If you've been following an elimination diet, such as the autoimmune protocol (AIP) diet or a low-FODMAP diet, you may be wondering when and how to start reintroducing foods. The elimination phase of these diets is highly restrictive and isn’t meant to be followed long-term. The reintroduction phase is a crucial step in identifying your individual food triggers and expanding your diet. This article provides a comprehensive guide to reintroducing foods after an elimination diet, covering various aspects from the AIP reintroduction stages to general elimination diet principles.
Understanding Elimination Diets
An elimination diet is a short-term method that helps identify foods your body can’t tolerate well and removes them from your diet. It may benefit people with irritable bowel syndrome (IBS), attention deficit hyperactivity disorder (ADHD), migraine, eosinophilic esophagitis, and skin conditions like eczema. Food intolerances and sensitivities are extremely common, with up to 20% of people worldwide experiencing a food intolerance.
The Phases of an Elimination Diet
Like the autoimmune protocol, most elimination diets have two main phases:
Elimination Phase: This phase involves removing foods from your diet that you suspect trigger symptoms. The duration is typically 2-3 weeks.
Reintroduction Phase: This phase involves slowly bringing eliminated foods back into your diet, one at a time, while looking for symptoms.
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The Autoimmune Protocol (AIP)
The autoimmune protocol (AIP) is a diet aimed at reducing inflammation in people with autoimmune conditions. The diet claims to lower systemic inflammation and improve various symptoms related to autoimmune diseases by eliminating potentially inflammatory foods such as eggs, dairy, and grains. Several small studies have shown the AIP diet may benefit specific autoimmune conditions, like inflammatory bowel disease (IBD) and Hashimoto's thyroiditis.
Phases of the AIP
The autoimmune protocol has three phases:
Elimination Phase: A strict elimination diet typically lasting around six weeks.
Reintroduction Phase: Foods are added back one by one to determine which foods trigger symptoms. This phase can last several months.
Maintenance Phase: A long-term eating pattern based on the foods identified as safe during the reintroduction phase.
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The AIP Elimination Phase
During the elimination phase, you’ll eliminate the following foods from your diet:
- Grains
- Legumes
- Dairy
- Eggs
- Nuts and seeds
- Nightshade vegetables (such as potatoes, tomatoes, peppers, and eggplant)
- Coffee and alcohol
- Refined sugars and oils
- Food additives and preservatives
It’s recommended to maintain this diet for at least one month once all foods are eliminated.
When to Reintroduce Foods on AIP
Typically, with elimination diets, the reintroduction phase starts once you see a significant improvement or resolution of symptoms related to your condition. Research shows this is generally after at least four to six weeks of being on the full elimination diet. Common symptoms of autoimmune conditions include:
- Joint or muscle pain
- Skin rash
- Fatigue
- Digestive symptoms, like diarrhea, constipation, upset stomach, or acid reflux
Work with your doctor and dietitian to monitor your symptoms and determine when you should start the reintroduction phase of the AIP.
How to Reintroduce Foods on AIP
The reintroduction phase of the AIP has not been well-researched. Most studies on the AIP diet to date have focused on the elimination phase and have not followed the participants through reintroduction. Foods are typically challenged one at a time during the reintroduction phase. This allows the person to monitor symptoms and identify which specific foods may be contributing. Depending on the protocol, each food group is reintroduced across a span of three to seven days, starting with very small portions and slowly increasing the volume.
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For example, when reintroducing grains, you might start with a few bites of rice on day one, ¼ cup on day two, and ½ cup on day three. During this time, it’s important to monitor your symptoms to identify possible flare-ups. If you don’t have symptoms, you can reintroduce the food back into your diet.
AIP Reintroduction Stages
The reintroduction stage of the AIP diet ranks foods from lowest to highest risk to determine the order of reintroduction. The foods least likely to cause a reaction are introduced first, and those with higher risk are introduced last. There are typically four stages to AIP reintroduction, but remember these may vary based on the plan you’re following. The AIP diet isn’t standardized, meaning several variations of the reintroduction stage exist, and these have not been extensively researched.
Stage 1: Reintroducing AIP Foods with Minimal Potential for Flare-Ups
During stage one, you’ll reintroduce the following foods one at a time:
- Egg yolks
- Seed oils
- Ghee (clarified butter)
- Legumes with edible pods (green beans, peas, sugar snap peas)
- Cocoa and chocolate
- Spices including peppercorn
- Coffee (on an occasional basis)
If you have a known allergy or intolerance to foods from any of the stages, you’ll skip that reintroduction.
Stage 2: Reintroducing AIP Foods with a Greater Potential for Flare-Ups
After reintroducing all of the foods from stage one, you’ll move on to stage two foods:
- Egg whites
- Nuts and seeds
- Butter
- Coffee (daily if desired)
- Alcohol (limited)
Some of the foods build up across the stages. For example, if you tolerate coffee on an occasional basis in stage one, you can enjoy it daily during stage two. However, if you don’t tolerate coffee during stage one, you won’t rechallenge it in stage two.
Stage 3: Reintroducing More Challenging AIP Foods
Stage three includes the reintroduction of the following foods:
- Limited nightshade vegetables, including eggplant, paprika, and peeled potatoes
- Dairy products, such as cheese, milk, and yogurt
- Legumes including lentils, split peas, and garbanzo beans
Stage 4: Reintroducing AIP Foods With Highest Potential for Reaction
The final stage reintroduces the remaining foods from the elimination diet:
- Remaining nightshade vegetables, including tomatoes, unpeeled potatoes, and peppers
- Gluten-free grains, such as corn, quinoa, rice, and oats
- Remaining legumes, including black beans, kidney beans, pinto beans, and peanuts
- Alcohol (in moderation)
General Guidelines for Reintroducing Foods
Choose the Right Time: Reintroduce foods when you are in a good place mentally and physically. Avoid times of stress, as stress can negatively impact digestion.
Start Low and Slow: Take very small increases in foods to begin with, at a pace you feel comfortable with.
Introduce Foods Individually: Each food group should be introduced individually over 2-3 days while looking for symptoms.
Monitor Symptoms: Watch for symptoms such as rashes and skin changes, joint pain, headaches or migraines, fatigue, difficulty sleeping, changes in breathing, bloating, stomach pain or cramps, and changes in bowel habits.
Keep a Food and Symptom Diary: Track what you eat, how much, and any symptoms you experience.
How Long Does Reintroduction Take?
The length of the reintroduction stage depends on how much time you decide to spend on each food category. If you spend seven days per food group, the reintroduction phase could last around four to five months. It’s essential to work closely with your doctor and dietitian during this phase for guidance. The end goal is to find the least restrictive eating pattern that works for your symptoms.
How to Track Your Reintroductions
It’s important to track your reintroductions to have a clear record of what you tried and the results. The best way to do this is to keep a food and symptom log. This will track important details like what you ate, how much, which symptoms you experienced (if any), and the severity of your symptoms.
Signs of an Unsuccessful Reintroduction
If you reintroduce a food and experience a flare-up of symptoms, that tells you the reintroduction was unsuccessful, and you should continue avoiding that food. For example, if you have inflammatory bowel disease (IBD) and experience abdominal pain or diarrhea after reintroducing dairy, you’ll want to keep dairy out of your diet in the long term.
What Successful Reintroduction Looks Like
Most people aren’t sensitive to all of the foods on the AIP elimination list, so adding several categories back into your diet will likely be part of your long-term plan. If you reintroduce a food by increasing portions over several days and experience no symptoms, you can put that food back into your diet.
Other Types of Elimination Diets
Besides the traditional elimination diet described, there are several other elimination diets:
Low-FODMAPs Diet: Removes FODMAPs, which are short-chain carbohydrates that some people can’t digest.
Few Foods Elimination Diet: This involves eating a combination of foods you don’t eat regularly.
Rare Foods Elimination Diet: Similar to a few foods diet, but you eat only foods you rarely eat because they are less likely to trigger your symptoms.
Fasting Elimination Diet: Involves strictly drinking water for up to 5 days, then reintroducing food groups. This diet should be done only with permission from a doctor because it can be dangerous.
Benefits of an Elimination Diet
Elimination diets help you discover which foods cause uncomfortable symptoms so you can remove them from your diet. However, an elimination diet has many other benefits, including:
It may reduce symptoms of irritable bowel syndrome (IBS): Many people find that an elimination diet improves IBS symptoms such as bloating, stomach cramps, and gas.
It may help people with eosinophilic esophagitis (EE): Many studies have shown that elimination diets are effective at improving symptoms of EE.
It may reduce symptoms of ADHD: Researchers have found that elimination diets helped reduce ADHD symptoms among children who were sensitive to foods.
It may improve skin conditions like eczema: Several studies have found that elimination diets may reduce symptoms of eczema.
It may reduce chronic migraines: An elimination diet may help reduce the number of headache attacks.
Risks of an Elimination Diet
Although elimination diets help you discover foods that cause problems, they also come with risks. For starters, elimination diets should be followed for only between 4 and 8 weeks. Following an elimination diet for longer is not recommended because it could cause nutrient deficiencies due to eliminating some food groups.
The Role of a Dietitian
Working with a dietitian before, during, and after following the AIP protocol or any elimination diet can help you maximize the diet's potential benefits. Your dietitian (along with your doctor) can help you determine if the AIP diet is right for you based on your medical history and the available research. Because the AIP elimination phase is highly restrictive, your dietitian can help you create a nutritionally balanced meal plan to follow during this period. Your dietitian can also guide you on when and how to reintroduce foods back into your diet, including tips on keeping a food and symptom log.
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