Low Salycilates Diet
by Sue Kira, Naturopath & Clinical Nutritionist
Salicylates pronounced ‘suh-lis-alates’ are an organic compound containing salicylic acid which is the main ingredient in ‘Aspirin’. I remember back in the late 70’s in a chemistry lab when I studied pathology that the first thing we made was Aspirin, or rather Acetylsalicylic Acid. It was rather fun, mixing salicylic acid, acetic anhydride, sulphuric/sulfuric acid, water, and ethanol.
It was amazing to think that the gooey, stringy mess we made was the core of a powerful painkiller, anti-coagulant and anti-inflammatory drug, so widely used by many medical professionals and their patients. History tells us that it was first discovered 150 years ago by a guy chewing on willow bark (naturally high in salicylates) and found it relieved his pain and the story went on from there.
Today, salicylates are used by the cosmetic industry in many beauty products, also by the cleaning industry, and the pharmaceutical system in many drugs. In plants, salicylates are a natural occurring substance that offers the plant protection against bacteria, fungi, insects, and many diseases. We know that salicylates can have a very important role in the life of plants and humans alike, but there are many people who are intolerant, sensitive, or even allergic to this chemical.
Salicylates are toxic for everyone at high doses and most cases of toxicity relate to the drug form rather than reactions from foods. But even at low doses in food, this chemical can cause issues for many.
There is still much research to be done in this area of sensitivity, but it has become common knowledge to avoid salicylates for those with asthma or gastrointestinal problems. More recently, studies have been trialled in the use of a low salicylate diet for autism support.
As an overview, salicylates are predominately found in certain plant matter e.g. fruit, vegetables, herbs and spices. Fresh meat and seafood sourced foods are low in salicylates.
Typical reactions to salicylates are respiratory or gastrointestinal related, but other symptoms related to salicylate sensitivity can include any of the following:
- Anxiety, depression, panic attacks
- Asthma, persistent cough, frequent throat clearing, nasal congestion, sinusitis, runny nose, nasal polyps
- Changes in skin colour, especially red patches of skin like red cheeks and dark circles under eyes are common reactions
- Behavioural problems such as restlessness, inattention, irritability, hyperactivity, oppositional defiance
- Headaches and/or migraines
- Swelling of face and/or lips (angioedema), hands, feet, eyelids
- Fatigue, especially after eating
- Sore, itchy, puffy or burning eyes
- Irritable bowel symptoms – reflux in babies or adults, nausea, vomiting, stomach bloating and discomfort, wind, diarrhea and/or constipation
- Itchy skin rashes such as hives (urticaria), eczema and other skin conditions
- Bedwetting, incontinence, cystitis
- Sleep disturbances – difficulty falling asleep, sleep apnea, night terrors, frequent night waking, insomnia
- Rapid or irregular heartbeats, arrhythmias and/or tachycardia
- Tinnitus (ringing noise in ears), hearing loss, hyperacusis (increased sensitivity to certain frequencies and volume ranges of sound)
- Joint pains, muscle aches, arthritis
How do I know if I’m sensitive to salicylates?
To start with you will probably have one or more of the above symptoms, but they can also apply to other conditions, so how do you really know if you are sensitive to salicylates?
Unfortunately, there is no medical test to see if you have a salicylate sensitivity, so the only way to know for sure is to exclude salicylates from your diet for a few weeks (yes it can take that long to know) and then gradually reintroduce (re-challenge) various foods to see if symptoms return.
It’s a bit tricky because it can take some time to clear the build-up of salicylates from your body and can also take some time for sensitivities to re-occur in your body. But with careful monitoring with your health practitioner, you will be able to see if salicylates are an issue or not.
Salicylate sensitivity can be related to other issues. By addressing these issues, many people removed their sensitivity to salicylates.
Over the years I’ve had many clients with salicylate sensitivity. When their leaky gut was healed and intestinal bacteria balanced, they could eat their favourite salicylate foods again (in moderation).
Other causes can be via inflammation pathways, so taking anti-inflammatory zinc (and other nutrients as needed) can reduce the severity of the sensitivity. Take care to not use turmeric as an anti-inflammatory because it is naturally high in salicylates.
Also note if you use fish oil as an anti-inflammatory, some find fish oil helps with salicylate sensitivity by reducing reactions, especially itchy skin, but others find it makes their symptoms worse. This is often due to fish oil’s high amine content. Others react to salicylates added to fish oils to minimise the fishy taste, such as lemon or other flavourings.
Some of my clients weren’t aware that they had a sensitivity to salicylates until I prescribed a herbal tonic blend for them which they reacted to. Because most herbs, especially pain relieving and anti-inflammatory herbs, contain a high level of salicylates it is quite common for people to react to salicylates in a tonic. By reducing dietary salicylates, using different healing aids, and allowing the body to heal itself within this positive environment, the salicylate sensitivity commonly goes away.
Sensitivity to salicylates can be triggered or made worse by certain medications, especially Aspirin, other NSAIDs (non-steroidal anti-inflammatory drugs) like Nurofen, anti-arthritis drugs and creams, teething gels, and natural salicylates in many herbal preparations. An adjustment in medication often makes all the difference, and then many find that foods high in salicylates are no longer an issue.
Check with your doctor, health practitioner or chemist if you are unsure if your medication contains salicylates.
Temporary antidote to salicylate reactions
As a temporary antidote for salicylate and other food chemical reactions you can use one teaspoon of sodium bicarb powder in a glass of water (half this dose or less for children under 12). You should feel better within a few minutes and the effect may last for about an hour. This is not recommended for regular use, as it will not only help clear food chemicals such as salicylates but will also increase excretion of other nutrients your body needs.
It is best to check with your practitioner if this is suitable for you to do. It’s better to get to the source of the problem than continue to antidote, as long-term use of bicarb is detrimental to your health. Those prescribed a low sodium diet or who have a heart condition should not do this without first getting medical advice.
Much research has been done on various conditions that have been well supported by a low salicylate diet, so if you have one of the following conditions or any of the symptoms mentioned previously, then it might be worthwhile to try the low salicylate diet.
Autism spectrum disorders and behaviour problems
Possibly due to certain genetic metabolic defects, many kids and adults with autism or behavioural problems are commonly sensitivity to salicylates. Many families found a low salicylate diet (along with other required intervention and support) made a considerable difference to their lives.
Many different types of auto-immune diseases have been supported by a low salicylate diet, but of particular importance are conditions like Celiac, Crohn’s, Ulcerative colitis, Hashimotos, Grave’s disease and others.
Diabetes and Insulin sensitivity
Diabetes is another auto-immune disease that can benefit from a low salicylate diet, but even simple blood sugar imbalance issues and insulin sensitivity can be helped with this diet.
There’s a chicken or egg situation here, because many say that salicylate sensitivity is because of leaky gut. If you have leaky gut, then you will very likely also have sensitivity to salicylates.
Another chicken and egg dilemma as many say that inflammation creates leaky gut which then creates salicylate sensitivity. But conversely, if you have a salicylate sensitivity then chances are you will have more inflammation in your body as a result.
If you have poor nutrient balance it may be due to consuming low-quality foods, but in many cases it is due to disturbances in the gut in the first place such as leaky gut, damaged micro-villi, inflammation, and food sensitivities.
Salicylates can be easily absorbed through your skin and via your lungs through inhalation, so it is best to remove any additional sources of salicylates around the home while you are on the low salicylates diet, and possibly avoid them altogether to avoid future sensitivity.
The following items often contain salicylates:
- Aspirin and all non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Neurofen are high in salicylates. Tylenol can be a low salicylate option.
- Seed & nut oils, aloe vera, bioflavanoids such as quercetin, ginseng, menthol, St. John’s Wort (Hypericum), geranium essential oil and other flower & plant oils, rose hips, camphor and castor oil are all high in salicylates.
- Vitamin supplements from ‘natural’ sources are commonly high in salicylates whereas the ‘nature identical’ ones are often ok
- Cosmetics and personal care items should have labels checked (things like plant oils and fragrances). If in doubt, leave them out.
- Arthritis creams generally contain high levels of salicylates (wintergreen, salicylic acid, camphor etc) as do sunless tanning products and sunscreens.
- Lip balms except for 100% Ultra Pure organic anhydrous lanolin with no preservatives, or unflavoured bees wax, are good options
- Acne medications, facial cleansers and astringents often contain salicylates.
- Many shampoos, conditioners and hair styling products contain salicylates.
- Anti-dandruff shampoos
- Avoid salicylic acid compounds, selenium sulphide/sulphide and coal tar.
- Wart and callous removers contain salicylates, as do mouthwashes and other gum care products. Alternatively brush your teeth with a paste made from baking soda and water and floss with unflavoured, unwaxed dental floss.
- Pepto Bismol & Alka Seltzer (antacids) are very high in salicylates
- When gardening, wear gloves and cover any portion of the body that might contact plants as many have salicylates.
- Air fresheners, cleaning products, bubble bath, detergents, fragrances, perfumes, hairspray, mouse, gels, lotions, shave cream, soap & others
General rule of thumb guides:
- Salicylates are highest especially in the skin and just under the skin.
- Generally, salicylates are concentrated in foods by processing, such as in powders, fruit or vegetable juices, pastes, sauces (esp. tomato), jams, syrups, and flavourings.
- Salicylate levels are also increased in genetically engineered plants that have greater resistance to disease, compared to non-hybrid original plants such as ‘heirloom’ types that are often quite low in salycilates by comparison.
- The highest levels of salicylates are found in things like liquorice and mints, so avoid chewing gum, mints and lollies/sweets, especially breath freshener types.
- Be aware of packet and processed foods, read all labels and avoid preservatives, colours (especially red, yellow and blue) and flavours.
Note: there does seem to be some discrepancies with levels of salicylates in foods, so it is very important for you to feel if your body reacts or not.
Most fruits have quite high levels of salicylates, especially dried fruits, pineapple and berries. Try to avoid most fruits except fresh, peeled and cored pears, golden delicious apples, Nashi pears, and small amounts of ‘just ripe’ banana and papaya/pawpaw. Read all labels to avoid foods sweetened with fruit juice. Keep fruit to no more than two pieces per day with one being pears or golden delicious apples.
Most vegetables are low in salicylates and if you peel and cook them this helps to remove some of the salicylates. Choose only fresh or frozen veggies, or canned with no added ingredients other than water or salt.
Avoid the nightshade vegetables. These include: cooked tomato and products made from tomatoes (some can tolerate fresh tomatoes in small amounts); eggplant/aubergines; capsicum/bell peppers; chilli and paprika. Potato (white potato peeled & cooked are generally fine, but keep quantities minimal).
Some suggest avoiding other vegetables such as canned mushrooms (fresh in small amounts are fine), cucumbers, radishes, zucchinis (peeled are fine) and broccoli. See the comprehensive list below of the low, medium, high, and very high salicylate vegetables. Vegetable powders seem to be mostly high in salicylates – even if the fresh vegetable is fine e.g. celery, tomato or onion powders are high.
Animal proteins have the least amounts of salicylates. This means that any meats, poultry, fish and eggs are fine. However, eggs can be a reactive issue for other reasons, so care still needs to be taken, especially the ‘whites’ which are high in histamines/amines (other food chemicals) and many people are allergic to eggs, independent of salicylate sensitivities.
Legumes, nuts, seeds and grains
These are generally within the acceptable range of salicylate content, with the exceptions of almonds, water chestnuts, and peanuts. Rice is usually quite low reactive and is a great low salicylate starch to use.
Herbs, spices and seasonings
Use sea salt to avoid salicylates. Most herbs and spices contain varying amounts of salicylates. Some can tolerate white pepper and small amounts of the herbs parsley and coriander/cilantro fresh, not dried. GF soy sauce or tamari is quite low, and so is GF tandoori. Malt vinegar is low but white vinegar is very high. I couldn’t find anything on apple cider vinegar.
Saffron has no salicylates. Spices like curry powder, cumin, aniseed, celery powder, cinnamon, chilli, paprika and cayenne pepper are all very high in salicylates. To give you an idea of scale – white pepper, which is considered borderline to use sparingly, has 1.1mg of salicylates per 100g (3.5oz), yet curry powder has a whopping 217mg per 100g (3.5oz). Spices are usually used sparingly, but it all adds up. By comparison, a golden delicious apple has 0.08mg per 100g (3.5oz)
Avoid all juices, as they have concentrated salicylates (diluted home-made pear juice can be ok in small amounts). Avoid soft drinks/sodas because of the artificial colours and flavours. Most alcoholic drinks are high in salicylates, not to mention that alcohol itself is quite toxic and should be avoided during any healing program.
Decaffeinated teas (not herbal) and coffees appear to be OK, provided they aren’t flavoured or contain chicory. Interestingly when tested, chamomile tea was quite low in salicylates. Water is always the best choice.
Avoid: avocados and avo oil; almonds and peanuts and their oils; mayonnaise; olives and olive oil; and salad dressings. Better to use lard, duck fat, chicken fat, rice bran oil or small amounts of coconut oil if tolerated. Cashews and pecans are quite low.
Honey is high in salycilates (this can vary depending on the type) but sugar, rice bran syrup, golden syrup and maple syrup are all low in salicylates. Cacao and carob are low but it depends if there are any additives.
For good references on exact levels of salicylates in foods, the Royal Prince Alfred Hospital (Friendly Foods) has a very comprehensive list on their website. Also, Sue Dengate’s Failsafe diet, book and website have some great information.
Additives, preservatives, synthetic antioxidants and flavour enhancers
Most additives are high in salicylates and should be avoided as much as possible. Those highest in salicylates are:
- 102 tartrazine
- 104 quinoline yellow
- 110 sunset yellow
- 122 azorubine
- 123 amaranth
- 124 ponceau red
- 127 erythrosine
- 129 allura red
- 132 indigotine
- 133 brilliant blue
- 142 green S
- 143 fast green FCF
- 151 brilliant black
- 155 chocolate brown
- Natural colour 160b annatto (160a is a safe alternative)
- 200-203 sorbates (in margarine, dips, cakes, fruit products)
- 210-213 benzoates (in juices, soft drinks, cordials, syrups, medications)
- 220-228 sulphites (dried fruit, dried vegetables, fruit drinks and sausages)
- 280-283 propionates (in bread, crumpets, bakery products)
- 249-252 nitrates, nitrites (in processed meats like ham, bacon)
- 310-312 gallates
- 319-320 TBHQ, BHA, BHT (306-309 are safer alternatives)
- 621 MSG, hydrolysed vegetable protein, yeast extract, 130 other names
- 627, 631, 635 disodium inosinate, disodium guanylate, ribonucleotides
- Strong flavours in many foods and children’s medicines (vanilla is safest)
Low salicylate vegetables
- Potato white peeled (not new or baby potatoes)
- Lettuce iceberg, the whiter leaves best
- Bamboo shoots tinned or fresh
- Bean shoots from mung beans, very fresh only
- Brussel sprouts fresh or frozen
- Cabbage red, green and Chinese
- Shallots/spring onions
Medium salycilates vegetables
- Bok choy
- Cucumber – peeled
- Green peas, snow peas, sugar snap peas (pea sprouts are high)
- Lettuce – cos, red, green coral, red, green oak, mignonette
- Pak choy
- Potato – all types (white potatoes are low salicylate)
- Pumpkin – squash type
- Sweet potato, kumara
- Zucchini peeled
High salicylates vegetables
- Alfalfa sprouts
- Broccoli and Broccolini
- Chinese broccoli – Gai lan
- Cucumber with peel
- Fennel (small amount of fennel seeds spice ok)
- Parsley (small amount as herb flavor is usually ok)
- Pumpkin – grey, Kent, Jap
- Radicchio lettuce
- Tomato fresh, peeled and sliced
- Water chestnut
- Zucchini with peel
Very high salicylate vegetables
- Broadbeans, fava beans
- Capsicum green, red, yellow
- Choy sum
- Eggplant, eggfruit, aubergenes
- Kang kong Chinese spinach
- Pickled vegetables, olives, cucumber, pickled onions, gherkins, sauerkraut
- Most herbs & spices (coriander & small amount of parsley is fine)
- Mustard greens
- Tomato dried, sun-dried, juice, puree, paste, sauce
- Vegetable juice, stock cubes, stock liquid, stock powder
Low salicylate fruits
- Pears fresh and peeled
- Pears canned in syrup (not juice as juice concentrates salicylates)
Medium salicylate fruits
- Apples peeled – Golden Delicious, Red Delicious
- Nashi pears peeled
High salicylate fruits
- Apple Bonza, Fuji, Gala, Granny Smith, Jonathan, Pink Lady, Sundowner
- Custard apple
- Dragon fruit
- Feijoa Guavasteen
Very high salicylate fruit
- Berries – all types
- Citrus – all (some reports say citrus is low and some say they are high. So?)
- Dried fruit – any type
- Fruit confectionery, ices, drinks, cordials, juices and teas
- Fruit flavourings, jams and jellies
- Kiwi fruits
There is no definitive length of time to be on a Low Salicylate Diet. This will depend on numerous factors, best determined in consultation with your health practitioner.
Before you commence your diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
During the early stages of a new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.