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.


Hi Sarah!

I have recently been looking into th1 and th2 imbalance for autoimmune disease. I recently also saw an acupuncturist that follows paleo principles who told me that since I have an autoimmune disease, I will have an imbalance for life. He wanted to test to see if I was th1 or th2 dominant by using herbs to see which made me feel better/worse. Do you agree that my body will never be able to get back to a balance on it’s own? I would much rather just follow your AIP and heal my leaky gut, would this eventually fix my imbalance?

Also, as soon as I got off the prednisone, I saw huge improvements with your AIP in just 5 days. I don’t know where I would be without your generous information and hard work. I’d probably be in a much worse place than I am now. These past 6 weeks have been some of the most miserable of my life, I think I could potentially have a life of misery ahead of me without you. Thank you so much.


Th1 vs Th2 balance is a very outdated concept in autoimmune disease. We now know that it’s much more complicated than that, with possible dominance not just of Th1 and Th2 but also Th9, Th17 and Th22. So, generally, I don’t think that immune stimulating herbs are a good idea and most practitioners are migrating away from that. Instead you could do CD4/8 blood panels and see if that tells you anything about your disease.

I emphatically isagree that your body will never be able to get back balance. I think the biggest factors in allowing your body to regain balance is following the very nutrient-dense AIP, and sleeping as much as possible. Vitamin D, zinc, omega-3 are all important supporters of regulatory T-cell whose job it is to keep everything balanced. And if you are seeing huge improvements that quickly, I don’t think you need to mess around with that. However, it is important to understand that even once you heal, your body will always retain the ability to attack itself. So, you can put your autoimmune disease into full remission, but it isn’t a cure.

I’ve been having a lot of problems falling asleep and staying asleep, I wake up every hour to hour and a half every night, I’ve been taking Natural Calm and drinking a lot of bone broth but still having problems. Would sleepytime tea be okay? The ingredients are chamomile, spearmint, lemongrass, tilia flowers, blackberry leaves, orange blossoms, hawthorn and rosebuds.

Should be okay. Other tips are spending some time outside in the morning and wearing amber tinted glasses the last 2-3 hours before bed. Also avoiding eating for at least 2 hours before bed (4 is better) and avoiding intense exercise in the last half of the day.

I hope this helps!

Hi Sarah!

According to bloodtests, I am anemic. My total iron levels are low and my transferrin saturation is low. My total iron binding capacity was low which was surprising to doctors (usually it’s high when the other two are low they said). I have an autoimmune disease and I definitely have issues with starches so I think that I have SIBO or candida overgrowth or something. I read on your site that the bacteria overgrowth can consume iron and B12 (which I was also low in) which I’m assuming can cause a deficiency. I have been eating 1+ lbs of grass-fed beef every day for a couple weeks so I feel like I should be consuming enough from foods. They want me to take an iron supplement. Do you think this is a good idea? Or is there something else that I need to do? I’ve been only eating leafy green vegetables for carbohydrates (and occasionally carrots) to try to combat the SIBO. I don’t eat anything starchier or any fruits. Thanks a lot for all your help.

I just listened to the most recent podcast and I am most definitely guilty of “veggie-phobia” lol. That is something I’m gonna have to work on!

Iron supplements come with a whole lot of side-effects, so I think it would be good to try diet first. Vitamin C dramatically increases iron absorption, so I would suggest taking 500mg-1g of vitamin C with each meal. You’ll also get more B vitamins from organ meat, so try mixing in some heart, kidney, and liver. Another thing to try is adding in a quality probiotic supplement like Prescript-Assist.

Hi, I have been reading your site a bit today and have recently (within the past year) been diagnosed with Hypothyroid. The docs at the VA don’t tell you much about it just take this pill and re-test in 3 – 6 months. I tried the additional iodine as per Dr Brownstein. My TH levels went from 4.2 to 6 and they were rather alarmed. Now that I have stopped the iodine I won’t be retested until the 1st of June. Anyhow, I was reading your reply about the organ meats and was wondering about the effectiveness of chicken hearts and gizzards and what benefit they might be. I’m not a real fan of kidneys and livers out of any animal. Thanks in advance for your response and thanks for being here with this information.

Chicken is fine. The fats aren’t great compared to other animals, so I don’t recommend chicken forming the basis of your diet and recommend pastured chicken if at all possible. When it comes to chicken organ meats, the benefits far outweigh the part where the omega-6 to omega-3 ratio is not ideal.

Hi again, I read further down the page and it would appear that chicken is excluded of the paleo diet. Therefor, I am guessing the heart and gizzard of them them would not be considered beneficial. Thanks again.

Were you diagnosed as iodine deficient? Iodine needs to be in a health range and both too much iodine and too little can interfere with thyroid function. Since it sounds like you won’t be tested again for a while, I would just focus on food sources of iodine (seafood and sea vegetables mostly). But, the thyroid is also heavily dependent on selenium (rich in quality meats especially organ meat and seafood), zinc and iron. Selenium supplementation is also worth discussing with your doctors. Are you following a paleo diet?

Hi Sarah!

What are your thoughts on intermittent fasting while on the AIP? I’ve been on AIP 100% for two and a half weeks and I have definitely seen significant improvements in my autoimmune disease (I have some kind of spondyloarthritis). I’ve read that I.F. can reduce inflammation but I’m worried about the increased cortisol, as my sleep has been bad. Could I.F. help me heal my leaky gut / AI disease or do you think I should wait until the symptoms completely pass and my sleep is normal?

Hello, Sarah. Such an informative site, and what a supportive voice for many seeking help! Hoping to start AI protocol for family member, but I need to have something to present to the family member that will convince that it will help Hidradenitis Suppurativa, especially since it is Stage 3, and has been going on for over 20 years. Thank you!!!

Hi Sarah, I have had neurological symptoms and at this point have been diagnosed with idiomatic neuropathy. I had read that fish oil supplements help with neurological symptoms so I started to take the maximum amount 2500 – 3000 a day. It does help. I also adjusted my diet and removed many of the foods you list above which also helped. However, I saw your post above about balancing out omega 3’s and 6’s and I don’t know how to do that. I am afraid of reducing my omega 3 supplement. How do I get my omegas balanced out? Could I be doing myself further harm by having so much omega 3 and not enough omega 6? I can’t wait until your box comes out!! Lucretia

There are some online food journal calculators that can help you figure this out. Generally, foods high in omega-6 are (most of the foods excluded on a standard paleo diet), nuts, seeds, chicken (especially conventional), and to a lesser extent meat from grain-fed animals. You can easily balance by avoiding nuts and seeds, keeping chicken to an occasional meat instead of a staple, and eating fish a few times per week (even if you’re eating conventional beef, pork and lamb the rest of the time). It’s pretty hard to over-correct for omega-6 intake given its prevalence in foods these days. Anywhere from a 1:1 to a 2:1 ratio should be good.

My understanding is that the Neu5Gc sugar is incorporated from diet into human cells, but it is present even in fetal cells so the mother must pass it on to the baby. It appears to be in all humans and, even though our bodies can create antibodies to it, cell machinery and metabolism do not see it as a foreign molecule and in fact, incorporate it into glycoproteins. There is controversy over whether the presence of antibodies against it is actually pathological or whether it’s another symptom of the immune dysregulation that occurs in the diseases in which its been tested. No link has been formed between antibodies against this protein and disease other than the observation that there is Neu5Gc present in tumors. Healthy normal people all seem to have antibodies against Neu5Gc. There have been no studies correlating antibody levels or Neu5Gc levels with any disease. There’s some interesting science here, but nothing to suggest that red meat should be avoided. Plus, there are also studies showing that higher red meat intake decreases risk of cancer or has no effect on cancer risk as long as you remove processed/cured meats. So, I feel like blog posts that make those kinds of generalizations have a pretty obvious agenda.

Okay thank you so much for your thorough answer! I’m getting an order today from slanker’s grass-fed meats and I’m gonna enjoy the **** out of it 🙂

Also you should check out Slanker’s! I used to order from US Wellness meats but Slanker’s has better prices on a lot of stuff and they don’t charge a handling fee (in addition to no shipping). The packaging is not as convenient as from US Wellness meats but the quality is great.

Thanks for this site. It has been very helpful. I have been dealing with a leaky gut for the past 5 years (It developed after living in Peru for four months). I feel like i can’t tell which foods bother me or not. Supposedly i have peanut and gluten intolerance but even when eating them I can’t tell a difference. My joints have recently started bothering me really bad(knees, elbows, shoulders, ankles). I’m only 31 years old and my body is starting to fall apart. I’m going to start your AIP diet. Would you have any thoughts? Is it neccesary to buy organic vegitables and fruit?

You almost certainly have an infection or parasite load and need to resolve that first. Find a good natruopath to work with.

Sorry to be annoying but when you update this page will you post it to the front page so we know it’s updated? Thanks for all the information it’s been a life saver.

Hi Sarah, this is my first time commenting, but I’ve been getting caught up on your blog entries (so many awesome entries!), especially the AI protocol. I won’t unveil my list of maladies here, but needless to say, it’s a laundry list (to the point that I’m considering contacting a paleo nutritionist for some guidance). I’m currently not paleo but I’d say about 80-85% on my way. I already know I have some food sensitivities/intolerances (via an Igg and Ige test I took years back) and also self-conducted elimination. That said I still don’t know where to really start in terms of healing since it seems like I’ll try something, it will help for a while, but then my body will go back to its previous state of misery (mostly digestion-related, but as you know, this affects every other area of my health). Okay, I have three questions for you:

1. Knowing that I have some digestion “issues” already, should I start with 100% strict paleo (e.g. a whole30) or dive in head first to the paleo AI protocol? My reluctance to going regular paleo is that I think certain “approved” foods are problem foods for me (i.e. the beloved sweet potato).

2. I’ve started to incorporate liver into my diet based on the numerous claims that it will help with healing and overall health (I’m also super duper anemic and with low ferritin stores), but now reading your comment above about avoiding liver…should I hold off on this?? I’m not eating massive amounts (I eat it a 1:2 ratio with liver to ground beef).

3. As someone who LOVES food (and beverages!), I have a hard time eliminating something until I find a “replacement” for it. Any tips for me regarding cutting out coffee (replace with irish tea perhaps?), my daily dose of crunchy/salty tortilla chips (my biggest hurdle to going paleo – not gonna lie) and chocolate!

I appreciate any info or tips you are able to provide! I’m so appreciative to have found such wonderful resources on health and nutrition via the paleo blog world (I also love the sense of comradery and community between everyone!). Thank you so much!

It makes sense to me to either jump into the AIP if you think you can handle it or to do Paleo but avoid foods you know are a problem. My research on liver for the book has decreased any concerns I had about it, so go for it. If you like black or green tea, that’s a good replacement for coffee, but don’t drink tons. You can check out my plantain cracker recipe to replace your tortilla chips but just remember that they are very carb dense. I don’t have a good recommendation for chocolate though. Carob is okay, but has a lot of sugar (and you’ll need to use carob powder not something like carob chips which usually have barley in them). I’d also suggest looking into digestive support supplements, such as digestive enzymes and ox bile, depending on your exact symptoms. Stomach acid supplements can also help but are contraindicated for tho with clotting disorder, stomach ulcers, or taking NSAIDs.

Thanks so much! And glad you mentioned the plantain chips recipe – I’ll check it out. I’m not shooting for LC at all, and in fact, going strict paleo is a bit scary for me since it’ll probably mean going even lower carb, and while I’m not anxious to gain a ton of weight, I am on the trim side and can’t seem to GAIN weight despite eating like a horse (or so it seems) and increasing my fats by the spoonful (coconut oil/butters/nuts and seed butters). L-glutamine, milk thistle, digestive enzymes (including Hcl) and probiotics have been part of my daily routine for a while now, hence me seeking something different to try It seems like I should not have to take a boatload of “extras” forever to keep the digestion moving! Again, thank you, Sarah!!

I don’t think low carb is a good idea for most people on the AIP, but I do think avoiding high blood sugar is important. That more means measured carbs, but I genially recommend somewhere in the 75-100g per day range.

May I ask exactly why carob would be okay as a legume? I see this being repeated on AIP sites with no specific explanation as to why it would make a difference chemically for the protective pod to be used instead of the carob seed. I see carob repeatedly included in lists of Paleo foods to avoid, and want to find the anti-nutrient information. Until then, I can’t see why I would need to include it and possibly jeopardize my healing. Thank you so much.

Great question! Carob powder is the ground up pod of the carob bean and not the bean itself. This greatly minimized the antinutrients since they are concentrated in the bean. Mature leaves of legumes like rooibos tea or pea leaves that you might put in salad are great too.

Hi there! I’m looking for the information you have on how to eat for Hashimoto’s. I know I saw it here somehwhere but now I can’t find it.
Lisa Vincent

Hi Sarah, Thank you so much for the contribution on the Auto Immune community. I have been suffering from AIED (AutoImmune Inner Ear Disorder) for last six months. While my right is normal after intratympanic injections, my left keeps fluctuating? While I started to do Paleo diet exept still eat (rice, millete) as I’m Indian Vegetarian, do you think doing strict AIP will help me to recover or improve my left ear? Have you come across people with auto immune ear disorders?

Thanks, Pradeep

H,i Sarah. I started your AIP a week and a half ago. The first week went okay, but for the past three days, I’ve felt awful. Doe the AIP have a period of time comparable to “paleo flu?” Three days ago, I had dinner at a restaurant and asked for a steak without pepper, veggies (bok choy) and I got a green salad with balsamic vinegar and olive oil brought to the table. The steak arrived sitting on top of a mound of mashed potatoes. The bok choy was braised in something — who knows what? The salad had tomatoes, raw cucumbers and croutons, all of which I scraped away.

Near the end of the meal, I developed stomach pain and cramping. It lasted until I finally fell asleep. The next morning I woke up anxious, with a sore stomach and burning eyes. I felt weak and tired. Since then, I’ve continued to have stomach pain, no appetite and feel just awful in general.

I assume there was something in that meal — nightshades (potatoes and tomatoes, though I scraped them all away as best I could), maybe some sort of artificial smoked flavoring on the meat or something the bok choy was braised in, something in the balsamic vinegar — that caused the immediate and severe distress. But that was three days ago and I need to start eating. Besides, before starting the AIP, I ate that very same meal a that same restaurant many times with no distress while on the general paleo diet.

I have been practicing paleo for 9 months. I undertook the AIP because two years ago I was diagnosed with a rare autoimmune condition, birdshot retinochoroidopathy. Basically, my immune system thinks my retinas are the enemy. I take a drug which weakens the immune system.

Any thoughts about what’s happening?

It sounds like classic gluten exposure, which an take anywhere from a few hours to a few weeks to repair from. And as your body heals, it will react more violently to the foods you are sensitive to (gluten being a very likely culprit with autoimmune disease). The best things to recover are lots of sleep, bone broth or a collagen supplement, and a clean diet.

As for the carb flu type symptoms, that would be expected if you are really dramatically lowering your carb intake compared to how you were eating before. But, if you were eating paleo before, there shouldn’t be that big of a difference. Are you eating any starchy vegetables or fruit? I think a little is really important (too low carb can be quite stressful for the thyroid gland, but it’s obviously also important to regulate blood sugars).

Hi Sarah,

I’m desperate. For the past two and a half months I have not been able to walk and I have been feeling horrible. Doctors think I have “Reactive Arthritis,” which is a form of spondyloarthritis. They say it is often triggered by a GI tract infection, such as shigella, which I had before I started getting massive swelling and pain in my feet / knee. I took prednisone for two weeks and it made me so much worse. I eventually refused to take all drugs (they wanted me to take a TNF inhibitor after the prednisone, but after seeing the symptoms, I refused). I did your AIP and saw a lot of improvement. Last week I was almost walking! The improvement was slow but it was definitely happening. Then last Thursday I got food poisoning or something. I think I didn’t cook my salmon well enough. I’ve been having diarrhea for 6 days straight. As I expected, on the 3rd day of diarrhea, everything got ruined. I have new flair ups and i’m worse than when I started. I can hardly get from my bed onto my wheelchair. I don’t know what to do. I’m going to go get a stool sample tomorrow.

If I have a bacterial infection, do you think I should take antibiotics? I know taking antibiotics can cause gut bacteria problems and I’m pretty sure I have either SIBO or candida overgrowth.

If they have NSAIDs that they can inject / cream will that still cause leaky gut?

What do you think I should be eating from the AIP since I have diarrhea? Is eating meat ok?

Thank you,

Oh, that’s awful James! I’m so sorry! Right when things were starting to come together. Diarrhea for 6 days seems a bit much for food poisoning, so doing a stool test seems like a good idea (with fish, the worry is more often parasites than bacteria). Any chance that you were exposed to gluten? So, for healing, the easiest to digest protein is actually fish, although you might understandably feel a bit leery. And broth would be a great idea. You might even want to try a collagen supplement (Great Lakes collagen is a good one) to help speed healing. And I would still suggest lots of vegetables, but maybe just eat cooked vegetables since those are easier to digest too. If it is bacterial and you’re body is not fighting it well on your own, then yes, if it was me I would do the antibiotics and then focus on probiotics afterward (you can start probiotics during and just try and take in between antibiotic doses). I don’t know about NSAID creams, but they sound fairly harmless. I do know that the injectable NSAIDs have reported gastrointestinal adverse effects (mainly ruptured ulcers but also intestinal perforations), which suggests that there’s still an effect on the lining of the gut (the mechanisms are systemic, so basically if it’s getting into your bloodstream, it can still theoretically hard your gut even if it’s not taken orally).

Okay thank you so much Sarah. I don’t think it’s possible i got glutened, as I cook all my food and I’m really careful. (but I do have a recurring dream where I eat something with gluten and then panic! Wierd right?) Should I limit my fruit? I’ve been craving fruit sooo much. I also notice eating foods high in fat make me feel a little queasy and give me a headache.

I have the same recurring dream, so not weird (it’s always pizza and I realize as I bite into the third slice that I’m being an idiot).

Just keep fruit to 2-4 servings a day. As for the fats making you feel queasy, that sounds like maybe gallbladder not working optimally. You could try some ox bile supplements and see if that helps.

Alright thank you so much! That’s really funny about the dream, I guess the addictive nature of those foods combined with the stress of worrying about autoimmune issues makes it not too uncommon. Also, do you know if there is an M.D. that exists anywhere that recommends doing the AIP for autoimmune diseases? It would make my parents feel a lot better and it would relieve my stress of constantly fighting with them about it.

I was wondering if you can eliminate AIP foods one by one to check for tolerance. For example can I be eating a Paleo diet but for one month cut out eggs then try them again to see how I feel and then the next month cut out tomatoes to see how I feel or do I need a completely clean slate for a month and then reintroduce the foods one by one? And how long do you give yourself to see if you’re affected? Will you just be sick to your stomach? Can’t wait for your book.

Absolutely! The only trick with doing it this way is that it can be hard to tease out more than one sensitivity. You would probably need 3-4 weeks to cut a food out and then 1-2 weeks after adding it back in. Symptoms can be highly variable, from any gastrointestinal symptoms, headache, fatigue, mood changes, depression, anxiety, rashes, skin changes, acne, dry skin, troubles sleeping, achy joints or muscles. I generally think it’s easier to cut out all of the possible culprits and then reintroduce one at a time (typically one a week).

I am just fining this site and find all the info fascinating. I was wondering do you have any RCT data or publications I could reference?


The current clinical trials are all ongoing, but there should be some published results early next year. There are hundreds of studies supporting the individual aspects, which I am including in my book.

I heard you on Jimmy Moore’s podcast and had to check out your website. I just sent a link of this page to someone suffering from Hashimoto’s. You might want to reconsider your recommendation on oral birth control (obc). I know I’ve heard some say on Jimmy Moore’s podcasts and I believe Chris Kresser talks a bit about how obc can cause sibo on his website.

I haven’t been diagnosed with an autoimmune disorder, but a naturopath tested my ANA and I was told it was slightly elevated. I haven’t done any further testing. But, I also have PCOS. He had me on a rotation diet using the results of food sensitivity testing (blood tests). I notice that some of the foods that I had no reaction to are foods that are on the “NO” list for the autoimmune protocol. So, I guess my question is, if I have blood tests saying I am not sensitive to some of these foods on the AIP list to avoid, should I still be avoiding them?

Check out my menu tab Autoimmunity->The Whys of the AIP because many of the foods omitted from the autoimmune protocol can be problematic in ways that are not food sensitivities and do not show up on any tests. That being said, if you have eliminated those foods and reintroduced them without suffering any symptoms, then I think they should be fine for you to continue consuming.

Hi Sara, I have recently started following the GAPS diet for an autoimmune disorder. I avoid all foods on your list except for home made organic grass fed cows milk yogurt. The GAPS diet says that fermenting the yogurt for 24 hours takes care of all the lactose and the yogurt making process denatures the casein. Is that true? if so is it okay to consume the GAPS suggested home made yogurt with someone with an autoimmune disorder?

I have seen huge reduction in inflammation and pain by being on the diet for just 5 days.


If you feel it’s working for you, then you should keep doing what you are doing. Fermenting long enough does denature casein, but that doesn’t necessarily render it non-allergic.

Thanks Sarah for your help. One more question. My pain has subsided quite a bit but not all the way. If I had to leave out yogurt or as a matter of fact any other food to check whether it is causing an issue or not; how long should I be off it to make sure its OK to consume? Or how long does it take for something to get out of the system so it doesn’t cause any negative reaction?

General rule of thumb is about 3 weeks. I would give what you’re doing the full 3 weeks before you decide if you want to remove yogurt since you’re seeing improvement now.

Serious knuckleball for you… I have Sarcoidosis, and as a result I believe I am extremely vitamin D sensitive. In November my blood calcium skyrocketed to 3.46 mmol/L while taking Norwegian Cod Liver oil. Blood panel suggests vitamin D and A levels are within normal range. I stopped the whole fish oil, problem goes away. I now take a refined fish oil capsule to evade vitamin D Exposure. How can I go about determining if I am Vitamin D hypersensitive without nearly killing myself via hypercalcemia again?

Yeah, that is tricky! How do you handle other food sources like wild-caught fish, and pasture-raised meat? But your levels are normal, so it sounds like you must be spending some time outside and synthesizing your own?

I wish that was the case… Sarcoidosis is one of a handful of disorders that spontaneously produce vitamin D3 on its own. In my case, without methotrexate treatment, it can produce over 100,000 iu per day! The standard advice is to avoid sunlight, stay away from dietary sources of vitamin D, and reduce calcium intake. When I am on methotrexate, the disorder is effectively deactivated. Thankfully.

In any event, I’ve started the autoimmune protocol, and after just one day, my chronic dry eyes are already much improved! I’m tired of taking toxic drugs to control this condition, so here’s hoping I respond well!

So, I’m guess what’s needed is vitamin A and vitamin K2 to balance the extra D production. Vitamin A is pretty easy to get on its own, but K2 is hard to find without vitamin D. The only source I can think of is bone broth.

That’s pretty cool that you’re seeing a difference so quickly!

I knew about vitamin A, but never even considered K2! My new mountain to climb, if you will. I will get on adding pastured bone broth to my meal rotation and report back!

Well, I’ve nailed the direct cause of my Dry Eyes. Dairy.

If I do not have any dairy, I can get through a day without any symptoms. If I have dairy, my eyelids begin burning after 2 hours, especially the leading edges where my tear glands are located.

I must then use a prescription cyclosporine eye drop to suppress my immune system locally, as well as take a combination anti-histamine/decongestant to keep the symptoms bearable. I still often end up with a foreign object sensation with the pharmaceuticals.

Sounds like a dyed-in-the-wool allergy to me, as opposed to a simple lactose intolerance issue.

I am unable to verify the problem exists with raw dairy, as I live in Canada, and its easier to get an 8 ball of crack compared to raw dairy.

Adios, cream in my coffee!

Should I consider a full allergy/sensitivity test, given this revelation?

I have a long list of “unexplained” and “stress related” symptoms including idiopathic hypothyroid, unexplained infertility, migraines, reynauds, badly breaking thinning hair “genetic” (I’m 36), eczema (dermatologist said never relAted to autoimmune) along with other issues. My mom has Hashimotos and Antiphospholipid Antibody (I’ve had one pregnancy loss). Every test they do is normal (8 vials of blood) and retests of a few things. though many tests are just barely within limits (dr isn’t worried) I’m thinking of trying this diet but I’m scared to make the change. Is it overkill if all tests are normal? I’m going to undergo IVF in 2-3 months for the unexplained infertility. Is this diet safe for pregnancy? Do you think within 2-3 months it could make a difference in the IVF working and me keeping the pregnancy? Have you heard of it helping treatments to work if I’m avoiding an immune reaction to food? I can’t find any info in the mainstream medical field. I just want to have definite answers. Thanks so much for sharing your knowledge!

Just wanted to add a question about how to chose which diet to do. The diet my rheumatologist said to try sounds like The AIP diet even though nothing has been diagnosed. The paleo diet seems much more doable. I want to be settled with one of those or neither before I do IVF in July.

I always recommend starting with a standard paleo diet and seeing how much improvement you can get from that before tackling the AIP (although standard paleo diet without nightshades is even better!). I do think it could help with fertility issues. You might also want to check out

Hello – I have followed your blog for about a month now and I am going to sound like a really big baby, but here goes! I have Hashimotos and know I need to be following this AIP. My problem #1 is that I had gastric sleeve surgery last August and most of what is on the list to NOT eat is what I do eat. It is so important for me to get protein in first and it doesn’t take much before I am too full to keep going. So, eggs, nuts and cheese are a large part of my diet as well as chicken. I still have difficulty with beef and pork sometimes. They are easy, quick and give me protein and good fat. If I sit down to eat meat, veggies and some type of carb I eat the meat and “maybe” one single bite of the other 2. Eating meat is pretty much the majority of my diet at this point. #2 I HATE Veggies…..seriously. I don’t like a single one of them except I can tolerate fresh leafy lettuce/spinich, etc. So, I know the answer is…too bad you big baby, you gotta eat them. But, I also would like to know what type of supplements (although I know is not best/first option) I could add to my diet to add in some of the nutritional aspects of veggies if I am not able to eat them. Scenario – I sit down with some steak & greens…I eat the steak and I am full, I am so not going to push myself to eat a veggie that I don’t even like when I am already about to be sick from being stuffed…..anyone that has had WLS knows, you cant even eat 1 extra bite after you are full or you are miserable…want to die, kill me now miserable. So, supplements do well for me because I can spread them out over the day and they don’t take up a whole lot of room (granted, I still cant take them when I am full) in my banana shaped stomach.
I guess I am just really stuck on where to start….changing my lifestyle and diet completely 8 months ago was a huge transition and I feel like I have done pretty well (Ive lost 130 lbs) so changing drastically again is so overwhelming to me when the staples I eat now are the things I need to cut immediately. Any suggestions on where to start or experience with others that have had WLS and what they have done?


Hi Sarah,

I’m looking into taking a drug that is a combination of salicylate (which apparently is the main ingredient in Aspirin) and a sulfa antibiotic. Do you know if the salicylate in Aspirin is responsible for causing leaky gut?

Thanks a lot

There are actually several different ways that aspirin increases intestinal permeability, but yes, salicylate in one of them. At high concentrations, it can open the junctions between the cells that line the gut (but not at lower concentrations… These studies were all done in cell culture systems so it’s hard to extrapolate to what would actually happen in your body when you take it, but its most likely at the lower concentration end of the spectrum). It also affects the permeability of the cell membranes (which is why it is combined with other drugs, as a way of helping get those other drugs into the body), which is reversible in healthy cells, but no one has studied what effect this might have on cells that are already under stress. The effects of salicylate on gut permeability are definitely weaker than aspirin (salicylates are also naturally found in many foods, so a small amount is a normal part of most of our diets). It is also the compound in aspirin that is typically the culprit for allergies to aspirin. I hope this helps.

Okay thanks a lot for the in depth response. I feel like drugs like methotrexate that cause leaky gut force people to stay on them forever because they never allow the body to heal the root of the autoimmune issue. I’m worried I could have the same experience with this drug, but at the same time I’m worried about permanent joint damage and being able to get back to school for next semester. I’m not sure what to do….

You are so generous with your hard-won information about AIP. Thank you so much. I’ve been following it 100% for nearly 3 months now. What do you think of adding mucilaginous, “slimaceous” teas (slippery elm, marshmallow, mullein) and DGL licorice in between meals? Would that speed healing of the gut lining? Apex Energetics makes something with those ingredients called RepairVite, but it’s soooo expensive, so I’m wondering if they are really that helpful.

It might sound funny, but when I say my prayers each day I pray specifically that the villi and themicrovilli / brush border will be healed and absorb nutrients the way God intended, and I imagine free-flowing villi like seaweed in the ocean. I also pray that my gut will “heal and seal”. I figure with all of my hard work, Heavenly Father will add extra blessings if it’s His will !

Oh, here’s another question: this past week my skin and eyes have become super, SUPER dry and thin, and insomnia has returned. Being 51 years old and peri-menopausal would you suspect it’s an hormonal imbalance, or, rather, that I am missing some essential fats? I eat salmon, sardines, grass-fed beef, chicken livers, etc. (btw, saliva tests showed my progesterone was off-the-charts too high 3 months ago, so I stopped supplementing progesterone–could levels have dropped that fast?).

I would recommend avoiding mucilaginous foods, especially concentrated supplements like DGL. They have mostly been shown to be immune stimulators, although the occasional cup of tea just because you like the taste is probably okay.

Dry skin and eyes could be a drop in progesterone (yes, it could be that fast), or maybe thyroid hormone? Are you eating enough carbs? I think many people go too low carb with the AIP which can put a strain on the thyroid (which is often already strained just by having an autoimmune disease). I would try adding in some starchy vegetables and maybe some fruit (try and stay below 20g fructose per day from fruit) and see if that helps. Keep on with the fish and organ meat, because that will help whether its progesterone or thyroid hormone.

Thanks a lot for your reply Sarah.

That mucilaginous supplement is a main focus of the 3 month protocol I’m on from my dr, for intestinal repair phase (plus the AIP diet). I would love to learn more about how they may stimulate the immune system. I want to be doubly sure I should stop taking the product if it is potentially harmful for AI.

I may not be eating enough carbs. Good idea! I’ll pay attention.

Good news about that RepairVite supplement with DGL. I emailed my doc and he said it is specifically formulated by Dr. Kharrazian (sp?) to be immune neutral and to encourage intestinal repair along with an AIP diet. Good luck working on this AIP book. I will stay posted so I can buy a copy. Thx!

I just found this site and have been reading through old posts. I am going to steal your imagery about villi! My 9 month post GF diet showed mine still were not growing back and now it’s over a year and a half and I know I am still not absorbing nutrients. Your prayer is beautiful!

I’ve been following along with updates (including questions and Sarah’s responses), and just wanted to post a great fructose resource (fruit only) from the blog real food forager. I’m pretty clueless when it comes to amounts of fructose, carbs, etc etc in foods, so for anyone with limited food options (especially carbs from starches/fruits), I think the more easy resources we have, the better! Here’s the link in case anyone else is interested (I just pinned it to my health/wellness board via pinterest).

Thanks again, Sarah for all of the information – you’re incredibly generous with your time and knowledge!

I have been on a paleo diet for a month and I am feeling worse. I have Chronic fatigue syndrome and hypothyroidism. Why would I feel worse on the paleo diet?. I donn’t eat any grains and no cow’s milk products. I eat mostly meats and most vegetalbes. I am allergic to many foods. Thanks

Paleo fixed my thyroid issue…I ate loads of wild salmon and Omega3 fish oil caps. But I am now doing the AIPP properly!! Definatley sorted out thyroid disfunction!!! Is your meat grass fed?? Becasue if a cow ate wheat and corn while it was alive, then you eat its muscle tissue ( a steak etc), you can have the wheat passed onto you…

Dear Sarah,

I made a special effort today here in London UK to find a grass fed freedom supplier!! I did! Wonderful hey! 🙂 They even sell marrowbones, which I heard is very good for health.. (one step at a time for me, as I have never boiled marrowbone before)!!
I ordered
Grass Fed Beef Dripping .
Roasting Joint loin (Pastured Pork)
Diced Meat (Grass Fed Lamb)
Diced Meat (Pastured Pork)
I can freeze most of it with herbs. But this will get me started! I was a bit lazy at the cooking when I first went Paleo last year, and still used loads of seeds and nut butters…
I might even have a go at making my own Paté one day as I have a VitaMix blender!! I would love to know how to make real gravy too.

Hi Sarah,

Thanks so much for all this information. It is organized so nicely and so well explained. Do you think probiotic supplements / fermented foods should be taken/eaten before or after a meal?

Hi there– I’m just starting the AI protocol to see if it helps me with my severe environmental allergies (I’ve had them for 30 years). I have adrenal burnout and am on a nutritional balancing program which uses Hair mineral analysis to determine what is going on in my system. I am supposed to be completely off fruit (and sugar of course) because my glucose regulation is out of wack. But cutting out fruit along with the rest of the AI regulations seems super restrictive. Today was my first day and I ate some berries. Do you think that just limiting fruit to lower glycemic varieties would work? I’ve been off gluten for a couple of years and on and off some other grains as I experiemented with GAPS and paleo…so the strict no grains/no dairy part of the AI is also a new way of eating now. I’m not even going into the FODMAP info.until I see how I do with a month on AI. Thanks for your informative site!

I can’t believe I forgot my main question! Before deciding to to the AIP I was looking at all of the info on avoiding high histamine foods. A lot of high histamine foods are part of the AI (ex: fermented foods, fish, avocados, etc). I don’t feel like I know enough about it all to know which I should be doing to heal allergies. I know I have lots of histamines– hence the allergies….but of course, this all stems from autoimmune disfunction. Do you have any thoughts on this? Thanks again!

Histamine intolerance is one of those possible consequences of a damaged gut. Not enough healthy gut cells to make the enzymes that detoxify histamine, and too many bacteria in the gut that can convert histidine into histamine. I would also save this for later. Especially if you don’t have overt reactions when you eat fish. And, especially since a high omega-3 content diet is one of the fastest ways to restore normal gut bacteria.

Fruit is not restricted in the AIP, except to make sure your fructose intake is beaten 10-20g per day. And of course, dried fruit is very high glycemic load. If you are worried about the impact on your blood sugars, you could get a glucometer and test your blood sugars first thing in the morning and after eating. Going too low carb can make adrenal fatigue worse (too high carb can too, of course).

I think it’s smart to save FODMAPs and other restrictions for a month down the road.

Feeling worse in the first few days of the protocol is common, right? i wasnt eating paleo prior to this (but was gluten free and off of fruit and most grains). Im feeling high cortisol at night and wondering if it may be a result of being too low carb? (i have adrenal burnout so my thyroid is most likely out of wack too. would adding in sweet potato work for more carbs? we are almost out of winter squash around here… and i cant overdo the fruit because it messes up my blood sugar and makes things worse. Thanks!

Yes, it is common and yes, add in some more starchy vegetables. And make sure you are getting good fats with your meals. Sleep as much as you can and manage stress as best you can.

Thanks for your input and explanations! My guess is that I needed to go lower carbs (because I was previously still eating grains)– and heal my gut some. I think most of the foods restricted on AI will be ok (or perhaps it’s just wishful thinking!).

Paleo Mom: have you looked into whether traditional OTC allergy medicine helps with autoimmune inflammation? I’ve been on your autoimmune protocol for several months and have noticed a huge difference in my autoimmune symptoms. For the spring pollen season, I added in Allegra D 12 hour and feel like it is also helping my autoimmune inflammation — in addition to nasal/throat allergy inflamation. Would love to hear your thoughts on this! And, thanks for the website — looking forward to your book.

I have celiac, hypothyroid, and a positive ANA. Due to painful tendonitis and stiffness all over my body, I take ibuprofen 2-3 times a day at 800 mg. If I shouldnt take NSAIDS, what should I take? Tylenol doesn’t seem to touch my pain at doses of 1000 mg at a time, should I up the dose?

Clinical trials have shown that high doses of fish oil (although I would recommend eating lots and lots of fish instead) reduces pain and NSAID use in rheumatoid arthritis. Another supplement that may help is collagen (or drinking lots of bone broth) and of course, everything else on the autoimmune protocol (lots of vegetables for the antioxidants, lots of organ meat). The drug naltrexone given at 3-5mg per day (also called low-dose naltrexone) can help both regulate the immune system and act as an analgesic.

Jessica, you probably already know this but don’t increase your Tylenol dose anymore than that. That is the maximum dose at a time you should take. Also, don’t take more than 4 grams (4000 mg) in a 24 hour period. Tylenol is one the leading causes of acute liver failure and death as a result.

I really appreciate the feedback. If I start the AIP do I have to be totally off ibuprofen? or can I start it and work to fond another option?

Hi, I’ve just found this post. I am starting- well, trying to in the face of all I’m reading now..- the Whole30 and am really looking forward to it; I have dealt with GI issues for as long as I can remember (I have Celiac Disease, diagnosed in 2002 & been gluten free since (I adhere 100% short of unknowingly taking in gluten anywhere), had a ‘normal’ follow up biopsy shortly later yet have had ongoing- seemingly worsening- GI disturbances daily. I’m ALWAYS bloated, virtually always tired (despite *+ hrs of sleep), deal with being ‘stopped up’ if you will often & occasional nausea. Despite trying innumerable approaches haven’t been able to figure out what exact/all foods are 2 blame (besides dairy and beans; I avoid those at all times). I recently saw a wellness oriented MD (a valid MD, though) who feels I must have other food sensitivities (through her I had both blood and skin food testing, ended up ‘needing’ to eliminate so many things I got frustrated & gave up) and feels I have gut permiability to blame as well. She did recommend a probiotic that has REALLY helped get things moving for me regularly, VSL#3. I really like that.). Most of Whole30s argument makes perfect sense to me; I’m eager to try it at least for a shot a better health, if not complete improvement in all my issues (fingers crossed!!!).

I am now really confused, though, the more I read about the autoimmune protocol and all that additionally eliminates.. Would Celiac Disease (even found to be under control via a follow up biopsy and, more recently, blood test showing no anitibodies) make me wise to follow that protocol? If so I have no idea what I’ll have for breakfast if I can’t have eggs in addition to the regular WHole30 ‘no’s (I haven’t had eggs in months, as they cause me unpleasant symptoms.. though tolerable).. AND I just planted 4 tomato plants in my garden.. whats better than fresh tomatoes from your garden?? 🙁 Most importantly, no sweet potatoes..?! That is a staple of mine, and was going to be my one form of starchy veggie when I needed a little more than the meat/seafood & green veggies (I am quite active). I’m already feeling a little discouraged by all I seem to ‘need’ to omit beyond that for the basic Whole30 and a bit overwhelmed by the accompanying AIP info. If you could offer thoughts I’d be grateful; thank you!

Are sweet potatoes a ‘no’? I’ve been eating them because I need more carbs– already I find too low of carbs gives me anxiety and worsens my insomnia (but I have adrenal burnout so probably react differently). I have tomatoes planted too– but maybe you’ll be able to add them in before they produce? That’s what I’m hoping for. I’m just starting this too– but if you’re overwhelmed maybe just do one at a time or think of it as a month of ‘no’s and then start adding if you’ve begun to feel better… Good luck!

Sweet potatoes are fine. You can try tomatoes, but I think they are probably the most likely to be problematic food of all the extra foods restricted on the autoimmune protocol (I had a meal with half a can of tomato paste in the whole pot last summer and had a flare for 3 months).

I would just stick with one thing at a time. If you feel great, no need to go to a more restricted diet. Also, I am in the process of revising this page. There are no vegetables that are omitted on the autoimmune protocol except nightshades. I will be clarifying this very soon (probably before the weekend).

Thanks to both of you for your responses! PaleoMom- I think your advice to stick to one thing at a time is wise, and I probably will have to; I’ve just read your posts on fruit & starchy veggies with SIBO as well as going Paleo without FODMAPS- as both are conditions I suspected re myself (being an 11yr confirmed Celiac w/ presumed IBS)- which I researched before ever looking into Paleo or knowing of this site. I actually already have an appt scheduled with a new GI doc here (in July) to be tested for SIBO.. although after learning about this way of eating, etc, I imagine that taking antibiotics for it- which I understand to be the standard treatment- may in fact have negative consequences in addition to the good its supposed to do..
In any case, between trying to follow AIP (will be tough, but doable) plus also taking into account the suggestions for those w/ SIBO or FODMAP problems, I think it will be tough to reconcile it all without going nuts.. But, I know I will simply have to decide whether to attempt cutting out EVERYTHING for SIBO & FODMAPS in addition to the regular AIP, or leaving some things in.

What I find really challenging/ unclear is knowing that I’ve truly “reacted” to a particular food. As I mentioned above, I never feel great, really, am bothered by constant boating, constantly stagnant gas to a greater or lesser degree (in a horizontal oval around my belly button), constipation (which has been helped immensely by a probiotic), and while I certainly feel notably worse sometimes (REALLY bad bloat, + flatulence, for ex), it’s typically just a steady level of discomfort. I have no visible symptoms to go by such as a skin irritation, swelling, or what not, thus find it hard to say “wow, I must not be able to tolerate ‘x.'” Does anyone else on here experience in the same boat and/or also face this added challenge of wanting to try avoid so much extra??

Try not eating broccoli, cauliflower, brussel sprouts, and wheat. That helps me some. Also avoid oats!

Thank you for the update Sarah! New information is always coming in. I really want to read your book to find out more about the reasons for these many changes. The information you share has always been welcome here.

I will keep these changes in mind, but I will also be using my experience and intuition in my decision making. I know you understand. Even though studies don’t show that eating low-FODMAP is helpful for SIBO or that eating insoluble fiber is harmful, that information isn’t changing my choices in that area. I’ve been studying my body a long time and it likes me to take it easy on FODMAPS and insoluable fiber. What I can handle changes depending on my level of health. The same goes for the amount of time that passes between meals. What works for me has been every 3 hours. When I’m healthier, hopefully I can go longer. I just listen to my body. I’m still trying to get a handle on how to get enough carbs into my diet without causing trouble in my body.

I suppose there are a lot of individual variables when it comes to an autoimmune diet. I’m not trying to be argumentative, just sensible. I’ve spent a lot of money and made a lot of mistakes jumping through the recommended hoops that keep on changing. Seems to be true of life in general as well.

Thank you for all that you do.

Funny. I really think the only two things that are different are removing the recommendations to combine the autoimmune protocol with GAPS-style avoidance of starchy vegetables and limiting fructose to 20g per day. Everything else is the same as I’ve always recommended, just spelled out more clearly rather than being spread across several posts and comments. Low FODMAP diets have been very well proven in the scientific literature to help SIBO, IBS and IBD, so I clarified that. But the whole point of the second-to-last bullet is that if you find something that works for you, whatever it is, you should stick with it!

Thanks for keeping this up to date despite being so busy finishing your much-anticipated book!

Just curious – what’s wrong with lemon balm? Are other plants from the mint family also not okay? I’ve always read/heard that lemon balm is good for people with Graves Disease.

It’s an immune stimulating herb. The whole “okay for Grave’s” thing comes from Th1/Th2 balancing, which is an out-of-date idea. As far as I can tell from the scientific literature, this doesn’t apply to mints.

Thanks, Sarah, for this great update of the AIP.
I dove in head first on April 1st in hopes of getting some relief from the awful itching I have from both psoriasis and eczema. I’m also getting acupuncture treatments and I’m taking Chinese herbs from the acupuncture clinic that are carefully sourced in the US. I’ve been so very careful about all the eliminations, I think, though I haven’t managed to get it all perfect, for sure. Some of my problems are sins of omission (like bone broth) but – as you can tell from the time stamp – my sleep isn’t always the greatest. I’m taking quite a few supplements. My work days can be very long, and sometimes I just decide to skip dinner and go to bed instead of eating and going to bed with a full stomach,
I’m discouraged that my itching is still so bad – I sometimes scratch myself bloody. I’m really careful to use coconut oil after my showers, but I’m not sure it makes much difference.
Sarah, I’m not even tempted to give up on this….I just know it will help. But do you, as a fellow skin-sufferer, have any particular advice for me??
I was counting on your book coming out soon – but I’m so grateful for all your help here. You are my guru!

Well, it’s hard to tell for sure from what you’ve just told me, but I do have some idea. First, and foremost, work on sleep. Get outside during the day (sun exposure on your skin is great for psoriasis but this is even more about melatonin production in the evening to help you sleep). Wear amber tinted glasses and keep the lights in your home very in the last 2-3 hours before bed. Go to bed early. Second, stress management, which will help sleep. Third, if you aren’t getting bone broth you could try adding a Great Lakes Collagen supplement (much easier, lots of glycine). Fourth, you could try switching from coconut oil (which can be a bit intense on very irritated skin) to a tallow-based moisturizer, emu oil or tamanu oil (I like to mix tamanu oil with either Green Pasture beauty balm or Vintage Tradition body balm). Either switch to using no soaps on your skin or something like Chrisal probiotic soaps–there’s links to most of these in my amazon store:

Thank you, Sarah. I’m trying harder to regulate my days to get to bed earlier – it’s a slow process to change some bad habits.
I got the collagen supplement you suggested and started it. And I’m looking to swap out my skin care.
I often do well all day without too much itch, but at night it takes off and sometimes actually keeps me from settling in to sleep for hours. I’ve started taking Zyrtec some nights to keep from going nuts….Do you think that’s okay???
And if it’s late and I haven’t had supper, is it okay to skip supper and go to bed a little hungry? I’ve lost a lot of weight in the past 2 years (100 pounds), but I still have quite a bit more to lose. One of the great things about AIP for me is that I really don’t have an cravings anymore, though I surely do enjoy the food that I eat. But I hate to eat and go to bed soon after. What do you think?
Thanks so much for all your help, Sarah.
And by the way – really awesome hair – love your glam photo!

I haven’t extensively researched antihistamines, but my understanding is that they aren’t problematic the way NSAIDs or steroids are, so I think it’s okay if it helps you sleep. Some of them can keep you from getting into the deeper stages of sleep though, so watch for effects on sleep quality. As for going to bed a little hungry, again I think it’s okay if it isn’t affecting your sleep quality (and it might be better than going to bed right after eating), and if you are getting enough nutrition during the day. So, again, watch for effects on sleep quality. Myself, I have this magic window of 3-5 hours after supper where I’m not overtly hungry when I go to bed but my stomach is empty enough that I sleep really well. If I wait longer, I’m often too hungry to fall asleep, and if I eat later, I tend to be more restless in the night.

Hi Sarah, thank you for all the research you do!
“Plants-based omega-3s are not predominantly ALA” – is this sentence true (I might have misunderstood, I am not a native speaker) or did you just mistype?

Dear Sarah, I have crohn´s disease (diagnosed in 2011) since then I have been hospitalized 3 times, and taken basically all of the medicine available on the market. All of my GI´s (during these past 3 years I have seen GIs on 3 continents, was diagnosed in Spain, continued treatment in the USA, and currently live in Brazil) have said that diet has nothing to do with my disease. Against the advice of my Dr. I tried the SCD diet and rather than a miracle cure, I got worse and almost had to have part of my large intestine removed. Remicade saved me from that surgery but it didn´t take long for it to stop working as well. For the past month I have been doing the Paleo diet (I have had less pain and bloating, but still a lot of other symptoms) and just this week I found your site and the information seems really interesting, relevant, and well researched. I am hoping that by making the autoimmune modifications I will see some progress! I was surprised that you don´t mention Crohns Disease or Ulcerative Colitis on your site, am I missing them? I am also wondering if you think that the medicine I am taking could be making my diet modifications ineffective? I currently am taking: 15 mg of prednisone, 5g of mesalazine, and 300ml of infliximab every 8 weeks. I am also curious about your thoughts on sweet potatoes, should I avoid them? Also, have you heard about Low Dose Naltrexone for autoimmune diseases? I would love to hear your opinion. Thank you so much for your time, hopefully I am just a few adjustments away from being another Paleo Autoimmune Approach success story!!!!!

The only recommendation I would make specific to IBD is to start with cooked vegetables. I would also definitely recommend digestive support supplements and focus on lots of fish, organ meat, shellfish and glycine-rich foods (the uphill battle with IBD or celiac is the damage to the gut makes it more difficult for your body to absorb all the nutrients it needs to heal). Yes, I do think your medications may be hindering your healing, especially the prednisone and mesalazine, but I still recommend getting the diet and lifestyle changes really dialed in (and work with your doctor on the best way to discontinue). LDN seems to be a very good option and is definitely worst looking into in addition to following the autoimmune protocol. There are quite a few differences between SCD and the autoimmune protocol, one of the chief of which is the AIP’s focus on eating very nutrient dense, healing foods (rather than just cutting problematic foods out). I think sweet potatoes should be fine. They are a high FODMAP food (one of the only starchy vegetables that is), but other than that, I think they should be fine. Don’t forget the importance of sleep and stress management.

This is brilliant, thank you for so generously sharing your research and recipes/tips/tricks with the internet-at-large. It’s great to find something so clear and concise and not overrun with science-ese. I was diagnosed with Crohn’s in ’98 and have had chronic sinusitis for 2 years now. We have just discovered Paleo and AIP and my adventurous (and healthy) husband is keen to make the lifestyle change with me. Looking forward to catching your book later this year.

Dear Sarah,

You are my new hero, Love, love, LOVE your updates to AIP and can’t wait for your book to come out! Currently I’m using carbonated water as a substitute for diet soda (my last little nasty habit), with or without a tiny bit homemade sugar syrup for flavor. I can’t find a lot of definitive information on carbonated water’s effects on the body, but I assume it could be treated like apple cider vinegar. what do you think?

It’s mildly acidic, so if you are drinking it with a meal it can potentially improve digestion. Between meals as long as you aren’t drinking a ton should be fine. I like it with fresh lemon and lime juice and it’s a pretty usual beverage for me to have in the late afternoons or with supper. 🙂

I have lupus and it effects my kidney’s. I was on raw food diet high on fruits before switching to paleo diet. I have messed up my digestion by being on a raw food diet or so many years. I have multiple food intolerances to dairy, soy, nuts. When i eat it feels like food sits in my stomach, when i belch it feels like the food will come back up. Most recently I am only 34 now in the beginning of peri menopause. I get severe headaches and extreme fatigue. I also have been told that I smell unpleasant (excessive body odor), despite excellent hygiene. It s uncomfortable to be around others because I do not smell anything. Doctors just tell me my lab work is normal, except low vitiamin d which is now corrected with supplementing no longer need vitiamin d.i have discontinued vitamin d levels are within normal range. I developed severe ringing in the ear when I continued to take 5,000 iu. I reduced to 800-1000 iu but still experience the ringing in my ers, so I stopped. I do take fermented cod liver oil, and probitic supplement which has helped. i still experience excessive sweating before my cycle, unable to sleep, acne which i have not had since i was a teeager and fatigue. Now when I eat fruit I start, within 30 minutes start sweating. Do you think perimenopause can make autoimmune disease worse such as excess estrogen? I have been following paleo diet but perimenopause symptoms have not improved? Do think there are any side effects with taking Supplements indole-3- carbinole (I-3-C) or Diindolymethane (DIM)? Any advice you give will be helpful.

Yes, perimenopause could be making an autoimmune condition worse. And vice versa. All of the things happening in your body that might be contributing to lupus may also be affecting your hormones. So, my recommendation would be the autoimmune protocol (including the focus on very nutrient dense foods like organ meat, fish and lots of vegetables), as much sleep as you possible can get (you may find that spending time outside during the day and then wearing amber tinted glasses and keeping light levels low in your home for 2-3 hours before bed will help), stress management (I would suggest trying mindful meditation), and digestive support supplements to aid with digestion. I’m not familiar enough with I-3-C or DIM to be able to advise you one way or the other.

Hi Sarah, I posted this a few days ago on the linked “the why’s about the AIP: Eggs” page but as I haven’t heard anything and given you’re always so prompt in responding thought I would post it here in case you rarely check that page (many thanks in advance!)

Hi Sarah, you mention in an earlier response to someone regarding breakfast sausage, “(there’s lots of options out there for pastured pork sausage, grass-fed beef/bison/lamb sausage).” Could you please point me in the direction of some of these options, either to make at home or for purchase in store/online? I’m having a hard time figuring out a palatable (and ideally quick, given having to get to work..) breakfast absent eggs (not that I loved them nor ate them frequently before, just now that I’m off my long time go-to breakfast of buckwheat & quinoa hot cereal I’m at a loss without eggs too..) as the last thing I want when I first get up in the morning is a lunch/dinner like meal.. and so far the only “breakfast sausage” recipes I found online taste just like something you’d make for lunch (spices like oregano, etc). Not being able to have any form of sugar on the Whole30 right now NOR various typical breakfast sausage spices like paprika given the AIP will undoubtedly make it more difficult to find a yummy breakfast substitute, but.. I’m confident they’re out there. Thank you!

There’s one AIP-friendly sausage recipe under Breakfast in the Recipes menu. If you make it with pork instead of beef, if will probably taste more breakfasty to you. I will have nine more recipes coming in my book (3 of which are traditional breakfast sausages). I was buying a great Farmer’s sausage from a local farmer that had pepper but no nightshades, but they’ve stopped making it. Tropical Traditions has some bison and lamb summer sausage that has no nightshades (does have pepper and I think coriander), but these aren’t breakfasty. What about bacon? Maybe you could have bacon and throw some Great Lakes collagen into whatever you drink in the morning.

Hi Sarah!

In your research, have you come across anything about the AIP and HLA-B27 related diseases like Ankylosing Spondylitis? I’ve read in some places that the reason it occurs much more frequently in people who are HLA-B27 positive (like myself) is because of a certain bacteria called Klebsiella that lives in the colon. Apparently connective tissue in HLA-B27 positive people looks like Klebsiella to the immune system so it gets attacked or something? Anecdotally, people have had some success with doing a no-starch diet and Ankylosing Spondylitis. Just wondering if you have any particular recommendations for this kind of autoimmune disease. Thanks a lot for the AIP update too, I breathed a huge sigh of relief when I read the updated list, I was so worried that I had been doing something that could be hurting me recovery.


HI James,
I have the exact same question, I am HLA-B27 positive and have AS. Have you come across anything since you posted this comment last year? I was following a no-starch diet for over a year and have developed a couple additional issues that I feel may have been brought on by not consuming enough carbs/starch.
The no starch diet worked at first (along with my NSAID), but after about 6 months my symptoms got worse again (but not as bad as pre-diagnosis) and I developed other issues. I’m trying AIP now (day 4), and am including starches, I’m just really scared I’m going to throw myself into an even worse flare than I’m already in. I haven’t been able to find any reports relating specifically to AS and AIP vs no starch. If you have any insight, I’d love to hear from you.

Hi Sarah, thank you for your response to my Q asking for direction on finding good breakfast options. Last weekend I found some (albeit beef) sausage at a couple local vendors, but in the ingredients of both was simply “spices” (all too common, of course.. *sigh*), so I figured I better resist.. I will look into online options like Tropical Traditions. Similarly, I’ve been eating mostly beef recently as I’m still unclear on what constitutes quality poultry (that having long been my go-to meat..), and plus the unfortunate fact I really don’t care for fish.. I can handle mild fish with enough other flavors on the plate to take my mind off the texture, but certainly not fishy fish.. I’ve seen you recommend eating as much cold water fish as possible for the Omega 3s; can you offer some suggestions as to the most mild of those options and good, basic ways one can easily prepare them, me being someone who has never cooked fish in her life..? Ha I’m sure I sound like a little kid, but I truly don’t care for fish.. yet want to try to incorporate it so that I’m not relying solely on beef (such a saturated fat-focused diet scares me..) nor, apparently, on poultry, which I now find a gray area!

Also, I’ve seen you mention on here collagen but am not familiar with it; what are the supposed benefits of eating (or drinking? I’m not sure if it comes in pill or liqued form) it, and how often is one advised to take it?

Lastly, I’ve seen you advise several ppl to wear shaded glasses near bedtime to help with sleep; is that, I presume, primarily helpful for those who have trouble winding down and falling or staying asleep, or do you feel it can help anyone achieve higher quality sleep, even those who seem to sleep fine yet wake up tired EVERY morning (as is my case, even had a sleep study performed that was found to be “perfectly normal”..)? I’m willing to try anything to begin regularly feeling rested for a change! 🙂

Hi Sarah,

Thank you for the wealth of information. Do you think that Bananas could be a cause of sensitivity in people with a leaky gut? If so why? I have read somewhere that they have lectins that worsen leaky gut. Is that true?



I haven’t come across any information that would support that. Although banana is a latex cross-reactor, so if you have a latex allergy, that might explain why bananas are a problem. Or I suppose you could just be sensitive to bananas.

Hi Sarah,

Thank you for all the info you share.
Do you think that dulse is an algae? or sea vegetable?
Is it ok to eat on the aip?
Thank you so much for all the good work!


Hi Sarah, thank you for your response to my Q asking for direction on finding good breakfast options. Last weekend I found some (albeit beef) sausage at a couple local vendors, but in the ingredients of both was simply “spices” (all too common, of course..), so I figured I better resist. I will look into online options like Tropical Traditions. I’ve been eating mostly beef recently as I really don’t care for fish.. but, I’m going to have to experiment to find one I do like enough to have every week; I imagine that eating beef- even grass fed- every day for lunch & dinner might not be the best thing 🙂

Do you have any suggestions for alternative protein options that are AIP-friendly? Mornings are always short on time for me so one thing I’ve recently tried for breakfast on the go is a smoothie (mostly vegetables w/ some canned ‘light’ coconut water; only a little fruit!), but I can’t figure out a good smoothie-appropriate protein source, which is of course key.. not being able to use any protein powder- all made from whey, egg whites or brown rice- nor nut butter has me stumped..

Lastly, I’ve seen you advise several ppl to wear shaded glasses near bedtime to help with sleep; is that, I presume, primarily helpful for those who have trouble winding down and falling or staying asleep, or do you feel it can help anyone achieve higher quality sleep, even those who seem to sleep fine yet wake up tired every morning (as is my case, even w/ a sleep study that found me to be “perfectly normal”..)? I’d be willing to try anything to begin regularly feeling rested!

Well, first, I’m not a big fan of smoothies as meal replacements since chewing is such an important signal for digestion. Nor am I a big fan of eating on the go since rushing around increases cortisol which hinders digestion. But, to answer your question, the only two AIP-friendly protein powders are collagen or gelatin (I like Great Lakes brand) or beef plasma protein (which does have sunflower lecithin in it, which isn’t the greatest, but is otherwise clean).

I have a quick question. I am considering taking the dietary leap after an autoimmune diagnosis. Once I go off gluten etc., will abstinence from it worsen the type of reaction I might have to it later on?

Initially yes. Once your gut has fully healed and your immune system is properly regulated, you should be able to handle occasional exposure (unless you have celiac, or an allergy).

I have a question (questions): I have IBD (I think UC based on symptoms but 2 diff drs have given me 2 diff diagnoses) and have tried GAPS, paleo, LDN, vegan…all to no avail. Considering this AIP but to be totally honest, I’ve had some psychological issues w/ fish since childhood and try as I might, can’t get it down. The liver…i think I’ve found a way to get that in. I’m intolerant to spinach, butternut squash, cucumbers, chicken, plus much more. I’m a fitness instructor who has to have extra calories to compensate for that. The last few times I’ve had salads, I’ve ended up sick and vegetables weren’t a big part of my childhood so I don’t have a broad scope beyond the “normal” stuff (most of which I’m intolerant to based on ALCAT) and don’t know how to fix them. So basically to sum it up, fish makes me sick and I don’t know what veggies to cook that I’m not intolerant to. Where do I start? I can do raw veggies, I love fruit, and I’m so confused!!

I would start with going to a grocery store or Farmer’s market and start picking up veggies you’ve never had before. If you don’t know what they are, ask. Then google how to cook them (really, most vegetables can be steamed, braised, or roasted very simply) and start trying new foods. And if you want to eat raw veggies, go for it (maybe look into plan enzymes to help digest them). How are you with shellfish? seaweed?

Hi Sarah,

Thanks so much for this resource. While my body issues pale in comparison to many people’s struggles, I still wanted to give an elimination diet a chance in order to try to clear up some skin stuff. I found your blog and a few months later I think I’ve got my body on the way to being figured out. Thanks again for making your resources available and so easy to understand.

Thank you so much for all the great work on this subject.

Here’s my question. I have read in other places that on the autoimmune protocol we should avoid mushrooms but you do not mention it in your list above. What is your feeling about eating mushrooms?

Hi Sarah,

I started drinking water kefir, but on the 3rd day my existing joint and muscle pain really flared up and I started getting extreme flu symptoms. Is this normal? Am I allergic to Kefir?



I stopped 2 days ago and so far the pain is getting better but at a slow rate. Long ways from where it was before I started Kefir. What do you suspect can cause this?



Kefir is high yeast, so it could be a sensitivity. Or it could be the sugar if you are very sensitive to blood sugar swings? Either way, I’d avoid it for now. How do you do with other fermented foods? If it’s the yeast, I would expect kombucha to cause a similar reaction. You might still be okay with fermented vegetables though, since the amount of yeast in them is so much lower than kefir or kombucha.

Thanks Sara.

I do OK with homemade yogurt so I will just stick with that. Just wanted to try something more potent. I guess it is too soon for that. I will try Saurkraut next.

Do you think my after Kefir symptoms will subside? Hopefully I didn’t cause any irreversible damage and made things worse for my self?

Thanks again.


I generally try hydration and a nap if I ever get a headache (rare for me now) and generally tough it out. But, if I’m really desperate for a pain released. I would take Tylenol.

Thank you. I tried willow bark tea, which usually will relieve it enough that I can handle it but this time it didn’t help. It may be diet related. I stay well hydrated. I don’t get headaches like I used to but when I do get one it will last for days and it will wake me up at night. I’ve only been on the AIP for about a week, but I’ve been gluten free for over a year, grain free for six months and dairy free for three months so I really didn’t have a lot of big things to cut out but still some things that I was eating every day. I am seeing some results already with stubborn symptoms that nothing seemed clear up, so obviously something I was still eating was affecting me negatively. I’ve lost tons of inflammation in the past year but I still have some stubborn residual inflammation that doesn’t want to go away. I’m really hoping the AIP will help with that, it seems to have relieved it a bit already. I wish I’d known about all this when I first became ill. I’ve been sick for so long that feeling better is absolutely amazing. I’m now looking forward to the rest of my life instead of just getting through each day 😀

Anyway, I just wanted to say thank you. I spent years and years going to doctor after doctor and only getting sicker until I just gave up and felt like I’d just keep getting worse. I really had no idea that a diet could change so much for me.

Hi Sarah,

This is by far one of the most in detailed blog posts on the AI Protocol I have found, so thank you. The auto-immune disease I have been dealt with is mild psoriasis, which has gotten worse since starting Paleo a few months back (Could also be due to a super stressful March). My psoriasis was definitely caused by a major over-exposure to anti-biotics. 3 months or so as a bad case of strep throat medication, 2-3 months or so as acne medicine almost directly following. After the acne subsided I began to develop psoriasis, and a lot of digestive issues which I thought was normal until about 6 months ago (I know this is very detailed, and I apologize).

Before I start and AI protocol with such drastic lifestyle and social changes I want to make sure I have it mapped out to where I can nail this the first try (I KNOW IT WILL WORK). So my questions are what is the best way to begin? Just bone broth, meats, some veggies, and probiotic enriched foods? Should I get added probiotic supplements? Should I try to buy all of the beneficial supplements above? I kinda just feel a mess and there is no real guidance I can receive (except from what I read online) as my insurance doesn’t allow me to visit any type of doctor that has any insight on healing through nutrition (I’ve called around forever) and me being a full time 25 year old broke student. I’m just trying to be able to enjoy summer activities with my friends and not be the guy that is walking around wearing pants in 100+ degree weather.

I understand that you’re probably a really busy woman but any answers or help would be much appreciated. I wish I had more doctors or knowledgable people such as yourself where I live.

Thank you,

Well, I guess the best place to start is whatever seems the easiest for you to do. It doesn’t have to be overwhelming and you don’t have to jump in with both feet. Since you’re already following a paleo diet, my recommendation on where to start in terms of diet is focus on organ meats, fish and a variety of vegetables, rounded out with probiotic foods, bone broth, regular meats, and fruit–as well as focus on removing nightshades, eggs, nuts and seeds. Organ meats are usually pretty cheap (they can all be ground and mixed with ground meat). I find canned fish to be the cheapest (and easiest) way to get lots of fish in my diet. If you cant afford grass-fed meat, just stick with lean cuts of regular meat and try to get more fish. Digestive enzyme supplements are a good idea if you have GI symptoms when you eat or can identify intact food particles in your stool. I think Prescript-Assist would be a good idea. If you aren’t getting broth every day, you could add a collagen supplement. With skin conditions its really crucial to get the stress management and sleep pieces to the puzzle in place too. You can always do the diet piece, see how far that gets you and then add supplements too.

Hi Sarah, this is an excellent, well-explained post (well, the whole blog!). I have just been diagnosed with MS and will go into the AIP full course. I am already off gluten, dairy, coffee, nsaids and many of the other no-items, so I don’t think the transition will be that hard. One question though, you mention that aloe vera and licorice root are “off”, would you mind explaining that a bit more? Many thanks, will definitely buy your book! Greetings from Stockholm, Ann

They are immune stimulators. Licorice stimulates cell-mediated immunity (aka Th1 dominance) wheas aloe stimulates humoral-mediated immunity (aka Th2 dominance). The old idea of using botanicals like these to balance the immune system ha mixed results (since there are far more players than Th1 and Th2), but these types of botanicals sometimes help people and sometimes cause flares.

Hi Sarah,
I’m so excited to have found your website! I had never heard of a paleo autoimmune protocol until now. While I have been playing with a paleo diet on and off for a couple of years now, I think that perhaps it did not “work” fully for me because of this missing link. I’m looking forward to exploring your site more (there’s so much information!) and have already pre-ordered your book! It’s always a little overwhelming to begin something like this, especially when others in the house aren’t fully on board, but I know the resources you have made available will help guide me!

Hi Sarah, I am completely obsessed with your blog!!! So much of information.
Do you have any cheaper suggestions for probiotic and prebiotic blend? As prescript-assist is quite expensive…

Prescript-Assist is the only SBO probiotic that has been well validated in the scientific literature. There are other options out there, but I’m not familiar with them to comment on their quality.

I feel like my diet is close to this right now (no grains, sugars) with the big exception of eggs, nut butters and coffee. I am happy to give these up but one of the issues I have is the red meat. This is something that always seems very hard for my body to digest. Any thoughts on if it will become easier once I eliminate the other foods? I do take digestive enzymes which helps with many of the foods I eat but doesn’t seem to do much for red meat. Additionally do you think the organ meats may be easier?

What kind of digestive enzymes do you take? You might try adding a Betaine HCl + Pepsin supplement, which is probably the best for trouble digesting meat (but also contraindicated in a variety of health conditions, so worth checking with your doctor first). The things that will make digesting red meat easier are the things that support stomach acid production and healthy digestion, like managing stress, getting enough sleep and activity, avoiding alcohol, not taking acid reducers or NSAIDs, eating a healthy diet devoid of gut irritants (which is sounds like you are doing, although if you’re drinking a lot of coffee that could be a culprit). Organ meats are definitely more easily digested than muscle meats, so that’s definitely worth trying out too.

Hi there,
Firstly thank you so much for all the fantastic information you share with everyone!

I’ve had Lupus for 19 years and have recently been diagnosed with breast cancer and have commenced chemo. I have been eating very similar to the autoimmune protocol for 6 weeks, however still having nuts, seeds and eggs. I have never had problems with food (no flares when I eat certain things, or bloating etc) so how can I tell if something does or doesn’t agree with me? I have also read that chia, gogi berries and some nuts are good for fighting cancer… any suggestions??


I would recommend getting a copy of Practical Paleo by Diane Sanfilippo. She has recommendations for cancer patients in addition to autoimmune disease. It’s tricky with both autoimmune disease and cancer because many of the recommendations for fighting cancer are immune enhancers that can make autoimmune disease worse. I would recommend sticking with a very nutrient-dense diet (like the one described on this page), and being very careful with supplements (and things like chia or gogi which are both immune enhancers). This is probably a good time to find a functional medicine specialist who can do some cytokine profiles and help tailor supplements for your situation. I would also highly recommend a strong focus on sleep and stress management. As for knowing if something doesn’t agree with you, the best way is to eliminate it from your diet for at least 3-4 weeks, then try it again and see if you notice any effects. If you check out my post on reintroductions, that should give you some guidance.

I have a quick question about L-glutamine. I just purchases some 500 mg capsules and the bottle says to take 10 capsules a day. Does this amount sound right to you and if not, how much would your recommend? Thank you!

Thank you so much! Your information and support is just amazing and can’t tell you how much I appreciate it! 🙂

28 year old male with autoimmune arthritis that began approximately 1 year ago. I have been on diet for 7 months. First 5 months I was on prednisone. I wasn’t aware that the diet is somewhat pointless while on prednisone. I came off prednisone and arthritis came back. I started methotrexate this week because the arthritis is too troublesome. I still have constipation despite adding magnesium. I plan on adding some digestive enzymes. Any other suggestions?

I recently reintroduced bananas into my diet and it seems to be causing hives which never happened before…. is this possible?

Hi Sarah, I’m hoping you can help me. I’ve been doing a pretty good job of following the AIP but have recently been diagnosed with a number of different issues. First, although I’m not on any thyroid medications I have high serum levels of thyroid hormone. I’ve also just been diagnosed with Sjogrens and Barrett’s esophagus. My GERD is severe (24-7) and I can’t take any chance of further burning out my esophagus due to the cancer risks so my doctor just put me on Nexium. Prior to that I was trying the apple cider vinegar protocol. To further complicate matters I have high uric acid serum levels. My physician believes it’s due to the larger than normal quantity of meat I’m eating along with the bone broth both of which are high in purines. Please help. I can’t seem to get this under control.

I would suggest taking digestive enzymes (both plant enzymes and pancreatin, but look for a brand that does not contain betaine HCl) and oxbile (again, look for a brand without HCl). With the nexium (and yes, with Barrett’s esophagus, you do need to take it for now), you will need extra help digesting food until you can correct the overgrowth in your gut that is causing the reflux. As for the purines, recent research shows that high sugar, especially fructose, is the problem (at least in the case of gout). That’s unlikely if you are following the AIP, but it might be preexisting. Diets rich in high purine content vegetables (mostly from the brassica family like cauliflower and cabbage) are known to decrease the risk of gout as is the inclusion of red meat in the diet. Are you eating a lot of veggies? That’s an important part of the AIP and can have a profound positive affect on gut bacteria. The other diet factor that is really important with overgrowth is getting plenty of omega-3s (lots of fish). You may also look at supporting liver function, meaning focusing on vitamins and minerals (organ meat, *fish*, vegetables, pink salt) and maybe taking milk thistle seed extract as a supplement. Make sure you are drinking enough water too (between meals more so than with them to optimize digestion).

Hi Julie, I’m from the UK and suffer from Sjogrens and gastroduodenitis so I have some idea of what you are suffering. I was told by a consultant here that a complication of sjogrens is defective mocosal secretions. An added complication is that you won’t be digesting carbohydrate very well because of low saliva production. I eat a fairly low carbohydrate diet (50-100 grams) depending on how hungry I am, and moderate amounts of protein i.e. 4 oz fish and 4 oz meat a day. I eat small amounts of berries but tons of vegetables i.e broccoli, cauliflower, carrots, leeks, cabbage, brussel sprouts, spring onions, salads, courgettes, often steamed, but mostly stir-fried in olive oil. I find avocado pears filling and soothing. Incidently if I eat a very low carb diet my eyes become worse and I develop Blepheritis. My eyes improve if I eat small amounts (50 grams a serving) of baby new potatoes. Digestive enzymes haven’t helped me, strict adherene to diet has.

I hope you manage to get your symptoms under control.

This is great information. I look forward to reading your book.

You state that chia seeds and hemp seeds should be avoided. Why is that?

I was also wondering if you knew anything about using Apex RepairVite and Apex Glutathione Recycler in conjunction with an elimination diet to help repair the gut.

Thank you.

I was told by my doctor to avoid fish and foods that are high in iodine as they often trigger an attack on the thyroid. My understanding is that these foods are good for people with hypothyroidism, but once it turns into Hashimoto’s, it’s best to avoid these foods. I would like to transfer to a Paleo Hashimoto’s friendly diet, and am in the middle of reading Practical Paleo by Diane Sanfilipino, but would have to make all the meals fish free and kosher. I am curious what your take on this is or if you have any recommendations for meals that fit the criteria?

Hashi’s sometimes goes with excess iodine (which is actually due to a deficiency in selenium) and sometimes with a deficiency in iodine. Even in the case of excess iodine, I do not recommend avoiding dietary iodine, but do recommend a focus on selenium-rich foods. The richest sources of selenium are fish. Plus, the omega-3 content in fish is extremely important for resolving inflammation. So, yes, I disagree with your doctor on that one. It might be useful to get both your iodine and selenium levels checked, and then you could decide on some targeted supplementation to help with the transition to the autoimmune protocol (which is my recommendation for Hashi’s). Zinc and iron are also very important for thyroid health. Incidentally, 90% of hypothyroidism is caused by Hashimoto’s, but many people never get tested.

I look forward to your book, 🙂 Until then could you tell me: will you write about what to do when eating out? I am on paleo already for two years, and I find very difficult to choose from the menu, when we go to a restaurant. I have Hashimoto, and If I try your autoimmun protocol, which is far more strict, I worry about, will there be anything, what I can eat in restaurants?

I do talk about eating in restaurants, other people’s homes and traveling, yes. My biggest advise is to call a restaurant ahead of time and ask if they can accommodate you. Often grilled and roasted meats, steamed or roasted veggies, salads (you have to ask for no nightshades or dressings, but usually you can get some olive oil and a lemon wedge) are usually fairly safe (often you can ask about seasoning in advance and get one with no seasoning or have them adjust seasonings for you). But, the most important is to have a dialogue with the kitchen (whether on the phone ahead of time or through your server). And part of this is knowing what you can handle on occasion (so, for example, I know I’m fine with pepper and other seed based spices but really can’t handle nightshades).

Hi PaleoMom, My only criticism is about insoluble fiber. I am a lifelong IBS sufferer who has finally found the answer with a grain free, FODMAP and Nightshade free diet. Over the years, IBS sufferers were told to take fiber. I can tell you first hand that while it may help temporarily, long term, it only adds to the IBS symptoms. Following the SCD protocol, I have been able to add a lot of soluble fiber through veggies. I used to avoid veggies because of IBS, but now that I know it is only FODMAPS that I need to avoid, I now know what to eat. So you may want to add a caveat to the fiber myth as it relates to IBS.

This is an oddball question but I figure I haven’t asked you a wierd one in a while so it’s a bit overdue 😛

I’m seriously considering trying Fecal Microbiota Transplant ( <— why I'm not just posting this on your Facebook) with a friend who has what I like to call "superpowers." Naturally very thin, no bloating at all in the stomach region, never had acne, allergies, or asthma, etc. So I figure if I have his gut bacteria I would get his superpowers. My only concern is that he eats gluten/nightshades, etc., do you know if simply transplanting his poop into my large intestine could cause me leaky gut/autoimmune issues?

I also have never said this but I'm really starting to believe that the AIP has changed my personality. I feel much happier and a lot of people have been telling me I seem like a completely different person than I used to (in ways I'm happy about). I really think a lot of my social anxiety was caused by inflammation and general bad health. I used to always have social anxiety but I've been noticing recently that it just doesn't happen, as in I'll reflect back on talking to someone and be like "Wow, I really wasn't self conscious at all I didn't even think about it!" And considering that almost everyone has some bad health these days, I really feel that a lot of people's issues with relationships and stuff could be resolved by calming inflammation and fixing micronutrient deficiencies.

That’s great James! (about feeling happier, I mean!). I think fecal transplant is pretty darned cool. There doesn’t seem to be a really standard process for choosing a donor, so healthy superpower friend seems like a good thing to try. When you talk to a doctor, they might also have donors they use frequently with good results, so keep an open mind there. There really shouldn’t be too much of an effect from gluten or nightshades since it’s going into your large intestine and where gluten and nightshades do the most damage is in the small intestine, but I’m sure you could ask for friend to abstain from those for 24-48 hours before the procedures just to be on the same side.

There is a Dr in Portland, Dr Davis that offers FT Therapy. He also is a great resource and does phone consults. If you are interested and can’t find his info let me know and I can send it your way. I think he could answer a lot of your questions. I am really considering this in the future as a complement to helminths.

You mention that the AIP diet includes eating 8-14 cups of vegetables a day. That seems like a lot for me. I can eat about one cup per meal, then I’m full. I’m guessing that I’ll need to start making smoothies to incorporate all those veggies. What do you recommend?

You could do smoothies with your meals (I recommend not having them on their own since chewing is such an important signal to the digestive system) or you could try reducing your portions of other foods to make more room.

Hi there, I am IR, Hashimotos, and I fear a leaky gut as well as the inability to process fructose. Exactly 24 hours after I have eaten say a watermelon slice, I get dizzy like my blood sugar is dropping. But testing my blood shows I am not low at all but within a normal range. I am very confused as to what diet to try. AIP. Paleo, IR, Leaky gut, which to do? I need help please!

I don’t know exactly what you are eating now, but after extensive research I feel that AIP is absolutely the best bet for any autoimmune disease. That being said, you might want to try standard paleo as a starting off point, especially if you are eating a typical Western diet now, and see how far that gets you (some people with autoimmune disease have great success with standard paleo and never need to do the AIP).

My Husband (34yrs old) has spend the last year working hard on healing his body. He has several auto-immune disorders. Following a 90%(he still eats a little gluten-free oats, rice, and beans due to the challenges of having Crohns) Paleo style diet… he has achieved AMAZING results including losing about 55lbs, debilitating Arthritis.. managed, constant Atrial Fibrillation…managed, Crohns/IBS…managed. He has been able to go off all his meds. Three different meds for the A-Fib and he’s off the Embrel injections. However, his Psoriasis has gotten much worse… out of control… the worse I’ve seen it. He seems to be having a similar experience that you described having yourself. He has tried to go on Candida diets. However, he has Crohn’s and can not tolerate raw vegges and only small amounts of fruit. He just feels horrible after a few days. After a year of watching his body’s reaction to food… we are totally convinced that he has leaky gut and/or a yeast/bacteria overgrowth in his gut. What are your thoughts on juicing? I have read that people living with Crohns can often tolerate veggies juices. BTW- The only thing that we have ever found that helps his psoriasis is The Lemonade Diet… he has tried this in 4-5 day trials… he wasn’t able to maintain enough energy to work a physical job though. We would appreciate any thoughts you may have!

I think that adding vegetable juices on top of eating some cooked veggies and drinking them with meals is a good idea. You might also look to the oats, rice and beans as culprits here. Eating more organ meat, pastured animal fats, fish, and bone broth can help too. Also a supplement like Great Lakes collagen may be helpful. Sleep is really important too.

Hi Sarah,

Thank you for all your.

Do you know of a good and reliable test to check for leaky gut and intestinal infections from parasites or microbes?



Hi Sarah!
I am very interested inthe AI as I have had digestive issues since I was a child. I recently tried a 30-day strict paleo challenge (I am already going gluten, dairy, bean and soy free because of intolerances). Unfortunately, strict paleo with a lot of veggies made me really sick. I experienced severe stabbing upper stomach pains with any dark green veggies, squash or acidic fruits/veggies. It has been very frustrating, and I have continued to try as strict paleo as I can, but it so hard when I have to eliminate so many veggies. I eat a lot of meat and some eggs because these are usually safe for me. Do you have any suggestions to resources or advice? Any help is GREATLY appreciated!

Hi PaleoMom, I am thrilled about your upcoming book and plan to pre-order. I wanted to ask you about the use of coconut in your recipes. The reason I am so excited about the book is that I have a son with allergies to egg, nuts, soy, legumes, dairy, buckwheat, and coconut. I know that your recipes will not include any of those except for the coconut. The book will not be helpful to me if many of the recipes include coconut products. I am hoping to heal his gut and have thought about GAPS in the past, but haven’t been able to pull the trigger. I am thinking your protocol will be very helpful. I have also been using avocado oil for high heat cooking, when animal fat won’t do. I did not see it mentioned in this post and I was wondering what your thought are on the subject. Thank you!!

While coconut is considered okay in moderation on the autoimmune protocol, I personally don’t tolerate it well and many people have issues with it. So, I have gone to great effort to create coconut-free dessert recipes for the book (in fact, I think only 8 or 10 recipes contain coconut out of 150, and most of the desserts do not). Also, avocado oil has a very high smoke point, so I think it’s great for high temp cooking.

Sarah, thank you for all your hard work on auto-immune diseases! I want to start the protocol but I have several issues and was wondering if you had any tips for me. I have auto immune hepatitis, IBS, PCOS, endometriosis, RA, and fibromyalgia that I know of. (I imagine I have others as well.) I also have extremely weak bones and teeth from spending my teens on high doses of prednisone. (160 mg) That tends to worry me about cutting out diary. I also cannot have ANYTHING with iodine. (I can’t even use iodized salt. ) No shrimp or shell fish. Any tips or advise would be greatly appreciated!

Dairy is not very absorbable/usable calcium. I would suggest supplementing with fermented cod liver oil if you can tolerate it, lots and lots of homemade bone broth, lots of organ meat (especially liver), and lots of green veggies, and maybe a collage supplement too for bone health (this should also help RA and fibro). Why can’t you have iodine? Iodine excess is usually a symptom of selenium deficiency, so it would be worth getting tested and probably supplementing (the best food sources of selenium are sea food).

Thanks! That is very helpful! Iodine causes hives and respiration problems for me. (Oh, I have asthma as well.) My airways tries to swell shut. I have even had reactions if someone touches me after handling shellfish/shrimp/etc.(also severely allergic to peanuts but that won’t be a problem..whooo) I know some people think that you can have an iodine allergy but for some reason I have a major problem with it. Can you check selenium with blood work? If so I could ask for it to be check with the next lever panel I have done. I am new to this site but, I have seen a lot about your new book. How many recipes will be AI protocol friendly? Thank you so much you have given me hope that I might be healthy one day!

In my book, 100%. My understanding is that you can test selenium, but I could be wrong. Also, I’d suggest getting your iodine checked too and see what’s up with that. 🙂

Hi! I have pre-ordered your book! I just wish it was out now! I have also just ordered the supplaments you recommended. I was hoping you could offer a general guideline of how much to take of each supplament and whether to divide up the dosing. It would be immensely helpful if you could do that! And maybe which ones are for long terms and which ones might just be until our stomachs “get back on their feet!”

Hello Sarah, I’ve been strictly following the AIP for about a month now, trying to beat gut dysbiosis and acne.

I was wondering what your thoughts are on the different types of dysbiosis? I have clear cut symptoms for both SIBO and putrefaction dysbiosis, but they’re treated with contradictory methods.

Also, would you suggest the Green Pasture’s plain FCLO over the butter oil blend for someone sensitive to lactose?Thanks

I think in either case, adding digestive support supplements will be helpful (plant enzymes plus pancreatin and probably ox bile too). There should be no lactose in the butter oil blend. I usually recommend just FCLO for autoimmune disease because trace dairy proteins can be a problem for some (but if you know you’re fine with ghee, then the butter oil blend should be fine).

Hi Sarah, I love your work and look forward to reading your book. I’m taking meds (T4 and T3) for Hashimoto’s, and over the past few years I’ve cut gluten, all grains, coffee (switched to tea) and most recently dairy. I do eat eggs, nuts, seeds, with no side effects. I teach high school, and sometimes it seems my brain uses all its energy and I become foggy. How might you address that with diet? I eat eggs, bacon, sweet potato for breakfast. Seems better with the carbs, for sure. My other issue is that I’m an athlete—I run 10-12 miles a couple times a week. Where can I get those extra carbs without turning to rice or quinoia? I don’t have any symptoms that appear when I eat those things, and I’m guessing potatoes should stay off the list. Thanks!

Hi! I have pre-ordered your book! I just wish it was out now! I have also just ordered the supplaments you recommended. I was hoping you could offer a general guideline of how much to take of each supplament and whether to divide up the dosing. It would be immensely helpful if you could do that! And maybe which ones are for long terms and which ones might just be until our stomachs “get back on their feet!”

I wanted to post an update since starting the AIP. I’m not sure if it was the best idea but I went from Paleo to AIP and also cut out FODMAP at the same time. I noticed drastic results from the FODMAP part of the diet with great reduction in gas and diarrhea. It was only after this improvement that I realized the improvements my crohn’s/colitis had undergone from my diet and helminthic therapy. I had to stop eating beef due to a continued sensitivity so I decided to move from AIP back to Paleo (needed more food options) to see how I reacted. It has been about a week and things are still going well. I was able to reintroduce eggs (every other day at most for now), almond butter and small amounts of coffee with no changes. I have also cut out pro-biotics for the time being, and will try adding them back in a few more weeks.
I have stuck with FODMAP very strictly (about 3 weeks now) and can’t stress how drastic the improvement has been! Please read the part about FODMAP’s above, if you have digestive issues such as bloating and gas after meals I would highly recommend trying it.
A huge thank you to Sarah for including this in the article, there is plenty of info out there about the diet but I don’t feel like you come across it very easily if you aren’t directly looking for it.

I am about to begin a Paleo diet, of which there are many versions. My reason is suspected Sjogrens which causes chronic pain and fatigue.

I noticed you mentioned foods that cause allergic reactions should be taken into diet consideration. I often get a mild-moderate reaction (throat closes) from eating certain UNCOOKED fruits/nuts and veggies (eg. bananas, melons, broccoli, carrots, walnuts, etc). If any of those foods are cooked I can eat them with no “noticeable” reaction (except sometimes fried eggs still cause a reaction).

I went to an allergist who said it was a reaction to the proteins in those foods, and not a true food allergy.

Should I abandon the known reaction causing foods even if they are cooked first? I see you don’t allow eggs, so that is taken care of.

Your very details writings are appreciated. I will be looking for your book. It’s been 10+ years of searching for the root cause, I sure hope this works!

Thanks much.

I’m not sure I have an answer for you. Generally, if you are sensitive or allergic to a food, I recommend leaving it out in addition to the protocol. I’m not sure why a food would work better for you cooked versus uncooked, other than something to do with denaturing the protein that is causing the reaction. I guess go ahead and try leaving those foods in cooked and see how you do and keep them in mind as a culprit if you aren’t seeing the kinds of improvements you’d like to see.

Thanks for the response. I’m glad I can begin with eating the cooked form, or I’d be left with precious little to eat other than meat.
I wonder if getting some form of allergy treatment would help with the reaction to so many uncooked foods.
I look forward to your book release. Any idea if it will be available on the google play store?

Hi! Thanks for the wonderful, informative info. I suffer from ra. I have read so many things about having to avoid meet. I know ra is a form of autoimmune disease. Your info seems to include eating grass fed meet. Do you suggest cutting out all meet if you suffer from ra? Thanks!

Thank you Sarah for all this information. I have been here for almost two days devouring your site. You may be my missing link, here I was thinking I was doing it right, when I still have it all wrong! I will definitely be getting your book.

My story: I have been hypothyroid for 30 years and just found out in June that it’s actually Hashimoto’s. I also have Raynaud’s and all the markers for Sjorgren’s. I switched to Armour Thyroid, went gluten/soy free and discovered HIIT almost 4 years ago and the results were miraculous! My laundry list of problems, and 15-20 lbs, went away. I have tested negative for gluten sensitivity twice, but am never going back. I thought I got a handle on my adrenal issues and have been doing Bulletproof coffee/low carb/Intermittent Fasting for a little while, and still feel much better than I used to. I take Vit D3, K2, Astaxanthin, 7-keto DHEA, CoQ10 and just started Acetyl-L-Carnitine to try to put on mass. All of the things on the ‘NO’ list have been my go to items when I dropped gluten. Eggs, nuts, seeds, raw goat dairy, whey or hemp protein and guacamole with tomatoes and jalapenos. I have had no luck building muscle mass or putting on weight. Everyone says I’m too skinny, but I know I’m not and have no desire to put the visceral fat back on now that it’s gone, or go back to feeling miserable all the time.

I guess my question is, how do I keep the weight on if I cut out the protein shakes? Whenever I take a break from them, I lose 5 lbs and strength, not what I want to do.

I am starting the AIP protocol today, along with any other insights you can provide.

Thanks again,
Mary Lou

The best thing is to make sure you are eating enough. You might be finding it hard to get those calories from solid food so when you cut them out, you just aren’t eating enough. I suggest figuring out how much protein, fat and carbs your shakes normally gave you and find some dense sources of those that you can replace them with.

Thanks Sarah, I just feel like I’m eating dinner all the time. It’s amazing how many ‘little’ things have changed after only a few days without the cross reactors. The white spots on my nails are gone, tongue coating as well, sleep is a bit better too, I think. I’ve noticed a bit of rumbling (not hunger) when I eat, so I’m adjusting, I guess. I’ve notice I don’t have the energy to work out in the morning without my bulletproof coffee, so I switched to the afternoons and that seems fine. Can’t wait for more details on avoiding ketosis and IF, I’m guilty of both, but felt great in comparison to how I was a few years ago, so I’m confused. Definitely have to have the array 4 done after reading the most recent posts. Thanks again!

This sounds like my story too! I was hypothyroid for 30 years and just found out I have Hashimoto’s. But what is HIIT?
I am still suffering from exhaustion after quitting wheat, and all grains for 3 months.
What can I do to help my body get better?

HIIT=high intensity interval training

I recommend the diet outlined on this page, lots of sleep, spending time outside, lots of low to moderate intensity activity, not going too low carb (important for thyroid), focus on nutrient density (especially seafood and organ meat for thyroid, but don’t skimp on the veggies either), and managing stress.

How can I tell if milk is helping me or hurting? Sometimes, its the only thing that calms my stomach inflammation, and others times it seems to make my overall swelling worse. I will be trying this diet for the first time, so I am assuming I will know when I try to add it back in, but just was curious if there was a good way to tell.

The easiest way is to cut it out for a few weeks then add it back in. It might be helping because it stimulates mucus production, but hurting due to intolerance, so right now you’re getting a mix.

Hi again Sarah,

Do you go into acid/alkaline in your book too? I hope so, as I was running extremely acid (5.0-6.5 saliva) even though I was strict paleo with the exception of raw goat milk/cheese. I haven’t checked recently but I think I will in a couple of weeks if you think it’s a good idea.

I just found your blog yesterday and wow, I love it and have learned so much! I’m coming off of a Whole30 that I did for about 24 days last month, which ended for no good reason other than thinking I was fine and it was all mental. Well a weekend of carbs (pasta, pizza, scones) and dairy (cheese, and cream in a latte) and that was enough. I’m considering the AIP and low FODMAP but want to make sure I’m not doing more than necessary as I struggled with the limitations of the whole 30 already. I don’t have anything diagnosed (yet) because I can’t afford to see a naturopathic provider or do any testing. I’m only 27 but my symptoms are joint ache/pains and stiffness (fingers, wrists, elbows, toes and sometimes knees and hips) daily, along with daily gas, bloating, and small floating stools every couple days (some constipation). I hardly ever have normal stools anymore, only showed slight improvement during the whole 30. I get dizzy, fog brain, mild-moderate headaches, and nauseated often as well, I think from grains/gluten (after pizza I was out for a day). So as I was doing my whole 30 this last month I stumbled across night shades and coffee and potentially causing my joint pains and plan to take those out, but what are your thoughts on AIP and low FODMAP for my other symptoms? I’m also starting to take cod liver oil daily- should I also be on a probiotic? I currently don’t eat any fermented veggies. Any suggestions on what to get tested when I see my PCP? I’m new to all of this and want to do it right. I’m tired of feeling the way I do or trying to convince myself it’s just mental (especially doesn’t help that my coworkers think I’m crazy)… Thanks for all your very helpful posts and articles. I can’t wait for your book! 🙂

I forgot to mention that I have always had poor circulation- my hands/feet are almost always freezing cold or if they are warm they are very hot. Also, if it matters at all, my hubby and I are planning/hoping to get pregnant in the next few months/year.

You could try the AIP and then start reintroducing once you see improvement, but I think standard paleo less high FODMAP foods makes good sense given the symptoms you describe. It would also be worth being very mindful of your omega-3 intake (may help the circulation issue but also help correct gut dysbiosis, which it sounds like you have). It would also be useful to look into digestive support supplements (described on this page). A probiotic or incorporating probiotic foods may help too (but you could wait until your stools normalize if you want). If you wanted to get tested for something, the SIBO breath test and the FODMAP breath test seem like the obvious first steps.

Thanks for your input!! So you don’t think I need to try the AIP for my joint pains? That was my main concern, or should the standard paleo plus less high FODMAP help with that too? I’m much more overwhelmed by the limitations of low FODMAP than AIP.

Dear Paleo Mom, would you advocate against eating prunes on paleo autoimmune protocol? They just help me so much & is it OK to eat 100 gr of them a day? Thank you

Hi, I was curious which sea vegetables you recommend and do you get them online or at an Asian grocery store (we have super h mart here in Atlanta)? I am not very familiar with any besides what is on sushi rolls. Also, could I eat kelp noodles? I just came across them at Wholefoods and thought they would be okay.
Thank you so much,

I love kelp noodles. Also like something like sea snax. Those are really the only two I buy regularly, but I also sometimes make a Japanese broth with kombu kelp and bonito flakes.

Hi Sarah! I have been in remission and walking for a full month now with no medication! I really can’t thank you enough, I would have never found or been convinced to do the AIP without you. I truly feel so lucky that this disease happened to me for many reasons, but the biggest reason is because of how dramatically doing the diet changed my life. I really believe that I was destined to have a pretty miserable life if I had never found your blog, I am still having health issues but I am happier than I’ve ever been.

I’m still having some issues which I think are being caused by SIBO. I’ve cut out all starches and FODMAPs for a few months now and I’m still always bloated and I never poop unless I take magnesium. I’m considering trying raw garlic as an antibiotic at the same time I do a week of FMT (I’m thinking that maybe the SIBO is being made worse because my large intestine has an imbalance which makes me constipated, thus it gets backed up and allows bacteria to overgrow in my small intestine?) do you think that’s worth a try?

Also because I’m not eating any starch, I find I’ve been going over the Fructose limit of 20g (I’m eating about 35 g a day). Even carrots and radishes have about half their sugar content from Fructose, and other than that I only eat kale and leafy greens for veggies, so if I only eat 20g of Fructose it’s really hard to get more than 40g of carbs a day (which is definitely too low right?) I’m not sure what to do, do you have any recommendations?

Dude! You’re in remission!!!! That’s FANTASTIC! Remind me whether or not you’re taking digestive enzymes? I think a good thing to try would be taking a plant enzyme, reintroducing some starchy vegetables and working on reducing the fructose (which might be causing the bloating) while continuing with magnesium (there’s benefits to a magnesium supplement beyond softening stool, so taking it every day isn’t a problem). Clearly, if you are in remission, good things are happening. I think the best plan now would be to get into a holding pattern to allow your body to continue to heal. The constipation might not be SIBO or FODMAPs per se, but may be an issue with gastric motility (which is regulated by melatonin and serotonin) or even nerve issues (if you have had chronic constipation for a while, it could be nerve damage), which are a little slower to fix themselves. Congratulations though. Remission is great news!

Yes it feels amazing! I also think it’s so cool that I’m part of the first generation of people to put a debilitating illness into remission on my own. I also have come to believe that the AIP is the “holy grail” of diet for health and I plan to eat this way forever (and my kids will have to also 🙂 ) I stopped taking my digestive enzymes and Betaine HCl about a week and a half ago, I just have been getting paranoid about taking supplements recently, my SIBO seems to have actually been slowly getting worse over the past 3 months or so and I didn’t have that much of an issue with it before I started taking the digestive enzymes and Betaine HCl. I was worried maybe that taking the enzymes was preventing my body from being able to make them on it’s own or causing other issues. I’m not sure what to do in terms of that. If I try some plantains for example and get really bloated should I still try to add a little bit in each day?

Also I just recently read a book called The Power of Now by Eckhart Tolle, you may have heard of it, but it really has made a huge difference in my daily fulfillment and stress. Not as much of a difference as the diet though! Also I’d love to write a success story for your blog if you’d like!

I would love a testimonial from you James! 🙂 You have a really powerful story to share and I’m sure you will inspire many! I would be a little leery of too much HCl (most people will have GI discomfort or warmth with too much, not everyone)… did you have obvious symptoms when you optimized your dose? Digestive enzymes should be fairly safe to continue (you could always try a half dose–the ones I take are 3 pills per meal, so if it was something like that you could take 2 or 1 and slowly wean off). If you get bloated after some starch, wait a couple of days and try less the next time you eat it. If it’s really not working for you, don’t do it.

I will definitely write a story and e-mail it to you, maybe I’ll wait and see if I can get my SIBO cleared up first. Thank you so much for all your help!!!

HI Sarah,
I recently stopped taking amitriptyline and hydroxyzine but am still taking 1 elmiron each night for interstitial cystitis. I have been gluten free for almost 9 months and, dairy, peanut, and egg free for about 6 months. I started paleo this past Sunday and plan on starting the AIP diet in a few weeks. I am waiting because I am currently fruit free (possible candida) and couldn’t imagine cutting everything else out at the same time. My question is, ever since stopping my amitriptyline I have developed tension headaches. I wake up every morning with one and it comes and goes throughout the day. I currently see a chiropractor and massage therapist 1 a week and it is not helping. I can’t stand waking up with a headache and makes me feel anxious in the morning. Do you think it would be okay if I started taking the amitriptyline again (10mg) without it hindering improvement with everything else? Or would it be better to take Tylenol when I need relief? I don’t plan on taking it forever and will try to go off of it again after awhile, but I start student teaching in September and do not want a headache everyday. Plus my frequency/urgency seems to have gotten worse as well. I am not sure how long it takes for the bladder to begin to heal but maybe I should just wait to see if the AIP diet helps? Would headaches be one of the first things to go? Any suggestions would be great!

I think it’s very likely that your headaches are from being too low carb. Are you eating any starchy vegetables? Are you getting enough good quality fat? The two diet factors that are the most powerful correctives for gut microorganisms are fiber and omega-3 fatty acids. Why would amitriptyline help headaches? I’m not super familiar with it, but anything with that many common gastrointestinal side effects is something I would be weary of.

I am eating carbs, I made some pumpkin muffins with no sugar, eating squash (mainly yellow and spaghetti), zucchini and sweet potatoes. For good fat I use coconut oil, olive oil, pure coconut milk, a small amount of nuts and grass fed beef. I started reading about tension headaches and amitriptyline is prescribed for them if they are chronic, it also helps with anxiety which I have been feeling a lot lately. Could an overgrowth in yeast be causing them? Is SIBO the same as candida? My main goal right now it to try to get rid of my headaches, backaches and sinus congestion and then of course attempt to heal my IC, endo, hypothyrodism, adenal fatigue and hormonal imbalance. I guess I am just not sure which “diet” to follow right now and for how long until I know to eliminate more foods. I am not really having any stomach bloating or cramping from foods currently so I am guessing just the AIP. Also, I do have a yeast sensitivity (testing done), should I be avoiding sauerkraut, pickles, homemade coconut yoghurt and things fermented as well?

Candida is a type of SIBO (and often misdiagnosed since overgrowth of bacteria is more common). Yes, it could be causing the headaches, but more likely culprits would be food sensitivity to something you are eating, inadequate sleep, or high cortisol. I do think straight AIP sounds like the best option for you compared to GAPS or candida diet etc. If you do have a diagnosed yeast sensitivity, I would suggest finding a yeast free probiotic supplement (like Prescript Assist) and avoiding all fermented foods (since all of them will have some yeast).

I appreciate all of your help! Thanks, I will try AIP and see how I feel. I do have high/elevated DHEA,my pooled value was 11. Is there anything you know that can help lower it besides decreasing my stress? I will start to avoid fermented foods, but was wondering if making coconut yogurt from young coconut meat and a pro-biotic would be okay, I was going to make this recipe or would that still contain yeast? Thank you again!

I don’t know enough about elevated DHEA to have a specific recommendation for you. Kefir is even higher in yeast than using a yogurt starter. You could make coconut milk yogurt using a yeast-free probiotic (lactobacillus based like Kirkman BioGold) as a starter.

Hi Sarah!
Thank you for your response to my question about bone marrow soup on FB! I’m not sure what is the best venue for my questions, FB or here? I’ve been doing the AIP for almost 4 weeks now to try to manage my Raynaud’s symptoms and I keep finding new, and often times, conflicting information on what I should/should not be consuming. If I can find this information somewhere else on your site, please just point me in the right direction.
1) I’ve read on your site I should not be eating coconut flour, flakes and I am deducing coconut manna as it is similar to coconut butter but I’ve found many supposedly AI-friendly recipes that call for these ingredients including the AI cookbook you recommend (sample page has a recipe for Coconut Tilapia with both coconut flour and flakes). This is so discouraging because these foods bring me some joy.
2) I read in Practical Paleo that those with AI diseases should avoid insoluble fiber found in leafy greens but these are great sources of calcium, vitamins, etc. while your site suggests them to add with digestion and I would be lost without them.
3) Formerly I exercised to excess 6 days/week and counted every calorie on MyFitnessPal. I was excited to cut back on exercise and started with the routine suggested in The Paleo Solution: 1 day strength training circuit, 1 day HIIT and 1 day rest/yoga; repeat. Now I’ve read that HIIT is not recommended for those with AI diseases as it can be a stress on the body. Do you have suggested guidelines for exercise with an AI disease?
4) What should I be doing externally for my body as far as deodorant, soaps, shampoos, moisturizers, toothpaste, make-up, etc.? I had completely ignored this potentially important piece of getting healthy.
5) Finally, we planned a 2 week trip to Italy and Switzerland prior to my beginning this regimen. My husband has already targeted me as a killjoy as we will be in the land of pizza, pasta, cheese and gelato. I consulted with a highly regarded Paleo dietician a few weeks into Paleo/AIP and lost weight I didn’t need to. In one sentence I was told I should never eat gluten again and in the next that I should not worry about what I eat while I’m abroad. Further complicating things, we will be staying with friends for 1 week and I won’t have control over what is served. So, will I be deathly ill if I fall off the AIP wagon and will it take me 5 times longer to recoup my healing losses? A big part of me wishes I hadn’t made the AIP discovery for another month :-/
Perhaps all of this can be found in your book but it’s a long time to wait or maybe each question posed individually on FB where more people can take advantage of your insight?
Thank you so very much for your time and sharing your knowledge. This is all so overwhelming…

1) I recommend limiting quantities of whole coconut, but not eliminating completely.
2) I 100% disagree with the idea of removing insoluble fiber. I have a series of posts about it in the works, but won’t have time to finish them until Sept. Also more info coming in the book.
3) I recommend avoiding strenuous exercise but what that is is different for everyone. Strenuous exercise causes a leaky gut (no matter how healthy you are). So, I’m not a huge fan of HIIT because it’s too strenuous for most. But, you just need to listen to your body and see how you feel after different types of exercises. Being too sedentary is a problem too.
4) Check out Liz Wolf’s Skintervention guide (link in the sidebar), Primal Life Organic (link in the side bar), Morrocco Methods Intonational (also link in the sidebar!).
5) Stress is a huge factor. Many people find that they can eat foods on vacation that they never can handle when they’re home. That being said, I think figuring out how you could avoid gluten (while maybe relaxing on other aspects of the AIP) would be worthwhile.

Thank you Sarah!
You’ve already reduced my stress level! I’m so happy I can continue to consume plenty of leafy greens and a bit of whole coconut 🙂 The information on exercise and skin care is greatly appreciated.

A friend told me she was surprised she didn’t get the jitters from cappuccino while in Italy although she does at home. I’ve also learned that they test for celiac disease at a very early age in Italy, the government gives subsidies and additional vacation time to those with the disease, and some restaurants provide gluten free options!

Thank you for taking the time to address each of my concerns. I’ll definitely be purchasing your book!

Hi Sarah,

I wanted to ask about fully healing an auto-immune condition with Paleo diet AP. I’ve been following the auto-immune protocol, probably 90%, for over 8 months and I’ve pretty much had complete remission of all my Chron’s symptoms which is awesome. Although I am just going on what I feel and see, I don’t have blood tests to back this up yet.

I want to commit to following a very strict version of the AP, which is what I feel best on, for the future. It’s just leaves, oily fish, fatty cuts of grass fed meat, some well-cooked veg and sweet potatoes, plus lamb tallow or coconut oil.

And I am going to try and see my specialist in couple of months to tell him that this is working well for me and how I want to continue. Previously I was on Remicade, as this was the treatment he recommended to heal a fistuala, but I stopped as I was, and still am, feeling so good on just Paleo alone. He has previously told me he thinks diet cannot affect inflammation outside the bowel wall, but I’ve had total relief of all my symptoms!

My question is, do you think over a long period of time feeling symptom free on Paleo I could reasonably expect the fistula to heal naturally? I know you can’t really answer questions on specific details of individuals conditions and I need to discuss it with my doctor but your opinion would make a big difference to me. As I REALLY don’t wanna go back on Remicade.

Thanks so much for all your posts and info,


Hi James. Well, I guess the short answer is that I don’t know. But, if remicade is expected to heal the fistula, and it’s a DMARD, then regulating the immune system with diet and lifestyle should be even more effective. And, I am writing my book exactly for this type of situation, so you can bring it in to your doctor’s office and show them the science (1200 citations) supporting that diet and lifestyle is a more powerful approach for regulating the immune system than any drug currently available.

Hi Sarah,

Thanks for you answer. That is reassuring to know that the Paleo diet and lifestyle is backed up some ‘hardcore’ scientific evidence I can show my doctor. Of course, it’s clear to me that the Paleo diet is light years ahead of any other auto-immune treatment in mainstream medicine, i.e. ‘take this pill, you’ll feel better’, not that I don’t think there’s a place for that. But it would be great to have the science to hand, not to mention I am feeling 100% better!

When is your book gonna be available? I definitely want a copy! : )

I also wanted to ask you a question about sleep. Over the last couple of months my sleep has been disrupted quite a bit and I wasn’t getting anywhere near my 8 plus hours per night. Although I am getting on top of it now. When I don’t sleep well I notice I am more sensitive to FODMOPS foods, mainly fructose and starch, and I get some itching. Does this make sense to you?

Thanks for answer and can’t wait to read the book.

Dear Sarah, this is my 17th AIP day, I am feeling great, yet see no hair regrowth. I will try to cut fructose to below 20 gr daily. I have started really craving fish skin (as I have no access to grass fed meat here, I eat loads of fish), I bake my fish & just eat the skin off it right away. I tried to google it, any idea what vitamins/minerals the body is craving? Thank you again for your input.

Collagen! Which actually makes a whole lot of sense since it’s a prime component of hair! You might consider adding Great Lakes Collagen as a supplement and see if that helps. (I also love fish skin).

I would recommend one (or both) of two things: limiting yourself to cooked veggies for a while (they are easier to digest) and taking digestive enzymes (especially plant enzymes).

Hi Sarah,
I wanted to ask if you think it is okay for me to take fermented cod liver oil since I have been tested for a yeast allergy? If not, what else could I take? Also, should I be avoiding mushrooms because of this allergy? I am guessing that after I follow the AIP diet for a while I could reintroduce some of the foods I tested sensitive to, I am hopeful!


I don’t actually know if fermented cod liver oil is lactofermented or wild fermented. If it’s wild fermented, it may have some yeast in it, but probably different strains so it might be okay. Mushrooms are similar enough that they may cause a problem but also might not, depends on exactly what antibody you are producing. I would suggest leaving all suspect foods out of your diet for a couple weeks and then challenge them very carefully.

Hi Sarah!

What do you think about eating insects on the AIP? I’m iron deficient and crickets are sooo much higher in iron than any other meat that I’ve been eating.

Also, SIBO create the biggest conundrum in the world, I want to be able to eat prebiotics to feed the bifidobacteria and other stuff in my large intestine, but it ha to pass through the small intestine first! I’ve noticed I seem to do okay with polyols (in terms of bloating), should I try to get a lot of those in to feed my bacteria in the large intestine? Will pretty much any FODMAP or starch feed the bacteria in the large intestine?


If you like them, go for it. Also, increasing vitamin C with meals can help with iron absorption. I wouldn’t go nuts on polyols, since they have a laxative effect too (which probably means that you aren’t digesting optimally). What really feeds your bacteria is fiber. Not all soluble fibers are fermentable, some insoluble fiber is fermentable, some starches will feed bacteria but it depends on your digestion. So, basically eat what vegetables and fruit you tolerate, and for now, don’t worry about trying to add anything.

Hi Sarah,

First of all, thank you very much for all the effort and time that you’ve poured into researching and writing about your findings.

I am a 39 years old. I have Hashimoto’s (I’m on 150mcg of T4) and I’ve been recently diagnosed with IBS as well. I’ve been gluten-free for 8 months now and I’ve been avoiding sugar/flour/processed foods for much longer than that. As a result, I don’t need to lose any more weight (after many years of being overweight, I’m down at 10% BF and trying to pack on some muscle).

I’ve been trying to avoid meat and making a conscientious effort to eat all of my vegetables, while using cheese, milk and whey for my protein needs. I’ve managed to restrict meat (which I love) and poultry to dinners only.

I’d like to give the autoimmune protocol a try, however I’m a bit concerned with the amount of meat I will have to eat (I hate all fish, they smell like garbage to me and I sincerely can’t eat them unless I’m starving). I need about 160 gr of good quality protein daily. With cheese, milk, eggs and whey out of the picture, this will translate to 800 gr of meat per day. Eating that much poultry or beef *every day* is not something that makes me feel comfortable, especially since I don’t live in the US and the whole grass-fed/organic/local farmers movement is not much of an option here. I’m afraid that it’s antibiotics-fed beef for me (and much of the rest of the world as well, please always keep this in mind).

How am I going to get all this protein? On a related note, is pea/rice protein powder out of the question?

Once again, thank you!

I’m not a fan of pea or rice protein for those with autoimmune disease. It’s too bad you don’t like seafood since that has the absolute best minerals for supporting thyroid function. I think it would be better to eat lower quality meat than be deficient in protein or the vitamins and minerals in meat that are essential for healing.

Do you know of another brand of cod liver oil that is not fermented that you trust? I found Carlson Labs and NOW Foods on Amazon; how many mg do you suggest a day? I haven’t been eating mushrooms for several months, should I notice a reaction if I were to try some and not introduce anything else new in my diet (even if I am not AIP, just paleo as of now)? Thank you and I can’t wait for your book!!!

Hi 🙂
I’m wondering what the reasons are for excluding eggs, nuts and seeds (all the rest I understand) as I haven’t heard of these being problems before and I really like them!
Thanks in advance 🙂

Hi Sarah,

I suffer from severe eczema on different parts of my body that started developing over 5 years ago and is still spreading (I’m 33). I have spent thousands of $$ and have yet to find something that works. I’m going to try this diet to see if this will help because my eczema is making me miserable! I’m confused between what eliminations you say, Dr. K ( and Mickey ( Is black pepper ok or not? Can I eat all fruit (Dr. K says no pineapple, dried fruit, and banana but I’m allergic to that anyways)? Seaweed chips ok? Is Cardamom seasoning ok to use sometimes? Are teas without caffeine ok (I like a rose/cardamom tea)? How do I know if I need to eliminate more foods and when then what you list as well as the others? I’m pretty sure I have a fungus overgrowth and I have been diagnosed with leaky gut and Lyme and was off a ton of foods/sugar, taken gut healing supplements with no results at all. I’ve been eating organic and don’t use anything on me with chemicals for years. I want to make sure I do this right and hopefully see something in the next couple months. I’ve been waiting on having another child (I have a 3 1/2 old) until I fix this (I’m determined and not giving up!) and it would be a blessing to me to get rid of my painful eczema so that I can have more kids and just do activities that I haven’t been able to do (exercise, swimming, running, even just leaving the house). Is it possible this diet may not work? Sorry for all the questions but I’m just desperate to get rid of my eczema as soon as possible!! Thanks in advance!

Mickey follows my recommendations. Dr. Kharrazian’s recommendatins are very similar to mine but with a focus on thyroid disorders wereas my focus is on immune function, which is more broadly applicable. Dried fruit should be in extreme moderation (due to high glycemic load). But all other fruits are fine (with the exception of any fruits that are nightshades). Seaweed chips are great, but make sure they’re cooked in a cook oil (like olive oil and not sunflower or canola). Herbal teas are usually okay, even black and green tea in moderation is usually okay. Cardamom is typically well tolerated, but I recommend a few weeks without initially. For skin issues, I recommend a big focus on fat soluble vitamin (which you’re typically getting from oily fish, grass-fed meat especially organ meat like liver, and rendered tallow or lard from pasture-raised animals), glycine-rich foods (broth, anything off the bone or with connective tissue in it, like skin, cheek, jowl, chuck roasts and/or supplementing with a collagen supplement), a huge focus on stress management (walks outside, yoga, meditation, etc.), and a focus on getting as much sleep as possible (at least 8-9 hours if not more). How long it takes to see a difference will depend on how nutrient-dense your diet is, how well you are sleeping and managing stress, and just exactly what’s going on with your immune system. You can expect anything from noticeable improvement in a few days to not much difference for a couple of months before you see a big difference. Skin is lowest priority for your body to heal, so a little patience might be necessary.

Thanks Mickey for your answers which help a lot. I have a few more too: Does this diet kill yeast and fungus overgrowth? How would I know if and when I need to eliminate more foods then what is listed? If my eczema gets better/gone, does that mean my gut is healed? If within 6 months my eczema is gone but my gut is not healed is it ok to get pregnant with a leaky gut but still be on the diet to heal? Or does pregnancy make it to hard to heal? I’ve already been taking lots of gut healing supplements, been eating organic grassfed meats/eggs, drinking bone broth, and eating liver it’s just eliminating the foods I haven’t done and need to do now that I know about AIP. So maybe its a little further in healing then taking nothing at all but the foods are preventing it from fully healing.

Sorry again for all the questions but that’s the rest I needed to ask! Thanks so much in advance!!

🙂 I’m Sarah (Mickey’s blog is another blog). Yes, it does fix overgrowths. If you have severe GI symptoms, trouble sleeping, headaches, especially after the first 2-3 weeks, then you’ll want to look at other foods (like FODMAPs). Pregnancy may actually make it easier to heal (although that varies), so I would go by how you feel. If you feel ready, go for it.

Hi Sarah,

So I’ve been on the AIP for over 3 months now. I’m also off FODMAP’s and a Candida diet. The diets have only helped with inflammation (although I do still get it around my period and other times I’m not sure why) and nothing with healing my eczema. I’m following the diets to a T with no cheating. I drink bone broth (or Great lakes collagen), slippery elm, marshmellow root, lots of lard, and fish. The only things that aren’t so great are my stress and sleep. I go to bed late but usually get 8-9 hours of sleep. I’m stressed everyday although I try not to be. Is going to bed late and stress causing me from seeing any results (besides my inflammation being reduced)? Should I get some kind of testing done to see if something else is going on that diet/sleep alone wont help with? I’m really determined to fix me so that I can have another kid soon because my son is 4 now and everyone keeps asking me and making me upset. I just don’t know what to do at this point or whats next. Thanks!!

The simple answer is yes, not enough good quality sleep and too much stress can completely undermine all the good work you’re doing with your diet. There are some other possibilities as well. Being on the candida diet, you might be too low carb (and this can actually affect your ability to manage stress and get good sleep). Slippery elm can be an immune stimulator, so that might not be helping. And, there could also be something else going on, like a parasite or persistent infection, or a micronutrient deficiency that is slowing down healing. My feeling is that the best first place to start is trying to go to bed earlier and do everything you can to improve your sleep quality (don’t eat for 2 hours before bed, spend time outside during the day, get a little exercise, wear amber-tinted glasses and keep the lights in your home low the last 2-3 hours before you go to bed, maybe meditate or do something else relaxing in the evening, like have a mineral salts bath) and reduce stress (avoid caffeine, exercise but not too strenuously, meditate or do something else relaxing like have a bath, yes, I’m repeating myself, find time for a hobby or to do something fun, ask for help, say no). And, it’s definitely worth talking to a medical professional who can review your whole history to see if additional testing might be helpful.

Hi Sarah,
I am hoping for a little help and insight…My 5 yr old is gluten intolerant, and went on the gluten-free diet when I was pregnant with my now 3 yr old. We pretty much replaced gluten with rice, quinoa, and whatever good gluten-free bread we could find. My 3 yr old has been classified as failure to thrive since he was about 3 months old. He has had signs of malabsorption since birth, but all of his test came out normal (except he shows as slightly anemic). He turns 3 on friday and only weighs 24lbs. I am concerned that he has a grain intolerance. We have eliminated eggs and dairy for a month each, and there was no improvement. I am wondering if an intolerance in me could have caused his malabsorption issues and if going on a paleo diet will help him gain weight. I also struggle with chronic constipation, can’t lose weight, and have rheumatoid arthritis. I have been doing an elimination diet for 2 weeks, and no improvements, but I did not eliminate rice or oats. With a paleo diet, how long does it typically take to see a difference?

Also I make a perpetual bone broth every week using chicken, but I hate the flavor of beef bone broth…is there a way to make it taste better, or do you recommend other types of bones? Thanks!

With RA, I think you’re at the right place. How long it takes to see a difference varries dramatically, and is at least partially dependent on how nutrient-dense your diet is (how much organ meat, fish and veggies you eat), how well you sleep and how well you manage stress. But, this is my recommendation for RA. As for your son, I don’t think that adopting a nutrient-dense diet devoid of foods that inhibit digestion could possibly be a bad idea. Definitely intolerances can lead to malabsorption and failure to thrive and it can be very tricky to figure out which foods are the culprits when there are multiple intolerances. I would suggest removing all of the possible culprits and again, focusing on the most nutrient dense (and in the case of your son also energy dense) foods you can (organ meat, fish if he’s not allergic, vegetables, fruit, good fats like grass-fed animal fats, fatty fish, rendered tallow or lard from pasture-raised animals, avocado, olives, avocado oil, olive oil). If you want to do any nuts or seeds for your son, I would suggest soaking and drying them first (but omitting them initially is probably a good idea given how common sensitivities are). And of course, I always recommend working closely with a health practitioner (I would suggest finding a functional medicine specialist in particular).

Hi Sarah. I am a beginner with the AIP diet. I am so thankful for finding your website and I cannot wait until your book is published. You mentioned above the DGL supplement. Would Licorice Root capsule that has no fillers, not chewable or lozenger be okay? Can you also take a moment to explain what teas are acceptable? From the bits and pieces discussed above, green tea should be avoided. Would that also include Jasmine and white tea? Should we also try to avoid chicory or chai type teas? I drink 2-3 cups of tea a day. I’ve limited it to herbal (like mint or chamomile) and ginger, but I just don’t want to eliminate the whole spectrum of teas if it’s unneccessary. Thank you so much for everything you provided to us on your website and taking the time to answer all of your questions.

Licorice root that is not DGL is an immune stimulator. You really need to look for DGL (there’s a brand in my a-store). I think a cup or two of black, green or white tea a day should be okay for most people (I drink quite a lot of black tea myself and have never cut it out). Just make sure to be really aware of how you are handling stress and how you are feeling (I do have a strict rule of no tea after noon for myself). Chicory tea is fine. Chai has some spices that are a bit dubious, but I think that tea is probably well tolerated (most of the problematic proteins will stay in the chunks in the tea bag rather than go into solution). Herbal teas like mint, chamomile and ginger (also lavender, cinnamon, dandelion root, milk thistle), are obviously the safest.

Hi Sarah,

Looking forward to your book, as we recently found out my mom has an autoimmune condition: Antiphospholipid Antibody Syndrome. This condition has led her to become dependent on bloodthinners (she takes coumadin), and therefore she cannot consume much of greens or other Vitamin K foods that diminish the effects of the drug. Can you offer any recommendations as to how she can follow the autoimmune protocol while avoiding these foods? Thanks so much! 🙂

Her dose of coumadin should have been optimized taking into account the consumption of leafy greens (which could be consumed in measured quantities rather than with the advice to avoid them!). I recommend working closely with a doctor to dramatically increase DHA and EPA omega-3 intake (which acts as a blood thinner) and testing INR or PT frequently to make sure coumadin dose is adjusted properly. This really needs to be cone under close supervision. Following the AIP, with high doses of fish or fish oil for the omega-3s should also allow her to start eating foods with vitamin K (it’s especially important to get K2, so she could also supplement with K2 if there is continued need to avoid K1) and lower her dose (if not slowly wean off completely) the coumadin.

Dear Sarah,

Is flax seed or flax seed oil allowed on the AIP diet? What about ACV or safflower oil…sunflower lecithin…xylitol..and.stervia? You are so great to answer all our questions,. Thanks so much. This is first auto-immune diet I have ever seen and it makes me so hopeful. Im going to have to start eating meat after becoming vegetarian for the last 5 years after getting cancer but due to an autoimmune illness I think I must make that choice after reading your information.

No flax seed. Flax oil really isn’t very useful (your body can only convert 0.5% of the ALA into DHA or EPA at best), so I suppose you could have it but I don’t see a point. ACV is fine. Safflower oil is a no, but might be tolerated in small amounts after healing (if you are really mindful of your omega-3 intake). Sunflower lecithin is best to avoid at the beginning. Xylitol and stevia are both nos.

Just bought Michelle Trescott’s cookbook which looks amazing and can’t wait for your book to come out. I am still not clear if coconut flour, dates, raw honey, tapioca starch and arrowroot are on the AIP version and what about balsamic vinegar, kelp noodles and xanthan gum for thickening soups? Also will split peas ever be legal…I can’t find mention of them yet. Just curious why stevia and xylitol are nos 🙁 so sad. Thanks again for your generous advice. I know for me, it has just made me want to try your program and buy your book even more. Just curious how you came upon all this knowledge? Wishing you great success in this noble endeavor.

Coconut flour, raw honey, tapioca, arrowroot all in moderation (coconut flour because of the high inulin fiber content, so careful, the others you just need to be mindful of your sugar intake). Balsamic vinegar and kelp noodle yes. Xanthum gum no. Split peas maybe, but dubious. I have a post on stevia. Xylitol is a gut irritant. I came upon this knowledge by a) having a PhD in medical biophysics and doing medical research for 4 years before deciding to be a stay-at-home mom, b) personal experience with my own autoimmune disease, c) reading about 3000 scientific studies in my research for my book.

Thank you for the answers….and very impressive credentials! I think all your knowledge and experiences are going to help a lot of people.

Dear Sarah, thank you for the answer on skin fish (collagen need)! What about asparugus? is it OK on the autoimmune protocol? Nata

Hi Sarah. I’m confused with digestive support supplements. I looked at some of the links to the suggested products and they are very expensive or geered towards people with serious medical problems. I followed your suggestions on the other supplements and picked up the Prescript-Assist, all in all, I think it’s positive so far. I’m just not sure what I should be doing or getting with the digestive support enzymes. I don’t have any serious condition. I have IBS (constipation and bloating) for many years. I have intollerences to all grains and corn, and dairy. Eating a lot of veggies and fruit doesn’t upset my stomact. (I’m not sure what does though.) So how do I know which digestive enzyme to get, and will I become dependent on them, will I make things worse if I pick the ox bile? As far as other autoimmune symptons, it’s mainly skin-related (roseacea and very sensitive to perfumes and detergents). I have endometriosis for over 15 years and the last couple of years hair loss (I’m young but Paleo diet has seemed to lessen the shredding). I had been a vegetarian since childhood (over 20 years) and vegan when adult. I believe it was during the latter that I developed some boarderline deficiencies, although my doctor said I was fine and thyroid was also fine. I found going back to the vegetarian diet wasn’t enough; I still felt horrible, so I began eating fish and chicken. 3 years later, and I’m Paleo, and finally feel like I’m repairing myself, but I somehow fall into the category of, regular Paleo diet worked for a while but I’m not fully. I’ve only been on AIP for a little over a week. I know it’s too soon to tell but there had to be some other food allergy I didn’t know I had because I do feel better. I think I’ve struggled with not getting help from a doctor because the test results show I’m not allergic or celic or thyroid, but obviously my body is saying something else. Sorry for being so long-winded. I’m mainly wondering about the digestive enzymes, but also if you think I really don’t fall into AIP category and am wasting my time. Thank you very much in advance for all your help and suggestions.

Well, endo is often associated with autoimmune disease and is a suspected autoimmune disease, so I don’t think you’re necessarily wasting your time. If you feel like you are digesting food well and absorbing nutrients, then I don’t think you need digestive support supplements. I do think that if you want to try them to see if it helps, then you definitely get what you pay for with them, which is why the brands I link to are the higher quality (and more expensive) brands.

Hi sarah, thanks for the information.
I would like to know if seeds in veggies and fruits like okra and guava are ok to eat.
I read that okra is good for gut. but is it ok to eat it with the seeds?

My rule of thumb is that if the seeds are small enough to be swallowed whole (like in berries), you’re fine. If you crunch the seeds with your teeth, then they are probably best avoided (at least at first).

So a step further. When adding seeded fruits and berries to make smoothies using high power blenders (like vitamix), the seeds are totally grinded. In that case, would I be correct to assume that it is better to keep those out of the blender, and just eat them?

ps. thank you for all the wonderful information in this website and your book. learning a lot. planning to put it all to work!

Hello Paleo Mom!
OMG… I’m so glad I found you! I was actually on a high fat high protein diet for the past 1 and 1/2 years, but have recently fallen into a terrible health crisis nonetheless because of high stress and anxiety (which I’ve since addressed). However, the damage was already done, and I was kicked into the worst digestive ‘relapse’ I’ve had in 20 years… complete with serious muscle fatigue and weakness, and other Parkinson’s-like symptoms. I am better when not eating, which tells me digestion is key… and I’ve had Leaky Gut in the past and re-lapse every 2 or 3 years. So I just came across your information on the Autoimmune Protocol, and LOVE it! I’m going to start right now, and order your book ASAP… and since it’s very similar to the diet I was on, the transition should be easy.
I am 40 lbs. underweight, so I’m in a scary place… but seem to be maintaining OK. I’m trying to beef up on my oils (like coconut and olive)… and eating avocado sparingly, and good, fatty fish like salmon and macarel.
I do have a couple of questions: 1) is it OK to eat the chicken skin? I love it, and it might provide help with my weight.
2) I’m also terribly constipated. The only thing that helps me to go once a day is a protocol I use with a seed base and aloe vera. The ingredients of the Fiber are: defatted ground flax seed, pea hull fiber, alfalfa whole leaf, barley whole leaf, and chia seed. Then I take an ‘Aloe Pure’ capsule: freeze-dried organic whole leaf aloe… and lately, I also need a couple of ‘Swiss Kriss’ tablets, which contains: anise seed, caraway seed, hibiscus, and I think the active ingredient is cascara sagrada. Together, these are the ONLY things I have found to make me ‘go’. Otherwise I’ll go 4 or 5 days without ‘going’ at all… and I can’t become dependent upon enemas.
These products either have seeds in them, or are forbidden on the AIP. Do you have ANY recommendations on how to get fiber and keep my perastalsis going? (or is this protocol OK?) I have tried all probiotics and fermented foods, good diet, etc… and absolutely nothing works.
3) Kombucha? I heard this is bad for most individuals… but I love it and it seems to be OK. Is it Ok for most people on the AIP? I use GT’s.
Your advice would be invaluable. Thanks so much!

1) yes, chicken skin is fine. The fats in it aren’t the healthiest but it’s high in glycine and other important amino acids, so it’s a good trade. 🙂
2) I have to say that every single ingredient in your supplement is problematic from an immune health standpoint. That being said, you need something to make you go. My suggestions are: get a squatty potty or similar stool (I reviewed squatty pottys under product reviews), try a magnesium supplement (natural calm is probably the best in terms of wanting the stool softening attributes), make sure you are eating lots of vegetables, make sure you are drinking enough liquid, increase your intake of high tryptophan content foods (organ meat and seafood–the reason for this is that serotonin and melatonin regulate gastric motility, which also means that things like having fun, managing stress, sleeping and spending time outside will all help too), and try digestive support supplements.
3)I think kombucha is great. Go for it. 🙂

Thank you… I will try those things… though for the most part I’ve been doing them. I can increase my fish intake (being careful of mercury issues)… I did Calm a while back and it took 3 TBLSP per day to even move me…. then it was of the runny kind; hard to regulate… but I’ll try it again! It’s tough to overcome a 20 year issue. Are occasional enemas OK?
Do you have a couple good digestive support supplements to send LINKS for? It’s hard finding something not in toxic capsules, or without bad ‘fillers’. Aren’t both Gelatin and Veggie Caps made of stuff we shouldn’t be eating?
Two more quick questions… well, three: 1) I’ve been doing far infra red saunas, and they feel great. Are those OK to be doing (reduce the ‘toxic’ load)?
2) I’ve been trying to eat exactly according to the diet, yet I still become nearly incapacitated after eating (fatigue, weakness… all my symptoms… progressively worse with each meal throughout the day). Does this necessarily mean I’m not healing?… or does it just take time to turn the digestive ‘ship’ around? NOTHING makes me feel good or strong.
3) Do you do phone consults?
Thanks soooooo much, and take care!

What you can do with calm is divide the dose, which should help with control. Occasional enemas are okay as long as they aren’t high pressure. The links in this page are to the supplement brands I know are good (gelatin capsules don’t bother me compared to other ingredients. veggie caps are usually just plant-derived gelatin). There’s also a few more options in my a-store (link in the right hand side bar). I’m not familiar with IR saunas, so I don’t feel comfortable making a recommendation for or against. Does it help to divide your meals into more frequent small meals? The digestive support supplements should help here (it sounds like your body is working really hard to digest). It doesn’t mean you aren’t healing, but it is a signal that it might be helpful to adjust something… (digestive support supplements being top, but also things like eating slowly and chewing thoroughly, maybe limiting to cooked veggies for a while). Check out my post on fish and mercury. Also, don’t forget about the importance of sleep and stress management. I don’t do phone consultations.

No problem on the phone thing… I’ll just write for a while… lots of questions as I’m trying to ‘turn this ship around’ and feeling awful. Thanks for the tips… I’ll try breaking up the doses of Calm into maybe 1 tsp 3 or 4 times a day.
You mentioned LINKS ‘in this page’ and LINKS ‘in the right hand side bar’… but I don’t see how to access those. I’m new to this, so might need more specifics on how to access these LINKS.
I have been steaming my veggies for about 3 minutes (as I don’t want to lose all the minerals, etc…. )… is that long enough?
Also, I eat a ton of high quality organic cultured veggies, which are obviously not cooked. Should I not be doing that since they’re raw?
I also drink 2 – 3 cups of bone broth per day… but read that you’re not supposed to drink liquid with meals… should bone broth be an in between meal snack, maybe with a dolup of coconut oil?… or is it OK to consume it with meals.
Finally, sometimes I blend my entire meal… oils, bone broth and all to make a soup-like meal, and to help with digestion… but again, the bone broth adds 1/2 – 3/4 liquid to my meals… and does blending take away from the fiber benefits of the veggies?
Your thoughts would be great!

Links are in the useful supplements part at the bottom.

Do not cook cultured veggies (they are easy to digest plus that would kill the probiotics).

What you could do is more soups, so the nutrients just go into the broth and you still get them. But you could also save moving to more cooked veggies until seeing what digestive support supplements do.

I often have broth as a snack, but then often between meals too. If you’re having say, a cup to a cup and a half with a meal, that should be fine. If you want to have all 2-3 cups in one sitting, try it as a snack.

Blending soups is great.

Just reading Steve’s posts and had a question. I have always been constipated as well but was recommended cellulose fiber supplement. It is so easy to take and doesn’t give me gas like phyllium. Works great as well. Is that in line with your diet recommendations Paleo Mom?

Is this product acceptable?… I consume a lot of it… but I think Kefir is a grain… but it’s fermented in young green coconut water.


I’ve also heard mixed reviews on Kombucha… some say don’t go near it if you have Leaky gut… others say it’s great. Man, it gets confusing out there.

So, if you approve of Inner-Eco… I’ll continue consuming it, along with cultured veggies; and I’ll add a probiotic. Should I be taking both a non-soil based organism as well as soil based all in the same regimen… or rotate? Do you have a probiotic protocol I can view?

They are called kefir grains because they are grainy in shape, but they aren’t a grain as in seed of a grass. They are actually a simbiotic culture of bacteria and yeast (SCOBY). I have no issues with kombucha consumption. I would just stick with soil-based since you have other probiotics well covered in fermented foods.

Ok… so coconut Kefir is OK? Yes!
Also… could you tell me, besides coconut oil, what other coconut products are SAFE to consume for this AIP? E.g., coconut butter, etc.?
I’d like to at least take it in one other form… Thanks!

Hi Sarah-First time I come across your site, very good information so THANK you so much. Question, I have Hashimotos and now IBS, so they say. I’m on the PALEO diet, and excluded nightshade veggies, but I do drink Almond milk. I noticed that you suggest no nits, since the Almond Milk is processed would this still be considered something I should avoid? I LOVE almond mil and it has been my friend ever since the switch to this new diet 2 months ago. Should I drink coconut mil instead? Thank you for your help.

Yes, I generally think coconut milk is better. The problem with packaged milks, whether almond or coconut, is the emulsifiers added which are all gut irritants. Homemade almond and coconut milk are both fairly easy to make. If you know you love almond, you could try just switching to homemade. Soak whole almonds in salted water overnight. Rinse really well, then add 2 parts water for every 1 part almonds you started with. Blend like crazy ina blender then filter through a paint straining bag or a nut milk bag. You could also add some vanilla for flavor.

Hey there! I’m supposed to be taking PhosCal(?) which is high quality Soy Lecithin with one of my regimens. Is that an OK thing to consume while on the AI diet? I could also use Sunflower lecithin… if that’s better. Thanks… Steve

Hello! First off, thank you. Secondly, I have a quick question. Is psyllium husk okay? I can’t seem to find an answer. I’m sorry if I missed it.

The lecithin is an important part of my sauna protocol (to detox from toxins)… that’s why I’m supposed to take it… is the sunflower any better?

Hi there, I have been loosely following a Paleo diet for the past year…but allowed some dairy and legumes. I have been having issues with my knees over the past few years…inflammation… and have had Psoriasis since my last pregnancy in 2005. After going to see a chiropractor who is working with other doctors on dealing with autoimmune diseases I have now been able to see how my knee inflammation is directly correlated with my autoimmune disease…Psoriasis. So, he had me blood tested and I definitely have gluten sensitivity. I also have cross-reactors with corn, dairy, oats, and a few others. I completely gave up all gluten, dairy, (except ghee…which now I am reading that I should give up..), and any other cross-reactors that I had. I also have issues with my insulin levels so I have given up honey, starchy veggies and all fruit except for berries on a limited basis.

My question to you is…I was tested and do not have issues with (cross-react) to eggs and rice which are to of the things you say to completely eliminate in the protocol. Are those things to give up if you don’t have the testing or do I need to give those ups anyway? My doctor has me drinking a shake in the morning made with 100% egg protein…so this is a really important thing to know! I was also tested for cross-reactivity with coffee and chocolate and I do not have issues with that…give up or not? Also, I talked to my doctor about nightshades and he said that there is no testing for that and that I would just need to keep a food journal of when I eat them and see if I react to them…or should I just give them up as well.

I have been eating nuts and am very sad to see that I should be giving up all nuts and seeds but I read that you can soak them and that they are fine after that?!?!? Similarly, I had also read that I could have beans if they are pressure-cooked because the issue is with the acid and that is taken care of with pressure cooking?!?! What is your take on that?

I know I have a lot of questions! I have been reading TOO MUCH information and want to get some sound advice so I can be guided in the right direction to heal my body inside and out and would appreciate any help you could give!

Wow, it sounds like you have a great doctor to work with. Every single thing omitted here can be problematic in ways that don’t show up with food sensitivity testing (not just nightshades). If you follow the links, you’ll find posts that explain why. The only thing in your list, that I think you are safe to include is egg yolk (the issue with eggs is the high rate of sensitivities/allergies and a protein in the egg white called lysozyme, so if you rent sensitive, egg yolks are a great nutrient-dense food to keep consuming).

Thank you Sarah, so almond milk would still be okay, even though i have Hashimotos so long as it is homemade? You know I don’t take any hormones for it because the #’s are always fine, my biggest thing has been my gut/IBS/constipation/bloating, for 3 yrs. What has helped me so much is the acupunture that i have been getting for over a yr now. And now I have switched to this Paleo diet and will add your suggestions as well. i will most def purchse your book. Can you tell me however why is that after getting 4 acu treatments when i first started i started to feel so much better? this is why i have continued my treatment. Also, i’m a little confused, in regards to fruit, since i have hashi can i not have more than 20G of fresh fruit per day? What does the sugar part have to do with all of this? I thank you SO much for your help. I have been going thru this for 3 yrs now and it has been so difficult when the drs are useless. Jennifer

No, no. 20g of fructose. Depending on what fruit you pick, that’s 2-5 servings. Fructose has a variety of effects on hormones and causes inflammation, but a little is good for you. That’s why there is a maximum.

I would rather see you try a time without the almond milk, but you made it sound like that was a nonstarter.

Acupuncture has been shown to be really helpful for people. If you think it’s helping, you should keep doing it.

Hi Sarah-One more question if I could please. You mention that most people with autoimmune conditions may suffer from low Iron, VIT D, A, K and magnesium. Yes I have been taking Iron for yrs now and as soon as i stop the #s go down, no dr has ever been able to tell me WHY, can you please? they used to say my menses, but they are wrong. also what vitamin regemin should someone with autoimmune conditions stay on? I have to check A, K and Magnesium but I know my D is now back down to 30 when it was at 70 for a while. thank you SO very very much.

OK-hopefully this is the last one-I just keep reading and find mor question, so since i have IBS, this could be either FODMAP-intolerance or SIBO. Well at first I took probiotics for months, the most natural and expensive nes out there to see if that was the problem, they even came with enzymes and lots of other things (they are from Garden of Life) so they were helpful at the begining, for week, 3 yrs ago I thought this was the problem I am all set, but then I went back to being constipated. Where I have the feeling that i want to go but then the feeling just disapears. OK-so my question with that said, could it be more of a FODMAP-intolerance rather than SIBO? What are your thoughts? I would like to stick to one diet, this is very hard to understand, so I’m sorry for all the questions. And I have to say that during accu it seemed as though everything was fine and i was eating anything I wanted but then the problems came back and they are just there, back and fourth, so then as of 2 months ago I switched the PALEO diet and am now discovering your autoimmune diet. another question, so the autoimmune diet, this is forever correct? we can no re-introduce the things we can not have, buts cacao etc..? But i can at least later on reintroduce more fresh fruits (outside the 20G a day) correct? If i deteremine this is FODMAP-intolerance? Thank you Sarah

I think whether it’s FODMAP intolerance or SIBO, the first thing to try is low FODMAP (GAPS and SCD type diets have not been validated in the medical literature for IBS but low FODMAP diets have been). The autoimmune diet is forever for some people, but most can reintroduce some or all of the foods.

Thank you Sarah, I will stick to the AIP diet along with low FODMAP-so basically do both? Because the low FODMAP allows for things that the AIP diet does not, so we have to use the AIP first and foremost along with low FODMAP? am i understa8ng this correctly? Will your book explain when people can reintroduce things? I have already pre-ordered it and can NOT wait for it to come out.Because I seem to do fairly well for a while eating fruits, nuts and such but I think what did me in is that I was having huge amounts of dried fruit for breakfast, along with fresh fruit. so this i think is what made me feel bloated and such, the constipation as I said is more like a feeling of having to go and then all of the sudden the urge is gone but the need to go is not, so hard to explain. Also, is there somewhere on your site to look at what the recomended VIT levels should be for people with autoimmune conditions?

It seems reasonable to me to choose AIP+low FODMAPs versus just low FODMAPs and give one or the other a try for a few weeks. If you choose just low FODMAPs, you could move to AIP+low FODMAPs if you don’t see changes in 2-3 weeks. If you decide to try it the other way around, you could try either adding back in FODMAPs or some of the foods after you start to see improvement. I generally like omitting all the possible candidates in an elimination diet, but that doesn’t necessarily work for everybody in terms of sticking with something, so you need to pick what you think will work for you.

I just finished a Whole30, but I feel I may need to up the ante so to speak and go autoimmune to address Crohn’s disease and adrenal fatigue which don’t seem to have improved (I have hypothyroidism however it’s not autoimmune but rather a crowding out of iodine with fluoride that I’ve been addressing with my integrative healer). My first question is about sausage. I’m living in Germany where there is an ABUNDANCE of amazing sausage, but I asked the grocer and there is sugar in every single freshly made daily variety. Do you think it’s too much sugar to include these sausages in my diet once a week or so if I’m going the AIP route? Also what if some of the supplements my healer has me taking have some AIP no-no ingredients? During the Whole30 I was advised that supplements are treated essentially like medicine, especially when prescribed by a healer/doctor/etc.

The amount of sugar is sausage is usually very low, so I wouldn’t worry about it. The more important question is to ask about spices since red pepper, paprika and cayenne are such common ingredients. If your supplement is working for you, then continue it. If it’s not, work with your doctor to find a better solution.

Do you know if digestive enzymes hurt our beneficial bacteria? I can’t find research but wonder. I read raw garlic can. My tests from the doc came back no growth on acidophilus and bifidus. Do you have info for all of us desperately trying to repopulate? I have been taking expensive probiotics for months! Help.

They shouldn’t. They are a normal part of the gut environment and those bacteria should have adapted. The supplements are really just to replace what your body is not making enough of anyway. Big things for repopulating: omega-3s (lots of seafood), vegetables (both non-starchy and starchy since both insoluble and soluble fiber are important for normal gut bacteria growth), fermented foods, sleep, and stress management.

How long must one stay on the AIP diet until you can graduate to Paleo? I am concerned about all this protein. I used to be a vegetarian and this is against my nature – but I want to do everything I can to heal my auto-immune illness. I was actually doing better with a vegetarian, sugar free, soy free, dairy free (with the acception of yogurt), and gluten free diet..but wanted to step it up a notch to get to the source of my issues, and this is the only place where I have found an Auto-immune diet. Also, is egg yolk (alone) allowed on AIP? Also the desserts such as the cheesecakes from the AIP recipes look absolutely amazing but how can one eat this and stay within the 20 sugar gram limit? Thank you for answering these questions until we are able to get your upcoming book. Looking forward to it!

Hi Sarah!
First of all, thank you so much for this website. I’m on week 3 of AIP for narcolepsy, and just realized I’ve been overdoing it with the fruit, and also ate some mustard (didn’t read the spices list carefully enough)! This is my question- how big of a difference does fruit make? But also, more importantly-I’m getting married Nov 11th. We’ve already paid for our AMAZING wedding cake, months before I decided to do AIP. This is only about two months away. I will have some gluten free options for food, but god I’d sure hate to miss my own wedding cake. If I am strict with AIP until then, will that cake set me back enough that I should just stop doing the AIP now and go back to regular paleo? Thanks so much!

p.s yes I have considered ordering a gluten free cake, a small one for me, but we are planning on trying for a baby in december, so i know I won’t have treats like that for a very long time.


Sorry for the other question, I sent the last too fast!
I know NSAIDS are prohibited, but part of having a sleep disorder (and living in texas with AWFUL allergies) is having headaches nearly every day. I’m a college senior, and doing research in a cancer lab, so without excedrine migraine I would be lost. What does this mean for me trying to do AIP? Thanks so much. I’ve already ordered your book- sorry I couldn’t wait until then 🙂

Hi Sarah, thank you for your blog about gallbladder disease. I have been sick with Hashi’s or Chronic Fatigue for 30 years. Do you think if I go on the AIP diet that I could get better. I am 64 now, and I am sensitive to lots of foods. If I eat lots of meat and vegetables I do feel better. Thanks for all you do and I can hardly wait for your book to come out.

Hello. Wondering if you’ve ever heard of seed milk? I make it w flax, pumpkin and sunflower seeds that have been soaked overnight, rinsed, blended and strained. Would this not be allowed on your protocol?

I think that’s great for standard paleo, and could certainly be introduced after an initial time completely seed free on the AIP, but it would not be considered part of the protocol.

Hi Sarah,
What an informative website – many many thanks for all the hard work you have obviously put into your research. I can’t wait until your book is out as well !
My questions relates to the AIP paleo diet. I have recently been diagnosed with autoimmune disease and have made many changes to my diet as a result, however I am still learning so much as I go. I have completely cut out grains and am currently eating a paleo diet which I personally think has made a huge differenct. I planut to go strictly onto AIP starting next month (currently travelling so a little too difficult to start until I am home again).
Can sprouts be eaten on the AIP ? Either home grown or shop bought (ie radish, broccoli, mustard seed, mung bean sprouts?). Also, how about seeds in vegetables – such as the seeds in the centre of cucumbers or zucchini – do these need to be removed prior to eating?
Thanks so much for your help.

Radish, broccoli or mustard seed sprouts would be fine. I’d stay away from legume spouts like mung beans since they do have agglutinins. And alphalpha sprouts are notoriously high in a type of mold that contains extreme levels of phytoestrogens.

Seeds in vegetables are a gray area. My rule of them is that if they are too small to break apart with your teeth, they’re fine. If you might break them apart with your teeth, try them and see how you feel. If you aren’t sure, remove them before eating for a few weeks then reintroduce.

What about fruit seeds ? I’d read about medicinal properties of some fruit seeds and things suggestive about eating watermelon seeds(high in magnesium but also high in linoleic acid) and other seeds and I used to eat them but since reading your suggestions about seeds in general I stopped eating them, and there’s not much info about their nutrition, benefits and risks as far as I know. But I keep eating the seeds of fruits that aren’t practicable to seperate such as pomegranate and berry seeds.

My rule of thumb is that you break up the seeds with your teeth, then it’s best to avoid at least initially; if most of the seeds get swallowed whole (like berry seeds), then they’re fine.

Hi Sara. Do you have any information for all of us desperately trying to populate our gut flora that digestive enzymes harm them? Please look into it. I got little info googling it. One man tested so many herbal candida treatments, raw garlic and digestive enzymes and so many killed a yogurt culture he attempted to grow. It got me wondering. My pro biotic count came back no growth despite months of expensive probiotics so now I’m trying to figure this out. Help!

Rachel, I have the same problem. NO bacterial growth. I do not take digestive enzymes, I tried them for a very short period, but found it was made with rice bran, so quit taking it quickly. I am now drinking a quart of water kefir every day, and find that it has done far more for my digestion and my gut health (read: BMs are normal and easy) than anything else. I’m also able to add back formerly reactive foods. Big plus: it is very cheap, and reproduces itself, so no additional endless bottles of probiotics. I have not done another stool test (its just too expensive for me to keep repeating), but I’m fairly certain things are better in there just by how I feel.

Hi again Sarah,
Thanks for the reply on the sprouts. Just to clarify – can you eat the seed portion from which the sprout grows? Or should you cut the sprout above the seeded portion to consume? Thank you!!

Hi, my name is Lora. I am a personal trainer and fitness instructor. I have AS and have recently started the protocol. However, I am having trouble figuring out what to eat for breakfast that will give me energy since my old go-to’s were eggs and plant based protein shakes. Please help!

I make a lot of homemade sausage for breakfast, or just fry up any random meat, and eat it with veggies, homemade sauerkraut and usually a serving of fruit too. Leftovers make a great breakfast too.

Hi Sarah. Would organic acacia senegal be allowed on the AIP protocol? Heather’s Tummy makes an Organic Acacia Senegal fiber to take before meals to help with IBS. Heather’s Tummy also has a Tamers Peppermint Oil Capsules made with peppermint oil, ginger oil and fennel oil. Do you think this would be okay while on the AIP protocol? I’m starting my 4th week on the protocol, and would like to do something for the IBS discomfort and irregularity, but not derail all my efforts with AIP. Thank you so much for answering my question!

Hi Sarah,

I already have a lot of expensive supplements such as dig. enzymes, glutamine, vit c and more. They have other ingredients such as stabalized rice bran and organic alchohol. Are they not ok to take then? What about homeopathics?
Thanks in advance!

Organic alcohol doesn’t bother me as long as the amount is very low. I think it would be better to find supplements without rice bran though. I don’t subscribe to the concepts behind homeopathics.

Hi PaleoMom, Thank you for some great helps for folks! I’ve read a good portion of this blog because I’m very interested in health and nutrition knowledge and so have over the years self educated about inflammation, toxicity (bromide, fluoride, mercury, pesticides, etc), heavy metals, nutritional deficiencies (iodine), leaky gut, brain fog, and my own allergies, hypo-thyroid and age related hypo-hormones. I searched this blog for, “BHRT”, “heavy metals”, “bromide”, “chelation” and did not find any mentions.

I’m respectfully asking why in the context of auto-immune disease, inflammation, leaky gut, you’ve not mentioned anything about detox, heavy metals, bromide/fluoride, using iodine (for many reasons(there’s an answer re TSH spiking)), BHRT, Low dose naltrexone (LDN)? I know tying these topics into a pure diet based solution spirals complexity for an individual’s protocols immensely. My view is that efficacy and outcome could be improved by mentioning all of these protocol possibilities for folks to investigate on their own.

Again thanks for tackling such a complex issue.

They are all on my list of topics to write about and are all discussed in my book. They aren’t here yet (along with about 300 topics on my To Do list) because I am one person with only so many hours in my day. 🙂 I’ll get to it though.

Hello Sarah!
I’ve been looking at your site and was wondering if your auto immune protocol diet could help treat alopecia areata. I’ve had it since February of this year. I’ve been using the paleo diet to try and control my acne as well and just wondered if you had heard of others getting results with your program. Thanks so much!

Absolutely! You’ll want to work extra hard on the stress and sleep aspects too, as well as focusing on fat-soluble vitamins (seafood and pasture-raised meats) and glycine-rich foods (bone broth, anything with skin or meat of the bone, and seafood).

Yes, it will at least be available as a kindle edition and on iTunes. I don’t know what else my publisher does but they’re the ones who take care of that part. It will also be available internationally.

Hello Sarah. First of all, thank you for all the time and energy you put into this great website and into getting information into our hands! I’m just starting to get into a paleo lifestyle and was finding myself in need of much help. I have gotten back results of food sensitivities and have indications also of some sort of autoimmune issue going on (tests are not back yet) -so I am very interested in your AIP. Because one of my sensitivities is coconut (ugh!) I have had to not just eliminate those foods, but also the many ways coconut derivatives are added into everyday non-foods. Finding out this sensitivity made me finally understand why whenever I put coconut oil onto my skin to “soothe it”, several hours later I wasn’t feeling very soothed! This has made me curious… AIP says to eliminate nuts and seeds, would that include trying to eliminate them from the things we use that are non-foods? Ex: For skin use… all the seed/nut oils. I was enjoying apricot kernel oil use on my face, but am unsure of it now. I understand (with my limited understanding) that the food and its oil can be very different. Anyway… any info, even any opinion, is appreciated. Thank you for your time, Sarah.

Different people have different sensitivities to nuts/seeds/gluten etc. in beauty products. I definitely think it’s worth experimenting with avoiding them especially for those with skin conditions.

WOW! This is all new to me. I was diagnosed with an Autoimmune thing almost 2 years ago. It really wasn’t a bother once I got it under control with a steroid. I was using the steroid maybe 2x a month and that was it. Really no biggie. In the past two months, I’ve transitioned to a Paleo diet and have noticed a big change in my autoimmune issue. Mainly, it being more inflamed and irritating. Thanks to your article, I’m giving up the Almond Milk in my smoothie and replacing it with Coconut Milk. I’m also going to try a few different flours in place of the almond meal. I know that Garbanzo beans are not Paleo approved, but is there a negative to using it as a substitute?
My husband just ordered some probiotics for us to use as well as some Cod Liver Oil pills.
I must admit, your article was a bit technical and over my head. I had to ask my husband to decode some of the information. I’m glad that I found your website and I look forward to getting my eating habits on track.

Hi there!
I still can’t wait for your book… my OCD tendencies are calling for something to follow exactly… LOL.
Hey… I’ve heard about the rage for Chia Seeds… escpecially the Mila brand; that it’s a great and safe fiber. What do you think about these for fiber?

If you have an autoimmune disease, your immune system doesn’t know how to regulate itself. If you stimulate the immune system with a drug or a compound in a food, it revs up your immune system attacking your body and can cause a flare.

Dear Sara, do you think AIP could help with autoimmune premature ovarian failure? The causes of this symptom are unknown, maybe inflammation in the ovaries etc? Did you ever come across any info/success stories with this? thank you

You are the first person to ask me about autoimmune premature ovarian failure. The principles behind the autoimmune protocol are based on regulating the immune system, so they broadly apply to all autoimmune diseases. Whether or not that can restore ovary function however, will depend on what damage has been done. I definitely think it’s worth a shot though, and also to help prevent development of additional autoimmune diseases.

Dear Sara, will try my best. Have managed 20 days of strict protocol only, then added 90% chocolate, have returned to strict AIP. Thank you for your work & waiting for your 2 books!

Thank you Sarah, for the comments about immune stimulators! It would be tremendously helpful to know which foods/supplements are indeed immune stimulating and that we should avoid on AIP. Will this great information be in your upcoming book…or is there somewhere we can go to find it?

Hi there!
I’m taking a super potent green food right now with Spirulina and Chlorella in it. I asked the creator of this food about the immune stimulating problem. She said that since the ingredients are fermented (pre-digested), there should be no problems at all… is that correct?

I haven’t seen any studies that evaluate whether fermenting spirulina and chlorella alter the immune stimulating properties at all. I would ask about whether that’s actually been measured or is just a guess (and given that it is unknown exactly what compounds are in spirulina that are stimulating the immune system, I have a strong suspicion that it’s a guess and it may or may not be a good guess at that!).

Hi Sarah… Your blog is so informative — I appreciate your sharing all of this knowledge. I’m a vegetarian (combination of ethical concerns and a severe meat aversion that I don’t think I can overcome) with multiple autoimmune conditions and active leaky-gut symptoms. I looked at your protocol in hopes that I could omit the suggested meats and rely on eggs for the protein (my go-to since I’m allergic to soy). Unfortunately, it looks like eggs are out on the protocol — at least the whites, and yolks at first. Do you think following the remainder of the protocol while continuing to consume eggs is worth a try, or is it unlikely to provide any benefit? Thanks!

Thanks. I have an allergy to shellfish, and I feel the same way about fresh water fish that I do red meat/poultry/etc. We’ll see how it goes. Do you have a recommendation re: grams of protein per day with the protocol so I can calculate how many eggs I should eat a day? (I realize most people probably don’t have to worry about that with all of the meat that is usually part of the plan.)

As an absolute minimum, you should be consuming 0.75g per kilogram lean body mass per day. If you don’t have a scale that gives you an estimated fat percentage, you can use a web calculator that will give you an estimate based on your BMI.

Hmmm….that would put me at about 16 eggs a day if I’m figuring it correctly. Do you have thoughts on Hemp protein powder?

I was wondering if you can help with my mental attitude? I have been so sick for so long. I have been doing everything I can the last few years to help myself. I have celiacs, hashimotos, and cyclic neutropenia. I have multiple food intolerances, so have been on a strict diet for a while now. I have been doing paleo for nearly a month, which I can cope with…. what I can’t cope with is the thought of the AI protocol. The thought of going without nuts and eggs and a glass or two of wine is too much! I am thinking about my health and diet almost constantly, it is exhausting! How do I get my head straight?

That’s a tough question! I know it’s really hard to feel sick and tired (literally!) and then look at the effort required to follow a restricted diet along with the feeling of self-deprivation that giving up some favorite or staple foods can cause. What I can say is that it gets easier very quickly as you start to feel better and that prioritizing sleep can do absolute wonders for making the diet changes feel easier. Is there anyone you can ask for help to maybe take something off your plate while you focus on your health?

I have an auto-immune similar to Lupus and have been taking Rhodiola which really helps me…but is it an immune stimulant and bad for me? And what about green tea?

Hi Sarah, I am pretty certain that my mom has autoimmune disease. She is following a restrictive diet already, although she is not on AIP 100%. Her doctors don’t seem to understand her condition, but she feels she needs some support from the medical community to help her understand what she can and can’t eat and to give her menus so she is not eating the same foods everyday, which leads to additional intolerances. How can she find an MD or a nutritionist who understands these conditions? Her energy-levels are VERY low, and that’s just not like her. I’m worried about her. 🙁 PS–I’ve already given her Mickey Trescott’s cookbook.

Hi Stacy! You can try and Is your mom local? There’s an internist registered in based in Buckhead who I know other people have really liked (Kimball Johnson). I’m also really hoping that my book will help bring a better understanding of the role that diet and lifestyle play in autoimmune disease to the medical community–of course, that’s still a couple of months away. Friend me on facebook or shoot me an e-mail and I can hopefully help with some more specific ideas (because it will probably be a month or more before I can make it to a yoga class).

Thank you, Sarah! I just sent you a FB friend request. My mom lives a couple hours away, but I’d be happy for her to come visit if she finds a doc near me. All the best!

What an amazing resource you have here! I have been on a 16 year journey of trying to figure out what the heck is going on with my body, and just last year decided to focus almost solely on diet. My struggles started when I was 16 and had a horrible case of Mono. Prior to that I was a successful athlete and runner, but afterwards, I couldn’t even run a mile. My first substantial symptoms began when my stomach would hurt so badly from eating that I would pass out. I was diagnosed with IBS and modified my diet accordingly. Over the years, numerous other symptoms joined the party (insomnia, extreme fatigue, stomach ulcers, etc.). When I was pregnant with my son four years ago, I felt better than I had felt for a long time. Once he was born and I was no longer nursing, however, my symptoms seemed to increase exponentially. In addition to the above mentioned ones I also gained a horribly itchy rash on my legs, hair loss, and acne. At my annual physical, I found that my hormones were severely out of balance, I was deficient in ALL of my vitamins and nutrients, and my liver and kidney enzymes were high. Last year, I found myself a great Functional Neurologist who vowed to get to the bottom of it all. He ran a bazillion tests, all of which were inconclusive (part of the test would support autoimmune, part would not). He put me on a diet very similar to your AIP with a few differences, and experimented with loads of different supplements. I did this for 2 months and noticed some of my skin symptoms improved (no more rash), but I was still struggling with horrible fatigue and mood. I began adding things back in slowly, and could never pinpoint specific things that were causing problems. I would be fine with things separately, but had reactions when they were in combination. I gave up, not wanting to subject myself to such deprivation for nothing. Sure enough, within a few weeks I began passing out again and all of my symptoms reappeared. Since then, I have been tested for Celiac (negative), had a digestion test (turns out my body digests food extremely fast-my GI doc told me she had never seen that in someone who had not had Gastric Bypass), and had a food intolerance test. As is always the case with me, all of my tests are inconclusive. My blood work is still all over the place, and my symptoms seem to be worsening.

I found your site a couple of weeks ago and decided that maybe I just hadn’t given it enough time. I feel much better this time because I actually have a resource to refer to. Last summer I did it all by myself and it was almost impossible to come up with meals, etc. I have been on the AIP for two weeks now, and I am finding my skin symptoms are not going away like they did last summer. Just yesterday I had a salad for lunch like I do every day, but I added some fresh squeezed juice (apple, pineapple, kale, spinach) and had a horrible reaction (back to passing out). After reading through your entire blog, I have a strong suspicion that I am also dealing with a FODMAP intolerance or SIBO as well. I am at a loss at how restrictive I should be right now. I am an “all-in” kinda gal, so I am more than willing to cut out more if I need to. What would you suggest? Do the AIP alone for now and if I don’t notice any improvement in three months then eliminate more? Or should I just jump in the deep end and eliminate SIBO and FODMAP foods as well? As I know you understand, I have been at the end of my rope for a long time. I look very healthy (well, besides the acne), so it is frustrating to have doctor after doctor tell me I am depressed and I need to just exercise. If I didn’t feel like I had been hit by a bus after standing for more than 5 minutes I would love to take that advice! I am desperate for something (anything!) to work, so I am willing to try anything.

Sorry for the LONG post. You are amazing!

Hi Melissa,

Well, it definitely sounds like an autoimmune disease, even if you don’t have a definitive diagnosis. By digesting food extremely fast, I assume that means fast transit time? that food is going from one end to the other unusually quickly? that sets off some alarm bells for me, because it probably means you aren’t digesting food well at all, or at least, not absorbing nutrients from your food effectively. And that may very well be linked to the vitamin and mineral deficiency. I think adding digestive support supplements (like pancreatic enzymes, plant enzymes, and ox bile) could be very helpful is supporting digestion. Very rapid transit time may also relate to neurotransmitter issues (peristalsis is regulated in part by serotonin), so things like tons of sleep, meditation, walks, yoga, whatever is fun for you, spending time outside, spending time in nature area all things that should help.

In terms of SIBO versus FODMAP, I am pulling away from my former recommendations for GAPS-style avoidance of starches for SIBO due to a lack of scientific studies validating that approach. Low FODMAP diets have been much better studied and shown to be beneficial in a variety of circumstances, including IBS so that might be a good way for you to go. The passing out though, doesn’t make me think about SIBO or FODMAPS but rather histamine intolerance (pineapple and spinach are high histamine foods). I have a post under Teaser Excerpts for my book about histamine intolerance that would be worth checking out. But I think that this is a case where keeping a food/symptom journal would be very helpful. It may help you pinpoint exactly what foods are causing problems. In the case of histamine intolerance, a soil-based probiotic can be helpful as can extra vitamin C. I think it’s worth tinkering to see what food or foods are causing symptoms. If you are experiencing symptoms like that, whatever food is causing it is probably also hindering your healing.

It’s also worth emphasizing that it would be normal to see improvements in your skin last, but see things like better energy, stamina and moods first. Skin is lowest priority for healing and you usually need to heal substantially internally before you see much improvement externally. Also, making sure to get glycine-rich foods (a collagen supplement if broth doesn’t work due to histamine intolerance) and fat-soluble vitamins (especially A, D, and K2, which you get from seafood as pasture-raised meats).

I hope this helps,

Hello Sarah! I am very interested in everything you say about autoimmune disease. Like you, I have been diagnosed with Lichen Planupilaris. I have it on my hair line and begins to lose my hair, this is very scary. I have been suffering from it for 4 years now. After many topical creams, it is still here. I have been on Paleo for one month but I do not see any change on this issue. I ma very healthy and I work out regularly. I am wondering if this is a result of menopause (I am 55). I had a total colectomy 30 years ago, could it be related? I am contemplating the idea of the AIP, do you have any advice for me?

Yes, the hormone shift of menopause can make immune and autoimmune diseases worse. I definitely recommend the autoimmune protocol. Because of the colectomy, you may have to adjust some of the foods especially the fruits and vegetables. I know some people find that they need lots and lots of fruits and vegetables and some find the exact opposite. If a low residue diet works better for you, then I would recommend green juices as a way of getting those nutrients. And generally, still focusing on the most nutrient dense foods like organ meat and fish is still very important. If you had the colectomy due to inflammatory bowel disease, I would also recommend digestive support supplements like pancreatic enzymes, plan enzymes and ox bile (since you may have inflammation in your small intestine that hindering absorption of nutrients). Sleep and stress management are also very important.


Thank you so much for your thoughtful reply; you have definitely given me some things to consider! Regarding the digestion: I had a gastric emptying test done and that is where my GI doc realized I have “Dumping Syndrome” (lovely name, right?). Basically, after chewing food, it is supposed to stay in the stomach for 3-4 hours before it moves to the small intestine. My food only stays there for around 30 mintues. So you are absolutely correct, I am not digesting and/or absorbing nutrients at all. The doc is pretty sure that this is why I pass out sometimes after I eat- because after the food is dumped into the small intestine, it will try to contine the digestive process by drawing fluid from the circulatory system resulting in a rapid drop in blood pressure. I guess my real confusion is what to focus on. Does it matter if autoimmune is causing the dumping syndrome or vice versa? I think for now I am going to contine the AIP and try to pinpoint certain foods/habits.

Regarding the skin issues, once again I do not follow the normal trend! It is weird to me that last summer I saw improvements in my skin, but no improvement in my mood/energy. Any idea why this would happen?

I know you are not an M.D., so I apologize for the continued nagging. But I feel like you understand, and it feels nice to find someone who “gets it”!

Well, I guess if dumping syndrome is caused by an autoimmune condition, it should improve with diet and lifestyle changes. Of course, the effect on digestion will make it more of a challenge to fix micro nutrient deficiencies. I’m not familiar enough with it to know what other possible causes there are or even have any brilliant suggestions for what to do about it.

Skin issues will often show rapid improvement with sun exposure (vitamin D) especially when concurrent with a more nutrient-dense diet, so that’s a possibility since it was in the summer.

Hi, I recently discovered your site and I have enjoyed reading through it. I am confused about some of what you have written above…you wrote that those with autoimmune disease should not ‘endeavor to be in nutritional ketosis’ but isn’t that what the paleo diet is…a ketogenic diet?

Hello! I found the autoimmune protocol while searching for information on whether the Paleo diet can help eczema/psoriasis (Doctors seem unable to decide which one I have. But it’s bad, bad enough for me to try very restrictive diets). So I started the Autoimmune Protocol on September 1, and I do think my skin is slowly starting to show some signs of healing.

But I keep getting sick with colds and even the flu! This is very bizarre and worrying. I wondered if you know of other people who have had this reaction, or if this is just some unfortunate coincidence? Perhaps it’s a die-off reaction, or my body purging toxins? I’ve been joking that my immune system got bored with no more harmless stuff to attack (ie skin, leaked food molecules), so now it’s overreacting to every errant virus that crosses my path. Do you think there’s any scientific reason to believe that following the AIP changes the immune system in such a way that it takes a much-needed vacation, only to come home and find the house on fire and burgled, if you follow my metaphor?

Also, I wanted to let you know that I appreciate your commitment to making recommendations backed up by scientific studies, and using citations. To that end, I eagerly await your book. Once my girlfriend can pore over all the scientific articles, it will be much easier to convince her that this “yet another crazy thing” I’m doing to heal my skin is the right thing for me to do. (Assuming it works, anyway.) So all that research you did isn’t just to gain legitimacy with the medical community – it earns the trust of us regular nerdy people too!

I’m not sure why you would be getting more colds from a immune system standpoint other than it just being that time of year. This diet helps support better immune regulation, but doesn’t suppress the immune system per se. As you progress, you should find yourself more resilient to infections. My kids both had a horrible flu last week, so there’s definitely some germs going around!

Hello… I have been on the paleo diet for 5 months and I am feeling better, but I have horrible constipation!
I have been taking metamucil psyllium fiber capsules? Is this ok or should I take other fiber? I do eat lots of vegetables , but I can only eat a few vegetables like lettuce, turnips; cabbage. Can you recommend a fiber supplement without milk products that I can take? Thank you in advance.

Hello there!
I had Magnesium recommended to me by Paleo mom… and another source recommended a key brand. I was VERY skeptical, because I’ve been constipated for 20 years… but I bought it, and by gollly, it totally works. The brand is called Live Live Oxy-Mag. I only take a flat Tsp in the morning (with fresh squeezed lemon juice), and a nice rounded Tsp in the evening (with lemon juice)… and man… it works. There’s a little more to it than that… but you can read up on it on the website. Here’s the LINK. Let me know what you think:


Hi Loree, I agree with Paleomom (Sarah) and Steve too about magnesium. And PLEASE ditch the fiber pills!! Those always just made it worse for me, and I have a feeling if you’re still constipated, they’re hurting more than helping. There are a few types out there (some that don’t affect the gut/stool as much and others that do). Sarah recommends Natural Calm (which I take and is a form of mag citrate). This WILL help but you’ll need to experiment with what dosage etc works for you. A bonus is that it helps with sleep and relaxation and making sure you’re keeping up your magnesium! all good things…When things get a little too backed up, I increase my dose of natural calm (say 2x per day instead of 1x), but for me, stress is a HUGE factor (and of course stressing about constipation won’t help the problem!). Another type of mag that may help is magnesium glycinate (this type is generally a little more expensive) and it really won’t give you loose stools, but Chris Kesser recommends this type, and I’ve found it helps me sleep all the same. My regimen is a full dose of mag glycinate at night before bed (to help with sleep) and if things aren’t moving the next day or two, I’ll add in either a half or full dose of natural calm in the morning, sipping it while I get ready for work. This is what I’ve found works for me, but everyone is different, you just have to find what will work for you! Good luck!

Hey there!
I was wondering… if I had cancer, is this particular diet still the best (even though I don’t know if cancer is an auto-immune disease)? I’m not sure that I have cancer, but definitely want to prevent it… would this still be the best diet? I always heard you MUST eat only fruit and vegetables to stave off and/or cure cancer… this diet is certainly meat/protein heavy.
Thanks for your input!

Hi Sarah,

I can’t wait for The Paleo Approach to arrive. I’m looking forward to all the educational information as I work on my own recovery. I have a question for the group, maybe you could post it on FB? I have stage 3 adrenal fatigue, hypothyroidism and intestinal parasites (yuck!) I’ve had symptoms for 25 years or longer. I’m finally being treated for adrenal fatigue/thyroid and will start an herbal treatment on the parasites (crypto and klebsiella) in a few months when I am stronger. Has anyone been through this that can share their experience of recovery, how long it took, any lessons learned? I am looking for messages of hope and ideas of how long it might take to feel better.

Thank you,

Thank you so much for your work! I just read on your article that “You should not endeavor to be in nutritional ketosis if you have an autoimmune disease”. OMG, this is the only way I can lose some weight! 🙁 I have hashis. What if I do that until I lose all the weight I need to? It’s going to be more beneficial than keeping the weight or it’ll be not worth it? I’ve read that obesity contributes to autoimmune response and I’m really overweight… Another question: can I have lo-huan while on AIP? Is it possible to have ANY sweetener at all? And I do have a suggestion: there are a lot of SCD websites where we can check what is legal/illegal on the diet. On Elaine’s book there’s also a list with everything we can or not eat on the SCD diet. I really think it would be really useful if you publish a list like that on your book/website. Thanks again!!! <3

Dear Juliana, I personally suffer from alopecia areata (autoimmune diseas) & was recovering, but 5 days on strict kerogenic diet (max 20 gr carbs a day, 5 small meals a day) lead to a huge flare up which took me 6 months to recover from 🙁 I read that acidic body environment is the worst for autoimmune sufferers, & kerogenic diet makes your body acidic. So my conclusion for my own body was low carb (below 100 gr carbs a day), & lots of body alkalizing through lemon juice & alkaline water.

Thank you for sharing Nati! Whenever I eat carbs, I crash. I feel like I have no energy at all… Once I was in a ketogenic diet for 8 months in a row and I never felt so good in my life… Maybe that’s because of the low cortisol. But I’ll add alkaline water on my diet and increase my lemon juice intake. Thank you for the tips. Also, I don’t eat small portions, I eat a lot on this diet! Specially a lot of omega 3 meats and a lot of Kale (homemade kale chips and pemmican are my favorite snacks). How was your calorie intake? I’ve read that low calorie diets are also no good for Hashis because it might impair the thyroid. I also read that low carb in overweight people helps with insulin resistance, which is my case. Maybe it’s the other reason I feel good when I’m on it. Might not work the same with people who are not overweight.

“It appears that weight loss is the deciding factor, and since low carb diets tend to be more effective at inducing weight loss in subjects, they also tend to be better at reducing insulin resistance in insulin-resistant, overweight people. Once you’re lean and weight stable, though, very low carb diets (less than 10% of calories from carbs) can reduce insulin sensitivity. This is normal and totally necessary in the context of a very low carb diet.”

If you think nutritional ketosis is working for you, then keep doing it. Studies with it in autoimmune disease are limited, but those that exist show increased cortisol which would make immune issues worse. I don’t know what lo-huan is, so I can’t answer your question. You can have natural sweeteners like honey, maple syrup, evaporated cane juice, in moderation (meaning just a bit and occasionally).

I have complete food lists coming in the book…

Thank you for your answer! I’m sorry I wrote the name of the sweetener wrong. It’s Luo Han Guo, it’s obtained from a fruit known as “Monk fruit”. I’m used to buy it from amazon.

“A member of the pumpkin family, the extract of this gourd is also about 300 times sweeter than sugar and rich in antioxidants. Luo Han Guo (or just lo han) has been used medicinally in China for centuries for treating cough and sore throat.”

About the ketosis, I struggle with low cortisol! That explain why I feel better when I’m low carb. Thank you! Have a great weekend!

Here is a link to luo han, it is a fruit closely related to some fruits like melons

I think what are called luo han or lo han are generally just the dried powdered fruit or a mogroside(the sweetening chemical in the fruit) extract from the fruit so most likely they must be fine, but I’m sure many readers will ask you this question if you don’t mention about it in the book. Many lo han including products I checked before also contain other ingredients such as sugar alcohols(xylitol, erythritol), dextrose, inulin, etc.

Here’s a list of sweeteners:

It seems there are other natural zero calorie sweeteners also and they may become popular with time so you may receive questions about them also.

Hi Paleo Mom!
Hey… I never heard back from you (or missed your post) about if this Auto Immune Paleo Diet is OK for cancer too (e.g., brain, etc.). I’ve always heard the best diet is totally fruits and veggies… but let me know what you think!

Everything about this diet is designed to support normal functioning of the immune system, which is relevant to autoimmune diseases, immune diseases, healing from infection, and cancer. Definitely agree with lots of veggies and some fruit (some cancers preferentially use fructose for fuel, so not too much), but also organ meat and seafood and other meat (meat doesn’t cause cancer, lack of green veggies when you also eat a lot of meat is the problem). Also check out Practical Paleo by Diane Sanfilippo.

I know you recommend raw macadamias for some of us nut allergy guys and let me tell you you are right that is the only one I can tolerate and thank God I know as I’d die from deprivation. Is there a seed more tolerable? I know it is not pumpkin. I’m reacting to organic brewed coffee, dark chocolate, nuts and seeds. All my loves in life. When is this leaky gut going to heal. I’ve been doing this 6 months. Just wondering if there is an unknown like these macadamia!! Thanks so much for all the guidance you give for all of us struggling.

Macadamias are special for two reasons: they are surprisingly low in phytic acid compared to other nuts (still higher than vegetables, of course) and they are very low in polyunsaturated fats. Most of the fats are monounsaturated, including being an excellent source of oleic acid, which is very important for cardiovascular health and is probably anti-inflammatory. I don’t know of any other nuts or seeds that have these properties. If you were going to try another nut, Brazil nuts have the most minerals of any nut (including being crazy high in selenium), sunflower seeds are the richest food source of vitamin E, and pumpkin seeds are very high in magnesium and some other minerals.

I am finally committing to the aip, but I have a question. Can you explain why aloe, slippery elm, and licorice ( I drink the tea) are no-no’s. There is no explanation for this above. I have gastritis and when my stomach is out of whack I use aloe and slippery elm to soothe it and it works amazingly. The licorice tea was recommended to me a few years ago for adrenal fatigue. I would like to understand why I should give them up. Thank you so much for this amazing website. I come here all the time 🙂

I read baking powder, baking soda, and cinnamon are gut irritants. Do you know anything about that? I’m trying to heal but maybe I’m messing myself up with irritants and all the chaos of reintroducing foods that seem to react every time. Baking is hard as I can’t have eggs, almond or coconut flour/ oil. I seem to tolerate soaked millet so bought some sprouted millet flour to attempt biscuits or pancakes. I’m afraid of the baking powder. Insight?

I’ve never read that about baking soda or cinnamon. Certainly, I wouldn’t recommend drinking baking soda in water since that can hinder digestion, but I think it’s fine in baking. Baking powder is usually made with a corn starch base, so it can be problematic for some people and I avoid it myself.

Hi, will your Autoimmune book be able to be delivered to Australia via Amazon? I would love to pick this up for my mother in law as a late Christmas present :o)

Thank you so much for getting back to me. I have just hooked her up with Kindle, so hopefully that will work brilliantly! It is fantastic that you have such a specialised Paleo site. It is much appreciated.

Just starting the AIP; having trouble fitting the diet into my budget. I was hoping you could answer a couple questions for me: How do you feel about wild rabbit meat? Where does it stand in terms of the ratio of Omega Fats? And how about using the rabbit bones to make the bone broth?

I have just discovered this helpful and educational site. I have been on GAPs/SCD for several years for celiac and collagenous colitis and this year my symptoms of chronic diarrhoea and accompanying exchaustion have improved hugely. I also have RA but it has been in remission for many years. Now blood tests show I am verging on severe neutropenia and a bone marrow biopsy shows I have BENIGN large granular lymphocyte leukemia which is an obscure clonal disease causing the decrease in neutrophills. I have been prescribed Methotrexate which I am loathe to take as I have always worked naturally. Neutropenia can be caused by auto-immune factors but the Haemotology hospital specialists say it is being caused by the LGL leukemia. This may be right out of your knowledge area (my GP had never heard of this obscure disease) but I thought it was worth contacting you just in case you have any advice re the taking of this drug. The consequence of not taking it is that my immunity will be so low that any minor infection can be life-threatening.

I would appreciate your thoughts. Thank you.

I don’t know much about LGL leukemia other than it is often associated with autoimmune diseases (which might mean it is one, but that’s not known yet). In the context of autoimmune diseases, I’m not a huge fat of methotrexate because it increases intestinal permeability and blocks the vitamin folate from being used properly. This can undermine your ability to heal with diet and lifestyle changes. That being said, there are certainly instances where methotrexate can be a life-saving drug. I think a TNF-alpha inhibitor has fewer potential adverse effects, although I don’t know if it would be helpful in LGL leukemia (and certainly the long term risks are similar to other DMARDs)… but if you are having a health crisis and in need of DMARDs, that is what I would ask your doctor about. Another, and more natural and safe, drug treatment to read up about is low dose naltrexone (I think the best info right now is on

In terms of natural approaches to disease management, have a read through the autoimmune protocol (it’s quite a bit more complex than GAPS/SCD although there’s a lot in common and there’s definitely some diet modifications that you could make that should help). Also, if you aren’t already working on lifestyle factors, sleep, stress management and mild activity (like walking, yoga…) are super helpful. My book will also have tons and tons of useful information (it will be out in just over 2 months). I hope this helps!

Thanks for your wonderful information throughout this site!

I’m one week into AIP. I’ve had Rheumatoid Arthritis since I was 16 (about 14 years now) and Paleo has helped me tremendously. My condition has improved to the point where I only have to use mild NSAIDs. I’m hoping AIP will take me that extra mile; my goal is to be completely off drugs.

How does someone who takes NSAIDs every day approach AIP? Are our efforts wasted until we’re completely off of NSAIDs? My dilemma is that without NSAIDs, the joint pain isn’t manageable, but by taking them I’m mucking up my recovery. Fish oil seems to help but not enough (what is considered “high does” that the studies have indicated decreases the need for NSAIDs?). Do you have any OTC recommendations? Might have a hard time convincing my Rheumatologist to write a Naltrexone Rx.

Oddly, my symptoms have gotten a little worse since starting AIP. Is this normal?

Sorry for all of the questions. I’m definitely buying your book! Thanks again for your information.

NSAIDs will hinder healing, but you should still be able to make progress.

You already mentioned 2 of the 3 things I would recommend for managing pain with RA, fish oil and low-dose naltrexone (studies with fish oil typically give about 5g per day, but I still recommend getting your omega-3s from fish if at all possible). The third is a collagen supplement (I like Great Lakes brand). Also, a probiotic can help minimize the damage caused by NSAIDs. I think it’s fine to get the diet and lifestyle stuff nailed down and then slowly start weaning off the NSAIDs (you can lower dose, or gradually increase the time between taking them). While weaning off, make sure your diet is squeaky clean and you are getting tons and tons of sleep.

It concerns me that you’re saying that symptoms are a little worse since starting AIP–are you eating enough carbs? You really can’t go too low carb with RA, so make sure you are eating starchy vegetables and some fruit.

Also, sleep and stress management are critical.

Thanks so much for your response.

On the fish oil side, I’ve been taking about 1-2 Tbsp of Barlean’s Fresh Catch Fish Oil a day, for a total of 4.2-8.4g of EPA and DHA combined. I also eat a 10-12oz piece of salmon at least once a week. For probiotic, I’ve been taken Jarrow’s Ultra Jarro-Dophilus (50 billion/capsule) once a day.

The odd thing about my symptoms getting a little worse is that my diet hasn’t really changed all that much. I’ve been Paleo for a while and while I’m avoiding all of the additional foods, I eat the same macronutrient ratio. My meals basically look like: 1/2 lbs of meat and a large salad or large portion of veggies. One or two meals will also include half a large sweet potato. For breakfast I’ll also sometimes have apple (peeled). I also may eat a few dates at night. Maybe some carrots and half an avocado somewhere in there.

The omega 3:6 is a challenging piece. I had some allergy testing done that pointed to a possible beef allergy, so I’ve been off beef since I started AIP as a precaution. It will be the first thing I’ll reintroduce. In the meantime, I’m eating pork, poultry, lamb, and fish.

Speaking of allergies, the reason I got tested was because I was interested in starting allergy shots. I’m allergic to cats, and have lived with two of them for years (they came with my lovely wife). My allergy symptoms are a lot better than they used to be, but in the interest of aggravating my immune system as little as possible, I figured allergy shots my help. What’s your opinion on allergies and allergy shots while doing AIP? Helpful? Can it hurt?

I think the lifestyle piece is in place. I Thai Box twice a week and walk a lot. I used to weight life 3x a week as well, but hearing how overtraining can worsen symptoms, I cut back on just doing the thing I love and less of it. I’ve never been a good sleeper but I have a 100% pitch black room and it’s been a lot better since ditching coffee. I work from home so stress isn’t terrible and I try to meditate daily.

I completely understand if this is too much information or too complicated a scenario to address in a blog comment. Thanks either way!

I think you could do allergy shots while on the AIP, but I’d give the AIP a bit of time before doing them. You really want to make sure that your body has all the nutrients it needs to properly regulate the immune system (and you just might find that you don’t need them after doing the AIP for a while). The shots can stimulate the immune system, so it is possible to have a worsening of your disease too, which is another good reason to wait.

Hi Sarah,
Thanks for this amazing blog, I have been on/off paleo for a few years now, but three weeks ago I finally started AIP to help heal my leaky gut. I have been very strict and have not had any cheating. The question I have is that after a food sensitivity screening, I was found to be sensitive to both coconut and lamb. I have been using coconut oil heavily during the AIP as well as having lamb a few times. Is this being counter productive? Should I also eliminate everything on my sensitivities list? If so, what fat would you recommend in place of the coconut?

It could be… depending on just how sensitive you are. Coconut oil hypothetically doesn’t have any proteins, so it should be okay. But, it would be better to avoid lamb. If you do want to replace coconut oil, lard from pasture-raised pigs, tallow from grass-fed beef, red palm oil and avocado oil are probably your best choices.

I am finally committing to the aip, but I have a question. Can you explain why aloe, slippery elm, and licorice ( I drink the tea) are no-no’s. There is no explanation for this above. I have gastritis and when my stomach is out of whack I use aloe and slippery elm to soothe it and it works amazingly. The licorice tea was recommended to me a few years ago for adrenal fatigue. I would like to understand why I should give them up. Thank you so much for this amazing website. I come here all the time 🙂

They have immune stimulating compounds in them. I recommend DGL (find a capsule and not a lozenge, there’s a link in my a-store in the sidebar) because it has the immune stimulating compound removed.

Thanks for the reply. So immune stimulating is bad? I understand immune suppression would be bad. I’m confused. Sorry. BTW, I do use the DGL too.

I have been on and off Paleo for a year now and finally committed to doing the Autoimmune Protocol on Oct. 1st because I have psoriasis and arthritis. I found out on the 10th, however, that I am pregnant :):) I am wondering if you think it is safe for me to proceed through my pregnancy on AIP? I had only planned to do AIP for about 1-3 months and then try to reintroduce some of my favorite foods, but now I am wondering if I might put my body
(and my little one) through too much of an ordeal to experiment with reintroducing foods while pregnant. Also, I am currently taking daily a probiotic, FCLO, folate, Vit. D, and rose hips for Vit. C (I also plan on trying to incorporate liver every 1-2 wks), but I am wondering if you think I need to be on a prenatal vitamin, and if so, if you could suggest one? Or even a multivitamin that would work as well? Everything seems to have weird fillers or some random tomato extract, etc.and I just don’t want to counter my efforts or miss out on a vital nutrient by being so strict on AIP. Thank you so much in advance and for all that you do. The knowledge I have gained from your website and listening your podcasts with Stacy is priceless and has made such an impact on my life! Can’t wait for your book to come out soon!!


I am having early autoimmune connective tissue disease symptoms suggestive of scleroderma. My ana is barely positive nucleolar 1:80. I am following the aip which is very helpful.

What are your thoughts on antibiotics (ap) or ldn to help me as well?

Great website

If diet and lifestyle changes are working for you, I think that’s the best approach. That being said, research into LDN has been very promising. There are pros and cons to antibiotics, so that really depend on your individual situation and I would recommend a discussion with a healthcare provider.

Hi Sara,

I was recently diagnosed with Lichen Sclerosus and trying to control a flare right now. A month ago I went gluten, dairy and sugar free. Two days ago I went grain and nut/seed free. I would like to ask what you think about foods high in oxalate, e.g spinach, celery, beets, etc. Are these good for people with autoimmune disease?


Just found your great site and was going to ask your opinion of oxalates.

I have been on the GAPS diet for 2 and half years now. Through this time I have restricted dairy, nuts and gone low oxalate and also noticed an issue with cooked tomatoes so that my diet has eventually wound up looking very similar to AIP.

My experience of high oxalate food especially nuts, rhubarb, spinach, beetroot and berries is to give me increased urination, a burning sensation along my urethra and into my bladder and weight gain. On occasions where I have eaten a lot I have also had burning stools. My young daughters are also very sensitive to high oxalate foods and without fail will wet the bed that night after eating them.

I have been following the GAPS yahoo group all this time and oxalate seems to be a very common issue. Although this is all anecdotal and doesn’t prove anything. I’m not sure ‘no evidence’ is a reason not to consider oxalates. I just think there is a lack of any research, except maybe in animals, to provide evidence one way or another.

Susan Owens has done a lot of research on oxalates over at

Research in people shows that higher oxalate diets actually protects the kidneys, reduces the chances of gout, and lowers risk of certain cancers. All of those foods are also high salicylate foods, which has been better described in the medical literature as a food sensitivity.

Hey Sara this is an important one for you to keep stressing as it is a big mistake many of us make. All of us past antibiotic users need to take the best probiotics we can get our hands on for the rest of our lives! I used to think I was fine after 2-3 bottles of 50 billion CFUs as they would repopulate my system. Wrong! They die off after a month of nonuse! I wish I knew that in the past. I would have made it part of my plan and maybe this leaky gut never would have happened after IV antibiotics giving birth due to strep b. God I’m still waiting to get better. I’m dying without nuts, chocolate, coffee and eggs. I want a brownie so stinking bad! 🙂

Hi –

I started the AI Protocol this weekend after 4 months of starch free eating for my Ankylosing Spondylitis. I can’t take my usual almond/walnut snack in the morning at work because nuts are excluded on the AIP. Do you have any suggestions for work appropriate snacks (I don’t think a can of sardines will make me many friends in the office!)?

Thanks. And I look forward to the delivery of your book!


I am starting AIP. About 2 months ago I had an ALCAT test done because once I started eating Paleo (Whole30 to be exact) I started having such awful reactions. (red swollen eyes, more eczema than usual, splotchy face) I did the aALCAT in hopes to help me figure out the culprits. Since you know more of the chemistry behind all of this, would you suggest that I implement those results on top of AIP (foods to avoid and rotation diet) or do you feel that isn’t a great test anyway. Would love your thoughts. It seems like I react to stuff when I eat certain things 2-3 days in a row. I still haven’t quite figured it all out by any means. Thank you so much for your work! You have sown a great seed and will reap one huge harvest. 🙂


I think the test can be useful, although I take positives and negatives both with a grain of salt. First, there are many ways you can be sensitive to foods that won’t show up on any of these kinds of tests. Second, a whole lot of positives can just be indicative of a leaky gut and cutting out all of those foods isn’t always necessary. So, basically, I think a good starting point would be AIP, remembering to eat all those super nutrient dense foods, and also eliminate the highest reacting foods on the ALCAT. You can play with reintroductions if that works for you, or eliminate other foods that showed up on the ALCAT if it’s not (although if it’s not working for you, also look at things like digestive support supplements, increasing sleep, managing stress, eating more seafood, organ meat and veggies). And anything that you react to when you eat 2-3 days in a row, you can either eliminate completely, or limit to 1-2 times per week.

Hi there again!
Hey… on this diet, is it ok to eat yams and/or sweet potatoes (I know regular potatoes are OUT).

You asked what probiotics I take. Theralac as recommended by my doctor and prescript assist because you mentioned it. When that is gone I was going to try the Kirkman one you suggested and keep up with the Theralac 3 x per week as the bottle suggests. Here and there Culturelle as the doc likes that over the counter one fot the certain acidophilus strain. I want to look into the new probiotic to help break down oxalates. SARA DO YOU KNOW ABOUT THAT? I used to use Dr. Mercola’s probiotic, Jarrow brand etc. I’m sensitive to yeast so can’t do kefir or kraut. I may try one or 2 days a week yogurt from A2 cows RAW too to help. I feel arthritis if I eaf dairy daily even the raw stuff. I’m still waiting and praying my gut gets healed. I tried carob last night in replace of chocolate but just doesn’t cut it! I have 100% Kona beans waiting to grind but I’m too sensitive to coffee still. I may just cheat once every 2 weeks but the fatigue and muscle weakness it gives me for 4 days takes the love away. Oh the new lease on life I will have when healed.

Hey there!
I must have missed your reply… but I was asking if it’s OK to eat yams and sweet potatoes on the AIP Diet? How about Acorn and Spaghetti squash?

I am hoping you may be able to help me. I have Hashimoto’s and was eating Paleo last year and feeling good, but I gradually got more and more constipated and ended up with two rectal surgeries due to a fistual and abscesses (they were from an injury). My rectal surgeon said that Paleo is good for no one, so I have been eating basically Vegan. I have found that I cannot tolerate beans and legumes as my gut is very sensitive- I run and cannot run on the days I eat beans. I know vegan is not helping me, but I am petrified to go through 8 months of sickness again (surgery and then thyroid crash). I have added fish back into my diet and it seems like I instantly feel so much better. I love all fish – nothing is off limits. I actually do not know what to do – I know I feel better eating meat but know my gut cannot handle a huge load of beef, pork, or poultry. I have had no constipation problems with fish or chicken livers (which I love). I work out everyday, don’t drink coffee, gluten free, dairy free and eat all leafy greens, veggies and cultured saurkraut. I also take 2 teaspoons of psyllium each day, prescribed by my doctor. Is it ok for me to customize AIP to fish, organ meats and bone broth?
Thanks very much for your advice,

You mean stick with the three healthiest protein sources? Yes! Although, I’d look for an alternative to the psyllium (like vegetables and fruit and a magnesium supplement).

Oh… thank you! That actually expands my menu considerably!
… also, I realize fruit is to be kept to a minimum, but I’m not totally clear what fruit I can eat. I mostly keep it to Green Granny Smith Apples… are those fine?
I also eat occasional Currants?
… and finally, regarding coconut… I mostly do coconut oil, but is shedded organic coconut OK?… and how about coconut butter?
Thanks again.

Eat whatever fruit you want but use a nutrition database to look up how much fructose it contains per serving and keep your total fructose intake for the day below 20g. That’s about 2 apples or 6 cups of strawberries. Currants are an okay occasional treat, but don’t overdo it. Coconut oil is fine, shredded organic coconut and coconut butter in moderation.

The fructose limit doesn’t seem to take half of the sucrose into account. Don’t you think sucrose need to be limited as half of it is fructose ?

I don’t like the idea of overly obsessing with counting things, so out of fruit or veggies, I wouldn’t worry about sucrose too much, but from added sweetners like maple syrup it should definitely be included.

Hi once more!
Hey… I’m getting mixed vibes on mushrooms… would they be OK on the diet?
… also, pineapple? Blueberry?

Thanks again… that’s so helpful. Essentially, I eat good organic, grass fed meats, organic veggies, organic bone broth and good oils for 90% of my meals. But it gets a little old, so knowing I can add yams, sweet potatoes, squash and the like, as well as fruit (within the fructose limits)… and coconut stuff… helps a lot!
I sure wish nut butters were on the menu… and I’m surprised to see shrimp on the menu… are you sure that’s OK? I always heard to NEVER eat crustaceans just because of the issue of pollution. But I love shrimp…
Oh… I also meant to ask you: due to their high sugar content, are beats and carrots OK?
Take care!

Hi Sarah,

I just recently started reading your blog and some of the information in it. My daughter has suffered from chronic urticaria for years. But not only was she only diagnosed with it within the last year, not once did any of the three physicians or dermatologists we’ve seen mention that it was an autoimmune disorder! I only woke to this fact through the information you present here, and subsequent research confirmed it.

I discovered recently that I am gluten intolerant and have seen improvement from cutting it out, so I believe without a doubt that changing diet can yield significant results. All of the above, combined with my arthritis and my husband’s severe eczema (again, didn’t know they are all autoimmune related!) lead me to think we should all be doing the AI protocol. I admit to being rather overwhelmed on where to start though. I have pre-ordered your book. In the meantime, can you suggest a course of action on how best to start? I am not overly familiar with the Paleo lifestyle on the whole. Should I start there? I do think I should have a plan of action before I start implementing further dietary changes. I suspect this will be challenging for us.

Thank you

I think it’s a good idea to start with paleo… work on cutting out grains, legumes and dairy (trying not to add in too many eggs, nightshades, nuts or seeds) and also focus on nutrient-dense foods (seafood, organ meat, vegetables, grass-fed and pasture-raised meat, fruit). It gets easier…

Hi There – thank you so much for your wonderful information. I’m wondering, is there a list of foods I CAN eat anywhere? My brain has a hard time thinking in can’ts. Thank you. 🙂

Hi Sarah. I had to look around for that oxalate probiotic info and the companies are and Probiotic- I’m wondering if oxalates are an issue as I just can’t get all the way better. If so scary as the AIP is already too restrictive. Any knowledge for all of us with leaky gut due to too many antibiotics that oxalates are an issue too? Hey and what is the problem with organic brewed coffee with me now? Cyrex labs stressed it is the instant. God I want it so bad. Just one cup a day. 🙁 I react too bad with fatigue and anxiety.

There’s no research to support any health benefit to low oxalate diets (and actually higher oxalate intake protects the kidneys are reduces chances of gout and lowers risk of cancer). Check out my Pros and Cons of coffee post… daily probably isn’t a good idea but you might be able to do one a week. I’ve been having a cup every 2-3 weeks and really enjoying it and doing fairly well with it (I get really revved up on it though, which is one reason why I don’t indulge very often).

I was mainly concerned about us leaky gut folks and oxalates messing with an already difficult situation. Why else would I react to dark chocolate and nuts/seeds when I never did before. I read big antibiotic use wipes out the friendly bacteria that digests it so wondered if that was the deal for me. Looks like a Canadian company probiotic-lab makes it but it is $150 a bottle. I may be desperate enough to try it. Oxthera is another but it is not for sale yet. I’m going to get some VSL 3 and maybe plantarum pro biotic too and see if it helps. No coffee, chocolate and nuts for a year is just too heartbreaking for this girl. My 3 life favs.

I properly soaked seeds and nuts to deal with the phytic acid and nope no improvements. I was hoping that was the answer. Maybe when my gut is healed I can have them again. I’m on month 9. Geez I hear of folks healing in 1-3 months. I’m doing dgl and glutamine. Can’t do the coconut oil or frements.

Thanks again for all of the great info that you provide and your wonderful research. I’ve been following your site for a while now and your ideas have helped me a lot. I’m anxiously waiting for the publication of your new book, as I’m sure you are too.

I recently came across a really interesting study from Cornell, where the researchers were looking into the potential cause of one of the more difficult AI diseases, MS. This study seems like one of the first where the researchers have made a possible significant link between bacteria in the microbiome and an eventual disease trigger in the brain. The basic info can be found at:

I was curious, given your background, what you might think of this research and what impact this kind of thinking might have on diet and treatment with different probiotics. I know this is a huge topic but one that I think is exciting because more mainstream scientist seem to be on the warpath.

Very interesting! I think there’s quite compelling research indicating that diversity and health of the microbiome has a profound effect on human health and I don’t see this overarching idea to be particularly controversial. But, of the 35000 species of bacteria that are known to be part of the human microbiota, only about 50 are even remotely characterized, so I think we’re a long way away from being able to measure someone’s gut organisms and target probiotics or probably more likely pro and prebiotics. But, I do think it’s a very promising and exciting field of research!

Hi Sarah,

Apologies if you have answered these questions before – I wasn’t sure.

(1) What are your thoughts on testing for parasites and internal fungal infections etc? I think I would like to have some testing done but I am unsure where to start or what ones to test for. I guess I would need to go to my GP for this and I’m not sure if it’s something that they do – so it would be good to have information before the visit.

(2) Recently I met someone who had had an endoscopy. From this test, the doctors told her she had an internal fungal infection. She was prescribed medication and has noticed a big improvement in her digestion. Are endoscopies/colonoscopies an appropriate way to test for fungal infections/bacterial overgrowths etc?

(3) Finally, recently, I was sent an extract from a study on salt and autoimmune conditions. It says salt should be avoided. I have been using sea salt in many of my meals for flavour – should I discontinue this? I do not eat packaged meals etc so the sea salt is the only type my body gets.

Here is the info I was sent:
– Salt can add flavor to dishes, but unfortunately it can also take a toll on our health. If you’re looking for even more reason to cut back on your salt intake, a new study may have linked dietary salt to a heightened risk of autoimmune diseases like multiple sclerosis.
After adding salt to the diets of mice, researchers noted that the mice’s bodies began to produce a type of T cells that is associated with autoimmune diseases. Furthermore, the mice that had salt in their diets developed a more serious type of experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis.
The inspiration for the study came from a prior observation that the production of inflammatory cells increased after eating fast food. These inflammatory cells are what attack healthy tissues in autoimmune diseases, so researchers hypothesized that the high amount of salt in the foods we eat could play a role in why many autoimmune diseases have become more prevalent.
“Today, Western diets all have high salt content and that has led to increase in hypertension and perhaps autoimmune disease as well,” study researcher David Hafler, the Gilbert H. Glaser Professor of Neurology, Professor of Immunobiology, and Chair of the Department of Neurology at Yale University, was quoted as saying.
While it may be surprising to some that the relationship between dietary salt and autoimmune disease has only recently come to light, researchers explain that test tube biology uses salt levels in the blood rather than in the tissues, which is where autoimmunity can be seen.

I am eagerly awaiting your book 


1) parasitical infections can be an obstacle, so if diet and lifestyle changes aren’t working, I think that’s a very good avenue for troubleshooting. Fungal infections generally should correct with supporting the immune system and healing the gut.

2) I don’t know. The usual tests are stool analysis.

3) The studies show that very high salt intake activates Th17 cells, but that doesn’t mean we should be avoiding salt altogether. Salt is an essential mineral and unrefined salt can provide you with over 80 other essential trace mineals. If you’re eating a paleo diet, using a high quality salt like pink salt of gray salt, not drowning your food in salt, I think you’re fine.

Thanks thanks Sarah. I just read the article KeithW posted – really interesting. In addition to AIP, is there anything else you recommend for MS?

Thanks so much for all your work on this topic

Hello, thank you for this great resource. I am planning to start the AIP protocol soon to get my Hashimotos under control. I am currently breastfeeding my 10-month-old son and was wondering whether you thought there might be any special consideration or adaptation necessary for a breastfeeding mom doing the AIP?
THanks, Janine


I used to see beige small things in my stool and I had a standard stool test for parasites in a university and it found nothing but I read that the tests were specific to only some parasites and most of the parasites were not detected and searched for a solution and found Hulda Regehr Clark’s parasite cleanse.

I never did enemas or zapping and I used raw frozen green juglans regia hull instead of green juglans nigra hull extract(they have the same antiparasitic chemical) and artemisinin(antiparasitic chemical in wormwood) capsules instead of wormwood capsules, freshly powdered cloves, ubiquinol instead of coq10, ozonated olive oil, n-acetyl cysteine instead of l-cysteine or free cysteine in potencies and periods not less than suggested and I also used many other antiparasitic herbs and coconut flakes and pumpkin seeds often and I also used a teaspoon Mesosilver colloidal silver everyday for about a month while I was also emulating Clark’s parasite cleanse which lasts 21 days.

But I saw such beige small things after all that again a few times(not checking everytime) and I also had itching of anus a few times. Do I have parasites ? Do I have to take a better test for parasites ? What are the solutions to the parasites if I have them ? If it may not be parasites, what may it be ? Do I have to take a test for it ? Do I have poor digestion ? If yes, what enzymes do I need and what else do I need ? Note: I’m somewhere between strict paleo and autoimmune protocol nowadays and I saw the beige things and had itching anus with this diet also but I didn’t have any other digestive problems, but at least one time I’m sure I didn’t eat anything with that color that could possibly be there when I saw it unless something with a different color became beige.

I’m sorry, I don’t know. The usual method for diagnosing parasites is stool tests (although there are some other tests, and I’m not familiar with all of them), but you’re right that some parasites are easier to miss on these tests than others. And, some parasites can be notoriously difficult to get rid of (even if you went conventional treatment with strong anti-parasiticals you would have to re-test several times to verify eradication). I would think that if you can see something in your stool, it should be relatively easy for a healthcare professional/lab to identify what it is, so I think it’s worth talking to your doctor about full stool analysis. Is it possible that it’s undigested food particles? Something typically harder to fully digest like nuts (trying to think of things that would be beige on the other end). In addition to revising the issue of testing with your doctor, I think it would be helpful to keep a food journal, stool journal, and symptom journal and see if you can identify patterns.

I’m sorry I don’t have any definitive answers for you. I definitely recommend working with a healthcare professional on this one.

Hi Sarah,
My 4yr daughter has eczema (although i have been told by several dermatologist that its not eczema, as its not typical, the skin biopsy was inconclusive, and they don’t know whats wrong with her skin ) it starts as a red itchy raised skin pore that can expands to 3mm wide spot which she scratches and sometimes become infected, she has these circle spots on her arms elbows knees, ankles and thighs.
One dr suggested it was due to Gluten, so we have been GF for 18 months and the scratching has reduced but the spots keep coming.
We are also dairy, soy and nut free, as i noticed that these foods increase the inflammation in her skin, And after small piece of cheese the night scratching returns.
She takes probiotics and i have now added Great lakes gelatin to her drinks.
Her diet is fairly limited and i am struggling to get many fruits/veggies into her (this was not the case 2 years ago, she would eat everything, now super picky)
she mainly eats rice and rice pasta and meats, after reading your AIP recommendations for dermatitis i have eliminated her Almond milk and seeds and although her bowl moments have greatly improved they are more formed (not small balls anymore) there is not improvement in her skin.
She is due for her annual Blood testing for Type 1 diabetes antibodies as my 6yr old has type 1 diabetes and the pediatrician usually asked for a CBC whilst they draw blood so my question is this, what else shell i include on the test ? can you think of anything that can help me solve her skin problem ?
no Dr /allergist can tell me whats wrong and why these spots keep coming? and i haven’t found which food is causing them to come , only which food makes them inflamed
she had blood allergy testing which came back as no allergies and scratch testing which revealed nothing too.

many thanks
worried mum

How frustrating! My youngest is so sensitive to dairy, that even eating something that was touched by someone that touched cheese before touching that food will cause a reaction (such severe reflux that she’s literally choking on the acid)… but her allergy tests came back negative! I think with foods sensitivities, the elimination diet approach that you are already playing with is really the most conclusive (there are so many ways that you can be sensitive to foods that you just can’t test for). A food and symptom journal might be helpful.

As for useful tests, this really isn’t my area of expertise. Something like c-reactive protein would give you an indication on how much inflammation your daughter has, but won’t tell you what’s causing it. Same with IgA or ANA. Something like a hydrogen breath test to test for fructose malabsorption and SIBO (different sugars in the drink so it has to be done at different times, but the process is the same) might help (since you mention that she has a history of type 1 stools). I found with my oldest that she became a lot less picky once we removed grains from her diet and she stopped having abdominal discomfort every time she ate (although it took over a year for her to gain confidence with foods and really start eating variety without battles).

I’m sorry I can’t be any more help.

Whim 2 weeks into AIP and last night was wanting a snack of something sweet. I ate some dry coconut flakes. Did fine, woke up this morning was fine, had my regular morning coffee and went to work. Around 10am a massive wave of nausea hit me and I ran to the bathroom and heaved my insides out. Tons of coconut flakes 🙁 again at noon I continued to throw up until I thought I’d see my shoes floating in the porcelain bowl soon. My face is covers in burst blood vessels from the forcefulness of heaving. Is there any possibility this was caused by the coconut flakes?

It’s possible it was a food sensitivity reaction, especially if you haven’t had an coconut for the past two week. It’s also possible it’s a stomach bug or food poisoning or something else, and it was just bad luck.

I think it’s worth talking to a doctor about. I’m not a medical professional so I can’t guide you through exactly what tests are appropriate for what ages, but I have heard from many people who have done lactulose-mannose tests with children through pediatric gastroenterologists.

HI Sarah,

Thank you so much for all the time and energy you have put into this wonderful site, blog and facebook. It is a wonderful resource and incredibly interesting!

I am 33 years old and have a vitamin B12 deficiency as well as chilblains, which I have read can have roots in autoimmune disease. The chilblains came incredibly early this year (Mid September, which is usual for me) and I began searching around to see if there was anything I was eating that could effect the early onset and that is when I found your website.

Almost two years ago I did a food intolerance test and found out that I have a diary intolerance (both lactose and Casein) as well as a grain and potato combination intolerance, so I have completely cut out all dairy, flour and yeast to be safe, but still eat whole grains and legumes.

I started about a week ago to follow the AIP diet and cut out grains, legumes entirely as well as nightshades to see if my conditions improve, but was curious if you have heard of either of my conditions going into remission on the AIP diet.

I also had a few questions about the diet itself.

I was curious if there is any safe vinegar to eat. I am having trouble coming up with a good salad dressing recipe 🙂

Also I noticed that it says to not consume dried fruit. I typically have 1-2 servings of dried apricots (Turkish apricots with no additives) a day as a “treat”. I can certainly cut this out but wanted to understand the effects further and see if you felt that was necessary

Also I wanted to see what your feeling was on including sprouted walnuts or walnut oil into the AIP diet.

Thanks so much again for all that you do to share your knowledge and for any advice you might have, I really appreciate it!
Looking forward to the cookbook!
my best,

I think you are the first person to connect with me with Chilblains, but I’ve seen many people reverse vitamin and mineral deficiencies (B12 included).

All vinegars except malt vinegar and grain vinegars like rice vinegar are included on the AIP, so feel free to use apple cider, red wine, white wine, coconut water, and balsamic vinegars. The only issue is that if you do have a food sensitivity to yeast, all vinegars (except maybe distilled wine vinegar) will have some.

Dried fruit is suggest in moderation due to it being high glycemic load. The important part is that your blood sugar is well regulated, so if you are just having a little and your blood sugars are fine afterward, then it’s okay to continue.

Walnut oil is probably well tolerated by most. Sprouted walnuts might be okay. Both of these I suggest omitting at first and then reintroducing after at least 2-4 weeks.

Good luck!

That is so interesting that no one has contacted you about chilblains before. It was your success with keeping your lichen planus at bay that inspired me to try AIP 🙂 I will definitely keep you posted on how it goes.

I have noticed that just within a weeks time the inflammation in the sores I have has gone down, I think the biggest test will be to see if I get any on my feet this year.

Thanks so much for the tips on the diet, it is good to know about the vinegar. I will check with my ND about the yeast that is in vinegar to see if that is okay.

Thanks again!
All my best, elaine


Over the last year or so I’ve developed multiple food sensitivities – gluten, dairy, soy, rice – and just recently found out I’m allergic to eggs, yeast and pecans. My food choices are further limited because I had both jaw joints replaced two years ago due to severe TMJ disease and when I eat things that are chewy or crunchy I end up with a lot of jaw pain (which also triggers migraines). I was also recently diagnosed with adrenal fatigue. I was diagnosed as hypothyroid over ten years ago, but I don’t know how to find out if it is autoimmune or not. I am hoping that the autoimmune protocol will help me with my health/food issues. I am concerned that I won’t be able to stick with it because of the amount of cooking required. I love to cook, but I’m so fatigued all the time there are many days cooking just isn’t possible. I’m trying to figure out a way I can do all my cooking on the weekend, so I’ll just have to reheat foods during the week and would appreciate any suggestions. I am also dealing with a lot of gut/nausea issues. When I am nauseous all I feel like eating is gluten free bread or crackers – do you have any suggestions for appropriate foods to eat when sick/nauseous?

Thank you,

Soups and stews, root vegetables mash, bananas, and you might want to check out my plantain cracker recipe (they keep at least a week and probably longer if you put them in the fridge.

As for cooking, I suggest making big batches when you do cook to maximize how much food you get out of the effort and time. Put extras in your freezer or do what you’re already planning of having a big cooking day each week.

Hi Sarah,

Thanks for replying! I’ve been checking out some soup/stew recipes and have found several I’m excited to try. Bananas have always been my go to fruit when my jaws are bad (like today – I led a grocery store tour yesterday which meant lots of talking, now today I can barely open my mouth), but was told to avoid bananas and other high potassium foods due to adrenal fatigue.

On a happy note I think I may have my husband convinced to try a three week trial of paleo along with me. He has been having increasingly worse psoriasis and I’m curious to see if eliminating gluten, etc. will help with that. If he does decide to join me it will definitely make this easier, especially if I can get him to help with the cooking :).

Thanks again,

Hi Sarah – I actually got my husband to do a trial of paleo (he did “standard” paleo while I did AIP) and we both felt much better, but then I got the flu and wasn’t up to cooking, we went out of town for a couple of weeks, the holidays, etc., etc. and so we’re now both feeling bad again. I have Mickey’s book (and yours on preorder – can wait for it to get here!) and started following her meal plan this week, but after three days of migraine (probably from caffeine withdrawal) went back to coffee with cream, etc. and am now trying to taper off caffeine and will go back on her meal plan next week. My question is that even following AIP and eliminating the foods I know I’m sensitive too I still seem to be having food reactions. Including this morning to a meal of beef patties, Brussels sprouts w/bacon and sweet potato. All of which I ate earlier in the week with no issue, but now eating them as leftovers am experiencing both cough and congestion. They seem to be a definite histamine response (coughing, congestion, chest tightness, shortness of breath) that happens within minutes of eating and lasts from a few minutes to a couple of hours, then fatigue the rest of the day. IGE testing showed no allergies, IGG testing shows reaction to egg, pecans and yeast which I never noticed symptoms from. Foods that I almost always react to/react most severely to are dairy, soy, gluten and rice. There is a variety of other foods I react to at times, but not others – Lara bars, pineapple, mango, port wine, etc. I have looked into sensitivities to histamine, amines, and salicylates and they all look like possibilities, but I have been able to come to no definite conclusions. I’m hoping your book will address some of these, but in the mean time any suggestions/input you might have would be greatly appreciated!

Hi Sarah
I have just discovered you, your work and your blog! Excellent – thank you. I’m on the other side of some very serious GI issues – trying to follow a Paleo diet combined with low FODMAP. I’ve just finished reading Grain Brain and am trying to eat low carb – the last nonPaleo element in my diet was brown jasmine rice. I have read you do not support low carb for people suffering from autoimmune diseases.

My challenge is two fold and I am hoping you may have some advice. I am challenged to eat enough carbs without the rice – I lose weight (which I can’t afford being underweight presently). I have trouble with sugars and starch. I have been eating nuts and seeds every day. Egg whites are problematic for me. In addition to my GI issues on my face I get rashes, hives and become very itchy after some meals. I can’t always identify the food causing the problem – egg whites seem to be a cause, possibly organic butter.

Fats make up 70% of my calories – olive oil, walnut oil, sesame oil, avocado oil, coconut oil, organic butter and ghee. I eat a lot of grass fed meat (beef, bison, llama, elk, lamb, pork), free range organic chicken and turkey, duck, wild caught fish and a variety of shell fish. I eat organic vegetables and have been avoiding fruit for months. I eat organic olives. Last time I tried avocado it made me quite sick (GI).

Any suggestions how I can get to 70-100g of carbs daily? The last time I ate sweet potato (Feb) I had hours of pain, bloating, gas and pressure. I’ve limited myself to cooked vegetables only – bok choy, spinach, chard, cauliflower, zucchini, carrots, turnip, spaghetti squash, butternut squash, acorn squash. I can only get to 40-50g eating 8 servings (2 for breakfast, 3 at lunch and supper). I still have mild GI symptoms – burping, heartburn, occasional reflux. I have been eating nightshades (tomatoes and peppers) but will eliminate them. When I increase my protein above 100g daily (I’m 109 lbs) my creatinine levels go too high.

Any suggestions? Looking forward to your new book – will it be in ebook?

My number one suggestion is to add digestive support supplements (either pancreatic enzymes or plant enzymes or both) to help you better digest starch in rice or starchy vegetables. How do you do with fruit? That’s another way to increase carbs as long as you aren’t overdoing it Also, you might consider checking out a FODMAP intolerance list and seeing if you recognize any patterns. Increasing carbohydrates and supporting digestion should both help normalize your weight too.

Hi Sarah, my question is about dairy allergies. I grew up eating pasturized dairy everyday. After I hit puberty dairy would give me horrible, painful acne but not right away, it would take about 3-5 days for the acne to show up. I had a allergy scratch test and found out I was allergic to many other foods as well. For example tomatoes give me hives BUT not everytime I eat them. I went on the GAPS diet and could only manage for about 2 1/2 months. While on the GAPS diet I realized that I am histamine intolerant as well! GAPS is very high histamine. I was able to work up to 4 BioKults per day. A couple days ago I tried the BioKult and it gave me horrible huge painful pimples – the same kind I get when I have dairy. Would your program help me with all my food intolerances and my histamine intolerance?

Hi Sarah,

Absolutely love your site, jammed full of info.
I’ve been following the AIP for 1.5 months strictly now & for 2 months loosely before that as I fazed out the perishables in my pantry and fridge.
my question is about lard and why it’s included on this protocol and not others.
I’m in a conversation with someone re Lard and they follow Izabella Wentz model of the diet & lard is not allowed as it apparently ‘lowers alkaline phosphatase which perpetuates the autoimmune reaction’ as this person explained, have you found an argument against this or is it so negligible a change as it causes no autoimmune responce, is the science solid?


ps. keep up the awesome work!!!

pps. I use lard a fair bit, I’ve started to make my own as I couldn’t get organic lard in Australia, so mine is now organic pastured biodynamic lard 🙂

Well, refined lard is sometimes used in animal feed to make high fat diets (along with lots of other stuff) and then additions are sometimes made to see effect on alkaline phosphatase, but I haven’t seen a study that really compares lard with other fats or isolates which fatty acids might be responsible. There’s one study looking at medium chain triglycerides that show that they stimulate ALP compared to lard… but there’s also studies showing that ALP is abnormally high in autoimmune diseases. None of these studies are particularly conclusive, and none of them form an argument to eliminate lard. Plus, pasture-raised lard is one of the best food sources of vitamin D available and is about 50% monounsaturated fat.

Hi Sarah
Thanks for your reply. I am taking probiotics and digestive enzymes. I’m also taking a daily dose of resotran and peg. I’m not eating fruit – have tried but had some difficulties. I was on Vivonex (orally) for 28 days in June and then gradually reintroduced food. I continue to be able to eat more – protein and fat are no problem. Sugars and starches are. So I’ve been sticking to cooked vegetables all low FODMAP. I’ve been reluctantly eating jasmine rice three times a day to maintain my weight. I have eliminated the rice but lose weight quickly and suspect I go into ketosis as my carb count drops to 40-60g daily.

Any comment on flax and hemp oils? Will your book be out in e-format? Thanks again

Not a fan of flax or hemp oils (our bodies need DHA and EPA, not ALA). Do you handle rice better than starchy vegetables? Have you tried plant enzymes?

Yes, my cook will be out in kindle and on iTunes.

Hi Sarah,

Awesome website, the information you provide is simply life changing to me, living with an auto-immune disease. Just a question regarding colostrum – there is some information out there that claims colostrum supplements can help repair a leaky gut. And that even though this is bovine colostrum, it can be used in people with dairy intolerances?

Have you found anything in line with these claims? Apologies in advance if you already have the answer on your website, just haven’t found it yet.

Can’t wait for your book 🙂 Christmas seems to far away !


Hi Sarah
Thanks again for your reply. I am very anxious to read your book! I have added digestive enzymes to my regime and have been experimenting with more varieties of winter squash to bring up my carb count. So far so good. I have also eliminated egg yolks (I react to egg whites) and nuts. I was soaking and dehydrating nuts. GI wise no problem but I continue to have itchy skin on my face at times. I’ve had to increase my oil intake to get sufficient calories – avocado, coconut, sesame and lots of olive oil. I’ve tried small amounts of avocado (1/4 cup is ok) and can eat olives. Any suggestions? Thanks again for your advice?

Verrrrry Interesting. Discovered Paleo/Primal a couple of years ago and now, at age 65, many of my long-time body issues are resolved: osteoarthritis no longer hurts — check; excess fat mostly gone — check; energy better — check. Rosacea? Not so much. Pimples here and there? Ditto.

Your protocol interests me, tho it will take me a while to wrap my head around avoiding the very foods that make primal do-able for me: lots of cultured dairy, tomatoes and peppers by the bushel basket, peppercorns, nuts and — oh, LORD — coffee. I’ve built shrines to coffee in my kitchen cupboard. Still, worth a go.

Question for today however has to do with magnesium, specifically it’s stool-loosening qualities. I take magnesium regularly, but have to stop every few days when the “loosie” gets unmanageable. My guess is that my gut isn’t particularly happy with this side-effect — is it possible that the magnesium also doing damage to my gut? Should I be hunting up some other way of getting it into my body? I don’t have time in my life (nor the inclination) for long epsom salt soaks.

Thank you for your excellent work, and for the dedication and time you invest — truly a generous spirit. ~ Kate

In high doses, it can. Food sources are always preferable, but you could also try switching forms of magnesium. Magnesium glycinate and magnesium taurate are more readily absorbed. You can also divide your dose throughout the day and take it with meals to improve absorption.

Hi Sarah,
I live in Germany and I can’t find much information about aip in german web. Can you tell me, if it makes sense to follow the aip for me, I suffer from this disease called graves’ disease. Even in your website I can’t find graves’ disease and aip. I have to avoid every food with iodine, so I can’t eat sea fish and other things like that. This may be a problem, doesn’t it?
What do you think about aip and graves’ disease?
Thanks for your advice! sorry for bad english 🙁

Yes, Grave’s is an autoimmune disease. It’s important to make sure you’re getting adequate selenium with Grave’s (fish is actually the best source, but you might want to hold off adding that in until you’ve been doing the AIP a while if you know fish causes you flares). Brazil nuts are also a great source, so even though I wouldn’t typically recommend nuts for autoimmune disease, this might be an exception.

Hi Sarah,

Thanks so much for all the info you provide. I am currently on the AIP and its going well however have been looking for noodle/pasta substitutes. Kelp noodles looks like a good one, but I have also come across something called Shirataki noodles which seem to be made from yams. They claim to be very low in carbohydrate however. Would this sort of food be acceptable on the AIP?



My mom has Type 1 Diabetes and Rheumatoid arthritis. I’ve stumbled on the AIP during my own Paleo research and I would really love for her to give it a try. The catch is that she’s been vegetarian for about 8 years and is simply grossed out by meat and poultry now (sigh), though she has said she is willing to give fish/seafood a try.
Do you think a pescetarian version of the AIP is possible? Eggs, nuts, seeds and beans have been her only protein sources for so long and she’d have to sacrifice them all. I really want this to work for her since her health constantly fluctuates (because of her diet, I am sure).
Suggestions very welcome!

Just finished Tara Grant’s Hidden Plague book and looking forward to yours. Something I’m confused about when cross-referencing all the AI/nightshade info out there is whether -coriander, cumin, mustard, nutmeg are ok or not. As far as I have read, these are not nightshades, but Tara both promotes them and puts them on her “watch out for” lists, which is confusing. Can you shed some light / share your point of view?

Background: I’m dealing with seborrheic dermatitis –which I think is leaky gut related, but unsure. Known triggers: sugar, stress, lack of sleep, alcohol. Suspected triggers: hot spices [possibly just the nightshade ones?], vinegar, pseudo-grains, blue corn, almond butter. Not sure if it’s the phytates, the PUFA, the sugars, or all of them. Foods I think are fine but am eliminating for now as part of the AI elimination diet: raw/aged non hormone cheese, cultured goat kefir, eggs [along w/ the full AI/nightshades list].

And just for further context, things that are helpful to my seborrheic dermatitis: topical ACV on scalp, topical Selsun Blue Shampoo [selenium sulfide]. I do not use these, however, because I want to troubleshoot the internal issue. Internally, things that have helped in the past are Nystatin (antifungal), and allicin tablets. And fasting — fasting for several weeks yielded a huge outbreak, and then COMPLETE elimination. But again, I want to control this via diet, because I have long stretches where I can/do. And I want to figure out, conclusively which foods just don’t agree with me or are triggering the presumed leaky gut.

Thanks so very much!

Hey Sara,

I have been on the paleo diet for about a year now, consuming a lot of veggies, eggs, pasture raised meats, fish etc. I eat pasture raised eggs every morning with a side of fruit (berries of some sort) and have a large salad every day for lunch. I also try to eat fish at least 2-3 times a week for dinner. I put siracha on virtually all my food and after initially losing weight and feeling great I have developed very dry skin and scalp. It is flaky and itchy constantly and I seem to be losing more hair than usual off of my head. I am still in excellent shape and workout as much as needed but I don’t understand why I am getting this excessive dry skin on my scalp and even my face (which shows up as a dry red patch occasionally). There are no other symptoms and I still get compliments on how great my skin is. I just can’t figure out what I need to do to get rid of this dry, itchy skin….initially I thought it was coffee because I had just started drinking it a couple months ago. Based on your article seems like cutting out eggs is a good start. I am 25, in good health, but any advice would be appreciated.


I would start with nightshades before eggs if you’re putting sriracha on everything. Far more problematic proteins in nightshades (although eggs are definitely still a contender).

Thanks for replying! I think my mom has actually preordered your book/cookbook, which I am very excited for her to try out. I hope she doesn’t get discouraged or bored of seafood for every meal and give it up.

Hi Sarah!

My eyesight, libido, energy, focus, confidence and more all improved when I went Paleo about 3 months ago but I still have serious issues sleeping more than a few hours per night due to chronic muscle tension in my lower and upper back along the spine as well as chronic pain in my sternum and frequent tight abdominal muscles.

It is only after laying down/sleeping for a few hours that this pain/tension/discomfort become noticeable enough to wake me up then I must get up and move around for an hour or two before I can get back to sleep.

This is my biggest remaining health issue. I do still have dry, flaky scalp, dry skin (but quite mild), and a touch of eczema here and there but it’s the lack of quality sleep that seems to be really holding me back.

On the rare occasion where I get 7-8 hours of decent sleep (this may occur 4-6 nights per month), I feel like a super hero the next day. Incidentally, the last time this occurred was when I slept about 10 hours one night last week after taking 200mg of Ibuprofen before bed – I don’t like taking the stuff, but when I do, the superior sleep is well worth it (even though the Ibuprofen seems to help only about 50% of the time on the rare night that I do take it).

I have a pretty good MD who had me take all kinds of blood, urine, stool, heavy metals, food allergy tests, etc. this past September and we determined that I have leaky gut and chronic inflammation to deal with.

I have been taking Omega 3, Vitamin D, digestive enzymes, garlic extract, berberis, magnesium (as well as applying magnesium oil to my sore/tight muscles before bed), B12, B6, serapeptase, and more for about a month now (in addition to continuing to eat Paleo) and still have this tension/pain in my back/sternum/abdomen that prevent me from getting a good night sleep.

About a week ago, I threw out the nuts, seeds, nightshades, etc. and have been following your AIP (fantastic fish, beef, pork recipes by the way!) with only slight improvements. I also began weight training (3 days/week) and regular sun exposure at the same time.

Now, I realize that a week on the AIP wont heal a couple years worth of back/sternum pain (I went to a chiropractor in October once a week for about 5 weeks regarding these issues as well but had little improvement) and a lifetime (I am a 31 year old male, 6′-2″, 150lbs) of skin issues, but is there anything more I can do to keep the back/sternum pain from creeping up on me during the night and ruining my precious sleep?



P.S.: You do awesome things here!

Yeah, that ibuprofen versus sleep is a dilemma. It sounds like you have a good doctor… it would be worth discussing the pros and cons of non NSAID pain killers to help you sleep. One option is low dose naltrexone (3-5mg/day, usually has to be specially compounded, and is the Go To source on it) which can help both with regulating the immune system and reducing pain (it’s been shown to be beneficial in quite a few autoimmune conditions now). Have you had your vitamin D levels checked (D supplements usually make me nervous since too much can cause problems)? Also, are you drinking broth? If not, you may wish to add a collagen supplement to your regime (good for skin, bone and joint health) as well as trying to get some broth in.

The biggest suggestion I have is to read 8 Steps To A Pain Free Back by Esther Gokhale, and better yet see if you can access one of her courses ( I did one of her workshops two weeks ago and it was amazing. She teaches primal posture, with alignment strategies for sitting, lying down, standing and walking, and I think this might be very helpful.

I hope this helps!

Thanks for feedback Sarah.

I have not yet resorted to the naltrexone as I have been sleeping better thanks to my acupuncturist (yeah, I was skeptical at first but I think it’s really helped me relax which is probably a large part of the problem).

I bought “Pain Free” by Pete Egoscue and tried some of his methods as well and they have helped too. I still have to check out Ester’s material.

Regarding the Vitamin D levels, I had those and others (omega 3, 6, 9, etc.) checked last fall and all were low so am taking supplements including drinking broth from time to time.

In addition to collagen, do you generally recommend taking any supplements to someone with leaky gut, candida, chronic inflammation, mild eczema & dandruff? Or are the AIP diet and exercise enough?


I’m not a huge fan of supplements in general. I think most people can benefit from magnesium. I also really like Prescript-Assist SBOs but even that isn’t necessary if you’re getting some access to locally grown vegetables and playing outside. There are a few supplements that can help with a leaky gut , namely DGL and L-glutamine, and I think those are worth trying if you’re frustrated that your other efforts aren’t working quickly enough.

Hi Sarah,

This is a great page, thank you for all the effort you put in.

I’m looking at a possible multiple sclerosis diagnosis and have been investigating diet changes to compensate. There is a site called Overcoming Multiple Sclerosis that seems popular and recommends a specific diet based on the inventor’s reading of the scientific research. The keystone of the diet is very low saturated fat (<20g/day) plus no dairy to avoid the milk protein. To achieve this the recommendation is a wholefood and seafood based diet with other meat dropped to avoid saturated fat. Grains and soya form a large part of the recommendations too.

At the same time I have been reading up on Paleo, which I was interested in before my diagnosis came to light, and now Paleo AI. My dilemma is the saturated fat content. Paleo seems to rely on it for energy and yet OMS pushes to eliminate it as much as humanly possible.

Would you be able to expand on the role or impact of saturated fat on autoimmune diseases?

Many thanks


I talk about this in my book. It’s quite a complex topic, but the most important points is that saturated fats are the most stable fats and least likely to be oxidized, so they’re actually less inflammatory. Also, they are the easiest fats for your body to use as energy, which is a good thing. Many hormones and neuroactive compounds are made from saturated fats/cholesterol, so they are essential for health. With MS, you should definitely check out, who is running clinical trials showing that this approach is exceptionally powerful for reversing MS.

Thanks for the reply Sarah. I’ll have a look at, definitely.

I think I can also feel a book purchase coming on 🙂

Dear Sarah, can I just say be blessed with all the hard work you are doing for people with autoimmune diseases! Big Hugs far away from Ukraine 🙂

Hi Sarah-

I need your advice. I have been on AIP for over a year now trying to heal my psoriasis. The only reintroductions I have made is nuts very occasionally (dont seem to bother me) and coffee, which I go on and off of, as I love it and dont feel like I react negatively to drinking 1 cup in the morning.

However, 2 weeks ago I broke out with the worst flare I have ever had since developing the condition 10 years ago. I have to admit, but AIP has not seemed to work that well for me. I was pretty much in remission for years, despite the fact that I was under way more stress, exercised twice as much and with more intensity, drank alcohol and coffee, and ate a SAD. I just dont understand why now, after making such dramatic dietary and lifestyle changes, my body is covered once again.

Im wondering if part of my issue is due to cortisol. I am working with a great doctor, and my most recent test showed normal cortisol in the morning but slightly elevated levels at night.

Now, because of my job I do fast for approximately 14 hours from my last meal in the evening. Im a personal trainer and M-F I start work at 6 am and usually have clients straight through until 10 am before I get a break. I do not eat during these hours as I really have no time in between sessions to eat a meal, and if I did, I would literally be shoveling in the food as fast as I could and then running around, which I know is less that ideal in terms of digestion. In addition to this, when clients complain, cancel, dont follow instructions etc. it really gets me worked up and frustrated, so Im sure that stress would hinder digestion.

If I eat dinner around 7:30 (in bed by 9:30), get up at 5:15 and dont eat until 10:30 or 11 am, is this far too long to go without food and could it be contributing to the elevated evening cortisol? I really dont want to eat meat and veg at 5:45 in the morning. I was drinking a cup of coffee over these 4 hours, sipping it very slowly and sometimes not even finishing. I have since stopped because of my flare and switched to a cup of Yerba Mate (40 mg caffeine) which I seem to be tolerating very well.

My life isnt super stressful, and most of my anxiety lies in my health. Its very difficult to not focus on my disease because it is so visible and seeing new lesions tells me that Im still doing something wrong. I try to do other things to address stress, exercise, yoga, and I sleep as much as I can, despite having to wake so early. My sleep isnt perfect and I definitely wake up a few times in the night.

What are symptoms of cortisol disregulation that I should look for, and what should I do about my need and want to fast during my morning work shift? Would cocount oil in my tea be enough to blunt those negative affects, or am I not fasting long enough for it to matter? Thank you!

A flare can definitely be caused by stress. It may just be that you finally hit a tipping point. And, not sleeping well is one of the classic signs of dysregulated cortisol. Also, having to pee in the night, waking up not feeling refreshed, getting worked up, aggravated or anxious easily during the day, sugar and fat cravings, weight gain or resistance to weight loss especially around the middle, headaches, inefficient digestion. Also, when you’re stress is higher, your ability to tolerate some foods will diminish, so when stress is a problem, that sometimes means tightening up the diet. IFing (and yes, being up for 5-6 hours before you eat counts, even if it’s only a 14 hour fast total) can also cause increased cortisol. Strategies to fix this would include trying to incorporate something like meditation into your day, going to bed even earlier, making sure you aren’t eating too low carb, making sure your workouts aren’t too intense. You might also want to take digestive enzymes with your meals and make sure you’re getting probiotic foods and/or a good probiotic supplement like Prescript-Assist. Other things specific to psoriasis include tons of omega-3s from seafood, glycine-rich foods like broth (or a collagen supplement), and vitamin A and D rich foods (like seafood, grass-fed meat especially organ meat).

Thank you, as always, for your thoughtful reply. I feel like Im doing most of what you suggested- eating fish (mostly canned salmon) at least 4x/wk and fermented foods,taking Prescipt Assist and HCL, Ox Bile, use Great Lakes a few times for week, collagen protein everyday. Definitely need to try the organ meat though and actually start taking my FCLO that is sitting unopened.

Despite being on AIP for so long, my gut is obviously not healed so Im sure I have some food sensitivities, I just cant seem to figure out what they are. And I hesitate to run a test because of their potential for inaccuracy. Thoughts on that?

Sarah, Im scared. Your last podcast nearly sent me over the ledge, especially when you said that a flare shouldnt last more than a few weeks and Psoriasis can be life threatening. Well Im going beyond the 2 week mark with no signs of it clearing up-it just seems to be spreading. And now its totally consuming my every thought. My doctor is starting me on low dose naltrexone next week, so hoping that helps to calm down my immune system.

But what did you mean when you said that sometimes diet/lifestyle changes arent enough and you might need medical intervention. What are your thoughts on taking topical steroids in an effort to get the lesions under control? Im miserable and at a loss for what else I can do.

I know this is hard, but the emotional stress is probably one of the biggest factors right now. I don’t remember saying a flare should only last a few weeks (it will keep going if you don’t mix whatever is causing it), but I definitely remember saying that psoriasis can be life threatening. It means when a doctor says “take these steroids if you want to live”, you need to take them. Sounds like are a long way away from that point, and LDN is definitely a good move. Topical steroids are a double edged sword, they can help dramatically, but increase cortisol resistance locally, but definitely have fewer adverse effects that oral steroids. They might be worth trying, but use them sparingly. And as a better first try, it can also be really helpful to apply a lotion with vitamins A and D (like one make with grass-fed tallow like Vintage Tradition, or Green Pasture Beauty Balm), and maybe look at some probiotic skin products (I like Chrysal products… they have a home mist that is unscented and is just water and they’re probiotic blend which you can actually use as a body spray and is pretty great). Ditch any irritating soaps, shampoos, cleaners too. Hang in there… you’ll figure this out. Try not to let it get to you.

What’s your opinion about using progesterone cream ? I’ve been using a progesterone cream prepared for men without parabens rarely in less than recommended amounts.

some flares can last longer periods but i agree not usually. If so i would contact your doctor as something else might be going on causing the flare to continue…even could just be stress from holidays, work or what ever.
People can die from autoimmune diseases but generally it is chronic …usually as long as you take good care of yourself, go see your rheum regularly (every 3-4 months) you should be able to live a long life!! Might have icky times in it …but eventually they should be able to get it under control.

Wondering what you think of fresh green only juicing for getting condensed nutrients?
Is there anything that you know of in juicing greens that would be inflammatory?
(kale, collards, chard, celery, cucumber, zucchini, sometimes a carrot, parsley, beet greens and sometimes a small beet. I add lime and ginger too)
I love the bone broth too and have again recently started drinking a mug a day, is there a bone broth daily limit?

Thank you so much for your work. I have been reading every post for a few days now. Looking forward to your book and totally appreciate your researching and dissemination of all of your understandings.

I don’t think there’s a bon broth daily limit (well, even water can kill you if you have enough of it). Certain you could have it at every meal and be fine. The issue with green juices is the sugar is very easily absorbed and when you remove the fiber, you’re missing out on all the benefits that can be directly attributed to it. If you love green juices and want to have a small glass with your meal, I think that’s fine, but I don’t recommend juicing “to get your veggies”. The whole food is always better.

i am not completely sure about you diet but saw about the typical RA diet regarding leaving out nightshades.
I did tried this with food journal and never once saw that avoiding nightshades either made me feel better or slow down the progression of my RA and flares.
I tried it for about 6 months before missing homegrown tomatoes off the vine and began eating them.
I actually felt better on a diet by 7th day Adventist doctor ..trying to remember his name from 80’s where you used no fat…saute in water. No meat and a lot of combing beans with grains to make complete proteins.
The mcdougall plan was his name! Now i did not 100% stick to this one as i did no nightshades. I did try for the most part but on a few days i did have small amounts of meat in a meal….or food prepared at restaurant was saute with healthy oil( i would ask which kind).
Have you heard of him? lately due to being no narcotic pain drugs…cooking just seems too much so i mainly eat easy things..sandwiches, smoothies …not healthy at all. Depressed moderately and am trying my best to find alternatives to help with my severe pain…pain specialists say no way i will be able to have any kind of life without narcotic pain help but agree it has affected my brain…as to zero motivation to things i once enjoyed like cooking, gardening etc.
Have any ideas? i am considering LDN…other is lack of doctors in this small town. Either they hate narcotics or do not have speciality to know how to treat me. closes specialist is over 3 hours away. thanks for any assistance

LDN can be very helpful with pain and also helps regulate the immune system (so it’s not just pain management, but can slow progression as well). Studies also show high DHA and EPA (fish oil supplements or lots of fish) reduces pain and stiffness in RA patients. And there’s lots of studies showing micronutrient deficiencies in RA patients, especially fat soluble vitamins, but also some minerals like zinc–this is the reason for the focus on the most nutrient-dense foods (organ meat, seafood, vegetables).

Hi. Can you let us know if maca powder is okay on AIP? Also, I wanted to say thank you. Your advice and website have been a major player in helping take control of my health. I really can’t say it enough, thank you! I’m going to buy a lot of copies of your books for every doctor I’ve seen over the last 10 years; I think they need a little re-education. I also have another quick question. I have only been on AIP diet for 4 months. I have multiple autoimmune disorders and your AIP diet has given me many reliefs. So I’ve been very strict and careful on AIP but I ate some store bought sausages that never caused a problem before. The ingredient list fell within the AIP but now the label just list “spices” so they must have changed their recipe. I hadn’t realized this until after I ate a bite and had a major allergic reaction — from head to toe, eyes and all, I was inflamed and in pain. I don’t know what “spice” might have caused the allergic reaction. I’ve had an allergy test done a year ago, prior to AIP, which came out as no allergies. Do you think it’s worth having a new one now, since AIP? I’m clearly going to stay away from anything dubiously labeled as “spices”. But if I ever wanted to eat something not personally prepared by me, and I think it’s AIP safe, how long should I wait after a flare up? Thank you so much for reading my questions. Happy New Year and wishing you lots of success with your books!

Hi, thank you for all of the information you posted here. I was wondering if your book addresses hidratenitis suppurativa? If not, do you have any insight on this disease?

My book focuses on the commonalities between all autoimmune diseases and how to regulate the immune system through diet and lifestyle, so my recommendations are broadly applicable and broadly helpful. You might want to check out The Hidden Plague by Tara Grant (who cites me for her recommendations).

A lack of protease is very common in autoimmune disorders. This results in a lack of available vitamin B12 which shows up as anemia. In the short term you need a protease enzyme supplement, plus B12 supplement, plus a diet high in fresh fruit and vegetables, providing other enzymes (pineapple and pawpaw have protease). Long term your body may start to make protease aga