Episode 88: The First AIP Pilot Trial in Rheumatoid Arthritis with Julianne Taylor

Can dietary change meaningfully improve rheumatoid arthritis symptoms?

A recently published pilot study investigating the Autoimmune Protocol diet in adults with rheumatoid arthritis found improvements in patient-reported disease activity, pain, fatigue, sleep, and quality of life measures—with several participants reaching remission-level scores by the end of the intervention.

In this episode of the Autoimmune Wellness Podcast, Mickey Trescott is joined by registered nutritionist, AIP Certified Coach, and PhD candidate Julianne Taylor to discuss the first clinical trial investigating the Autoimmune Protocol in rheumatoid arthritis.

Julianne shares her personal journey into autoimmune nutrition research, explains how the study was designed, and walks through the results of the pilot trial—including improvements in fatigue, sleep, pain, and disease activity.

Together, they also explore the nuances and limitations of dietary research, discuss why individual responses vary, and dive into Julianne’s broader scoping review of elimination and reintroduction diets in rheumatoid arthritis spanning decades of research.

In this episode, you’ll learn:

• How Julianne’s personal health experience led her into autoimmune nutrition research
• What a pilot feasibility study is and why it matters
• How the AIP rheumatoid arthritis study was designed
• Why patient-reported outcomes like fatigue and sleep are important in RA research
• What improvements participants experienced during the intervention
• Why some participants experienced challenges or adverse effects
• How nutrient density and food eliminations may both influence outcomes
• What historical elimination diet research in RA reveals about common trigger foods
• Why nightshades continue to be an important area of interest in autoimmune nutrition
• What future research on AIP and rheumatoid arthritis may explore next

Resources:

• Paleo Zone Nutrition (blog)
• Julianne Taylor Nutrition (website)
• Julianne Taylor on Instagram
• The First AIP Pilot Trial in Rheumatoid Arthritis
• Elimination, Reintroduction Diets, and Oral Food Challenge in Adults with Rheumatoid Arthritis: A Scoping Review

Episode Timeline:

00:00 – Introduction to the first AIP rheumatoid arthritis pilot study

01:56 – Introducing Julianne Taylor

03:54 – Julianne’s personal health journey and early paleo research

11:34 – What a pilot feasibility study is

13:05 – The questionnaires used in the AIP RA pilot trial

17:07 – The AIP intervention and elimination phase

19:32 – Results of the rheumatoid arthritis pilot study

24:56 – Discussing adverse effects and individual variability

30:57 – Diet quality versus food eliminations

33:54 – Reviewing decades of elimination diet research in RA

38:48 – Common trigger foods identified in the literature

42:31 – Nightshades and rheumatoid arthritis

44:31 – Upcoming AIP and RA research

51:20 – What Julianne hopes clinicians and patients take away from the research

53:23 – Where to follow Julianne’s work online

Can dietary change meaningfully improve rheumatoid arthritis symptoms?

A recently published pilot study investigating the Autoimmune Protocol

diet in adults with rheumatoid arthritis found improvements in patient-reported

disease activity, pain, fatigue, sleep, and quality of life measures, with several

participants reaching remission level scores by the end of the intervention.

In today's episode, we are going to explore what this first of its kind trial

actually found, the important limitations and nuances of the research, and what

a broader review of elimination and reintroduction diets in RA might reveal

about how food affects autoimmune disease.

Welcome to the Autoimmune Wellness Podcast, where we explore evidence-based

strategies for living well with autoimmune disease through nutrition,

lifestyle, mindset, and community.

I'm your host, Mickey Trescott, and today I'm joined by Julianne Taylor, a

registered nutritionist from New Zealand, whose work many longtime members of the

AIP community might already recognize.

In fact, I first discovered Julianne's work well over a decade ago through

her Paleo Zone Nutrition blog.

She was writing about dietary approaches to managing RA long before

these conversations were mainstream.

In fact, this was one of my initial introductions to the Autoimmune Protocol.

So I have Julianne to thank for this path that my life has taken.

We later met in person when I traveled to New Zealand during the

book tour for the metric edition of The Autoimmune Paleo Cookbook.

And over the years, Julianne has remained an active and respected

member of the AIP community, including becoming an AIP Certified Coach.

So now that you guys know some of my personal background with

Julianne and her work, I'm going to read you guys her official bio.

Julianne Taylor is a registered nutritionist with the Nutrition

Society of New Zealand.

She's an AIP Certified Coach, and she's a New Zealand Registered

General and obstetric Nurse.

She recently completed her PhD coursework at Auckland University

of Technology, where her research focused on dietary strategies for

rheumatoid arthritis, particularly elimination reintroduction approaches

and the Autoimmune Protocol diet.

She's got one final hurdle to clear before her PhD is official, and we

are all cheering her on and wishing her luck with that this summer.

Julianne's recently published pilot feasibility study is the first clinical

trial investigating the effects of the AIP diet in adults with rheumatoid

arthritis, with several additional papers from that PhD currently under review.

Her interest in autoimmune nutrition began in 2009 while working with one

of New Zealand's earliest CrossFit gyms, where she was introduced

to the paleo diet and the work of Dr. Loren Cordain and Robb Wolf.

Intrigued by that emerging idea around ancestral nutrition and

autoimmune disease, she began diving into the scientific literature and

eventually experimented with paleo diet herself, experiencing significant

improvements in longstanding joint inflammation and eczema.

That experience ultimately inspired a transition from careers in

nursing and design into nutrition science and clinical research.

And in 2015, she conducted qualitative research interviewing people with RA

who reported symptom improvements using paleo and AIP approaches, laying this

groundwork for the clinical research that she would later pursue during her PhD.

And in addition to her academic and clinical work, Julianne is also an

accomplished competitive powerlifter who has represented New Zealand

internationally, earning a bronze medal in the 2019 World Championships,

and later becoming world champion in her division for both 2023 and 2025.

I just think this is so cool.

Thank you so much, Julianne.

Welcome to the podcast.

Thank you.

Thanks for having me.

Yeah.

So let's just jump right in.

I would love to start by hearing your personal story.

Like a lot of us, you got into this because of your

own personal health issues.

I would love to hear what led you to explore paleo nutrition and

then eventually the Autoimmune Protocol in the context of RA.

Sure.

So I, I probably always had an interest in nutrition.

Like, I trained as a nurse.

I practiced for, uh, three or four years post registration.

Throughout my younger years, I was always interested in diet,

but it was more for weight loss.

Constantly going on and off diets in order to, you know, keep that- Small

body, as young people tend to do.

Then, a little later, when I was about 18, I started getting,

um, some joint inflammation.

So one of my knees would swell, just get fluid-y and hot, and I get-- had

a really stiff, stiff sore neck and, um, inflammation in my jaw joints.

And that time I was investigated by a rheumatologist who found that I

had a positive ANA, not-- It's an anti-nuclear antibody, which is linked

with a number of autoimmune diseases.

It wasn't strong, but it was present.

Nothing got really bad, but what was interesting is my mother has lupus,

and I had identical symptoms to her, so the knees, the neck, and the jaw,

like the same inflammation pattern.

And she had the same positive ANA.

So I was never diagnosed officially, but that's-- I see it

as probably autoimmune inflammation.

In the '90s, this is going back to '95, my boyfriend at the time,

who's now my husband, he bought a book back from America called Enter

the Zone by Dr. Barry Sears, which really focused on having balanced

meals, low glycemic carbohydrates, protein at each meal, healthy fats.

So when I changed to that diet, I had a-- Like it was quite mind-blowing for me.

You know, like I think a lot of people experience this.

My joint inflammation improved, especially when I added some

more omega-3 into my diet.

Like I started taking a supplement.

My energy was better.

I lost weight more easily.

I found I probably was really under-eating protein because at that time everybody

was kind of semi-vegetarian and, you know, eating fairly high carbohydrate

diets as per what we thought that was the healthiest thing to do.

So a more balanced diet made a really big difference to my energy levels,

recovery from the gym, and some improvement in my joint inflammation.

So I retrained as a Zone Diet coach but kept up my working in

the design field at that time.

But later, I got a job at a CrossFit gym because being Zone, all about Zone and

all about paleo, which I'd never heard of.

So I thought, I've got to start investigating this paleo diet.

And that's really when I went down into the work that Robb Wolf was doing

because he was aligned with CrossFit.

Loren Cordain, started reading his papers.

Watched his series.

I don't know if people are familiar with it, but there's

a series of YouTube Videos.

I'm not sure if they're on YouTube anymore, but they're available online

somewhere for the Multiple Sclerosis Foundation, where he started talking

about removing certain foods like nightshades, gluten, dairy, in order to

reduce the symptoms of autoimmune issues.

So I was really taken with this, particularly because I had done a

graduate certificate in nutrition at that stage because it was

aligned with scientific principles.

So I immediately thought, "I'm just going to try this out." And within three weeks,

my joint inflammation just disappeared, so I was like, "This is amazing." And I

had a couple of ganglion cysts on my wrist which had been there for years, like 10

years, and that just kind of shrunk away.

So I thought, "Well, that's even more interesting."

And so I ranted and raved about this to my dad, who's a doctor, and,

my mum decided to try it as well.

And as part of her lupus, she had small airways disease, so she had

quite a lot of lung inflammation.

And so she went on the paleo diet, and she had significant improvement

from her lung inflammation within a short period of time.

So that really controlled that for most of the rest of her life, actually.

So that was, that was my story.

And then I became involved in the ancestral health community, and the

community here in New Zealand as well.

And through that community, I started hearing about people who,

with rheumatoid arthritis who had significant improvements in their, joint

inflammation or their symptoms as a result of a paleo-type, AIP-type diet.

And at that time, I was doing my post-grad diploma, very slowly, one paper at a

time with bringing up kids as well.

And, as my final project, I decided that it would be useful to start exploring

this, and doing some research in the area.

And that led to the qualitative study where I interviewed 10

people who had got improvements.

So getting improvements on a diet with anecdotal stories doesn't mean

it's going to work for everybody, and this is why we need clinical studies.

And I don't think a lot of people realize the importance of having a clinical

study where you take a group of people and see what the spectrum of results is.

You don't hear about all the positive experiences.

You also hear about maybe negative experiences or ones that, you

know, might just be, hmm, ho-hum.

So, that was my thinking at the time, and, um, eventually I got there with

my studying a master's research year, which I upgraded into a PhD. Yeah.

I love that

Yeah.

I love it.

I love it.

Thank you for sharing all that, and honestly, thank you for sharing

and writing on your blog, because I remember the time that I found

it, I was looking for stories of people who had done this themselves,

because I was in a similar boat.

One thing for our listeners, getting classified with a rheumatological

autoimmune condition is actually really challenging, and I mean,

if you have one, you know.

But you kinda have to have enough markers in a certain category in order

for them to say, "You have rheumatoid arthritis," or, "You have psoriatic

arthritis." I actually just got diagnosed with psoriatic arthritis after 15 years.

But early on, when I discovered your blog, I had determined from my own research

that I likely had a connective tissue autoimmune disease, which is actually how

I think I landed there, because you were writing about your own experience having

some of these markers of RA, and having lupus in your family, and really wanting

to intervene before things got to the point where you have full-blown disease.

Because we know that people with especially RA have this period

of, pre-diagnosis, where they have symptoms, but they're not classified,

and then they can't access treatment, and it's just really tricky.

So I'm just really grateful that you had the ability to write about it, and that

I heard about it from halfway across the world, and it really changed my life.

So thank you.

So you did your qualitative research, you know, for your graduate program.

You upgraded that to a PhD, and then you ended up just publishing the pilot

study using AIP for rheumatoid arthritis.

Talk us through that study, kind of how you designed it, what a pilot study is and

what that means, and what the participants actually did as that intervention.

Sure.

So a pilot study is really the start of a research program.

It's not the end in itself.

It's really a feasibility study.

So what you're wanting to find out is there an effect, first of

all, and how big is that effect?

How many people, what's the average rate of improvement, if

you like, if there is an effect?

You're also wanting to look at adverse effects, so asking people like, you know,

"Do you get any negative effects from your diet?" So you do the pilot study and

then once you've got all these parameters like how well did it work, if it worked,

were there negative effects, what was the effect size, all of those things, then

you've got the basis to do a larger study.

And it could be a really large study or it could be another kind of pilot

study where you have a slightly larger group and then you have a

control group or a comparative group.

So that's what we're thinking about next.

However, how did I design the pilot study?

So I wanted to gather as much information as possible without spending money

So basically when I started, it was, as I said, it was my master's research year,

which is the second year of a master's.

And the money was like, in the pot was about a thousand New Zealand

dollars, so there really wasn't enough money to even do biological markers.

So I looked at questionnaires that people could do online, 'cause at that

time we had just come out of our first COVID lockdown, and who knows if we were

going to go into another COVID lockdown.

So a lot of this needed to be information that could be gathered online.

So I decided on a couple of validated questionnaire measures that had been

compared to objective measures, say, that our rheumatologists would do,

like joint counts and, C-reactive protein, and they had strong validity

for being a good comparator to those.

So that was the RAPID3.

And then there was RA, Rheumatoid Arthritis Impact of Design, which very

few people have actually done in research.

However, it was designed to ask questions that really mattered to

people with rheumatoid arthritis, and that was how it was designed from--

by people with rheumatoid arthritis.

So that was their sleep quality, fatigue, quality of life, pain,

just things that really mattered.

So we had those measures.

I also wanted to understand how difficult it was, so e-each week we

had a question like, "How difficult was this diet to implement compared to

the normal diet?" And, "How expensive was it compared to your normal diet?"

The other one I wanted to do was an in-depth nutritional analysis, so I

collected three-day dietary records where people weighed and measured their food

for three days, two days like Thursday, Friday, and then one day a weekend.

And did that four times.

I also needed a comparative, so not just a single baseline, but I wanted

to measure their normal responses over the course of a few weeks.

So we decided on a four-week controlled, or habitual diet phase where they did

all the same measures that they were going to be doing for the next eight

weeks on the Autoimmune Protocol.

So I had a good comparator when we didn't have like a control group.

So that just gives a little bit more validity to the results when

you have this control period.

I love that.

And, and I thank you for explaining the validated questionnaires, 'cause

a lot of the problems in research are how do we compare this result

to other studies, other dietary studies, and, these questionnaires.

Every condition, you know, the listeners have heard me talk about, some of

the IBD research and the Hashimoto's research, really these disease-specific

questionnaires are used in other research.

So this isn't something that you're coming up with.

Of course, you have some questions that you're using to tease out

some information when for when you're writing up your paper.

But really, these are measures that are used in other studies that you

can kinda see, how that person's experience lines up with the clinical

markers without actually having to run labs, which I think is so smart.

Julianne, I didn't know what a budget you did this study on,

which that's really incredible.

Yeah.

Yeah.

It was literally-- yeah, I think I spent almost no money on doing

the study other than my time.

Yeah.

Yeah.

That's, that's incredible.

And I mean, it's so amazing how much you can learn from people by

using these types of questionnaires.

We did something similar with the Hashimoto's research, which similarly,

Hashimoto's doesn't need a lot of lab investigation in order to hone in on

the things that's important to patients.

So like you mentioned with RA patients, sleep and quality of life, it's very

similar with Hashimoto's, and those are the things that people actually care

about, not really their hormone levels.

I just love that you did that thoughtfully and inexpensively.

So let's talk about the intervention.

So they were their own controls, so there was a control phase and

then a diet implementation phase.

Talk to us about how long they implemented AIP for, and

then what your recommendations within that framework were.

Sure.

So the four weeks were the control period, and then I gave them a booklet

that I put together, so they had a one-hour, one-on-one session with me.

So there were nine people in the study.

And they started the study as soon as they enrolled, so people

weren't starting all at once.

They were staggered, which made it a little bit easier to manage.

And so we had a one-on-one, and I went through the principles, the idea

behind the Autoimmune Protocol, and gave them a booklet of information

that had a whole bunch of lists of all the New Zealand foods, yes and

no foods, resources to buy food.

Yeah, just everything I could-- that I thought would be useful for them to

implement the program in New Zealand without having to use overseas resources,

which are often very Americanized.

The food names are different.

You know, you have arugula, we have rocket.

So there's a whole bunch of different things, that have different names that

people go, "Oh, what's that food? Never heard of it." And also local resources

where you could buy like cassava flour and the arrowroot starch and things like that.

So literally overnight people put it into practice, so it was a

really big ask, and it was quite a mental load for people as well.

And there were a few disasters with meals.

Like people would try some kind of macar- macaron recipe and it

wouldn't work out, for example.

So yeah, there were things like that.

Um...

And, and were they expecting you to hold their hand through that?

That's, that's a lot.

not really.

People were-- I mean, the thing about... And, and this is one of the

limitations of a study like this.

Anybody that's going to sign up for this kind of study is

going to be highly motivated.

They're going to be resourceful.

They're going to have a supportive environment behind them.

Mm-hmm.

Yeah.

Yeah, that's a really good reminder.

Yeah, they may not be your average person on the

street with rheumatoid arthritis.

And how long did they do the elimination phase?

And we're talking about Core AIP.

Yeah.

So core I- or, uh, AIP, they did it strictly for eight weeks.

Okay.

Okay, great.

Yeah.

So that's kind of right in the middle of the general recommendation.

And so talking about the results, talk to us about some of the findings

and how that panned out, and if that was surprising to you in any way.

Yeah.

The RAPID3 is fairly standard and used quite regularly.

It's also used in rheumatological practices where they just want to

get immediate feedback from a person without having to do their joint count.

So the RAPID3 includes things like how easy is it for you to turn on and

off a tap or faucet, in your language.

How easy is it to walk three kilometers?

So there was a lot of getting in and out of a car, so it was like, can't do at

all, bit difficult, no problem at all.

So there was a spectrum of answers they could answer.

And there was about 10 or 14, I think, of those questions, everyday

living, and then one on pain.

So over the course of the eight weeks, I found that people's RAPID3 dropped,

seven, I think seven out of nine reached.

The final answer, and you just put all these into an algorithm, and it

comes out with a number out of 10.

So people ranged from kind of a one out of 10 right up to about six out of 10.

So there was quite a range of people when they started during their, control period.

And by the end of eight weeks, all except one, I think, had dropped down below one,

and the mean was 0.99 out of 10, from about ... I can't remember exactly, sorry.

About three out of 10.

So

Mm-hmm.

Most reached remission from either moderate-high or low

disease activity, and one person had very low disease activity the whole

way through, so that didn't change.

And one person got a little bit worse.

Okay.

Yeah, we'll talk about that, 'cause the adverse effects are a really important

part about learning th- about this, right?

the ... Yeah.

And then the RAID, the RA Impact of Disease, had questions that aren't

frequently asked in rheumatoid arthritis studies, and that was one reason

why I really wanted to include that.

And that is, how good was your sleep, on a, on a rating of zero to 10,

so 10 being really, really bad, and your fatigue on, again, zero to 10.

And we found both of those improved quite markedly, which is interesting

because particularly fatigue, so there are studies where they've

looked at, people's fatigue levels.

Even on the modern biological drugs, their fatigue levels haven't really improved

over time as medication has improved.

So that's something that consistently remains not great for people

with rheumatoid arthritis and is considered one of their unmet needs.

And interestingly, I didn't find a single study in probably nearly 80

intervention studies that have been done across the years that had assessed

sleep in rheumatoid arthritis in associated with a dietary intervention.

And we did find sleep improved.

So the other thing that I didn't mention was that at the end of the eight

weeks, I did a qualitative interview.

So every person was interviewed for around about an hour on a number

of different questions, like how difficult things were to put into

practice, barriers, facilitators, and what actually influenced the results.

So with regards to fatigue, for example, everybody said, "I can't believe

how much my energy levels improved.

So I just had so much energy.

I didn't have to have a nap in the afternoon.

You know, I just felt so good." And with regards to sleep, the ones that

really had dramatic improvement in sleep said that, "I wasn't waking up

all the time because my joints were achy and sore, and I had to turn over.

I didn't have all that pain interruption in my sleep." That was

the main thing that they said they thought influenced their sleep.

Okay.

Yeah, that, I mean, that's so amazing, I think, that you honed in both on

those more clinical markers, and then some of the under-assessed

areas like, fatigue and sleep.

That actually really stood out to me because I'm really interested

in the areas that are not studied when we have interventions for

various autoimmune conditions.

Hashimoto's is another condition that has been studied for AIP, and one of the

key features is all of the things that are not treated by the thyroid hormone,

which is the only standard treatment.

So with RA, it sounds like there are lots of tools in the toolbox,

biologics, that can, stop that joint damage and progression.

But it sounds like it's not always effective for things like fatigue and

sleep, and I mean, that really leads to an impaired quality of life for people, even

if they are conventionally well-managed and not damaging their joints.

It's hard to live when you're tired all the time, so, I love that you

included that measure in the study.

So let's talk a little bit about that one participant that worsened.

We saw this with the IBD study.

There were a couple strictures, and that really highlighted for the community

of people that do AIP that, for that population, there are some things that,

if you have some, anatomical changes, you definitely have to be careful

when implementing a high-fiber diet.

Do you have anything to say about, that one person that got worse?

Any thoughts on that?

Yeah.

So in, in terms of adverse effects, there was the one person that got

worse, and then there was another person whose markers didn't get worse.

As I said, they stayed around zero to one the whole time, but they

developed diarrhea from week five.

And this was a male who had a very- active job, lifting heavy things in

and out, driving a huge truck all day.

So the first woman, she just lost her appetite.

She said, "I just didn't feel like eating. I had no appetite." And

she got more and more fatigued.

Her oldest daughter, she was an older woman, around the age of 60, and her

oldest daughter actually did it with her, who didn't have any autoimmune

issues, but she supported her.

And the daughter had no problems at all.

Like didn't have, didn't lose weight, didn't lose her appetite.

They were eating the same meals, you know, but she just said, "Look, you could put a

piece of the most delicious thing in front of me, and I would just turn my nose up at

it." One thing that I did discover, and I didn't find this out until the interview,

was she said, "I have a sensitivity to sulfites." And I looked, and she was

eating a lot of, like using cassava flour and making like, I don't know, p- uh, just

Breads and tort-- Yeah, yeah, yeah.

And there is some indication that they might have trace

levels of sulfites in them because of the way they're processed and

also because cassava is it can have kind of a natural sulfite in them.

So that's one possibility.

So I would say, as a result of that, be very careful about assessing people

for any sensitivities if they're going into, the Autoimmune Protocol.

You know, whether it's histamines or oxalates or sulfites or anything that

the AIP diet might increase just because of the foods that you're cutting out

and the foods that you're adding in.

And be careful about adding in novel foods, that is foods that

they've never eaten before.

So cassava was things that nobody had eaten previously.

Nobody else had a problem on them.

So that was one possibility.

The other one is she actually had a pretty good diet prior to the AIP.

So she would have what are steel-cut oats for breakfast every morning, for example.

And they've got beta-glucan, which is a really good

prebiotic for your gut bacteria.

So there are foods that she might have cut out that were actually beneficial for

mm-hmm, mm-hmm.

her.

Um, so there was that side, and it could have been just a natural progression.

She was having difficulty controlling her rheumatoid arthritis, and over

the year following, it continued to get worse, even changing her diet

back to sort of a one that worked, she found worked better for her.

Great.

Well, thank you for that discussion, and I think, the health coach in us

wants to figure out, what was different?

What was new?

I've had so many people try AIP and either discover a histamine intolerance

because they never ate fermented foods, or discover like a coconut or a cassava

is actually a pretty common sensitivity in, within the AIP community, because

again, we don't really eat it until we do this, and we're, maybe over-relying

on it, depending on who it is.

So I think that's a good warning for people just to, if there's somebody that

gets worse, most people don't get worse.

So if you do, it's a clue to, to maybe not just keep going and

feeling worse for a certain amount of time, and try to investigate.

Because, my experience is most people, not everyone, but most people start

to feel measurable improvements as they go through time, you know?

Yeah.

I think it's worth mentioning too that there is a transition

period for some people.

So I noticed one of the people, if you look at the paper, her, I think her

rapid three actually went up a little bit before it dropped back, back down.

So there's that transition where people can get gut symptoms because

of the change in fiber, fatigue, you know, carbohydrate, sweet cravings.

You can get headachey.

Some of your things might flare up a little bit and get worse as you're

releasing sort of maybe arachidonic acid from your cell membranes that

build inflammatory eicosanoid hormones.

There's reasons for possible reasons, or it's just the transition, your body

getting used to something different.

And on that note, there was a guy who, as I said found it difficult to eat enough

to maintain his weight with his-- 'cause he's male, heavier, very active because

of his job, and then ended up getting diarrhea, and he was sitting in a truck.

He was snacking on fruit all the time.

Yeah.

So his fruit intake went hugely up.

His vegetable intake went up.

His fiber literally tripled.

So it could have been that increase in fiber, and he's-- he also said

he just didn't feel satisfied.

He was used to having five eggs and a can of baked beans for breakfast

okay.

just to give you a sense of how much he ate.

Yeah.

Yeah.

Yeah.

He sounds like he would be ideal for Modified AIP in today's protocol.

Give him some white rice and let's go.

Yeah.

Yeah.

Okay.

Well, well great.

Thank you for discussing that.

And before we move on to some of the next studies on the docket, I loved

the nuance that you just talked about dietary quality and that you assessed

that diet before and then the diet during the intervention, and you reported that

people were eating more vegetables, seafood, fiber, and fewer refined foods.

And I know that you have another paper coming at some point breaking down all

of this, but I would love to just hear your thoughts on maybe teasing out how

much of this effect could maybe be from eliminations versus dietary improvement,

if you have any thoughts either way.

I wish we had a definitive answer.

I honestly do.

There's very few studies.

I think I only found two studies that were looked at that aspect.

So yeah, we improve dietary quality.

So when you increase fruits and vegetables, there's evidence showing

that increasing potassium through natural sources reduces inflammation.

Increasing seafood reduces inflammation.

Polyphenols and fiber feed your gut bacteria and then you have a lot of

anti-inflammatory me- metabolites in your body that can improve your diet.

Reducing white, refined carbs, particularly cereal grains like wheat,

which is super interesting 'cause the standard New Zealand diet when

you do an analysis of it, and this is from looking at thousands of people,

30% of the diet comes from wheat.

Wow.

And I found in my group that they had the standard kind of

amount of food from wheat and only one of those six servings was whole grain.

The rest was white flour, and that was a very typical New Zealand diet.

And then of course, added sugars.

So you're getting a whole lot of highly refined starch and sugars,

which will feed your bad gut bacteria.

So is it the gluten or is it the stuff that's feeding the bad

pathobiont gut bacteria or is it the anti-inflammatory components?

It's... Yeah.

So there is that.

However, the other study which you know I've done is, looking at elimination

reintroduction diets and rheumatoid arthritis across the years, and there

is evidence- That suggests that at least 30% of people seem to have some

kinds of sensitivities that have been clarified through clinical studies.

Okay.

I haven't heard that yet, and that's actually really important information

because I think when people learn about something like the Autoimmune Protocol,

they wonder what, where the effect is.

You've done this review, so part of this work, now we're transitioning to,

from talking about the pilot trial to this scoping review, where basically

Juliane went and she looked at all of the literature about dietary interventions

in rheumatoid arthritis spanning decades of research, and reviewing

it, and then writing a paper basically summarizing kind of all of those findings.

So talk to us about what stood out from you about reviewing all of that

literature and what that process was like.

Mm. Hugely time-consuming is all I can say.

A labor of love.

A scoping review is kind of cool because it-- you can take all kinds of studies.

So you can take case studies, you can look at, PhD theses, kind of anything that's

kind of online that gives a good picture.

It doesn't have to be like in a peer review journal as such.

So... But it has to be a decent quality study to a certain extent.

So you can look at, yeah, case studies in particular and small

studies, pilot studies, all kinds.

So I went back and I found a whole lot of research, and then I actually looked

through all the references as well of some older papers because some of those

just don't show up, like in Google Scholar or, on the standard searches.

So found a lot of quirky little studies, case studies, that were kind

of interesting, but they all had this similar aspect where they had eliminated

food in some way and then tested it, as a reintroduction or as a food challenge.

So yeah, I looked at... I ended up finding quite a few studies

in the end and case studies.

And at the range of success in those was really variable.

Sometimes you would get 100% of people responding to an

elimination reintroduction, and some studies said, like 5%.

So

the consensus seems to be around 30%.

One of the studies I found particularly interesting was the work by Gail

Darlington, who is a researcher in the UK.

I think she's still around.

She'd be fairly elderly by now, I think.

But she wrote an entire book on her elimination reintroduction studies.

And she started off with a really interesting start.

So one of her young patients with, junior arthritis, rheumatoid arthritis,

had been quite crippled by this.

And then the next time she saw her, this kid was running into the

surgery with literally no pain.

So she was fascinated by why is this girl so well?

And then she found out this child had done a particular

elimination reintroduction diet.

And so I went and found this particular booklet, which was done

by the Allergy Society of the UK.

Yeah, I can send you a PDF.

It's quite fascinating.

I would love that.

Way back in like the 1980s, I think.

So this girl came in, bouncing around, and this started, Dr. Darlington off

on a ser- doing a series of studies.

So she used this particular elimination reintroduction protocol with a number

of clients, and she did studies, a whole range of studies, over a

period of time, and she continued to follow through with these patients.

And the numbers were, I think, into the hundreds.

And she found that something like 30% of people were able to maintain

low disease activity over the years, sometimes up to, I think the last

time she wrote about it was in 2004.

So it was about 17 years some of these people have been following a

diet that eliminated certain foods.

Wow.

Hmm.

Wow.

Wow.

That is so interesting.

Yeah, and that sounds like that goes in the way back, so you're unearthing

history, doing, interlibrary loans.

I had to do some of that for my master's, where you read a reference and you're

like, "Uh-oh, this is old. We don't have it in the digital library."

And so my librarian's writing a letter to another librarian and trying to

get me a photocopy of a manuscript.

So, um,

Exactly.

And some of the pages are like, you know, a little

Ha-

and old and yeah.

yeah.

Well, I love that.

I love that you did that research project and brought that into the modern approach

so that we can consolidate what's known, and then move on to the future

with that information and build on it.

That's what research is all about.

Talk to us a little bit about some of the most common trigger foods that you

saw appearing the most often in some of these historical elimination protocols.

Mm. Not all of the studies, but a percentage of the

studies actually listed how many people reacted to certain foods

and what foods they reacted to.

So in the studies that were kind of carefully detailed those foods, I put

everything into a big Excel sheet as you do, and just looked at all the different

foods that people had measured, and the numbers of people and the times, basically

did a collation of all of those studies.

And a lot of them were case studies as well, because they tend to be

very specific in identifying foods.

Yeah, so what was interesting is with rheumatoid arthritis, a lot of them

were common to Autoimmune Protocol.

So we found the cereal grains were common, and the two common cereal

grains, and this is what surprised me, was not just wheat but corn.

So corn, corn tortillas, maize-type corn was really common.

Then we had eggs.

Dairy was another big one.

And if you looked at the fruits and vegetables in particular,

citrus came up fairly high.

I don't know whether that's something that it's-- 'cause you don't know how much

of this is a belief or actually measured because some of the studies were like,

"Oh yeah, I ate that food and I reacted."

And then there was one particular clinical study where they had, done big

surveys of people, and they'd found, I think five or six people that said,

"Yeah, I definitely react to these foods." So they brought them into the

hospital, they gave them these foods, and they had no measurable reaction.

So

is it they just thought they did, or was it because it's

combined with some other food?

It's-- So it's not like definitive because some of it is subjective.

But there was also, a little increase around tomatoes and potatoes.

Pips.

Sometimes it was just pips, which is just a word for nuts and seeds, and

Oh, okay.

I'm like

of... Yeah.

So that was a little bit of a blip there.

The other big two that surprised me, mm, sort of surprised

me, but was beef and pork.

Okay, I was going to say, I think I know where you're going here.

Yeah.

So those are commonly eaten Autoimmune Protocol foods, and I've actually had,

anecdotally clients who have said, "I-" Beef, pork don't work for me.

And if people are on the Autoimmune Protocol, you want to go, "Okay,

well, what might be going on here?"

Mm-hmm.

I now when I'm working with people with rheumatoid arthritis, I

tell them, "Look, this is a sensitivity that comes up often. It's not recommended

to remove it on the Autoimmune Protocol, but you may want to be aware that

could be something you react to."

Mm-hmm.

Mm-hmm.

Yeah, the people that I've encountered usually, um, either, A, they, have a

history with those foods and have already determined, these are inflammatory

for me, or B, they have spent time in a community that villainizes those

foods because of, the saturated fat or cultural beliefs, but they don't have

experience that they're bad for them.

So, depending on the person, I coach them a different way.

But yeah, there definitely can be real sensitivities for some people, so I'm glad

you brought that up and that's documented.

And interesting to hear about the nightshades.

I really haven't come across very much research in my investigating

about nightshades, and they're not usually a category.

Sometimes, like you mentioned, tomatoes and potatoes, they're kind

of broken out into, a specific food.

That's an interesting one for the autoimmune community.

Yeah, there is-- there was no nightshade

category in any of those studies.

One that particularly stood out was, a case study where, which

is more, more recent, I think it was 2010, where nightshades

was a big inflammatory response.

So yeah, I had a look at-- I think I did a blog post about nightshades, because

they're-- interestingly, there are no clinical studies testing nightshades

in people with autoimmune disease.

Zero.

But

Uh-huh.

yeah.

But you talk to people in the autoimmune community, and everybody

wants to talk about how they affect them, so we gotta research this, right?

Yeah.

Well, there's an interesting, the no-nightshade diet that was written,

oof, a long time ago, might have been the '60s, by a guy who was a plant scientist,

and that's an interesting story in itself, how he ended up coming across

nightshades and, curing his-- cutting them out, curing his own arthritis.

And then he s- he decided to, get his secretaries to send out, notices to like-

letters to people saying, "If you've got arthritis, do you want to try this

no-nightshade diet?" Had his book and he had a little postcard that people

sent back and said, "Yeah, I tried this no-nightshade diet and it helped my

arthritis." So it was like an informal study done right at the beginning.

I mean, but that's amazing.

That's what happens when you have autoimmune disease, nobody knows how to

help you, and you find something that works, and you try to get the word out.

It sounds like he was just trying to influence the arthritis community back in

the day with letters, which is amazing.

Yeah.

really cool.

I don't want to take up too much of your time, Julianne.

This has been such an amazing conversation.

I do want to spend a couple minutes just talking about what's coming next

because this pilot study, you guys, I'm going to link it in the show notes.

I would encourage you to give it a read.

There's so much information there.

But Julianne is actually working on several more papers

prepared from the same dataset.

Can you talk to us a little bit about what's coming and

kinda what you're working on?

Yep.

One of the studies, was, as I said, the-- it's the-- I took, three-day diet

diaries, twice during the four weeks.

Well, at the beginning of the four weeks, at the end of the four weeks, and then

twice week 4 and week 8 of the AIP diet.

, Then I analyzed their differences between their diet before and after.

So as I said already, the fruit and veggies and the fish and the

seafood and the omega-3 improved.

Potassium and vitamin C went up hugely.

A lot of the others stayed relatively the same.

ALA, alpha-linoleic acid and linolenic acid, which is the omega-6 and the

plant omega-3 both dropped significantly because there are just a very few

sources of that on the AIP diet.

Which probably isn't a big issue as long as you're getting the long-chain version.

The other thing that I think is worth considering and paying attention

to is that both iodine and calcium dropped quite precipitously.

Calcium because people cut out dairy and they didn't replace it with anything.

The only way really to get it is some of the greens and the fish

in cans with the soft bones.

So I would be really careful about

Mm-hmm.

Monitoring people's calcium level

Mm-hmm.

iodine as well.

So they may have got more iodine depending on whether they used iodized salt or not.

Mm.

And it did depend a little bit on did they add some seaweed.

Some people did, some people didn't.

So it- In New Zealand we have very, very low iodine in the

soil, so that is problematic.

Yep.

So that was something I would ask people to monitor is the nutrient content

when they're changing their diet and they're cutting out a lot of foods.

So that was the main thing from the dietary analysis.

The other one I did was the interviews, so qualitative interviews at the end.

I think what came out of that is probably all the standard stuff that people say.

Like food preparation time increases astronomically.

Support is really important and makes a huge difference.

So people had their spouses, their adult children, or someone else in their life

that they could connect with who were doing it with them or supporting them.

It made a really big difference.

Eating out wasn't so much a problem because soon after we started,

we went into another lockdown

Yeah.

like going, "What am I going to eat at this cafe? There's

nothing I can eat. What am I going to do with my colleagues and friends?"

You know, like that was a real dilemma for people.

And it's like, oh, we're into lockdown, so it didn't matter anymore.

Or we just had backyard, yard barbecues with our neighbors, and

I just brought my own food and my, you know, soda water and stuff.

So that was the qualitative.

And then the other one I did was a one-year follow-up on everybody.

So

I'm excited about that.

I'm

yeah.

So that was, again, and this isn't published yet, so yeah.

I did their Rapid 3 and their RAID, and everybody's, except for that one

person who was getting worse, got even worse over the course of the year.

But most people stayed right down within very close to the

remission levels that they'd had.

After a year?

a- after a year, yeah.

And they did the reintroduction by themselves.

So I gave them all the outline how to do it, walked them through it.

It was coming up close to Christmas which made it really difficult.

So one person just went, "Blow it. I'll just eat all the crap again," and felt

terrible for it, but kept doing it anyway.

The others just mostly just reintroduced foods they really wanted.

So I said, there's options here.

You can just go through this protocol and way of doing it that

is outlined, or you can introduce the foods that you most want to eat.

So of course eggs was there for everybody, and nobody had a reaction to eggs.

Yeah.

So everybody happily started eating eggs again.

People introduced dairy, but not so much joint symptoms,

but gut symptoms interestingly.

A couple of people only used goat dairy, like goat cheeses instead

and found that not a problem.

Nuts and seeds weren't really a problem.

Nightshades, yes, potatoes.

Two or three people said potatoes, and then they went out and had like a

chili meal at a restaurant, and they woke up the next day with more pain.

So two people had said that.

So yeah, nightshades does seem to be there.

It is a little bit tricky though because everybody was on, methotrexate

or biologics or a combination.

So that does tend to dampen your immune response.

So... In a lot of the older studies that I looked at in my scoping review,

they actually took people off all their medication before they did the study.

So that was very clear what people reacted to if they were to react.

Sad for them though, because I mean, RA, the consequences of not managing

that inflammation can be permanent.

I think the way that you did it is a lot kinder to your participants.

off.

That would be unethical to take

Yeah.

I agree.

I agree.

Yeah.

Yeah, 'cause the joint damage you see in, in the

pre-biologics is just... I mean, yeah, my mother-in-law had rheumatoid arthritis, so

Mm-hmm.

You know, she had all those classic deformities.

And it's pretty horrendous compared to what people get now, which is

minimal if they're managed well.

Mm-hmm.

Mm-hmm.

So yeah, that was, that was quite exciting for the one year.

They did mention in their, interview so that their energy levels were less.

But is that because of the diet or is it because that we were out of lockdown,

they were going about their normal lives and a lot busier than they were before?

So there's, there's so many other factors that can influence,

Mm-hmm.

your fatigue and your results other than diet as we know.

Absolutely.

And it's hard to manage all those confounders.

So you just have to say, "Look, this is a limitation."

Mm-hmm.

Well, thank you so much, Julianne.

This research that you've done is really thoughtful.

I know the community is really supported just by having this information, and it

sounds like you're kinda just getting started and hopefully on to more

research, and I just can't wait for these publications that you have coming.

My final question for you before we go is just what do you hope clinicians,

researchers, and patients take away from where the research is at this stage?

I think the research is fairly clear, and this has come

out in another couple of studies as well, one I'm following called ITIS.

I don't know if you're familiar with the ITIS and the Mediterranean

diet study, which is not dissimilar to Autoimmune Protocol, except

they cut out red meat as well.

I'd say definitely the research around diet and rheumatoid arthritis

is evolving in the right direction.

So we're now seeing, anti-inflammatory patterns of diet with some exclusions

might be the best way to go clinically proven best way to go going

forward, which I think is exciting.

And I think people that are working with people with rheumatoid arthritis, seeing

these studies, clinical studies and peer-reviewed journals of good quality,

I think that really makes a difference.

You know, like I've heard recently, a colleague of mine who has psoriatic

arthritis, her rheumatologist told her to do the AIP diet, and I had no idea.

I don't even know who this rheumatologist is.

So things like that are exciting to hear because until there are

clinical studies, it's just seen as a fad, really, to be honest.

Yeah.

Which is why I wanted to do it.

Oh Oh, we're so grateful for you, Julianne.

Thank you so much for joining me today, for all this work that you're doing.

I think it's really meaningful that you've helped pave the way, bring some of these

longstanding patient experiences, and then transition that into formal research, and

be really honest about the limitations, kinda the variability and responses, and

a lot of the questions that still remain.

I'm really excited about learning more about some of these questions,

and how we can help people in a more specific and nuanced way.

And I'm personally really excited.

This isn't the end of the story, and there are more papers in the pipe for us.

So I'm just definitely going to keep everybody updated as

these studies are released.

For listeners who want to follow your work, learn more about your research, or

connect with you and watch some of your world championship PRs on Instagram,

where's the best place they could do that?

'Cause actually that's one of my favorite things that you share is actually some

of your strength training work, too.

It's so inspiring . So where can, where can people find you?

I guess I'm most active on Instagram.

Like, yeah.

And everything's sort of like I've just got a grant proposal

in for further research.

So everything's a little bit quieter now, so I'm hoping to post a bit more,

Awesome.

Study results and talking about other research.

And I'll be doing that on Instagram.

Also do it-- I've got a couple of blogs.

So my old one is Paleo Zone Nutrition, it's a fairly old blog now, but

it's interesting just to see how things transition over time on that.

And just my nutritionist one, which is juliannetaylornutrition.com.

I will link to all of that in the show notes, and I'll also

say one of the things that I like that you do on Instagram is you're

a good curator of kinda what's going on, re-sharing, interesting

topics in the nutrition community.

So if anybody listening is a nutrition nerd, Julianne's also a good person to

follow for that, 'cause she's got some good taste, and people to follow, and

things that are going on in the community.

You can follow her for that.

Thanks again so much for being here.

Thank you to everybody for listening to the Autoimmune Wellness Podcast.

We will see you guys again next time.

Cool.

Thank you.

Cool.

Thank you so much.