Advice for Super-Responders

Some very sensitive individuals with food chemical intolerance require a diet that is restricted beyond the level required by the failsafe elimination diet. This is particularly true of individuals who have severe/chronic symptoms, autism or autistic-like traits, and of those with chronic pain, fatigue syndromes, and underlying endocrine problems like untreated hypothyroidism.

Before introducing further restrictions, it may be worth trying the following:

Improving Tolerance

  • Avoid taking the pill or hormone replacement therapy. Oestrogen appears to lower food chemical tolerance in some women.
  • Avoid soy and other foods that contain pseudo-oestrogens (chickpeas and some other legumes). For the same reasons as above.
  • Have your thyroid tested for normal function. Poor thyroid function appears to worsen tolerance in some – although food chemical intolerance symptoms often also mimic poor thyroid function, so do not make assumptions about what is wrong!
  • Avoid taking all non-essential medications, particularly antidepressants and psychoactive drugs. Some (not all) psychoactive drugs affect tolerance levels. This is particularly true of MAOIs, which can induce food chemical intolerance symptoms in previously tolerant individuals. Different psychoactive drugs can improve or worsen different symptoms in different individuals.
  • Avoid caffeine. Caffeine appears to exacerbate some symptoms that are related to food chemical intolerance, such as insomnia, dermatitis, rosacea, etc. It can also induce ‘manic’ happy-high reactions in some.
  • Vitamins: folate and B12 in particular have differing effects in different individuals. Some people experience an improvement of symptoms, others experience a worsening of symptoms. Folate and B12 can strongly affect mood and clarity (inducing mania or clearing brain fog depending on the individual and dosage) and affecting seizure threshold. Adequate vitamin D and sunlight (both UVB and SAD lighting) appear to improve tolerance during the winter months when symptoms are at their worst, this is particularly true of those who have a poor tolerance of stress. A number of failsafers have reported both positive and negative reactions to zinc – probably because it antagonises copper, a rate-limiting factor in the monoamine oxidase (MAO) enzyme, and potentially induces angiotensin converting enzyme (ACE), an enzyme implicated in food chemical intolerance. When ACE is a problem, individuals tend to feel better when they avoid salt (sodium chloride) and/or season with lo-salt (potassium chloride) instead. Zinc may also improve symptoms as it is the “master” mineral that controls the metabolism/absorption/excretion of all other minerals and detoxifies heavy metals (lead in particular is known to affect dopamine function).
  • A ketogenic diet, whilst not suitable for everyone, appears to dramatically increase tolerance and symptom threshold in some individuals, probably due to its inhibition of glutamate. It is particularly useful for mental/mood symptoms and seizures.
  • Be patient! A number of symptoms associated with food chemical intolerance are due to depression of the immune system, and an infection may be present (such as in skin conditions, ear aches, thrush, some (not all) cases of digestive upset, and possibly fibromyalgia). The body may need extra time to fight off an infection or a little extra help from antibiotics or antifungals to do so.

Foods to Test

If you continue to have chronic symptoms on the failsafe diet, it is essential you try the following before giving up:

  • Ensure you have double-checked allowed foods and you have examined the checklist of common mistakes on the Food Intolerance Network website
  • All individuals whose symptoms do not clear up on the failsafe diet should also go gluten and casein free for at least two weeks (see the gluten and casein responders page)
  • Test for reactions to eggs (some individuals have severe non-IgE idiosyncratic reactions to eggs)
  • Be certain you are following amine handling guidelines correctly (most people make this mistake)
  • Try cutting out sulphurous vegetables such as allowed cruciferous vegetables and garlic (some people do not tolerate garlic at all)
  • Try cutting out fruit and vegetables partially or completely, as per the guidelines below:

Salicylate Super-Responders

General Tips

  • Restrict the amount of fruit, vegetables and legumes you eat to two servings per day
  • Then, restrict to one serving per day
  • Finally, restrict to one serving every other day

This should help to clarify whether you react to very small amounts of salicylates and SLAs, as you may notice digestive upset, or a ‘hangover’ reaction on the day after eating salicylates. Please do not restrict foods unless absolutely necessary. Failsafers must continue to eat meat, eggs, and dairy (if tolerated) whilst exploring super-sensitivity to salicylates.

White sugar is the safest sweetener, followed by maple syrup, then golden syrup.

A number of gluten-free grains/seeds can be problematic. Gluten-free flours are notorious for causing digestive problems due to the gum additives, so stick to unprocessed grains to begin with. Quinoa can cause reactions in some individuals, and amaranth is thought to be safer than quinoa. Buckwheat has been reported to cause urticaria in some individuals.

Potatoes must be large, mature, brown skinned, white fleshed, and thickly peeled. They must not have green patches or sprouts. Sensitive failsafers do not tolerate new potatoes and potatoes with skins. Trying different varieties can help a lot. For example, this author tolerates Maris Piper very well, but some creamy tasting baking potato varieties give her salicylate/solanine symptoms like heart palpitations.

Brown split lentils are tolerated better than red split lentils. You may find that you tolerate beans better than lentils. White, colourless beans like lima beans and butter beans seem to be more tolerable. Generally, the reactivity of beans and pulses is higher than that of some vegetables.

Buy varieties of pears that do not have a strong aromatic smell. Williams pears have a lemony scent and are more reactive than conference pears, which are relatively safe and subtly flavoured.

Sweet chestnuts have not been tested for salicylate content and do not appear on any failsafe lists, however some varieties seem to be well tolerated and may be useful for those individuals who have to restrict many foods. The wild/châtaigne variety with a number of separate kernels in one nut is safer than the single kernel marron variety.

Rice: remember that basmati and jasmine rice are not failsafe. White rices are safer than brown rices. Short grain rices appear to be safer than long grain rices. The safest rice of all is sushi rice. Super-responders should check the rice table below.

Limiting Salicylates - Stage One (Strong Intolerance)

The following plant foods contain zero salicylates. Although some foods also contain traces of amines and also salicylate-like aromatics, it may be worth restricting allowed foods to those in this list:

  • Arrowroot
  • Bamboo shoots
  • Barley
  • Beans, blackeye
  • Beans, borlotti
  • Beans, chickpeas/garbonzo
  • Beans, lima
  • Beans, mung
  • Beans, soya/soy
  • Buckwheat
  • Carob
  • Celery
  • Green cabbage
  • Iceberg lettuce
  • Lentils, brown
  • Lentils, red
  • Maple syrup
  • Millet
  • Oats
  • Pear
  • Peas, dried green split
  • Poppy seed
  • Potato
  • Rice
  • Rye
  • Saffron
  • Sugar
  • Swede

Limiting Salicylates - Stage Two (Serious Intolerance)

As many fruits, vegetables, legumes, pulses, nuts and seeds contain other salicylate-like aromatics (SLAs), including colours, flavours and smells, some very sensitive people do not tolerate a zero salicylate diet. This is the next stage of restrictions for those people, based on the accumulated advice of failsafers:

  • Barley
  • Celery
  • Green cabbage
  • Iceberg lettuce
  • Maple syrup
  • Millet
  • Oats
  • Potato
  • Rice
  • Rye
  • Sugar
  • Swede
  • Wheat

Limiting Salicylates - Stage Three (Severe Intolerance)

White carbohydrates only – no fruits, vegetables, legumes, pulses, nuts and seeds.

  • Barley (white)
  • Millet
  • Oats
  • Potato
  • Rice
  • Rye (white)
  • Sugar
  • Wheat (white)

A number of the white carbohydrates listed above contain gluten, which can be problematic in itself. Not everyone tolerates millet or oats, leaving only potatoes and rice as the safest carbohydrate foods. Please follow the potato and rice guidelines as above. People this sensitive usually only tolerate sushi rice and have to be very selective about potato consumption. Remember: only a tiny number of failsafers have to restrict their diet beyond the normal failsafe diet, and those individuals must ensure that they have accounted for all possible causes of their salicylate sensitivity, such as requesting thyroid and nutritional testing. It is absolutely essential that individuals who are on this diet for more than a couple of weeks take a full spectrum of vitamin and mineral supplements to ensure adequate nutrition.

Fine-Tuning Rice Tolerance

This is a subjective compilation of tolerance levels to different varieties and brands of rice from two severe salicylate super-responders in the UK. Listed from most to least reactive.

Type of RiceL’s ReactionE’s Reaction
Basmati rice (any brand)Severe fatigue/exhaustion, brain fog, fibromyalgia symptoms the following day. Worse than a regular salicylate reaction.
Short grain pudding rice (any brand)Insomnia and nightmares.
Carnaroli risotto rice (any brand)Insomnia and nightmares.
Arborio risotto rice (any brand)Insomnia and nightmares.
Paella rice (any brand)Insomnia and nightmares.
Kokuho Rose Sushi RiceVery aspie/hyper - I found out this one is fortified with folic acid.
Nishiki Sushi RiceHypoglycemia, I feel high and clear temporarily.
Okomesan Sushi RiceHypoglycemia, I feel high and clear temporarily.
Sun Rice Sushi RiceVery sleepy, bloated, my head feels fine.
Yutaka Sushi RiceHead does not feel so clear but otherwise I’m fine.Insomnia for an hour or two on the first night it’s eaten, then get used to it.
Clearspring Organic Sushi RiceA bit sleepy but clear headed.No reaction at all.

Amine and Glutamate Super-Responders

General Tips

For a full overview of how to limit amines, please see the guidelines for minimising amines in foods.

  • Don’t buy meat from the supermarket
  • Don’t buy vacuum packed meat
  • Avoid beef until you are able to test it properly
  • Avoid shellfish, squid and crustaceans (except lobster) until you are able to test them properly
  • Cook and eat meat the day you buy it or else freeze it
  • Eat meat within a month of freezing
  • Avoid sourdough bread and soaked and fermented grains and beans
  • Avoid soups, stocks and broths until you are able to test them properly
  • Avoid long slow roasting until you are able to test properly
  • Remember that pork and game are not failsafe!

Limiting Amines in Dairy Products

Dairy products listed from most reactive to least reactive.

Type of Dairy ProductNotes
Strong yellow cheesesThe stronger the taste of the cheese, the higher in amines and particularly glutamates it will be.
Mild white cheesesMild brie and fresh goat’s and sheep’s cheeses are sometimes tolerable. Feta and mozzarella are not safe for failsafers.
KefirAccording to published analyses, kefir cultures are very variable in bacterial makeup. A variety of species found commonly in kefir are known to make free glutamate and amines. Lactococcus lactis (found in cheese and kefir) and a variety of lactobacillus and bifidus species produce amines.
Probiotic yoghurtA variety of species found commonly in "probiotic" yoghurts are known to make free glutamate and amines. Lactobacillus casei, a common probiotic, forms free glutamates. A variety of lactobacillus and bifidus species produce amines.
Fromage frais, fromage blanc, maquée, quarkUsually safe, but should not be left in the fridge for too long after opening.
Cottage cheese, cream cheese, crème fraîcheUsually safe, but should not be left in the fridge for too long after opening.
Non-probiotic (traditional) yoghurtTraditional yoghurt cultures are made with the species lactobacillus acidophilus, streptococcus thermophilus, and lactobacillus bulgaricus. These three species do not form amines. If the yoghurt is made in a properly controlled environment (not contaminated) it will be safe.
Fresh milkFailsafers sometimes report unusual reactions to UHT milk. Raw milk does not appear to be beneficial. Regular milk is considered safe for those who tolerate dairy products.
Fresh creamSafe for those who tolerate dairy products.
ButterSafe for those who tolerate dairy products.

Gluten and Casein Responders

For a full overview of how to test and limit gluten and casein, please see the gluten and casein responders page.