Common traps when starting the FAILSAFE elimination diet

There are a few common traps when starting the low salicylate, amine and glutamate elimination diet (also called the failsafe or Royal Prince Alfred Hospital diet) that seem to confuse many people.

As a quick recap: the RPAH elimination diet eliminates salicylates, amines, glutamates and certain food additives from the diet, and challenges to identify if these are causing food symptoms. FAILSAFE is the strict level of the RPAH elimination diet.

Read on to find out about these common pitfalls.

JOIN THE COMMUNITY: BRAND NEW Dietitian led Facebook group: Amines, Salicylates and Glutamates: The Food Intolerance Dietitian for great information and community support.

1. WHITE FLESH Potatoes

Only the white flesh potatoes are low in salicylates. The cream fleshed potatoes have moderate levels of salicylates.

That in itself is not confusing but the tricky bit is knowing how to find these elusive white flesh potatoes!

Recommended white fleshed potatoes (as per Fed up website): Coliban | Kennebec | Kestrel (sometimes can get at ALDI) | Nadine | Sebago | Russet Burbank.

Apparently, they used to be easy to buy but now you need to actually find out the brand you are buying. Many leading supermarkets do not label their generic bags of potatoes, so trying for your local fruit shop may be needed.

Don't forget to wash well, and peel thickly as salicylates are concentrated under the skin.

Discard any potatoes with a green colouring under the skin as it indicates the presence of glycoalkaloids which is a toxin (separate to the low chemical diet issue).

If it is too hard to find- settle for LARGE DIRTY WHITE POTATOES and thickly peel. Large is useful as you have all this wonderful lower salicylate flesh once the peel is stripped away (aim for a good 2mm peel)

2. Shallots or Spring Onions?

The terms shallots and spring onions seem to be used interchangeably. Another term- scallion- is also sometimes used.

The aim is to choose the type which has very little bulb as shown in the picture above.

If there is quite a bulb at the end, or even very much looking like a small onion, don't use as will be high in salicylates.

For low FODMAPs use the green leafy tips only.

Keep the bottoms in a jar with some water and watch them re-grow!

3. Corn and Corn Flour: avoid but Corn Starch is ok

Corn flour (= maize flour) is high in salicylates and glutamates but when it is processed to corn starch ( = maize starch) it is ok as the salicylates and glutamates are processed out.

Many gluten free products such as gluten free pasta is made from corn. This is not suitable and will be high in salicylates and glutamates.

The following corn is low in salicylates and glutamates (nly need to be avoided if there is a suspected corn allergy):

• Corn starch (as discussed above) or maize starch or White Wings cornflour (as it is really corn starch and white in colour)

• Highly processed corn: corn or maize starch is further processed to produce dextrin, modified starches or thickeners, glucose syrup, corn-fructose syrup and caramel colour.
  

See my blog: corn flour and the FAILSAFE diet for more information.

4. Limit on cashews

Cashews are limited to 10 raw or lightly roasted per day (1/2 this amount for children).

Extra note on cashews: make sure they are raw or only lightly roasted, the more roasted cashews are moderate in amines.

While cashews are low in salicylates and amines- too much will tip over into the high categories so keep an eye on these limits, especially if following the strict level of the elimination.

5. Pears: a lot to know...

Pears have a limit: 2 for adults and one for kids. Pears are not really low sallicylate, they are somewhere between low and moderate so a limit helps to keep a cap on the salicylate content. Pears: make them juicy as the riper they are the lower the slaicylate content. When unripe and crisper, they are moderate in salicylates. Pear skin: give a nice thick peel as salicylates are in the skin and just under the skin.

6. Leeks: white part only

I have noticed that many people revert to the green parts of leek, especially if they are FODMAP sensitive. The green parts of leeks are very high in salicylates and need to be avoided. Stick to the white stalk. 7. Make Sure You Have your Head Around Meat Amine Management Just choosing low amine meats is not enough, get good information on how to manage your low amine meat to keep it low amine. Depending on how amine sensitive you are looking, a lighter or stricter approach may be useful for you.

8. Make sure you have had all your medications and supplements checked

So many medications and supplements can have added salicylates in the form of concentrated herb extracts, flavour and in the case of medications, additives such as artificial colour. Don't cease a needed medication but if there is an unsuitable ingredient(s), (check excipients as well as inactive ingredients), an alternative can be discussed with your doctor or the same medication compounded without the issue ingredient.

9. Make sure you have maximised your diet

Not everything needs to be eliminated, an experienced Food Intolerance Dietitian will see if a major food protein such as dairy, soy and gluten can be kept in the diet or best removed.

10. Check your toothpaste, mouth wash etc

These are always very high in salicylates. If minted, then likely an issue. Seek information on alternatives as well as low fragrance porducts (if this applies to oyu) from your Specialist Food Intolerance Dietitian.

11. Check Your Nutrition

If you are undernourished, your food sensitivities can worsen.

If you are removing any major food groups for example dairy and soy or wheat on on a restricted very low diet, you will need some CLEAN supplements. Get help to make sure you keep your self well.

OTHER SMALLER NOTES

• raw sugar and coconut sugar are high in salicylates, forget the fancy sugars

• coconut in all its forms is best avoided unless doing a mild elimination

• cheese substitutes are not recommended

• avoid NSAIDS (eg Voltaren, ibuprofen), use paracetamol without additives

• check possible amines: probiotics | melatonin | omega 3 oil

• If you need a supplement for example vitamin C when you have a cold, or magnesium for sleeping or keeping oyur gut regular: ask your specialist Dietitian for surrent, available clean versions

• MOULD: actually is not a small point: can often cause these issues, so treat any. mould or remove your self from mould if possible.

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REFERENCES

1. Food Intolerance Network. What's wrong with potatoes? Nothing! Except that it is so hard to buy white ones... Accessed June 12, 2018.https://fedup.com.au/news/blog/what-s-wrong-with-potatoes-nothing-except-that-it-is-so-hard-to-buy-white-ones

2. RPAH elimination diet handbook: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2011 (revised edition).

3. Food Safety Authority of Ireland. Green potatoes. Accessed June 12, 2018. https://www.fsai.ie/faq/green_potatoes.html