Is there anything I can eat?

Basket of Vegetables

Seems like every autoimmune blog out there suggests a specific diet – paleo, AIP, GAPS, and Wahls – and for special situations, FODMAPs and elemental diets. With each diet claiming to be ‘the only diet you’ll need,’ and so much conflicting information, how do you decide what’s the best choice for you? It’s rare that I’ll recommend a diet in its entirety to anyone. The big name diets are great starting points to get ideas on how to adapt your food choices to one that’s more suitable for your situation. They are guidelines for changing the way you feed your body. Through understanding more about how your body reacts to food, we adjust and adapt so that you can get the greatest variety of foods while avoiding the ones that are most problematic for you. Let’s start with some history on each of the main diets, and then a comparison of key features.

Paleo – The diet can be traced to 1975, in a book by gastroenterologist Walter Voetlgin. It was further expanded in 1985 by Stanley Boyd Eaton and Melvin Konner. In 2002, Lore Cordain made the diet concept popular in his book The Paleo Diet. The diet has its foundation in the belief that our human digestive system hasn’t evolved to digest the processed and refined foods that resulted from a shift from hunter-gatherer to agrarian societies. The diet focuses on gaining calories primarily through meats with approximately 15-20% from fruits, vegetables, nuts, and seeds and 10-15% through fats and oils.

AIP – The Autoimmune Protocol diet is a variant of the Paleo diet. The food selection and focus on proteins from meat, non-starchy vegetables, and healthy fats remains, but the allowable foods are more limited. Foods that are known to cause inflammation or stimulate the immune system like nightshade vegetables, eggs, nuts, seeds, and alcohol are restricted. The diet is intended to be followed strictly for a period of time, 6 weeks to 6 months, or until autoimmune symptoms subside. Then, foods can be added back to more closely align with the paleo diet.

GAPS – The Gut and Psychology Syndrome diet was created by Dr. Natasha Campbell-McBride and is based on the Specific Carbohydrate Diet. The diet is divided in two phases – the introduction diet, and the maintenance diet. During the introduction phase, participants are very restricted in their diet choices, and new foods are added in slowly, observing any reactions during the trial phase. In the maintainance phase, the diet restricts dairy and all sugars, is low in fruits and grains, and encourages meat and meat broth, as well as fermented foods to maintain healthy gut flora.

Wahl’s – The Wahl’s protocol was defined by Dr. Terry Wahl, a physician and MS patient. She was following a paleo diet, but found that it wasn’t enough to keep her disease from progressing. Through personal research, she discovered that her diet needed to focus more on feeding the mitochondria – the energy producing segments of a cell. By eating the foods rich in the nutrients that feed mitochondria, she was able to overcome the limits caused by the demyelination from her MS. The key feature of her diet protocol is the inclusion of 9 cups of vegetables daily.

FODMAP – The Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols is a very restrictive diet created by Monash University. It was intended to be a dietary strategy for people with irritable bowel syndrome. The diet is restrictive of starchy carbohydrates and sugars, believing that they are not digested well, leading to irritation and inflammation in the intestines. The diet includes grains, breads, and baked goods, as long as Celiac disease or gluten intolerance is not present.

Sugar and starchGrainDairySoy inclusionFatVegetablesOther lifestyle modificationsExpected duration
Paleoraw honey, good quality maple syrup, organic Stevia, molasses, and a few lesser known natural sweeteners like chicory root and inulin fiberNoneIncluded in neo-paleo variantNonefish oil, coconut oil, olive oil, palm oil, ghee, animal fats from organic grassfed meats, nuts and avocadosInfinite amount of non starchy vegetablesStresses importance of socialization, outdoor activity, quality sleep, and emotional balanceLifetime
AIPNoneNoneNoneNonefish oil, coconut oil, olive oil, palm oil, ghee, animal fats from organic grassfed meats, nuts and avocadosInfinite veggies minus nightshadesStresses socialization, outdoor activities, encouragement from support groupsCan be relaxed after initial inflammation is reduced
GAPSNoneBegins as gluten free only, then progresses to grain freeEliminated, then reintroduced if toleratedNonefish oil, coconut oil, olive oil, palm oil, ghee, animal fats from organic grassfed meats, nuts and avocadosInitial phase reduces high fiber veggies to heal digestive tract, then unlimited non-starchy vegetablesPrimary focus on food, but encourages exercise in unpolluted settingsTypically 2-3 years, then transition to a paleo or Mediterranean
Wahl’sNone, and very limited to no fructoseNoneNoneNonefish oil, coconut oil, olive oil, palm oil, ghee, animal fats from organic grassfed meats, nuts and avocados9 cups of veggies per day – 3 cups leafy greens, 3 cups sulfur-rich, 3 cups colorful veggiesFocus on reducing stress through meditation, exercise, and time in natureLifetime
FODMAPBeet sugar, cane sugar, brown sugar, table sugar, palm sugar, maple syrup, no artificial sugarsAmaranth, Buckwheat, Corn, Millet, Oats, Quinoa, Rice (brown), Sorghum, WheatLactose free dairy acceptableSome soy products acceptableLimit butter, coconut oil, palm oilNon-starchy vegetables, no onion, garlic, beet, cabbage, celery, asparagus, artichokesPrimary focus on food2 to 6 weeks before food reintroduction

You can see that these diets all have a few things in common. First is the avoidance of processed, packaged foods. None of these approaches will encourage you to eat the refined sugars and flours common in many grocery store foods today. They all focus on foods being as natural as possible, and preferably organic. They also encourage significant consumption of vegetables, with limited fruits.

Virtually all the diets restrict soy consumption. While soy has been touted as a health food, it is very heavily processed, typically tainted with pesticides and herbicides, and of limited value in the diet (link to huffpo). Vegetarians and vegans tend to look to soy as a protein source, but I would encourage alternatives. My rule of thumb – if you’re eating foods that have had some element replaced – fat free, dairy free, gluten free, then your food is overly processed and you’re not getting the best benefit from it.

What do I recommend? I’m an engineer, so the answer is always a qualified, ‘it depends.’ There are many considerations when choosing a diet for someone. There’s not a single best diet, but all the diets I recommend include whole, unprocessed foods with a focus on low carbohydrates and nutrient rich protein and vegetable sources.