Immunologists' knickers in a twist about salicylate elimination diets for children

In the current issue of the Medical Journal of Australia, a group of paediatric immunologists say, based on people attending an allergy clinic, that low salicylate diets are not supported by evidence and may be harmful. Their evidence is no better than the science they are attacking as they acknowledge "our cohort has an inherent selection bias and ... without a control group".

The Food Intolerance Network strongly supports the peer-reviewed publication of evidence regarding the effects of salicylates on health, behaviour and learning and acknowledges that more research needs to be published, particularly using dietary salicylates.

The Food Intolerance Network always recommends that for severe symptoms, diagnosed conditions or symptoms serious enough to consult a doctor, people should consult an experienced, supportive dietitian who can supervise a three week trial of the strict RPAH (Royal Prince Alfred Hospital) elimination diet. This diet is free of additives and low in salicylates, amines, glutamates, probably dairy free and in some cases gluten free as well, depending on your symptoms.

On the other side of the fence from the immunologists' report:

* Professor Robert Loblay, of the department of clinical immunology at Sydney's Royal Prince Alfred Hospital, and coauthors said that "with suitable guidance" salicylate elimination diets based on a single patient trial method were safe, could improve quality of life and that intake of nutrients by children on a low chemical diet was usually at or about the recommended daily amount. (Unfortunately their full article is only available to subscribers).

* Professor Geoff Cleghorn, professor of paediatrics at the University of Queensland, told MJA InSight that while the literature review had found no evidence of benefit from low salicylate diets, the researchers had drawn a long bow in linking the diets to harm.

* Dietitian Joy Anderson commented publicly:

"As a dietitian who uses the RPAH Allergy Unit Elimination Diet in my everyday practice, I can assure you that it does work brilliantly in the majority of cases, in infants (via mother's breastmilk), in children and in adults as well. However, it needs to be done properly. From what is written above, it sounds like people just do this on their own indefinitely. Saying that it is useless because of this is like throwing the baby out with the bath water. The diet should be supervised by an Accredited Practising Dietitian with experience in food-chemical intolerances and conducted as a test diet, for a limited period of time - usually only 3-4 weeks in duration. Occasionally it may go longer, but the dietitian ensures that nutrients are adequately compensated for. The challenges are then performed in a timely manner and the diet refined to be liberalised as much as possible, while only avoiding the problem foods long term. I have many, many satisfied clients who were fobbed off by other health professionals in the past, because they didn't 'believe' in food-chemical intolerance".

The Food Intolerance Network provides a list of supportive and experienced dietitians (email This email address is being protected from spambots. You need JavaScript enabled to view it.) who can supervise members through the elimination, challenge and reintroduction phases of the RPAH elimination diet, as in the following reader report:

"I am new to food intolerance but I have had my son to the doctors in the past (and just been fobbed off) for pains in his legs, tummy aches, stuffy nose, he over-reacts to situations with anger or tears and does not seem to sleep much ... One month later ... We have been to a dietitian from the list you sent. It was great advice as it really smoothes the way when having to deal with doctors and other govt. agencies - they are now very accommodating. We are into day five and I have already noticed the voice volume decrease and far less fighting between the two children." - failsafer, NZ

* Dumbrell et al asked (Med J Aust. 1978 Dec 2;2(12):548, 569-70) "Is the Australian version of the Feingold diet safe?" and concluded that "the mean intakes of all computed nutrients were above the recommended level in the Australian Dietary Allowances for both diets. The nutritional quality, in terms of the level and balance of nutrients in the elimination test diet, was superior to that of the normal diet. With proper dietary counselling, the elimination test diet is safe for use in the treatment of children .."

Comment from registered nurse and failsafer to MJA 22/6/2013

"...insufficient to prove any risk associated with the diets... harm may occur when children and adolescents are placed on such restrictive diets."

So, let me get this right: Risk can't be proven, yet in the same breath, 'harm' is basically listed as a potential risk?

'Harm' 'may' occur at any point in time, to any cohort, sample or group of individuals, children or teenagers.

How many preschoolers, due to fussy appetites are walking around with undiagnosed nutritional deficiencies, (iron, Vitamin D being the most obvious). What about eating disorders (including anorexia, as the authors have specifically highlighted), they too are an unfortunate but common feature of teenage years in our society. We also know - from evidenced based studies – that they tend to have multi-factorial (often non-food related) causative factors.

Now, the authors do admit they have a sample bias and no control group and so one might perhaps expect a less dramatized conclusion than the one that, in spite of itself, stretches to predict 'harm.'

I do however agree with their final point:

"We would invite any proponents and prescribers of the diet to produce evidence of the efficacy and safety for the disorders."

As a Registered Nurse and mother of a food sensitive family who have been on a low salicylate diet for 2.5 years (and are the healthiest we have ever been), I would love to see a secure evidence base for the sole purpose that more may benefit from the dietary changes that have transformed the lives of both myself and my children - Naomi (Read more of Nurse Naomi's experiences at http://nursenaomi.wordpress.com/2013/04/26/tangerine-tantrums-how-our-food-intolerance-story-began/)

* The last say ... goes to our readers

We've noticed a HUGE difference in our son's temper tantrums and violent tendencies! - Julie, NSW

We have been really pleased by the change in behaviour of our 8 year old son who is diagnosed with Aspergers (and ADHD). His oppositional tendencies in particular have markedly reduced. - Marg, by email

Our daughter is massively improved since we discovered you by googling 'explosive diarrhoea.' Love our happier little girl!! - Veronica from facebook group

We are day 6 into the elimination diet, and having amazing results. My son (8yrs) was diagnosed with Aspergers a few weeks ago and within days a lot of his symptoms are reducing. The meltdowns are nothing to what they were. Plus, the skin rashes are almost gone too, yet we are still working on the night time bed wetting – Nicole from facebook group

We've been on a low Salicylate diet for only a couple of weeks now and the change in my son is absolutely remarkable. For the first time this year he is having his first full day at school today. His attention-span and distractedness is still an issue, but to a lesser degree - Jo from facebook group

and see many more in a 71 page story collection about salicylates

Further reading:

http://fedup.com.au/factsheets/additive-and-natural-chemical-factsheets/salicylates

https://www.mja.com.au/insight/2013/22/salicylate-diet-claims-unconvincing

Salicylate elimination diets in children: is food restriction supported by the evidence? Paul E A Gray, Sam Mehr, Constance H Katelaris, Brynn K Wainstein, Anita Star, Dianne Campbell, Preeti Joshi, Melanie Wong, Brad Frankum, Karuna Keat, Geraldine Dunne, Barbara Dennison, Alyson Kakakios and John B Ziegler. Med J Aust 2013; 198 (11): 600-602. https://www.mja.com.au/journal/2013/198/11/salicylate-elimination-diets-children-food-restriction-supported-evidence

Feedback since this Breaking News appeared:

The proof is in the pudding so they say and [my son] is the pudding! - Amy

Low sals diet is "harmful"?? Who on earth did they pick for their sample? It certainly wasn't any of us! Nor any other of the thousands of very healthy, happy failsafers out there - Naomi

No one asked me here in NZ. I've been nearly 60 yrs trying to find out what was wrong with me. Even the immunologist couldn't help. Now I have energy to burn! - Di

Hmm bubble and squeak with rice popped chicken and pear crumble, for pudding . Philli and pear mountain wraps and boiled egg for lunch. Shocking diet. I would much rather eat processed ready meal with chips, coke and lcm bars for lunch. Ah throw a slush puppy in as well. Insert sarcasm. Yes this diet is limited but it is short term. Surely all of us are a diverse sample group with no bias other than wanting the best for our loved ones. You can keep your 5 veg 2 fruit wheat and processed marg. I will stick to my butter, pears, and cabbage – Carrie

Just skimmed their article now, it's HIGH time there was some decent clinical studies put forward, particularly in the light of these criticisms (can lead to eating disorders?!) and the emphasis on NSW being "where these diets happen" ie a stab at the RPAH. I wish the RPAH would do their own retrospective study. Why don't they??? It's been years since they published anything at all on their work and what they do is positively life changing, not "harmful" in the slightest. I must say this study has made me extremely angry - Naomi

They can come and study my violently sal intolerant kids. At 6 months, one of my sons cried for 8 hours after eating a small serve of mashed pumpkin. Even tiny amounts of mod sal foods like carrots and sweet potato brought on massive rashes and stomach aches. Wish sceptical people could see this stuff - Veronica

Google "PubMed urticaria salicylates" and there is actually quite a bit there - some is food intolerance and exclusion diet but not specifically food salicylates, some is specifically aspirin, but urticaria from food salicylates is there too eg http://www.ncbi.nlm.nih.gov/pubmed/6148685?report=abstract - Tracy

There are a few things that jump off the page to me, the definition of "harmful" is one and also the insinuation that elimination diets are linked to eating disorders. Do these "doctors" have any idea about the causative issues relating to eating disorders? Because from what I recall from the Mental Health side to my (nursing) degree, the evidence base clearly stated that they are very much linked to a myriad of non-food related issues – Naomi

Diet success stories include recovery from eating disorders after going failsafe. http://fedup.com.au/factsheets/symptom-factsheets/eating-disorders-and-food-intolerance. But I can see how an elimination diet done incorrectly or handled badly could trigger eating disorders in those at risk - Tracy

When faced with the alternative of taking mind altering drugs long term, I'll live with the small chance of minor nutrient deficiencies from a limited diet thanks. The failsafe diet as far as I know is actually quite a balanced diet if done properly - Lydia

This is the best thing i have done for my son . He is a new man. All I can say is that he eats 100% better and a well balanced diet than most kids I know - Tanya