Most people have never even heard of salicylate intolerance. Those who have connect it with hyperactive children. But, as Diane Palmer found to her cost, you do not have to be a hyperactive child to be salicylate intolerant.

In 2001, I was eating what I thought was a fairly good, healthy diet – breakfasts of cereals, topped with fresh fruit and/or nuts and seeds; lunchtime salads, evening meals with vegetables; fruit and fruit juices for snacks, with my favourite tipple of red or white wine at the end of long working weeks. I was also very fit, training, running and playing competitive sports at least 3 times a week.

Decline
However, I began to feel continually unwell and lacking any energy. I would have days when I would have swollen glands in my neck, a very puffy face, and my whole body would hurt, being very sore to touch - as though I had been run over.

I consulted my GP and was told to go home and rest, as I probably had ‘sub clinical’ flu. I also then developed chronic bowel disturbances, which were investigated fully by gastro-enterologists, but with no result. Just the predictable label of irritable bowel syndrome.

Could it be diet?
My initial symptoms got worse, and in addition I would experience chest tightness and throat swelling; I had mouth ulcers; fluid retention over my whole body and a racing heart that would continue for hours. I analysed everything, and in desperation I wondered whether it had to do with what I was eating. I found a local doctor who was doing electrodermal food intolerance testing as a private ‘sideline’ and sceptically went for a test.

Salicylate bombshell
Wheat, yeast and dairy were pinpointed as issues (I subsequently had positive IgE food allergy tests for wheat and milk protein), as was aspirin. Well, that's fine I told him as I never take aspirins anyway, and the only symptom I don't suffer with is headaches!

I was stunned and still a little sceptical when he explained that natural aspirin, or salicylates, is found in many foods, particularly fruits and vegetables. He gave me a very general list to take away of those foods with highest and lowest levels of salicylates in them.

Over the following months, I avoided scrupulously the wheat, dairy and yeast (with a few near misses that I now know are part of every food avoidance learning curve). However I had little symptom improvement by avoiding those foods in the moderate/high salicylate categories.

So I began researching salicylates for myself. This was not an easy task with little information available at the time. However finding one piece of research done in Australia that detailed specific amounts (mgs) of salicylates per 100g of food items, made things a little clearer and I was able to clean my diet of any remaining salicylate content. Symptom relief has thankfully since followed.

What can I eat?
It is easier to tell you now what I can eat without encountering any salicylate or reaction.

Fresh meats, fish and eggs, iceberg lettuces, celery and water are totally salicylate free and are my mainstays.

I am also able to eat Brussels sprouts, and heavily peeled asparagus, although not every day, as these do have trace amounts in them. One lesson I have learnt is that salicylates can build up in the body and will catch you unawares with a full blown reaction one or two days later.

Thankfully, the gluten free wholegrains – quinoa, millet, amaranth and buckwheat - are all salicylate free and cause me no problems provided they are well cooked. I am now an expert in hypoallergenic porridge.

Weird Anomalies
As with all food reactions, I have found some anomalies and mysteries. For example, peeled pears, bananas, rice, peeled white potatoes, swede, white cabbage and peas/legumes are also salicylate free. However I am unable to tolerate these. Similarly, I react to normal white granulated sugar, but am fine with organic, refined, white granulated sugar.

There is no apparent rhyme or reason for which foods do or don't contain salicylates, and food families do not give any clues to relative levels.

Salicylates are also very stable to processing, so cooking at high temperatures is not an answer. It really is a question, as they say, of 'knowing your onions'.

Chemical Similarities
Salicylates are very similar in chemical structure to nitrates /nitrites, benzoates, oxalates and sulphates/sulphites, and are a major component of many food colourings and flavourings. I also experience similar reactions to foods containing even traces of these chemicals. So, fresh, unprocessed foods are definitely the way to go.

Salicylate levels
As many foods are not covered by the available existing research, their actual salicylate level is unknown, and so trying to safely increase dietary variety can be difficult. Similarly different people may have different levels of tolerance to salicylate – depending upon how their body deals with and is able to process it. So, in my experience, it is important to establish a personal level of tolerance, and not rely on others' generalisations no matter how well-intentioned the advice.

Even the special dietary product manufacturers are generally unable to cater for the salicylate issue. Maize starch is found in many products. Vague terms on ingredient lists (such as ‘'vegetable' oil and ‘'natural flavourings') are not helpful. The salicylate avoider needs to know WHICH vegetable the oil is from (palm or corn oil are probably not good, but rapeseed, safflower and sunflower oils may be), and what the flavouring is that has been added.

Non-food Products
Unfortunately salicylates also pervade many other products (medicines, vitamin/mineral and herbal supplements and toiletries) adding to the challenge of living a healthy life. Until recently, I did not believe I had any problems with toiletries. However, my most recent experience (this year) is of severe allergic skin reactions causing my eyelids, my eyes and my face to swell and become inflamed for several days.

I would really appreciate any help or advice anyone else can offer in tracking down exactly what it may be in toiletries (I don’t wear cosmetics, just use moisturisers) that could be causing this problem.

Moving On
Despite my problems with foods, I still count myself lucky, as the whole experience has given me a passion for diet and nutrition. I am currently in my final year of study to become an ION Nutritional Therapist, with the primary aim of focusing my practice on helping others manage food allergy/intolerances.

I have also discovered that I enjoy my kitchen - experimenting with alternative flours and the fewingredients I can use. I am always on the look out for any potentially suitable foods/products I have previously not encountered.

So, for anyone else who may be eating what is generally believed to be a vitality promoting, antioxidant rich diet, but who cannot retain their health, then may be it is your daily fruit, herb and vegetable intake that you need to examine further.

Diane suggests that this is the most useful/accessible site for salicylate levels in foods.

Salicylate Update

Diane Palmer's article in last month's Foods Matter provoked a speedy response - including a postscript from Diane herself.

Having re-read the article last night, it has occurred to me that there are two things I didn't touch on that it may be important for others to know about.

Firstly, drinks.... I can only drink water - plain, but either hot or cold!! Tea, coffee, juices, cordials, alcoholic drinks - all have salicylates in them although whisky, gin and vodka are listed as salicylate free. As I can't have them, and don't even think about drinks any more, it didn't even cross my mind to include them.

Similarly, I didn't specify that all spices contains salicylate, and most at very high levels. Although you only use a pinch each time, they are very concentrated, so even a pinch can produce a reaction.

From Margaret Moss - Nutritionist:

Natural chemicals in fruits and vegetables do indeed cause problems for sensitive people. There are various reasons including phenols, amines, boron, lectins, cyanide, vitamin C and carotenoids.

There are phenols in fruit and vegetables. For example, there is quercetin in cabbage, grapes and pear, kaempferol in strawberries and Brussels sprouts, apigenin in celery, luteolin in red bell peppers, and isoflavone in soya. There are amines in bananas, cheese and fish. Amines, phenols and vitamin C are processed by the body, using sulphate.

People with food and chemical sensitivity tend to be inefficient at doing this, and may be unable to eat foods that are healthy for the rest of the world. Sulphate levels can be increased, using vitamins B2 and B5, omega 3 fats from fish, and molybdenum. Some foods, like oranges, spinach and radish, slow down the detoxification of phenols and amines.

There is boron in apples, pears, plums, peppers, tomatoes, peanuts, hazelnuts and soya. It causes excretion of vitamin B2. Seeds contain lectins. These include wheat, rice, potatoes, swede, beans, peas and lentils. Lectins attach themselves to specific sugars in the body, causing symptoms. Cyanide is released from maize and millet, when eaten with lettuce or celery. Some people are inefficient at dealing with cyanide. People who convert carotenoids too avidly to vitamin A may experience vitamin A toxicity symptoms. There are carotenoids in tomatoes, peppers, carrots, spinach, cabbage, mango and melons.

Food sensitive people tend to react to more than one category of chemical, rather than just to one type, like salicylate.

I am puzzled that Diane says the structure of the organic chemical, salicylate, is similar to that of inorganic nitrate, nitrite, sulphite and sulphate. Sulphites can be found in drinks, salads and coal smoke, and are harmful. However, the enzyme, sulphite oxidase converts them to sulphates, which are anti-histamines, needed for the integrity of the gut wall, and the release of pepsin, stomach acid and digestive enzymes. They are needed for detoxifying amines and phenols.

Moisturisers can be troublesome. It is better to have adequate omega 3 and 6 fats in the diet, to keep the skin healthy from within. If Diane wants to know more, I can send her a copy of our article, ‘'The plasma cysteine/sulphate ratio: a possible biomarker' by Moss M and Waring RH, published in the Journal of Nutritional and Environmental Medicine in 2003.

(Margaret can be contacted at the Nutrition and Allergy Clinic 0161 432 0964 www.nutritionandallergyclinic.co.uk)

First published in 2005

For an in depth investigation into salicylate intolerance see Dr Joneja's article here and for a wide selection of other articles on salicylate intolerance, including some personal experiences see here. For articles on other uncommon allergies and intolerances see here.