The Failsafe Diet- Instructions and Lists

The Failsafe Diet- Instructions

Special thanks to AlienRobotGirl for putting together these tables and info. If it had not been for her, I would have never found out about this miraculous plan!!

This is a trial diet that is designed to eliminate additives, salicylates, amines and glutamates. It is not suitable to treat food allergies or coeliac (celiac) disease. It is not a gluten/casein free diet, a low opioid peptide diet, a low oxalate diet (LOD), the specific carbohydrate diet (SCD), a low lectin diet, a low goiterogenic diet, or a low phytoestrogen diet. This is a copy of the Royal Prince Alfred Hospital elimination diet, but may contain some minor differences. This page is not endorsed or checked by the RPAH.

This diet is designed to test and treat your ability to tolerate additives, salicylates, amines, and glutamates. The elimination diet is designed to eliminate all of these chemicals at once, because sensitivities to these chemicals often occur together and the symptoms caused by each individual chemical largely overlap. Currently, the only accurate way to test if you have a food chemical sensitivity of this kind is to eliminate all of the chemicals involved and then challenge them one by one. This is so that you can figure out which chemicals in particular affect you, and what quantity of chemicals you can manage without experiencing adverse symptoms. This enables you to eat the widest range of food without experiencing adverse symptoms.

It takes most affected people an average of four weeks to “clear” their symptoms and feel better on the diet. In small children and in those who aren’t too badly affected it can take as little as two weeks. In the very badly affected, it can take six weeks or even three months before symptoms clear. Some symptoms you experience may be caused by an infection acting on your immune system. If this is the case, these symptoms may take longer to clear up, and there is no reason why you should not request additional help in the form of antibiotics or antifungals, as long as these treatments are salicylate and additive-free and you are able to trial the prescription carefully in case of an adverse reaction.

How to Perform the Diet

Treat the diet as a scientific experiment. Try to control all of the variables that can affect you. The diet is not designed to eliminate all chemicals or allergens from your menu, just the ones that we know typically affect people with this range of symptoms. In some people, allergies and other intolerances to wholefoods can cause similar symptoms. Therefore it is important to use your common sense judgement with certain foods. If you suspect an allergy or an intolerance to a wholefood (for example, if bread gives you arthritis pains, people in your family don’t get on with milk, or eggs give you a rash), you should also eliminate those foods while you are on the trial diet as allergens and other intolerances will muddle your experiment. People sometimes experience intolerances to foods they “cannot live without” or that they crave, so be particularly wary of cravings for foods. If you suffer from pollen allergies, it is best to avoid doing the diet trial during the spring allergy season.

• Avoid allergens during the diet trial – in food or the environment
• Avoid strong smells, perfumes, air fresheners, industrial fumes, cigarette smoke, coal tar fumes and car exhaust fumes
• Avoid scented, coloured or strong cosmetics and toiletries
• Avoid large doses of vitamins and minerals (particularly some B vitamins)
• Avoid NSAIDs (aspirin, ibuprofen, diclofenac, naproxen)
• Avoid over the counter drugs and prescription drugs unless essential
• Avoid coloured capsules and coatings on drugs (wash off or remove contents)
• Avoid mint and menthol products and other decongestant inhalants
• Avoid chlorine and chloramines found in swimming pool water
• Eat only the foods and drinks allowed on the elimination diet
• Do not be tempted to do your “own version” of the diet (it will not work)

Keep a diary recording everything you eat, the places you visit, any persistent smells or chemicals in your environment, anything you put on your skin or hair, any laundry or washing up products you use, and any symptoms of ill health you experience. Symptoms can appear almost immediately after consuming a food chemical you cannot tolerate, or they may appear the following day, or they may take as long as three to five days before they appear. Reactions can differ depending on the strength, quantity, and the type of chemicals you have consumed. Reactions often build up very slowly and sneakily over several days and may take several more days or a week to abate.

Initially you may experience withdrawal symptoms. These may be related to caffeine withdrawal, or to the presence of food chemicals which your body has grown used to. You may find that you crave “forbidden foods” and strong flavours. Try to resist these as they will only make you feel worse. Rarely withdrawal symptoms can be unpleasant and can mimic SSRI withdrawal. Try not to worry too much about the unusual symptoms that you experience during the first few weeks of the diet.

Do not worry about nutrition. The diet is restricted but still highly nutritious when performed properly. You may even find that your nutrition improves. Meat, eggs, whole dairy foods, pulses, beans and whole grains are some of the most nutritious foods in the human diet. Please use your common sense and eat a normal, balanced diet. Do not use the diet as an excuse to binge on your favourite foods or eat large amounts of refined carbohydrates or vegetable oils. Please do not avoid eating meat or fish, even if you are afraid of amines, just concentrate your efforts on finding a good supplier of fresh meat. If you are concerned about vitamin C, understand that most fruits and vegetables contain only small amounts, and only a specific minority contain high amounts. Brussels sprouts, potatoes and cabbage are all very good sources of vitamin C. Pure ascorbic acid can be purchased if you dislike the taste of these foods. Sometimes people complain that there is “nothing to eat”. This is usually because they are placing additional self-imposed restrictions on their diet or they are struggling to use their imagination in preparing meals. There is no reason why people should go short on calories on the diet.

Take Professional Advice

This diet takes a lot of time and brainwork to perform correctly, and most people slip up many times when they first begin. It is not possible to do your “own version” of the diet, excluding only those foods you consider high in specific chemicals. There may also be hidden chemicals or allergens in the food you are eating that are not labelled, or you are not aware of them. Consider seeking the advice of a professional who is already well-versed in the RPAH elimination diet, or at least asking questions on some of the online failsafe discussion groups. Furthermore, do not trust the advice of professionals who have not heard of the dietor are unfamiliar with it, as they will tend to dismiss it or make as many mistakes as you would do alone.

Trying The Diet

This table contains a comprehensive positive list of the allowed food items on the diet. If a food is not in the table below, you should not eat it on the trial diet. You must also avoid the additives listed separately at the end of this page, and use caution with processed foods that may contain unlabelled additives. Eat only the amount specified in the maximum allowed column. Remember to read the common pitfalls column carefully so that you don’t make mistakes with foods you thought were safe. The food chemicals column gives information on any very small amounts of food chemicals that are in these foods and may be useful if you are very sensitive to food chemicals. The other problems column gives insight into other reactions that people can experience to the food. Don’t worry about this column to start with, though it might help you to understand any idiosyncratic or quirky reactions you cannot explain in the future.

Food Group	Food Item	Instructions	Maximum Allowed	Avoid – Common Pitfalls	Food Chemicals (per 100 grams)	Other Problems
Fruit	Pears	Fresh, soft, ripe, thickly peeled Canned in sugar syrup Homemade pear juice or smoothies Conference pears are well tolerated	2 per day	Pear skins Nashi pears Commercial pear juice (salicylates from pear skins) Pears canned in fruit juice (salicylates from pear skins) Dried pears (sulphites)	Pears without skin 0mg of salicylate Pears with skin up to 0.31mg of salicylate Pears contain small amounts of spermine and spermidine	Pears contain moderate amounts of oxalates
Vegetables	Bamboo Shoots	Fresh, or canned without additives		Do not confuse with water chestnuts, which are very high in salicylates	Bamboo shoots 0mg salicylate	Oxalate content unknown
	Brussels Sprouts	Fresh or frozen	Limit to sensible amounts		Brussel sprouts 0.07mg salicylate Sulphurous vegetable	Brussels sprouts contain moderate amounts of oxalates
	Cabbage, Red or Green/White	Fresh or frozen	Limit red cabbage to sensible amounts	Kale, Rabe, Spring greens, other leafy greens that do not form a round cabbage bud	Cabbage, fresh, green 0mg salicylate Cabbage, fresh, red 0.08mg salicylate Savoy cabbage salicylate content unknown Sulphurous vegetable	Cabbage is low in oxalates
	Celery	Fresh			Celery contains traces of natural benzoates Celery contains some natural nitrates	Raw vegetables can irritate sensitive stomachs Celery is high in oxalates
	Chives	Fresh or frozen	As a garnish		Chives 0.031mg salicylate Contains other phenolic/aromatic compounds	Raw vegetables can irritate sensitive stomachs Chives are low in oxalates
	Choko/Chayote	Just ripe			Choko 0.01mg salicylate	Oxalate content unknown
	Garlic	Fresh	Limited amounts, not every day if sulphur sensitive		Garlic 0.1mg salicylate Very sulphurous vegetable	Raw vegetables can irritate sensitive stomachs Garlic is moderate in oxalates
	Leeks	Fresh			Leeks 0.08mg salicylate Sulphurous vegetable	Leeks are high in oxalates
	Lettuce, Iceberg	Fresh		Other kinds of lettuce, particularly strongly flavoured or brightly coloured lettuces including rocket and endive		Raw vegetables can irritate sensitive stomachs Lettuce is low in oxalates
	Parsley	Fresh	As a garnish		Parsley 0.08mg salicylate Contains other phenolic/aromatic compounds	Raw vegetables can irritate sensitive stomachs Parsley is high in oxalates
	Coriander	Fresh	As a garnish		Coriander 0.02mg salicylate Contains other phenolic/aromatic compounds	Raw vegetables can irritate sensitive stomachs Coriander is high in oxalates
	Potatoes, White	Large white, dirty brown, thickly peeled, stored in dark sacks		Red potatoes Commercial, instant, pre-prepared potato chips, crisps or mash (sulphites, preservatives) Hot chips (sulphites, preservatives)	Potatoes without peel 0mg salicylate Potatoes with peel 0.12mg salicylate Red potatoes salicylate content unknown Potatoes are a natural source of nitrates in the diet Potatoes contain solanine, especially when exposed to light, green, or with sprouts	Potatoes are not allowed on the Specific Carbohydrate Diet Potatoes are moderate in oxalates
	Shallots, AKA Green/Spring/Salad Onions	Green stemmed fresh onions Must have a straight stem, without a bulb shape at the bottom		Use caution as identity can be mistaken Onions with a bulb shaped bottom contain salicylates These shallots are not Mediterranean shallots	Shallots 0.03mg salicylate Sulphurous vegetable	Raw vegetables can irritate sensitive stomachs Shallots are moderate in oxalates
	Swedes/Rutabagas	Large, yellow/purple colour Fresh, ripe, not rotten		Do not mistake turnips for swedes, turnips are small and white/pink in colour and contain salicylates	Swedes 0mg salicylate Turnips 0.16mg salicylate	Swedes are variable in oxalates, some lists low, some lists high
Pulses and Legumes	Lentils: Red, Brown	Dried, or canned without additives		Puy lentils (French, bright/dark green) have not been tested for salicylate content, so use caution	Lentils, all, 0mg salicylate Lentils contain small amounts of spermine, spermidine and histamine	Lentils contain small amounts of lectins but do not need soaking and high-temperature boiling Lentils contain phytic acid Lentils are low in oxalates Allergenic
	Beans: Blackeye, Borlotti, Brown, Carob, Chickpeas/Garbonzo, Kidney, Lima, Mung, Mung bean sprouts, Soya/Soy, Soy Milk, Tofu	Dried, or canned without additives, fresh or canned mung bean sprouts Soak beans overnight and boil on a high temperature as per the appropriate cooking instructions		Avoid broad/fava beans, they are far too high in salicylate Fresh, unfermented soy like tofu and soy milk are the only soy products allowed	Mung bean sprouts 0.06mg salicylate Broad/fava beans 0.73mg salicylate Dried beans, all except brown 0mg salicylate Dried beans, brown 0.002mg salicylate Beans contain small amounts of spermine, spermidine and histamine Bean sprouts are higher in salicylates and amines than dried beans	Beans contain lectins, particularly kidney beans Beans contain protese inhibitors, particularly soya Beans contain pseudo-oestrogens, particularly soya and chickpeas Beans contain thyroid inhibitors (goiterogens), particularly soya and chickpeas Beans contain phytic acid Beans are not allowed on the Specific Carbohydrate Diet, with the exception of lima beans Beans are moderate in oxalates Allergenic
	Beans, French or Green	Fresh or frozen		Relatively high in salicylate, so watch for reactions in the most sensitive	French beans contain 0.11mg salicylate	French beans are high in oxalates
Nuts and Seeds	Cashew Nuts	Fresh, unroasted	10 per day (1/2 oz)	Roasted cashews (amines, preservatives)	Cashews 0.07mg salicylate Cashews contain small amounts of spermine and spermidine Roasted cashews contain amines	Cashews are thought to be moderate in oxalates Allergenic
	Poppy Seeds	Dried or fresh, unroasted	Sprinkle	Roasted poppy seeds (amines)	Poppy seeds 0mg salicylate Roasted poppy seeds contain amines	Oxalate content unknown
Grains	Arrowroot, Barley, Buckwheat, Millet, Oats, Rice, Rye, Wheat	White/refined grains appear to be less reactive than brown amongst failsafers, but both are allowed Rice varieties/brands tested as safe include Calrose (California Rose sushi rice), and Sungold and Sunbrown brown rices, and long grain rice Sushi rice is well tolerated		Basmati rice, jasmine rice, wild rice, black rice, and red rice all contain salicylates and are not allowed Processed bread products (propionates, E280-E282) Avoid corn/maize products Use caution with gluten free flours which may contain bleaching agents and sulphites	All grains 0mg salicylate Gluten grains (wheat, oats, barley, rye) contain opioid-peptides that affect some failsafers	Rye and rice are low in oxalates Barley, oats, wheat are moderate in oxalates, whole grains are higher than refined grains Grains contain lectins Wheat and oats contain insulin-like lectins that can disturb blood sugar Grains contain phytic acid Grains are not allowed on the Specific Carbohydrate Diet Allergenic
Grains/Flours	Amaranth, Sago, Tapioca/Cassava, Quinoa	These foods have not been tested for salicylate content but most failsafers tolerate them	Use caution and trial properly if you intend to consume regularly	Avoid corn/maize products Use caution with flours, particularly gluten free flours which may contain bleaching agents and sulphites	Salicylate content unknown but thought to be negligible Tapioca/Cassava is thought to be high in amygdalin, a cyanide containing benzaldehyde that failsafers may react to	Grains contain lectins Grains contain phytic acid Oxalate content unknown Grains are not allowed on the Specific Carbohydrate Diet Allergenic
Eggs and Dairy	Eggs	Store in a cold fridge Eat cooked eggs (i.e. quiche, custard) on the day they have been cooked		Do not store eggs for more than a couple of weeks or leave them out of the fridge Raw eggs do not degrade, but do not keep cooked eggs in the fridge overnight	Sulphurous food	Undercooked egg white contains histamine degranulators (pseudo-allergy) Allergenic
	Fresh Dairy: Butter, Ghee, Cream (fresh, sour, crème fraîche), Milk, Yoghurt, Ice Cream	Store in a cold fridge, keep for three days after opening A2 milk is better tolerated (opioid-peptides)		Whipped cream (additives) Kefir (amines) Flavoured shakes and yoghurts Check that colourings have not been added to butter, organic is safest Check that flavourings and colourings have not been added yoghurt and ice cream Do not keep dairy for longer than three days after opening	Milk contains opioid peptides, A2 milk (Guernsey, goat, sheep, buffalo) is very low in opioid peptides compared to regular A1 cow’s milk	Dairy contains lactose (milk, smaller amounts in yoghurt and cream), which can cause digestive problems Lactose is not allowed on the Specific Carbohydrate Diet Allergenic
	Cheeses: Cream Cheese, Mascarpone, Ricotta, Farm Cheese, Cottage Cheese, fresh white cheeses	Store in a cold fridge, keep for three days after opening		Feta, Mozarella All other yellow or aged cheeses Do not keep for longer than three days after opening	Blue vein cheese 0.05mg salicylate Camembert 0.01mg salicylate Mozzarella 0.02mg salicylate Almost all cheeses contain amines Cottage cheese can form tyramine Not all failsafers tolerate fresh cheeses	Allergenic
Meat	Beef (fresh, unaged), Veal, Lamb, Rabbit, Chicken (preferably without skin)	Meat that is less than two weeks from slaughter and not vacuum packed is suitable for the elimination diet In very sensitive individuals, meat should be no more than two or three days from slaughter Eat the day it is bought, do not leave overnight in the fridge Freeze for up to four weeks Thaw rapidly in warm water Cooked meats must be refrozen until required as they degrade very quickly Stocks can be made if they are simmered for no longer than two hours, cooled rapidly in cold water and used or frozen immediately	Failsafers often slip up with meat that is not fresh enough, do not make this mistake!	Ageing causes amine formation, meat that is more than two weeks old is too old for failsafers Offal forms amines rapidly Pork forms amines rapidly Chicken skin is prone to amine formation Game is high in amines due to hanging Bacon, ham, sausages, processed meats, paté, stock cubes (preservatives, colourings, flavour enhancers) Browning, grilling and charring increases amines Hung meat and vacuum packed meat are not allowed (sealed bags/containers), as meat can be several weeks old but still appear fresh Salted, smoked and cured meats Avoid stocks that have been simmered for many hours as they contain glutamates	Liver 0.05mg salicylate Pork, offal, hung meat, game, chicken skin, salted, smoked and cured meat all contain amines Processed meats usually contain sulphites or nitrites/nitrates as well as amines
Fish, Shellfish and Crustaceans	Fresh White Fish, Fresh Crab, Fresh Lobster, Calamari (squid), Sea Scallops	Eat the day it is caught, do not leave overnight in the fridge Freeze for up to four weeks Thaw rapidly in warm water Throw away leftovers		Seafood forms amines very quickly, avoid seafood that tastes stale or fishy or is of unknown age Prawns (amines) Salmon (amines) Tuna (amines) Canned fish (amines) Oysters (amines, particularly tyramine) Salted, smoked and cured fish Prawns are usually sulphited, use caution	Prawns 0.04mg salicylate Scallops 0.02mg salicylate Prawns, salmon, tuna, canned fish, oysters, salted, smoked and cured fish all contain amines Prawns and some other shellfish and crustaceans are sulphited	Allergenic
Hot Beverages	Milk, Malt Drinks (ovaltine), Decaffeinated Instant Coffee	Make weak, preferably half a teaspoon of coffee	Use caution with malt drinks and coffee, no more than one or two cups per day to start with	Too much coffee Decaffeinated espresso/filter coffee contains salicylates Decaffeinated tea Herbal teas Coffee substitutes	Instant decaf coffee 0mg salicylate Coffee from fresh beans 0.45mg salicylate Coffee, instant caffeinated up to 0.84mg salicylate Tea, up to 7.34mg salicylate	Caffeine can be problematic for some failsafers
Cold Beverages	Water, Homemade ‘Lemon’ Drink (citric acid, sugar, water), Soda Water, Tonic Water, Lemonade	Use a filter to improve the taste of tapwater	One glass of lemonade per week only	Salicylates in lemonade Preservatives in tonic water and lemonade Extremely sensitive failsafers sometimes react to citric acid as it causes histamine degranulation
Alcoholic Beverages	Gin, Vodka, Whiskey	Drink neat, with tonic, soda water, or homemade ‘lemon’ drink		Preservatives and flavourings	Gin, Vodka, Whiskey varieties tested 0mg salicylate	Alcohol can be problematic for some failsafers
Cooking Fats	Butter, Ghee, Safflower, Sunflower, Canola, Soya/Soy	Oils from fresh, antioxidant free		Avoid preservatives and antioxidants, can be present but unlabelled, organic is safest Suet and dripping contain amines and glutamates Lard and tallow may be acceptable if they are pure white and refined		Seed oils are high in polyunsaturated omega 6 fatty acids Seed oils can go rancid quickly Soy contains pseudo-oestrogens Soy contains thyroid inhibitors (goiterogens)
Baking Aids	Salt, Bicarbonate of Soda, Citric Acid, Cream of Tartar, Gelatine, Baker’s Yeast	Boiling removes sulphites from gelatine		Use caution with gelatine as it can contain sulphites and glutamates	Gelatine can contain glutamates
Herbs and Spices	Vanilla Essence, Saffron, Poppy Seeds, Chives, Parsley, Garlic		2 drops a day of vanilla essence Limit use of all these ingredients to a sprinkle	Avoid pepper, herbs and spices, they can be very high in salicylates and other aromatics	Contains other phenolic/aromatic compounds
Sweetners	White Sugar, Rice Syrup, Golden Syrup, Pure Maple Syrup	Choose only pure, filtered syrups	Limit use of unfamiliar syrups to begin with	Brown sugar Honey Syrups can contain sulphites, boiling removes these	Honey up to 11.24mg salicylates, very variable
Toiletries	Toothpaste: Unflavoured Toothpaste, Salt, Bicarb of Soda, Homemade Toothpaste made with Bicarb of Soda or Calcium Carbonate Powder and Glycerine	Choose flavourless, white, preservative and additive free toothpastes if available, or make your own	Use caution with new products	Mint, herbal flavours, lemon flavours	Mint flavouring is pure salicylate All scents contain salicylate or other problematic phenolic or aromatic compounds
	Soap: Plain, Unperfumed or Lightly Perfumed Soap, Bicarb of Soda, Sodium Lauryl or Laureth Sulphate	Choose white, preservative and additive free plain soaps, preferably made from tallow if available Very sensitive individuals should avoid commercial soap	Use caution with new products	Coloured, scented products Products with preservatives like BHT and parabens Products made from high-chemical plant fats like coconut and olive oil	All scents contain salicylate or other problematic phenolic or aromatic compounds	SLS can be allergenic for some
	Shampoo: Plain, Unperfumed or Lightly Perfumed Shampoo and Conditioner, Bicarb of Soda, Sodium Lauryl or Laureth Sulphate, Citric Acid	Choose white, preservative and additive free plain shampoo designed for sensitive skin Very sensitive individuals should avoid commercial products and make their own shampoo bars from SLS beads, or use bicarb and citric acid	Use caution with new products	Coloured, scented products Products with preservatives like BHT and parabens	All scents contain salicylate or other problematic phenolic or aromatic compounds	SLS can be allergenic for some
	Bath: Bicarb of Soda, Epsom Salts (Magnesium Sulphate), Plain Bath Salts	Use about a cup per bath	Therapeutic	Coloured, scented products Avoid all essential oils	Bicarbonate of soda is considered therapeutic for failsafers and helps ease reactions
	Deodorant: Plain, Unperfumed or Lightly Perfumed Roll On, Bicarb of Soda, Alum Crystal	Choose white, preservative and additive free plain deodorant designed for sensitive skin Very sensitive individuals should avoid commercial products and use bicarb of soda or alum crystal	Use caution with new products, bicarb and alum can irritate very sensitive skin, especially when skin has been shaved	Coloured, scented products Products with preservatives like BHT and parabens	All scents contain salicylate or other problematic phenolic or aromatic compounds
	Sunscreen: Plain, Unperfumed or Lightly Perfumed Sunscreen without PABA	Only use when really necessary, failsafe sunscreens are hard to find	Use caution with new products	Coloured, scented products Products with preservatives like BHT and parabens	PABA causes reactions in failsafers All scents contain salicylate or other problematic phenolic or aromatic compounds
	Laundry: Plain, Unperfumed or Lightly Perfumed Products for Sensitive Skin	Use a wash cycle that rinses clothes properly, don’t overload the machine	Use caution with new products	Coloured, scented products	All scents contain salicylate or other problematic phenolic or aromatic compounds
	Cleaning Agents: Vinegar, Citric Acid, Bicarb of Soda, Lye	If cleaning agents are strongly scented, in spray form, or will come into contact with the skin, use these alternatives	Use caution with new products	Coloured, scented products	All scents contain salicylate or other problematic phenolic or aromatic compounds
Medications	Essential Medications Only, White Tablets, Powdered Contents of Capsules, Preservative-Free Injections	Remove powder from coloured capsules Wash or scrape off coloured coatings of tablets Preservative free injections only	Use caution, and minimise use to only essential medications, as they are often problematic	Additives, preservatives, colours NSAIDs and aspirin Menthol, mint, oil of wintergreen, muscle balm MAOIs SSRIs (paroxetine, fluoxetine) Phenolic drugs and CNS depressants like benzodiazepines, barbiturates	Medications can be problematic for failsafers
	Pain Killers: Paracetamol (Tylenol)	Remove powder from coloured capsules Wash or scrape off coloured coatings of tablets	Use caution and minimise use	Paracetamol use can cause rebound headaches and back pain	Medications can be problematic for failsafers
	Antacids: Bicarbonate of Soda, Calcium Carbonate Powder, Potassium Bicarbonate	Mix your own antacid	Therapeutic	Don’t abuse antacids
Vitamins	Vitamins and minerals without PABA, colours, flavours and additives	Vitamins providing your RDA only Molybdenum is useful for the sulphur sensitive		Vitamin megadoses PABA Herbal supplements Chinese medicines Aromatherapy Use caution with folic acid intake, some failsafers react to it	Vitamin megadoses are problematic for failsafers PABA causes reactions in failsafers Folic acid can cause reactions in failsafers in high doses

If The Elimination Diet Fails

If you do not see a significant improvement in your symptoms or they continue to persist whilst on the elimination diet, consider the following possibilities:

• You are “cheating” too often
• You are not following the diet correctly – go through the foods you have eaten and check they all match the criteria above
• You have not been on the diet long enough to make a difference (at least four weeks)
• You are still coming into contact with environmental chemicals, smells, toiletries or cosmetics – people often cheat with shampoos or perfumes because they do not think it will make a difference – it does
• Environmental or food allergies are interfering with your ability to progress
• You are taking pharmaceutical drugs, vitamin supplements, or herbs that are interfering with the diet (eliminate them all, no matter how harmless you think they are)
• You are reacting to foods on the elimination diet
  
  • Because you have a wholefood allergy or intolerance that is contributing
  • Because you have not sorted out a supply of meat/fish that is low enough in amines (a very common pitfall)
  • Because you are not limiting your consumption of low-salicylate allowed fruits and vegetables
  • Because you are very sensitive to salicylates and other aromatics and must further restrict fruits and vegetables
  • Because you are very sensitive to sulphur and must further restrict sulphurous foods
  • Because you have other contributing sensitivites such as oxalates, lectins, and the opioid peptides in casein and gluten
  • Because there are contributing factors like an infection from which you must also recover
• You are not food chemical intolerant

If you have seen no improvement in your symptoms and you feel you have followed the diet correctly, consider doing a flood challenge by reintroducing all high chemical foods into your diet at once. If you feel worse, it may be that you are sensitive but the diet alone is not enough to get rid of your symptoms. Once you have considered these possibilities, you can move on.

If The Elimination Diet Makes You Worse

If in the unlikely event that you feel the diet is making your symptoms worse without showing any benefits, or if the diet has been successful in reducing your daily symptoms but you seem to be hypersensitive when you cheat, consider the following possibilities:

• Check for hidden additives and food chemicals in foods that you believe are safe – people usually make a number of mistakes to begin with
• Look back through your symptom diary from before you started the diet and assess whether you genuinely feel worse – some people focus on the negative symptoms they have when reacting instead of focussing on their state of health between reactions
• You are still going through a withdrawal period (this can last up to three months), during which you may become temporarily more vulnerable to pain, infections and overreactions
• You have started eating something which you are allergic to or intolerant of (wholefoods, oxalates, lectins, opioid-peptides) which you did not eat before, such as wheat, oats, beans, pulses, dairy, eggs or potatoes
• Despite improvement, you are genuinely more sensitive when challenged with food chemicals – some people do experience this
• You are unnecessarily restricting your nutrition for fear of reactions to foods, like: meat, eggs, dairy, legumes, pulses, or grains
• You are eating in an unbalanced way and have increased your intake of refined carbohydrates or vegetable oils
• You have a problem with a different set of chemicals (oxalates, lectins, goiterogens, opioid-peptides)
• There are contributing factors like dysbiosis which you may have exacerbated by increasing carbohydrate consumption (specific carbohydrate diet)
• Food chemical intolerance can get worse or better over time despite dietary intervention, due to hormonal influences beyond your control
• Your condition is not related to food chemical intolerance, but is progressive and requires medical investigation

You may feel that food chemicals make you feel good and you only feel bad when you withdraw them. This is because they can produce a happy-high feeling in some people – unfortunately this also produces a rebound low several hours later or the following day, which you may not have associated with food. In this case the answer is still to eliminate the food chemicals from your diet as they are producing moodswings (bipolar disorder).

If The Elimination Diet Helps

Most people are content to wait for a few weeks after starting the elimination diet in order to give their body a rest or enjoy their new sense of health. Once you are ready, and you have been on the elimination diet for at least two weeks with at least five days in a row without symptoms, you can begin the food challenges. The RPAH prefer to perform blind, placebo-controlled capsule challenges in order to produce a high level of proof, but for those who are unable to follow this route, food challenges can also be performed.

• Keep a daily diary noting how much of each food you ate, how you felt, and anything else that could have happened to upset you
• Wait for two weeks on the elimination diet, with five days in a row without symptoms
• Eat at least the recommended amount of food for each challenge, every day, spread out over the day
  
  • For wheat, milk, salicylates and amines, eat the foods for seven days
  • For additives, eat the foods for three days
• Stop if your symptoms come back or worsen
• Stop if you have completed a food chemical challenge without experiencing a reaction
• Continue if at the end of a challenge you are unsure if you are reacting, and continue until you are sure
• Repeat challenges two or three times if you are unsure whether you are reacting
• Leave in milk and wheat if you have not reacted to them after seven days
• Wait for at least three days after stopping a challenge to see if there is a reaction (doesn’t apply to milk and wheat as withdrawal usually produces immediate effects)
• Don’t start the next challenge until you have had three full days in a row free of symptoms and do not require any additional medication
• Be patient during challenges, reactions can take up to 48 hours to begin, if you hurry your challenges you are likely to get confused and will have to start again

Food Challenges

The RPAH recommend challenging foods in order of usefulness and nutritional content in the diet, and therefore recommend starting off with milk, wheat, and bread challenges, if you have had reason to exclude these foods. If you have not had reason to exclude these foods but do not feel on top form, you may find it useful to test them. This can be done by excluding each food for a week and then adding it back in to see if it makes a difference. Next challenge salicylates, followed by amines, then glutamates/MSG. Glutamates/MSG are usually found in the same foods as amines and are usually only worth testing separately if you do not react to amines. Additives should be tested last since the foods they are in are rarely nutritious or useful, and because people who react to salicylates and amines always react to additives as well. The most useful additives to test separately are propionates (E280-E283), the bread preservative, since if you tolerate them it is much easier to shop for bread.

Challenge Amounts Per Day

	Food	Quantity	Length of Challenge
1.	Milk	1-3 cups of milk	Seven days
2a.	Wheat Flour	1 cup plain coked pasta (no colour) and 12 water crackers	Three days, and if no reaction start including bread (2b)
2b.	Bread	Continue with pasta and water crackers

• 4 slices of unpreserved bread (must be propionate (E280-E282) free, whey and milk powder free, without vinegar)

Seven days
3.
Salicylates
Choose 6 foods from the list below and eat them each day of the challenge in any combination:

Fruit	1 large Granny Smith apple 1 50g stone fruit, fresh or canned 1 mango 1/4-1/2 rockmelon 1 cup strawberries 1 large slice watermelon
Vegetables	6-8 asparagus spears 1/2-1 capsicum 1 cup carrot 1/2-1 cucumber 1 cup pumpkin 1 cup sweet potato 1 medium zucchini (courgette)
Sweets	1 tablespoon honey 10 pepp-o-mint lifesavers or peppermints without colour
Spices	1 teaspoon cinnamon 1 teaspoon curry powder
Drinks	150ml apple juice (unpreserved, sulphite free) 1 cup strong tea or peppermint tea

Seven days
4.
Amines

• 2-3 large bananas and
• 60-120g plain chocolate (milk free if milk is not allowed)

In addition the following amine containing foods may be eaten freely:

• cocoa powder and drinking chocolate
• pawpaw
• pork (but not ham or bacon which are preserved)
• salmon (canned)
• sardines (canned)
• tuna (fresh, canned)
• mild yellow cheese (if milk is allowed)

Seven days
5.
Glutamates (MSG)
Natural free glutamates and amines are mostly found in the same foods. You only need test MSG separately if you haven’t reacted to amines.

• 4 tablespoons soy sauce (glutamates and amines)
• Parmesan cheese, sprinkled liberally (glutamates and amines)
• 500ml chicken noodle packet soup (glutamates and salicylates)

Three days (may need longer)
6.
Propionates (E280-E282)
Propionate reactions tend to build up slowly and subtley, watch out for sneaky reactions.

• 4 slices of preserved bread (must contain propionate (E280-E282)) or
• 4 crumpets, muffins, home-bake rolls (must contain propionate (E280-E282))

Three days (may need longer)
7.
Sorbates (E200-E203)

• 25g low fat spread with sorbate preservative (must not contain E160b colour annatto)
• 100g cottage cheese in tubs with sorbate on the label

Three days
8.
Benzoates (E210-E218)

• 1 litre lemonade preserved with benzoates (not suitable if very sensitive to salicylates or amines)

Three days
9.
Antioxidants (gallates E310-E312 and butylates E319-E321)

• 3 tablespoons of cooking oil with antioxidants
• hot commercially cooked chips or oven baked fries
• plain crisps with antioxidants on the label

Three days
10.
Colours
Food colourings can be bought in the cake making section of the supermarket. Add the recommended number of drops to a glass of unpreserved lemonade or soda water and repeat two or three times a day. Try a different colour each day.

• Yellow (E102 & E124) – 10 drops per glass
• Red (E102 & E122) – 10 drops per glass
• Green (E102 & E142) – 5 drops per glass
• or Pink Musk Sticks (at least 6 per day)
• or any other artificial colours on the problem list

Three days
11.
Nitrites (E249-E252)
If you had no reaction to amines, test nitrites to find out whether you can eat preserved meats.

• 4 slices (120g) of ham, bacon or corned beef

Three days
12.
Sulphites (E220-E228)

• dried apricots (salicylates and sulphites)
• dehydrated beans with sulphites on the label
• commercially prepared potatoes preseved with sulphites (may also contain antioxidants)

Three days

Problem Additives

Additive Type	Additive Name	E-number
Food Colour	Tartrazine, yellow #5	E102
	Quinoline yellow	E104
	Yellow 2G	E107
	Sunset yellow	E110
	Azorubine, carmoisine	E122
	Amaranth	E123
	Ponceau 4R, brilliant scarlet	E124
	Erythrosine	E127
	Red 2G	E128
	Allura red	E129
	Indigotine, indigo carmine	E132
	Brilliant blue	E133
	Food green S, acid brilliant green	E142
	Caramel plain caramel is failsafe but some caramel contains sulphites	E150
	Brilliant black BN	E151
	Brown HT, chocolate brown	E155
	Annatto extracts, bixin, norbixin	E160b
Sorbates	Sorbic acid	E200
	Sodium sorbate	E201
	Potassium sorbate	E202
	Calcium sorbate	E203
Benzoates	Benzoic acid	E210
	Sodium benzoate	E211
	Potassium benzoate	E212
	Calcium benzoate	E213
Sulphites	Sulphur dioxide	E220
	Sodium sulphite	E221
	Sodium bisulphite	E222
	Sodium metabisulphite	E223
	Potassium metabisulphite	E224
	Potassium sulphite	E225
	Potassium bisulphite	E228
Nitrates and Nitrites	Potassium nitrite	E249
	Sodium nitrite	E250
	Sodium nitrate	E251
	Potassium nitrate	E252
Propionates	Propionic acid	E280
	Sodium propionate	E281
	Calcium propionate	E282
	Potassium propionate	E283
Antioxidants (gallates)	Propyl gallate	E310
	Octyl gallate	E311
	Dodecyl gallate	E312
Antioxidants (butylates)	tert-Butylhydroquinone, tBHQ	E319
	Butylated hydroxyanisole, BHA	E320
	Butylated hydroxytoluene, BHT	E321
Flavour Enhancers (glutamates)	L-Glutamic acid	E620
	Monosodium L-glutamate (MSG)	E621
	Monopotassium L-glutamate	E622
	Calcium di-L-glutamate	E623
	Monoammonium L-glutamate	E624
	Magnesium di-L-glutamate	E625
Flavour Enhancers (ribonucleotides)	Disodium guanylate	E627
	Disodium inosinate	E631
	Disodium 5′-ribonucleotides	E635
Artificial Sweeteners	Aspartame (Nutrasweet, Equal)	E951

Any number of additive trials can be performed. Some additives have specific effects to watch out for – such as ribonucleotides (E627, E631, E635) which tend to cause rashes (“ribo rash”), or aspartame (E951) which tends to have MSG-like effects and cause depression. Additives not on the problem list are less likely to be problematic, however some other additives not in this list have been shown to have adverse effects on people. Splenda (sucralose, E955) can cause rashes especially in the chlorine sensitive, and sugar alcohols or polyols (E420, E421, E953, E965-E968, E1100) tend to cause digestive distress.

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