Salicylate Intolerance Information:

By Cheryl and Doug Atkinson (updated Sep 2008)

Introduction:

This is an article about Salicylate Intolerance. Salicylate is a substance found in Aspirin, but is also naturally found in many foods, such as apples, grapes, tomatoes, and oranges, for example. If  you have adverse reactions to aspirin, it may be that you are also suffering from reactions to these other foods without even knowing it! This article covers Cheryl's story of her debilitation, and the subsequent discovery of its cause. We write this in the hopes it may help others find relief from their pain as well.

Since we started in this track, we have discovered that there has been some research done on this sensitivity, but only in recent years has the information become widely available. One of the primary sources for the information we have is from the Feingold Association (http://www.feingold.org)

But, it requires full and absolute avoidance to determine if you are in fact sensitive to Salicylates. It will be a long and hard journey during this trial time, but if you can conclude this to be the problem plaguing you, what better reward could you ask for then gaining the knowledge of how you can manage your Salicylate related symptoms?

Possible symptoms of a salicylate/aspirin intolerant person (from Feingold)

Skin

Reddening of the eyes and face

Increased tear secretion

Ears

Ringing in the ears

Neurological

Depression - meanness, grouchiness, mood swings, irritability

Skeletal

Pain in the joints, with or without swelling

Other physical symptoms

Chronic fatigue; mental and physical sluggishness, upset stomach, pressure across forehead; heaviness in the head, sensations of swelling, thirst, stinging of the lips and/or throat, hot flashes

Muscle incoordination

Eye muscle disorders such as nystagmus, strabismus

Cognitive and perceptual disorders

Short attention span, inability to concentrate, poor self-image, distorted views of the world

Behavioral Deficits

Fidgetiness, nervousness, workaholism, temper flare-ups, distractability

Note: symptoms vary greatly and can be very difficult to determine because these symptoms fall into to so many other possible categories.  For example, when Cheryl first saw the list she did not think she had many of the symptoms indicated. However, the more she paid attention to her symptoms, the more she realized she had disregarded many of them as “normal” functionings.


Cheryl's Story:

When I was twelve, I took an aspirin for a headache. Shortly afterward my face became swollen. We didn't make a strong connection to aspirin at the time, as I had taken aspirin up to that point with no problems, although it was the only clue we could connect the sudden symptoms to. My mother told me not to take aspirin again, just in case. As time had passed I had forgotten the incident and when the need had arisen I took two aspirins. This time there were worse reactions, including the severe swelling of my face, my eyes were swollen shut, and I had some difficulty breathing. We immediately concluded that I was indeed allergic to aspirin!

In the months to follow I began to have problems with pain and weakness in my left knee, then to include my right knee. Over the years the pain and weakness increased to include my ankles, shins, knees, feet, toes, shoulder, wrists, hands, fingers, neck, and back; basically my entire skeletal structure was affected! Some days weren't so bad, other days I could hardly stand to move anything.I often felt very fatigued, sluggish and depressed but I assumed that chronic pain justified all these.

Before I was married I was at my worst state. There were many days I couldn't get out of bed because the pain and weakness were so severe. I would often feel lightheaded or experience vertigo with the room shifting back and forth a few times. When I could get out of bed, I often walked with a cane to help support the weakness in my legs, but even this was extremely difficult because my wrists and hands where also weak and painful.

I was however, very blessed with a fantastic general Physician (GP). Through the years he helplessly watched my condition worsen and he explained that being a doctor is much like being a detective. They gather the clues (symptoms) and try to solve the mystery (the cause of the illness) through their vast resources of training, information and experience. He then explained that it was patients like me that grieved him the most. He could see that I was in pain and he had run out of theories to try and could not "solve" my mystery. I remember that one day he called me at home and said that he had found an article in the newspaper about tomatoes causing symptoms similar to mine and he thought of me right away. He sent the article to my house encouraging me to give it a try. It wasn't the "magic bullet", but he was on the right track.

As time went on, I thought for sure that I was headed for a wheelchair. My grandmother had suffered a similar condition. She had started falling in her twenties for "no reason"; her legs would just give out underneath her so she had started using a wheelchair as she could not rely on her own mobility. In the doctors' efforts to figure out her problem she was injured during a spinal tap and was paralyzed from that time on. I've often wondered if she had the same sensitivity to food and additives.I do know that she was very allergic to tomatoes as she would get blisters in her mouth when she ate them. However, she died long before I learned about salicylates.

I had been to as many kinds of specialist doctors as you can imagine during that period of about ten years and none of them could find anything wrong with me. Every test result would come back "normal". Some would add something like," I don't know what's wrong with you and I don't know where else to send you." It was even suggested on two different occasions by two different doctors that I see a psychiatrist.

Life is hard and full of trials. In fact, it is the trials of life that can make us either bitter or better. I had put my faith and trust in the Lord Jesus Christ at a very young age and I have trusted Him to lead me through any dark waters that I must pass. For more than 10 years that trust and faith was tested through what felt like a long silence from the Lord concerning my pleading for relief. Then, when the appointed day arrived, the Lord graciously revealed my salicylate intolerance.

My mother was always reading diet books for arthritis, as the symptoms were similar. One of the books was Prevention magazine's Nutrition Advisor by Mark Bricklin. This book provides nutritional information on foods. While reading the text she found an aspirin alert next to certain foods. For example: "Those allergic to aspirin may react to the natural salicylate in grapes."Since we were aware of my allergy to aspirin I copied all the foods down and avoided them for a period of three months. The result was I found almost total relief from my symptoms.

When I share this with people they often say,"Oh, that's a shame that you can't eat strawberries and such!" However,I feel so very blessed that I can understand what causes my symptoms and I can avoid problems. However, to my shame, I often give in to temptation by choice or naiveté and end up paying the price to some extent. Rarely does the level of toxin get so bad that I am confined to bed or in need of a cane. I have learned the warnings of my system being over-loaded and I know when I need to go back to strict avoidance.

Currently, if I eat or am exposed to a product containing salicylates, my face will flush. Then, depending on the food or environment trigger and the amount of toxin already in my system, the order and severity of the following symptoms will vary, such as: face and neck flush, lips burn, vertigo, mental sluggishness, pain in my neck, back,shoulders and/or legs, fatigue (sometimes severe), ringing in my ears (which is almost constant, becomes louder), all followed by depression.

Since the "mystery" of my pain and weakness have been solved, I have found many other people who are also intolerant of salicylates, most of whom didn't realize it. It seems to be virtually unknown in the medical field, as details have been very difficult to find.Also, as far as we know, there are no clinical tests to determine a salicylate intolerance. It can only be determined through and elimination diet with complete abstinence of the foods and triggers. This takes a great deal of determination and I have found that unless someone has suffered for a long time they are very unwilling to give this a fighting try. I hope that as this intolerance becomes more well known among the medical industry that more scientific research will be done. I believe that there is a great deal yet to learn.


The Bucket Theory:

From what we have read, the salicylate intolerance is not really an allergy, as an allergy strikes no matter how much of the allergic item is ingested. An intolerance, however, seems to fit what is sometimes called the “bucket theory”.

With this sensitivity, imagine that there is a bucket in your body. If the bucket were nearly empty there would be no symptoms. As you are exposed to more and more salicylates, the bucket fills, yet you still don't experience any reactions. However, as it nears the top, the reactions will start to arrive. Just as a bucket of water tends to spill out when being carried across the room, if the bucket fills to overflowing, the reaction will be severe until the salicylates levels have decreased in the bucket. The bucket level will lower over time and with the avoidance of more salicylates.

What is salicylate?

Salicylate is a chemical that plants produce to protect themselves from soil bacteria. Therefore, some amount of salicylate is found in every plant. The natural salicylate radical, which is not necessarily identical to aspirin but is closely allied in the basic structure, can induce the same reaction to manufactured aspirin. Chemical companies commonly use synthetic flavorings, colors and preservatives that contain a salicylate radical.


What to do?

The goal is to eat only the fruits and vegetables that have low-to-moderate levels of salicylates and to avoid Don't be fooled - Reactions to a salicylate intolerance can be immediate or delayed. You may have a glass of orange juice in the morning, but not get a headache until bed time or even the next day, leaving you to believe that the orange juice had no connection. This is why it's going to take at least six weeks without cheating before you will see results. You cannot just cut out some of the foods on the list as a "trial", because each “illegal” food will fill the bucket more. Remember the bucket theory: everything counts!

You will probably need to avoid all restaurants for the trial period, as they all use ingredients that contain salicylates to some extent and it is almost impossible to order foods that won't fill the bucket a bit. The Feingold Association has information available on many restaurant menus, but for the trial run, it is best to avoid them altogether if possible. It is also suggested that you try this test during a time that you can avoid eating at someone else's house. It may be tough during November and December, for example, because of the many family and holiday get-togethers, parties,and so forth.

It may also be helpful to chart the food you eat after about two weeks of strictly following the diet as it will take some time for your body to eliminate the stored salicylates. After noting what you eat, check for any signs of reactions every so often, noting your findings. This will help you to see if there have been any changes in symptoms over a duration of time.

Guidelines for a Salicylate Free Diet:

FOODS TO AVOID

Fruits & Nuts: almonds, nectarines, peppers, apples, oranges, eggplant,
apricots, peaches, radishes, blackberries, plums or prunes, blueberries,
cherries, raspberries, fresh pineapple, currants, strawberries,
gooseberries, cucumbers and pickles, grapes and raisins, tomatoes

Other sources of salicylates include food and products containing artificial colors and artificial flavors.
Be sure to read all labels carefully as vanillin is the only artificial flavor clearly labeled by its name.

Avoid these also

margarine
cider, balsamic and wine vinegar
cake mixes
diet supplements
bakery goods (except plain bread)
peanuts and peanut butter
Jell-O™
chili powder, cayenne,cloves,
curry, ginger, paprika, rosemary
Chinese five spice (MSG; note: MSG can be cited as "natural flavor")
candies, gum, oil of wintergreen
molasses, clover honey
aspirin (use Tylenol™ tablets Extra Strength)
lunch meat
hot dogs
Aloe vera

All grown spices have salicylates, so use them conservatively. Some will cause more reaction than others when used, especially in large quantities.

Also avoid preservatives such as: BHA, BHT, TBHQ, sodium benzoate

For the trial period, avoid these beverages completely:

Kool-aid™ and similar
all distilled drinks
soda
beer, wine
all tea (peppermint tea may be okay, but avoid until after trial period)
diet drinks
coffee

As you begin to read all the product labels of your grocery list you'll quickly realize how greatly limited you will be. Just looking for products that don't have artificial colors and flavors would be hard enough, but then add preservatives to the list and the grocery store that is the size of a football field is reduced to a small convenience store in its practicality to your needs!

Because this is so hard to accomplish with only an exclusion list, below is a list of things you can eat, including some product names you can look for in your store.

Often, in place of tomato sauce I will choose from a variety of chicken broth brands found in stores carrying organic labeled foods. (You'll need to check for trigger ingredients. Don't just trust an organic label)  Sometimes it works for the meal you're cooking, and sometimes it's just not a good replacement. Be sure to always check the ingredients labels on even recommended products because companies do change their ingredients from time to time. I also use this as the base for my soups and gravies. All of those great canned "cream of" soup recipes are out of the question unless you start from this base and make your own or can find an organic brand without any of the above ingredients.

Monosodium Glutamate (MSG) can also cause reactions in sensitive individuals. However, you can't just look for the MSG ingredient, as there are other ingredients that contain enough MSG to trigger reactions. These include: Calcium caseinate, Textured protein, Gelatin, Monopotassium glutamate, Sodium caseinate, Yeast extract, Autolyzed yeast extract, and Hydrolyzed protein (information from: http://www.truthinlabeling.org/hiddensources.html).

Foods that should be SAFE to eat. Of course, this list is not exhaustive and brands may vary depending on your area. The Feingold Association has an extensive booklet available that lists safe foods.

Fruit
mango, passion fruit, pears, rhubarb, casaba, melon, coconut, crenshaw melon, figs, honeydew, kiwi,
kumquat, lemons, limes, papaya, watermelon, avocado, banana, cantaloupe, grapefruit,
cooked or canned pineapple

Vegetables
With the exception of tomatoes, cucumber & pickles, radishes, peppers and eggplant, all other vegetables are permitted

Nuts
cashews, brazil nuts, hazelnuts, poppy seeds
pecans, walnuts, sunflower seeds

Sugars
granulated sugar, maple syrup

All grains should be acceptable
Wheat, Oats, Millet, Buck Wheat, Spelt, etc.

Store bought bread products must be carefully read. I currently am grinding my own wheat and baking our bread but have in the past purchased a variety of Arnold Brand Natural Breads.  Again, remember to always check the label for changes in their ingredients, especially in healthy breads as they tend to add raisin juice, almonds, or other natural but salicylate containing ingredients.

All meat and fish (unprocessed), though avoid meats with added nitrates (hot dogs, hams)

Dairy products
milk, cream, vanilla, or plain yogurt, cottage cheese, butter cream cheese
all white cheeses such as: white cheddar cheese, mozzarella, Swiss cheese, American, etc.
**yellow cheese is achieved with artificial colors

Snack foods
pretzels, natural brand potato chips such as Lays™, Tostitos Chips, Utz™, etc.
popcorn (homemade), Ritz™ crackers, corn chips

Cookies
Pepperidge Farm™ Milano: milk chocolate, double chocolate, chocolate mint=
Newman's Own Brand™: Fig Newman's, chocolate chip, chocolate sandwich cookies
Loacker Brand™ wafer cookies: Chocolate and lemon flavor
Stauffer™ Animal Crackers
Whole Foods 365 Brand sandwich cookies
Trader Joe's brand Joe's Joe's
Back to Nature™ Chocolate Chip, Fudge Mint (like Girl Scout Thin Mints)

Cake mixes
Duncan Hines™ moist deluxe cake mix dark chocolate fudge
Frosting must be homemade or simply sprinkle confectioner's sugar on top

Ice Cream
Turkey Hill™ ice cream sandwich
Bryers™ (black container only - not "No Sugar Added" variety): Natural Butter Pecan, Natural Mint Choc. Chip, Natural vanilla, Natural chocolate, Natural Vanilla Fudge Twirl
Haagen-Dazs™: Butter Pecan, Choc, Choc chip, chocolate, choc chip, cookies and cream, vanilla, vanilla fudge
Luigi's Italian Ice™: chocolate, lemon
Mama Tish's™ Fruttuoso Sorbetto Premium Italian Ice: Lemon

Puddings
Kozy Shack™: Chocolate, rice, tapioca, vanilla
Swiss Miss™: choc pudding in the 4oz cups (not "fat free" varieties)

Cereals
Grape Nuts™
Cream of Wheat™
Old fashioned Oat Meal
Some Kashi™ brand cereals
Barbara's™ Brand Bite size shredded oats, cinnamon puffs, puffins crunchy corn, shredded spoonfuls, shredded wheat
Kellogg's™ Crispix (Large box only, not individual sizes)
Some natural Granolas, but it is hard to find any without raisins or other prohibited items

Beverages
7-Up™ in cans or bottles (though I think it still contains preservatives)
Canada Dry™ ginger ale (same)
Lemon/Lime natural sodas if you can find them (check ingredients)
Seltzer water: plain, lemon/lime flavors
Postum™ (coffee substitute, if you can acquire the taste)
grapefruit juice (check for added grape juice in ingredients)
frozen lemonade concentrate (not pink, again due to grape juice added)
carrot juice
pear juice (usually found near baby food)
pineapple juice
Celestial Seasonings™ or other Herbal tea: peppermint (can make iced tea with these)
cranberry juice (in moderation)

Stores

Whole Foods Markets
Teader Joes
Wild Oats
Stop And Shop

All of these stores offer a wide variety of choices for those of us with sensitivities. More and more stores seem to be carrying potential products for us but, buyer beware! There are also more and more imposters on the scene as the market interest is growing, read your labels carefully!

Products which list "natural flavoring" on the label may contain one or more salicylates and there is no way to determine what they are. Avoid these if at all possible during your trial period.

You will need to do the majority of cooking from scratch. Believe me when I tell you I know how hard it is, but home made food is better for the whole family in the long run too. (If that's any consolation in spite of our out-of-the-box, can, container, fast food friendly society.) Don't give up the fight, keep your eyes on the prize of good health and hopefully, a pain-free life awaits. Set your goal of at least 6-8 weeks for a strict trial, stick to it at all costs and if nothing else you can chalk it up to an adventure, but I personally hope it's much more than that!


More Information:

If you find you are salicylate intolerant, we highly recommend you join the Feingold Association. The cost is a bit high at about $69 (plus shipping) for the first year, but the large binder of information you get along with a monthly newsletter will be well worth it. Although Feingold's focus is on children with ADHD, the Stage 1 diet eliminates foods with salicylates, artificial colors, flavors, and preservatives, which is perfect for those with salicylate intolerance!

http://www.feingold.orgAn excellent resource. Offer materials, a newsletter, an online forum, recipes, and more, including a members only area.

http://www.foodcanmakeyouill.co.uk Food Can Make You Ill. Website features e-books and articles on health, including Salicylate Intolerance. By Sharla Race.

http://www.fedupwithfoodadditives.info Sue Dengate's site on the effects of food on behavior, health and learning ability in both children and adults.

http://www.psha-inc.com/guai-support/ International Guai-Support Group, provides a section on the Salicylate Issue and an interactive forum for discussion


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