I often say that my main motivation for everything I do now is to help people find the answers they need without having to hit the health lows that I did before finding the Paleo diet and the Autoimmune Protocol.  But, I do also want to recognize that, in many ways, growing up with autoimmune disease forged who I am.  While my intelligence and talent are innate, I believe that my ambition and work ethic were borne out of striving for academic excellence while feeling exhausted and in pain almost all of the time (being too tired to get into teenage mischief helped too).

My stubbornness and resolve arose from being mercilessly bullied as “the fat kid” on the playground, too often facing misogyny as a woman seeking a high-profile career in male-dominated scientific fields, and the experience of rising up from the poverty of my childhood. My passion for helping others was ignited by decades of seeking help from medical professionals and being figuratively patted on the head and told that I was just a stressed student who needed Prozac and to count my calories and exercise.  Without the qualities developed from those experiences, I wouldn’t be able to do what I’m doing now: leading a revolution in the alternative health community by educating autoimmune disease sufferers on the role that diet and lifestyle play in both their disease activity and in disease management.

If you’d asked my in my teens or twenties, I would have told you that my health problem [problem, singular] was being overweight.  Those dozen diagnosed chronic health conditions didn’t seem separate to me from being obese.  And obesity, to me, felt like wearing a sign at all times that read “Look at me!  I’m unhealthy!  I’m a failure!”. Despite my academic achievements (including graduating with distinction with an Honors Bachelors of Science, earning my PhD in medical biophysics by the age of 26, numerous scholarships and awards for research excellence,  securing post-doctoral research positions in some of the highest profile laboratories in the country, getting my own grant funding as a post-doctoral research fellow, and publishing highly-cited papers in top-tier journals), being morbidly obese was an undercurrent that eroded all sense of accomplishment that I should have felt.  I made up for it by cursing regularly, dying my hair crazy bright colors (blue, purple, platinum, fire engine red…), wearing power suits, and generally putting on a show of assertiveness that I never really felt, covering up my impostor syndrome with a confident exterior. So, I naively thought that, if I could just lose the weight and solve that problem, everything in my life would fall into place.

Then in 2007, I had my first daughter.  Still obese when I conceived, my pregnancy was complicated by gestational diabetes and pre-eclampsia.  My newborn had colic and rarely slept more than 45 minutes at a time.  She wouldn’t latch onto a bottle, so I was up all night nursing her.  And, I couldn’t do it.  I was too sick to balance motherhood and applying to tenure-track faculty positions, the expectation being that I would continue to work 80-hour weeks until I had established my own research program and a perfect self-renewing cycle of grant funding, a process that typically takes years.  I had wanted to be a medical researcher from the time I was 7-years old, and here I was, unable to take that final step.  The autoimmune diseases that fueled my stubborn desire to succeed were now stopping me from achieving a two-decades-old life goal.  And, yet denial is powerful force: I still blamed my weight; I said that I was inspired by my mom staying home when I was young; I credited a program by the National Institutes for Health (called reentry grants for women) for giving me the option to take a few years off; and I called it “a break”.

My Paleo First Steps

After losing 100 pounds on a low-carb diet (spurred by realizing that I had developed type 2 diabetes when my oldest daughter was one year old, and facilitated by the fact that I wasn’t working), I was frustrated to discover that my life wasn’t magical unicorns and rainbows. In fact, while losing weight reversed my metabolic syndrome and normalized by blood sugar levels, all of my other disease symptoms worsened—my migraines were more frequent, my joint pain was more unrelenting, my asthma and gastrointestinal symptoms required higher doses of medication to manage, my depression was bigger, my anxiety attacks were more frequent, and my skin was a mess!  I had eczema, acne, and my two autoimmune skin conditions—lichen planus and psoriasis—were in full flare.  I had lost most of the weight I needed to lose, but it still felt like I was wearing that failure sign plastered across my forehead.

In the summer of 2011, I was sitting in my second daughter’s bedroom watching her play (she was 1  1/2 years old at the time), wearing long sleeves and pants to hide my skin, the weather in the mid-90s (mid-30s Celsius), hot, miserable and in pain… when I had my epiphany.

The words thin and the words healthy don’t mean the same thing.

I was active, and only 30 pounds from my goal weight, but I wasn’t healthy.  I was missing something.

That’s when I started to think about diet in terms other than what I needed to eat (or not eat) to lose weight. Gazing at my inflamed skin, I remembered a tidbit I had picked up somewhere about eczema being linked to egg allergy; and, I began to wonder if my collection of skin conditions were caused by the food I was eating.  I turned to Dr. Google and found an article on the original version of thepaleodiet.com talking about lichen planus and the Paleo diet; Professor Cordain linked to a few scientific studies at the bottom of that article.  I thought three things:

1. “oh, this is that weirdo diet that Chad is doing” (my friend from undergrad who actually introduced me to my now husband);
2. “there’s no [expletive] way I’m doing this [expletive] crazy diet and cutting out all those foods”; and,
3. “ooh, scientific studies to read!”

The science was my hook. I took the next few months to read as much as I could about the Paleo diet.  I read The Paleo Solution by Robb Wolf and The Paleo Answer by Loren Cordain.  I dove into PubMed and read the studies that Professor Cordain cited.  And, it all started to make sense.  I started to understand lectins and antinutrients.  Despite conducting medical research on the immune system and the gut barrier, all of my research background was either focused on basic science or drug development (as most medical research is).  I needed to teach myself nutritional sciences.   Fortunately, I had experience switching scientific fields, so teaching myself a new branch of science was something I had the skills to do.  Eventually I had learned enough to realize that I had nothing to lose, but I would see Robb Wolf’s “try it for 30 days and see how you look, feel and perform” and raise him another 60 days.  On August 31st, 2011, I dove head-first into Paleo, with an initial commitment of 3 months.

From Paleo to The Paleo Mom

After two weeks of a standard Paleo diet, I was able to discontinue all six prescription medications I was on at the time (medications for asthma, allergies, GERD and IBS).  I haven’t had a migraine since (except for the few times I’ve accidentally consumed dairy).  My IBS and GERD completely disappeared.  My anxiety attacks stopped.  My energy improved. My aches and pains diminished greatly. My asthma no longer required daily medications to control.  My weird allergies (like breaking out into a rash every time I touched cardboard) went away.  My eczema and acne cleared. I started losing weight again despite having been plateaued for months.  And, I became a zealot.  I was all in.  Like, let’s start a blog as an outlet for my enthusiasm level dedicated to the Paleo cause.

I never intended my website to become a career.  As far as I was concerned, my plan was still to return to medical research once my youngest daughter was in school.  I was simply nerding out over the science behind Paleo and enjoyed the exercise of writing about it in my own words—doing so provided me a link to the career I so deeply missed. I decided to transition my husband and kids to Paleo (read more about their stories in About Dr. Sarah’s Family) and I enjoyed sharing that experience with the anonymous internet.  I was having fun experimenting in the kitchen and was proud to share my creations.  ThePaleoMom.com was a great hobby.  And then, it took off.  People love the way I explain complex scientific concepts.  They love my recipes.  My story resonates.  My audience grew, rapidly and completely organically. And, ten short months after I wrote my first blog post, I was offered book deals from two different publishers a week and a half apart from one another.

My AIP First Steps

As magical as those first few months of Paleo were, it wasn’t enough to actually fix everything.  I still had lichen planus lesions and scalp psoriasis.  I was convinced of the role of diet in my health, but I needed to dig deeper.  That’s when I discovered that lichen planus and psoriasis are autoimmune diseases.  Autoimmune.  That word.  Where had I seen it before?  Ah yes, page 201 of The Paleo Solution, a three-quarter-page inset titled “Autoimmune Caveat”.  Robb recommended additionally eliminating eggs, nuts, seeds, tomatoes, potatoes, eggplants and peppers for a month or two for anyone with autoimmune or inflammatory issues (in addition to grains, legumes, dairy and manufactured foods—a typical definition of the Paleo diet in those days was a list of foods to avoid).  In Chapter 9 of The Paleo Answer, Professor Cordain recommends that autoimmune disease sufferers additionally eliminate nightshades, alcohol, NSAIDS, oral contraceptives, and antacids (again in addition to strict avoidance of grains, pseudograins, legumes, and dairy—no 80/20 rule for us autoimmune folks).  I found two websites at the time that combined these two overlapping-but-not-identical lists of foods and that dubbed them “The Autoimmune Protocol”.  I decided I needed to try it, so as a New Year’s resolution for 2012, I eliminated all of the above.

The scientific explanations for these additional eliminations weren’t robust enough to satisfy me (I continue to this day to dislike the typical diet book formula, where the assumption is that the reader doesn’t care about science so all of the scientific evidence is glossed over, oversimplified, and reduced to ridiculous analogies), so I dove into the scientific literature on immune function and the intersection with prolamins, agglutinins, phytates, glycoalkaloids and lysozyme.  Dr. Terry Wahls’ TedxIowaCity talk had just gone viral and I was learning about the roles of vitamins, minerals, amino acids, fatty acids, phytonutrients, and fiber.  I was sold on nutrient density, so I worked on upping my vegetable intake and eating organ meat.  My oldest daughter started sleeping through the night for the first time (at 5 years old!) after we eliminated gluten from her diet, and how much better I felt got me interested in the role of sleep in immune function.  That got me interested in other lifestyle factors.  All of the immunology that I had learned in grad school suddenly became very relevant.  And, already, my website was transitioning from a mommy blog to the comprehensive health education site that it is today.

I felt like I was figuring out what the Autoimmune Protocol even was while I figured out how to implement it—not because there was a need for additional communication (although there was), but because the protocol itself was so rudimentary at the time that it was hard to even apply the term protocol. I researched all of the details, expanding the protocol and writing about each facet as I learned, adding the pillars of nutrient-density, sleep, stress management and activity, and making calls on those gray-area foods for which there was no guidance, solidifying the eliminations.  I was integrating my other knowledge into the protocol, changing its focus from the negative what to avoid, to the positive what to eat, emphasizing lifestyle in addition to diet.  I was developing recipes, trying to figure out how to eat AIP on a tight budget, and trying to understand what was specific to my body versus generally applicable and supported by scientific consensus. I bonded with a small group of other bloggers who were also implementing the AIP for their own health reasons, and who were following along with my research and also refining and writing as they went, and helping to spread the word to their own audiences (Mickey Trescott and Angie Alt of Autoimmune Wellness, Eileen Laird of Phoenix Helix, Christina Feindel of A Clean Plate, and Whitney of Nutrisclerosis). We were the small seed of what is now a vibrant AIP community, and we supported each other in both our health and professional journeys.

Popularizing the AIP

While technically the Autoimmune Protocol predated by entry into the Paleo and AIP communities, I recognize that it would not be what it is today without my research and my writing.  Truly, I was just trying to figure out the missing pieces of my own health, but I intuitively understood that I’m not alone in this struggle, nor am I the only supernerd hungry for the scientific evidence in the world.  As I researched the reasons for each AIP elimination, I started being able to rank their importance, and make judgment calls on the many foods and ingredients for which no prior determination had been made.  And I started to understand the nutritional requirements of the immune system, I integrated a nutrient-density focus to the AIP.  As I took a more holistic approach for my own health, I started to write about how lifestyle factors impact immune function.  I didn’t realize at the time that my research was transforming the Autoimmune Protocol from an obscure fad based on a basic list of eliminations to a valid and comprehensive dietary strategy to support people with autoimmune disease.  I didn’t realize that my core belief in the importance of representing scientific evidence in an unbiased and nuanced way brought scientific validity to the AIP.  And I certainly didn’t realize that, while I was counting down the days until my youngest started kindergarten so I could return to the research lab, that I was actually creating a new career for myself, something much more important.

When deciding between my book deal offers, I was choosing between writing a Paleo desserts cookbook (one specific book deal offer) or a book of my choosing (the other offer).  It was actually a really easy decision!  The world needed a book about the Autoimmune Protocol.  And, I had the glorious opportunity to write a book the way I wanted to, not shying away from science, but instead leaning into it.  I didn’t need to gloss over scientific evidence, nor to condescend to banal analogies to belabor my points; but instead, I could take the time to explain detailed scientific concepts in a way that was approachable and accessible to a general audience.  I could respect my audience, break free of the diet book mold, and create something unique both in format, and I hoped, in usefulness!

It took about 14 months from signing the contract to The Paleo Approach making it onto book shelves. Originally, The Paleo Approach and  The Paleo Approach Cookbook were going to be one book, but my publisher realized when I turned in the first part, that my original plan was too ambitious and the book needed to be divided into two.  Because I worked on both in tandem, they were both published in 2014. It was such an amazing learning experience to write a book, and I loved it (why I continue to write books!), like working on a review article (or seven) but dropping all the pretentious scientific jargon.  I had not only found something that I was uniquely qualified and skilled at, but I also found something fulfilling beyond what I had ever experienced working at the lab bench.

Thanks to referencing over 1200 scientific articles and to my writing style, The Paleo Approach became the definitive guidebook on the Autoimmune Protocol — creating the comprehensive protocol that exists today.  I subsequently wrote two AIP cookbooks, The Paleo Approach Cookbook and The Healing Kitchen (the latter a collaboration with Alaena Haber of GrazeandEnthused.com); collaborated with Mickey Trescott and Angie Alt of AutoimmuneWelness.com to create the AIP Certified Coach practitioner training program; and created the AIP Lecture Series for autoimmune disease sufferers and their caregivers.  My other interests led me to write Paleo Principles (now the definitive Paleo guidebook), The Gut Health Guidebook and The Gut Health Cookbook, and found Nutrivore.com, which will be launching soon.

But it took me years to release an e-book guide on the Autoimmune Protocol, something that, looking back, seems like it should have been an obvious resource for me to have created from the very beginning.  The reason for the delay is wrapped up in my reluctance to take ownership of the AIP (holdovers of having worn that failure sign for so long), and, because my career as an author and health educator is an accidental one, my lack of understanding, until recently, that the most robust online educational medium that I can use to communicate with people is all of them, everywhere, all at once.

Taking Ownership of the AIP

This is the hardest part of my AIP journey for me to write about, and something that I’ve never discussed publicly before.  I was reluctant to be viewed as an, or even the, AIP leader and creator.  I acknowledge that the AIP would not be what it is today without my extensive work, the overly simplistic origins would likely have fizzled into obscurity. I took something that existed only in a very rudimentary form, and through my research and writing, I expanded it, refined it, fine-tuned it, gave it scientific credibility, and popularized it.  But at the same time, like a master baker creating a gorgeous wedding cake using a collection of ingredients that likely came from different sources, I had a starting place, inspiration and mentors, colleagues and likeminded individuals, all in addition to my research skills and my own passion—my own ingredients to use to create something beautiful. And, just like that master baker needs a community to elevate them, so too did I have that community, an amazing group of AIP bloggers to amplify my work so that it could take on a life of its own. This is why I resonate with the term creator, rather than founder or inventor or originator or architect or engineer or developer, because it can encompass both my invaluable work to make the AIP what it is today but also acknowledges the contributions of so many others…. like the master baker could not create her masterpiece without the chocolatier or the florist or the farmer.

Now, the majority of people find the AIP through my work, and the now vibrant community of AIP bloggers who all rallied behind The Paleo Approach as their singular definitive AIP guide.  With the success of The Paleo Approach (it’s a New York Times bestseller), I became the deciding voice on whether or not some ingredient would be considered part of the Autoimmune Protocol or not. I actually always enjoyed this responsibility — for me, it just means spending a few hours searching around PubMed for compelling reasons to include or exclude the food in question based on its impact (or lack thereof) on the immune system, hormones, the gut barrier or the gut microbiome.  That’s fun for me.   Many AIP bloggers then took it upon themselves to police the AIP, calling out any recipe or packaged food labeled as such that included verboten ingredients, to protect everyone following the AIP from erroneous information and potentially problematic foods, maintaining the clarity and integrity of my AIP messaging.  And, this wonderful group of AIP bloggers enhanced the AIP community with their recipes, tips, strategies, and personal stories.

Also, I’m a scientist.  And as such, I believe that knowledge belongs to everyone. The Autoimmune Protocol is based on scientific knowledge, something everyone should have access to.  It felt conceited and power-hungry to view the AIP as my singular responsibility, as my possession.  I’m also terrible at self-promotion, perhaps driven by some lingering impostor syndrome (I can’t express how challenging it is to write about myself and my vulnerabilities like this!).  I’m much more in my element when I’m reading scientific papers, writing or teaching. It’s taken years for my perspective to shift, and not to one where I feel like the AIP belongs to me, but rather I feel like, as the person who created what it is today and best understands all of the science that goes into it, I am best equipped to protect the Autoimmune Protocol.  Not ownership per se, but stewardship. That doesn’t mean keeping the AIP static.  In fact, I strongly believe the AIP needs to adapt and update as new scientific studies that inform various aspects of the AIP are performed and as we start so see the results of AIP clinical trials (see Updates to the Autoimmune Protocol).  But, I want to protect the AIP from commercialization, pyramid schemes of supplements that somehow mean you don’t need to do the hard work, from bastardization, unjustified modification to the point where the therapeutic potential is lost, and from dilution, where the central message behind the AIP is drowned out by a cacophony of unfocused, useless recommendations.

I am indebted to the Autoimmune Protocol for my current good health, for the influence I’ve been able to have on the medical community and the alternative health community, and for my ability to truly make a different in people’s lives.  And, the best way for me to return the favor is to work to maintain the integrity of the AIP, to keep it freely available, to support the AIP’s current transition into the mainstream, and to embrace my role as the world’s leading expert and authority on the Autoimmune Protocol.  It’s not a position I sought,  but it’s one I feel obligated and honored to have.

Part of my transition to feeling comfort in my role as the AIP creator and steward was recognizing the need to enhance my ability to communicate with the hundreds of thousands of people using the Autoimmune Protocol to mitigate their diseases.  That was the major driver behind creating The Autoimmune Protocol e-book.  In one digital resource, I was able to update the Autoimmune Protocol, provide a quick-start for anyone new to the protocol, help everyone well into their AIP journeys hone in on the most important facets of the protocol to get the most out of it, and develop a method to communicate directly with you regarding all things AIP.

In a normal world, I would have written The Autoimmune Protocol e-book long before ever getting a book deal.  The e-book would have gone through iterations, and when I did finally write an in-print book, it would have been based on a refined version of my e-book.  Because my audience grew so quickly out of the gate, I ended up writing The Paleo Approach first.  And then, I was scared that if I released an e-book on the Autoimmune Protocol, that it would cannibalize sales of The Paleo Approach, a terrifying prospect given that I have long relied on book sales to support my website and team. That’s why it took me 5 years to put together The Autoimmune Protocol e-book. I think I needed the experience of creating the AIP Certified Coach practitioner training program and teaching The AIP Lecture Series to realize that my resources layer on top of each other, that each of these ways of learning about the Autoimmune Protocol support each other. The best way that I can increase recognition of the Autoimmune Protocol, to perform my stewardship duties, is to provide as vast a collection of AIP resources, all at different levels of detail, as possible.  And on the bright side, The Autoimmune Protocol e-book is a really darned awesome resource, far better than I could have created five years ago!

The Common Themes of My Journey

Let’s face the bitter truth:  my experiences of facing prejudice and bullying, of not being taken seriously by my doctors, of struggling with symptoms for decades before I knew the name of my autoimmune diseases, of being so defeated by my symptoms that I believed I deserved how I felt. . . those experiences aren’t unique to me. Variations of those experiences are the common theme of life with autoimmune disease.  And it just shouldn’t be that way!  But what’s also amazing is that my experience of feeling so inspired and indebted to the AIP that I committed my life to educating others about it isn’t unique either!  There are so many talented AIP bloggers out there creating AIP resources, recipes, cookbooks, all to help drive this movement forward.  And, each one of them has an inspirational story of healing.  Here are just some of my favorite stories from AIP bloggers:

• Phoenix Helix: My Experience with the Paleo Autoimmune Protocol
• A Squirrel in the Kitchen: Reversing Hashimotos The Story of my Recovery
• Joanna Frankham: Hidradenitis Suppurativa My Story (Video)
• Wellness Unraveled: My Autoimmune Protocol AIP Story
• LissMS: AIP and ME. Why I Started and my First Three Months
• Lichen Paleo, Loving AIP: My Health Journey 
• Real Food and Love: Healing Update (Hopefully the Last?)
• Emotional Autoimmunity: Part 1 – Getting Sick, My Autoimmune Disease Symptoms  & Part 2 – Diagnosis, Cronic Disease and the ‘New Normal’
• The Unskilled Cavewoman: My Health Journey (Podcast)
• Adventures in Partaking: My Story: Endometriosis and Infertility
• Healing Family Eats: Children and the AIP – a Teens Honest Account
• Kirstie Howard Living Well: Hashimotos, AIP & Me!
• Bon AIPpetit: My Autoimmune Story
• Reversing Autoimmune Disease: My Five Year Anniversary on the AIP
• Healthy Fat & Fit: What it’s Really Like to Live with Hypothyroidism
• Real World AIP: My AIP Story- how I put celiac into remission and fixed my leaky gut & brain fog! (Video)
• Cook 2 Nourish: This is my Fight
• Hashimoto-co.de: My experience with the Paleo Autoimmune Protocol (AIP)

I hope that my story and those of the above AIP bloggers inspire you to learn more about the Autoimmune Protocol, dive deeper, and take your next step on your path to health.  So, if you want to learn more about the AIP or share resources with a friend or family member, here’s my suggested order to go through my resources:

1. Read my summary webpage on the Autoimmune Protocol here. (There’s lots of links to specific articles too.)
2. Get my free AIP Quick-Start Guide here.
3. Grab a copy of The Autoimmune Protocol e-book (it’s only $20 and your purchase helps support this website).
4. Read The Paleo Approach. (You can also cook out of The Paleo Approach Cookbook and The Healing Kitchen.)
5. Sign up for the next session of The AIP Lecture Series.
6. If you’re a healthcare professional or wellness provider, check out the AIP Certified Coach practitioner training program.

And please note that any purchase from ThePaleoMom.com helps to support me, my team (without whom I couldn’t do even a fraction of what I do), and the costs of operating this site.  Thank you!

The post My Personal Journey with the Autoimmune Protocol appeared first on The Paleo Mom.

As I discussed in My Personal Journey with the Autoimmune Protocol, my work both popularized the AIP and helped transform it from an obscure fad to a valid dietary strategy to support people with autoimmune disease. My core belief in the importance of representing scientific evidence in an unbiased and nuanced way brought scientific validity to the AIP. I wrote The Paleo Approach (which remains the definitive guide to the AIP), based on collective insight gleaned from over 1200 scientific studies. Since its publication in 2014, hundreds of thousands of people have successfully used the AIP to manage and mitigate their autoimmune diseases.

But the most exciting thing that has been happening is the increase in medical studies that have formally evaluated the benefits of the AIP on serious clinical health conditions.  These studies are building the type of concrete proof that has the capacity to transition the AIP from a complementary approach to first-line course of treatment, advancing the AIP to the mainstream. It is the culmination of nearly a decade of my work in conjunction with the AIP community at large, and something for which I am immensely proud.

Autoimmune Protocol Clinical Trials

Let’s review the clinically-validated benefits of the Autoimmune Protocol (so far)!

Konijeti GG, Kim N, Lewis JD, Groven S, Chandrasekaran A, Grandhe S, Diamant C, Singh E, Oliveira G, Wang X, Molparia B, Torkamani A. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Nov;23(11):2054-2060. doi: 10.1097/MIB.0000000000001221.

This 2017 study evaluated the efficacy of the Autoimmune Protocol for management of inflammatory bowel disease.

Fifteen patients with active inflammatory bowel disease—9 participants with Crohn’s disease and 6 with ulcerative colitis, and 47% of which were on biologics—were placed on the Autoimmune Protocol by transitioning gradually over 6 weeks (using the SAD to AIP in 6 program), followed by 5-weeks maintaining the strict elimination phase of the AIP (see The 3 Phases of the Autoimmune Protocol). Patients were closely monitored and given access to health coaching. They were also given two books The Paleo Approach by Dr. Sarah Ballantyne, PhD and The Autoimmune Wellness Handbook by Mickey Trescott, NTP and Angie Alt, NTC, CHC, as resources for following the protocol. This study evaluated disease markers for IBD including the Harvey-Bradshaw Index (HBI) for those with Crohn’s disease, and Mayo Score for those with Ulcerative Colitis—both of which are pain and symptom scores—as well as endoscopy improvements and laboratory markers.

For patients with ulcerative colitis, the Mayo scores at 0, 6 and 11 weeks were significantly improved from 5.8 to 1.2 to 1.0. And for patients with Crohn’s disease, the mean HBI was improved from 7 to 3.6 and finally to 3.4. The mean fecal calprotectin (a serology marker of inflammation) improved from 471 to 112 at week 11. Endoscopy improvements were also noted in 6 of the 7 participants who completed a follow-up endoscopy at week 11.

Clinical remission was achieved by week 6 in 11 of the 15 (73%) study participants, and all 11 maintained clinical remission throughout the study’s maintenance phase. The authors did not expect to achieve clinical remission so early into the study, and remarked that 6-week remission “rivals that of most drug therapies for IBD.” The authors note that dietary therapy and modifications can be used as an adjunct to current IBD therapies and medical practices in those even with moderate-to-severe disease.

Some limitations of this study include the lack of detailed follow-up with regard to the non-dietary aspects on patient improvement, such as: close follow-up with practitioners, stress, sleep, physical activity, social support etc. Treatment for IBD relies heavily on reducing overall inflammation and isolating the effect of all factors independently was not considered. Nutrient repletion was also utilized for participants with deficiencies in vitamin D and iron, which may have impacted the results for those few patients.

Chandrasekaran A, Molparia B, Akhtar E, Wang X, Lewis JD, Chang JT, Oliveira G, Torkamani A, Konijeti GG. The Autoimmune Protocol Diet Modifies Intestinal RNA Expression in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct;1(3):otz016. doi: 10.1093/crocol/otz016.

This 2019 study evaluated the effect of the AIP diet on gene expression for those with inflammatory bowel disease (IBD), by extending the data analysis from the above-described 2017 trial where 73% of IBD patients achieved clinical remission by 6 weeks on the Autoimmune Protocol.

This data extension included examining changes in mucosal RNA expression from baseline to the end of the study. In this previous cohort, 5 participants had biopsies collected for analysis at both time points (at the baseline and end of diet implementation). There was only 1 patient with Crohn’s disease, therefore the analysis was limited to the 4 patients with ulcerative colitis (UC) only.

The results of the study illustrated that there were 324 significant differentially regulated genes, of which 167 were down regulated—that is they were “turned down”, and 157 genes were up regulated—that is they were “turned up”. The study found beneficial modulation of functional pathways involved in inflammation, DNA repair, metabolic processes, and cellular proliferation.

In particular, the gene expression changes observed are associated with downregulation of inflammatory T-cell-mediated responses, which drive tissue injury in autoimmune disease, so turning down these genes is a great thing! And, there was also concurrent upregulation of regulatory T-cell responses and function, the insufficiency of which is a hallmark of autoimmune disease. Regulatory T-cells are crucial for regulating the adaptive immune system—these cells suppress the activity of immune and inflammatory cells to shut down T-cell-mediated immunity toward the end of an immune reaction. So, turning up these genes is also a great thing!  Other functional pathways that were modulated indicate increased gut mucosal healing (yay!), including protein synthesis, fatty acid synthesis, and DNA repair.

The authors conclude: “Results from this RNA substudy would suggest dietary elimination, along with emphasis on a nutrient-dense diet, has the potential to positively modify inflammation and reduce symptoms in UC.”

Chandrasekaran A, Groven S, Lewis JD, Levy SS, Diamant C, Singh E, Konijeti GG. An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct;1(3):otz019. doi: 10.1093/crocol/otz019.

This 2019 study is another data extension from the same IBD cohort in which the improvement of quality of life (QOL) scores were evaluated for the participants with irritable bowel disease (IBD).

This study also evaluated disease markers for IBD including the Harvey-Bradshaw Index (HBI) for those with Crohn’s disease, and Mayo Score for those with Ulcerative Colitis—both of which are pain and symptom scores—as well as endoscopy improvements and laboratory markers. The participants also completed the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at baseline weeks 3, 6, 9 and 11, which is the most commonly used tool for evaluating the quality of life in patients with IBD. The SIBDQ uses total scores ranging from 10-70 and ≥50 being a good quality of life. Upon completion of the 11-week trial, patients mean Mayo score improved from 5.8 to 1.0 and the HBI improved from 7 to 3.4. Laboratory inflammation markers showed marked improvements, and for those with follow-up endoscopies, there were observed improvements also.

While the SIBDQ survey completion percentage reduced throughout the study, the final analysis revealed that mean scores improved from 46.5 at baseline to 61.5 at week 11. Some limitations of this study were dietary compliance, survey responsiveness, and the effect of health coach interactions on QOL independent from actual clinical improvement. Additionally, the cohort was a relatively small sample size at 15 people, and a control group was not incorporated. This study was intended to act as a pilot study for the potential efficacy of AIP on people with IBD.

The study acknowledges that the AIP has the potential to significantly improve quality of life measurements in patients with IBD, and that larger randomized controlled trials are warranted. I agree!

Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis. Cureus. 2019 Apr 27;11(4):e4556. doi: 10.7759/cureus.4556.

This 2019 study studied 16 middle-aged women diagnosed with Hashimoto’s thyroiditis, and the impact of the Autoimmune Protocol on their symptoms, quality of life survey and serological testing. Currently, there are few, if any, efficacious treatments for Hashimoto’s thyroiditis outside of thyroid hormone replacement.  Similar to the IBD study design, study participants were placed on the Autoimmune Protocol by transitioning gradually over 6 weeks (using the SAD to AIP in 6 program), followed 4-week maintaining the elimination phase of the AIP, and facilitated by health coaches.

Patients experienced a statistically significant improvement in health-related quality of life scores as measured by the 36-Item Short Form Health Survey and Cleveland Clinic Center for Functional Medicine’s Medical Symptoms Questionnaire (MSQ). In fact, the clinical symptom burden, as measured by the MSQ, decreased from an average of 92 at the beginning of the study to 29 after the 10 weeks. There were no statistically significant changes in thyroid function including TSH, free and total T3, and free and total T4, and thyroid antibodies. Inflammation however was significantly decreased by 29%, as measured by C-reactive protein (a measurement of systemic inflammation)!

The study concluded that a diet and lifestyle program facilitated by a multidisciplinary team could significantly improve the health related quality of life and symptom burden of women with Hashimoto’s thyroiditis, and could reduce systemic inflammation and even modulate the immune system (as evidenced by changes in white blood cell counts in the serology of participants).

The authors highlight that “[t]he role of the physician, health coaches, and NTPs, as well as the participants’ communal group environment, cannot be understated and appears to be the primary mediating elements behind the high rate of adherence.”

There are some other AIP studies in the works and I’m excited to share them once they complete the peer-review process and are published!

If you’re looking to deepen your knowledge on the AIP, the AIP Lecture Series is without a doubt my most effective and comprehensive resource for learning about the Autoimmune Protocol, thanks to my careful layering of information with a multimedia approach plus the interactive nature of this online course. I teach every aspect of this course and provide individual support within a private Facebook group, where I connect with every student and answer ever question posed during the session. Of the (many) benefits of this type of intensive educational experience is the opportunity to:

• emphasize the comprehensive and holistic nature of the Autoimmune Protocol;
• maintain a positive focus on what to eat (rather than perseverate on what to eliminate);
• dive into the nitty gritty why’s behind, and scientific evidence for, each facet of the protocol;
• discuss how to troubleshoot and individualize the AIP; and
• address mindset, balance, and sustainability when it comes to utilizing the AIP as a complementary approach to healing.

Over the last 4 years of running my course, I have learned that this deep understanding and learning about the AIP is not only interesting and helpful for students, but it is a keystone to the true empowerment and confidence that transforms autoimmune disease sufferers into disease warriors!!

However, my virtual classroom is far from the only way to learn the ins and outs of the AIP!  You can also do so through self-education (reading my books [especially The Paleo Approach and The Autoimmune Protocol] and/or the vast collection of freely available and up-to-date articles on the AIP on my site, for example), 1-on-1 coaching (like working with an AIP Certified Coach), or group coaching (like SAD to AIP in Six).

Additional Dietary Elimination Protocol Studies – The Wahls Protocol

The Wahls Protocol is the most similar approach to the Autoimmune Protocol out there, and because Dr. Wahls has led the way with her rigorously-designed studies, her protocol is a reliable additional proof of concept that a nutrient-dense diet and healthy lifestyle can improve autoimmune disease.

The Wahls Protocol diet is mainly focused on eating 9 cups of vegetables per day (3 cups each of green veggies, colorful veggies, and sulfur-rich veggies), animal and fish protein while encouraging fish oil consumption, nutritional yeast consumption, kelp and algae consumption, allowed non-dairy milk substitutes, limited non-gluten containing grains, and completely eliminated dairy, gluten, and eggs. The biggest point of differentiation between the Wahls Protocol and the Autoimmune Protocol is the inclusion of nightshade vegetables if tolerated, but also the inclusion of nuts and seeds and limited servings of some other non-AIP foods like quinoa, corn, rice, gluten-free oats, soy, lentils, dried beans, and peanut butter. If you’re familiar with my work, you’ll recognize most of those as early AIP reintroductions. So, while the Wahls Protocol leaves room for self-experimentation and has added the Wahls Paleo and Wahls Paleo Plus levels that have more eliminations, the AIP take the approach of eliminating all of the possible culprits driving inflammation and immune overactivation and then methodically testing individual tolerance through a reintroduction phase. Both diets heavily promote nutrient-density including eating tons of veggies (the AIP does not put a firm serving amount on any food but does suggest aiming for a minimum of 8 to 10 servings per day), organ meat and seafood. Exercise and meditation are also endorsed on the Wahls Protocol, although the lifestyle focus on the Autoimmune Protocol is more rigorous.

With that said, there have been some amazing studies including the Wahls Protocol in recent years and the following section summarizes them as an important inclusion to the healing power of food, and the similar principles of AIP. See also The First Clinical Trial Using a Paleo Diet for Autoimmune Disease.

Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, Darling WG, Hoth KF, Kamholz J, Snetselaar LG. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021 Jul 31;7(3):20552173211035399. doi: 10.1177/20552173211035399.

In this brand-new 2021 study, 77 participants were studied over a 12-week interval and 72 participants were continued onto a 24 week study period to determine the effect of dietary modification on the impact of relapsing-remitting multiple sclerosis (RRMS). Trial participants were randomized into two different dietary protocol groups: the Swank diet or the Wahls Protocol. The Swank diet is a low-saturated fat diet, whereas the Wahls Protocol centers around the Paleolithic elimination diet focusing on high nutrient density and elimination of specific dietary antigens such as gluten, casein and lectins. The Wahls Protocol was randomized with 39 participants completing the primary endpoint, and the Swank diet had a cohort of 38 complete the 12-week duration. The primary evaluation points were to measure the change in perceived fatigue as determined by the Fatigue Severity Scale (FSS). Secondary results evaluated the Modified Fatigue Impact Scale (MFIS), the mental and physical quality of life (MSQoL-54 score) and the 6-minute walking test (6MWT).

The results showed significant mean reductions in FSS from baseline for both diets with the Wahls Protocol outperforming the Swank diet at the final 24-week endpoint. Additionally, both groups saw a reduction in MFIS with the Wahls Protocol group significantly outperforming the Swank diet at all time intervals. The MSQoL-54 measurements revealed the Wahls Protocol participants again achieving clinical significance through both time points and achieving significantly more improvement when compared to scores in the Swank diet group. Additionally, the 6MWT groups in the Wahls Protocol group severely outperformed the Swank diet participants and achieved the mark of clinical significance at the 24-week mark.

The findings of this study illustrate that both diets achieved significant reductions in fatigue and QoL for participants, however the Wahls Protocol was superior in all metrics at the final 24-week endpoint. “In addition, two trials show that dietary modification improves the mass and diversity of the gut microbiota in people with MS. Evidence suggests that people with MS have reduced mass and diversity of their gut microbiota compared to healthy controls, which likely promotes inflammation.”

Chenard CA, Rubenstein LM, Snetselaar LG, Wahls TL. Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern. Nutrients. 2019 Mar 1;11(3):537. doi: 10.3390/nu11030537.

The goal of this 2019 paper was to assess the nutritional content in of the Wahls Protocol in relation to the dietary reference intakes (DRI) of the Dietary Guidelines for Americans (DGA) Healthy US-style Eating Pattern (HEP). Different dietary protocols are often utilized in people with multiple sclerosis (MS), but due to the lacking scientific evidence there is limited guidance for patients on how to improve outcomes outside of medical treatment. The concern is that the Wahls protocol eliminates large food groups, and therefore has the potential to be deficient in nutrients. The analysis also took into account the nutrient composition and inclusion of any dietary supplements recommended on the Wahls protocol. Several iterations of the Walhs protocol were modeled with varying vegetable and fruit consumption amounts, and the subsequent nutrient sufficiency of 17 vitamins and minerals was evaluated.

The study found that the Wahls Protocol was of similar sufficiency as the HEP in all modeled cases, including variations in the serving numbers of fruits and vegetables. While the protocol alone demonstrated a shortfall of vitamin D and magnesium, the supplementation recommended alongside the diet protocol corrected the deficiencies in all cases modeled. However, supplementation did not correct the other shortfall nutrients such as iron and calcium, linoleic acid, choline, dietary fiber, and potassium. Some nutrients that were exceeded on the Wahls protocol include sodium, vitamin K, and saturated fats. Additionally, the high amount of nutritional yeast that is included in the diet results in high levels of B vitamins. Dr Wahls hypothesizes that some of the higher vitamin concentrations are helpful for remyelination (that is the growing of new myelin sheaths around the axons in the central nervous system), thus helping to ‘heal’ the body from the effects of multiple sclerosis. The study culminated in guidance for practitioners to closely monitor in their MS clients who are on the dietary protocol, especially with regard to lipids, vitamin D, bone, vitamin K, and iron status. The study was not able to determine levels of polyphenols, iodine, sulphur compounds, and biotin because data was not available.

Titcomb TJ, Bisht B, Moore DD 3rd, Chhonker YS, Murry DJ, Snetselaar LG, Wahls TL. Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet. Nutrients. 2020 Jun 20;12(6):1844. doi: 10.3390/nu12061844.

Similar to the previous study, the goal of this 2020 paper was to determine the nutrient sufficiency of the Wahls Protocol diet on 19 participants, through means of dietary recall (that is, the participants were tasked with remembering their meals for the study periods), and the diets were analyzed with a nutrition software. Three 24-hour non-consecutive dietary recall entries were taken from each participant and modeled for analysis. Blood markers were collected from the participants both at the baseline and completion of the study period to determine any biomarker changes.

The study concluded that the micronutrients intake from food was sufficient in all clients, except for vitamin D, choline, and calcium. One participant exceeded the upper limit for zinc, one exceeded the limit for vitamin A, and 7 participants (or 37%) exceeded the chronic disease risk reduction (CDRR) limit for sodium. When vitamin intake from additional supplements was included, several individuals exceeded upper limits for magnesium, zinc, sodium, and vitamins A, D, C, B₆, and niacin. “Serum values of vitamins D, B₁₂, K₁, K₂, and folate significantly increased compared to respective baseline values, while homocysteine and magnesium values were significantly lower at 12 months. Calcium and vitamin A serum levels did not change.” The study concluded that the Wahls Protocol, otherwise known as a modified Paleolithic diet, is associated with minimal nutritional risks. However, the use of supplements alongside the dietary modification could result in exceeding upper limits of nutrients, and may be of concern.

Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma β-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr. 2021 Jan;40(1):13-25. doi: 10.1080/07315724.2020.1734988.

In this randomized controlled study, 15 participants with multiple sclerosis (MS) were randomized to 3 groups to determine the effect on fatigue and quality of life:

• modified Paleolithic diet (Paleo group: 6 participants)
• medium-chain triglyceride (MCT)-based ketogenic diet that included coconut as a fat source (Keto group: 5 participants)
• usual diet (Control group: 4 participants)

“Participants had blood drawn every 4 weeks to monitor nutritional ketosis. Participants completed 4-day weighed food records, measures of disability, fatigue, quality of life (QoL), cognitive function, and physical function at baseline and 12-weeks.”

The macronutrient intake and measured blood levels of β-hydroxybutyrate indicated that the Keto group had achieved nutritional ketosis by week 12. Macronutrient intake and blood levels indicated that neither the Paleo group nor the control were in nutritional ketosis at week 12. “The Paleo group had significant within group reductions in fatigue scores and maintained cognitive function scores compared to the Control group. The Keto group had significant reductions in fasting glucose and insulin compared to baseline values; however, no clinical outcomes significantly changed.” The study concluded that while the Keto group was able to obtain nutritional ketosis, it was not associated with significant clinical improvement, whereas the Paleo group experienced significant clinical improvement when compared with both the Keto and the Control groups. The study concludes that larger randomized controlled trials are required to determine the efficacy and safety of the modified Paleolithic diet for patients with MS.

It’s worth noting that I’ve written about the limitations and problems with a ketogenic diet before, so I’m in no way surprised that it was ineffective and comparable to the control group in this study. Read more in How Ketogenic Diet Wreaks Havoc on Your Gut, Adverse Reactions to Ketogenic Diets: Caution Advised, The Case for More Carbs: Insulin’s NonMetabolic Roles in the Human Body and TPV Podcast, Episode 140: The Danger of Ketogenic Diets.

Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017 Jan 4;7:1-18. doi: 10.2147/DNND.S116949.

In this 2017 study, 17 patients were evaluated to determine the dietary effect of the modified Paleolithic dietary intervention (MPDI), for the treatment of fatigue and other clinical symptoms on relapsing-remitting multiple sclerosis (RRMS). The control group was 8 participants including one male, where the intervention group was 9 participants including one male. Study participants in the control were given training on completing food diaries, where the intervention group was trained on filling out a more detailed food log, to properly capture the detail required in the intervention group. The study length was 3-months and measurements were taken at baseline and at 3 months.

“Significant improvements were seen in Fatigue Severity Scale score and also in Multiple Sclerosis Quality of Life-54 and time to complete (dominant hand) 9-Hole Peg Test from baseline in MPDI subjects compared to controls. Increased vitamin K serum levels were also observed in MPDI subjects postprotocol compared to controls.”

The study concluded that modified Paleolithic diet may be useful in the treatment and management of MS, by reducing fatigue scores, increasing quality of life (both mental and physical), increasing exercise capacity, and improving hand and leg function. The results also showed that intervention participants had higher vitamin K serum levels than the control group, which may also reduce inflammation.

In Summary

The benefits of the AIP, and similar dietary approaches such as the Wahls Protocol, are gaining validation both in practice, and in the scientific literature. Those of us with anecdotal experience in the success of AIP for supporting our health goals are relieved, excited and understandably emotional about the validation offered by the scientific community.

I continue to anticipate further randomized controlled studies to further validate the impact of the AIP (there are a couple in the works!), and I look forward to all of the autoimmune disease warriors who will be helped in the future when the AIP becomes standard practice and a recommended adjunct therapy to the current medical interventions and treatment protocols.

Acknowledgements

I would be remiss to not offer my support and a shout-out to Mickey Trescott and Angie Alt of Autoimmune Wellness, whose organization works to provide funding and support of studies relating to the Autoimmune Protocol. Without their passion for AIP and the scientific method, many of these works would not be published today. Also, I must comment on my immense respect to Dr. Terry Wahls and her tireless mission towards providing infallible science to support her fellow MS disease warriors.

The post Autoimmune Protocol Clinical Trials and Studies appeared first on The Paleo Mom.

As I enter my fifth (!) year of teaching this online course, I am resharing my updated AIP do’s and don’ts to communicate the holistic and comprehensive nature of the Autoimmune Protocol, in addition to helping those of you who have opted to learn about the AIP via other means experience some of the same beneficial self-reflection as my students. The AIP Lecture Series is without a doubt my most effective and comprehensive resource for learning about the Autoimmune Protocol, thanks to my careful layering of information with a multimedia approach plus the highly interactive nature of this online course (I answer every single question and follow-up posed during the session, plus engage with every common on every discussion post—in fact, students are consistently amazed by my thoughtful responses and high level of interaction).  However, my virtual classroom is far from the only way to learn the ins and outs of the AIP!  You can also do so through self-education (reading my books [especially The Paleo Approach and The Autoimmune Protocol] and/or the vast collection of freely available and up-to-date articles on the AIP on my site, for example), 1-on-1 coaching (like working with an AIP Certified Coach), or group coaching (like SAD to AIP in Six).

No matter how you’ve chosen to learn about the AIP and the why’s behind each facet of this protocol, as you read through the AIP do’s and don’t’s below, I encourage you to reflect. What are the easiest aspects of the Autoimmune Protocol for you to implement?  What aspects of the Autoimmune Protocol enrich your life and bring you joy (independent of how healthy they are for you)? What are your biggest hurdles to fully implementing and/or sticking with the Autoimmune Protocol? What can you do to overcome these challenges? Thinking about possible upcoming challenges and identifying practical solutions is also a great way to insulate (at least as much as possible) against surprises that might otherwise derail your efforts. And appreciating the positive aspects of implementing the AIP is an great way to overcome mindset challenges.

The 20 AIP Do’s

Let’s start with summarizing the AIP do’s, basically a concise list of the fundamental principles on which the Autoimmune Protocol is built in addition to healthy mindset and practical strategies to set yourself up for success.

1. Eat a variety of nutrient-dense anti-inflammatory foods

Nutrient-density (i.e., Nutrivore) is arguably the most important facet of the Autoimmune Protocol, and indeed any healthy eating plan.  Each biological system in the human body requires a collection of nutrients in order to function properly, including the immune system, which tends to go into overdrive when we’re deficient in key nutrients (like vitamin A, vitamin D and zinc).  In fact, a huge variety of nutritional insufficiencies are linked to increased risk of developing specific autoimmune diseases,  and there are even a handful of studies showing targeted supplementation can decrease disease activity, a reflection on just how important these immune health nutrients are.  Of course, the AIP goes beyond the nutrient requirements of the immune system and endeavors to achieve nutrient sufficiency, meaning that we get all of the essential and non-essential nutrients our bodies need to thrive in adequate and synergistic quantities from food. Note the variety part of this principle too: variety of whole [AIP] foods equates to variety of nutrients. Check out Chapters 8, 9, 10 and 16 in Paleo Principles to see just how different the nutritional content can be of even highly related foods (like kale vs. collards, or even different cuts of beef!). See also the Autoimmune Protocol, The Importance of Nutrient Density, Essential Nutrient Deficiency and Autoimmune Disease, What Is a Nutrivore?, Fructose and Vitamin D Deficiency: The Perfect Storm?, 7 Nutrients You’re Probably Deficient In, 8 Nutrients for Leaky Gut and 5 Nutrients You’re Deficient In… If You Eat Too Much Sugar.

2. Incorporate superfoods like organ meat, shellfish and sea vegetables into your diet

It’s nearly impossible to achieve nutrient sufficiency without incorporating the nutrient superstar foods like organ meat, fish, shellfish and sea vegetables in the diet. Avoidance of organ meat or “weird foods” is one of variations of food phobia that I encounter in people frustrated at lack of results on the AIP, see AIP, Orthorexia and Food Phobia.  The benefits of these nutrient superstar foods are discussed in detail in: Why Everyone Should Be Eating Organ Meat, Why Broth is Awesome, Broth: Hidden Dangers in a Healing Food?, Oysters, Clams, and Mussels, Oh My! Nutrition Powerhouses or Toxic Danger?, Why Seaweed is Amazing! Why Fish is Great for the Gut Microbiome, The Importance of Fish in Our Diets, Why Fish is Great for the Gut Microbiome, The Mercury Content of Seafood: Should we worry?, Should We Be Worried About Radiation from Fukushima?, 3 Painless Ways to “Eat Your Liver”, Why Crickets Are Great for the Gut Microbiome, What The Heck Does Our Liver Do Anyway? Detoxification Explained, The Best Foods and Nutrients to Support Liver Detox, and The Health Benefits of Sea Vegetables.

3. Eat a wide variety of vegetables and fruits, getting at least 8-a-day

I think of Paleo and the Autoimmune Protocol as plant-based diets with two-thirds to three-quarters of every plate covered in fresh vegetables and fruits.  Along with being an incredible source of micronutrients, vegetables supply fiber and phytochemicals that can protect against numerous chronic diseases and improve the composition of the gut microbiome. Aim to eat the rainbow (red radishes, orange carrots, dark leafy greens, purple cabbage, white cauliflower, and so on) to ensure that you receive the full spectrum of what vegetables have to offer. And, don’t be afraid of starchy veggies since these are a concentrated source of many important nutrients and eating root vegetables is associated with gut microbiome and diverse health benefits! This is discussed in more detail in: The Importance of Vegetables, The Amazing World of Plant Phytochemicals: Why a diet rich in veggies is so important!, The Diet We’re Meant to Eat, Part 3: How Much Meat versus Veggies?, The Fiber Manifesto-Part 1 of 5: What Is Fiber and Why Is it Good?, The Fiber Manifesto-Part 2 of 5: The Many Types of Fiber, The Fiber Manifesto-Part 3 of 5: Soluble vs. Insoluble Fiber, The Fiber Manifesto-;Part 4 of 5: Fiber, Cholesterol and Bile Salts, The Fiber Manifesto-Part 5 of 5: Busting the Abrasive Insoluble Fiber Myth, Polyphenols: Magic Bullet or Health Hype?, Elevating Mushrooms to Food Group Status, Why Fruit is a Good Source of Carbohydrates, AIP FAQ: Carbohydrate Intake on the Autoimmune Protocol, Cruciferous Vegetables and Thyroid Disease, What Is the Gut Microbiome? And Why Should We Care About It?, Why Root Veggies Are Great for the Gut Microbiome, The Health Benefits of Root Veggies, The Health Benefits of Winter Squash, The Health Benefits of Cruciferous Vegetables, The Health Benefits of the Parsley Veggie Family, The Health Benefits of Leafy Greens, The Health Benefits of Ginger, The Health Benefits of Tropical Fruits, The Health Benefits of Apples, The Health Benefits of Bananas and Plantains, The Health Benefits of Melons, The Health Benefits of Berries and The Health Benefits of Citrus Fruits. Phew!

4. Have a healthy relationship with food

In the AIP Lecture Series, the first week of the course is dedicated to laying the scientific foundation from which we can readily discuss each facet of the Autoimmune Protocol.  The second week is focused on the tremendous variety of AIP foods to eat and why.  Only after I’ve discussed all the wonderful foods that nourish our bodies that should be on our plates to I discuss elimination.  The reason for this is that I have found that it’s much easier to maintain a healthy relationship with food when we focus on all the delicious healthy foods we do eat, rather than perseverate on the old favorites we’re missing out on.  Eliminations are still important, but it’s not the foods that you cut out of a diet that determine whether or not that diet is healthy, it’s what you actually put in your mouth that counts!  In addition to maintaining this positive mindset when it comes to the AIP diet, it’s important to recognize when we do bring baggage to the AIP (which we all do!) and when that baggage is becoming a problem.  I discussed this in detail in AIP, Orthorexia and Food Phobia.  Also see AIP Mindset: Optimism, Hope and Healing, AIP Mindset: Putting Myself First, AIP Mindset: Cooking is Not a Burden, AIP Mindset: Getting Beyond Feeling Deprived, and Making Healthy Choices: What’s Your Currency?

5. Engage in the local food movement

Food variety, quality and seasonality are important themes in both the Paleo and AIP communities, and I think the best way to achieve these goals is to plug ourselves into our local food movement.  You can do this by shopping at local farmers markets, farm stands, visiting local farms, joining local CSAs, and buying from local independent vendors.  If the highest quality foods aren’t available to you geographically or budgetarily, that isn’t necessarily a barrier to healing on the AIP and it certainly doesn’t mean that you can’t follow the AIP.  This is where having a thorough understanding of the nutritional difference between a high quality and a lower quality version of a food comes in handy.  See also Budget Paleo: Priorities and Strategies, 5 Tips for Eating Paleo On a Budget, Paleo FAQ: “Can I still do Paleo if I can’t afford or source grass-fed beef and organic produce?” , Grass-Fed Beef: A Superfood worth the Premium Price and Olive Oil Redemption: Yes, It’s a Great Cooking Oil!

6. Avoid dietary and environmental toxins

Yes, eliminations are still an important aspect of the AIP (until you’re ready to try reintroductions, of course) and for many people, ditching autoimmune disease triggers and inflammatory stimuli extend beyond their food. Just to get you started (there’s way more detail in both The Paleo Approach and Paleo Principles), check out:  Why Grains Are Bad-Part 1, Lectins and the Gut, Are all lectins bad? (and what are lectins, anyway?), How Gluten (and other Prolamins) Damage the Gut, Worse than Gluten: The Agglutinin Class of Lectins, Why Grains Are Bad-Part 2, Omega 3 vs. 6 Fats, Why Grains Are Bad: Part 3, Nutrient Density and Acidity, How Do Grains, Legumes and Dairy Cause a Leaky Gut? Part 2: Saponins and Protease Inhibitors, What Is A Leaky Gut? (And How Can It Cause So Many Health Issues?), Which comes first: the leaky gut or the dysfunctional immune system?,  Trans Fats: What Are They, and Why Are They Bad?, Saturated Fat: Healthful, Harmful, or Somewhere In Between?, Which Fats Should You Eat?, The Great Dairy Debate, What Are Nightshades?, The WHYs behind the Autoimmune Protocol: Nightshades, The WHYs behind the Autoimmune Protocol: Alcohol, Nuts and the Paleo Diet: Moderation is Key, The WHYs behind the Autoimmune Protocol: Nuts and Seeds, The WHYs behind the Autoimmune Protocol: Eggs, Is It Paleo? Guar Gum, Xanthan Gum and Lecithin, Oh My!, Is It Paleo? Fructose and Fructose-Based Sweeteners (I’m looking at you, Agave!), Is It Paleo? Splenda, Erythritol, Stevia and other low-calorie sweeteners, What’s the Next Superfood Sweetener?, Coffee and Autoimmune Disease, Is Fructose a Key Player in the Rise of Chronic Health Problems?, 4 Ingredients to Avoid in 2018. Phew!

7. Get plenty of quality sleep

Sleep is so important that I wrote an entire online sleep program called Go To Bed!!! Getting adequate sleep—8 to 9 hours every night for most adults—reduces the risk of a number of chronic diseases (including diabetes, heart disease, stroke, obesity, and autoimmune disease), improves vitality and mood, improves athletic performance and work performance, decreases inflammation, regulates the immune system, regulates hunger and metabolism, reduces stress, and gives us energy throughout the day. It can even help us live longer!  You can also read more in Sleep and Disease Risk: Scarier than Zombies!, How Much Sleep Do We Need? Understanding the Hunter-Gatherer Evidence, Sleep Requirements and Debt: How much sleep do you need?, Because Fiber Wasn’t Awesome Enough: New Science Suggests Fiber Improves Sleep Quality!, 10 Tips to Improve Sleep Quality, 5 Ways to Improve Your Bedroom Environment for Sleep, and 4 Biohacks for Better Sleep.

8. Be consistent in your bedtime

Yes, getting sufficient quantity and quality of sleep every single night is super important for immune health, hormonal health, gut health, central nervous system health, cardiovascular health, metabolic health, etc.  But, it’s also important to sleep on a consistent schedule, meaning even us grown-ups need bedtimes!  This data is best understood in the context of insulin and metabolism, see The Link Between Sleep and Your Weight, The Hormones of Fat: Leptin and Insulin, 3 Ways to Regulate Insulin that Have Nothing to Do With Food, The Case for More Carbs: Insulin’s NonMetabolic Roles in the Human Body, The Hormones of Hunger.

9. Live an active lifestyle, but avoid overtraining

Frequent gentle movement (such as walking, yoga, or stretching), as well as some moderate-intensity activity that you find enjoyable and that works with your particular health situation (such as hiking or lifting weights) can decrease your risk of cardiovascular disease, type 2 diabetes, depression, and some cancers (via immune regulation and metabolic health), as well as improve your mood. At the same time, it’s important to avoid over-exercising, which can create a new set of health problems like immune suppression and leaky gut. See The Importance of Exercise, The Benefits of Gentle Movement, Why Exercising Too Much Hurts Your Gut, and What Is A Leaky Gut? (And How Can It Cause So Many Health Issues?).

10. Actively manage stress and incorporate resilience activities into your day

Reducing unnecessary stress in our lives (including saying “no” to optional activities that would drain us, asking for help when we’re feeling overwhelmed, and reevaluating our goals and priorities), as well as taking measures to better handle the stress we can’t avoid (such as through meditating, spending time in nature, walking, and stretching), helps support healthy hormone function, reduces inflammation, improves immunity and sleep quality, and reduces cravings and uninhibited eating behaviors.  Covered under this “do” is addressing mental health challenges (such as addiction or PTSD), HPA axis dysfunction, and other barriers to successful stress management. See also How Stress Undermines Health, How Chronic Stress Leads to Hormone Imbalance, Demystifying Adrenal Fatigue, Pt. 1: What Is Adrenal Fatigue?, Demystifying Adrenal Fatigue, Pt. 2: Testing Adrenal Glandular Function, and Demystifying Adrenal Fatigue, Pt. 3: Nutrition & Lifestyle Support for the Adrenal Glands, The Health Benefits of Nature, AIP Mindset: Optimism, Hope and Healing, TPV Podcast, Episode 319: Abundance Mindset, TWV Podcast Episode 479: Stress, Coffee, Breakfast, and Walking, and TWV Podcast Episode 446: Nutrient Deficiencies Caused by Stress.

11. Actively work to shore up your support network

Social connection provides profound health and longevity benefits, in addition to immune regulatory effects. Even if you’re not close to your family and don’t have a spouse, making an effort to nurture existing relationships or form new ones can go a long way. Even owning a pet has been shown to reduce risk factors for chronic disease and obesity. There’s a practical aspect to connection as well. When we have people in our lives whom we can depend on, we have resources to help us reduce stress and put other priorities, like getting enough physical activity and sleep, at the top of our To Do lists. And having a companion while we tackle the job of healing, whether it’s a walking buddy, a friend to meet up with at the farmers market, someone to watch the kids while we exercise, or a family member to batch cook with on weekends, can make all the difference.  See The Health Benefits of Connection and Chapter 30 in Paleo Principles, as well as TWV Podcast Episode 476: Social Isolation – Can Living Like A Hermit Be Healthy?, TWV Podcast Episode 402: The Benefits of Pets (and Sarah’s getting a puppy!) and TPV Podcast Episode 382: Social Media.

12. Seek balance and sustainability

Sustainability is the ability for something to be maintained at a certain rate or level. This can mean many things, depending on which aspect of the AIP we are talking about (environmental sustainability, economic sustainability, etc.). In the context of implementing the dietary and lifestyle facets of the Autoimmune Protocol, the discussion of sustainability means individual sustainability or, rather, your ability to stick with these changes for the long haul.  This is made easier by the self-discovery aspect of the Autoimmune Protocol, where you’ve gone through reintroductions and have personalized the AIP to meet your individual needs.  But, even before then, it’s important to seek balance.  This means finding that mindset where following the AIP is empowering because you are taking the reigns of your health journey, and the give-and-take choices you make are made with intention and in a fully informed capacity. See also AIP, Orthorexia and Food Phobia,  AIP Mindset: Optimism, Hope and Healing, AIP Mindset: Putting Myself First, AIP Mindset: Cooking is Not a Burden, AIP Mindset: Getting Beyond Feeling Deprived, and Making Healthy Choices: What’s Your Currency?

13. Try some reintroductions

It’s a surprisingly common experience to feel so good on the AIP that a person is afraid to try any reintroductions. But reintroducing eliminated foods is a critical step of your health journey. This is because some eliminated foods (like eggs, nuts, seeds, cocoa, and grass-fed dairy) have some impressive nutritive value and can improve the overall nutrient density of your diet if well tolerated. Plus, the more dietary flexibility you have, the easier life is—you’ll have less difficulty traveling or eating in restaurants or at potlucks, work meetings, or any social situation. The knowledge you glean from reintroductions is empowering. If a reintroduction goes well, you’ve got a new food to add to your diet, increasing the variety of foods you eat. If a reintroduction doesn’t go well, this is still great information! You now better understand the dietary triggers of your disease and which lines you can’t cross. And in the uncommon case where a reintroduction goes very poorly (the fear of which is what stops many people from even trying), remember that the AIP is an entire toolkit for healing. You have the knowledge and skills to recover quickly and get back on your feet. Just go back to 100% AIP, get plenty of sleep and low-strain activity, and stay hydrated until you feel better. See AIP, Orthorexia and Food Phobia, The 3 Phases of the Autoimmune Protocol and The Reintroduction Phase of the AIP.

14. Work with your doctor to refine and troubleshoot

It’s important to emphasize, that while the AIP is the most expedient diet and lifestyle intervention for autoimmune disease, it does not replace the care of your physician and other healthcare professionals. Instead, it should be seen as a complementary approach to healing, used in conjunction with a functional/integrative approach to health which may include judicious and informed use of medications, supplements, alternative therapies and other medical intervention.  The point is to use the best of all worlds to support our healing. Consider working 1-on-1 with an AIP Certified Coach and finding a functional or integrative medicine practitioner.  See AIP, Orthorexia and Food Phobia and TPV Podcast Episode 338: Integrative, Functional or Naturopathic?

15. Put yourself first

Informal surveys indicate that there’s a strong correlation between type A individuals and autoimmune disease, as well as people who find themselves in intense caregiving roles. For those of us who feel a strong sense of responsibility and obligation to our family, friends, communities, employers, volunteer organizations, etc., taking care of everything and everybody else, to the detriment of self, it’s easy to become overtasked, and spread so thin that self-care never makes it on to the To Do list.  Remember that you are much more effective in looking after others and meeting your obligations when you are healthy. It’s important to make sure that those practical things that are important to do for your health make it onto your To Do list (things like grocery shopping, cooking, getting enough sleep, going for a walk in the woods…), which might mean a re-evaluation of all of the items on the To Do list to re-prioritize. See also AIP Mindset: Putting Myself First.

16. Communicate with your loved ones about your needs

One of the best things you can do to successfully navigate the Autoimmune Protocol is to ask for help. This might mean asking your spouse to cook dinner a couple of times a week, or asking your kids to set the table. This might mean asking your neighbor or a friend to watch your kids so you can take a nap or get errands done more efficiently, or asking a family member to pick up your CSA box for you. This might mean inviting a friend over on the weekend during your batch-cooking day; beyond an extra pair of hands in the kitchen, visiting with a friend makes the time spent cooking much more fun. It’s also important to communicate about your emotional needs to friends and family.  Perhaps, it makes you feel frustrated and sad to watch them eat a dessert that contains ingredients you now recognize as trigger foods and it would be easier if they didn’t eat it around you.  Maybe you just need a good listener to talk to about your experiences.  Even if you’re accustomed to being very self-sufficient, it’s important to recognize that your loved ones do want to help and support you.  Tell them exactly what you need so they can be effective!

17. Plan ahead and prepare for the unexpected

The best way to stay on track on the Autoimmune Protocol is to plan ahead. It’s important to know in advance what you’re going to eat on a rushed weeknight, how you’re going to handle getting out the door in a hurry in the morning, and what you’ll do when the rest of your family is enjoying a tempting treat. Planning ahead can be as simple as making a shopping list and sticking to it! Other useful strategies include meal planning, batch cooking, cooking for the freezer, planning meals with lots of leftovers, and preparing ingredients for the week ahead of time (such as chopping up veggies for the week).  Having a special indulgence that is just for you can be the difference between feeling a sense of deprivation that drives you to fall off the wagon and feeling pampered and content (I recommend Sweet Apricity and anything from the ShopAIP sweet treats category!).  See also See also AIP Mindset: Cooking is Not a Burden, AIP Mindset: Getting Beyond Feeling Deprived, and Making Healthy Choices: What’s Your Currency?

18. Have contingency plans so you can stay on track

This is a natural extension of planning ahead, but now you’re going through the mental exercise of finding solutions ahead of time, just in case something goes wrong.  If you’re traveling, think about what you will eat if your flight is delayed, or if you arrive to your hotel in the evening and the grocery store you were going to shop at to stock up on AIP foods is closed.  Call a restaurant before making a reservation to make sure they can accommodate your needs (and have a snack in your purse just in case you get there and they can’t!).  Do you need ready-made meals in your freezer for evenings that you’re too tired to cook.  Do you need an AIP-compliant sweet treat available for when cravings hit to keep you on track (check out Sweet Apricity caramels and the sweet treats category on ShopAIP!).  Do you need to go to your doctor’s appointment armed with information to request a test or supplement, or just talk about the AIP? Do you need to have a conversation with your in-laws about not bringing gluten into your home when they come to visit? The more you can think through potential challenges before you’re faced with them, the less you’ll get sidelined unexpectedly.  If you’re struggling to stay on track, I highly recommend working with an AIP Certified Coach to help identify for stumbling blocks and work around them!

19. Nurture yourself

I separate this “do” from “putting yourself first” because I believe that nurturing yourself is something a little different.  I think of “putting myself first” as making sure that those things that need to get done in a day to support my health get done.  Nurturing myself encompasses those things that go above and beyond the basics.  In some ways, this is the collection of small ways that I demonstrate my love for myself, treat or spoil myself.  This can be as simple as taking time to cuddle up with a good book when I know there are more productive things I could be doing with my time (and not feeling guilty about it!!!!).  Or, it could be a getting a massage, or taking time to do my hair and makeup so that I feel pretty.  I think it’s common among people who have struggled with their health for a long time to have a lot of negative self-talk.  Nurturing yourself is about changing that internal dialogue to self-respect, self-love, and self-care.

20. Be patient – it’s called a healing journey for a reason

How autoimmune disease develops and progresses varies from person to person. Two people may suffer from celiac disease that causes malnutrition, have similar gastrointestinal symptoms, and be dangerously underweight—and to many physicians, it is as simple as diagnosing celiac disease and recommending a gluten-free diet. End of story. However, one of those people may be more deficient in fat-soluble vitamins while the other one is more deficient in magnesium and zinc. These subtleties affect how the body responds to diet and lifestyle changes and how quickly the body heals. The differences among people create a complex set of factors that make each person’s disease so distinctive that it is impossible to predict how long healing will take or how rigidly each person will have to adhere to the AIP for how long before trying reintroductions versus digging deeper with a functional medicine specialist. The good news is that healing is a process, and the vast majority of people will notice improvement in their symptoms long, long, long before the process is complete. As your body heals, it will become easier to identify triggers in your diet and elsewhere in your life. Over time, you will figure out what the most important dietary factors are for you personally—both foods to avoid and foods to prioritize. Over time, lifestyle triggers will also become blatantly obvious, to the point that you will probably be able to predict exactly how you will feel as a result of a night of lost sleep or an additional stressor at work. This understanding of your own body will help you continue to make healthful lifestyle choices to prioritize your health. The self-discovery aspect of the Autoimmune Protocol, discussed in The 3 Phases of the Autoimmune Protocol, will allow you to find what works for you, the lines you can’t cross, and your wiggle room.

The 10 AIP Don’ts

I built this list of AIP don’ts over years of talking with people at live events, interacting on social media, and answering e-mails and podcast questions. It’s a compilation of those most common stumbling blocks that I observe, responsible for people not experiencing the symptom improvement they were hoping for when adopting the AIP. Some of these are opposites of AIP do’s, basically missing some critical facet of the protocol related to diet, lifestyle, refinement, troubleshooting, mindset, or respecting the journey. But, others represent a fundamental misalignment with the foundational principles of the Autoimmune Protocol.  For example, if you aren’t eating nutrient-dense superfoods, you aren’t following the most important facet of the AIP.  I would be hard-pressed to call eating a diet that omitted these nutritionally invaluable foods as one that qualifies as AIP.

1. Developing/ignoring orthorexia or incompatible goals

Orthorexia is an eating disorder characterized by an unhealthy obsession with only eating those foods that are deemed “healthy”.   It doesn’t matter if the foods are actually healthy, but rather that you have labelled them as such, so you can be orthorexic  and vegan, or Paleo, or AIP, or calorie-counting, or low-fat, or keto….  It’s important to seek treatment for orthorexia, which may include relaxing dietary choices until a healthier relationship with food can be established. This is discussed more in AIP, Orthorexia and Food Phobia.

Another aspect of this don’t is focusing on goals that are incompatible with the AIP, for example endurance athlete performance (see Why Exercising Too Much Hurts Your Gut) or weight loss.  In fact, my most recent deep dive into the scientific literature reveals that we actually can be healthy at any size, that science has failed to show that losing weight actually improves health, and that the far more important thing is to improve health-related behaviors, which is what the AIP is all about!  If you’re hoping to lose weight on the AIP, or scared of gaining weight on the AIP, please engage with my detailed resources on weight stigma: Can You Really Be Healthy at Any Size?, TWV Podcast Episode 471: The Harm of Weight Discrimination and Stigma – Part 1 and TWV Podcast Episode 472: The Harm of Weight Discrimination and Stigma – Part 2.

2. Fearing reintroductions

Reintroductions should be considered part of the AIP.  It’s so important, both for self-discovery and diet expansion.  I’ve talked about this in detail above, and in AIP, Orthorexia and Food Phobia, The 3 Phases of the Autoimmune Protocol, and The Reintroduction Phase of the AIP

3. Veggiephobia or other food phobia

A food-phobic implementation of the AIP is problematic from a nutrient-sufficiency standpoint as well as a mental health standpoint. By overly restricting the diet, nutrient variety and synergy is reduced, and nutrient insufficiencies can be worsened.  I’ve discussed this in detail in Veggiephobia: Why limiting your vegetable intake might be slowing down healing and AIP, Orthorexia and Food Phobia. This can also be a result of calorie, carb or fat restriction for weight loss goals. Again, the goal of the AIP is to improve health, and this is not compatible with a primary focus on losing weight (although, if you are overweight, you may lose weight on the AIP, this is because your body is ready to be smaller not because you were trying), see Can You Really Be Healthy at Any Size?, TWV Podcast Episode 471: The Harm of Weight Discrimination and Stigma – Part 1 and TWV Podcast Episode 472: The Harm of Weight Discrimination and Stigma – Part 2.

4. Not eating superfoods

It’s near impossible to achieve nutrient sufficiency without basing your diet on nutrient-dense superfoods, including organ meat, seafood, and vegetables (and rounding out with other healthy choices like fruit, healthy fats, fresh herbs, meat and poultry).  Not to mention restoring adequate levels of any nutrients you might be deficient in before you start the AIP!  Check out all the links in Do’s #2 and #3 above and AIP, Orthorexia and Food Phobia.

5. Not eating enough variety

Stuck in a rut? That’s not cool from a nutrient standpoint! The more we can vary the foods on our plates day to day and season to season, the higher our chances of achieving nutrient sufficiency. Mix up the types of vegetables you eat, look for fun varieties of your staples (like purple carrots or heirloom lettuce), eat meats from different animals, and embrace snout-to-tail ideals. The single best way to ensure that we are getting the nutrition our bodies need is to eat as much variety as possible. This means variety in both the plant foods and the animal foods we are eating.  Check out Chapters 8 thru 16 in Paleo Principles.

6. Ignoring sleep

Not getting enough sleep, by itself, is inflammatory.  And, sleeping in on the weekend is not sufficient to return inflammation levels to normal.  The importance of sleep just can not be understated.  If this is a challenge for you, I highly recommend getting my online sleep program Go To Bed.

7. Ignoring stress

Guilty as charged (see My Personal Battles with Stress) and I know I’m not alone in this one!  I have to be constantly vigilant about my behaviors relating to stress, and while I’ve been more successful at this the last few years, I think managing my stress will be a lifelong endeavor.  Remember that stress and sleep are linked: the best thing you can do to manage stress is get enough sleep and the best thing you can do to support sleep quality is manage stress.  That means that focusing on both together is very helpful!  See Chapters 26 and 27 in Paleo Principles.

8. Avoiding medications, supplements or other medical treatments that are indicated

Autoimmune disease can be challenging to diagnose because it often presents as a collection of vague symptoms (such as fatigue, headaches, and muscle or joint aches). Too often these symptoms are dismissed as signs of getting insufficient sleep, working too hard, stress, being over- or underweight, or age. In fact, a survey performed by AARDA showed that the majority of patients later found to have serious autoimmune conditions had a difficult time obtaining a diagnosis: 45% of them were labeled hypochondriacs in the earliest stages of their illnesses.  So, it’s no wonder that it’s so common for autoimmune disease sufferers who have discovered the therapeutic potential of the Autoimmune Protocol to want to fire their doctors, discontinue every steroid and DMARD and painkiller, and never walk into an exam room again.  But, it’s really (really, really, really) important to be medically supervised as you’re making changes, to always discuss supplements and medications with a qualified health professional, and rather than eschewing all medical intervention, embracing the powerful tools that conventional medicine have to offer us with informed and judicious use of additional treatments and therapies.  Medication is not failure.  Requiring medical intervention doesn’t mean that you didn’t “AIP hard enough”, but it also doesn’t get you off the hook for making all those important healthy choices on a daily basis. And, if you aren’t seeing any improvement within 3 or 4 months on the Elimination Phase of the AIP (and you’re doing everything in this article), then it’s really important to find an advanced practitioner to work with to help identify underlying health challenges that are inhibiting your body from responding to all the good choices you’re making. See TPV Podcast Episode 338: Integrative, Functional or Naturopathic?

9. Giving up too early (or never getting there in the first place)

Sometimes people get stuck in the Elimination Phase of the AIP, but this “don’t” is the opposite of that: giving up too early.  Healing takes time. How long it will take your body to heal enough for you to notice an improvement in the symptoms of your disease depends on a wide variety of factors: how leaky your gut is, how inflamed your body is, exactly what types of antibodies your body is producing, and which cells in your body they are attacking. It depends on how much damage has been done to which tissues and which hormones are dysregulated and to what degree. Just as your genes will predispose you to developing autoimmunity, they also dictate how easy it is for your body to stop producing those antibodies and for your body to heal. It’s quite hard to predict who will experience earth-shatteringly rapid improvement and who will have a long, drawn-out recovery.  Just as it’s important to troubleshoot with a functional medicine specialist when you aren’t seeing results, some patience is also required.  Most of us experience incremental improvement that’s really only impressive when we look back at our healing journeys—not noticing differences day to day, but being able to point to healing month to month. Being patient can be especially challenging if you opt for a step-by-step transition (especially if you’re one of those people who are super sensitive to a food you haven’t eliminated yet), so avoid giving up before you ever even fully transition to the AIP. See Transitions: All In or Baby Steps?

10. Holding yourself to impossible standards

The AIP can be thought of as a collection of best practices when it comes to diet and lifestyle to support healing, not to the exclusion of other treatments and therapies, and respecting bio-individuality via self-discovery. Does that mean we need to do every single thing right every single day in order to be a successful AIPer?  No!  Don’t let perfection be the enemy of the good.  It’s okay to have a give and take, to make compromises, to let things slide from time to time, to make a sub-optimal choice, to stumble, to pick yourself back up again… it’s okay to be human.  Yes, a slip-up can set you back, but if you’ve created a set of expectations for yourself following the AIP that is causing high stress, and especially if it’s causing an on-the-wagon-off-the-wagon cycle, it’s important to re-evaluate, again seeking balance and sustainability.  And here’s where I make one final plug for my AIP Lecture Series because understanding the ins and outs of the AIP is really key to navigating its principles and applying them successfully and efficiently.

Phew! Yes, that’s a lot to think about.  But, on one final note, remember that your AIP learning doesn’t need to happen overnight!  You can continue to learn as you implement.  This week marks 8 years since I launched my website and started my AIP journey (happy blog anniversary to me!).  I’ve learned so much along the way, not just the science, the physiology and biology, but also the intersection with psychology, practical how-to’s, and the importance of a strong knowledge base to make informed decisions.  That’s why I so firmly believe that a thorough understanding of the AIP is key to using it successfully and sustainably, whether that’s through self-education (reading my books and/or the vast collection of articles linked above, for example), 1-on-1 coaching (like working with an AIP Certified Coach), group coaching (like SAD to AIP in Six), or my personal favorite, a virtual classroom like the AIP Lecture Series. However you choose to start your AIP journey, remember it begins with taking that first step.

The post AIP Do’s and Don’ts appeared first on The Paleo Mom.

When it comes to learning about and implementing the AIP, there’s definitely a learning curve.  I liken this to the similar learning we do when we move out on our own for the first time.  No matter how well our parents prepared us for that new independence and responsibility, the reality of having to buy our own groceries on a budget and prepare all of our own meals forces us to develop some skills pretty quickly!  I remember as a young college student running out of money a week before payday and having to stretch $20 worth of cheap bread and peanut butter for every meal that week.  That only happened once, because I budgeted much better the following month!  I also remember eating meals that I had prepared that decidedly did not taste good, because I couldn’t afford to throw out food.  I think there’s no better way to learn to cook than to make mistakes in the kitchen that you’re forced to eat!  In fact, my recipe development skills were borne out of trying to fix cooking mistakes during that period of my life. Fortunately, when it comes to the AIP, we don’t need to completely relearn all these lessons.  Instead, we build on the skills we’ve already developed and only adapt what we already know to a new dietary template.  I can say unequivocally that it was far, far, far easier for me to learn how to buy and cook AIP foods than it to learn how to buy and cook food in the first place.

Once you get through this learning curve and figure out how to fit the AIP to your life, the AIP becomes matter-of-fact: it’s just how we eat.  Getting to “the other side”, where the AIP is as second nature as the standard American diet was before our health journeys began, requires troubleshooting individualized yet common challenges.  We need to figure out: what we’ll eat for breakfast when we accidentally sleep in; what we’ll prepare on those busy weeknights when we get home hangry after work and chauffeuring the kids to their after-school activities; what pre-packaged foods we’ll keep on hand for a quick snack or an indulgent treat; new favorite recipes for quick meals and comfort foods; where we can get quality ingredients near us or a delivery service that provides great bang for our buck.  To help you through this learning curve, I recommend The Autoimmune Protocol e-book, my AIP Lecture Series, and see 3 Time-Saving Strategies for the AIP, AIP Do’s and Don’ts, and Meal Plan with Real Plans!

Once we get through that learning curve, most of us adapt to the AIP and find that any trade-off in convenience is more than made up for in how we feel.  But, I also want to acknowledge the collection of ongoing challenges to implementing the AIP that many people face, and provide you with a collection of strategies to meet those challenges head on.

Making Healthy Choices: What’s Your Currency?

We think that the AIP is only worth pursuing if we complete adhere to it 100% for months on end.  Certainly, doing so is definitely the most expedient way to heal, to enjoy the benefits of the AIP, and get to those life-enhancing reintroductions, but it’s not the only way to go about the AIP. I want to directly address those of you who are hesitant to start the AIP because of that one thing, commonly quality-of-life foods like coffee and chocolate.  And here’s the take-home message: If that one thing is keeping you from diving into the AIP, keep it in your diet and do everything else prescribed on the AIP. If this one compromise is what gets you to take that first step, to make all of the other amazing, positive, healthy choices associated with your diet and lifestyle, then that is your currency. Buy in! Learn how to approach AIP while keeping that one thing in my post Making Healthy Choices: What’s Your Currency?.

Transition: All-In or Baby Steps?

Some people implement lasting change more successfully from a jump-in-with-both-feed approach, while others sustain change better with a gradual step-by-step implementation.  When it comes to the AIP, there are certainly compelling reasons to go with one approach versus the other that might override your natural tendencies.  But all else being equal, I think the first step to a successful transition is understanding ourselves, knowing our personal history and assessing the roadblocks we know could get in our way. Then, we can choose a route based on our desired outcome and timeline.  Learn more in my post Transitions: All In or Baby Steps?

Common AIP Pitfalls

After creating AIP resources for eight years, talking with thousands of people about the AIP, and teaching my AIP Lecture Series, I’ve identified a list of common challenges, mistakes and pitfalls that can hinder healing.  I generally find that a thorough AIP education is the best way to inure ourselves to these pitfalls, which is why I created the AIP Lecture Series in the first place.  But, no matter how you’ve chosen to learn about the AIP and the why’s behind each facet of this protocol, as you read through the AIP do’s and don’ts (linked below), I encourage you to reflect. What are the easiest aspects of the Autoimmune Protocol for you to implement?  What aspects of the Autoimmune Protocol enrich your life and bring you joy (independent of how healthy they are for you)? What are your biggest hurdles to fully implementing and/or sticking with the Autoimmune Protocol? What can you do to overcome these challenges? Thinking about possible upcoming challenges and identifying practical solutions is also a great way to insulate (at least as much as possible) against surprises that might otherwise derail your efforts. And appreciating the positive aspects of implementing the AIP is a great way to overcome mindset challenges. Read about the common AIP pitfalls in my post AIP Do’s and Don’ts. 

Getting Beyond Feeling Deprived

One way to get beyond the feeling of deprivation is to focus on what foods we already love that are easy to make AIP. Yo, steak and bacon are totally AIP! (Here’s a tip: truffle salt makes a rockin’ awesome steak seasoning!)  Love roast chicken?  That’s easy to make AIP!  You can make awesome dinner salads, roast veggies, and root veggie mash all AIP easily!! And fruit is AIP, and sweet potatoes, and plantains, and cassava. And there are tons of great new products out there that fill the void left behind by some eliminated foods. Not to mention all of the amazing recipes available by the community of AIP bloggers out there. When you incorporate more of the foods you already love that are AIP (or easily made AIP with a small adjustment), then it’s harder to miss those foods that no longer make your usual rotation. So yes, the AIP does include restrictions the rest of the world might not follow. It can require diligence and commitment to follow. But it affords us an amazing opportunity to take control of our health, and that’s something I see as a privilege, rather than a burden. I hope you can shift your mindset to see it that way too! Find more way to not feel deprived in my post AIP Mindset: Getting Beyond Feeling Deprived

Cooking is Not a Burden

I know that some of us lack confidence in our cooking skills; cooking can feel stressful and requires more of our attention.  But, we can overcome this feeling of cooking as a burden by thinking about our time investment in the kitchen differently. One mindset shift I’ve seen work time and again is embracing our kitchen as the center of our healing. It’s really the premise behind my second cookbook, The Healing Kitchen. When our pantry and fridge are filled with nutrient-dense, nourishing foods that our bodies are craving, it’s completely within our power to cook amazing meals that quite literally help us heal. That’s pretty cool!  Plus, cooking for ourselves eliminates any stress or negativity that might surround eating out during the elimination phase of the Autoimmune Protocol. When we know each and every ingredient in a given dish, we can be sure we won’t have a negative reaction and can eat without fear of discomfort. Plus, cooking allows us to make just what we and our families like. Seeing the satisfaction on a loved one’s face after you’ve made an amazing meal is a feeling unlike any other! Read more in my post AIP Mindset: Cooking is Not a Burden

Putting ‘YOU’ First

No matter our hang-ups, it comes down to this: we cannot give ourselves fully to others when we are empty. The time you put into your health now will mean a longer, healthier, fuller life. It will mean you have more energy, attention and motivation in all your tasks. It might even change your outlook on life entirely.  Think of your time investment into yourself as filling your car up with gas:  once you’ve got a full tank, you can go farther and do more.  But, you do need to top up your tank from time to time. In the case of self-care, I recommend committing some time every single day for the activities and commitments to yourself that keep you healthy and happy. Give yourself permission to focus on yourself and to put “me time” on your To Do list. When we are tempted to feel “selfish” for taking time to heal and nurture ourselves, we can remember that this time is not just for us, but for the people we love.  By putting ourselves first, we’re investing in their future as well! Find more helpful tips on how to put ‘YOU’ first in my post AIP Mindset: Putting Myself First.

Optimism, Hope, and Healing

I know that when you are facing a chronic illness, hope and optimism can feel elusive.  We can find hope by becoming our own health experts through educating ourselves about our diseases and the details of the AIP.  And, just as we can take control of our diet and lifestyle, we can actively work to cultivate a practice of optimism with the simple tools described in my post, AIP Mindset: Optimism, Hope and Healing. And that’s good news, because cultivating hope and optimism might just be the most important mindset shift of all!

The Baggage We Can Bring to the AIP

I would argue that a food-phobic implementation of the AIP doesn’t qualify as actually following the Autoimmune Protocol.  I’ve talked with people who only eat 12 different foods.  Just because those foods are AIP, doesn’t mean that their diet is (they’re almost certainly missing out on important nutrients with such limited food variety).  I can make a similar argument about avoiding reintroductions (there’s no opportunity for individualization, self-discovery, or nutrient expansion!) and orthorexia (lifelong health requires finding balance and sustainability, not to mention the stress management and mental health sides of this equation). Because the importance of addressing these mindset challenges can be lost in the absence of a thorough AIP education like the AIP Lecture Series, I feel that it’s important to call them out. Read more about food phobia and reintroduction fears in my post, AIP, Orthorexia and Food Phobia. 

The AIP Is a Journey

The AIP can more accurately be described as a sophisticated elimination and challenge diet that embraces self-discovery via its reintroduction phase and respects bioindividuality via its maintenance phase.  In this regard, the AIP is more like a step-by-step plan to help you identify your autoimmune disease triggers, truly understand the diet and lifestyle requirements of your own body, and hone in on a personalized diet and lifestyle plan that is optimal for you as an individual and sustainable for your entire life.  You can think of the Autoimmune Protocol as encompassing three phases: Elimination, Reintroduction, and Maintenance. Discover all 3 phases in my post The 3 Phases of the Autoimmune Protocol.

Set Yourself Up for Success

I firmly believe that a thorough understanding of the ins and outs of the AIP is key to using it successfully, whether that’s through self-education (reading my books and/or the vast collection of articles on the AIP on my site, for example), 1-on-1 coaching (like working with an AIP Certified Coach), group coaching (like SAD to AIP in Six), or a virtual classroom (like the AIP Lecture Series).

The AIP Lecture Series is quite simply my best, most comprehensive and robust resource for the Autoimmune Protocol, whether you’re completely new to this healing template or are an AIP veteran in search for better results.  In this 6-week online course, I provide individualized guidance and support while teaching you the scientific foundation for the diet and lifestyle tenets of the Autoimmune Protocol (AIP), plus providing tons of tips and strategies for implementation, refinement and troubleshooting! The next session starts January 10th, 2022! Learn more here.

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