Autoimmune diseases, where the immune system mistakenly attacks the body's own tissues, affect millions worldwide. While there is no cure, dietary interventions like the Autoimmune Protocol (AIP) diet have gained traction for their potential to manage symptoms and improve quality of life. The AIP diet is an elimination diet designed to reduce inflammation by identifying and removing potential food triggers. This article provides a comprehensive overview of the AIP diet, its phases, food lists, potential benefits, and considerations.
Understanding the AIP Diet
The AIP diet is an elimination diet that aims to reduce inflammation by identifying and removing potential food triggers, focusing on improving gut health, hormone regulation, and immune system regulation. It is particularly helpful for individuals with chronic inflammation or autoimmune disorders. People with autoimmune disorders often experience a range of symptoms associated with inflammation, including headaches, fatigue, gastrointestinal upset, aches and pains (including muscle and joint pain), difficulty sleeping, and skin health changes. The AIP diet works by cutting out and replacing certain foods known for being inflammatory triggers with nutrient-dense foods.
Some research suggests that an increased inflammatory response may occur when certain foods are consumed due to the gradual erosion of intestinal barriers in the digestive system over time, leading to a "leaky gut." The goal of the AIP diet is to minimize symptoms for people who have these chronic conditions by choosing anti-inflammatory foods and foods that promote gut health.
How the AIP Diet Works: Three Phases
The AIP diet works in three phases, each focused on taking inventory of the foods you’re eating and the symptoms you experience after eating those foods or removing those foods from your daily consumption. The AIP diet can seem complex, which is why it's important to work with a dietitian before starting it on your own. Cutting out foods means you need to focus on eating a wide variety of foods to get the nutrition your body needs to stay healthy and strong. It could also be helpful to keep a food diary to track the kinds of foods you’re eliminating, the kinds of foods you’re re-introducing and the kinds of symptoms you experience, along with the level of their severity. Doing this can help you zero in on exactly which foods prove to be problematic and which foods are fine to keep around long term.
Phase 1: Elimination
The first phase of the AIP diet can last from four to six weeks and up to a few months. During this phase, certain foods, additives, and medications believed to cause intestinal inflammation, an imbalance in gut microbiota, or worsen an immune system response are eliminated. Some of the foods you eliminate during this phase include:
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- Grains (especially gluten-containing grains)
- Legumes (including beans, peas, and lentils)
- Nightshade vegetables
- Dairy products
- Processed foods
- Refined sugars
- Eggs
- Nuts and seeds
- Coffee
- Alcohol
You also want to eliminate the use of tobacco and nonsteroidal anti-inflammatory medications (NSAIDs). When eliminating these foods, you should cut them out of your diet all at once. Then, over the course of the next four to six weeks, monitor your chronic inflammatory symptoms closely. If the AIP diet is working, people tend to have overall improvements in their quality of life and they’ll experience fewer symptoms the longer they’ve eliminated some of these foods.
Phase 2: Reintroduction
The second phase of the AIP diet can begin when you’ve experienced significant improvement in your symptoms. During this phase, you start to reintroduce the foods you’ve eliminated during the first phase back into your diet. You do this one at a time for a period of five to seven days before reintroducing the next food. The goal is to identify which of these foods contribute to your symptoms so you can continue to avoid eating those foods and reintroduce all of the foods that don’t cause any symptoms.
When reintroducing foods, you want to follow these steps:
- Choose one food to reintroduce into your diet. Plan on sampling this food several times during the first day of reintroduction. If at any point during reintroduction, you experience a return of your autoimmune symptoms or any reactions you experienced before the elimination phase, you’ll want to stop and avoid this food going forward.
- Start with a small amount, like a teaspoon, and then wait 15 minutes to see if you experience any autoimmune symptoms or have a reaction. If you have reactions, stop.
- If you don’t have a reaction, try a larger portion, like 2 teaspoons of the same food and wait two to three hours. If you have a reaction, stop.
- If you don’t have any reactions, 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 you have any reactions during the five-to-seven-day period, avoid this food going forward and move on to the next food after about a week. If you have no reactions, you can reintroduce this food fully back into your diet.
- Repeat this process for the next food you’d like to reintroduce.
The importance of waiting up to one week after testing each food is because it could take some time for your body to develop a reaction.
Phase 3: Maintenance
This final phase of the AIP diet takes everything you’ve learned from the first two phases and combines them into a long-term maintenance plan. During this phase, there’s an emphasis on personalization and an increased focus on food diversity and diet flexibility. For example, certain foods might be triggering unwanted symptoms for you, so you’ll want to continue avoiding those foods in the long term (whereas someone else might not need to avoid those foods). And in some ways, you may be able to have some of those foods in small amounts under circumstances that feel right for you. It’s also up to you to decide how liberal you want to be with your diet and how much you want to impose those self-restrictions. But it’s possible to sustain a new approach to the foods you eat and avoid for the long term if it helps reduce the likelihood and severity for autoimmune reactions.
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Foods to Avoid on the AIP Diet
Examples of foods you should eliminate on the AIP diet include:
- Grains: Rice, oats, wheat, barley, rye, quinoa, corn, and any products made with these ingredients, like cereal, pasta, bread, muffins, and other baked goods.
- Legumes: Black beans, kidney beans, lentils, peas, chickpeas, soybeans, peanuts, and products made with these ingredients, like tofu, peanut butter, and hummus.
- Nightshade vegetables: Tomatoes, potatoes, peppers, eggplant, tomatillos, jalapenos, and spices made from these vegetables, like cayenne pepper or paprika.
- Dairy products: Cow’s milk, goat’s milk, or sheep’s milk, and any products made from these, including ice cream, cheese, butter, and any dairy-based protein powders or supplements.
- Eggs: Whole eggs, egg whites, or foods containing these ingredients.
- Processed foods: Deli meats, hot dogs, sausages, canned vegetables, canned soups, microwave meals, packaged snacks, and processed vegetable oils like canola, corn, or soybean oil.
- Refined sugars: Sweets, sodas, candies, chocolate, cane sugar, corn syrup, brown rice syrup, etc.
- Nuts and seeds: All nuts, seeds, and foods made from these ingredients, including flours, butter or oils, cocoa, and seed-based spices like coriander, cumin, fennel, mustard, and nutmeg.
- Certain beverages: Coffee and alcohol.
- Food additives: Artificial sweeteners like stevia, saccharin, or xylitol, food colorings, emulsifiers, and thickeners.
Foods to Include on an AIP Diet
Examples of foods you can eat while on the AIP diet include:
- Vegetables that aren’t nightshade vegetables like cucumbers, spinach, sweet potatoes, and zucchini.
- Fresh fruits like apples, oranges, mangos, strawberries, bananas, and blueberries.
- Minimally processed meat like grass-fed beef, fish, seafood, organ meats, and poultry.
- Minimally processed vegetable oils like avocado oil, olive oil, and coconut oil.
- Natural sweeteners like honey, agave, and maple syrup.
- Herbs and spices like ginger, garlic, cumin, coriander oregano, salt, and black pepper.
- Fermented foods that are non-dairy-based and non-nightshade-based like sauerkraut, pickles, and kimchi.
Potential Benefits of the AIP Diet
If you're able to recognize and cut out problem foods, the AIP diet can help you better manage an autoimmune disease. It can lower the level of inflammation in your body, which plays a role in many health issues. In particular, the diet aims to calm irritation and heal damage in your intestines, which may be linked to autoimmune diseases. With an emphasis on vegetables, fresh fruits, lean meat, and fish, the AIP diet also gives you lots of important nutrients, including protein, fiber, and vitamins, which benefit your overall health.
Research-Backed Benefits
Several studies have investigated the effects of AIP on gut-related autoimmune conditions and thyroid disorders. Research demonstrated that people with irritable bowel disease who completed AIP (six weeks of elimination phase and five weeks of maintenance phase) reported improvements in bowel movement frequency, stress, and the ability to enjoy hobbies and leisure activities. Also, newer research suggests that AIP may positively affect Hashimotos (a thyroid condition). After completing AIP for 12 weeks, participants had smaller thyroid gland sizes and lower levels of circulating free thyroid hormones and thyroid-stimulating hormones (TSH).
Risks and Considerations
Because you have to cut out so many foods, you could fall short on important nutrients and get other health problems. Don’t try the AIP diet if you’re:
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- Pregnant
- Underweight
- Malnourished
Nutrient Deficiencies
The AIP diet, while promoting whole foods, can lead to potential nutrient deficiencies due to its restrictive nature. Excluding grains might result in deficiencies in vitamins B1, B2, and B3, fiber, and iron. The Paleo diet, which shares similarities with AIP, may hinder adequate vitamin D and calcium intake, given the exclusion of vitamin D and calcium-rich dairy products.
Importance of Professional Guidance
Given the potential risks and complexities, it is crucial to consult with a healthcare provider or registered dietitian before starting the AIP diet. A dietitian can help plan meals and ensure you get the nutrition you need by recommending healthy substitutions for the foods you’re avoiding. They can also provide guidance on how to properly reintroduce foods and monitor your symptoms.
Sample AIP Diet Meal Plan
Here's what a day's eating during the elimination phase of the AIP diet could look like:
- Breakfast: A baked sweet potato drizzled with honey, plus a smoothie made from coconut milk, spinach, bananas, and blueberries
- Lunch: Grilled free-range chicken on a salad with mixed greens, avocado, cucumber, and mushrooms, tossed with herbed vinegar and extra-virgin olive oil
- Snack: Apple slices and peppermint tea
- Dinner: Wild-caught shrimp stir-fried in coconut oil with broccoli, zucchini, cabbage, carrots, basil, ginger, and garlic over cauliflower rice
The AIP Diet vs. Other Diets
The AIP diet is similar to the paleo diet and paleo approach (sometimes referred to as the Paleo Autoimmune Protocol) in the types of foods allowed and avoided. However, the AIP diet is more restrictive than the Paleo diet, particularly during the elimination phase. For example, eggs and seeds are a core part of the paleo diet but are eliminated in the first phase of the AIP diet.
AIP vs. Paleo
Both the AIP and Paleo diets include an elimination phase, but the AIP goes a step beyond the Paleo diet, aiming to minimize the existence of any possible antigen that might trigger an autoimmune response. Thus, individuals who follow the AIP will develop a personalized dietary pattern based on their food tolerances. Moreover, accurately implementation of the AIP requires guidance and support, as it is crucial to correctly follow the phases to address individual food sensitivities and health concerns. In contrast, the Paleo diet does not require this level of expert guidance and assistance. Furthermore, the AIP elimination phase is stricter, with more foods being excluded than the Paleo diet, including eggs, nuts and seeds, nightshades, food additives, refined oils, coffee, and alcohol.
AIP vs. Mediterranean Diet
The Mediterranean diet is another anti-inflammatory diet that focuses on whole foods. However, it is less restrictive than the AIP diet and includes foods like grains, legumes, and dairy in moderation. The Mediterranean diet is often recommended for its overall health benefits and may be a good starting point for individuals who are not ready for the strict elimination required by the AIP diet.
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