AIP: The Autoimmune Protocol Diet

While many who follow the autoimmune protocol diet report having improvements in the way that they feel as well as their symptoms of autoimmune diseases decreasing such as fatigue, gut issue, and joint pain, research on the AIP diet is limited yet very promising. 

The healthy immune system produces antibodies that attack foreign pathogens or harmful cells in the body, however, those with autoimmune disorders have an immune system that mistakenly tends to produce antibodies that attack healthy cells and tissues rather than fight infections. This can lead to a variety of symptoms ranging from fatigue, brain fog, diarrhea, joint pain, abdominal pain, and tissue and nerve damage. 

Autoimmune diseases are thought to be caused by a variety of factors such as genetic propensity, infection, inflammation, stress, and medications. Some research also suggests that in those who are susceptible damage to the gut barrier can lead to increased intestinal permeability, and this leaky gut may trigger the development of certain autoimmune diseases. Additionally, certain foods can possibly increase gut permeability which can increase the likelihood of leaky gut. 

The autoimmune protocol diet aims to remove foods from the diet that may increase gut permeability and replace them with foods that are health-promoting and nutrient-dense options thought to help heal the gut to ultimately reduce inflammation and the symptoms of autoimmune diseases. The AIP diet also removes certain ingredients such as gluten that may cause an abnormal immune response in those who are susceptible. 

Many experts believe that leaky gut may be a plausible explanation for inflammation experienced by those with autoimmune disorders, however, they caution that current research does not allow for confirmation of a cause and effect relationship between the two and that more research is required to make any strong conclusions. 

This diet resembles the paleo diet due to the similarities in the types of foods allowed/avoided and in the phases that it comprises, but the AIP diet is more strict. The first phase of this diet is an elimination phase to remove foods and medications believed to cause gut inflammation, imbalances in gut flora, or an immune response. 

At this time foods like nuts, seeds, eggs, dairy, legumes, nightshade vegetables, and grains are removed, as well as tobacco, alcohol, oils, coffee, additives, refined and processed sugar, and certain medications. This phase encourages the consumption of fresh nutrient-dense foods, fermented foods, bone broth, and minimally processed lean cuts of meat along with improvements of other lifestyle factors like sleep, physical activity, and stress. 

The elimination phase is typically maintained until there is a noticeable reduction in symptoms, which can vary from person to person, it may be in 30-90 days, or it could be as early as within the first 3 weeks. 

Once the elimination phase has produced measurable improvement in symptoms and overall well-being occurs the reintroduction phase can begin. During this time foods that are being avoided can be gradually reintroduced into the diet one at a time based on tolerance. This is done to identify food that have been contributing to symptoms to help build the widest dietary variety that can be tolerated. 

Foods are reintroduced one at a time about 5-7 days apart to allow enough time to detect if any symptoms reappear before adding another food. Food that is well tolerated can be added back onto the regular menu while those that trigger reaction should be eliminated, keeping in mind that food tolerance can change over time, meaning that you could retest for eliminated foods every once in a while.

For example, choose one food to reintroduce, plan on eating this a few times per day then avoid it for 5-6 days. Eat about 1 teaspoon of the food and wait about 20 minutes to monitor for a reaction. If there is a reaction the test is over, avoid this food. If there are no symptoms up the portion size to around 1.5 tablespoons and wait 2-3 hours. If there is a reaction at this time, the test is over, avoid this food. If there are no symptoms eat a normal-sized portion then avoid it or reintroducing any other foods for 5-6 days. If there are no symptoms during this time you may keep this food in your diet and then move on to repeat this process with another food. 

Sometimes it is recommended to reintroduce food in a certain order such as when reintroducing dairy, choose those with the lowest lactose concentration first. Also, it may be best not to reintroduce foods under circumstances that tend to increase inflammation such as during an infection, when you feel stressed, following a strenuous workout, or after a poor sleep. 

The autoimmune protocol diet has strict recommendations on what to eat/avoid during the elimination period. The more food removed during this phase the more likely it is to discover food triggers: 

Food to avoid

Grains; rice, wheat, oats barley, rye, etc and any food derived from them

Legumes; lentils, beans, peas, peanuts, soy, etc, and any food derived from them

Nightshade veggies; eggplants, peppers, potatoes, tomatoes, etc, and any food derived from them

Eggs; and any foods containing them

Dairy; cow, goat or sheep milk, etc, as well as food derived from them

Nuts and seeds; as well as all foods derived from them

Processed vegetable oils, refined or processed sugars, starchy foods, processed meats, condiments, food additives, artificial sweeteners, as well as soda, alcohol, and coffee. 

Although not specific to all AIP protocols some have further recommendations to avoid all fruit during the elimination phase while others allow the inclusion of 1-2 portions of fruit per day. Also, some protocols recommend avoiding algae during this time as this type of sea vegetable may also trigger an immune response. 

Food to eat

Vegetables; a variety of any with the exception of nightshade veggies and algae

Fresh fruit; a variety in moderation 

Tubers; artichokes, yams, sweet potatoes, and taro

Fermented probiotic-rich foods: kimchi, pickles, sauerkraut, kombucha, avoiding dairy

Dairy substitutes 

Herbs and spices; non-seed derived

Vinegar; free of added sugars

Natural sweeteners: honey and maple syrup in moderation

Minimally processed oils: avocado oil, olive oil, or coconut oil

Minimally processed meat: lean cuts, grass-fed, wild-caught whenever possible

Tea: 3-4 cups of green or black tea per day

Bone broth; without added sugars and added salt 

Most protocols recommend moderating salt intake, as well as saturated and omega-6 fats, all sugars, and coconut-based foods. Some protocols further suggest moderating intake of high glycemic foods.

During this phase as you slowly reintroduce foods individually monitor for symptoms such as joint pain, fatigue, difficulty sleeping, headaches, migraines, rashes, skin changes, bloating, changes in bowel habits, stomach pain, cramps, and changes in breathing. If no symptoms appear typically it is assumed to be safe to eat, negative symptoms suggest that you have identified a food trigger that should be removed from your diet. 

Although research on this diet is limited, evidence suggests that it may help to reduce inflammation and symptoms of certain autoimmune diseases. Many of these individuals often have a leaky gut, experts believe that there may be a connection between inflammation and the permeability of the gut. A healthy gut typically has low permeability allowing it to act as a good barrier preventing food and waste from leaking into the bloodstream, while a leaky gut allows particles to crossover into the bloodstream to possibly cause inflammation. 

Growing evidence indicates that the foods consumed can influence the gut’s immunity and function and in some cases reduce the degree of inflammation that one may experience. As such the hypothesis that the AIP diet is helping heal a leaky gut by reducing the degree of inflammation experienced in those with certain autoimmune diseases. However, more research is required to specifically understand the exact ways in which it may be helping as well as the precise circumstances in which it does. 

The restrictive nature of the elimination phase may make this diet potentially hard for some to follow, especially in social situations like at a restaurant or eating at a friend’s home. It is also worth noting that this diet does not guarantee that it will reduce inflammation or related symptoms in all individuals with an autoimmune disorder. 

Additionally, some people may be hesitant to progress to the reintroduction phase after experiencing reductions in their symptoms. Remaining in the elimination phase can make it hard to meet daily nutrient requirements which in the long term could risk the development of nutritional deficiencies and poor health over time, making it important not to skip the reintroduction phase. 

As with any diet, especially a restrictive one it is recommended to consult with your physician or certified medical professional before beginning for guidance to avoid difficulties and to design a plan that is right for you. 

While autoimmune diseases can’t be cured, the symptoms can be managed. This diet aims to help you to do so by identifying foods that are triggering your specific symptoms. Seeking qualified professional guidance can help to pinpoint what may be causing a specific symptom, as well as ensure that you meet the nutritional requirements as best as possible throughout this diet.