What are salicylates? This must be the most common question I hear as a Food Intolerance Dietitian.
JOIN THE COMMUNITY: BRAND NEW Dietitian led Facebook group: Amines, Salicylates and Glutamates: The Food Intolerance Dietitian for great information and community support.
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 in the early 1800s. Now, we can make salicylates in the lab for use in common medicines like aspirin (salicylic acid), creams such as arthritis creams and teething gels, and alternative medicines (willow tree bark extract/herbal arthritis pills).
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. If you are sensitive to salicylates, all medicinal products with salicylates need to be avoided. Cross reactivity can also occur with neurofen.
Salicylates are present in foods that we eat often, like onions, tomato pastes and oranges. They are in much smaller doses compared to aspirin. However, some people who are extra sensitive to salicylates can react to the lower dose of salicylates in these foods. This causes symptoms of salicylate sensitivity.
SYMPTOMS OF SALICYLATE SENSITIVITY
Sensitivity to salicylates can manifest in extremely different ways. A few of the more common symptoms are:
· Gut symptoms - bloating, gut pain, constipation or diarrhoea
· Rashes or eczema
· Chronic mouth ulcers
· Sinus issues
· Foggy thinking
· Joint pain or inflammation
· Behavioural issues in children - extreme silliness (Silly Sals!), hyperactivity
· Colic in babies
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
Currently there is no scientifically validated medical tests for salicylate sensitivity.
The only way to test for salicylate sensitivity is to take out the high salicylate foods and see if symptoms improve.
Diet elimination followed by diet challenges 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.
Salicylates can pass through breast milk
Salicylates, amines and glutamates consumed by a breast feeling mother can pass through the breast milk into the baby. This can cause symptoms in sensitive babies such as poor sleep, skin rashes and eczema, gut pain, mucus poos and reflux. The food chemical elimination diet has been shown to be a powerful diet to help reduce symptoms in babies with food sensitivities.
FOODS HIGH IN NATURALLY OCCURRING SALICYLATES
Salicylates are found in foods derived from plants.
The amount of salicylates in the food can be low, moderate, high or very high, and is affected by a large number of factors.
Ripening can decrease the salicylate content of the food and baking can also break down salicylates..
In the low salicylate diet, foods that are low included in the diet (and maybe some moderate salicylate foods), and foods that are high or very high are excluded or significantly reduced.
The diet can be very personalised; it depends on how severe and frequent your symptoms are. A qualified dietitian can help guide the process of designing a personalised diet.
Very high salicylate foods: Avoid or Reduce on the Elimination Diet
Fruit tends to be a significant source of salicylates.
Oranges + mandarins + lemons + limes, strawberries, kiwifruit, many berries, grapes, plum, dried fruit and concentrated tomato such as tomato paste and tomato based pasta sauces are all foods that contain a lot of salicylates.
VEGETABLES: herbs + spices + chilli + curry spices + spinach + capsicum + onion all contain high levels of salicylates.
SAUCES: Almost all commercial sauces + commercial gravy + commercial stock + pepper, tomato sauce, mustard, salad dressings, mayonnaise will contribute a lot of salicylates (as well as amines, and in particular glutamates).
OTHER FOODS: peppermint, some oils, throat lozenges, chewing gum, honey, most jams, cups of tea and coffee, many alcoholic drinks such as beer and wine all constribute a lot of salicylates in the diet..
THE LOW SALICYLATE ELIMINATION DIET
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.
The low salicylate diet usually gets the best results when combined with amines, glutamates and some food additives (such as msg and artificial preservatives).
This is for two reasons:
1. The symptoms from salicylates, amines, glutamates and food additives are often overlapping and it is impossible to determine without elimination what food chemical is causing which reaction.
2. If you have a salicylate sensitivity, there is a higher chance you will also be sensitive to amines, glutamates or food additives.
In addition to food chemical sensitivity, some people may have sensitivities or allergies to whole foods and/or FODMAPs. Careful assessment can help determine what to eliminate!
It is important when doing an elimination diet that you are getting all the nutrients you need. This might mean adding in some different vegetables into your diet that you don't usually have, like swede, cabbage or brussel sprouts.
Vitamin and mineral mineral supplementation might also be recommended depending on the level of elimination.
This diet is difficult but can be more easily implemented, monitored, supported and managed if you see a Food Intolerance Dietitian.
Contact me to see if I can help you with you respect salicylate intolerance .
Updated April 2024
REFERENCES
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 handbooks 1 and 2: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2018 (revised edition).