More than 24 million Americans have an autoimmune disease. Scientists have identified over 80 of these conditions[1]Autoimmune Diseases. National Institute of Environmental Health Sciences. Accessed 10/27/2022. .
An autoimmune disease is a malfunction of the immune system, wherein the immune system attacks the body. These diseases can affect many different systems of the body, and can become life-threatening if they are not treated properly. Genetics and the environment are likely risk factors for the development of an autoimmune disease.
Most of these conditions have no current cure, and sometimes, lifelong treatment is required.
For those looking for additional ways to help cope with their symptoms, the AIP (autoimmune) diet may help.
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What Is the AIP Diet?
The autoimmune protocol diet (AIP) is a modification of the Paleolithic (paleo) diet–a diet that promotes the way our prehistoric ancestors ate and rejects modern-day, processed foods. The AIP diet begins with the elimination of specific foods and western dietary patterns that have been shown to disrupt gut health, leading to a disregulated immune system. Popularity of the AIP diet is credited to early adopters of the diet who wrote about how this eating pattern helped with their autoimmune disease symptoms.
“The goal of the AIP diet is to help reduce or relieve autoimmune-related symptoms. In other words, to help patients live more comfortably and healthfully,” says Laura Purdy, M.D., a family medicine physician and entrepreneur.
The rationale behind the AIP diet is to identify and limit or avoid foods that can trigger gut inflammation and/or food intolerances. Sharon Palmer, registered dietitian, author and faculty member at Prescott College in Prescott, Arizona, explains that the elimination of trigger foods “[is] targeted at reducing the possibility of leaky gut.”
Leaky gut, or increased gut permeability, is an unhealthy gut lining that allows partially digested foods, germs and toxins to leak through and penetrate the tissues behind it. Increased gut permeability plays a part in certain gut conditions and autoimmune diseases, Crohn’s disease and irritable bowel syndrome.
Additionally, the AIP diet promotes consuming nutrient-dense foods, healthy sleep habits, stress management and a support system.
Who Should Try the AIP Diet?
People living with an autoimmune disease resulting in symptoms may benefit from the AIP diet, says Palmer. However, she adds that it is not a proven diet to treat autoimmune conditions as a whole and larger clinical trials are needed to fully understand the benefit of the diet since studies showing the diet’s effects are limited. As such it’s always a good idea to consult with your physician to see if the diet is right for you, advises Dr. Purdy.
Among the many autoimmune diseases, inflammatory bowel disease (IBD) and Hashimoto’s thyroiditis are the two conditions that researchers have observed the AIP diet to have an effect on.
Inflammatory Bowel Diseases (IBD)
IBD includes Crohn’s disease and ulcerative colitis and affects the gastrointestinal tract. Common symptoms of IBD include abdominal pain, diarrhea, bloody stools, fatigue and weight loss.
A 2017 Inflammatory Bowel Diseases study looked at the effects of the AIP diet in a small cohort of participants living with IBD with 50% of them on conventional IBD drug therapy. Clinical remission (when symptoms have lessened or abated) was achieved in 11 of the 15 participants by week six. Study authors note that “achieving clinical remission by week 6 rivals that of most drug therapies for IBD.” The results suggest that dietary intervention “can be used as an adjunct to conventional IBD therapy[2]Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Nov;23(11):2054-2060. .”
Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis is characterized by inflammation of the thyroid gland and is the most common cause of hypothyroidism in the U.S. The condition typically progresses slowly and includes symptoms such as constipation, dry skin, depression, increased sensitivity to cold, weight gain and in women—irregular or heavy menstrual cycles.
A 2019 Cureus study examined the effects of the AIP diet in a small group of women diagnosed with Hashimoto’s thyroiditis. Researchers observed statistically significant improvement in quality of life markers, “with the most marked improvements noted in the physical role functioning, emotional role functioning, vitality and general health[3]Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto's Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. .” However, there were no statistically significant findings in thyroid function or antibodies.
Researchers note that larger clinical trials are needed to validate findings and to observe the long-term effects of the diet.
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How Does the AIP Diet Work?
The AIP diet has three phases—an elimination phase, a maintenance phase and a reintroduction phase. It’s important to note that while general guidelines are outlined here, the process and duration can vary by individual.
Researchers and experts interviewed advise working with an interdisciplinary healthcare team—a physician and a nutritional therapy practitioner (NTP) or registered dietitian (RD). In addition to nutrition counseling, they recommend assessment for nutrient deficiencies and routine monitoring. A physician can also obtain labs to see if you’re moving in the right direction. “For example, you might see a decrease in certain inflammatory markers over time,” says Arika Hoscheit, a Nashville-based registered dietitian and founder of Food Courage, a blog featuring AIP diet information. “However, there’s no single indicator and [the diet] is a relatively subjective process,” she adds.
Elimination Phase
“[This] first step of the AIP diet involves removing various foods from the diet for a period of time, usually about four to six weeks,” says Hoscheit. During the elimination phase, foods that may cause inflammation are eliminated in stages. Hoscheit adds that the goal is also to consume nutrient-dense foods to promote healing.
Maintenance Phase
In the maintenance phase, the elimination of foods not allowed is sustained until symptoms improve. Hoscheit notes that there is no hard and fast rule for how long to stay in this phase before moving on to the reintroduction phase. “Some people start to notice big improvements within a week of starting the diet, while others might not feel much of a difference until a month into the diet,” she says. Researchers note that in practice, this phase can occur anywhere from 30 to 90 days. Hoscheit advises people who are still experiencing symptoms beyond 90 days to explore other potential causes.
Reintroduction Phase
Once symptoms improve, eliminated foods are gradually reintroduced to the diet. As such, more variety and nutrients are added to the diet resulting in “a diverse gut microbiome, [which] is important for decreasing inflammation and regulating the immune system,” says Hoscheit.
It’s important to pay attention to how your body responds as you reintroduce foods back to your diet. Hoscheit recommends the following steps:
- Introduce one food at a time, every five to seven days.
- Start with eating 1 teaspoon of one food and observe how your body reacts for 15 minutes.
- After 15 minutes, if no adverse reactions are noted, have a slightly bigger bite and wait another 15 minutes.
- If still no reactions occur, wait a few hours and eat a regular-sized portion of the food.
- Once the above steps are complete, wait five to seven days and observe how your body responds. If no symptoms occur, this food can be reintroduced back to the diet.
- Repeat the process with a new food.
If any adverse reactions occur, make note of the triggering food and avoid it. Dr. Purdy recommends keeping a food log and noting any reactions. “People who have reactions are often uncomfortable until that food is processed all the way out of the system,” she says. She notes that adverse reactions can include intestinal discomfort, nausea, rash, itch, swollen tongue and difficulty breathing. “Difficulty breathing and swelling of the tongue are severe and need immediate medical attention as it can be life-threatening,” she advises.
What Foods Do I Eat and Avoid?
In the elimination phase, these listed foods are avoided:
- Grains
- Legumes
- Nightshade vegetables such as eggplants and tomatoes
- Dairy
- Eggs
- Nuts
- Seeds
- Processed foods
- Refined sugars
- Processed oils such as canola oil, corn oil and soybean oil
- Food additives
- Coffee
- Alcohol
The AIP diet encourages consuming a variety of the following minimally processed and health-promoting, nutrient-dense foods, says Hoscheit.
- Fruits
- Non-nightshade vegetables
- Roots and tubers
- Meat (grass-fed as much as possible)
- Poultry
- Seafood (particularly fish rich in omega-3 fat)
- Fermented foods
- Bone broth
- Minimally processed oils such as olive oil, avocado oil and coconut oil
- Herbs and spices
- Honey
- Tea
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Does the AIP Diet Have Any Risks?
As with any elimination diet or diet that recommends the removal of entire food groups even for a short period, there’s a risk for nutrient deficiencies, cautions Dr. Purdy. When done correctly, the AIP diet is nutrient-dense, notes Hoscheit. However, “the main way people run into trouble is [when] they find a handful of select foods that they are comfortable with and only eat those foods for weeks or months on end. This increases the risk of nutrient deficiencies,” she adds.
“It is hugely important to make sure you’re still getting all the essential nutrients your body needs. So start by chatting with your doctor,” Dr. Purdy advises.
AIP and Autoimmune Disease Resources
Making dietary and lifestyle modifications can be challenging––fortunately, there is support. In addition to her website, Food Courage, which offers AIP diet information and recipes, Hoscheit recommends the following AIP diet and lifestyle resources.
- Autoimmune Wellness is an online community founded by early adopters of the AIP diet and lifestyle, nutritional therapy practitioner, Mickey Prescott, NTP, and certified health coach, Angie Alt, CHC.
- The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body by Sarah Ballantyne, Ph.D., medical biophysicist, creator of award-winning online resource The Paleo Mom and New York Times bestselling author.
- AIP Certified is an online directory of AIP certified coach practitioners
- Shop AIP is an online marketplace of AIP products
Whether you are living with an autoimmune disease or caring for someone who does, it can bring uncertainty and burdens. The Autoimmune Association website offers support wherever you or your loved one is at in the journey. Resources include educational information, tools and resources for patients and caregivers such as support group information and finding a physician specializing in autoimmune disease, research news and advocacy information.
