The Autoimmune Protocol: Reintroductions

It’s day 65 on the Autoimmune Protocol (AIP), and this week, I reintroduced black pepper.

It’s been a long road to these reintroductions.

I was nervous. I tried to reintroduce black pepper about a month ago, and had a rough flare that week. Looking back, I wouldn’t say it was the pepper’s fault – I had just returned from my first weekend of travel on AIP, was ramping up my running after a 50K, and was juggling some major life decisions. The environment was not conducive to food reintroductions; however, I was antsy.

First meal with black pepper! Featuring my cacti.

After recovering from that flare, making some additional lifestyle changes, and getting through two weeks of cross country travel, I’m feeling ready for these reintros. There are fewer variables, fewer symptoms, and I’ve been strictly following AIP for two months. I’ve seen incredible improvement in my symptoms. I’m ready. It’s time.

Last weekend, I dug my pepper mill out of my off-limits AIP cabinet, cranked it out for two days, and then waited. It was a major success. Welcome back, black pepper. I’ve missed you.

The world is my oyster with this additional spice. Rotisserie chickens are no longer off the table on a busy weeknight. Every brand of jerky is mine for the taking. Half of my freezer is no longer off limits (the pre-AIP days included pepper with every meal). This… this is glorious.

Reintroductions on AIP are an exciting time.

Today, I’m reintroducing paprika to my diet (largely because, with black pepper and paprika, I can go to CAVA, a Mediterranean Chipotle-style restaurant I have missed dearly).

There is a science to reintroductions; however, I am not directly abiding by that science. I’m using it as a template. In fact, I think the entire Autoimmune Protocol should be considered a template. Throughout this process, I am learning a lot about my body. I’m discovering just how fragile my digestive system is and intimately exploring my relationship with food, the act of eating, and my appearance. The last 65 days have not been easy, by any stretch of the imagination. There have been tears, tantrums, utter defeat, and behaviors resembling that of a four year-old while handling raw liver.

AIP is a template. It is just one season of my healing journey.

It’s important to note that this protocol is just that: a protocol. It is not a diet. It includes an elimination phase and a reintroduction phase. The goal is not to live in the elimination phase forever. The goal is to make the time and space for your body to heal by removing certain foods, and then slowly, methodically and with an open mind, reintroduce those foods and expand your diet. I am seeking health and healing, not a set weight or clothing size. And I firmly believe that a wide variety of foods is necessary both for our physical and mental health. We cannot live in the elimination phase forever. Nor should we.

With that, let’s talk reintroductions.

Sarah Ballantine, the medical biophysicist who created the Autoimmune Protocol, outlines the reintroduction phase well in her book The Paleo Approach. I’ll be combining her methodology with the suggestions and protocol provided by my physician and dietician-nutritionist.

When reintroducing foods, it’s important to maintain a journal of symptoms, especially as some food reactions may seem completely unrelated to the food consumed.

Reactions may include:
  • Symptoms of your disease returning or worsening
  • GI symptoms: bloating, gas, stomachache, changes in bowel movements, etc.
  • Reduced energy or fatigue
  • Food cravings for sugar or fat
  • Pica (cravings for minerals from nonfood items, such as clay, chalk, or sand)
  • Trouble sleeping
  • Headaches
  • Dizziness or lightheadedness
  • Increased mucus production (runny nose, postnasal drip, etc.)
  • Coughing or increased need to clear your throat
  • Itchy eyes or mouth
  • Sneezing
  • Aches and pains
  • Changes in skin (rashes, acne, dry skin, dry hair or nails)
  • Mood changes (mood swings, feeling depressed, anxious, less able to handle stress)

Even just one of these symptoms may indicate a food sensitivity (yes, even mood swings!). Symptoms may occur an hour after the food was consumed all the way up to a couple of days after the fact. You want to limit the variables when reintroducing foods, so do your best to keep your lifestyle the same. If you’re sick, facing a looming deadline at work, or suddenly decide to train for a half-marathon, it isn’t time to reintroduce foods. Remember that any number of factors can cause the above reactions, so do your best to limit the lifestyle factors that may complicate your reintroduction process.

When you’re ready to reintroduce foods (huzzah!), Dr. Ballantine suggests the following protocol:
  1. Select one food to challenge, be prepared to eat it two to three times in one day, and then avoid it for a few days.
  2. First, eat a tiny nibble of the food (a half teaspoon or less). Wait fifteen minutes. Then, eat a tiny bite of the food (one teaspoon). Wait fifteen minutes.
  3. If you have any symptoms, stop! It’s not time for this food quite yet. If you don’t have symptoms, eat a slightly bigger bite (1.5 teaspoons). Carry on with your day.
  4. After two to three hours, monitor yourself for symptoms.
  5. Now, eat a normal-size portion of the food – either by itself or as part of a meal.
  6. Don’t eat the food again for 3-7 days, depending on your sensitivity. Don’t reintroduce any other foods during this time. Monitor yourself for symptoms.
  7. If you have no symptoms over three to seven days, you’re in the clear! Nom away.

For me, I’m going to follow a slightly looser reintroduction methodology, especially as I work my way through the spices.

My reintroduction protocol is more like this:
  1. Select one food to challenge, be prepared to eat it over the course of one to two days, and then avoid it for three to four days.
  2. Eat a meal’s worth of that food/spice – ideally, cook with the spice for a meal and enjoy it.
  3. Monitor yourself for symptoms in the hours following that meal.
  4. If no symptoms occur, eat another meal with that food (in this case spice) either the same day or the following day.
  5. Don’t eat the food again for three to four days. Don’t reintroduce any other foods during this time. Monitor yourself for symptoms.
  6. If no symptoms occur, you may reincorporate that spice/food into your regular diet (boomshakalaka).

When reintroducing foods, it can be hard to decide what to reintroduce first. Some say to reintroduce what you miss the most first. Others, what would add more ease and convenience to your life. Ballantine suggests a set order of reintroductions based on what is most likely to cause a reaction. For me, I’m combining these tactics and creating my own system based on my symptoms and triggers.

Here is Ballantine’s suggested order of reintroductions, as outlined in The Paleo Approach:

Stage 1:

  • Egg yolks
  • Legumes with edible pods (green beans, sugar snap peas, peas, etc.)
  • Fruit- and berry-based spices
  • Seed-based spices
  • Seed and nut oils (sesame seed oil, walnut oil, etc.)
  • Ghee from grass-fed dairy

Stage 2:

  • Seeds (including whole, ground, and butters, like tahini)
  • Nuts (including whole, ground, and butters like almond butter), except cashews and pistachios
  • Cocoa or chocolate
  • Egg whites
  • Grass-fed butter
  • Alcohol in small quantities

Stage 3:

  • Cashews and pistachios
  • Eggplant
  • Sweet peppers
  • Paprika
  • Coffee
  • Grass-fed raw cream
  • Fermented grass-fed dairy (yogurt, kefir)

Stage 4:

  • Other dairy products (grass-fed whole milk and cheese)
  • Chili peppers
  • Tomatoes
  • Potatoes
  • Other nightshades and nightshade spices
  • Alcohol in larger quantities
  • White rice
  • Traditionally prepared legumes (soaked and fermented)
  • Traditionally prepared gluten-free grains (ideally, soaked and fermented)
  • Foods you have a history of a severe reaction to
  • Foods you are allergic to
Since I started this protocol, one thing has become very clear: my lifestyle is my main trigger.

Despite spending 60 days on the protocol, I have caused flares, GI distress, and surges in symptoms solely through my physical activity, stress management techniques, and (lack of) sleep. For me, managing my illness is more so about managing my stress and shifting my mindset and lifestyle than it is about what I eat. I am not downgrading the importance of AIP and eating a nutrient-dense diet – these have been huge in my healing process – however, I know, for me, my lifestyle is the biggest factor in my healing journey. Not my diet. With that said, my process for reintroductions will differ from someone suffering from a different autoimmune disease with different symptoms and triggers.

My Reintroductions Plan

Gang’s all here.

I am going to reintroduce all spices (including the seed-and fruit-based spices and nightshades), followed by eggs and tomatoes and sweet peppers. Nightshades are typically associated with pain, which I have never experienced as a symptom, so we (me and my treatment team) are going to approach these foods first. I am going to avoid all nuts, dairy, and legumes a while longer, as these have caused major GI issues for me in the past.

Rather than create a comprehensive four-stage reintroduction phase, I am taking it one food at a time, and continuing to work to improve my stress management techniques and lifestyle choices.

Want to learn more about the Autoimmune Protocol? Check out my introduction posts and explore the leaders of the AIP community: Sarah Ballantine at thepaleomom.com and Autoimmune Wellness, which provides a wealth of information curated by the powerful duo Angie Alt and Mickey Trescott.

Are you on the Autoimmune Protocol? How are you approaching your reintroductions?

2 thoughts on “The Autoimmune Protocol: Reintroductions

  1. I was on AIP for about a year. After I was treated with intravenous steroids in December, I felt some improvements, and I started to reintroduce foods. I suggest trying homemade goat kefir and goat yougurt. I started eating these three weeks ago and I think these probiotics make me feel better. I never had success with probiotics in capsules.

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