Fruit and the Autoimmune Protocol

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One of the most common questions I get asked is “How much fruit should I include on the Autoimmune Protocol?”. Just having completed the 21 Day Sugar Detox, I have a renewed perspective on the role of sugar in the form of fruit in my diet. The answer isn’t simple, so I thought I would dedicate a post to it.

First off, fruit itself is not restricted on the Autoimmune Protocol. Different varieties of fruit (especially colorful ones) come loaded with vitamins, minerals, and antioxidants which are a great compliment to a healing diet. While fruit can have a lot of sugar, that in itself is not reason enough to avoid it. When we eat fresh, whole fruit, we are getting the nutrients in a nice little package with fiber, nutrients, and water.

Worried about the sugar content in fruit? Sarah Ballantyne, in The Paleo Approach (p.123) advises limiting fructose between 10-20 grams per day. Taking that into consideration, that is about 2-5 servings, depending on the fructose content of a particular fruit.

Dried fruit, however, can be problematic because of its high glycemic load, and should be reserved for the occasional treat. I find dried fruit particularly easy to over eat and only reserve the use of say dates in a dessert or something, never as a snack.

What if I react to fruit? This is another question I get asked often. Even though fruit is allowed, some people have GI symptoms when eating it. This is usually a sign that dysbiosis, or an imbalance in gut flora is present. If this is due to SIBO (Small Intestine Bacterial Overgrowth), a person might react to fruits high in FODMAPs, like apples, pears, peaches, grapes, and watermelon. Some people also have fructose malabsorption, which would mean that they don’t tolerate any foods with a high fructose content. If you don’t tolerate fruit for a reason you suspect is not an allergy, I would suggest finding a practitioner and getting tested for FM or gut pathogens that could be contributing to your symptoms. Aglaee Jacob’s book, Digestive Health With Real Food is an excellent resource for anyone trying to troubleshoot digestive issues.

Fruit’s affect on blood sugar balance. One reason to restrict fruit might be if you have issues with blood sugar regulation. If you find yourself shaky, crabby, with a headache, or ravenous between meals, and those feelings are relieved by grabbing a banana… I hate to tell you that you aren’t doing yourself a favor. This doesn’t mean to starve yourself through a low-blood sugar crash, by any means! A better idea would be a small meal with fat and protein—think half a sausage patty and some guacamole, leftover veggies cooked in coconut oil, or vegetable chips and pate. I have a personal rule that I never consume fruit between meals without some sort of fat—this means a scoop of coconut concentrate on an apple. After my vegan days, my body knows all to well what it is like to be on that blood sugar roller coaster, and I am not going back!

Your personal threshold. Having said all that, its best to find an amount of fruit that works for you and your healing process. I think 2-5 servings of fruit is a reasonable amount, but I also recognize that some people do better with either no fruit or more than that amount. After my experience completing the 21 Day Sugar Detox, I realized that I do better restricting my fruit intake but not restricting my starch intake. This means, for me that I eat only a piece of fruit a day, if that, but I am sure to eat some starchy vegetables like squash, sweet potato, plantain, taro, or yam at 2 or 3 of my meals.

I also like to let my intake of fruit wax and wane with the seasons. Right now, there isn’t a lot of fruit in season, save for citrus. I have been enjoying a lot of grapefruit, since that was allowed on the 21 Day Sugar Detox. I’m sure in summer, I will be enjoying berries and stone fruit, as they come in to season here in the Northwest.

I hope that helps clarify some of the confusion over sugar, and if you have any more questions be sure to ask away in the comments!

How much fruit do you eat on the Autoimmune Protocol?

About Mickey Trescott

Mickey Trescott is a cook and one of the bloggers behind Autoimmune Wellness. After recovering from her own struggle with both Celiac and Hashimoto’s disease, adrenal fatigue, and multiple vitamin deficiencies, Mickey started to write about her experience to share with others and help them realize they are not alone in their struggles. She is a certified Nutritional Therapy Practitioner by the Nutritional Therapy Association, and is the author of The Autoimmune Paleo Cookbook, a guide and recipe book for the autoimmune protocol, and AIP Batch Cook, a video-based batch cooking program. You also can find her on Instagram.

29 comments

  • Diana says

    Hi, Mickey. I’m on my second month on AIP and Paleo in general. I’m used to eat lots of fruits. But I started cutting my fruits portions after I found your blog and then Sara’s. So now I either eat couple servings with breakfast or don’t eat them at all. I’m a little confused about peaches for example. They have much lower fructose content then apples, the same time they’re on FM list. So if I have problem with digestion, I need to pay attention to FM list too?

    • Mickey says

      Hi Diana,
      I wouldn’t say if you have digestive issues you need to stay away from all fructose–some people have fructose malabsorption, or SIBO, which calls for a therapeutic diet (and treatment in the case of SIBO). Peaches and apples should be fine for most people, but if you notice your GI symptoms worsening when you eat them it might be something to look in to!

      Hope it helps!

      Mickey

  • Cheri says

    Hi Mickey,

    I am the same way, as far as the starch thing. I can tolerate some fruit in the day, but if I don’t get enough starch, I can get a little hypoglycemic. This is especially true for how I start the day. I have to have some starch at breakfast, and the breakfast that has been working for me recently is your carrot and sweet potato “chilli”. I am not a big fan of sweet potatoes, but they are perfect in this recipe and the balance of protein, fat and starch seems to work great for me.

    Thanks!
    Cheri

  • Billye says

    I have Hashimoto’s and was told to stop eating grapefruit so I haven’t had it in years. I also found out recently to not have vegetables with goitrogens. I am currently taking armor thyroid but recently started the AIP diet so I am hoping to be able to control my thyroid through diet. Do you still have kale and spinach? Can I have grapefruit again??

    • Mickey says

      Billye, I’m not sure why you would be told to not eat grapefruit unless you were sensitive to it. Some people are allergic to citrus. I think goitrogens are fine (as long as you aren’t eating them in massive quantities or juiced), here is an article I wrote on it: http://autoimmune-paleo.com/goitrogens-why-you-dont-need-to-avoid-them/

      Mickey

      • Bridget says

        Careful, grapefruit interferes with a lot of medications, that may be why your doc told you to avoid. Check your Rx descriptions to see if it is contraindicated, quite a few ‘slow release’ meds can become ‘fast release’ in the presence of highly acidic fruit.

    • kaitlyn says

      I have also been instructed to stay away from grapefruit (which I LOVE) because it has a negative interaction with many medications, specifically thyroid hormones. Even the info that comes with the pills will tell you this. Basically it will inhibit your absorption of the pill, but many resources I’ve found online say it’s fine to have it at least 4-6 hours after you take your pill.

      • Mickey says

        Kaitlyn, would you believe I have never heard of this? I wouldn’t say I eat a lot of grapefruit, but I do have it occasionally. It makes sense that if it does have an effect, it wouldn’t be a problem if you waited a few hours for your medication to absorb.

        Thanks for letting me know!

        Mickey

        • Michelle says

          Grapefruit inhibits an enzyme in the liver called CYP3A4, which is required to metabolize various substances including certain drugs. The following quote indicates that

          “The interaction caused by grapefruit compounds lasts for up to 72 hours, and its effect is the greatest when the juice is ingested with the drug or up to 4 hours before the drug. Furanocoumarins irreversibly inhibit a cytochrome P450 metabolizing enzyme called CYP3A4.”

          The following study shows that the effect on bioavailability of thyroxine is minimal. However in certain individuals it could be enough of a change to create problems. Here is the study I found https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884777/

          • Amy Downey says

            Please note that the study referred to is about the affect of grapefruit on the absorption of the synthetic T4 hormone levothyroxin and NOT natural desiccated thyroid medication (NDT). Also consider that the study notes that the malabsorption of synthetic T4 medications is slightly increased and some people taking that medication may not absorb as well when taken with grapefruit. In fact, it is recommended that levothyroxin be taken on an empty stomach with water only and there are many things besides grapefruit that are should not be taken within 2-4 hours of it. Examples would be: other supplements, such as magnesium. Additionally, soy and caffeine (coffee) can interfere with the absorption of levothyroxin (synthetic T4). I make the distinction only because not everyone uses synthetic hormones to treat hypothyroidism/hashimotoes. So this study is not applicable to everyone.

          • Brian says

            In general grapefruit inhibits the p450 enzyme. This makes it harder for the liver to remove the drug you have taken. So it raises the amount of drug that is in your system. This would be true whether it’s a synthetic drug or a natural compound. The opinion that just because something is natural grapefruit won’t affect it is false.

  • Kat says

    I have FODMAP and get terrible gas when I eat complex carb sources like winter squash (and sweet potatoes and yams give me a reaction) so I’ve been struggling for some time to get enough carbs on my paleo. I’ve started adding berries in the morning and I’m still wiped out all day. Is it okay to get more of my carbs from low glycemic fruits in this case? I have dysbiosis so for a long time I was avoiding fruits and just doing winter squash but the indigestion was so bad it was keeping me up at night. Since I cut winter squashes I’m not having that problem. Currently I eat between 6 and 12 ounces of blueberries (with avocado or coconut.) Not sure how much is too much/too little when it comes to fruit/carbs on the AIP.

    • Mickey says

      Kat,
      That sounds like quite the predicament. I also feel awful when I cut my carbs too much. Have you seen a doc to diagnose and treat your dysbiosis? Cutting carbs isn’t always an effective way of getting rid of pathogens. We all have different thresholds for carb amounts that put us into ketosis or not, but chances are if you feel tired the berries are not enough. I hope you find some answers soon!

      Mickey

  • Jami says

    I have been on the AIP diet due to leaky gut and uncomfortable skin issues that I am wanting gone. Everything was going really well until a few weeks ago when I started noticing my blood sugar levels dropping throughout the day. I don’t have much energy and I feel light headed in between meals and when I go to bed and wake up in the morning. I eat the recommended foods from the Paleo Mom’s blog and stay away from the iffy ones. I am wondering if it could be a fructose issue. What role does starch play in leveling out blood sugar issues? I will take your advice on a snack with fat and protein and fruit with a fat as well.

    • Mickey says

      Hi Jami,
      If you are having issues with blood sugar, it is important to make sure to have balanced snacks (those with protein and fat) available for when you feel hungry. It is not a good idea to “ride it out” until your next meal. You also may need to eat more protein and fat at mealtimes. Hope it helps!

      Mickey

  • heidi says

    Why is it not wise to eat fruit (such as a banana), when blood sugar feels low?

    • Mickey says

      Heidi,
      Because it perpetuates the highs and lows of the blood sugar roller coaster. Eating sugar without adequate protein or fat will cause blood sugar to spike, and then crash later.

      Hope it helps!

      Mickey

  • heidi says

    That makes sense. So, you still believe diet is the best way to control blood sugar, just pay attention to your food choices, right?

  • Karen says

    Hi Mickey. How did you work out you do better on less fruit & more starchy veggies?

  • jenna says

    Hi. It is funny as I used to just eat meat vegetables and fat no fruit or starch for years. My hormones got worse and I have gained weight despite at first dropping to 104 lbs. Lately I started eating fruit w fat in the am and I feel better. Sweet potatoes bloat me but bananas and or dried fruit in the am seem ok. I have issues with gastritis and reflux as well as IBS/dybiosis. It ia trial and error.

    • Mickey Trescott says

      Hi Jenna,
      Sorry to hear of your issues, but I would suggest seeking out a functional medicine practitioner and having a comprehensive stool test done (if you haven’t already). Not tolerating certain carbs/starches can be a sign of overgrowth, and testing is best to find out what treatment may resolve your issue. Wishing you luck!

  • Jiji says

    Would this be an appropriate AIP breakfast or midday smoothie? 1 cup of canned coconut milk, 1 cup frozen blueberries, 1 banana, and 1 scoop of Ancient Nutrition brand pure bone broth protein

  • Wendy says

    Can I eat dates or do they have too much sugar for the autoimmune Paleo diet?

    • Mickey Trescott says

      Hey Wendy! They are technically AIP compliant, but as per Sarah Ballantyne’s recommendations we try not to go over 20g fructose per day which comes quickly with dates. Hope it helps!

  • Brian says

    I think you are quite right that people need to individualize their own protocol. Like some others here I don’t do well on a low-carb diet. About 100 to 150 carbs per day is about right for me. I have found that if the carbs are almost exclusively fruit I feel much better then if the carbs come from other sources. Lately I have realized that eating foods that stimulate th2 help considerably. It may be the quercetin and other polyphenols in fruit that ratchet up th2 that helps. At any rate, my best strategy is to eat non-starchy vegetables and fruit.

    • Mickey Trescott says

      Hey Brian! Thanks for sharing, hope you continue to feel better by individualizing your diet.

  • Ann says

    Everything is so confusing. I have hashimotos, celiac disease, mctd,alopecia areata (since I was 17),carpal tunnel syndrome, plantar fasciitis and soon will be tested for ankilosing spondilitis. I eat very healthy as I grew up on a farm in eastern Europe, with everything organic, grass fed meats,pastured pork and eggs.Loved the homemade butter and lard.Also,love veggies and fruits,can’t get enough.After going gf in 2008 ,everything started to go down the drain. Had my son in 2009,and my daughters in 2012 and 2014.Nursed for a total of 8 1/2 years and still going strong.My body after the first 2 was great,still 110 lb at 5′.7″ and never sick.Unfortunately,after my 3rd I am still 20 lb overweight with a huge belly that constantly hurts,especially at night.My alopecia returned last year and I feel overly tired ,which never happened to me before.I am 39 and 50% gray.
    I am already dairy free,nut free and eggs free as I found out a few years ago that I am sensitive to them.I did keto for 3 months and got worse.I still do the intermittent fasting and I eat healthy fats like pasture lard,coconut oil ,avocado oil and tons of veggies,especially green.Our meat is always organic grass fed and I cook everything at home.We do not eat in restaurants. With all this I am still 20 lb overweight with no energy, dry skin and my hair went from curly to completely flat. At this point I am scared of starches,especially after loosing about 6 lb with a low starch diet after having my 3rd child.Besides meat and fat,everything bloats me,but I love my green veggies. I have Sarah Ballantyne’s book,but scared to do the protocol as I’m afraid I will gain weight.
    Did anyone loose weight on this protocol?
    Also,as I don’t have headaches, brain fog or any other symptoms like most people have, will this diet help with joint pain (keto did help just a bit,but not enough)
    Thank you.

    • Mickey Trescott says

      Hey Ann! Wow, I am sorry to hear about your struggles here. Have you thought about enlisting the help of a practitioner to help troubleshoot and guide you on your journey? We have a listing of coaches we’ve trained here – http://aipcertified.com. Wishing you success on your journey!

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