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4 Concerns With The Autoimmune Paleo Diet

The autoimmune Paleo (AIP) diet is recommended to people with all different types of autoimmune conditions, including Graves’ Disease and Hashimoto’s Thyroiditis.  And while some people thrive when following this diet, others find this to be a very challenging diet to follow.  There are a number of concerns people have when following the AIP diet, and in this blog post I am going to discuss four of the main ones.

Concern #1: The duration of the diet.  Upon having the AIP diet recommended to them, many people become concerned as to how long they will need to follow this diet for.    This isn’t meant to be a long-term diet, although how long someone needs to follow the AIP diet depends on the person. For example, the AIP diet also serves as an elimination diet [1], and many healthcare professionals will recommend for their patients with an autoimmune thyroid condition to follow this diet strictly for 30 days.  This is the approach I take in my practice.

After 30 days some people choose to slowly reintroduce some foods, while others continue to follow the AIP diet for a few additional months.  If after 30 days someone is thriving while following the diet then it makes sense for them to continue following it for at least a few additional months.  If someone feels worse after 30 days of following an AIP diet then it might be best for them to reintroduce foods.

It’s worth mentioning that some people aren’t necessarily thriving after 30 days, but they are feeling somewhat better, yet they find following the AIP diet to be a major struggle.  In this situation it probably is best to have the person continue with the diet, and re-evaluate after two to four weeks.  While some people will experience physical symptoms, there is a mental aspect as well.

For example, if someone started following the AIP diet with the mindset that they would need to be strict for three months, mentally this would be more challenging than planning on being strict with the diet for 30 days, and then taking it on a month-to-month basis after the 30 days had passed.  Of course everyone is different, as some people don’t find following an AIP diet to be a struggle at all (at least that’s what some patients tell me!), while others are thinking about reintroducing foods after one or two weeks.

Concern #2: Will following this diet cause nutrient deficiencies?  Some people are concerned that following an AIP diet for a prolonged period of time will lead to nutrient deficiencies.  As a reminder, this isn’t meant to be a long-term diet, but this isn’t out of concern that people will become deficient in certain nutrients.  Even though it’s a restrictive diet, the allowed foods are nutrient dense. And while some of the excluded foods are also nutrient dense, such as eggs [2], nuts, and seeds, you can still get all of the nutrients you need from the AIP diet.

While meat is nutrient dense, especially when it is from a good quality source, vegetables are also an excellent source of nutrients. One problem is that most people don’t eat enough vegetables per day, and another problem is that many people who eat plenty of vegetables don’t eat enough variety.  I realize that for people who don’t enjoy eating vegetables this can be challenging, but as I’ve mentioned in past articles and blog posts, you can “sneak” in some vegetables by adding them to a daily smoothie.

In addition, how you prepare your vegetables can make a huge difference with regards to taste. For example, I don’t enjoy eating plain steamed broccoli.  On the other hand, if I add garlic [3]and olive oil to the broccoli then I find that it tastes much better.  You might prefer to add something else, and while I can’t say that I’m very creative in the kitchen, that’s what cookbooks are for.

Should you be concerned about nutrient deficiencies if you are a vegan or vegetarian?  After all, if you don’t eat meat or fish then you will rely on getting all of your nutrients from fruits and vegetables.  I spoke about this in an article entitled “Vegetarians, Vegans, and the Autoimmune Paleo Diet [4]”.

Concern #3: The stress associated with following this diet.  Most people are dealing with chronic stress prior to making any dietary changes, but the AIP diet is perceived as a stressor by many people.  Probably the biggest concern by most people that follow the AIP diet is simply the challenge of following a restrictive diet due to the number of excluded foods.  Another concern by some people, especially many with hyperthyroidism and Graves’ Disease, is losing weight while following this diet.   I have worked with many people over the years who have lost a lot of weight due to their hyperthyroid condition, and most are concerned that following a strict AIP diet will result in even more weight loss.  I spoke about this in greater detail in a past blog post entitled “How To Maintain A Healthy Weight While Following An Autoimmune Paleo Diet [5]”.

Of course many people have the opposite problem, as they would love to lose weight, but are having a difficult time doing so, even when following a strict AIP diet.  Although the primary goal of the AIP diet isn’t to lose weight, this can still be a stressor for many people.

Either way, the increased stress levels associated with following an AIP diet shouldn’t be overlooked.  And the reason for this is because some of the benefits of following an AIP diet can be counteracted by the person’s increased perception of stress.  Knowing that there is the possibility of reintroducing foods after 30 days can greatly help to decrease one’s stress levels, but for some people, 30 days can seem like an eternity when they can’t eat most of the foods they have regularly eaten for decades.

This is why some people need to take baby steps.  For example, it might be best for some people to first work on adding more servings of vegetables so that they won’t be as hungry when they start eliminating foods.  If someone is accustomed to eating only one or two servings of vegetables per day they can make it a goal to eat an additional daily serving of vegetables each week, so that by the time four weeks have passed they will be eating four additional servings of vegetables on a daily basis.  Some people will then be able to jump into the AIP diet at this point, while others might feel the need to exclude one or two foods each week.

The time of the year can also play a role in how stressed out someone is when following the diet.  For some people, following the AIP during the holiday season [6] is very stressful due to the temptation of family dinners, holiday parties, etc.  Going on a vacation can also be an obstacle, as I’ve had patients who were planning to go on a vacation a few months after starting the AIP diet, and their goal was to follow the AIP diet strictly for 30 days and then to start reintroducing foods, regardless of how they felt after the 30 days.  The point here is that rushing the reintroduction process can also result in added stress on the person.  You want to try to set yourself up for success, and realize that no matter what time of the year you start this diet there will always be challenges.

Concern #4: Having decreased bowel movements.  Constipation is a concern with the AIP diet, and the reason for this is because a lot of people rely on the excluded foods for their main sources of fiber.  This includes grains, legumes [7], nuts and seeds.  I spoke about this in a blog post entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and Short Chain Fatty Acids (SCFA). [8]

In this blog post I discussed how those who follow an AIP diet will need to get their fiber from fruits and vegetables.  But the problem is that most people don’t eat enough vegetables.  In addition, some people who do eat plenty of vegetables don’t eat a sufficient number of fiber-rich vegetables.  The truth is that most people don’t know which fruits and vegetables are highest in fiber, and in the blog post I mentioned some of these, including apples, artichokes, avocados, broccoli, Brussels sprouts, dried figs, pears, plantains, and sweet potatoes.

So while there can be different factors that can cause chronic constipation [9], if you became constipated shortly after starting the AIP diet then you want to make sure that 1) you are eating plenty of vegetables per day, along with some fruit, and 2) most of the fruit and vegetables you eat are higher in fiber.  So for example, while it’s fine to eat some lettuce and spinach in the form of salads and smoothies, these are lower in fiber when compared to other vegetables.  As a result, if leafy greens are your primary source of vegetables then you very well might become constipated.  I personally enjoy eating salads, and I also add leafy green vegetables to my smoothies each day, but I also try to eat other vegetables that are rich in fiber.

In summary, for those who are thinking about following an AIP diet, or are currently following it, hopefully this blog post will help you to overcome some of your concerns.  If there are other concerns you have that I haven’t mentioned in this post about the AIP diet, please feel free to let me know in the comments below.