AIP Reintroductions

We at Paleo in the UK need to be very up front and clear about our approach to the steps required when using the Autoimmune Protocol.

1. Removal of inflammatory foods

2. Replacing inflammatory and immune aggravating foods with nutrient-dense whole foods such as bone broth, organ meats, bone-in and oily fish/seafood and piles of vegetables

3. REINTRODUCING AS MANY FOODS AS POSSIBLE – to personal tolerance levels

It is here where we see so many mistakes on AIP Protocols.  People are great at removal… they can be slightly worse at introducing the nourishing, healthful foods.

But mostly, people suck at reintroduction.

We get it.  We know where it comes from.

Two places:

1. Lack of symptom improvement

2. Fear

TIMING IS EVERYTHING

Before we address these two major concerns, let’s talk about timing. 30-day challenges are all the rage, but realistically with autoimmunity you have to be looking at a longer haul. Anecdotally, the length of time taken to both see effects and to also be confident with understanding the impact of reintroductions (see below) seems to be directly correlated to the level of damage done by the autoimmune condition with which you are dealing.

It also has to do with which organs/tissues are involved in your individual autoimmunity. If you have coeliac disease, any form of inflammatory bowel disease or an autoimmune condition affecting your gastrointestinal tract then your job is a bigger one because the gut is the means of delivering nutrition to your body.   You have to heal this before the benefit of the truly nourishing foods can really be completely felt. When autoimmune gut conditions are present this complicates the process. It is still eminently possible, it just may take more patience.

Those with multiple autoimmune conditions tend to fall into two camps: either experiencing rapid resolution OR lengthy resolutions where, symptoms drop away one at a time.

Those with autoimmune skin conditions such as eczema and psoriasis tend to find their symptoms take a while to resolve. This is because the outer skin is one of the body’s lower priorities when it comes to healing and can regularly be the last thing to resolve once all other internal healing has been achieved.

All of this said, regardless of what can be seen on the surface or felt internally, throughout the process, the focus on nutrient density, low inflammatory foods and overall systemic healing, will mean that the body is repairing.

You should notice some improvements (even minor ones like better temperature control or easier digestion) within a month or two… and yet the process to feeling confident with reintroductions and more complete symptom remission may take a year, or possibly even more.

NO IMPROVEMENTS?  EVEN AFTER A LONG TIME?

If you are struggling with (1) above then you may have underlying health issues which cannot be resolved using dietary manipulation alone. You may have either damage or comorbidities which prevent nutritional approaches from ‘healing’ you. This can include gut problems, specific nutritional deficiencies not easily resolved by food intake, genetic SNPs which affect nutritional usage or metabolic processes, toxins and infections of which you are unaware and/or other components in the mental, emotional, psychological and social realms which must be dealt with.

Our recommendation is always to view your progress through AIP as an investment – of time, of effort, of energy and of awareness. If you are uncertain about your approach or choices and are not seeing results then now is the time to consult a practitioner to guide you – even if only for a one-off consultation to ascertain where improvements or iterations can be made. Choosing to do this will genuinely save you money in the long run, it is bound to save you time – but most importantly, it will help you remove any guilt that naturally comes if you are not feeling better after following AIP for a while.

If Fear is an issue… understanding Elimination Diet Science will help…

Elimination Diets, particularly in the case of the AIP Diet, change the intestinal environment and the immunological function. The AIP Diet will heal issues which have taken hold within the GI tract, such as intestinal permeability. The AIP Diet will often, especially if fermented foods have been included in your diet, shift the bacterial balance within the GI tract.

By default, this means that you are, digestively speaking, healthier after following AIP than previously  A healthier digestion means your body breaks down foods into smaller and smaller pieces before moving it through into your small intestine. It means that the intestinal tight junctions and cellular barrier function is once again working well. And a healthy digestion removes countless ‘stressors’ from reaching and aggravating the immune system.

As such, being on the AIP Diet can feel safe, secure, hopefully symptom-free. It is associated with healing, with feeling better, with ‘curing’ your illness and resolving your conditions.

And yet, you are living without whole food groups and major sources of nutrition. Eggs alone are a powerhouse of nutrients which you are wilfully avoiding. It would be nice to know if you could actually eat them, wouldn’t it? It would be lovely to understand your true tolerance for all of the foods that you avoid.

It is likely that your reactivity to certain foodstuffs prior to AIP was based on poor intestinal health and overall high inflammatory loads, rather than genuine intolerances.  It is also likely that a good proportion of the foods you eliminated during AIP were either not actually issues for your immune systems or true triggers for your autoimmunity.

 

The ONLY way to know what foods are suited to your body on an ongoing basis is to reintroduce them. This is actually the effective part of Elimination Diets like AIP… Not the elimination, but the process of reintroduction.  Here is where actual information is gleaned.

And no, not everything is going to go well. But… that’s how and why it works. If your fear is preventing you from taking reintroduction steps, read the below to understand why you must…

The Science of Elimination – How the Autoimmune Paleo Diet Works

The AIP Elimination Diet removes common, known and suspected antigens or inflammatory compounds from the body.

Whilst consuming these foods, the immune system has a networked response of checks and balances to all foods eaten. This works on a see-saw of processes: the first being ‘react’ and the second being ‘calm the reaction’.

The initial inflammatory, immune response at the presence of an antigen comes from one branch of the immune system. This initial response is then brought down by a complementary branch of the immune system. (In fact, one theory of autoimmunity is that it is this complementary, ‘calm the reaction’ branch which is ineffective and cannot shut off immune reactivity once threats have dissipated.)

This bringing down of the reaction is simply done to avoid the body being reactive and hyper-inflammatory all of the time – but all of this means that the body is locked in a state of react/quell the reaction/react/quell the reaction – and while the immune system is on overdrive, you feel generally awful.

The AIP Diet removes reactionary foods, and hence removes the need for the immune system to ‘react’ in the first place. You therefore also remove the need for the ‘calm the reaction’ response. All of the immune cells involved in these paired processes start to diminish in the body on AIP, as the body no longer has the need for the specially made, targeted reactive T cells which fought the antigenic foods. It therefore no longer needs or makes the cells that match those T cells to bring the reaction down.

 

The magic of Elimination Diets is that the cells which suppress the ‘reaction’ T cells disappear far quicker than the memory T cells which create the reaction in the first place. i.e. the ‘react’ branch retains memory of antigens for a good while, just in case. But the ‘calm the reaction’ branch very quickly stops making its calming cells which seem clearly to be no longer needed.

This means that when eliminated foods are brought back into the diet after a period of time, if you have any reaction it will be more reflective of the things that truly aggravate your immune system. The ‘react’ cells are still there, waiting just in case – but you no longer have a ready supply of the ‘calm the reaction’ cells. You will get symptoms if you really cannot tolerate that food – and the symptoms are the clue to whether you personally are reactive to that foodstuff.

Here is a good place to reiterate… the AIP Diet is NOT a personalised regimen excluding all the foods you are intolerant or reactive to. It is a broad brush which eliminates all the foods known to trigger immune activity, generally.

This means that you are highly, highly unlikely to be truly reactive to every food eliminated on the AIP Diet. The reintroduction of certain foods may have no impact at all. Other foods may have a larger impact than they ever did when you consumed them prior to AIP.

 

THIS is how you know what foods are truly problematic for you personally, and how you personalise your diet going forward.

This is why Elimination Diets work. In the symptomatic fog of a highly inflamed state, whilst consuming a diet filled with foods that your immune system doesn’t like, living with the perpetual checks/balances, flare/suppression dance of reactivity it is very difficult to observe reactions for what they truly are.

Removal means that reintroduction will cause you to react more overtly to certain things that are real triggers for you personally. But it also empowers you to know the foods that you are absolutely, perfectly fine to eat going forwards.

Coping with the flares and reintroduction phases of the AIP Diet requires a mindful awareness of the following:

1. If you do have a symptom flare on reintroduction, your foundations after several months of low-inflammation, AIP living will be far stronger than they were when you began this process. You will quieten the reaction and you will be able to move forward

2. This is truly an information-gathering exercise in which you are the driver and the experimenter. You are learning everything you need to know about the reality of what affects – and doesn’t affect – your body. Whilst flares and reactivity during reintroductions might feel like failures, they are not completely backwards steps. They are knowledge-gaining, information-gleaning experiences which will continue to empower your journey going forward.

Life doesn’t start at reintroduction, nor does AIP disappear once you have your “crib-sheet” of foods. At Paleo in the UK we are firm believers that everything on both the AIP and Paleo sections of this website are tools. These tools clear the reactivity in the body and foster the relationships of awareness between us and our food, our environment and our lifestyle practices. We can learn ourselves, and in so doing create an understanding of how we stay healthy in our lives.

If you have had any autoimmune condition take root in your life then the real way to get through it is to find any tools you need to modify the levels of threat your body feels it is experiencing on a moment-by-moment basis. A part of this is the dietary piece – but there are so many other fragments of life which affect and will help to decrease immune reactivity.

 

READ ON BELOW FOR THE HOW TO GUIDE TO COMPLETE AIP REINTRODUCTIONS… And do continue to explore the rest of this site to discover more. And if you’re still scared and fear the AIP Reintroduction phases – reach out to us for help today.

A few key rules about the ‘when’ of reintroductions:

1. Have you AIP’ed for long enough? This is a totally personal question and it is actually relatively little to do with the months on a calendar. What you are seeking is a relative LACK of inflammation, reactivity, permeability and distress. Whilst you don’t have to be fully clear of symptoms to attempt reintroductions you do need to have a good degree of self-awareness and understanding. You have to be clear enough of reactions such that you can judge any symptoms that a reintroduction may cause

2. GO SLOWLY – this is not a race, this is not about forcing things too quickly because you will go backwards. The process of reintroduction is about learning and educating yourself about how foods truly affect you, at this moment, on your healing journey. This process should not involve your ego or be focused on achievement

3. ONE AT A TIME – sounds obvious, but it is really easy to NOT follow this rule. One ingredient or foodstuff is reintroduced at a time. You MUST try this for at least 3, up to 7 days. Don’t try to introduce another food for 7 days. (And the ‘Paleo treat’ made using multiple grain-free flours, dried fruit and spices does NOT qualify as “one food”…)

The following paragraphs are identical to our “Paleo Reintroductions” Page, so feel free to skip if you’ve read them there – but a review of the info is always good!

What Are You Looking For?

Obviously if you notice any overt digestive symptoms which cannot possibly be attributed to any other cause then this is a red flag to you that this food is not healthful for your body.

But it’s more subtle than that – and the following is just a small list of what might crop up:

SKIN

Acne, rashes, hives, skin swelling and/or inexplicable irritation, itching, dryness, eczema or spots – anywhere on your body

CONGESTION & IRRITATIONS

Phlegm and coughs, nose irritations, eye soreness and redness

BOWEL DISTURBANCES

Either immediately or the next day – either rushing or feeling ‘bunged up’ more than normal, along with any other digestive swelling, bloating, distention, indigestion and/or abnormal motility

MENTAL SYMPTOMS

Brain fog, word forgetfulness, inability to think in straight lines or logically, confusion, disorientation or feeling ‘unlike yourself’.  Also – heightened anxiety for no real reason and/or depression and flatness of mood (known as ‘flat affect’) which leaves you feeling ‘heavy’, ‘lethargic’ or ‘disinterested’ (also known as anhedonia)

Conversely: manic-ness, feeling hyper, enraged and quick to anger, unable to regulate emotions or behaviour, excessively violent or vitriolic and being more ‘short-tempered’ than usual (please use this guideline with common sense – we all have days where our fuse is short and tiredness, hormones and stress all play into this one. This is more of a guideline to judge reactivity in children when they seem to lack inhibition after exposure to something their immune system cannot detoxify)

SLEEP DYSREGULATION

Another one to be wary about reading too much into but sleep is also an important marker.  Sleep is tightly regulated by hormones which are closely controlled by the immune reactions and can be disturbed by food choices. What is classed as unusual?  Anything that is different for you – wide awake and unable to sleep? waking up with a start in the early morning hours if you’re not someone who normally does so? frequent urination keeping you up all night? and much  more – all of this can be an indicator that your body didn’t deal well with the food you attempted to reintroduce.

Step 1: Choose a single food from the lists in the order suggested below and be prepared to eat it quite a bit over the coming days – prepare your kitchen for this.

Step 2: Eat a tiny amount of the food – a half teaspoon or a nibble and wait 15 minutes.  Symptoms? (See above) STOP. Symptom-free? CONTINUE.

Step 3: Eat one teaspoon of the same food. Wait 15 minutes. Symptoms? (See above) STOP.  Symptom-free? CONTINUE

Step 4: Eat 1.5 teaspoons (or a really big bite). STOP ENTIRELY. WAIT 2-3 HOURS AND MONITOR

Step 5: Time to serve a ‘normal portion’ of the food – by itself or part of a meal which contains only other foods that you have eaten before. By now you’ve had a tiny amount, a teaspoon and 1.5 teaspoons all in the space of the day. This is done the same day as the steps above – having a proper portion with a meal.

Step 6: You can choose, if you want, to eat another normal-size portion of this food during the same day. If you do – go ahead. If you do not wish to do this then do not.  REGARDLESS OF WHETHER YOU HAVE A SECOND FULL PORTION OR NOT: WAIT AT LEAST 3 DAYS BEFORE EATING THIS FOOD AGAIN.  You can actually wait up to 7 days, monitoring all the time for symptoms.

DO NOT ATTEMPT TO TRIAL ANY OTHER REINTRODUCTIONS DURING THIS TIME

Once you have trialled the nibble, teaspoon, 1.5 teaspoons, normal portion (and optional second ‘normal portion’) and then waited… you will have a full picture of potential reactivity of that food.

***A note on foods consumed in smaller amounts: for spices etc. never exceed a ‘normal’ portion. In cases like this, the first two exposures are absolutely tiny – building to the ‘normal’ portion which would  only be a tiny part of teaspoon in any case.

Our recommended reintroduction order is based on a scientific understanding of the order of ‘least commonly reactive’ foods through to the ‘most commonly reactive’ foods. This is NOT to be perceived as a mandatory rule book and if you’re at all concerned or feel that this might be the wrong order for you, we encourage you to work with someone who understands immunity, autoimmune conditions and the science of the Elimination Diet approach. Reach out to us at Paleo in the UK if you would like to find someone to work with.

1st Foods

Egg yolks:

Chosen because the yolk is jam-packed with nutrients and amino acids and is one of the dietary sources richest in choline. This is a powerhouse of nutrients so if you can have this in your nutritional arsenal then this is of huge benefit. WE REALLY DO MEAN YOLKS ONLY, THOUGH!

Ghee:

There is so little dairy protein (the potentially antigenic part) in ghee (it is comprised of approx. 97% fat, up to 100% for the cultured versions) and the fatty acids present in ghee are nourishing (see our “All About Dairy” page). If you can source it then CULTURED, grass fed, organic ghee is the best first choice. Beware the Indian supermarket ghee in metal tubs – the milk used to make ghee will vary enormously depending on the feed of the cow. Not only will the nutritional profile be vastly different, but the non-organic, non-grass-fed dairy products are far more at risk for containing antibiotics and/or hormones – which can be antigenic to humans, quite separate from the reaction each individual may have to dairy proteins.

Legumes within their pods:

i.e. sugar snaps, mange tout, green beans, peas: chosen because these are typically very non-reactive for people

Fruit-, berry- and seed- based spices (NOT peppers, yet):

These are normally ‘safe’ for those with autoimmune conditions, simply because the quantity of spices used is so low. HOWEVER – a word of caution: we have found that there are those for whom these seed spices can be the really tiny, niggling reactive foods. Cumin seed, caraway seed, fennel seed and black pepper have all been remarked upon by our clients as REAL issues, so go slow (see ‘How’ Section below) and watch carefully for a flare in symptoms.

2nd Tier Re-introductions

Whole Seeds and their ground/butter versions:

e.g. tahini, sesame seeds and ground sesame seeds

Whole Nuts and their ground/butter versions:

e.g. almonds, almond flour and almond butter, but exclude pistachios and cashews for now (NOTE: NOT PEANUTS (they’re a legume)!)

Chocolate:

Super dark (80%+ cocoa) no soya lecithin, low sugar, preferably organic, you can also explore ‘raw’ – and make sure ‘cocoa mass’ is on the ingredients list

Egg Whites:

No matter your success or failure with the egg yolk reintroduction, remember that for our purposes, egg whites are classed as different foods and therefore MUST be tried ALONE

Butter:

Obviously good quality, grass-fed sources (Kerrygold is a commonly available one)

Alcohol:

Small quantities – and start with clear spirits and see our “Paleo Reintroductions” page for the full details of how to bring alcohol back in.

Stage 3 of Reintroductions

Cashews and Pistachios

Aubergines

Coffee

Cream:

Again, grass-fed, raw, unpasteurised, unprocessed cream – preferably organic

Fermented grass-fed dairy:

e.g. yoghurt – and make your own if possible – again, grass-fed milk of the highest quality and unprocessed/pasteurised

Sweet peppers and paprika

4th LEVEL- MORE LIKE ‘PALEO REINTRODUCTIONS’ WHICH TRANSITION YOU OUT OF AIP

White Rice:

See our Paleo Reintroductions Page for the backdrop to the rice argument

Tomatoes

Potatoes

Nightshade vegetables and spices not currently reintroduced:

Including chilli, but try different ‘types’ of chilli (dried, flakes, powder, fresh) at different times, treating them as different foods.

Dairy products not yet introduced:

Again, grass-fed e.g. Whole milk (never semi-skimmed or skimmed) and cheese

Alcohol in larger quantities:

Again see our Alcohol section in Paleo Reintroductions for the how and “All About Alcohol” for the why

Soaked and sprouted legumes

Soaked, possibly sprouted grains:

Those that are NON-GLUTEN CONTAINING. Some people who have followed Paleo like to reintroduce gluten eventually. Those who have had previous history of a diagnosed autoimmune condition are not advised to do so. Gluten is known to be more challenging to the digestion and intestinal integrity than most foods. Those with previous complications due to autoimmunity are never recommended to introduce into their diet those foods which compromise intestinal barrier function, potentially risking a triggering of the immune system again.

From the reintroductions above, you may be in a great place – however, AIP is not a lifelong sentence and it is not a permanent and static state.

By going through this process, step by step, you will be discovering a personalised template of what foods really make your symptoms flare and your body suffer, and those which are completely benign and can be eaten by you regularly.

AN IMPORTANT NOTE: Everything within autoimmune disease is about balancing and ameliorating stressors whilst nourishing and supporting the body and encouraging it that you are safe. In times of higher stress, excess demands, flu seasons and challenging periods you are likely to experience an inability to easily tolerate some foods which you have successfully reintroduced above. Think of the AIP template as the lowest inflammation diet possible. Your reintroductions are building on top of this. If, during high stress periods, you experience reactivity – you can always return to an AIP baseline to help stabilise your body. You will have to do a version of reintroductions to move forward but it is likely to be quicker – and may even give you a different template – the next time around.

There is much confusion and lack of clarity when experimenting with reintroductions. With the above information you could now do this process alone. However, we will warn you that sometimes we can either will ourselves to ignore symptoms or just miss the signs because we so desperately want a food to be “ok”. At other times we can will ourselves into having symptoms due to our fear’s ability to regulate our sympathetic nervous system and thereby cause a flare from our immune system.

Our ultimate advice would, therefore, be to try and do this alongside someone and with someone’s help. This isn’t always a professional, sometimes it is someone who can dispassionate observe our reactions and our responses to life – and in particular the mood impacts, which are sometimes easier for our loved ones to observe than us.

Working with a practitioner for this can be invaluable particularly if you are highly stressed and/or your symptoms are a bit of a foggy mystery to you. Health and Nutritional Coaches are trained to guide you through this but there are, as with everything, certain better ‘qualified’ professionals than others. This is not about certifications or training, but about understanding, empathy and intimate knowledge of the complexities of nutritional and immune interactions, alongside a grasp of nutritional psychology. We do not post a list of recommended practitioners on this site because we believe practitioner/patient matching is very individual.

That said, if you want direct help from us, you are welcome to contact us directly and we will guide you in your specific situation.  Just get in touch today.

And lastly, just to fully bring home our overriding ethos with any use of AIP. You are removing triggers and potential stressors – dietarily and across all elements of your life. What you can cope with and tolerate will vary depending on so many factors of your life. If you are experiencing a sense of frustration, inability to expand your diet or if you are stuck on the basic AIP template and don’t know where to go next, we’d encourage you to seek professional assistance to ensure that you are not limiting or restricting yourself unnecessarily (which has its own consequences) and that you are able to eat the fullest diet – and live the fullest life – possible.