The Autoimmune Protocol

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TPA as a bookThe Paleo Approach is now available!   If you want the nitty gritty details (explained in an approachable way!), the diagrams and illustrations, the scientific citations, all of the information in one place, FAQ, information on supplements, help troubleshooting, practical implementation tips,  food lists, it’s all in my book:

Buy Now!

The Paleo Approach Cookbook is also now available! It provides expert tips on how to make the switch to The Paleo Approach easily and economically. It explains how to stay within your food budget, how to make the best use of your time in the kitchen, and where to shop for what you need. Complete food lists, shopping guides, meal plans, and over 200 recipes take the guesswork out of eating to maximize healing.

Note:  I will always keep this cliff notes version of the autoimmune protocol here for free for everyone to see.  That’s right.  I’m not holding this information hostage.  While my book goes into far more detail and explains the detailed WHYs behind these recommendations, you don’ t need to buy it to start making positive changes that can help regulate your immune system and heal your body.

Interested in learning even more about The Paleo Approach? This video from my YouTube Channel is just a quick tour (the book is so big that giving you a broad overview takes 13 minutes!) but you get to see just how comprehensive and detailed this book is.

My original research into the dietary guidelines for those with autoimmune disease started with the recommendations in The Paleo Solution, The Paleo Answer, and various podcast and YouTube interviews with Robb Wolf, Prof. Mat Lalonde and Dr. Terry Wahls (author of Food As Medicine and Minding My Mitochondria). These are all great sources for more information while you wait for my book to be released. However, as I have delved into thousands of scientific studies (1200 of which are referenced in my book) evaluating the roles of nutrients, hormones, and the bacteria in your gut in the development or prevention of autoimmune disease, I have refined these recommendations to reflect my new-found (very thorough) understanding of how the foods we eat interact with our gut barriers and influence our immune systems.

Autoimmune disease is caused by the immune system losing the ability to differentiate proteins belonging to your own body with proteins belonging to a foreign invader (like a bacteria, virus or parasite). What causes symptoms is the build up of damage to cells, tissues and/or organs in the body–damage caused by your own immune system attacking those cells. Which proteins/cells are attacked is what separates once disease from another. In Hashimoto’s Thyroiditis, the thyroid gland is attacked. In Rheumatoid Arthritis, the tissues of your joints are attacked. In psoriasis, proteins within the layers of cells that make up your skin are attacked. However, the root cause is the same.

Genetic predisposition to autoimmunity makes up about one third of your risk of developing an autoimmune disease. The other two thirds of your risk come from environmental factors, which include: diet, lifestyle, infections (both prior and persistent) exposure to toxins, hormones, weight, etc. While you cannot control your genetics or whether or not you had mono as a kid, you do have an immense amount of control over your diet and lifestyle (and the extent that these affect hormones and weight and even toxin exposure). By removing the foods that contribute to a leaky gut, gut dysbiosis (the wrong numbers, relative quantities, or types of microorganisms typically growing in the wrong locations in your gut), hormone imbalance, and that stimulate inflammation and the immune system, you can create the opportunity for your body to heal. By addressing important lifestyle factors and changing your focus to eating nutrient-dense foods that support optimal gut health (and optimal health of your gut microorganisms), that restore levels of important nutrients and provide all of the building blocks that your body needs to heal and properly regulate the immune system, that help resolve inflammation and support organ function, you create an environment in your body conducive to healing.

This is not a cure (once your body learns to attack itself, it can never un-learn this), but you can put your disease into remission, often permanently. Depending on how long you have had your disease and how aggressive it is, there may be permanent damage (which might, for example mean that you need to take organ support supplements such as thyroid hormone in the case of Hashimoto’s thyroiditis for the rest of your life), but you can stop your immune system from attacking your body and heal substantially.

This diet is appropriate for everyone with diagnosed autoimmune disorders or with suspected autoimmune diseases. It is very simply an extremely nutrient-dense diet that is devoid of foods that irritate the gut, cause gut dysbiosis and activate the immune system. You will not be missing out on any nutrients and this diet is absolutely appropriate to follow for the rest of your life. If you have a specific autoimmune disease that causes extra food sensitivities, those should be taken into account with your food choices. Because I get asked this question more than any other question: yes, this diet will help you.

One of the most important contributors to autoimmune disease is nutrient deficiency (which of course, is built right into the Standard American diet, which while being rich in energy is very poor in actual nutrition). Even if you have been following a paleo, primal, GAPS, SCD, or WAPF diet for a while, it is likely that you have not corrected nutrient deficiencies (if you had, you probably wouldn’t be reading this page).

Gut dysbiosis and a leaky gut are believed to be involved in all autoimmune diseases (and are present in every autoimmune disease which has been tested). The presence of gut dysbiosis and a leaky gut are directly related to diet and lifestyle (the foods you eat, the foods you don’t eat, how much sleep you get and how stressed you are). The diet recommendations of The Paleo Approach are all designed to help heal the gut, to restore normal/healthy gut microorganisms, to reduce inflammation and to regulate the immune system both through healing the gut, regulating hormones and addressing micronutrient deficiencies.

My understanding of autoimmune disease goes beyond diet. The Paleo Approach will go into great detail about exactly why prioritizing sleep, managing stress, protecting circadian rhythms, and incorporating plenty of mild to moderately-intense activity (and avoiding strenuous activity) into your day is also exceptionally important. In fact, if you ignore these lifestyle factors, you might completely undermine all of the efforts you are making with your diet.

The first dietary recommendation for those with autoimmune disease is to adhere to a strict paleo diet with no cheating. To be clear, this means: no grains, no legumes, no dairy, no refined sugars, no modern vegetable oils, no processed food chemicals. While other people may be able to enjoy the occasional bowl of rice or corn chips or even ice cream, if you suffer from an autoimmune condition you are not one of these people. Gluten should be banned for life. Grains and legumes should never be consumed. Dairy of any kind (even grass-fed ghee which can still have trace lactose and dairy proteins!) should be avoided initially. This may be true for the rest of your life but some people may be able to reintroduce many foods after their diseases are in remission.

In addition, if you have an autoimmune condition, you should completely avoid:

There are a variety of reasons these are omitted, including: causing gut irritation, causing gut dysbiosis (overgrowths are most common), acting as carrier molecules across the gut barrier, acting as adjuvants (stimulating the immune system), increasing gut permeability, causing inflammation. In addition, you should ensure that your blood sugar levels are well managed (this should happen naturally but for those with a history of diabetes, obesity, and/or metabolic syndrome, using a glucometer may be helpful). This does not mean low carb. It just means not high carb.

There is also some evidence that hormonal birth control can contribute to hunger and digestive hormone dysregulation, leading to inflammation and immune activation.

Perhaps even more importantly than removing foods that negatively impact gut health or stimulate the immune system, is eating a nutrient-dense diet. Micronutrient deficiencies are the strongest diet-related factors contributing to increased risk of autoimmune disease. If you have autoimmune disease, it is highly likely that you are deficient in one or more of: fat soluble vitamins (A,D,E,K), several minerals (zinc, iron, copper, magnesium, selenium, iodine, etc.), B-vitamins, vitamin C, antioxidants and other non-vitamin nutrients (like CoQ10), omega-3 fatty acid (in relation to omega-6 fatty acid intake), certain amino acids (like glycine), and fiber.

So, just as some foods should be eliminated, there is also a focus on eating more of the following:

  • organ meat and offal (aim for 5 times per week, the more the better)–read more here.
  • fish and shellfish (wild is best, but farmed is fine) (aim for at least 3 times per week, the more the better)–read more here and here.
  • vegetables of all kinds, as much variety as possible and the whole rainbow, aim for 8-14 cups per day
    • Green vegetables
    • Colorful vegetables and fruit (red, purple, blue, yellow, orange, white)
    • Cruciferous vegetables (broccoli, cabbage, kale, turnips, arugula, cauliflower, brussels sprouts, watercress, mustard greens, etc.)
    • Sea vegetables (excluding algae like chlorella and spirulina which are immune stimulators)
  • quality meats (grass-fed, pasture-raised, wild as much as possible) (poultry in moderation due to high omega-6 content unless you are eating a ton of fish)
  • quality fats (pasture-raised/grass-fed animal fats [rendered or as part of your meat], fatty fish, olive, avocado, coconut, palm [not palm kernel])
  • fruit (keeping fructose intake between 10g and 20 g daily)
  • probiotic foods (fermented vegetables or fruit, kombucha, water kefir, coconut milk kefir, coconut milk yogurt, supplements)–read about them here and here.
  • glycine-rich foods (anything with connective tissue, joints or skin, organ meat, and bone broth)

You can also improve your intake of important trace minerals by switching to Himalayan Pink Salt or “dirty” sea salt. Other tips like eating locally-grown organic produce can make a big difference (both in terms of micronutrients and in terms of probiotics). It is also very helpful to drink plenty of water between meals and to make sure you are consuming enough food. The body is not very efficient at healing itself when you are running a caloric deficit (you shouldn’t have to gain weight to heal, but losing weight may be a competing goal for now). If you are underweight or worried about losing weight, see this post.

Fruits and vegetables may be consumed raw or cooked. I recommend eating the rainbow and including something green with every meal (or at least most of them) and as much variety as possible. The only fruits or vegetables that are restricted on The Paleo Approach are nightshades and legumes. Dried fruit are high sugar and should be reserved for occasional treats due to their potential impact on blood sugar. All other fruits and vegetables are low or moderate glycemic load (which is more relevant than glycemic index in terms of impact on blood sugar) and the vast majority of people will be able to sufficiently regulate blood sugar levels without limiting or counting fruits or vegetables at all. In fact, eating a large amount of vegetables is really important and I think that there are so many fears about which vegetables might be bad (starchy vegetables for SIBO, FODMAPs, Salicylates, histamines (teaser excerpt from The Paleo Approach on this coming soon), goitrogens, insoluble fiber, high sugar from fruit, etc.) that people under-eat fruits and vegetables to the detriment of their healing. While some of these are certainly worthy areas to explore should you not experience dramatic improvement in 3-4 months, unless you have diagnosed fructose malabsorption or diagnosed histamine or salicylate sensitivity, that isn’t where you should start. Don’t like vegetables? I don’t care. Eat them. Eat liver, fish and oysters too.

Some quick myth-busting and FAQ:

  • Starchy Vegetables (GAPS, SCD): Avoiding starchy vegetables for SIBO has not been validated in the scientific literature (but eating low FODMAP has been proven very effective for people with IBS, IBD and SIBO). Many people do anecdotally find symptom relief from starving overgrowths with these very low carb approaches, but the low carbohydrate/fiber intake can be stressful on the thyroid and cause dysregulated cortisol (and both of those are bad!). The two diet factors that have been shown in the scientific literature to have the most dramatic corrective impact on gut microorganims is high omega-3 fatty acid intake (lots of fish!) and high fiber intake (from vegetables and fruit), both soluble and insoluble. If you do have confirmed SIBO or strong gastrointestinal symptoms, you may want to combine the autoimmune protocol with a low FODMAP approach or you may wish to save low FODMAP for troubleshooting a month or two down the road.
  • Insoluble fiber: While insoluble fiber gets a bad reputation as being an “irritating” fiber, recent studies actually show that higher insoluble fiber intake speeds healing in models of colitis and diverticulitis. Also, the higher the intake of insoluble fiber, the lower the chances someone will have high c-reactive protein (implying that it reduces or prevents inflammation). Soluble fiber reduces the chance of having high c-reactive protein too, but not as much as insoluble fiber. Insoluble fiber also reduces risk of cancer and cardiovascular disease. I can’t find a single scientific journal article that actually shows that insoluble fiber irritates the gut and I have a feeling this is myth. Instead, I can find evidence that it reduces bile acid loss (which ultimately improves digestion), is an essential signal for ghrelin suppression after meals (which has a ton of different important effects in the body), that it improves insulin sensitivity, and helps to remove toxins from the body. I can’t find a single reason why insoluble fiber should be limited. If you have intact pieces of high insoluble fiber vegetables in your stool, add digestive support supplements (especially plant enzymes) and try limiting yourself to cooked vegetables until your digestion improves. For more information, see Part 1, Part 2, Part 3, Part 4 and Part 5 of my Fiber Manifesto series.
  • Goitrogenic vegetables for thyroid disorders: Again, there is no scientific evidence for their exclusion even for those with thyroid disorders. I explain in detail in this post.
  • Fruit: Many people avoid fruit because it is high in sugar. If you have FODMAP-intolerance, you will want to avoid high fructose fruits and everyone will want to keep their fructose intake below 20g per day, but fruit in moderation is endorsed and is actually a great source of vitamins, minerals, fiber and antioxidants. Depending on which fruit you choose, and how you define a serving, you can typically enjoy 2-5 servings of fruit per day and stay below 20g of fructose.
  • Omega-3 intake is very important: Aim for between 1:1 and 1:3 ratio of omega-3 fatty acids to omega-6 fatty acids. If you eat grass-fed, pasture-raised meat, not too much poultry, and some fish, this will be natural. If you eat more conventional meat or more frequent servings of poultry, you will need to increase your intake of oily cold-water fish (like salmon, mackerel, sardines, herring, kipper, anchovies, trout, fresh tuna, and carp). Rendered animal fats used for cooking should always come from grass-fed or pasture-raised animals. Omega-3 fatty acid intake is one of the most important factors for correcting gut dysbiosis. It is better to get your omega-3 fats from fresh fish rather than fish oil. Plants-based omega-3s are predominantly ALA, which is not as usable by your body as the long chain DHA and EPA in fish and pasture-raised/grass-fed meat. Increasing omega-3 fatty acid intake has been shown to dramatically reduce the need for NSAIDs in patients with Rheumatoid Arthritis.
  • Protein is important: You can heal your body by limiting your animal-based foods to fish and shellfish, but you need protein. The protein in fish and shellfish is more digestible than meat (and meat protein is more digestible than any protein from plants), which may be relevant for those with severely damaged guts.
  • Vegetables are important: don’t skimp on the vegetables. If you are a person who has a very hard time eating large servings of vegetables, smoothies or vegetable juices might be consumed in moderation as part of a meal (and not as a meal replacement because chewing is an important signal for digestion). If you have trouble digesting large amounts of vegetables (if you have any gastrointestinal symptoms or can identify intact vegetable particles in your stool), try taking digestive support supplements with your meals and limiting yourself to cooked vegetables initially (plant enzymes are especially helpful for breaking down fiber).
  • Gray Areas: egg yolks, legumes with edible pods (such as green beans and snow peas), walnut oil, macadamia nut oil, grass-fed ghee, and gluten-free alcohol when used in cooking are gray areas. I suggest omitting them in the beginning, but can typically be reintroduced much earlier than other foods. Whole coconut products (coconut butter, coconut cream concentrate, creamed coconut, coconut flakes, coconut chips, fresh coconut) should be consumed in moderation (due to being very high in inulin fiber and moderately high in phytic acid). Coconut milk and coconut cream (not to be confused with creamed coconut or coconut cream concentrate) should be guar-gum free and limited to 1 cup per day. Coconut oil is fine if well-tolerated.
  • FAQ Foods:
    • carob, rooibos tea, black and green tea in moderation, DGL, apple cider vinegar, wine vinegar, balsamic vinegar, coconut water vinegar, coconut water in moderation, vanilla extract (if cooked), pomegranate molasses in moderation, maple syrup and maple sugar very occasionally, honey very occasionally, dried fruit very occasionally, dates and date sugar very occasionally, molasses very occasionally, unrefined cane sugar (sucanat, evaporated cane juice, muscovado, very occasionally, coconut aminos, are okay.
    • algae (chlorella, spirulina), wheat grass (contains wheat germ agglutinin), barley grass, brown rice protein, pea protein, hemp protein, licorice root (except DGL), aloe, slippery elm, chia, flax, lemon balm (tea is probably okay but avoid in supplement form), commercial egg replacers, decaf coffee, herbal sleep aids that contain oat seed, some adaptogenic supplements (ashwagandha is a nightshade), are not okay.
  • Meal FAQ: It is better to eat larger meals spaced farther apart and not snack, unless you have a very damaged gut that can not handle digesting large amounts of food all at once. If you are used to grazing, transition slowly. You should not intermittent fast if you have autoimmune disease. You should not endeavor to be in nutritional ketosis if you have an autoimmune disease (teaser excerpt from The Paleo Approach on this coming soon). You should not eat when under duress. It is better to avoid excessive liquid with your meals, chew your food thoroughly and not rush to the next activity when you eat. You should not eat within 2 hours of bedtime (disrupts sleep). Meals should always include animal foods and plant foods (within the guidelines above), including a quality fat source, and some carbohydrates. There are not firm guidelines for proportion of your meals that are protein, fat and carbohydrate (make sure you get “enough” of each, and then just eat what makes you happy).
  • Useful Supplements:
  • Quality Matters (but it isn’t everything): the better quality food you can source, the better. But if you just can’t afford all grass-fed/pasture-raised meat, wild-caught fish, and organic locally-grown produce, just do the best you can. My post on the importance of grass-fed meat contains some suggestions for incorporating it into your diet in a budget-conscious way. This post ranks different animal proteins to help you prioritize which ones to buy. Whole9Life has a wonderful chart on when fruits and vegetables are in season including which fruits and vegetables are important to buy organic and which aren’t, if budget is an important concern.
  • Your body knows best: If you know that a food that is omitted from The Paleo Approach works very well for you (such as raw grass-fed dairy) or if you know that a food normally recommended on The Paleo Approach does not work well for you (such as coconut oil), then it’s find to modify accordingly. If you aren’t sure or aren’t seeing success, go with the above recommendations. If you find something that truly works for you, whatever it is, stick with it.
  • Reintroductions: Ideally, you should wait until your disease is in full remission before attempting reintroductions (which are discussed in this post). If you are feeling very deprived, you may choose to attempt some reintroductions once you are no longer taking DMARDs or steroids and can see substantial improvement in your disease symptoms. If you do not feel deprived, there is no compelling reason to reintroduce any foods.

Don’t forget the crucial importance of: getting enough sleep (at least 8-10 hours every night), managing stress (mindful meditation is very well studied in the scientific literature and universally shown to be beneficial), protecting circadian rhythms (being outside during the day, being in the dark at night and avoiding bright lights in the evening), nurturing social connection, having fun, making time for hobbies, relaxing, and getting lots of mild to moderately intense activity (while avoiding intense/strenuous activity).

I know from experience that this is a very challenging task. I also know from experience that, in many cases, 90% is not good enough (and the more serious your condition, the more important compliance is until your body has healed). I know from experience that this increases your food budget (although perhaps this can be negated by decreasing your medical expenses). I try to focus on the delicious foods that I do get to eat (yes, there are lots of them!). I try to focus on the fact that I have a strategy for improving my health that is far more powerful than any prescription medication (Note that in many cases you will still need to be on prescription medications, especially those that support organs attacked by your disease, although you may be able to reduce your dose. Please work with your doctor on this one!). And, compliance gets much easier once you start to see improvement (how long this takes will be different for everyone, but typically anywhere from a couple of days to a couple of months). It’s only effort until it’s routine.

Additional Resources

Autoimmune Paleo CookbookWant a great cookbook to help you get started (and while you wait for my cookbook to be released)? The Autoimmune Paleo Cookbook was written by my friend Mickey Trescott.  The print version which was just released contains 150 recipes and the e-book version contains 110 autoimmune protocol-friendly recipes including some wonderful treats (and only 3 or 4 are similar to recipes in the e-book version and about a dozen in the printer version as what will be included in my book, so it’s a great compliment to The Paleo Approach). Read my full review of the e-book version here and see preview recipes here and here.

My friend and functional medicine specialist Anne Angelone has written a set of very handy guides to help you get started, including:

These are great additions to your paleo autoimmune library. And, you can actually get all three and a bunch of other great stuff in Anne’s The Autoimmune Paleo Breakthrough Kit.  This is definitely worth checking out.


Also, my assistant Christina Feindel has released an e-book called 28 Days of AIP which contains a 28-day autoimmune protocol meal plan (including several new, exclusive recipes) to help you get started, stay on track, and illustrate that the AIP is a flavorful diet full of variety. Check it out here.

Another great resource for reintroducing foods into your diet safely is Reintroducing Foods on the Paleo Autoimmune Protocol by Eileen Laird. Eileen walks you through the process of reintroducing foods one at a time and gives you pointers on when to start reintroducing foods, keeping a food journal, and how to know if you have a reaction. She also provides recipes appropriate for various stages of reintroducing! Get the e-book here.

Consulting Services

Finally, if you find yourself needing help and 1-on-1 support throughout this journey, then I encourage you to check out my new consulting company:

Consulting Logo

Whether you are just beginning your wellness journey or are a seasoned traveler on the wellness path, you may find you need help getting started, troubleshooting roadblocks, optimizing health, figuring out which labs to request from your doctor, or just need support during this major life change. Our consultants can help!

When you work with one of our consultants, you can expect:

  • A thorough review of your health history to establish goals while recognizing obstacles.
  • A fully customized plan tailored to meet your individual needs so that you can reach your goals.
  • Expert guidance to help you navigate your unique challenges.
  • Frequent communication to answer your questions, to adapt recommendations, or optimize your approach as needed, and to provide compassion and encouragement.
  • Concrete strategies to help you succeed.
  • Support every step of the way.

Click here and read the consultant bios to find out how you can get a FREE 10-minute informational consult to help you determine the best choice for you.


Legumes are not vegetables…they are seeds. Just like grains, nuts, and seeds if you plant legumes into the ground they grow into a plant…they are all seeds. It’s just that some of these seeds have specific names, while other seeds just get called seeds.

I have heard and read many places that lemon balm extract actually is good for those with autoimmune conditions yet above you say to avoid it and do not provide an explanation. Could you briefly tell me why?

I am also interested in this question. I am growing it in my yard and I have read it is good antiviral. What I have also read is that it can slow the thyroid down if someone has hyperthyroid it can be beneficial, but with hypothyroid the amounts would have to be limited. But I would love to hear your opinion.

Thank you for the information about the connective tissue issue related to Lupus and RA….but what’s interesting is that I have Mitral Valve Prolapse and I think its also related to a connective tissue disorder. My mother has osteoarthritis and Mitral Valve Prolapse.

Are there any books to help with putting an 11 year old boy, with autoimmune disorders yet very active in sports… on the auto-immune diet?

The Autoimmune Paleo cookbook is incredible. My 11-year-old son was recently diagnosed with celiac disease and between the recipes in this book, great nutritional counseling and supplements, he has shown marked improvement in four weeks!

Your site has plenty of educational articles, and I cannot thank you enough for the excellent information you share to enlighten the world on autoimmune diseases. However, would love your insight and guidance for folks that are Vegetarian (no poultry, meat or sea food) by religion or by choice and suffer with SIBO, autoimmune, and histamine intolerance. With a diet devoid of legumes, grains, meat, nightshades, sugar, carbs, nuts, egg whites, What protein sources do you recommend to keep the diet interesting and nourishing?

When my daughter developed allergies to egg, soy, and dairy, we stopped being vegetarian. She later developed allergies to peanut and wheat. Without meat, she would not thrive. With two legume allergies, beans are a poor choice of staple for her, and nuts are also highly allergenic.


I am due to have dental surgery soon – I need to have my wisdom teeth removed. They have not descended and have, instead, grown horizontally under the gum instead of descending vertically. In fact, one of them, has grown into my sinus. Before and after the operation I have been prescribed antibiotics. My dentist said he cannot operate on me unless I take the antibiotic because of the risk of infection – especially because of the removal from the sinus. I have also been prescribed codeine pain relief. Normally, I try to avoid all drugs but in this situation I’m not sure if I can. Do you have suggestions as to how I can best prepare my body/gut for the antibiotics/codeine? There is a likelihood I have MS so I want to be super careful.

Thank you

Sometimes, those medications are the lesser evil. Really sticking to Paleo principles like getting good sleep, eating lots of nutrient-rich veggies, seafood, offal, and bone broth, and managing stress are great ways to prepare your body for that tough time and help it heal faster afterward. – Christina, Sarah’s assistant


I posted this 15 mins ago on your site but don’t think it submitted, so apologies if you receive it twice.

I’ve found your site after looking for ways to use nutrition to improve my health. I have pulmonary sarcoidosis and asthma. Although I have a healthy diet the only other time i’ve ever used nutrition in this way was when I started drinking green smoothies every day a year ago. They have improved my health so significantly that im now excited about how else I can improve my health through what I eat.

I’ve just ordered your book and after reading a lot of info on your website am considering launching in to the Autoimmune diet. Do you advise going straight into this? Do you think it would be okay to continue with green smoothies every day? I usually put in these a lot of different leafy greens, either a banana or avocado and soaked flaxseeds (with the soaking water), should I stop having the flaxseeds on an autoimmune diet?

I’ve never eaten a great deal of meat so am also a bit nervous of introducing so much of it in to my diet, im concerned about how my stomach will handle it all. Do you have any advice about this?

Im also a person with a very high metabolism and am quite slim and high energy, so sometimes I can get shaky and feel weak. I’ve always eaten nuts at these times which make me feel a lot better, do you have an alternative for this solution that you could recommend?

I really appreciate your help with my multitude of questions, sorry there are so many! As im sure you well understand, it can feel quite scary and upsetting trying to understand what the right thing to do is and how dangerous my food choices could be.

Thank you and kind regards

Sarah discusses all of that in more detail in her book, but you can take on the AIP however quickly or slowly you need to to make it sustainable; flax is not AIP; low stomach acid is a common problem for people who do not eat meat, so you may need to start slowly with meat or use supplements to help digest it; high-fat foods like avocado, coconut, and good-quality meats should help stabilize your blood sugar in place of nuts. – Christina, Sarah’s assistant

Thank you so much Christina, I appreciate your help. I’ve attempted to start it but realise I need to ease in to make it sustainable as I just keep ‘failing’ – its quite shocking to realise how many grains and wheats are throughout my everyday diet!

Thanks again

I am trying to heal my damaged intestinal lining and slippery elm, marshmallow root are two of the ingredients in the products. How else other than bone broth and meats and steamed vegetables can I heal my leaky and inflamed gut lining? What does the immune system do when you take these products? Also I have noticed now I am sensitive to organic coconut oil and artichokes. I wonder why? After taking a teaspoon of the coconut oil that helps to keep the bad bacteria and yeasts down, I got really weak…my legs got week…what was this all about? My immune was overloaded? Not sure.
I have been tested for autoimmune disease and they can’t find anything on the blood tests, with the anti DNA test for the double stranded AI Lupus, etc. I don’t have Lyme disease but a leaky gut…I have a chronic fungal infection I can’t seem to get rid of ….why?
Is leaky gut an AI disease in itself?
I was diagnosed with EBV, CFS, and Cytomegalovirus along with Blastocystis Hominis and Candida infection back in 1990=1994 and nothing was really done for me…I was very stressed at that time with work and my marriage (which ended in divorce) I worked in a toxic work environment were my employer laughers at me when I said the darkroom fumes weren’t being vented out of the darkroom. (I had OSHA come in and it was discovered the damper was stuck in place so the fumes couldn’t get out). So the office was fined! The toxicologists that saw me (the one for the Workmans comp side said that the chemicals couldn’t hurt me, but they did…they suppressed my immune system).
I am so sad and depressed with the world and how Ihave been treated my whole life…I pray to God everyday that my pain goes away. My liver is now being affected as when I take B vitamins they feed the fungus…so my liver can’t function because the fungus eats the B vitamins. Last night I awoke at 5 am with terrible pains in the liver from the bile backing up…I have low numbers of Bile acids in my stools also as the fungus is getting stronger from the foods I am eating…I am basically starving…eating only bone broths, meats, eggs and steamed vegetables.
This is my reality….could you please tell me what things would help to heal my gut lining that won’t affect my immune system…I notice when I eat something I am allergic to my heart rate goes up. I have many food allergies and rotate my meats every day….I seem to be getting less reactions too. I take Nystatin, Berberine,…the Nystatin burns in my colon…I have no Lactobacillus in my colon for some odd reason as I eat yogurt…which I chase with a nystatin.
I have a FM doctor that’s trying to help me but I need nutritionist that understands what’s going on with me….do you have someone in mind that could work with my FM doctor?
Thanks a bunch.

The autoimmune protocol as described above is a great place to start for healing leaky gut, which is not an AID, but is present in all AIDs. Sarah has consultants available at to help troubleshoot. – Christina, Sarah’s assistant


I’m reading your book ‘The Paleo Approach’ and I have a question.

On Page 65 in chapter 1 review it says a leaky gut is necessary for an autoimmune disease to develop but on page 53, the last sentence of the 2nd paragraph says ‘a leaky gut is the [LEAST] common denominator among autoimmune diseases.’

That doesn’t really make a lot of sense to me, are those 2 sentences not contradicting each other?


It’s a math metaphor. The least common denominator is the simplified version of fractions. In other words, it’s the common thread connecting autoimmune diseases. – Christina, Sarah’s assistant


Im on the AIP diet and just want to clarify – I’ve read here that its important to cut out all diary, but yoghurt is recommended for its probiotic qualities – is this correct?

Many thanks!

This book seems to focus on healing the gut. However many folks recommendations ignore people’s food intolerances.

Does this book (I did buy it but haven’t looked at it yet) consider how to heal the gut if a person has intolerances to histamines, salicylate, etc?


Thanks for the response. 1 comment on the Kindle Version. The pictures and illustrations need to be improved to be read on a Kindle B&W only version.

Hi, I have just ordered Sarah’s new cookbook, and I am now concerned that the recipes are not AIP, which I am wanting. AIP with no eggs, nuts, some spices…etc. Can you tell me if the recipes are for AIP or Paleo.

ok that’s great. Sarah sometimes uses the microwave, is that a good way to heat food, any damage to the food and me, cheers

Hi there,
First, thank-you for all the time and effort you have put into your website and your books. I am so happy to have found you! Your website has been a blessing to me while on my healing journey and I cannot wait until my copies of your books arrive. Thank-you, thank-you!
I was wondering if it is normal to have an autoimmune flare while following the AIP. I have been following it strictly for 16 days now and after initially feeling an overall improvement, this past week I have been experiencing a very intense (aren’t they all) flare-up. I have mixed connective tissue disease and my pain is bringing me to tears. I’ve also had my butterfly rash for the last week or so as well as several other symptoms – too many to list, but you get the gist. My Naturopath thinks it could be a ‘healing crisis’. Have you heard of this happening to anyone before? I feel so disheartened now (pain does that to you). I am determined to see this through though!

Many people do report getting worse before they get better and 16 days isn’t that long — your body may just need a lot more time to heal. If it keeps happening, it may indicate a need to further troubleshoot for things like infections, hormone imbalances, deficiencies, or additional food sensitivities. – Christina, Sarah’s assistant

Hi Cindy. I experienced something very similar after a couple of weeks on AIP. It got so bad that one morning I woke up with just about every rib and neck vertebrae on my right side out and even taking a breath hurt. I went to a very experienced acupuncturist and she told me that my liver energy was so low that it could not process and eliminate fast enough to keep up with the “cleansing” that was going on. With the very first treatment I noticed a huge improvement, with more during subsequent treatments, I also used Milk Thistle, which I think is not recommended, but I was desperate. It seemed to help also. Don’t know if this is something you would want to try but thought I’d share the one, ok maybe two, things that helped me.

Hi Cindy,

“Don’t let a flare define your world. Having a flare doesn’t mean you’re not healing. When you’re new to a healing diet, it can take time for the flares to go away completely. Mine diminished in number and intensity once I changed the way I ate, but it was almost a year before they were gone for good.”

See more at:

Best wishes on your healing journey,


Hi, I see cookies chocolate chip peanut butter, or date square, or pumpkin cake that I would love to try, but are AIP, with eggs, nuts that has been recommended to avoid . I just want to make some snack food, cheers


I have Hashimoto’s thyroiditis and I’m on my 3rd month of AIP diet. I’m also currently taking Levothyroxine (thyroid medication). But it gives me acne and bloat me a lot – I noticed that because my symptoms improved a lot after I stopped taking it during a week or so.
And then I saw that my medication contains lactose and corn starch, so what should I do ? It’s not very AIP friendly… Is it possible that even such a low dose could harm me ? Should I try to switch to another medication – without those ingredients ?

Thank you for your reply !
I must precise that I live in France so I do not have access to most of allergen-free meds that exist in the USA :/ My doctor prescribed me some liquid T4, but it contains alcohol and hydrogenated castor oil… but it’s the only alternative I have for the moment.
So should I take it instead of Levothyroxine ?

Hi Sarah & Christina

Some of the links for the ‘Useful Supplements’ above no longer work – can you please advise which brands you recommend for L-Glutamine and Vitamin C?


Hello, thank you very much for the tips. I’m lactating, my baby is eight months, I have endometriosis (diagnosed at caesarean section) and I suspect I have keratosis pilaris, I have abdominal pain, constipation and some swelling in the abdomen. I suffered from infertility for many years, to eliminate chemicals, cosmetics, etc. and gluten (though not entirely) I got pregnant. however continue my digestive problems and my baby has atopic and seborrheic dermatitis. I want to be better but I do not know which foods to eliminate, so I want to start and autinmune protocol. It is convenient in lactating? or how could “attach” to this stage diet without milk production, which is now affecting demand.


It’s possible the AIP may affect supply. Many women find that adding in dense sources of carbs like white rice helps, but it’s really a conversation that should be had with your doctor or a lactation specialist. – Christina, Sarah’s assistant

Perhaps raspberry leaf? Not sure if this is okay (imagine it is, raspberries have seeds, but it’s the leaf that helps lactation) Steeped fresh chopped leaves or dried tea, taken without any sweeteners or dairy. It’s nice cold, as well. Works a treat to bring in milk

Has this diet been studied long-term (in the present day)? I am concerned about the cumulative effects on the liver, kidneys, heart, and digestive system from eating so much meat.

For instance, this is some of what I have heard (and believed, for now) about eating meat:

Animal protein is much harder to break down and to use in the body than plant protein, and takes a long time to get through the intestines, causing putrefaction and the release of harmful toxins. Red meat especially has a high uric acid content, hard on the kidneys. Animal protein also requires a ton of insulin during digestion, despite not spiking blood sugar, taxing the pancreas. Unlike carnivorous animals, who have way more hydrochloric stomach acid than humans, we don’t break down meat proteins completely. It can stick around in your colon (causing colon cancer eventually), and line your blood vessels, causing heart disease. (This is the protein, not the animal fat!) No matter how fresh or high-quality the meat, it is still ‘dead’ and decomposing, and the proteins completely coagulate through cooking. The body cannot use coagulated proteins for cell building, they are instead treated as a pathogen in the body, stimulating an immune response which may feel good, i.e., increased energy, but which ends up weakening the body which in turn leads to congestion in the liver and lymph and cardiovascular system.

I am hoping you can prove me wrong on some of this, because I would really like to try the AIP for my Graves’ disease and Graves’ opthalmopathy.

Many people seem to improve their health by going more vegetarian – is it just all to do with autoimmune aspect that makes this a poor choice for us? Lastly, once your gut is healed and your AI condition is in remission, can you try going off the AIP?

Thank you so much, I support what you do, just trying to sort it all out for myself!

Robb Wolf has some excellent posts debunking many of the meat myths: The AIP is intended to be a short-term elimination diet, although what you are able to reintroduce depends on your health. It is nutritionally sound enough for the long-term. Sarah does not endorse a diet free of animal products and encourages consuming as wide a variety as is available to you, though eggs and seafood may be adequate if necessary. – Christina, Sarah’s assistant

Hi there
I’m living in London and I’m wondering if the suplement products are available here as well. Thank you so much for the replay.

I’m the AIP since near 2 months and I’m very happy with the results until now!!! I need more time in order to recover completely but for now the result is being amazing.
Thank you for sharing all the tips and information.


Would you consider Interstitial Lung disease to be an autoimmune disease…I know someone who got it out of the blue. Thank you for your help!

Can you explain what’s the issue with white rice for someone with hashimoto’s? I understand the cross contamination problem but if it says gluten free specifically?

You’ve suggested a supplement in the book [and on the site here], Betaine HCL .

1. I assume we should select one that has Pepsin.
2. You’ve recommended to consult a doctor before supplementation with HCL.

However, there’s a ‘home test’ for low stomach acid that suggest taking Betaine HCL with Pepsin and continue adding a pill [each day] until getting a warm filling in the stomach.

– do you feel this test is a valid one?


I was wondering if lactic acid is okay on the aip diet. I love olives and the ones ive been eating have lactic acid in them. Thanks!

Do symptoms often get worse before they get better? I have done the AIP 2 times, for a month each, but then didn’t transition well out of them for different reasons (vacation, holidays, frustration at feeling worse)…going back to normal paleo too quickly to learn anything. So i’m trying again, this time for the long haul. i’m only 3 weeks in, but as happened last time, my symptoms (20 years undiagnosed of severe weakness often keeping me from walking well or at all, torso contractions, extreme exhaustion and brain fog to the point of mumbling and staring at the ceiling for long periods) are getting worse. And others are cropping up, like joint pain, which I never have. I’m making sure to get enough carbs and fat, and am packing in the nutrition with a Whals 9 cups of goodness a day approach, and doing all the other lifestyle stuff like yoga, sun, good sleep, journaling, serious stress reduction, laughter etc.

Anyone have thoughts on this? On the AIP did any of you get worse before you started stabilizing and then getting better?

I don’t have any problem committing to the program 100%, as long as I don’t think it’s exacerbating my condition for some reason, (though I can’t see why it would be)….. Thoughts?

Thanks everyone! tara

Tara, I felt weaker the first week and developed a itchy rash on the inside of my legs it was the same rash I had when I had the stem cell therapy a few yrs ago. I’m better now and feeling better.

I’m tending toward the Whals plan of 9 cups of veggies per day, however I HAVE to eat some sweet potato or rice pudding every day or I get way too weak and my Hashimotos gets a lot worse.

I literally just wrote the same thing Tara! I also tried to do this last year and had to stop from such a bad flare up it made doing anything impossible. At the time I thought it was my medication change but the medication I am on now is working really well, and I haven’t had a flare up pretty much all winter (unheard of) until now, 3 weeks into the AIP. I’m thinking it might be a “gets worse before it gets better” but I don’t know how long I can continue, because I simply cannot walk when I get a bad flare up in my knees. Hopefully Sarah will be able to shed some light on this.

I recently found your site and THANK YOU SO MUCH! My question is about L-glutamine. How should it be taken to maximize absorption? The L-glutamine I purchased is white glutamine powder in a gelatin capsule (no other ingredients)

Hi Sarah,

I tried doing the AIP last year. I have Rheumatoid Arthritis and I have had it for 9 years. Im 33. Last year I was changing from Enbrel to Infusions as it wasn’t working in one of my knees, and I had such a massive flare up in both my knees I could no longer walk. I only managed to do the diet for a month and put the flare up down to the infusions not working and I have been on Humira ever since. I was also on Methotrexate which they have since taken me off due to my liver having pain and fatty liver and a strange spot, most probably benign. Anyway, I have started the AIP again and have been on it already for 3.5 weeks, I am beginning to get a quite bad flare up in my knees again. I cant help but wonder is this due to the diet? I’m not sure I can go on if it is. Is this a common reaction in the beginning?


Thank you for providing this extremely helpful information!

Are green plantains acceptable on the AIP you recommend?

Thank you,


I am new to AIP. I have mostly been consuming meat and vegetables, with the more starchy vegetables and fruits to a lesser extent. Is there a ratio guideline as to how much meat, vegetables, fruits and starchier vegetables so as to achieve a balance? Thank you for your help.


Thank you for your blog.
I find The Paleo Approach for autoimmune disorders very restrictive and feel discouraged. I have Hashimoto and have the treatment since 2007 or 2008. I take Levothyroxinum and I feel generally ok. It`s true I no longer have the same physical endurance, but I accept it and try to live more zen.
You tend to underline that Hashimoto patients have probably leaky gut. How can I know it?And if I take away eg. nuts from my diet, when will I know if there is improvement?
I don`t feel terribly bad, I don`t feel awesome either….but I`m getting annoyed with food after food being taken away… it doesn`t help to be social nor happy :(

Thank you for your support,

Karolina, Any Holistic/Functional Medicine/Integrative Medicine doctor can order a leaky gut test on you. Then you will find out if you have a leaky gut. You drink Lactulose and it will leak into your kidneys. It can be measured this way.

Hi, three years ago I took amoxilicina (penicillin) for sinusitis and gave me reaction on his face that persists to this day me and no medical solution (purple around the eyes, jaw, forehead, all very swollen face, feel my face heavy an even pressure on the face, my face seems to rot.)’m horrible to 3 years. I sent an email to a girl blog “Autism and Homeopathy” about the case and she told me that the drug had damaged my immune system and ruined my intestinal flora. I 1 month I started this diet as you orient to your blog. More has the following where I work as I do not have to bring food, they give food there is a strange climate refeitório..fica I be the one to bring food, etc. all ask The only problem I think the food is being made with a little soy oil (and sometimes a bit of tomato paste, some sauce … Because the menu is so good sequinho chicken, etc. I ask you the same I in home eating what on your blog and recommend eating there with this small amount of soybean oil, even I do not have an auto immune disease … this small amount of soy or something else will hurt in treating my gut?’m doing food at home with coconut oil, etc. I bought vitamin d3, vitamin c, … I really want to heal me I’m horrible for a long time … I am Brazilian and the translation was done by google (laughs)

Whether or not soy, rice, or other non-Paleo (or Paleo gray area foods) affect you depends on how well you personally tolerate them. Sarah does recommend eliminating them completely initially for the best results. – Christina, Sarah’s assistant

I am polymyositis and crohn’s disease patient for last more than 12 years. I started following Paleo AIP/TPA diet from last three months. Before that for 2 months I was following SCD.

I have lost lots of weight. I was 64 KG (141 pounds) (stable at this for years), but started losing weight after the diet. Today I weigh only 52 KG (114 pounds). My height is 5 feet 8 inch (gender male).
I am strictly following AIP. and most of the dietary suggestion (ofals, meat, fish, lots of green vegies, a fruit a day, etc).

Good news is that my CPK count (blood test) has come down to 1000 (from above 4000).

But I am worried about too much of weight loss. Also there is no change in stool count. Rather this month I am experiencing little bit of watery stool sometimes and also increase in count. (General stool count is 4-5 times, but this week increased to 6-7 times).

Am I doing right thing or doing something wrong? I am from India and cannot consult or meet personally. This is so much expensive diet that I am spending 1/3 of my salary in it just for me.

Please help.

In paleo diet can eat tubers (yams, cassava, sweet potatoes, ..)? I’m with my flora by antibiotics with impaired immune symptoms self in the face.

When you recommend eating organ meat and offal at least 5 times per week, what constitutes a serving? The standard 3 oz? Thanks!

You say to avoid emulsifiers and other food additives. I have seen several AIP recipes that include bacon as an ingredient. Most bacon I have come across, even from pastured pork, includes nitrates, nitrites, cultured celery extract, etc. Are these allowed while following the AIP? Are they not considered food additives?

Is Hemp used in Hemp protein powder considered a nightshade? I’ve been avoiding nightshades but didn’t realize paprika was a concern as well. Thanks!

I think the problem with hemp protein powder, in regards to this diet, is that it is made from seeds…and seeds (except for coconut), for some reason is not allowed on this diet (at least in the initial phase).
I am pretty sure hemp is not in the nightshade family.

I raise chickens in my backyard, they have been soy and corn free as well as all organic and gmo free too. I got these girls before I was put on AIP. I spoke with my ND and she said that they are probably fine for me to continue eating but I wanted to get your opinion as well.

I have high Tryptase levels. How do you adjust the autoimmune Paleo Diet for me? I’m not supposed to eat fresh fruits or vegetables. If I feel I need them I am supposed to cook them first & only eat very small quantities.I am also allergic to seaweed. I have Sjogren’s Syndrome & Celiac Disease. I am already gluten free.

I used antibiotic for a while and developed pseudomembranous colitis. I’ve been doing the paleo diet with resistant starch, take vitamins, most feel that lack a push to improve my flora once. And how long with a paleo diet the gut back to normal?

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