Salicylate intolerance is a condition where the body reacts adversely to salicylates, natural chemicals found in plants, medications, and other products. These chemicals, produced by plants as a defense mechanism against threats like bacteria, fungi, and insects, can trigger a range of symptoms in sensitive individuals. This article explores salicylate intolerance, its symptoms, causes, and how a low salicylate diet can help manage the condition.
What is Salicylate Intolerance?
Salicylate intolerance occurs when the body reacts negatively to salicylates, natural compounds present in various plants. Salicylates protect plants from threats like disease, bacteria, fungi, and insects. While many people can consume salicylates without issues, some individuals experience adverse reactions.
Common symptoms of salicylate intolerance include:
- Airway inflammation and asthma
- Gastrointestinal (GI) inflammation
- Diarrhea
- Hives
Salicylate levels differ across foods, but they are commonly found in vegetables, fruits, nuts, spices, alcohol, coffee, and tea. While salicylates can cause problems for some, particularly those with mast cell activation syndrome (MCAS), recent research suggests they may possess anti-inflammatory properties. It's important to consult a healthcare provider to determine if a low salicylate diet is appropriate for you.
The Low Salicylate Diet
A low salicylate diet involves consuming foods with no or very low levels of salicylates to reduce symptoms of intolerance. The diet typically begins with eliminating salicylate-containing foods, followed by a gradual reintroduction to identify triggers. This process should be carefully managed with guidance from a healthcare provider.
Read also: The Hoxsey Diet
The goal of a low salicylate diet is to alleviate the symptoms of salicylate intolerance by minimizing the intake of these compounds. This often involves an elimination phase, where high-salicylate foods are removed from the diet, followed by a carefully monitored reintroduction to identify specific trigger foods. It is crucial to undertake this dietary change under the supervision of a healthcare professional.
Foods and Salicylate Levels
Many studies have analyzed salicylate levels in foods, but results can vary due to differences in testing methods, food processing, and source. The following list should be used as a general guide in consultation with your healthcare provider.
Fruits
- Negligible: Banana, Canned Pear (in sugar syrup), Nashi Pear
- Low: Apple (golden delicious), Apple (red delicious), Papaya
- Moderate: Avocado, Canned Pear (in natural juices/syrups), Cantaloupe, Blackberry, Pear (ripe and peeled), Paw Paw, Custard Apple, Grapefruit
- High: Apple (all other varieties), Lime, Lemon, Kiwi fruit, Blueberry, Loquat, Lychee, Boysenberry, Mango, Mandarin, Cherries (all other kinds), Passion fruit, Melons, Cranberry, Pear (w/peel), Mulberry, Currant, Persimmon, Nectarine, Date, Pomegranate, Peach, Grape, Rhubarb, Sugar banana, Guava, Fresh Tomato, Watermelon, Loganberry, Orange, Pineapple, Plum, Raisin, Raspberry, Redcurrant, Strawberry, Sultana, Tangelo, Tangerine, Tomato, Youngberry
- Very High: All dried Fruits, Canned or dried Fig, Canned Morello Cherries, Blackcurrant
Vegetables
- Negligible: Bamboo Shoots, Bean Sprouts, Cabbage (green or white), Celery, Lettuce (iceberg), Potato (old/white and peeled), Swede, Water Chestnut
- Low: Asparagus (trimmed), Alfalfa Sprouts, Beans (dried - not borlotti), Borlotti beans, Aubergine (peeled), Artichoke, Chicory, Green Split peas, Chickpeas, Chives, Green Beans, Leek, Radish, Mung bean sprouts, Parsnips, Sweet Potato, Watercress, Water Chestnut, Shallots, Snow Peas, Sweet corn, Turnip, Yellow split peas
- Moderate: Brussels Sprouts, Carrot, Endive, Gherkin, Mushrooms, Sprout, Zucchini
- High: Asparagus, Aubergine (w/peel), Cabbage (red), Broad Bean, Courgette, Green Peas, Okra, Potato (new and red Pontiac), Pumpkin, Tomato Products, Zucchini
- Very High: Beetroot, Champignon, Black Olives, Canned Asparagus, Broccoli, Chili peppers, Lentils (brown), Lentils (red), Fresh Tomato, Fresh Asparagus, Frozen Spinach, Eggplant, Peas (dried), Lettuce (other than iceberg), Fresh Spinach, Hot pepper, Marrow, Peppers, Radish, Onion, Potato (white w/peel), Shallots
Nuts & Seeds
- Negligible: Poppy seed
- Low: Desiccated coconut, Macadamia nuts, Pumpkin seeds, Sunflower seeds
- Moderate: Cashews, Pine nuts
- High: Almond, Hazelnuts
- Very High: Brazil nuts, Peanut Butter, Peanuts w/skins on, Pecan, Sesame seeds, Pistachio, Walnuts
Sweets
- Negligible: Carob, White Sugar
- Low: Caramel, Homemade Caramel, Maple Syrup
- Moderate: Chewing gum, Golden Syrup, Jam (except pear, preferably homemade)
- High: Fruit Flavors
- Very High: Molasses, Cocoa, Raw Sugar, Malt Extract, Honey, Honey Flavors, Liquorices, Mint flavored sweets, Peppermints
Seasonings, Condiments, Sauces & Toppings
- Negligible: Golden Syrup, Salt, Soy Sauce (if free of spices), White pepper, White Vinegar
- Low: Apple Butter (only if homemade from acceptable varieties of apples), Chives, Maple Syrup (pure), Mayonnaise
- Moderate: Fresh Coriander Leaves (also known as Chinese parsley), Horseradish, Fennel - dried, Parsley (except Chinese parsley also known as coriander)
- High: Aniseed, Malt Vinegar, Garlic, Cardamom, Cinnamon, Celery powder, Shallots
- Very High: All Spice, Bay leaf, Basil, Caraway, Black pepper, Cayenne, Cloves, Chili flakes, Coriander, Chili powder, Ginger, Cider vinegar, Mixed herbs, Commercial gravies and sauces, Mustard, Cumin, Pimiento, Curry, Dill, Fenugreek, Fish, meat, and tomato pastes, Garam masala, Ginger, Honey, Jam/Jelly (all commercial varieties), Mace, Marmite, Mint, Mustard, Nutmeg, Oregano, Paprika, Peppermint, Rosemary, Sage, Saffron, Tabasco, Tarragon, Thyme, Turmeric, Vegemite and other Yeast Extracts, Wine Vinegar, Worcestershire Sauce
Fats & Oils
- Negligible: Butter, Ghee, Copha, Coconut Oil, Canola Oil, Corn Oil, Safflower Oil, Soy Oil
- Low: Almond Oil
- Moderate: Sesame Oil, Olive Oil
- High: Margarine
- Very High: Peanut Oil, Walnut Oil, Sunflower Oil
Grains
- Negligible: Buckwheat, Cornmeal, Maize, Plain Oats, Polenta, Rice, Maize
- Low: Millet, Rice cereals (plain)
- Moderate: Barley, Corn/maize cereals
- High: Flavored breakfast cereals
- Very High: Breakfast cereals that include fruit, nuts, honey or coconut, Rye, Wheat
Meat
- Negligible: Beef, Chicken, Eggs, Fish, Lamb, Organ meats, Rabbit, Scallops, Tripe, Veal
- Low: Liver
- Moderate: Prawns
- High: Gravy made from prepared mixes, Seasoned meats (e.g. salami, sausages, frankfurters, and hotdogs)
- Very High: Fish canned in an unacceptable oil and/or with seasonings added, Processed luncheon meats, Sausage casing
Dairy & Soy Products
- Negligible: Butter, Cream, Milk, Yogurt (natural only)
- Low: Cheese (not blue vein), Goat Milk
- Moderate: Blue vein cheese, Rice Milk, Tofu
- High: Ice Cream
- Very High: Soy Milk
Baking Supplies
- Negligible: Arrowroot, Corn Syrup, Corn starch (also known as corn flour), Golden Syrup, Poppy seeds, Rice Flour, Sago, Sugar (brown, castor, granulated, icing, powdered), Tapioca, Wheat Flour
- Low: Sesame seeds
- Moderate: Malt
- High: Malt extract
- Very High: Soy Flour
Commercial Snacks
- Negligible: Plain potato chips (read the ingredient list), Popcorn
- Low: Apple chips (only if homemade rom acceptable varieties of apples)
- Moderate: None listed
- High: Fruit flavored candy, gelato, ices, popsicles, sherbet, and sweets
- Very High: Chewing gum (all flavors), Popping corn, Licorice (all flavors), Mint/peppermint/wintergreen flavored candy/sweets, Pickles (and anything pickled)
Beverages
- Negligible: Decaffeinated coffee, Dandelion coffee, Coco cola, Milk (goat and cow), Store bough pear juice, Water
- Low: Homemade Pear Juice, Rice Milk
- Moderate: Regular coffee, Ovaltine, Rose hip syrup
- High: All teas, Fruit and vegetable juices, Soy Milk
- Very High: Rose hip tea, Cordials and fruit flavored drinks
Alcohol
- Negligible: Gin, Liquor, Vodka
- Low: Cider
- Moderate: Whiskey, Beer
- High: Port
- Very High: Sherry, Wine, Brandy, Rum
Products That Often Contain Salicylates
Salicylates can be found in a wide array of everyday products, making it crucial to be vigilant about product labels. Common items that may contain salicylates include:
- Acne products
- Air fresheners
- Alka Seltzer
- Breath savers
- Bubble baths
- Cleaning products
- Cosmetics
- Detergents
- Essential oils
- Fabric conditioners
- Fragrances and perfumes
- Gums
- Hair sprays, gels, and mousses
- Herbal remedies
- Lipsticks and lip glosses
- Lotions
- Lozenges
- Medications
- Mouthwash
- Muscle pain creams
- Pain relievers
- Pepto-Bismol
- Razors with aloe strips
- Shampoos and Conditioners
- Shaving cream
- Skin cleansers or exfoliants
- Soaps
- Sunscreens and tanning lotions
- Supplements derived from rose hips or bioflavonoids
- Toothpaste
- Topical creams
- Wart or callus removers
Ingredients to Avoid
When managing salicylate intolerance, it's essential to be aware of specific terms and ingredients that indicate the presence of salicylates in products. These include:
- Acetylsalicylic acid
- Aloe Vera
- Any coal tar derived dye
- Artificial flavorings
- Artificial food colorings
- Aspirin
- Azo dyes
- Benzoates (preservatives)
- Benzyl salicylate
- Beta-hydroxy acid
- BHABHT
- Choline salicylate
- Disalcid
- Ethyl salicylate
- Eucalyptus Oils
- Isoamyl salicylate
- Magnesium salicylate
- Menthol
- Methyl Salicylate
- Mint
- Nitrates/Nitrites
- Octylsalicylate
- Oil of Wintergreen
- Peppermint
- Phenylethyl salicylate
- Red Dye (#40)
- Salicylaldehyde
- Salicylamide
- Salicylate
- Salicylic acid
- Salsalate
- Sodium Salicylate
- Spearmint
- Yellow Dyes (#5 & #6)
Common Drugs Containing Salicylates
It is important to consult with a pharmacist or doctor to determine if a medication contains salicylate. Never start an elimination diet without checking all medications and consulting a professional.
Read also: Walnut Keto Guide
Salicylates, Mast Cell Activation Syndrome, and Histamine Intolerance
People with Mast Cell Activation Syndrome (MCAS) often consider histamine intolerance, but intolerances to lectins, oxalates, FODMAPs, and salicylates can also be relevant. Salicylates can trigger mast cells, leading to inflammation and symptoms like abdominal pain, gas, ear ringing, trouble breathing, sinus issues, and asthma.
Salicylates can contribute to the "mast cell inflammation bucket," similar to histamine, oxalates, mold, toxins, chemicals, and other inflammatory foods. When this bucket reaches a threshold, mast cells become overactivated, causing a cascade of symptoms.
Causes of Salicylate Intolerance
Salicylate intolerance can stem from various factors:
- Excessive salicylate intake (food or supplements)
- Mold toxicity impairing detox pathways
- Nutrient deficiencies
- Oxalate issues
- Lack of sulfur in the diet
- Inflammatory mast cell mediators like histamine
Mold toxicity can lead to salicylate intolerance because the body prioritizes detoxifying mold toxins, leaving fewer enzymes to break down salicylates. Additionally, mold toxicity can increase oxalate levels, further depleting sulfur, which is needed for salicylate detoxification.
The Oxalate-Salicylate Intolerance Link
Oxalates, found in many plant foods, can also contribute to salicylate intolerance. They use up sulfur in the body, reducing the sulfur available for detoxifying salicylates. It's important to address oxalate issues carefully under the guidance of a healthcare practitioner.
Read also: Weight Loss with Low-FODMAP
Low Salicylate, Low Histamine Foods
For individuals managing both salicylate and histamine intolerance, the following foods are generally considered safe:
- Fruits: Golden Delicious apples (peeled), Red Delicious apples (peeled), Fresh Figs, Loquat, Mango, Passion Fruit, Lemon (½ teaspoon, if tolerated), Lime (½ teaspoon, if tolerated)
- Vegetables: Asparagus, Bean Sprouts, Brussels Sprouts, Cabbage (green/white), Red Cabbage, Carrots, Cauliflower, Celery, Chives, Dried Green Split peas, Leeks, Lentils (Brown & Red - keep below ½ cup cooked), Lettuce (iceberg), Other Lettuce, Onion, Rutabaga / Swede, Shallots, Turnip, Yellow Split Peas
- Nuts and Seeds: Dried Coconut (can be a little higher histamine), Pecans, Poppy seeds, Sesame Seeds, Sunflower Seeds
- Sweeteners: Maple syrup (small quantities only)
- Seasonings: Chives, Cilantro / Fresh Coriander Leaves, Fennel, Garlic, Parsley - Flat Leaf, Poppy Seeds, Saffron, Sea Salt, Shallots
- Oils and fats: Grass Fed Butter, Cold Pressed oils such as sunflower, Grass Fed Ghee
- Grains & Starches: Brown Rice (limit due to higher oxalate), Buckwheat, Cassava, Millet (limit due to higher oxalate), Oats (limit due to higher oxalate), White rice
- Meat, fish, poultry, and eggs: Freshly cooked meat (except beef) or poultry (Pasture-raised is best), Bison (not ground), Chicken, Duck, Eggs (if tolerated), Goose, Lamb, Liver, Ostrich, Pork, Quail, Rabbit, Salmon (gutted and frozen within 30 minutes of catch), Turkey
- Dairy: Butter (if tolerated), Cream - Grass Fed (if tolerated)
Research on Low Salicylate Diets
A study involving 30 patients with NSAIDs hypersensitivity found that a personalized low salicylate diet (PLSD) significantly improved symptoms of asthma, rhinosinusitis, and urticaria. The intensity of symptoms was measured before and after the dietary intervention using the asthma control test (ACT), the sino-nasal outcome test (SNOT-22), and the four-item itch questionnaire (FIIQ). The intake of salicylates decreased from 0.79 mg/day (before intervention) to 0.15 mg/day (during intervention).
Diagnosing Salicylate Intolerance
Currently, there are no definitive laboratory tests for salicylate intolerance. Diagnosis typically involves a detailed medical history, food and symptom diary, and potentially an elimination diet under the guidance of a healthcare professional.
Important Considerations
- Consult a Healthcare Professional: Before making drastic dietary changes, consult a doctor or registered dietitian.
- Avoid Unnecessary Restrictions: Salicylates have health benefits, so avoid restricting them unless necessary.
- Monitor for Deficiencies: Restrictive diets can lead to nutritional deficiencies, so monitor your nutrient intake.
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