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.
Okay, are you ready for the most detailed, “Full Monty,” every-single-detail Autoimmune Protocol post ever? Good! Strap in and get ready for some knowledge to be dropped. We have assembled the most comprehensive, all-in-one-spot, definitive AIP resource ever and all you have to do is scroll. (Well, and read… you also have to read.)
The Autoimmune Protocol as an Elevator Speech
What is AIP?
The Autoimmune Protocol (also known as “Autoimmune Paleo”, “The Paleo Approach”, or “AIP”) is a science-based elimination and reintroduction diet and lifestyle protocol. It focuses on repairing gut health, balancing hormones, and regulating the immune system.
The dietary component includes removing food-driven sources of inflammation and restoring nutrient density, while the lifestyle component includes approaches to sleep, stress management, movement, and connection (both with humans and nature), in order to help best manage autoimmune disease. It has been used successfully alone or in combination with conventional treatments, depending on a person’s needs, and has even been the focus of medical research.
Who came up with AIP?
The idea that there may be dietary approaches to helping manage autoimmune disease was first floated by Dr. Loren Cordain, the founder of the Paleo movement. Later, Robb Wolf, Chris Kresser, and Datis Kharrazian, other well-known members of the Paleo and functional medicine communities with medical or research backgrounds, began to add some detail to the concept.
Finally, in 2012, Dr. Sarah Ballantyne (of ThePaleoMom.com) motivated by her personal experience with autoimmune disease and experimentation with the AIP concept, began to use her Ph.D.-level education in medical biophysics to research, refine, and write extensively about the protocol. AIP as it stands today is largely the result of her work.
You can read more about the origins of the AIP movement in our post The State of AIP 2018, or if you’d like a print book with all of these details, check out our co-authored guide The Autoimmune Wellness Handbook.
Now, let’s get into details.
Two Phases of a Three Stage Process
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” (more detail below). The Reintroduction stage constitutes the second phase of AIP where the focus is no longer on eliminating, but instead on bringing certain foods back into the diet (more detail below).
Stage 1: Transition to Autoimmune Diet (Elimination Phase)
Transition is the process of moving one’s diet to the elimination phase, with a focus on nutrient-density. This can be a slow-and-steady process or a cold-turkey process. Most folks are best suited to a slow-and-steady transition.
Stage 2: Maintenance (Elimination Phase)
Maintenance is the period following full transition. The focus is to maintain the food eliminations while concentrating on nutrient-dense additions, with a goal to maximize healing. Maintenance needs to be 30 days at a minimum for everyone, as this cleans the slate for a clear reintroduction process. For most, 60-90 days in Maintenance is more ideal and allows the most healing.
If by 90 days progress is not as expected, it is time to enlist the help of doctors or allied healthcare providers to dig deeper into possible obstacles that cannot be addressed through dietary changes alone and are preventing progress with AIP.
Stage 3: Reintroduction (Reintroduction Phase)
Reintroduction is the second phase and final stage in the process. This stage is reached when a person has spent 30-90 days fully compliant in the elimination phase and has had measurable improvements in their symptoms from their baseline as evidenced from tracking and journaling (and/or lab testing). Ideally, there will be relief of symptoms.
At the end of this stage a person’s diet is individualized, sustainable (both practically and socially), and nutrient-dense. It should be the least-restrictive diet that gives them the best health.
The Elimination Phase: What and Why?
AIP begins with an elimination phase where foods are temporarily removed from the diet.
The foods to avoid are:
- All grains (including rice, corn, and grains that contain gluten: wheat, barley, and rye)
- All pseudo-grains and grain-like substances (think quinoa or amaranth)
- All dairy (pretty straight-forward)
- All legumes (this includes soy, peanuts, and beans)
- All processed vegetable oils (think canola)
- All processed food chemicals and ingredients (preservatives, dyes, emulsifiers, thickeners, etc.)
- All refined sugars and non-nutritive sweeteners (like high-fructose corn syrup or stevia)
- All nuts and seeds (this includes seed-based spices, coffee, and chocolate . . . we know, we know!)
- All fruit and berry-based spices (like black pepper, for instance)
- All nightshade-family produce and the spices derived from them (looking at you tomatoes!)
- All eggs (no, ostrich eggs are not allowed)
- All alcohol (kind of “duh,” right!?)
Want a handy print-out of all of these foods? Scroll to the bottom to have it delivered to your inbox!
Why in the world would a person eliminate that many foods?
There is a ton of very deep science behind these foods to avoid. This is not just a random guess or an experiment in surviving on air and water (we know you were thinking it!). Each of these foods was carefully evaluated for compounds that can stimulate the immune system or harm the digestive tract.
Once the foods were vetted based on their allergen and/or inflammatory potential, as well as overall nutrient value, they got an “in or out” vote. Avoiding foods that may contribute to disease via the inflammatory response or, at a minimum, foods which interfere with the healing process, allows the body a reset period and a better chance at wellness. (Check out the book The Paleo Approach by Sarah Ballantyne for more info on the “whys” here).
We don’t just eliminate foods during this phase though, we also add them.
Flooding the body with super nutrient-rich foods is a crucial component to success with AIP. The foods to include are:
- Healthy fats (like olive oil and pastured lard, yes, lard)
- Bone broth (if you haven’t heard about this, you are living under a rock)
- Organ meats (for real!)
- Colorful vegetables (loads of them)
- Fermented foods (think sauerkraut)
- Fish and shellfish (as long as there is no allergy, these foods are a rich source of nutrients)
Why do we add these foods while on AIP?
Again, there is very strong science supporting the inclusion of these foods in our diets. Especially in the presence of autoimmune disease, these incredibly nutrient-rich foods can help fuel healing, which is a very nutrient intensive process.
There are specific vitamins and minerals that are offered by each of these food categories and some of them pack a powerful anti-inflammatory punch, but overall these additions represent ounce-for-ounce the most nutrient varied and nutrient dense foods we can consume. Also, don’t fear the “gross” factor. Over time the taste buds adapt, and the body gives strong craving signals that it actually wants these delicious, healing foods.
Still need convincing that these additions are important? Check out our article The Argument For Nutrient Density.
The Reintroduction Phase: What and Why?
During the reintroduction phase, you progress through a process of testing your response to the foods you’ve eliminated one-at-a-time.
The foods are 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 are least nutrient-dense and most likely to cause a reaction. To learn about the four stages of reintroduction foods, read our Definitive Guide to Reintroductions.
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. Strict AIP Isn’t Meant to Last Forever, and reintroduction is just as important.
Implementation: How do you do AIP?
Now that you understand what AIP is, how it was developed, the three stages, and the details of the elimination and reintroduction phases, it’s time to talk about how to actually adopt the protocol. For practicality sake we’ll explore implementation by stages.
Earlier we mentioned that during the first stage, Transition, you basically have two choices to help you arrive at the full elimination diet: a slow-and-steady process or a cold-turkey process.
The slow-and-steady process is a gradual, phased approach to eliminating the foods that are initially avoided on AIP, starting with those foods which are least nutrient dense and most likely to be driving symptoms. It is much more gentle and often more sustainable than cold-turkey, plus a good fit for those who may experience a lot of overwhelm with such a big dietary change.
The downside is that results take longer (although not significantly longer) to realize.
The time frame for doing the eliminations in phases is variable (you can do it over a few weeks or a few months), but there is an existing framework for accomplishing it over six-weeks (developed by Angie and used by thousands of people over the last five years in her program SAD to AIP in SIX!).
The cold-turkey process is a fast, immediate transition to the full elimination portion of AIP. This transition method utilizes a three-day quick-start in order to prepare and is a good fit for those who are desperately ill and/or highly motivated. The downside is that it is often not sustainable, and you may burnout before you see results, after realizing that big dietary changes have a whole life impact.
Implementation during Maintenance is more than simply “maintaining” the food eliminations.
It is normally the period where the bulk of learning about your new way of eating and living occurs. It includes learning how to meal plan, how to source and budget for foods of higher quality, how to batch cook, and on a deeper level how to manage time and relationships differently based on your changing approach to your healthcare. There are many invaluable, existing resources to do this learning, but the key to implementing this phase is finding support.
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 steps:
- 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 (make use of possible food reaction checklists, journals, and trackers)
- 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)
Now, here’s the procedure:
- Select a food to reintroduce.
- 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 three–seven 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, 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 actually the gold standard for identifying food-driven symptoms, even more so than largely inaccurate food sensitivity testing (read more in our article Why Food Intolerance Testing Doesn’t Work).
The Lifestyle Aspects of AIP: What and Why?
There are four areas of your overall lifestyle that should also be addressed when adopting AIP (in order of importance):
Just like with the dietary aspect of AIP, focusing on these four areas was not just a random guess. Through careful evaluation of the scientific literature these areas were pinpointed as having significant impacts on regulation of the immune system, hormonal balance, and/or the healing process itself.
Those with autoimmune diseases are particularly vulnerable to imbalance in these areas and learning how to approach each can have as great an effect, if not greater, than dietary changes on restoring health and well-being. Emphasizing both diet and lifestyle is typically a powerful combination, improving the quality of life baseline for almost everyone.
The “how” of tackling each of these areas can feel pretty overwhelming, especially when attempting to implement the diet portion at the same time. Just like with diet, we recommend that most folks start tweaking with a slow-and-steady method.
Can I combine AIP with my conventional medical treatment?
Yes! The answer is yes. While we have seen many reduce or even completely wean off medications, that is not always possible. Needing to combine medical care of any kind (whether that is surgical or pharmaceutical) with AIP is not failure. The goal should be living to your highest standard of wellness with autoimmune disease, and if a thoughtful combination and conventional and natural helps you achieve that, it’s great! You may find that conventional treatments work much better after you’ve dialed in AIP.
Luckily, as the movement around this more natural approach to autoimmune disease that patients can put into practice themselves has grown, more and more doctors have started recommending it. Whether your doctor is supportive or not, be sure they know you are taking this big step, because AIP is powerful enough to impact future healthcare decisions and a collaborative relationship with your doctors includes giving them all the information. Read more at Where Medication Fits Into A Healing Diet.
Will AIP help my autoimmune disease?
We are not medical practitioners. We can’t diagnose you and we can’t say if any one approach will help. Additionally, there are over 100 confirmed autoimmune diseases and many more suspected autoimmune diseases. It would be impossible for us to evaluate the impact of AIP on every single one of them.
What we can tell you is that between our two health coaching practices we’ve personally been involved in helping thousands of folks take this step and watched many, many positive outcomes. We’ve also had the privilege of sharing many first-hand accounts in our Stories of Recovery series and The Autoimmune Wellness Podcast from people with all kinds of different autoimmune diseases. Ultimately, the “worst” side effect of AIP comes down to eating more nutritious food, so it might be worth it to give it a shot and see if you can move the needle with your autoimmune disease.
But there is more than anecdotal evidence that it works…
Has AIP been medically studied?
Yes! The answer is yes. In 2016 Angie partnered with a gastroenterologist and helped lead the first-ever medical study of AIP for a group of participants who had severe and long-standing autoimmune inflammatory bowel diseases. The results were outstanding, with 73% of them reaching and maintaining clinical remission by week six of the study.
Some of those participants were able to discontinue medication and still achieved remission. This study lends weight to what we know anecdotally and hopefully opens the future to larger studies and studies of other autoimmune diseases. If you want to know to all the details, they can be found here.
One Last Thing: Emotional Considerations
This seems like a big adjustment, right? If you’ve been paying attention for the last 2,943 words you are probably starting to notice the elephant in this room. The process of changing diet and lifestyle to make health the number one priority comes with more than a few emotions to process.
You may find yourself going through a grieving process, not only about your experience with autoimmune disease, but also now with the steps required to heal. The grieving process might include denial, anger, fear, and sadness. You might have challenges around social adjustments and sometimes in the same way relationships can be strained by chronic illness, they can be strained by such an intensive healing protocol. Some might find there is a lot of struggle around letting go of certain foods, while others might realize they’ve fallen into a need for flawlessness around food. (If you think your patterns are leaning toward disordered eating, it’s important to get the right kind of help so that you can use AIP as it was intended and not allow it to just become another burden on your heart and mind.)
The good news is that thousands and thousands of us have navigated similar emotional challenges and come out the other side happier, stronger people, with a greater sense of self and commitment to our miraculous bodies. In general, the emotional piece of this journey can best be navigated if you:
- Avoid perfectionism
- Set boundaries
- Resist comparison to others
- Find encouraging support
- Practice gratitude
It might help to see this process at its core, to help with the emotional “digestion.” Reading through the key ideas we outline in our Autoimmune Wellness Manifesto can help take the pressure off. You can also find more about navigating emotions at these links:
- Life Is Happening NOW (And Why It Matters In Autoimmune Disease)
- From Victim to Empowered – Create Your Life With Autoimmune Disease
- Remember… You Are More Than A Diagnosis
- Change the Channel, Change Your Life
- Six Ways to Mentally Prep for AIP
If you’ve stayed with us all the way to the end, you may be considering AIP, 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.
If working 1:1 with an AIP Certified Coach isn’t accessible for you right now, Angie’s group coaching program runs four times a year. You can check out all the dates and details on the SAD to AIP in SIX website.
Looking for more AIP 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 AIP. 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
You will then be subscribed to our newsletter, where we deliver free, exclusive content in the form of tips, articles, recipes, news, and more! By signing up, you will be the first to know about what is happening in the autoimmune community!