Have you started or thinking about trialling the RPAH or FAILSAFE elimination test diet but are worried about how may affect your nutrition? Read on to find about how your vitamin A intake may be affected.
JOIN THE COMMUNITY: BRAND NEW Dietitian led Facebook group: Amines, Salicylates and Glutamates: The Food Intolerance Dietitian for great information and community support.
Vitamin A is probably not a nutrient you would normally think about, but is the one of the most likely nutrient to be impacted when taking on the FAILSAFE or RPAH diet.
As Vitamin A can be stored in the body (unlike the water soluble vitamins which continuously need to be topped up), after a period of a low intake, you may need to think about repleting levels in your body via boosting your vitamin A intake.
A short term reduction in vitamin A content in your diet won't be an issue, but a moderate or longer term restriction can lead to vitamin A deficiency over time.
When we talk about vitamin A, which is a fat soluble vitamin (along with the other fat soluble vitamins, vitamin D, vitamin E and vitamin K), we need to also be aware that b-carotene in foods (such as you find in carrots) will convert to vitamin A in the body. Foods that are high in b-carotene are an excellent vitamin A source.
Let's read more about boosting vitamin A / b-carotene in our diet.
Tip #1 - include dairy and/or soy in your diet
On top of restricting the variety of foods such as fruit and vegetables, it is not uncommon to also be excluding some major allergens or protein foods such as dairy and soy.
If you tolerate dairy or soy, then you will most likely be fine. A cup of cow's milk or soy milk will give you all the vitamin A you need. This is because vitamin A is a fat soluble vitamin and can be found in the fat content of dairy and soy.
Tip #2 - the following foods will help boost your vitamin A.
What if you also don't tolerate dairy or soy and are following the strict elimination?
You can boost the natural vitamin A intake by choosing the following low salicylate and amine foods on a regular basis:
Nuttelex (1 TBSP): this will provide half your needs.
2 eggs
a serve of green beans (a serve of vegetables is 1/2 cup)
wombok cabbage (1 cup)
and include on a regular basis: chicken, carob powder, Brussel sprouts and leek.
This almost meets your needs, but not 100%. Keep reading on to how to further boost your vitamin A or b-carotene.
Tip #3 - Include up to 1/2 cup of a moderate salicylate vegetable daily with an emphasis on.....
You probably have worked out that the strict version of the RPAH or FAILSAFE diet has a limited number of fruit (one to be precise) and vegetables (15 but we are including chives as one of those choices and sprouts as another).
It feels counterintuitive to every thing you have heard about healthy eating but remember: this is a trial only, and once you can work out your dietary triggers, you should be able to replace tolerated foods back into the diet and expand your intake over time.
If you can manage a small amount of moderate vegetables, then often an allowance of 1/2 cup of moderate vegetables can be included in the diet on a daily basis at the elimination phase.
It is usually recommended to vary the allowed daily 1/2 cup of moderate vegetable in ensure you don't habitually choose the same moderate vegetable that ends up being higher in salicylates than anticipated. This can happen as salicylate content can vary - affected by sub species, soil condition, how early on or late on in the season for that particular vegetable and likely many other factors. The salicylate/amine/glutamate charts (I go by the RPAH food charts: see resources below) are a rough guide only.
As part of keeping up a variety of moderate vegetable choices, lean into the orange moderate vegetables: peeled carrot, butternut pumpkin and/or sweet potato, as these are very rich in b-carotene, and hence, vitamin A.
In fact, a 1/4 cup of these orange vegetables will 100% meet your recommended vitamin A amounts, so even smaller amounts will go a long way in boosting the vitamin A in your diet.
NOTE: the 15 veggies low in salicylate are: green beans (all the different types), Brussel sprouts, cabbage (all the different types), celery, chives + garlic chives, choko, garlic (small amounts), leek, lentil sprouts, lettuce (iceberg), parsley: sprinkle, potato, white + peeled, spring onions, shoots ( bamboo, bean, mung bean), swede.
Tip #4 - If you are dairy free, soy free and strictly low
If you are dairy and soy free, and cannot manage even a small amount (eg 1/2 serve) of moderate salicylate vegetables in your diet- then having a multivitamin is an excellent idea.
Check that the multivitamin is suitable for the FAILSAFE or RPAH diet, and that it does in fact contain vitamin A.
Tip #5 - Take care with vitamin A supplementation if there is a chance you become pregnant.
Too much vitamin A is not recommended when pregnant as can be harmful to the foetus so take care with any supplements containing vitamin A.
The RDI or recommended daily intake for vitamin A (pregnancy) = 700ugRE = 2333IU so it is important to avoid any vitamin A supplement that is close to these figures if you are pregnant or thinking of becoming pregnant.
Tip #6 - Important note re: breast feeding
When breast feeding, including some or unlimited moderate vegetables is usually recommended to avoid poor nutritional intake. Such a diet should only be undertaken with an experienced Dietitian, with a view to expanding the diet and appropriate supplementation.
Protect your Vitamin A or B-carotene intake
If you are excluding dairy and soy from the diet, and unable to include some moderate orange vegetables, then supplementation of the diet with vitamin A needs to be seriously considered if the restriction continues over time, choosing a suitable supplementation. Be very cautious with any supplementation if there is a chance of pregnancy.
Read up on the rest of the upcoming series on nutrients to watch out for when embarking on the FAILSAFE or RPAH diet.
Frances Walker
Specialty Food Intolerance Dietitian, APD
29/5/23
RESOURCES: RPAH salicylate | amine | glutamate charts: friendly food available online: just goog=gle the title, and the handbooks from the RPAH allergy unit website: https://www.slhd.nsw.gov.au/RPA/allergy/resources/foodintol/ff-handbooks.html
