Tips & Advice

Autoimmune Protocol Series: AIP Reintroductions

AIP reintroductions cover photo.
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What are the AIP reintroductions and how do you begin to incorporate new foods after the AIP elimination phase?

This post is part of a three-part series on the Autoimmune Protocol. For the first two posts in the series, see What is AIP? and AIP Lifestyle Factors. In this post, we will walk through the AIP reintroduction phases, so you can begin to incorporate more foods into your diet and determine the specific foods that may be contributing to your unique symptoms.

When to reintroduce foods on AIP

The Autoimmune Protocol is both a temporary elimination diet, as well as a long-term diet and lifestyle. The elimination phase improves autoimmune symptoms by cutting out foods that are most likely to cause inflammation and leaky gut. But once your symptoms and/or bloodwork have substantially improved, you can begin to reintroduce foods you originally eliminated, to determine if they are a problem for you.

Most people follow the AIP elimination phase between 30-90 days. Some follow it for longer. The amount of time you follow the elimination phase will depend on how long it takes you to see substantial improvements in your health. And this can depend on a wide variety of factors, including nutrient status, intestinal damage, sleep habits, movement, stress, and environmental factors. But the goal of the elimination phase is to heal first, then begin to reintroduce foods. This way, you can better identify which foods may be a trigger for your specific symptoms and tailor your diet for long term healing and symptom management. So don’t move into reintroductions until you have seen substantial improvement in your disease.

At the same time, many people feel so great during the elimination phase, they are afraid to reintroduce foods, fearing a flare up of their symptoms. But if you’re feeling well, don’t be afraid to move into AIP reintroductions! Reintroducing foods allows you to get a wider variety of nutrients in your diet, as each food has a different nutrient profile. It also makes it easier to eat in restaurants, travel, and eat in social situations. And all of those benefits are also vital to your mental health, which is a very important factor in your healing.

AIP Reintroductions

After following the AIP elimination phase for a minimum of 30 days (or until you see substantial healing), you can begin to reintroduce foods to determine which foods cause an increase in your symptoms versus those that you tolerate. Whatever you do, don’t reintroduce foods all at once. You’ll shock your system and you won’t be able to determine which specific foods cause symptoms for you. Reintroduce foods one at a time, and space each reintroduction out 5-7 days, so you can fully understand your reaction to each individual food.

The reintroductions are done in phases, beginning with the foods least likely to cause symptoms and slowly transitioning to foods most likely to cause symptoms. If a food is not listed in any of the reintroduction phases, it is best to avoid it for life, as it is likely a pro-inflammatory food in all people (i.e. gluten, refined sugars and conventional dairy).

Additionally, some of the foods you reintroduce may become occasional foods, rather than a regular part of your diet. For example, you may tolerate an occasional cup of coffee or side of rice. Knowing you tolerate a small amount of these foods makes it a lot easier to eat in social situations or while traveling, but eating them on a regular basis may cause a flare in your symptoms, or push more nutrient-dense foods out of your diet.

A final word of advice before getting into the AIP reintroduction steps: don’t be in a rush to reintroduce foods. The slower and more methodically you introduce foods, the better you will be able to judge your symptoms and understand how specific foods make you feel. For best results, introduce all stage 1 reintroductions before moving on to stage 2, and so on.

AIP Reintroduction Steps

  1. Select a single food from the stage 1 foods list. Eat the food in isolation (don’t reintroduce more than one food at a time).
  2. Eat 1/2 a teaspoon of the food (or even less), wait 15 minutes and see if you have a reaction.
  3. If you experience any symptoms, don’t eat any more. Record your symptoms in a food journal and try the food again at a later date. If you don’t have a reaction, eat a whole teaspoon of the food and wait another 15 minutes.
  4. If you experience any symptoms, don’t eat any more. Record your symptoms in a food journal and try the food again at a later date. If you don’t have a reaction, eat 1-1/2 teaspoons of the food and wait 2-3 hours.
  5. If you still haven’t experienced any symptoms, eat a normal size portion of the food. Don’t eat that food again for 5-7 days, and don’t introduce any other foods during that time.
  6. If you don’t have any symptoms during that time, you may incorporate that food into your diet and move on to the next food on your list.

Symptoms to look out for:

Many of the symptoms you are looking out for can be subtle. In fact, most people live with these symptoms for most of their lives and just assume they are “normal.” The problem is, though, if you reintroduce different foods that cause a variety of symptoms, the symptoms begin to compound and before you know it, you’re feeling unwell again. So watch out for these symptoms and if you experience any of them, take the food back out of your diet and try reintroducing at a later time.

Here are the symptoms to look out for with each reintroduction:

  • Symptoms similar to seasonal allergies
    • increased mucus, runny nose, postnasal drip
    • itchy eyes, nose or mouth
    • coughing or excessive throat clearing
    • sneezing
  • Neurological symptoms
    • headaches or migraines
    • dizziness or lightheadedness
    • increased anxiety or decreased ability to handle emotional stress
    • mood swings or depression
  • Gastrointestinal symptoms
    • tummy ache, heartburn, nausea, constipation/diarrhea, gas/bloating, undigested/partially digested food particles in stool, or a change in bowel movement frequency
    • cravings for sugar, fat, salt or caffeine
    • cravings for minerals found in non-food items, like clay, chalk, dirt or sand
  • Aches and pains
    • muscle, joint, tendon or ligament pain
  • Changes in skin
    • rash, eczema, tiny bumps or pink/red spots
    • acne
    • dry or brittle hair, skin or nails
  • Any diagnosed disease symptoms coming back or getting worse

Stage 1 AIP Reintroductions

Introduce foods from this list first, before moving onto Stage 2 Reintroductions.

  • egg yolks (not the whites, yet)
  • fruit-, berry- and seed-based spices (i.e. black pepper, cumin, dill seed, allspice, cardamom, etc.)
  • seed and nut oils
  • ghee (from grass-fed dairy)
  • coffee (occasionally; not every day)
  • cacao/chocolate (without dairy or other additives)
  • peas and legumes with edible pods (snow peas, sugar-snap peas, green beans, etc.)
  • legume sprouts (i.e. pea shoots, etc.)

Stage 2 AIP Reintroductions

Introduce foods from this list after introducing foods on the Stage 1 list and before moving onto Stage 3.

  • coffee on a daily basis
  • seeds (chia seeds, sunflower seeds, hemp, etc.)
  • nuts
  • egg whites
  • grass-fed butter
  • alcohol in small quantities (i.e. half a glass of wine with dinner)

Stage 3 AIP Reintroductions

Introduce foods from this list after introducing foods on the Stage 1 and Stage 2 lists and before moving onto Stage 4.

  • “mild” nightshade vegetables (i.e. eggplant, sweet peppers, paprika and peeled potatoes, but not tomatoes)
  • grass-fed dairy
  • lentils, split peas and garbanzo beans (aka chickpeas)

Stage 4 AIP Reintroductions

Introduce these foods after you have completed all the reintroductions from Stage 1, 2 and 3. These foods are most likely to cause symptoms in those with autoimmune disease, so don’t be surprised if you are unable to successfully reintroduce all of them.

  • “spicy” nightshades (i.e. chili peppers, jalapeños, and nightshade spices)
  • tomatoes (fresh and cooked)
  • unpeeled potatoes
  • alcohol in larger quantities (but don’t overdo it; 1-2 drinks/day for men and 1 drink/day for women is the general rule of thumb for safe alcohol consumption)
  • gluten-free grains and pseudo-grains (i.e. buckwheat, quinoa, amaranth, etc.)
  • traditionally prepared or fermented legumes (i.e. beans soaked for at least 24 hours before cooking, sprouted legumes, etc.)
  • white rice, then other rices (i.e. brown, wild, etc.)
  • foods you are allergic or have a history of strong reactions to (do this with the guidance of a functional medicine practitioner or dietitian)
AIP Reintroduction stages graphic.

A Few Extra Tips for AIP Reintroductions

  • Try to reintroduce foods when you are feeling relaxed and at ease. If you are already stressed, your body is going to react to the food differently and you may have a reaction from the stress, alone. If you are under a lot of stress, try delaying reintroductions until your stress is under control. Before testing the food, sit down, relax and breathe deeply for a few moments. Get your body into “rest and digest” mode.
  • Addressing AIP Lifestyle Factors can greatly improve your chances of successfully reintroducing foods into your diet. If you are struggling with reintroductions, try sticking with the AIP elimination phase for a bit longer and working on lifestyle factors before moving into reintroductions again.
  • Many food intolerances develop from over-exposure. Try to eat a varied diet, and don’t eat the same food more than three days in a row. Give your body a break of about four days before eating that food again. You don’t have to be super strict about it, but don’t over-do any one food.
  • If you find that you are sensitive to a specific food, continue eliminating it and re-test in a few months, once your gut has had more time to heal. If you have a true allergy to a food, do not reintroduce it without the assistance of a qualified medical professional.

AIP reintroductions can be overwhelming, but they teach us so much about our bodies! I know how difficult reintroducing foods can be, so I hope this post will make it a little easier for you! Our bodies and tolerances are constantly changing, so if you find you are not able to reintroduce a food, just give your body a rest and try again later. If you find reintroductions sends you into a flare, just revert back to the full AIP elimination phase for a bit and start fresh. You can do it!

If you have any questions or additional tips, please drop them in the comments below, so others can see them as well!

*Most of the information in this post is adapted from Dr Sarah Ballantyne’s book, The Paleo Approach. For more information and the science behind the AIP, be sure to check it out!

Medical Disclaimer: None of the ideas presented on this website, programs, or services are intended to replace medical advice of any kind. I am not a doctor, and reading this content does not form a doctor/patient relationship. The information provided here has not been evaluated by the U.S. Food and Drug Administration, and is not intended to diagnose, treat, cure, or prevent any disease, condition or illness. For more information, please see the full medical disclaimer, here.

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