GAPS Diet Protocol... What the heck is GAPS?!

I won't lie... the GAPS diet is not like a traditional diet. If you're reading this, chances are you found it by searching for GAPS diet in google. There really aren't as many free resources available out there as one would hope. And for parents who are on an extremely limited budget, with a child who has a medical condition that GAPS has been indicated to help... free can make the difference between success and failure. I'm writing this because I've now spent the last 5 weeks on the GAPS full diet (you're about to learn what that means) and will be gearing up to do the introduction diet for GAPS (wait, shouldn't it be the other way around?)

If you are new to my blog, I will give a very brief background. My two year old daughter has Food Protein Induced Enterocolitis Syndrome. In the easiest way to explain it, she's allergic to food. Her body can react to any and all things she sticks in her mouth, or consumes in any way. Many children who have this, will eventually outgrow it. But it can be painful, difficult to manage, and indeed life threatening if not managed well. We were pointed toward the GAPS diet as a possible way to help "heal" my daughter's gut, and reverse some of the symptoms and sensitivities her body has to foods. My daughter does not have a mild version of FPIES... nor does she have it as bad as some others. Many children who have this syndrome are only "allergic" to less than a handful of foods. We have 10 known food allergies at this time, and all new foods are strictly introduced on a special trial schedule. It can be exhausting. And as any parent of a special needs child can attest, sometimes you're willing to try anything if it may help make it easier in the long run. 

In addition to that, I have struggled with my weight and weight related health issues for several years. The GAPS diet has been indicated to help with these issues as well. I figured, what do we have to lose?

5 weeks in, and I am down 10 lbs. But cheating on this diet is not like cheating on weight watchers, or some other weight loss diet. I caved yesterday and ate pizza at the office. I was sick all afternoon and all night long. My body had detoxed off of grains and sugars, and the pizza just didn't sit well at all. I could feel it this morning too. I am now convinced that GAPS has had a positive effect on my body. I am sleeping better, feeling better, and have seen a decrease in anxiety/depression and in my weight, and an increase in my energy. I have no financial steak in whether you do this diet or not, I can only say that modern medicine has not helped us up to this point, but GAPS has. If you're tired of dead end roads with the medical community, having pills thrown at you to alleviate symptoms but  not the cause of your illness, and you're ready to make a change... what have you got to lose?

Bear with me while I attempt to give you as much information as I can in regards to the practical application of starting the GAPS diet. If you want the history of the GAPS diet, the full details, or more information on it, there are other great resources out there. Dr. Campbell-McBride has her own website, and there are many other good sites for giving you pieces of the puzzle for figuring out the GAPS diet on your own. Everyone tells you to buy and read her book, but if you're like me, and you haven't yet done it but want to make steps in the right direction... then read on my friend.

GAPS DIET

Basic Info:

•  This diet is designed to eliminate grains, beans, sugars, and starches to allow the gut to heal and the body to start properly digesting and absorbing nutrients the way it was intended to do.
• GAPS diet is a temporary diet, and the length depends on what you’re intending to heal. Usually a couple of months to two years in length.
• Is recommended to help with healing of a whole host of autoimmune diseases. Can be used for diabetes, autism, FPIES, IBS, chrones disease, ADD/ADHD, dyslexia, dyspraxia, depression and anxiety, schizophrenia, 
• Starts with a 6 stage intro diet (the hardest part) where you progress based on symptoms.
•  “Die off” is where the body may revolt a bit and you experience an increase in symptoms as your body detoxes during the intro phase of the diet. Once symptoms start to subside, you move on to the next stage or phase of the diet.
• GAPS does require you to do your homework and some prep work prior to getting started. It is possible to start eliminating some of the harmful foods now, but you’ll want to source or make some of the essential foods ahead of time (bone broth, fermented veggies or dairy, organic eggs, grass fed meats, etc.)
• The entire diet recommends organic and grass fed versions as much as possible to avoid the meat/dairy/eggs being contaminated from modern feeding practices of animals (penned up without proper exercise to condition the meat properly, the lack of fresh grass which is high in essential vitamins that end up in the meat/dairy/eggs, etc.)
• Many people prefer to start with the “full GAPS diet” until they are comfortable with what is going to be expected, get the hang of the cooking, gather recipes and source needed products/ingredients. We did this, and I feel like it was the best way to transition for us. We purchased a bulk beef package from a butcher shop, and managed to get meat and bones for stock donated by local hunters (due to my daughter’s medical condition). After figuring what store brand versions were easily accessible, and what we liked (Bubbies vs. Olykraut) we were then able to determine what we wanted to ferment on our own (youtube and blogs are essential, anyone can learn to do it!) This diet doesn’t have to be expensive. It’s all in the planning. If you take the time to plan, make a binder, and write your game plan down (including recipes, what is require of you during each stage, etc.) then you can easily do this on a tight family budget.

GAPS INTRO DIET

Tips:

     -   A cup of broth should be taken with all meals if not already broth based

     -    Probiotic foods should be increased gradually starting from a spoon or two of the juice, working your way up to the veggies, and then up to eating the veggies at each meal for about a half cup a day

     -    Work your way up to two eggs per day

     -     Any nuts used to make nut butter should be rinsed/soaked/dehydrated first to remove phytic acid (this can help with reversing tooth decay!) and make it easier to digest while healing your gut

     -   Fruits are essentially your “sugar” on this diet. So moderation is key. Eat them as snacks, or when you’re not fully hungry to limit yourself from eating too much.

     -     Fruits should be fully ripe when eaten to get the maximum nutrition and benefit to your gut.

Stage 1

•           Broth/Soup made from bone, meat or fish
•           Boiled meat (from the making of stock)
•           Non fibrous veggies cooked in stock until soft (think soup)
•           Juice of fermented veggies added to slightly cooled stock when ready to eat (sauerkraut juice)
•           Dairy based ferments (think live plain yogurt or kefir)
•           Ginger, mint or chamomile tea with a little organic honey

Stage 2

•           All in stage 1
•          Organic Egg yolk in soup (if no issues with adding this into your diet, you can then have soft boiled eggs)
•           Ghee
•           Fermented fish
•           Increased quantities of probiotic foods from stage 1

Stage 3

•           Everything from previous two stages
•           Ripe avocado
•          “Pancakes” made from nut butter, eggs and winter squash
•           Scrambled eggs
•           Sauerkraut and fermented veggies

Stage 4

•           Everything from previous three stages
•           Roasted and grilled meats
•           Cold pressed olive oil (not to cook with, but as a sauce or dressing)
•          Nut based breads (almond flour, eggs, and any winter squash)
•           Fresh veggie juice (start with carrot juice, you can make it or buy it)
• Start with a few spoonfuls on an empty stomach and work your way up to 1 cup a day.
•  After you’ve worked your way up without added symptoms, you can add other veggies one at a time (cabbage, lettuce, mint, celery, etc.)

Stage 5

•           Everything from previous four stages
•           Cooked peeled apple (cook in a bit of ghee!)
•           Raw veggies
•    Start by introducing softer parts of lettuce/peeled cucumbers.
• Move on to carrots, onion, cabbage, tomatoes, etc. when softer veggies are consumed without further symptoms
• Avoid any starch based veggie! No potatoes, yams, sweet potatoes!
•          Juiced apples, mango or pineapple (avoid citrus fruits) added to your veggie juice!
•  Make sure fruits don’t make up more than 50% of the mix!

Stage 6

•           Everything from previous five stages
•          Add in raw apple and other raw fruits (avoid citrus)
•           Make homemade dried fruits (store bought contains added sugar and preservatives) to add into nut breads!

Once you’ve done the intro diet, you can move on to the full version of GAPS! Yeah, you survived it!

Disclaimer

Memoirs of a Nursing Mother disclaims any liability or warranties of any kind arising directly or indirectly from use of this blog.  It shall not be held liable or responsible for any misunderstanding or misuse of information contained in “Gut and Psychology Syndrome” or for any loss, damage, or injury caused or alleged to be caused directly or indirectly by any treatment, action, or application of any food, food source, or dietary supplement discussed. Use of the letters "GAPS" in this blog are used as an acronym for Gut And Psychology Syndrome. All information contained in this blog is intended to support the book “Gut and Psychology Syndrome” by Dr. Natasha Campbell-McBride. The information on this site is provided for general education purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. I am not a medical doctor and cannot give you medical advice or a diagnosis. Always seek the advice of your physician or health provider. Never disregard professional medical advice or delay seeking it because of something you have read on this blog. Always consult your health care provider before making dietary changes. Links to external sites contain information created and maintained by other individuals and organizations and are provided for your convenience. I do not control nor guarantee the accuracy, relevance, timeliness, or completeness of this information. Neither is it intended to endorse any view expressed nor reflect its importance by inclusion in this site.  The use of any information provided on this site is solely at your own risk. 

Excess Lipase and 400 oz of bad milk...

Despite my ups and downs with supply, I've managed to build a nice little freezer stash by pumping prior to returning to work. Like so many others, I had planned to use the frozen milk on days where I didn't have enough milk from the previous day's pumping sessions, or for visits to grandma's, Mondays (so that I wouldn't have to pump on the weekend) and all the other times I might need a little extra. I ended up having over 400 oz in a freezer (a freezer we bought especially for breast milk storage). I'm committed and determined to breast feed my child. My body on the other hand, seems to have other plans. I finally needed to pull out some of the milk from the freezer last week. Low and behold, every bag I pulled out wreaked of soured milk. Some of them smelled like spit up, some smelled like metal, some just smelled so bad I couldn't even describe it.

Bag after bag of frozen breast milk turned rancid smelling and the taste was so bad I wanted to puke just testing it from my finger tip... I finally began to understand why my daughter wasn't eating during the day. I have excess lipase in my breast milk. Meaning, that as soon as I pump, the clock starts running on how long I have before the taste of my breast milk starts to turn. Some sites describe the taste as soapy, or metallic. Mine was metallic and spit up taste combined. For me, I typically pump at work, and then use the milk from today for her to drink tomorrow. Unfortunately, by the time she's ready to drink it, my milk has already started to turn (an hour by hour taste test helped me to pin point that my milk starts to turn by hour 22. Not enough for her to make it a full day.)

I want to make it clear, that breast milk with excess lipase is perfectly fine and safe for babies to drink. It only tastes bad, which is why some babies won't drink it. Some don't mind the taste and will drink it. My daughter will not.

I began to panic. I cried, I sobbed, and I had a total melt down. All those hours of pumping, all the lost sleep, all the work that went into making that stash. All that milk. I now understand why my daughter has been stuck on a reverse cycle for over two months!!

Then I got online and started researching. I was clearly not alone. Tons of nursing mothers have had this same problem. A friend of mine from my mommy group also had excess lipase, so I had a starting point for what to look for. I found out that it could be more than excess lipase, that it could possibly be chemical oxidation. If you're nursing and you've never heard of either of these (like me) then I'll give you the nutshell version. They both make your milk taste bad. But they do it because of different reasons.

Excess lipase is an over abundance of the enzyme (lipase) in your breast milk that helps break down the fats for digestion. It basically has so much, that it breaks it down too fast and starts to turn the milk before your baby can drink it when it's been expressed. The time frame varies from woman to woman, and I was unable to find information on why it happens. It may not happen each time a woman has a baby either. So if you've had it once, you might not have it next time. Chemical oxidation on the other hand, makes your milk taste bad due to the process of pumping/storing and what you put into your body. If your refrigerator isn't cold enough (32-39 degrees F) then your milk might be turning faster, and can make you think you have excess lipase when that really isn't the case. If you have city water with a lot of chemicals in it, these might also affect your milk because of how you wash and sterilize your bottles and pumping equipment. If you eat an excessive amount of polyunsaturated fat then you can also have chemical oxidation from this as well (from what limited information I was able to find).

To be honest, it frustrated the hell out of me knowing that it could be multiple reasons. The first thing I did was review my storage process. I started with the fridge. I bought a fridge thermometer and found out my fridge was at 42 degrees. Not cold enough to keep breast milk. I was also keeping my milk on the top shelf toward the front. We now keep it on a lower shelf in the back, since the thermometer revealed that as the coldest place in the fridge. I had been washing all my gear in regular tap water. I bought distilled water for rinsing and sanitizing and boiled them each night for a week. Turned down the temp. Moved the milk. Sterilized everything. Nothing changed. I was pretty sure it was excess lipase at this point, but wanted to be sure, as it would make a big commitment on my part to keep pumping milk. I then did the last test I could figure out... I scalded the milk. I read that scalding the milk will make milk that has chemical oxidation taste even worse because it further breaks down the milk and it will turn even faster. However, if you have excess lipase, your milk will taste fine after scalding and will last longer than it does without scalding.

My fridge and kitchen looked like a laboratory. I used 3 tubes of 2.5 oz containers of breast milk. The first (control) contained milk that was pumped and put straight into the fridge. The second, contained milk that was pumped, put in the fridge at work, brought home, scalded to 180 degrees, then put back into the fridge. The third contained milk that was pumped, scalded immediately, and then put in the fridge. The fist container turned before 24 hours was up. The second, didn't have that taste to it, and lasted 4 days before I tossed it, The third came out the same as the second and lasted 4 days before I tossed it. Both may have lasted longer, but I just needed to know if I could salvage milk pumped on Fridays to be used on Mondays.  It just proved that I could scald either immediately, or wait till I got home from work. I had read mixed reviews about this though, that the additional cooling and heating could break down the milk further, and to try to do it right away if possible.

But I work... full time.... so how the heck was I going to make that happen? I already take so much time away from my desk a day to pump. Then I ran across a blog that gave the best advice ever. I couldn't believe how easy this was going to be, and why I didn't think of it myself!

So you have excess lipase?

You don't have to stop breast feeding/pumping. It is still possible to do it, and to still have enough to freeze. It will just require an extra step on your part. If you work full time like I do, this means you'll need even more equipment at work, and I'd suggest letting HR know what's going on. Mine was super accommodating and said to do whatever I needed to do and to not stress about it. They know I'm aiming for one year, and that I'm the kind of employee that will make up the work. Only 7 more months to go right?

What to do about it:

Buy an instant read digital thermometer, bottle warmer without an auto shut off feature, and a stainless steel bottle. When you pump at work, pour the milk into the stainless steel bottle immediately, and then scald the milk in a bottle warmer, and pull it off as soon as it hits 180 degrees. I then cool the milk under running cold water until it's cold enough to put into glass bottles (I found that for me personally the glass absorbs smell and bacteria less than the plastic ones, and Dr. Browns glass bottles are the same fit as my Medela pump). Then I put them in the fridge at work until I go home. It does add on time, and I get everything ready to go while pumping. (Double check with your HR department to make sure your work's fire alarm system won't be activated by the hot steam just in case). As soon as I'm done, I pour the milk into the stainless steel bottle, and then start the bottle warmer. I clean up while it's heating up. Then I only have a couple more min before it reaches the right temp. I unplug the bottle warmer and dump the rest of the hot water from it. Bring a towel, since 180 degrees is very hot. You will need to cool the milk as soon as you heat it. Don't let it sit to get cool. This information was super helpful:

Cooling down heat-treated milk: Cooked foods have a ‘danger zone,’ a temperature range from 60ºC/140ºF to 4ºC/39ºF where bacteria like to grow. It is therefore important to cool milk down quickly after it has been heated. Cooling the container in ice water is the quickest way to cool milk. Depending on the amount of milk, cooling it in the refrigerator is generally not recommended as the milk will cool unevenly, leaving some milk too warm for too long. Please know that not all glass is suited for heating and rapid cooling. (see source number 3 below)

This great note from Kelly Mom was very helpful for me:

What can I do if my storage problem is due to excess lipase? Once the milk becomes sour or rancid smelling/tasting, there is no known way to salvage it. However, newly expressed milk can be stored by heating the milk to a scald to inactivate the lipase and stop the process of fat digestion. Scald the milk as soon after expression as possible.

To scald milk:
Heat milk to about 180 F (82 C), or until you see little bubbles around the edge of the pan (notto a full, rolling boil).
Quickly cool and store the milk.

Scalding the milk will destroy some of the antiinfective properties of the milk and may lower some nutrient levels, but this is not likely to be an issue unless all of the milk that baby is receiving has been heat-treated.

Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

I find that I'm able to let pumped milk from Friday at work, sit without issue, and without being frozen, in the fridge until Mondays when she drinks it. After being scalded and cooled immediately, the milk is able to survive the weekend.

If you have chemical oxidation, here is what you can do about it:

Cut out all polyunsaturated fat and rinse all pump parts/bottles with distilled water. Make sure you sanitize your bottles and pump equipment every time you use them in distilled water. Also use a soap that is phosphate free (medela breastmilk soap is what I used). Some sites also recommend that beta carotene and vitamin E need to be increased in your diet (be careful as I've read that these can be toxic in the wrong doses).

What do I do with all that frozen milk with excess lipase?

If you found out late in the game, and have a big freezer stash like me? Consider donating to a legitimate milk bank... be careful, as most hospitals can only accept through one of these places since they do a blood screen (their cost, not yours) and the milk is pasteurized so that they can still use it. NICU babies often are tube fed, so they won't have to taste the bad flavor, but can still receive the benefits. Some places are "milk banks" that charge the recipients. You can read more about this here. Don't trust these places, as they don't go to the families in need. There are only 14 legitimate milk banks in the US that hospitals receive this milk from. You can find them here.

Amazing resources:

1.  http://sdbfc.com/blog/2012/9/4/battling-and-resolving-excess-lipase-in-breastmilk.html

2.  http://simplythoroughmama.com/2012/07/on-not-crying-over-spilled-milk/

3.  http://www.eatsonfeetsresources.org/?page_id=485

4.  http://forums.llli.org/showthread.php?115946-Excess-Lipase-vs-Chemical-Oxidation

5.  http://kellymom.com/bf/pumpingmoms/milkstorage/lipase-expressedmilk/