Low Salicylate Diet
What Is the Low Salicylate Diet?
A low-salicylate diet is one in which salicylates are not consumed in order to avoid the symptoms believed to be associated with their consumption. Individuals can have a sensitivity to salicylates and this sensitivity can manifest through skin, gastrointestinal, respiratory, and nervous system issues. Some children with Autism Spectrum Disorder (ASD) have been shown to have issues breaking down salicylates and therefore may benefit from this diet.
Salicylates are naturally-occurring chemicals found in fruits and vegetables.
Salicylates activate the immune systems’ white blood cells including basophils, eosinophils, macrophages, mast cells, and lymphocytes. These cells are activated when the body has an immune or allergic response.
Phenols are a group of chemical compounds that include salicylates, amines, and glutamates. All may be potentially problematic for different people, though this note will specifically focus on salicylates. In short, salicylates are phenols (technically a particular category of phenol).
Sulfation is the process by which our bodies break down phenols.
An enzyme called phenol sulfurtransferase (PST) is critical to the process of sulfation.
Sulfate is critical to the function of this enzyme and insufficient sulfate can lead to poor sulfation and reactions to phenols.
This is where salicylates intersect with autism. People with autism often have low sulfate levels which lead to impaired sulfation and sensitivities to salicylates and phenols in general.
For those with low sulfate and poor sulfation, removing phenols relieves the burden of this biochemical process.
A low-salicylate diet is one in which salicylates are not consumed in order to avoid the symptoms believed to be associated with their consumption.
Aspirin contains salicylates which inhibit the cyclooxygenase enzyme (which is involved in the conversion of arachidonic acid to prostaglandin).
Prostaglandins promote inflammation and are involved in muscle contractions, blood vessel constriction, blood clotting, and pain.
This is how aspirin works, by reducing prostaglandin synthesis.
Similar Diets
The Failsafe Diet limits phenols in general, which includes limiting salicylate intake.
The Feingold Diet is a similar diet that focuses on reducing hyperactivity. In the Feingold diet, salicylates are removed, along with artificial dyes, flavorings, fragrances, certain preservatives, and artificial sweeteners.
Who Would Benefit From This Diet?
A low salicylate diet may be beneficial for people that suspect a salicylate intolerance or sensitivity and experience any of the following symptoms soon after ingesting salicylate-rich foods.
Salicylate sensitivity manifests most often with:
rhinitis or inflammation of the nasal membranes
asthma
nasal polyps
urticaria
gut inflammation as evidenced by gastrointestinal pain or upset
Symptoms of general phenol sensitivity include:
red cheeks and ears
hyperactivity
disrupted sleep
aggression
irritability
diarrhea
headache
headbanging/self-injury
inappropriate laughter
hives/rashes
skin conditions like eczema, psoriasis
upset stomach
asthma
bedwetting and urinary incontinence
fatigue
depression
difficulty concentrating
joint pain
Recommended Foods
Proteins:
Plain fresh, frozen or canned meat, poultry and fish
Eggs
Fruits:
Vegetables:
Grains & Legumes:
Nuts, Seeds & Their Oils:
Fresh cashews, hazelnuts and pecans
Plain, natural peanut butter
Dry sesame seeds and sunflower seeds
Dairy:
Butter, cream, milk, sour cream and plain yogurt without additives
Other:
Homemade condiments without any ingredients to avoid
Margarine and vegetable oils, lard
Baking chocolate, confectioner’s sugar, maple syrup, corn syrup, molasses, sugar and pure cocoa
Certain herbs and spices like pepper, parsley, nutmeg, horseradish, fresh ginger, fresh garlic, fresh coriander, dried allspice
Plain coffee, plain carbonated and mineral water
Baking powder and baking soda, distilled white vinegar, malt vinegar, plain gelatin, pure vanilla extract, pure soy sauce
Foods to Avoid
Fruits:
Vegetables:
Cucumbers, asparagus, sweet corn, tomatoes, black and green olives, sweet potatoes, spinach
Tomato sauce and tomato paste
Nuts, Seeds & Their Oils:
Almonds, brazil nuts, coconut, macadamia nuts, pine nuts, pistachios, walnuts, water chestnuts, and lentils
Other:
Honey and flavored syrups
Licorice and peppermint candies, fruit snacks, candied fruit and commercial candy, flavored gelatin
Certain types of tea including peppermint, lemon, black tea, coffee
Drink mixes, fruit flavored powders, concentrates, pineapple juice, cider, orange juice, tomato juice, cranberry juice and wine
Carbonated drinks and soft drinks
Ice cream, yogurt or frozen desserts with high salicylate fruits
Herbs and spices, especially curry, paprika, thyme, garam masala, anise, rosemary, basil, cumin, cinnamon, mint, mustard, oregano, turmeric, flavoring extracts and flavoring packets
Condiments like mustard, pickles and relish, ketchup, Worcestershire sauce, commercial salad dressings and commercial gravies
Lifestyle Changes
Some medications (like aspirin) and beauty products also contain salicylates. Aspirin contains a much higher dose of salicylate than any food so those with a sensitivity should avoid it.
Beauty products that may contain salicylates include sunscreen, perfume, shampoo and conditioner, cosmetics, lotions, cleansers, mouthwash, toothpaste, shaving cream and muscle pain creams/balms. Those with a sensitivity to salicylates should determine if topical salicylates like those in these personal care products cause a reaction.
Helpful Resources
Salicylate-Free Personal Care Products
Recommended Supplements
The person should be monitored for any nutrients that may be deficient in the diet as a result of the salicylate restrictions. Supplements can be recommended on an as-needed basis.
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.
Low Salicylate Diet in the Research
Symptoms of Salicylate Intolerance
Asthma, rhinitis and nasal polyps, as well as chronic gastrointestinal irritation and urticaria following acetylic salicylic acid ingestion may suggest intolerance. [1]
Sulfation and Autism
Severe autism was associated with low sulfate levels while mild symptoms were associated with higher levels of sulfate, which suggests that sulfate may be helpful in reducing both the incidence and severity of autism. [9]
Three toxins most implicated in the U.S. autism epidemic are acetaminophen (Tylenol), oral antibiotic amoxicillin/clavulanate (Augmentin), and most recently herbicide glyphosate (Round-up). Acetaminophen depletes sulfate and glutathione required to detoxify it. Oral antibiotics kill and glyphosate inhibits intestinal bacteria that synthesize methionine (precursor of sulfate and glutathione, and required to methylate DNA). [10]
Researchers have noted that patients with ASD have various metabolic and nutritional abnormalities including issues with sulfation, methylation, glutathione redox imbalances, oxidative stress, and mitochondrial dysfunction. [11]
Children may respond to sulfate supplements in the form of magnesium sulfate via epsom salts in bathwater or as trace minerals. They may also benefit from removing chocolate, bananas, citrus and artificial food colorants from their diet because a combination of low sulfotransferase activity and low sulfate levels greatly reduces the capacity for detoxification of amines and phenols, both endogenous and exogenous. [12]
Children with autism had high urinary sulfate levels. Reduction of urinary sulfate levels was associated with improvement in clinical symptoms as reported by caregivers. [12]
A major route of inactivation of amines in the central nervous system is via formation of sulphated conjugates and so low sulfate levels can lead to increased concentrations of neurotransmitter amines and prolonged effects on the central nervous system. [12]
In the gastrointestinal tract, the enzymes are often sulfated in order to activate them. As children with autism often have achlorhydria and low sulfate levels, the indirect consequence may be that there are reduced levels of secretin and reduced hydrolysis of dietary proteins. [12]
Dietary Treatment
Currently, the dietary approach recommended to control hypersensitive reactions is via an elimination and rechallenge protocol. [2]
A successful low salicylate diet must have enough calories to prevent deficiencies, which tend to occur when calories are restricted, but not too many calories as to result in weight gain or obesity. [3]
There is little evidence as to the efficacy of a low salicylate diet and the risk–benefit ratio should be considered when contemplating the dietary exclusion of multiple foods, particularly those foods which may confer some health benefit such as foods high in natural salicylates. [4]
A high proportion had adverse outcomes on the restricted diet, including nutritional deficiencies and food aversion. [5]
Salicylate-Rich Foods
High salicylate foods include berries and dried fruits, gherkins, tea, licorice and peppermint candies, honey and herbs and spices including curry powder, paprika, thyme, garam masala, and rosemary. [6]
Genetic Connection
Recent epidemiological studies have shown a strong statistical correlation between risk for ASD and either maternal or infantile atopic diseases, such as asthma, eczema, food allergies and food intolerance, all of which involve activation of mast cells. [7]
This study provides evidence that pregnancy environmental phenol exposures may increase the risk for non-typical development in a high-risk population. [8]
The Bottom Line
Overall, salicylate sensitivity has unique and chronic symptoms that recur when offending foods are ingested. It is possible to have a varied diet even with avoidance of high salicylate foods. There seems to be a general consensus on the salicylate content of certain foods, while the content of other foods is contested in the research. The difficulty of this diet hinges on whether or not salicylates are the only sensitivity that the person faces. This could be said of any diet, that the more sensitivities, the more restriction and the more difficult the diet will be to maintain. Restriction of salicylate rich vegetables and fruits may lead to nutrient deficiencies and thus restrictive diets should be monitored by a dietitian. In conclusion, evidence is limited as to the efficacy of a low-salicylate diet for those that are sensitive. Implementation of the low salicylate diet alone is not overly arduous to implement or maintain and may be worth trying with the assistance of a dietitian.
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, 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 somewhat restrictive but there are many common and allowable foods.
Research ★★
There is some research to support the use of this diet and professional guidance may be beneficial to avoid any nutrient deficiencies that can result from dietary restrictions.
Grade: C
Disclaimer: Diet changes can be difficult to implement and/or potentially dangerous if not approached properly. If you are considering making dietary changes, we strongly advise working with a registered dietitian to ensure that your child's nutrition needs are being met. A dietitian can provide professional, practical guidance on how to implement dietary changes in a way that works for you and your family.
The information provided in the Autism Nutrition Library is intended for educational purposes only and should not be interpreted as medical nutrition therapy, nutrition counseling, diagnosis, prognosis, health care treatment, instruction, advice, or any other individualized medical service. Always let your physician know about any of your health concerns, and check with your doctor or dietitian before making any diet, medication, exercise, or lifestyle changes.
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[1] Baenkler HW. Salicylate intolerance: pathophysiology, clinical spectrum, diagnosis and treatment. Dtsch Arztebl Int. 2008;105(8):137-42.
[2] Malakar S. Bioactive food chemicals and gastrointestinal symptoms: a focus of salicylates. J Gastroenterol Hepatol. 2017;32 Suppl 1:73-7.
[3] Szczuko M, Romaniuk R. [Low salicylate diet and the possibility of nutrient deficiencies]. Pomeranian J Life Sci. 2016;62(4):18-24.
[4] Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy. 2015;5:34.
[5] Gray PE, Mehr S, Katelaris CH, et al. Salicylate elimination diets in children: is food restriction supported by the evidence. Med J Aust. 2013;198(11):600-2.
[6] Swain AR, Dutton SP, Truswell AS. Salicylates in foods. J Am Diet Assoc. 1985;85(8):950-60.
[7] Theoharides TC, Tsilioni I, Patel AB, Doyle R. Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders. Transl Psychiatry. 2016;6(6):e844.
[8] 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.
[9] Williams RJ. Sulfate Deficiency as a Risk Factor for Autism. J Autism Dev Disord. 2020;50(1):153-61.
[10] Good P. Evidence the U.S. autism epidemic initiated by acetaminophen (Tylenol) is aggravated by oral antibiotic amoxicillin/clavulanate (Augmentin) and now exponentially by herbicide glyphosate (Roundup). Clin Nutr ESPEN. 2018;23:171-83.
[11] Bjørklund G, Waly MI, Al-Farsi Y, et al. The Role of Vitamins in Autism Spectrum Disorder: What Do We Know. J Mol Neurosci. 2019;67(3):373-87.
[12] Waring, R., 2009. Sulphur Metabolism In Autism. [online] researchgate.net. Available at: <https://www.researchgate.net/publication/232032839_Sulphur_Metabolism_in_Autism> [Accessed 12 November 2020].
