I was recently contacted by Mickey Trescott of autoimmunewellness.com, who had some very exciting news to share. The Paleo autoimmune protocol (AIP) has been put to the test in a formal research study, and the results are nothing short of fantastic.
For those of you who are familiar with scientific research, you know that it’s incredibly hard to get a study like this funded. Not only is there no pharmaceutical company to profit, but it also completely overturns current paradigms in clinical research. No agency wants to fund something that is “too out there” or “doesn’t yet have any evidence.”
Sometimes, though, things just work out. In this case, a gastroenterologist at Scripps was introduced to AIP after witnessing one of her patients with ulcerative colitis make an astonishing recovery using the elimination diet. She decided to put together a study to formally investigate the diet in both ulcerative colitis and Crohn’s disease patients. It was entitled “Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Diseases,” and it was published last month in the journal Inflammatory Bowel Diseases.
In today’s article, I’ll break down the methods of the study—and the impressive results they found. First, I’ll review the two types of inflammatory bowel disease (IBD) and discuss why an elimination diet might be effective.
More evidence that the AIP diet is effective for IBD.
What Causes IBD?
As of 2015, 231 single nucleotide polymorphisms (SNPs) within 200 different genes are associated with IBD risk. Still, genetics only account for a small proportion of the variance in disease (8.2 percent for CD and 13.1 percent for UC) (1, 2). This means that environmental factors likely play a significant role. Factors implicated in IBD include gut dysbiosis, environmental toxins, and diet, among others.
The Standard American Diet has been associated with an increased risk of IBD, while anti-inflammatory diets have shown some promise for relief (3). Many patients with IBD have known food sensitivities (65 percent, 4), yet some patients may not know which foods might be harming them. I’ve discussed the limitations of food sensitivity testing previously on my podcast. This is where an elimination diet can be really helpful.
Enter the Paleo Autoimmune Protocol
The Paleo autoimmune protocol (AIP) is a Paleo-type diet, which removes grains, legumes, dairy, refined seed oils, and refined sugar, but also recommends initial removal of eggs, nightshades, coffee, alcohol, nuts, and seeds. The basic rationale is to avoid foods that might trigger intestinal inflammation or promote gut dysbiosis and immune dysregulation.
Like Paleo, AIP encourages consumption of nutrient-dense, healing foods, including bone broth, organ meats, and fermented foods. The elimination phase is typically followed by a maintenance phase until sufficient improvement in symptoms is achieved. At that point, select food groups can be carefully reintroduced. This allows patients to expand their diets, while identifying any foods that might be contributing to their symptoms.
I’ve mentioned before that the restrictions of AIP really aren’t based on any peer-reviewed evidence. While the study discussed today was not a randomized controlled trial, it certainly adds to the credibility of AIP, beyond just anecdotal support and my clinical experience with patients.
SAD to AIP in 6 Weeks
For the study, 15 patients were enrolled that had been living with IBD for an average of 19 years. A team including a nutritional therapist and registered dietitian led the participants through a six-week phased elimination program to transition from their current diet (SAD) to AIP. They remained on the full AIP diet for five weeks. Mayo score (a measure of ulcerative colitis activity) or Harvey-Bradshaw score (a measure of Crohn’s disease activity) was determined at baseline, after the six weeks of phased elimination, and at eleven weeks after a month on full AIP. Seven of the 15 patients were actively taking medications to help manage the symptoms of their disease during the intervention. Patients who were identified as deficient in vitamin D (three patients) or iron (six patients) were also started on nutritional supplements to correct these deficiencies.
So, the results? The authors write:
Clinical remission was achieved by week 6 by 11/15 (73%) of study participants, and all 11 maintained clinical remission during the maintenance phase of the study.
Wow. Seventy-three percent of participants achieving clinical remission in six weeks rivals most drug therapies for inflammatory bowel disease, without any of the side effects. Let’s look at the breakdown by disease across the three timepoints.
Average Mayo score (disease activity) in ulcerative colitis patients:
- Baseline: 5.8
- Week six: 1.2
- Week eleven: 1.0
Average Harvey-Bradshaw index (disease activity) in Crohn’s disease patients:
- Baseline: 7.0
- Week six: 3.6
- Week eleven: 3.4
Additionally, four participants were able to discontinue some or all of their medications.
What It Means
This study suggests that the Paleo autoimmune protocol can be used as an effective treatment in many patients with IBD and that remission occurs quite rapidly. I’ve witnessed it quite often in the clinic, but I’m thrilled to see it documented in the literature as well!
For more information on AIP, be sure to check out these resources:
- What is AIP?
- 5 steps to personalizing your autoimmune protocol
- Pills or paleo: preventing and reversing autoimmune disease
Research Spotlight: Health Coaching and Gut Health
Periodic Phone Calls from Nurses Improve Remission Rates for Patients with Crohn’s Disease
Crohn’s disease is a form of inflammatory bowel disease. Sufferers often experience cycles of flare-ups in response to known and unknown triggers, and symptoms can include abdominal pain, diarrhea, weight loss, and nutrient deficiencies. Common treatments include steroids, immune-suppressing drugs, anti-inflammatory drugs, and specific diets like the autoimmune protocol. As with other chronic diseases, adherence to strict treatment plans for Crohn’s disease can be quite low. A study published in 2018 showed that periodic phone calls from nurses who were trained in motivational interviewing improved remission rates for patients with Crohn’s disease.
- The researchers sought to determine whether having frequent check-in calls would improve outcomes for patients being treated for Crohn’s disease.
- There were 381 adults with Crohn’s disease who were being treated with adalimumab, an anti-TNF (tumor necrosis factor)-alpha therapy, who were randomly assigned to two groups. One group received periodic Care Coach Calls, given by nurses trained in motivational interviewing, throughout treatment (which lasted up to 18 months), while the second group did not receive these support calls.
- The group of patients who received the Care Coach Calls had a 17 percent increased likelihood of remission based on the Harvey-Bradshaw Index at a follow-up assessment between six and 18 months after initial treatment.
In the Functional Medicine model of collaborative healthcare, health coaches are change agents who help patients realize their motivations for changing lifestyle and/or eating behaviors. In this study, Care Coach Calls did something similar—they helped patients realize their motivation for starting medication in the first place in order to stick to the treatment plan, which resulted in a greater chance of remission. These findings indicate that health coaches play important roles in all kinds of medical practices, and that they aren’t just for patients only using “natural” treatments.
Health coaches, through techniques like motivational interviewing, support clients as they make big lifestyle changes. Having this support can make a difference when it comes to achieving lasting behavior change. Find out more about what health coaches do from the ADAPT Health Coach Training Program.