Should any single pernicious anemia diet plan become your sole treatment?
Absolutely not.
Pernicious anemia, by definition, is when your lack of B12 is the result of your body being unable to absorb B12 through the gut. This happens because of autoimmune attacks on either your IF (intrinsic factor, a protein that drives the absorption of B12), or the gastric parietal cells, which produce IF in the gut in the first place.
When you have true pernicious anemia, no diet in the world is going to get enough B12 into your bloodstream, cells, and tissues. You will most likely need a lifelong B12 shot therapy to live a good, normal life, with as few PA symptoms as possible.
However, diet does have a strong impact on health. Top scientists believe the main cause of autoimmune diseases is leaky gut. This is an ailment where your intestinal barrier function is flawed, making way for proteins, toxins, and other particles to get into your blood circulation. The immune system reacts to these invaders, and if some of them look like your own tissues, then your body ends up hurting your tissues as well.
Which brings us to…
AIP: Best Diet for Pernicious Anemia?
The Autoimmune Diet Protocol, described in Dr. Sarah Ballantyne’s book, gets rid of irritants and major offenders to gut health. It’s designed to sooth your immune system, reduce inflammation, and help your body embark on a path of healing.
Remember, pernicious anemia is first and foremost an autoimmune disease.
Did you know?
Gluten, for example, tends to pry open the tight junctions of the gut. This allows the passage of toxins and food particles into the blood flow, which sets off inflammatory and autoimmune feedbacks. It’s no surprise that gluten-free diets seem to help against autoimmune diseases like type 1 diabetes, rheumatoid arthritis, autoimmune hepatitis, and multiple sclerosis.
After plenty of anecdotal evidence, the AIP starts to get academic attention. Check out this study from 2017, where the diet showed potent effects against inflammatory bowel disease. 11 of 15 people who followed the AIP had total remission by the sixth week.
With the AIP, you will start a phase of at least a month, where you will cut out some foods. Then, once you feel a lot better, you will slowly start to add these foods back in your diet – one by one – and try to gauge how your body reacts.
This isn’t just a pernicious anemia diet plan, but a good template for anyone with an autoimmune disorder. And remember, this dietary plan should only supplement your B12 treatment. Never stop your B12 shots if you were tested and diagnosed with PA.
Now, let’s see what you can or can’t eat on the AIP.
Foods to Avoid With Pernicious Anemia AIP
- Grains, i.e. wheat (bread, pasta, etc), rice, corn, barley, oat, bulgur, rye, sorghum, spelt. Also take out grain-like seeds, like buckwheat, amaranth, quinoa, millet, teff.
- Legumes, i.e. black beans, kidney beans, fava beans, lima beans, soybeans, green beans, chickpeas, lentils, peanuts.
- Eggs. One of the most common food allergies. When you later add eggs back in, have just the yolks first. Many find the whites irritating but not the yolks.
- Dairy products of any kind, i.e. cheese, milk, cream, yoghurt, butter and ghee.
- Nightshades, i.e. white potatoes, tomatoes, eggplant, all kinds of bell and spicy peppers (including spices like paprika, cayenne, chipotle, chili powder or flakes, etc. As a rule of thumb, no red spices). Also tomatillo, tamarillo, pepino, okra, goji berries, ashwagandha, naranjillas, kutjera, cocona, garden huckleberries, cape gooseberries.
- Nuts, i.e. hazelnut, walnut, macadamia, Brazil nut, chestnut, cashew, pecan, pistachio, pine nut, almond. Coconut is the exception (in fact, it’s actually a fruit).
- Seeds, i.e. sesame, chia, safflower, flex, pumpkin, sunflower, hemp, etc.
- Spices from seeds, i.e. cumin, black pepper, curry, nutmeg, coriander seed, allspice, anise, annatto seed, fennel seed, vanilla beans, caraway, celery seed, mustard, poppy seed, cardamom, green and pink peppercorns, juniper, white pepper, fenugreek.
- Seed oils like canola, soybean, sunflower, grape seed, etc.
- Chocolate (cocoa is a seed).
- Coffee (the coffee bean is a seed).
- Alcohol.
- Dried fruit. Too much sugar, and easy to over-eat.
- Food additives like thickeners, artificial food dyes, emulsifiers, xanthan or guar gums, sodium nitrite, high fructose corn syrup, etc.
- Refined sugars and processed foods.
- Sweeteners like stevia, xylitol, aspartame, etc.
- Algae, i.e. Chlorella, Spirulina.
- NSAIDs (painkillers such as aspirin or ibuprofen), which can harm your gut lining.
Get rid of any other food you know you’re sensitive or allergic to.
Now, what can you eat?
List of Foods to Eat
- Meat, i.e. beef, chicken, fish, shellfish, bison, turkey, elk, pheasant, rabbit, duck, lamb, pork, wild boar, goat, goose, venison, etc. In our opinion, if you want to play it safe, avoid seafood at the beginning, and gradually add it later.
- Organ meats and offal, i.e. liver, kidney, heart, brain, spleen, tongue, tripe. The AIP author suggests 5 times a week or more, but we recommend two or three times at most. Gelatin (from grass-fed animals if you can find it) is also great.
- Fruits of all kinds and colors, i.e. watermelon, banana, apricot, peach, apple, berries, cherry, orange, lemon, grapefruit, fig, date, kiwi, melon, plum, pineapple, persimmon, mango, grape. We advise limiting fructose intake to 2-3 fruits a day. Berries, though, are very low in sugar and can be eaten more liberally.
- Vegetables (except for nightshades), i.e. artichoke, cabbage, kale, chard, spinach, squash, sweet potato (try the Japanese purple ones!), Brussels sprouts, cassava, beet, arugula, mustard greens, bok choy, onion, lettuce, turnips, watercress, cauliflower, leek, parsnip, rutabaga, fennel, asparagus, sea vegetables.
- Mushrooms, i.e. portobello, champignon, shiitake, enoki, oyster mushroom, etc.
- Non-seed fats, i.e. avocado, olives, coconut (and its oil, cream, and milk), animal fats. We advise using olive or avocado oil for salad dressing, and a saturated fat like lard, beef tallow, chicken or duck fat, or coconut or palm oil for sautéing.
- Probiotic foods, like fermented vegetables or fruits (sauerkraut, kimchi, olives, pickles, etc), kombucha, water kefir, and coconut-milk kefir/yoghurt. Important: If you have SIBO (small intestinal bacterial overgrowth), avoid all fermented foods other than the ones known to work well with your condition.
- Non-seed herbs & spices, i.e. turmeric, salt, basil, dill, saffron (the only red spice you can have), garlic, sage, cinnamon, rosemary, mint, bay leaf, chives, oregano, cilantro, parsley, thyme, peppermint, ginger, lemon balm, chamomile, chervil, clove, horseradish, lavender, mace, marjoram leaves, tarragon, savory leaves.
- Vinegar. Types like apple cider, balsamic, ume plum, coconut, red or white wine, sherry, and champagne are all good. Without added sugar, of course.
- Honey and maple.
- Water, tea, and broth for drinks.
- Grain-free flours (if you insist), i.e. tapioca, tigernut, coconut, arrowroot, etc.
As you see, lots of options.
Potassium and Folate (Important!)
When you start injecting B12, your anemia will get better and you’ll begin to build red blood cells normally. During the first few months, your potassium levels may drop, so keep an eye on it and eat a lot of potassium-rich foods. Good AIP-friendly sources are sweet potato (with the skin), salmon, watermelon, coconut water, avocado, banana, beet, butternut squash, pomegranate, and dark leafy greens like spinach or kale.
Also, remember that B12 and folate (vitamin B9) need each other in order to function properly. If you’re not on the upper end of the suggested folate range, then supplement with l-methylfolate. This is the best form of folate, much better than folic acid.
How to Reintroduce Foods?
After at least 30 days on the AIP, and until your blood work improves and you feel significantly better, you can start adding foods – one by one – back in the rotation. Go slowly, and give each food three days to cause a reaction (headaches, bloating, mood swings, skin changes, fatigue, etc). If your body reacts, eliminate that food forever.
You may want to steer clear of some foods anyway, even if you’re a healthy person. For example, refined sugars, processed products, food additives, seed oils, most grains and legumes (unless soaked and fermented). They’re not good for anybody.
Follow the Pernicious Anemia Diet Plan
To sum up, we advise adopting the AIP as your pernicious anemia diet therapy, but only as an adjunct to the B12 shots. Make sure you’re getting enough potassium and folate (in the best form). After adding safe foods back in, you will end up with your own unique AIP template, a clean diet just for you. Stick to it to minimize the flaring of symptoms.
There are plenty of stories of the AIP bringing autoimmune conditions into remission for some people. Please report back to us if it helped you in any way.
We’ll keep an eye out on anything diet and PA related. Ideally, in the years to come, we’ll find out how to stop patients from producing antibodies to intrinsic factor or parietal cells through diet alone. That would, in effect, give us a cure for PA.
Until, and if that ever happens, keep injecting your B12.
All in all, this pernicious anemia dietary treatment is highly recommended, and should be a very welcome boost to the all-important B12 shot therapy.
Good luck.