AIP vs Mediterranean Diet (and 9 Other Diets) Compared

AIP vs Mediterranean diet comes down to one trade: the Autoimmune Protocol removes eight food groups to find personal triggers, while the Mediterranean diet keeps nearly everything and adds fish, olive oil, legumes and vegetables. The Mediterranean diet has randomized trials in psoriasis (MEDIPSO, 2025), Crohn's disease (DINE-CD, 2021) and rheumatoid arthritis (Sköldstam, 2003). AIP has two small uncontrolled pilots, one in IBD (Konijeti, 2017) and one in Hashimoto's (Abbott, 2019), with large symptom improvements. The best-supported sequence for most people is a Mediterranean base, with AIP used as a time-limited elimination when symptoms persist.

This page goes pair by pair. For each matchup you get what each diet removes, the autoimmune trial evidence, difficulty, nutrient risk and who it suits. If you want the overview of all seven major autoimmune diets in one matrix first, read the autoimmune diet comparison. If you have already decided on AIP, the AIP diet for Hashimoto's guide and the AIP meal plan cover the practical side.

Why AIP Is the Reference Point

AIP is the most restrictive diet that still has clinical data in autoimmune disease. That makes it a useful yardstick: every other diet can be described by what it keeps that AIP removes.

The AIP elimination phase removes grains, legumes, dairy, eggs, nuts and seeds, nightshade vegetables (tomato, potato, pepper, eggplant), coffee, chocolate, alcohol, added sugar, seed oils and food additives. It keeps meat, fish, organ meats, vegetables, fruit, tubers, olive and coconut oil, and fermented vegetables. After 30 to 90 days, foods return one at a time.

The theory is that some of these foods increase intestinal permeability or provoke immune reactions in susceptible people. Work from Alessio Fasano's group showed that gliadin from wheat triggers zonulin release and opens tight junctions in intestinal tissue (Drago et al. 2006). That offers a plausible route for gluten to drive inflammation beyond the gut. Evidence for the other excluded groups is weaker and mostly mechanistic.

The AIP Evidence, Read Honestly: Grade B

Two studies carry the AIP evidence base:

• Konijeti et al. 2017 (Inflammatory Bowel Diseases): 15 adults with active Crohn's or ulcerative colitis followed a 6-week elimination and 5-week maintenance phase. Clinical remission was reached by 11 of 15 (73%) at week 6. Fecal calprotectin fell from 471 to 112 on average, though that change missed statistical significance (P = 0.12), and CRP did not change.
• Abbott et al. 2019 (Cureus): 16 women with Hashimoto's completed a 10-week online AIP coaching program. Symptom burden on the Medical Symptoms Questionnaire dropped from 92 to 29, a 68% reduction, and hs-CRP fell 29%. TSH, free T3, free T4 and thyroid antibodies did not change.

Both studies were small, uncontrolled and short. A 2023 Polish study of 28 Hashimoto's patients on AIP for 12 weeks (Ihnatowicz et al.) reported fewer symptoms, but TPO antibodies rose rather than fell. AIP improves how people feel. It has not been shown to switch off the autoimmune process.

AIP vs Mediterranean Diet

The Mediterranean diet is built on vegetables, fruit, legumes, whole grains, nuts, olive oil and fish, with modest dairy and little red or processed meat. It removes almost nothing outright.

Mediterranean Evidence in Autoimmune Disease: Grade B

Unlike AIP, the Mediterranean diet has been tested in randomized controlled trials across several autoimmune conditions:

• Psoriasis. MEDIPSO (Perez-Bootello et al., JAMA Dermatology 2025) randomized 38 adults with mild to moderate psoriasis to a 16-week dietitian-guided Mediterranean diet with extra virgin olive oil, or standard low-fat advice. PASI fell by 3.4 points in the Mediterranean group and did not move in controls. Nine of 19 (47%) reached PASI 75, compared with none of the controls.
• Crohn's disease. DINE-CD (Lewis et al., Gastroenterology 2021) randomized 194 adults with mild to moderate Crohn's to the Mediterranean diet or the Specific Carbohydrate Diet. Symptomatic remission at week 6 was 43.5% on Mediterranean and 46.5% on SCD, not a meaningful difference. The authors concluded the Mediterranean diet may be preferred because it is easier to follow.
• Rheumatoid arthritis. Sköldstam et al. (Annals of the Rheumatic Diseases 2003) randomized 51 patients with active RA to a Cretan-style Mediterranean diet or their usual Western diet for 12 weeks. DAS28 fell by 0.56 in the Mediterranean group, with gains in physical function and vitality. The control group did not change.

These are modest trials, and none tested remission off medication. Each, though, had a control group, which the AIP studies lack.

Head to Head

The two are less opposed than they look. Both cut ultra-processed food and sugar, both raise vegetable and omega-3 intake, and both favor olive oil. The real disagreement is over legumes, whole grains, nuts and dairy, which AIP removes and the Mediterranean diet treats as staples.

AIP vs Anti-Inflammatory Diet

"Anti-inflammatory diet" has no single definition. In research it usually means a Mediterranean-like pattern with extra emphasis on oily fish, berries, legumes, whole grains and probiotic foods.

The best-designed example is ADIRA (Vadell et al., American Journal of Clinical Nutrition 2020), a crossover trial in 50 Swedish patients with RA. Participants ate an anti-inflammatory diet or a typical Swedish diet for 10 weeks each, with about half their food delivered to their homes. In the main statistical model, DAS28 did not differ significantly between periods (P = 0.116). Among the 44 who completed both periods, DAS28 was lower after the anti-inflammatory diet (median 3.05 vs 3.27, P = 0.04).

Grade: B for RA. The effect was small, and the primary analysis was negative. That honesty matters when comparing it to AIP, whose larger effects came from studies with no comparison group at all.

The practical difference: an anti-inflammatory diet asks you to add foods, while AIP asks you to remove them. Adding is easier to sustain. Removing is better at revealing a specific trigger. For RA specifically, see our rheumatoid arthritis diet guide.

AIP vs Paleo

AIP grew out of paleo. Paleo removes grains, legumes, dairy, refined sugar, seed oils and processed food. AIP removes all of that, plus eggs, nuts, seeds, nightshades, coffee and chocolate, and it adds a planned reintroduction.

There are no trials of standard paleo in autoimmune disease. The closest is the Wahls Protocol, a modified paleo diet tested in multiple sclerosis. In the WAVES trial (Wahls et al. 2021), 87 people with relapsing-remitting MS were randomized to the Wahls diet or the low-saturated-fat Swank diet. Both groups had clinically meaningful drops in fatigue at 12 weeks. Mental quality of life improved only on Wahls. There was no usual-diet control group.

Grade: C for paleo in autoimmune disease generally; the WAVES data apply to MS. In practice, paleo is where many people settle after AIP reintroductions, because eggs, nuts and seeds come back easily for most.

AIP vs Keto

Keto and AIP target different things. Keto restricts carbohydrate to shift the body into burning fat and producing ketones. AIP restricts food groups on an immune-trigger hypothesis and does not control carbohydrate amount; sweet potatoes, plantains and fruit are allowed.

The strongest autoimmune data for keto come from MS. Brenton et al. (Journal of Neurology, Neurosurgery and Psychiatry 2022) enrolled 65 adults with relapsing MS on a 6-month ketogenic diet. Adherence was 83%. Fatigue and depression scores fell by nearly half, and disability scores improved modestly. The study had no control group.

Grade: C. Keto also carries specific risks for autoimmune patients:

• Low-carbohydrate intake can lower T3, a concern if you have Hashimoto's and already struggle with conversion.
• Fiber drops sharply, which can starve the gut bacteria that produce butyrate.
• LDL cholesterol rises substantially in some people, which matters because RA and lupus already raise cardiovascular risk.

Stacking keto on AIP leaves very little to eat. If you want to test keto for a neurological condition, do it as a separate, supervised experiment.

AIP vs Specific Carbohydrate Diet (SCD)

SCD was designed for gut disease. It removes grains, starches, most sugars except honey, and lactose-containing dairy. Unlike AIP, it allows eggs, nuts, aged cheeses and 24-hour homemade yogurt.

SCD is the only restrictive diet tested head to head in a large IBD trial, and it did not win. In DINE-CD, SCD matched the Mediterranean diet for symptomatic remission (46.5% vs 43.5%), fecal calprotectin response and CRP response. In PRODUCE (Kaplan et al., American Journal of Gastroenterology 2022), 54 children and teenagers (ages 7 to 18) with active IBD entered N-of-1 crossover trials comparing SCD with a modified SCD, against their usual diet as baseline. Only 21 completed the full trial and 24 withdrew. Neither diet consistently improved symptoms or inflammation, though some individuals may have benefited.

Grade: B for IBD, with the caveat that it has not beaten a simpler diet. AIP has no head-to-head IBD trial at all. For Crohn's and colitis, the data point toward starting with a Mediterranean pattern and reserving SCD or AIP for people who do not respond. Our Crohn's supplements guide covers the nutrient gaps these diets can create.

AIP vs Low FODMAP

Low FODMAP removes fermentable carbohydrates: onion, garlic, wheat, many legumes, apples, pears, stone fruit, lactose and sugar alcohols. It was developed for irritable bowel syndrome, not autoimmunity.

That distinction shows up in the data. Cox et al. (Gastroenterology 2020) randomized 52 people with quiescent Crohn's or ulcerative colitis who still had IBS-type symptoms. After 4 weeks, 52% on low FODMAP reported adequate symptom relief, compared with 16% on a control diet. Inflammatory markers did not change, and beneficial bacteria such as Faecalibacterium prausnitzii and Bifidobacterium species fell.

Grade: B for gut symptoms in IBS-overlap; no evidence it changes autoimmune activity.

Low FODMAP and AIP overlap on wheat and legumes but split on onion and garlic (allowed on AIP, removed on low FODMAP) and on eggs and nuts (the reverse). Running both at once is difficult and best done with a dietitian. Use low FODMAP when bloating and urgency persist after your inflammation is under control. Keep it short, because the microbiome changes are the wrong direction for long-term gut barrier health.

AIP vs Carnivore

Carnivore removes every plant food. It is simpler to follow than AIP on paper and far harder to justify on the evidence.

A 2026 scoping review in Nutrients (Lietz et al.) found only nine human studies of the carnivore diet, all small, short and without control groups. It flagged risks of vitamin C, vitamin D, calcium, magnesium, iodine and fiber deficiency, and higher LDL and total cholesterol. The authors concluded that long-term adherence cannot be recommended. There are no autoimmune-specific trials.

Grade: C. AIP keeps the vegetables, fruit and tubers that supply fiber and polyphenols, the raw material for short-chain fatty acids that support the gut lining. Removing them runs against most of what is known about the gut-immune axis. Our carnivore diet for autoimmune disease article covers the anecdotal claims in more detail.

AIP vs Whole30

Whole30 removes grains, legumes, dairy, added sugar, alcohol and additives for 30 days, then reintroduces them. It keeps eggs, nuts, seeds, nightshades and coffee.

There are no published trials of Whole30 in autoimmune disease. Grade: C. Its value is practical: it is a gentler elimination with a firm end date and a large recipe ecosystem. For someone who finds AIP overwhelming, 30 days of Whole30 followed by careful reintroduction is a sensible first test. If symptoms improve partially, a full AIP elimination can follow.

AIP vs DASH

DASH (Dietary Approaches to Stop Hypertension) cuts sodium, sweets, sugary drinks and red meat while emphasizing vegetables, fruit, whole grains and low-fat dairy. It was built and tested for blood pressure. We found no trials of DASH in autoimmune disease.

Grade: C for autoimmune outcomes. DASH still has a place. People on long-term corticosteroids, people with lupus kidney involvement and anyone with high blood pressure benefit from its sodium limits. It is a cardiovascular diet, not an elimination tool, and it pairs naturally with a Mediterranean pattern. For lupus specifically, see the lupus diet guide.

Intermittent Fasting vs AIP Diet

Intermittent fasting is not a rival to AIP. It sets when you eat; AIP sets what you eat. The two can be combined.

The most cited autoimmune fasting trial is old but well designed. Kjeldsen-Kragh et al. (Lancet 1991) randomized 53 people with RA to a 7 to 10 day subtotal fast followed by a gluten-free vegan diet and then a lactovegetarian diet, or to an ordinary diet. Tender joints, swollen joints, morning stiffness, ESR and CRP improved in the diet group, and the benefits held at one year. This tested an extended fast plus diet change, not daily 16:8 eating, and there are still no autoimmune RCTs of daily time-restricted eating.

Grade: C for daily intermittent fasting in autoimmune disease. Our intermittent fasting for autoimmune disease guide covers protocols by condition, and the fasting mimicking diet guide covers the 5-day cycles with more immune data.

If you combine them, start gently. AIP already lowers calorie intake for many people, and a 12 to 14 hour overnight fast is enough to begin. Fasting is unsafe without medical supervision if you take insulin or sulfonylureas, are pregnant, are underweight or have a history of disordered eating.

Nutrient Risks Across the Restrictive Diets

Every elimination diet trades breadth for information. The more you remove, the more you have to replace.

In the Konijeti AIP study, investigators started vitamin D repletion in 3 and iron repletion in 6 of 15 participants. People with IBD start these diets with deficiencies already in place. Ask for baseline labs before you begin.

Which Diet Should You Start With?

Most people do not need to pick one diet forever. They need a sequence. The evidence above supports this order:

1. If you have celiac disease, a strict gluten-free diet comes first. It is treatment, not a trial. See the celiac-thyroid connection if you also have Hashimoto's.
2. If you eat mostly processed food, switch to a Mediterranean pattern for 8 to 12 weeks. This step has the most randomized support and is easy to sustain.
3. If you already eat well and still flare, run a time-limited AIP elimination for 30 to 90 days, then reintroduce one food every 5 to 7 days. Our AIP reintroduction guide walks through the phases.
4. If gut symptoms persist with inflammation controlled, add a short low FODMAP trial with a dietitian.
5. Maintain on a Mediterranean pattern minus the specific foods that failed reintroduction.

Best Diet by Condition

For psoriasis, our psoriasis diet guide covers MEDIPSO and the supplement evidence in more depth. For gluten's role outside the gut, see gluten and joint inflammation.

Safety: When to Talk to Your Doctor First

Diet changes are low risk for most people, but elimination diets are not risk-free. Talk to your doctor or a registered dietitian before starting AIP, SCD, keto, low FODMAP or carnivore if any of these apply:

• You have active IBD, unintended weight loss or a BMI under 18.5.
• You are pregnant, breastfeeding or planning pregnancy.
• You have a current or past eating disorder. Restrictive diets can trigger relapse or avoidant/restrictive food intake disorder.
• You take insulin, sulfonylureas or other glucose-lowering drugs and plan to cut carbohydrate or fast.
• You take levothyroxine. Large changes in fiber, coffee or soy intake can shift absorption, so recheck TSH 6 to 8 weeks after a major diet change.
• You take warfarin. Big swings in leafy green intake change vitamin K and INR.

Never stop or reduce prescribed medication because a diet is helping. Bring your symptom log to your next appointment and let your doctor decide whether doses should change.

FAQ

Is AIP or the Mediterranean diet better for autoimmune disease?

For long-term eating, the Mediterranean diet has stronger evidence, with randomized trials in psoriasis, Crohn's and RA. AIP has small uncontrolled pilots with large symptom gains. Most people do best with a Mediterranean base and AIP as a 30 to 90 day elimination.

What is the difference between AIP and an anti-inflammatory diet?

An anti-inflammatory diet adds foods such as oily fish, legumes, whole grains and berries. AIP removes eight food groups and then reintroduces them. The ADIRA trial found a modest benefit from an anti-inflammatory diet in RA among those who completed both diet periods.

Is AIP the same as paleo?

AIP is a stricter paleo. It also removes eggs, nuts, seeds, nightshades, coffee and chocolate, and it adds a reintroduction phase.

Can I do AIP and keto together?

You can, but it is very restrictive and raises the risk of under-eating, low fiber and lower T3. Test keto separately and under supervision if you want to try it.

Can I combine intermittent fasting with AIP?

Yes. Start with a 12 to 14 hour overnight fast. Avoid fasting if you take insulin or sulfonylureas, are pregnant, are underweight or have a history of disordered eating.

How long should I stay on AIP?

The published studies used 6 to 10 weeks of elimination. Most practitioners suggest 30 to 90 days, then reintroducing one food every 5 to 7 days.

Find Your Starting Point

The right first diet depends on your condition, your current eating pattern and what you have already tried. Take the free 3-minute quiz to get a personalized protocol that matches diet, supplements and lifestyle steps to your profile, each with its evidence grade.

Related reading:

• Autoimmune Diet: 7 Approaches Compared
• AIP Diet for Hashimoto's
• Leaky Gut Autoimmune Protocol
• Thyroid Healing Diet

References

• Abbott RD, Sadowski A, Alt AG. (2019). Efficacy of the Autoimmune Protocol diet as part of a multi-disciplinary, supported lifestyle intervention for Hashimoto's thyroiditis. Cureus. PMC6592837
• Brenton JN et al. (2022). Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits. Journal of Neurology, Neurosurgery and Psychiatry. PMC9350909
• Cox SR et al. (2020). Effects of low FODMAP diet on symptoms, fecal microbiome, and markers of inflammation in patients with quiescent inflammatory bowel disease in a randomized trial. Gastroenterology. PMID 31586453
• Drago S et al. (2006). Gliadin, zonulin and gut permeability: effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scandinavian Journal of Gastroenterology. PMID 16635908
• Ihnatowicz P, Gębski J, Drywień ME. (2023). Effects of Autoimmune Protocol (AIP) diet on changes in thyroid parameters in Hashimoto's disease. Annals of Agricultural and Environmental Medicine. PMID 37772528
• Kaplan HC et al. (2022). Personalized research on diet in ulcerative colitis and Crohn's disease: a series of N-of-1 diet trials. American Journal of Gastroenterology. PMID 35442220
• Kjeldsen-Kragh J et al. (1991). Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet. PMID 1681264
• Konijeti GG et al. (2017). Efficacy of the Autoimmune Protocol diet for inflammatory bowel disease. Inflammatory Bowel Diseases. PMC5647120
• Lewis JD et al. (2021). A randomized trial comparing the Specific Carbohydrate Diet to a Mediterranean diet in adults with Crohn's disease. Gastroenterology. PMC8396394
• Lietz A, Dapprich J, Fischer T. (2026). Carnivore diet: a scoping review of the current evidence, potential benefits and risks. Nutrients. PMC12845189
• Perez-Bootello J et al. (2025). Mediterranean diet and patients with psoriasis: the MEDIPSO randomized clinical trial. JAMA Dermatology. PMC12461594
• Sköldstam L, Hagfors L, Johansson G. (2003). An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Annals of the Rheumatic Diseases. PMC1754463
• Vadell AKE et al. (2020). Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA): a randomized, controlled crossover trial indicating effects on disease activity. American Journal of Clinical Nutrition. PMC7266686
• Wahls TL et al. (2021). Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: the WAVES randomized parallel-arm clinical trial. Multiple Sclerosis Journal: Experimental, Translational and Clinical. PMC8326636

This site provides educational information only. Not medical advice. Always consult your healthcare provider before changing your treatment plan. Evidence grades reflect our assessment of the current literature and are meant to support informed conversations with your physician or dietitian.