Failsafe Diet
What is the Failsafe Diet?
The Failsafe diet is also known as the RPAH (Royal Prince Alfred Hospital) elimination diet and was designed by a group of allergists in Sydney, Australia. Failsafe stands for “Free of Additives Including Low Salicylates, Amines and Flavor Enhancers”.
The Failsafe diet removes man-made and natural flavors, colors, and preservatives found in foods. Most of these compounds are known in chemistry as phenols. Salicylates, amines, and glutamates are all types of phenols and while they are in many nutritious foods, they may be potentially problematic for some people like children with autism.
Our bodies break down phenols by a process called sulfation. An enzyme called phenol sulfurtransferase (PST) is critical to the process of sulfation. Sulfate is a mineral and is essential to the function of the PST enzyme.
Insufficient sulfate can lead to poor sulfation and reactions to phenols. In those with poor sulfation, removing phenols relieves the burden of this biochemical process and relieves symptoms.
The Feingold diet is similar to the Failsafe diet but the Failsafe diet is more comprehensive and includes all types of phenols rather than just salicylates.
Who Would Benefit From This Diet?
Those who show symptoms of phenol sensitivity. These symptoms are varied and may include:
Red cheeks and ears
Persistent dark circles under eyes
Aggression/irritability
Abdominal pain and diarrhea
Chronic headaches, headbanging/self-injury
Ear infections, asthma, and sinus issues
Hives/rashes, skin conditions like eczema, psoriasis
Bedwetting and urinary incontinence
Those with a history of these symptoms may benefit from a trial of the Failsafe diet.
Stages of the Failsafe Diet
The first stage of the diet is 3 weeks and includes the elimination/removal of many items including gluten, dairy, artificial and natural additives, salicylates, amines and glutamates, strong-smelling chemicals found in cleaning or personal care products, and certain medications.
The second stage of the diet is the challenge phase with a methodical reintroduction of like-items or individual foods to determine reactions and/or sensitivities.
The final stage is the liberalization of the diet. Based on the result of the challenge, an appropriate diet can be customized and the threshold for reaction can be determined. The goal is to make the diet as unrestrictive as possible while avoiding reactions/symptoms.
If the elimination diet has been strictly trialed, symptom improvements will likely occur within 8 weeks.
Recommended Foods
Fruits: Pears
Vegetables: certain varieties of potatoes, chives, garlic, red cabbage, green beans, celery, cabbage, Brussels sprouts, iceberg lettuce, leeks, shallots
Protein: eggs, fresh fish, fresh meat and poultry, dried beans and lentils, chickpeas, split peas
Dairy (can eventually be challenged/re-introduced to determine if it causes any reactions): pure butter, cream cheese, cottage cheese, ricotta cheese (with no preservatives)
Grains (gluten-containing grains can eventually be challenged/re-introduced to determine if it causes any reactions): rolled oats, plain pasta, couscous, white rice, pearl barley
Foods to Avoid
For a detailed and complete list of all foods and ingredients to avoid, see the helpful resources section below.
Amines
Fermented or pickled foods like vinegar, yogurt, kombucha, kefir, sauerkraut, pickles, soy sauce, Worcestershire sauce
Wine and beer
Smoked, cured, and aged foods
Cocoa, chocolate
Soy sauce
Monosodium glutamate (MSG)
Soy sauce
Parmesan cheese
Gelatin
Artificial and Natural Additives (about 50)
Colors (FD&C colors, annatto)
Preservatives (sorbates, benzoates, sulfates, nitrates/nitrites, propionates, fermented items)
Flavors (glutamates, disodium guanylate/inosinate, yeast extract, hydrolyzed vegetable protein)
Additional eliminations:
All fragranced products (which contain phthalates) such as personal care products (things like perfumes, cosmetics, air fresheners, scented garbage bags, cleaning products or toiletries, mint-flavored toothpaste and mouthwash, and even essential oils).
Certain medications:
Acetaminophen
NSAIDs and COX-II inhibitors like aspirin and ibuprofen
Lifestyle Changes
Since there are so many items to eliminate with this diet, it can be helpful to start slow and chip away in order to eliminate what is necessary to improve symptoms. Starting with the Feingold diet may be helpful since it is a simplified version of the Failsafe diet.
Careful label reading is an absolute must, in order to implement this diet correctly. Careful attention must be paid to household products as well and substitutions may be necessary for scented items.
This diet may be particularly challenging for children that are extreme picky eaters. It may even be dangerous to completely uproot the limited number of foods that a child does eat. Working with a feeding therapist or dietitian trained in autism and picky eating may be necessary to implement a restrictive diet like this successfully and safely.
Keeping a food & symptom/behavior diary can be very helpful because a dietitian may be able to look at it and determine what categories of foods are problematic for the child, even before implementing a diet like this. This can give the practitioner an idea of where to start with implementing the diet.
Helpful Resources
Video from Australia Autism Summit 2021:
Websites:
Recipes:
Recommended Supplements
Ensure that any medications or herbs which are taken regularly are not in high phenol ingredients.
Epsom salt baths can be helpful because they allow the body to absorb sulfate, to aid in the sulfation process which breaks down phenols.
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
The Failsafe Diet in the Research
The Failsafe diet has not been well researched in its entirety, although the many elements which make up the diet have been studied and are categorized below. We do know that children with autism are sensitive to a range of foods and ingredients.
Food Sensitivity & Autism
Research shows a positive association between food hypersensitivity (food allergies and food intolerance) and autism spectrum disorder, and girls and subjects younger than 12 may be more sensitive to this association. [5]
Propionates/Propionic Acid (Preservative) & Autism
Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. [8]
Increased propionic acid (PPA) exposure in humans, animal models and cell lines elicit diverse behavioural and biochemical changes consistent with inborn errors of metabolism, mitochondrial disorders and autism spectrum disorders (ASD). In this study, PPA treatment showed altered social and locomotor behaviour without changes in learning and memory. Brief systemic administration of propionic acid produced behavioural and dynamic brain ultrastructural changes, providing further validation of the PPA model of ASD. [9]
The data supports a significant role for propionic acid in modulating hNSC patterning leading to gliosis, disturbed neural-circuitry, and inflammatory response as seen in ASD.[11]
Acetaminophen (Medication) & Autism
The use of acetaminophen in babies and young children may be much more strongly associated with autism than its use during pregnancy, perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceuticals during early development. [6]
Phthalates (Endocrine Disrupting Chemical Found in Fragrances) & Autism
Several chemical exposures such as air pollution, pesticides, bisphenol A, phthalates, mercury, and nutrition deficiency such as folic acid, vitamin D, or fatty acid may possibly be associated with an increased risk of ASD. [12]
Findings of this review suggest that the etiology of ASD may involve complex interactions between genetic factors and certain environmental toxicants that may act synergistically or in parallel during critical periods of neurodevelopment, in a manner that increases the likelihood of developing ASD.[13]
Higher gestational concentrations of some phthalate metabolites were associated with higher scores of autistic traits in boys, but not girls; these small size effects were mitigated by first trimester-of-pregnancy folic acid supplementation.[14]
Parabens & Autism
Pregnancy environmental phenol exposures may increase the risk for non-typical development in a high-risk population. [4]
The Bottom Line
The Failsafe diet is extremely comprehensive in it’s elimination of potentially problematic food components. The advantage of the Failsafe diet is that it is not intended to be long-term. It is an elimination diet that should be used to determine what specific food components are causing symptoms and what amount, if any, is tolerable. The disadvantage of the Failsafe diet is that, while it may be ideal to eliminate every possible ingredient and additive, the question remains, is it practical? This will depend very much on the child and whether or not a total diet overhaul is safe and appropriate for them and the family as a whole. If you think this diet would be beneficial for your child, work with a dietitian to make the transition as smooth and simple as possible.
Rating Scale: 1 - 5 stars ★
We rate the quality and quantity of the research supporting the efficacy of the diet in improving symptoms as well as the Ease of Adherence, taking into account the cost, resources available, the time required, social acclimation to the diet including options available in restaurants and grocery stores which assist in convenience and adherence
EASE OF ADHERENCE ★★
The diet is temporary but very restrictive and will likely be difficult to follow and will require a complete dietary overhaul for most people.
RESEARCH ★★★
There is some research to support the use of this diet and professional guidance may be beneficial to support such a drastic dietary change and ameliorate behavioral or nutritional issues that can result from dietary restrictions.
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[1] Dengate. Accessed June 7, 2021. https://www.fedup.com.au/images/stories/Failsafebooklet2011.pdf
[2]Howard. All food additives, problems highlighted - Food Intolerance Network. Accessed June 7, 2021. https://www.fedup.com.au/information/information/complete-lists-of-additives
[3] Autismrecoverysystem.com. Accessed June 7, 2021. https://autismrecoverysystem.com/wp-content/uploads/2017/05/Phenol-Sensitivity.pdf
[4] Barkoski JM, Busgang SA, Bixby M, et al. Prenatal phenol and paraben exposures in relation to child neurodevelopment including autism spectrum disorders in the MARBLES study. Environ Res. 2019;179(Pt A):108719.
[5] Li H, Liu H, Chen X, Zhang J, Tong G, Sun Y. Association of food hypersensitivity in children with the risk of autism spectrum disorder: a meta-analysis. Eur J Pediatr. 2021;180(4):999-1008.
[6] Parker W, Hornik CD, Bilbo S, et al. The role of oxidative stress, inflammation and acetaminophen exposure from birth to early childhood in the induction of autism. J Int Med Res. 2017;45(2):407-38.
[7] Watkins T. History of our elimination diet - Allergy Unit - Royal Prince Alfred Hospital. Gov.au. Accessed June 7, 2021. https://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/development.html
[8] Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health. 2002;38(4):373-6.
[9] Lobzhanidze G, Japaridze N, Lordkipanidze T, Rzayev F, MacFabe D, Zhvania M. Behavioural and brain ultrastructural changes following the systemic administration of propionic acid in adolescent male rats. Further development of a rodent model of autism. Int J Dev Neurosci. 2020;80(2):139-56.
[10] Swain A, Soutter V, Loblay R, Truswell AS. Salicylates, oligoantigenic diets, and behaviour. Lancet. 1985;2(8445):41-2.
[11] Abdelli LS, Samsam A, Naser SA. Propionic Acid Induces Gliosis and Neuro-inflammation through Modulation of PTEN/AKT Pathway in Autism Spectrum Disorder. Sci Rep. 2019;9(1):8824.
[12] Fujiwara T, Morisaki N, Honda Y, Sampei M, Tani Y. Chemicals, Nutrition, and Autism Spectrum Disorder: A Mini-Review. Front Neurosci. 2016;10:174.
[13] Rossignol DA, Genuis SJ, Frye RE. Environmental toxicants and autism spectrum disorders: a systematic review. Transl Psychiatry. 2014;4:e360.
[14] Oulhote Y, Lanphear B, Braun JM, et al. Gestational Exposures to Phthalates and Folic Acid, and Autistic Traits in Canadian Children. Environ Health Perspect. 2020;128(2):27004.
