6 tips for label reading on the RPAH/FAILSAFE Elimination Diet
Updated: Mar 28
Reading ingredient lists on food labels as well as medication pamphlets when avoiding salicylates, amines, glutamates and some food additives when on the FAILSAFE or RPAH elimination diet is very tricky, but a few pointers may help you develop these high level skills, and learn more about foods in the process.
1: Avoid ingredients high in SAG chemicals
To recap: RPAH stands for Royal Prince Alfred Hospital elimination diet that eliminates significant food and environmental sources of salicylates, amines, glutamates (SAG) and problematic food additives.
If you have access to the food charts outlining content of salicylates, amines and glutamates (provided in 'Friendly Foods" or the handbooks by the RPAH allergy unit doctors and Head Dietitian- see in resources below) then you can use this as an excellent guide as an example of what foods to avoid.
FOOD LABELS: look at the ingredient list and look for any ingredient items that come from plants such as:
- vegetables: tomato, spinach, mushrooms
- citrus: lemon, lime, orange, pineapple
- juice: any juice
- herbs: any herbs such as basil, oregano, coriander, Italian herbs, mint, peppermint
- spices: any spices such as turmeric, chilli, 5 spice
- pepper (salt is permitted)
- seeds (poopy seeds ok): individual seeds such as sesame seeds, seeds in grainy bread, chia seeds
- coconut: coconut milk, cream, yoghurt, desiccated coconut
Check out the handbook for the rest.
2: Avoid certain food additives
Not all additives have to be avoided, only certain ones. Some, like like additive number 500 just mean simple items such as sodium bicarbonate so is fine.
Watch out for:
Artificial colours: 102, 104, 110, 132-3, 151, 155, 122-124, 127, 129, 142-3
Natural colour: annatto: 160b (anatto). NOTE: 160(a) is fine.
Flavour enhancers: 620-625, 627, 631, 635-7, 640-641
Preservatives: Sorbates (200-203, Benzoates (210-213, 216, 218, PABA), Sulphites (220-225, 228). Nitrates (249-252), Propionates (280-283)
Artificial antioxidants: 310-312, 319-321.
There are some natural antioxidants that are generally well accepted such as 300 (ascorbic acid), or 307-309 (the tocopherols).
Sometimes the problematic food additives may be listed by name instead of number so look out for words above such as benzoate or sorbate: for example sorbic acid.
Note that the gluten free crumpets above are not suitable as they contain a preservative: potassium sorbate, listed at the end. Not listed by number, only by name.
3: If vegetable oil is listed need to find out what type of oil it is
Sometimes oil may be plainly listed as just 'vegetable oil'. It is important to know what type of vegetable oil it is.
Vegetable oils could mean low chemical oils such as rice bran oil, sunflower oil, Canola oil , rapeseed oil (= cotton seed oil) or palm oil.
Vegetable oils could also be olive oil or coconut oil which are high in salicylates and amines and are not acceptable.
The company may need be contacted to see what type of oil it is.
If the oil is cold pressed or expeller pressed- this means the oil is not as refined so may contain salicylates. Cold pressed oils are best avoided (unless is rice bran oil which did not have salicylates to begin with).
4: Check if the fat is less than 5g per 100g (see nutritional panel)
Check the nutritional panel. If the oil or fat is less than 5g/ml per 100g then there may be unlisted antioxidants.
There is a 5% labelling loophole that means if an ingredient is less than 5% of the food/drink item then the ingredients of that ingredient does not have to be stated (unless it is an allergen, for example dairy or soy).
This is relevant for foods that contain less than 5% oil as that oil carries a real risk of containing artificial antioxidants to stop the fat going rancid or going off.
Many high fat foods will contain more than 5% fat so they are not at risk of having unlisted artificial antioxidants. This means, any foods with more than 5% fat (5 g of fat per 100g- check the nutritional panel), will have to have any artificial antioxidants listed on the ingredient list.
In summery: If there is less that 5g of fat per 100g of the food (check the nutritional panel), then there is a risk of unlisted artificial antioxidants. Check with the company to check.
5: FLAVOUR listed as an ingredient
If the flavour really hits you- avoid it like the plague! Big flavour = big glutamates!
The ingredients of FLAVOUR do not have to be listed (trade secret), although any additives or allergens do need to be listed.
The type of food can give a hint as to whether the FLAVOUR ingredient is likely to be an issue or not. Savoury foods will tend to have glutamates. In contrast, sweet, vanilla tasting foods may be ok. The flavour may just be vanilla (often commercial rather than natural) which is failsafe although the vanilla flavouring may not be tolerated by some.
6: Watch out for TRICKY words
Tricky words are words that mean an ingredient may look ok but actually refer to food additives, salicylates, amines and/or glutamates.
For example 'cultured dextrose". Dextrose itself is acceptable but 'cultured dextrose' may approximate the artificial additive- propionate. You will often find this ingredient in commercial breads and bakery products, instead of propionates. .
Yeast extract is also to be avoided as an ingredient as is high in salicylates, amines and glutamates. Meat extract is also very high in amines and glutamates (both listed in the RPAH elimination handbook). Easy words to overlook, especially as 'yeast' as a word is acceptable as part of the RPAH elimination diet, only to be avoided if you think you personally think you have have issues with yeast.
TVP (textured vegetable protein) or HVP (hydrolysed vegetable protein) also need to be avoided as high in natural glutamates. Other hydrolysed proteins may also be problematic.
Organic sugar or cold pressed /organic oil indicate less processed and likely to contain significant levels of salicylates (in the case of sugar) and/or amines (in the case of oils). An exception is rice bran oil, which is not an issue if cold pressed as did not have any appreciable salicylates to begin with.
Take Home Message
When reading labels remember to:
Check for any words that you know are high in salicylates such as citrus, lemon, tomato, herbs & spices, fruit flavour
Check for certain food additives by number or class name (eg preservative) or name (eg sorbate)
If oil is just listed as just 'vegetable oil', you need to know what type of oil
Check fat content : if less than 5g per 100g then the there is a risk of unlisted artificial antioxidants
Be very wary of the ingredient "flavour'
Check for tricky ingredients such as cultured dextrose
HOW TO CHECK OUT IF A FOOD IS OK
Ring the company
Check if the food is already termed a failsafe product through the Fedup website or the associated Facebook groups. A failsafe food means it has been already checked.
Ask your Dietitian: a specialist Dietitian in food intolerances may have already checked it out or will chase it up for you.
Ingredients change without notice, so always double check- even an old favourite.
Over time, one can get quite expert at identifying problematic ingredient words such as tomato, herbs, spices, pepper, onion and checking for any food additives by name in foods. See blog on reading ingredients in medications to further enhance your label reading skills.
RPAH elimination diet handbook: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2019 (revised edition).
Friendly Food: the essential guide to managing common food allergies and intolerances. Anne Swain, Velencia Soutter, Robert Loblay, 2019 (revised edition).