The Autoimmune Protocol (AIP), an elimination and reintroduction protocol geared toward serving to these with autoimmune illness establish meals sensitivities and enhance nutrient-density has at all times been rooted in scientific proof (see The Paleo Method, the 2014 e-book written by Sarah Ballantyne, PhD, containing over 2,000 references [1]). Sarah’s work impressed many to embark on their very own AIP journeys, resulting in lots of if not 1000’s of tales in regards to the protocol’s efficacy for quite a few autoimmune situations (and you may learn many of those private accounts in our tales of restoration collection!). Over time, some savvy and forward-thinking medical doctors and researchers took notice after seeing constructive modifications of their sufferers, resulting in medical analysis into the efficacy of the Autoimmune Protocol for numerous autoimmune situations. This text summarizes all of the scientific analysis that has been printed to this point on the efficacy of the Autoimmune Protocol.
The Autoimmune Protocol for IBD (Crohn’s and UC)
1 – Pilot examine on efficacy of AIP for IBD
The primary examine into the efficacy of AIP was a potential cohort examine performed by Dr. Gauree Konijeti and her group at Scripps San Diego, Efficacy of the Autoimmune Protocol Weight loss plan for Inflammatory Bowel Illness [2]. Dr. Konijeti and her group enrolled a gaggle of 15 sufferers with energetic Crohn’s illness or ulcerative colitis to embark on a 6-week gradual elimination and a 5-week upkeep section in accordance with the Autoimmune Protocol. Some notable statistics in regards to the incoming cohort had been that the imply illness length was 19 years and that about half of the sufferers (47%) had been on biologic remedy going into the examine. These had been sufferers who had long-standing illness and had not achieved medical remission even with using highly effective medicines in keeping with the standard normal of care. Surveys, labs, and doctor assessments had been performed at baseline, week 6, and week 11, and endoscopy, radiology, or biomarker assessments to evaluate mucosal therapeutic had been performed each at baseline and the tip of the examine.
Intervention particulars: For the primary six weeks, sufferers went by means of a staged elimination of meals, slowly eradicating two meals teams per week and including in meals to extend nutrient density in accordance with the Autoimmune Protocol. At six weeks, individuals had been within the full elimination section (no grains, dairy, eggs, nuts, seeds, or nightshades) and maintained these eliminations for a 5-week upkeep section. For each phases, Angie Alt’s SAD to AIP in SIX program was used because the mannequin to information sufferers in implementation and supply assist in transitioning and sustaining the dietary and way of life intervention [2].
Outcomes: At week 6, 73% of the sufferers had achieved medical remission, and all of them maintained this remission throughout the upkeep section of the examine. It ought to be famous that at week 6 individuals had solely simply completed a staged week-by-week removing of meals and entered the total elimination section of the Autoimmune Protocol, indicating that the dietary modifications had been efficient in a short time for these sufferers and that all of them had been capable of preserve that remission for the rest of the examine. There was no distinction within the charges of remission between sufferers with Crohn’s illness or sufferers with ulcerative colitis. Though sufferers had been suggested to not make any remedy modifications throughout the examine, 4 sufferers discontinued or lowered their medicines and all both achieved remission or measureable enchancment in scores representing illness severity. There was one adversarial occasion within the examine, the place a affected person with a identified stricture resulting from previous surgical procedure skilled a bowel obstruction and needed to drop out. One other affected person with a identified stricture additionally dropped out resulting from worsening signs. This means that those that have a historical past of bowel surgical procedures must be monitored intently by their medical group for the potential for dietary modifications to result in issues when making an attempt a high-fiber intervention just like the Autoimmune Protocol [2].
2 – Examine on AIP and high quality of life for IBD sufferers
A second examine was printed analyzing modifications in high quality of life utilizing the information from the AIP IBD pilot examine, An Autoimmune Protocol Weight loss plan Improves Affected person-Reported High quality of Life in Inflammatory Bowel Illness [3]. Right here, the Quick Inflammatory Bowel Illness Questionnaire (SIBDQ) was used to evaluate IBD illness exercise and high quality of life at baseline and at weeks 3, 6, 9, and 11 of the examine. SIBDQ scores of > 50 point out good health-related high quality of life.
Outcomes: For sufferers who accomplished all surveys within the AIP IBD pilot examine, SIBDQ scores improved from 46.5 at baseline to 61.5 on the finish of the examine, displaying a substantial enchancment in health-related high quality of life over the interval that the Autoimmune Protocol was applied as an intervention [3].
3 – Examine on AIP and intestinal RNA expression in IBD sufferers
A 3rd examine was printed using knowledge from the unique AIP IBD examine, this time analyzing genetic expression in stool samples of 4 sufferers with ulcerative colitis that the analysis groups had tissue biopsies each at baseline and on the finish of the intervention: The Autoimmune Protocol Weight loss plan Modifies Intestinal RNA Expression in Inflammatory Bowel Illness [4]. RNA expression was examined in tissue samples at baseline and finish of the intervention and in comparison with decide if there have been any patterns or modifications. One of these evaluation is experimental, however factors to the explanation why an intervention could also be efficient at producing the kinds of tissue-level modifications seen within the AIP IBD pilot examine.
Outcomes: 324 vital differentially regulated genes had been recognized following the AIP intervention, with 167 downregulated and 157 upregulated. Downregulated genes included these related to inflammatory T-cell responses that result in autoimmune irritation. Upregulated genes included these related to a T-regulatory cell response that result in immune modulation and transcriptional pathways related to mucosal therapeutic and DNA restore. It’s attention-grabbing to take these outcomes along with the outcomes of the AIP IBD pilot examine to see how an intervention like AIP may be working by way of altering genetic expression within the gut, which is the location of irritation and harm within the case of IBD [4].
4 – Survey on AIP dietary patterns and IBD
Along with observing the results of the Autoimmune Protocol as an intervention for IBD sufferers, the group at Scripps additionally needed to survey those that had already efficiently used AIP to assist handle their IBD: Medical Course and Dietary Patterns Amongst Sufferers Incorporating the Autoimmune Protocol for Administration of Inflammatory Bowel Illness [5]. The analysis group needed to know data like how lengthy sufferers had a prognosis of IBD, in the event that they had been on medicines and which of them, how they went about implementing AIP, and which meals they reacted to within the reintroduction section.
Outcomes: 78 IBD sufferers submitted surveys, with a imply age of 39.4 years and imply illness length of 13.4 years. 73% of respondents reported reaching medical remission after implementing AIP, and 32% of them reported discontinuing steroids after implementing AIP. A majority of respondents reported reintroducing meals between 5 weeks and 1 yr of implementing AIP, with solely 12% reporting needing greater than 1 yr within the elimination section. When it comes to meals that respondents reported unable to reintroduce, gluten (58%), processed meals (52%), nightshades (46%), dairy (42%), and non-gluten grains (29%) had been the most typical.
Pilot examine on the efficacy of AIP for Hashimoto’s thyroiditis
A second potential cohort examine into the efficacy of AIP was modeled after the IBD examine, besides this time, the sufferers had Hashimoto’s thyroiditis, the most typical autoimmune illness: Efficacy of the Autoimmune Protocol Weight loss plan as A part of a Multi-disciplinary, Supported Life-style Intervention for Hashimoto’s Thyroiditis [6]. Dr. Abbott and his group enrolled a gaggle of 17 ladies with Hashimoto’s thyroiditis to embark on a 6-week gradual elimination and 4-week upkeep section in accordance with the Autoimmune Protocol. Surveys quantifying symptom burden and lab assessments assessing thyroid hormones, antibodies, and inflammatory markers had been carried out initially and finish of the examine. Purposeful drugs lab assessments reminiscent of urine natural acids and complete stool evaluation had been carried out at baseline.
Intervention particulars: The intervention was the identical because the AIP IBD examine that preceded it, utilizing Angie Alt’s SAD to AIP in SIX program. For the primary six weeks, sufferers went by means of a staged elimination of meals, eradicating two meals teams per week and including in meals to extend nutrient density. At six weeks, individuals had been within the full elimination section and maintained these eliminations for a 4-week upkeep section [6].
Outcomes: 16 individuals completed the examine, 1 dropped out resulting from being pregnant. Medical symptom burden within the type of MSQ decreased from a mean of 92 (SD 25) at baseline to 29 (SD 20). No modifications in thyroid hormone ranges or antibodies had been seen, however 6 out of 13 individuals lowered or discontinued their thyroid hormone remedy dosage, and HS-CRP decreased by 29% from baseline to finish of the examine (P=0.0219).
Qualitative analysis on the efficacy of AIP for rheumatoid arthritis
Julianne Taylor is a nutritionist primarily based in New Zealand performing analysis for her postgraduate diploma [7]. A part of her analysis concerned interviews with 10 individuals who had been profitable utilizing the Autoimmune Protocol to handle their rheumatoid arthritis. She performed a collection of 90-minute interviews to learn the way they applied AIP, how they determined what to eat and what to keep away from, and the meals they perceived as problematic or suitable for eating. The group included 1 man and 9 ladies, imply age 41.7 (28-60 years), and imply time on AIP 2.9 years (6 months to five years).
Outcomes: Julianne reported a number of themes in her interviews. First, most sufferers had been launched to AIP by means of a holistic practitioner, and determined to strive it once they learn anecdotal proof of efficacy. Probably the most vital barrier to implementation was altering to a restrictive food plan, and most individuals reported planning forward with a selected begin date and making a cold-turkey transition. Probably the most vital barrier to sustaining the food plan was the attitudes of others, and having the assist of at the very least one particular person was instrumental in success in upkeep. The first motivation for staying on the protocol was the shortage of ache and all individuals reported it was definitely worth the effort. You possibly can learn extra about Julianne’s analysis right here.
Pilot examine on the efficacy of AIP for eczema and psoriasis
In 2020, a 3rd analysis group carried out a potential cohort examine on the efficacy of AIP for eczema and psoriasis. Just like the IBD and Hashimoto’s research, Angie Alt’s program SAD to AIP in SIX was used because the intervention. Whereas there have been some lab delays throughout the pandemic, we’re anticipating the outcomes to be printed someday in 2023! We’ll replace this text after we know extra.
Whereas present analysis into the efficacy of the Autoimmune Protocol as an intervention for autoimmune illness is promising, we have now to be lifelike that it’s in its infancy. Critics are fast to level out the small pattern dimension of the pilot research and the character of self-reported knowledge within the surveys. Those that are accustomed to the analysis course of know that it’s important to take small steps earlier than you may take massive ones. A “pilot” examine supplies as a proof of idea, to indicate security and that there’s something there worthwhile exploring additional. From right here, analysis groups can construct on what has been explored to this point, and design bigger, extra managed research that may higher add to what we find out about how dietary and way of life interventions will help these with autoimmune illness reside more healthy lives.
Some questions we’d like to see answered in additional AIP analysis:
- What’s the efficacy of AIP for frequent autoimmune illnesses which have but to be studied? (like celiac illness, rheumatoid arthritis, lupus, a number of sclerosis, Grave’s, sort 1 diabetes, and alopecia.)
- Are there any modifications that ought to be made to AIP when contemplating implementing it for a selected autoimmune illness?
- What sufferers mustn’t think about an intervention like AIP?
- Why do some autoimmune illnesses reply shortly to dietary modifications, whereas others take time, and what timeline of therapeutic is common for particular illnesses (like IBD vs. psoriasis)?
- Can implementing AIP at the side of typical remedy lower remedy wants and healthcare prices?
- How does implementing AIP change the long-term course of autoimmune illness?
- Which elements of AIP (eliminations, nutrient-density, or concentrate on sleep, stress-management, motion, and connection) are best at altering outcomes for autoimmune sufferers, and are a few of them extra essential for particular situations?
- Which meals are most-commonly capable of be reintroduced following the elimination section of AIP? Are there noticed variations relying on situation?
My hope is that after studying this evaluation, you’re excited in regards to the state of AIP analysis, and desperate to study extra. I’ll be updating this text with new analysis because it is available in, so keep tuned!
References
1. Ballantyne S. The Paleo Method. 1. publ. ed. Las Vegas: Victory Belt Publ; 2013.
2. Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the autoimmune protocol food plan for inflammatory bowel illness. Inflamm Bowel Dis. 2017;23(11):2054-2060.
3. Chandrasekaran A, Groven S, Lewis JD, et al. An autoimmune protocol food plan improves patient-reported high quality of life in inflammatory bowel illness. Crohns Colitis 360. 2019;1(3):otz019.
4. Chandrasekaran A, Molparia B, Akhtar E, et al. The autoimmune protocol food plan modifies intestinal RNA expression in inflammatory bowel illness. Crohns Colitis 360. 2019;1(3):otz016.
5. Lee J, Pedretti C, Konijeti G. Medical course and dietary patterns amongst sufferers incorpo- ranking the autoimmune protocol for administration of inflammatory bowel illness (P12-010-19).
6. Abbott RD, Sadowski A, Alt AG. Efficacy of the autoimmune protocol food plan as a part of a multi-disciplinary, supported way of life intervention for hashimoto’s thyroiditis. Cureus. 2019;11(4):e4556.
7. Taylor J. Rheumatoid arthritis and the paleo food plan – a qualitative examine. 2020. https://autoimmunewellness.com/rheumatoid-arthritis-and-the-paleo-diet-a-qualitative-study/.
