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.


I went into spontaneous Premature Ovarian Failure at the age of 38. This has been very traumatic for me. I do not know whether or not there is an auto-immune cause. I have never been to an endocrinologist. I really thought it could be caused by 6 years of unwittingly drinking arsenic contaminated borehole water. I started taking bio-identical hormones last year. 3 months after starting it, my doctor tested for thyroid antibodies and my ATG was 647 and my ANA 1:160. I was taking high doses of kelp prior to this and think I may have been selenium deficient, so wonder if this could have triggered the thyroid auto-immune attack. I stopped taking kelp and started supplementing with selenium. I started researching the Paleo Auto-Immune Protocol and loosely followed it. 5 months later my blood level of ATF was down to 36 (negative) and my ANA down to 1:80 (borderline normal). I have no overt clinical auto-immune disease that I know of. In January this year I did AIP strictly for 30 days and 2 months later am not even through stage 1 of the re-introductions. I am super frustrated. I find it so hard to know whether or not I am sensitive to a food, because, as it is, I have many symptoms related to my hormone imbalances and am under chronic financial stress beyond my control. I therefore cannot distinguish between food sensitivities and my usual waxing and waning symptoms related to my early menopause, such as foggy head, anxiety and feeling down. I also cannot afford to postpone the reintroductions indefinitely, especailly since I am 6 kg underweight (hence at high risk for osteoporosis) and cannot gain weight on the AIP program. PLEASE HELP!

It was a great blessing to me to have a doctor do an IGE blood test for me that tests for something like 21 different (main) allergy foods. I had 7 moderate food allergies, many to those it looks like you should stay away from here (grains, legumes, nightshades, etc.) 2 severe allergies to shellfish types and quite a few low sensitivities. I only had two foods with zero allergies (yeast and chocolate). Look into the test, it was heaven sent for my family and takes some of the guesswork out of it.

Sara, while I can’t give you any “expert” advice, I want to encourage you to hang in there! My friend (who is a registered dietitian & did not believe one word I was telling her until she too had to go gluten free. She found out she has microscopic colitis & I have non-celiac gluten sensitivity. I had genetic testing done and my friend did too and we both have genetic tendencies so we can never eat gluten ever again). It took both of us THREE years to get better, mainly because main stream doctors do not know how to treat us. I highly recommend using this lab for genetic testing: and if you can find and afford a functional medical practitioner in your area you will be on your way to getting better. And follow this plan too! Good luck!

Currently doing Aip for alopecia, done 5 weeks and aiming for 8, is this long enough? Do I continue this diet until I have a full head of hair?? I have been feeling a bit clueless lately, not knowing if I am doing the diet right or how long to continue with it. Does anyone have any advice?

This diet is something I believe that you’re going to have to continue for the rest of your life. The point of this diet is to heal your system and body from the foods that caused it to be damaged or damage itself. If you quit the diet you’ll be back to square one. However, if your body does heals after a couple of months of trying this diet, you should be able to gradually start adding foods back to your diet that you’ve eliminated to see if it was the cause of your symptoms. But I wouldn’t suggest Stopping the diet completely if you have an autoimmune disease or disorder!

Like Rachel, I too am doing the AIP for alopecia (universalis) and intend to stay strictly on it as long as possible. I will not do any reintroductions until it has grown back if it ever does that it. I have only been on it for about 3 weeks so no progress yet but my digestion is so much better so I think that is a very good sign. I am also trying to juggle a salyicilate sensitivity, I have atopic eczema and when I eat foods high in salyicilates my skin worsens. So annoying as I am really struggling to eliminate coconut and avocados whilst on this diet. Do you think perhaps this salycilate sensitivity may resolves itself whilst eating a nutrient dense aip diet? Could I perhaps permit just organic rice milk as one non aip compliant item whilst on the diet. It would help me a lot but I do not want to do this if it could damage my healing? So tempted to also ask how long it might take to see progress but I guess it is like’how long is a piece of string’ everyone is different .

I’m sorry if my questions are redundant, I need some help clarifying if the following are AIP compliant.
-cocoa butter/powder or cacao butter/powder
-arrowroot flour
-apple juice

Can carob powder replace cocoa powder?

I take allergy medication that was customized for me based on certain grass/food allergies. Is that a problem for AIP healing?

does onion and tapioca included in AIP diet ? I have read in few websites, they shouldn’t be added to the food list.

Yes, both onion and tapioca flour are included on an AIP diet, but be careful with the tapioca as some people can be sensitive to it. -Kiersten

Hi, I have been following the AIP for approximately 9 months now and the results are amazing. I have rheumatoid arthritis. I was diagnosed 10 years ago and have been taking different medications over those ten years to continue to function in my every day life including working fulltime. My inflammatory markers in my regular blood tests have reduced significantly since following the AIP. My goal is to totally get off the medication – but I am taking a slowly, slowly approach.
My question for the community is: My sister has just received a diagnosis of Reactive Arthritis, and the little I have read about it, there is no cure. Would the AIP work for this illness? Is there anyone that has this illness or knows of someone that has had success with AIP?
I also have a friend whose mum has Crohn’s Disease; would the AIP help with her illness?

Both Reactive Arthritis and Crohn’s disease are listed as confirmed or suspected autoimmune conditions and as such would likely benefit from the autoimmune protocol as it is described in The Paleo Approach. -Kiersten

Hi Lorraine,

I was googling “inflammation marker reduced on AIP” & your comment came up in my search. This recently happened to me at my primary care appointment 2 weeks ago. My blood work for the first time in a while was ALL normal. I have been AIP since 1/4/16. However, I don’t feel any better, my swelling and pain are still quite signifigant. I also developed more issues since going AIP. I suddenly have ad TMJ which is causing a host of eye problems.

My question is. Do you think now that my blood work is appearing normal I would begin to see and feel the progress? I am really hoping so. I am not sure when I will be able to reintroduce any food back since I haven’t been feeling any better.

And yes, your sister and friend would both benefit from AIP. Anyone with ANY autoimmune condition will.

Good luck to you!


I’ve been doing AIP for a year and a half to help with my lupus and it took several months to feel real significant improvements. Lab work can be tricky sometimes, but I often find that my flares or improvements show up in my blood before the symptoms. Depending on how severe your disease is, you may need to stay in elimination phase longer. For me it was all worth it when 3 months later I could all of a sudden last the entire day at work without feeling wiped out and my joints were no longer swollen every single day. Don’t give up, keep going! Good luck!

I have a question about the autoimmune diet. I’m vegetarian so I’m wondering if I just load up on the fish, which I don’t like to do, or how do I make up for the meat that I won’t be eating ?

Thank you,

Sarah doesn’t believe that you can get adequate nutrition to reverse autoimmune disease without eating animal foods. The lack of fat soluble vitamins, vitamin B12, and complete proteins prevents the body from fully being able to reduce inflammation and immune activation. However, including seafood in place of other animal foods is compatible with healing. So consume seafood along with lots of AIP friendly plants and fats. -Kiersten

I find this really strange. I asked a genuine question and it does not get through the moderation, yet people that came after me are posted on here.

All I asked is if iGe tests are reliable as I had no sensitivities, yet I have alopecia areata.

Why doesn’t a normal and genuine question like this get through your moderation?

I have waited for weeks. Very disappointing.

I’m sorry. Sometimes things get lost in the shuffle. Facebook is generally a better place for questions as they are less likely to be overlooked because of the way they are presented. And to answer your question, IgE testing can test for true allergies, but not sensitivities. The current gold standard for food sensitivities is an elimination diet. -Kiersten

I have been following the AIP protocol for 38 days. I am 5’9 and have lose 10lbs. So my current weight is 119. I cannot continue to lose weight. I have added nuts into my diet to increase healthy fats, but I have not seen a weight gain and continue to loose. I am eating avacados, coconut oil, coconut milk, sweet potatoes every day. I do not want to give up this diet. I currently have Raynauds, Mixed Connective tissue disorder, RA, and Hashimoto’s. Main symptoms are chronic joint pain and fatigue. What can I do to increase my weight?

Make sure you are eating enough calories overall. When we restrict the types of foods we are eating it is really easy to accidentally restrict the amount as well as we figure out what we can eat. Cassava, taro, and plantain are other great AIP carb sources in addition to sweet potatoes. -Kiersten

I forwarded this article to my partner, as we are both taking the plunge into AIP. I have been diagnosed with Anklyosing Spondylitis after 10 years of joint pain and bouts of Uveitis. My Rheumy wants to apply for Humira this June, but the side effects of the drug frighten me.

My partner finally realized that I cannot take the plunge into AIP alone and has decided to join me in the effort to do so, I find that my mentality is hard to alter and I find myself failing again and again. I wish to push off the drug for now until I get AIP fully integrated into my lifestyle and see the changes it makes within my body. I wish to have children in the foreseeable future and all of these medications I have been taking make me worry as to what kind of host my body will be.

That’s fantastic that you have such a supportive partner! That’s HUGE when making dietary changes like going AIP. Good luck with everything and I truly hope you’re able to find healing. If you need some great resources, check out Sarah’s books (The Paleo Approach, The Paleo Approach Cookbook, and The Healing Kitchen). -Kiersten

Hi everyone!

I am finally ready to embark on the full AIP journey. I’ve been transitioning to aip for months now 😀 But I’ve found out that my selenium supplement contains rice powder, too (I was so happy to find one without yeast since a test told me I do not tolerate yeast well). Should I discontinue its use or is it not the quantity I should worry about?

Many thanks,

It’s hard to say. Some people are incredibly sensitive to things like rice powder and others aren’t. Biotics Research has a selenium supplement in liquid form that I don’t believe has any added rice powder or yeast. I think they have a yeast free tablet too but I’m not certain of the other ingredients. You can find it on amazon though if you wanted to try cutting out the rice powder. -Kiersten

Hi all,
I’ve switched to a paleo diet just two weeks ago – in an attempt to fix my rheumatoid arthritis (affecting knuckles and knees). I have, over the last two years, regularly taken olive leaf extract to try to ward off colds. It seemed to work very well for me. But now I’m wondering of it’s a immune stimulant and if I should stop using it under the autoimmune protocol.
I hope you can help.


Olive leaf extract should be fine as I’m not aware of any immune stimulant effects. However, I definitely wouldn’t recommend taking an herbal antimicrobial like olive leaf extract long term because it can wipe out your gut flora (good and bad). So make sure you’re reinoculating your gut with good probiotics at least. -Kiersten

Dear Kiersten,
I have a question about nuts. Is it OK for AIP to eat nuts that have been soaked for overnight and then dehydrated (almonds, for example)?
I read that soaking the seeds and nuts removes the enzyme inhibitors they contain.

Many thanks,


While soaked nuts tend to be easier to digest than regular raw or roasted nuts, it is still recommended that you completely eliminate all nuts and seeds from your diet for at least 30 days on the autoimmune protocol. You can read more about what Sarah has to say on the importance of eliminating nuts and seeds in this post on the whys behind the autoimmune protocol. -Kiersten

Could you please let me know if romaine in allowed in the AIP diet? I would think it would be, but it is not listed like the many other types of lettuce are. Thanks!

m suffering from uveitis from 3 months .i m 24 years old.please suggest me how should I take my diet ?I want to get rid of this inflammation as soon as possible as I m going to marry in 2 months please suggest me

I am very new to this AIP idea, have been paleo for sometime, lost a great deal of weight and it healed joint issues. My concern is with my mom who lost likely had some sort of autoimmune disease however she won’t go to the dr. I feel whatever she has is most likely genetic, as she has fibromyalgia and I have it too.

I am trying to help her get started on AIP to see if she has any success-but it is ingrained in us to be boosting our immune system with supplements non stop-how do we undo this learning and/or is it a major factor? I went thru chemo 12 years ago for breast cancer and have always tried to keep my immune system strong because of this so I worry about finding the right balance of immune response. Any advice greatly appreciated!!!

The thing with autoimmune conditions is that anything that boosts your immune system can also flare up your autoimmune disease. You may find the information in The Paleo Approach helpful as Sarah discusses the issue of balancing the immune system in depth. Also, it’s always good to discuss with your healthcare practitioner. -Kiersten

Your advice here is ill-advised for those with certain autoimmune diseases such as Graves disease, and it is patently false to say that all autoimmune diseases include a leaky gut.
Graves Disease requires specific dietary restrictions that include avoiding iodine-rich foods (seafood, oily fish, sea-salt, Himalayan salt, cranberries etc.) and eating foods high in other nutrients (including whole grains) in order to prevent a recurrence of the condition and/or maintain remission status. Certain other conditions or medical histories (e.g. colon cancer; inherited forms of hypercholesterolemia) benefit from an increase in dietary fibre of the type found in legumes, and/or a reduction in consumption of animal fats. To advise people to avoid legumes is odd. It is without scientific basis and runs counter to a great deal of scientific evidence in support of consuming legumes. Some of the healthiest populations on the planet consume primarily legumes and so are free from certain conditions such as diverticulosis/itis for example: lentils are a staple for most of the 1.2 billion citizens of India and many Central and South Americans. Those with a diet high in legumes show clear evidence of better health outcomes for certain diseases, and I suspect those include many autoimmune diseases. Legumes are a key part of a healthy diet & a sustainable food crop in an increasingly populated world. Now I see people starting to replace beans with red meat as a direct result of advice from sites like this one. This is entirely the wrong direction from a health and environmental standpoint, not to mention expensive and *encourages* factory farming of livestock. There is not enough grass-fed meat (or water to support it) on the planet to allow anyone but the most privileged among us to follow an (imagined) Paleo diet. I think someone like Michael Pollan has a sounder take on a good diet for non-vegetarians. His series “Cooked” on Netflix (, while a bit simplistic and also resting on some likely fictional assumptions, does a good job of showing how grains fit into our diet and how good they are for us, and explains some of the history of why we eat the way we do and how our diet has benefited humankind save for the over-processed, fast-food period of the last 50 or so years. Why not just eat meat judiciously, eat legumes a couple of times per week, avoid junk, processed food and too much sugar in any form, including fructose (in honey, fruit & non-dextrose sugars)? See Guila Enders – Gut ( for more information on how poorly many people digest fructose.

I have the same questions….I wish someone would answer. I don’t live in North America and it is VERY difficult/impossible for me to access most of the items on this diet, every meal includes rice and legumes, and getting organic grass fed, hormone free meat is impossible (and when I am in North America it is too expensive for me to buy)

Sarah has written about legumes, fiber, red meat, and vegetarianism on the blog many times. I suggest you check out those articles if you have questions. -Kiersten

Dear Kiersten,
While on AIP, what supplements, medications can I use to help with cold’s symptoms (sore throat, etc.) and with hay fever (grass pollen allergy)?
Many thanks,

The problem with most supplements that are used to help with colds and allergies is that they often work by enhancing the immune system in one way or another. For those with autoimmune conditions, boosting the immune system is the last thing you want to do. Because of this I would avoid any supplements with herbs that enhance the immune system like elderberry, goldenseal, echinacea, ginseng, and quercetin (to name a few). A good vitamin D supplement (check the label to make sure there are no non AIP additives) and a probiotic can be helpful for preventing colds and boosting overall health in general, while still being safe for those on the autoimmune protocol. -Kiersten

Dear Kiersten,
I am on AIP for two weeks so far and now have my seasonal hay fever. I am taking VIt D and probiotics, but my hay fever is getting worse. Can I use cetririzine dihydrocloride or Loratadine or other antihistamine medications?
Nutri Aller-C with Quercetin dehydrate,Bioflavonoids and uncut Bromelain used to help in the past, can I use it now?
I need something that can help with hay fever while I am on AIP (besides VIt D and probiotics) otherwise it makes me so tired and sick, I cannot work.

Tania, I’d recommend you discuss this with your health care practitioner to find something that will help with your hay fever without exacerbating your autoimmune issues. You can always test it out too like you would with reintroducing any non AIP food. Try taking a small amount of the supplement that helps with your hay fever and see if it makes your autoimmune symptoms worse. If it doesn’t, then you’re probably okay to keep taking it. If it does make it worse, then it’s a matter of determining which symptoms are harder to manage and dealing with those. Ultimately allergies come down to a compromised gut lining so working towards healing the gut throughout the process is very important. -Kiersten

I am new to this website and AIP, and am feeling pretty overwhelmed with all of the information. It seems so difficult to accomplish this 100%…

At the moment, I am particularly confused about goitrogenic foods and iodine. I was diagnosed with Hashimoto’s about 8 years ago, and have a strong family history of thyroid disease.

In an earlier post (Modifying Paleo for Autoimmune Conditions (i.e., The Autoimmune Protocol) Dr. Wahls is quoted: “Note: If you have Grave’s Disease or Hashimotos Thyroiditis, you must also avoid goitrogenic foods, which include raw cruciferous veggies, radishes, spinach, peaches, and strawberries (cooking reduces the goitrogens; fermentation increases them).”

However, in this post, Dr. Ballentyne says: “Goitrogenic vegetables for thyroid disorders: Again, there is no scientific evidence for their exclusion even for those with thyroid disorders.”

I realize the latter is the most-up-to-date version of the AIP, but I would like to know if there has been an overall change in thinking on goitrogenic foods between the dates of the two posts because I have also found recent conflicting information on this topic elsewhere.

Secondly, Dr. Ballentyne says “I also recommend an extra serving of seaweed each week as well as at least three servings per week of oily cold-water fish to support thyroid function (except in the case of Hashimotos Thyroiditis as there are mixed reports of iodine taken either as a supplement or in iodine-rich foods actually worsening the disease).”

As an (apparenly now former) vegetarian, the only kind of meat I am comfortable eating is seafood. However, how much iodine is “too much” for someone with Hashimoto’s? I enjoy seaweed salad and dried seaweed snacks, but it sounds like these are deterimental. My seafood intake for AIP would likely be in the form of salmon and shrimp.

Thanks for any clarification you can provide!

Please address the contradictions in the AIP diet vs. the AIP + Fodmaps……..For some reason nightshades, eggs, many fruits, potatoes. rice, are on the SAFE list that are not on your list of AIP/Paleo safe, If we are combining the Paleo and FODMAP lists, there should be less safe foods after FODMAP foods have been eliminated. Please see the PaleoFodmaps Food List and give some guidance. I am so frustrated with researching for countless hours and just ending up with constant contradictory information even on the same websites. I feel like giving up before I even started :( Thank you for your time.

The AIP low FODMAP diet excludes all the same foods as the regular AIP diet (grains, dairy, legumes, eggs, nuts, seeds, nightshades, etc) but with the addition of excluding high FODMAP foods. Keep in mind that Paleo and AIP are not the same, so that may be where the confusion comes in over what is and what is not allowed, as there are paleo friendly foods that are not allowed on an AIP diet. -Kiersten

I have recently been diagnosed with Sarcoidosis, and am investigating Auto Immune and Paleo diet to find ways to control systemic inflammation, and help with my uveitis, joint pain, and skin symptoms.

I find this talk of gut involvement and auto immune disease fascinating.

4 years ago, I had an H pylori infection. In the course of that infection, and very icky anti biotic treatment which cured it, I lost 60 pounds. It took 2-3 years before my GI system felt normal again.
Within 2 months of being cured , symptoms began, to the extent that I had to seek medical attention, which eventually led to a Sarcoidosis diagnosis.

In hindsight, my doctors feel I have had sarcoidosis for 20 years, with barely noticeable symptoms back then that can now be explained with the new sarc diagnosis. I feel the H pylori infection triggered the sarcoidosis to re-surface with a bang. My doctors think it’s just a coincidence.

I feel if GI issues can contribute to a resurgence of auto-immune issues and inflammation, I want to do what I can to keep my GI tract in optimal health, and keep the inflammation at bay.


I think it’s definitely possible that there is a connection between the H pylori infection and sarcoidosis resurfacing. As you said, gut health and autoimmunity go hand in hand. So definitely focusing on optimizing gut health, potentially with an AIP diet to help the gut to heal, and keeping inflammation at bay is important. -Kiersten

What can I eat if I need sugar is coconut yogurt ok I’m struggling can’t have honey no chocolate fruit doesn’t do it for me I missing my oats in the morning and coffee what else could I have are eggs out ?

Coconut yogurt often has a lot of additives in it, but if you find one that is just cultured coconut milk, then that is just fine to have. Sarah has a great recipe for coconut milk yogurt. Eggs are eliminated on the autoimmune protocol, but not a regular Paleo diet. A great egg free breakfast option includes bacon or sausage with veggies. Sarah has a lot of great options on the blog and in her cookbooks, The Paleo Approach and The Healing Kitchen.


I have been looking into the AIP diet for months and have a question about how long one really needs to stay on it. Many say you need to follow it for 1 month minumum or preferably 3 months before re-introducing foods. I’m yet to find anyone online on instagram who has only followed it for this short a time. Most say they have been on it for years, many who have multiple AI’s say it’s taken 18months to 2 years to work so why is the starting point so low and is there a guide to how long depending the AI you have? I really don’t want to go in with a 1-3 month view if reality is it will take much much longer.


It’s pretty impossible to say as it is such an individual thing (read more in this post on Finding Patience with the AIP). You may be able to introduce certain things at the one month or three month mark, but other things may take longer. I would go into it with the mindset that you’re going to do it for however long it takes to heal your body. When you focus on healing your body, as opposed to the time frame, it can make it easier. I hope that helps! -Kiersten

Can I have plan based protein powder. I like to work out and enjoy a proton shackle once in a while. Gave up whey protein. Started eating paleo for a few months and last Tuesday started the AIP for psoriasis.

Plant based protein powders typically don’t contain complete proteins and they’re often derived from seeds, grains, or peas, none of which are allowed on an AIP diet. A good option to get some extra AIP friendly protein in is Vital Proteins collagen peptides. -Kiersten

So my question is regards to sleep – I have a toddler who does not sleep well. I am up 4 -5 times a night and its been like this (and worse) his whole life. If I can’t fix my sleep routine is there any point to the AIP diet? Will it help even a little bit?

It may not be possible to heal 100% without being able to address the sleep factor, however improving the diet and addressing the other lifestyle factors like stress management, community, and play will remove a number of huge stressors on the body and I definitely think it’s worth doing still. And when it comes to the sleep thing, can you take naps? Even just a 30 minute nap during the day has been proven to be helpful. And a mindful meditation practice (recommended in The Paleo Approach) is not only helpful for stress management, but also helps to improve sleep quality. Give it a try and let us know how it goes! And good luck with your restless toddler. I hope he or she is able to start sleeping better soon. -Kiersten

My question concerns AIP and normal periods. Due to my diagnosed Hashimoto’s, half a year ago I switched from gluten-free pescatarian to paleo, and 6 weeks ago I made a transition to AIP. With paleo diet, my pms symptoms disappeared, my skin became clear, my shorter periods were extended to 28 days. But now that I follow the AIP diet (in addition to the many benefits including less mood swings, more balanced energy levels), my period is 10 days late at the moment. I also involuntarily lost 3 pounds (I have always been thin), I seemingly have no fat now under my skin, luckily, muscle remained, it looks good but I don’t know if it’s healty, it might be messing with my hormones. I continued my excercise routine (5 times a week, including running, lower resistance workouts, horse-riding). I don’t know if I should cut down on it. I eat as much as I want within the framework of AIP, the only restriction concerns sugars.
Is this irregularity in my period normal with regard to all the above written or should I start worrying?

A whole different thing: I have learned about how parasites and other critters in our bodies affect the health of the gut lining. The various articles I encountered agreed that the good thing is to get rid of them. But is this also true to helminths? I read about the so-called helminthic therapy where they deliberately infest autoimmune patients with worms to tame their (auto)immune reactions. And I got confused by the contradiction here. Not that I wanted to try it, just curiosity 😀

I’m not familiar with helminthic therapy, but ensuring you don’t have any parasitic infections is certainly important as far as healing the gut.

Even if you’re not restricting your food with AIP, it’s still possible that you’re unintentionally cutting calories. It may be worth tracking your calorie intake for a few days to make sure it is sufficient for your level of activity. Any kind of calorie restriction or other stressors (like over exercising) can cause irregularity in your cycle. I can’t tell you if that amount of exercise is too much for you, but if you’re concerned about it, it may be worth exploring.

Hope that helps! -Kiersten

Is there any way of doing the AIP as a vegan? I’ve cut out all the foods on the avoid list and am now just eating lots of different fruit and veg throughout the day, trying to focus on high protein food like broccoli, spinach etc. Obviously it’s very hard to do since pretty much every vegan source of protein is on the avoid list. Could I get away with using a protein powder in a smoothie every morning? (Options include pea protein, hemp protein which I know are on the avoid list but I’ve heard they’re unlikely to cause irritation) Should I do a month or two on the AIP then reintroduce peas, hemp seeds or other vegan sources of protein? I know none of this is recommended but is it possible??

I don’t believe that you can adequate nutrition to reverse autoimmune disease without eating animal foods. Particularly the lack of fat soluble vitamins, B12, and complete proteins are a major obstacle to reducing inflammation and immune system activation. It would be possible to do AIP as a pescetarian, however. The thing with the AIP diet is that it’s not just about what you’re avoiding, but also the nutrient dense foods that you’re adding in (more vegetables, organ meats, seafood, etc.). I talk about this more on page 188 of The Paleo Approach.

How can you get better if you can’t tolerate histamine, fodmaps, fruit or probiotics? I eat almost nothing and have to skip meals due to work (can’t do left overs because of histamine formation). Bone broth leaves me exhausted and so do probiotics. I replaced these with prescript assist, l-glutamine, magnesium, and gelatin powder but is that even enough? I find it bizarre that Ballantine and Wahls recovered so quickly from more dire circumstances. Yet I’ve never even been hospitalized before and I can barely function due to fatigue and pain. I also don’t tolerate most vitamins as they give me migraines.

I have a question concerning seeds we traditionally eat when eating veggies and fruits. I mean we usually do not cut out the seedy part of cucumbers, zucchinis, let alone berries. Can they be a problem during the elimination phase? Or what is the difference between the seeds of berries and the seeds on the AIP avoid-list?

Hi there!
I’m sorry if this is a question that has already been answered throughout these posts…I am about to embark on the AIP diet and noticed that most recipes include coconut products; however I react to coconut and will need to eliminate it. I’d appreciate your recommendations for replacing coconut products in recipes, especially coconut milk.
Thank you!

Tiger nuts (not actually a nut, but a tuber) can be made into a non dairy, AIP friendly milk alternative which would likely work in most recipes calling for coconut milk. The fat content will be different so it may not work exactly the same in baked goods though. There isn’t a one to one substitute for coconut flour, but you can look for recipes using other flours like cassava flour. I hope that helps! -Kiersten

Hello Kiersten!

I just started the AIP this past week, so I guess I’m the new kid on the block! I was diagnosed with Celiac’s about 2 years ago – and had suspicions about it about 4 years ago, so I cut out Gluten at that point. Recently I have been more and more sensitive to Dairy.
I am pretty confused about reintroduction…my husband loves to cook with nightshades and wants to know when he can start using them in his cooking again. At what point can I start reintroducing foods? Will I ever be able to reintroduce Dairy and Gluten? Or is it a play-it-by-ear game?

Sorry about the many questions! Woops! :)

Can AIP be used in combination with a SIBO protocol? I actually feel best (digestive wise) strictly juicing but know my body requires solid food as a part of healing, as well. ANY solid food seems to present some sort of trouble for me. I have found that seed rotation and eliminating meat (only ever had grass fed) has helped my cycle significantly. I am G/GF, DF, SF, no caffeine. Take HCL, L-Glutamine, zinc, MCT oil, digestive enzyme supplement daily.
Any suggestions how to best begin to implement AIP.

AIP can be used with a low FODMAP diet, which (along with antibiotics, herbal or prescription) has been shown by science to be the most effective way of treating SIBO. There are several eBooks specifically for doing a combined low FODMAP and AIP diet. See here and here. -Kiersten

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