Gut and Psychology Syndrome (GAP Syndrome or GAPS)

Originally published on the GAPS web site; Used with permission.

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Image from the cover of Dr. Natasha Campbell-McBride's book: Gut and Psychology Syndrome: Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression and schizophrenia.

We live in the world of unfolding epidemics. Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder (ADHD/ADD), schizophrenia, dyslexia, dyspraxia, depression, obsessive-compulsive disorder, bipolar disorder and other neuro-psychological and psychiatric problems in children and adults are becoming more and more common (1,2,3,4).

In clinical practice these conditions overlap with each other. A patient with autism often is hyperactive and dyspraxic. There is about 50% overlap between dyslexia and dyspraxia and 25-50% overlap between ADHD/ADD and dyslexia and dyspraxia (3,4). Children with these conditions are often diagnosed as being depressed, and as they grow up they are more prone to drug abuse or alcoholism than their typically developing peers (3,4,5). A young person diagnosed with schizophrenia often suffered from dyslexia, dyspraxia or/and ADHD/ADD in childhood (6). When we start examining the patients with these so-called mental conditions, we find that they are also physically ill. Digestive problems, allergies, eczema, asthma, various food intolerances and immune system abnormalities are universally present amongst them (5,6,8). We have created different diagnostic boxes for these patients, but a modern patient does not fit into any one of them neatly. The modern patient in most cases fits into a rather lumpy picture of overlapping neurological and psychiatric conditions.

Why are all these conditions related? What underlying problem are we missing?

To answer all these questions we have to look at one factor, which unites all these patients in a clinical setting. This factor is the state of their digestive system (7,8,9,10,11,12,13,14,15,16,17). I have yet to meet a child or an adult with autism, ADHD/ADD, dyspraxia, dyslexia, schizophrenia, bipolar disorder, depression or obsessive-compulsive disorder who does not have digestive abnormalities. In many cases they are severe enough for the patients or their parents to start talking about them first. In some cases the parents may not mention their child’s digestive system, yet when asked direct questions, would describe a plethora of gut problems. So, what have digestive abnormalities got to do with these so-called mental problems? According to recent research and clinical experience – a lot! In fact it appears that the patient’s digestive system holds the key to the patient’s mental state.

What is a typical scenario we see in clinical practice?

Before examining the patient it is very important to look at the health history of the parents. Whenever the parents are mentioned people immediately think about genetics. However, apart from genetics there is something very important the parents, mother in particular, pass to their child: their unique gut micro-flora (18,19,20,21). Not many people know that an adult on average carries 2 kg of bacteria in the gut. There are more cells in that microbial mass than there are cells in an entire human body (19,21). It is a highly organized micro-world, where certain species of bacteria have to predominate to keep us healthy physically and mentally. Their role in our health is so monumental, that we simply cannot afford to ignore them (18,19,20,21). We will talk in detail about the child’s gut flora later. Now let us come back to the source of the child’s gut flora – the parents.

After studying hundreds of cases of neurological and psychiatric conditions in children and adults, a typical health picture of these children’s mums has emerged. A typical modern mother typically has not been breast fed when she was a baby, because she was born in 60s or 70s when breast-feeding went out of fashion. Why is it important? Because it is well known now that bottle fed babies develop completely different gut flora to the breast fed babies. This compromised gut flora in a bottle fed baby later on predisposes her to many health problems. Having acquired compromised gut flora from the start, a typical modern mum had quite a few courses of antibiotics in her childhood and youth for various infections. It is a well-known fact that antibiotics have a serious damaging effect on gut flora, because they wipe out the beneficial strains of bacteria in the gut (21, 22, 23). At the age of 16 and sometimes even earlier the modern mum was put on a contraceptive pill, which she took for quite a few years before starting a family. Contraceptive pills have a devastating effect on the beneficial (good) bacteria in the gut. One of the major functions of the good bacteria in the gut flora is controlling about 500 different known to science species of pathogenic (bad) and opportunistic microbes. When the beneficial bacteria get destroyed the opportunists get a special opportunity to grow into large colonies and occupy large areas of the digestive tract. A modern diet of processed and fast food provides perfect nourishment for these pathogens and that is a typical diet a modern mum had as a child and a young adult. As a result of all these factors a modern mum has seriously compromised gut flora by the time she is ready to have children. And indeed clinical signs of gut dysbiosis (abnormal gut flora) are present in almost 100% of mothers of children with neurological and psychiatric conditions (21, 22, 23).

But why are we talking about mother’s gut flora? Because her baby is born with a sterile gut (19,20). In the first 20 or so days of life the baby’s virgin gut surface is populated by a mixture of microbes. This is the child’s gut flora, which will have a tremendous effect on this child’s health for the rest of his/her life (19,20,21). Where does this gut flora come from? Mainly from the mother at the time of birth. Whatever microbial flora the mother has, she passes to her newborn child. Fathers with abnormal gut flora contribute to the bodily flora of the mother and through her to the gut flora of the child (19,20,21,26).

The role and importance of the gut flora

Gut flora is something we do not think much about. And yet the number of functions the gut flora fulfills is so vital for us that if some day our digestive tracts were sterilized we probably would not survive (19,20,21,26).

The first and very important function is appropriate digestion and absorption of food. If a child does not acquire normal balanced gut flora, then the child will not digest and absorb foods properly, developing multiple nutritional deficiencies (4,22). And that is what we commonly see in children and adults with learning disabilities, psychiatric problems and allergies. Many of these patients are malnourished. Even in the cases where the child may grow well, testing reveals some typical nutritional deficiencies in many important minerals, vitamins, essential fats, many amino acids and other nutrients (4, 22,23 24).

Apart from normal digestion and absorption of food, healthy gut flora actively synthesizes various nutrients: vitamin K, pantothenic acid, folic acid, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pyridoxine (vitamin B6), cyancobalamin (vitamin B12), various amino-acids and proteins. Indeed, when tested, people with gut dysbiosis present with deficiencies of these nutrients (19,21). Clinical experience shows that restoring the beneficial bacteria in their gut is the best way to deal with these deficiencies (4,19,21,26).

The majority of children and adults with neurological and psychiatric conditions look pale and pasty. When tested they show various stages of anemia, which is not surprising (19,21,26). To have healthy blood we require many different nutrients: vitamins (B1, B2, B3, B6, B12, K, A, D, etc.), minerals (Fe, Ca, Mg, Zn, Co, Se, boron, etc.), essential amino acids and fats. These patients not only can't absorb these nutrients from food, but their own production of many of them in the body is damaged (19,21,26). On top of that people with damaged gut flora often have particular groups of pathogenic bacteria growing in their gut, which are iron-loving bacteria (Actinomyces spp., Mycobacterium spp., pathogenic strains of E.Coli, Corynebacterium spp. and many others). They consume whatever iron the person gets from the diet, leaving that person deficient in iron. Unfortunately, supplementing iron only makes these bacteria grow stronger and does not remedy anemia (19). To treat anemia the person requires all the nutrients we have mentioned many of which healthy gut flora supplies (19,21,26).

Apart from taking a vital part in nourishing the body, beneficial bacteria in the gut act as the housekeepers for the digestive tract. They coat the entire surface of the gut protecting it from invaders and toxins by providing a natural barrier and producing anti-bacterial, anti-viral and anti-fungal substances (19,20,21,26). At the same time they provide the gut lining with nourishment (19). Beneficial bacteria normally control various opportunistic and pathogenic microbes in the gut. Lack of beneficial bacteria would allow disease-causing microbes to grow and occupy large parts of the digestive system causing damage and inflammation in the gut wall (19,20,21). So, it is no surprise when the gut flora is abnormal, the digestive tract itself cannot be healthy. Indeed most patients with learning disabilities, psychiatric disorders and allergies present with digestive problems: constipation and diarrhea, infantile colic and abdominal pain, bloating and flatulence, reflux and indigestion (4,17,21,22,23). Examination by gastroenterologists commonly reveals inflammatory process in the gut and many of these patients are diagnosed with celiac disease (10,11,12,14,15,16,17,27,30). Housing a mass of pathogenic microbes the gut cannot be healthy. Indeed, long before these patients develop so-called mental symptoms they usually suffer from digestive problems and all other typical symptoms of gut dysbiosis pretty much from the start of their lives (4,10,11,17,22,29).

The role and importance of the immune system

A baby is born with an immature immune system (25). Establishment of healthy balanced gut flora in the first few days of life plays a crucial role in appropriate maturation of the immune system (19,20,21). If the baby acquires compromised gut flora from the mother then the baby is left immune compromised (1,21,22). The result is lots of infections followed by lots of courses of antibiotics, which damage the child’s gut flora and immune system even further (2,4,21,25,28). The most common infections in the first two years of life in the children with neurological, psychological and atopic disorders are ear infections, chest infections, sore throat and impetigo. At the same time in the first two years of life the child receives a lot of vaccinations. A child with compromised immune system does not react to vaccinations in a predicted way. In many cases vaccines deepen the damage to the immune system and provide a source of chronic persistent viral infections and autoimmune problems in these children (2,4,21,25).

The beneficial bacteria in the gut ensure appropriate production of different immune cells, immunoglobulins, keeping immunity in the right balance (19,20,21). Damage inflicted upon the gut flora typically leads to an imbalance between major parts of immunity, resulting in allergies, asthma and eczema – symptoms, which children and adults with neurological and psychiatric conditions commonly suffer from (25,26,28,29).

There has been a considerable amount of research published into the state of the immune system in patients with learning disabilities and psychiatric problems (4,28,29,31,32,33,34,35,36,37,38,39,40,41,42,43). The research shows deep abnormalities in all major cell groups and immunoglobulins. The most common autoantibodies found are to myelin basic protein (MBP) and neuron-axon filament protein (NAFP). These antibodies specifically attack the person’s brain and the rest of the nervous system (4,35,38,40,41,43).

To summarize

A child born from parents with abnormal gut flora did not acquire normal gut flora from the start (4,19,20,21,22). The flora may have been damaged further by repeated courses of antibiotics and vaccinations (2,19,21,45). As a result, these children commonly suffer from digestive problems, allergies, asthma and eczema (22,25,33,38,42,45,46). However, in children and adults who go on to develop neurological and psychiatric problems, something even worse happens. Without control of the beneficial bacteria, different opportunistic and pathogenic bacteria, viruses and fungi have a good chance to occupy large territories in the digestive tract and grow large colonies. Two particular groups, which are most commonly found on testing, are yeasts (including Candida species) and the Clostridia family (4,17,43,44,45,46,47). These pathogenic microbes start digesting food in their own way producing large amounts of various toxic substances, which are absorbed into the blood stream, carried to the brain and cross the blood–brain barrier (4,20,21,22,48,49). The number and mixture of toxins can be very individual, causing different neurological and psychiatric symptoms. Due to the absence or greatly reduced numbers of beneficial bacteria in the gut flora, the person’s digestive system instead of being a source of nourishment becomes a major source of toxicity in the body (2,4,6,9,17,19,21,22,27,36,43,46).

So, what kind of toxic agents are we talking about?

There are many toxins, which we have not studied very well yet. But some toxins have received a considerable amount of research. Let us have a look at them.

Acetaldehyde & Alcohol

What have these substances got to do with our patients? The most common pathogenic microbes shown to overgrow in the digestive systems of children and adults with neuro-psychiatric conditions are yeasts, particularly Candida species. Yeasts ferment dietary carbohydrates with production of alcohol and its by-product acetaldehyde. An overgrowth of yeast in the gut would constantly supply the body with these poisons flowing from the gut into the blood stream. This condition was first described by Japanese researchers in the 70s and 80s and named “an auto-brewery syndrome” (4,6,9,17,22,43,46).

Let us see what does a constant exposure to alcohol and acetaldehyde do to the body.

  • Liver damage with reduced ability to detoxify drugs, pollutants and other toxins.
  • Pancreas degeneration with reduced ability to produce pancreatic enzymes, impairing digestion.
  • Reduced ability of the stomach wall to produce stomach acid.
  • Damage to immune system.
  • Brain damage with lack of self-control, impaired co-ordination, impaired speech development, aggression, mental retardation, loss of memory and stupor.
  • Peripheral nerve damage with altered senses and muscle weakness.
  • Direct muscle tissue damage with altered ability to contract and relax and muscle weakness.
  • Nutritional deficiencies from damaging effect on digestion and absorption of most vitamins, minerals and amino acids. Deficiencies in B and A vitamins are particularly common.
  • Alcohol has an ability to enhance toxicity of most common drugs, pollutants and other toxins.
  • Alteration of metabolism of proteins, carbohydrates and lipids in the body.
  • Inability of the liver to dispose of old neurotransmitters, hormones and other by-products of normal metabolism. As a result these substances accumulate in the body, causing behavioral abnormalities and many other problems.

Acetaldehyde is considered to be the most toxic of alcohol by-products (4,6,17,19,36,46). It is the chemical, which gives us the feeling of hangover. Anybody who experienced a hangover knows how dreadful he/she felt. Children, who acquire abnormal gut flora with a lot of yeast from the start, may never know any other feeling. Acetaldehyde has a large variety of toxic influences on the body. One of the most devastating influences of this chemical is its ability to alter the structure of proteins. Acetaldehyde – altered proteins are thought to be responsible for many autoimmune reactions (25,26,28,29). Patients with neuro-psychological problems are commonly found to have antibodies against their own tissues (26,28,29).

Clostridia Neurotoxins

There are about 100 different Clostridia species known so far (4,6,46). They are present in the stools of people with autism, schizophrenia, psychosis, severe depression, muscle paralysis and muscle tone abnormalities and some other neurological and psychiatric conditions (2,4,6,9,17,19,21,22,27,36,43,46). Many Clostridia species are normal inhabitants of the human gut. Clostridium tetani, for example, is routinely found in the gut of healthy humans and animals. Everyone knows that tetanus is a deadly disease, due to an extremely powerful neurotoxin Clostridium tetani produces. Clostridium tetani, which lives in the gut, is normally controlled by the beneficial bacteria and does us no harm, because its toxin cannot get through the healthy gut wall. Unfortunately, patients with disturbed gut flora do not have a healthy gut wall, and these powerful neurotoxins are absorbed through the damaged gut lining, then cross the blood-brain barrier affecting the patient’s mental functioning (2,4,21,22,43,46). Many other species of Clostridia (perfringens, novyi, septicum, histolyticum, sordelli, aerofoetidum, tertium, sporogenes, etc.) produce toxins similar to tetanus toxin, as well as many other toxins. Dr. William Shaw at Great Plains Laboratories describes in detail a number of autistic children, who showed considerable improvements in their development and biochemical tests while on anti-Clostridia medication (4). Unfortunately, as soon as the medication was stopped, the children slipped back into autism as they did not have a healthy gut flora to control Clostridia. In many cases Clostridia is not identified in the stools of these children, because Clostridia is strictly anaerobic and very difficult to study. Professor Gibson of Reading University in the UK has identified Clostridia overgrowth in the gut of autistic children, His team is working on finding effective treatments for the problem (2,4,22,27,46).

Yeasts and Clostridia have been given a special opportunity during the era of antibiotics. Broad-spectrum antibiotics do not touch them, but eliminate the beneficial bacteria in the gut, which normally control yeasts and Clostridia. The patients we are talking about, are usually exposed to numerous courses of antibiotics pretty much from the beginning of their lives.

Gluteomorphins & Casomorphins (opiates from gluten and casein)

Opiates are drugs, like opium, morphine and heroin, which are commonly used by drug addicts. What have they got to do with our patients?

Gluten is a protein present in grains, mainly wheat, rye, oats and barley. Casein is a milk protein, present in cow, goat, sheep, human and all other animal milk and milk products. In gut dysbiosis these proteins do not have a chance to be digested properly before they are absorbed in the form of substances with a similar chemical structure to opiates, like morphine and heroin. There has been quite a substantial amount of research done in this area by Dohan, Reichelt, Shattock, Cade and others, where gluten and casein peptides, called gluteomorphins and casomorphins, were detected in the urine of schizophrenic patients, autistic and ADHD children, patients with depression and autoimmune conditions (2,4,6,9,17,19,21,22,27,36,43,46). These opiates from wheat and milk enter the blood-brain barrier and block certain areas of the brain, just like morphine or heroin, causing various neurological and psychological symptoms.

We have mentioned a few toxins found in these patients. There are many others currently being studied. The mixture of toxicity in each child or adult can be quite individual and different. But what they all have in common is gut dysbiosis (abnormal gut flora). The toxicity, which is produced by the abnormal microbial mass in these patients, establishes a link between the gut and the brain. That is why it is logical to group these disorders under one name: the Gut and Psychology Syndrome (GAPS)™. The GAPS children and adults can present with symptoms of autism, ADHD, ADD, OCD, dyslexia, dyspraxia, schizophrenia, depression, bipolar disorder, sleep disorders, allergies, asthma and eczema in any possible combination. These are the patients who fall through the gap in our medical knowledge. Any child or adult with a learning disability, neurological or psychological problems and allergies should be thoroughly examined for gut dysbiosis. Re-establishing normal gut flora and treating the digestive system of the person has to be the number one treatment for these disorders, before considering any other treatments with drugs or otherwise (19,20,21,22,24,26,50,51).

Gut And Psychology Syndrome (GAP Syndrome or GAPS) establishes the connection between the state of the patient’s gut and the functioning of the brain. This connection has been known by medics for a very long time. The father of modern psychiatry French psychiatrist Phillipe Pinel (1745-1828), after working with mental patients for many years, concluded in 1807: “The primary seat of insanity generally is in the region of the stomach and intestines.” (43). Long before him Hippocrates (460-370 BC), the father of modern medicine has said: “All diseases begin in the gut!” (19,20,21). The more we learn with our modern scientific tools, the more we realize just how right they were!

In order to help patients with GAP Syndrome, we have to concentrate on treating the patient’s digestive system: we need to re-establish normal gut flora and heal and seal the damaged gut lining. Healing the digestive system stops the flow of toxins from the gut to the brain and as a result removes or reduces the plethora of mental and neurological symptoms the patient displays (1,3,4,7,8 14,15,17). As the gut starts functioning normally, the food gets digested an absorbed properly removing the many nutritional deficiencies, which these patients suffer from. As a result the patient becomes healthier physically as well as mentally. All this can be achieved with the GAPS Nutritional Protocol, consisting of a very specific diet, nutritional supplementation and some changes in the life style of the patient. This program has been used by thousands of patients in the last few years with good results: patients diagnosed with autism, dyslexia, dyspraxia, ADHD/ADD, schizophrenia, bipolar disorder, depression, epilepsy and other so-called mental and neurological conditions.

To learn more about Gut and Psychology Syndrome, how it develops and how to treat it effectively with a sound nutritional protocol please read the book by Dr. Natasha Campbell-McBride Gut and Psychology Syndrome: Natural treatment for autism, ADHD/ADD, dyslexia, dyspraxia, depression and schizophrenia. To learn more go to www.Doctor-Natasha.com

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