The Autoimmune Protocol (AIP) diet is a specialized elimination diet designed to reduce inflammation and manage symptoms associated with autoimmune diseases. Similar to the paleo diet in its focus on whole foods, the AIP diet takes a stricter approach by eliminating foods believed to trigger inflammation and immune responses. This article provides an in-depth overview of the AIP diet, including its principles, phases, allowed and restricted foods, and potential benefits.
What is the AIP Diet?
The AIP diet, also known as the Paleo Autoimmune Protocol, is an elimination diet that aims to identify and remove food-based triggers for inflammation. It is particularly helpful for individuals with chronic inflammation or autoimmune disorders. Autoimmune diseases result from uncontrolled inflammation, where the immune system mistakenly attacks the body's own cells. By eliminating potential inflammatory triggers, the AIP diet seeks to reduce symptoms and improve overall gut health, hormone regulation, and immune system function.
How Does the AIP Diet Work?
The AIP diet operates in three phases: elimination, reintroduction, and maintenance. Each phase involves careful monitoring of food intake and symptoms to identify problematic foods and create a personalized, long-term dietary plan.
Phase 1: Elimination
The elimination phase typically lasts from four to six weeks, but can extend up to a few months. During this period, certain foods, additives, and medications believed to cause intestinal inflammation, gut microbiota imbalances, or worsened immune responses are removed.
Foods to eliminate during this phase include:
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- Grains: Wheat, barley, rice, oats, rye, corn, and any products made with these ingredients (e.g., bread, pasta, cereal, muffins, baked goods).
- Legumes: Lentils, beans (garbanzo beans, black beans, green beans, etc.), soy, peas, and products made with these ingredients (e.g., tofu, peanut butter, hummus).
- Nightshade Vegetables: Tomatoes, potatoes, peppers, eggplant, tomatillos, jalapenos, and spices made from these vegetables (e.g., cayenne pepper, paprika).
- Dairy Products: Cow's, goat's, and sheep's milk, and any products made from these (e.g., ice cream, cheese, butter, dairy-based protein powders).
- Eggs: Whole eggs, egg whites, or foods containing these ingredients.
- Nuts and Seeds: All nuts, seeds, and foods made from these ingredients, including flours, butter, oils, cocoa, and seed-based spices (e.g., coriander, cumin, fennel, mustard, nutmeg).
- Processed Foods: Deli meats, hot dogs, sausages, canned vegetables, canned soups, microwave meals, packaged snacks, and processed vegetable oils (e.g., canola, corn, soybean oil).
- Refined Sugars: Sweets, sodas, candies, chocolate, cane sugar, corn syrup, brown rice syrup.
- Certain Beverages: Coffee and alcohol.
- Food Additives: Artificial sweeteners (e.g., stevia, saccharin, xylitol), food colorings, emulsifiers, and thickeners.
During the elimination phase, it's important to focus on foods that can be included, such as vegetables (excluding nightshades), fruits, fish, grass-fed meats, organ meats (like liver), and poultry. Alternatives to eliminated foods can also be explored, such as using cauliflower rice instead of grains or honey instead of processed sugars.
Phase 2: Reintroduction
The reintroduction phase begins after experiencing significant improvement in symptoms. During this phase, previously eliminated foods are reintroduced one at a time, over a period of five to seven days each. The goal is to identify which foods contribute to symptoms and which can be safely reintroduced into the diet.
When reintroducing foods, follow these steps:
- Choose one food to reintroduce. Plan to sample this food several times during the first day of reintroduction.
- Start with a small amount, like a teaspoon, and then wait 15 minutes to see if any autoimmune symptoms or reactions occur. If reactions occur, stop.
- If no reactions occur, try a larger portion, like 2 teaspoons of the same food, and wait two to three hours. If reactions occur, stop.
- If no reactions occur, eat a normal portion of the same food and then avoid that food for five to seven days without reintroducing any other new foods.
- If any reactions occur during the five-to-seven-day period, avoid this food going forward and move on to the next food after about a week. If no reactions occur, this food can be reintroduced fully back into the diet.
It's important to monitor symptoms throughout the reintroduction process and to avoid reintroducing foods when the body is already stressed (e.g., during a cold, infection, or lack of sleep).
Phase 3: Maintenance
The maintenance phase is the final, long-term phase of the AIP diet. It involves personalizing the diet based on the findings from the elimination and reintroduction phases. The emphasis is on food diversity and diet flexibility, while continuing to avoid foods that trigger unwanted symptoms.
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During this phase, individuals may be able to occasionally consume trigger foods in small amounts or during special events. However, it's important to prioritize foods that promote well-being and minimize autoimmune reactions.
AIP Diet Food List
The AIP diet has specific recommendations for foods to eat and avoid, particularly during the elimination phase.
Foods to Avoid
- Grains: Rice, wheat, oats, barley, rye, and foods derived from them (e.g., pasta, bread, breakfast cereals).
- Legumes: Lentils, beans, peas, peanuts, and foods derived from them (e.g., tofu, tempeh, peanut butter).
- Nightshade Vegetables: Eggplants, peppers, potatoes, tomatoes, tomatillos, and spices derived from nightshade vegetables (e.g., paprika).
- Eggs: Whole eggs, egg whites, or foods containing these ingredients.
- Dairy: Cow's, goat's, or sheep's milk, and foods derived from these milks (e.g., cream, cheese, butter, ghee), as well as dairy-based protein powders or other supplements.
- Nuts and Seeds: All nuts and seeds and foods derived from them (e.g., flours, butter, oils), including cocoa and seed-based spices (e.g., coriander, cumin, anise, fennel, fenugreek, mustard, nutmeg).
- Certain Beverages: Alcohol and coffee.
- Processed Vegetable Oils: Canola, rapeseed, corn, cottonseed, palm kernel, safflower, soybean, or sunflower oils.
- Refined or Processed Sugars: Cane or beet sugar, corn syrup, brown rice syrup, and barley malt syrup, as well as sweets, soda, candy, frozen desserts, and chocolate.
- Food Additives and Artificial Sweeteners: Trans fats, food colorings, emulsifiers, and thickeners, as well as artificial sweeteners (e.g., stevia, mannitol, xylitol).
Some AIP protocols recommend avoiding all fruit during the elimination phase, while others allow 10-40 grams of fructose per day (around 1-2 portions of fruit). Some protocols also suggest avoiding algae, such as spirulina or chlorella.
Foods to Eat
- 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 foods, 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
Despite being allowed, some protocols recommend moderating intake of salt, saturated and omega-6 fats, natural sugars, and coconut-based foods. Depending on the AIP protocol, small amounts of fruit may also be allowed, typically a maximum intake of 10-40 grams of fructose per day, or about 1-2 portions of fresh fruit.
Potential Benefits of the AIP Diet
While research on the AIP diet is limited, some evidence suggests that it may reduce inflammation and symptoms of certain autoimmune diseases.
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May Help Heal a Leaky Gut
People with autoimmune diseases often have a leaky gut, which may contribute to inflammation. The AIP diet focuses on eliminating foods that may increase gut permeability and replacing them with nutrient-dense foods that promote gut health. By helping heal leaky gut, the AIP diet may reduce the degree of inflammation experienced.
May Reduce Inflammation and Symptoms of Some Autoimmune Disorders
Several small studies have shown promising results regarding the AIP diet's ability to reduce inflammation and symptoms of autoimmune disorders.
- An 11-week study in 15 people with IBD on an AIP diet reported significantly fewer IBD-related symptoms by the end of the study.
- Another study had people with IBD follow the AIP diet for 11 weeks, with participants reporting significant improvements in bowel frequency, stress, and the ability to perform leisure or sport activities as early as 3 weeks into the study.
- In a study of 16 women with Hashimoto’s thyroiditis, following the AIP diet for 10 weeks resulted in a 29% decrease in inflammation and a 68% decrease in disease-related symptoms. Participants also reported significant improvements in their quality of life.
However, it's important to note that these studies are small and more research is needed to fully understand the effects of the AIP diet.
Considerations and Precautions
The AIP diet is a restrictive elimination diet, which can be challenging to follow, especially in its elimination phase. It may also make it difficult to eat in social situations, increasing the risk of social isolation. Additionally, there's no guarantee that this diet will reduce inflammation or disease-related symptoms for everyone with autoimmune disorders.
Remaining in the elimination phase for too long can lead to nutrient deficiencies. Therefore, the reintroduction phase is crucial and should not be skipped. If experiencing difficulties with the reintroduction phase, consider reaching out to a registered dietitian or other medical professional knowledgeable about the AIP diet for personalized guidance.
The AIP diet may be most beneficial for people with autoimmune diseases such as lupus, IBD, celiac disease, or rheumatoid arthritis. It aims to help identify which foods may be triggering specific symptoms.