When you have active ulcerative colitis (UC), all you want is relief. It’s hard to live a normal life with frequent diarrhea, belly cramps, and rectal bleeding -- to name just a few common symptoms.
Medications for this inflammatory bowel disease (IBD) can help you feel better, but they don’t work for everyone. So it was exciting when a study showed that people with IBD had fewer symptoms and less inflammation after following the autoimmune protocol (AIP) diet. At its core, AIP is a strict elimination diet that excludes inflammatory foods and favors nutrient-rich choices.
Gastroenterologist Gauree G. Konijeti, MD, led the AIP study, published in the journal Inflammatory Bowel Diseases in 2017. A patient years earlier had piqued her research interest in the protocol.
Konijeti says this was a new patient with a long history of severe UC, including hospitalizations. She was surprised when he arrived to his appointment feeling fine. His explanation: “I did the autoimmune protocol diet for my UC. That’s why I’m finally better.”
Of course, she couldn’t just take him at his word. “I said, ‘Let’s do a colonoscopy to see how you’re doing [on the inside],’” recalls Konijeti, director of the Inflammatory Bowel Disease Program at Scripps Clinic in California. “Lo and behold, he had no inflammation.”
What Is AIP?
If you’ve never heard of AIP, you may not have an autoimmune disease. AIP, which some mistakenly call the immune protocol diet, has a growing following in the autoimmune community. Instead of promising weight loss, AIP offers hope for symptom relief from a range of autoimmune diseases.
Here’s how AIP co-creator Sarah Ballantyne, PhD, defines the protocol on her blog, The Paleo Mom. “[It’s] a complementary approach to chronic disease management focused on providing the body with the nutritional resources required for immune regulation, gut health, hormone regulation and tissue healing while removing inflammatory stimuli from both diet and lifestyle.”
As for the brass tacks of this protocol: Eat organ meats, grass-fed beef, some poultry, wild-caught fish, veggies, fruits, healthy fats, and a handful of other generally healthful foods. Foods to avoid include:
- Alcohol
- Eggs
- Coffee
- Grains
- Grain-like seeds, including chia and quinoa
- Dairy
- Legumes
- Processed vegetable oils (which is most of them)
- Artificial colors and flavors
- Most forms of sugar, including commercial sweeteners
- Sugar substitutes
- Nuts
- Seeds and spices that come from them
- Nightshades and spices that come from them
Over time, anywhere from 3 weeks to 4 months, you should start to see health improvements. That’s when you can gradually reintroduce other foods to learn how your body reacts to them.
Diet May Improve IBD
Symptom improvement with AIP is largely anecdotal; the diet is neither well-studied nor widely recommended by doctors -- at least not officially. But elimination diets like AIP have long been used to diagnose and manage health conditions. At least three similar diets show promise in IBD: the specific carbohydrate diet (SCD), Crohn’s disease exclusion diet (CDED), and the IBD anti-inflammatory diet (IBD-AID).
There are many different types of elimination diets that help ease the symptoms of GI disorders, says Carla Salcedo, a clinical dietitian who specializes in gastrointestinal disorders at UC San Diego Health. “What do they have in common? They decrease known inflammatory foods that have a negative effect on the gut microbiome.”
Salcedo says not all foods you exclude will trigger UC symptoms. It depends on individual sensitivities. Dairy, for example, is bad news for only some people. “A lot of our patients with GI disorders are lactose-intolerant, so right off the bat they feel better without it,” Salcedo says. “Red meat is another tricky one. Some patients tolerate it, and others don’t.”
She adds that stress management and quality sleep are also crucial for gut health. The “AIP lifestyle” emphasizes these, too.
Is AIP Right for Your UC?
Missy Hall, a registered dietitian in Florida, tried a couple of elimination diets for her ulcerative colitis. First she followed the specific carbohydrate diet. Like AIP, it focuses on nutritious, whole foods and eliminates grains and processed foods, including sugar and canola oil. “After about a year, I really didn’t see the results I wanted,” she says.
Then she reached out to the UMass Medical School Center for Applied Nutrition, which developed and is now testing the IBD-AID diet. The diet is a spinoff of SCD, with changes that reflect current research on the gut microbiome. It eliminates most of the common inflammatory foods, emphasizes prebiotic and probiotic foods, and allows oats.
Almost as soon as Hall started this diet, she felt better. “I think I improved 75-80% overnight just by adding oats. That was the first thing I added that significantly helped me,” she says. “Gradually, over the next year, I added foods back slowly and really listened to my body. If I had pain, I would analyze what I ate and what I had been doing.”
With the diet, regular exercise, and better stress management, her UC got better -- much better. “As of June [2020], I’ve been in complete remission,” she says. She’s now a telephone counselor for the UMass IBD-AID program.
Could AIP work this well? Salcedo seems to think so. It’s one of the diets she recommends to people she treats. “When a patient comes in, we want to know: What have you tried in the past? What’s your current diet like? Those answers are going to influence which elimination diet is most appropriate for them,” she says. “It’s not a one-size-fits-all answer.”
