If you’ve ever eaten a big bowl of spaghetti bolognese or devoured a spicy curry, it’s highly probable that you’ve consumed a chemical known as salicylates. Found in plant-based foods as well as synthetic products such as aspirin and acne creams, salicylates offer many health benefits to humans (1). From their anti-inflammatory and anti-cancer properties to their antiemetic and anticonvulsant effects, scientific literature is starting to unravel the important role this pharmacological agent plays in human health.

For some people, however, salicylates can cause a world of pain, leading to distressing symptoms if too much of the chemical is consumed (2,3). Salicylate sensitivity varies from individual to individual and appears to be dose-dependent. When it comes to experiencing symptoms it’s helpful to think of their relation to dietary triggers in terms of the “bucket theory” rather than isolated events. For example, eating a lot of foods high in salicylates may bring about symptoms imminently, whereas eating smaller amounts over many days may not be enough to trigger symptoms, instead accumulating in the body until your personal threshold for salicylates is exceeded and symptoms ensue.

That’s where the low salicylate diet comes in. Eating meals low in salicylates ensures highly sensitive individuals don’t overshoot their threshold and thus don’t experience unwarranted symptoms. There are various lists (4, 5) that categorise foods as being either negligible, low, medium, high or very high in salicylates. These inventories help sensitive people to customise their meals to incorporate foods that are less likely to trigger symptoms. It’s important to be aware that salicylate intake isn’t just limited to food, but can also be found in medicines, health and beauty products and household cleaners.

While a low salicylate diet is undoubtedly restrictive, the focus shouldn’t necessarily be on exclusion, but rather on inclusion. Really more a process, than a diet, it’s about determining what foods make you feel good and discovering ways in which higher salicylate foods can be incorporated throughout the days and weeks so as not to trigger symptoms. An example is someone who really wants to indulge in a tomatoey pizza on the weekend but is scared of the repercussions. It may be that they eat low salicylate meals throughout the week, so come Saturday they can indulge in a slice or two without overshooting their salicylate threshold and thus no symptoms ensue. As mentioned previously, there are many health benefits attributed to salicylates. Methodical experimentation to determine exactly which foods are triggering, as well as the quantities in which they elicit a reaction, is necessary to ensure food groups aren’t cut out unnecessarily.

Something to note is that a diverse microbiome is linked to improved health outcomes (6), and one of the best ways to achieve this is through a varied diet, more specifically, eating 30+ plant foods a week (7). Though it may seem difficult at first, with concerted effort, those on a low salicylate diet can hit their 30 plant foods a week, ensuring their microbes are left feeling nourished.

Many symptoms of salicylate sensitivity overlap with the symptoms of other, often serious, health conditions, making it a somewhat difficult condition to diagnose. To ensure misdiagnoses and/or nutritional deficiencies are avoided, before undertaking a low salicylate diet, it’s highly recommended to seek the advice of a GP or a registered dietitian. If a salicylate sensitivity is suspected, a common course of action is to first undergo an elimination diet which involves cutting out common food chemical triggers, establishing a baseline, and then reintroducing salicylates to see if they are indeed the culprit. If salicylate sensitivity is unveiled, a low salicylate diet may then be recommended. It’s important to remember that the goal isn’t to stay on a low salicylate diet forever. Instead, the diet is there to help give you a unique understanding of what foods you can tolerate and in what amount and/or what time of the day. Many people with food sensitivity find they’re able to include a little bit of the ‘triggering’ food in their diet, they just can’t consume large amounts of it in any one sitting nor eat it along with other higher salicylate foods so as to avoid ‘salicylate stacking’ effects.

Unfortunately, salicylate sensitivity is still a poorly understood condition. While more high-level evidence is needed to fully understand the scope of this chemical sensitivity and its relationship to health disorders, anecdotally, many, including myself, have found reprieve in limiting intake of high salicylate foods and products, and thus have achieved improved quality of life.

Brigid xx

References

1.) Yeasmin, Fatema, and Hyong Woo Choi. “Natural Salicylates and Their Roles in Human Health.” International journal of molecular sciences vol. 21,23 9049. 28 Nov. 2020, doi:10.3390/ijms21239049

2.) Tuck CJ, Malakar S, Barrett JS, Muir JG, Gibson PR. Naturally-occurring dietary salicylates in the genesis of functional gastrointestinal symptoms in patients with irritable bowel syndrome: Pilot study. JGH Open. 2021 Jul 21;5(8):871-878. doi: 10.1002/jgh3.12578. PMID: 34386594; PMCID: PMC8341183.

3.) Baenkler, Hanns-Wolf. “Salicylate intolerance: pathophysiology, clinical spectrum, diagnosis and treatment.” Deutsches Arzteblatt international  vol. 105,8 (2008): 137-42. doi:10.3238/arztebl.2008.0137

4.) Malakar, S., Gibson, P. R., Barrett, J. S., & Muir, J. G. (2017). Naturally occurring dietary salicylates: A closer look at common Australian foods. Journal of Food Composition and Analysis, 57, 31-39. https://doi.org/10.1016/j.jfca.2016.12.008

5.) Anne R. Swain, Stephen P. Dutton, A. Stewart Truswell, Salicylates in foods,Journal of the American Dietetic Association, Volume 85, Issue 8, 1985, Pages 950-960, ISSN 0002-8223, https://doi.org/10.1016/S0002-8223(21)03743-3.

(6) Manor, O., Dai, C.L., Kornilov, S.A. et al.  Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun 115206 (2020). https://doi.org/10.1038/s41467-020-18871-1

(7) University of California – San Diego. “Big data from world’s largest citizen science microbiome project serves food for thought: How factors such as diet, antibiotics and mental health status can influence the microbial and molecular makeup of your gut.” ScienceDaily. ScienceDaily, 15 May 2018 <www.sciencedaily.com/releases/2018/05/180515092931.htm>