Nutrition for Autoimmune Disease
What is the Autoimmune Protocol diet, and is it the best diet for autoimmune disease?
Autoimmune disease can feel like the body is betraying itself. Our immune systems, designed to protect us from dangerous pathogens in the environment, turn on us instead. To makes matters worse, there is little understanding as to why these conditions occur. Some research has suggested that individuals may inherit genes that lay dormant until they are turned on by a stressful event such as certain medications or infections, leading to prolonged immune activation (1). Examples of autoimmune diseases include Hashimoto’s thyroiditis, polycystic ovary syndrome, eosinophilic esophagitis, inflammatory bowel disease, alopecia areata and rheumatoid arthritis.
How does nutrition play a role in autoimmune disease?
Autoimmune diseases are difficult to diagnose, and often are just as difficult to treat. But a lot of buzz has been generated recently about the potential impact of the foods we eat on the prevalence of these conditions. These theories stem from the understanding that the gut is an organ system not only designed for digestion and absorption, but that also plays a role in protecting us from toxic substances by nature of how highly exposed it is to the external environment. Because of this potential exposure to pathogens, 70% of our immune tissue lives in the gut (known as gut associated lymphoid tissue, or GALT). Environmental factors such as food may act as antigens that activate an immune response (2).
Additionally, the intestines are structured to form a physical barrier to any molecules that should stay out of the human body. When that barrier is compromised, pathogens may enter the host and activate an immune response. This is known as leaky gut, and the inflammation it triggers is thought to be linked to autoimmune disease (3).
Considering the large amount of immune activity in the gut, interest in whether certain foods can trigger autoimmune diseases has grown. Which begs the question, is there a best diet for autoimmune disease? To date, the best way to research this would be to cut out any potential trigger foods and watch for changes in symptoms. Unfortunately, these types of elimination diets are incredibly difficult to follow, making them hard to study. Limited research has been published on the autoimmune protocol diet (AIP), yet it is still making waves.
The AIP Diet: What Foods Do I Avoid?
According to the protocol, the AIP diet is a modified paleo diet that removes grains, legumes, nightshades, dairy, eggs, coffee, alcohol, nuts, seeds and refined/ultra-processed sugars, oils and food additives from an individual’s diet. The protocol emphasizes increased consumption of nutrient dense foods, bone broth and fermented foods. The most studied format for the AIP diet follows a 6-week elimination period followed by a 4-week maintenance phase. Ideally, a challenge phase would ensue to figure out exactly which foods trigger the individual’s immune response, so only those specific foods have to be avoided longer term.
Bone broth is recommended while on the AIP diet.
Does the AIP Diet Work? What the Research Says
One study has been published on the effect of the AIP on Hashimoto’s thyroiditis. A small sample of women underwent the AIP diet along with lifestyle change (sleep hygiene, stress management, exercise, etc.) for 10-weeks, with significant support from physicians and nutrition therapists. At the end of the intervention, there was an overall reduction in symptoms and improved quality of life, and blood tests for inflammation showed improvement (4). Though promising, the study had a few key limitations. With such a small sample size, lack of control group and joint effect of dietary and lifestyle changes, it is impossible to say whether the observed effect of the AIP could be attributed to changes in diet alone or if other improved lifestyle habits were responsible. There was also no food re-introduction phase, which would have supplied more insight into which foods are most inflammatory.
The AIP diet has also been studied for irritable bowel disease (IBD). A small sample of participants with active Crohn’s disease or Ulcerative Colitis were enrolled in a 6-week elimination, 5-week maintenance phase study. With support from a health coach and registered dietitian, participants implemented the AIP dietary changes as well as recommended lifestyle changes. 11 out of the 15 participants were in disease remission by week six and remained in remission throughout the maintenance phase (5). Despite this, two participants dropped out of the study due to the adverse effects of the diet on their disease. Like the previous study, these results must be interpreted cautiously due to small sample size, lack of control group and combined effect of diet and lifestyle change.
So, is the AIP the best diet for autoimmune disease?
No other studies were available specific to the AIP diet and autoimmune disease, and limited research has been published on the AIP diet at all. Which means that, unfortunately, more evidence is needed before a definitive judgement can be passed on whether the AIP diet can be beneficial for autoimmune diseases. However, that does not mean that food has no role to play in autoimmune disease. Ensuring that you are eating enough is a crucial part of your care, as many symptoms of undereating are similar to those of many autoimmune conditions, such as fatigue, irritability, anxiety, menstrual irregularity, digestive distress, and hair loss.
If you or your team of medical professionals suspect that an unknown food allergy or intolerance may be at the root of your symptoms, undertaking an elimination diet with proper medical guidance could be helpful. Without that medical support, however, the AIP diet runs the risk of becoming an excessively restrictive diet. Diet culture has a way of co-opting nutrition research indicated for medical conditions and selling them to the otherwise healthy public, often leaving out the crucial food reintroduction phase. This can be very unhealthy, as elimination diets can make it difficult or almost impossible to get certain essential nutrients without supplementation.
All told, the AIP diet requires more extensive and higher quality research before it can become standard practice or dismissed entirely for the treatment of autoimmune diseases.
Want to learn more about how restrictive diets can increase disordered eating? Check out my post on disordered eating in retired athletes.
References:
1. “Autoimmune Diseases | Autoimmune Disease Symptoms.” MedlinePlus, U.S. National Library of Medicine, 25 Mar. 2022, https://medlineplus.gov/autoimmunediseases.html.
2. Valdés-Ramos R, Martínez-Carrillo BE, Aranda-González II, Guadarrama AL, Pardo-Morales RV, Tlatempa P, Jarillo-Luna RA. Diet, exercise and gut mucosal immunity. Proc Nutr Soc. 2010 Nov;69(4):644-50. doi: 10.1017/S0029665110002533. Epub 2010 Sep 22. PMID: 20860856.
3. Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017 May 23;8:598. doi: 10.3389/fimmu.2017.00598. PMID: 28588585; PMCID: PMC5440529.
4. 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. PMID: 31275780; PMCID: PMC6592837.
5. 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. PMID: 28858071; PMCID: PMC5647120.
