AIP FAQ: “I am confused about fruit on the paleo autoimmune protocol. Could you explain?”

February 4, 2013 in Categories: by

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I am going to be addressing many Frequently Asked Questions about the Autoimmune Protocol in some posts over the next few months.  If you have a question that you think should be answered, use the form on this page to contact me.

I get asked about fruit on the AIP very frequently.  I am intentionally vague with my recommendations for and against fruit in the Autoimmune Protocol because tolerance and need are highly variable.  The short answer is, it’s individual.

I will, of course, be going into extreme detail to answer this question in my book.  However, I feel like this question also needs to be answered here.

There are a couple of factors that are going to determine whether or not fruit is okay or beneficial for you to include in your diet, which fruits and how much fruit.

Many autoimmune diseases are very sensitive to blood sugar changes. This is more likely to be true if you’ve had a history of obesity or metabolic derangement. In that case, limiting to one serving of fruit with each meal seems to work well.  Lower sugar fruits like berries tend to be better for blood sugar regulation.  Berries are also high in several vitamins and antioxidants, which can be very beneficial for resolving inflammation.  Other good low-sugar fruits include grapefruit (one of my personal favorites) and other citrus,  melons (except watermelon), kiwis, apricots, and tart green apples.

For others with better blood sugar regulation, fruit can be an important source of carbohydrates in the absence of starchy vegetables. Because of the high frequency of gut dysbiosis in autoimmune disease, most people with autoimmune diseases need to be very careful about starchy vegetables, at least at first.   But, going too low carbohydrate can also be problematic (increases leptin resistance which stimulates inflammation).  So, increasing fruit intake can be very helpful for anyone who is  underweight to normal weight (and not needing to lose weight) but who also doesn’t tolerate starchy vegetables.  In this case, higher sugar fruits and larger portions are typically well tolerated.  High glucose content fruits will be the most helpful for those who want to gain weight.  These include bananas, grapes, apricots, figs, plums, cherries, and pineapple.  Citrus, berries and melon (except watermelon) also tend to have more glucose than fructose.

Fructose contributes more to inflammation than glucose.  So, keeping portions of very high fructose content fruits on the small and infrequent side is a good idea even for those who don’t have FODMAP sensitivities (they aren’t explicitly banned, but do be aware of how you feel after you eat them).  These include mango, red apples, papaya, and watermelon.  Dried fruits tend to concentrate the sugars so extra caution is required in terms of portion size.

As a quick aside (but seems relevant here), starches are avoided for everyone with overgrowths (bacterial or yeast), which is the majority of those with autoimmune diseases.  But, some people suffer undergrowths in which cases starches are very valuable (starches tend to be high in “prebiotics” which is anything hard for you to digest but easy for your gut bacteria to digest). That mostly applies to people with gut disorders like celiac disease and IBD, but also anyone who has frequent diarrhea as a symptom of their disease.

More information on starches:

More information for anyone who is underweight:

More information about my book:

Comments

For weight loss purposes, which fruits would be most optimal then? I know little to none would be ideal, but if you were to select certain fruits, which would you choose and why?

I would stick with the lower sugar fruits mentioned for those with blood sugar regulation issues. You should still lose weight limiting to 1/2-1 serving of fruit with each meal.

Thank you for this! When you say starches need to be avoided for yeast overgrowth and bacterial infections, are you referring to all starches or more so the ones like sweet potatoes? I have h pylori and yeast overgrowth. Also need to gain weight and I train intensely with weights 4x a week. I’ve been consuming 1/2 a brown banana and butternut squash on these days post workout. I know squash is acceptable for AIP in certain circumstances but should it be a no go for me? Thanks!

I think butternut squash is a good choice. The denser the starch, the more problematic it tends to be. So acorn squash, sweet potatoes, taro, yucca, lotus root, and green plantains are probably the worst (although there is again some variability here).

I wish your book was out now. :)

I am following AI to heal a leaky gut as a result of a yeast overgrowth. I am intolerant to many veggies now, so I am rotating my food. On one week of my three week rotation, I rely heavily on squashes like butternut squash and spaghetti squash and a bit of acorn squash in addition to bok choy and Swiss chard. Is this fine? (My overgrowth was discovered in September, and I haven’t had any carbs except squash and fruit since October, and then only once every three weeks on my rotation.)

Finally, I am confused about seeds. I know for AI you should avoid seeds. Can I still eat kiwi then even though it has seeds?

Thanks!

Butternut and spaghetti are definitely okay. Acorn is a longer starch, so if you feel it works for you, go for it. If you feel a little bloated or gassy, then maybe try pumpkin instead?

So, my rule of thumb with seeds in fruit and vegetables is that if they are big enough that you might break them apart with your teeth, don’t eat them (like maybe cucumber seeds or pomegranate seeds), but if they are small enough to enter your digestive system intact (like berries, bananas, kiwis) then they are typically okay (that being said, they are something to look at if you aren’t seeing improvement on the AIP).

I have two questions:
1. I am confused, dosen’t underfeeding cause leptin levels in the blood to fall? isn’t overflow of leptin the cause of the resistence, among other things?

I have rehumatoid arthritist and gluten sensitivity, I read fasting reduces total systematic inflamation, you mentioned eating organ meats, I have a reaction to organ meats, and any other meat I tried so far, everything from animal

Sugars and fruits also cause inflamation in me. nuts, seeds, root vegetables like sweet potato, potatos and dairy.

Do you have suggestions off other foods I could try? and/or how to be able to eat meat again without causing inflamation?
Thanks.

Leptin sensitivity decreases in response to both overfeeding and underfeeding… one of the reasons it’s so hard to keep weight off when you “go on a diet”. Tricky little hormone. Fasting seems to work better in men than women, but there are some mixed results about how well it works in sick people.

How are you with fish? Is it one specific animal, like beef? Have you tried some meats that you haven’t eaten in a long time (eg bison, goat, lamb)? Have you tried digestive support supplements when you eat meat?

I am bad on fish, not too long ago ate Salamon from norway in the oven, very bad reaction :(
I read all meats have purine and the by product of breaking it down creates uric acid, and on some people can
lead to gout
I don’t know if I have that too, I haven’t tried lamb in a while, but I am so afraid something tells me it won’t go well, I never took any digestive supplements how do these work?

is meat really essential for healing?

Marcelo, have you ever looked into the Gaps Diet? The author says that when you have leaky gut, you can react to any food, which doesn’t mean you are actually intolerant to those foods. It’s just that your body’s digestion has broken down. I have RA as well, and this past spring, I felt like I was reacting to everything and started to fear food altogether. I went on the Gaps Diet, ate the foods allowed (without question) and slowly improved until now I’m 85% better and completely over the crisis level of pain and inflammation. Now, I’m doing the Paleo AI Protocol to test for food intolerances, because my body is calm enough that I can trust its messages. If you want to check it out, here’s the website: http://gapsdiet.com/INTRODUCTION_DIET.html

No No no! I can’t have what he’s saying at all, it paralise me with pain all over my body, I can’t eat/touch any fatty meat or meat at all ( Homemade meat or fish stock. )

Sarah, quick question: what have you heard about citrus? I’ve heard it can be an autoimmune trigger, so I voluntarily removed it for my AI protocol, but I notice you recommend citrus. Is it a very rare intolerance? I’m thinking of having it be one of my first reintroductions, since it’s in season and I miss my lemons and grapefruit!

I haven’t fact checked this, but I’ve heard that something in orange can exaggerate other food sensitivity reactions. I had always heard that this was just oranges though and not other citrus. I mostly eat grapefruit and lemons and seem fine.

Thank you for promoting this post on your Facebook page today… I am very glad to have seen it. I have just come to the conclusion that I likely have a bacterial “undergrowth” and this is the first place I have seen it mentioned as a real thing, so I appreciate the confirmation! After 7 months on a low starch diet for Crohn’s disease without a lot of improvement, I finally abandoned it for AIP and saw immediate improvement when I cut out dairy, legumes, nuts, etc. and then even more improvement when I started eating starchy vegetables again. All this time I thought I had a bacterial overgrowth, but now I’m positive I had it backwards. I’m working on a blog post about it right now that I will post tomorrow at http://www.gutsybynature.com.

I also was surprised by the information about “undergrowth.” I would love more information about this — I’ve done well with potatoes in the past, without the joint pain I typically get with tomatoes, etc., and since I’m not able to gain weight on a strict AIP protocol, I’m thinking maybe I should be eating them again. Where can I learn more about what works for IBD, since it seems to be somewhat different from all the other autoimmunities?

Starches are discussed in the post (read the comments for a mention of IBD). Weight gain on the AIP is discussed here: http://www.thepaleomom.com/2012/11/how-to-gain-or-maintain-weight-on-the-autoimmune-protocol.html Potatoes and other starches were discussed on a recent episode of The Paleo View, you can read show notes/listen to the show here: http://www.thepaleomom.com/2014/02/tpv-podcast-episode-78-domestic-man.html You may want to post your specific question in The Paleo Approach group on Facebook: https://www.facebook.com/groups/TPACommunity/ — Tamar, Sarah’s assistant

I am wondering what Sarah’s opinion is on the opposing theories that fruit should be eaten alone vs with meals. There are those that claim it rots and ferments the other food eaten along with it. Then there are those (like Sarah) that recommend eating fruits with meals better for blood sugar regulation. I have also heard that the rotting theory has no scientific base. I have tried, and been playing around with both. I have noticeably less gas and bloating when I eat my fruit alone, however I just checked my blood sugar shortly after eating a small bowl of fruit salad and it was 127. Is that too high? I have no history of diabetes or anything like that. I am not overnight (well, I think I am but I’m really not :P) I weigh about 157 I’m 5’6″, female, almost 40 (next week!) and exercise regularly. I am also about 1/3 of the way through the paleo approach.

So as to give you a brief history (as I know everyone’s journey is individual) I have been on AIP (strict) for about 6 weeks. I have hashimoto’s, (on low dose armour for hypo) vitiligo, interstitial cystitis (in remission for a few years on it’s own) IBS (chronic constipation) possible celiac (definitely gluten intolerant-been GF for about 18 months, grain free for about 9).

I have noticed some improvement so far, but I am still chronically constipated. I have to consume either magnesium (natural calm) or smooth move every night just to go. I stopped consuming raw veggies and that has helped the digestion some. Should I cook my fruit too? I am only consuming about 2 servings of fruit a day.

I was considering signing up with the consulting service. Should I give it more time first? I’m trying to be patient. I also tried coming off the thyroid meds but immediately noticed going hypo again. I was not ready for that yet! I am still eating smaller meals more frequently as my digestion can’t take large meals. I am also considering starting on some DGL.

Thank you in advance for any and all advice :))

p.s. I forgot to add, I currently take digestive enzyme support, betaine HCl with pepsin and gentian bitters, probiotics, vit d-3, and start every morning out with kombucha and fish oil.

p.p.s. I also take collagen hydrosylate! I usually have a cup of bone broth with the collagen every evening after dinner

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