How to Gain (or Maintain) Weight on The Autoimmune Protocol

November 6, 2012 in Categories: , , by

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The autoimmune protocol is, by default, a fairly low-carbohydrate diet.  This is especially true for those with gastrointestinal symptoms, suspected or confirmed Small Intestinal Bacterial Overgrowth, and/or FODMAP sensitivity because these conditions warrant the elimination of starchy vegetables.  Sugar (even from fruits and starchy vegetables) can be a strong trigger for many with autoimmune disease, so many people find that even fruit can aggravate their symptoms.  This is because sugar itself is inflammatory but also because the insulin secreted to help our bodies use and store that sugar is inflammatory.  The most effective version of the autoimmune protocol for most people is a fairly low carbohydrate implementation (although typically not so low that you are going into ketosis).  This is a fabulous way to lose weight and many overweight people with autoimmune disease see the weight loss that goes with this diet as an added bonus to managing their disease (or maybe a silver lining to living with such a restricted diet).

But what if you don’t have weight to lose?!

An often glossed-over fact is that a large percentage of autoimmune disease patients are underweight (or at least not overweight).  The last thing these people need is to follow a diet conducive to weight loss!  And if you suffer from a disease in which flares mean dramatic weight loss (as is the case with inflammatory bowel diseases but also many other severe autoimmune diseases), then you probably prefer walking around with a little extra weight to help protect yourself from getting too ill should you experience another flare–and the sad truth about autoimmune disease is that even following the AIP is not a guarantee that you will never flare again.  This diet is a management strategy and not a cure.

So, how do you gain weight while following the autoimmune protocol?  The most important thing is to increase overall caloric intake.  So, first and foremost, eat more fat–especially healthy, easy to digest, healing fats.

The best fat sources are:

The fats in coconut and palm are especially easy to digest.  These medium chain triglycerides (MCTs) can be passively absorbed (no digestive enzymes necessary) and used as fuel by your cells without modification.  These MCTs are also antimicrobial, so they are very useful for those with overgrowth of bacteria or yeast in their digestive tracts, and they promote healing.  Saturated fats are not easily oxidized so they supply the body with essential fatty acids without causing inflammation.  The conjugated linoleic acid (CLA) in the fat from grass-fed animals has potent anti-inflammatory properties and can help promote healing.  The omega-3 fats in fish and the fat from grass-fed animals is also critical for reducing inflammation.

Saturated fats are the best for cooking.  This means that good cooking fats are coconut oil, palm oil, palm shortening, tallow, and lard.  Monounsaturated fats are better used raw such as in dressings for salads and steamed vegetables.  Olive or avocado oil makes a great dressing with lemon juice, lime juice, or balsamic vinegar (you can throw some herbs in too if you like).  When mono- and polyunsaturated fats are part of a whole food (as in grass-fed meat, fish, olives and avocado), they are less likely to oxidize with cooking.

In conjunction with eating more fat, it’s important to have enough carbohydrates in your diet for your body to store the fat.  You need some insulin to store fat.  I recommend getting these carbohydrates from higher glucose fruits and from glucose-based starches for those without Small Intestinal Bacterial Overgrowth.

Higher glucose fruits include:

Because you don’t want to overdo the sugar, dose is important here.  Whether your carbs come from fruit or starchy vegetables (see below), aim to consume between 15g and 30g of carbohydrates with each meal (perhaps as much as 45g with a large meal).  This will ensure your blood glucose doesn’t get high enough to cause problems, but that there’s enough insulin to help store fat.  Other lower sugar fruits are just fine too, such as berries, citrus and some melons.  Look for any fruit that is at least half glucose compared to fructose.  If the sugars are more than half fructose, then avoid those fruits (there’s a great table here; look for the fructose number being smaller than or the same as the glucose number).

Lower starch starchy vegetables are often well tolerated.  These include:

  • Winter squash (e.g. butternut, acorn, spaghetti)
  • Onion (FODMAP)
  • Beet (FODMAP)
  • Carrots
  • Rutabaga
  • Jicama
  • Kohlrabi
  • Turnips
  • Pumpkin

If you know from experience that you can handle denser starch starchy vegetables, then by all means go for it.

Don’t forget the protein.  Protein from quality meats and fish is still essential.  You should be aiming to consume anywhere between ½ and 1 gram of protein per pound of your bodyweight per day.  For me, this amounts to at least 6oz of meat or fish with each meal.

For those with difficulty digesting food (basically, if you have any digestive symptoms), cooked vegetables (and even stewed fruits) will be the easiest to digest.  Some people report diarrhea from coconut and palm oils, which may be due to die-off (the excess bacteria in your gut dying).  If you do experience diarrhea from too much fat with each meal, pull back on the dose.  You can add a teaspoon of coconut oil between meals several times a day, which is typically a small enough dose to be well tolerated.  If you digest animals fats better, then it’s perfectly fine to just stick with that.

Other factors that will help with normalizing weight are getting enough rest, managing stress, and making sure you have enough Vitamin D.  Anything you can do to help reduce inflammation and heal the gut will help you absorb more nutrition from your food, regulate hormones, and regulate your weight (basically following the autoimmune protocol is designed to do this).  L-glutamine and zinc can be very useful supplements for those with autoimmune disease to help restore gut barrier function.  Probiotics, either as a supplement or from live fermented foods, can also be beneficial since our gut microflora have an important role to play in our digestion.

I don’t advocate eating more frequently to try to gain weight since there is pretty good evidence that spacing out meals (4-5 hours between them) is better for regulating some hormones that are key in reducing inflammation.  However, a mid-day snack would be appropriate (try to get at least 3 hours between your meal and snack) for those with schedules that would mean that more than 5-6 hours would pass between meals.  Also, while eating shortly before bed can completely undermine one person’s attempt to lose weight, it might be a good tool for those trying to gain weight.  This is because eating carbohydrates (whether on their own or with a meal) can suppress the release of human growth hormone, which is required for the body to convert stored fat into glucose.  If there is less human growth hormone in your system, your body cannot as easily burn fat while you sleep.  There is a balance here because this can also affect sleep quality, which is why people who have difficulty sleeping are advised to not eat for at least 2-3 hours before bed.  If sleep is an issue for you, try to eat around 2 hours before bed, otherwise, you can try as close to bedtime as 1 hour, but watch for signs that your sleep is not as restorative as usual (getting up to pee in the night, remembering many dreams when you wake up, having a harder time getting out of bed in the morning, a crash of energy in the afternoon, feeling moody or feeling like you’re not thinking clearly).

It might take a little self-experimentation to figure out how to eat to achieve a healthy weight while following the autoimmune protocol, but gaining weight is completely achievable.  Remember that slow and steady wins the race and don’t get too frustrated if it takes a few weeks to figure out exactly what is going to work for you.


You are in my heart with this post! I am following paleo diet for 5 months and for 1 month I am on AIP, but cannot control my weight loss. I see huge improvement with my “myasthenia gravis” and I am very determined to continue this diet. It is hard because here I cannot find coconut oil/butter, and the increasing of animal fats in my nutrition is not always a joy for my stomach and gallbladder. I hope to stabilize my weight somehow since I am already thin. I will put your advice into practice and see what happens.

Thank you for addressing the issue of weight loss. It has become a significant challenge for me after going on GAPS 5 months ago.

This post has a lto of great information – Thanks so much. Since coconut is related to nuts (it’s a drupe which almonds are as well), does that mean it is more conducive to the development of intolerance/allergy? I think that is what happened to me from eating it so frequently.

It’s in a very different class from tree nuts since palm trees are more closely related to grass (and are not technically trees), so most people who are intolerant of nuts can eat coconut. However, I hear from A LOT of people who are sensitive to coconut. With a leaky gut, we can pretty much become sensitive to anything, especially things we eat frequently.

My understanding is that coconut is high in amines so if you have an amine sensitivity, they could be causing you problems.

Yes, I have found it to be very difficult. However, it has been effective in improving my gut health and autoimmune conditions.

I can’t even start to tell you how timely this post is. Let’s just say that last night there was an AIP showdown in the house. I’ve become underweight but am determined; my sweet husband is worried for me. Coincidentally my ‘Practical Paleo’ arrived yesterday and I’m just finishing a breakfast recipe from it. It’s my new favourite book and will help me too. I AM going to gain weight, dang it, and your info will help – I’ve searched for months for exactly this. Many sources refer to the weight loss as a bonus. Not for boney ol’ me. Thank you for writing about it!!!!!

Ketogenic diets work in part because there is never enough insulin released to effectively store fat. That’s why it’s important to eat enough protein and some carbs if gaining weight is the goal. But you also need an excess in energy, that’s why you need to eat more fat. It’s a way of efficiently consuming those excess calories without causing inflammation.

You truly are my fairy godmother! When I am going to stop being surprised that you post the very information I need.

My naturopath is pleased with my diet and said that it is an efficient way for the body to operate. But he is concerned because I can tolerate so few starchy vegetables and told me not to lose any more weight.

I increased my daily protein consumption to about 1 gm per pound of body weight, but the weight keeps dropping off. I have wanted to question you about it but it seemed insensitive to complain about weight loss when so many of your readers/listeners say they are overweight and struggle to lose even a few pounds. But when I got on the scale today, I knew it was time to do something. I was considering giving up the AIP or even eating rice or bread! Something, anything, to stop the weight loss! Then I read your blog which I do each morning, and you had just the right information at the right time.

I’m going to try to add some fruit and see what happens. I’m eating a lot of good fat already. Maybe an evening snack would help. I wouldn’t have thought of that. Thank you for thinking of EVERYONE on this paleo path to better health. You are the best fairy godmother a person could have!

Are the numbers in the glucose vs. fructose table per serving or 100 grams of fruit? I can’t seem to find that info.
Thanks for the awesome post, as always!

Oh my goodness. I was just on facebook and decided to pop on one of my many Paleo pages I follow and ask the question, “How do I gain wait without eating nuts??”. Yours was the first page I clicked on and I saw your post. THANK YOU!

I have lost 15 pounds since starting Paleo, and I’m down to a size 0. NOT GOOD! It actually hurts to sit in chairs now because I have no fat on my butt! People always say they wish they had my problem, but it actually has been causing me much stress and I eat all day long and can’t put on weight.

I also have GI issues, so I’m gassy and bloated if I “cheat” which I have been eating rice lately to add some calories into my day, but I don’t feel good when I do. I don’t tolerate fats well, either, so I’ve pretty much been eating coconut oil on everything. I used to eat an avocado daily, but I don’t tolerate it well, so had to stop.

I will pour over this post again and see if I can make some changes and gain some weight. Is there any coconut milk that doesn’t have gums in it? Also, how much fat is okay to consume in a day? I know there are so many different types of fats that you need, so a balance is needed. I’m reading “Fats that Heal, Fats that Kill” right now so I can try and figure all of that out!

Thanks again, from us not by choice skinny folk out there trying to heal our bodies!! 🙂

Natural Value coconut milk is the only one I know of that has no gums and is in a BPA-free can.

I also have a recipe on my site for homemade coconut milk. You can easily (and healthily) get up to 60% of your caloric intake from fats, which means eating 2-3 Tbsp of fat at each meal for most people. If you are sticking with the healthy fats mentioned in the post, you really shouldn’t have to worry about eating too much.

I know it’s a bit to late to jump in this conversation, but if by any chance you get a notice in your email about my question, I’d very much appreciate your time answering it. I only now ( Nov 2014) am starting the Paleo diet and was also concerned about losing weight. It’s funny, how most people think that I must be joking to even dare to complain about being underweight. But it’s been a serious problem for me for many years. It is very hard to gain weight for me. I refuse to fill up on donuts and cakes to achieve my goal, I would like to do it healthfully but so far nothing worked. My question to you is it’s been 2 years since your post, how did you do? Did this approach work for you? Thanks.

I just read that coconut oil is sometimes used for weight loss, can lead to ketosis, and can tie up albumin that is needed for transport. What are your thoughts on this, and how much coconut oil is safe each day? Thanks!

Coconut oil does provide ketone bodies to be used as energy. You would only be in ketosis though if you were consuming coconut oil in the context of very low carb and moderate protein. Medium chain triglycerides such as in coconut only partially bind to albumin so a large percentage can still cross the blood-brain barrier (compared to long chain fats that are completely bound to albumin). This makes coconut oil a very safe fat to consume and it also means it can be used for energy without modification by the liver. There are even some reports that supplementing with large amounts of coconut oil can benefit those with dementia. I have not seen any safety limits to coconut oil consumption, but that bein said, I wouldn’t recommend eating a gallon of it.

Thanks for this post – I am quite small and have recently lost almost 7 kg (15 pounds) with Crohns as I haven’t been able to eat much for several weeks. I am now customizing my diet mixing the Auto Immune Protocol with some things from the GAPS diet (bone broth, liver) and also avoid all the foods I can’t tolerate. On top of that I am now on a high dose of Prednisone and I know that being on a very low sodium diet helped me in the past not to get a “moon face”. I am grateful that I can tolerate coconut products ! I was not able to find many blogs with AIP recipes …so I adapt the recipes. If you have some recipes (AIP) or good blogs, websites or cokbooks to recommend please let me know! I might also post a few recipes on my own blog !

I don’t have any illnesses, just wanted a healthier way of eating, when Paleo popped up in my Google Search. I have lost 14kg and now want to maintain my weight. Quick question: How much coconut milk should I drink weekly to maintain my weight and not lose any more? Thanks.

I eat strict Paleo and for work, houseclean two days a week at 8 hrs per day, and use the Ab Circle Pro twice a week. Oh, I’m 48, 5’3″, small frame and 55kgs.

Thanks for the great post, Sarah! I’m trying to gain weight as I lost too much when going on the AI diet (I have Hashimoto’s thyroiditis); I’m now 20lbs underweight! The tricky thing is that I’m having issues with fats. Olive oil, avocado oil, flaxseed oil and I think coconut oil all make me itch. Other foods do as well (it’s one of my main symptoms at the moment), and I seem to have FODMAP issues esp with starchy tubers, so it’s tricky: the most nutrient dense/high caloric foods don’t seem to work for me, yet those are the ones I need to gain pounds. I’ve been trying duck fat, but it may be giving me symptoms as well. I have reactions to beef, lamb, turkey, pork, salmon and cod, though beef fat seems ok so far; it’s just that the flavour is so strong ;-p. Have ordered Spectrum’s palm shortening, so crossing fingers and toes that I will tolerate it. I guess my two concerns are how to find other tolerable fats, and preferably ones with a higher Omega 3 content, as right now chicken fat is the only one I seem to tolerate…and given my meat intolerances, it’s pretty well the only protein I’m getting, aside from eggs and sole, so I’m guessing my Omega 6 intake is a bit high. My AI doc says no dairy for now…does that mean that Ghee is out? What about macadamia and/or palm kernel oils? Would appreciate any pearls of wisdom you have to share 🙂

I would go for red palm oil over palm kernel oil (although it also has a distinct flavor). Macadamia oil is a good choice as long as you aren’t sensitive to macadamias. As for dairy, ghee still does contain trace proteins so it still can be a problem for many people. Are you sure you’re digesting the fats well? Have you tried digestive support like ox bile?

Guess I would have to try the palm and macadamia oils to see if I’m sensitive to them. Let’s just say I’ve been returning a lot of items to the health food store lately 😉 It’s possible I’m not digesting fats properly, and/or there might be a salicylate issue going on (just looked that up and there are quite a few foods with SS’s that I react to with either itching or headaches). I have been taking Digestive Spectrum by Enzymedica for about a month and it’s helped a lot, but not with the above issues, apparently. Do you think adding ox bile to the mix might be a good experiment re: fat digestion? I guess if it doesn’t, that may narrow my issue down to a salicylate one…

Firstly, thanks for the post, there’s a shortage of em out there to put on weight. I notice you don’t mention butter (grass-fed) or flax oil in your list of good fats, I was just wondering why not? I’ve lost a ton of weight since trying to heal my leaky gut (I have really low secretory iga), and dangerously low BMI at the moment, and I’ve been trying so hard but nothing’s putting any weight on me. I take enzymes and probiotics to try to help with both digestion and absorption, but was mainly relying in ghee for fat. I’ve heard amazing things about butter and flax though, so I was curious as to why they’re not on your list. Thanks!

Butter is contraindicated for those with autoimmune disease because of the high frequency of sensitivity to dairy proteins. Flax is actually a very fragile fat, has a tendency to oxidize, and only provided ALA omega-3 fats which need to be converted into DHA and EPA fats to be used by your body, which is not an efficient process. Flax is definitely overfilled as a superfood.

Ghee can still have trace proteins, which can be a problem for some people. Others tolerate it though, so you don’t know until you try (sounds like it’s working for you?). Are you taking coconut oil?

I was, but started getting palpitations which I’m not sure if it was die-off or salicylate sensitivity so I stopped. I was also having a lot of chicken broth but started reacting to that too, I’m not sure if my gut is just too leaky or what. I have cod liver oil, but I’ll try the fermented one to see if it helps. I do eat a lot of ghee, as it’s my main source of fat at the moment. How many tablespoons of fat a day should I be having? I have about an oz of protein per lb, and definitely enough of the carrot/turnip variety of starchy veg but I still lose weight. I’ve been tested for crohn’s/colitis etc, but the results were normal. Potatoes have started giving me a body rash so I’ve stopped those for now. Thanks a lot for your help, I really appreciate it.

I would suggest at least 6, but really as many as you can handle without it disrupting your digestion. Have you looked into digestive support supplements? Ox bile, digestive enzymes and maybe a stomach acid support? It’s definitely something to consider (careful with the acid, might want to talk to a health care professional before doing that one).

I’ve been taking enzymes but they’re plant based, my naturopath advised against hcl for now, though mine is definitely low. I’m also trying to bump up my probiotic intake so I absorb my nutrients. I’ve been taking probiotics and using sauerkraut juice, I must make your coconut kefir soon but it’s hard to get the grains for it. I have zinc/copper imbalance and some heavy metals/adrenal exhaustion. I do have type 5 stool but I think it’s more related to starchy veg than fat, and I do have low good gut bacteria with no growth of some beneficial strains. I’ll definitely look into the ox bile if it would help! Just can’t seem to get the fat/protein/carb intake right for things to normalize. I upped my protein intake because I was craving it but it put strain on my kidneys.

Yeah, getting your bacteria levels and diversity up will definitely help. Sounds like you have a good naturopath though. Have you talked about a mucus supporter like licorice root or DGL? Also have you talked about adrenal support supplements (again, not my area of expertise)?

How long does it usually take to reinoculate the gut with good bacteria? I had to drink a lot of barium sulfate last week before an MRI which I don’t think helped. I’m looking into rebuilding the mucous lining (I’m sensitive to glutamine), what’s your opinion on colostrum? I’ve been having cloudy urine and protein meat binges the last few days though and feeling horrible, with kidney pain. And it seems to be making me lose weight rather than gain..really not sure what fat/protein/carb combo is best for me, but it’s probably the reactions I’m having more than anything else.

Denise, I’ve lost too much weight on the AI diet as well – I’m 20lbs underweight – and it’s been a real struggle to stabilize and gain again. Despite wanting to do the diet perfectly so I could heal my gut sooner rather than later, all three of my docs (including my AI doc) have agreed that gaining back weight is my number 1 priority, which will mean the gut healing process will be slower. Because of a gazillion food sensitivities as well, esp. to carbs and fats (ironically some of the most calorie-laden foods!) my diet is restricted to about 10 foods right now. I had to add back quinoa for the carbs and calories, as I tolerate it well, and my other staples are chicken, duck fat, a bit of carrot and zucchini, and sole. After months of weight loss, I’ve finally stabilized and am slowly gaining again, despite the minimal number of foods. I really didn’t want to add back any grains, but it was necessary. I’m also starting to feel really good now, with much more energy, better mood, less pain, and way less stress and anxiety. I just wanted to tell you my story in case it helps; maybe adding back some non-AI foods will make a difference for you, too. In any case, I can highly recommend duck fat 🙂

Wow, thanks for your comment. I’ve had to add back in a few things too, as it’s either that or go to hospital and be fed through a nose feed, which has all kinds of things like soy leicthin, maltodextrin, vegetable oil, E numbers and a variety of non gut-friendly things, so it’s better than the alternative! It took you a few months thous though? Unfortunately because of my weight situation I don’t have that long, so hopefully it’ll kick in sooner! Also, really nice to know you’re feeling less anxious and depressed and everything. Being a normal weight would definitely help that. Hopefully I’ll get there too.

I’m crossing my fingers and toes that you’ll get back to gaining weight soon. It did take a few months until the weight loss stopped, but your situation is way more extreme than mine. Maybe you can find a naturopath and/or nutritionist to help with more weight-gaining food ideas? Weight loss such as ours can also be linked to underlying illness, so hopefully you’ve been checked out already for other possible causes. Hang in there 🙂

I have the exact same issues. I am severely underweight since changing my diet with my Hashimotos diagnosis. Got a referral to see a Endocrine Specialist and fear it is something else. I am terrified!

Great article, like many others commenting here, when you’re underweight it’s not something most people want to hear about. I’m lucky not to have an AI problem (that i know of – i do suffer with yeast infections) I started following the paleo diet a couple of months ago to be more healthy but lost weight that i didn’t want to lose. The trouble with paleo is that you suddenly get all this extra energy and can go longer between meals, which is fantastic, but when you’re slim already, it’s a bit of a shock when you step on the scales. I’m now forcing myself to eat more high calorie foods, including your scrummy chewy granola, and i’m slowly gaining weight. I never thought of eating coconut oil straight from the jar so i’ll be giving that a try.

Hi, thanks for this post, it’s really great I’m doing AIP and slowly seeing some results but I am also breat feeding a 7 month old and am have lost a lot of weight ( I was already thin). Any further recommendations while breastfeeding? My bub is a big boy and still feeds a lot despite starting on some solid food. I feel as though I have to eat sooo much (loads of good fats and proteins) and still need to snack between meals. Increasing fruits causes digestive upset.

If I am 5’1″ is 110 pounds a healthy weight? I have latent autoimmune diabetes in adults, so I do not have much insulin production left. So the part about needin insulin to gain weight doesn’t really work for me. I’m currently hoping to stop the autoimmune process so my pancreas retains some function. Generally I was thinking I could gain 5 pounds of healthy weight but without a lot of insulin I have not been able to get above 110. But I have never been above 110 so could it be my ideal weight?

It’s hard for me to answer the question of whether or not you’re at a healthy weight since that depends on so many things. If you feel good and have good energy, then there might not be a need to push to gain more weight. It’s also okay for weight gain to be very slow, so you don’t need to be injecting too much insulin or stressing your pancreas. Focusing on healthy fats with each meal will still help. The other way to get energy in your cells is to use a very fast energy source (like juice or honey) right after exercising.

Just to follow up, I recently started insulin injections because my pancreas no longer makes enough insulin to keep my blood sugar normal even on a low carb diet. I stopped the autoimmune protocol earlier this year because I wasn’t seeing any change and it is HARD! But with insulin injections I now have no problem gaining weight, so it must have just been that I was way insufficient in insulin. I am looking forward to giving AIP another try when your book comes out. I still believe there is an underlying cause and that my body could heal if I could just calm the antibodies down. Can’t wait for the book and thank you for all that you do!

I am still losing weight despite all the oils and fats added to my food. I feel the only way is to add back some carbs, but sweet potato is giving me a sore tongue and cannot eat it very often. Some fruit are ok, but you wrote that over 20 grs fructose is a problem. Doing some counting and I cannot reach 100 grs of carbs just from veggies and fruits I eat. I don`t know what to do from now on, but I weigh 48 kgs at 164 cm and I look like a child at my age.

Thank you so much for this article. I can’t find many articles about gaining healthy weight. I would love to see more info/tips about gaining weight on Paleo Diet. LOVE your site—-a life savor while dealing with mold issues!

Usually that would mean cooking with it, making dressings, eating avocado or olives or similar with your meals… but if you’re really struggling to incorporate it into your meals, then yes, you could eat it out of the jar.

Hi! I just found your website and will be checking out all your posts. I don’t have a particular question, but just wanted to chime in because there aren’t many people out there (certainly not in”real life”) that I can relate to and it would be nice to connect with people in a similar situation. I’m underweight (5’5, 98lbs.) and have many dietary restrictions, so I struggle to put weight on. I have celiac disease, chronic pancreatitis, Barrett’s esophagus (caused by acid reflux), and osteopenia (I’m very close to osteopororis). I’m also pre-diabetic. I think that has to do with decreased pancreatic function (I have a low level of insulin which is closer to a Type 1 situation than a Type 2). I’m 40 yrs. old. I have to watch my fat consumption b/c of the pancreatitis. And I can’t eat too many carbs or my blood sugar gets really high. No acidic foods b/c of the Barrett’s and no eating 2-3 hrs. before bedtime b/c of the Barrett’s. I’ve been following the low-FODMAP diet (in addition to semi-Paleo–with full Paleo I dropped to 95 lbs) the last few weeks b/c of lingering digestive problems and that has helped greatly, but it’s still more restrictions! LOL I think following the AIP could be helpful in general gut healing as well as maybe clear up my acne,but eggs are one of my “staples” and I don’t want to give them up! I’ve already given up all the other foods on the AIP list (oh–except one cup of coffee a day–don’t want to give that up either!). I can’t imagine that eggs are a trigger for me. It’s the one food I feel terrific eating. Maybe I’ll try just eating the yolks. That’s allowed, right? Anyway…thanks for listening. 🙂

Yolks are sortof a gray area since 1-2% of people are allergic (but most don’t know they are). But I always say, if you feel great with what you’re doing, keep doing it. If you think eggs are really working for you, there’s not reason to give them up.

Just a comment on the eggs….about six months ago my youngest daughter and myself had food allergy tests done and came back highly allergic to eggs. My daughter never liked them, but I would never, ever thought I had any issues with them. My mother is also allergic to them. So….it could really be worth having a food allergy panel done. We were on the Specific Carbohydrate Diet for 14 months, our family eating 11 dozen eggs a week. I kept wondering why we were not seeing the dramatic results that others were!

I’m eating lots protein, fats, and safe vegetables (zucchini, carrots, spinach, green beans), but I am losing weight rapidly (which I really really don’t want–I want to gain weight). I’m also extremely tired and constipated. I eat three big meals a day, take enzymes, HCI, and probiotics. I don’t know what else to do. I’m beginning to think the paleo diet is just another fad diet based on specious reasoning. Anyone have any thoughts on this?

Why are you avoiding other veggies? Please read my veggiphobia post, because that’s probably going to make a big difference.

Also, making sure that you’re getting enough sleep and managing stress makes a big difference to both digestion, and hormones that control metabolism. Gut peristalsis is regulated by serotonin and melatonin, so high tryptophan foods can be very helpful (organ meat and seafood, especially shellfish).

Thank you so much for this detailed post! I started the AIP about three weeks ago for an inflammatory arthritis. The diet has worked wonders for the autoimmune process but I’m very concerned about the amount of weight I’ve lost, and am continuing to lose. I’ve made coconut milk at home a few times in the past and I noticed you listed it as a possible added source of fat. I’m considering drinking coconut milk each day now for the added calories/fat. What is your opinion on how much I can consume a day (is one cup too much?). Is drinking coconut milk on a daily basis too often? Thank you so much for your help!

I would usually recommend about 1 cup per day as a starting point (just based on the phytic acid content), but I think you can play with adding more (especially since you’re seeing an improvement in your symptoms, it should be easy to gauge if you go overboard). Digestive support supplements can really help with weight gain as can increasing sleep and managing stress. It might also be worth keeping a food journal and talking to a nutrition consultant or functional medicine practitioner to make sure you’re getting sufficient amounts of all your micro and macronutrients.

Thank you! I’ll start and one cup, try adding a little, and see what happens.

Do you have any advice on foods to get starchy carbs from with each meal? My go-to are sweet potatoes, but I really don’t want to eat them with every meal and risk developing an intolerance. However, without a starch like this at a meal, I feel light-headed. It’s hard for me to eat enough vegetables to add up to 30 grams of carbs a meal, and I know I shouldn’t be eating too much fruit either. And I know you don’t recommend white rice. Do you have any other recommendations for easy, safe carbs? Thank you!

This is the best post of weight loss reversal that I have seen online. I am 5’9″ and 125lbs on a good day and come from a line of long and lean folks who burn it off quickly. My health issues have made it a priority for me to follow your AIP and I’m seeing positive results so far, but keeping the weight on has always been tricky. Thanks so much for your great site!!!


Since ketogenic diets are very therapeutic for people who have neuro degenerative disorders, is it possible to be in ketosis and not lose weight?

I just saw the nutritionist today with my mom, the one her doctor recommended. Mom is 86.5 pounds and stands 5’3″. The nutritionist warned against ketosis at this point because her weight is so low. She suggested more carbs, especially starchy ones plus 5 meals a day with Boost twice per day and ice cream, whatever she wants. She agreed with adding healthy fats but said that since mom is 88 yrs old, eating organic isn’t going to matter for the short term. I don’t agree. Is there any good substitute to commercial Boost? I’m sure it’s got corn syrup in it and tons of things not good for her. Yet she is so thin, I’m relenting there. I got her 12 bottles of it

I’ve tried adding more fat, she gets fuller quicker and eats less. I’m at my wits end and I’m scared I’m hurting her rather than helping. I’m chronically sleep deprived caring for her with very little help from my fsmily. I’m in tears writing this. She wants food , yet it takes over an hour or more just to finish breakfast. She coughs almost and her

Thanks Christina, I read that article before and I do get her to eat some pureed organic fruit (I even add some raw honey to the cooled puree) as well as adding fat to every thing she eats. Meat has been a real challenge as far as pureeing it to the right consistency for her. I’ve even used baby food meats, but stopped when I saw that it has corn starch in it. It was convenient but not healthy for her. I’ve also added sweet potatoes with honey to her breakfast meal which she loves! Lately breakfast has been a real challenge because I think she is bored with eggs and leafy greens. She gets full quickly especially with all the fat. Thats my challenge. Along with having to cook all the time. Paleo is not convenient. I so wish we were rich and had a cook!

Hi Ginny,
I had similar with my mother at 82 years. I’ve been into healthy, organic, etc. for many years but to be honest, if I couldn’t get improvement quickly with natural, I’d be taking the nutritionist’s advice and going with whatever might bring about some improvement. Because I think survival is sometimes more pressing than quality of food.
Is your mother able to give you pointers as far as what she would like to eat? Is blended food easier for her to handle? Does she have structural difficulties causing her eating difficulty that can be helped with medication or other strategies? And are you able to get some respite to enable you to focus on your own needs (so very important, at a number of levels!)?
I’m hoping what I’ve written doesn’t lead to any further difficulty or confusion for you.
My heart goes out to you both. xx

Thanks Pat. I do need respite. Meeting soon with conflict counselor along with my siblings in hopes of getting more of their help.

Mom has a full upper plate denture but only 9 lower front teeth. No chewing surfaces, so she has to have her food pureed to stage 1 consistency. Before this, we tried various consistencies of food that did not work. I’ve had to call 911 twice for scary choking episodes, many other scary episodes too that resolved to my relief.

Mom is always hungry and has always had a good appetite. She’s always been slim her whole life, but her typical adult weight was always 115 (at 5’5″). She still wants food but has swallowing issues even with the right consistency. At every meal, she coughs and has problems getting phlegm to come up. Today at breakfast I couldn’t feed her but two bites before she started holding the food in her mouth and not swallowing. I made her scrambled eggs with bacon gravy, sweet potatoes mashed with coconut oil/cinnamon and raw honey, pureed cooked spinach, all organic. She didn’t even open her eyes at the breakfast table, so I had to stop feeding her. I only got most of one Boost in her this morning. This evening I got her to drink another Boost with PurePaleo protein mix added plus pureed fried chicken with pepper gravy/mashed potatoes and gravy/green beans – none of it was organic or paleo. I fed her in her bed because she doesn’t have the strength to sit up on her own.

It feels like I am giving up on her, but I’m really just switching gears. Once she gains some weight, maybe I can start getting more good healthy food in her. If i knew more about nutrition and how to cook (and was getting 8 hours sleep per night which won’t happen any time soon) maybe this would be easier. But to me it’s very difficult while also working full-time. Even inundating at times. Thanks for your concern.

This post was extremely helpful. I’m currently on AIP with FODMAP restrictions to combat chronic yeast, but I’m finding it difficult to keep my energy up without being hungry all the time. I’ve also lost a considerable amount of wait with the drastic reduction in carbs. I noticed you have kohlrabi, pumpkin and jicama on the starchy veggie list, but I’ve seen those cited as FODMAPs on other lists. This makes the list of approved starches very limited. Do you have suggestions on keeping energy and carb levels at a healthy level but substituting for the high FODMAP vegetables? Thanks!

Thanks Christina, yup I read that article as well. What I’m struggling with is finding enough starch to balance all the additional fat and protein that are not FODMAP, and several ones on this list have been cited as FODMAP in other lists. I didn’t know if there are any other possibilities other than just carrots, parsnips, and squash all the time.

Also, do you have brand preferences for the digestive enzymes recommended for additional gut healing? Thanks again!

So much amazing information here. My 14 year old son has recently been diagnosed with UC and his GI Dr., though well studied in this disease, could absolutely care less about nutrition, his instructions were to eat lots of white bread, pizza and hamburgers to gain weight…. WHAT???? I’m glad I’ve found this thread. My 5’7 94 pound teen needs to gain weight without destroying his colon :-/ We are following AIP as closely as possible. Most night shades don’t agree with him, the only exceptions so far are baked potatoes. Even so, we serve them sparingly. Thank you so much for the abundant amount of free information. I will purchase your book to support and help get the message out there. XOXO from the bottom of our hearts.

I am 5’9 and been on the paleo AIP for 5 months. I wa diagnosed with RA in Fall 2011. In the beginning, I went extreme and was afraid to eat losing a lot of weight. I decided to just go gluteen free and dairy free which helped, but my RA was moderate at the time. I consumed dairy and wheat after my second trimester, thinking it was best for the baby. 2 months after giving birth, my body shut down, and I could barely move. When I became gluten and dairy free again, I lost my pregnancy weight and even more rapidly. I have lost 10 more pounds, since going AIP 2 years later. I’m on a glutathione cream, enzymes and probiotics. I am doing amazingly better , but my weight is 110. I am on a rotation diet and was using 2-4 tbl coconut oil on sweet potatoes and other veggies daily. I gained a few pounds, but started to get discomfort near my galbladder. I confirmed I have a gallstone. The pain went away after I stopped the oil. Is it ok to consume oils with a gallstone? I did not always eat the meat at the same time or the fruits with the oil, I tended to eat parts of my meal at different times, like eat meat then 30 minutes later eat a sweet potatoe with oil. I also tried to eat 2200 calories and consumed large portions of ground meats(high quality) 2-3 patties. I stopped earing bacon every three days as well. Will any of the above advise help me?

How to treat gallstones and change your diet for gallbladder issues is best discussed with your healthcare provider. Sarah has licesnsed consultants available at and also recommends and – Christina, Sarah’s assistant

This may be a silly question, but what ways do you suggest getting the fats into your diet most easily? I cook with EVOO (which I guess I should not do seeing the above) and dump a little on my food. I use EVOO and flax as a salad dressing. I add coconut oil to my oatmeal (I know- not paleo, but I am a breast feeding mom and it helps my supply quite a bit and I do not have any negative side effects). I eat a few avocados per week. I also put coconut oil on my sweet potato. What other items can I put oil on that will still taste good? Thank you!

i am a 44 male type 2 diabetic with severe diabetic neuropathy who would like to try a ketogenic diet with the same foods as on a paleo diet except I will be in ketosis (50 grams of carbs and under) for better blood sugar control and to combat my diabetic neuropathy. So my qeustion is can i maintain my weight while in ketosis, please let me know, thank you.

Check out The Wahls Protocol by Dr Terry Wahls. The highest level of the diet, Paleo Plus, is ketogenic. She put her MS in remission with this diet, and many others with autoimmune diseases are having success. She also has some strategies for maintaining weight while on the diet.

What does one DO with sardines? I’ve been trying for years to figure out how, exactly, people eat these, and not enough people seem to eat them at all for me to be able to get a good answer!

Before i started the AIP diet i was 178 at 6.1. I was athletic and I was feeling great. Now, I count everything i eat and I average1600-1900 calories a day. With this diet my body is shrinking. I am 153 pounds now. The diet is just too clean. This is scary and I am afraid to disappear. I think i need to get some rice or millet or something to get some calories. With all the limitations its not possible to hold to normal weight. The hardest part is that I have TPO antibodies and no symptoms and good lab results. This seemed to be silent stage of Hashimoto and the diet is the worse experiment I ever did. I cannot notice any changes with the diet. No food sensitivities, nothing. It made me unhappy. I dont eat stuff i used to love. I live in prison and funnies part is that my TPO went up from 96 to 490 on this diet with 100% commitment. No cheating!!!

Thanks for this information – I just started the AIP diet last week to help with a variety of issues I’m experiencing. I’m already a little underweight, developed amenorrhea about 17 months ago after losing a lot of weight and now struggling to gain weight. I also have LADA but am not yet on insulin so still have to watch my carbs very closely. I can barely eat any starchy vegetables without experiencing a spike in blood sugar over normal ranges. I eat plenty of fat and am now upping my protein to at least 6oz at meals and eating more non-starchy veggies. But how do I gain more weight when I can’t really eat much starch or fruit at any meal due to my blood sugar issues??

Following you and my nutritionist advices I started to eat plenty of good fat. But then I make a stool test which shows that I don`t absorb fats or steatorrhea condition. I am really confused now… Is it because I almost do not eat any sugar and carbs?

Hi. I’ve been on the AIP diet for about three months and have lost a ton of weight very quickly. I’m scared now and have even wondered about cancer! But after reading all of these posts, it seems that this is common with this diet. While I’m grateful for some symptom relief with my autoimmune disease, I feel now that my greater concern should be with my weight. I do eat lots of meat and healthy fats such as avocado and coconut and I have big meals but nothing is working. And I have to gain fast, not keep experimenting to see if I will gain or lose more. So, I’m struggling with the temptation to add non-gluten grains back in and maybe dairy too. I hate to lose the opportunity to test for food intolerances via slow reintroductions, but feel that I’m at that point. Maybe more needs to be said to people about this danger when on the diet to try to prevent this from happening. Any ideas? Any suggestions for healthy shakes or something? Thank you.

I was Paleo for 6 months in 2015 then added back rice due to weight loss. December 2015 was 98 (my normal though I want to weigh more) got dx with SIBO and have low fecal elastase. I was extremely stressed in January and went to 89 pounds (5’2). I am back to eating normally (some GF grains while treating SIBO, but now just started SCD) and 87 pounds. Is it possible for me to gain weight while treating SIBO? Im scared at the weight I am at.

I would live to know how people struggling with weight loss have done since employing your dietary recommendations for gaining weight on the AIP. Have they had success? I weigh a ridiculous48 kg at 1.69m and went into premature menopause at the age of 38 (so big risk for osteporosis). I cannot go on this way! Please help!!

Hi Sara,
There don’t seem to be many replies from the author(s) here lately, but I also struggle with weight loss (I’m following the GAPS diet) and am getting concerned myself. What seems to be helping me is to eat more. I was often finding that I was feeling hungry regularly because I’m not getting enough calories. I’ve started making a habit of bringing fruit with me to snack on, and keeping lots of ready to eat stuff in the fridge. I cut up fresh vegetables, snack on baby carrots, and keep cooked fish and meat pieces in the fridge, and make big batches of hamburger soup and freeze it so I always have stuff on hand. I’ve also found that imitation crab products (which are made from pollock) are very inexpensive and I like them, so I keep a bunch of that in the fridge to snack with some fresh veggies, or with stir fried veggies. It’s taken a while to get into the swing of it, and the weight loss has slowed, but I’m not sure it’s stopped, so I’m now looking to add more foods like beans and squashes and other higher carb foods.
Here are a couple other articles I’ve found that might help you. and

Only saw your reply now. Thanks, Steve!! I feel rather lost and isolated after purchasing and implementing all the AIP books yet still struggling and not receiving any replies from the author.

Cocoa powder is not allowed on the autoimmune protocol, but if you’ve been able to reintroduce that then go for it! -Kiersten

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