AIP Analysis Replace: A Hashimoto’s AIP Examine from Poland

Excellent news! The Autoimmune Protocol (AIP), an elimination and reintroduction protocol aimed toward serving to these with autoimmune illness determine meals sensitivities and enhance nutrient-density, continues to be the main target of medical analysis investigating its efficacy for particular autoimmune situations. Whereas AIP has been broadly used within the autoimmune group since 2011 (see the Historical past of the AIP Motion), medical analysis into its efficacy started round 2015, with outcomes of the primary pilot research revealed in 2017. Since then, research have been performed utilizing AIP as an intervention for inflammatory bowel illness (Crohn’s and ulcerative colitis), Hashimoto’s thyroiditis, rheumatoid arthritis, eczema, and psoriasis. Should you’d wish to study extra about earlier research, together with what interventions have been used and the outcomes, try the AIP Medical Analysis Assessment. 

At this time I’ll be highlighting the latest AIP medical research, Results of Autoimmune Protocol (AIP) weight loss program on adjustments in thyroid parameters in Hashimoto’s illness by a analysis crew from Poland, Paulina Ihnatowicz, Jerzy Gębski, and Małgorzata Ewa Drywień [1]. That is the second research that has been performed up to now utilizing AIP as an intervention to handle Hashimoto’s thyroiditis and positively provides to our data base of the best way to use the protocol for managing it [2]. Hashimoto’s will not be solely the commonest autoimmune illness, however typical therapy isn’t profitable as many sufferers discover that they proceed to have signs though their hormone ranges have been “handled to focus on” [3]. 

Intervention particulars

For this research, 28 sufferers with Hashimoto’s thyroiditis have been enrolled, with 20 of them finishing the research. The typical age was 35, with sufferers between 23-55 years outdated. Sufferers underwent preliminary testing, surveys, and dietary evaluation, after which have been prescribed individualized, 12-week dietary plans compliant with Core AIP Elimination. It must be famous that in distinction to prior research utilizing AIP, there was no use of a transition section–individuals made fast transitions to the elimination weight loss program [2]. 

When it comes to testing accomplished at baseline and completion of the research, sufferers had their top and weight measured in a clinic, had lab attracts for thyroid hormones (TSH, whole and free hormones) and thyroid antibodies, an ultrasound of the thyroid, they usually additionally accomplished surveys to seize symptom burden. Prior dietary consumption was captured utilizing a survey for evaluation and comparability of prescribed AIP meal plans. 

After preliminary testing, every participant was prescribed an individualized, 12-week Core AIP meal plan based mostly on their anthropometrics (top and weight). They have been instructed to proceed all prescribed drugs and dietary supplements as earlier than, and no changes have been made to doses. Help was provided through month-to-month group teaching calls. 

Outcomes 

Vitality and macronutrient consumption

A comparability of prior weight loss program and prescribed AIP weight loss program confirmed that vitality consumption (energy) was roughly the identical earlier than and after the research (2,067 to 1,997 energy). When it comes to macronutrient consumption, protein elevated from 16.77% to 24.9% of whole energy, which is a rise of roughly 85 to 125 grams per day (based mostly on a 2,000 calorie consumption). The rise in protein got here primarily from decreased fats consumption. 

Micronutrient consumption 

Evaluation of nutrient consumption through prescribed AIP weight loss program confirmed there was a broad enhance in nutrient density in the course of the intervention. Particular nutrient consumption will increase included Beta-carotene (550%), fiber (162%), folates (198%), long-chain fatty acids (262%), potassium (196%), vitamin A (341%), vitamin C (886%), with different vitamins like B nutritional vitamins, iron, zinc, and magnesium with appreciable will increase. The authors famous that evaluation of some vitamins was difficult by supplementation, particularly magnesium, vitamin C, and potassium. 

Biochemical thyroid adjustments 

Blood check evaluation confirmed Thyroid stimulating hormone (TSH) considerably decreased from a imply of three.72 to 2.69. Free T3 and T4 considerably decreased, though each stayed inside reference ranges (3.31 to 2.88; 1.36 to 1.20). Imply anti-TPO antibodies elevated (210 to 293) and anti-Tg decreased (317 to 300), though these outcomes didn’t meet statistical significance. 

Bodily thyroid adjustments

A comparability of thyroid ultrasounds earlier than and after intervention confirmed the appropriate lobe quantity decreased by 5% and the left lobe quantity decreased by 6%. 

Weight and physique composition adjustments 

Anthropometric measurements taken earlier than and after intervention confirmed that imply weight decreased from 69 kg to 65.5 kg (152 lbs to 144 lbs). Imply physique fats proportion decreased from 33% to 29.5%, indicating that twice as a lot weight was misplaced from fats than muscle. 

Symptom burden

Evaluation of questionnaires confirmed a broad enchancment of signs generally reported by Hashimoto’s thyroiditis sufferers. The biggest decreases have been seen within the following areas:

1. Digestive operate
   1. Constipation – 36% to 11% (25% distinction)
   2. Gasoline – 61% to 21% (35% distinction)
   3. Flatulence – 61% to 29% (32% distinction)
   4. Diarrhea – 29% to 7% (22% distinction)
   5. Belly ache – 29% to 14% (15% distinction)
2. Vitality 
   1. Tiredness – 82% to 29% (53% distinction)
   2. Drowsiness – 64% to 21% (43% distinction)
   3. Fatigue – 50% to 11% (39% distinction)
3. Psychological
   1. Impaired focus – 71% to 18% (53% distinction)
   2. Complications – 39% to 11% (28% distinction)
   3. Despair – 29% to 4% (25% distinction)
4. Ache
   1. Muscle cramps – 43% to 7% (36% distinction)
   2. Joint ache – 57% to 21% (36% distinction)
5. Pores and skin 
   1. Hair loss – 64% to 32% (32% distinction)
   2. Pores and skin issues – 57% to 7% (50% distinction)
   3. Dry pores and skin – 71% to 32% (39% distinction)

Along with the above outcomes, the authors offered an evaluation of particular nutrient consumption associations with the entire measures within the research. 

Dialogue and takeaways

AIP is an extremely nutrient-dense weight loss program

That is the primary research to offer an in depth evaluation of the nutrient-density of Core AIP in comparison with an ordinary weight loss program. The evaluation confirmed that Core AIP is very wealthy in beta-carotene, retinol, fiber, long-chain fatty acids, B nutritional vitamins, and minerals (like iron, magnesium, and potassium). You will need to word that the authors prescribed nutrient-dense meals like fermented meals, cold-water fatty fish, broth, and colourful vegetables and fruit of their meal plans, in line with AIP pointers. We all know that these vitamins are important to a wholesome physique and immune system, and it’s doable that lots of the anti-inflammatory and restorative advantages of AIP probably come from this enhance in nutrient density. Takeaway: Don’t overlook to use nutrient density in your method to AIP! 

Will we give attention to thyroid hormones or signs to trace progress with Hashimoto’s? 

The outcomes of this research have been a bit paradoxical when it comes to thyroid hormones. You will need to word that sufferers coming into this research have been thought of euthyroid, or being inside regular thyroid hormone reference ranges. As a practical medicine-trained nutritionist, my view is that this group really might have been thought of subclinical hypothyroid with a imply TSH of three.72, as practical drugs makes use of a narrower reference vary for TSH (.5 to three mU/L, in comparison with the 0.27 to 4.2 used within the research). By that commonplace, AIP did a superb job of bringing TSH down below 3, with a lower of the imply to 2.62. 

The half that’s paradoxical are the thyroid hormone outcomes. Free T4 and free T3 noticed small however important adjustments downward. Often this could point out that there’s much less thyroid hormone accessible for use within the tissues and in line with the traditional mannequin of thyroid therapy, maybe trigger signs. However once we check out different indicators of thyroid well being used on this research, this doesn’t appear to be a nasty factor: 

• Thyroid ultrasound confirmed a lower in thyroid quantity. That is essential as a result of thyroid quantity is linked to larger autoimmune exercise, irritation, and signs in sufferers with Hashimoto’s thyroiditis. 
• Physique composition adjustments point out constructive metabolic adjustments regardless of a weight loss program an identical in vitality density. The imply weight reduction was 8 kilos in 12 weeks, with a 4% lower in physique fats proportion. 
• Surveys point out a lower in Hashimoto’s signs. 

After we take all of those outcomes collectively, they appear to recommend an enchancment in a few of the core areas of concern for sufferers with Hashimoto’s (thyroid swelling, weight acquire, and excessive symptom burden). The discount in TSH, which is a sign from the mind indicating it wants the thyroid to provide extra hormones, factors to the physique discovering stability and having sufficient thyroid hormone for metabolic wants. In their very own dialogue, the research authors theorized that the paradoxical end result could possibly be attributable to an improved dietary standing rising sensitivity to thyroid hormone within the tissues.

Earlier than we get again to the query on what to give attention to when gauging progress with Hashimoto’s, I need to share a few options of the illness. First, the one typical therapy for Hashimoto’s is optimizing hormones with thyroid hormone substitute medicine. Second, medical analysis exhibits that Hashimoto’s sufferers usually proceed to have signs even after their hormones are corrected to reference ranges [3]. 

As a Hashimoto’s affected person myself, I discover the outcomes of this research extremely validating that somebody with this situation can see a drastic enchancment of their signs with out it being mirrored of their hormone ranges. Whereas hormone ranges are essential for monitoring and therapy, I’ve all the time been a proponent of equally valuing symptom burden as a significant indicator for progress in managing this illness. Takeaway: Leads to decreased thyroid quantity, weight reduction, and symptom administration point out improved thyroid standing, regardless of paradoxical ends in thyroid hormone parameters.

How do these outcomes examine to the outcomes of the primary AIP Hashimoto’s pilot research?

There are two main variations between the interventions utilized in these research. First, the unique AIP Hashimoto’s research used a 6-week transition section and a 4-week elimination section [2]. This research didn’t use a transition section and had a for much longer elimination section of 12-weeks. Second, the unique AIP Hashimoto’s research applied small adjustments in life-style areas like sleep, stress-management, motion, and connection. This research centered solely on the dietary facet of AIP. 

Each research noticed related outcomes when it comes to symptom burden and enchancment of high quality of life for sufferers with Hashimoto’s. Within the authentic AIP Hashimoto’s research, drugs have been titrated based mostly on thyroid hormone ranges and they didn’t see any adjustments in hormone or antibody ranges, though they did see a pattern for lowered medicine want by the top of the research [2]. 

Measures examined between the 2 research differed just a little. The unique AIP Hashimoto’s research didn’t check anthropometric adjustments, thyroid quantity, or the nutrient comparability of the diets, however they did measure a marker of irritation, hs-CRP (which decreased by 29%) [2]. This was not included within the Polish research. Takeaway: This new AIP Hashimoto’s research provides to our data about AIP’s efficacy when it comes to nutrient density, chance to lower thyroid quantity, and weight reduction. 

What concerning the adjustments in thyroid antibodies? 

Hashimoto’s is an autoimmune illness for which two antibodies are recognized. This research discovered a rise in anti-TPO and a lower in anti-Tg, though these outcomes didn’t meet statistical significance (that means the end result couldn’t be differentiated from probability 1 out of 20 occasions). 

I need to share my private view on antibodies based mostly on evaluation of analysis on this matter and my scientific expertise working with Hashimoto’s sufferers. First, there’s analysis associating antibodies with the next symptom burden and decrease high quality of life for Hashimoto’s sufferers; there’s additionally analysis displaying that antibody ranges are usually not correlated with signs. My statement as a clinician is that antibodies are useful for analysis and within the early levels of therapeutic, however don’t all the time line up with symptom burden reported by the affected person. I’m an advocate for having them examined and tracked, however not utilizing them to gauge progress exterior of different indicators of thyroid optimization (like signs or hormone ranges). Takeaway: Antibodies shouldn’t be a main marker of illness burden for sufferers with Hashimoto’s. 

Conclusion

That is the second high quality research displaying AIP is efficient as a dietary intervention for managing signs that include Hashimoto’s thyroiditis. I’m actually impressed with the work of the Polish crew that put this collectively, particularly their consideration to nutrient-density and customised meal plans. The addition of thyroid ultrasounds in addition to the longer length of the research are very useful in understanding extra concerning the bodily adjustments doable in addition to the timeline over which sufferers can count on to see outcomes.

Should you or a cherished one has Hashimoto’s, I hope you realized some nice takeaways from this evaluation! 

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References 

1. Ihnatowicz P, Gębski J, Drywień ME. Results of Autoimmune Protocol (AIP) weight loss program on adjustments in thyroid parameters in Hashimoto’s illness. Ann Agric Environ Med. 2023;30(3):513-521. doi:10.26444/aaem/166263
2. Abbott RD, Sadowski A, Alt AG. Efficacy of the Autoimmune Protocol Weight loss plan as A part of a Multi-disciplinary, Supported Way of life Intervention for Hashimoto’s Thyroiditis. Cureus. 2019;11(4):e4556. Revealed 2019 Apr 27. doi:10.7759/cureus.4556
3. Groenewegen KL, Mooij CF, van Trotsenburg ASP. Persisting signs in sufferers with Hashimoto’s illness regardless of regular thyroid hormone ranges: Does thyroid autoimmunity play a task? A scientific evaluation. J Transl Autoimmun. 2021;4:100101. Revealed 2021 Apr 15. doi:10.1016/j.jtauto.2021.100101