Title: Low salicylate diet
Key words: cancer, eczema, hyperactivity, salicylates, urticaria
Date: April 2001
Category: Special diets
Author: Dr M Draper
Low salicylate diet
Clinical indications to implement a trial of a low salicylate diet
Salicylates are naturally occurring substances, present in the barks of trees and the skins of fruit and vegetables. They appear to be produced by the plants as a response to injury. There may, therefore, be higher levels present in organically grown produce, which tends to have more blemishes and signs of insect or other damage.
Aspirin (acetylsalicylic acid) was first produced from the bark of the Willow tree, though it is now manufactured in bulk by chemical synthesis. Aspirin is used extensively as a pharmaceutical agent in the primary and secondary prevention of stroke and heart attacks, as an anti-inflammatory agent and for the relief of mild pain. Aspirin (and perhaps the naturally occurring salicylates) also appears to protect against cancer (through COX2 enzyme inhibition). Various trials are in progress to evaluate the effect of aspirin, with or without other dietary modifications e.g. prebiotics or resistant starches, on the risk of developing cancer (e.g. colon cancer).
There is evidence that animals will forage for foods containing high levels of salicylate - and we should, therefore, only exclude them when there are other benefits being sought and, if possible, for a short period only.
Why exclude salicylates from the diet?
There are certain groups of people, such as those who become sensitive to aspirin, who may benefit from a reduction in the salicylate content of the diet. These groups include:
(1) Children with hyperactivity
(2) Children or adults with eczema, when there is a sudden flaring up with an urticarial component to the eczema (a history of exacerbations after curry may be a clue.).
(3) Chronic Urticaria patients. A skin condition characterised by skin lesions that resemble nettle stings (Urtica Urens) which come and go relatively quickly.
(4) Irritable Bowel Syndrome patients.
Low salicyate (see Table 1) or salicylate elimination diets (and Modified Exclusion diets, which are also low in salicylates) are often followed by improvements in bowel and other symptoms. In my experience, avoidance of salicylates alone can be beneficial at reducing symptoms especially if there is coexisting chronic urticaria. In this situation, assessing the effect of a low salicylate diet before other exclusions may allow the patient to see the link between their condition and their food. This can make the process of implementation easier, because motivation will be stronger.
How long should I exclude salicylates from my diet?
This is a difficult question. I would suggest an initial exclusion of 3 weeks, to assess any benefits. At the end of this period, if improvement has occurred, it would be worth continuing for about 4-5 months. During this period, the implementation of dietary and nutritional modifications (especially lipids and antioxidants) to strengthen membranes will often mean the salicylates can once again be tolerated. This is obviously a good thing, given their perceived benefits in the prevention of chronic disease.
Table 1. The Low Salicylate Diet
Very High Salicylate Content Foods
Raisins, prunes. aniseed, cayenne, celery powder, cinnamon, curry powder, dill powder, chinese five spices, garum massala, mace, mixed dried herbs, mustard, oregano powder, paprika, rosemary powder, dried sage, tarragon powder, turmeric, powdered thyme, Worcester sauce.
High salicylate content
Apples (sharp Granny Smith), berries, citrus fruits, currant, dried fruits, figs, guava, grapes, kiwi, pineapple.
Broccoli, chicory, endive, gherkin, mushroom, peppers, radish, watercress.
Allspice, bayleaf, chilli, cloves, ginger, mint, nutmeg, black pepper, pickles
Almonds, pistachios, macadamia, pine nuts
Honey, liquorice, peppermint, chewing gum
Tea, rum, port, Tia Maria, Benedictine, Drambuie
Moderate salicylate content - Eat only occasionally
Apricots, dates, lychees, peach, plum
Asparagus, avocado, cucumber, cauliflower, onion, tomato (tinned)
White pepper. Brazil nuts, walnuts. Cornflour
Drinks - Coffee (instant), rose hip tea, beer, cider, sherry, wine: red and white
Low salicylate content - Eat Freely
Apples (not sharp), mango, passion fruit, pawpaw, pears (peeled), persimmon, rhubarb (NB - lower in riper fruit)
Chick peas, dried beans, french beans, bean sprouts, beret, cabbage, carrot, leek, lentils, lettuce, peas, potato, shallots, spinach, sprouts, swede, sweetcorn, tomato (fresh and juice), turnip
Coriander leaves, garlic, fresh parsley, saffro soy sauce, Tabasco sauce, Tandoori powder, vinegar, (malt)
Cashews, dried coconut, hazelnut, peanuts, pecans, poppy seeds, sesame seeds, sunflower seeds
All cereals except cornflour
All meats, fish, shellfish, milk, cheese
Coca-cola, most herbal teas, tea (decaffeinated), brandy, gin, vodka, whisky
Environmental Medicine in Clinical Practice By Anthony H, Birtwistle S, Eaton K, and Maberly J.
BSAENM Publications 1997. Available from PO Box 28, Totton, Southampton SO40 2ZA Tel 01703-822124.