Guest Post: Dr. Judy Tsafrir Boston MA GAPS Practitioner ~ Training with Dr. Natasha

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Dr. Judy Tsafrir, Holistic Adult and Child Psychiatrist Click here to listen to my Blog Talk Radio interview with Dr. Judy Tsafrir.

Today I am thrilled to share a guest post with you from Dr. Judy Tsafrir who recently became one of “Dr. Natasha's Army” by becoming a certified GAPS Practitioner at Dr. Natasha Campbell-McBride's GAPS Practitioner's Training held in New York.  Dr. Tsafrir is a holistic adult and children's psychiatrist and has been doing the GAPS diet herself for several months.  Her office is located close to Boston, Massachusetts.  And now without further adieu I give the floor to Dr. Tsafrir.

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During the final weekend in September I attended a very stimulating GAPS Practitioner’s Training workshop on Long Island with 40 other health care practitioners.  I was one of 4 physicians: 2 neurologists, one pediatrician, and me. (I am an adult and child psychiatrist). The majority in attendance were chiropractors, naturopaths, nutritionists, occupational therapists, acupuncturists, i.e. alternative health care practitioner types.

Since mid-September Dr. Campbell-McBride has been traveling around the USA doing two day workshops in Chicago, Seattle and New York. She is planning one more training this year following the Weston A. Price Wise Traditions conference in Dallas in November. Ultimately at the end of her tour, there will be 120 trained GAPS practitioners in the USA.

GAPS (Gut and Psychology Syndrome) was originally designed as a self-help program, but Dr. Natasha felt that some people have had a need for assistance from a qualified professional, and thus conceived of the GAPS Training Program for Practitioners. The demand for her services at her clinic in Cambridge, England is overwhelming, and she cannot accommodate all the people who seek her help from around the world. She conceived of the GAPS Practitioner Training to provide the needed service, as well as to take her work, message and method of healing out into the world.

She described to us how she conducts a consultation in her clinic. When she sees a new patient, she leaves an entire morning free.  Her philosophy is that a patient should be given all the time they need to tell their story and to relay everything that might be on their mind. She allows them to talk until they have completely said all they have to say. “Until they are completely drained.” She noted patients’ gratitude and relief to have someone finally really listen to them. It is often the first time in their life. It is up to the patients how much of her time they would like to have, and she charges by the hour.

She then does a brief physical examination, and lastly gives the patient feedback about how she understands the cause of their condition, and what she proposes as a treatment plan. In 2 weeks time they receive a long very detailed report from her with all her specific treatment recommendations for their diet, recipes, instructions for supplementation, behavioral programs for children, and detoxification measures. She does not automatically schedule a follow up meeting. Her feeling is that her services are expensive for some people, and some prefer to try and manage on their own. Many people do, however, schedule follow-ups, and she sees some patients for years.

Dr. Campbell-McBride also runs groups for her GAPS patients. These two hour group meetings consist of a didactic portion where she gives a 30 minute lecture on some aspect of GAPS with a question and answer period, a time for news where people update one another on their progress and/or setbacks, and then a sharing of a GAPS recipe and a cooking demonstration. At the end of the meeting members individually privately briefly check in with her to ask personal questions. Patients find these group meetings very supportive and it provides an affordable format for ongoing contact with Dr. Campbell-McBride, and for them to avail themselves of her expertise.

One of the things that I learned during the weekend that surprised me was that for most patients, Dr. Campbell-McBride does not recommend starting with the Introductory Portion of the diet. She said that unless a patient has diarrhea, there is no need for that. I have been doing GAPS myself for the past 6 months, and I stayed on the Intro Diet for about 6 weeks or so, even though I did not have diarrhea. I thought I was supposed to. I put myself though that for nothing!

Similarly, so far I have prescribed GAPS for 5 patients in my private practice of psychiatry. These are all people with mood and anxiety disorders. None of them had diarrhea, and I unfortunately told them all to start with the Introductory Diet and to stay on it for at least a month*. It was unnecessarily restrictive and depriving. Now I know better.

I asked Dr. Campbell-McBride that if someone was on the GAPS diet for several years and they resolved all their symptoms, healed and sealed their gut, and strengthened their immunity, would it be possible that they still nevertheless could suffer from a specific food allergy, such an egg allergy. She said “Absolutely”. I felt fascinated and surprised when she said that the unresolved allergy might be due to a worm or a fluke. I never considered that a food intolerance could be caused by a parasite.

There is much to learn about treating patients with GAPS. Dr. Campbell-McBride has vast experience with a huge variety of psychiatric, neurologic, immunologic, dermatologic, and rheumatologic conditions. I have only treated garden variety anxiety and mood disorders with the GAPS healing protocol so far, but these handful of patients all feel much better. Several have been able to come off their anti-depressants and mood stabilizers. That is very exciting for me and for them! I am looking forward to trying to help patients with other types of symptoms. I believe GAPS is a very powerful methodology, but some patients are just not up for it. They cannot imagine giving up their favorite dishes, having only homemade food and eating bone broth and fermented vegetables. Even though they feel sick and tired on their psychiatric medications, they will still not even consider it. No way.

I have a blog on my website and I am planning to often write about GAPS topics. I invite all of you to subscribe. I will be eager to read the comments of people who are doing GAPS and learn from you about your experiences.

Dr. McBride plans to have a section on her website for practitioners to share their experiences and to ask each other questions. There is still so much to learn and we can all contribute to expanding our knowledge and understanding by communicating with each other. It is totally awesome that there is now a method for helping people with health problems for which conventional medicine has had nothing useful to offer. Hope is a huge blessing and even better, effective help is finally available for many who have been suffering miserably for years.

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Thank you Dr. Tsafrir for that interesting look into the day with Dr. Natasha.  I totally love what you said on your blog post about the experience and how you described Dr. Natasha “At the end of the workshop, she gestured to us with a sunny smile on her face and lightheartedly said ‘You are my army'.”

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*Dr. Tsafrir and I emailed just a bit about what Dr. Natasha said about a person not needing to do introduction unless they have diarrhea.  On Dr. Natasha's website she says:

Those without serious digestive problems and food intolerances can move through the Introduction Diet quite quickly. However, please do not be tempted to skip the Introduction Diet and go straight into the Full GAPS Diet, because the Introduction Diet will give your patient the best chance to optimize the healing process in the gut and the rest of the body. I see cases where skipping the Introduction Diet leads to long-term lingering problems, difficult to deal with.

I have always felt a little bit uncomfortable with this snippet from Dr. Natasha's website, because I personally tend to recommend that people start with full GAPS, and then move to Introduction when they are accustomed to the new routine of cooking all meals from scratch, sourcing the foods, etc., etc. I have always wondered if it was out of line for me to recommend full GAPS first, then intro.  In fact I had submitted a question to Dr. Natasha's FAQs to ask if it was okay to make this recommendation.   Now it appears that it is okay for people to do full GAPS first, and only full GAPS.  I feel conflicted!

I can tell you that I have seen many many people come through on the Yahoo Groups GAPShelp list and admit that they saw more improvements and more healing after doing Introduction.

So, maybe Dr. Natasha will address my question in the FAQS eventually when she has more time and we'll see what she has to say.  I don't want to be giving out wrong information!  🙂

UPDATE: Dr. Natasha has responded to my question on her FAQ page:

Question: I know you say we should not skip introduction, but can you clarify for us if it is OK to do the Full GAPS Diet first and then do Intro after a few weeks of transitioning the body to lower carbohydrates, lower fibre, higher fats and the addition of probiotics?

Answer: Absolutely! Some people start from the Full GAPS Diet, and then later on, if there is a need, they do the Introduction Diet. Some people, particularly those without severe digestive symptoms, never do the Introduction Diet; they get well with the Full GAPS Diet alone. It is very individual. Generally, the Introduction Diet should be followed if there is diarrhoea, other serious digestive problems and food intolerances. Children and adults with severe learning disabilities do well on the Introduction Diet. But if we have an adult without much digestive trouble, and who finds it difficult to change their diet at all, they often start from the Full GAPS Diet. An adult with chronic persistent constipation usually does well starting from the Full GAPS Diet; later on many of them find it very useful to do the Introduction Diet, when they are mentally ready for it.

Thank you again, Dr. Tsafrir for sharing with us today.

 

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9 comments to Guest Post: Dr. Judy Tsafrir Boston MA GAPS Practitioner ~ Training with Dr. Natasha

  • Very interesting! Thanks for sharing. I too wondered about that part…that doing full GAPS before intro could cause problems. I do have digestive issues, but not diarrhea. Wonder if I should do intro at some point or not. I’m doing a modified intro right now…not full out since I’m breastfeeding. I’ll be anxious to hear what you find out.

    [Reply]

  • Emily

    Thank you, Starlene and Dr. Judy for this informative post.

    I am pleased to share that I too am among the new GAPS Practitioners in Dr. Natasha’s “army” and completed the first training with her in Seattle.

    In regards to the confusion about Intro…I referred back to my notes from the training… perhaps it will help shed some light.

    According to my notes, here is a list of who needs to start at Full GAPS and skip Intro:
    – those without serious GI symptoms
    – those who have chronic constipation
    – adults with endocrine, autoimmune and mental illnesses, and food allergies (if no GI symptoms present)
    – those with busy, stressful lifestyles that involve a lot of travel and little time (allow them to try Full and ease toward Intro in their own time)
    – Older children without severe GI problems
    – those who are hesitant about starting the diet and more likely to try Full GAPS (with possibility moving into Intro)

    Hope this helps and I look forward to hearing the final word from Dr. Natasha too!

    Health to all!

    [Reply]

    Starlene Reply:

    @Emily, thank you very much for sharing your notes with us, this helps! Did you get the impression she meant to skip intro altogether? Because on a couple of those she does indicate doing intro at some point in time. Thank you again. Starlene

    [Reply]

  • Emily

    Glad its of help, Starlene!

    I got the impression she meant to skip intro altogether, unless they had symptoms indicating a need for Intro, yet were hesitant or had a fast-pace lifestyle, in which case that would be based on that individual’s unique symptoms.

    For example, a Business Executive who has IBS but is too busy to implement Intro could start with Full GAPS. Then if they are able to get acquainted with the diet enough to where they are able implement Intro, they could do so. A busy Business Exec with chronic constipation, however, could start on and stay on Full GAPS since Full GAPS is indicated for severe constipation.

    Also, I found in my notes where it details WHO NEEDS INTRO:
    – Anyone with chronic diarrhea
    – Anyone with GI illness (Crohn’s, Colitis, Celiac, IBS, or other IBDs)
    – Anyone with autism
    – Those with Type 1 Diabetes (not type 2)
    – Those with severe learning disabilities
    – Anyone with severe food allergies/food intolerances
    – Anyone with diarrhea brought on from travel, flu, virus or a “tummy bug”

    [Reply]

    Starlene Reply:

    @Emily, thank you again for the clarification… I’m sorry but could you clarify one more thing. In your first comment you said “adults with endocrine, autoimmune and mental illnesses, and food allergies (if no GI symptoms present)” as people who need to start at full GAPS and skip intro. But in this comment you said “anyone with severe food allergies/food intolerances” NEED INTRO. Can you clarify that point? We in the trenches have been under the impression due to what Dr. Natasha says on her site, and also from repeated experience, that *everyone* benefits from Introduction as an opportunity for the gut to get a jump start on healing. Although as I said I usually recommend that people do full GAPS first, and then intro at some point when they feel ready. On the GAPShelp list, again and again I’ve seen people doing full GAPS and see more healing once they do intro.

    [Reply]

    Emily Reply:

    @Starlene,

    Sure Starlene, happy to clarify as best I can.

    I see how confusing it can be!

    Its my understanding that the difference lies in the level of “severity” of the food allergies/intolerances. I think “severe” is the key word there. If food allergies and overall symptoms are “severe” then Intro is needed. It was also my impression that children are more likely to need Intro than adults with conditions listed above.

    As both a GAPS Practitioner AND a GAPS patient myself, it is my sense that Intro is beneficial for most too, like you said, as a jump-start to heal and seal the gut, and that in most cases, its beneficial to do it when the person is open to it and able to start it right off. One main exception was for those with severe constipation to start Full GAPS, as too much broth and whey would further contribute to constipation.

    These are all general guidelines and like Dr. Natasha said, its important to consult with someone IN DEPTH to completely understand their unique case and determine what is best for that individual. Having a thorough evaluation may be necessary for some to be certain of where to start, and thank goodness we now have GAPS practitioners to help facilitate and clarify the journey!

    Those interested can visit the GAPS Practitioner page on http://www.gaps.me to find someone in their area. They are in the process of starting to add names of graduates and will complete the list over the next few months.

    And again, you may want to ask Dr. Natasha to get it straight from her, as these are my impressions based on my training and personal experience.

    Health to you!

    [Reply]

    Starlene Reply:

    @Emily, thank you for clarifying your answer. I was wondering if “severe” had something to do with it. Thank you again and I wish you great success!

  • Lene

    I have started on the intro diet because I assumed my swollen eye lids and increase of eczema on my forearms every time I try to eat healthy was a food intolerance. Now I am starting to think that maybe it is only detoxification.

    How long can I expect this detoxification to last and do you recommend the intro diet for me or should I do a full gaps diet?

    [Reply]

    Starlene Reply:

    Hi @Lene, oh boy. Well, first off I’m not a GAPS practitioner… so my next thought be to suggest joining the GAPShelp group and asking there. It could very likely be detoxification and you might need to push through and see what happens. Have you read Dr. Natasha’s white paper Food Allergies? http://www.gaps.me/preview/?page_id=344 It might help you sort out if you have food intolerance or if it is just detox. Also, Dr. Natasha answers a question similar to yours in her FAQs: 1. How do I tell whether a reaction to food means “back off of this food” or a die-off that means “go slowly but go ahead”? For example, when I introduced yoghurt both my son and I got eczema. I though it meant that we needed to stop dairy, but you told me to “push through” – and sure enough, after a while eczema did resolve?

    There are two reasons for reacting: damaged “leaky” gut wall and “die-off”. Damaged gut wall allows through partially digested foods which cause reactions. If the reaction is very severe and you know which particular food you have reacted to, avoid that food for a few weeks, then try to eat a tiny amount. If you still react, again wait for a few weeks and try again. As your gut wall starts healing, the food in question will get the chance to be digested properly before absorbing and the reaction will disappear. In order to heal and seal the gut lining follow the GAPS Introduction Diet. This also applies to phenols and salicylates in foods (please read more about that in the GAPS book). In the case of probiotic foods, such as yoghurt and kefir (they are the first dairy we introduce on the Introduction Diet) most reactions are “die-off”. It means that the beneficial microbes in the probiotic food are killing the pathogens in your gut; when those pathogens die, they release toxins which cause unpleasant symptoms – a “die-off reaction”. It is important to control this reaction by introducing probiotic foods gradually starting from small amounts. The introduction process is always individual: some people sail through it, others take a very long time to introduce a few teaspoonfuls of yoghurt or kefir. HTH, Starlene

    [Reply]

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