I have spent two years, studying the work of experts in the field of autoimmunity and have combined what I’ve learned, in 24 steps. I’ll be sharing one step every week for the next 24 weeks, on my website and social media platforms (starting Monday 18 May 2020). This is step 24 of 24.
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STEP 24: REINTRODUCTIONS
The Autoimmune Way program is based on the Autoimmune Protocol, also known as AIP. It is designed to flood the body with nutrient dense food and to avoid food that may cause inflammation, stimulate the immune system or harm the gut environment.
The AIP is an elimination diet at its core, often referred to as the elimination phase of your healing journey. The best part about an elimination diet is that, eventually, you get to reintroduce the food you have been avoiding. Your ultimate goal should be to live a healthy life while following the least restrictive diet possible. Let’s be honest, after removing the food on the “food to avoid” list, your diet has become pretty restrictive.
WHEN AM I READY FOR REINTRODUCTIONS?
You reach the reintroduction stage when you have spent 30-90 days fully compliant in the elimination phase and have measurable improvement in symptoms from your baseline (the way you felt before you started the course) as evidenced from tracking and journaling, and/or lab testing. An excellent method of tracking the progress you’ve made is to do our self-assessment questionnaire before you start your healing journey and again 1 – 6 later.
You could be ready for reintroductions if your total self-assessment score is substantially lower (by at least 100 – 150 points) when compared to the total score you got, before you started the course.
Ideally, you should avoid food reintroductions until your disease is in full remission, in other words, mostly symptom free. Your decision should come from feeling good and seeing improvement, not cravings. If you think your immune system is still attacking your own cells, then it is too early for reintroductions.
IF THESE FOODS CAUSE INFLAMMATION, WHY SHOULD I DO REINTRODUCTIONS?
- You are working towards designing a diet that is perfect for your unique needs and your end result will look different from any other person using the protocol. You want to use the protocol to your advantage, identifying which foods are causing symptoms, expanding your diet to include foods that are most supportive, and eliminating more long-term the foods that undermine your health.
- Some of the elimination foods are valuable to re-incorporate into your regular diet from a nutrient standpoint (eggs, for example).
- It’s also true, both from a practical and social sustainability standpoint, that reintroductions are a wise step (i.e. it’s easier to travel if you can eat rice and it’s nice to occasionally go out to Happy Hour with friends).
- There is psychological benefit in working towards expanding your diet as your wellness returns, rather than allowing food-driven fears to take hold.
THE BASICS OF REINTRODUCTIONS
Reintroductions is the second and final phase of the AIP eating plan where the focus is no longer on eliminating, but instead on bringing foods back into the diet. During the reintroduction phase, you progress through a process of testing your response to the foods you’ve eliminated one-at-a-time.
Each food is best tested in a specific order, beginning with foods that are most nutrient-dense and least likely to cause a reaction and moving toward foods that least nutrient-dense and most likely to cause a reaction.
There are 4 stages in the reintroduction phase:
If a food or food group does not appear in the four stages, it indicates that you may want to avoid that food long-term due to its negative impact on those with autoimmune disease or its overall negative health consequences for the majority of the population.
Gluten, for instance, is likely to contribute to further immune stimulation for everyone with autoimmune disease, while processed vegetable oils, food chemicals and additives, and refined sugars and non-nutritive sweeteners, are harmful for everyone. Many experts also warn agains reintroducing dairy.
BEFORE YOU START REINTRODUCTIONS
Implementation of the reintroduction stage is not difficult, but it does require methodically following a multi-step procedure. Reintroductions can almost be viewed as performing a scientific experiment on yourself. The experiment started with you eliminating anything that can cause harm and then reintroducing these potentially harmful objects back into your life, to test its impact. The reason for the multi-step procedure is to help you be the best possible scientist, controlling, evaluating and measuring the “science experiment” you are about to conduct.
Before you start, consider these important points:
- limit variables (for example, avoid reintroductions when you are sick or under stress).
- avoid reintroducing known food sensitivities, intolerances and allergies.
- no need to reintroduce food you don’t miss or enjoy.
- follow the below procedure.
- track all the data.
- be willing to accept the conclusions, even if they disagree with what you were hoping for.
- remember that reintroductions can be reattempted (sometimes more healing time is all that is required).
IT’S TIME FOR REINTRODUCTIONS
- Select a food to reintroduce from the stage 1.
- Start with half a teaspoon or less and wait 15 minutes. If there are reactions, stop.
- If there are no reactions, eat one full teaspoon and wait 15 more minutes. If there are reactions, stop.
- If there are no reactions, eat one-and-a-half teaspoons and wait two–three hours. If there are reactions, do not go any further.
- If there are no reactions, eat a normal portion of the food and wait 3–7 days. Do not reintroduce any other foods and track reactions during this time. (Many reactions could indicate a potential food sensitivity, but the most obvious is a return of your autoimmune symptoms.)
- If there are no reactions different from your improved baseline after the AIP elimination phase, that food can be brought back into your diet and you can begin another reintroduction.
- Be aware that you may find a food is tolerated when you eat it occasionally, but not when eaten regularly.
- It should be noted that this process of elimination and reintroduction is medically the “gold standard” for identifying food-driven symptoms, even more so than largely inaccurate food sensitivity testing.
- Once you completed stage 1 reintroductions, proceed to stage 2, then stage 3 and end the reintroductions with stage 4 foods.
- Once you’ve completed all the reintroduction stages you may start to incorporate those foods you didn’t react to, in your diet, in moderation.
- Always be on the lookout for symptoms and negative reactions and make adjustments accordingly. Sometimes your body has the ability to tolerate a little bit of a certain food occasionally but when you start having it often, it might trigger a reaction.
HOW TO TRACK REINTRODUCTIONS
We made that sound kind of easy, but it actually takes a little bit of organized data collection. We suggest utilizing a simple journal page with space to record the following details:
- Name of the food you are attempting to reintroduce.
- The date.
- What time it was when you attempted the half teaspoon of the food and your reactions.
- What time it was when you attempted the full teaspoon of the food and your reactions.
- What time it was when you attempted one and half teaspoons of the food and your reactions.
- What time it was when you attempted a normal serving of the food and your reactions.
- Reactions on Day 2.
- Reactions on Day 3.
- Reactions on Days 4-7 (if you decide to take extra time between reintroductions).
- A little space for your reintroduction results (whether that food is a positive or a negative for you).
SYMPTOMS TO WATCH OUT FOR
One of the more challenging aspects of AIP food reintroductions is figuring out what constitutes a reaction. Outside of something very obvious, like suddenly breaking out in hives or vomiting, it can be a little confusing. And since food-driven symptoms can show up days later (although typically if you are sensitive you will notice within 48 hours), it can be especially tough to notice them or connect them to a food.
The good news is that once you’ve cleared the slate, taken ample time in the AIP elimination phase to improve your baseline, and tackled anything underlying that needed treatment, you’re likely to find that your body’s communication, even its more subtle clues, becomes very clear to you. Things that previously didn’t get your attention will be much more obvious.
Below is a list of symptoms you might encounter when reintroducing a food back into your diet. You can run through this list during a reintroduction attempt to check-in with yourself each day (up to 7 days after you try a reintroduction, if you are being particularly cautious), to see if you are experiencing these things. Note any that you are experiencing, but which had been resolved prior to beginning the reintroduction process, on your reintroduction tracking page.
Possible reactions might be:
Autoimmune related symptoms
- Disease symptoms returning/worsening (flare-up)
- Unable to stay awake
- Unable to stay asleep
- Not feeling rested after sleep
- Sugar cravings
- Fat cravings
- Need for caffeine
- Craving minerals from non-food items (like chalk, dirt, or clay)
- Pink bumps or spots
- Dry hair, skin, or nails
- Muscle aches or pains
- Joint aches or pains
- Tendon aches or pains
- Ligament aches or pains
- Stomach ache
- Undigested food in stool
- Mood swings
- Low stress tolerance
- Noticeable increase in anxiety
- Reduced energy levels
- Afternoon energy dips
- Headache (from mild to migraine)
- Dizzy or lightheaded
- Phlegm, runny nose, or postnasal drip
- Coughing or constant need to clear throat
- Itchy eyes, mouth, or ears
9. FREQUENTLY ASKED QUESTIONS
Can you still reintroduce foods even though you don’t feel any better?
If you aren’t feeling any improvement after 90 days on the elimination diet, it is important to enlist the help of a functional medicine practitioner to troubleshoot some root cause issues that may be impacting your healing process. If you try to reintroduce foods before you start to feel improvement, you will have less ability to tell if a food is causing a reaction or not.
Do all of your symptoms need to reverse before reintroducing foods?
No, but you do need to see measurable improvement to create that “baseline” and gauge reactions. Even if you have not had total remission of your autoimmune symptoms, look for positive changes in other areas, like skin, digestion, mood, sleep, and energy. If those subtler changes are clear and measurable enough, you can start the reintroduction process. The rule of thumb: If you’re not sure you’re ready, you probably aren’t.
What if you have a condition like Hashimoto’s that comes with symptoms that are hard to pin down?
Some autoimmune diseases, like Hashimoto’s thyroiditis come with symptoms that are more subtle and hard to track, such as energy and mood fluctuations. This is where very careful symptom journaling and tracking comes in. Certain indicators like bowel movement frequency and type, morning body temperatures, and monitoring thyroid hormones via blood work can be helpful. Even though progress might be harder to ascertain, you should be able to see forward movement using this information when combined with your symptom tracking.
Should I reintroduce food I know I’m sensitive, intolerant or allergic to?
Absolutely not. Never reintroduce any known food sensitivities and allergies.
Should I reintroduce all the food in each stage?
It’s not necessary to reintroduce all the foods. Select the foods, you’ve missed, the foods you would like to test and those that can often be found in the food served in your culture.
Do I have to reintroduce every spice before moving onto the next stage?
Unless you have a reaction to any of the spices, I usually say trying out 3-4 spices individually from each category seems to be sufficient, though you may want to separate out and do each of the nightshade-based spices individually as those tend to cause more issues with people.
What if you have a bad reaction to a food?
This is what everyone is nervous about, as we don’t want to experience the disappointment that comes when a food reintroduction is not successful. While it is disappointing, it is also a valuable communication from your body.
Stop and do not include this food in your diet at this time. Depending on the severity of your reaction, go back to the elimination phase until you reach the baseline of health that you had before you started reintroducing foods. This could take a matter of days or weeks to achieve but it is important to “clear the slate” before you begin the process again with a new food. If you do not give time to the “clearing the slate” process, it will be difficult to gauge positive or negative reactions to the next reintroduction attempts. Remember that a food that did not work today may work in the future with more healing.
How long do you have to go back to the elimination phase if you have a bad reaction?
This depends on the severity of reaction. It could be a matter of days or weeks. It’s important to re-establish your improved baseline (the way you were before you started the reintroductions) before starting again.
If you react to one food in an earlier stage does that mean you can’t move on to the next stage?
No, but it is recommended to try some other foods from that stage before moving on to the next stage. For instance, if you try ghee in Stage 1 and get a reaction, but you have successfully reintroduced green beans, cardamom, black pepper, and macadamia nut oil, you could consider moving on to foods in the Stage 2 list. However, if you find that you are reacting to most of the foods in a particular stage, you may need to wait for deeper healing before moving further.