What is the Autoimmune Protocol (AIP)?
The Autoimmune protocol otherwise known as AIP, is an elimination and reintroduction diet designed to help reduce inflammation and symptoms from autoimmune disease while providing a nutrient dense diet to support the body to improve overall health.
With the goal to repair gut health, regulate the immune system and balance hormones, AIP removes potential food triggers, ingredients that could be causing sensitivities, symptoms and negative effects on gut and overall health. After a period of time, foods are reintroduced one at a time to assess any symptoms that occur and what foods can be tolerated. The foods that are removed may be contributing to negative effects on the gut, triggering unwanted immune responses and causing ongoing symptoms.
Another component of AIP is the emphasis on improving lifestyle factors also known to affect chronic health conditions and symptom management. These include improving sleep, stress management, movement, and connection to others and nature, all of which can have an impact on autoimmune disease.
Research around AIP is still relatively new but gradually expanding. Research has shown that AIP can be supportive for improving symptoms in a range of conditions including rheumatoid arthritis, inflammatory bowel disease (e.g. Chron’s disease and ulcerative colitis), Hashimoto’s, eczema and psoriasis. With people with other autoimmune diseases likely to find symptom improvement.
AIP is similar to the Paleo diet as both focus on whole nutrient-dense foods. However, AIP takes the elimination phase further, by removing additional foods that may trigger sensitivities or reactions.
The two versions of AIP
There are two options when it comes to AIP. AIP core elimination and AIP modified elimination. AIP modified elimination has been created as many people can have good results with a less restrictive AIP diet, where the AIP core elimination is more restrictive for people who may struggle to get results from a less restrictive version.
As with any elimination protocol/diet, it is best to only do the full elimination phase for a short period of time before reintroducing tolerated foods to expand the diet and support the gut microbiome. Aiming to have a diet that is as varied as possible while still maintaining symptom control. In some people it can be difficult to expand the diet again because of being sensitive to many different foods, this is often why people can resort to the carnivore diet for symptom control. Understanding your own body and learning how to heal the gut and support the microbiome to be able to increase the number of foods that can be tolerated is an important step to be able to expand variety in the diet again.
The three phases of AIP
The transition phase
The transition phase is the period of time to go from your current diet to the elimination phase. This can happen in a day or two, or slowly over a few weeks to gradually remove foods and prepare for AIP elimination. For some people, it is easier to do a gradual transition over a few weeks to the full AIP diet so that it isn’t such a sudden change, with others preferring to just start out with the full elimination phase straight away.
This does add more time to the already relatively long process, but for some, a gradual transition can increase the likelihood and beliefs of possible success. It can take time to prepare for, to get different foods or make plans for best adherence to AIP, so this needs to be a personal decision based on each individual's situation.
The Elimination phase
This is the period of time where only AIP compliant foods are eaten, whether following the core AIP or modified AIP restrictions. During this time the goal is to focus on ensuring a nutrient dense diet and adhering to the food eliminations to best maximize healing. The elimination phase is for a minimum of 30 days, and for some people 60-90 days is better to manage symptoms and allow the body time to heal.
The reintroduction phase
Once you have done the elimination phase for 30-90 days at full compliance and have obvious symptom improvement, noticeable by tracking and journalling progression throughout the elimination phase, it’s time to reintroduce foods. Ideally all symptoms will be reduced or gone, but for some, other approaches are needed. The aim of this phase is to introduce foods one at a time to assess any food reactions and sensitivities. Understanding what foods are reacted to, and how severe the symptoms are, is an important part of AIP.
The goal is for each individual to find a diet that works for them to help manage symptoms, that is varied, sustainable to adhere to, and nutrient dense to support overall wellbeing.
Elimination phase: Core or Modified Autoimmune Protocol?
Whether to undergo the core AIP or modified AIP depends on each individual's circumstances, health conditions, severity of disease, as well as a range of factors including the ability to adhere to and implement AIP, cooking ability and skills, food availability and affordability/budget. It is best to talk to a practitioner or nutritionist with knowledge of AIP, autoimmune disease, and gut health, to assess what is most suitable for your individual situation.
AIP core elimination foods avoided
Gluten, grains, pseudo grains (buckwheat, chia, quinoa, amaranth), dairy, eggs, legumes, nightshades (including spices made with nightshades), processed vegetable oils, nuts and nut oils, seeds (including coffee, cocoa, and oils and spices made from them), sweeteners, processed foods and ingredients, and alcohol.
AIP modified elimination foods avoided
Gluten, grains (except rice), dairy (except ghee), eggs, nightshades (including spices made with nightshades), soy, tree nuts and peanuts, sweeteners, processed foods and ingredients, and alcohol.
The differences between core and modified AIP
Modified AIP has more foods included and therefore is less restrictive, these foods are ones that for most people undergoing AIP, have been shown to cause no reaction. Modified AIP includes rice, pseudo-grains, ghee, legumes except soy, and seeds (including coffee and cocoa). Including these foods help make the elimination phase more sustainable, convenient and affordable, which can help with adherence to the protocol and is likely to still be successful for many individuals.
Nutrient dense foods to include during AIP
A key benefit of AIP is its emphasis on nutrient density, encouraging the consumption of fibre rich, nutrient-dense foods. This often increases vegetable intake and supports a healthy gut microbiome. This supports the body to improve nutrient status and increase healing. Including certain foods that are some of the highest in nutrient density are encouraged to support the body to heal and increase success.
Extra nutrient dense foods include
Healthy fats like olive oil and avocado oil
Organ meats (a good addition to meals, important to use in moderation e.g. liver mixed with ground beef. Great to boost nutrient status)
Colourful fruits and vegetables
Bone broth
Fermented foods
Fish and shellfish
Gram for gram, these foods are among the most nutrient-dense, offering a wide range of essential nutrients and providing anti-inflammatory benefits.
The reintroduction phase
It is important to do this phase of any elimination diet, staying in the elimination phase for longer than necessary can cause negative effects to health and the gut microbiome. It is important to reintroduce foods to understand what can be tolerated so that each individual's diet can become as varied as possible while still managing symptoms. Some of the foods initially eliminated are a great source of nutrients and expanding the diet improves its practicality. This helps us enjoy life more and support our gut microbiome by providing a larger range of gut friendly foods.
Some people can become anxious or fearful of food reintroductions, it is important to approach this process mindfully, with unnecessary restriction feeding into food-driven fears. Identifying which foods are tolerated is key and psychological factors can play a large role in our food behaviours. There is a risk of developing orthorexic tendencies if we become overly fixated on restriction of “good” or “bad” foods, so it is important to understand and only restrict foods that genuinely trigger symptoms.
Foods reintroduced in this phase are done in a specific order. This is because certain foods are more likely to cause a reaction. These foods are introduced one at a time, monitoring any changes in symptoms, with a few days in between to allow time for any delayed response, and to ensure there is only one food in the system at a time to assess reactions.
Introductions are started with the most nutrient dense foods least likely to cause a reaction. This process is done systematically while tracking food reintroductions and reactions and can take a few months when done carefully. It is a pretty long, drawn-out process, but when done right it means it hopefully shouldn’t need to be repeated and each individual gets an understanding of their particular sensitivities.
The foods found to cause symptoms may not be needed to be avoided forever. Some people can end up feeling very restricted by their diet due to a range of sensitivities that are discovered. Over time, certain sensitivities can go away as the body continues to heal and gut health improves with a nutrient dense diet and as symptoms are being managed. After longer periods of time, it may be possible to reintroduce some of the foods found to cause symptoms, with the tolerable quantity likely to vary. Some foods may always trigger symptoms and others that may be able to be included again when the gut is more healed.
Reintroduction order of foods for core and modified AIP
The reintroduction of foods is split into stages, 4 for core AIP and 2 for modified AIP. These stages are designed so that foods can be introduced from the least likely to cause a reaction to most likely. In each stage introducing one food at a time in throughout the food categories to assess any symptom triggers and reactions.
You can check out the breakdown of the foods in each stage on the autoimmune wellness website here:
https://autoimmunewellness.com/how-to-reintroduce-food-on-aip-the-definitive-guide/
Can anyone do an elimination diet or the Autoimmune protocol?
If you have ongoing autoimmune, chronic inflammation, or gut symptoms, AIP may be a suitable diet to learn what foods influence symptoms. Being a highly nutrient dense and gut health supporting diet, with no processed foods, it is likely to benefit many people. Depending on each individual's health conditions, what they have tried to date, and other lifestyle and dietary factors AIP may be appropriate.
For many people it is likely that success and improvements in health can be made on a less restrictive diet, focusing on nutrient density, gut health support, minimal processed foods, additives, sugar and alcohol.
For those with a history of disordered eating, eating disorders, food fixation, or stress around food, while this diet may help with symptoms, it’s crucial to first address your relationship with food. Consulting a counselor can provide support in developing a healthy mindset before starting a restrictive diet, which may otherwise reinforce harmful behaviors.
Overall
The Autoimmune protocol is a fantastic option for many people with autoimmune disease to shed light on foods, habits, and behaviours , that influence symptoms. Its focus on nutrient density and gut healing is essential when it comes to autoimmune disease and is a great option for a systematic approach to get to the bottom of whether food is contributing to symptoms.
It can be a hard thing to adhere to and for some people it can take longer for results than others, with consistency and patience required throughout the elimination and reintroduction phases. I did the Autoimmune protocol myself, having coeliac disease and wanting to manage my autoimmune arthritis (juvenile idiopathic arthritis), it played a huge role in my healing journey, where it helped me improve my gut health and I managed to understand symptom triggers to better manage my inflammation.
It is a great foundation for learning more about your symptom triggers but may not work to the same extent for everyone as there are often many contributing factors to autoimmune disease.
AIP can be tough to navigate, and having a nutritionist by your side can make a big difference, whether it’s troubleshooting, personalizing the approach to fit your life, or simply having someone who understands the journey.
If you think AIP may be valuable for you to do to improve your health and wellness and reduce the symptoms you're struggling with, I would love to support you on the journey. You can book a free 15-minute wellness investigation with me where we can talk about your health goals and how I can best support you.
References
https://autoimmunewellness.com/what-is-aip-the-definitive-guide/
https://autoimmunewellness.com/how-to-reintroduce-food-on-aip-the-definitive-guide/
