Hints
for challenges
If you react to both salicylates and amines …
After challenges, what's your tolerance?
This page is intended to support people who are following the RPAH (
Your dietitian's booklet will tell you exactly what to eat and how much
to eat of it during your challenges.
The key is to concentrate on one food chemical at a time and to eat lots
of it. As a rule of thumb, 3 days for artificial additives and 7 days for
natural chemicals such as salicylates; however, we find that people may need
longer for bread preservative 282 (5-7 days or more) and at least 10 days for
milk.
The rules of challenge
that your dietitian will recommend are:
·
Several days without symptoms before
each challenge (ask your dietitian – usually it’s 3-5 days)
·
Stick strictly to the elimination
diet. Start again at the beginning (several days without symptoms) if you make
a mistake.
·
Stick strictly to the challenge
foods on your dietitian’s list
·
Eat enough foods: at least the
minimum amount of the specified challenge food every day. This is essential.
Especially if you start slowly, you may get confusing results.
·
Eat only specified foods. Foods like
oranges, tomatoes and avocadoes have no place in salicylate or amine challenges
because they contain both.
·
Continue until there is a reaction.
A full seven days is often recommended. However, be realistic. One boy who
broke a window at school during his salicylate challenge was punished severely.
Continuing after you have seen a behavioural reaction may help to identify
other symptoms that may develop (e.g. physical symptoms such as rashes may come
after behaviour) but think about the consequences to the child - you may need
to keep your child at home or stop the challenge early. Some people (e.g. with
arthritis, may need a longer challenge), see Bernard's story on the arthritis
factsheet.
·
No mini challenges except for
babies. Do not give your child one or two serves of one particular fruit and
conclude that "she's OK with bananas" or "apricots don't affect
him". It depends what else he or she eats. Only the most sensitive will react
to a mini challenge. You are looking for the slow cumulative build up of food
chemicals which cause good days and bad days with no obvious cause.
This is the diary of a seven day salicylate food challenge with a five
year-old boy who exhibited different kinds of effects - behaviour, rash and
bedwetting. Note that effects can be delayed, occur at different times, build
up slowly and fluctuate. Behavioural reactions depend on the environment so if
the child is getting his own way he will be fine, but when asked to do
something he doesn't like, he will overreact. From story [446] on www.fedup.com.au
Day
1 - No reaction
Day
2 - Tantrum, kicking, punching (wanted more
peppermints)
Day
3 - Punched a peer's arm at kindy
Day
4 - Itchy rash appeared on inside of elbow
Day
5 - Well behaved
Day
6 - Red blotches and pimples all over lower half of
face, tantrum, screaming and hitting me (didn't want photo taken)
Day
7 - More blotchy and spotty, face sore and raw. [End of
challenge foods]
Day
8 - Wet bed
Day
9 - Wet bed, sore tummy, sore red anus, constipated
Day10
-Wet bed, kindy complained of very small attention span, loss of concentration.
Day11
- Face clearing, no wet bed, generally seems to be getting better
Day12
- wet bed again.
By the end of your elimination diet, you must know whether you are
sensitive to salicylates and amines. Otherwise you may be restricting healthy
foods unnecessarily. If you are avoiding dairy foods, wheat or gluten, the same
applies. Very sensitive people and young babies need not challenge. Reactions
to small amounts of salicylate or amine containing foods will already have been
obvious.
It is easy to make mistakes during challenges. The worst case scenario
is an inconclusive result. People at teaching hospitals will get capsule
challenges which are quick and obvious. Others do food challenges. Most people
enjoy the salicylate and amine challenges, at least until reactions start.
Don’t expect immediate reactions. People are different. Some reactions build up
slowly and some reactions are very delayed.
·
Same day: can occur almost
immediately or within a few hours and last a few hours
·
Next day: can start the next day and
last for a whole day
·
Slow reaction: can build up slowly,
sometimes worst on the third day, then slowly improving – it can take a week or
up to a month for effects to fully disappear. Children who take a month to
completely recover can be extremely difficult to work with because can appear
to have recovered but may flare up again if there is a negative interaction.
Artificial colours and MSG
are often a same day reaction, preservatives a next day reaction, and
salicylates or amines a next day or slow reaction, but everyone is different.
Expect anything. Timing also depends on the size of the dose.
Most people assume they can
add challenge foods back into their diet as soon as they pass a challenge. However,
so many people make mistakes when doing this - such as thinking 'I don't react
to salicylates so I can eat broccoli again' although broccoli contains both
salicylates and amines (I did this!) - it is better to finish all your
challenges before reintroducing the food chemicals you can tolerate.
None of the very high
salicylate foods (tomato sauce, broccoli, oranges, your favourite lasagne
recipe) are suitable for the challenge because they all contain amines as well.
Some people get inconclusive results from their challenge because they expect
salicylates to be like food colours, one big dose and you see a big reaction,
but it's not like that. Salicylates are eaten many times a day every day and
reactions can build up slowly to have the same effects as food colours.
Your dietitian will tell you
to eat a certain number of serves per day of the following foods. It is
important to eat as much as possible. One serve equals approximately one cup.
It is best to use more high salicylate foods (capsicum, corn, cucumber,
zucchini, Jap pumpkin, Granny Smith apples, apricots, guavas, peaches,
nectarines, cherries, strawberries, rockmelons, watermelons) than moderate
salicylate foods (mango, asparagus, carrot, butternut pumpkin). You can also use spices such as cinnamon or
curry-type spices (turmeric, cardamom, coriander, cumin, garam marsala, ginger,
paprika, pepper) in powder form - not curry paste that can contain colours or
synthetic antioxidants; honey,
preservative-free apple juice and peppermint tea. Use salicylate options in
recipes and see salicylate challenge recipes in the Failsafe Cookbook and Fed
Up. It is important to eat the highest dose of salicylates you can, right from
the start.
Salicylate challenge story 1: ‘Of the foods
listed we ate tinned apricots (heaps) in syrup on our rice bubbles,
preservative-free apple juice, curries or pumpkin soup for dinner and only
vegetables recommended for the salicylate challenge. We put away mountains of
carrots and similar of grannies in a week as well as large quantities of
pumpkin, kumara, corn, capsicum (had forgotten how good that tastes), cucumber,
curry, cinnamon, tea and everything else we could find in season that was on
the list.
‘We went for about the first three days with no reaction
at all. Everyone seemed to respond differently. My husband and one son seemed
not to react. My 8 year old son - the reason we started this thing - became
fractious and difficult and seemingly continuously involved in conflict with
his brothers and sisters, pretty well back to pre-elimination behaviour. Yuk!
The youngest two had wet beds and seem a bit anxious and grumpy. I have
probably had the most obvious reaction. My flesh felt like it was crawling, my
eyes were stingy, I was tired and grumpy. I also had bloating and tummy aches
and alternating constipation and loose stool. I got restless legs so badly
while I was trying to fall asleep that I would nearly jump off the bed.’
Reader, by email.
Salicylate challenge story 2: 'I found the
salicylate challenge really difficult. Even though salicylates have the worst
effect on my children, it took me over a year to work that out because they are
delayed responders and the reactions are irrational fears and social withdrawal
- not what I had expected'.
Your dietitian will probably
tell you to eat a certain number of ripe bananas and dark chocolate every day
for seven days. It would be less for small children. Amine reactions are
usually delayed up to several days or more. For dark chocolate you can use
commercial dark chocolate bars or Nestle dark chocolate choc bits. For children
who don't like dark chocolate - although most do after three weeks on the
elimination diet - you can cook the choc bits into chocolate cake or banana
muffins, or freeze the bananas and process into banana icecream topped with
melted chocolate, see recipes in the Failsafe Cookbook.
You can also eat as much as
you want of: canned tuna, salmon, sardines, frozen fish, seafood except prawns,
pork chops and roast pork (but not bacon and ham with preservatives) or
homemade gravy (see recipe in the cookbook). In my experience, and research
supports this, amines can be associated with aggression and conduct problems in
some children. Consider keeping children with a potential to react like this at
home for the amine challenge (and preferably for all challenges). You can use
an antidote as soon as you are convinced there is a reaction, but you need to
keep noting effects in your diary - some children take up to a week or even a
month to recover from the amine challenge, with increasing good days punctuated
by occasional outbursts.
If you react to both salicylates and amines …
·
Once you are convinced there is a
reaction, you can use an antidote (look under Antidote in the index of any of
my books), although it will only help for an hour or two
·
People who react to both salicylates
and amines can stop challenges now as they will probably react to additives as
well, although it is worth doing some challenges, see below
·
It is useful for asthmatics to
identify which additives are associated with their asthma - e.g. sulphites,
benzoates - but this should be done supervised by your dietitian
If you have passed
salicylates or amines, it is worth doing the rest of the challenges. Some
people react only to one or two additives, yet if they eat them every day the
result is the same as for a person who reacts to everything.
Dairy and wheat challenges should be
done at some stage if you are avoiding these.
·
Your dietitian will probably
recommend at least one cup of milk every day for a week. In our experience, ten
days is better, as this can be a slow reaction. We recommend the same for A2
milk, in our experience, it's worth challenging
A1 and A2 milk separately. A2 milk (www.A2australia.com.au) is sometimes
better tolerated by people with food intolerance.
·
Your dietitian will probably
recommend a serve of plain uncoloured pasta plus a certain brand of plain wheat
crackers (no hidden antioxidants!) every day for a week for the wheat
challenge. Note that bread is not suitable for a wheat challenge because
it contains so many other ingredients. If you pass your wheat challenge, you
may still need to consider wholegrains. Many people find they can manage
refined white flour products such as bread and pasta but wholegrain wheat
products affect them. This has been implicated in everything from behaviour to
irritable bowel to psoriasis. You can try at least 4 wholegrain biscuits such
as VitaBrits or Weetbix per day as well as wholegrain flour, pasta and
wholemeal failsafe bread for three days or more.
Bread preservative (282)
is worth challenging because it is often eaten unknowingly every day in a
healthy food and some people are so badly affected. Although the label may list
preservative, the dose can vary especially in winter. In our experience it is
best to continue for a week if you don’t see a reaction within a few days. Eat
as much preserved bread, crumpets and/or English toasted muffins per day as you
want – at the very least a few slices per day.
Annatto colour (160b)
is worth challenging because it is in so many foods labelled 'all natural'.
Many failsafers report reactions from vanilla yoghurt coloured with annatto
(try it several days in a row. If dairy free, look for soy yoghurt with
annatto, or the Sanitarium So Good Bliss vanilla icecream. Some custard powders
also contain annatto. If you see a reaction, please report it to us! (suedengate@ozemail.com.au)
Sulphites (220-228)
- sulphites are the additive most likely to affect asthmatics, but they are
also associated with the complete range of food intolerance symptoms including
behaviour. Some people are very sensitive to even tiny amounts. Most foods
which contain sulphites (eg wine, dried fruit, sausages, fresh grapes) also
contain salicylates or amines so it is best to do those challenges first. WARNING
If you are an asthmatic, don't do this challenge without supervision by your
doctor or dietitian as it can be rapidly life-threatening, even if you've never
noticed a reaction before. See reader experience below.
Sulphite challenge story:
"Our food journey all started with me picking up your Fed Up with Asthma
book from the bookstore after our four year old had just experienced a bout of
wheezing. I read it all in one sitting and was left both horrified and hopeful.
We decided that since we had nothing to lose that we would try the diet as a
family in an attempt to pinpoint the trigger of our daughter's asthma. I was
optimistic about finding a trigger but not really expecting to find it. Grace
did the sulphite challenge with an apricot fruit bar as recommended by our
dietitian (she had no reaction to the salicylate or amine challenges) that I
gave her at the start of a short car journey. Within 5 minutes of finishing the
bar, her breathing had become so laboured and wheezing so loud that I had to
stop the car to give her Ventolin.
Over the next few months I repeated
the challenge with a different brand of fruit bar, berry flavour and again with
4 dried apricots. The same results each time. Prior to the diet she would eat
dried fruit, sausages and non-organic grapes quite often and was on a
substantial twice daily preventer medication regimen as well as Ventolin about
1-2 times per week. Funnily enough it had never occurred to us that ‘healthy’
food could possibly trigger asthma."
Benzoates (210-213)
If you think lemonade is a relatively safe drink for your failsafe child at
parties, it’s worth doing this challenge. It’s also worth doing because sodium
benzoate (211) or other benzoate preservatives are used in most medication for
babies and children. At the time of writing, Schweppes canned lemonade contains
benzoates but the bottled lemonade is preservative-free but this can change – read
the label. You can try several cans of lemonade per day for several days.
Antioxidant challenge
·
Gallates (310-312)
·
TBHQ, BHA, BHT (319-321)
This challenge is definitely
worth doing because these additives are often unlisted. Your dietitian may recommend
a particular brand of cooking oil or margarine. These change constantly so
check the label. At the time of writing, McDonalds fries contain BHA 320 and
could be used as a challenge but you would need to check this first on their
website, as ingredients change frequently. Many failsafers have been tripped up
by assuming hot chips are a safe snack when shopping because they haven’t seen
a reaction after one dose. You need to know what to expect if your child eats
synthetic antioxidants every day for three or four days – kids love this
challenge. Please report reactions to us!
Sorbates (200-203) – This challenge is worth doing
because many families noticed reactions when sorbate preservatives were first
added to cream cheese. You can also use Philly preserved cream cheese in the
tub but not the packet (read the label). As it is the kind of item often used
every day e.g. in sandwiches, and the reaction can be a slow build up, you
could try normal serves every day for a week or extra high doses (e.g. in a
home-made cheese cake) for a few days. Please report reactions to us!
MSG (621 and natural
glutamates) – your dietitian’s booklet will probably
recommend soy sauce with meals, although I have heard of a dietitian suggesting
MSG powder such as Ve-tsin from Chinese groceries. We find that many people can
manage the small amounts in green peas, even if they react to large doses of
MSG. For a green pea challenge, eat green peas twice a day every day for three
days. If no reaction, you can add peas back into the diet.
Flavour enhancers 635, 627
and 631 also called ribonucleotides, disodium guanylate and
disodium inosinate - if you don't react to anything else, you could still be
affected by these additives, see the Ribo
Rash factsheet. We don't recommend challenges because some people never
recover. If you eat any product containing these additives, look for possible
reactions for the next 48 hours, and understand that reactions are related to
dose - if you don't react to a small amount, you can still be affected by a
larger amount. This new additive has been associated with everything from
behaviour problems to anxiety and heart palpitations and many people develop an
unbearably itchy rash and/or swelling of the lips, throat and tongue. To see if
you are affected by these additives, it is best to keep a detailed diary of
food and reactions.
Nitrates (249-252)
– your dietitian will probably recommend processed meats such as ham or bacon.
Not for amine reactors. Check that the ham or bacon contains only nitrates, not
sulphites or flavour enhancers as well. We don’t recommend this challenge
because when eaten frequently, nitrates are a known carcinogen (cancer-causing
agent). Even if you pass this challenge, it is best to limit your intake of
nitrates.
Sugar - This challenge is optional. It is for people who
are convinced their children react to sugar. In nearly all cases, this will be
due to salicylates or additives. However, there are a very few extremely
sensitive people who do react to white sugar. You need to test this with a
challenge. Eat 10 sugar cubes and observe reactions. If no reaction, double the
amount.
Fish oils, supplements and other foods - You can
choose to challenge anything you want, from favourite foods to herbal or
nutritional supplements. Just follow the rules of challenge. My children chose
Mars bars - one a day every day for three days - and failed.
After challenges, what's your tolerance?
Your dietitian will probably
suggest very careful gradual reintroduction: for example, half a cup or less of
moderate salicylate foods (e.g. carrots or butternut pumpkin for salicylates)
every two or three days for a few weeks, then every day for a few weeks; then
increasing the dose and so on. As usual, keep a diary! When you start reacting,
you go back to the previous level. This is where a lot of people come unstuck.
They keep on adding salicylate-containing foods until the levels are quite
high, then six months or a year later, they say ‘the diet isn’t working as well
as it did when we first started.’ Effects can sneak up on you. If the diet
isn’t working as well as you’d like, you can go back to low salicylate foods
and keep the rest for holidays when your tolerance is higher due to lack of
stress.
Reader comment:
'I am at the stage now where I have reintroduced amines [e.g. bananas, tinned
tuna] into my diet about twice a week, with the exception of my premenstrual
week. I am prone to being over confident and blowing my reintroduction from
time to time but I have pretty much worked out the timing and culprits'. -
reader, NSW
[877] 621: Juvenile Rheumatoid Arthritis – pain
free when avoiding MSG (November 2009)
SUCCESS!!! Our 12 year old daughter with Juvenile
Rheumatoid Arthritis is pain free!!
We have
finished all challenges on the elimination diet and have discovered glutamates
- MSG and all 600 numbers to be extremely bad for our daughter with arthritis.
Within 8 to 12 hours of having MSG our daughter went from no pain to all the
symptoms of arthritis, swollen joints, very sore, trouble walking, and lots of
pain. We continued the challenge for 48 hours and by then she had problems with
all her joints, soreness, swelling and was absolutely miserable! Within 12 hours of stopping MSG her symptoms
settled and she was back to "normal" – no pain! We now totally avoid
MSG, all 600 numbers and unspecified 'flavour' listed on any product!
It has been 7
months now since we began the elimination diet and took our daughter off all
arthritis medication. She is fantastic!
We had a check up with the rheumatologist recently and she was
amazed. We don't need to see her for
another 6 months and she has classed our daughter as "in
remission"!!!! No pain, No symptoms
and No medication!
I hope this is
of assistance to other sufferers of arthritis!
It has made a huge difference to our daughter's life. Thank you for your
wonderful information, without this we would be further down the track of a
life of pain, misery and medications with nasty side effects for our daughter.
To look at our daughter now, you would never know that she suffers from a
chronic, debilitating condition, she is full of energy and her love for life is
back again!
We completed
all food challenges in this order: milk,
wheat, bread, salicylates, amines, MSG, propionates, sorbates, antioxidants, colours,
benzoates, nitrites and sulphites (all food not capsules). The only challenge
our daughter reacted to was MSG, 600 numbers and naturally occurring
glutamates. She had no reaction to any other challenge. Once we had completed
all the challenges we challenged tomatoes, broccoli and those foods high in
natural glutamates separately. She came out in an itchy rash if she ate too
many tomatoes or broccoli (at least
We saw the
dietitian you recommended. She was very helpful, knowledgeable and thorough in
what quantities etc to challenge. She was very interested in the results. She
suspected MSG from early on because we had commented on how over the Christmas
holidays (before elimination diet), our daughter had eaten CC's and was so sore
the next day she could hardly walk. We kept a daily food diary and I also kept
a dated scrap book with labels of products we had eaten so I could check back
as a reference if needed.
For the MSG
challenges we used "Coles Farmland" packet chicken noodle soup, about
500 mls to a litre a day (contains 621, 627 and 631) and soy sauce about 4+
tablespoons a day. (Need to check labels for soy sauce because not all list MSG
or 600 numbers).
We are amazed
at how many foods with unspecified 'flavour' (but no MSG or 600 numbers listed)
affect her. We have found this with tomato soups, tomato pastes etc where they
list 'flavour' and our daughter has been sore after having this. We have
completed our own challenge with some of these products and her reaction
varies. We avoid any savoury type products that have 'flavour' listed with no
specific ingredient numbers on labels. The unknown is not worth the soreness
for our daughter.
Foods
previously eaten which we avoid completely now include: All packet soups, cup of soups, packet
stocks, stock cubes, any chips or corn chips that have a flavour, BBQ shapes
and all shape/savoury biscuits with flavour, tomato and BBQ sauce, some
mayonnaise and dressings, packet pasta mixes (ie continental pasta packs),
sausage rolls, pies, breads with savoury toppings, pizza, concentrated tomato
paste, tomato soup - most have unspecified 'flavour' - and lots of other
savoury foods. We never used to eat a lot of these foods, but even having
things once to twice a week was enough to have our daughter in continuous
pain.
She now is
totally pain free, medication free and living a very active, sporting life. She plays netball weekly, has participated in
the school athletics and cross country team this year and is currently in
weekly training with the school volley ball team to go to Nationals in
December. All of these activities were
completely impossible 12 months ago! The difference is amazing! We are so thankful that your website and
information has led us to finding an alternative to medication, and a way to
manage our daughter's condition and allow her to live a very active life. I
hope that there will be others out there that will try the elimination diet and
find an alternative to medications and a life of chronic pain. - Sandra, Vic
The information given is not intended as
medical advice. Always consult with your doctor for underlying illness. Before
beginning dietary investigation, consult a dietician with an interest in food
intolerance. You can find a supportive dietitian through the Dietitians
Association of Australia www.daa.asn.au or
write for our list of supportive dietitians (confoodnet@ozemail.com.au)
© Sue Dengate update November 2009
