Do I need to stay on the AIP Diet forever?
Posted on October 21 2020
Let’s start with the question on all our minds: Do I need to stay on the AIP diet forever?
-by, Amanda Jones
It is a common question and concern among people adapting to this new way of life, and as with so many things, the honest answer is, “it depends.” It can be helpful to break this down into two questions:
- How long does it take for the immune system to rebalance itself after we eliminate a particular food antigen?
- How long does it take to heal the intestinal lining and restore optimal function?
Food and The Immune System
When you think about it, your digestive tract is a tube that runs through you, but it actually contains the outside world. It is our closest, most intimate interaction with “non-self,” which is why so much of your immune system is centered around the digestive tract in what is known as the gut-associated lymph tissue or GALT. A colorful cast of different types of immune cells stands ready to guard you as you process your food, deciding on a molecular level what should pass through the barrier and enter circulation, and what needs to be turned away. When you think about it, we all need a leaky gut in order to absorb nutrients and survive...we just don’t want it to be too leaky so that it overwhelms the immune system.
For a number of different reasons (infection, nutrient depletion, alcohol, processed foods, stress, etc), our intestinal barrier can become compromised, allowing larger and more numerous food particles to cross into the bloodstream, activating the immune system. This immune response includes B cells that produce antibodies to these food particles. The antibodies work like flags on these food particles, notifying the rest of the immune system that we have an invader, and setting off an inflammatory cascade. The antibodies bind to the food particles, which are then considered food antigens after they’ve been tagged as enemies.
Some amount of IgG antibody production to food is natural and normal. In most cases, the food antigens bound to antibodies can be cleared from the body and balanced by other parts of the immune system to help induce tolerance before they ever cause a problem. The problems arise when the volume of oversized food antigens crossing the intestinal barrier becomes too high (hello leaky gut) and our counter-regulatory systems are not able to balance the immune response. A snowball effect begins, wherein the ongoing pro-inflammatory immune response causes even more leaky gut, and the cycle continues until we eliminate the antigens and resolve the immune response (Gocki & Bartuzi, 2016).
Elimination Trial vs Healing Protocol
The full story on B cells, antibodies, and the various components of our immune system is marvelously complex. Individual B cells can live a surprisingly long life and have mysterious ways of passing on their memory (criminal mugshots) to the next generations of B cells. Generally speaking, your body will begin to reduce the number of antibodies produced to a food antigen within four weeks of last exposure. That means four weeks is the minimum amount of time needed for you to see a clear reduction in symptoms, although you may begin to experience relief a lot sooner. Arguably, six weeks is even better, so we are going to use that number here. After six weeks of elimination, levels of those antibodies will continue to decrease and will be virtually gone by 18 to 24 months after the last exposure to a particular food antigen. There may be some distant memory of the food antigen remaining in the immune cells, but it will be greatly reduced and in the context of a healthier gut, can be kept in balance when you reintroduce the food. This means that there are two timelines to consider, depending on whether you are using AIP as a trail to discover food sensitivities or using it as a longer-term healing diet. In this way, AIP really is a choose your own adventure book!
- Elimination Trial: There are many different ways to design food elimination trials, and AIP is the golden standard because it takes out such a large and well-studied group of irritants and common food antigens. The duration and number of foods you eliminate will determine the anti-inflammatory state you will achieve as a baseline, and how clearly you can identify symptoms upon reintroduction. If you are just starting down this path and are not experiencing severe symptoms or autoimmune conditions but just want to optimize your health or improve digestion and performance, you can think of this as a 6-week commitment, followed by the reintroduction period, and quickly arriving at a maintenance diet that is closer to a full Paleo template, plus or minus a few foods you discovered during your elimination trial.
- AIP as a Healing Protocol: For a lot of people, their immune imbalance and intestinal damage are more severe or long term, and the body needs more time to heal and rebalance before starting reintroduction. If this is you, you will want to frame AIP as a longer-term healing lifestyle, with the elimination period lasting from six months to two years before beginning the reintroduction phase. Here are a few ways to know if this is you:
- You have more advanced signs and symptoms or have been diagnosed with an autoimmune disorder.
- You tried a 6-week elimination and experienced a lot of negative reactions and setbacks upon reintroduction.
- You have major symptoms and/or conditions that are not getting better during the 6-week elimination.
Everyone is Unique
The time it takes to reduce the inflammation in the intestines, restore proper permeability levels, and calm down the immune system will vary depending on several factors. One of the most fundamental differences is the timeline - how long has excessive inflammation in the intestines been happening? How much damage has occurred to the tissues or how destructive has the immune response been? Someone who noticed signs and symptoms, had good resources and information, and took decisive action with their diet and lifestyle early might be able to reintroduce more foods earlier.
Factors that slow recovery time:
- Genetic Factors: Many individuals with autoimmune disorders have genes that create hyper-effective immune cells that may have helped them survive a plague a few generations ago, but are now running riot and overreacting to daily exposures.
- Co-diagnosis: Whether independent or directly related to leaky gut and food intolerance, a co-diagnosis can make it more difficult to resolve inflammation and restore function, including diabetes, digestive functional disorders like GERD, IBS or SIBO, etc.
- Environmental factors: If someone is being exposed to occupational or environmental exposures such as construction fumes or toxic mold, the immune system will stay in overdrive.
- Hidden drivers: Is there a food on the “AIP approved” list that is non-reactive for most people, but is causing an issue for you?
- Stress: It can’t be said enough - stress blocks healing. Researchers have observed an almost immediate increase in intestinal permeability following high-stress events, and chronic stress will dysregulate the immune system in innumerable ways.
- Macronutrient balance: The balance and quality of dietary fats, proteins, and carbohydrates can impact the efficiency of our metabolism as well as our digestive health - both of which are directly connected to immune balance.
- Going off AIP: Are you being exposed to inflammatory foods either by choice or by accident? If so, the consequence (and time on AIP) will vary depending on exposure. In individuals with celiacs, for instance, gluten exposure can cause tissue damage that can take up to 24 months to fully recover from! Depending on who you are and what you are reactivating to, there are very different risks. Consuming a food that triggers excessive antibody body production is likely to have greater consequences than something like a small amount of a seed that contains an irritating anti-nutrient. Whatever choice you make, you simply need to understand that there are consequences, and it will impact the time it takes to recover health and begin reintroduction.
Factors that help you heal faster and promote tolerance:
- Food Quality: Remember that much of what determines quality is not just what food, but how it was produced, stored, and prepared. As much as possible, buy organic/sustainable meats and vegetables produced without insecticides, herbicides, fertilizers, and processing/manufacturing contaminants.
- Nutrient Density: Fill your plate with whole foods that supply all the vitamins, minerals, and phytonutrients that are essential to every function in the body.
- Nutrient Diversity: Expand your palate and reach for the widest variety of foods available within AIP and be aware of over-extending food restriction. AIP already eliminates many options, so it is important to keep an adventurous mindset and avoid the “chicken, broccoli, sweet potato, salt only” rut. (Yay for Paleo On The Go options!)
- Anti-Inflammatory Herbs and Spices: Many of the AIP approved culinary spices are truly medicinal foods! Incorporate generous amounts of things like turmeric, ginger, garlic, rosemary, thyme, oregano, etc.
- Gut Healing Foods: Functional foods like bone broths and stocks provide the peptides and amino acids in easy-to-use forms that help fuel and heal the intestinal lining.
- Microbiome Builders: Fermented foods and healthy whole food fibers help build diversity and abundance in the beneficial flora. A healthy microbiome encourages immune tolerance, speeds healing, and protects against future injury or imbalance.
- Lifestyle: Sleep, movement, and mindset all impact intestinal hyper-permeability and immune balance.
Takeaways and Tips
Depending on your health status and your health goals, you may want to stay in the elimination period for six weeks up to two years. Don’t get in a hurry - the longer you focus on healing, the more likely you will be able to reintroduce foods without any setbacks. As you reintroduce foods, go slow in terms of how often you incorporate them into the diet - in other words, we know you’ve missed them, but don’t go nuts on nuts! Track your symptoms and let your body lead you. If adhering to AIP feels stressful, get help. Trustworthy food services can help make it more manageable so you can focus on reaching your health goals. If you’ve been on AIP for six months or longer and are not seeing the improvements you hoped for, be sure to work with a qualified functional health care provider to explore more advanced testing.
Reference: Gocki, J., & Bartuzi, Z. (2016). Role of immunoglobulin G antibodies in the diagnosis of food allergy. Postępy dermatologii i alergologii, 33(4), 253–256. https://doi.org/10.5114/ada.2016.61600
Amanda Jones is a nutrition and lifestyle professional for optimizing women's brain health and aging. Follow her on Facebook here @TheHealthAtlas