Marissa Mekelburg Functional Medicine Dietitian
AIP Elimination Diet: It Won't Work For Everyone
Updated: Dec 7, 2022
Have you been thinking about trying the AIP elimination diet?
Or, have you been on the AIP diet for a while, without relief?
Then this article is for you.
Here I’ll discuss:
What the AIP diet is
Who the AIP diet is designed for
Why things might not be going as smoothly as you’d like
What else you can do
What is the AIP Diet?
The AIP diet stands for the Autoimmune Protocol (or sometimes you will see it listed as Autoimmune Paleo). AIP is an elimination diet (I’ll cover exactly what that means in a bit) designed to help those suffering from autoimmune conditions; diseases in which your body is attacking your own cells and tissue, causing harm.
The intention of the AIP diet is to calm your overactive immune system by removing the foods that cause your body to have a big reaction, your immune system gets to simmer down, rest and repair.
The AIP diet was first being created in 2011 by practitioners as well as lay people who were looking for answers beyond medication to their chronic autoimmune symptoms.
There are different versions of the AIP diet. There is beginning research to support its use, but we are still in the early phase.
And, the AIP diet won’t work for everyone. Especially if you’re on a restrictive phase for too long.
What are autoimmune disorders?
Autoimmune diseases are more and more prevalent. There are several theories about why, which include our stressful lifestyle, medications, our low vitamin D status, and our (very highly-processed) typical diet.
It is important to acknowledge that this uptick of autoimmune conditions cannot be explained by genes alone, or better recognition leading to more diagnosis.
Autoimmune diseases are any condition where your immune system gets its signals crossed and believes that your own body cells are invaders.
What does your body do when it senses an invader? It attacks.
There are many different autoimmune conditions, depending on what part – or parts – of your body are under attack.
Here are a few examples of autoimmune conditions:
Celiac - your body attacks the lining of your GI tract
Type 1 Diabetes (T1DM) - your body attacks your pancreas
Rheumatoid arthritis (RA) - your body attacks your joints
Hashimoto's - your body attacks your thyroid
Multiple Sclerosis (MS) - your body attacks your nervous system
And with the rise in our appreciation of the role of gut health in all health, there is even debate on if other conditions fall into the realm of autoimmune conditions, such as PCOS and Autism (1, 2).
Benefits of AIP Diet
The AIP diet is restrictive and a big change from what most of us eat on a given day.
The benefits of the AIP diet are that it is very nutrient dense: full of the nutrients that provide your body with the tools to dial back inflammation.
AIP is loaded with fruits and veggies which also means it's full of fiber and able to provide the nourishment that our gut microbiome needs to thrive.
Did you know that we don’t actually digest fiber? Fiber is food for the bacteria living and “working” in our large intestine. And in thanks, they provide nutrition to the cells living in our gut and help to keep them healthy and intact - i.e. - the opposite of leaky.
Is the AIP diet the same as paleo?
There are different versions of the AIP diet as well as the paleo diet.
There is a lot of overlap between the AIP diet, but the “rules” of the diet depends on who is talking about it. Some consider AIP a version of paleo, but a bit more strict.
Who is the AIP diet designed for?
As mentioned, AIP may benefit anyone with an autoimmune condition, however, because it eliminates so many foods, it would not be recommended to try “just because.”
It is also not recommended to stay on the elimination phase of the AIP diet for forever.
Psst: More information about not being on an elimination diet for too long in this blog post.
What can I eat on an AIP elimination diet?
AIP is not a one-and-done diet to try and then follow forever. The intention is to follow a rest and repair, elimination phase. Let the immune system wind down a bit, the gut to heal and then to begin reintroducing foods.
The AIP diet elimination phase
The AIP diet starts with an elimination phase. The goal is to remove anything that might be irritating the gut, making it leakier or causing inflammation. You can also focus on preparing foods in a way that makes them easier to digest, such as pureeing veggies into soups and fruits into smoothies.
What to avoid on AIP diet?
Grains (although some versions allow rice)
Nightshade vegetables (ex: tomatoes and peppers)
Additives - including preservatives, dyes, and emulsifiers (ex: polysorbate 80, carrageenan)
Coffee (gads, I know)
Most fruits and vegetables (not nightshade vegetables)
Meat, poultry, fish
Healthy fats and oils, like coconut oil and avocado
The elimination phase is also an opportunity to begin addressing other factors that are contributing to your health and wellness.
For example, are you sleeping enough? Sleep is your body’s opportunity to rest, digest and repair your gut health.
Are you managing your stress? Life is pretty nutty these days, but we can feel better when we have joyful movement, time to unwind, and to show gratitude.
We’ll cover more about contributing factors later in this article, stay tuned. For now - let’s walk through the reintroduction phase.
The AIP diet reintroduction phase
Once you are starting to feel better, your symptoms are simmering down and you’ve done some of the work to reduce other factors holding your wellness back, it is time to do a systematic reintroduction of the foods that you’ve eliminated.
The purpose of this phase is to reintroduce foods, one at a time, to see how your body reacts and how you feel.
If something changes for the worse, you know exactly what caused it and you learn which foods to keep out, for now.
What does the research say about AIP?
For Inflammatory Bowel Disease (IBD) there are a few short studies so far and they show good remission of symptoms (3, 4).
The participants felt better, but the lab data didn’t show much change. It is possible that the diet was off to a good start but needed to be followed longer to show those changes.
Similarly, in a small group of women with Hashimoto’s thyroiditis, the participants felt a whole heck of a lot better, but the researchers didn’t see big changes in their bloodwork (5).
The AIP elimination phase is not meant to be followed for forever. It is a therapeutic intervention to calm the immune system and to rest and repair the gut. Our gut (and body) thrives on diversity in our diet so being able to reintroduce foods is important.
If you broke your leg - you’d expect to have a cast as part of your treatment and healing. But once your bone had knit back together, the cast would come off - right? You wouldn’t keep the cast on forever.
Same with the AIP - it has powerful therapeutic potential, but it is also restrictive and not meant to be forever.
If you’ve been following the diet for a while and not feeling better, there might be other factors at play. This is an opportunity to look for root causes and to address them.
Photo by Jake Givens on Unsplash
What other factors are at play?
Our health – especially our gut health – is not a stagnant thing.
And this is the important thing - if you’re following an AIP elimination diet for too long, you can actually be creating new issues by not having a diverse enough diet. Oof!
So what else can be going on?
Food sensitivities - if your body is wound up and overreacting to foods, it needs a break! In my experience, far too many of my clients have been diligently following a very restrictive diet and still feel terrible. When we do functional nutrition testing, it turns out that the few foods that they have been allowing themselves to eat are contributing to their symptoms - ugh! Prepare to be amazed at how good you can feel while following a truly personalized anti-inflammatory diet.
Vitamin D Status - if your vitamin D status is too low (or any other nutrient) your immune system can be impacted. You can be low in nutrients because you’re not getting enough to begin with, you’re not able to absorb them well, or – eesh – both. Improving gut health means you’re able to better absorb the nutrients from your meals.
Sleep - not enough sleep means that you’re not resting and repairing your gut. A good night’s sleep is good for all wellness, but especially for your digestive system.
Stress - we all have stress – it is more important how you manage and move through stress. If you make time to do exercise, creative hobbies, connect with friends and family, meditate, journal and so on, you’re moving through that stress instead of holding onto it. Your digestion will benefit!
Not enough stomach acid – we tend to think about stomach acid in the context of heartburn and thinking we have too much. But really, our stomach acid is critical for our digestion. If you’re not making enough stomach acid or using medications or supplements to reduce your acid, you might be experiencing some unintended consequences.
Microbiome imbalances - we feel and function best when we have a diverse community of bacteria in our gut. We call this the microbiome. If we don’t have the best mixture of organisms, we can experience more symptoms.
Environmental toxins – such as being in a house with mold, can have a huge impact on your health. Have you identified all possible environmental triggers to your health?
Gluten contamination - it is also possible to think that you’re following an AIP diet and have actually been contaminated with gluten or other foods that you’re trying to avoid. Gluten can be sneaky - working with a functional nutrition dietitian can ensure that you’re eating (and avoiding) what you mean to.
Photo by LinkedIn Sales Solutions on Unsplash
When to Seek Help
The thing is: food is tricky. Even on a good day.
And if you’ve been struggling with digestive health and frustrated by symptoms that won’t let up, it’s time to seek help.
As a registered dietitian nutritionist, I work to help you to uncover what root causes might have been making you feel poorly to begin with. And the thing is, food might be a huge part of that, but not the entire thing.
I would like you to have as much freedom with your food as possible while still enjoying respite from your symptoms. It’s possible – I promise.
And if you’ve been struggling with unexplained issues, flares of your autoimmune condition or have been following the AIP diet for a while and are not feeling better, it is time to help.