Checklist of common mistakes

Updated February 2007

All of these mistakes have been made by readers. Each one was enough the stop the diet from working, but difficult to identify because effects build up slowly. If the diet isn’t working, read the list below. You can also ask your dietitian or email support group to check every item for you.

See also Tips for extra-sensitive amine responders, Tips for extra-sensitive salicylate responders

MISTAKES

Accidental or deliberate mistakes • one or two serves of hot chips, takeaways, Vegemite or any other mistakes per week can be enough to prevent improvement

Child sneaking food at school • supportive schools can ban lunch swapping - one desperate family tried the diet unsuccessfully three times before they discovered their daughter had been eating coloured lollies at school nearly every day • some children do better on home detention for three weeks while doing the diet, which is how Superintendent Peter Bennett achieved success with juvenile offenders in the UK • you can start your diet during school holidays

SALICYLATES

Too many salicylates • beware the advice ‘an apple a day can't hurt you’ - some extra sensitive people cannot tolerate any fruit • some people even have problems with low salicylate items such as shallots, leeks, golden syrup or brown sugar • no one ever notices an immediate reaction to salicylates in foods but you won't get the improvement you want - or you will see an improvement but after a while the effects will build up and you'll be back where you started - stick to low salicylates during your supervised elimination diet • worrying about nutrition is counterproductive in the first three weeks as your most urgent need is to get rid of cravings for food chemicals

Pear juice is not failsafe because commercial pear juice contains the peel and is therefore moderate in salicylates • pears canned in juice instead of syrup are not permitted • pears (fresh, tinned, pureed, jam and ketchup) are limited to two pears or equivalent per day, less for some people • pears must be ripe, soft and peeled

Flavours • artificial and natural flavours, fruit flavours and even vanilla can cause problems. If your child is not improving, avoid ‘flavours’, ‘vanillin’ or ‘vanilla’ in commercial products such as lemonade, marshmallows, jelly beans and Rice Bubble Treats (LCMs), vanilla flavoured yoghurt, custard, soymilk, caramels, biscuits, carob and lollies. Home cooking is safer but avoid vanilla in that too.

Toothpaste • mint flavoured or herbal toothpastes such as fennel are not failsafe because herbs contain salicylates • coloured toothpaste - even pale pink - is not ok • there have been numerous problems caused by strong mint flavours, particularly with young children who will suck the toothbrush or eat the toothpaste - see Product Updates for alternatives or use a wet toothbrush instead • don’t expect to see a big reaction - one little boy improved beautifully for two weeks on the diet, then slowly started to get worse and by week 3 he was back to pre-diet behaviour because his family had switched to strong mint flavoured toothpaste at the end of the second week.

Cold-pressed oils • cold pressed canola, sunflower and safflower oils can contain small amounts of salicylates that can build up slowly to cause symptoms • cold pressed ricebran oil although not listed for your supervised elimination diet seems to be well tolerated by some failsafers but there has been a report of a slow build up of symptoms from a family who are known to react to wholegrains (see wholegrains below).

Chicken with seasoning or stuffing • it is not okay to eat the meat and avoid the skin of BBQ or roast chicken with seasoning or stuffing • beware of stuffed fresh chickens in supermarkets

Carob • beware of added flavours in carob products, and milk powder if you are sensitive to dairy foods • failsafers have reported problems with carob powder that has a bitter taste.

Raw sugar, dark brown sugar • white, soft brown, icing and caster sugars are failsafe • raw sugar, honey and dark brown sugar coloured with molasses contain salicylates • avoid commercial products which contain raw sugar (soymilk, cereals).

Corn or maize kernels, sweetcorn, cornmeal, polenta, corn chips and popcorn contain salicylates • cornflour and refined maize flour (called cornstarch in the USA) is refined white starch from corn low in salicylates, although it may contain residual sulphites that can affect the extra sensitive • flour made from wholegrain corn or maize(for tortillas) contains salicylates • if gluten free, check that the corn starch is not made from wheat.

ADDITIVES

Annatto 160b natural yellow colour in many dairy foods such as yoghurt and icecream (especially if labeled 'lite', 'creamy' or 'wholesome)', as well cheese slices, frozen or crumbed products, biscuits, breakfast cereals, croissants and a wide variety of other processed foods - since it usually causes a next day reaction, people don't realise when it affects them.

BREAD

Vinegar is not failsafe and must be avoided, even in small amounts in products such as bread

Whey powder can be cultured with natural propionate (282) preservatives • avoid whey powder in bread and other bakery products • whey powder is okay in non-bakery products such as icecream and yoghurt

WHOLEFOODS

You may need to exclude more foods • people with severe symptoms or extra sensitivity may need to avoid some of the following • dairy foods • wheat or gluten • soy • eggs • citric acid • cashew nuts • canola oil (sunflower is safer) • potatoes • rice • gelatine (see below) • even Nuttelex can cause problems • some people report that more than one cup of decaf coffee a day is too much • if not improving and you don't know why, consult your dietitian and don't eat these foods every day.

Dairy foods and substitutes • families are often reluctant to give up dairy foods but whatever you love the most is most likely to affect you – if not improving consider your options • some people do well on A2 milk (www.A2Australia.com.au) but some people are affected by it including children with behaviour problems • some people are affected by soymilks • ricemilks are probably the safest but children or adults with nut or soy allergies may be affected by chickpea flour added for extra protein

Wholegrains • many children with behaviour problems and others are affected by wholegrains in e.g. Weetbix, Vitabrits, Weeties, Allbran, wholemeal bread • limit (eg 2 Weetbix every second day) or if no improvement, avoid • alternative sources of fibre include psyllium hulls and guar or xanthan gums used in gluten free baking.

Too much fibre • in foods such as whole grain products, raw rolled oats, dried beans, uncooked cabbage and other vegetables can cause cause bloating, stomach aches and diarrhea especially in people with irritable bowel symptoms or when introduced suddenly in large amounts.

Gluten free • malt contains gluten so check labels on puffed rice cereals, soymilks etc • assume cornflour in confectionary, baking powder and other products is wheaten cornflour unless otherwise specified • avoid contamination e.g. from family members’ toast crumbs in the Nuttelex • when eating out avoid gravies, sauces and anything with thickener • spelt flour is not gluten free although some people with gluten intolerance can tolerate it

PRODUCTS AND LABELLING

Product changes occur frequently • read labels especially with a packaging change • vegetable oils, soymilk, lemonade, pastry, margarine, butters, cream cheese, cooking oils and rice crackers are some of the most changeable • read about changes in Product Updates on www.fedup.com.au or in the newsletters (email: failsafe_newsletter-subscribe@yahoogroups.com with ‘subscribe’ in the subject line).

Changes in previously safe brands • these updates are correct at the time of writing • Darryl Lea white jelly beans are limited to 4 per day but best completely avoided in anyone who hasn’t improved • 7UP now contains benzoate preservative (211) and is not safe • some Schweppes lemonade or other brands might be preservative-free but avoid them altogether if you are not improving otherwise the limit is less than one small glass a week • Peters Lemonade Icypoles with a new stronger flavour are now not okay for many • Vitasoy have phased out their use of unlisted BHA(320) but their previously failsafe soymilk uses dried cane juice may contain salicylates • Vitasoy ricemilks are now failsafe • Sanitarium So Good soymilk range removed unlabelled TBHQ (319) and seem to be safe, So Good regular soymilk with added flavour appears to be well tolerated so far • avoid all McCains frozen potato products due to unlisted antioxidant BHA (320) • some ‘plain’ ricecrackers contain nucleotide flavour enhancers, read the label • Sakata plain rice crackers should be failsafe but we have received many complaints, approach all ricecrackers with caution and avoid for anyone who has not improved • Smith’s range of plain chips - now with sunola oil - seem to be affecting failsafers, it’s best to avoid such commercial products with a child who is not improving • Philadelphia cream cheese now contains sorbate preservatives in all tub products but not blocks • ingredients can change at any time, always read labels and be suspicious if there is a change of packaging

Illegally unlisted additives • it is not enough to read labels - ask about all unpackaged and restaurant foods • one survey found 58% of samples of mince (ground beef) in NSW contained illegal sulphites, now supposed to be improved due to better monitoring - if you don't trust your butcher, test your mince with our sulphite test strips (see sulphite test kits on the front page of the website) or make your own mince • unlisted additives can occur in any product – if you think a product is affecting you, avoid it and reintroduce, if convinced, contact us, we frequently find illegal ingredients labels, report your suspicions to us and avoid suspect commercial products – we were caught for months by an illegally unlisted additive in blended butter

Contamination such as added flavours can occur on production lines of e.g. plain chips. Discard any product with a flavour that tastes wrong.

Antioxidants in oils are often unlisted - due to mistakes or the 5% labeling loophole - in any product that contains vegetable oils or margarine, for example biscuits, snack foods, breads, pizza bases, frozen potato products and fudge • check the shopping list for safe products • for unlisted products, check to see if the oil is less than 5% of the product • if the 5% labeling loophole applies, the only way to find out whether oil contains nasty antioxidants is to phone the manufacturer and ask ‘are there antioxidants in this oil’ • natural antioxidants 300-309 are safe • synthetic antioxidants 310-312 (gallates) and 319-321 (TBHQ, BHA, BHT) are nasty • if no improvement, avoid any commercial product containing any kind of vegetable oil, vegetable shortening, vegetable fat, beef fat or tallow unless you are absolutely certain they are OK

Changes in products with antioxidants in oils can occur without warning and there will be nothing on the label to indicate the change. At the time of writing, McCains frozen chips, pizza bases, etc contain unlisted BHA (320) but Woolworths Homebrand straight cut, Woolworths Select French Fries and Logan Farm frozen chips are okay • in biscuits, Arnotts biscuits previously contained unlisted 320 but are now okay, but with other brands you do not know unless you phone the manufacturer • in soymilks, unlisted antioxidants come and go, see Product Updates • home cooking oil in Australia is generally pure with a few exceptions, read the label • commercial oils usually contain nasty antioxidants so assume that any hot chips and other fried takeaway foods contain these additives • bread can contain these nasty additives, unlisted (Bakers Delight and Brumbys do not use them) • reactions are likely to build up slowly over several days or more

Antioxidants in New Zealand oils • nearly all supermarket oils, commercial oils, margarines and products such as bread, biscuits and fudge contain nasty antioxidants in NZ • ask our Christchurch contact for the NZ shopping list and be suspicious of any that don’t have listed antioxidants (see Product Updates regarding current labeling problems with NZ oils)

Unlisted sulphites • sulphites are widely used in unlabelled foods such as sausages, prawns, and potato products such as hot chips (but not crisps) because potatoes are often soaked in a sulphites solution after peeling to prevent browning, but none of these foods are failsafe.

AMINES

Amines in meat • eat meat as fresh as possible, see p. 000 • fresh meat that has been hung by your butcher for a week or two is acceptable • supermarket meats are now vacuum packed for up to three months, avoid if possible.

Amines in fermented products • wine, beer, soy sauce, tempeh, miso, chocolate, cheese, sauerkraut, and even strong yoghurt and sourdough bread • despite seemingly failsafe ingredients (eg flour, water, salt), yeast free bread can be made by a long rising process which encourages fermentation and can be a problem for the extra sensitive • bakers' yeast is failsafe and yeasted bread can be safer than yeastfree bread for this reason

Fetta cheese is not failsafe • this was a mistake in Fed Up - bland fresh white cheeses such as preservative free cottage, ricotta and cream cheeses and mascarpone are failsafe, sharp fermented white cheeses are not.

Cashew paste must be made from raw cashews. Commercial cashew paste from lightly roasted cashews is not okay, make your own (see recipe, the option with maple syrup is particularly good).

SULPHITES

Sulphites in gluten free flours • most failsafers can tolerate the tiny amounts of sulphites in gluten free flours but failure to improve on diet or worsening of symptoms including asthma and eczema when gluten free may be sulphite-related • rice, rice flour, rice noodles, plain rice cakes, buckwheat, millet and organic products do not contain sulphites, see p.000.

Sulphites in gelatine • high levels of sulphites (220) are permitted in gelatine but dissipate due to heat and storage, see p. 000.

CHALLENGES

Challenges can be inconclusive if the dose isn't big enough • it is better to use high salicylates foods than moderate salicylate foods • don’t use very high foods such as oranges and tomatoes because they also contain amines, see p. 000.

MEDICATIONS AND REMEDIES

Do one thing at a time • do not try to combine a candida or other diet with failsafe eating - your efforts are much more likely to be successful if you get failsafe 100% right • it’s best to avoid optional visits to GPs, specialists, naturopaths, optometrists and dentists while doing the elimination diet because most medications and supplements will interfere with the diet • obviously you will need to take essential medication (e.g. asthma, epilepsy) until advised otherwise by your doctor

Prescription and over-the-counter medications, herbal remedies, lotions and supplements • salicylates in aspirin, other painkillers, anti-inflammatory drugs and skin remedies such as wart remover are not suitable during a low-salicylate diet • colours, flavours, preservatives and active ingredients in syrups, capsules or lotions, herbal remedies including Echinacea and supplements including fish oils can cause • you can ask for white tablets or powdered capsules, mix contents with syrup, jam or icecream, or see the Vitamin Icypole recipe problems • supplements etc can be reintroduced as challenges after you have achieved success on your supervised elimination diet.

Children’s vitamins and syrups • flavours or preservatives in vitamins or children's syrup medications such as paracetamol, cold medications, antibiotics, chewable vitamin tablets, iron supplements don't have to be listed on the label but will appear on the Consumer Medication Information sheet • do a Google search for ‘name of product’ and ’ingredients’ • ingredients listed as 'superarome' literally mean strong flavour, see more on the Supplements Factsheet.

Eyedrops • preservatives and colours from diagnostic or therapeutic eyedrops and some preserved contact lens solutions are easily absorbed through the eye and can cause problems.

Dental treatment • take your own toothpaste • plaque disclosing tablets contain artificial colours

Worm treatment • there are no failsafe worm tablets, if necessary worm your children before starting the diet

Hormone treatments • the contraceptive pill can cause problems for female failsafers

Absorption through skin • salicylates and additives such as benzoate preservatives in skin creams, wart ointment, arthritis rubs, acne wipes and paw paw ointment can be absorbed through the skin and if used every day • effects can build up slowly • with children, beware of coloured bubble baths, playdough, facepaint, finger paints

Inhalation • beware of inhaled salicylates from perfumes, perfumed products (see Product Updates for alternatives), Vicks Vaporub, Deep Heat, strong smelling flowers, leaves and bark for example citrus or pine trees, cut flowers.

ENVIRONMENTAL CHEMICALS

Exposure to perfumes, industrial chemicals, heavy metals and other smells • perfume in toiletries, cosmetics, after shave, washing powders, shampoo, conditioners, aerosols, deodorants, sunblock for all family members and household cleaners (see Product Updates for alternatives) • essential oils, incense and ‘naturally fragranced’ products • food dyes in playdough (see Playgroup factsheet), bubble baths, finger paints, preschool paints and glues • paints, solvents and other renovating fumes • smells of new or newly cleaned soft furnishings, upholstery, carpets, new mattresse, plastic casings of new computers, fax, etc • shopping malls, hairdressing salons - alternatives include fast cuts or home hairdressing services, pet shops, cigarette smoke • workplace chemicals • chemical smells of new cars, appliances including computers and CD players and furniture – display or second-hand models are safer • strong smelling plants e.g. herb plants, strongly fragrant flowers and trees e.g. eucalypt, camphor laurel, pine, particularly freshly cut as in a Christmas tree • freshly sawn timber, sawdust and new timber for renovations • the smell of wood and smoke from wood fires • lawn clippings and mower fumes • the smell of strongly spicy food - don’t cook it for others • fumes are generally worse in hot conditions.

Exposure to swimming pool chlorine • chemicals called chloramines formed by heating chlorine or by reactions of chlorine with perspiration or urine can cause the same reactions as food chemicals in some children (asthma, hives, behaviour) • the strong chlorine smell in public pools is chloramines • saltwater pools generally contain some chlorine but not as much as public pools • some families find they can minimize the effects of chloramines by children wearing goggles and showering in fresh water immediately after swimming, outdoor pools are safer, home pools are generally better than public pools

STRESS

Too much stress, confrontational parenting or teaching styles. Reduce stress by • avoiding confrontations, the 1-2-3 Magic video or book (from Amazon or www.parentshop.com.au in Australia) can show how to do this • laughter therapy such as watching family comedies together • family walks, bike rides or camping holidays - preferably with no shops or advertising, e.g. in a national park • relaxation tapes or music – instead of radio and TV, play any music by Mozart for a calming effect • encourage positivity in the family by treating each other with kindness and respect and remember the good times by going though old photos together • for adults, meditation is considered to be the single most effective stress reduction method.

Non-food factors such as an absent parent, a new baby, moving, house renovations, illness, changes in medication, a new school, bullying, criticism, punishment or lack of friends. Children on the diet need a failsafe house, support, love, praise, exercise and time with parents.

Hints for extra sensitive amine responders

Amines are more difficult to deal with than salicylates because amine content depends on the age and handling of the food. Amines are formed by the breakdown of protein or by fermentation.

Don't buy meat which looks or tastes old - the fresher the better. Cryovacced meat can be very high in amines. You will have to ask your supermarket or butcher which meat is cryovacced, and sometimes the answer will be "all of it".

Buy meat and cook it that day or freeze and use within 4 weeks, preferably less.

When meat is cooked, freeze leftovers and use within a week. If very sensitive, avoid leftovers.

Buy fish fresh (preferably within 12 hours of capture) and cook or freeze and use within two weeks or less and be wary of all seafood.

Cooking increases amines (only for amine containing foods, not for fruit like pears). Quick cooking methods are best - microwaving or steaming.

Browning increases amines (only in amine containing foods like meat, not flour products such as cakes and bread) - again, microwaving or steaming are best.

Use only fresh eggs.

Avoid vinegar (eg in bread and canned beetroot.)

Avoid all cheeses except bland white bland cheese like cottage cheese.

Avoid yoghurt or make fresh mild yoghurt for yourself.

Avoid sourdough or yeast-free breads. These use a slow-rising, fermentation process which creates amines.

Soups and stews containing meats or meat stocks are not suitable for extra sensitive amine responders.

Hints for extra sensitive salicylate responders

- thanks to Robin of the discussion group

Salicylates in foods

You may not tolerate all the foods listed as low in salicylates, particularly in large helpings, as many of them still do contain a low amount of salicylate. The safest vegetables I have found for myself are potatoes (mature brown skinned, white fleshed and thickly peeled), cabbage, swede, iceberg lettuce and celery. Most grains, both brown and white are fine. Another surprise was maple syrup caused no problems, whereas I react to brown sugar and golden syrup.

Be aware that the food chemical categories that RPA groups foods into are designed for an average dietary intake of that food. When you are multiply food chemical sensitive, you may find yourself eating well in excess of what is considered an average intake of a particular food.

Every year I find a time (early on in the year) that there are no sufficiently mature potatoes and they all cause me a salicylate reaction. They are improved by buying and storing for about 6 weeks. [Stephanie from the US reports that potatoes there cause a salicylate problem for her]

Try to work out if you are gluten, dairy and amine tolerant, even to some degree as this makes food choices easier.

If you suspect you're not so sensitive to amines, try using dripping or clarified butter (or butter) instead of oil or Nuttelex.

Quinoa is not as safe as amaranth (from Pat in the discussion group)

Inhaled salicylates

Avoid smelly things as much as possible. Be particularly suspicious of odours you really like or dislike. Trust your nose - if it smells strong to you, even if others can't smell it, you probably react to it. Don't wear, and strongly discourage those around you from wearing perfumed deodorants, perfume, aftershave and other cosmetic products.

Perfumed products are totally pervasive in our society. Many teens liberally use them. I have had to try and rid the smell of perfume transferred to our lounge suite, all bedding, my daughter's clothes and even from the fabric of the car seat.

Be aware of strong smelling plants - herb plants, strongly fragrant flowers, eucalypts e.g. 'peppermint' gum, pine trees particularly if freshly cut as in a Christmas tree, macrocarpas - common in NZ.

The amount of smell given off by plants varies with weather conditions. Frost can break down the internal structure even if frost tolerant, then as the day warms the plant gives off a strong smell. A cold inversion layer or cool damp conditions will trap the odour until wind moves it. Also heat stress causes some plants to give off more smell.

Increasing temperature increases off-gassing of chemicals in your car or any new appliances or furniture in your house (probably not strictly salicylates).

Lawn clippings may cause a reaction.

Get someone else to remove offending plants and trees where realistic. Employ a gardener as a 'one off'.

Avoid where possible the smell of strongly spicy food. Don't cook it for others.

Change your cleaning chemicals to bicarb soda and vinegar. Treat vinegar with caution though as most vinegars have a salicylate content and a strong smell. I find storing my vinegar in a labelled pump bottle means that I can control the amount I use to just a very small amount on a cloth. (Good additional suggestion from Caroline was to substitute citric acid for vinegar)

Hunt out as close to fragrance free as possible a dish detergent and dish wash powder. In NZ I have found that Budget brand detergent and Pams dishwash powder have negligible smell. Clean up any spills of detergent in cupboard as if there is any fragrance in your liquid it is concentrated when spilt.

Use fragrance free laundry washing powder. Lux flakes are the best I've found for hand washing (in terms of lack of fragrance), but do still have some smell.

Don't use commercial upholstery cleaning products. They all have a strong smell. Try hot water and bicarb soda. Be aware that even using a commercial carpet cleaner without the chemicals in it will still leave an odour from the residual chemicals - I learned that the hard way!

Use unperfumed soap eg. Simple. Use unperfumed shampoo. I get away with Derma-veen which has a very light fragrance. Melrose shampoo has been mentioned as an option in Australia. Simple shampoo now has a herbal extract added.

Use unflavoured toothpaste such as Soul Pattinson plain toothpaste. I get my Australian friends and family to buy it for me. Persuade your partner to use the same.

Avoid hairdressing salons, pharmacies (I note on my recent trip to Australia/Darwin that they weren't the same problem as here in NZ), and other strongly perfumed places. Can someone else cut your hair? I have found a hairdresser who is willing to come to my place instead.

Go shopping early. Keep the time short. Can someone else go for you?

Be aware of what wood you burn for heating. Burning pine (especially not fully seasoned) may be a problem - both the smell of the unburnt logs and the smell in the smoke.

New furniture and appliances are likely to have a problematic smell. New pinewood slats of a bed caused a problem in our family, as well as the MDF (‘customwood’) used in the drawers under the bed. If buying a new household item such as CD player and speakers, consider asking for the display one, or even better buy second hand. (This not necessarily a salicylate problem, but you will probably react to these chemicals as well)

Don't let anyone with heavy perfume on (or perhaps any), sleep on your fabric covered lounge furniture. Best even to ban them from sitting on it! Tactfully educate your family and friends to use suitable personal products.

Find a fragrance free sunscreen if possible. This seems really difficult at the moment, though I notice my daughter bought some fragrance free 'cancer society' sunscreen earlier this year. The sunscreen products advertised as suitable for babies usually have only very light perfume.

If in doubt, ask! Sue Dengate at suedengate@ozemail.com.au