So “Low Salicylate Diets Don’t Work”? My Thoughts on a Recent Study

You've got to love the humble, low salicylate pear (ripe and peeled, mind!)

You’ve got to love the humble, low salicylate pear (ripe and peeled, mind!)

Below are my initial thoughts on this study: Salicylate Elimination Diets In Children: Is Food Restriction Supported by the Evidence? by Gray and Mehr et al. 2013. This study was published in the Medical Journal of Australia a couple of weeks ago by a group of Paediatric Immunologists. Their topic was the Salicylate Elimination Diet, (read official study summary and other comments here).

After this is a copy of a comment I made online in response to the study’s disappointing conclusions. As you know from my Food Intolerance posts, this low food chemical diet plays a crucial role in keeping my family healthy and happy.
“Harm” and Further Assumptions
1. In short, the study set out to assess whether a short term elimination diet containing low salicylate foods was beneficial for a range of symptoms including things like Behaviour Disturbance and Eczema.
These are the precise symptoms that have prompted many (thousands) of us to live on the Failsafe diet which is a diet low in sals (salicylates)  and also frequently low in other food chemicals. By the way, it is quite normal for the food sensitive to have numerous food sensitivities, or to discover more sensitivities, once one is diagnosed.
2. The authors highlighted that they had a highly biased sample from the outset.
Hmm. This doesn’t bode well for particularly transferable study findings now does it? But that’s OK, many studies have a bias and it’s important to note that. However, such biases can significantly decrease the overall utility of a study and can even in some circumstances raise  questions on why the study was conducted in the first place. I’m not saying that Grey et al. shouldn’t have bothered doing this study even though I disagree with part of their conclusions, I’m actually glad they did conduct this study, for reasons you will see below.
3. The authors expressed that they could find no peer reviewed evidence stating that low sals diets are beneficial for these symptoms yet certain clinics in NSW prescribe these diets for their patients.
This is true to a certain extent, there is little recent research done in this area. The ‘clinics’ referred to in NSW is of course, the RPAH Allergy Unit and this study from my perspective at least, appears to be  directed to the Unit (the conclusion openly challenges the prescribers of the diet to publish their findings/evidence base). However, I wonder whether this may have a positive outcome. I’d love the RPAH to publish their recent findings/case studies anything really so that the whole world can see what incredible, life changing work they are doing and  so grant them the recognition they deserve. I would also love their treatment philosophy to be adopted worldwide by other immunologists, paediatricians, dieticians and for providers in the Primary Health Care sector to be receive education on this topic. But this can’t happen without recent publications and a demonstrated, solid evidence base.
4. The conclusion of the study was that a low salicylate diet was not proven to be beneficial – in their sample.
OK fine, since we know their sample was biased and small, this really is no big deal. The big deal follows thus:
5. The authors then went an extra mile and proposed that low salicylate diets can be ‘harmful.’ They claimed that ‘harm’ could occur if children and teenagers are on these diet for long periods.
I struggle with this. I am happy to concur that there is little recent evidence base for the low sals diet, but where is their evidence base to make such a claim that ‘harm could occur’ if it is continued for long periods of time? I have two issues to raise here:
  • I’d argue quite the opposite, the hardest part of switching to a low sals diet or any big dietary change is the first few weeks/months. If you’re talking about ‘harm’ this is where you may find it as people do struggle with change. I know I did. However, after this initial adjustment period everything improves dramatically. Long term…The future is bright!
  • Secondly, do they have any studies to refer to in order to back up this claim? The answer of course, is no and this very claim is just as scientifically unverifiable as they claim the regular prescription of the low sals diet is, as treatment, for the various presenting symptoms.

Is Lowering Other Food Chemicals Harmful?

Something else that I found jarring in the comments on the study on the MJA Insight was that one professional said that by limiting low sal food, you will automatically end up eliminating other food chemicals. This stood out to me for three reasons: Firstly, as a Failsafer and strict follower of a low food chemical diet (and I’ll admit it, an evangelical advocate) …I have to say, YES! This is the whole point! Granted, there are many food intolerant individuals who can’t tolerate high sals but can tolerate amines and glutamates, but there are many of us who need to lower all food chemicals (as I said before, intolerances often don’t occur in isolation).
Secondly, if you just take a quick glance at the RRAH food chart, you can see many foods that are high in all three food chemicals are heavily processed. Surely, one would argue that it would be a good, not a bad or harmful thing to avoid heavily processed foods? It just so happens that some of the healthiest and nutrient dense foods (pulses, brussels sprouts, buckwheat and amaranth) are low in salicylates and other food chemicals. One could even argue that society would be healthier on a “low Sals” and low food chemical diet because they would be pushed to consume raw and nutrient packed super foods like this! My two and five year old get very excited by eating brussels sprouts: Fave Veggie. Just thought I’d slip that one in…
But thirdly, and most importantly, is the assumption that a diet, restricted for the purpose of lowering food chemicals, is inherently a bad thing. This is not ‘any old’ restricted diet but a diet specifically chosen and selected for this purpose.  Says who (and show me the evidence base)  that such a restricted diet  i.e chosen because it is low in sals AND all other food chemicals, is potentially harmful/damaging/a bad thing?  There are no studies that can demonstrate that a diet restricted for the purpose of lowering food chemicals is harmful  and it cannot be lumped together with ‘any other restrictive diet’; I find this point philosophically flawed and scientifically unsatisfactory.
The funny thing is, the diet that my children and I plus many failsafers live on is a heck of a lot healthier than any of these researchers can dream of! No processed food AT ALL, everything made at home with fresh, raw ingredients…limited yes, but tasty and highly nutritious.
The evidence IS out there, however it is purely anecdotal at this stage. This means it needs to be recorded and written up, and only then will it be deemed a sufficient evidence base, and quite rightly too, this is how science and medicine work: We need references! Ph.d anyone?
(My comments can be found on the Food Intolerance Network website along with many other responses from fellow Failsafers right here).

“…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.

Feel free to leave your own comments below, whether you agree or disagree 🙂

  6 comments for “So “Low Salicylate Diets Don’t Work”? My Thoughts on a Recent Study

  1. July 4, 2013 at 9:54 pm

    Great article Naomi. I would also love to see the RPAH publish more evidence. The original study seemed move like an opinion than a scientific examination of any kind! Totally agree that our kids (and families) eat far healthier than many of their peers!

    • Naomi R Cook
      July 5, 2013 at 1:52 am

      Thanks so much for taking the time to comment and it’s good to hear your own feedback.

      There is so much more I wanted to comment in depth on, like the almost hilarious title “Who Prescribes These Diets?” with a paragraph dedicated to clinics Sydney without actually naming the RPAH (go on, just spit it out!) . And then there was the throwing around of pretty important words like “eating disorders” and “alopecia” ( Baldness? From an elimination diet, Really??) but simply have no time. And what’s the point? Like you say, the study simply seems to be a formal way of putting their opinions forward and challenging fellow clinicians.

      I have asked the RPAH what their response was (as fellow health care worker and patient of their unit, I feel I/we have a right to know) but have not had a response from them on this matter even though I have heard back from them since (on other matters).

      The whole thing has a slight soap opera feeling to it, and it’s annoying. This diet and underlying philosophy dictate pretty much the ENTIRE health and wellbeing of my children and I. Like you, I am taking this study (and the fallout) very seriously.

  2. July 5, 2013 at 3:38 am

    Yes! Thanks, Nurse Naomi. I wish *they* could come and see what life is like with Sals… and without. And come and see what my kids are eating. There is no unconscious eating done in this house. Every bite is carefully considered for its chemical content and its nutritional benefit and balance. There is absolutely no harm being done here. Quite the opposite.

    • Naomi R Cook
      July 5, 2013 at 3:44 am

      That’s right! Thanks Frilly Pants, I really appreciate your comments here.

  3. Shirley
    July 11, 2013 at 8:30 am

    I’ve been recommended the RPAH diet and am worried about the amount of vegetables that I can’t eat!! I love vegetables and being Chinese and not able to eat my Asian greens, carrots, eggplant etc. is horrible! I already pretty wholesome diet with none of the premade packaged meals or chips or junk food. I flavour my meals with spices so I rarely use salt. So being told I am not able to eat what the bulk of dieticians consider healthy ie. diverse range and multi-coloured vegetables is more a step backward step in health and variety.

  4. Naomi R Cook
    July 12, 2013 at 12:26 am

    Hi Shirley, thanks for taking the time to leave your thoughts. Getting started with the RPAH Elimination diet definitely involves a complete head-change (my mum still finds it hard to accept that I can’t eat Olive Oil: “But it’s so healthy?” She says!). Sometimes though, stepping back from the “norms” can be very revealing…I hope you find your Elimination Period OK (at the end of the day, that is only supposed to be for a few weeks) before challenging yourself. After challenges, you may find that you are able to include Veggies from your traditional diet anyway, but you won’t know whether or not you react to them without removing them in the first place. Good luck and keep in touch.

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