The Autoimmune Protocol (AIP) diet is a specialized dietary regimen designed to reduce inflammation, manage symptoms, and support healing in individuals with autoimmune diseases. In autoimmune conditions, the immune system mistakenly attacks the body's own healthy cells, leading to chronic inflammation and a variety of symptoms. The AIP diet aims to mitigate these symptoms by identifying and eliminating foods that may trigger an immune response, while emphasizing nutrient-dense foods that promote gut health and overall well-being.
Understanding the AIP Diet
The AIP diet, also known as the Paleo Autoimmune Protocol, is derived from the Paleolithic diet but is a stricter version, eliminating foods that may be antigenic, stimulate the immune system, or create dysbiosis. It is not intended to be an all-inclusive list of the allowed and restricted foods, nor does it define all the rules of the diet. This list should NOT be used as a guide to following the diet.
The Three Phases of AIP
The AIP diet consists of three distinct phases:
Elimination Phase: This initial 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. The elimination phase is the first and most restrictive phase of the diet. It must be followed for a minimum of 30 days, but may require longer use.
Reintroduction Phase: In this phase, foods are gradually reintroduced into the diet, one at a time, based on the person's tolerance. The goal 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.
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Maintenance Phase: This final phase involves sustaining personalized restrictions and reintroductions as long as the individual remains symptom-free. The foods that were tolerated in the Reintroduction Phase are incorporated back into the diet. Unlike some other therapeutic diets in which reintroductions are de-emphasized or cautioned against, AIP emphasizes and encourages the adding back in of tolerated foods to achieve healthy diversity.
Why Target Inflammation?
Chronic inflammation wears down the body and can cause physical and mental symptoms, including body pain, weight changes, chronic fatigue, diarrhea or constipation, low mood, and frequent infections. It's much easier to stay healthy and feel energetic when inflammation levels are under control.
Who Can Benefit from the AIP Diet?
The AIP diet is designed to help reduce inflammation, pain, or other symptoms caused by autoimmune diseases and may be a good diet for people with autoimmune disorders. As such, it may work best for people with autoimmune diseases, such as lupus, inflammatory bowel disease (IBD), celiac disease, or rheumatoid arthritis. Many autoimmune patients have found success in managing their symptoms by following an AIP diet.
Conditions Studied
A few 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 Hashimoto's (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).
Leaky Gut and Autoimmunity
Some scientists believe leaky gut syndrome triggers an autoimmune response. The stomach lining serves as a protective barrier between the contents of the stomach and our bloodstream. In individuals with leaky gut, the lining of the stomach is weakened, allowing bacteria, toxins, and other foreign substances to leak into the bloodstream.
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Foods to Include on an AIP Diet
The AIP diet focuses on incorporating whole foods and eliminates highly processed food items. Foods included in the AIP diet are mainly whole foods without preservatives or additives. Additionally, many of these foods are high in fiber and lower in added sugar and saturated fats. When following the AIP diet, you will be increasing your intake of fresh, micronutrient-dense, whole foods that don't trigger your disease.
Vegetables
Vegetables are very nutrient dense. They contain a huge variety of essential vitamins, minerals, and phytonutrients (beneficial compounds produced by plants). Many phytonutrients have powerful antioxidant and anti-inflammatory properties that are very beneficial for our health. Vegetables are also rich in dietary fiber, which helps feed our gut bacteria. Research has found that lack of fiber in the diet will cause some bacteria to begin feeding on the protective layer of mucus that lines the intestines. This weakens the mucus layer and allows pathogens to reach the intestinal lining.
Best AIP Vegetables:
- Leafy greens: kale, spinach, lettuce, cabbage, watercress, beet greens, collard greens
- Cruciferous: broccoli, cabbage, cauliflower, kale, brussel sprouts, arugula, turnips, mustard greens, radish, turnips
- Alliums: onion, leek, garlic, ramps, scallions, shallots, chives
- Tubers and roots: sweet potato, beets, carrots, parsnips, turnip, acorn squash, yam
- Edible fungi: mushrooms
- Sea vegetables: laver, hijiki, wakame, dulse, Irish moss, alaria
Fruits
Fruits are also a great source of nutrients, although they are higher in fructose than vegetables. Choose colorful fruits to ensure a diverse range of phytonutrients with antioxidant, antimicrobial, antiviral, and anti-inflammatory benefits.
Best AIP Fruits:
- Apples (red, yellow, green, etc.)
- Apricots
- Avocado
- Bananas
- Berries (strawberries, blueberries, blackberries, raspberries, cranberries, etc.)
- Cantaloupe
- Cherries
- Coconut
- Figs
- Grapefruit
- Grapes (green, purple, etc.)
- Kiwi
- Lemon
- Lime
- Lychee
- Mandarins
- Mango
- Orange
- Papaya
- Passion fruit
- Peaches
- Pears
- Pineapple
- Plums
- Pomegranate
- Rhubarb
- Tangerines
- Watermelon
Meats and Fish
Protein is an essential nutrient for the body. It's involved in many cellular functions, such as maintaining and regenerating tissue, making antibodies, synthesizing hormones, transporting nutrients, and acting as an energy source.
Best AIP Meats and Fish:
- Anchovies
- Grass-fed beef
- Bison
- Clams
- Cod
- Halibut
- Herring
- Lamb
- Lobster
- Mackerel
- Oysters
- Pork
- Free range or organic poultry (in moderation)
- Wild-caught salmon
- Sardines
- Shrimp
- Trout
- Tuna
- Turkey
- Venison
Glycine-Rich Foods
Glycine is an amino acid used to make glutathione, a powerful antioxidant that protects the body from oxidative stress. Glycine is critical to many physiological processes and has been shown to have anti-inflammatory effects. Glycine has even been shown to improve sleep quality and to reduce daytime sleepiness when you're not getting enough sleep.
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Best Glycine-Rich Foods:
- Bone broth
- Organ meat
- Tendons, ligaments, and skin of animal meats
- Seafood, especially carp, clams, oysters, and wild salmon
- Dried seaweed
- Spinach
- Watercress
Fermented Foods
Fermented foods have undergone a process that converts food components, such as carbohydrates, into alcohol or organic acids. Fermented foods contain probiotics, which have been found to reverse intestinal permeability and improve the gut barrier function. Probiotics can also help restore the gut microbiome when it has been affected by dysbiosis, or an imbalance in the gut's microbial ecology. Probiotics may also help boost immune function by reducing pathogen-related inflammation and stimulating protective responses from cells in the gut lining.
Best AIP-Compliant Fermented Foods:
- Sauerkraut
- White kimchi (nightshade-free)
- Kombucha
- Pickled vegetables and fruits
- Coconut milk kefir
- Coconut milk yogurt
Oils and Fats
Oils, along with fatty fish, are sources of essential fatty acids that our body is unable to make. Monounsaturated and polyunsaturated fats have been found to have anti-inflammatory effects.
Best AIP Oils and Fats:
- Avocado oil
- Coconut oil
- Extra-virgin or virgin olive oil
- Lard
- Tallow
- Schmaltz (rendered chicken or goose fat)
Herbs and Spices
Many herbs and spices have traditionally been used not just for flavor enhancement but also for their medicinal properties.
Best AIP Herbs and Spices:
- Basil
- Bay leaf
- Chamomile
- Chives
- Cilantro
- Cinnamon
- Cloves
- Dill weed
- Garlic
- Ginger
- Kaffir lime leaf
- Onion powder
- Oregano
- Parsley
- Peppermint
- Rosemary
- Sage
- Saffron
- Spearmint
- Tarragon
- Thyme
- Turmeric
Other AIP-Friendly Options
- 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 3â4 cups per day
- Bone broth
Foods to Avoid on an AIP Diet
During the elimination phase of the AIP diet plan, foods that typically increase inflammation in the body are removed. It's recommended to cut the following foods as you begin your AIP diet plan. The modern diet tends to be high in processed foods, refined carbohydrates, and saturated fatty acids, with low levels of mono- and polyunsaturated fatty acids, dietary fiber, and micronutrients. All of these factors combined are believed to lead to inflammation and an increased permeability across the intestinal barrier, otherwise known as "leaky gut." Food additives are also eliminated on the AIP diet, as research suggests they can disrupt the gut microbiome and cause inflammation.
Foods and Medications to Avoid:
- Grains (barley, buckwheat, corn, millet, oat, quinoa, rice, rye, wheat, etc.)
- Legumes (black beans, fava beans, chickpeas, soybeans, etc.)
- Nightshades (potatoes, eggplant, peppers, goji berries, and tomatoes, and spices such as cayenne, paprika, chili powder, etc.)
- Dairy
- Eggs
- Coffee
- Alcohol
- Nuts and seeds (including spice seeds such as cumin, fennel seed, mustard, etc.)
- Refined or processed sugars and sweeteners (except for honey)
- Oils (except for avocado oil, coconut oil, and olive oil)
- Food additives (emulsifiers, thickeners, etc.)
- Medications that can trigger intestinal inflammation, dysbiosis, food intolerance (e.g., NSAIDs)
Reintroducing Foods: A Step-by-Step Protocol
During the reintroduction 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.
Step-by-step reintroduction protocol:
- Choose one food to reintroduce. Plan to consume this food a few times per day on the testing day, then avoid it completely for 5â6 days.
- Eat a small amount, such as 1 teaspoon of the food, and wait 15 minutes to see if you have a reaction.
- 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 2â3 hours.
- 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 5â6 days without reintroducing any other foods.
- If you experience no symptoms for 5â6 days, you may reincorporate the tested food into your diet, and repeat this 5-step reintroduction process with a new food.
Itâs 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 nightâs sleep, when feeling unusually stressed, or following a strenuous workout. Additionally, itâs 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.
Tips for Grocery Shopping on an AIP Diet
Food costs are high, but there are strategies you can use to eat well while sticking to your budget. First, build a weekly menu that features ingredients on sale at your local grocery store. If chicken thighs are on sale that week, try to cook more meals with chicken (and buy extra to freeze, if possible). The same approach should be taken for vegetables, fruits, and other essentials. Second, use coupons to save a few dollars on food. Many stores offer paper or digital flyer books. To save time, you can use apps like Flipp. Lastly, consider visiting a few stores or farmerâs markets to complete your shopping. This allows you to compare prices and ensure you get the best value for every dollar. Planning and preparing these details can help you save money while you work towards your health goal.
Potential Benefits of the AIP Diet
Though research on the AIP diet is limited, some evidence suggests that it may reduce inflammation and symptoms of certain autoimmune diseases.
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. In parallel, thereâs growing evidence that the foods you eat can influence your gutâs 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.
May Reduce Inflammation and Symptoms of Some Autoimmune Disorders
To date, the AIP diet has been tested in a small group of people and yielded seemingly positive results. For instance, in a recent 11-week study in 15 people with IBD on an AIP diet, participants reported experiencing significantly fewer IBD-related symptoms by the end of the study. Similarly, a small study had people with IBD follow the AIP diet for 11 weeks. Participants reported significant improvements in bowel frequency, stress, and the ability to perform leisure or sport activities as early as 3 weeks into the study. In another study, 16 women with Hashimotoâs thyroiditis, an autoimmune disorder affecting the thyroid gland, followed the AIP diet for 10 weeks. By the end of the study, inflammation and disease-related symptoms decreased by 29% and 68%, respectively. Participants also reported significant improvements in their quality of life, despite there being no significant differences in their measures of thyroid function.
Considerations and Potential Drawbacks
The AIP diet is considered an elimination diet, which makes it very restrictive and potentially hard to follow for some, especially in its elimination phase. The elimination phase of this diet can also make it difficult for people to eat in social situations, such as at a restaurant or friendâs house, increasing the risk of social isolation. Itâs also important to note that thereâs no guarantee that this diet will reduce inflammation or disease-related symptoms in all people with autoimmune disorders.
However, those who experience a reduction in symptoms following this diet may be reticent to progress to the reintroduction phase, for fear it may bring the symptoms back. This could become problematic, as remaining in the elimination phase can make it difficult to meet your daily nutrient requirements. Therefore, remaining in this phase for too long may increase your risk of developing nutrient deficiencies, as well as poor health over time. This is why the reintroduction phase is crucial and should not be skipped. If youâre experiencing difficulties getting started with the reintroduction phase, consider reaching out to a registered dietitian or other medical professional knowledgeable about the AIP diet for personalized guidance.