What are SALICYLATES?
What are salicylates? This must be the most common question I hear as a Food Intolerance Dietitian.
Salicylates (pronounced: SAL - ISSY- LATES) are a naturally occurring chemical produced by plants that provides protection from pathogens (invaders). Think of salicylates as equal to a plant's immune system.
Salicylates were first isolated from a plant based on a common known remedy at the time in the early 1800s. Since this time, salicylates have been provided in the form of aspirin to people around the world for pain relief. Currently, salicylic acid/aspirin is produced synthetically in the lab rather than isolated from the plant, which is the norm for many chemicals and food ingredients.
Some people have been shown to be sensitive to aspirin with symptoms such as flushing, itchy rashes (hives), blocked and runny nose and asthma (sometimes severe), usually within an hour of taking a tablet.
Other medications may also contain salicylic acid such as some alternative medicines (willow tree bark extract/herbal arthritis pills) and creams such as arthritis creams and teething gels. If you are sensitive to salicylates, these products need to be avoided. Cross reactivity can also occur with nurofen.
Some people who are extra sensitive to salicylate can also react to the lower dose of salicylates found naturally within commonly eaten foods. Although salicylates are present in foods in much smaller doses compared to aspirin, it can still cause symptoms if you are threshold is low enough.
Reported symptoms can be extremely varied ranging from IBS/gut symptoms such as bloating, gut pain, constipation and/or diarrhoea to rashes or eczema, chronic mouth ulcers, reflux, sinus issues, behavioural issues in children that can manifest as extreme silliness (Silly Sals!), hyperactivity in children, foggy thinking, colic in babies, joint pain/inflammation and a host of other issues.
One persons salicylate issues can be very different to another, even from the same family!
Often salicylate sensitivity can run in the family so if a close member has been diagnosed with salicylate intolerance then other members of the family may also have this sensitivity.
HOW TO TEST FOR SALICYLATE SENSITIVITY
The only way to test for salicylate sensitivity is to take out the high salicylate foods and see if symptoms improve. At this point in time, there are no scientifically validated medical tests which is why a diet elimination and challenge is the only way to diagnose and treat food salicylate sensitivity.
People who are sensitive to salicylate foods can also be sensitive to amines and glutamates which, like salicylates, occur naturally in foods. Some food additives can also cause similar issues. Removing foods rich in these food chemicals can result in significant improvements in a wide range of symptoms.
The food chemical elimination diet has been shown to be a powerful diet for the right adult or child. These food chemicals, like allergens, can pass through the breast milk onto a baby and can cause symptoms in sensitive babies such as poor sleep, skin rashes and eczema, gut pain, mousse poos and reflux.
FOODS HIGH IN NATURALLY OCCURRING SALICYLATES
It is not surprising that foods rich in salicylates are foods are derived from plants. There is a spectrum of salicylates in plant foods from low to moderate to high and very high. So many factors affect the salicylate content of a food such as growing conditions, season, length of storage, level of ripening, and also cooking such as boiling vegetables can reduce the salicylate content.
When trialling a low salicylate diet, foods that are low or moderate are often included while the high and very high foods excluded. The level of restriction depends on the frequency and severity of the symptoms and the level of restriction that is appropriate to the circumstances.
Some examples of very high salicylate foods:
FRUIT: oranges + mandarins + lemons + limes, strawberries, kiwifruit, many berries, grapes, plum, dried fruit and concentrated tomato such as tomato paste and tomato based pasta sauces
VEGETABLES: herbs + spices + chilli + curry spices + spinach + capsicum + onion
SAUCES: most commercial sauces + commercial gravy + commercial stock + pepper, tomato sauce, mustard, salad dressings, mayonnaise etc
NUTS & SEEDS: all roasted nuts, most nut pastes, desiccated coconut, tahini
OTHER: peppermint, some oils, throat lozenges, chewing gum, honey, most jams, cups of tea and coffee, many alcoholic drinks such as beer and wine.
THE LOW SALICYLATE ELIMINATION DIET
The low salicylate diet usually gets best results when combined with amines, glutamates and some food additives (such as msg and artificial preservatives) as symptoms from these can be overlapping and it is impossible to determine without elimination what food chemical is causing which reaction.
The low chemical elimination diet is also called the Royal Prince Alfred Hospital elimination diet (RPAH elimination diet) or the FAILSAFE elimination diet. The FAILSAFE diet refers to the stricter level of elimination, while in actual fact the diet can be more of a moderate restriction or even a simple elimination can be applied.
Having a salicylate sensitivity increases the chances you may be sensitive to amines or glutamates or food additives, so it can be useful to remove altogether to achieve maximum benefit.
In addition to food chemical sensitivity, some people may have sensitivities or allergies to whole foods and/or FODMAPs. A specialised food intolerance Dietitian can help determine what is useful to eliminate or not!
In any elimination diet it is imperative to replace any eliminated foods with other foods that can provide important nutrients. This may mean for the salicylate elimination diet using vegetables you may not normally use such as swede and cabbage or and Brussel sprouts in addition to the go to veggies like potatoes and green beans to ensure a balanced intake of vitamins, minerals and fibre. Sometimes supplementation is a good idea depending on the level of elimination.
When symptoms seem overwhelming, and you feel it is related to food, ring up for a chat to see if diet changes could be an option for you.
The Food Intolerance Dietitian
Allergic Reactions to Aspirins and other Painkillers, ASCIA. Retrived from: https://www.allergy.org.au/patients/drug-allergy/allergic-reactions-to-aspirin-and-other-pain-killers. Accessed 8th April 2019
RPAH elimination diet handbook: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2011 (revised edition).