Autoimmune Paleo (AIP) Dietitian Review
Updated: Mar 9
This post was adapted from episode 23: "Autoimmune Paleo (AIP) Diet Review" of the Nourished & Free™ podcast. Listen to the full episode: AIP Diet Review
The autoimmune protocol (AIP), also known as the autoimmune paleo diet, is a proposed dietary intervention for those struggling with autoimmune diseases such as rheumatoid arthritis, psoriasis, lupus, inflammatory bowel disease, and others.
Allegedly, this diet is supposed to help to reduce the symptoms of autoimmune diseases by reducing the inflammation potentially caused by dietary intake. But how legitimate is this protocol? Is it based on solid research or just another restrictive diet that is causing more alarm than helping to reduce harm?
Let’s dive into this AIP Diet Review and start off with answering the question I’m sure you’re (maybe) asking: what is the autoimmune protocol diet?
What is an Autoimmune Protocol Diet?
The AIP is an elimination diet used to identify foods for an individual with an autoimmune disease that may be causing inflammation, thereby worsening autoimmune symptoms. However, the foods that the AIP diet claims to cause inflammation are not exactly accurate. More on that soon.
What is an Elimination Diet
Before I dig more into the food lists for this AIP diet review, I want to review how an elimination diet works.
An elimination diet means there are foods eliminated from the diet aka detoxed for an extended period (typically about 1-2 weeks) then reintroduced slowly (typically 1 food every 2-5 days) to allow time for observation with each individual food or ingredient.
What we’re looking for is symptoms in the reintroduction phase that might point to inflammation – symptoms are our best indication that the body is responding poorly. We can infer that inflammation is occurring if there are symptoms such as bloating, headaches, migraines, diarrhea, skin rashes, muscle and joint aches, weight loss resistance, sleep problems, pain, or lethargy. Once we know this, we can decide if we want to continue having that food or avoid it, based on how much we like to live on the edge.
Here’s what I want you to hear: elimination diets are not supposed to be a lifelong exclusion of the eliminated foods. It is a short-term experiment to find an individual’s trigger foods. Anyone who is following the AIP diet (or any elimination diet) for the rest of their life without ever reintroducing foods is doing it wrong and is likely miserable, nutrient-deficient, exhausted, and low-key malnourished.
What is Inflammation?
As a reminder, inflammation is the body’s response of saying something is wrong. This will happen because of pathogens, irritants, and allergens. It doesn’t just happen randomly.
If someone is allergic or intolerant of a food, there will be an inflammatory response in the body. Conversely, if a wellness influencer says that a food like maltodextrin (long chains of glucose) causes inflammation, that does not mean there will be an inflammatory response. 😉
Inflammation is a big part of autoimmune diseases, so it is natural to be curious about what foods cause inflammation, especially for those trying to manage the symptoms that inflammation causes.
If you want to know what diet is good for autoimmune disorders, you need to know what foods cause inflammation and I’ll tell you what: it’s not all the foods on the autoimmune paleo diet food list.
Let’s review the AIP diet list and then dive deeper into this AIP diet review:
Autoimmune Paleo Diet Food List
Foods to be excluded during elimination:
· All grains (including oats, wheat, and rice)
· All dairy
· Nuts and seeds
· Legumes and beans
· Nightshade vegetables (tomatoes, potatoes, eggplant, peppers)
· All sugars, including alternative sugars, such as stevia and xylitol
· Butter and ghee (clarified butter)
· Oils (other than coconut oil, olive oil, and avocado oil, which are allowed)
· Herbs derived from seeds
· Food additives or processed foods
Foods to be included:
· Meat (preferably grass-fed) and fish
· Vegetables, excluding nightshade vegetables
· Sweet potatoes
· Fruit in small quantities
· Coconut milk
· Avocado, olive, and coconut oil
· Dairy-free fermented foods (such as kombucha, sauerkraut, kefir made with coconut milk, or kimchi)
· Honey or maple syrup in small quantities
· Fresh non-seed herbs (such as basil, mint, or oregano)
· Green tea, and non-seed herbal teas
· Bone broth
· Grass-fed gelatin and arrowroot starch
Which Foods Reduce Inflammation?
As we review the list above, the assumption is that the foods to be excluded during the elimination phase are the ones that are generally pro-inflammatory while the foods to be included are generally anti-inflammatory.
Well, I am not entirely sure how these foods made it to the AIP diet list in the way they did because the evidence that the foods on the ‘do not eat’ list are generally inflammatory is weak if not nonexistent.
All of the classic culprits that the wellness industry claims to be inflammatory are on this list: gluten, dairy, seed oils, and foods containing a protein called lectin.
Really quick, let’s just debunk ALL of those.
Is Gluten An Inflammatory?
There is ZERO evidence showing that gluten is inflammatory when symptoms do not exist. Converse to popular beliefs, having gluten is:
- Not associated with coronary heart disease
- Not associated with type 2 diabetes
- Not associated with irritable bowel disease (an autoimmune disease)
Gluten is not inflammatory unless you have symptoms (such as someone with celiac disease will have). Gluten-free (GF) foods are shown to be lower in essential nutrients so they may actually lead to nutrient deficiencies. To put a cherry on top, GF foods also cost an average of 267% more – so please don’t waste your money.
Is Dairy An Inflammatory?
No. Dairy is actually shown to have anti-inflammatory properties.
Do Seed Oils Cause Inflammation?
Not exactly. Excess amounts of omega 6's (found in seed oils) may be pro-inflammatory, but a healthy balance of omega 3's and omega 6's is necessary for a healthy diet and may actually reduce inflammation if the ratio is decent.
There is also data showing that omega 6's (which seed oils have a high amount of) have little to no effect on the autoimmune condition, inflammatory bowel disease.
Does Lectin Cause Inflammation?
No. Foods that contain lectins are shown to be anti-inflammatory, if anything.
If your nutritionist tells you that lectin causes inflammation and is exacerbating your autoimmune disease, they may be referencing a “connection between the two” as shown by this study – which was actually done on Caenorhabditis elegans AKA roundworms. You can’t correlate that to humans very well now, can you?
Lectin is a protein mostly found in plants. In other words, if you were to eliminate lectin, you are eliminating many foods to are shown to be anti-inflammatory. Here is a meta analysis looking at 83 studies (71 of which were clinical trials) showing that fruits and vegetables have a beneficial effect on 1 or more biomarkers of systemic inflammation.
Now let's say someone says, "but Michelle they are inflammatory for people with autoimmune disorders".... Okay, to cater to the autoimmune argument: it has also been shown that increased vegetable intake (which will naturally increase lectin intake) can reduce the risk of developing irritable bowel disease (an autoimmune disorder) by up to 44%.
Based on all the evidence above – you could easily argue that lectins are anti-inflammatory. This argument is really about the foods that lectins are found in, not in the exact food component itself as we aren't exactly chomping on lectin all by itself. With that being said, all of the foods that lectin naturally occurs in are more than likely anti-inflammatory.
How To Figure Out What Foods Cause Inflammation
What would be helpful is if we had an evidence-based tool that showed how much inflammation a food causes. If only such a tool existed!
OH BUT IT DOES.
Insert the empirical dietary inflammatory index (EDII), formerly known as the Dietary Inflammatory Index (DII). As far as I know, this tool was not used when creating the AIP diet list.
The EDII is a tool developed by researchers who used 1,943 research studies to see how certain foods (or components of food) affected systemic inflammation markers. Using this information, they listed 45 nutrients and whole foods and provided a score, indicating their likelihood to be inflammatory, anti-inflammatory, or neutral.
Which Foods Causes Inflammation?
First of all: Any foods that an individual is allergic or sensitive/intolerant to WILL cause inflammation (remember that inflammation is a response to something being wrong) and the only way to really know if someone is allergic or intolerant to a food is to test it.
So how do we test it?
- Allergies can be tested by an allergist who is looking for antibodies called Immunoglobulin E (IgE) responses. This is the safest way to test for allergies. You will also know if you’re allergic to a food if your throat closes up after eating it. Here’s a list of the top 9 major food allergens.
- Food intolerances or sensitivities cannot be tested in any way except an elimination diet despite all of the blood/urine/breath tests out there – those are complete scams and are measuring Immunoglobulin G (IgG)*. Therefore, we have to eliminate suspect foods & reintroduce them with an elimination diet then look for symptoms.
*A note on food sensitivity tests: IgG is found in the system simply in response to something else being present. In other words, if you ate a banana you will have an IgG response to that banana whether you’re sensitive to it or not. If you take a food sensitivity test, you’re likely to see that a bunch of random foods get flagged that really surprise you. The fact is that you’re probably not sensitive to those foods. Rather, traces of them are just in your system and your body is still signaling that it recognizes them.
More Foods That Cause Inflammation
Other foods that are generally shown to cause inflammation according to the EDII (when eaten in excess – remember that the dose determines the poison!) are:
- Foods that are high in added sugars
- Fried foods
- Packaged, ultra-processed foods
- Red meat
- Saturated fats
- Omega 6 fatty acids* (found in corn/peanut/safflower/soy/vegetable oils)
*Omega 6 is still essential fatty acid though, which means you are supposed to have some in your diet. Again, it's all about dosing here.
Which Foods Are Anti-Inflammatory?
The most anti-inflammatory nutrients and foods, according to the EDII (remember this is an evidence based tool and the AIP diet is not) are:
Flavones (an antioxidant)
Isoflavones (an antioxidant)
Beta Carotene (an antioxidant)
Flavanols (an antioxidant)
Omega-3 Fatty acids (an antioxidant)
Vitamin C (an antioxidant)
Green and black tea
Foods containing magnesium
Now here’s where things get interesting. If you’ve been paying attention, you noticed that almost all of the foods listed above which are anti-inflammatory are recommended by the AIP to be eliminated due to their generally ‘inflammatory’ properties. Let’s break down the ones that weren’t obvious:
- AIP says to eliminate nightshades vegetables, which include tomatoes and eggplants – but flavones and Vitamin C are found in nightshades.
- AIP says to eliminate soy – but isoflavones are found in soy.
- AIP says to eliminate foods like bell peppers, but beta carotene can be found in bell peppers.
- AIP says to eliminate fruits (or only eat a small amount), but flavanols and vitamin C can be found in fruit
- AIP says to eliminate seeds, but omega 3’s can be found in flaxseeds and chia seeds
- AIP says to eliminate foods like tofu, beans, nuts, seeds, whole grains, and chocolate – but magnesium is often found in all these foods.
The AIP diet does not make a whole lot of sense from an pro/anti inflammatory standpoint. However, it does make sense from an elimination diet standpoint. Let me explain.
Does the AIP Diet Work?
The AIP could be helpful for an individual trying to identify food triggers that are worsening existing inflammation. However, this is NOT because the AIP eliminates foods are "shown to cause inflammation” (it doesn't, many of the foods eliminated are actually anti-inflammatory without an allergy or sensitivity present). Rather, it is because someone MAY have a sensitivity or allergy to a food and not know without following an elimination diet and paying close attention to symptoms in the reintroduction phase.
If you remember from what I said before, allergies do cause inflammation. But without an allergy or intolerance present to that specific food, inflammation does not occur.
Overall Thoughts: AIP Diet Review from a Registered Dietitian
Summing up this AIP Diet Review, I am all for it from an elimination diet perspective but NOT because I agree that the foods AIP claims to be inflammatory are accurate.
What concerns me the most is that those with an autoimmune disease (or not) will see a list of foods thought to cause inflammation and they will err on the side of caution and eliminate those foods indefinitely rather than going through the reintroduction phase and truly feeling safe to eat the foods that present no symptoms.
Using this protocol may help someone find their specific food triggers which are causing inflammation. However, inflammation is a HUGE buzzword in the wellness industry right now and I don't like that the AIP is pushing a narrative about the foods excluded on the AIP being generally pro-inflammatory (they're not). Instagram influencers and big-name doctors are BOTH getting behind this trend, which is frightening to say the least. Fear mongering is unhelpful for the general public AND those with autoimmune conditions (uh, hello! We don’t need any more stress!).
What Diet is Good for Autoimmune Disorders?
First off – a diet that does not include your specific triggers. In the grand scheme of things, it is generally uncommon for someone to have true triggers or allergies to foods. Don’t assume that because you have an autoimmune condition that you MUST have tons of food triggers.
Second, a diet with a huge amount of variety that is rich in a variety of plant-based foods (fruits/veggies, beans, nuts/seeds, legumes, soy, etc), lean meats, seafood, and dairy should cover all of your bases when it comes to having an anti-inflammatory intake of foods. If you need ideas, searching for Mediterranean recipes is a good place to start.
But keep in mind that you can still eat all of the other foods that the world has to offer (barring you don’t have any allergies or intolerances)! It’s really all about finding your own unique tolerance level. Listen carefully to how your body responds to different foods. When in doubt, work with a dietitian (bonus if it’s a registered dietitian nutritionist for autoimmune disease).