Exploring participant experiences with the autoimmune protocol (AIP) diet in rheumatoid arthritis: a longitudinal qualitative study

Abstract

Many dietary interventions have been conducted in rheumatoid arthritis (RA) with quantitative outcomes the key focus; qualitative research exploring participant experiences remains limited. The autoimmune protocol (AIP) diet is an elimination reintroduction approach designed for autoimmune conditions. This study explored the experiences of nine adults with RA who completed an eight-week AIP dietary intervention, with semi-structured interviews conducted immediately post-intervention and again one year later. Interviews explored participants’ motivations, challenges, enablers, and perceived effects of the intervention, their experiences with food reintroduction, and the degree to which dietary changes were sustained. Thematic analysis identified three themes related to initial intervention experiences. Open to change, captured initial motivations, trust in the protocol and willingness to attempt substantial dietary change. Navigating dietary transition described the mental, practical, and social strategies used to manage challenges and support adherence. Reflections on benefits and looking ahead , captured perceived health changes and intentions for future dietary practices. At one-year follow-up, three further themes were identified. Personalised reintroductions and responses highlighted how participants observed the effects of foods on RA and health. Finding and sustaining balance reflected the ongoing process of negotiating dietary structure with flexibility, particularly in social contexts. Reflections on wellbeing and future intentions encompassed perceived benefits, persistent challenges, and plans for ongoing dietary management. High initial adherence was facilitated by participant motivation and structured study support. The reintroduction protocol was perceived as burdensome, however, most participants sustained meaningful dietary change, even without ongoing formal guidance.