GUT AND PSYCHOLOGY SYNDROME
by Dr. Natasha Campbell McBride
GAPS - what is it? Learn about the condition which is behind many mental
and physical problems, which our children and adults suffer from.
Gut and Psychology Syndrome (GAP
Syndrome or GAPS) is a condition, which establishes a connection between the
functions of the digestive system and the brain. This term was created by Dr
Natasha Campbell-McBride, MD, MMedSci (neurology), MMedSci (human
nutrition) in 2004 after working with hundreds of children and adults with
neurological and psychiatric conditions.
We live in the world of unfolding
Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder
(ADHD/ADD), schizophrenia, dyslexia, dyspraxia, depression, obsessive - compulsive disorder, bi-polar disorder and other neuro-psychological and
psychiatric problems in children and young adults are becoming more and more
In clinical practice these
conditions more often than not overlap with each other. A child with autism
often is hyperactive and dyspraxic. There is about 50% overlap between dyslexia
and dyspraxia and 25-50% overlap between hyperactivity and dyslexia and
dyspraxia. Children with these conditions are often diagnosed as being depressed
and as they grow up they are more prone to substance abuse or alcoholism than
their typically developing peers. A young adult diagnosed with schizophrenia
would often suffer from dyslexia, dyspraxia or/and ADHD/ADD in childhood.
Schizophrenia and bi-polar disorder are often described as two sides of one
coin. We have created different diagnostic boxes to fit our patients in. 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
When we examine these patients in
a clinical setting, we find that apart from so-called mental problems, they are
also physically very ill. Digestive disorders, malnourishment, allergies,
asthma, eczema, chronic cystitis, thrush and fussy eating habits are a
consistent part of the picture.
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 of
genetics there is something very important the parents, mother in particular,
pass to their child: their unique gut micro-flora. 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. It is a highly
organised 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. 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
or neurological and psychiatric conditions in children, a typical health picture
of these children's mums has emerged.
A typical modern mother was probably not 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 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 the gut
flora, because they wipe out the beneficial strains of bacteria in the gut. 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 foods
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. The most common health problems in mothers are digestive
abnormalities, allergies, auto-immunity, PMS, chronic fatigue, headaches and
A baby is born with a sterile
gut. In the first 20 or so days of life the baby's virgin gut surface gets
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.
Where does this gut flora come from? Mainly from the mother.
So, whatever microbial flora the mother has she would pass to her new-born
Gut flora is something we do not
think much about. And yet the number of functions the gut flora fulfils is so
vital for us that if some day our digestive tract got sterilised we probably
would not survive.
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. 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. The most common deficiencies, recorded in these
patients, are in magnesium, zinc, selenium, copper, calcium, manganese, sulphur,
phosphorus, iron, potassium, vanadium, boron, vitamins B1, B2, B3, B6, B12, C,
A, D, folic acid, pantothenic acid, omega-3, 6, 9 fatty acids, taurine, alpha-ketoglutaric
acid, glutathione and many other amino-acids. This usual list of nutritional
deficiencies includes some most important nutrients for normal development and
function of the child's brain, immune system and the rest of the body.
Apart of normal digestion and
absorption of food healthy gut flora actively synthesises various nutrients:
vitamin K, pantothenic acid, folic acid, thiamine (vitamin B1), riboflavin
(vitamin B2), niacin (vitamin B3), pyridoxine (vitamin B6), ciancobalamine
(vitamin B12), various amino-acids and proteins. Indeed, when tested people with
gut dysbiosis always present with deficiencies of these nutrients. Clinical
experience shows that restoring the beneficial bacteria in their gut is the best
way to deal with these deficiencies.
The majority of children and
adults with neurological and psychiatric conditions look pale and pasty. When
tested they show various stages of anaemia, which is not surprising. To
have a 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 cannot absorb these
nutrients from food, but their own production of many of them in the body is
damaged. 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
anaemia. To treat anaemia the person requires all the nutrients we have
mentioned, many of which healthy gut flora supplies.
Apart from taking a direct 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 a lot of anti-bacterial, anti-viral and anti-fungal substances. At the
same time they provide the gut lining with nourishment. It is estimated that 60
- 70% of energy, the gut lining derives, is from the activity of bacteria,
which live on it. So, it is no surprise that when the gut flora is abnormal the
digestive tract itself cannot be healthy. Indeed most children and adults with
learning disabilities, psychiatric disorders and allergies present with
digestive problems. In many cases these problems are so severe, that the
patients (or their parents) talk about them first. In some cases they may not be
very severe, but when asked direct questions the parents describe that their
child never had normal stool, that their child suffered from colic as a baby and
that tummy pains, bloating and flatulence are a common part of the picture.
Adult sufferers describe the same kind of symptoms. In those cases where these
children and adults have been examined by gastro-enterologists inflammatory
process in the gut was found along with faecal compaction and an over-spill
syndrome. Dr. Andrew Wakefield and his team at the
in the late 90s found an inflammatory condition in the bowel of autistic
children, which they have named Autistic Enterocolitis. Schizophrenic patients
were always known to have serious digestive problems. Dr. Curtis Dohan, MD has
devoted many years to researching digestive abnormalities in schizophrenia. He
found a lot of similarities between coeliac disease and the state of the
digestive tract in schizophrenics. Indeed, in my clinical practice long before
these patients develop psychotic symptoms they suffer from digestive problems
and all other typical symptoms of gut dysbiosis pretty much from the start of
their lives. Children and young adults with ADHD/ADD, OCD, depression and other
neuro-psychological problems are very often reported to suffer from digestive
symptoms of gut dysbiosis do we know?
Well-functioning gut flora is the
right hand of our immune system. The beneficial bacteria in the gut ensure
appropriate production of different immune cells, immunoglobulins and other
parts of the immunity. But most importantly they keep the immune system in the
right balance. What typically happens in a person with gut dysbiosis is that two
major arms of their immune system Th1 and Th2 get out of balance with
underactive Th1 and overactive Th2. As a result the immune system starts
reacting to most environmental stimuli in an allergic or atopic kind of way.
A baby is born with an immature immune system. Establishment of healthy balanced
gut flora in the first few days of life plays a crucial role in appropriate
maturation of the immune system. If the baby does not acquire appropriate gut
flora then the baby is left immune compromised. 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. 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 throats 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 most cases vaccines deepen the damage to the
immune system and provide a source of chronic persistent viral infections and
autoimmune problems in these children. There has been a considerable amount of
research published into the state of the immune system in children and adults
with learning disabilities and psychiatric problems. The research shows deep
abnormalities in all major cell groups and immunoglobulins in these patients.
The most common autoantibodies found are to myelin basic protein (MBP) and
neuron-axon filament protein (NSFP). These antibodies attack the person's
brain and the rest of the nervous system.
So, the modern patient (child or
adult), who we are talking about, did not get normal gut flora from the start
and then got it damaged even further by repeated courses of antibiotics and
vaccinations. As a result these children and adults commonly suffer from
digestive problems, allergies, asthma and eczema. But apart from that in people
who then go on to develop neurological and psychiatric problems something even
more terrible 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 of the patient and grow large
colonies. Two particular groups which are most commonly found on testing are
yeasts (including Candida species) and Clostridia family. These pathogenic
microbes start digesting food in their own way producing large amounts of
various toxic substances, which get absorbed into the blood stream, carried to
the brain and cross the blood - brain barrier. The number and mixture of
toxins can be very individual, causing different neurological and psychiatric
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.
kind of toxins 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.
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. 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, which would impair 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 behavioural
abnormalities and many other problems.
Acetaldehyde is considered to be
the most toxic of alcohol by-products. It is the chemical, which gives us the
feeling of hangover. Anybody who experienced a hangover would tell you how
dreadful he or 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. Children and adults with neuro-psychiatric problems are commonly
found to have antibodies against their own tissues.
There are about 100 different
Clostridia species known so far. They are present in the stools of people with
autism, schizophrenia, psychosis, severe depression, muscle paralysis and muscle
tonus abnormalities and some other neurological and psychiatric conditions. Many
Clostridia species are normal inhabitants of a human gut. For example
Clostridium tetani is routinely found in the gut of healthy humans and animals.
Everybody 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, which we are talking about, do not have a healthy gut wall. In gut
dysbiosis this powerful neurotoxin can get through the damaged gut lining and
then cross the blood-brain barrier affecting the person's mental development.
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 number of autistic children, who showed serious
improvements in their development and biochemical tests while on anti-Clostridia
medication. Unfortunately, as soon as the medication was stopped the children
slipped back into autism, because these children do not have healthy gut flora
to control Clostridia and not to allow their toxins through the gut lining into
the bloodstream. In many cases Clostridia were not identified in the stools of
these children, because Clostridia are strict anaerobes and are very difficult
to study. We need to come up with some better ways of testing for these potent
Yeasts and Clostridia have been
given a special opportunity by the era of antibiotics. Broad-spectrum
antibiotics do not touch them while killing the beneficial bacteria in the gut,
which are supposed to control the yeasts and Clostridia. So, after every course
of antibiotics these two pathogenic groups get out of control and overgrow. The
patients that we are talking about usually are exposed to numerous courses of
antibiotics pretty much from the beginning of their lives.
& Casomorphins or opiates from gluten and casein.
Gluten is a protein present in
grains, mainly wheat, rye, oats, barley. Casein is a milk protein, present in
cow, goat, sheep, human and all other milk and milk products. In the bodies of
children and adults with autism and schizophrenia these proteins do not get
digested properly due to the fact that their digestive systems are full of
abnormal microbial flora and hence unhealthy. As a result of misdigestion
gluten and casein turn into substances with similar chemical structure of
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 and autistic children.
Incidentally, these substances were also found in patients with depression and
rheumatoid arthritis. These opiates from wheat and milk get through the
blood-brain barrier and block certain areas of the brain, just like morphine or
heroin would do, causing various neurological and psychiatric symptoms. Based on
this research the gluten and casein free diet (GFCF diet) has been developed.
These are two frightening toxic substances with opiate structure, which have
been found in autistic children by a biochemist Alan Friedman, PhD. Dermorphin
and deltorphin were first identified on the skin of a poison dart frog in
. Native people used to dip their darts into the mucous on these frogs in order
to paralyse their enemy, because deltorphin and dermorphin are extremely potent
neurotoxins. Dr Friedman believes that it is not the frog that produces these
neurotoxins, but a fungus, which grows on the skin of this frog. It is possible
that this fungus grows in the gut of autistic children, supplying their bodies
with dermorphin and deltorphin.
now in many laboratories around the world identify various metabolites of
microbial activity in the gut, which get absorbed and finish up in the
patient's urine. Many of these metabolites are highly poisonous substances.
Sulphate is a common
picture in these patients, which is an indirect indication of toxicity in the
body, because sulphates are essential for many detoxification processes and
normal metabolism of brain neurotransmitters. In many cases the person may be
getting plenty of sulphates through the diet, but they all get consumed by the
detox pathways struggling with the river of toxicity, which is constantly coming
from the person's gut. At the same time another large group of bacteria, which
commonly overgrow in the gut dysbiosis situation are sulphate-reducing bacteria,
which make sulphur unavailable for the body to use. These bacteria metabolise
sulphate coming from food into sulphites, many of which are toxic like hydrogen
sulphide for example, which is the gas with rotten egg smell. Some parents of
autistic, hyperactive and other children tell me that their child's stool has
this characteristic smell.
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. The toxicity, which is produced by the abnormal
microbial mass in these people, establishes a link between the gut and the
brain. That is why I have grouped these disorders together and gave them a name:
the Gut and Psychology Syndrome (GAP Syndrome). The GAPS children and adults can
present with symptoms of autism, ADHD, ADD, OCD, dyslexia, dyspraxia,
schizophrenia, depression, sleep disorders, allergies, asthma and eczema in any
possible combination. These are the patients who fall in the gap in our medical
knowledge. Any child or adult with a learning disability, neurological or
psychiatric problems should be thoroughly examined for gut dysbiosis.
Re-establishing normal gut flora and treating the digestive system of the
patient has to be the number one treatment for these disorders, before
considering any other treatments with drugs or otherwise.
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." Long before him Hippocrates
(460-370 BC), the father of modern medicine has said: "All diseases begin in
the gut!" The more we learn with our modern scientific tools, the more we
realise just how right they were!
article is published o
nline at GAPS.me
Campbell-McBride graduated with Honours as a Medical Doctor in 1984 from
Bashkir Medical University in Russia. In the following
years she gained a Postgraduate MMedSci Degree in Neurology and completed a second Postgraduate Degree in Human Nutrition at
Sheffield University, UK. Having
treated her son off the autistic spectrum, Dr. Campbell-McBride returned to practice in 2000 and runs the Cambridge Nutrition Clinic.
She has specialised in using nutritional approach as a treatment, and
has become recognised as one of the world's leading experts in
treating children and adults with learning disabilities and other mental
disorders, as well as children and adults with digestive and immune
To learn more about Gut and
Psychology Syndrome, how it develops and how to treat it effectively with a
sound nutritional protocol please read Dr Campbell-McBride's book "Gut
and Psychology Syndrome. Natural treatment for autism, ADHD/ADD, dyslexia,
dyspraxia, depression and schizophrenia"
Gut and Psychology Syndrome is 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.