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If you've been doing the elimination phase of the Autoimmune Protocol (AIP) Diet for a while and you're ready to move on to reintroductions, this post is for you! I'll go over the why’s, how’s, what you should reintroduce in each phase, and how to track your foods and reactions. Plus you'll be able to get a PDF worksheet set for tracking foods and symptoms.
Overview of the Autoimmune Protocol Diet and Reintroduction
The Autoimmune Protocol (AIP) Diet, which is essentially an elimination diet, is a more restrictive version of the Paleo diet. It is used to manage symptoms of autoimmune disorders by excluding potentially irritating inflammatory foods from the diet for a period of time while also eating a lot of nutrient-dense foods.
After a time, foods are slowly and systematically re-introduced to assess tolerance to each food and to broaden the variety of the diet. To read more about the AIP Diet, check out the Beginner’s Guide to the Autoimmune Protocol.
Why is AIP Reintroduction Important?
The elimination phase of AIP is not easy, so you may be in a hurry to bring your favorite foods back into your diet. You may be wondering if you even need to bother doing the reintroduction phase. OR You may be thinking “I feel great on the elimination phase so why change that?”
Whichever side of the fence you're on, consider the following points regarding reintroduction:
- The elimination phase of AIP was never meant to be a long-term fix-all, rather it's just a tool for sorting out what adjustments need to be made to your diet. Reintroduction is an important part of the overall process.
- Reintroduction allows you to have a greater variety of nutrient-dense foods in your diet and keep you from getting bored.
- It allows you to give your gut a greater variety of plant fibers to improve your gut microbiota diversity.
- Adding a variety of foods back to your diet may help to prevent loss of oral tolerance. According to Dr. Kharrazian, eating the same foods over and over again can promote loss of oral tolerance (basically developing sensitivities to certain foods).
- It gives you a chance to clearly assess each food one by one to see how you respond without the “noise” and confusion of other food reactions going on in the background.
- Greater flexibility with social situations, travel, and overall living!
How Long Should You Wait to Start Reintroducing Foods?
The elimination phase is generally meant to be done for about 4-6 weeks before reintroducing foods, however many do it for longer. Once you feel like your symptoms have resolved (or at least greatly improved), it’s time to start slowly adding foods back to your diet. Generally, the longer you wait (within reason) and the better you feel, the more likely you’ll be to have success with reintroductions.
3 Phases of the AIP Diet
- Elimination Phase- This is when you are eliminating problem foods from your diet and focusing on eating many highly nutritious foods. If you’re reading this article, you may have already been doing this part for a while.
- Reintroduction Phase- This phase is the one we’re talking about in this article. This is where you slowly and systematically start reintroducing foods.
- Maintenance Phase- This phase happens once you’ve reintroduced all the foods you want to add back in and still feel like you are feeling good and tolerating them well.
How Does AIP Reintroduction Work?
Dr. Sarah Ballantyne developed the AIP diet and the order of foods to reintroduce. The order of reintroduction is based on the likelihood of the food causing a reaction and nutrient density. Generally speaking, you’ll reintroduce the “easier” more nutrient-dense foods first, then work your way up to the potentially more challenging less nutrient-dense ones.
What Are the Stages of Reintroduction?
Reintroduction is broken down into 4 stages with specific foods to reintroduce in each phase. The following stages do include the June 2019 changes.
- Fruit and Berry-based spices- This includes things like allspice, star anise, caraway, cardamom pod, juniper, pepper (from black, green, pink, or white peppercorns), and sumac.
- Seed-Based Spices- These would be things like anise, annatto, caraway, cumin, celery seed, coriander, Cumin, dill seed, fennel seed, fenugreek, mustard seed, nutmeg, poppy seed, and sesame
- Egg Yolks
- Coffee (occasional)
- Nut and Seed Oils (only the oils)
- Legumes with edible pods (green beans, snap peas, snow peas, etc)
- Legume Sprouts
- Nuts and Seeds (includes butters and Flours)
- Coffee (Daily)
- Egg Whites
- Alcohol (small amounts)
- Sweet Peppers
- White Potatoes (peeled)
- Grass-Fed Dairy
- Lentils, Split Peas, and Chickpeas
- Remaining Nightshades
- Alcohol (in slightly larger amounts)
- White Rice
- Other Gluten-Free Grains- Things like amaranth, buckwheat, corn, millet, quinoa, sorghum, teff.
- Other Legumes
Preparing for Reintroductions
You’ll want to make sure you do your reintroductions during a time when there are not a lot of other health or situational things going on that may make it more difficult to identify food reactions. Overall, the goal would be to do them in your normal environment and when your health is at your most recent (hopefully less inflamed) baseline.
Reasons to Hold off on Reintroduction:
- Your symptoms are still persisting: If you’ve been on the AIP for a few months and you’re still experiencing symptoms, it may be worth working with a functional practitioner to help fine-tune your approach. It is possible to have sensitivities to foods that are on the AIP diet and not realize it. There could also be other issues going on that are completely unrelated to food and require further testing/investigation.
- Lack of Sleep- Since tiredness can be a food intolerance symptom, not getting enough sleep will make it difficult for you to know if you’re tired because of lack of sleep or because of the food you are reintroducing. Try to reintroduce foods during a time when you know you'll be able to get a reasonable (or at least your usual) amount of sleep.
- Stress- Stress can trigger plenty of physical symptoms making it hard to tell if the food is causing reactions, so try not to do reintroductions during a time you know you will have stressful events/occasions/travel going on.
- Infections/Illness- Make sure you're feeling good and not experiencing any symptoms of illness as these can make it difficult to tell if a food is causing issues.
- Cravings- Though it can be tempting, don’t start reintroductions because you’re craving a particular food. You want to be able to make an informed decision about whether it’s the right time to start reintroductions rather than doing it impulsively and having it backfire.
How to Deal With Fear of AIP Reintroductions
It’s not uncommon to feel wonderful in the elimination phase of AIP and not want to ruin that by reintroducing foods. However, it’s important to start bringing at least some foods back in.
If you’re anxious about doing reintroductions, know you’re not alone. Seek out support as you embark on your reintroduction experiments.
There some great Facebook groups for this:
- The AIP Reintroductions Group on Facebook has over 1000 members going through the same process. This can be a great way to bounce ideas off of others if you get stuck on something and/or vent your frustrations if a reintroduction doesn’t go as planned.
- The AIP Elimination Diet Support Group has 52,000 members and they discuss everything AIP including reintroductions.
If you feel like you could use some more direct guidance and specialized support, hiring an AIP certified coach may be a good option.
- Start at a healthy baseline- make sure you're feeling relatively good.
- Only introduce one food every 5-7 days.
- Stop the reintroduction process for any food you react to.
- If you’re having a hard time distinguishing which foods are causing which symptoms, wait longer between reintroductions.
How to Reintroduce Foods
- Select a food from the list to reintroduce.
- The first time you eat the food, eat half a teaspoon or less. Wait 15 minutes.
- If you have any reactions, stop there. If you don’t, eat one small bite (about a teaspoon). Wait 15 minutes.
- If you have any reactions, stop there. If you don’t, eat a slightly larger bite (about 1 ½ teaspoons).
- Wait two to three hours and watch for symptoms.
- If you still haven’t experienced any reactions, eat a normal-sized portion of the food—either by itself or as part of a meal.
- Don’t eat that food again for 5 to 7 days, and don’t reintroduce any other foods during that time. Keep an eye out for the return of any symptoms.
- If you have no symptoms during the first day it’s reintroduced or in the 5 to 7 days after, it's fine to add this food back into your diet.
How to Track Reintroductions
Use a notebook, spreadsheet, app, or whatever works best for you. Be sure to record the:
- Name of the food you are attempting to reintroduce
- The Date
- What time you attempted the half teaspoon of the food and your reactions
- What time you attempted the full teaspoon of the food and your reactions
- What time you attempted one and a half teaspoons of the food and your reactions
- What time you attempted a normal serving of the food and your reactions
- Reactions on Day 2
- Reactions on Day 3
- Reactions on Days 4-7 (if you decide to take extra time between reintroductions)
To make this process a little easier, I developed an 11-page printable Reintroduction PDF Worksheet Set which outlines the above process and allows you to track foods and reactions.
You can grab this from the signup form below.
Reintroduction Symptoms and Reactions
Determining what’s a food reaction and what's not can be confusing because symptoms are often subtle or may occur a couple of days after eating the offending food. This is why tracking is so incredibly important. You’ll probably find that when you’re tracking symptoms, you pay much closer attention to how foods are affecting you.
The good news is, that if you’ve been doing the elimination phase for a while, you’ve already calmed down a lot of inflammation and “noise” so you have a pretty calm baseline to start with. This should make it a little easier to recognize symptoms when they occur.
Here are some things to look out for:
- Autoimmune symptoms you've had in the past
- Itchy skin, rashes, hives
- Reddened, flushed, or swollen skin
- Dry hair, skin, or nails
- Headache or migraine
- Pain in muscles and joints
- Stomachache, ramping, gas/bloating
- Diarrhea or constipation
- Unable to stay awake
- Feeling exhausted after sleeping
- Cravings for sugar, fat, caffeine
- Cravings for non-food items (like chalk, dirt, or clay)
- Irritability, hyperactivity, or nervousness
- Brain Fog
- Mood Swings
- Dizzy or lightheaded/ Vertigo
- Lower energy levels
- Energy dips
- Scratchy Throat
- Phlegm, runny nose, or postnasal drip
- Coughing or needing to clear throat
- Itchy mouth or ears
- Itchy, watery eyes
- Dark circles under the eyes
- Wheezing/Asthma or shortness of breath
What if You Have a Bad Reaction to a Food?
While disappointing, if you have a bad reaction to a food, don’t continue eating it. Stop and keep it out of your diet for now. Wait for your overall health to get back to baseline before reintroducing other foods. Keep in mind that our tolerance to foods can change over time. If you react to a particular food this time, it may just be that you can’t tolerate it right now. Down the road, there may be the potential to have better success with it as you heal.
Books That Can Help with Reintroduction
I hope you enjoyed this post. Leave a comment below and let me know some of your biggest questions or struggles when it comes to reintros. I'd love to hear from you!
Don’t forget to follow me on Instagram @foodcourage for the latest AIP/Paleo recipes and Food Courage happenings!
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