Pros and cons of the Autoimmune Protocol (AIP) diet
I get asked about the Autoimmune Protocol diet fairly often. Many clients have tried a version of this protocol before they come to me. So here are my thoughts on it.
There are several variations of the AIP. For those who haven’t come across it before, the chart below provides one version of it.
Excessively restrictive
The AIP is usually presented as simply a list of foods to avoid, with no guidance around who it may be appropriate for and how to implement it. As you can see at a glance, if you were to comply entirely with it, it would be extremely restrictive - and probably stressful.
The protocol is based on research that looked at all the foods that may trigger inflammation in people with autoimmune conditions. However no single person will react to every food on the list.
The result often is that people end up cutting out many foods unnecessarily, causing stress, which we know increases inflammation in the gut and an excessive burden on the liver, both of which increase the risk of autoimmune symptoms.
In addition, following this protocol over the long term results in a really narrow diet that damages the health of the gut microbiome, which is highly dependent on diversity of fibre. Research shows that a healthy gut microbiome promotes immune tolerance and lower inflammation levels. A narrow diet over time also increases the risk of nutrient deficiencies, another contributing factor to autoimmunity. Lastly, following a very restrictive diet over the long term can increase the risk of eating disorders and anxiety around food.
Designed for short term use only
The most important piece of the missing guidance around the AIP is that is was designed for short term use only. When someone is going through a very severe autoimmune flare, particularly when the gut is directly affected, such as in Crohn’s or colitis, the information in this protocol can be extremely useful. When someone is in a flare, inflammation levels are very high, and this makes them more likely to react to foods. So the chances are they many be temporarily reacting to many of the foods on the list.
However, they would still benefit from professional guidance in working out which foods particularly apply to them, and bringing back in foods to their diet as soon as possible, within a few weeks generally.
Prioritisation and personalisation
For those people not in a flare, trying to cut out all of these foods would probably not be helpful. They would benefit from guidance in helping them to work out which foods they are likely to be reacting to and how to go about managing this.
Certain foods on this list, such as gluten and dairy, are much more likely to be causing problems than others. This is because gluten and dairy are the most allergenic and are also so common in our diets.
It would also be helpful for people to understand what categories these different foods fall into. Some are there because they contain highly allergenic proteins. Others are there because they irritate the gut and so can causes local inflammation (eg legumes and nightshades). Some, like nuts, are often very dependent on quantity. Many people eat huge amounts which causes problems, whereas having two or three once or twice per week would not cause symptoms.
These distinctions are really important to know about. Not only do the allergenic proteins tend to cause more inflammation than the local irritant foods, meaning they should be prioritised. But there is also a lot we can do to reduce the impact of local irritants, such as legumes and nightshades, on our gut, such as soaking, cooking with seaweeds, or removing the skins or shells where appropriate. I find with most clients that they do not necessarily need to avoid the local irritant foods, but simply take steps to reduce the irritation, such as by swapping passata in for chopped tomatoes, removing the shells of chickpeas, increasing the cooking time, or just by reducing the frequency or amount. These foods are really important for autoimmune health and so shouldn’t be completely removed without good reason.
Histamine
Some of these foods fall into the histamine category, which can be very relevant to some people with autoimmunity. (See this post for further information.). Yet as no information is provided around why each of these foods is on the list, and how to group them, people don’t understand this. When they don’t have this information around categorisation, this means that they are less able to monitor reactions and understand their significance. This reduces their ability to learn from the process and adapt effectively.
The success of nutrition and lifestyle changes depends largely on being able to observe how changes affect you and to adapt your strategy appropriately. So it’s much harder to notice if, say, histamine foods affect you if you don’t know which foods belong to the histamine group and what the specific symptoms of high histamine are. So the opportunity to use this valuable information is often lost.
Motivation and belief waver
When things are too confusing or too hard, they become unsustainable and can also lead to loss of self-esteem. It makes people lose confidence, both in themselves and in the ability of food to make a difference to their health.
Ultra processed foods
The list also includes various ultra processed foods, but doesn’t name them as such. Ultra processed foods - anything with a long list of ingredients that you don’t recognise, most foods that been processed in a factory, virtually all convenience foods (particularly those with large health claims on them!), anything that should go off within days but somehow has an expiry date of months or years down the line! - will all cause damage to your gut and can increase the risk of autoimmunity over time if eating them is a consistent pattern for you. Yet because the AIP doesn’t explain this, some people go to great lengths to avoid certain ultra processed foods that are on the list, but end up eating large amounts other highly processed foods that are potentially just as damaging. So the incompleteness of this aspect of the list can lead to wasted effort.
It can also lead to a situation where people feel unable to follow the AIP in its entirety, so they follow some elements of it and not others. But often this ends in them avoiding many of the ‘real’ foods (foods in their natural state that may just be causing a small level of local irritation) in their natural state and still eating the ultra processed foods, because this feels like the easiest way to at least follow part of the protocol. This approach can cause significant damage to the health of the gut microbiome over time. Prioritising a trend towards ‘real’ foods - foods in their natural state with nothing removed or added and minimal processing - and away from ultra processed foods should always be the basis of any nutrition approach.
What DO I eat?!
Perhaps the most important guidance missing around the AIP is what we should eat! We should always aim to put in more foods than we remove from a diet, so the net impact is to widen the diet. This is important not just from a nutrient perspective, but also particularly to make sure the gut microbiome remains resilient. We often find the gut microbiome is struggling in people with autoimmunity for a number of reasons, so this has to be a priority for us. The last thing we want to do is to follow a nutritional strategy that damages the long term health of the gut microbiome. Different fibres feed different microbes, so diversity of plant foods feeds a diversity of fibres, and this is what makes our microbiome - and our immune systems - more resilient.
Anyone cutting out foods from their diet will need help from a registered nutritionist or other healthcare professional to make sure they have plenty of meal options that they are happy with. Enjoying our food is vital because it ensures we are secreting the digestive juices and enzymes required for good digestion. Following a very restrictive diet can remove the pleasure from eating and this can be harmful for our wellbeing over time.
The research underpinning the AIP is very useful - what is missing is how to apply it to YOU
I think the information on which the AIP is based is extremely useful in managing autoimmune conditions. These are all foods I think about when I talk to my clients and there is good research behind all of them to justify considering whether they are relevant to each client.
However, it would be a huge jump to recommend that all people with any autoimmune condition, in any phase of their condition, should remove them all. Science can only tell us so much. Beyond that, we need to use our observational skills and judgment to interpret the information in a way that is appropriate to the individual. The very nature of the way we conduct scientific research makes the findings a generalisation only. Personalising those findings to create advice that is appropriate for an individual is where the skill lies. Prioritising certain foods, educating the client about the groups they fall into and which reactions to look out for, rotating foods, adding in additional foods to widen the diet and ensure good nutrient intake, are all part of the process.
What is making you react to foods in the first place?
If we only look at food reactions, we are unlikely to get very far. We need to consider what is making us react excessively to foods in the first place. Issues like mould, viruses, candida and other non-beneficial microbes in the gut, as well as conditions like IgA deficiency, significantly increase the likelihood of food intolerances. So does chronic stress, eating on the move and problems with producing adequate digestive secretions.
What else is contributing to inflammation?
We know that inflammation increases the risk of autoimmune symptoms. But food intolerances are not the only cause of inflammation in our bodies. Other factors contribute to inflammation, such as blood sugar dysregulation, certain nutrient deficiencies, environmental toxins, other problems with gut barriers function. We also need to consider how well our livers are coping and what we can do to support liver function, because we know that when the liver can cope with the challenges that come its way, autoimmune symptoms tend to reduce.
There are so many aspects to autoimmune health. How we eat, when we eat, how we combine foods, and how we live day-to-day are all factors that contribute to our autoimmune health, so we should keep the AIP in perspective and use the information wisely as part of a holistic approach.