As you may know, I'm currently in the full elimination phase of the autoimmune diet protocol (AIP). I decided back in June that I would try AIP again to see if it could help some of my lingering symptoms. After a phased in approach to the eliminations (of which I wrote about over on Mickey Trescott's blog, Autoimmune-Paleo), I decided to stick with 100% elimination for a number of months while I work at getting rid of my Giardia friends. So its been quite a while that I have been without grains, legumes, dairy, sugar, alcohol, nightshade veg, nuts, seeds or eggs!
Conducting an n=1 experiment with the Autoimmune Protocol definitely requires patience and dedication! The protocol takes a while, and often times people are (er, I mean, I am) impatient to add all the foods back in during the reintroduction phase because they miss them. Totally understandable. This is exactly what I did the first time I tried AIP, and I lost all the opportunity to really learn if any of the foods listed above could be triggers for autoimmune flare or symptoms.
So lets not waste all this effort of some fairly radical food elimination by rushing the reintroduction! I decided to plan out my approach this time, and in doing so am going to share with you. This will be a two part series that will out line the steps I am taking while I start my reintroduction phase.
What is a reintroduction phase?
The basic concept is that you start reintroducing foods one by one slowly back into your diet. By doing this, you control the variables you need to analyze so that you can identify if any specific food is a trigger. It's a lot easier in concept than it is in application. For example, I eliminated nuts & eggs (full list above) as an entire food group in one step. But during reintroduction, I'll need to reintroduce walnuts separately from almonds, separately from cashews, etc. The same with eggs: egg yolks separately from whites (more people are intolerant to whites than yolks). Couple that with the notion that it takes sometimes up to 3 days to create a response from an irritating food, you can start to see why reintroduction takes some patience! You'll want to vary the meals and keep track of any symptoms that may arise as a result of a reintroduction.
Preparation for Reintroduction
This is a super important step! If you are not prepared, then its easy to rush because you have not set any established guidelines for yourself. But what does that really mean? Most people are on full AIP elimination for 30-60 days. Well, I for one have been on it now for 5 months and plan to go to 6 months. All that time away from those wonderful foods - well the imagination gets to you after a while. I have conjured up mental images of just eating eggs and chocolate for breakfast, and lunch, and dinner... and snacks for a week but I know that won't be wise. With a little preparation, its much easier to be successful at the end!
- Decide what you will introduce first, second, and so on. This can be done based on your particular AI condition, or you may want to base it on seasonal availability of certain foods. Or, you may decide that you simply miss certain foods more than others. Either way, know which foods you will never reintroduce - for me, I won't introduce gluten; I already know its a bad idea for me - and which foods you want to try again. Remember, there is no guarantee after being on full AIP elimination, that you *will* be able to tolerate a food. You won't know, however until you try.
- Figure out a system for documenting symptoms and health markers. What we don't measure, won't improve! I always like to keep copious notes on all sorts of health markers when I reintroduce a food. You'll want to keep track of as many markers as possible: items such as sleep quality/quantity, skin health (rashes, itching, breakouts), digestive health (gas, bloating, belching, etc), energy/fatigue, mood, headaches, stool quality/quantity (use the Bristol stool scale), blood sugar/ketone levels, weight, joint pain/stiffness, etc. For some, this is going to be a journal and pen, for others its going to be a spreadsheet, and for me, I like to use a symptom tracker app, like this one that was recently introduced to me by a client.
- Food Detective - this is another app, but its really a great way to determine if a food is causing inflammation for you. It tracks the components of what you eat during meals and also monitors for elevated heart rate. Its based on the Coca Pulse Test that says if, after eating, your pules increases more than 16 beats per minutes above your morning pulse, then you may have eaten something you body is having difficulty breaking down or digesting. What is nice about this app, is that you can introduce two foods at a time and in combination with pulse tracking and symptom tracking (Step 2) you can narrow in on a food sensitivity and compress the time it takes for reintroduction.
- Set a schedule or plan. This last step is really important. You'll want to not only prioritize, in Step 1, but also set out a plan. The rule of thumb is that you want to introduce a single food across 3 days and at varying meals, and then give yourself another 3 days of rest without the food before having it be a "permanent" addition. The rest days are important because often times the symptoms are subtle and we won't notice them until they disappear. With the addition of Food Detective, you can have an additional food item introduced across the 6 days. This allows us to test 2 foods every 6 days. Depending on the number of specific foods, you can see how this might add up to a long period of time!! Start to plan out the foods and meals you plan to use in those weeks that you reintroduce.
In the next installment of the series, I'll lay out my plan for reintroduction and which meals I will introduce those items to share that with all of you.
Are any of you planning or doing a reintroduction phase now? Would love to hear about your experience! If you have questions, leave a comment below!