NOTE: This post has been updated as of June 2019 and reflects the latest updates to the Autoimmune Protocol. We work hard to ensure that this page is the first to be updated on our website in order to share the most current research and emerging nutritional science. Keep it bookmarked to stay informed.
Recently we shared What Is AIP? The Definitive Guide as the most detailed, “Full Monty,” Autoimmune Protocol post out there. And it was full of info on every aspect of AIP, including reintroductions, but we also saw a need for a separate, even more in-depth and specific guide to this process. It can be a tricky procedure and many of us have approached it with some confusion.
But not after today! We have assembled the most comprehensive, all-in-one-spot, definitive AIP reintroductions resource ever and all you have to do is scroll. (Well, and read… you also have to read.)
Autoimmune Protocol stages – how did we get here?
The dietary component of AIP basically consists of two phases: Elimination and Reintroduction, which are implemented in a three-stage process: Transition, Maintenance, and Reintroduction.
The Transition and Maintenance stages together constitute the first phase of AIP known as Elimination.
Reintroduction constitutes the second phase of AIP and final stage in the process, where the focus is no longer on eliminating, but instead on bringing foods back into the diet.
The Reintroduction phase – what is it?
During the reintroduction phase, you progress through a process of testing your response to the foods you’ve eliminated one-at-a-time.
Each food is best tested in a specific order, beginning with foods that are most nutrient-dense and least likely to cause a reaction and moving toward foods that least nutrient-dense and most likely to cause a reaction.
The four stages of reintroduction are as follows:
- Egg yolks
- Legumes (only including the beans with edible pods)
- Legume sprouts
- Nuts and seeds (only the oils at first)
- Seed-based spices
- Fruit and berry-based spices
- Coffee (on an occasional basis)
- Nuts and seeds (whole, flours, and butters, including cashews, pistachios, & chia seeds)
- Alcohol (in small quantities, think 5 oz. of wine)
- Egg whites
- Coffee (daily basis)
- Nightshades (only eggplant, paprika, sweet peppers, peeled white potatoes)
- Lentils, split peas, garbanzo beans
- Grass-fed Dairy
- Nightshades (all remaining, including unpeeled white potato)
- Alcohol (in larger quantities, think 2, 5 oz. glasses of wine)
- White rice
- Other gluten-free grains
- Other legumes
If a food or food group does not appear in the four stages, it indicates that you may want to avoid that food long-term due to its negative impact on those with autoimmune disease or its overall negative health consequences for the majority of the population.
Gluten, for instance, is likely to contribute to further immune stimulation for all with autoimmune disease, while processed vegetable oils, food chemicals and additives, and refined sugars and non-nutritive sweeteners, are harmful for everyone.
Want a handy print-out of this chart? Scroll to the bottom to have it delivered to your inbox!
Why do you need to reintroduce foods?
The #1 question we are asked about reintroductions is “If you feel good after eliminating all those foods, why bring them back?”.
There are no gold stars for the longest, most perfect AIP elimination phase. Instead, you begin with the end in mind; a goal to eventually arrive at the least-restrictive diet that promotes your individual best health. You are working toward personalization and your end result will look different from any other person using the protocol. You want to use the protocol to your advantage, identifying which foods are causing symptoms, expanding your diet to include foods that are most supportive, and eliminating more long-term the foods that undermine your health.
Some of the elimination foods are valuable to re-incorporate into your regular diet from a nutrient standpoint (eggs, for example). It’s also true, both from a practical and social sustainability standpoint, that reintroductions are a wise step (i.e. it’s easier to travel if you can eat rice and it’s nice to occasionally go out to Happy Hour with friends). Finally, there is psychological benefit in working towards expanding your diet as your wellness returns, rather than allowing food-driven fears to take hold. To read more, check out the article Strict AIP Isn’t Meant to Last Forever.
The elimination phase is not meant to last for a lifetime, reintroduction is just as important as elimination to the Autoimmune Protocol.
When can you start reintroducing foods?
You reach the reintroduction stage when you have spent 30-90 days fully compliant in the elimination phase and have measurable improvement in symptoms from your baseline as evidenced from tracking and journaling (and/or lab testing).
Ideally, you are looking for relief of your autoimmune disease symptoms. At the end of this stage you have a diet that is individualized, sustainable (both practically and socially), and nutrient-dense. It should be the least-restrictive diet that gives you the best health.
If you reach 90 days without improvements, it’s time to get your healthcare providers involved for some testing. There may be something underlying that needs treatment beyond diet and lifestyle changes and which is preventing your progress. The sooner those issues are dealt with the better, so that you can start reintroductions and enjoy expanding your diet again.
If you are confused about the elimination phase or have been having trouble with implementation, check out What is AIP? The Definitive Guide for food lists and resources for the first phase of the Autoimmune Protocol.
Implementation: How do you reintroduce foods?
Implementation of the Reintroduction stage is not difficult, but it does require methodically following a multi-step procedure. The reason for this procedure is to help you be the best possible scientist, controlling the “science experiment” you are about to conduct.
First, consider these important points:
- limit variables (this means that you had maximum compliance during elimination, that you’ve given attention to lifestyle factors, more on that later, and that you avoid reintros when you are sick or under stress)
- follow the procedure (outlined below)
- track all the data (more on that below)
- be willing to accept the conclusions (even if they disagree with what you were hoping for)
- remember that reintros can be reattempted (sometimes more healing time is all that is required)
- Select a food to reintroduce from the stages chart.
- Start with half a teaspoon or less and wait 15 minutes. If there are reactions, stop.
- If there are no reactions, eat one full teaspoon and wait 15 more minutes. If there are reactions, stop.
- If there are no reactions, eat one-and-a-half teaspoons and wait two–three hours. If there are reactions, do not go any further.
- If there are no reactions, eat a normal portion of the food and wait 3–7 days. Do not reintroduce any other foods and track reactions during this time. (Many reactions could indicate a potential food sensitivity, but the most obvious is a return of your autoimmune symptoms.)
- If there are no reactions different from your improved baseline after the AIP elimination phase, that food can be brought back into your diet and you can begin another reintroduction.
- Be aware that you may find a food is tolerated when you eat it occasionally, but not when eaten regularly.
It should be noted that this process of elimination and reintroduction is medically the “gold standard” for identifying food-driven symptoms, even more so than largely inaccurate food sensitivity testing. If you’d like to know more about that, you can read about it in the article Why Food Intolerance Testing Doesn’t Work.
In what order do you reintroduce foods?
It’s really up to you. You can take the stages in a different order or skip around. However, how well you react to several foods in an early stage is a very good gauge for your likely ability to tolerate foods in the next stage. From this perspective it is most valuable to take a methodical approach, starting with Stage 1 foods and if you are having positive reactions, progressing through the next stages.
Exactly how should you track reintroductions?
Yeah, we made that sound kind of easy, but it actually takes a little bit of organized data collection. We suggest utilizing a simple journal page with space to record the following details:
- Name of the food you are attempting to reintroduce
- The Date
- What time it was when you attempted the half teaspoon of the food and your reactions
- What time it was when you attempted the full teaspoon of the food and your reactions
- What time it was when you attempted one and half teaspoons of the food and your reactions
- What time it was when you attempted a normal serving of the food and your reactions
- Reactions on Day 2
- Reactions on Day 3
- Reactions on Days 4-7 (if you decide to take extra time between reintroductions)
- A little space for your reintro results (whether that food is a positive or a negative for you)
Okay, so what sensitivity symptoms should you be looking for?
One of the more challenging aspects of AIP food reintroductions is figuring out what constitutes a reaction. Outside of something very obvious, like suddenly breaking out in hives or vomiting, it can be a little confusing. And since food-driven symptoms can show up days later (although typically if you are sensitive you will notice within 48 hours), it can be especially tough to notice them or connect them to a food.
The good news is that once you’ve cleared the slate, taken ample time in the AIP elimination phase to improve your baseline, and tackled anything underlying that needed treatment, you’re likely to find that your body’s communication, even its more subtle clues, becomes very clear to you. Things that previously didn’t get your attention will be much more obvious.
Below is a list of symptoms you might encounter when reintroducing a food back into your diet. You can run through this list during a reintroduction attempt to check-in with yourself each day (up to 7 days after you try a reintroduction, if you are being particularly cautious), to see if you are experiencing these things. Note any that you are experiencing, but which had been resolved prior to beginning the reintroduction process, on your reintroduction tracking page.
Possible reactions might be:
- Disease symptoms returning/worsening
- Unable to stay awake
- Unable to stay asleep
- Not feeling rested after sleep
- Sugar cravings
- Fat cravings
- Need for caffeine
- Craving minerals from non-food items (like chalk, dirt, or clay)
- Pink bumps or spots
- Dry hair, skin, or nails
- Muscle aches or pains
- Joint aches or pains
- Tendon aches or pains
- Ligament aches or pains
- Undigested food in stool
- Mood swings
- Low stress tolerance
- Noticeable increase in anxiety
- Reduced energy levels
- Afternoon energy dips
- Headache (from mild to migraine)
- Dizzy or lightheaded
- Phlegm, runny nose, or postnasal drip
- Coughing or constant need to clear throat
- Itchy eyes, mouth, or ears
Want a handy reactions checklist? Scroll to the bottom to have it delivered to your inbox!
You still have questions, right? We get it and we’ve got answers! Check out our drop-down menu here:
Can you still reintroduce foods even though you don’t feel any better?
If you aren’t feeling any improvement after 90 days on the elimination diet, it is important to enlist the help of a practitioner to troubleshoot some root cause issues that may be impacting your healing process. If you try to reintroduce foods before you start to feel improvement, you will have less ability to tell if a food is causing a reaction or not.
Do all of your symptoms need to reverse before reintroducing foods?
No, but you do need to see measurable improvement to create that “baseline” and gauge reactions. Even if you have not had total remission of your autoimmune symptoms, look for positive changes in other areas, like skin, digestion, mood, sleep, and energy. If those subtler changes are clear and measurable enough, you can start the reintroduction process.
What if you have a condition like Hashimoto’s that comes with symptoms that are hard to pin down?
Some autoimmune diseases, like Hashimoto’s thyroiditis come with symptoms that are more subtle and hard to track, such as energy and mood fluctuations. This is where very careful symptom journaling and tracking comes in. Certain indicators like bowel movement frequency and type (check out a Bristol Stool Chart for help), morning body temperatures, and monitoring thyroid hormones via blood work can be helpful. Even though progress might be harder to ascertain, you should be able to see forward movement using this information when combined with your symptom tracking.
What if you have a bad reaction to a food?
This is what everyone is nervous about, as we don’t want to experience the disappointment that comes when a food reintroduction is not successful. While it is disappointing, it is also a valuable communication from your body.
Stop and do not include this food in your diet at this time. Depending on the severity of your reaction, go back to the elimination phase until you reach the baseline of health that you had before you started reintroducing foods. This could take a matter of days or weeks to achieve but it is important to “clear the slate” before you begin the process again with a new food. If you do not give time to the “clearing the slate” process, it will be difficult to gauge positive or negative reactions to the next reintroduction attempts. Remember that a food that did not work today may work in the future with more healing.
How long do you have to go back to the elimination phase if you have a bad reaction?
This depends on the severity of reaction. It could be a matter of days or weeks. It’s important to reestablish your improved baseline before starting again.
If you react to one food in an earlier stage does that mean you can’t move on to the next stage?
No, but it is recommended to try some other foods from that stage before moving on to the next stage. For instance, if you try ghee in Stage 1 and get a reaction, but you have successfully reintroduced green beans, cardamom, black pepper, and macadamia nut oil, you could consider moving on to foods in the Stage 2 list. However, if you find that you are reacting to most of the foods in a particular stage, you may need to wait for deeper healing before moving further.
If you’ve stayed with us all the way to the end, you may be ready to move on to reintroductions, but hoping to do it with professional support. We are one-step ahead of you! We’ve trained hundreds of health and wellness providers from every kind of background (medical doctors to health coaches and lots of professionals in-between) how to help you adopt the Autoimmune Protocol in our practitioner training program. You can search listings to find a practitioner near you on the AIP Certified Coach website.
Looking for more AIP and reintroduction resources?
Between the two of us, we’ve written three books on AIP. Mickey’s The Autoimmune Paleo Cookbook was the very first AIP cookbook and still a favorite in the community. Angie’s The Alternative Autoimmune Cookbook was the first to tackle the emotional side of healing along with delicious recipes. And Mickey and Angie’s co-authored guide, The Autoimmune Wellness Handbook serves as an all-angles guide to every area those with chronic illness want to cover, from the AIP diet to sleep, stress management, and connection.
We’ll be the first to tell you that you don’t need to buy ANY of our books to get connected to all the information you need to embark on a successful Autoimmune Protocol. We have over 100 articles on the site covering every detail of AIP, in addition to over 250 AIP compliant recipes and even more resources and links on our resources page. You can also tune in to The Autoimmune Wellness Podcast for an audio version of the information we present here.
If you are looking for more information and resources on getting started with AIP, you will want to sign up to get our AIP Quick Start Guide. Just pop your email in the box below and we will send you the following over the course of five days:
- Complete, printable lists of the foods to avoid and include during AIP
- A 2-week AIP meal plan and shopping list
- A 90-minute batch cooking video from Mickey
- A practical tips video from Angie talking balance, temptation, and body image
- Printable guides on food reintroductions and reactions
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