Autoimmune Paleo Diet: should I try it?

This is a big question and one I get asked often in practice! Before jumping into the answer let’s do a quick review of what it is.

What is the autoimmune paleo diet?

The autoimmune paleo diet (or AIP) was popularized in 2014 by Dr Sarah Ballantyne with her book the “Paleo Approach.” The diet was promoted as a way to reverse and manage autoimmune conditions and relies on the elimination of foods that are thought to “trigger” immune reactions. A strict AIP protocol would eliminate the following:

Grains
Legumes
Nightshades
Dairy
Eggs
Coffee
Alcohol
Nuts and seeds
Refined sugars and oils
NSAIDs (Non steroidal anti inflammatory drugs)
Food additives

This strict elimination is done for 90 days, then foods are reintroduced so that triggers can be identified.

What are the benefits of AIP?

There are two ways of answering this question. Anecdotally, AIP is quite popular in the wellness space. So, on social media or on blogs, the benefits are touted to be reducing inflammation, remission of autoimmune conditions, symptom improvement, and weight loss.

However, from an evidence perspective, AIP is very poorly studied and we have very limited evidence of benefit. There are two studies that have been done. One on Hashimoto’s and the other on Inflammatory Bowel Disease.

The 2019 study on Hashimoto’s showed an improvement on symptoms and quality of life, but did not change any thyroid markers (Abbott 2019). The 2017 study on Inflammatory Bowel Disease, showed remission and improvement in quality of life. However, some study participants were in remission prior to the study and others had started medication previous to the study, so it’s hard to know if it was the diet or the medication (Konijeti 2017).

Both studies suffered from being very small and neither had a control group which makes the results less reliable as randomization didn’t occur.

In short, we’d like to see much more robust data. Bigger population samples and the ability to compare a group who does nothing to one that changes its diet. Also, because of the high level of restriction, it’d be important to monitor people for longer than 12 weeks.

Are there harms to AIP?

I know this sounds like a leading question, but the truth is that the diet is quite restrictive, so we need to consider the potential harm against the potential benefit. There are three main areas to address from a physical health perspective and then one area from a mental health perspective that is important to underscore. Generally, though, extreme elimination diets have the risk of nutritional deficiencies as whole food categories are being avoided.

Bone health:

With the elimination of one of the principal sources of calcium in the diet, dairy, there is cause for concern around bone health and osteoporosis risk. In addition, this diet eliminates nuts, seeds, and legumes which could be additional plant-sources of dairy making it very hard to achieve an adequate daily intake. Also, drug treatment is sometimes necessary in autoimmune conditions to manage a flare or to prevent long term damage. These medications, like steroids for example, affect bone density independently and if you also remove dietary calcium, the harm could be significant.

Gut health and the microbiome

Such an intense elimination really goes against the well established principle around the importance of fiber for gut health and overall health. Legumes, whole grains, nuts and seeds are all significant sources of fiber and part of maintaining a diverse microbiome. With elimination of these broad food categories, it is VERY hard to ensure adequate fiber intake.

Cardiovascular health

Certain autoimmune conditions are also associated with increased cardiovascular risk. In particular, rheumatoid arthritis as well as lupus would fall into this category. The flip side of eliminating major food categories, is also adding in higher amounts of saturated fat like bacon, fatty beef or other animal proteins and high coconut oil. In turn, this can exacerbate any issues around cholesterol and put someone at further risk of cardiovascular events.

Mental Health

We likely don’t talk enough about the cost of restriction. Such an extreme elimination can lead to food phobias or disordered eating behavior. Additionally, if someone already has an eating disorder, this would not be the right approach as it’s going to be inappropriate and harmful. Finally, food and eating are often communal and social events and not only affect one individual eater. Family meals, going out to eat, or being invited to dinner or travel can all but feel impossible on a diet of this style and be quite isolating.

What dietary pattern is best?

If you poke around the site, you’re going to see quite a bit of the Mediterranean diet. What I’d like to add is that diet is about the long game and your whole health goals. Any pattern that is rich in colorful fruits and veggies, low in saturated fat and high in fiber and done for decades is going to confer benefit. We have good evidence on the Mediterranean diet in rheumatoid arthritis, lupus, IBS and IBD. The flavors are less important than the principles and consistency.

And diet is part of a complete plan which looks at your baseline, personal health history, and health goals.

If you’d like to talk about a sustainable and realistic plan tailored for you, schedule a time to chat below and learn about membership. Or join an upcoming cooking class where we cut through the noise and return to good solid nutrition advice and delicious recipes.