Three Questions to Ask Before Starting the AIP Diet

Fix me. That’s what I wanted to say when I finally received my myositis diagnosis.  Since autoimmune diseases can’t be cured – but can be managed – I knew that I had a long road ahead of me (the rest of my life).  And I had felt like crap for so long. I wanted and desperately needed some healing. This isn’t my first serious illness rodeo and I knew that part of my healing would be up to me. 

I recall a brief conversation (actually the exchange wasn’t long enough to be considered a conversation) with my new doctor.  I asked about diet – specifically an anti-inflammatory autoimmune diet. Did it make a difference?  The response I got was that some patients feel that it helps them.  Hmmmm.  There’s got to be more to it than that.  For perspective, searching “autoimmune diet” generates more than 54,000,000 results on Google. I’m not the only one who wants to know.

The Autoimmune Protocol Diet

I took some time to explore the diet – more specifically, AIP, the autoimmune protocol diet. Great!  A diet that that will help everyone with an autoimmune condition!  But I’m not a one-size-fits-all kind of person. When I think about one-size-fits-all I think about things like hospital gowns. I’m a small person and I’m not exaggerating when I say that I can almost wrap one twice around my body.  I remember, with a strange fondness, the day I was having a heart procedure done. Somehow the nurse managed to find a pediatric hospital gown for me.  It fit perfectly and it was a bright, lovely color.  I felt like I could be a fashion model on a cardiac catwalk.  The point is that is what works for some people doesn’t work for others – for a whole bunch of reasons. 

Since inflammation is a classic sign of autoimmune disease, it makes sense that adopting an anti-inflammatory diet could help. There is no shortage of autoimmune diet information, planning guides and recipes available on the internet.  There are lots of books, too.  

The premise of the AIP diet is that certain foods create inflammation in the body. Eliminating them and focusing on vitamin and nutrient-dense foods can heal the gut and reduce the inflammation. 

It’s very similar to the paleo diet, which is also a whole foods diet.  While both are whole foods-based diets, AIP is like paleo on steroids.  It’s much more restrictive.   

Let’s quickly compare the differences between them.

Rather than listing what you can have, here’s what you can’t have:

PALEO DIET: FOODS NOT ALLOWED

• Dairy
• White potatoes
• Grains and pseudo grains (including but not limited to rice, oats, wheat, barley, rye, bulgur, quinoa, corn)
• Legumes (all kinds of beans, peas, peanuts)
• Soy
• Processed sugar
• Refined “industrial” oils (such as grapeseed, peanut, vegetable oil, safflower, canola, corn)
• Processed foods (defined as foods that are not found in nature and whose nutritional composition has been altered)

To transition from paleo to AIP, you’ll need to remove all of the foods listed above as well as those listed below:

AIP DIET: FOODS NOT ALLOWED

• Eggs
• Nightshade vegetables (tomatoes, eggplants, peppers)
• Nuts and seeds
• Coffee
• Chocolate
• Alcohol

Say what??? But I have perfected my pasta and red sauce!

On the plus side, many people don’t stay on the AIP diet forever.  They may decide to gradually reintroduce certain foods at some point – anywhere from 30 days to several months, although there are certain foods that ought to be eliminated forever (think processed sugar and heavily processed foods). 

On the not-so-plus side – holy mother of sweet baby Jesus! Whether you try paleo or full-on AIP it’s an understatement to say that you will be dramatically and suddenly changing your entire way of eating.

Don’t get me wrong.  I’m a believer in healthy eating.  But I’m also a believer in healthy skepticism.  As a naturally compliant and disciplined person, I also think that that anything worth doing is worth doing right.  But what does it take to do AIP the right way?  What should I (or anyone) consider before making the leap?

Is the AIP diet right for you?

Here’s where I landed:  there are three questions you need to ask yourself before pitching your pasta and leaping head first into the AIP diet.  If you can honestly answer “yes” to all three, AIP may be a great choice for you.

Can you commit 100% to trying the AIP diet for at least 30 days?

This is a question not only of willpower (try avoiding mashed potatoes and gravy on Thanksgiving and let me know how that goes).  It’s also a question of personal discipline.  You’ll need to grocery shop based on a very carefully planned menu of permitted foods, and establish a meal plan with recipes that will be both nutritionally dense and satiating. Remember, while you can use natural oils like olive and avocado oil, you won’t be consuming dairy products, eggs, beans, legumes, rice or white potatoes – and those can typically be very satiating foods.  

I was surprised to learn that on AIP certain spices are not permitted because they are considered inflammatory.  Please, don’t take my pepper and chili flakes away.  You’re trying to reset your gut, so if you’re going to try AIP, you have to be ALL IN.  This means that you need to be able to identify and avoid hidden sources of prohibited foods and additives – like gluten and added sugar. If you read more about AIP you’ll learn that it’s not a diet that will be completely effective if you only do some of it or if you cheat a little bit. 

Even though the AIP diet isn’t forever, it’s certainly a big and long term commitment.  After the initial 30 day elimination period, you can begin to reintroduce foods to see how you feel.  This process could take quite some time if you want to do it correctly, since you’re reintroducing them one at a time.  This is the only way you’ll know which ones are or aren’t causing you a problem.

Can you manage the stress of major lifestyle change?

Please don’t think this is silly.  This is just as important a consideration as any other.  Whether you are newly diagnosed with an autoimmune disease or have been living with one for quite a while, you know that stress plays a role in how active your disease is.  Stress (physical or emotional) is a known trigger for autoimmune disease. Stress can send you into a flare.  It can (and probably will be) stressful to suddenly change your way of eating to one where you have to plan more carefully and most likely spend more money on groceries.  You will need to be super vigilant about what you’re consuming and understand that you will need to deprive yourself of foods – even those that are seemingly healthy – in order to comply with the AIP way of eating.

If you are the person who shops and prepares the food for your family, you will be faced with either forcing everyone on board (good luck with that) or preparing additional foods that they can enjoy… but you can’t.   And if someone else typically shops and cooks, they are going to feel that frustration, too.  If you live alone, this is probably an easier decision.  If you have a family, it’s a decision that should be made with these practicalities in mind since it will require additional effort and planning.

Are you aware of your specific nutritional needs?

This may sound controversial. Who’s going to argue that eating whole foods isn’t a good idea?  No one.  But I will argue that each of us is unique. We need to consider our specific health conditions when we’re going to enter into a dietary program that immediately eliminates not only specific foods but entire food groups, like beans, legumes and grains.  (That’s the part I’m skeptical about.) Will you be able to make sure that you are eating balanced meals that take into consideration any vitamin or mineral deficiencies that you may have? 

For instance, if you typically have low potassium or vitamin D levels, you’ll need to make sure to account for that when you’re planning meals since you’ll be eliminating things like white beans, potatoes, dairy and eggs.  If you’re on a blood thinner, you’ll need to monitor your intake of vitamin K rich foods – like leafy greens, asparagus, Brussels sprouts and cauliflower.   

 In short, you should work with your doctor and have blood work done to assess your nutritional status. Then you should work with a nutritionist to help you plan meals and snacks that will meet your nutritional needs and comply with the AIP diet. 

Why I’m reluctant to start the AIP diet

I have no doubt that eating whole, unprocessed foods is healthier than our standard American diet.  But I am reluctant to make a big change without a lot of planning.  I know from experience that it can backfire.  In mid-2016 I decided to adopt a mostly vegetarian lifestyle (I ate fish on occasion, so technically that made me a pescatarian).  I had been mulling over the idea for years – for both health and ethical reasons.  So one day I decided I’d stop eating meat.  Just like that.  How hard could it be?  I have always eaten and enjoyed virtually every vegetable, all grains and every type of bean (yes, even lima beans).  I could still have dairy products and eggs and I love to cook and try new recipes. 

Mentally, I adapted fairly well to being a vegetarian. I didn’t feel deprived. But I did little planning for the protein and iron (as well as some other nutrients, I’m sure) that I was losing by giving up meat.  About four months later, I began to experience vague symptoms that in retrospect were early symptoms of myositis, the autoimmune disease that I have.  It would take another two years before I would be diagnosed.  In the interim, I found out that I was anemic.  And by the time I was diagnosed I was severely protein deficient.

Can the wrong foods trigger an autoimmune disease?

Am I suggesting that a poorly-planned vegetarian diet triggered my autoimmune disease?  I’m not sure – but I’m definitely going to explore it.  Is it too big a coincidence that my gradual onset of symptoms began four months or so after giving up meat?  Sure seems like it.  As I think back, I hadn’t thought about the reality that I was giving up a whole food source without regard for how I was going to replace the protein, vitamins and other nutrients. In the end, I may have replaced the protein with a disproportionate amount of carbohydrates. 

So where did I land?  I gave up the vegetarian diet a few months before being diagnosed with myositis.  I was not functioning well and was losing weight I never needed to lose (likely a function of the toll of the disease on my body). And I was literally too tired to eat as much as I needed to. I had hoped that adding meat back into my diet would help restore my iron level and reduce my fatigue.

The food we eat does matter!

I think this supports the notion that we should let our food be our medicine and our medicine be our food.  Or something like that. Because if food can trigger an autoimmune reaction, then it stands to reason that the right foods can reduce the autoimmune response. And maybe the bigger lesson learned is that it’s not something to be done without paying attention to our individual needs.  That’s why I’m not on the one-size-fits-all bandwagon.

As far as the AIP diet, I just couldn’t do it.  I was gun shy because I had just adopted a diet that I thought would make me healthy but may have contributed to me getting sick.  Because I was taking a high dose of prednisone, I was ravenously hungry all of the time.  Weighing in at a 100 pounds, I couldn’t afford to lose more weight. Weight loss is one of the happy benefits of the paleo and AIP diet for most people.  I did give up gluten for one month.  It wasn’t nearly as difficult as I thought it would be. But I didn’t notice any difference in how I felt.  I eliminated processed, added sugars for a month too, although sugary things are not my go-to snack anyway.  I’m the girl who eats pickles and olives for a midnight snack.

Everything in moderation

I can’t say that I’ll never try the autoimmune protocol.  I admire people who have been able to successfully adopt it and am thrilled that some have experienced remarkable improvement in their symptoms.  But I’ve decided to continue to eat healthy, anti-inflammatory whole foods… and everything else in moderation.

If you’re considering the AIP diet, I encourage you to answer the three questions honestly and take advantage of all of the information that’s available – as well as a myriad of recipes. If you’re not ready to try the diet, you can (and should) make sure that you are eating lots of whole foods, incorporating nutrient dense anti-inflammatory foods into your diet and minimizing processed foods. This journey we’re on is a marathon, not a sprint.

We have a complex relationship with food. Why? Because food nourishes more than our bodies. Beyond fulfilling its role of sustaining us, it also plays a social and cultural role in our lives. Food offers a way to connect with others. It is a source of expressing and celebrating traditions. It can comfort us and transport us back in time, laying us safely within the arms of warm memories of the people and experiences that have shaped who we are. I guess that’s why a meal made “with love” really does taste better.

Many years ago I worked for a man who loved to cook (and equally enjoyed eating). He graciously invited our work team to his home and prepared a delicious (that’s an understatement) dinner.  The meal included a French dish, potato Dauphinoise.  It was a glorious and unctuous marriage of potatoes baked in butter, garlic, heavy cream, eggs and Gruyere cheese.  I remember him commenting about how unhealthy it was, given the calories… and the fat.  “It didn’t matter,” I said.  “It feeds the soul.”