SALICYLATE INTOLERANCE
The only form of salicylate proven to be the cause of symptoms is acetylsalicylic acid (a drug known as “aspirin” in the United States, although this term is a registered trade name in Canada). Sensitivity to acetylsalicylic acid is more common in persons with asthma than in those without it. Furthermore, up to 25% of people who are sensitive to acetylsalicylic acid also react adversely to the azo dye tartrazine, but it is not known whether the two chemicals act in a similar way in the body. Sensitivity to acetylsalicylic acid has also been linked to sensitivities to benzoates and sulfites, but cross-reactivity to these substances has not yet been confirmed by research studies.
Salicylates (but not acetylsalicylic acid) occur naturally in many foods, including fruit, vegetables, herbs, spices, nuts, and seeds. However, research studies have not proven that this source of salicylates causes adverse reactions even in people who are sensitive to acetylsalicylic acid. The level of salicylic acid may be the determining factor in salicylate sensitivity. Dietary consumption of salicylate is estimated to be from 10 to 200 mg daily, whereas one dose of regular-strength aspirin provides 300 to 325 mg of acetylsalicylic acid and extra-strength aspirin provides 600 to 650 mg. So, a diet with the highest level of salicylate-rich foods is unlikely to provide as much salicylate as one tablet of regular-strength aspirin.
Sensitivity to acetylsalicylic acid has been implicated in causing urticaria (hives) and angioedema (tissue swelling) and in leading to an asthmatic attack in persons with asthma. However, people with asthma who are sensitive to acetylsalicylic acid can usually ingest the salicylates in foods without difficulty. No controlled research has been undertaken to study the effect of reducing dietary salicylates on the course of asthma.
What Causes Salicylate Sensitivity?
Acetylsalicylic acid inhibits the cyclo-oxygenase pathway of arachidonic acid metabolism, thus reducing the production of certain prostaglandins (hormonelike chemicals) that mediate the sensation of pain. This reduction accounts for the analgesic (pain-reducing) properties of aspirin. Another result of this inhibition is increased production of leukotrienes, hormone-like chemicals that mediate the smooth muscle contraction that causes the bronchospasm of asthma. This effect explains why many persons who are sensitive acetylsalicylic acid suffer from asthma.
Symptoms of Salicylate Sensitivity
Wheezing, urticaria (hives), and angioedema (tissue swelling) are reported symptoms of salicylate sensitivity. Some investigators think that the hyperactivity experienced by some children is due to salicylate sensitivity; however, the role of salicylates in attention-deficit hyperactivity disorder (ADHD) has not been proven by controlled studies. Investigations of the role of food components and additives in this disorder are currently in progress.
Some practitioners in the field of food intolerance believe that, although avoiding foods high in salicylates is unlikely to diminish the symptoms of most persons sensitive to acetylsalicylic acid, a trial on a salicylate-restricted diet may benefit those individuals who have severe symptoms and get no relief from other treatments. For those who wish to investigate the effects of limiting salicylates, the diet in Table The salicylate-restricted diet is suggested. It restricts the foods with the highest levels of salicylates and provides suggestions for low-salicylate substitutes. The diet should not be followed for longer than four weeks initially.
Food Sources of Salicylates
Salicylates are a natural component of many food plants. Several researchers have developed tables to indicate the level of salicylate in foods. However, none is entirely accurate, because the level of salicylate in a food varies according to plant variety and conditions in the growing environment. It would be extremely difficult, if not impossible, to come up with a nutritionally adequate diet that does not include any foods that contain salicylate. However, some foods have lower levels than others. Table Examples of foods with “high” and “low” levels of salicylate lists foods high in salicylates and those with lower, “acceptable” levels of salicylates to give you an idea of how these compare.
The Salicylate-Restricted Diet
Table The salicylate-restricted diet provides you with a list of the foods allowed and those restricted on a diet that will limit your intake of salicylate — and still supply you with the nutrients essential for a well-balanced diet. No diet is completely “salicylate-free” unless it is also “food-free,” but this comes very close!
Table Examples of foods with “high” and “low” levels of salicylate
| Food Category | High Salicylate Content | Low or No Salicylate Content |
| Herbs | Mint
Thyme Tarragon Rosemary Dill Sage Oregano Marjoram Basil Celery seed Sesame seed |
Poppy seed
Chives (fresh) Parsley |
| Spices | Aniseed
Cayenne Cinnamon Cumin Curry powder Fenugreek Mace Mustard Paprika Turmeric |
Saffron (dry powder) |
| Fruits | Most; especially high
levels in Pineapple Apricot Raspberry Loganberry Cherry Dates Dried currants Raisins |
Banana
Pears (peeled) Pomegranate Mango Papaya Golden Delicious apple |
| Vegetables | Most; especially high
levels in Cucumber Gherkin Olives Endive Potato skin Sweet corn Sweet potatoes |
Cabbage (green)
Cabbage (red) Brussels sprouts Bean sprouts Celery Leeks Lettuce Peas Potato (skin has a high level) Bamboo shoots (canned) Chayote squash Shallots |
| Nuts | Almonds
Brazil nuts Macadamia nuts Peanuts Pine nuts Pistachios Walnuts Water chestnuts Coconut |
Cashew |
| Beverages | Coffee
Tea Cola drinks Peppermint tea Fruit juices Most alcoholic drinks |
Gin
Vodka Whiskey Cocoa (powder) Decaffeinated coffee powder Oval tine powder Camomile herbal tea (bag) |
| Confectioneries
and Sweeteners Flavorings, Condiments, and Sauces |
Honey
Licorice Peppermints Yeast-rich products Marmite Stock cubes Tomato sauce Worcestershire sauce |
Granulated sugar Maple syrup
Soy sauce Malt vinegar |
| Other | Processed foods Instant (prepared) meals | |
| Meats and Fish | None | Meat
Fish Shellfish Eggs |
| Milk and
Milk Products |
None | Milk
Cheese |
| Grains
Legumes: Dried Peas and Beans |
None
Broad beans (fava beans) |
Wheat
Rye Oats Barley Rice Yellow split peas Brown beans Soy beans Mung beans Lima beans Green split peas Chick peas Brown lentils Red lentils Black-eyed peas |
Table The salicylate-restricted diet
| Type of Food | Foods Allowed | Foods Restricted |
| Milk and
Milk Products |
• Plain milk, buttermilk, cream,
sour cream, and yogurt • All plain uncolored cream cheese, cheddar, mozzarella, cottage cheese, Quark • Parmesan • Additive-free ice cream made with allowed ingredients • Butter |
• Chocolate-flavored milk
• Milkshakes • Flavored yogurt • Prepared - Cheese foods - Cheese slices - Dips - Spreads • Other ice cream and frozen treats |
| Breads and
Cereals |
• Any pure flour or grain except
cornmeal • Any prepared, plain bread, buns, biscuits, pizza dough with allowed ingredients • Homemade or purchased baked cookies, pies, etc., made with allowed ingredients • Prepared breakfast cereals with allowed ingredients • Oats and oatmeal • Red River Cereal • Plain oat bran • All plain grains and their flakes, except cornmeal • Plain crackers such as - Grissol Melba Toast - RyVita - Rye Krisp - Wasa Light or Golden Crackers • Homemade crackers • Plain pasta • All homemade crackers, cereals, and pasta dishes with allowed ingredients • Plain and wild rice • General Foods Minute Rice |
• Products made with restricted
items • Cornmeal • Crackers with color, flavor, or restricted ingredients • Read labels on all packaged crackers • Pasta or rice dinners |
| Vegetables | • Bamboo shoots, canned
• Beans, fresh, green • Brussels sprouts, fresh • Carrots, fresh Cauliflower, fresh Celery, fresh Cabbage, green, fresh Cabbage, red, fresh Corn, niblets, canned Corn on the cob Leeks, fresh Lettuce Mushrooms, fresh Onion, fresh Peas, green, fresh Potato, white, peeled, fresh Pumpkin, fresh Shallots, fresh Spinach, frozen Tomato, fresh Turnip, fresh Watercress, fresh |
All others |
| Fruit | Apple, Golden Delicious
Banana, fresh Figs, fresh Figs, kadota, canned Lemon, fresh Mango, fresh Papaya (pawpaw) fresh Passionfruit (granadilla), fresh Pear, Bartlett, canned Pear, Packham, peeled, fresh Pineapple juice Pomegranate, fresh Rhubarb, fresh |
All others |
| Meat, Poultry,
and Fish |
All pure fresh, frozen, or
canned meat, poultry, or fish Processed meat made with allowed ingredients |
• Processed with restricted
ingredients, such as spices |
| Eggs | All | • All prepared with restricted foods |
| Legumes | Black-eyed peas
Brown beans Brown lentils • Chickpeas (garbanzos) • Green split peas • Lima beans • Mung beans • Red lentils • Soy beans • Yellow split peas • Pure, natural peanut butter |
All others |
| Nuts and
Seeds |
• Brazil nuts, fresh
• Cashew nuts, fresh • Coconut, dry, desiccated • Hazelnuts, fresh • Macadamia nuts, fresh • Pecan nuts, fresh • Pine nuts, fresh • Pistachio nuts, fresh • Poppy seed, dry* • Sesame seeds, dry • Sunflower seeds, dry • Walnuts, fresh |
• All other nuts and seeds
• Any with spices or seasoning |
| Fats and Oils | • Pure butter, cream,
shortening • Pure vegetable oils including canola, olive, sunflower, soy, peanut • Homemade salad dressings with allowed ingredients • Lard and meat drippings • Homemade gravy with allowed ingredients |
• Margarine
• Prepared salad dressings with restricted foods • Commercial gravies and sauces |
| Dry Spices
and Herbs |
• Allspice, dry powder
• Basil, dry powder • Bay leaf, dry leaf • Caraway, dry • Cardamom, dry powder • Chili, powder and flakes • Cloves, whole, dry • Fennel, dry powder • Nutmeg, dry powder • Paprika, sweet, dry powder • Pepper, black and white, dry powder • Saffron |
• All others
• Seasoning salts • Flavoring extracts • Flavoring packets • Any product labeled with “spices” |
| Herbs and
Seasonings |
• Chili peppers, green, red
and yellow, fresh • Chives, fresh • Coriander, fresh leaves • Dill, fresh • Garlic, fresh bulbs • Ginger root, fresh • Horseradish |
All others |
| Sweets and
Sweeteners |
• Sugar, molasses
• Maple syrup, corn syrup • Icing sugar • Pure jams, jellies, • Marmalades and conserves made with allowed fruit and without added color or flavor • Plain artificial sweeteners • Homemade sweets with allowed ingredients |
Honey
Prepared dessert fillings Prepared icings and frostings Spreads with restricted foods Prepared candies Cake decorations Other confectionery Commercial candies Fruit Rollups Fun Fruits Fruit peel Glace fruit Flavored syrups Licorice Peppermints |
| Other | • Baking powder
• Baking soda • Cream of Tartar • Distilled white vinegar • Malt vinegar • Baking chocolate • Pure cocoa • Plain gelatin • Pure vanilla extract • Relishes with allowed ingredients • Black and green olives • Pure soy sauce made with allowed ingredients • Vegemite and Marmite |
Whipped toppings
Topping mixes All other vinegars with “flavorings Chocolate candy, sprinkles, and syrup Flavored gelatin Prepared pickles Other relishes Worcestershire sauce Mustard |
| Beverages | • Plain and carbonated
mineral water • Plain coffee • Ovaltine powder • Tetley tea • Twinings teas: - Lemon-scented - Irish Breakfast - English Breakfast - Orange Pekoe • Indian/Burmese green tea • Jasmine tea • Rosehip herbal tea • Chamomile herbal tea* • Alcohol: - Sherry - Dry vermouth - Hennessey Brandy - Smirnoff Vodka - Johnnie Walker Whiskey - Gilbey’s Gin |
All other carbonated drinks and
soft drinks Flavored coffee and coffee mixes • Other teas • Fruit-flavored powders and concentrates • All drinks with color, flavor or spices • Diet drinks and diet shakes • Meal-replacement drinks • Liqueurs and coolers • Drink mixes and pre-mixed drinks |
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