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The AIP Diet

THE AUTOIMMUNE PALEO DIET IS PALEO 'PLUS'

This means that the Autoimmune Paleo diet builds upon the foundations of the approach of a Paleo Diet and goes several steps further.

The basics of the foods not eaten when following a Paleo approach can be found on our “Paleo – Foods That Are Out” page – but also, and most importantly, the “Superfoods” that are included on our “Paleo – Foods That Are In” page MUST be included on an AIP protocol – with the exception of ghee. This inclusion of nutrient dense, highly nutritious foodstuffs is almost always the fundamental key to really succeeding using an AIP approach.

 

This is because the AIP diet is NOT (contrary to what you might have read) solely focussed on exclusion and elimination. The nutrient density and quality of foods on the AIP diet is specified in order to rebuild and repair the gut lining, to restore the energy and nutrient reserves of the body and to provide the full plethora of amino acids, vitamins and minerals that a body requires in order to rebuild, repair, reduce inflammation and balance hormones, immune function and every physiological system.

 

The body does not heal through elimination and avoidance alone – it heals through elimination of that which is poorly tolerated AND inclusion of that which can heal, repair and replenish – exactly what those with autoimmune conditions need. And exactly what the AIP diet is established to provide.

 

Another important factor to stress is that AIP might look like it’s founded on food and food alone, more specifically on removing foods from your life. However, this is only one part of the reduction of the stress burden and regulation of the dysfunctional immune system. Every other step is just as vital and just as profound as the diet.

 

So whilst the food gets the focus, and sets the foundation for creating functioning biochemistry – what we are doing through the elimination protocols is removing stressors to the system. You MUST remove stressors from all areas of your life, not just from your diet, in order to effect real and lasting change on your immune function and biology.

 

For more on the Lifestyle components of AIP that’s here, the Psychology/Mindset components are here and the genetic and ‘elimination diet’ science is here.

 

But with all of that said… onto the dietary specifics.

 

In short, off the AIP (and Paleo) table are:

 

  • all grains
  • all dairy
  • all legumes
  • refined and processed oils
  • all refined sugars and artificial sweeteners
  • alcohol
  • emulsifiers, thickeners, preservatives and dyes

FURTHER ELIMINATIONS ON AIP

EGGS

 

Eggs are actually really complicated. They’re not just one thing, after all – with the yolk, the white and then the homogenous whole all being different ‘entities’ inside our bodies. For everything you could ever want to know about the immune triggering potential of eggs, please check out our “All About Eggs” page. But on an AIP diet, these must be excluded. They are actually in the top ten of the highest ranked allergenic substances and their proteins have been studied widely in the context of inflammation – something we are trying to avoid judiciously with AIP.

 

Ghee

 

Whilst ghee, despite being dairy, is actually on the Paleo OK list, it is eliminated on the Autoimmune Paleo protocol. Some ghee products are now supposedly certified casein and whey free (i.e. free of dairy proteins) and theoretically should be pure butter fat, which could be fine. However, for autoimmune patients who are avoiding all other dairy we feel that it is wise to eliminate even these products initially. Other ghee products are typically 97% fat, which leaves 3% of proteins remaining. These proteins are potentially immune activating – and dairy proteins are another of the top ten most allergenic foods.

So whilst dairy tends to be associated with many immune reactions, typically autoimmune patients are able to bring back ghee relatively quickly (see our “AIP Reintroductions” page for all on this). There are products available which are cultured (which ferments and gets rid of any remaining proteins) grass-fed, organic and from well- nourished cows. This ghee is free from toxins and hormones or antibiotics and rich in Conjugated Linoleic Acid and butyrate – great for human health. It is certainly high, like eggs, on the list of reintroductions – but on the strict AIP it must be eliminated.

 

Nightshade Vegetables and Fruits

 

Included in the nightshade category are all varieties of tomatoes, all varieties of peppers, aubergine, white potatoes and the spices derived from all of these foods like cayenne, chilli and paprika.

Additional nightshades that you won’t necessarily realise are from the same family are ashwagandha (a common “chill out” adaptogenic herb), goji berries, physalis/cape gooseberries (the Americans call these ‘ground cherries’) and tobacco.

For all the detail on the why behind nightshade exclusion, read our “All About Nightshades” page.

 

Nuts and Seeds

 

This means nuts and seeds in both their raw and roasted forms, along with all of the oils derived from them. Also eliminated are the milks, flours, butters and pastes produced from nuts (which includes tahini, which is ground sesame seed paste).

Also eliminated are all of the spices which are derived from seeds: e.g. caraway, cumin, mustard, dill, fenugreek and star anise.

Nuts and seeds contain lectins. We go into great detail about lectins (toxic lectins) on the “All About Gluten” page on our website, because gluten-containing grains are rich in lectins. Whilst nuts and seeds do NOT contain lectins that have been shown in any studies to interact with the gut barrier and create intestinal permeability, the lectins present within nuts and seeds can cause issues if the gut barrier is already permeable (e.g. due to gluten interaction).

Nuts additionally have the ability to interact negatively with oestrogens in the human body (they contain phyto-oestrogens which can compete with the body’s own). Seeds are actually used in hormone therapy approaches for this reason.

The primary for the elimination of nuts and seeds on AIP is due to the fact that they are tough on the digestive system. They may be rich in certain nutrients and form part of an overall healthy diet, but for those with autoimmune conditions intestinal inflammation and permeability is always a concern. For this reason, anything that increases intestinal distress (both through irritation and by creating localised inflammation if the gut is already permeable) needs to be dealt with with caution. Nuts and seeds are therefore ruled out of an AIP diet – and because there are many risk factors with nuts (including freshness/rancidity and the oxidisation of the fats etc. along with their irritation to the GI tract) they can also often be quite tough to bring back in. Seeds are often more well tolerated, with some people never fully being able to digest nuts in any quantities until some years in remission from their autoimmune condition.

 

Alcohol/Stimulants/Adrenal Stressors

 

On the Paleo sections of this site alcohol is a “Grey Area” food/substance, but for AIP this is very much off-limits. Alcohol is a toxin, as explained extensively in our “All About Alcohol” page, and whereas those without health issues might feel that their bodies tolerate occasional beverages, for anyone with autoimmunity this becomes too much of a stressor for an already impacted physical system.

The same is true for other stimulating substances and products which affect adrenal function – such as liquorice, caffeine-containing white teas etc. and also chocolate (below).

Stimulants do what the name suggests: they stimulate. The whole nature of autoimmunity is that there is an overstimulation of the immune system. An AIP Diet, therefore, removes all substances that increase blood pressure, boost adrenals too much and/or stimulate a stress-based response within the body.

 

Chocolate

 

We mention this separately because it is one of those foods that people love – and that those with autoimmunity yearn to eat to have some ‘sweetness’ or ‘dessert’.

Chocolate is a complex creature, and even in the 100% dark versions which are pure cocoa mass there are challenges to those with autoimmune conditions. In some versions of the AIP diet, chocolate or cacao (pure cocoa) is permitted. In others, people recommend eliminating cacao and replacing with carob. The literature on chocolate is actually quite clear: whilst impure and poorer quality chocolate can have negative consequences, good quality, well-sourced chocolate can be part of an autoimmune diet from very early on – perhaps only eliminating for 30 days.

Chocolate is actually made from a seed – the cocoa bean. As with nuts and seeds and nightshades (above) cacao has polyphenols and micronutrients which work by slightly stressing and stimulating an hormetic stress in the body. They also contain the lectins and phytates of nuts, seeds, nightshade vegetables and fruits. However, unlike nuts, seeds or nightshades we never eat chocolate unprocessed. Even ‘raw’ chocolate has been processed to a certain degree. In so doing, many of the lectins and phytates (the anti-nutrients) in chocolate are actually broken down. So unlike the digestive issues created by consuming raw or barely cooked nuts, seeds and nightshades – Chocolate is actually relatively low in anti-nutrients.

And yet, the whole point of AIP is to remove stressors. Chocolate – even the good quality stuff – is one of those foods which can prove too challenging to those who are vulnerable and prone to hyper-reactivity (the stimulating compounds might be too aggravating) or those with any histamine issues. It contains caffeine and theobromine, and is a histamine liberator. Therefore, we would always recommend an initial 30 days without such stimulants and histamine aggravators, just to see if chocolate sensitivity is part of your autoimmune picture.

When you do bring it back in, it must be in the form of pure, good quality dark chocolate, with no fillers or emulsifiers – and we are definitely NOT meaning ‘raw’ chocolate here. No matter the marketing hype, raw cocoa is not something you want to bring if you have autoimmune conditions – because in this instance it is the roasting and processing that temper the anti-nutrients in the cocoa beans. For more on the right way to choose chocolate – and the best way to incorporate it into your overall diet – check out our “All About Chocolate” page.

And lastly on chocolate: if you are of the opinion that the reason to eliminate chocolate on AIP is because it is a cross-reactive with gluten then please do read our extensive explanation on “All About Chocolate” page. There is no scientific literature to support the cross-reactive theory, and only a weak suggestion that cross-reactives are anything to worry about at all – especially in those without coeliac disease. That, of course, doesn’t mean that Chocolate sensitivity is not forming part of your immune over-sensitivity picture – just that it might not be for the reasons that you think, and it may be able to come back into your life sooner than you think.

 

MUCILAGINOUS FOODSTUFFS

 

A bit of a controversial one, this one, but strictly speaking the foods which contain mucilaginous fibre (a substance that turns to sticky, gloopiness inside the intestines) are excluded from the initial AIP diet. Whilst mucilaginous fibres have been linked with beneficial impacts on overall health (especially in intestinal permeability and some digestive disorders), in those with autoimmunity mucilage is a fibre which can prove stimulating to the immune system.

This category includes many seeds (which would be eliminated anyway – see above) but also Agar Agar, Okra, Liquorice (again) and Natto. And yet, it also includes Plantain, Cassava, Aloe Vera and Marshmallow Root/Slippery Elm – the latter three of which are renowned for their healing properties.

The science suggests that mucilaginous fibres can stimulate certain branches (either Th1/Th2) of the immune system. That said, it is a myth that immune conditions are solely down to so-called “Th1 or Th2 dominance/imbalance” (this is a woeful underestimation of the complexity of immunity). That means that it is difficult to know whether and how these mucilaginous substances are going to affect each individual and their condition. Another potential trigger to the immune system comes from the fact that mucilaginous fibre influences digestive bacteria by feeding ALL bugs, so any bacterial dysbiosis or pathogenic activity will be magnified. This will increase inflammation in the body – and this is not healthy for those with autoimmune conditions.

The general feeling among the AIP community is this food group acts as an amplifier, and if digestive dysbiosis is a feature of your symptom presentation it must be rectified prior to adding in the mucilaginous foods – including things like Slippery Elm or Marshmallow which are supposed to heal intestinal permeability.

If, however, your digestion and microbiome are well controlled and you are on a healing path, these foods are unlikely to trigger any reactivity in isolation. There are always exceptions to the rule, and if Th1/Th2 imbalance is a specific feature of your autoimmune condition these substances would be best avoided (though as we said, this is MUCH less simple than the internet would have you believe). However, after a brief period of avoidance these substances might actually be beneficial, particularly for overall healing. Obviously, ALWAYS watch closely, and if you do eliminate them, incorporate each food, singly, as one of your early, Stage 1 reintroductions – for more on what this means, see our AIP Reintroductions Page.

 

 

SO WHAT’S LEFT?!!

 

Trust us, there are far more foods on the ‘eat’ list than the ‘don’t eat’ list… but the above is a basic outline of what you remove.  What’s left is all the really great foodstuffs:

 

  • meat in all its cuts and all its guises – with a focus on quality, grass-fed, organic (if possible) meat and overall freshness

 

  • fish and shellfish – all varieties – look for wild fish and freshness

 

  • all vegetables that are not nightshades – which includes a plethora of plants, everything green and leafy, cruciferous veg, starchy veg, tubers, roots, leaves, bulbs etc. etc. etc.

 

  • all fruits that are not nightshades – sweet, natural and rich in polyphenols – look for a variety of colours

 

  • healthy, natural fats – cold pressed and high quality – from both animals (tallow, lard, duck fat, goose fat etc.) and plants (coconut, olive, avocado)

 

  • any broths, soups, stews, casseroles, salads, dressings, ‘crisps’, puddings and combination of wonderful foodstuffs that you can make using any and all of the above

 

If you would like an incredibly thorough list of foods that are “In”, our recommendation would be to purchase “The Paleo Approach” by Dr Sarah Ballantyne, PhD. On page 236-239 you will find the most rounded list we have ever seen of foods that you are able to consume whilst still staying staying perfectly AIP.  It is like an education in enormous variety of foodstuffs this planet produces – and whilst you won’t access all foods in the UK, there are a myriad of suggestions for different meat cuts and weird vegetables that are worth exploring.

 

So as you can see from the above – there are many restrictions whilst following an AIP diet, but there are also countless foods that you CAN incorporate. Yes, it takes time, effort and a bit of investigation – but keeping your diet as broad as possible is an investment well made.

 

To conclude, we stress that AIP is a restrictive, healing nutritional intervention designed as a tool to systematically remove inflammation and then nourish, restore and rejuvenate the body.

 

It is perfectly possible that you will react immunologically or digestively to foods NOT eliminated on this list – everyone is individual. Just because a food appears on the ‘In’ list, if it makes you feel bad or causes symptoms, STOP consuming it.

 

It is also perfectly possible you are contending with other issues alongside autoimmunity – such as digestive dysbiosis, intestinal permeability complications and/or histamine, salicylate and oxalate intolerances borne out of impaired gut bacterial/hormonal/enzymatic/short-chain-fatty-acid production etc. If you have these complications, your journey will be more of a challenge and we encourage you to reach out to us, or to a professional for help.

 

Therefore we say and repeat again: AIP is a powerful tool when used in the right circumstances.  It is designed as a short-term intervention, not a lifelong prescription designed to remain rigid and restrictive indefinitely.

 

It is also not a panacea.  If you are unsure whether there are other factors involved, or if you are experiencing challenges and more symptoms or stress whilst trying to stay AIP our Functional Medicine Consultant and Founder, Victoria would be happy to help – you can reach out to her directly here.

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