The Autoimmune Protocol (AIP) diet is a specialized eating plan designed to minimize pain, inflammation, and other symptoms associated with autoimmune diseases. It works by reducing exposure to foods known to trigger inflammatory reactions and promoting gut healing. Paloma Health has recommended the AIP diet as a potential approach for hypothyroid patients with Hashimoto's disease who continue to experience symptoms despite treatment.
Understanding Autoimmune Diseases
In autoimmune diseases, the body's immune system mistakenly attacks its own organs, glands, and tissues. Hashimoto's thyroiditis and Graves' disease are examples of autoimmune thyroid diseases. Other common autoimmune diseases include rheumatoid arthritis, multiple sclerosis, lupus, celiac disease, psoriasis, type 1 diabetes, and inflammatory bowel disease (IBD). Symptoms of autoimmune diseases can include fatigue, joint and muscle pain, gastrointestinal problems, and damage to the targeted areas of the body.
Various factors can trigger autoimmune diseases, including heredity, genetics, viral and bacterial infections, environmental exposures, chronic stress, and chronic inflammation. Chronic inflammation in the gut can lead to a more permeable intestinal lining, a condition known as "leaky gut." This increased permeability allows toxins and inflammatory foods to pass through the gut lining more easily, potentially triggering immune reactions and autoimmune diseases.
According to AIP Certified Coach Stephanie Ulrich, a significant portion of the immune system resides in the gut. Therefore, supporting gut health is crucial for managing autoimmune diseases.
What is the Autoimmune Protocol (AIP) Diet?
The AIP diet is a two-phase elimination diet. The first phase, called "Elimination," involves removing foods and ingredients known to trigger inflammation, allergies, or autoimmune reactions. These trigger foods are replaced with nutrient-rich, anti-inflammatory foods that support gut healing. The second phase, called "Reintroduction," involves gradually reintroducing the eliminated foods while carefully monitoring symptoms to identify individual triggers.
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Phases of the AIP: Elimination and Reintroduction
The AIP diet consists of two main phases: the elimination phase and the reintroduction phase.
The Elimination Phase: During the elimination phase, certain foods and medications believed to cause gut inflammation, imbalances between levels of good and bad bacteria in the gut, or an immune response are removed. This phase typically lasts for at least 30 days, but ideally 90 days, or until a significant reduction in symptoms is experienced. Some experts recommend gradually eliminating specific foods or food categories one at a time.
The Reintroduction Phase: After the elimination phase, assuming improvements in symptoms have been observed, the reintroduction phase can begin. Foods are reintroduced slowly, in small quantities, and one at a time, while monitoring for any worsening of symptoms or reactions. Stephanie Ulrich recommends starting with foods less likely to be chronic triggers. The objective is to broaden the diet and identify trigger foods to continue avoiding.
Foods to Eliminate During the Elimination Phase
During the elimination phase of the AIP diet, the following foods, drinks, and products should be eliminated:
- Grains: wheat, oats, rice, amaranth, barley, buckwheat, bulger, corn, millet, quinoa, rye, sorghum, and spelt, as well as products made from grains such as pasta, bread, cereals, and crackers.
- Legumes: beans, including soy, and soy products like tofu and tempeh.
- Nightshades: vegetables like tomatoes, peppers, eggplant, and potatoes.
- Goji berries
- Dairy: all forms, including butter and ghee.
- Eggs
- Coffee
- Chocolate
- Alcohol
- Nuts, including nut butters and peanut butter.
- Seeds
- Seed-based spices: allspice, anise, celery seed, cumin, fennel seed, sesame seeds, mustard, nutmeg, and poppy seeds.
- Fruit and berry-based spices: allspice, anise, caraway, cardamom, juniper, peppercorn, sumac
- Sugar: including sugar substitutes like xylitol, mannitol, and stevia.
- Refined and processed foods
- Refined oils and seed oils: canola oil, sesame oil, and sunflower oil.
- Food additives, dyes, and thickeners
- Chlorella
- Spirulina
AIP diet experts also recommend eliminating tobacco products and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
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Foods to Eat on the AIP Diet
The AIP diet allows for a variety of food choices, including:
- Meat, game, and poultry: ideally organic, pesticide-free, free-range, and grass-fed whenever possible.
- Fish
- Vegetables: except for nightshade vegetables.
- Tubers: including sweet potatoes, yams, taro, and artichokes.
- Fruit: in small quantities.
- Coconut milk
- Avocado oil, olive oil, and coconut oil
- Fermented foods without dairy: such as kombucha, kimchi, coconut kefir, coconut yogurt, sauerkraut, pickles, and pickled vegetables.
- Leafy herbs without seeds: such as mint, basil, oregano, chives, cilantro, dill, garlic, parsley, rosemary, sage, thyme, and turmeric.
- Green tea and herbal teas from leafy herbs (i.e., mint tea)
- Bone broth
- Vinegars
Lifestyle Changes as Part of the Autoimmune Protocol
Lifestyle changes are integral to the AIP diet. Stephanie Ulrich recommends incorporating three key lifestyle components: sleep, stress management, and movement. Aim for seven to nine hours of quality sleep per night to allow the body to repair itself. Stress management techniques, such as deep breathing, yoga, meditation, and social connection, are also essential. Finally, incorporate daily physical activity, being careful not to overexert yourself.
How Long to Follow the Elimination Phase
The elimination phase typically lasts for at least 30 days, but ideally for a full 90 days, to experience a significant reduction in symptoms. Functional nutritionist Risa Groux recommends 90 days for individuals diagnosed a long time ago or with multiple autoimmune diseases.
The Reintroduction Phase in Detail
After the Elimination Phase, and assuming that you have noticed improvements in your symptoms, you can move into the Reintroduction Phase. Typically, it's recommended that you reintroduce foods slowly, in small quantities, and one at a time. You can then gauge your symptoms and response and watch for any worsening symptoms or reactions.
Stephanie Ulrich recommends starting the Reintroduction Phase with foods that are less likely to be chronic triggers. During the Paloma Speakers Series event on the AIP diet, she shared the following chart, showing recommended stages for reintroducing various foods.
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During the Reintroduction Phase, your objective is to broaden your diet and reintroduce a wider variety of foods while identifying those trigger foods you should continue to avoid.
Ulrich explains: "Start at first eating a very small amount of foods. And then you're going to wait a couple of hours. How do you feel? And then you're going to try a little bit more, and then how do you feel? It's a slow reassessment, and I always recommend that everyone keep a symptom and food journal because you want to keep track of what foods you're trying, how you react, and symptoms."
Suppose you tolerate a normal portion of food well without any reaction. In that case, it can be included in your diet going forward. It would be best if you continued avoiding foods that cause a reaction or symptoms. Because food intolerances can change, you should periodically try again to reintroduce a trigger food to help determine if you are still reactive to it.
A Step-by-Step Reintroduction Protocol
Here’s a step-by-step approach to reintroducing foods that were avoided during the elimination phase of the AIP diet.
- Step 1. Choose one food to reintroduce. Plan to consume this food a few times per day on the testing day, then avoid it completely for 5-6 days.
- Step 2. Eat a small amount, such as 1 teaspoon of the food, and wait 15 minutes to see if you have a reaction.
- Step 3. If you experience any symptoms, end the test and avoid this food. If you have no symptoms, eat a slightly larger portion, such as 1 1/2 tablespoons, of the same food and monitor how you feel for 2-3 hours.
- Step 4. If you experience any symptoms over this period, end the test and avoid this food. If no symptoms occur, eat a normal portion of the same food and avoid it for 5-6 days without reintroducing any other foods.
- Step 5. If you experience no symptoms for 5-6 days, you may reincorporate the tested food into your diet, and repeat this 5-step reintroduction process with a new food.
It’s best to avoid reintroducing foods under circumstances that tend to increase inflammation and make it difficult to interpret results. These include during an infection, following a poor night’s sleep, when feeling unusually stressed, or following a strenuous workout.
Additionally, it’s sometimes recommended to reintroduce foods in a particular order. For example, when reintroducing dairy, choose dairy products with the lowest lactose concentration to reintroduce first, such as ghee or fermented dairy products.
Potential Benefits of the AIP Diet
The AIP diet offers several potential benefits for autoimmune disease and overall health, including:
- Reduced leaky gut and improved gut balance.
- Reduced autoimmunity.
- Reduced inflammation and inflammation-related symptoms.
- Reduced antibody levels.
One recent study of women with Hashimoto's following a 10-week AIP program reported a significant improvement in health-related quality of life, including physical function, emotional well-being, and vitality. While thyroid and antibody levels didn't change during the 10-week study period, inflammation and symptoms decreased considerably.
AIP and Weight Loss
While the AIP diet is not specifically designed for weight loss, eliminating inflammatory and trigger foods, as well as processed and junk foods, may lead to some weight loss. Risa Groux emphasizes that "weight loss is a side effect of wellness, and the AIP protocol focuses on wellness."
Downsides and Considerations of the AIP Diet
The AIP diet is not recommended for individuals who are pregnant, significantly underweight, experiencing malnutrition, or have a history of disordered eating. It is crucial to review your health situation with your doctor before making any significant dietary changes.
Without careful meal planning, it can be challenging to obtain a nutritionally balanced diet or enough dietary fiber during the Elimination Phase. Working with a nutritional expert can help develop recommended meal plans and ensure adequate nutrition. Because the Elimination Phase is restrictive, eating away from home can be difficult, requiring a focus on simply prepared whole foods. The AIP diet can also be challenging for those who do not cook. Finally, giving up coffee and caffeine can be a significant challenge for some individuals.
The AIP diet can be complicated. It's important to assess your ability to handle the protocol and gradually transition, potentially starting with the Paleo Diet before moving to AIP. Risa Groux suggests that individuals may respond well to simply removing gluten, dairy, soy, and sugar, emphasizing that everyone is different and should do what works best for them.
Research on the AIP Diet
Several small studies have investigated the impact of the AIP diet on autoimmune diseases. A 2017 study of 15 people with inflammatory bowel disease (IBD) for 11 weeks showed improvements in symptoms. A 2019 study of 17 people with Hashimoto's disease for ten weeks found improvements in symptoms. However, research on the AIP diet is limited by small sample sizes and short study durations.
Specific Studies and Results
- Hashimoto's Thyroiditis: A 12-week study on women with Hashimoto's thyroiditis showed significant improvements in symptom scores. Some women were able to decrease their medication dosage.
- Inflammatory Bowel Disease (IBD): A 2017 study on individuals with active ulcerative colitis or Crohn's disease found that 73% achieved clinical remission by week 6 of the AIP diet. A follow-up study in 2019 found a down-regulation of inflammatory T-cell mediated responses and an up-regulation of regulatory T-cell response and function. Another study in 2019 showed that all participants experienced an increase in their quality of life by week 11.
These studies suggest that the AIP diet may improve the quality of life for individuals with specific autoimmune diseases and alter immune function expression to improve symptoms.
The AIP Diet vs. Other Diets
The AIP diet shares similarities with other diets, including the Paleo diet, Whole 30, Keto diet, Pegan diet, and Atkins diet. However, the AIP diet is generally more restrictive, especially during the elimination phase.
- Paleo Diet: The AIP diet can be seen as a stricter version of the paleo diet, with more foods being excluded, including eggs, nuts and seeds, nightshades, food additives, refined oils, coffee, and alcohol.
- Whole 30: Similar to AIP, Whole 30 excludes grains, legumes, dairy, and sugar.
- Keto Diet: The keto diet also excludes whole grains and legumes.
- Pegan Diet: The Pegan diet combines the principles of the paleo diet and the vegan diet.
- Atkins Diet: The Atkins diet limits but doesn’t eliminate grains, legumes, and sugar.
The Autoimmune Protocol Diet: A Detailed Look
The autoimmune protocol diet (AIP) is a personalized elimination diet that aims to determine and exclude the foods that might trigger immune responses, leading to inflammation and symptomatology associated with autoimmune diseases. Focusing on gut health and the importance of the gut microbiome in immune regulation and overall well-being, the AIP starts by eliminating foods that might create negative effects on the patients and continues by developing a personalized and tailored diet plan for them. This comprehensive approach aims to mitigate symptoms and improve quality of life of individuals with autoimmune conditions.
The Three Phases of the AIP Diet
The AIP diet encompasses three phases: elimination, reintroduction, and maintenance.
- Elimination Phase: During the first phase, grains, legumes, nightshades, nuts, seeds, dairy, eggs, coffee, and alcohol are completely removed from the diet. In addition, all refined sugars, oils, processed foods, food additives, artificial colors, and flavorings are excluded due to their contribution to gut dysfunction. The use of non-steroidal anti-inflammatory drugs (NSAIDs) is also avoided during this phase. Patients are encouraged to consume nutrient-dense whole foods, such as vegetables, fruits, mono- and poly-unsaturated fatty acids, tubers, wild game, poultry, organ, and non-processed meats. This phase spans from 6 weeks to 6 months.
- Reintroduction Phase: During the second phase, eliminated foods are reintroduced to identify the ones that trigger individual responses. Generally, there is no rule of thumb on how to initiate the reintroduction. The most common manner is to reintroduce the foods that each patient enjoys the most, or the ones that are less likely to induce negative responses, in an effort to increase the food options. This phase is time-consuming; if performed methodically however, it results in distinct beneficial health outcomes for each individual.
- Maintenance Phase: The last AIP phase involves maintaining the protocol and has no specific duration. It aims to provide a healthy diet and lifestyle that will reduce autoimmune responses. In this manner, each patient adopts a dietary pattern associated with a lack of intolerances, considering the reintroduction phase responses.
The Importance of Gut Health
The AIP diet is based on the penetration of food antigens due to a dysfunction in the gut barrier, leading to increased permeability (“leaky gut”). Paired with microbial dysbiosis and in the presence of genetic susceptibility, it can synergistically act as an environmental trigger for autoimmunity.
The AIP Diet and the Gut Microbiome
The gastrointestinal tract contains a series of protective layers that physically separate systemic circulation from external triggers, including mucus, epithelium, and lamina propria. The intestinal epithelium layer consists of a monolayer of intestinal epithelial cells (IECs) connected by tight junction proteins and desmosomes, exercising strict control over permanent molecules. IECs exhibit pattern-recognizing receptors (PRRs) such as toll-like receptors (TLRs) and identify pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs) that can originate from food antigens or gut microbiota. Subsequently, proinflammatory mediators, such as cytokines, are activated, leading to differentiation, maturation, and activation of immune system cells.
Elimination Diets Throughout History
The basis for elimination diets dates back to the Paleolithic era due to the need to search for food and the limited options available at different times. The subsequent reference to food elimination was made by Hippocrates in 400 BC, referring to lactose intolerance, suggesting eliminating dairy products to relieve discomfort. The term “elimination diets” was first reported in 1926 by Dr. Rowe in 1944. During the same period, the elimination of gluten among patients with celiac disease was reported. In the early 2000s, the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet emerged as another iteration of elimination diets recommended for alleviating symptoms of irritable bowel syndrome. Over the past decade, specific forms of elimination diets, including the AIP and the Wahls protocol, appeared and were recommended for autoimmune diseases and multiple sclerosis, respectively.
Clinical Evidence and Outcomes
Elimination diets have long been used to manage diseases, including celiac disease, allergies, and inflammatory bowel disease (IBD). Regarding autoimmune diseases, the AIP diet has been implemented in organ-specific and systemic autoimmune diseases such as Hashimoto thyroiditis (HT), IBD and rheumatoid arthritis (RA), improving QoL and disease-related symptoms.
- Hashimoto Thyroiditis (HT): Two uncontrolled clinical trials concluded that patients undergoing the AIP improved and showed that the physical and emotional statuses had less malaise and enhanced general health subscales.
- Inflammatory Bowel Disease (IBD): One uncontrolled trial implemented the AIP in patients with active disease for 11 weeks. Clinical remission and endoscopic improvement were documented in most patients as opposed to inflammatory markers (C-reactive protein, fecal calprotectin), which remained unaltered.
- Rheumatoid Arthritis (RA): In systemic autoimmune diseases, a non-randomized, crossover trial was conducted in patients with RA, comparing QoL measures following the AIP against the usual diet.
Potential Nutrient Deficiencies
Despite its stringent nature, the AIP advocates a nutritious regimen, rich in whole foods, including colorful vegetables and fruits, organic meat, and lean fish. While the AIP includes some sources of meat and vegetables, excluding grains might result in deficiencies in vitamins B1, B2 and B3, fiber and iron. The study on women with HT revealed that 50 % of the participants exhibited folate, vitamin B12, or riboflavin deficiencies. Moreover, the Paleo diet may hinder adequate vitamin D and calcium intake, given the exclusion of vitamin D and calcium-rich dairy products.
Is the AIP Diet Right for You?
If you have an autoimmune condition, you might want to give it a try. The elimination phase of the AIP diet can be tough to stick to, though, since you need to avoid a long list of foods. Eating out can also be problematic. There aren’t likely AIP diet side effects, but you want to make sure you don’t stay on the elimination phase of the diet for too long since you could develop nutritional deficiencies.