It wasn’t long ago that the “autoimmune protocol (AIP diet)” was unknown term for what used to be known in functional medicine as the “elimination and provocation diet.” Today, the AIP diet is a well-known tool in autoimmune management, and thousands of autoimmune patients have used it successfully to help recover their health.
However, while many people feel better on the AIP diet, some feel no better, while others feel worse. It’s frustrating to take on such a big challenge that is supposed to produce amazing results, only to find it doesn’t.
If this is you, don’t throw in the towel or blame the diet. Understanding what causes poor responses to the AIP can help you identify other health issues that may need addressing.
Why isn’t the AIP diet working for me?
The move from the SAD (“Standard American Diet”) to the AIP is a profound one. Sometimes, that big change can feel great. If you have a gluten or dairy sensitivity, for example, your body will thank you for the relief from the inflammation.
You may have been used to eating lots of processed carbs (breads, pastas, pastries, etc.), sugars, and caffeine, as well as gluten, dairy and grains. Going off those foods at once can be a shock, both physically and mentally, and some reactions in the beginning are normal.
However, if you have been following the AIP diet for a long time and steadily feeling worse and developing new food sensitivities, it’s time to investigate other possibilities. The diet is meant to help you find which foods you have an immune reaction to and then adjust from there. It was never meant as a single cure-all for chronic and complex health conditions to be followed for the rest of your life.
Below are some reasons the AIP diet may make you feel worse initially. If you have been on the diet a long time and developed more food sensitivities and your health has declined, you likely have lost oral tolerance.
A higher fiber diet than before
Most people on the SAD don’t eat nearly enough fiber in the form of vegetables. The AIP is very fiber-intensive. For those whose gut is already compromised, this change can cause temporary disruption. Working to heal leaky gut and using nutritional therapy can help improve your gut integrity and ease your reaction to the fiber.
Yeast, bacteria, and parasite die-off
Many people with disrupted gut function have harmful yeast, bacterial, and other parasitic infections. The AIP cuts out excess carbs, gluten, and processed carbs. This can rapidly kill off these infections, causing sudden and uncomfortable symptoms. This is especially the case in patients with constipation or poor liver detoxification. Supporting proper elimination and liver detox may help you through the die-off.
Low blood sugar and adrenal fatigue
Your plate on the AIP may look much different than before in terms of your ratios of protein, fat, and carbs. In the beginning, many people new to AIP can end up with symptoms of low blood sugar and adrenal fatigue until they adjust to a lower-carb diet and adjust their ratios of protein and fats to be more sustaining.
Low blood sugar on the AIP is typically caused by not eating enough calories, not eating frequently enough, or eating too many carbs and not enough protein and healthy fats. Many people feel better once they shift this balance.
If you suffer from low blood sugar, it’s recommended to eat every two to three hours (or even more often if necessary) until your blood sugar is stabilized. For some, this can take a few months.
Make sure to eat a breakfast high in protein and healthy fats and low in sugars and carbs. Avoid sugary fruits that can spike blood sugar. If caffeine is causing your blood sugar to spike and then plummet, you will probably feel better without it.
It’s also important to look into what else may trigger your blood sugar or adrenal issues, such as autoimmune reactions, brain-based issues, a chronic viral infection, or chronically high blood sugar
The digestion of gluten and dairy produces opioids, morphine-like chemicals. Some people are very sensitive and even immune reactive to these opioids. Eliminating gluten and dairy can cause withdrawal reactions with symptoms such as depression, lethargy, agitation, and anger. This reaction can be intense for some people. Increasing opioids in healthy ways may help the transition, but it simply requires weathering the discomfort for a couple of weeks.
Adjustments in mood-related brain chemicals
Diets high in sugars and processed carbs can contribute to imbalances in brain neurotransmitters, particularly dopamine and serotonin. Both of these chemicals play a role in our mood, motivation, and sense of well-being. A sudden change in brain neurotransmitter levels can result in changes in mood, behavior, and personality. While the AIP allows plant-based carbs such as sweet potatoes or low-glycemic fruit, if you have been on a high-carb diet, it may be necessary to wean off the carbs slowly to reduce these effects. I go into depth on the brain neurotransmitters in my book, “Why Isn’t My Brain Working?”
Insomnia and anxiety
While a lower carb diet is calming for many people, some people experience insomnia and anxiety if carbs are lowered too drastically and too quickly. If this is the case for you after some time on the AIP, experiment with your carb consumption to find an amount that helps you sleep but doesn’t spike blood sugar.
Many people with disrupted gut function experience reactions to aged or fermented foods that are high in histamines. This may include rashes, headaches, runny nose, anxiety, and more. Avoid these foods as you heal your gut, and you will likely find you can include them later. Some people also report reacting to slow-cooked bone broth.
Increased food sensitivities
One of the goals of the AIP as an elimination and reintroduction protocol is to determine your list of immune reactive foods. Many people who go on the AIP are aware they have food sensitivities and are surprised when the list of foods to which they react actually grows after they have been on the AIP diet a long time.
However, it’s a mistake to think the AIP causes this. Instead, this is called loss of tolerance and is a result of different factors.
For instance, it’s common for people to fall into a rut on the AIP diet of eating the same foods over and over. This is a big factor in loss of oral tolerance and developing new food sensitivities. Gut bacteria diversity, which depends on an ample amount of plant fiber that is continually diverse, is vital to maintaining oral tolerance.
Also, the AIP diet alone may not heal leaky gut. People can develop leaky gut for a variety of reasons and it’s important to address the underlying causes of gut inflammation. This can be a complex situation that requires dedicated effort in order to unwind.
I address this in my article on oral tolerance.
Find a positive outlook and support system
It’s also important to address the mental and emotional aspects of making such a big dietary change. What we eat is a big factor in our social lives with friends and family. A restricted diet can cause feelings of loss or resentment in social situations. This is understandable in the beginning but as people’s health improves and they become accustomed to eating in a way that makes them feel better, this adjustment becomes easier.
Practicing a positive outlook and developing a healthy support system will help a lot in this process. The initial changes are the hardest but if you can weather them you may find the effort was worth it.
Use the AIP diet as a foundation for healing
The AIP is not intended as a standalone protocol. Like the foundation to a house that also has walls, rooms, and a roof, it is meant as a foundation upon which improved health can occur. The AIP diet helps to improve gut health, build proper nutrient density, determine food sensitivities, regulate blood sugar to help reduce inflammation, balance hormones, and regulate the immune system. After an introductory period of immune recovery, you can begin reintroducing foods one a a time every 72 hours to determine which ones you’re ok with.
However, many people with chronic health disorders have other underlying issues that need to be addressed, so don’t expect the AIP to be a singular solution to feel well again. The help of a qualified functional medicine practitioner can be key for successfully navigating this terrain.