The Royal Prince Alfred Hospital (RPAH) from Australia has been a leading researcher in studying Salicylate Sensitivity and food intolerances for about forty years. In this video I cover information about their three books to purchase, how their research got started, if they're still doing research, and some of the pros and cons of using their products.
- What is RPAH and their allergy unit introduction: 0:00
- Focus on elimination diet and several food chemicals: 4:10
- Friendly Food Recipes and Food Elimination Diet Handbook: 6:13
- History of their salicylate research (Anne Swain) 10:49
- RPAH criticisms/concerns: 13:37
- RPAH currently works and treats patients: 16:33
- Food Elimination Book tour and layout: 19:31
- Book criticisms: 21:48
- Do I include RPAH's values on my lists: 25:16
- Thumbs-up for RPAH - Comment and connect! 27:09
Books and References
RPAH Elimination Diet Handbook - 2019 - new version
The Diagnostic Elimination Diet Handbook Volume 1 has been released in 2019 and is an updated edition of the "RPAH Elimination Diet Handbook". This handbook is intended to be used for the investigation and management of people with suspected food intolerance.
- This handbook is available for interested Accredited Practising Dietitians and medical practitioners to purchase for their patients. It is also available to members of the public.
- Purchase from Australia: https://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/ff-handbooks.html
- Includes bulk and international orders, note prices are in AUD.
RPAH Friendly Food: The essential guide to managing common food allergies and intolerances
(Murdoch Books® ISBN 978-1760524593)
- Free pdf of book introduction or order directly from RPAH Australia: https://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/friendlyfood.html
- Amazon Kindle: https://amzn.to/3y8QJv5
- Amazon book (prices vary because there are so few - don't overpay!) https://amzn.to/3dA2m4Y
As an Amazon Associate I earn from qualifying purchases. This means if you click on the link and purchase the product, I may get a small commission for the referral. Thank you for clicking! Other companies, like Etsy or individual vendors, are not affiliated and those are just there for your information.
- Kęszycka PK, Szkop M, Gajewska D. Overall Content of Salicylic Acid and Salicylates in Food Available on the European Market. J Agric Food Chem. 2017;65(50):11085-11091. doi:10.1021/acs.jafc.7b04313
- Malakar S, Gibson P R, Barrett J, Muir J G. Naturally occurring dietary salicylates: A closer look at common Australian foods. Journal of Food Composition and Analysis. 2017; 57:31-39. https://doi.org/10.1016/j.jfca.2016.12.008. View full pdf at: https://www.fedup.com.au/images/stories/Malakarsalicylate2017.pdf.
- Swain AR, Dutton SP, Truswell AS. Salicylates in foods. J Am Diet Assoc. 1985;85(8):950–960. https://pubmed.ncbi.nlm.nih.gov/4019987. View full pdf at: https://www.slhd.nsw.gov.au/rpa/allergy/research/salicylatesinfoods.pdf
- Swain's thesis: Swain A. 1988. The role of natural salicylates in food intolerance. [Sydney, Australia]: University of Sydney. https://www.slhd.nsw.gov.au/rpa/allergy/research/students/1988/AnneSwainPhDThesis.pdf. Thesis covers: introduction, salicylate analysis, dietary investigation of recurrent idiopathic urticaria, dietart management and follow-up, salicylate pharmacokinetics, clinical spectrum of food intolerance, family studies, follow-up, historical perspective, and conclusions.
- RPAH's webpage: https://www.slhd.nsw.gov.au/rpa/allergy/default.html
Provided for visual learners, improved accessibility, and for translating the page
Hey guys, Sarah here with low-sal-life. And today we're talking about what is RPAH, let me tell you, RPAH is the abbreviation that makes the YouTube captioning robot bonkers - I edit all my captioning before my videos go up. So, I try to publish my video at night and then usually like 12 hours later, the captioning robots go through and they do their best. And then in the morning, I will go through and edit the captions so that everybody has a best chance of understanding what I'm saying, especially if they you don't understand it, you can turn on the captioning. And then there should be a written version of it.
So, that RPAH is one of those that I have to go in and fix all the time that one and salicylates believe it or not, you know that all the chemical names are really easy like polyphenol, or you know whatever, like those big long ones are, those will show up with no problem. But salicylates always come in as “solace lights”, solace lights. I guess I can hear it. But anyway, so today, we're talking about RPAH and the question is, who are they? What are they? What do they do? Why are they so important? Like you know, what's up with them. So now, I don't live in Australia, I've never been there. I've never interacted with anybody from there. So, I'm probably not the best person to be talking about this. But I will tell you what I can gather from being on their website and using some of the products. RPAH stands, for Royal Prince Alfred Hospital. They are located in the Sydney area within the Sydney Health District. They are the teaching hospital for the University of Sydney. So, that means that when any doctor or surgeon or anybody goes through med school at the University of Sydney, they will be assigned to this hospital. And so, it's usually a really good thing to have a teaching hospital because there's usually a lot of research and a lot of really educated people. It’s just like anybody in any field, there are doctors that, you know hit their climax and think that they're done learning. This goes for people and students, right you go through high school or university and then you graduate and then you're like, I'm done learning anyway. But these teaching hospitals tend to be really modern and really kind of up there with continually learning and doing active research and that kind of thing.
So, that is what RPAH is. In RPAH, they actually have an allergy unit, is what it is called, in the allergy unit, they have a section on their website that is dedicated for food intolerances. Now, food intolerances are not an allergy. But you know, according to their taxonomy, it made sense to put food intolerances under allergy, they're basically treated pretty much the same for the most part. So, it makes sense that it would go under there. So, food intolerance and sensitivities are under that section. And they've done quite a bit of work in the realm of salicylates sensitivity. They also treat a lot of people with salicylate sensitivity. And maybe if you live in Australia, and you've had interactions or experiences with them, you can leave in the comments what they've done for you, what kind of treatments they've done. So, I've got a look into it I guess in Germany, there's a test that you can take. So, to find out if you're salicylates sensitive. I know that there's some varying level of tests available, but RPAH for the most part, my understanding is they recommend an elimination diet. So, they really are looking at quite a few chemicals, not just the salicylates. They look at salicylates and amines together as usually what they will combine for their elimination diet. They'll also recommend that you kind of stay away from some of the big problem foods like wheat and dairy, corn, soy, some of those that are pretty high up there for allergies or intolerances. They would recommend that you eliminate those or at least test for it and then there's also other chemicals too like nitrates, sulphites, sulphates and glutamates. Basically, they recommend that you try an elimination diet, and then you test your foods, those chemicals later. And then if you get a reaction, then you probably should stay away from that one. And then you go through and test the rest of the foods until you're done. So, it's pretty standard, that's a good method, right? There's really only one way that you can tell if a food or chemical is bothering you, and that is by removing it, do your symptoms improve, then adding it, do your symptoms get worse. So, that's actually a pretty solid, scientific method. On their website, I see anything else there, forgot here? Got my notes. Oh, yeah, link is down in the description. If you want to check out their website, I also have it linked off of my website. And I also have some of the research articles also, linked off the research section of the website.
I also have “other websites to check out” section on my website. So, any new or old, some really old websites are on there, too. Those will be under the website section. And then if they have a research article or something like that, then that goes into the main research page. Okay, we're going to talk next about the products that they have available, which is actually very interesting. And maybe I'll thumb through a couple of pages for you. So, you can kind of see what to expect if you decide to order this, on their website they have a book called “The friendly Food, Recipe Book.” And it has a bunch of recipes that are low in salicylates and low in amines. I did not order that, and I don't see a free copy of it online. I just see, it looks like there's a few free pages in there. And then you click on them there’s only like a couple like the first four pages so you can kind of get a tour. But even those pages aren't very helpful. They don't really look like, I'm just saying from this perspective, the one that's up doesn't look, isn't very informative. So, I'll show you a couple pictures today. I do hear from a lot of people that they'll try - pear chutney! That's one that somebody gave me that they recommend that was in this Friendly Food Book. And so, I'm curious and want to order it. But you know like, I'll get to it I haven't been doing very much baking or cooking, lately. Still eating though I don't know how that's possible.
Okay, the second set of books that they have, I have one of them. So, it's “The Food Intolerant Handbook, Volumes One and Two”. This is Volume One; so, it's green I think the second one is, red, and maybe it has red pears on it. This is you can see it's a pretty decent book, spiral bound. And inside it has a bunch of lists. Their Book Two, is called “Challenges Liberalizing and Living with Intolerances.” So, I don't know what it's all about. If you have it, or you know want to comment on it below. Let's let us know in the comments. So, just for prices and checking out through it, it's definitely an old site. They have the recipe book is $35. And then the volume set is $60. I don't know, I feel like Volume Two might be new. I ordered this Volume One last year, like maybe March or April, it was right after the pandemic had started, I had moved to our new house. And I was kind of worried that it would take forever to arrive from Australia. So, it was fine. But I probably would have bought Volume Two, if it was sold as a set. Anyway, $35 for the cookbook, $60 for the set. And then it's $50 for shipping. And I did put all three books in there and shipping was still $50 that’s to the US and Canada. So, it's very simple, shopping cart and everything. Yeah, it took like maybe two or three weeks to get it, it was pretty simple. And I do want to say that these are in Australian dollars. So, at first, I mean, I didn't do the conversion. And it's just like well, if it's $70 this here with the shipping was $70. I remember that. I was like, Oh, it's so much. But I guess if I have to get it, I have to get it right, because I want to make sure that whatever information I'm telling you that it matches up with RPAH. So anyway, it’s Australian dollars. I didn't bother doing the conversion, but at the time, it only cost me in the $40 range. So, and also if you're on their website, they do have information about how the elimination diet was developed. They do have another section that has some research articles, and we'll talk about that in a second. For the most part, RPAH’s considered basically like the gold standard for following a Salicylates Sensitive Diet or Low Amine Diet, they do make their materials available, so that everybody can find it, right. I don't know, there's a part like, for some reason, they're very popular, and they're the gold standard, but then you have to pay for a hardcopy book to find out what they actually teach. I think that's really interesting. Most information, like for me, I think all information should be free especially, when it comes to people's health. Like I don't think that people should have to pay for like, to find out what's on your list, call me old fashioned, actually, that's not old-fashioned thinking that's a little broader than that, unless you count libraries, libraries basically have that same motto.
Alright, we're going to move on to their kind of model in the research. So, this book here has Anne so, we all know Swain et al 1985, right. This should all be ingrained in our brains by now, especially if you've watched any of my videos. So, Swain et al, et al means “and many others”. Swain is Anne Ruth Swain; she is one of the authors on this book. And this book okay, their copyright information is on their back. So, it was first published in 2009, with Anne Swain and just let you know, I have the updated copy. This is 2019, which is their newest edition, they do not put on their website, what the newest edition is. So, I don't know if they've come out with a  like I said, I just bought it last year. So, it should be the newest edition and then there are a PDF that they have online doesn't have this back page on it only, has the first couple pages. So, kind of frustrating trying to find that information. Now, this was written by Anne Swain and before she wrote this in 2009, she wrote a research article that tested 300 common foods in Australia, that is the one that basically was the mother of all salicylate lists ever made. Since 1985, a few things have changed I believe that we have better testing tools available in the last 40 years. Also, our food production has changed and like, food growing and food processing, and the length of time it takes to get to us like these are all different things that have changed. So, just some things to consider. Since 1985, a few things have changed, since 1985. So, besides that study, which is very popular, and very important in 1988, she presented her thesis, I have that link from my research page. So, go in and read that basically, it talks about the experiments that they test, tried with people, and how you know, people got better if they tried a low-sal-diet. There's a lot more information that I'd have not read it, but you can because reading theses are so much fun, actually I've done a few.
Okay, all of that is very cool. It said that the thesis started the testing as far back as 1977. I don't know if Anne Swain was part of that. It said it started under RL Clancy, who was a staff immunologist that was all with RPAH, that is kind of the backstory. Now, I do have one criticism; and I don't know, do we need to call them criticisms? Do we need to say analytical question? Comment, concern? This is a little bit of a concern for me that I have seen in the salicylates forums and it is that RPAH is the one doing research. They're the ones that should be making the rules for salicylates sensitivity kind of thing. Okay. Now, RPAH is not saying this. This is somebody who is defending RPAH, this was the statement. I have two statements about that one, nobody holds the answers for science and truth that is a collective arrangement by many people, many communities, science and science truth should be able to be reproducible by others, given you know like, you provide the method somebody else should be able to reproduce it right. That's good science basics. Okay. Nobody holds the truth, which is another reason I find it irritating that they don't publish this stuff publicly like, why do you have to order a book? That's so annoying. The second thing, is I have an issue with that they're the ones doing the research. No, unless their website is just very, very, very outdated, they actually haven't done any research on salicylate sensitivity in a really long time. I'm going to give them the benefit of the doubt that, they're just not publishing their stuff anymore and like I said, their website does look old. But they did update this so that you can buy a book, but and they haven't updated their website, there are some pretty recent articles on there. I'm just going to say, if you look on the research articles page, there is actually no articles that include salicylate in it, until you hit 1999.
So that was more than 20 years ago, there was a Chronic Fatigue Syndrome article in 2000, that I was not able to find, I will have to contact my library and see if they can track it down. It was free if you're part of the AMA, but it should be free for hospitals like, university hospital staff, right? Like even if they're not part AMA, anyway. Chronic Fatigue Syndrome in 2000 I couldn't even read the abstract on it so, that was really frustrating. But it might have been mentioned in that but even if it we say that, it is mentioned in there, that's still over 20 years ago. Are they actively doing research on salicylate sensitivity for all of us? No, they're not. Unless it's being published somewhere else and not updated on the site, it's not. But I will validate the reason why their book is good. So, here's the thing; I look at salicylate sensitivity from a research perspective like, I want to make sense and organize all of this data that is being made worldwide, right. We've got research in Poland, in Scotland, in Japan, Korea, I just saw an article in Korea. So, we have all this research everywhere. It's not organized in one place, there's no nonprofit organization to represent and do this work for us. So, I am happy to put it on my website. But I don't work with patients, I work with myself. My mother had salicylates sensitivity. So, you know, we worked on that together like, hey, this works for me, you should try this out. Okay, that didn't work for you. Okay. So, you know that's that. And then, oddly enough, my mother-in-law also is salicylate sensitive, not as bad as my mom and I were, but she has done the take everything off the high list, and is fully functioning, not having her problems anymore. So, that is fantastic. So, you know, I'll share little tidbits with her and stuff. But that's been the reach of my salicylate experience with other people, besides answering your comments and talking to you guys, on Zoom chat and in the public, and in the comments and stuff.
But RPAH, they are actually working with patients. And they work with a lot of patients and they probably see plenty of patients having reactions to certain foods and not having reactions to other foods. So, the reason why they're able to update a book like this in 2019, even though it was last revised in 2011 and things have changed and moved off the lists. They are probably consulting some of these updated lists like Keszycka and Malakar with some of their updated lists. And they're also probably getting feedback from their patients that say, Hey, I react to this all the time like, what's going on? So, in those cases, they might think like, oh, this is you know, challenging for a lot of people, we should move it up higher on the list. So, that is one reason why they should still be considered the gold standard, because they're actually working with patients. So, a little bit different perspective, where I come from like, this is what the research says, and this is what we can gather from it. This is hey, we work with patients on a regular basis and this is how we're going to change it. But there's also something else to consider, if they have something on the higher list and it's lower on a research article, or vice versa. That's something to consider, like, oh, well, the research says this, and they say this, which one am I going to believe so, you got to kind of do what's best for you. Again, that's the reason why elimination diets are, so fantastic. Real quick, I will just give you a tour of this book, because this is the one that I have. But basically, I will show you kind of the nuts and bolts of this. So, essentially you have these tabs, there you go so this got all this introduction stuff. I think this introduction section is completely online, here's information on how to do the elimination diet. Okay, and then the charts are the most interesting. So, here you can see the food lists. So that is basically the majority of the book. And then the very back end of it has like meal suggestions, supplements, finding personal care and things like that.
I mean, it's not a lot of information. But if you're just getting started, it's really a great book to use. Not only that, I like the way the pages feel the spiral bound is, really nice like all together, it feels like it's a good book. And I like it because you can, because of the spiral binder, I can just like drop it in a folder and take it with me like I live part of the time in western Washington. And so, I always take this with me in case you guys have questions, I can be like well, this is what the research says and this is what RPAH says. One thing that I don't like about this, which is kind of nice and kind of not nice but basically, they have a low, moderate, high and very high set, I really wish that they would have a negligible set. And they don't have that because some of these, like vanilla is low, but it's not really low, it says low in small amounts. But you know, I would like to see a negligible list like, to me it says parsley pinch only, which is nice because that's like okay, I can have a tiny bit of parsley, but parsley has been tested high. And obviously, if you eat a lot of it, you're going to have a reaction to it. So, that should be anyway there's a few things I don't like. The other thing that I don't like is I show you this here because it's not just for salicylate sensitivity it is for a lot of things. They categorize everything by if, it has amines it will have “A” on here like this one here lecithin malt vinegar, those have amines in it, and so it's in the moderate chart, but it's actually in the low chart for salicylates. So, if this here were rewritten as a salicylate chart, lecithin in malt vinegar would be in the low chart, but because it has amines it's moved up to the moderate. And then here for the high, you have gravy is all the way up in the high section. Well, gravy can be made without salicylates. So, it couldn't be in the low list if you're just salicylate sensitive. Okay so, that's one thing that I don't really like, because you'll be on a forum or whatever and people are like, Oh, my gosh, malt vinegar is on the moderate list and then you're like, yeah, it's on there because it has amines, we're talking about salicylates you know, sometimes people will have a more restricted diet, because they're eating off the low only list and don't look and see that, they could also be eating gravy. Fish sauce, oyster sauce, rice wine vinegar, you know, like all of these are in the high list, but they're actually without salicylates.
So, that's just something to keep an eye on when you start using this and something that I don't like and something that's really confusing that people don't catch. Anyway, it's kind of interesting it also has these like cooking tips and guidelines hints like, this here says citric acid use sparingly instead of lemon juice and vinegar as too much can cause reactions in sensitive individuals. I think that's all true. This one here is funny maize starch, corn starch, corn flour, corn flour is the generalized term of the starch portion of any grain, anyway so goes into that. Corn starch, corn flour is fine. We do in the US have like a yellow corn flour and used to use it for gluten free baking a long time ago, I don't think that that would be the same thing as corn starch, which is the white, fluffy, starchy part, which I think in Australia, they call corn flour, just letting you know. But that's not the same as the yellow corn flour we have here. Alright, so in general, I have not updated my website to include RPAH’s food items on there I kind of feel like I should, so that you guys can just have access to all the information. I do quote, when I do put something on there, I do put that it's their 2019 version. But number one, that would take an eternity to do and I think that the actual research information is actually, better to know about then what is in here.
But if there is an item that does not have a research value, I feel like palm oil is one of them. We just talked about that a few videos ago. If like let's say, palm oil doesn't have a lab result, then if RPAH has made a statement about it, I will put in that value into my list. So, and every single time and you guys asked me questions, I will say something like brussels sprouts, even though they've tested high in other research studies, actually tests high, RPAH actually listed as low or whatever it is. Let's see what they have it in here, I can't believe it's still on low. It's still on low. I cannot eat that stuff. Yeah, I think chayote is another one, choko that one, I don't think has a research result for it but it's listed as low on here. So that would be one that I would put in. Yeah, brussels sprouts is still low - and beans, I know French, and yellow beans have come up really high in some testing. So anyway, just some things to think about like I said, I won't be putting every single one up there I do put the important ones that are missing articles up there.
I think that's all for now, if you have any comments or challenges to any of the statements I made, I would be very interested in hearing about it. And for the most part, I'm going to say “way to go RPAH!” way to, you know, stake the claim and help the rest of us get on board even if it takes 50 years, 77 they started working on this. So, I appreciate that - I do think that your resources should be free. This is the 20s so, I think information like this should be free and available, especially when there's so many people worldwide, including, you know countries that don't have the infrastructure or health care or information like this available to them. I think it'll go a long way if it was and with that, I think I'm heading out you know what to do thumbs up, subscribe, comment. Check out my website at low-sal-life.com and best place to message me is probably through Instagram, that one’s the easiest for me to manage. Alright, with all that. See you guys later. Bye