What Is AIP?

March 13, 2017

 

 

Autoimmune Protocol

 

Autoimmune disease is growing throughout society, latest figures estimate 50 million Americans are affected. Being a part of Sweat Nation means you don't have to be part of this concerning trend. Genetic predisposition may account for approximately one-third of your risk of developing an autoimmune disease, the other two-thirds comes from your environment, your diet, and your lifestyle. Experts are increasingly recognizing that dietary factors are key contributors to autoimmune disease, placing these autoimmune conditions in the same class of diet- and lifestyle-related diseases as type 2 diabetes, cardiovascular disease, and obesity. This means that autoimmune disease is directly linked to food choices and how we decide to live life. The great thing about that is that you can manage and reverse autoimmune disease simply by changing how you eat and making better choices about sleep, activity, and stress… You have the power!

 

There are more than one hundred confirmed autoimmune diseases and many more diseases that are suspected of having autoimmune origins. The root cause of all autoimmune diseases is the same: your immune system, which is supposed to protect you from invading microorganisms, turns against you and attacks proteins, cells, and tissues instead. Which proteins, cells, and tissues are attacked determines the autoimmune disease and its symptoms. In Hashimoto’s thyroiditis, the thyroid gland is attacked. In Rheumatoid Arthritis, the tissues of your joints are attacked. In psoriasis, proteins within the layers of cells that make up your skin are attacked. However, the root cause is the same.  The Autoimmune Protocol, typically abbreviated AIP, is a powerful strategy that uses diet and lifestyle to regulate the immune system, putting an end to these attacks and giving the body the much needed and wanted opportunity to heal.

 

The Autoimmune Protocol is a strategy that brings greater focus on nutrient density and guidelines for which foods should be eliminated so that your immune system strengthens. Foods can be viewed as having two kinds of constituents within them: those that promote health (like nutrients!) and those that undermine health (like inflammatory compounds). (While there are constituents that neither promote nor undermine health, they are not used to evaluate the merit of an individual food.) Some foods are obvious wins for a health-promoting diet because they have tons of beneficial constituents and very few or no constituents that undermine health—good examples of these superfoods are most vegetables, seafood, and additions such as organ meats. Other foods are obvious fails because they have a relative lack of health-promoting constituents and are rife with problematic compounds—good examples are gluten-containing grains, peanuts, and most soy products. Many foods fall into the amorphous world of gray in between these two extremes. Tomatoes, for example, have some exciting nutrients, but they also contain several compounds that are so effective at stimulating the immune system that they have been investigated for use in vaccines as adjuvants (the chemicals in vaccines that enhance your immune response to whatever you’re getting immunized against). The biggest difference between a standard diet and the Autoimmune Protocol is where we draw the line between “yes” foods and “avoid” foods in order to get more health-promoting nutrients and fewer detrimental nutrients in our diet. Those who are typically quite healthy can tolerate less-optimal foods than those who aren’t. Many think of the Autoimmune Protocol as a pickier version of the Paleo diet; it accepts only those foods that are clear winners.

 

As such, AIP places greater emphasis on the most nutrient-dense foods in our food supply, including organ meat, seafood, and vegetables. AIP eliminates foods allowed on a typical Paleo diet that have compounds that may stimulate the immune system or harm the gut environment, including nightshades (like tomatoes and peppers), eggs, nuts, seeds, and alcohol. The goal of AIP is to flood the body with nutrients while simultaneously avoiding any food that might be contributing to disease (or at the very least interfering with healing efforts). It is an elimination diet strategy, cutting out the foods that are most likely to be holding back your health. After a period of time, many of the excluded foods, especially those that have nutritional merit despite also containing some (but not too much) potentially detrimental compounds, can be reintroduced.

 

How Does The Autoimmune Protocol Work? 

The Autoimmune Protocol works by addressing four key areas known to be important contributors to chronic and autoimmune diseases. Drawing on insights gleaned from more than 1,200 scientific studies and counting, these diet and lifestyle recommendations specifically target:

  1. Nutrient density. The immune system (and indeed every system in the body) requires an array of vitamins, minerals, antioxidants, essential fatty acids, and amino acids to function normally. Micronutrient deficiencies and imbalances are key players in the development and progression of autoimmune disease. Focusing on consuming the most nutrient-dense foods available enables a synergistic surplus of micronutrients to correct both deficiencies and imbalances, thus supporting regulation of the immune system, hormone systems, detoxification systems, and neurotransmitter production. A nutrient-dense diet further provides the building blocks that the body needs to heal damaged tissues.

  2. Gut health. Gut dysbiosis and leaky gut are key helpers in the development of autoimmune disease. The foods recommended on AIP support the growth of healthy levels and a healthy variety of gut microorganisms. Foods that irritate or damage the lining of the gut are avoided, while foods that help restore gut barrier function and promote healing are endorsed.

  3. Hormone regulation. What we eat, when we eat, and how much we eat affect a variety of hormones that interact with the immune system. When dietary factors (like eating too much sugar or grazing rather than eating larger meals spaced farther apart) dysregulate these hormones, the immune system is directly affected (typically stimulated). AIP is designed to promote regulation of these hormones, thereby regulating the immune system by proxy. These and other essential hormones that impact the immune system are also profoundly affected by how much sleep we get, how much time we spend outside, how much and what kinds of activity we get, and how well we reduce and manage stress.

  4. Immune system regulation. Immune regulation is achieved by restoring a healthy diversity and healthy amounts of gut microorganisms, restoring the barrier function of the gut, providing sufficient amounts of the micronutrients required for the immune system to function normally, and regulating the key hormones that in turn regulate the immune system.

Inflammation is a factor in all chronic illnesses, and this is one area where the foods you eat can make a huge difference. In some cases, an immune system that isn’t regulating itself properly directly causes the illness; in others, inflammation is merely an element of the illness or a contributor to how the illness came about—but it is always a player and a problem. What this means is that reducing inflammation and giving the immune system the resources it needs, as well as the opportunity to regulate itself, can help in every single chronic illness. This is important because inflammation is strongly influenced by what we eat, how well we sleep, how stressed we are, and how active we are. And this is why chronic illness can respond so positively to changes in diet and lifestyle.

Food has therapeutic potential for every chronic illness—but that’s not the same thing as calling food a cure. Depending on the illness you’re struggling with, how long you’ve had it, how aggressive the disease is, and what confounding factors you’re dealing with, dietary changes may get you as far as a complete reversal of your disease, or they may slow the progress of your illness, or they may simply improve your quality of life. These are all successes worth celebrating. Good food may not be the miracle cure you’re hoping for, but it’s pretty darn powerful all the same, after all it is your first line of defense.

As you adopt AIP, your food choices become focused on consuming the nutrients to support healing—foods that provide everything your body needs to stop attacking itself, repair damaged tissues, and get healthy again: proteins, carbohydrates, and fats to sustain a normal metabolism, build new tissue, and produce hormones, important proteins, and signaling molecules; and the full range of fat-soluble vitamins, water-soluble vitamins, minerals, and antioxidants to get rid of inflammation, regulate the immune system, and support the normal functioning of all the body’s systems.

 

 

What To Eat and What To Avoid

 

Following AIP involves increasing your intake of awesome, nutrient-dense, health-promoting foods while avoiding foods that may be triggers for disease.

In summary, the rules of what to eat are:

  • organ meat and offal (aim for 5 times per week, the more the better)Liver, heart, Kidneys

  • fish and shellfish (wild is best, but farmed is fine) (aim for at least 3 times per week, the more the better)

  • vegetables of all kinds, as much variety as possible and the whole rainbow, aim for 8-14 cups per day

    • Green vegetables

    • Colorful vegetables and fruit (red, purple, blue, yellow, orange, white)

    • Cruciferous vegetables (broccoli, cabbage, kale, turnips, arugula, cauliflower, brussels sprouts, watercress, mustard greens, etc.)

    • Sea vegetables (excluding algae like chlorella and spirulina which are immune stimulators)

    • Edible Fungi, like mushrooms

  • herbs and spices

  • quality meats (grass-fed, pasture-raised, wild as much as possible) (poultry in moderation due to high omega-6 content unless you are eating a ton of fish)

  • quality fats (pasture-raised/grass-fed animal fats [rendered or as part of your meat], fatty fish, olive, avocado, coconut, palm [not palm kernel])

  • fruit (keeping fructose intake between 10g and 20 g daily)

  • probiotic/fermented foods (fermented vegetables or fruit, kombucha, water kefir, coconut milk kefir, coconut milk yogurt, supplements)

  • glycine-rich foods (anything with connective tissue, joints or skin, organ meat, and bone broth)

  • Source the best-quality ingredients you can.

  • Eat as much variety as possible.


In addition, remove the following from your diet:

  • Grains

  • Legumes

  • Dairy

  • Refined and processed sugars and oils

  • Eggs (especially the whites)

  • Nuts

  • Seeds (including cocoa, coffee and seed-based spices)

  • Nightshades (potatoes, tomatoes, eggplants, sweet and hot peppers, cayenne, red pepper, tomatillos, goji berries etc. and spices derived from peppers, including paprika)

  • Potential Gluten Cross-Reactive Foods

  • Alcohol

  • NSAIDS (like aspirin or ibuprofen)

  • Non-nutritive sweeteners (yes, all of them, even stevia)

  • Emulsifiers, thickeners, and other food additives

 

Moderate your intake of the following:

  • Fructose (from fruits and starchy vegetables, aiming for between 10 and 25 grams per day)

  • Salt (using only unrefined salt such as Himalayan pink salt or Celtic gray salt)

  • Moderate- and high-glycemic-load fruits and vegetables (such as dried fruit, plantain, and taro root)

  • Omega-6 polyunsaturated fatty acid–rich foods (such as poultry and fatty cuts of industrially produced meat)

  • Black and green tea

  • Coconut

This diet is appropriate for everyone with diagnosed autoimmune disorders or with suspected autoimmune diseases. It is very simply an extremely nutrient-dense diet that is devoid of foods that irritate the gut, cause gut irritation and activate the immune system. You will not be missing out on any nutrients and this diet is absolutely appropriate to follow for the rest of your life. If you have a specific autoimmune disease that causes extra food sensitivities, those should be taken into account with your food choices.

 

Lifestyle Factors 

Sleep: getting enough sleep (at least 7-9 hours every night), managing stress (mindful meditation is very well studied in the scientific literature and universally shown to be beneficial), protecting circadian rhythms (being outside during the day, being in the dark at night and avoiding bright lights in the evening), nurturing social connection, having fun, making time for hobbies, relaxing, and getting lots of mild to moderately intense activity (while avoiding intense/strenuous activity). 

 

Elimination and Reintroduction

 

AIP can be thought of as nutritional interventions for a diet gone crazy with an overabundance of empty calories and relatively lacking in actual nutrients. But how well an individual tolerates suboptimal foods—whether we’re talking about something like tomatoes, which are included in many diets but eliminated on the Autoimmune Protocol, or something like grains, which are now becoming excluded in many nutritional approaches—depends on nutrient status, stress, sleep, activity level, genetics, and health history. As we improve as many of these as possible with diet and lifestyle changes, it’s fairly common to see tolerance of certain foods increase. AIP is an elimination diet at its core, designed to cut out the most likely foods that flood the body with anti-nutrients. The best part about an elimination diet is that eventually, you get to reintroduce foods that you’ve been avoiding, and see how your body reacts giving you a clearer picture of what works for you.

How long is eventually? Ideally, you’d wait to reintroduce foods until you’re feeling amazing, but as long as you’re seeing improvements thanks to your diet and lifestyle changes, you can try some reintroductions after about thirty days. The full protocol for reintroductions, including which foods are best to try reintroducing first, is detailed in the Sweat Nation 30 day reset guide. In general, reintroduce only one food every five to seven days and spend that time monitoring yourself for symptoms. Symptoms of a reaction aren’t always obvious, so keep an eye out for the following:

  • Symptoms of your disease returning or worsening

  • Gastrointestinal symptoms: tummy ache, heartburn, nausea, constipation, diarrhea, change in frequency of bowel movements, gas, bloating, undigested or partly digested food particles in stool

  • Reduced energy, fatigue, or energy dips in the afternoon, or a second wind in the late evening that makes it hard to go to bed at a good time

  • Cravings for sugar, fat, or caffeine

  • Pica (craving minerals from nonfood items like clay, chalk, dirt, or sand)

  • Trouble falling asleep or staying asleep, or just not feeling well rested in the morning

  • Headaches (mild to migraine)

  • Dizziness or lightheadedness

  • Increased mucus production: phlegm, runny nose, or postnasal drip

  • Coughing or increased need to clear your throat

  • Itchy eyes or mouth

  • Sneezing

  • Aches and pains: muscle, joint, tendon, or ligament

  • Changes in skin: rashes, acne, dry skin, little pink bumps or spots, dry hair or nails

  • Mood issues: mood swings, feeling low or depressed

  • Feeling anxious, less able to handle stress

The procedure for reintroductions, taken from the procedure used to challenge food allergies and sensitivities, is as follows:

  1. Select a food to challenge. Be prepared to eat it two or three times in one day, then avoid it completely again for a few days.

  2. The first time you eat the food, eat half a teaspoon or even less (one teensy little nibble). Wait fifteen minutes.

  3. If you have any symptoms, don’t eat any more. If you don’t, eat one teaspoon of the food (a small bite). Wait fifteen minutes.

  4. If you have any symptoms, don’t eat any more. If you don’t, eat one and a half teaspoons of the food (a slightly bigger bite).

  5. That’s it for now. Wait two to three hours and monitor yourself for symptoms.

  6. Now eat a normal-sized portion of the food—either by itself or as part of a meal.

  7. Do not eat that food again for five to seven days and don’t reintroduce any other foods during that time. Monitor yourself for symptoms.

  8. If you have no symptoms during the challenge day or at any time in the next five to seven days, you may reincorporate this food into your diet.

It’s best not to be in a hurry to reintroduce foods. Generally, the longer you wait, the more likely you are to be successful. When you introduce particular foods is ultimately your choice. How you feel is the best gauge, and only you will know if you are ready. A word of caution, though: don’t let cravings influence you. Your decision should be based on how good you feel and how much improvement you’re seeing in your body and disease. And to help you out with cravings until you’re ready for this phase, Sweat Nation has created some amazing comfort food and treat recipes, so you won’t feel like you’re missing out!

 

 

AIP FAQ's

Some quick myth-busting and FAQ:

 

1. Starchy Vegetables (GAPS, SCD): Avoiding starchy vegetables for SIBO has not been validated in the scientific literature (but eating low FODMAP has been proven very effective for people with IBS, IBD and SIBO). Many people do anecdotally find symptom relief from starving overgrowths with these very low carb approaches, but the low carbohydrate/fiber intake can be stressful on the thyroid, cause dysregulated cortisol (and both of those are bad!) and lead to bacterial undergrowth in the digestive tract. The two diet factors that have been shown in the scientific literature to have the most dramatic corrective impact on gut microorganims is high omega-3 fatty acid intake (lots of fish!) and high fiber intake (from vegetables and fruit), both soluble and insoluble. If you do have confirmed SIBO or strong gastrointestinal symptoms, you may want to combine the autoimmune protocol with a low FODMAP approach as a short-term intervention or you may wish to save low FODMAP for troubleshooting a month or two down the road.

2. Insoluble fiber/Leafy Green: While insoluble fiber gets a bad reputation as being an “irritating” fiber, recent studies actually show that higher insoluble fiber intake speeds healing in models of colitis and diverticulitis. Also, the higher the intake of insoluble fiber, the lower the chances someone will have high c-reactive protein (implying that it reduces or prevents inflammation). Soluble fiber reduces the chance of having high c-reactive protein too, but not as much as insoluble fiber. Insoluble fiber also reduces risk of cancer and cardiovascular disease. There hasn't been a single scientific journal article that actually shows that insoluble fiber irritates the gut and as of now is just a myth. There is evidence that it reduces bile acid loss (which ultimately improves digestion), is an essential signal for ghrelin suppression after meals (which has a ton of different important effects in the body), that it improves insulin sensitivity, and helps to remove toxins from the body. I can’t find a single reason why insoluble fiber should be limited. If you have intact pieces of high insoluble fiber vegetables in your stool, add digestive support supplements (especially plant enzymes) and try limiting yourself to cooked vegetables until your digestion improves. 

3. Fruit: Many people avoid fruit because it is high in sugar. If you have FODMAP-intolerance, you will want to avoid high fructose fruits and everyone will want to keep their fructose intake below 20g per day, but fruit in moderation is endorsed and is actually a great source of vitamins, minerals, fiber and antioxidants. Depending on which fruit you choose, and how you define a serving, you can typically enjoy 2-5 servings of fruit per day and stay below 20g of fructose.

4. Omega-3 intake is very important: Aim for between 1:1 and 1:3 ratio of omega-3 fatty acids to omega-6 fatty acids. If you eat grass-fed, pasture-raised meat, not too much poultry, and some fish, this will be natural. If you eat more conventional meat or more frequent servings of poultry, you will need to increase your intake of oily cold-water fish (like salmon, mackerel, sardines, herring, kipper, anchovies, trout, fresh tuna, and carp). Rendered animal fats used for cooking should always come from grass-fed or pasture-raised animals. Omega-3 fatty acid intake is one of the most important factors for correcting gut dysbiosis. Plants-based omega-3s are predominantly ALA, which is not as usable by your body as the long chain DHA and EPA in fish and pasture-raised/grass-fed meat. Increasing omega-3 fatty acid intake has been shown to dramatically reduce the need for NSAIDs in patients with Rheumatoid Arthritis. 

5. Vegetables are important: don’t skimp on the vegetables. If you are a person who has a very hard time eating large servings of vegetables, smoothies or vegetable juices might be a great option as part of a meal (and not as a meal replacement because chewing is an important signal for digestion). If you have trouble digesting large amounts of vegetables (if you have any gastrointestinal symptoms or can identify intact vegetable particles in your stool), try taking digestive support supplements with your meals and limiting yourself to cooked vegetables initially (plant enzymes are especially helpful for breaking down fiber). 

6. Gray Areas: egg yolks, legumes with edible pods (such as green beans and snow peas), walnut oil, macadamia nut oil, grass-fed ghee, and gluten-free alcohol when used in cooking are gray areas. I suggest omitting them in the beginning, but can typically be reintroduced much earlier than other foods. Whole coconut products (coconut butter, coconut cream concentrate, creamed coconut, coconut flakes, coconut chips, fresh coconut) should be consumed in moderation (due to being very high in inulin fiber and moderately high in phytic acid). Coconut milk and coconut cream (not to be confused with creamed coconut or coconut cream concentrate) should be guar-gum free and limited to 1 cup per day. Coconut oil is fine if well-tolerated.

7. Is THIS AIP?

carob, rooibos tea, black and green tea in moderation, DGL, apple cider vinegar, wine vinegar, balsamic vinegar, coconut water vinegar, coconut water in moderation, vanilla extract (if cooked), pomegranate molasses in moderation, maple syrup and maple sugar very occasionally, honey very occasionally, dried fruit very occasionally, dates and date sugar very occasionally, molasses very occasionally, unrefined cane sugar (sucanat, evaporated cane juice, muscovado, very occasionally, coconut aminos, are okay.

algae (chlorella, spirulina), wheat grass (contains wheat germ agglutinin), barley grass, brown rice protein, pea protein, hemp protein, licorice root (except DGL), aloe, slippery elm, chia, flax, lemon balm (tea is probably okay but avoid in supplement form), commercial egg replacers, decaf coffee, herbal sleep aids that contain oat seed, some adaptogenic supplements (ashwagandha is a nightshade), are not okay.

 

8. Useful Supplements:

  • digestive support supplements (digestive enzymes (plant enzymes or pancreatin or both) ox bile, and Betaine HCl unless contraindicated — CHECK with your doctor before taking stomach acid supplements! or an all-in-one type digestive support supplement)

  • L-glutamine,helps restore gut barrier function

  • magnesium (especially, if you have unmanaged stress)

  • vitamin C (if you have unmanaged stress)

  • DGL (capsules with no fillers, not chewables or lozenges)-helps repair the gut

  • Prescript-Assist probiotic supplement (even if you eat fermented foods)

  • Collagen may be useful for those with diseases affecting skin and/or connective tissue.

9. Quality Matters (but it isn’t everything): the better quality food you can source, the better. But if you just can’t afford all grass-fed/pasture-raised meat, wild-caught fish, and organic locally-grown produce, just do the best you can. My post on the importance of grass-fed meat contains some suggestions for incorporating it into your diet in a budget-conscious way. Whole9Life has a wonderful chart on when fruits and vegetables are in season including which fruits and vegetables are important to buy organic and which aren’t, if budget is an important concern.

10. Your body knows best: If you know that a food that is omitted from The Paleo Approach works very well for you (such as raw grass-fed dairy) or if you know that a food normally recommended on The Paleo Approach does not work well for you (such as coconut oil), then it’s find to modify. If you aren’t sure or aren’t seeing success, go with the above recommendations. If you find something that truly works for you, whatever it is, stick with it.

 

 

Consulting Services

Finally, if you find yourself needing help and 1-on-1 support throughout this journey, then I encourage you to reach out for a Sweat Nation Coach.

Whether you are just beginning your wellness journey or are a seasoned traveler on the wellness path, you may a helping hand for troubleshooting roadblocks, optimizing health, figuring out which labs to request from your doctor, or just need support during this major life change. Our coaches can help!

When you work with one of our coaches, you can expect:

  • A thorough review of your health history to establish goals while recognizing obstacles.

  • A fully customized plan tailored to meet your individual needs so that you can reach your goals.

  • Expert guidance to help you navigate your unique challenges.

  • Frequent communication to answer your questions, to adapt recommendations, or optimize your approach as needed, and to provide compassion and encouragement.

  • Concrete strategies to help you succeed.

  • Support every step of the way.

Here's to your health, wealth and happiness

 

 

 

 

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