A Diet to Treat Autism

The GAPS diet explained through Western and Chinese medical theories
An emerging area of study in Western science, the relationship of diet and digestion with
mental function has always existed in Chinese medicine. Dr. Natasha Campbell-McBride MD,
MMedSci (neurology), MMedSci (nutrition) has developed this idea from the point of view of
Western science into what she calls the Gut and Psychology Syndrome, or GAPS, with much of
her focus on autism. In addition, she designed a diet to heal the digestive system of GAPS
patients in order to treat the behavioral and digestive symptoms that the damaged digestive
system caused. By analyzing the symptoms of autism and their possible causes from the
perspectives of both Western and Chinese medical theories, the GAPS diet can be understood as
an effective treatment for autism.
Autism is a disorder diagnosed based on behavioral criteria outlined in the Diagnostic
and Statistical Manual of Mental Disorders, or DSM. In 2013, a new edition of the DSM was
published and one of the biggest changes made in this fifth edition was the diagnostic criteria for
Autism Spectrum Disorder, or ASD. The DSM-5 criteria for ASD are much more open to the
range of possible behaviors that can occur in autism than the previous edition. It encompasses
four different disorders from the fourth edition of the DSM: autistic disorder, Aspergers
disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise
specified. It also outlines different levels of severity possible within the diagnosis, and lastly, the
new criteria encourage diagnosis at an early age rather than of school-aged children as was the
aim in the DSM-4. (dsm5.org)
The DSM-5 outlines two broad behavioral criteria for an autism diagnosis. The first is a
deficit in social communication and interaction. This is characterised by the presence of three

social impairments, the first being in social emotional reciprocity. To give a better
understanding of what this means, the DSM-5 provides examples of possible behaviors that may
fall under this category such as an inability to participate in a back-and-forth conversation, a
disinclination to share interests or emotions, and an aversion to initiating or responding to social
interactions. The next impairment is in nonverbal social communication such as abnormal eye
contact or body language, difficulty understanding and using gestures in a social context, and an
absence of facial expressions or nonverbal communication. The final impairment is in
developing, maintaining and understanding relationships. Examples of this include difficulty
changing behavior to fit certain social contexts, challenges in making or playing with friends,
and a lack of interest in peers. To summarize, for a patient to fit this behavioral rubric he or she
must have difficulty relating to other people, understanding nonverbal social cues, and making
friends. (Autism Speaks)
The second diagnostic criterion for Autism Spectrum Disorder includes repetitive
behaviors, interests, or activities. An individual must have two of four possible types of
behaviors to meet this criterion. The first is the appearance of stereotyped or repetitive motor
movements, use of objects, or speech. Again, the DSM-5 gives examples of possible behaviors
that may fall within this description such as motor stereotypies like hand flapping or rocking,
lining up toys, and echoing what another person says. The second possible behavior that can
occur within this diagnostic criterion is an insistence on sameness, inflexible adherence to
routines, or ritualized patterns of verbal or nonverbal behavior. For example, a patient may be
attached to a certain routine and become anxious with small changes to that routine, or have
difficulties with transitions. This is very similar to a compulsion, which is, as defined by Bob
Flaws and James Lake, MD in Chinese Medical Psychiatry, an urge to act or think that is

difficult to resist, (Flaws 377). The third type of behavior that may characterize this criterion
for a diagnosis of ASD is highly intense restrictricted and fixated interests. Example behaviors
include strong attachments to unusual objects, and a very narrow range of interests. This type of
behavior is similar to an obsession, which Flaws and Lake define as a recurring intrusive
thought (Flaws p.377). The final behavior that may be present within this diagnostic criterion is
hyposensitivity to, hypersensitivity to, or an unusual interest in environmental stimuli. For
example, a patient may be indifferent to pain or temperature, may be averse to certain sounds or
textures, or may be fascinated with lights or movement. In short, the presentations that may
occur within this criterion include repetitive behaviors, inflexibility or compulsions, intense,
narrow interests or obsessions, and sensory abnormalities. For a diagnosis of autism, a patient
must present with all the behaviors of the first criterion as well as at least two of the four
behaviors outlined in the second criterion. In addition, these symptoms must have been present
in early childhood and must impact everyday functioning. (Autism Speaks)
Although not included in the criteria that define autism, there are other symptoms that are
often present in individuals with the diagnosis, namely, digestive symptoms. Several studies
have shown a correlation between ASD and gastrointestinal symptoms, and as researchers James
B Adams et.al. state, There is general consensus that GI problems are common in autism. The
type of digestive problems seen, though, are extremely variable. In general, these studies have
looked at some combination of the frequency, consistency, smell, and appearance of the patients
stool as well as the presence of vomiting, belching, gaseousness, and abdominal distention or
discomfort. As with the behavioral symptoms of autism, there is a wide spectrum of digestive
symptoms that may appear with the diagnosis.

From the perspective of Chinese medicine, most of the behavioral symptoms defining
Autism Spectrum Disorder in the DSM can be seen as an imbalance in the energy system of the
heart. In Chinese medicine there is a saying that the heart houses the mind, and more
specifically, it is the blood of the heart that is the residence of the mind. As Giovanni Maciocia
writes in his book The Foundations of Chinese Medicine, Heart blood roots the Mind, embraces
it and anchors it, (110). The functions of the mind in Chinese medicine are similar to the way
Western medicine views the functions of the brain. One of its major roles is in understanding
and connecting with other people. As Maciocia puts it, A healthy heart and Mind will
positively influence our ability to relate to other people. On an emotional level, the state of
the heart determines a persons capacity to form meaningful relationships, (110). This directly
speaks to the first diagnostic criterion of Autism Spectrum Disorder in the DSM-5. With an
imbalance in the heart-mind, a person will have difficulty socially and emotionally responding to
another person, understanding social cues, and forming relationships with other people.
The energetic system of the heart also affects speech so an imbalance of the heart often
results in speech abnormality. Maciocia writes that, The condition of the heart also affects
speech, and abnormalities may cause stuttering or aphasia. Often disharmonies of the heart
can cause a person to talk incessantly or laugh inappropriately, (113). This can be applied to
two aspects of the behavioral criteria for autism. First, incessant talking and inappropriate
laughter could be an aspect of a social anomaly, and second, abnormal speech is part of the first
behavior associated with the second DSM criterion: stereotyped or repetitive motor movements,
use of objects, or speech. Finally, the heart-mind plays a large role in how a person perceives
external stimuli: All sensations of sight, hearing, smell, taste, and touch depend on the Mind in
much the same way as they depend on the brain in Western medicine, (Maciocia 70). With an

imbalance of the heart, an individuals perception of the outside world may be skewed as is the
case with some patients with ASD. This heart function lines up with the fourth possible
behavioral symptom of the second diagnostic criterion: hyposensitivity to, hypersensitivity to, or
an unusual interest in environmental stimuli. So, through the lense of Chinese medicine, an
imbalance in the energy of the heart is a major contributing factor to the presence of many
behavioral symptoms that define autism in Western medicine.
The other organ system in Chinese medicine that plays a role in the behavioral
presentation of autism is that of the spleen. As the spirit of the heart is the mind, the spirit of the
spleen is intelligence or thinking. An imbalance in the spleen energy, especially when paired
with a heart imbalance, often results in symptoms related to thinking such as rumination, overthinking, worry, and anxiety. Flaws and Lake explain that, Over-thinking, worry, and anxiety
are all seen in patients with heart-spleen patterns, (119). These symptoms can be linked to
both the compulsive-like behaviors and the obsession-like behaviors possible in ASD. As a
result of imbalances in both the heart and the spleen, ...there is uncontrollable worry and anxiety
and compulsive behavior, (Flaws 380), and there can also be ...persistent anxiety and
preoccupation, obsessional thinking, (Flaws 119). This can apply to the inflexible, compulsivelike routines and intense, narrow obsession-like interests commonly seen in patients with autism.

The spleen in Chinese medicine also plays a major role in the digestive symptoms so
often suffered by those affected with autism. Digestion is the spleens primary role so it follows
that, Any Spleen disharmony will always influence the digestive process, with such
symptoms as abdominal distention, lack of appetite and loose stool, (Maciocia 567). These are
some of the very symptoms experienced by individuals with ASD, implicating a spleen

dysfunction in the development of these symptoms. In all, the behavioral and digestive
symptoms of autism recognized by Western medicine and science relate to the symptoms of both
heart and spleen dysharmonies as seen by Chinese medicine.
While there is an overall consensus about the symptoms of autism, Western medicine has
yet to clearly define the root cause of these symptoms. Without understanding the root of the
disorder, it is very difficult to develop a successful treatment for it. As researchers Karoly
Horvath, MD, PhD and Jay A. Perman, MD put it, Because the cause of autism is unknown,
many hypotheses have been suggested and many different therapies have been implemented in
autistic children. Although the exact mechanisms underlying autism are unclear, it is generally
accepted that a combination of genetic predisposition with certain environmental exposures is the
fundamental cause.
Autism was looked at largely as a genetic disorder when research into its roots first
began. Recently, however, a study colloquially referred to as The Twin Study, conducted by
Joachim Hallmayer, MD et al. revealed the extent to which prenatal and early postnatal
environments play a role in the development of autism as opposed to genetics. They looked at
192 pairs of twins where at least one twin was affected by ASD, and compared the prevalence of
ASD in both of the twins in the identical pairs (who share all of their genetic material) with that
of the fraternal pairs (who share half of their genetic material.) The researchers found that the
rates of identical twins that were both affected by autism were, ...comparable to those reported
in prior studies, (Hallmayer et al.). The same rates in fraternal twins, though, were, ...higher
than previously reported and have a significant impact on the heritability analysis, (Hallmayer
et al.). From this further analysis of heritability, Hallmayer et al. concluded that genetic
heritability accounted for 37% of the liability for autism whereas shared environmental factors

accounted for 55% (Hallmayer et al.). This study has had a strong impact on how Western
science views the cause of autism, with more emphasis now being placed on environment and
less on genetics.
Some studies looking at possible environmental factors linked to autism have identified
exogenous toxin exposure in utero or soon after birth as a potential cause, the most notable
toxins being diesel particulate matter and mercury (Roberts et al.). Others, instead, have shifted
towards examining toxins made inside the patients gut as a key player in the development of
psychological and behavioral disorders such as autism. One scientist in particular, Dr. Natasha
Campbell-McBride, MD, MMedSci(neurology), MMedSci(nutrition), has done invaluable work
with this concept which she calls the Gut and Psychology Syndrome, or GAPS. This explanation
of autism is able to account for the behavioral symptoms as well as digestive symptoms of ASD,
and accounts for both inherited and environmental causes.
Dr. Campbell-McBride believes an imbalanced flora in the gut is a major causative factor
in the development of autism and other behaviorally characterized disorders. There are many
different microbes that can populate an individuals gut, some are beneficial and absolutely
essential to a persons health, and others can have very detrimental health effects. The beneficial
bacteria maintain the integrity and health of the cells lining the intestines (enterocytes) and play a
vital role in digestion. They provide several mechanisms for protection against pathogenic
micro-organisms, so an unbalanced gut, which doesnt have this protection, is vulnerable to
invasion by anything it is introduced to. The beneficial bacteria also nourish the enterocytes and
govern their process of renewal, so a deficiency in these strains of bacteria disrupts the
production and maturation of the enterocytes, leaving them diseased and malnourished. The
diseased cells are then left unable to do their job of properly digesting and absorbing food.

Finally, beneficial bacteria play an integral role in digestion: Certain ingredients in our foods
cannot be digested by a human gut at all without the help of beneficial bacteria, (CampbellMcBride 22). A deficiency of good flora consequently results in impaired digestion. So, a gut
with insufficient beneficial flora is vulnerable to pathogens, malnourished, and unable to fulfill
its role of digesting food and absorbing nutrients.
Certain harmful bacteria, referred to as opportunistic, take advantage of the opportunity
to populate a gut unprotected by beneficial flora. As Dr. Campbell-McBride explains in
reference to the opportunistic flora, In a healthy gut their numbers are limited and tightly
controlled by the beneficial flora. But when this beneficial flora is weakened and damaged, the
opportunists get out of control, (41). Some opportunistic bacteria can damage the lining of the
intestines, making it leaky to harmful substances. For example, certain families of spiralshaped bacteria are able to push themselves between intestinal cells, ...breaking down the
integrity of the intestinal wall and allowing through substances which normally should not be
allowed through, (Campbell-McBride 42). A strain of yeast, Candida albicans, has this ability
as well but by sending projections through the intestinal wall like roots. This leakiness of the
intestines combined with the incomplete or improper digestion of food results in a number of
food intolerances. When the partially undigested food is allowed in the bloodstream, the
immune system recognizes it as foreign and issues an immune response. It is no surprise, then,
that food intolerances are so often seen in patients with autism. Some opportunists produce toxic
chemicals as a result of their metabolic processes. For example, E. coli and Staphylococci
among others produce histamine, a key player in inflammation, and an overgrowth of these
bacteria cause just that -- inflammation of the gut. Other bacteria produce toxins that act in the
brain and nervous system affecting mental function, the root of the gut-brain connection.

There are many bacteria known to produce chemicals toxic to brain functioning, and
many more are being studied. Members of the Clostridia family, and yeasts such as Candidas
are some of the most notorious overgrowths shown to have a detrimental effect on the nervous
system. A strain of bacteria in the Clostridia family produces the neurotoxin responsible for
tetanus. Dr. Campbell-McBride points out that some behaviors seen in autism are similar to
those found in tetanus, namely, ...sensitivity to light and noises, and, ...abnormalities of
muscle tonus, and she postulates that theyre connected (46).
Other strains of opportunistic gut bacteria produce alcohol and opiate-like molecules.
Both alcohol and opiates are known to impact the functioning of the brain and behavior, whether
they are ingested or the results of an unbalanced gut. Yeasts, such as Candida albicans, are one
of the most common pathogenic overgrowths in the gut of patients with autism. As any beer
brewer knows, yeasts consume sugars and convert them into alcohol, a process called alcoholic
fermentation. In a person with an intestinal yeast overgrowth, carbohydrates and other sugars are
digested through this pathogenic process as opposed to the physiological process of glycolysis.
As a result, the individual is chronically exposed to low levels of alcohol leading to a number of
health consequences including, Brain damage with lack of self-control, impaired co-ordination,
impaired speech development, aggression, mental retardation, loss of memory, and stupor,
(Campbell-McBride 52). This description is not dissimilar to some of the behavioral
presentations of ASD.
Another effect of this long-term exposure to alcohol from Candida overgrowth is an
impairment in the production of stomach acid. Stomach acid is the first step in the digestion of
proteins, such as gluten from wheat and casein from dairy. It also stimulates the release of
digestive enzymes from the pancreas for the following step in protein digestion. Therefore, an

impairment in the production of stomach acid leads to an impairment in the digestion of proteins
including gluten and casein. These two proteins are then left partially digested as
gluteomorphins and casomorphins -- molecules similar in structure to opiates. Dr. CampbellMcBride explains that These opiates from grains and milk are thought to get through the bloodbrain-barrier and block certain areas of the brain, just as morphine or heroin would do, (54). To
summarize, an imbalance of flora in the gut impairs digestive functioning through the
malnourishment of intestinal cells, invasion of pathogens, and inflammation of the intestines, and
impairs mental functioning through neurotoxins produced and absorbed as a result of this
digestive dysfunction.
Gut flora is passed down from mother to child and is then altered depending on various
environmental stimuli. A childs first exposure to bacteria is through the mothers vaginal canal
and after that, through breastfeeding. Dr. Campbell-McBride firmly states that Breastfeeding is
the one and only opportunity we have in our lives to populate the entire surface of our gut with a
healthy mixture of bacteria to lay the very basis of our future health, (37). If an expecting
mother has an unbalanced gut flora that is producing toxins, the developing child will be exposed
to those toxins in utero. Once born, the child will continue to be exposed to these toxins through
breast feeding and will also inherit the mothers unbalanced flora and start producing his or her
own toxins, further affecting development.
The main environmental factors that can alter gut flora later in life, is the use of
antibiotics, and diet. Campbell-Mcbride explains that Antibiotics have a devastating effect on
beneficial bacteria in the human body, (33) giving the opportunistic bacteria a chance to invade,
such as Clostridia and Candida which are resistant to antibiotics (Campbell-McBride 42). Most
people have taken antibiotics to treat a bacterial infection such as strep throat, but many arent

aware of their prevalence in food. Livestock and farmed fish are regularly given antibiotics so
conventional animal products such as meats, eggs, and dairy often contain antibiotics.
Campbell-McBride includes that, Fruit, vegetables, grains, legumes and nuts are sprayed with
antibiotics to control disease, (33). These exposures to antibiotics in conventional foods and
treatments of infections have an extremely damaging effect on gut flora.
In addition to being a source of antibiotics, our diet can promote the growth of certain
bacteria and unfortunately the standard Western diet, dominated by processed foods, feeds the
opportunistic flora. As Dr. Campbell-McBride puts it, A modern diet of convenience rather
than nutrition, full of processed foods, has a serious detrimental effect on the gut flora, (37).
She specifically mentions sugary foods, processed carbohydrates, and fibre from grains as some
of the most harmful as they increase the numbers of Clostridia and Candida among other
opportunists. So, the widespread use of antibiotics in treatments and in conventional diets along
with the extensive consumption of processed food have had devastating effects on gut flora.
Since gut flora is inherited, these effects have been compounded over several generations and
now has lead to the increased prevalence of disorders such as autism, learning disabilities, and
allergies to name a few.
From a Chinese medicine perspective, this Western view of autism as being caused by
the combination of a genetic predisposition with an unbalanced gut flora can be paralleled with
kidney and spleen disharmonies. The genetic component of autism can be linked to the energy
system of the kidneys. The kidneys store a persons prenatal (or pre-heaven) essence which can
be generally equated to an individuals DNA. In The Foundation of Chinese Medicine, Maciocia
eludes to this when he states that, Conception is a blending of the sexual energies of man and
woman to form what the ancient Chinese called the 'Pre-Heaven Essence'... of the newly

conceived human being. ... The Pre-Heaven Essence is what determines each persons basic
constitutional make-up, strength and vitality. It is what makes each individual unique, (44). So,
like each individual's DNA is a unique combination of his or her parents' DNA, an individual's
prenatal essence is a unique combination of his or her parents' essences.
In addition to prenatal essence, there is also the concept of postnatal essence, ...that is
refined and extracted from food and fluids by the Stomach and Spleen after birth, (Maciocia
45). Together, the prenatal and postnatal essences form the kidney essence which determines
growth and development among other essential functions for life. Therefore, impairments in
growth and development leading to disabilities such as autism can be seen as a kidney essence
deficiency in Chinese medicine. This lines up very well with the Western medical view of the
root of autism as a combination of genetic predisposition and environmental factors, and even
better with Dr. Natasha Campbell-McBride's view that the major environmental factor is
impaired digestion, as kidney essence is a combination of genetic inheritance (prenatal essence)
and the environmental factor of nutrition (postnatal essence).
As Dr. Campbell-McBride describes the link between digestion and mental state into
what she calls the Gut and Psychology Syndrome, this connection between the bodys digestion
and the functioning of the mind can also be made in Chinese medicine. Maciocia explains that,
One of the most important characteristics of Chinese medicine is the close integration of body
and Mind, which is highlighted by the integration of Essence (Jing), Qi, and Mind, called the
Three Treasures, (69). The organs connected with the three treasures are the kidneys, spleen
and heart, the very organs involved in autism. The kidneys store essence, and the heart houses
the mind, as explained earlier. The spleens role in the three treasures is through the production
of qi, which can be roughly translated as energy. It is common knowledge that a person gets

their energy from the food they eat, and in Chinese medicine, this digestion of food into energy,
or qi, is performed by the energy system of the spleen.
The relationship between these three organs and their treasures illuminates the connection
between the underlying kidney essence deficiency in autism and the heart-spleen imbalance
involved in the behavioral and digestive symptoms. It has already been established that the
spleen contributes to kidney essence as the kidney essence is a combination of the prenatal
essence inherited from the parents and the postnatal essence extracted from food by the spleen.
These essences in combination are the foundation of the mind. As Maciocia puts in, The Mind
draws its basis and nourishment from the Prenatal Essence stored in the Kidneys and the
Postnatal Essence produced by the Stomach and Spleen. Hence the Three Treasures, (69). It
follows, then, that a deficiency in these essences will negatively affect the functioning of the
mind. Maciocia states that, If Essence and Qi are depleted, the Mind will suffer and may
become unhappy, depressed, anxious, or clouded, (69). So, in autism, a child is born with an
inherited kidney essence deficiency -- a combination of genetic predisposition and digestive
impairments -- which results in a poor foundation for the mind, leading to the behavioral
presentation.
While prenatal essence is generally seen as fixed and unchangeable, like DNA, the
quality of postnatal essence coming from food and fluids, can be altered by the quality of the
diet. Similarly, Dr. Natasha Campbell-McBride believes that a change in diet can impact the
symptoms of autism and other gut and psychology syndromes. In her book Gut and Psychology
Syndrome, Natural Treatment for Autism, A.D.D./A.D.H.D., Dyslexia, Dyspraxia, Depression,
Schizophrenia, Dr. Campbell-McBride outlines a diet that can treat autism and other gut and
psychology syndromes. Her goal is to detoxify the patient, ...to lift the toxic fog off the brain

and allow it to develop and function properly, (89). She believes that in order to do this the
digestive tract needs to be healed so it stops producing toxins and its ability to nourish is
restored. The GAPS diet is designed to remove foods that irritate the gut, and include foods that
nourish the lining of the gut and that promote the growth of beneficial flora. In the beginning,
the diet is fairly strict, but as the gut heals, more foods can be introduced because the digestive
system is healthy enough to handle them.
In discussing the diet, first Dr. Campbell-McBride explains what foods to avoid within
each of the three macronutrients: carbohydrates, protein and fats. Starches, a type of
carbohydrate, are strictly avoided in the GAPS diet. This includes all grains and starchy
vegetables. Carbohydrates, including starches, are made out of sugars -- yeasts favorite food.
Also, being complex carbohydrates, starches are very difficult to digest, especially for someone
with a damaged digestive tract. The final step in carbohydrate digestion, from a double sugar to
a single sugar, is performed by enterocytes. In a patient with sick enterocytes, this step is not
completed, leaving the double sugars to feed the opportunistic gut flora such as the yeast
Candida, reinforcing the underlying problem. So, starches are rigorously excluded from the
GAPS diet, eliminating one of the primary foods feeding the opportunists.
Patients with GAPS, such as those with autism, also have a hard time digesting proteins.
As previously discussed, gluten and casein are two of the most harmful proteins for those with
an unhealthy digestive system because they are digested into opiate-like molecules which are
absorbed into the bloodstream through the damaged and leaky gut wall. Then they travel to the
brain and cause similar dysfunctions as opiates. Dr. Campbell-Mcbride references a study done
on the digestion of casein from dairy which found that it is converted into, ...beta-casomorphin7, which gets taken up by 32 various areas of the brain, many of which are responsible for vision,

hearing and communication, (119). This is why Campbell-McBride recommends avoiding

wheat and dairy and suggests eggs, meats and fish as, ...the best sources of easy-to-digest and
very nourishing proteins, (103).
Fats are relatively easy for GAPS patients to digest because they dont require much
work from enterocytes. The only problem lies in excessive mucus production as a response to
the pathogenic invasions of the gut. This mucus coats food particles and fat, blocking digestive
enzymes and bile. The fat, therefore, is undigested and gets excreted as greasy stool. This can
result in deficiencies in the fat soluble vitamins: A, D, E, and K. Once the gut lining is healed, it
wont have the need to produce excessive mucus anymore and proper fat digestion will be
restored.
One of the most harmful aspects of the modern diet is processed foods, and they are to be
strictly avoided by patients with GAPS. Processing foods changes their chemical and biological
natures into a form that the body was not designed to digest and use. It strips foods of their
flavor, color, and nutrients, so to compensate, various flavor-enhancers and dyes are added and
the foods are enriched with artificial vitamins that the body doesnt recognise. As Dr.
Campbell-McBride puts it, Synthetic vitamins have very low absorption rates, which means that
most of them go through and out of your digestive tract without doing you any good, (109).
And not only do processed foods not do any good, they do harm. Campbell-McBride explains
that, Many of these chemicals have been conclusively shown to contribute to hyperactivity,
learning disabilities, psychiatric disorders and other health problems, (103). This fact alone
clearly illustrates why those who already have behavioral abnormalities should stay away from
processed foods.

The most common type of processed food is carbohydrates. In nature, carbohydrates

from grains, fruits, and vegetables and digested and absorbed slowly. Processed carbohydrates,
on the other hand, are absorbed very quickly, causing the blood sugar to spike and a resulting,
...feeling of a high with hyperactive and manic tendencies and self-stimulation in autistic
children, (Campbell-McBride 106). The body then responds by secreting large amounts of
insulin, drastically lowering blood sugar and resulting in patients feeling, ...unwell, often with a
headache, bad mood, tantrums, aggression and general fatigue with excessive sweating,
(Campbell-McBride 103). These behaviors are very often seen in autism, further highlighting
the importance of eliminating processed foods in the diet of individuals with autism. Finally, as
discussed earlier, carbohydrates are a primary food for the bad flora in the gut, providing yet
another reason processed foods need to be avoided in GAPS patients.
In her book, Dr. Natasha Campbell-McBride provides a general scaffold for what to eat
in the GAPS diet, with the addition of certain alterations depending on the specific symptoms of
the patient. Based on the Specific Carbohydrate Diet, the GAPS diet excludes all complex
carbohydrates -- grains and starchy vegetables -- only allowing sugars in their single form
(glucose, fructose and galactose) from fruits and non-starchy vegetables. These single sugars
can be readily absorbed without needing to be digested. Dr. Campbell-McBride advises against
eating fruit with a meal as it can interfere with the digestion of meats. She also explains the
importance of eating fruit when it is ripe as unripe fruit can have too much starch. Because table
sugar is sucrose (a double sugar) it needs to be excluded from the diet and can be replaced by
honey, made up of glucose and fructose, both single sugars. Campbell-McBride recommends
natural cold-pressed honey because other extraction processes can be damaging to the natural
makeup of the honey.

Meats and fish are an extremely important part of the GAPS diet. They provide almost
all necessary nutrients in a form that is easy to digest with fruits and vegetables providing the
remaining nutrients. While it is important to eat fruit as a snack away from meals, it is beneficial
to eat vegetables with meals. Dr. Campbell-McBride explains that digestion of meats and fish
result in an accumulation of acids, while digesting vegetables leads to an alkaline state, so, By
combining the meats and vegetables in one meal we balance the acidity in the body, which is
important because both too acid and too alkaline states are not very healthy, (CampbellMcBride 130). The only meats not allowed in the GAPS diet are preserved meats because they
contain too many additives. These include ham, bacon, deli meats and commercially available
sausages. Finally, meats should be bought, prepared and eaten in their full fat form. CampbellMcBride explains that, Our physiology can only use meat fibres when they come with the fat,
collagen and other substances that a proper piece of meat will provide, (132). Animal fats are
an important source of nutrients for a GAPS patient as they, ...provide all the right nutrients for
restoring immunity, gut and nervous system, (Campbell-McBride 140). So, it is best to cook
meats with a good fat covering and eat poultry and fish with the skin. Animal fats are also best
to cook with because in addition to their nutritional benefits, their chemical nature isnt changed
by heat. Oils, on the other hand, will change from an unsaturated fat to a trans fat with the
addition of heat, and many nutrients will be destroyed. Only cold-pressed oils are recommended
in the diet because they havent been heated in the extraction process, and they are only to be
used as a dressing.
In addition to fruits, vegetables, meats and fish, eggs should be an extremely important
part of the diet of a GAPS patient. Egg yolks are rich in a plethora of nutrients including
vitamins, minerals, amino acids and fatty acids, all in a readily absorbable form. Dr. Natasha

Campbell-McBride compares raw egg yolks with human breast milk because all if their nutrients
can be almost entirely absorbed without any digestion. This is crucial for those with impaired
digestive systems. Egg whites are a different story, though, as they contain complex proteins
that can be difficult to digest. Many people who are sensitive to eggs react to the whites while
the yolks are generally unproblematic. Campbell-McBride recommends 2-6 raw or lightly
cooked egg yolks per day for children with GAPS and 4-8 for adults.
Nuts and seeds can be an excellent source of minerals, amino acids, and fats, but Dr.
Campbell-McBride suggests introducing them slowly as they can be hard to digest. She advises
buying nuts and seeds either in their shells or freshly shelled and not processed in any way. Nuts
can be soaked to make them more digestible and seeds should be soaked until they are slightly
sprouted. This helps remove some of the substances that make them difficult to digest and also
makes them more nourishing. Nuts are used extensively in the GAPS diet as ground nut flours
for baking.
Beans can also be difficult to digest and should also be introduced slowly. Some can be
starchy, so only dried white (navy) or haricot beans, dried and fresh lima beans, string beans,
lentils and split peas are included in the diet. Similar to nuts and seeds, beans should be soaked
before cooking with them, and when first introducing them into the diet, should be fermented.
Not only does fermentation aid in the digestion of the beans, it also provides the gut with
beneficial bacteria, further supporting the healing of the gut.
Salt is not only a delicious seasoning, it can also provide essential minerals and trace
elements that the body needs. Dr. Campbell-McBride goes so far as to say that, Natural salt is
just as fundamental to our physiology as water is, (141). Table salt, however, does not include

these fundamental nutrients -- it is pure sodium chloride. So, salt should be used in the GAPS
diet as long as it is natural such as whole unprocessed sea salt, Himalayan, and Celtic.
The beverages in the GAPS diet include plenty of water, freshly pressed juices, and meat
and fish stock. Dr. Natasha Campbell-McBride advises drinking one glass of still mineral or
filtered water at the start of the day and between meals, but not with a meal as it can interfere
with digestion. Instead, homemade meat stocks are beneficial to drink at mealtime as they
stimulate the release of digestive secretions. They are also extremely nourishing and easy to
digest. Campbell-McBride states that meat stocks are, ...full of minerals, vitamins, amino-acids
and various other nutrients in a very bio-available form, (178). Freshly pressed juices support
the liver and help the bodys process of detoxification. In addition to these nourishing
beverages, fresh and unprocessed coffee and tea is allowed in the diet as well as homemade milk
substitutes such as almond and coconut milk.
Finally, Dr. Natasha Campbell-McBride outlines specific instructions for the introduction
of dairy into a GAPS patients diet. Dairy is notorious for causing digestive upset, and as
discussed earlier, can be absorbed partially digested as an opiate-like toxin; But this is only
taking into account unfermented and pasteurized dairy. In the process of fermentation, most of
the proteins in milk (including casein) and the sugar lactose are broken down, so it is much easier
to digest. Not only that, eating fermented foods in general provides the gut with beneficial flora
that can fight the opportunists. Dr. Campbell-McBride outlines what she calls the Dairy
Introduction Structure, which begins with clarified butter, or ghee -- very easy to digest -- and
progresses through different degrees of fermentation of dairy products, ending with natural
cheese -- one of the hardest dairy products to digest. The fermented dairy products that the

GAPS diet includes are yogurt, sour cream and kefir which should all be homemade. Butter is
also allowed and should be organic.
In addition to fermented dairy products, other fermented foods are encouraged in the
GAPS diet to supply the gut with beneficial bacteria. Fermentation occurs when beneficial
bacteria are added to a food which partially digest it before it is eaten. For example, pickles are
fermented cucumbers and sauerkraut is fermented cabbage. Most foods can be fermented
including vegetables, dairy, beans and even grains. This makes the foods much easier to digest
since many of the substances are pre-digested, and it provides the gut with a source of beneficial
bacteria. If fermented foods arent eaten every day, then Dr. Campbell-McBride recommends
supplementing with a probiotic to fulfill this need of supplying the gut with beneficial flora.
The foods included in the GAPS diet are the most nourishing for the lining of the gut and
for the entire body. These are the foods that the body is the most adapted to because they have
very little or no processing and therefore are being eaten in their whole form, the way nature
intended. The GAPS diet also recommends plenty of fermented foods and supplementation with
probiotics to promote the growth of beneficial flora. In addition, the diet excludes foods that
promote the growth of opportunistic flora. In all, the GAPS diet encourages the healing of the
digestive system and rebalances its flora to remedy the digestive symptoms and eliminate the
pathological production of toxins causing the behavioral symptoms of autism and other gut and
psychology syndromes.
From a Chinese medicine perspective, the state of the gut and its flora can be linked to
the state of the spleen energy system because the spleen rules digestion as does the gut and its
flora. An unhealthy gut and flora from a Western science point of view or, from a Chinese
medicine point of view, an imbalance in the spleen energy system, leads to impaired digestion.

With impaired digestion, comes impairment in the production of postnatal essence, perpetuating
the kidney essence deficiency underlying autism. Like DNA, the prenatal aspect of kidney
essence can't be changed, but because if it's relationship with postnatal essence, it can be
positively influenced through nutrition. As Maciocia puts it, Since it is inherited from the
parents at conception, the Pre-Heaven Essence can be influenced only with difficulty in the
course of adult life. However, due to its interaction with the Post-Heaven Essence, it can be
positively affected, even if not quantitatively increased, (45). So, healing the gut and
rebalancing its flora, as the GAPS diet does, will treat the digestive symptoms of autism, and by
benefiting the production of postnatal essence will strengthen kidney essence. Because kidney
essence is the foundation of the mind, strengthening it will ultimately strengthen the functioning
of the mind, thereby treating the behavioral symptoms of autism as well. So, through benefiting
the health of the gut and its flora from the Western scientific view, and the quality of the
postnatal essence from the Chinese medicine view, the GAPS diet can treat the behavioral and
digestive symptoms of autism.

For additional and more detailed information about the GAPS diet and implementing it
(including recipes), Dr. Natasha Campbell-McBrides book, Gut and Psychology Syndrome,
Natural Treatment for Autism, A.D.D./A.D.H.D., Dyslexia, Dyspraxia, Depression,
Schizophrenia, is very informative. You can also find more information and recipes at her
website: http://www.gaps.me/

Works Cited

Adams, James B., Leah J. Johansen, Linda D. Powell, David Quig, and Robert A. Rubin.
"Gastrointestinal Flora and Gastrointestinal Status in Children with Autism -Comparisons to Typical Children and Correlation with Autism Severity." National
Center for Biotechnology Information. U.S. National Library of Medicine, 16 Mar. 2011.
Web. 11 Jan. 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072352/>.
"Autism Spectrum Disorder." Dsm5.org. American Psychiatric Publishing, 2013. Web. 5 Jan.
2014.
<http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet
.pdf>.
Campbell-McBride, Natasha, MD, MMedSci(neurology) MMedSci(nutrition). Gut and
Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia,
A.D.H.D., Depression, Schizophrenia. Cambridge, U.K.: Medinform Pub., 2012. Print.
"DSM-5 Diagnostic Criteria." Autism Speaks. Autism Speaks Inc., 2014. Web. 5 Jan. 2014.
<http://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria>.
Flaws, Bob, and James Lake. Chinese Medical Psychiatry: A Textbook & Clinical Manual:
Including Indications for Referral to Western Medical Services. Boulder, CO: Blue
Poppy, 2001. Print.
Hallmayer, Joachim, MD, Sue Cleveland, BS, Andrea Torres, MA, Jennifer Phillips, PhD,
Brianne Cohen, BA, Tiffany Torigoe, BA, Janet Miller, PhD, Angie Fedele, BA, Jack
Collins, MBA, Karen Smith, BS, Linda Lotspeich, MD, Lisa A. Croen, PhD, Sally
Ozonoff, PhD, Clara Lajonchere, PhD, Judith K. Grether, PhD, and Neil Risch, PhD.
"Genetic Heritability and Shared Environmental Factors Among Twin Pairs With

Autism." JAMA Network. American Medical Association, Nov. 2011. Web. 12 Jan. 2014.
<http://archpsyc.jamanetwork.com/article.aspx?articleid=1107328>.
Horvath, Karoly, MD PhD, and Jay A. Perman, MD. "Autism and Gastrointestinal Symptoms Springer." Autism and Gastrointestinal Symptoms - Springer. Springer Science+Business
Media, 2002. Web. 11 Jan. 2014. <http://link.springer.com/article/10.1007/s11894-0020071-6#page-1>.
Maciocia, Giovanni. The Foundations of Chinese Medicine: A Comprehensive Text for
Acupuncturists and Herbalists. Edinburgh: Churchill Livingstone, 2005. Print.
Roberts, Andrea L., Kristen Lyall, Jaime E. Hart, Francine Laden, Allan C. Just, Jennifer F.
Bobb, Karestan C. Koenen, Alberto Ascherio, and Marc G. Weisskopf. "Perinatal Air
Pollutant Exposures and Autism Spectrum Disorder in the Children of Nurses Health
Study II Participants." Environmental Health Perspectives. National Institute of
Environmental Health Sciences, 18 June 2013. Web. 12 Jan. 2014.
<http://ehp.niehs.nih.gov/1206187/>.