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So you're curious about going salicylate-free and found a list. Maybe you've started and are still having reactions when eating bowls full of Brussels sprouts. Or maybe you're in a few months and have had nothing but meat and cabbage because it's the only thing you think you can eat. Well, this is a post for you! One of the most challenging things when starting a low-salicylate diet is choosing a list to use and then "listening" to your body. Why is there so much variation?

You may be frustrated or confused, but I'm hoping the sleuthing I've done for you (and really for me) will help clear things up and put you back on the right track.

The first thing that I must say is if your doctor or health care practitioner gave you a list, use that. They know you and your history, and they know what you're trying to accomplish. Next, if you choose to pick a list to use, take it to your provider and have them agree that it's safe to use for your healthcare plan.

Youtube Video Part 1 - Why is there so much variation?

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YouTube link: https://youtu.be/YbuDn_2hYQM

Find on Low-sal-life references to:

How were lists made?

Original research

There are two very influential and important lists that measure the levels of salicylic acid (SA) in foods. The first was done in 1985 by researchers/practitioners Anne Swain, Stephen Dutton, and Stewart Truswell in Sydney, Australia. They tested 333 common foods and published their results in the Journal of the American Dietetic Association - view Swain article. This study was the first of its kind, and set the standard for the majority of lists you find on the internet. It was published 35 years ago.

The second study of similar nature was published in 2017 by another Australian team, Sreepurna Malakar, Peter Gibson, Jacqueline Barrett, and Jane Muir, for the Journal of Food Composition and Analysis. This study also tested salicylic acid (both free and bound forms) in 112 foods, many of them overlapping with the Swain study from 1985. This study was published three years ago and many websites have not yet updated their lists to reflect the new changes, nor do they provide a date for when they published their information. View Malakar article.

There are quite a few smaller studies that test the levels of SA in food, though not as comprehensive. If I find a list, I will add it to the sources section of my Food/Products List page. Some of these include: Robertson & Kermode 1981, Venema et al. 1996, and Wood et al. 2011. Here's a tip when looking through the list - compare the units of measure. Swain used SAmg/100g, and Malakar used SAmg/kg.

Practitioners

Practitioners from all over the world have been working directly with patients and helping them heal. They are using the original research articles to make their lists to give to patients, and then also getting direct feedback from their patients if they're having issues. For example, if the 1985 article says lemon is low (1.8mg/kg) but your patients are reacting to it, you might move this item up the list on foods to avoid. Questionable foods like this are ultimately what spurs research to retest foods. Malakar et al. in 2017 found lemons to be much higher at 6.74mg/kg.

The Royal Prince Alfred Hospital (RPAH)  in Australia is what I'd consider the gold standard treatment for salicylate sensitivity and food chemical diets. They cover both common allergies and chemical sensitivities. The Food Intolerance Network is ran by Sue Dengate, also in Australia, who provides a comprehensive plan to do elimination testing.

 

Why is there so much variation in lists?

Outdated information: The most obvious result of variation is outdated information in lists. We can control this by being educated and managing how we source information! Below, check out my reviews on many lists that show up in the top 20-30 search results and what I think about them when I compare them to original research.

Bad information: Some websites just provide bad or wrong information. Many of these sites do not provide resources or links where they got the information. Yes - believe it or not, there is some bad or fake information on the internet. Two of the worst sites for this is the melbentgroup.com.au and drugs.com. They both provide advice contradictory to what any research or practitioner supports, it almost seems like they got their columns wrong when setting everything up.

Different Countries: All the foods in the Swain and Malakar studies were done in Australia, about 30 years apart. There are two things to consider here. The first is that Australia makes food differently that the US or the UK. While testing whole foods like veggies will lead to less variation, the way they bottle juice or oil may be different. For example, oils can have certain preservatives added that may not be allowed in other countries. The second thing is that over 30-40 years, the food industry has changed. Certain processing chemicals used then may no longer be used now (or vice versa). Practitioners building lists for their patients may be observing these differences based on where they live. Besides this, places like the US barely recognizes salicylate sensitivity as a condition and provides no information for lists or how to manage the condition.

We don't know which types were tested: Another thing that is not mentioned for all the foods in the studies is what was the variety of food that was tested. In many cases, they listed the brand of food if it was packaged. For iceberg lettuce, cabbage, mangoes, and lemons, the varieties are not listed (and they wouldn't be listed at the store anyway when you buy them!). A meyer lemon compared to a citron lemon may be wildly different! Reading the published articles

Different practitioners: Different practitioners focus on different foods and may include foods for healing and particular results. For example, Karen Fisher, author of The Eczema Diet and nutritionist in Canada, recommends flax seed which is good to treat eczema and good for the skin. I wasn't able to find any original research what the flaxseed SA levels, but Joliee skincare (now skinfriend.com) is owned by Karen Fisher and lists them as medium. A different doctor, focused on respiratory health, may not recommend eating flaxseed because it is a medium sal food.

Why is there so much variation in foods?

Varieties within a species -There is just no better way to say this, but there is going to be variation in cultivated fruits and veggies. Look at a head of "normal" cabbage, Brassica oleracea var. capitata: at first glance we have purple(red) and green cabbage. Pretty simple, right? Well, this is a cultivated food which means humans have been developing it for many centuries. Now try looking for seeds to plant some. The Gardener's Path is a website that lists their top 9 favorite varieties (implying there are more): Brunswick, Charleston Wakefield, Earliana, Golden Acre, January King, Late Flat Dutch, Mammoth Red Rock, Red Acre, and Savoy Perfection. Do you think their SA levels are all going to be equally negligible to low? The Swain, Wood, and Robertson & Kermode studies all tested green cabbage at zero or almost zero. In 2017 Malakar tested cabbage at 2.55mg/kg, which on most lists is classified as a medium SA food! We don't know which varieties they tested, and there's always going to be variation within a species.

Variation within a species - This may seem like a duplicate, but I promise it's not. Varieties aside, if you just have a plain species (without cultivars, varieties, sub-species, and hybrids), that species is going to have variation in their genes. We can easily see variation in human genes (phenotype) with hair color or texture. Try applying that idea to how much chemical amounts can vary in plants. When we say a category now tests high, it could be that a good portion of bananas test low most of the time -  but we have to be aware that sometimes they can test much higher.

Pesticides vs organic - Salicylates are made by plants for their immune system and part of their defense system. It has been found (I'm still looking for a source) that organic plants may produce more salicylates to ward off pests since they are not being sprayed with conventional pesticides to do some of the work for them. Like the varieties listed above, plants are selected by the gardener for certain traits. Those that are more disease resistant or pest resistant are bred the next year. Those that are more disease or pest resistant likely have higher amounts of salicylates.

Plant respond to pressure - this one is hard for people to wrap their heads around, because we don't come close to thinking that plants move, think, or are even close to being sentient. Unlike animals, we don't anthropomorphize them (basically turn them into cute cartoons and give them names and feelings). Plants are very sensitive and respond quickly to pressures like animals eating them, they build communities, and support their offspring to grow and have a competitive advantage over others. A plant could have low levels of chemicals or toxins in their leaves under normal situations. After an animal comes and chews on them, they may produce chemicals in their leaves to prevent that from happening again. It might be possible that this happens with salicylates.

Foods processed differently - The SA levels in food are reported by mass SAmg/kg (number of salicylates in milligrams per kilograms). A fresh fruit, like a fig, has a substantial amount of water in it, so by mass it has a lower amount of SA in it - Swain records it as low at 1.8mg/kg. In the same study, a dried fig, however, is in the high category at 6.4mg/kg. Why are they so drastically different!? I don't think it's a result of the food changing during processing that increases the level. It's more like one fresh fig weighs the same as three dried figs.  If you can handle three fresh figs a day, you might be able to handle one dried fig a day instead.  Juices are a bit similar. Modern juices are highly concentrated and usually use the peels when making it. Conventional pear juice is high with the peels whereas a homemade pear juice made with peeled pears can be quite low.

Variation in the ripeness - I've seen arguments that the less ripe a fruit is, the more salicylates there will be (bananas). I've also seen that the less mature it is, the fewer sals there will be (argument for fresh vs frozen spinach). I haven't seen any research showing that, but I don't doubt it. If I find information on these, I'll update my comment here.

 

YouTube Video - Part 2 - Reviewing lists

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Popular lists - and my thoughts

These are from the first two pages of Google search results while searching for "salicylate diet".

  • https://www.drugs.com/cg/low-salicylate-diet.html 
    Accessed May 3, 2020. This article says it is medically reviewed, yet doesn't provide sources. When I first accessed it, it showed it was updated Feb 3, 2020 which means they would have had access to Malakar et al. 2017 research. This is the #1 Google Return. This clearly followed the Swain study as the premise, although some of the foods even contradicted that. My first review was done on May 3. I didn't make a copy for you to view - It was pretty bad. It is much better now, and shows it was updated Feb 19 (although, I think it was updated in May, this can manually be done for any date on the backend). I have a feeling they may have found my review and addressed the issues - because it corrects every wrong remark I had made in my published draft. I dislike that they've made the list binary - just yes or no. This is a terrible way to manage salicylate intolerance and people need to know there are varying levels in foods.
    • Original review on May 3
      • It said that grapefruit was ok - this has never been the case. Swain tested it as a high food in 1985.
      • Corn was listed as ok which is wrong - first, it doesn't specify which product. Cornmeal and corn flours were tested high by Swain et al. 1985. Fresh corn was also reclassified into a high category after Malakar tested it.
      • These foods were listed as low on the website (following Swain et al. 1985) but have now been moved to a high list (Malakar et al. 2017)
        • Lemons, Rhubarb, Cashews, Mangoes, Asparagus, Mushrooms (doesn't specify fresh or canned), Squash (doesn't specify what type, but most are high), peas, green beans, and fresh corn.
      • Listed "Greens" as ok to eat, and "lettuce spinach, and other greens" - this was just bad advice because it is vague and the majority of greens are extremely high in sals.
      • Vinegar type was not specified and recommends it's ok. This is not the case. White vinegar is very high (Swain et al. 1985), as is red wine and apple cider vinegar. Malt vinegar is zero (Swain et al.), and I've heard that rice vinegar may also be ok.
      • It says to avoid sparkling water, gin, vodka, and whisky - this is wrong, these are all very low in salicylates, and water has no salicylates.
      • It says to avoid potatoes - this is also wrong. While there are a lot of potato varieties, and peeling them reduces sals, they should inform people that a peeled white potato should be ok. As I mentioned they may vary a bit.
    • New review on May 21
      • Grapefruit, mushrooms, mangoes, corn, sparkling water, squash, and greens were removed
      • Green beans, Brussels sprouts, and bananas should be considered for moving into to the avoid/high category (Malakar et al. 2017).
      • Cabbage and celery have all retested higher (low end of medium) and should be addressed.
      • Now specify vinegar type
      • Moved gin, vodka, and whisky to the low sal column
      • Specified white peeled potatoes as ok
    • New review on May 25
      • pages reverted back to the Feb 3rd edit. I'm guessing this is from caching, but that doesn't matter. It's still wrong and confusing.
  • https://www.healthline.com/nutrition/salicylate-sensitivity
    • #2 Google Return
    • This is a well written article and provides resources to original research and medical practitioners/organizations. It doesn't provide a comprehensive list, but the foods listed to avoid are correct and supported by all the research I've listed.

  • https://www.samterssociety.org/low-salicylate-diet
    • #3 Google Return
    • Doesn't provide list, doesn't recommend a low-sal diet for AERD.

  • http://www.foodcanmakeyouill.co.uk/salicylate-in-food.html
    • #4 Google Return
    • This website was written by Sharla Race who also wrote The Salicylate Handbook. She is a very thorough researcher. Her information was monumental when I was starting out. Most of her lists are supported by the Swain research, but she also provides information on what she reacts to and how she copes.
      • Lists banana, lime, cabbage, celery, cashews, brussels sprouts, garlic, green peas, lemons, rhubarb, asparagus, and green beans as negligible or low (supported by Swain et al. 1985) but these have all been moved up to medium or high categories (Malakar et al. 2017). If she doesn't react to them, she could make an update on her website indicating there is variation in the testing. The rest of her list is solid, as is her research.

  •  https://melbentgroup.com.au/low-salicylate-diet-part-2/ 
    • #5 Google Return
    • This is probably one of the most inaccurate lists I've found, and it has such a high search result! First of all, it provides no date for when it was updated last, and second, no resources to back up the claims. It actually looks like maybe they got their columns messed up in some parts, putting high in low areas.
    •  Items in the low category that just shouldn't be:
      • herbal teas & coffee are OK (they should specify that reg coffee is not low sal, and most herbal teas aren't), Allspice, Caraway seeds, cardamom, Chilli (tested lower for Malakar et al, but is still in the high group), Cinnamon, Cloves, Fresh herbs, ginger root, marmite, nutmeg, pepper, vanilla, vegemite, vanilla ice cream, chili peppers, coconut, vague "all other nuts" - not the case, chestnut, pinenuts, pistachios are all high,
    • Items that are in the low/no category that should be moved to up to a medium range (Malakar et al. 2017)
      • pawpaw
    • Items that are in the low/no category that moved to up to a high range (Malakar et al. 2017)
      • banana, garlic, mango, lemon, passionfruit, rhubarb, mushrooms (fresh)

  • http://www.eatrightstore.org/~/media/eatrightstore%20documents/books%20and%20publications/faisalicylatesensitivity.ashx
    • #4 Google Return
    • I like that it recommends general guidelines, and includes a phrase that says "vegetables show a wide range of salicylate levels". They also say that testing if very challenging and that everyone is a bit different.
    • This document hasn't been updated since 2013, which means it leaves out Malakar's 2017.
    • Many of the fruits, veggies, and spices in the low level columns follow Swain's 1985 recommendation. Many of the foods should be taken of the low levels, or specify varieties and provide more info.

  • https://www.sjhc.london.on.ca/sites/default/files/salicylate_free_diet_food_guide.pdf
    • Good list, easy to read - needs to be updated
    • Does not include amounts for food
    • References on last page reference the salicylatesensitivity.com website. This website hasn't been updated since 2011, which lists Swain's 1985 study at the primary source.
    • I don't like that they include sooo many hair care products that are low in sals. I've had reactions with a few of them, and most have fragrance. At the least, it should be titled low-salicylate hair product guide, not salicylate-free. I think they got this list from the fibromylgiatreatment.com website (no longer exists) - which has a little bit different need for how they manage their salicylates levels compared to salicylate intolerance.
  • https://atpscience.com/salicylate-foods-sensitivity-intolerances-and-food-list/
    • Good list, but outdated - it uses Swain's 1985 study only. It was updated in 2015, and as we all know by now, something came out in 2017!
    • Bonus points for including units. They are showing the amounts per Swain's SAmg/100mg, which is why their amounts don't match up with mine. My lists are per kg (that's how Malakar and other studies display it). Per unit is really important to include, and they do include a note at the top of the text (I missed it the first time around).
    • I used this study when I first started out.
  • https://www.dietvsdisease.org/salicylate-intolerance/
    • Website was updated in 2019
    • Great infographics, but only uses Swain 1985 lists - they didn't update the infographics with Malakar's information.
    • Charts don't include a per unit and should (like is it SAmg/100mg or 1000mg?)
    • They get bonus points for including sources!

  • http://www.pkdiet.com/pdf/oxalate%20lists.pdf
    • Good list, but uses Swain's list only. Needs to move some foods up the list and include Malakar's study.
    • Doesn't include sources or a date.

  •  https://www.fwdfuel.com/low-salicylate-diet/
    • Not necessarily a list, but it was the last article I was looking at before finishing up.
    • Outdated food lists based on Swain only.
    • First, the picture of Brussels sprouts and cashews is enough to make me sick for a few days. Both of these have been moved up to higher categories.
    • I do appreciate they are writing about, bringing awareness to salicylate sensitivity!
    • Personal peeve: No science ever PROVES anything. It is very important if you see an article with "prove" in it, you find another article. Science builds up a body of evidence that SUPPORTS a theory. Even with gravity, we can't say a falling object proves gravity is real. It supports the theory, but could never prove it.

The reason I provide the reviews, is because I want the owners to update and maintain them. People are finding them and having mixed results. People who present information online have a responsibility to maintain it and remove it once it's no longer relevant.

I hope you've found this information useful. If you have a list (especially original research) please send it to me through the contact page. I'd love to review it.