*The diets featured here are featured in the context of their support for autoimmune health. Weight loss is an outcome, but not a goal, of an anti-inflammatory diet or, more accurately, right-sizing is: you may gain weight as your gut heals and you become better able to absorb more nutrients if you’ve been chronically underweight from an autoimmune disease like IBD. If you’re overweight from hormonal imbalance, improper nutrition, inflammation, water retention, or all of the above, you’re likely to lose weight. But where weight management is a natural outcome of healthy eating, we don’t discuss “weight loss diets” since our context is combatting chronic illness.
**On a two-phase diet, there is typically an elimination phase followed by a reintroduction phase. The elimination phase is typically 30 to 90 days, during which time symptoms are expected to resolve. Then, you can enter a process of reintroduction, which typically allows for a single food at a time. If no symptoms appear after 72 hours of that food being reintroduced, you can add in a second new food. If symptoms do reappear, you reset to baseline before adding in another new food.
***There are two recommended options for an elimination diet:
1) The Autoimmune Protocol (AIP), above, in which the first phase is an elimination diet and the second phase is reintroduction. The advantage of this diet is that it was specifically developed for people with autoimmune conditions, has a fair bit of road testing, and a lot of support around it for going through it as a process and getting specific recipes to counterbalance the sense of deprivation you can get when “giving up” your favorite foods (including a heavy emphasis on “picking up” new favorite foods).
2) The Institute for Functional Medicine’s Elimination Diet. This is also a two-step approach with specific guidance about what’s in and what’s out, as well as how to reintroduce foods. See the handy one-page chart here.
I would caution you against trying ‘Susie’s Homemade Elimination Dietary Protocol’ — or whatever you might find wherever on the internet — because then you risk doing all that hard work and not getting the outcome and insight that are on-point. That’s not a good use of your time and resources.
Citations for more information:
1. Ancestral diets as a broad category refer to dietary protocols that are rooted in the way our ancestors ate in the age before genetic modification, manufactured foods, pesticides, and herbicides entered the scene – which you might notice equates to the same timeframe in which the dominant world health issues transitioned from being about infection and acute care to chronic illness. Huh. Coincidence? Hence the proliferation of interest in a return to eating the way our ancestors did (plus all the ensuing evidence that it reduces inflammation and improves nutrition to do so). As always, there are iterations of diets, since people spend a great deal of time thinking about the best way to eat. At the end of the day, the best way to eat is the way that’s best for you to manage, reduce, or eliminate symptoms.
2. Learn more in “What is the Paleo Diet?” by Robb Wolf, or by Dr. Sarah Ballantyne, a.k.a The Paleo Mom.
3. Consumer sources for Paleo-compliant foods include Thrive Market, Paleo on the Go, OneStopPaleoShop, Barefoot Provisions, and Shop AIP. The definitive voice on the Paleo diet as it relates to Autoimmunity is Dr. Sarah Ballantyne of The Paleo Mom.
4. Two good introductions to The Paleo Autoimmune Protocol (AIP) include those by Dr. Sarah Ballantyne (The Paleo Mom), and Mickey Trescott and Angie Alt (AutoimmuneWellness.com). Foods can be sourced through the same resources as in #3.
5. The first clinical trial of the efficacy of The Autoimmune Protocol dietary impact on people suffering from autoimmune disease was conducted on people with IBD, who achieved favorable results. Published in the IBD Journal of the Crohn’s and Colitis Foundation in November 2017 by Gauree G. Konijeti, MD, MPH NaMee Kim, MD James D. Lewis, MD, MSCE et al.
6. Founding contributors include Paleo diet pioneers Robb Wolf and Chris Kresser, researcher Loren Cordain, functional medicine practitioner Datis Kharrazian, researcher Sarah Ballantyne, and experiential learners and community leaders Mickey Trescott, Angie Alt, Eileen Laird, Whitney Ross Gray, and Christina Feindel. Learn more.
7. Dr. Terry Wahls discussed The Wahls Protocol as a recent guest on Straight Up Paleo. Wellness Mama’s post also gives a summary. There is a Wahls Warrior Parent Facebook Community (Wow! Kids eating 9 cups of vegetables and fruits a day!?).
8. Modified Paleo “safer-side” food reintroductions might include a small amount, on occasion, of a favorite food that you find you can tolerate after doing an elimination diet. For example, see a discussion by Samantha Jo Teague of The Unskilled Cavewoman on Success with Dairy in Your Diet. Dr. Perlmutter’s Grain Brain Cookbook is another example of options.
9. Dr. Axe’s site has a good summary of the Keto diet, or here’s a beginner’s summary of the Keto Diet and comprehensive resources by Craig Clarke et al on Ruled.me. Note that “Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.” May be challenging for someone in a fragile autoimmune state. Dr. Mark Hyman, renowned leader of the functional medicine approach to chronic disease, began his early journey into functional medicine in part due to dramatic results he achieved with the Keto diet with a patient who’d seemed beyond recovery with neurodegeneration. A video by Dr. Hyman on the Ketogenic diet can be found here.
10. Here are the Whole30 Rules. Recent press like in US News* and Good Housekeeping have published articles against the Whole30 diet (using conventional food arguments as well as the fact that results are scientifically undocumented). Woman’s Day came out ”for”and Cosmopolitan came out “against.” Bottom line, it seems similar to a Paleo approach, but is focused on a different outcome – weight loss, vs. autoimmune support. Prevention discusses how to succeed on a Whole30 diet if you want to persist.
11. It can be daunting to apply a FODMAP diet as an added filter on top of an anti-inflammatory diet for autoimmunity (grain-, soy-, and dairy-free, plus possibly nuts- and egg-free to start). Luckily, there are bloggers who do that, by showing you which recipes are both Paleo or AIP and FODMAP compliant, for example. Using the particularly well-resourced meal-planning service Real Plans may be essential in this situation, where you can choose a dietary basis to follow, and then apply further food restrictions to take advantage of their robust search engine to do the menu planning for you. (Thank goodness for clever programmers being invested in healthy meal planning.)
12. FODMAPs and Irritable Bowel Syndrome by Monash University, https://www.monashfodmap.com/about-fodmap-and-ibs/.
13. Learn more about the GAPS diet by Rachel Link, MS, RD on Dr. Axe’s blog or get the definitive orientation by the founder Dr. Natasha Campbell-McBride at http://www.doctor-natasha.com/.
14. I prefer the term “non-gluten” to “gluten-free” as a dietary choice because it serves as a reminder that the goal is to seek foods that are naturally free in gluten, versus foods that are manufactured with grain substitutes and pseudo-grains that are loaded with sugar, undesirable oils, and gums to try to arrive at a facsimile of the gluten-containing original. Note that this doesn’t mean living without baked goods: there are a gazillion baked goods in the ancestral food diets that meet our need for the comfort foods and treats we grew up with – they just don’t contain grains, sugar, or gums. Nosh on.