The Autoimmune Protocol (AIP) diet is a specialized elimination diet designed to alleviate symptoms associated with autoimmune diseases. Characterized by the immune system attacking healthy cells and tissues, autoimmune disorders can manifest in various symptoms, including joint pain, fatigue, abdominal pain, and cognitive difficulties. The AIP diet aims to reduce inflammation and manage these symptoms by identifying and eliminating trigger foods, promoting gut health, and supporting overall well-being.
Understanding the AIP Diet
A review published in 2024 describes the AIP diet as a challenging personalized diet that has the potential to offer symptom relief in people with inflammatory and autoimmune conditions like IBD. The AIP diet operates on the principle that certain foods can increase gut permeability, also known as "leaky gut," potentially triggering or exacerbating autoimmune responses.
The AIP diet is similar to the paleo diet, both in the types of foods allowed and avoided, as well as in the phases that comprise it. Due to their similarities, many consider the AIP diet an extension of the paleo diet - though AIP may be seen as a stricter version of it. By removing these foods and replacing them with nutrient-dense alternatives, the diet seeks to heal the gut, reduce inflammation, and alleviate autoimmune symptoms. The diet begins by eliminating foods that may trigger inflammation and the development of autoimmunity.
What Foods are Eliminated?
The AIP diet involves a strict elimination phase, where the following foods are removed:
- Grains: rice, wheat, oats, barley, rye, etc., as well as foods derived from them, such as pasta, bread, and breakfast cereals
- Gluten: A protein found in wheat, barley, and rye.
- Legumes: lentils, beans, peas, peanuts, etc., as well as foods derived from them, such as tofu, tempeh, mock meats, or peanut butter
- Nuts and Seeds: all nuts and seeds and foods derived from them, such as flours, butter, or oils; also includes cocoa and seed-based spices, such as coriander, cumin, anise, fennel, fenugreek, mustard, and nutmeg
- Nightshades: eggplants, peppers, potatoes, tomatoes, tomatillos, etc., as well as spices derived from nightshade vegetables, such as paprika
- Eggs: whole eggs, egg whites, or foods containing these ingredients
- Dairy: cow’s, goat’s, or sheep’s milk, as well as foods derived from these milks, such as cream, cheese, butter, or ghee; dairy-based protein powders or other supplements should also be avoided
- Sugar: cane or beet sugar, corn syrup, brown rice syrup, and barley malt syrup; also includes sweets, soda, candy, frozen desserts, and chocolate, which may contain these ingredients
- Coffee:
- Alcohol:
- Food Additives and Artificial Sweeteners: trans fats, food colorings, emulsifiers, and thickeners, as well as artificial sweeteners, such as stevia, mannitol, and xylitol
What Foods are Allowed?
During the elimination phase, the AIP diet focuses on consuming foods that are less likely to trigger inflammation and support gut health. These include:
Read also: Navigating Risks on the Bean Diet
- Vegetables: a variety of vegetables except for nightshade vegetables and algae
- Fresh Fruit: a variety of fresh fruit, in moderation
- Tubers: sweet potatoes, taro, yams, as well as Jerusalem or Chinese artichokes
- Minimally Processed Meat: wild game, fish, seafood, organ meat, and poultry; meats should be wild, grass-fed or pasture-raised, whenever possible
- Fermented, Probiotic-Rich Foods: nondairy-based fermented food, such as kombucha, sauerkraut, pickles, and coconut kefir; probiotic supplements may also be consumed
- Minimally Processed Vegetable Oils: olive oil, avocado oil, or coconut oil
- Herbs and Spices: as long as they’re not derived from a seed or a chili pepper
- Vinegars: balsamic, apple cider, and red wine vinegar, as long as they’re free of added sugars
- Natural Sweeteners: maple syrup and honey, in moderation
- Certain Teas: green and black tea at average intakes of up to 3-4 cups per day
- Bone Broth
The Two Phases of the AIP Diet
The AIP diet consists of two main phases: the elimination phase and the reintroduction phase.
1. The Elimination Phase
The first phase involves removing foods and medications believed to cause gut inflammation, imbalances between levels of good and bad bacteria in the gut, or an immune response. During this phase, foods like grains, legumes, nuts, seeds, nightshade vegetables, eggs, and dairy are completely avoided. Tobacco, alcohol, coffee, oils, food additives, refined and processed sugars, and certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) should also be avoided.
On the other hand, this phase encourages the consumption of fresh, nutrient-dense foods, minimally processed meat, fermented foods, and bone broth. It also emphasizes the improvement of lifestyle factors, such as stress, sleep, and physical activity.
The length of the elimination phase of the diet varies, as it’s typically maintained until a person feels a noticeable reduction in symptoms. On average, most people maintain this phase for 30-90 days, but some may notice improvements as early as within the first 3 weeks.
2. The Reintroduction Phase
Once a measurable improvement in symptoms and overall well-being occurs, the reintroduction phase can begin. During this phase, the avoided foods are gradually reintroduced into the diet, one at a time, based on the person’s tolerance. The goal of this phase is to identify which foods contribute to a person’s symptoms and reintroduce all foods that don’t cause any symptoms while continuing to avoid those that do. This allows for the widest dietary variety a person can tolerate.
Read also: Your 30-Day Weight Loss Journey Starts Here
During this phase, foods should be reintroduced one at a time, allowing for a period of 5-7 days before reintroducing a different food. This allows a person enough time to notice if any of their symptoms reappear before continuing the reintroduction process.
Foods that are well tolerated can be added back into the diet, while those that trigger symptoms should continue to be avoided. Keep in mind that your food tolerance may change over time. As such, you may want to repeat the reintroduction test for foods that initially failed the test every once in a while.
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.
Read also: The Hoxsey Diet
Potential Benefits of the AIP Diet
Research on the AIP diet is still emerging, but early studies and anecdotal evidence suggest several potential benefits, including:
1. Reducing Inflammation
The AIP diet aims to lower inflammation by removing foods that may trigger an immune response. By eliminating potential irritants, the diet can help reduce the overall inflammatory burden on the body.
2. Alleviating Autoimmune Symptoms
Many people following the AIP diet report a reduction in common autoimmune symptoms such as fatigue, joint pain, digestive issues, and skin problems. This improvement is attributed to the diet's ability to identify and eliminate specific trigger foods.
3. Promoting Gut Health
The AIP diet emphasizes foods that support gut health, such as fermented foods and bone broth. By promoting a healthy gut microbiome, the diet can improve digestion, nutrient absorption, and overall immune function.
4. Improving Quality of Life
By reducing inflammation and alleviating symptoms, the AIP diet can significantly improve the quality of life for individuals with autoimmune diseases. Many people report increased energy levels, better sleep, and an overall sense of well-being.
5. May Help Heal a Leaky Gut
People with autoimmune diseases often have a leaky gut, and experts believe there may be a link between the inflammation they experience and the permeability of their gut. A healthy gut typically has a low permeability. This allows it to act as a good barrier and prevent food and waste remains from leaking into the bloodstream. However, a highly permeable or leaky gut allows foreign particles to crossover into the bloodstream, in turn, possibly causing inflammation. In parallel, there’s growing evidence that the foods you eat can influence your gut’s immunity and function, and in some cases, possibly even reduce the degree of inflammation you experience. One hypothesis entertained by researchers is that by helping heal leaky gut, the AIP diet may help reduce the degree of inflammation a person experiences.
Research on the AIP Diet
While more extensive research is needed, several studies have explored the effects of the AIP diet on autoimmune diseases:
- Inflammatory Bowel Disease (IBD): An 11-week study involving 15 people with IBD reported that participants experienced significantly fewer IBD-related symptoms by the end of the study.
- Hashimoto's Thyroiditis: A 10-week study with 16 women with Hashimoto's thyroiditis showed that inflammation and disease-related symptoms decreased by 29% and 68%, respectively. Participants also reported significant improvements in their quality of life.
These studies, though small, suggest that the AIP diet may offer benefits for individuals with specific autoimmune conditions.
Challenges and Considerations
The AIP diet, while potentially beneficial, also presents several challenges:
1. Restrictiveness
The AIP diet is highly restrictive, especially during the elimination phase. This can make it difficult to adhere to the diet and may require significant lifestyle adjustments.
2. Social Limitations
The strict nature of the AIP diet can make eating out and attending social events challenging. Planning meals in advance and communicating dietary needs can help mitigate these limitations.
3. Nutritional Deficiencies
Prolonged adherence to the elimination phase without proper reintroduction can lead to nutritional deficiencies. Working with a healthcare professional or registered dietitian is essential to ensure adequate nutrient intake.
4. Lack of Long-Term Data
Most studies on the AIP diet have been conducted over a short period. More research is needed to assess the long-term effectiveness and safety of the diet.
5. Individual Variability
The AIP diet's effectiveness can vary significantly from person to person. Factors such as genetics, gut microbiome composition, and underlying health conditions can influence the outcomes.
Practical Tips for Implementing the AIP Diet
- Plan Ahead: Before starting the AIP diet, create a meal plan and stock up on AIP-friendly foods.
- Cook at Home: Preparing meals at home allows for better control over ingredients and reduces the risk of accidental exposure to restricted foods.
- Find Support: Join online communities or work with a healthcare professional to gain support and guidance throughout the AIP journey.
- Be Patient: The elimination phase can be challenging, but it's essential to remain patient and consistent to experience the potential benefits.
- Reintroduce Foods Carefully: Follow the reintroduction protocol diligently to identify specific trigger foods and expand the diet gradually.
- Consult a Healthcare Professional: Work with a registered dietitian or healthcare provider to ensure the AIP diet is safe and appropriate for individual needs.
Personal Experiences with the AIP Diet
Many individuals have shared their experiences with the AIP diet, highlighting both the challenges and the positive outcomes. One person with ulcerative colitis shared their journey, noting that the first two weeks were the hardest. They found relief by sourcing organic meats and produce from a local farm and Wegmans. After about four weeks on the AIP diet, they noticed significant improvements, including reduced bloating and improved sleep.
Another individual on day 45 of the AIP elimination stage shared that the first two weeks were brutal, with cravings and temptations abounding. However, by the third week, they settled into a routine, finding local farms and stores that provided AIP-friendly foods. They lost 15lbs, likely due to reduced inflammation, and their joint pain disappeared.
These personal accounts underscore the importance of perseverance and finding personalized strategies to make the AIP diet sustainable.
Historical Context of Elimination Diets
The concept of elimination diets dates back to ancient times. Hippocrates, in 400 BC, suggested eliminating dairy products for those with lactose intolerance. In 1926, Dr. Rowe formally introduced the term "elimination diets." Over time, various elimination diets have emerged, including the FODMAP diet for irritable bowel syndrome and the Wahls protocol for multiple sclerosis. The AIP diet is a more recent iteration, specifically tailored for autoimmune diseases.
The AIP Diet vs. Other Diets
AIP vs. Paleo Diet
The AIP diet is often considered a stricter version of the paleo diet. Both diets emphasize whole, unprocessed foods and eliminate grains, legumes, and refined sugars. However, the AIP diet goes further by excluding eggs, nuts, seeds, nightshades, and other potentially inflammatory foods. The AIP is personalized, with different foods allowed or eliminated, depending on individual tolerance.
AIP vs. Keto Diet
The keto diet focuses on high-fat, low-carbohydrate intake, leading to a metabolic state called ketosis. While the keto diet also excludes grains and legumes, it allows dairy, which is restricted on the AIP diet. The AIP diet prioritizes nutrient-dense foods and gut health, whereas the keto diet primarily aims for weight loss and metabolic control.
AIP vs. Pegan Diet
The Pegan diet combines principles from both paleo and vegan diets. It emphasizes fruits, vegetables, nuts, seeds, and lean proteins while excluding dairy and grains. The AIP diet is more restrictive than the Pegan diet, particularly during the elimination phase, and focuses specifically on managing autoimmune symptoms.
The Importance of Gut Health in Autoimmunity
The gut microbiome plays a crucial role in immune regulation. A healthy gut barrier prevents the leakage of undigested food particles, bacteria, and toxins into the bloodstream, which can trigger an immune response. In individuals with autoimmune diseases, a compromised gut barrier, often referred to as "leaky gut," can contribute to chronic inflammation and symptom exacerbation.
The AIP diet aims to restore gut health by removing potentially irritating foods and promoting the consumption of nutrient-dense, gut-supportive foods. Fermented foods like sauerkraut and kombucha provide beneficial probiotics, while bone broth supports gut lining integrity.
Potential Adverse Events and Considerations
While the AIP diet is generally considered safe, it's essential to be aware of potential adverse events:
- Nutrient Deficiencies: Restricting numerous food groups can increase the risk of nutrient deficiencies, particularly if the elimination phase is prolonged.
- Weight Loss: Some individuals may experience unintended weight loss due to the reduced calorie intake associated with the AIP diet.
- Social Isolation: The dietary restrictions can make it challenging to participate in social events and may lead to feelings of isolation.
- Emotional Challenges: The strict nature of the AIP diet can be emotionally challenging, especially during the initial elimination phase.