Guts, gaps & lyme e book by kate hope nutrition

Guts,   GAPS & Lyme TM

Using the GAPS Diet   as Nutritional Therapy   for Lyme Disease

Kate Hope, MS, CGP

ÂŠ Copyright 2016 Kate Hope Nutrition Disclaimer: This book is for information purposes only and does not provide medical advice. The information in this book is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it because of something you have read in this book. GAPSTM and Gut and Psychology SyndromeTM are the trademark and copyright of Dr. Natasha Campbell-McBride. The right of Dr. Natasha Campbell-McBride to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patent and Designs Act 1988.

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Table of Contents Introduction

Your Digestive System

What is Leaky Gut?

Can Lyme Disease Cause Leaky Gut?

The Consequences of Leaky Gut

What is the GAPS Diet?

How the GAPS Diet Heals a Leaky Gut

The Two Stages of the GAPS Diet

The GAPS Introduction Diet

The Full GAPS Diet- List of Foods to Include and to Avoid

Selected Recipes

Resources

References /More Information

Introduction I grew up in New York State, near the border of Connecticut, not too far from Old Lyme, the town known as ground zero for Lyme Disease. My family lived in a wooded area, we had lots of animals: dogs, cats, chickens, horses, and I was always in the woods. Every year I picked ticks off the animals and myself, but I was never bothered. I have since moved to a similar environment in New Jersey, and I have to say I’ve gotten my fair share of tick bites here as well. I’m no stranger to Lyme Disease. My family’s dog came down with Lyme, my dad had the signature bullseye rash and was treated, my friend’s mom was hospitalized twice with Lyme, and a friend’s young daughter was on IV antibiotics for the disease. In addition, my son contracted Lyme when he was eight years old, and thank goodness, he was treated successfully. I never thought Lyme would affect me personally. I thought I had a pretty good constitution and immune system throughout life. Yet a number of events happened that I believe led to a compromised immune system, and my subsequent succumbing to Lyme. First, I was hospitalized for cellulitis from a cat bite, and I was on intravenous and oral antibiotics for a month. In addition, I had a tetanus shot that didn’t sit so well with me. Then, a couple of months later, I got the final tick bite that I call the “straw that broke the camel’s back”, which I think was the tipping point for my immune system. Within a few weeks I started developing symptoms. Fatigue, migrating muscle and nerve pain, intense brain fog, headaches, involuntary twitches, light and sound sensitivity, anxiety, and sleep issues were just some of my complaints. I was treated by a Lyme-literate medical doctor (LLMD), and went on an antibiotic protocol. I would have preferred a totally natural route, however I agreed to the medication because my symptoms were so severe. I used a combination of the conventional medication with diet and lifestyle modifications. These included breathing exercises, meditation, yoga, gentle exercise, chiropractic, homeopathy, diet and herbs. Being a nutritionist, I put myself on a strict diet. Having read Dr. Natasha Campbell-McBride’s book, Gut and Psychology Syndrome, I was familiar with her GAPS Diet. I decided to try it, and I had great success. I feel the diet helped heal my compromised gastrointestinal system which was ravaged from both the Lyme bacteria and the antibiotics. I liked the diet so much that I went through the training to become a Certified GAPS Practitioner. It amazes me how diet is still so underrated. A client of mine told me a medical doctor said it didn’t matter what she ate, and it wouldn’t help her heal from Lyme. Well, I know from my own experience as well as my clients’, that food really does matter. I believe, as Hippocrates stated 2500 years ago, that “food is medicine”. Now, I spread the word about the GAPS Diet and how it can help not only Lyme Disease, but many ailments brought on by what we call a “leaky gut”. Conditions like ADD/ADHD, autism, schizophrenia, Irritable Bowel Syndrome, Crohn’s Disease and other chronic problems. This diet does wonders to “heal and seal” the gut lining and improve our immune system. To sum up my journey, I feel I can empathize with my clients because though everyone's healing path is different, especially with Lyme, I know what they're going through, and I know how it feels. This book is intended to give you a brief overview of how Lyme Disease can affect the gut, and how the GAPS Diet can put you on the road to health and healing. Many blessings, -Kate

Your Digestive System If you’re like most people, you eat three meals a day and maybe a few snacks. Do you ever think about what happens after you ingest food? Unless you have gastrointestinal problems, you probably don’t think too much about it. Well, a complex set of processes start once the food enters your mouth, and if everything is working properly, nutrients are extracted and absorbed, and waste products are eliminated. What you eat and absorb, ultimately becomes you. Your digestive system is made up of the digestive tract, otherwise known as the gastrointestinal (GI) tract, plus the liver, gallbladder and pancreas. The GI tract is a hollow tube that goes from the mouth to the anus. Food passes through this tube and it is digested before being absorbed into your body. In essence, it is open to the outside world, and the intestinal lining is the gatekeeper. This thin membrane selectively decides what particles are absorbed and what substances are not allowed to enter. Along the way, digestion is assisted by enzymes and digestive juices from the salivary glands, the stomach, the pancreas and the liver. Inside the intestines, there are many beneficial bacteria, viruses and fungi that help with digestion as well. These commensal organisms are collectively known as the gut ‘microbiome’. Somewhere between 60-80% of our immune system is in our gut, and the microbiome plays a big part in keeping it healthy.

What is Leaky Gut? The lining of the intestinal system is the doorway between the outside world and the inside world. This membrane is called ‘semi-permeable’. It selectively lets fully digested food particles in, and keeps foreign substances out. It is a delicate layer, only one cell in thickness. Problems arise when this layer is compromised. There are many assaults on the intestinal system, such as bacterial, viral and fungal infections, medications like antibiotics and NSAIDs, hormonal imbalances, stress, a bad diet, bad fats, processed foods, and substances like gluten and casein. These can poke holes in the GI lining, allowing seepage into our blood stream and tissues. When these holes are formed, a “leaky gut” results, which allows foreign invaders to enter. These substances are not recognized as foods by our body, and they are attacked by the immune system. Even foods that are good for us may cause a reaction if they are not fully digested before they enter the blood stream. So, people with a leaky gut may have many food intolerances. They may find they have problems with healthy foods they were once able to eat. However, after following the GAPS protocol, people find that as their gut heals, food intolerances can clear up.

Can Lyme Disease cause Leaky Gut? In Lyme Disease, the pathogenic bacteria along with co-infections, viruses and yeasts, can cause a leaky gut. These invaders take up residence in the intestines and crowd out the beneficial bacteria, preventing them from doing their job. The role of the beneficial bacteria is vast, and includes assisting in the digestive process, feeding and protecting the cells that http://textbookofbacteriology.net/Lyme.html line the intestines, and keeping the immune system strong. When these bacteria are killed off or compromised, the opportunists are able to take hold, causing inflammation in the gut and the release of toxins. Some of the “bad” bacteria, such as the common coinfection, Bartonella, can create waste products called lipopolysaccharides (LPS) that can loosen the junctions between the intestinal cells, causing a leaky gut. This allows toxins and undigested foods to be absorbed into your system. In addition, antibiotics used to reduce the pathogenic load can contribute to the problem. These medications are used to kill the bad bacteria, but many of the good microbes perish along with the bad. That’s not to say you shouldn’t use antibiotics to fight Lyme. Many people have success using antibiotic medication along with herbs and supplements. The goal is to work on healing the intestinal lining at the same time you are reducing the bacterial load. You can adopt a gut-healing protocol like the GAPS Diet while you are on medication. Additional factors that can cause a leaky gut in Lyme patients are stress and sleep disturbances, hormonal issues and blood sugar dysregulation. The unhealthy Standard American Diet (SAD) doesn’t help either.

The Consequences of Leaky Gut When the lining of the GI tract is compromised by bacteria, toxins, medications and a bad diet, inflammation occurs and can produce symptoms of bloating, distention and pain in the gut. As undigested food particles and other foreign substances leak into the blood stream and tissues, other symptoms can occur including joint pain, heart problems, metabolic weight gain, headaches and allergic reactions. In response, the body mounts an attack. It creates chemicals called cytokines to “alert the troops” to fight the invaders. Unfortunately, these cytokines can get out of control and can cause some damage due to “friendly fire”. Organs such as the thyroid gland or the adrenal glands can be hit, which can lead to a compromise in function. This can cause some of the symptoms we often see in Lyme Disease such as fatigue, sleep problems, low body temperature, intolerance to cold, and hormonal imbalances. If the gut is leaky, science is showing now that the brain can be leaky, too. The brain is surrounded by a membrane called the blood-brain barrier (BBB) which can be compromised like the intestinal tract. If unwanted molecules cross this barrier, symptoms like brain fog, balance problems, memory issues, neurological symptoms, anxiety and depression can occur. By healing a leaky gut, the leaky brain can improve as well.

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What is the GAPS Diet? GAPS stands for Gut and Psychology Syndrome, or Gut and Physiology Syndrome. The diet was developed by Dr. Natasha Campbell-McBride in the 1990s. She is a neurologist and she recognized the connection between the gut, the brain, and diet, which many people are talking about these days. Her first book, Gut and Psychology Syndrome addressed the gut-brain connection, and she’s in the process of writing another book, called Gut and Physiology Syndrome, to address the rest of the body. When Dr. McBride started implementing her GAPS Diet protocol, she had a lot of success with autistic children (including her own son) and people with depression, ADHD, schizophrenia and eating disorders. And in virtually all these cases, she found that there was gastrointestinal problems, which was pretty interesting. But as time went on, the GAPS Diet started helping people with all kinds of problems, including heart issues and chronic diseases. The diet is based on “healing and sealing” the intestinal lining. It works to repair a leaky gut that will prevent toxins, allergens and undigested food from entering the body. It balances the body’s microbiome (our internal ecosystem that contains the trillions of beneficial bacteria, viruses and fungi) and it can help reverse some of the chronic and autoimmune symptoms that accompany Lyme Disease. There are two parts to the diet, the GAPS Introduction Diet, and the Full GAPS Diet. In a nutshell, the GAPS diet uses “food as medicine”. The diet incorporates foods that are easy to digest, and it removes offending items. The protocol “weeds, seeds and feeds” the gut microbiome. First we “weed" out the bad bacteria, then we "seed" the intestines with good bacteria, and then we “feed” them so they flourish. This helps heal and seal the intestinal lining so it is not leaky anymore. The GAPS Diet is based around nourishing bone broths (which is one of its mainstays), healthy meats, eggs, lots of non-starchy vegetables, fruits, a few allowed legumes, nuts and seeds, healthy fats, fresh-pressed juices and fermented foods (which is another mainstay). Needless to say, all the foods should be organic, nonGMO, pastured, grass-fed, or wild-caught, or as many as possible. The diet isn’t necessarily low-carbohydrate or high-fat, or high-protein, or ketogenic. It is a diet that restricts starchy carbohydrates, promotes adequate good quality protein, and a good amount of healthy fats. It also encourages fermented foods, including fermented dairy. www.eater.com

How the GAPS Diet Heals a Leaky Gut Your diet consists of macronutrients and micronutrients. The macronutrients are your carbohydrates, fats and proteins. Let’s talk about how macronutrients are handled in the GAPS Diet and how they can help repair a leaky gut. Carbohydrates are sugars and starches. The simple sugars are monosaccharides, or monosugars which are glucose, fructose, and galactose. These can easily go through the gut lining without being digested. The gut cells, or enterocytes, as they’re called, don’t have to do much work to absorb the simple sugars. Glucose and fructose are found in pretty much all fruits and vegetables, and also in honey. Galactose is found in soured milk products like yogurt. These monosugars are easiest for us to digest, so they should be the main carbohydrates that are consumed on the GAPS diet. In the vegetable category, good choices are zucchini and all kinds of squashes, pumpkin, lettuces and green leafy vegetables, mushrooms, onions, peppers, carrots, celery, eggplant, broccoli and cauliflower. Some less starchy legumes are allowed on the diet, and they are lentils, Lima beans and Navy beans. For the most part fruits are allowed, like bananas, grapes, kiwi, apples, oranges, papayas, mangoes, peaches, lemons and limes. Those are just some of the things on the list. You don’t want to go too crazy with fruit because fruits do have more sugar than vegetables, and too much sugar can feed Candida yeast, an overgrowth of which can be problematic for Lyme patients. Carbohydrates can be more complex, as well. Disaccharides, or double sugars, are made from two monosaccharides linked together. These are things like sucrose (table sugar), lactose (milk sugar), and maltose (which is a double sugar produced when more complex starches get broken down). The problem is that it takes work for your enterocytes (or the gut cells) to digest disaccharides. If you have a healthy gut, then fine, but if your gut is compromised, you’re not going to digest them properly.

You see, these enterocytes have little hairs on them called microvilli. This is called the brush border of your intestines. And this brush border makes enzymes to digest the disaccharides. But if your gut is compromised (like it probably is if you have Lyme), then these enzymes arenâ&#x20AC;&#x2122;t made, and the disaccharide sugars arenâ&#x20AC;&#x2122;t digested. If they stay in your intestines, they can feed the bad bacteria and yeasts, and cause more toxins to be released. The same thing is true with the more starchy foods, which are your complex carbohydrates. They remain in the intestines and feed the bad bacteria. In a healthy gut, things are balanced and you can handle more complex carbohydrates, but if your gut is unhealthy, these foods are removed while the gut is healing. After the intestinal tract is healed, some of these foods will be able to be reintroduced. So, all grains are removed, which means all grains containing gluten, like wheat, rye and barley, as well as corn, soy, oats and rice. Potatoes, sweet potatoes, yams and most starchy beans, or legumes are removed as well. These contain disaccharides and complex starches. Lactose is not allowed either because it is a double sugar. Fermented dairy is allowed, though, because the lactose sugar is removed, for the most part, in the fermentation process. If you remove all of these foods, your intestines will have a chance to start healing.

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Protein is very important for growth and repair of our cells. Molecules of protein are large, so they need to be broken down into single amino acids before being absorbed by the intestines. In order for this process to work properly, we need hydrochloric acid in our stomachs as well as digestive enzymes from our pancreas. However, many times these aren’t working properly. As a result, proteins are only partially digested, and remain as larger groups of amino acids, called peptides. If the gut is compromised by bacteria, toxins and medications, it becomes leaky, and the junctions between the intestinal cells are loosened. This will allow the larger peptides to be absorbed into the system. This can wreak all kinds of havoc in the body. Peptides from gluten, (from wheat, barley and rye) create molecules called gluteomorphins. And peptides from casein, which is milk protein, create casomorphins. If these molecules get into your brain, they can attach to the opioid receptors and create the addictive qualities that we see with some of these foods. The larger protein molecules shouldn’t be roaming around your bloodstream and tissues, so the body launches an attack because it doesn’t recognize these things as food, but instead as foreign invaders. Here is where autoimmune symptoms can come in, because as your system is fighting, some of your body’s own tissues get attacked by mistake. It’s like ‘friendly fire’. These molecules can also lodge in your muscles, your joints and your brain, and cause all the symptoms many Lyme patients are familiar with, such as fibromyalgia, chronic fatigue, neuropathy, brain fog, and anxiety to name a few. So, we want easy to digest proteins such as boiled, stewed and poached meats and fish. These are easier to digest than fried, roasted or grilled. Eggs are nature’s perfect protein, so unless you have a clear allergy to eggs, the GAPS diet recommends them. You want to stay away from casein, which is milk protein, but you can have foods like pastured butter and ghee, which, for the most part, are just milk fat, and contain almost no casein milk protein. Fermented milk products are recommended if you can handle dairy, and the GAPS program teaches you how to make homemade yogurt and kefir (which is a fermented milk). You can purchase these foods, but just look for the cleanest source, preferably organic and grass-fed. Homemade is always the best, though.

Fats are very healing foods, and they are very important on the GAPS Diet. But first, fats need bile to be digested and absorbed. So if your whole digestive system isn’t working properly, you might not be producing adequate bile. Secondly, if you have a compromised intestinal tract, your body is going to produce extra mucus to protect it. But too much mucus can coat the food particles and not let the bile do its job. So many people with damaged guts don’t absorb fats well. That’s why sometimes you can see a lot of fat ending up in your stool. Consequently, if you don’t absorb fats well, you’re not going to absorb the important fat soluble vitamins like vitamins A,D, E and K. But evidence shows that if you remove the starch and double sugars, the gut starts healing and then you can absorb fats better. The GAPS diet recommends good quality, healthy fats from meats, grass-fed butter and ghee, as well as foods like olives, avocados, nuts and seeds. The nuts and seeds should be properly prepared by soaking them first to remove some of the “anti-nutrients” like lectins and phytates. This will make them more digestible. Butter and ghee are wonderful foods for healing the digestive tract. They provide fat-soluble vitamins A, E and K2 (K2 is important for calcium metabolism) and also butyrate which is a short chain fatty acid that can reduce inflammation. It can also help the mitochondria which are the little powerhouses in each of our cells. When the mitochondria get tired, we get tired, so the butyrate from butter and ghee can help. Butyrate is also the main fuel for the intestinal cells, which have a tough job as gatekeeper to our insides. We need to stay away from processed seed oils, however, which are highly refined and can turn rancid, especially when cooked on high heat. Extra virgin olive oil is allowed, but should be drizzled on food after cooking, so it is not denatured. Butter, ghee and coconut oil can withstand higher cooking temperatures.

The Two Stages of the GAPS Diet There are two stages to the GAPS Diet. The GAPS Introduction Diet and the Full GAPS Diet. The Introduction Diet is designed to quickly heal and seal the gut lining. The Full GAPS Diet is the healing maintenance diet that is followed once you finish the Introduction Diet. Since the GAPS Introduction Diet is quite restrictive, some people begin with the Full GAPS Diet and back into the Introduction Diet when ready. This allows for a wider variety of foods. The Full GAPS Diet will heal the intestinal lining as well, albeit more slowly, but it is often sequenced in this manner with people who are very ill. I recommend this approach to many of my Lyme clients, who find it to be an easier transition. The GAPS Introduction Diet The GAPS Introduction Diet is designed as a gut-healing program, and it can be followed anywhere from a few days, to weeks, or even up to a year. It aims to repair the intestinal lining by the following: 1.) The diet provides nourishing substances for the gut lining in the form of amino acids, gelatin, glucosamines, fats, vitamins, minerals and various other micronutrients. These are substances that help the gut repair and renew itself, and they are plentiful in the dietâ&#x20AC;&#x2122;s healing bone broths. In order for your system to heal, it requires very special nourishment. 2.) People with Lyme Disease often have inflammation and ulcerations in their gut lining without even knowing it. They may have no intestinal discomfort, however, the damage can cause systemic problems. The GAPS Introduction Diet removes fiber and other substances that irritate the gut and interfere with the healing process. 3.) Our microbiome (the beneficial bacteria and organisms in our intestines) orchestrate the gut regeneration and healing process. The GAPS Introduction Diet supports this community by providing these good bacteria right from the start, in the form of nourishing fermented foods. The Full GAPS Diet The Full GAPS Diet offers a wide variety of foods, but still restricts very starchy carbohydrates that are harder to digest. It is recommended that you follow the Full GAPS Diet for about two years. People who heal quickly may be able to add non-allowed foods earlier, but some who are very ill may have to follow the diet for a longer period of time. I find the Full GAPS Diet is a very healthy diet to stay on long term, if necessary. It has a good ratio macronutrients as well as loads of healthy micronutrients. On the following pages you will find the basic outline for the GAPS Introduction Diet, and lists of the foods to include and to avoid when transitioning to the Full GAPS Diet. 11

GAPS Introduction Diet Stage 1 Bone Broths (with meat and well-cooked vegetables) Add teaspoon probiotic juice (from fermented vegetables) to each cup of broth (work up slowly) If prone to diarrhea, can add good quality fermented dairy (whey, sour cream, yogurt, kefir). Donâ&#x20AC;&#x2122;t do if there is constipation (just stick with fermented veggies) Ginger tea Water Stage 2 Bone Broths (with boiled meats, fish, soft tissues off the bone) Stews and casseroles with meats and vegetables (avoid spices in this stage, but can add fresh herbs) Continue with fermented veggie juice and dairy (if tolerated) Fermented fish, i.e. gravlax (if desired) Raw egg yolk stirred into each cup of broth (work up slowly from one a day) Soft-boiled eggs can gradually be added to the diet as well Add tsp organic Ghee into cups of broth (work up slowly from one a day) Ginger tea Water Stage 3 Same as above Add mashed avocado (can add to soups, start with 1-3 tsp/day and work up slowly) Pancakes (nut butter, eggs, squash, cooked in ghee). Start with 1 per day Scrambled eggs (avocado, onions and other cooked vegetables can be added) Use ghee, fats from meats, coconut oil for cooking (work up slowly) Add the actual fermented vegetables (start with 1-4 tsp/day)

GAPS Introduction Diet, cont. Stage 4 Same as above Add roasted and grilled meats (no bbq or fried) Add extra-virgin olive oil to meals (start with few drops, then work up to 1-2 tbs/meal) Fresh juices (carrot, celery, cabbage, mint leaves) Baked breads, muffins with nut flours, eggs, squash, fats (ghee or coconut oil)one per day to start Stage 5 Same as above Add cooked apple (apple sauce, puree; can add a touch of honey) Can add honey (start slow, up to few tsp/day) Add raw veggies (start with cucumber, then carrots, tomato, onion, cabbage, etc.) Add apple, pineapple or mango to fresh juices (avoid citrus at this stage) Stage 6 Same as above Add peeled raw apple Gradually add more fresh, raw fruits and more honey Gradually add more baked items (use dried fruits or honey as sweetener)

*You may move through the Introduction Diet faster or slower depending on your individual symptoms. For some itâ&#x20AC;&#x2122;s a few weeks, for some it can take a year. *Keep track of abdominal pain and stool changes. *Let pain and diarrhea clear before moving to the next stage. *Low fiber in the Introduction Diet may cause constipation. Enemas may be indicated.

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Full GAPS Diet  Foods to Include Almonds, including almond butter and oil   Apples  Apricots, fresh or dried  Artichoke, French   Asiago cheese  Asparagus  Aubergine (eggplant)  Avocados, including avocado oil  Bananas (ripe only with brown spots on skin   Beans, dried white (navy or haricot, string beans and lima beans, properly prepared   Beef  Beets  Berries, all kinds  Black, white and red pepper: ground and peppercorns  Black radish  Blue cheese  Bok choy  Brazil nuts  Brick cheese  Brie cheese  Broccoli  Brussels sprouts  Butter (organic, grass fed)  Cabbage  Camembert cheese  Canned fish in oil or water only  Capers  Carrots  Cashew nuts, fresh only  Cauliflower  Cayenne pepper  Celeriac  Celery  Cellulose in supplements  Cheddar cheese  Cherimoya (custard apple or sharif)  Cherries  Chia seeds  Chicken  Cilantro  Cinnamon  Citric acid  Coconut, fresh or dried (shredded) without any additives

Coconut milk  Coconut oil  Coffee, weak and freshly made, not instant   Collard greens  Colby cheese  Courgette (Zucchini)  Coriander, fresh or dried  Cucumber Dates, fresh or dried, without additives  Dill, fresh or dried  Duck  Edam cheese  Eggplant (aubergine)  Eggs, organic, free-range  Filberts  Fish, fresh, frozen or canned in its juice or oil   Flax, seeds or oil  Game, fresh or frozen  Garlic  Ghee  Gin, occasionally  Ginger root, fresh  Goose  Gorgonzola cheese  Gouda cheese  Grapefruit  Grapes  Haricot beans, properly prepared  Havarti cheese  Hazelnuts  Herbal teas  Herbs, fresh or dried without additives  Honey, natural  Juices freshly pressed from permitted fruits and vegetables  Kale  Kiwi fruit  Kumquats  Lamb  Lemons  Lentils  Lettuce, all kinds  Lima beans (dried and fresh)  Limburger cheese  Limes

Full GAPS Diet  Foods to Include, cont. Mangoes  Meats, fresh or frozen  Melons  Monterey Jack cheese  Muenster cheese  Mushrooms  Mustard seeds, pure powder and gourmet types   without any non-allowed ingredients  Nectarines  Nut flour or ground nuts  Nutmeg  Nuts, all kinds freshly shelled, not roasted,   salted or coated  Olive oil, extra-virgin, cold-pressed  Olives, preserved without sugar or any other   non- allowed ingredients  Onions  Oranges  Papayas  Parmesan cheese  Parsley  Peaches  Peanut butter, without additives  Peanuts, fresh or roasted in their shells  Pears  Peas, dried split and fresh green  Pecans  Peppers (green, yellow, red, orange)  Pheasant  Pickles, without sugar or other non-allowed   ingredients  Pigeon  Pineapples, fresh  Pork  Port du Salut cheese  Poultry  Prunes, dried without any additives or in their own juice  Pumpkin  Quail  Raisins  Rhubarb  Roquefort cheese  Romano cheese

Satsumas (tangerines)   Scotch, occasionally   Seaweed, fresh and dried   Shellfish   Spices, single and pure without any additives   Spinach  Squash (summer and winter)  Stilton cheese   String beans  Swedes  Swiss cheese  Tangerines  Tea, weak, freshly made, not instant   Tomato puree, pure without any additives   except salt   Tomato juice, without any additives except   salt  Tomatoes  Turkey   Turnips  Ugly fruit  Un-creamed cottage cheese (dry curd)   Vinegar (cider or white); make sure there   is no allergy  Vodka, occasionally  Walnuts  Watercress  White navy beans, properly prepared   Wine, dry, red or white  Yogurt, homemade  Zucchini (courgette)

Full GAPS Diet  Foods to Avoid Acesulphame   Acidophilus milk   Agar-agar  Agave syrup   Algae   Aloe vera, once digestive symptoms   are gone, you can introduce it  Amaranth  Apple juice   Arrowroot  Aspartame  Astragalus  Baked beans  Baker’s yeast  Baking powder and raising agents of all kinds   except pure baking soda   Balsamic vinegar  Barley  Bean flour and sprouts  Bee pollen  Beer  Bhindi or okra  Bitter gourd  Black-eyed peas  Bologna  Bouillon cubes or granules  Brandy  Buckwheat  Bulgur  Burdock root  Butter beans  Buttermilk  Cannellini beans  Canned vegetables and fruit  Carob  Carrageenan  Cellulose gum  Cereals, including all breakfast cereals   Cheeses, processed and cheese spreads   Chestnuts and chestnut flour  Chèvre cheese  Chewing gum  Chickpeas  Chicory root   Chocolate

Cocoa powder  Coffee, instant and coffee substitutes   Cooking oils  Cordials  Corn  Cornstarch   Corn syrup  Cottage cheese  Cottonseed  Couscous  Cream  Cream of tartar  Cream cheese  Dextrose  Drinks, soft  Fava beans  Feta cheese  Fish, preserved, smoked, salted, breaded   and canned with sauces  Flour, made out of grains  FOS (fructooligosaccharides)  Fructose  Fruit, canned or preserved  Garbanzo beans (chick peas)  Gjetost cheese  Grains, all  Gruyere cheese  Ham  Hot dogs  Ice cream, commercial  Jams  Jellies  Jerusalem artichoke  Ketchup, commercial  Lactose  Liqueurs  Margarines and butter replacements   Meats, processed, preserved, smoked,   salted  Milllet  Milk from any animal, soy, rice, canned   coconut milk  Milk, dried  Molasses

Full GAPS Diet  Foods to Avoid, cont.

Mozzarella cheese  Mung beans  Neufchatel cheese  Nutrasweet (Aspartame)   Nuts, salted, roasted or coated   Oats   Okra  Parsnips  Pasta, of any kind  Pectin  Postum  Potato, white  Potato, sweet  Primost cheese  Quinoa  Rice  Ricotta cheese  Rye  Saccharin  Sago  Sausages, commercially available   Semolina  Sherry  Soda, soft drinks  Sour cream, commercial  Soy  Spelt  Starch  Sugar or sucrose of any kind   Tapioca  Tea, instant  Triticale  Turkey loaf  Vegetables, canned or preserved   Wheat  Wheat germ  Whey, powder or liquid  Yams  Yogurt, commercial

Selected Recipes for the GAPS Diet

Stages 1 and 2 Ginger Tea 1 Tbs freshly grated ginger root Water In your teapot put the grated ginger root and add boiling water. Cover and brew for 5-10 min. Pour through sieve, and serve. Soups- Meat Stock Lamb, pork, beef or game Put the joints, bones and meat into a large pot, add 5-10 peppercorns, and salt to taste. Fill with water. Heat to boiling. Cover and reduce to simmer for at least 3 hours (longer will be more nourishing). Take bones and meat out and pour stock though a sieve into a separate container. Store in refrigerator or freeze for later use. Keep meat for later meals. Chicken stock Put a whole or half chicken into a large pot. Fill with water. Add salt. Heat to boiling. Simmer at least 1 1/2- 2 hours. Take chicken out and put through a sieve. Store stock in refrigerator or freeze for later use. Keep chicken meat for later meals. Fish stock Put bones, heads and tails of fish in pot. Save meat to cook for later recipes. Fill with water. Add 8-10 peppercorns. Heat to boiling. Cover, reduce heat and simmer for 1-1 1/2 hours. Add salt to taste at the end of cooking. Take out fish bones and put through sieve. Store in refrigerator or freeze for later use. Basic Soup Recipe Bring homemade soup stock to boil. Add chopped vegetables and simmer for 20-25 minutes. Good suggestions are onion, leeks, cabbage, carrot, broccoli, cauliflower, pumpkin, zucchini, and other squashes. If desired, add 1-2 tablespoons chopped garlic at the end. Bring to boil and then turn off heat. For variety, you may also blend your soup for a creamy consistency.

Additional Soup Recipes Creamy Roasted Garlic Soup 10-15 cloves garlic, unpeeled 1 head cauliflower 2 medium zucchini 7 Tbs ghee 2 tsp salt 2 tsp dried basil 2 onions coarsely chopped 1/2 leek sliced 4 cups chicken stock 1. Preheat oven to 400 degrees. 2. Divide cauliflower into florets. Cut zucchini into large slices. Put veggies and unpeeled garlic into large bowl. 3. Melt 3 Tbs ghee and pour over veggies, stir to coat. 4. Put veggies in baking pan and roast for 30-40 min 5. In large soup pot, melt remaining ghee and saute onions and leek until soft. Stir in basil. Add stock and bring to boil. 6. Remove skins from garlic. Put roasted veggies in food processor or blender. Add a little stock if necessary. Blend until smooth. 7. Add pureed veggies to soup pot and reduce heat. Allow to cook 5 min. Stir well and serve. Winter squash soup 1 1/2 liters homemade stock 1 leek sliced Broccoli, 3-4 medium sized rosettes 1 medium carrot sliced 1/2 medium buttercup or 1/3 medium butternut squash (or any orange variety) 3 garlic cloves peeled Peel, deseed and cut squash into small chunks. Cut all other vegetables. Put in soup pot. Add stock. Bring to boil. Reduce heat and simmer for about 30 min. Use an immersion or regular blender to puree soup.

Zucchini Avocado Soup 1 Tbs ghee 1 large onion chopped 2 zucchini diced 2 carrots diced 4 cups chicken broth 1 clove garlic crushed 1 avocado sliced Juice of 1/2 lemon Salt and pepper to taste 1. Saute onion and carrot in ghee over medium heat until softened. 2. Add zucchini and stir to coat with ghee. 3. Add broth, salt and pepper. 4. Bring to boil, then simmer until zucchini is cooked through. Remove from heat. 5. Just before serving, add garlic, avocado and lemon juice (Avocado must be added just before serving. You do not want to reheat soup with avocado in it).

Stage 3 Light and Fluffy Pancakes with Honey Lemon Syrup For the pancakes: 1 cup cooked squash, pureed 1 cup nut butter 5 eggs 1/2 tsp salt 1 T cinnamon Dash of other spices if desired (cloves, nutmeg, etc.) Ghee or other cooking fat

For the Syrup: 1/4 cup honey 1/2 lemon, juiced vanilla extract (optional) 1. Separate eggs, putting the whites into one large bowl and the yolks into a separate large bowl. 2. Add remaining ingredients to the egg yolks and mix together. 3. Beat the whites until soft peaks form, and then fold them into the yolk mixture.â&#x20AC;¨ 4. Fry in fat using a skillet or griddle on low-medium heat (careful, they burn easily) 5. To make syrup, combine the ingredients in a saucepan and warm until the honey is soft enough to stir in. Note: When cold, these pancakes work well to make sandwiches. Peanut Butter Pancakes 1 very ripe banana, mashed 2 T salted peanut butter (you can substitute other nut butters) 3 eggs Ghee or other cooking fat 1. Blend all ingredients together with a whisk or hand mixer. 2. Pour mixture into greased griddle or frying pan that has been preheated to medium 3. Cook until done on one side, flip and watch carefully as the second side generally cooks faster. These pancakes will be very thin. For thicker pancakes, additional nut butter or nut flour can be added. Note: You can serve these pancakes with a little ghee melted on top or a blend of honey, ghee and fresh lemon juice. Fresh or frozen fruit heated with honey will also make a nice syrup.

Stage 4 Basic Bread/cake/muffin recipe 2 1/2 cups ground almonds (or almond flour, or substitute other nut or seed flours) 1/4 cup ghee, coconut oil or animal fat 3 eggs Preheat oven to 300 degrees. Mix all ingredients well (add more or less flour to reach a porridge-like consistency). Grease baking pan with butter or ghee, line with baking paper and put mixture in. Bake for about an hour. Check occasionally until a knife inserted comes out dry. Varieties in Stage 4 include dried herbs, tomato puree, grated cheddar cheese if tolerated, grated carrots, nuts, seeds.

Stage 5 Fresh juices General recipe for ingredients: 50% highly therapeutic ingredients: carrot, small amount of beetroot (no more than 5% of total mixture), celery, cabbage, lettuce, greens (spinach, parsley, dill, basil, beet tops, etc.) 50% tasty ingredients: pineapple, apple, grapes, mango, etc. Make juice in a juicer.

Stage 6 Pumpkin Muffins 4 eggs 1 cup pumpkin puree 1/4 cup coconut oil softened 1/2 cup coconut flour 1 tsp baking soda 1 tsp vanilla 1-2 Tbs pumpkin pie spice, or cinnamon 1/4 cup honey Preheat oven to 350 degrees. Mix dry ingredients in one bowl and wet ingredients in another. Mix both together and put into lined muffin tins. Bake 17-20 min or until toothpick inserted comes out clean. Makes 12 large or 24 mini muffins.

A Note about Supplements in the GAPS Diet The GAPS Diet protocol is based on the idea that “food is medicine” and that the broths, fermented foods, healthy fats and fresh juices provide the necessary micro and macronutrients for good health, However, for people who are suffering from illnesses such as Lyme Disease, additional supplementation is often necessary. It is suggested that you work with a practitioner to determine the need for supplements and the proper dosages. Some supplements commonly used in conjunction with the GAPS Diet are: probiotics, fish oil/cod liver oil capsules, Vitamin D, digestive enzymes, betaine HCl, L-glutamine, and a quality multivitamin/mineral. Don’t forget that fresh herbs and spices are a great way to add wonderful healing qualities into your diet.

Additional GAPS-Friendly Recipes Breakfast Casserole 2 cups shredded cauliflower 1 cup shredded cheddar cheese (optional) 1 cup chopped sausage, cooked 1/3 cup chopped onion 1/3 cup chopped bell pepper 2 cups egg (approx 8), beaten Salt and pepper to taste In a bowl, combine all ingredients except eggs. Add mixture to a greased casserole dish with lid. Pour eggs over mixture. Bake at 350 degrees F for 35-40 minutes or until center is firm. Honey-Glazed Drumsticks 1T ghee 2 lbs chicken drumsticks (about 6 or 7) 1/4 cup lemon juice 1/4 cup honey (or less if desired) 3 cloves garlic, crushed 1-2 inch piece of ginger, grated Salt to taste Melt ghee in heavy-bottomed pan with lid. Brown the meat. In a saucepan, mix honey, lemon juice, garlic, ginger, salt, and heat gently to melt honey. Pour mixture over chicken and coat well. Cook on medium-low heat, covered for about 25-30 minutes. Take lid off and cook another 5-10 minutes, or until the sauce has reduced to desired thickness. Scallops with Shiitake Mushrooms in Ginger Sauce 2T ghee or coconut oil 1 lb large or jumbo scallops 3 cloves garlic, minced 1 medium onion, finely chopped 1-2 inch piece of ginger root, grated 1 1/2 tsp salt 1 cup sliced shiitake mushrooms 1 cup snow peas 1/4 cup homemade broth (any variety) 2-3 green onions, thinly sliced Melt coconut oil or ghee in large skillet or wok. Rinse and pat scallops dry. Brown in hot oil on medium-high heat, approx. 2 minutes per side. Do not crowd scallops in pan. Remove to a bowl, leaving fat in pan. Add onions to pan and cook for several minutes to soften. Add additional fat if necessary. Add garlic, ginger and salt. Stir and sautĂŠ, and then add broth. Add vegetables and continue to sautĂŠ until they are cooked, about 5 minutes. Pour vegetables and sauce over the scallops and stir. Sprinkle green onions over top and serve.

Stuffed Bell Peppers 4-5 bell peppers 2 T ghee, or other fat for cooking 1 medium onion, finely chopped 1 lb ground beef 3-4 cloves garlic, crushed 2 tsp cumin 2 tsp oregano Salt to taste Chopped cilantro 1/2-1 cup meat broth 1 tomato sliced Cheese (optional) To make filling, melt fat in large skillet. SautĂŠ onion on low heat for about 5 minutes. Add seasonings and garlic. Stir. Add meat and sautĂŠ until meat is done. Turn off heat and mix in cilantro. Preheat oven to 350 degrees F. Cut tops off peppers and remove pith and seeds. Grease bottom of ovenproof pan with lid. Carefully fill each pepper with filling and place open side up in the pan. Pour the broth around the peppers. Place lid on pan and bake for 30-45 minutes. When done, place one slice of tomato on top of each pepper and sprinkle with cheese if desired. Return to oven for a few minutes to warm tomato and melt cheese. Sunflower Cake 2 1/2 cups sunflower seeds, soaked and wet 2 T coconut oil 1/3-1/2 cup honey 4 eggs 2 tsp cinnamon Preheat oven to 350 degrees F. Grind sunflower seeds into a smooth paste in the food processor. Add rest of ingredients and blend until well combined. Pour mixture into greased 8x8 baking dish or 9 inch cake pan. Bake 50-60 minutes. A knife inserted in center will come out clean when cake is done. Baked Apple Chunks with Walnuts 2 apples, peeled and cut into bite size chunks 2 T coconut oil 2 tsp honey 1/2 cup walnuts 1 tsp cinnamon 1/2 tsp nutmeg Pinch of salt Heat oven to 375 degrees F. Toss apple chunks with remaining ingredients, except walnuts. Place in covered casserole dish and bake for about 35-45 minutes until tender. Top with walnuts and bake 15 minutes more, uncovered.

Suggested Resources General Information/Websites and Book GAPS Websites www.gaps.me www.gapsdiet.com

Dr. McBride

Campbell-McBride, N. Gut and Psychology Syndrome. Cambridge, UK: Medinform Publishing, Revised edition 2010 (available on Amazon) Cookbook/Recipes Internal Bliss. Middle River, MD, USA: International Nutrition, Inc. 2010. (available on Amazon) Cooking with GAPS DVD (available on Amazon) Fermented Foods/Information and Products Cultures for Health http://www.culturesforhealth.com/ Immunitrition http://www.immunitrition.com/ Body Ecology https://bodyecology.com/ Wise Choice Market http://www.wisechoicemarket.com/organic-raw-fermented-vegetables/ Real Pickles http://www.realpickles.com/ Bone Broths Wise Choice Market http://www.wisechoicemarket.com/bone-broth/ U.S. Wellness Meats http://grasslandbeef.com/beef-marrow-bone-stock-broth-14-oz Bam Bam Broth Co. http://www.bambambroth.com/

References Campbell-McBride, N. Gut and Psychology Syndrome. Cambridge, UK: Medinform Publishing, Revised edition 2010 Internal Bliss. Middle River, MD, USA: International Nutrition, Inc. 2010. Rakel, D. Integrative Medicine. Philadelphia, PA: Elsevier. 2012 Selhub et al. Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry. Journal of Physiological Anthropology 2014, 33:2 Fasano A. Intestinal Permeability and its Regulation by Zonulin: Diagnostic and Therapeutic Implications. Clin Gastroenterol Hepatol. 2012;10(10):1096-1100 Fermented Foods: How to ‘Culture’ Your Way to Optimal Health. mercola.com Bone Broth: One of Your Most Healing Diet Staples. mercola.com

Kate Hope Nutrition Allow me to help you on your path to wellness. I have a Masters Degree in Applied Clinical Nutrition, and I am a Certified GAPS Practitioner. If you would like to work with me, I see clients personally in a one-on-one or group setting, or remotely over the phone or by Skype. If you or a loved one is suffering from Lyme Disease and/or its co-infections, the GAPS protocol is a good choice for an anti-inflammatory, healing diet. Please don’t hesitate to contact me for more information about my services or to make an appointment. I know how it feels to have Lyme, but I also know how much better I am now. I attribute a great deal of this success to my diet, and GAPS was a big part of it. Many of my clients are reaping the benefits of this healing diet as well.

Kate Hope 732-440-8859 Email: katehopenutrition@gmail.com Visit my website: www.katehopenutrition.com Follow me on social media: www.facebook.com/katehopenutrition www.twitter.com/Kate_M_Hope

I look forward to helping you on your healing journey!