The Failsafe Diet

About the Diet

Printable Failsafe Diet Sheet

This is a trial diet that is designed to eliminate additivessalicylatesamines and glutamates. It is not suitable to treat food allergies or coeliac (celiac) disease. It is not a gluten/casein free diet, or a low FODMAPs diet, though some individuals may wish to explore these options to relieve other food intolerances. 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. Food intolerances can weaken your immune system and cause secondary infections, (for example eczema or dermatitis). 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 diet or 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 unrelated 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 GroupFood ItemInstructionsMaximum AllowedAvoid - Common PitfallsFood Chemicals (per 100 grams)Other Problems
FruitPearsFresh, 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. Pears contain FODMAPs.
VegetablesBamboo ShootsFresh, or canned without additives Do not confuse with water chestnuts, which are very high in salicylates.Bamboo shoots 0mg salicylate.Oxalate content unknown
Brussels SproutsFresh or frozenLimit to sensible amounts. Brussel sprouts 0.07mg salicylate. Sulphurous vegetable.Brussels sprouts contain moderate amounts of oxalates. Brussels sprouts contain FODMAPs.
Cabbage, Red or Green/WhiteFresh or frozenLimit 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. Cabbage contains FODMAPs.
CeleryFresh Celery contains traces of natural benzoates. Celery contains natural nitrates.Raw vegetables can irritate sensitive stomachs. Celery is high in oxalates.
ChivesFresh or frozenAs a garnish. Chives 0.031mg salicylate. Contains other phenolic/aromatic compounds.Raw vegetables can irritate sensitive stomachs. Chives are low in oxalates.
Choko/ChayoteJust ripe Choko 0.01mg salicylate.Oxalate content unknown.
GarlicFreshLimited 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. Garlic contains FODMAPs.
LeeksFresh Leeks 0.08mg salicylate. Sulphurous vegetable.Leeks are high in oxalates. Leeks contain FODMAPs.
Lettuce, IcebergFresh 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.
ParsleyFreshAs a garnish. Parsley 0.08mg salicylate. Contains other phenolic/aromatic compounds.Raw vegetables can irritate sensitive stomachs. Parsley is high in oxalates.
Potatoes, WhiteLarge 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 moderate in oxalates.
Shallots, AKA Green/Spring/Salad OnionsGreen 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. Shallots are high in FODMAPs.
Swedes/RutabagasLarge, 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 LegumesLentils: Red, BrownDried, 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. Lentils are high in FODMAPs.
Beans: Blackeye, Borlotti, Brown, Carob, Chickpeas/Garbonzo, Kidney, Lima, Mung, Mung bean sprouts, Soya/Soy, Soy Milk, TofuDried, 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 protease 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 moderate in oxalates. Allergenic. Beans are high in FODMAPs.
Beans, French or GreenFresh 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 SeedsCashew NutsFresh, unroasted10 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. Cashews are high in FODMAPs.
Poppy SeedsDried or fresh, unroastedSprinkle.Roasted poppy seeds (amines).Poppy seeds 0mg salicylate. Roasted poppy seeds contain amines.Oxalate content unknown.
GrainsArrowroot, Barley, Buckwheat, Millet, Oats, Rice, Rye, WheatWhite/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. Allergenic. Gluten grains are high in FODMAPs, non-gluten grains are low FODMAP.
Grains/FloursAmaranth, Sago, Tapioca/Cassava, QuinoaThese 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.
Eggs and DairyEggsStore 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 CreamStore 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 to 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. Allergenic. Milk is high in FODMAPs, as lactose is a FODMAP.
Cheeses: Cream Cheese, Mascarpone, Ricotta, Farm Cheese, Cottage Cheese, fresh white cheesesStore 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.
MeatBeef (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 CrustaceansFresh White Fish, Fresh Crab, Fresh Lobster, Calamari (squid), Sea ScallopsEat 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 BeveragesMilk, Malt Drinks (ovaltine), Decaffeinated Instant CoffeeMake 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 BeveragesWater, Homemade ’Lemon’ Drink (citric acid, sugar, water), Soda Water, Tonic Water, LemonadeUse 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 BeveragesGin, Vodka, WhiskeyDrink 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 FatsButter, Ghee, Safflower, Sunflower, Canola, Soya/SoyOils 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 AidsSalt, Bicarbonate of Soda, Citric Acid, Cream of Tartar, Gelatine, Baker’s YeastBoiling removes sulphites from gelatine. Use caution with gelatine as it can contain sulphites and glutamates.Gelatine can contain glutamates.
Herbs and SpicesVanilla 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.
SweetnersWhite Sugar, Rice Syrup, Golden Syrup, Pure Maple SyrupChoose 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. Honey is high in FODMAPs.
ToiletriesToothpaste: Unflavoured Toothpaste, Salt, Bicarb of Soda, Homemade Toothpaste made with Bicarb of Soda or Calcium Carbonate Powder and GlycerineChoose 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 SulphateChoose 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 AcidChoose 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 SaltsUse 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 CrystalChoose 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 PABAOnly 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 SkinUse 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, LyeIf 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.
MedicationsEssential Medications Only, White Tablets, Powdered Contents of Capsules, Preservative-Free InjectionsRemove 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 BicarbonateMix your own antacid.Therapeutic.Don’t abuse antacids.
VitaminsVitamins and minerals without PABA, colours, flavours and additivesVitamins providing your RDA only, do not megadose unless you are certain you have a vitamin deficiency. 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 sensitivities such as FODMAPs, oxalates, lectins, or 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, but you may wish to try other diet trials, such as the FODMAPs diet, or the low oxalate diet.

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 mood swings, or even 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

FoodQuantityLength of Challenge
1.Milk1-3 cups of milk.Seven days
2a.Wheat Flour1 cup plain cooked pasta (no colour) and 12 water crackers.Three days, and if no reaction start including bread (2b)
2b.BreadContinue 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.SalicylatesChoose 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.Amines2-3 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, paw paw, 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 subtly, 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.ColoursFood 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

Food ColourTartrazine, yellow #5E102
Quinoline yellowE104
Yellow 2GE107
Sunset yellowE110
Azorubine, carmoisineE122
Ponceau 4R, brilliant scarletE124
Red 2GE128
Allura redE129
Indigotine, indigo carmineE132
Brilliant blueE133
Food green S, acid brilliant greenE142
Caramel (caramel itself is actually failsafe but some caramel contains sulphites)E150
Brilliant black BNE151
Brown HT, chocolate brownE155
Annatto extracts, bixin, norbixinE160b
SorbatesSorbic acidE200
Sodium sorbateE201
Potassium sorbateE202
Calcium sorbateE203
BenzoatesBenzoic acidE210
Sodium benzoateE211
Potassium benzoateE212
Calcium benzoateE213
SulphitesSulphur dioxideE220
Sodium sulphiteE221
Sodium bisulphiteE222
Sodium metabisulphiteE223
Potassium metabisulphiteE224
Potassium sulphiteE225
Potassium bisulphiteE228
Nitrates and NitritesPotassium nitriteE249
Sodium nitriteE250
Sodium nitrateE251
Potassium nitrateE252
PropionatesPropionic acidE280
Sodium propionateE281
Calcium propionateE282
Potassium propionateE283
Antioxidants (gallates)Propyl gallateE310
Octyl gallateE311
Dodecyl gallateE312
Antioxidants (butylates)tert-Butylhydroquinone, tBHQE319
Butylated hydroxyanisole, BHAE320
Butylated hydroxytoluene, BHTE321
Flavour Enhancers (glutamates)L-Glutamic acidE620
Monosodium L-glutamate (MSG)E621
Monopotassium L-glutamateE622
Calcium di-L-glutamateE623
Monoammonium L-glutamateE624
Magnesium di-L-glutamateE625
Flavour Enhancers (ribonucleotides)Disodium guanylateE627
Disodium inosinateE631
Disodium 5′-ribonucleotidesE635
Artificial SweetenersAspartame (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.