Saturday, January 12, 2013

GAPS Diet and Adrenal Problems

(My blog has moved. You can see this article on my new blog here: 

The Gut and Psychology Syndrome (GAPS) Diet is recommended for curing a long list of autoimmune illnesses, including relatively mild symptoms such as allergies and eczema, and also more severe symptoms such as fibromyalgia, rheumatoid arthritis, and even autism. The GAPS Diet typically takes one-to-three years to cure these autoimmune issues.

I decided to undertake the GAPS Diet back in Fall 2010, after having joint pain in my left shoulder for over eight months. This pain made it difficult to pick up my infant, exercise, or even to push the kids on the swings. In addition to my shoulder pain, I was also exhibiting signs of adrenal fatigue, such as balding lower legs, vertical lines on my fingertips, irritability, low energy, cold hands, and sensitivity to sunlight.

The first few months I was on the GAPS diet, I felt wonderful. My shoulder pain disappeared and my adrenal fatigue symptoms abated. I felt better than I had in years! But after about five months on the GAPS diet, I started to notice some energy problems. Specifically, I started having spells of extreme lethargy and fatigue. As in, "I have to go lay on the floor for awhile" and "I can't keep my eyes open". All of my adrenal fatigue symptoms came back and were even worse than ever. After lots of research and some self-experimentation, I figured out that this problem was caused in large part by eating too few carbohydrates.

Is the GAPS Diet Low-Carb?

The GAPS diet relies heavily on nutrient-dense foods such healthy fats, meats, vegetables, bone broths, and fermented foods. The diet allows no processed foods, starches (such as potatoes and corn), grains, or complex sugars. However, the GAPS diet is not necessarily a low-carbohydrate diet. Fruits, veggies, lentils, white beans, and honey are all allowed on the diet. But, I tended to shy away from things like lentils and white beans while on GAPS because they caused digestive upset for some of the other members of my family. I also tended to not each much fruit or sweets. So it was easy for me to unintentionally eat very few carbs while on the GAPS diet.

Does the Body Need Carbs?

Popular low-carb diets, such as Primal and Atkins, are quick to point out that people do not need carbs, since the body can manufacture them from other energy sources. However, it became clear to me that I do need plenty of carbs to have normal energy levels.

As I have researched this issue, I have learned that the body actually prefers to use glucose as a fuel, and the brain prefers to use ONLY glucose as a fuel. Glucose is delivered to the brain via the glucose in our blood. With a low-carb diet, the body strives to maintain optimal blood glucose levels through the process of gluconeogenesis. To achieve this, the adrenal glands send messages to the liver and kidneys to convert protein and fat into glucose. These messages from the adrenal glands come in the form of cortisol, which is one of the body’s stress hormones. The body sees a lack of carbs as a stress, and in the long term this can be detrimental.

When the body is deprived of carbohydrates for an extended period of time, the adrenal glands have to keep sending signals for gluconeogenesis over and over again. This can cause the adrenal glands to become overworked. It can also lead to other problems because the body is constantly in a state of elevated stress.

GAPS Can Worsen Adrenal Issues!

In my case, I had adrenal problems even before going on the GAPS diet, and the low-carb version of GAPS I naturally followed made my adrenals have to work even harder. To compound this problem, I was also nursing an infant while on GAPS, and a large amount of glucose was leaving my body in the form of breastmilk. My poor adrenal glands!

In talking with others on the GAPS diet and researching on the internet, I found out that adrenal issues such as low energy are not uncommon for people on the GAPS diet. The low energy problems seem to develop rather quickly for women who are pregnant or nursing, but they also develop for other women and men who stay on the diet for an extended period of time (and after all, the diet is recommended to last from one-to-three years, so it is intended to be used for an extended period of time).

How to Avoid Adrenal Problems While on GAPS

My body clearly indicated that it wasn’t ready to go off the GAPS Diet, with a recurrence of shoulder pain anytime I strayed from the strict GAPS diet. I had to learn how to nourish my adrenal glands while staying on GAPS, and this involved much more than changing my diet. The main principle of nourishing overworked adrenal glands is to allow them to rest by reducing all forms of stress on the body.

Any of the following can contribute to adrenal problems:

  • Inadequate sleep
  • Being stressed out
  • Too much exercise
  • Inadequate protein, fat , and/or carb intake
  • Intake of stimulants such as caffeine (which cause the adrenals to release more stress hormones)

After much reading and self-experimentation, I found the following to help in avoiding adrenal problems while on GAPS:

  • Get plenty of sleep. The more sleep you get, the better. 8 hours a day would be nice, but to really help adrenal health, aim for even more. Go to bed no later than 10pm, and stay in bed until at least 7am. If you feel tired, or if you have a hard time getting good nighttime sleep, take a nap every day! And don’t feel guilty about making sleep a priority, as this is really important for recovering adrenal health. Since my youngest child is not sleeping through the night yet, I have had to prioritize a daily afternoon nap for myself.
  • Do not workout excessively. When my adrenals were at their worst, I was surprised to learn that exercising made me feel worse and worse. If I did any intense exercise, such as strength training, sprinting, or interval training, the next day I would be absolutely exhausted and very irritable. Exercising also caused my basal body temperature to plummet, which is another sign of too much stress on the body and overworked adrenals. I stopped all exercise for a few months, and this was tremendously beneficial to my adrenal health. Then I started to gradually add in very mild exercise, such as yoga and walking. Initially, even those forms of exercise were too much for my body! Nowadays, I can do strength training and interval training with no ill effects.
  • Eat plenty of carbs. The following list of GAPS-legal carbs should be used liberally if you have any adrenal issues. I found it beneficial to eat at least one of the following with every meal, and to allow myself to eat much more fruit and GAPS-legal desserts than I would normally eat.
    • Lentils
    • White navy beans
    • Milk kefir or yogurt
    • Winter squash, such as butternut, pumpkin, and spaghetti
    • Fruit
    • Honey
    • GAPS-legal desserts such as ice cream and cookies 

  • Follow your body’s cues. If you are willing to listen closely to your body, it will tell you what foods you need. I tend to really over-think what I eat, by thinking about what is “healthy” and what I “should” eat. When I am willing to pay attention to my body’s cues, I feel much better. (Dr. Natasha Campbell McBride, the author of the GAPS Diet, also advocates listening to your body’s cues to determine what to eat.) When I started eating intuitively, I was shocked to see that my body really wanted ice cream, lots of ice cream, as in two or three bowls of ice cream each day. I would normally have denied my body the ice cream, out of fear that it was unhealthy, but after struggling with energy problems for over a year, I decided it was worth a shot to go with the flow of my body’s cues. This really helped my energy levels and helped me kick-start the path to adrenal recovery. After about 6 weeks, my desire for ice cream dropped off dramatically. Even now, though, I find that my body wants more sweets than I would normally allow, and if I go with the flow my energy levels are much more even.
  • Do NOT intentionally try to lose weight. Restricting calories, just like restricting carbs, results in your body releasing more stress hormones, and can thereby cause more adrenal problems. If you try to cut calories while your adrenals are already stressed, you will likely see a rapid increase in your adrenal symptoms. I gained about 10 pounds in the first few months of really trying to heal my adrenals; although not ideal, this weight gain has corresponded to me feeling much better overall. And if I have to choose between being a bit heavier or feeling like the walking dead every day, I’ll take the weight! (And my weight has remained steady for the last 7 months, so there hasn’t been a continual gain for me while I’ve implemented these adrenal recovery measures.)
  • Make relaxation and stress relief priorities. When the adrenals are healing, the body really needs plenty of time to relax, and stress-relief must be a priority. I found it helpful to make myself take some time to sit on the couch every day (which is something I don’t typically do). To keep “busy” during this time, I like either watching the kids play, reading a book, or working on a crochet project (I’m a newbie to crochet, but I love that it can be such a relaxing yet rewarding activity). Once I committed to making relaxation and stress relief priorities, I was also able to take a step back and see that I was spending way too much time in the kitchen. I have simplified meal preparations by relying more on simple foods, and this has freed up quite a bit of time.
  • If all else fails, start adding in GAPS transitional foods. If, like me, you have had adrenal problems for quite awhile, even liberally eating GAPS-legal carbs may not be enough. I had to find the balance between following GAPS and allowing some carb foods such as potatoes and even white rice (which is recommended as a “safe” starch in The Perfect Health Diet, and which is much easier on my digestion and joints than brown rice). If you are near the beginning of your GAPS journey, then adding in these foods may not be an option, but if you’ve been on GAPS for quite awhile you may want to start experimenting to see what foods your body can tolerate without a recurrence of symptoms. 

My Progress

While I am not completely recovered from my adrenal problems yet, I have come a long way towards health in the last year. For the first time since I started tracking my basal body temperature back in 2006, my temperatures are now normal. I’ve lost my sensitivity to sunlight, the vertical lines on my fingertips are nearly gone, and I no longer have balding lower legs or cold hands. My only remaining adrenal complaint is that I still struggle with low energy at times, but my energy levels are still vastly improved over a year ago. I hope that my experiences in regaining adrenal health can help others prevent or recover from similar problems.

UPDATE: to learn more about my health recovery in the years after the GAPS Diet, check out this post:
Can a Perfect Diet Lead to Perfect Health?

This post is part of Pennywise Platter and Fat Tuesday


Unknown said...

I really enjoyed this article. I find that when I eat low carb I just don't function very well... but I also have high blood sugar (doc has no idea why bc I'm normal weight and still loosing without trying) so it's a balancing act for sure! Thanks for the information.

PattyLA said...

It is funny. When my energy is low I do tend to reach for carbs for a quick pick me up but I have figured out that fat helps me even more. In fact those carbs rarely help me like I think they should. Fat and electrolytes are the key here. I have healed my adrenals on very low carb GAPS.
The key for me has been getting plenty of fats in and making sure my mineral and electrolyte intake was high enough. All that detoxing wastes lots of minerals and those are also needed by your adrenal glands to function properly. And of course saturated fat is needed to make hormones of all kinds.

Unknown said...

This is so very interesting. I listened to Dr. Natasha in an all day seminar. I loved it! I've never followed GAPS because I never felt the need for full GAPS, but I keep her protocol in mind when it comes to making food choices. I'm not paleo either, but eat very low grains. I find the whole issue of grains particularly interesting. I think grains deserve much greater study. I find that I can't go without any, but I also can't have very many, but I don't understand WHY?

Thanks for your thoughtful post!

Anonymous said...

thank you for sharing. It is interesting as I also struggled with same problems not knowing that i went too low on carbs.

Lisa said...

Thank you for this. I went off GAPS after a year, because of adrenal problems. But my old symptoms required me to get back on GAPS again, so hopefully this will help me stay on it longer this time.

Jennifer at Purposeful Nutrition said...

Really interesting. I am getting into health coaching and teaching and health blogging and I am finding out some really interesting information. Your article is really helpful.

Kerri C. said...

Thank you for all your hard work on this issue and for shining a light on the way for the rest of us! I have read some of your other posts on your adrenal issues in addition to this on. They have helped me immensely, and I am always referring others to you. Thank you!

PC said...

My thoughts are that we need carbs, yet they are also a problem in other ways. Paleo people talk about how we didn't eat lots of carbs before the advent of agriculture, but we probably lived very different lives back then and weren't as stressed or as social as we are now. My guess is that we probably need a lot more fuel in the modern day to cope with day to day life.

PC said...

Thankyou for this post, I found it really helpful. I developed problems quite quickly after going on GAPS, so returned to a higher carb diet, but I keep going back bto lower carb. I seem to feel better with less carbs inb my system, yet I also have energy problems. I'm hoping to find a nice balance in time.

fearless_fallen_angel said...

Thank you for the post. I think that you absolutely made the most important point -- we each need to find what works for us, through individual experimentation and follow that. Its taken me more than 4 decades on this earth to finally figure out that no specific diet plan will ever work as well as my own understanding of what foods are inflammatory for me and which are not.

Anonymous said...

Actually braincells can also use ketone as fuel. That is why some patients with Altzheimers can benefit from taking coconutoil as a source of ketones. The damaged cells that no longer can use glucose can survive and function if enough ketones are around.
I like the rest of your post, just not the line that glucose is the only fuel for the brain.
Please excuse my english (I am from Sweden)

Sarah Smith said...

Thanks for the clarification. I'll update the wording!

Jenny L. said...

Dear Sarah,
I can totally relate to what you said here. I felt excellent for the first two months on the GAPS diet - I could tell that the gut was being healed, and my anxiety issue was relieved by an enormous amount. Then I began to have extreme fatigue as you did and from then on had to make some changes, including cutting out vigorous exercise (the exercise thing really surprised me too).

This post was helpful! I'm going to add more carbs into my diet and have more time for relaxation.

Taryn Kae Wilson said...

Thanks for writing this Sarah. This is something our family has had issues with on the GAPS diet. I know we need more healing on GAPS and we need to increase our carbs to give us more energy.

Lindsay Wilson said...

I have generally read/heard that our bodies are running on a sugar metabolism and the key is to shift the body back into running on fat (for lack of better words). I can imagine, that if the adrenals are already taxed by lifestyle/diet before this shift, it is...for most people...a very intense shift. We actually find out how exhausted we are from running on sugars -- the up and down waffling that is largely absent from indigenous and traditional cultures' physiology. This is more of a modern issue. I think you articulated all of this very well in your article.

I think the important thing for folks in transition to note (at least, as I understand) is that we are assisting our bodies in the transition from running on sugar to running on whole fats. Of course, we need sugar -- but our bodies are not meant to be running on these sugars. Looking back at our ancestors -- sweet could be found in the natural environment (wild hives) and sweet is technically in every food...but, it was a precious thing that was somewhat rare to find it in a concentrated form.

Finally, there are other ways to support the adrenals and kidneys as one makes this shift. I would suggest licorice root tea, nettles/oatstraw infusion, and an adaptogenic herb such as astragalus root (add to bone broths). To your health!

Sherry said...

I find this to be very true. Low carb usually works just fine as long as you don't forget the fat and minerals. I have found it is difficult for most people to realize how much fat we can actually eat....75% of your plate should be fat according to Dr. Jaminet.

Sarah Smith said...

Yes, I also read that there is a transition to burning fat instead of sugar. I kept hoping that would happen for me (and had read the different protocols for doing so to make sure I was doing it the right way). I was on low carb/high fat GAPS for 18 months, and the adrenal symptoms kept getting worse and worse, which is when I finally gave up. I think low carb works fine for some people, and some people are clearly able to transition to becoming fat burners. But that doesn't seem to be the case for me, at least not at this point when I am still nursing (which means I am outputting a tremendous amount of glucose through breastmilk) and with previously existing adrenal problems.

Kwizikl said...

I've had chronic fatigue syndrome for 30 years and just can't do without some grains. I think I'm wired differently as I rarely get into ketosis despite trying for years with different methods and I just crash and burn without some grains. Glad you posted on this topic as I wonder how some young children feel on GAPS that can't verbalise how their body feels??

Eileen said...

It's interesting how many people accidentally go low-card on Gaps, because Dr. Campbell-McBride absolutely doesn't recommend that. In fact, on the Intro. Diet, she includes winter squash from day 1, and juice soon thereafter. I've been on Gaps 6 months and without trying, average between 150-200 carbs daily. I don't choose sweets often, because I prefer fruits and veggies. Pears, Cabbage, Winter Squash are all pretty high carb. Add a few servings of each and you're in the moderate (instead of low) carb range.

Smiler said...

Thanks for posting this. I am thinking of going on the GAPS diet and I needed this bit of information because even now I'm struggling with adrenal fatigue and I have not even started it yet. I love your blog. Please keep posting!

Anonymous said...

Hi Sarah

Very interesting thoughts. Just a few thoughts of my own for debate. A lot of authors think the thyroid (not the adrenal) is the master gland of the body even regulating the adrenal, but both are important in fatigue issues. I have to admit my own research has been limited to the thyroid and haven't spend much time on the adrenal. Will do that soon.

I have discovered iodine (as in orthoiodosupplementation) to be a good adjunctive treatment in thyroid issues (most of the symptoms you are listing as in fatigue, low body temp, as well as thinning hair, dry skin, cracked heels, large tongue with scalloping, etc.) Kelp and other seaweeds are not high enough in iodine (have to increase up to 50mg to sometimes have a desireable effect once you have health concerns), as maintenance they seem fine.

What was interesting in my research into iodine is that it seems to get depleted more quickly on a high fat diet which could explain the result GAPS people find, and if you are also avoiding processed iodized salt (which is for some people their best source of iodine) this will happen even faster. Apparently soils are getting really really low in iodine over the last 50 years and this is why our dietary intake is not nearly enough except if you eat a LOT of produce from the sea more than once daily.

Would appreciate your thoughts.

Daleen Amb

Sarah Smith said...

Hi Daleen,
I have done quite a bit of research on thyroid as well. My understanding is that adrenals and thyroid work together, and if one is out-of-whack, the other is likely out-of-whack as well. I have a friend who is into iodine supplementation for thyroid issues. She uses relatively high doses and is part of a Yahoo group where people talk about how they use iodine as well as other supplements they find helpful to take in conjunction with iodine (such as extra salt, magnesium, Vit C, etc).

I myself am wary of taking supplements in general. I did try iodine once or twice and felt strangely afterwards, so I didn't try it any more. But I know some other people do have good results with it. I do try to make sure I get plenty of dietary iodine through grassfed butter, lots of egg yolks, etc. Oh, one other protocol I've seen for iodine is painting the skin with it (for instance the bottoms of the feet can be painted and then socks put on). That is supposed to allow the body to absorb as much iodine as it needs through the skin and not get excess (as can happen with internal supplementation).

Also, you may be interested in this article about using homeopathic iodine:

I hope you find the path to health that works for you!


Anonymous said...

Hi Sarah

I am definitely not up to speed about the adrenals and it is on my priority list now, due to your and other people's prompting.

The thing of interest to me was that high fat in the diet (which I am all for because of following GAPS myself) could deplete iodine very quickly. I thought that the high fat would restore the function of the adrenals, but if it is taking iodine away from the thyroid in people who are already iodine deficient, could it not be causing the problem we are seeing with people experiencing fatigue on the GAPS diet? According to Brownstein, 97% of people he sees in practice are iodine deficient (although he lives in the goiter belt).

I'm just throwing ideas out there and hoping others who have pondered the subject as well might chip in. I don't think we should eat less fat, just take in more iodine due to the higher demand. Iodine tends to be displaced by other halogens as well and those (fluoride and bromide) all over the place and impossible to avoid, hence the need for higher levels required to stay healthy.

Have to put a dislaimer in here now - I'm not even an expert on iodine, have just been researching it for the last 2 weeks :).

HTH, Daleen

Sarah Smith said...

Hi Daleen,
Thanks for sharing your thoughts. The possibility of needing more iodine with a high-fat diet is definitely something worth looking into, and maybe some self-experimentation is in order. :)

Sarah said...

Yes I have found this helpful too! along with what Sarah and Dr. McBride said about listening to your body and eating what it needs. Though I was puzzled about how to get more fat into my diet when I am also dealing with a 1.3 cm gallstone. But I found that taking a larger quantity of coconut oil and coconut milk has been a huge benefit as it requires less bile to digest. Aside form the benefit of easy digestion coconut oil does not store up like other fats which lends to no fat accumulation and also more energy. There is a wealth of good info about this in Eat Fat lose Fat by Mary Enig and Sally Fallon.

Sarah said...

Thank you Sarah for your blog and for posting this. One of the reasons I am doing the GAPS is to address adrenal weakness, so I learned a lot from your post and reading all the comments. I am now following you!

Sarah Smith said...

Welcome, Sarah! I'm glad you found this helpful, and hope you find plenty more good stuff to read and make on the blog!

Sarah @ Politically Incorrect Health said...

Thank you for sharing this! I travel for my job and that naturally messes up my sleeping patterns and energy levels. I have been trying to make sleep a priority, but even when I do get around 8 hours of sleep, I feel so tired with little energy (I am 25 btw). I have been on the GAPS diet nearly a year with great success in improving various health issues including for me to transition off. I have been thinking there is something wrong with me and I am not doing everything right. Maybe it is time for me to re-introduce potatoes and some gluten-free digestion. However, in more recent months I have lost my energy. I am wondering if it is time grains. I have been reading that some people need to eat these carbohydrates and that the GAPS diet long term is not good for everyone.

Please share your thoughts and advice! I would like to gain back my energy!! Thanks, Sarah

Anonymous said...

Hi Cassidy, my interest was peaked by your comment on the high blood sugar, normal weight. Have you been tested for obstructive / central sleep apnea? This is an anatomical predisposition that results in lose of breath at night, and isn't just affecting those that are overweight or obese. In fact, increased cortisol levels at night due to not breathing impacts insulin levels and ability to manage sugars. Check into just to be sure :) -- Marsha Fulton, RPSGT

Anonymous said...

Patty and Sherrie I think this is where I am going wrong, not enough fats and feeling very faint and hungry right now. I am only day 1 on the intro diet so wanted to give it a couple of days before adding in the ghee but I don't think I can wait any longer, will have to prepare some tonight.

Unknown said...

This is great information, thanks for sharing it. I do question what blood type your are. I know Dr Natasha addresses The Blood Type Diet in her GAPS book. I am blood type O and do really well on a low-carb diet. However, my husband, is blood type A and feels better having some grains in his diet. Both are true to what the Blood Type diet states. I believe having an awareness of your blood type and eating for your type might help in understanding why some of there is a difference in the posts/people above.

Sarah Smith said...

Oh, that's interesting Kerry. My blood type is B+. I don't remember seeing anything about that is the GAPS book, and a quick look didn't turn up anything. What chapter does Dr. NCM talk about that in?

Anonymous said...

I agree with Kerry and have been wondering if people who don't do so well on GAPS are blood type A. I have had the same experience in that my daughter and I have been on GAPS for 2 years and have done very well and we are both O's. My sister found she could not do low carb and she is A+.

PS. Can't figure out how to post this without choosing Anonymous??)

Virginia said...

Dr. NCM does not talk about blood type diet in her book. In her FAQ page she mentions it and says there is no basis to it. Maybe it was eating for your ancestral type that she has spoken of and one could easily misunderstand that to mean blood type?

Anonymous said...

I really appreciate this particular blog because it specifies some physical adrenal stress symptoms that I have, which have never been pointed out to me as being a result of adrenal stress (especially the vertical fingernail lines). Also giving an idea of how long it might take to actually be free from symptoms.

My question is with respect to weight gain -- you said you gained 10 lbs at first but have not gained anymore in the following 7 months. Yet you said you started tracking symptoms in 2006 which is 7 years ago. Could you have intended to say you had not gained weight in the past 7 years?


Jeni Clark-Leonard said...

Interesting post as we have been GAPS for 4 years. I "fixed" most of my health issues with diet but eating GAPS modified (no dairy here). HOwever, when I decided to begin working out again, I FRIED my adrenals/thyroid and CANNOT for the life of me, despite diet, get them working again. Frustrating to say the least as I finally was able to incorporate fitness into my routine after years of putting it on the back burner. IF I eat grains, I gain about 1 pound a DAY! I just dont process them well. Suggestions?

Judith said...

I found eating low carb I was always hungry. It did not matter how much fat or protein I ate, I felt exhausted and shaky. I know it effected my adrenals and the real sign something was wrong was how my skin on my face looked. Very dry and way too many wrinkles, especially in new places. Has anyone else noticed a difference in their ski

Sarah Smith said...

Hi Kathy,
Sorry for the confusion. I didn't start GAPS until Fall 2010, and didn't start implementing these adrenal measures until January of 2012. So the 10 lbs I referenced was in the beginning of 2012.

I started tracking my body temperature back in 2006, but that was for a different reason. I was using that to predict ovulation and thereby used it for birth control and then for getting pregnant twice. So my weight has actually fluctuated widely in the last 7 years since I've had two pregnancies. When I started GAPS (which was 6 months after my second pregnancy), it resulted in me very quickly losing all of my postpartum weight. But then my weight actually started to creep up after being on GAPS for a year (about 5 pounds). Then I gained about 10 pounds implementing these adrenal recovery measures, so right now I'm holding steady at about 15 pounds over my "normal" weight. But I feel so much better energy-wise, and I'm still nursing my youngest, so I'm not overly concerned about the weight now.

Sarah Smith said...

Hi Jeni,
If you are like me, then adrenal recovery will take awhile of really focusing on extra sleep, stress reduction, and very little exercise (with NO intense exercise at all). I had to decide to be okay with the weight gain, as I feel so much healthier and function so much better. And by the way, the weight gain for me was not really related to less exercise; it was more related to purposely over-eating a little bit to jumpstart my adrenal recovery (and it did work in that regard).

Sarah Smith said...

Yes, I also noticed that I got more wrinkles while eating low-carb!

Sarah Smith said...

I would try to reintroduce some potatoes in combination with making sure to get LOTS of sleep and little-or-no exercise.

Anonymous said...

Hi Sarah, I too am a homeschooling mother of three boys. I have followed your site through our journey with leaky gut and strep infection, passed from childbirth, for the past year. Thank you for your info you have helped me through those many times of uncertainty. We have been on GAPS for 8 months now and I can relate very well to this article. My eldest boy with the majority of health issues and compromised immunity started to look pale and very lathargic and his behaviour wasn't great very defiant. What I wanted to share with you is something I have recently discovered. My son and I have both been diagnosed with Pyrrole dysorder which is hereditary and results in many thiings such as fatigue, irritabity, anger, behaviour issues, poor memory/concentration ... a simple urine test and it can be cured very quickly with supplements mainly of B6 and Zinc I was amazed with this finding. Thankyou for your hard work and willingness to share. Kym

Sarah Smith said...

Thanks for sharing this info, Kym!

John C. A. Manley said...

In my experience and research, the body only resorts to gluconeogensis if there is inadequate fat in the diet (and an excess of protein). Supply the body with enough fat and it'll turn them into ketones and avoid the stress of gluconegensis. I eat over a cup of fat (mainly ghee) a day and feel fine without any symptoms of adrenal fatigue. Plus I exercise every day very intensely.

I agree that adrenal fatigue is a problem with high protein, moderate fat, low-carb diets; but I don't think this will happen with high-fat, moderate protein, low carb.

Of course, that's assuming that the bile duct and liver are working properly and can process dietary fat correctly. Dr. Natasha talks about how to clear up fat absorption/digestion problems.

Lastly, if the body is in a state of stress it'll turn to gluconeogensis to produce quick energy in the form of sugar. I suspect it maybe that that the stress comes first, more often than not, then the cortisol, then the gluconeogensis. It's not that the body considers low-carb stressful, it's that the body wants sugar if it is stressed -- and if it's not available in the diet it turns to gluconeogensis.

Sarah Smith said...

I don't think inadequate fat was the problem for me. At that time, I was getting about 65% of my daily calories from fat. I think that, for me, I already had adrenal issues and they just got worse on low-carb. Some people do fine on low-carb (although I have don't personally know anyone that has done well on low-carb for long-term, 2+years). But it seems that, particularly for pregnant/nursing mothers or people with adrenal problems, low-carb can be especially detrimental.

Anonymous said...

I've been eating low-carb (goal is less than 20 grams a day at the recommendation of my naturpath) for about six months. I eat a no sugar, yeast and gluten free diet with minimal dairy (I do eat raw yogurt regularly) and no processed foods. I eat grass-fed beef, good sources of chicken and seafood (mostly salmon). Systematic candida is a huge issue for me, as candida/fungal infections often go hand in hand with adrenal issues which I now understand I've had for a long time. I don't feel that I do well (and interestingly I'm A- blood type)on low carb for extended periods--my adrenals suffer and now I'm experiencing bad anxiety and sinusitis. For those of you who are incorporating carbs into GAPS, have you had any issue with Candida? My naturopath said I need to be below 20 grams of carbs to balance candida which I've been battling for two years with many, many supplements and low-carb diet. I don't know if the candida is the source of my anxiety or adrenal issues to the stress of ongoing infection (sinusitis). Maybe my focus should be more on adrenal repair than candida eradication/balance at this point?

Sorry I could only post as anonymous but my name is Linda

Sarah Smith said...

Hi Linda,
You might find this video about candida interesting:
(Obviously he is a bit tongue-in-cheek/juvenile at times, but he still has some good information nonetheless.)

From what I've learned , many people do not do well on low-carb for an extended period of time. I myself found some great adrenal relief by following Matt Stone's Diet Recovery program. In addition, my family has great success using homeopathy instead of GAPS to stimulate the body to heal itself. I wrote more about that here:

Anonymous said...

Thank you! That is helpful!

Anonymous said...

Hi Sarah,
Although I work with a naturopath, I left a message with Alan Saxon as I'd like to consult with him. I'm really concerned about the anxiety and food allergies I've developed on a l0w-carb, anti-candida diet. I have to take Xanex to control it. I'm 47 and never had to deal with anxiety before. I swear I'm getting worse on the diet and supplements my naturopath prescribes and I've spent a lot of money over the past two years. Anyway, thank you for all the great information on your blog. I will continue to follow it. I will continue to strive toward optimal health although I'm more than discouraged at this point.

Anonymous said...

Great article! Do you mind asking what your temps were averaging at the height of your adrenal problems vs what they are now?

Sarah Smith said...

I saw a 3-degree improvement in my temperatures. When my adrenals were at their worst around the end of 2011, my temperatures were in the low 97's (with an ear thermometer, which runs 1-2 degrees below oral temperature). I'm not currently taking my temperature anymore (don't need to), but over the first six months of 2012, my temperatures rose to high 99's and low 100's (once again with the ear thermometer).

I would estimate that with an oral thermometer, the temps would have been high 95's/low 96's at their worst, rising to high 98's/low 99's through implementing the adrenal recovery measures.

Anonymous said...

Hallo Sarah, thank you for sharing your experience. Very interesting. As i do not have much time to read through comments and other articles, can you please tell me if you are still grain free? I had been on Scd for long, but suffered low energy. When i went back eating starches, it helps with improving energy. But later i find myself having joints problems = stiffness and sore, that i find myself limping, etc... I start to wonder if it is because of grains - I eat gluten free grains, like rice and gluten free flours. thanks, Karin

Sarah Smith said...

No, I'm not grain free anymore. My energy levels are much better if I include potatoes and a small amount of grains in my diet. I do best sticking to millet and true sourdough white bread; whole grains (brown rice and whole wheat), even when soaked or sprouted, make my joints stiff.

Anonymous said...

Thank you for your reply. Can you please advise what one can do about stiff sore joints? How can we rid of it?

Sarah Smith said...

My joint pain was cured through constitutional homeopathic care with an experiened, classically trained homeopath.

Anonymous said...

Just curious. How did you find an experienced classically trained homeopath? Was part of you protocol detoxing metals? It is well known that metals like mercury can poison the thyroid & H P A axis, block absorption of minerals & mimic thyroid hormones. Candida[and other opportunistic microbes] have also adapted to thrive in mercury toxic individuals. This is why you MUST detox the metals or you hit a wall every time no matter what you do.

Unknown said...

Hi! Thought you might be interested since you battle with adrenal (hormonal) imbalances; I stumbled upon Diana Schwarzbein and her books a couple of years ago and they've provided so many answers and explanations to things going on in my body and all these myths and diets in this health era... She talks besides nutrition about the importance of sleep and relaxation, and smart exercise in her books, and how there isn't any magic diet that will cure you, that it is about balance in everything and how our hormones play important roles in our wellbeing and interestingly that you have to be HEALTHY first in order to lose weight, and you can't become healthy by losing weight. Would recommend to read the second and third one, and really can't recommend them enough!! Many things you mentioned that had/hadn't been working for you or things that work now made me think of her books, I think you would find them interesting. Here are some links: and

Sarah Smith said...

Thanks for the recommendations, Irene!

Erin said...

I've struggled to understand where this paleo idea comes from that there existed some primal man who lived in caves and did not cultivate crops. Perhaps it is an atheist thing. From my finding in the Bible, as soon as Adam was kicked out of Eden he was told he would deal with thistles and weeds as he cultivated the ground. There was agriculture in the beginning therefore, and why would one assume they did not grow grains? It was popular during Jesus' day and the eating of grains was not discouraged biblically. Of course modern wheat has been made toxic but the older varieties like Emmer and Einkorn and even rye still contain only 14 chromosomes and at least rye has been studied and shown to turn on numerous anti inflammatory genes within the body. Modern wheat and even spelt have 42 chromosomes (if memory serves). I see the benefit to a low-grain diet utilizing the old varieties properly prepared.

I just don't understand where this non-agriculture man that is being touted by the paleo club comes from, which seems to be the basis for not eating grains? The first man was a farmer, his first son was also a farmer, and so forth. Am I missing something? Do we have actual evidence that Adam did not cultivate grains?

Anonymous said...

Was it that you were sensitive to sunlight or heat? I'm curious because I'm sensitive to heat

Sarah Smith said...

I was (and am still) a bit sensitive to heat, or more specifically to humid heat.

Anonymous said...

The moment you withdrew yourself from eating the wrong foods, you are setting your feet into the right road towards the attainment of your goals.

Read more:

Anonymous said...

I'm not clear on how many carbs you needed to eat to feel right. Ie) 100 grams? 150 grams? Please share :)

Susan said...

I'm curious, did you get a blood workup prior to GAPS? Could the fatigue possibly be related to low iron?

Sarah Smith said...

I did not have a blood workup immediately before GAPS, but I did have one a few months earlier (at my 6-week postpartum visit after having my son) and my iron levels were fine at that time. The fatigue didn't start until I had already been on GAPS for many months, and I would be surprised if my iron levels got lower on GAPS considering the amount of red meat, salmon, and egg yolks that I was eating on GAPS.

Sarah Smith said...

That is highly individual. Some people need more (for instance people who are working out a lot, pregnant, or breastfeeding). Others can do fine with less. It seems like, from all the research I have done, men seem to do better on low-carb for extended periods than do women of childbearing age.

Allan said...

If you have questions on Pigmentation Treatments Delhi:-

Anonymous said...

I am type O blood and have been following a diet even more restrictive than GAPS (an extremely low carb diet to try to heal from SIBO). This diet has caused me to have extreme fatigue (adrenal fatigue). My ND is a SIBO specialist and believes in blood type diets, but my nutritionist also treats a lot of SIBO patients and does not believe in it. I think the verdict is still out!

Anonymous said...

Hi Daleen and Sarah,

I do not follow the GAPS diet, but I follow a very low-carb version of an Autoimmune Paleo, Low FODMAP, no fructose (I have fructose malabsorption) diet (basically, I consume VERY FEW carbohydrates). I am trying to heal from SIBO, but my adrenals and thyroid have taken a huge hit by eating this way (although my digestion feels much better). Within two weeks of beginning this diet, I dropped 10 lbs (down to 103 lbs- I am a 5'4", 22 yr old female). I have now been on this diet for 3.5 months and I just keep getting more and more fatigued. I am leading a very low-stress lifestyle and getting plenty of sleep. My free T3 levels are out of the normal range and continue to drop. My kidney indicators are on the high-end of the acceptable range and my glucose is on the low-end of the acceptable range. A supplement called Metabollic Complex that contains both iodine and thyroid tissue improved my fatigue by 75%, but I think my adrenals keep plummeting because the highest dose that my NDs recommended is no longer enough to combat my debilitating fatigue. Any time I try to introduce a food with even a minimal amount of carbohydrates (such as raspberries, spaghetti squash, etc.), my digestive and leaky gut flare up. I want to combat my SIBO, but not at the expense of my ability to function somewhat normally.

Marsha said...

Early humans ate very little grains - just that which those hunter-gatherers happened upon -- and the grains of today are not at all like the wild ones then. Today's wheat, for instance, has 40 times the gluten that it did just 50 years ago, according to Dr. Perlmutter in "Grain Brain". Grains contain huge amounts of phytates, lectins, and saponins - the plants' defense mechanisms cause intestinal distress thereby discouraging predators from continuing to eat them. Grains, especially wheat, can be very addictive, actually acting upon our dopamine and opiate receptors in our brains, which is why when one first stops eating them one may feel withdrawal symptoms and cravings.

Anonymous said...

Thanks for this post, Sarah. It's been so helpful and exactly what i needed to read. I've been in ketosis for 2 years and 4 months. I've read so many raving reviews of low-carb and now finally somebody can empathize with me. While many, if not all of my digestive difficulties are cleared up, I gained a bad case of fatigue. I think my lymph system is overworked too... my poor skin, mostly on my back and stomach. I wouldn't say i have any another other signs of adrenal exhaustion but i went from being a professional athlete to a professional napper. Tomorrow i am done with ketosis.

Thanks for your blog,

Sarah Smith said...

You're welcome, Alison! I'm glad you found support through reading this article. It can definitely be hard to go against the flow on this; that is what kept me trying even long past the time when my body was telling me it was time to be done with GAPS/low-carb.

Unknown said...

Yes, I think fat is the key to maintaining good strong and consistant energy levels as well as feeling solid and grounded. Fat is a vital nutrient.

Anonymous said...

Hi guys,

I also read another posts that said heavy metals need to be detoxed first.

Well ..

* there's no viable tests to truly detect heavy metals.

* many people get sick when they try agressively detox heavy metals

Plus what if one is ALREADY fatigued and underweight (which ALOT...)
of peoplare who are already stressed out with gut, brain, etc issues.

Any strategies?? Where to start with first to do this SAFELY and get optimal results
Without becoming miserable?

CR said...

Hey there Sarah,

Thank you SO MUCH for this article!

I am a now 29 yo woman who did the GAPS diet for about 18 months about two years ago (at age 26). It had been recommended to me as a way to heal some intestinal bloating/gas and anxiety, as well as to help restore my periods which had been absent (secondary amenorrhea) for 9 years (!), and to prevent developing the colitis that my mother has.

The first few weeks were tough - constipated, low energy, etc., but eventually after about a month, my energy and stools improved, my gassy/bloated feeling disappeared, and I felt like I had a calmer, more steady energy, though it was certainly on the whole - lower than it had been before. (Probably mostly due to lack of grains and coffee, and an underlying adrenal fatigue).

After the first two months though, I think I basically steadily declined in terms of my adrenal health and exhaustion/fatigue/depression. I began to need to spend my days off in bed most of the day. My insomnia increased as well so that I was not sleeping well at night and exhausted all day. I started experiencing periods of constipation and facial puffiness as well.

I'm sure there was an underlying adrenal fatigue issue to begin with which I had been masking by coffee, and I was definitely living a stress-filled lifestyle. However, I think that like you say here, the lack of grains/available glucose probably contributed. I started to CRAVE oats and rice after about 6 months, but held off for another six months, at which point, I introduced them and absolutely loved it!

Because GAPS had not brought back my period, and had probably made my energy issues worse, I started seeing a Chinese medical doctor, who did weekly acupuncture sessions and prescribed Chinese herbs to address all of these issues. This brought back my period! And while it helped my energy, cold hands/feet, these issues were not entirely solved, so I then saw a nutrition doctor (Dr. Kunin who wrote Megahealth and Megahealth for Women and beieves in everyone having a “right amount” of carbohydrates), and started a heavy vitamin supplementation program (heavy on B12, C, D, B complex, E, coQ 10, cod liver oil, etc.).

Now, two years later, I basically eat everything as long as its grass-fed and organic, except refined sugar, flour, caffeine (especially coffee), cheese/milk, and vegetable oils (though I’m a lot less strict on these rules than I used to be… and will eat something small if I really want it – even if it has these things in it), and try to minimize cold/raw foods (per Chinese medicine recommendations). ! On the whole, this is working a lot better for me.
I have also reduced my vitamins significantly – only a multivitamin, coQ10, and turmeric, with an occasional B complex, and take Chinese herbs to strengthen my Spleen and Blood, and support my Liver (reducing Liver Qi Stagnation). I have also continued doing weekly acupuncture sessions, and have started studying acupuncture and Chinese medicine myself because I am totally fascinated.

HOWEVER - I still struggle with my energy - and tend to get bloated before my periods, and exhausted during and afterwards... where I experience some mental fatigue, facial/eye puffiness, and just general body exhaustion. I have decreased my level of physical activity to basically walking and yoga in the mornings and significantly reduced my life stress, but I frequently wonder if that small amount of exercise is still too much! I have probably done 5-7 days of some sort of cardio (used to be running 5 miles… now more like walking 2-3) for the past 18 years.

I read your suggestion to take time entirely off of exercise with great interest (and some definite fear!), and saw your recommendation of Matt Stone's books, which I had not heard of before. I would love to know if you think they would be worth purchasing, and also welcome any other ideas or suggestions you may have! What was it like to stop exercising all together? How did your body react at first? And how did that change over time?

With much gratitude,

Sarah Smith said...

Hi Colleen,
Glad you are finding a path to health, and sorry to hear that you experienced many of the same problems I did while on GAPS. Overall, I have found homeopathy to be much better at leading to long-term health benefits compared to dietary or lifestyle changes. I did like Matt Stone's program at that time, as it did help me jump-start my adrenal recovery, but over time I have found homeopathy to just be better for my and my family.

Regarding exercise: if you watch your waking basal body temperature, you should be able to see if the exercise you are doing is having a detrimental effect or not. At the height of my adrenal issues, I could very well tell that exercise was not helping me as my basal body temperatures would plummet the day after working out. Now, though, I am able to exercise as much as I want with no ill effects, although I never have gone back to the high intensity interval training/crossfit-type workouts I used to do. It just seems somehow pointless to me now, but I do go for walks and hikes, with some sprinting thrown in just because I like running, and can do advanced power yoga classes with no ill effects. Homeopathy has really stabilized my energy levels much better, although I have to assume that doing Matt Stone's program prior to starting my homeopathic treatment likely helped as well.

Anyhow, I hope this helps. If you want to know more about the types of results we're seeing with homeopathy vs diet, there is this article:

CR said...

Dear Sarah,

Thanks so much for your response to my post and sharing the experiences of you and your family! I'm sure I will try homeopathy at some point - it sounds wonderful and very helpful! And would love to hear any suggestions for how to find a practitioner when the time is right!

But for now, I think I'll start with a gentle RRARF... mainly stopping all the low intensity cardio I was doing (even though it was basically just walking at this point with little running intermixed... I think it was sapping my energy at the beginning of each day) and starting each day with a BIG breakfast of Matt's 4 'S's (sugar, starch, salt, saturated fat) in whatever form I most crave at the moment, and then nap or eat when I feel tired... do some yoga/meditation if I feel like it... and whatever else I feel like.. mostly rest. And monitor my BBTs. I was wondering for you how high they got in your follicular vs. luteal phases since Matt's book doesn't go into too much depth on that. Mine seems to be around 97.3-4 for follicular, and bounces around between 98.1 and 98.3 for luteal (using an oral thermometer).

Also - I just read Matt's Diet Recovery 2 book, but was wondering if you'd still suggest reading his other books Diet Recovery and/or Eat for Heat as well? Or some other author entirely? Broda Barnes? I feel like there's some more depth and nuance that I'm interested in learning about to understand what's going on in my body/troubleshooting. I'm definitely experiencing some bloating and indigestion with eating big meals, and wondering if that's really the best way for me to do this.

Many thanks again for all you do!

Sarah Smith said...

Hi Colleen,
I'm not sure exactly what my basal temps were, and I don't have them written down and haven't tracked them now in several years (since I no longer need to). I'm not sure which other books to recommend to you, as I didn't read many others. Once we started homeopathic treatment, a lot of this dietary stuff just leveled out and I didn't need to keep worrying about it.

If it helps, though, I did write a series of posts about my experiences with RRARFing here:

My chronic homeopathic treatment started a few months after the second of those posts, so it has now been almost 5 years and has worked amazingly well, with steady incremental progress all along the way. My energy levels have now been stable for a few years, I haven't had any joint pain in years (minus one random day last year), and my menstrual cycle has been pretty consistent at 25-26 days for the last few years as well. Exercise no longer causes me any mood/energy issues at all, and hasn't for at least a couple years.

I hope this helps, and let me know if you need any more information,