Autoimmune Diet Comparison: Paleo, Primal, SCD, GAPS

Don’t lie.  When you first heard of the “caveman diet”, you scoffed didn’t you?  Or perhaps you grunted a little.  Sure sounded like another fad diet.  I personally would’ve picked the name “Encino Diet” to make it more competitive with Atkins, but hey caveman marketing is a bit primitive.

Fortunately for us, this doesn’t appear to be a scam.  Many patients with autoimmune or autoimmune-like conditions seem to benefit by changing to a diet based on evolutionary principles.  No doubt you’ve hemard of some of the most popular ones: Specific Carbohydrate Diet (SCD), Paleo, Primal, GAPS, and more.  There are a ton of resources out there on each diet, so I’ll focus on the main differences between these 4 most popular diets & delve into success metrics, where available, rather than the details of each diet.

Yo McFly I’m borrowing the DeLorean to take a closer look at these dietary blasts from the past:

1) Paleo Diet, aka the Stone Age Diet

By far the most popular one, led by Loren Cordain & Robb Wolf.  The focus is on all-natural (i.e. grass fed) animal fats and natural fats (ghee, avocado etc), and of course, no carbs. (Update: starchy root vegetables, white rice, and other starches without antinutrients are allowed according to some Paleo expert)  The basic tenet is that we’re simply not evolved to optimize digestion and absorption of agricultural products.

Success: There are no controlled studies on this diet yet, but lots of >90% success rates reported by various doctors internationally.  Dr. Jean Seignalet in France conducted a trial on autoimmune patients, with success being defined as 50% reduction in symptoms, and here are the results:

Rheumatoid arthritis: 200 (sample size), 80% (success rate)
Lupus: 13, 100%
Multiple Sclerosis: 33, 97%
Fibromyalgia: 41, 97%
IBS: 220, 98%
Crohns: 40, 100%
Chronic Fatigue Syndrome: 11, 85%

– http://paleozonenutrition.com/2011/04/01/dr-jean-seignalet-ancestral-diet-and-auto-immune-disease-trials/

(Note: I left out some illnesses that aren’t the focus of our blog.)

2) Primal Diet

Mark Sisson is the main proponent.  Basically the same as Paleo except it allows full-fat dairy.  According to Mark’s pictures, shirts should also be avoided:

Chronically Ill Patients First Look at Primal Diet

Wouldn’t mind having that body though!

Chris Kresser is another big proponent of Paleo that has incorporated dairy such as grass-fed butter and kefir into his protocol with much success.  He talks about not tolerating more than a teaspoon of kefir at first, but slowly building up to pints a day.  I’ve heard similar stories from ME/CFS patients that benefit from fermented dairy.  His theory is that taking probiotics via kefir actually changes your microbiota or gut flora to allow your gut to tolerate dairy.

Success: I couldn’t track down any statistics specific to the Primal Diet, but due to its similarity to Paleo I would imagine if you could tolerate dairy, the statistics for Paleo might be a good reference.

3) Specific Carbohydrate Diet

This was developed by Sydney Valentine Haas, MD.  At first glance it sounds like a low-carb diet, but the basic tenet is actually that carbs feed overgrowth of yeast & bacteria in the gut, so limit both the amount & types of carbs to well-absorbed.  The major difference from Paleo: legumes such as beans are allowed, and like Primal, dairy is allowed.

Success:

“Proponents of the diet claim there is an 80% recovery rate for Crohn’s disease and a 95% recovery rate for diverticulitis.” – http://altmedicine.about.com/od/popularhealthdiets/a/specific_carb.htm

“According to ARI, 71% of parents say SCD is beneficial for their child.”  http://www.nourishinghope.com/page.php?f=u

And most impressive, results of a pilot study done on Irritable Bowel Syndrome:

“Notably, 9 out of 11 patients were able to be managed without anti-TNF therapy, and 100% of the patients had their symptoms reduced. ” http://crohnsdad.com/2012/01/13/ibd-pilot-study-using-diet-based-on-scd-shows-100-success-rate/

4) GAPS Diet:

Based on the SCD diet, and developed by Dr. Natasha Campbell-McBride.  The main difference from the other diets is the focus on  healing the gut, as opposed to just feeding it foods that are optimally digested & absorbed.  Main difference from SCD:

emphasis on bone broth and fermented foods, less beans, gradual implementation of dairy casein to tolerance starting from Ghee (which has virtually no lactose).

Update: I previously wrote GAPS was recommending vegetarian diets now, but I couldn’t verify this.

Success: Because this diet’s the newest of the list, statistics are lacking so far.  In my personal opinion, based on what we know about leaky gut though, the use of bone broths to provide easily-absorbed nutrition and seal the gut en route to building tolerance of fermented products makes this diet especially appealing for severe LGS.

Final Thoughts:

There is far more similarity within these diets than there is different.  GAPS was mostly developed as an improvement to SCD, and Primal was mostly developed as an improvement to Paleo.  In the end, many practitioners agree that ultimately an elimination diet where you eliminate a food for 30 days and then add one thing in at a time (and monitor how you feel) is the way to figure out which foods and amounts of those food your body reacts to.

  • http://thepaleocookbooks-review.weebly.com/index.html Sherri

    Interesting to read the descriptions of these similar diets. . . and now I realize I’m more of a Primal woman than I am a “cave woman” because while I love eating Paleo, I just can’t give up my cheese!

    • http://www.healclick.com/ Joey Tuan

      Oops I meant to reply to you:

      Hehe Sherri.  A lot of people can’t!  Have you read this:  http://www.cheeseslave.com/gaps-diet-myths/

  • mjj

    Can you share where you read that GAPS is encouraging vegetarianism instead of heavy meat? I have never once read that, and it is always quite the opposite. Is that a typo?

    • http://www.healclick.com/ Joey Tuan

      Hi mjj,
      You may be right.  I couldn’t verify the source on that, so I deleted that line.  Thanks for letting me know about this! 

      • http://SaveOurSanity.net Linda

        Joey, [this is probably not the right place to post this so please add these comments wherever you see fit. I hope it’s not the round file…]
        It would be extremely helpful for people to take a second look at Vitamin D supplementation. Scientists have found that there is indeed a strong correlation between a low level of vitamin D and disease. But they are only assuming that this is a vitamin D deficiency which is causing disease. Scientists such as Trevor Marshall, PhD are saying that it’s just the opposite! -that a low level of D is caused by a bacterial infection and that these bacteria feed on vit D. In other words, the more you take in supplemental vit D, the more you are feeding the enemy. The enemy will eventually win the war, meaning that you will be dead, but not until you’ve suffered a great deal with “autoimmune” disorders such as lupus, sarcoidosis, Lyme, ALS, or psychiatric problems, etc.

        BTW, “autoimmune” disorders, it turns out, are not really the immune system attacking its own body’s tissues. The immune system is attacking “stealth” or “L-form” bacteria that was, until now, hidden in those tissues. Now, with this knowledge and the right medical treatment, people are recovering from “autoimmune” diseases incuding lupus and Lyme. “Stealth” or “L-form” bacteria LOVE vitamin D. I avoid D like the plague.
        I know this all sounds controversial but if you read the research, you’l see that it’s solid.

  • http://twitter.com/BottomlessHeart BottomlessHeart

    I haven’t tried any of the diets mentioned here, but I had a lot of success reducing my fibro symptoms when I could afford to eat organic.  I was also avoiding prepackaged, convenience, junk and fast foods and having 3 days each week without meat.  It wasn’t just diet though, it also included lifestyle changes such as learning, and using, stress reduction techniques.

    I had done a lot of research into toxins/chemicals (especially the bio-accumulative class) and their affects on the endocrine system and health and my research fueled the changes in my diet.

    Now that I no longer have a home with a garden and am living on foodstamps, it’s not possible, financially, to eat only organic.  But I try to buy organic staples (brown rice, legumes, flour, etc) to make my own mixes and/or cook from scratch. I use the Environmental Working Groups Clean 15 and Dirty Dozen lists when choosing non-organic fruits & veggies – and a few other things I’ve learned along the way.

    I managed for three + years without medication for my fibro, arthritis, neuralgia, disintegrative disc disease and several non-visible disabilities that cause symptoms/pain.  And even now, I am managing with only one medication. 

    Now I’m wondering if, perhaps, the benefits of the diets mentioned here (for those without food allergies or reactions anyway) could exist because of the absence and/or reduction in the consumption of toxins and chemicals rather than just the types of foods allowed…

    • http://www.healclick.com/ Joey Tuan

      Hi there!

      You make a great point.  I’ve wondered that myself to.  Some of the paleo advocates counter that, even though some people appear to tolerate legumes and say brown rice (perhaps due to epigenetic expression of our genes) that doesn’t negate the body of research showing there’s anti-nutrient qualities to the bran in brown rice which makes it inoptimal from a digestion standpoint. 

      Ultimately, I think trialing with different diets is the only way to see what’s optimal, rather than just what helps us feel better from our worst.  I’ve heard from a number of people that have issues with brown rice and dairy, for example.  For the people with severe LGS, my personal opinion is that these above diets and especially GAPS make a lot of sense as a starting point.  

  • William

    I have primary sclerosing cholangitis. Within 7 days primal, 9 years of insomnia stopped. Within 3 months, chronic pain & fatigue were 50% less and migraines were gone. Within 6 months, pain and fatigue were 95% less on bad days and 100% less most of the time. Now at 7 months in, I have one symptom left, pruritis (itching). It is lessening and is about 25% less than old levels.

  • Erin

    As someone who has been on a GAPS diet for almost a year, I can assure you that GAPS does not promote vegetarianism. It is possible, but not desirable, to do a vegetarian version of GAPS by not eating meat and consuming lots of other animal products (full fat dairy, eggs, etc.) It is impossible to follow GAPS on a vegan diet.

    Thanks for this comparison list, since I’m considering switching to a paleo/primal diet from GAPS.

  • noname

    I came across this page on a search for the best diet for severe bloating. I have IBS w/ chronic severe bloating (4 inches in a day). I also have a long history of psychiatric (mood instability, depression/suicidality, panic) and neurological (head tremor, migraine) problems. My gastroenterologist put me on a gluten/dairy free diet and I’ve been on it for about 6 weeks without any improvement in the bloating whatsoever. She has treated me for H. pylori and also says that I have a large overgrowth of yeast in my gut + very low levels of healthy gut bacteria + lab work indicates that my immune system is compromised (low blood platelets and lymphocytes, proteinuria). I am hopeful that one of these diets can ultimately help me with my mental problems but I am absolutely desperate to stop the bloating ASAP. It is more than I can handle at this point. Does anyone have any information about which diet would be best for the gut-related problems I explained (specifically the bloating)? Thank you for reading this and for any help you may have to offer.

    • http://www.healclick.com/ Joey Tuan

      You may want to look into paleo diet. When gluten/dairy free doesn’t help, I think it’s worth looking into removing as many antinutrients (the husks of grains, legumes, nuts etc) as possible.

      You may want to discuss the issue with a GI specialist if dietary changes don’t resolve the problem. There are some fairly safe medications on the market that address this issue.

  • Douglas

    I have Crohn’s and am starting up on Paleo as of the last few days here, so I’ll see how this goes.

    The only difficulty for me so far is that I’m fairly tall and have a high metabolism, so I’m having some difficulty in figuring out what I can eat to get in the calories I need. This was simple when I could just bulk up on calorie dense pasta, but it’s not so clear what I should be eating with Paleo. If anyone has any suggestions in that regard, feel free to chime in.

    I’m curious — do you personally use any of these diets, Joey?

    • http://www.healclick.com/ Joey Tuan

      I do use the Paleo diet Douglas. Have for almost a year now.

      Like you I’m pretty tall and have really high metabolism. Avocadoes are my favorite filler fat, while sweet potatoes are my favorite source of carbs. Lately I’ve been switching to more monounsaturated fats (Cordain’s diet for athletes) to see if it’s able to get my lp(a) down. I do have that genetic risk.

    • http://www.healclick.com/ Joey

      I do use the Paleo diet Douglas. Have for almost a year now.

      Like you I’m pretty tall and have really high metabolism. Avocadoes are my favorite filler fat, while sweet potatoes are my favorite source of carbs. Lately I’ve been switching to more monounsaturated fats (Cordain’s diet for athletes) to see if it’s able to get my lp(a) down. I do have that genetic risk.

    • Tatiena Smith

      for extra calories, I would increase the fat intake. avocados, coconut oil, ghee, and olive oil. You could also eat more sweet potatoes.

  • HealingMama

    I have done the GAPS diet and Dr. Campbell-McBride very strongly does not advise following a vegetarian diet. I’m not sure where you got the information from about that. On page 156 of the Gut and Psychology Syndrome book, she states:

    “1. Vegetarian children are more prone to health problems than children who eat meat, particularly to psychomotor impairment and diseases of the blood.

    2. Vegetarians are prone to muscle loss and bone damage. They, on average, have lower muscle strength.

    3. According to census data vegetarians die younger than people who eat meat.

    From my clinical observations I have yet to meet a healthy vegetarian.”

  • Mitch

    Cool article! One correction: in the link to the second article you refer to the efficacy of the SCdiet in treating Irritable Bowel Syndrome (IBS), however the article is actually about Inflammatory Bowel Disease (IBD). Some doctors consider IBS to be a more mild form or precursor to IBD but they are separate diagnoses.

  • joey

    Oops I meant to reply to you:

    Hehe Sherri.  A lot of people can’t!  Have you read this:  http://www.cheeseslave.com/gaps-diet-myths/

  • joey

    Hi mjj,
    You may be right.  I couldn’t verify the source on that, so I deleted that line.  Thanks for letting me know about this! 

  • joey

    Hi there!

    You make a great point.  I’ve wondered that myself to.  Some of the paleo advocates counter that, even though some people appear to tolerate legumes and say brown rice (perhaps due to epigenetic expression of our genes) that doesn’t negate the body of research showing there’s anti-nutrient qualities to the bran in brown rice which makes it inoptimal from a digestion standpoint. 

    Ultimately, I think trialing with different diets is the only way to see what’s optimal, rather than just what helps us feel better from our worst.  I’ve heard from a number of people that have issues with brown rice and dairy, for example.  For the people with severe LGS, my personal opinion is that these above diets and especially GAPS make a lot of sense as a starting point.