.
e.g. One whole banana or orange.
Third to half a glass of suitable juice.
Small handful of berries or grapes.
Small amount of suitable dried fruit (e.g. 10 sultanas).



Excess Fructose vegetables:
Sugar snap peas

Excess Fructan vegetables:
Artichokes (Globe & Jerusalem)
Brussel Sprouts
Dandelion leaves
Onion (brown, white, & Spanish)
Radicchio lettuce
Spring onion (white section).

Excess Polyol vegetables:
Snow peas

Bamboo shoots
Bean shoots
Beans (green)
Bok choy
Broccoli (may not be suitable for everyone…)
Choy sum
Corn (raw corn may bother some people)
Eggplant (this may be troublesome for some; asses individual tolerance)
Lettuce (may be ok or not)

Spring onion (green section)
Squash (this may be troublesome for some; asses individual tolerance)
Sweet potato
Tomato (cherry tomatoes often are moldy – try to avoid)
Zucchini (this may be troublesome for some; asses individual tolerance)

Special notes on vegetables:
Onion is one of the greatest contributors to IBS. Strict avoidance is recommended.
• Onion (brown, white & Spanish), Onion powder, White section of spring onion.
• Leeks,  Shallots, Garlic.
There is undeclared onion hidden in many processed foods including, chicken salt, vegetable salt, vegetable powder, dehydrated vegetables, stocks, gravies, soups, marinades, & sauces.
• Chives
• Green part of spring onion
• Asafoetida powder (* contains gluten).
• Fresh & dried ginger, coriander, basil, lemongrass, chili, mint, parsley, marjoram, oregano, thyme, rosemary & others.


PROBLEM WHEAT & Rye products:

Bread (white, wholemeal, multigrain, sourdough, pita, & many rye)
Pasta & noodles (regular, two minute, spelt, egg noodles, hokkien & udon)
Breakfast cereals (containing wheat, excess dried fruit &/or fruit juice).
Savoury biscuits (wheat based)
Cakes & baked goods (wheat based)
Sweet biscuits (wheat based)
Pastry & breadcrumbs (wheat flour made)
Others (semolina, couscous, bulger)


Corn (may bother some people)

Gluten free bread, 100% spelt bread, wheat free rye.
Gluten free pasta, rice noodles, wheat free buckwheat noodles.
Porridge, wheat free muesli, rice bubbles, corn flakes, & gluten free cereals.
Corn thins, rice cakes & crackers, gluten free crackers, ryvitas, & rye cruskits.
Gluten free cakes, flourless cakes.
Gluten free biscuits.
Gluten free pastry mixes, & bread crumbs, polenta, cornflake crumbs.
Buckwheat, polenta, millet, sorghum, sago, tapioca, rice, & corn flours.

Special notes on Wheat:
• Wheat free Rye is tolerable for most (assess individually).
• Small amounts of wheat, such as breadcrumbs, may be tolerable (assess individually).
• Those with diagnosed Coeliac disease should eliminate gluten from their diet.
• Gluten free foods do not contain wheat, rye oats & barley.
o             A low FODMAP diet allows oats & barley.
• Trace amounts of wheat ingredients such as soy sauce should not be a problem.
• Many wheat derived products such as wheat starch, wheat thickeners, wheat maltodextrin, wheat dextrin, wheat dextrose, wheat glucose, & wheat color caramel are fructan free glucose chains & should be safe to eat.


OTHER FODMAPs FOODS (containing, FRUCTOSE &/or Fructans) to AVOID:
• Honey
• Corn syrups
• Corn syrup solids
• Fruisana
• Chickory
• Dandelion tea
• Inulin
• Artificial sweeteners (see GOS)
• Sugar free or low carb sweets, mints, gums, & dairy desserts.
• Baked beans, lentils, & chick peas

• Golden syrup
• Treacle
• Molasses
• Maple syrup
• White, brown, raw & castor sugar (sucrose) eaten in moderation.
• Tea, coffee, & herbal teas
• Nuts & seeds (moderation)
• Oat bran
• Barley bran.
• Psyllium.
• Rice bran.
• Suitable sweeteners (nutrasweet, sucralose, aspartame, stevia, saccharine, tic tacs, minties, regular gum).

Special comments:
• Limit alcohol intake.
• Avoid alcohol which is high in indigestible carbohydrate, such as beer.
• Clear spirits such as Vodka & Gin with water/soda flavored with fresh suitable fruit in moderation is preferable.
• Drink plenty of water.
• Eat in moderation.
• Chew your food well.
• Limit processed foods (hidden FODMAPs & irritants).
• Limit or avoid processed meats ((hidden FODMAPs & irritants).
• Fresh fruit, vegetables, & whole meats/fish are best.

I would be grateful to any readers who would be willing to leave comments about their experience with FODMAPs in combination with GAPS, so that all of us can learn more about how we might make use of these two approaches to heal the debilitating condition of IBS.


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  1. TS, 1 week ago Reply

    Thanks. I joined the AIP facebook group and think I will give it a try.

  2. TS, 1 week ago Reply

    Does anyone have tips for following a healing diet (SCD, GAPS, and/or Low FODMAP) with these restrictions: intolerant to eggs and all dairy, almonds, and morally prefer to not eat meat. Any suggestions would be great!

    • Gretchen, 1 week ago Reply

      I am 40 year old female, was strict vegetarian for 7 years in my 20-30’s and no red meat in 21 years. I believe my vegetarian diet greatly contributed to many auto immune issues I developed. In addition to RA, Fibro, ..leaky gut, ibs, gerd etc etc. Our moral feelings about meat doesn’t change our bodies actual physical and chemical nutritional requirements for a little of it 😉 I am still very meat selective, and will only eat organic, and try for “farm to table” as much as possible. Not all meat is produced like the PETA videos. I am still limited to chicken and fish. I can also tell you from a environmental standpoint, vegetarianism has its down falls too. There is a good chance your diet is still causing gut damage. The auto immune protocol gut healing diet eliminates all grains, eggs, beans nuts and seeds, dairy, and nightshades. Your starches will need to come from parsnip, sweet potato, plantain, arrowroot starch, taro…. etc etc. There are plenty of non nightshade resistant starch sources out there, be diverse… or you could find yourself allergic to something you eat too often .
      AIP for You and Me is a great FB group.

      • TS, 1 week ago Reply

        Thanks. I joined the AIP facebook group and think I will give it a try.

  3. Christine, 8 months ago Reply

    Hello Judy,

    I have had digestive issues for years (always just thought I had a very sensitive stomach) and I was diagnosed with a gluten allergy/ intolerance from a blood test about 6 months ago. Avoiding gluten has helped slightly, but definitely not 100%.

    Do you recommend starting a GAPS diet or low FODMAPS diet TOGETHER or try each individually first? I’m confused on whether I should adapt a GAPS diet, FODMAPS, or SCD? Or all 3?

    Thank you!

    • admin, 8 months ago Reply

      Actually these days I am recommending the Paleo AIP in my practice, along with GAPS principles and healing foods like broth and fermented foods. There is a great website called Phoenix Helix about Paleo Auto Immune Healing and Protocol. Its the most effective approach for most people, but not all.

  4. Michelle, 1 year ago Reply

    This article and all the comments are really interesting – thanks! So we did GAPS about a year ago and it was fantastic for my daughter. I felt really good in a number of ways…increased energy, clear head…but my IBS was never worse! I couldn’t figure it out! We only lasted 6 mths on GAPS as a busy mum with 3 kids and working from home in my own business it was too time intensive and I really struggled.

    Anyway – just recently I discovered FODMAPS and it changed my life. Amazing!!!! Irritable bowel completely gone for the first time in my life.
    I know GAPS is good for gut healing, I could eat cheese for the first time in years!!! But I was also eating a lot of high fodmap foods on gaps like almonds, onion, garlic, honey etc.

    Recently I had a 10 day course of antibiotics for strep throat and I think it has completely ruined my gut. Everything I eat, even low fodmap foods make me bloated and sore…I can’t wear jeans without feeling uncomfortable!!! So I started thinking about GAPS again…but am really nervous about how hard it will be doing it in conjunction with low Fodmaps!!

    After googling GAPS and fodmaps I got here. How did your patient improve on this combo? I am thinking it will be worth a try as I’m in so much discomfort :-( I think I may add potatoes though as I’ve always tolerated them well and it will make the diet a bit easier.
    Thanks for the article and I’ll be grateful if you have any more insights after doing this with your patient…and I think you wrote this article a few years ago now.
    Michelle :)

    • admin, 1 year ago Reply

      Unfortunately as I recall, they did not stick with it long enough to assess if it made a difference or not. Have you read about the Paleo auto immune protocol (Paleo AIP)? Some people have allergic responses to foods that are GAPS legal, like eggs, dairy, nuts and seeds, and it can really delay healing. In some ways the Paleo AIP approach is less restrictive than GAPS because starchy tubers are permitted. It may be something to think about.

  5. Marilyn, 1 year ago Reply

    I don’t understand this:

    Spelt is listed under “Pasta & noodles”, under “PROBLEM WHEAT & RYE products”

    But then:

    Spelt is listed under “ALTERNATIVE TO WHEAT PRODUCTS”
    as “100% Spelt Bread”

    How can it be a problem as pasta/noodles and not be a problem as 100% Spelt Bread?
    Please advise.
    Thank you.

    • admin, 1 year ago Reply

      Spelt contains gluten. It apparently better tolerated than wheat by some people, but should be avoided by those with gluten sensitivities.

  6. Marci, 1 year ago Reply

    I am suffering for abdominal discomfort. I have been seeking both traditional and alternative solutions. Last week I was given GAPS book by a homeopathic dr and it was also highly recommended by a good friend who is a nutritionist. Tiday I have an appointment with a gastrointestinal doctor. He recommended a low-fodmap diet. He gave me a list of suitable food and those to eliminate which came from obs They seem to contradict the foods on the gaps diet. I am so confused. The question that led me to this site was “comparing the Gaps and low-formal diets. When I read the above posts my head becomes more confused. What list should I follow? I am a carnivore and already try to avoid high carbs, sugar, and processed foods, while limiting diary.

    • admin, 1 year ago Reply

      The GAPS healing protocol is very healing to the digestive tract for many people. It does, however, include foods that some people cannot tolerate. Myself, for instance, cannot eat egg whites or nuts and seeds, both of which are legal GAPS foods, and quite an integral part of the diet. So I needed to modify. I did not include nuts and seeds, or egg whites, but did try and have a whole foods, nutrient dense unprocessed diet, including soups and fermented foods. So you need to leave off the FODMAPS foods, if you want to follow your doctor’s recommendations. So no onions, for instance. Look at what foods are permitted on GAPS, and if they are not permitted on low FODMAPS, cross them off the list of allowed foods. I hope this helps.

  7. gretchen jones, 1 year ago Reply

    I am on the fodmops and aip protocol and I am a little confused because you list nightshades are acceptable food s in a couple places up there. Potatoes, tomatoes, eggplant, and peppers of any kind including chili and paprika are a huge no no. Especially if one has had extend from AIP to fodmops to achieve results.

    Am I missing something ?

    • admin, 1 year ago Reply

      That post was only about FODMAPS and GAPS, not Paleo AIP. If you are doing the Paleo AIP, you must avoid all nightshades during the elimination phase of the diet.

  8. Irene, 1 year ago Reply

    Most Artificial Sweeteners, in particular Aspartame and Saccharin are a disaster in more ways than one. Aspartame is an Excitotoxin which is extremely harmful to many areas in the body especially the brain. You need to research for yourself.

  9. jb, 2 years ago Reply

    Check out Kate Scarlata’s website. She is in touch with Monash University and is more up to date on the amounts of the FODMAPs in particular foods. I see some discrepencies here (boysenberries).

  10. Elle, 3 years ago Reply

    I’ve been mostly doing a low FODMAP diet since the beginning of this year to try to help my IBS (C). I found it did help but then we moved house and I was stressed & all my symptoms returned. I then read about GAPS, went to a practitioner and attempted to start a low FODMAP + GAPS diet but really struggled to commit and restrict myself. I was previously vegetarian since early teens so it was a massive change eating bone broths and no carbs. I tried to do it as much as possible, but would get fed up and see no improvement so quit.

    Recently I’ve gone back to eating a low FODMAP diet but am still struggling with my digestion! I have been contemplating whether or not to commit to a strict SCD or GAPS diet and see if it offers any improvement. This time I would have to do it 100%. Alternatively I have read about hypnotherapy being useful for IBS. Any thoughts?

    • admin, 3 years ago Reply

      Thank you for writing. I believe that for some people it is really necessary to do the GAPS diet in quite a scrupulous manner in order to see improvement. I think doing it only partially, especially if it involves eating grains, is not as likely to succeed. I know it is really difficult, especially if you were vegetarian previously. Have you ever kept a food diary and tried to figure out what foods you seem to particularly react to? That can be very useful. And IBS is definitely a mind body condition, so any kind of work that you can do that reduces your level of stress will have a very beneficial impact. I could imagine that if you are a good candidate for hypnosis and you find a practitioner with whom you click, it could be helpful.

  11. D, 4 years ago Reply

    My 7 year old son had ongoing constipation and encopresis. Immediately on starting the FOODMAP diet, my son did lovely healthy fat bowel movement, the soiling stopped and we stopped all his constipation medication. Hallelluyah!

    • judytsafrirmd, 4 years ago Reply

      Wow. Thanks so much for writing and telling me this. There are so many foods to climate in FODMAP, that it can be quite daunting. Did you have a sense of which were the offending foods? Did you eliminate the entire list I included in my article? Did you go through any process of sequential reintroduction in order to try and figure out what were the triggers? Thanks again for writing. It’s great to hear a success story!

      • D, 4 years ago Reply

        I forgot that I left this comment 2 months ago- sorry. We have had years of visits to GPs, Gatroentrologists, Nurses, Psychologists etc with no success. It is such as devastating condition for a child and their family. I was told about FODMAP from another mother who had success and I thought she was a little crazy. Then a Nurse who had IBS told me about it and I listened. I saw the link between fruits and accidents. I pleaded with my husband (who is a GP) to try one more diet. The whole family went cold turkey and attempted to follow all the rules. It is tricky but worth it. Occasionally we bend the rules of the diet, sometimes we get away with it and sometimes we dont. Basically he needs to stick to all the rules of Sue Shepphards FODMAP reccomendations. I am very passionate about the issue because I know how upsetting and fustrating it is.

  12. Edie, 4 years ago Reply

    Very interesting information; I love how you have opened such a wonderful dialogue here! Sharing and learning from eachother is so important on the path to healing.

    For those struggling with what route to go and/or how to manage a healing protocol such as GAPS, there are now Certified GAPS Practitioners all over the world to help! It is so individualized and overwhelming, and there are so many misconceptions and conflicting information out there…I wish there were GAPS practitioners when I started my healing journey years ago!!

    Best of luck to all! It is worth it, to finally be WELL and feel great. Thanks again for a fascinating and supportive post.

  13. Angie, 4 years ago Reply

    GAPS was also too low carb for me (same symptoms as commenter above plus muscle twitches and spasms and worsening of heartburn) and my kids as we couldn’t tolerate the allowable carb sources due to FODMAPS. We eat safe starches a la Jaminet’s Perfect Health Diet and are all feeling much better. Perhaps it is taking longer for my gut to heal — who knows? — but it’s worth it to feel and function so much better. Also, I had gotten the impression that carbs are mostly bad and we she all be eating low carb. It certainly seems true for some, but definitely not for all. Children and active adults can benefit greatly from having a moderate (not LC or VLC) carb consumption from safe starches.

    • Elle, 3 years ago Reply

      This is so interesting Angie! What sort of digestion problems did you have?

  14. LFN, 4 years ago Reply

    I hope the FODMAP diet helps Keiko! I have found it to be very helpful for me, resolving 10+ years of near constant illness. It does take time to figure out each person’s sensitivities but it is time well spent! I believe the 75% improvement rate comes from a study done at the University of Virginia. Anyone interested in the original sources of the diet should check out the works of Dr. Sue Shepherd and Monash University (both based in Australia, which is far ahead of the US on this issue). Best of luck!

    • judytsafrirmd, 4 years ago Reply

      Thanks so much for writing, your good wishes and the helpful info. I will check out the resource you mentioned. It’s so great you figured out what your own sensitivities are.

  15. Nikhil Hogan, 4 years ago Reply

    I hope Keiko gets better!

    • judytsafrirmd, 4 years ago Reply

      How kind of you. I think we are already seeing some improvement.

  16. Ali, 4 years ago Reply

    I have tried low FODMAP for a few months to manage my severe IBS and it only helped me somewhat. I still got severe flare-ups however! I am now just starting GAPS and so its too soon yet to see how much it is helping. I will start slowly introducing allowable FODMAP foods while on GAPS. I’m hoping GAPS is the answer!

    • judytsafrirmd, 4 years ago Reply

      Hi Ali. Thanks for writing. I hope GAPs is the answer for you. The list for FODMAPs is so different than the one for GAPS. I am amazed that they report that 75% percent of IBS patients improve on the FODMAPs plan. It’s really high carb. I did not think all that starch would be good for people with IBS.

  17. Philip Thackray, 4 years ago Reply


    You could spend weeks going through Peter’s blog (Hyperlipid). In the comments of his most recent post, Dr Eades (who I really admire) when asked “have you been reading Hyperlipid lately” replied “Yep, I always read Peter’s stuff”.

    To some extent, Dr. Campbell-McBride, Cassandra Forsythe, Dr Terry Wahls (Multiple Sclerosis) and others seem to be stuck in one or more phases of “The Vegetarian Myth” (moral, political and nutritional) as described in Lierre Keith’s book of that title and – In my opinion – that has prevented them from going far enough in their designs of diets to treat the various diseases they champion.

    Where was any recognizable fruit or vegetable 10,000 years ago? If we were “gatherers” we would still look like pre-human primates. Nothing in the build of these primates would have prevented them from farming had their brains so developed. Now here is Man, upright, fast moving, arms free and mostly hairless, a brain in need of massive energy (relative to the rest of the body), with an enzymatically based digestive system (for proteins at least) and a minimal large intestine (fermentation) . This design was evolutionarily speaking made possible by, and has only one main purpose – hunting.

    To me, I’m seeing too many fruits and vegetables in these various “treatment” diets. It doesn’t seem like much can be proved in the nutrition world. Each of the above practitioners and others have achieved some success with their approaches. The testing will never be done to “prove” what is ideal but after living in the Low Carb world for as long as I have and seeing the extensive “evidence” of its benefit across an amazing spectrum of modern ailments I simply believe that the listed practitioners could have gone farther but are prevented from doing so by, at least in part, the inability to get past the “fruit and vegetable myth”.

    I recognize that they may feel the need to moderate their recommendations to help broaden their reach and also to stay somewhat within the mainstream. I’m sure some of them would admit that in a confidential conversation. You have a clinical practice and probably have the same concerns. “Rearranging” the food pyramid – perhaps ok, turning it upside down – no way!

    Nutritionally, I’m speaking to the personal choices individuals can make without taking professional risks. But should Low Carb ever make it in to the mainstream (which I doubt) then one could go further without the professional risk, that would be nice.

    Best Regards,


    • judytsafrirmd, 4 years ago Reply

      I basically agree with you with the exception that Dr. NCM in no way buys into the Vegetarian myth. I believe that she views animal fat as the most healing food. It’s so hard for most people to give up grains, sugar and starchy vegetables. If you restricted the diet much further, I think you are right, that there are few people who ould sign p. it’s too hard to maintain. I would probably benefit, from the standpoint of digestion, to eat only meat and fish and a little cooked vegetables. But that sounds pretty grim long term. We’ve grown accustomed to so much variety. It’s hard to give it up.

  18. Kati, 4 years ago Reply

    We found that a low oxalate version of GAPS got us most of the way to where we need to be, although we had to pull a lot of the FODMAPs foods as well for awhile. NAET has helped us to address the fructose issues we were experiencing and now we have been able to add back some fruit without problems. We have not yet added galactans but once we get further on our NAET treatments I hope to at least add back red lentils (they are low oxalate).

    Just FYI, I have some friends that swear by the Soil-Based Organisms for getting rid of the belly bloat.

    • judytsafrirmd, 4 years ago Reply

      Kati, thank you for writing. Could you write in something about NAET. I never heard of it before. It sounds like its been an important piece of your healing.

  19. Philip Thackray, 4 years ago Reply


    I started with the Forsythe site and she linked to Medscape where many FODMAPs articles exist. Certainly we are seeing more and more evidence of the importance of our digestive system. The first linked article suggests that hydrogen production is a component of digestion/fermentation of the FODMAPs carbohydrates. That sent me back to a series of articles by Peter Dobromylskyj at Hyperlipid. Gut hydrogen production supports some very nasty bacteria away from the small and large intestine. While this may not directly relate to your young patient it is something for all to consider from a Wellness viewpoint. Once again, thumbs up to Low Carb eating. Here are the Hyperlipid links:

    Type “hydrogen” in the Hyperlipid search function for more articles.

    Peter also has several very interesting posts on IBS as well. He is one of the earliest blog authors to focus on intestinal issues.

    I have been Low Carb for about 8 years. My own observation is that the list of allowable FODMAPs foods is probably too long. We are still stuck on fruits and vegetables as inherently healthy and necessary. All modern fruits are artificially high in fructose due to genetic selection and most of the allowed vegetables’ on the FODMAPs may be lower in FODMAPs than the forbidden veggies but most of the allowed foods still contain FODMAPs carbohydrates. Nothing makes me more flatulent than wild blueberries. Flatulence is a sign that FODMAPs are being poorly digested/fermented.

    One note for lactate (which is on the not allowed list), full fat yogurt (of course try to find that!) and most cheeses are very low in lactate as the lactate is consumed by the bacteria used to produce those produces. Fermentation wins again!


    Philip Thackray

    • judytsafrirmd, 4 years ago Reply

      Good Morning, Phillip, thank you for another wonderful, informative, rich comment. I will need to look into all these links you mentioned. Looks great.

      In terms of the lactate, Dr. Natasha recommends making yoghurt and kefir at home, so that it can be fermented for at least 24 hours, which results in the lactose in the milk being digested by the bacteria. Store bought yoghurt and kefir are often fermented for a shorter time and thus still containing lactose. Hard cheeses also are very low in lactose, and thus permissible on GAPS, but not fresh cheeses like ricotta or mozzarella.

      I know what you mean about the prevailing cultural mindset about healthy fruits and veggies. Especially fruits cultivated and genetically engineered to be super sweet, bear absolutely no resemblance to wild crab apples or tart berries. It is very unnatural and results in many health problems.

  20. Steven Wright, 4 years ago Reply

    Hey Judy – We have lots of people who combine FODMAPS and SCD on our site. Works like a charm and usually over time they can add the FODMAPS vegetables and fruits back in. In the short term they just can’t handle them especially any dried fruits and they also seem to have problems with any nuts. Most of these people are also dairy free which makes them almost GAPS.

    Our site and the book we wrote uses a reverse elimination diet approach whereby one rebuilds their diet using SCD foods but tests each one. We subscribe to the idea that everyone has their own custom diet, and needs to test each food. So in a way following our protocol you would test each FODMAP food along the way. We also advocate for retesting foods later after being on the new diet and seeing success. Many times people will react to foods in the first few months indicating severe leaky gut but as they stay on the diet and the gut heals they have no problems with normal SCD food.

    • judytsafrirmd, 4 years ago Reply

      Dear Steven, Thanks so much for writing. I will check out your site. It sounds really promising. Actually GAPS is not a dairy free diet, but permits fermented dairy and eventually as an individual heals, fresh raw dairy. Pasteurized dairy is never recommended. I really appreciate your comment and look forward to what I can learn on your site.

  21. Natalia, 4 years ago Reply

    I have to do a fodmaps version of GAPS. It did in fact improve substantially in the first few months of gaps, but an unfortunate incidence with repeated oxalate damage over the year caused it to get bad again, so I lost cauliflower and eggplant. For me I believe most of my intolerances come from oxalate damage (high oxalate foods and high dose vitamin c which converts to oxalate.) I look forward to getting more foods back with a low oxalate version of gaps.

    • judytsafrirmd, 4 years ago Reply

      Thank you, Natalia, for writing. It’s all really complicated, isn’t it? I am not really very familiar with the oxalate problem. I think I looked into it once in the past, but have not given it much thought since. Do high oxalates result in digestive symptoms for you?

      • Natalia, 4 years ago Reply

        Yep BIG digestion problems with oxalate. When I dump oxalate, 90% of the time it goes through my gut. Insane bloating, sometimes pain from it, I get clear square shaped crystals come out.. I become sensitive to everything food wise especially fodmaps and salicylates. All accompanied by the lovely brain fog, insomnia, headaches, irritability etc. it really does a number on me!

        • judytsafrirmd, 4 years ago Reply

          Wow, that is a very impressive awful reaction. Thanks for writing and describing what goes on for you with oxalates. It may give others a clue about what is at the heart of their difficulties. There are so many factors to consider. I am going to have to get up to speed on this issue, Are there sources that have been particularly useful to you?

          • Natalia, 4 years ago

            That’s great you want to learn more. Lots of people can’t be bothered taking on more info! Well two resources I use are and the yahoo group- where you can join and read through the files and messages of people on the diet & their experiences, and the regular findings Susan Owens makes (the pioneer in oxalate research). She’s particularly interested in oxalate and autism. There are people with all types of symptoms there who are benefiting- ranging from hives, hypothyroid, IBS, parents of children with ADHD/autism/dyspraxia etc, allergies/intolerances and more.

          • judytsafrirmd, 4 years ago

            Thank you, Natalia. Those look like great resources that I look forward to exploring.

  22. Jenna, 4 years ago Reply

    I am referring to homemade yoghurt and kefir, although I actually don’t seem to have a problem with lactose, myself, so I also tolerate the store-bought versions well. I think the homemade versions have more benefits, though, so I would stick with those.

    • judytsafrirmd, 4 years ago Reply

      Everyone needs to find their own way. The lists I have looked at seem to have conflicting information.

  23. Jenna, 4 years ago Reply

    Also, I just wanted to mention that there are a lot of foods on the allowed list that you have that I do not tolerate. Grapes, nuts, squash, pumpkin and raw veggies come to mind as the most problematic that I see. I actually don’t eat any fruit or nuts and all of my veggies are well-cooked.

    • judytsafrirmd, 4 years ago Reply

      Thanks, that is really useful information. Its all so individual. You mentioned that fermented dairy is good for you. Are you referring to home made yoghurt and kefir? I would think that store bought yoghurt and kefir would not be fermented long enough to get rid of the lactose. I am grateful to you for taking the time to write and to share what has worked for you and what has not. I am distressed about my little patient and I am really eager to figure something out.

  24. Jenna, 4 years ago Reply

    I have a similar story. I suffer from Celiac and Grave’s disease (both autoimmune diseases) and went on GAPS to treat those, but my condition got much worse. I discovered that I have Fructose Malabsorption and Small Bowel Bacteria Overgrowth (both associated with and sometimes called IBS). Through a lot of trial and error, I now do something of a combination of FODMAPS and GAPS, but I eat potatoes, which are not allowed on GAPS. I found that without potatoes, when you get rid of all the FODMAPS foods, GAPS becomes very low carb, and I don’t do well with very low carb. I have now added potatoes but I am on GAPS other than that, and I do great! I would also recommend to go very low and slow with fermented veggies, as these tend to be a problem for FODMAPS people, but fermented dairy is usually not a problem, so eat up on those.

    • judytsafrirmd, 4 years ago Reply

      Hi Jenna. Thank you so much for writing and telling a bit about your experience. I need to find out all i can about this, and its so helpful to hear what individuals have personally experienced. This is definitely an area where there are no hard and fast rules, and each person will have to customize their plan to suit their unique physiology. Thanks again for the tips.

    • Ali, 4 years ago Reply

      Hi Jenna, I am curious what your symptoms were when you tried full GAPS that made you have to stop. I am one week into GAPS and i feel horrible: very weak, shaky, dizzy and flu-like. I don’t know if this is for me,I cant go on feeling so terrible! My IBS has totally calmed down however!

      • Jenna, 4 years ago Reply

        I had basically the opposite reaction. GAPS made my IBS terrible–completely unbearable whereas pre-GAPS it was not really a big issue at all. I was occasionally uncomfortable, but no big deal. I did GAPS to heal autoimmunity. But then, when I did GAPS + FODMAPS, it was just way too restrictive, especially because it did not allow me any significant sources of carbs. I had all the typical symptoms of too low carb–low T3, low energy, low libido, feeling very depleted. Then I added potatoes and I feel great. I definitely think my gut is still healing even with the potatoes, too, because I recently had nuts (which I couldn’t tolerate before) and I was okay. Still not something I would eat regularly, but not bad. If I were you, I would give GAPS about a month or so, but if you are still having so many problems, you might think about some changes.

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