The RPAH Elimination Diet (Failsafe)

About the Diet

This is a trial diet that is designed to eliminate additives, salicylates, amines and glutamates. It is not suitable to treat food allergies or coeliac (celiac) disease. It is not a gluten/casein free diet, a low opioid peptide diet, a low oxalate diet (LOD), the specific carbohydrate diet (SCD), a low lectin diet, a low goiterogenic diet, or a low phytoestrogen diet. This is a copy of the Royal Prince Alfred Hospital elimination diet, but may contain some minor differences. This page is not endorsed or checked by the RPAH.

This diet is designed to test and treat your ability to tolerate additives, salicylates, amines, and glutamates. The elimination diet is designed to eliminate all of these chemicals at once, because sensitivities to these chemicals often occur together and the symptoms caused by each individual chemical largely overlap. Currently, the only accurate way to test if you have a food chemical sensitivity of this kind is to eliminate all of the chemicals involved and then challenge them one by one. This is so that you can figure out which chemicals in particular affect you, and what quantity of chemicals you can manage without experiencing adverse symptoms. This enables you to eat the widest range of food without experiencing adverse symptoms.

It takes most affected people an average of four weeks to "clear" their symptoms and feel better on the diet. In small children and in those who aren't too badly affected it can take as little as two weeks. In the very badly affected, it can take six weeks or even three months before symptoms clear. Some symptoms you experience may be caused by an infection acting on your immune system. If this is the case, these symptoms may take longer to clear up, and there is no reason why you should not request additional help in the form of antibiotics or antifungals, as long as these treatments are salicylate and additive-free and you are able to trial the prescription carefully in case of an adverse reaction.

How to Perform the Diet

Treat the diet as a scientific experiment. Try to control all of the variables that can affect you. The diet is not designed to eliminate all chemicals or allergens from your menu, just the ones that we know typically affect people with this range of symptoms. In some people, allergies and other intolerances to wholefoods can cause similar symptoms. Therefore it is important to use your common sense judgement with certain foods. If you suspect an allergy or an intolerance to a wholefood (for example, if bread gives you arthritis pains, people in your family don't get on with milk, or eggs give you a rash), you should also eliminate those foods while you are on the trial diet as allergens and other intolerances will muddle your experiment. People sometimes experience intolerances to foods they "cannot live without" or that they crave, so be particularly wary of cravings for foods. If you suffer from pollen allergies, it is best to avoid doing the diet trial during the spring allergy season.

• Avoid allergens during the diet trial - in food or the environment
• Avoid strong smells, perfumes, air fresheners, industrial fumes, cigarette smoke, coal tar fumes and car exhaust fumes
• Avoid scented, coloured or strong cosmetics and toiletries
• Avoid large doses of vitamins and minerals (particularly some B vitamins)
• Avoid NSAIDs (aspirin, ibuprofen, diclofenac, naproxen)
• Avoid over the counter drugs and prescription drugs unless essential
• Avoid coloured capsules and coatings on drugs (wash off or remove contents)
• Avoid mint and menthol products and other decongestant inhalants
• Avoid chlorine and chloramines found in swimming pool water
• Eat only the foods and drinks allowed on the elimination diet
• Do not be tempted to do your "own version" of the diet (it will not work)

Keep a diary recording everything you eat, the places you visit, any persistent smells or chemicals in your environment, anything you put on your skin or hair, any laundry or washing up products you use, and any symptoms of ill health you experience. Symptoms can appear almost immediately after consuming a food chemical you cannot tolerate, or they may appear the following day, or they may take as long as three to five days before they appear. Reactions can differ depending on the strength, quantity, and the type of chemicals you have consumed. Reactions often build up very slowly and sneakily over several days and may take several more days or a week to abate.

Initially you may experience withdrawal symptoms. These may be related to caffeine withdrawal, or to the presence of food chemicals which your body has grown used to. You may find that you crave "forbidden foods" and strong flavours. Try to resist these as they will only make you feel worse. Rarely withdrawal symptoms can be unpleasant and can mimic SSRI withdrawal. Try not to worry too much about the unusual symptoms that you experience during the first few weeks of the diet.

Do not worry about nutrition. The diet is restricted but still highly nutritious when performed properly. You may even find that your nutrition improves. Meat, eggs, whole dairy foods, pulses, beans and whole grains are some of the most nutritious foods in the human diet. Please use your common sense and eat a normal, balanced diet. Do not use the diet as an excuse to binge on your favourite foods or eat large amounts of refined carbohydrates or vegetable oils. Please do not avoid eating meat or fish, even if you are afraid of amines, just concentrate your efforts on finding a good supplier of fresh meat. If you are concerned about vitamin C, understand that most fruits and vegetables contain only small amounts, and only a specific minority contain high amounts. Brussels sprouts, potatoes and cabbage are all very good sources of vitamin C. Pure ascorbic acid can be purchased if you dislike the taste of these foods. Sometimes people complain that there is "nothing to eat". This is usually because they are placing additional self-imposed restrictions on their diet or they are struggling to use their imagination in preparing meals. There is no reason why people should go short on calories on the diet.

Take Professional Advice

This diet takes a lot of time and brainwork to perform correctly, and most people slip up many times when they first begin. It is not possible to do your "own version" of the diet, excluding only those foods you consider high in specific chemicals. There may also be hidden chemicals or allergens in the food you are eating that are not labelled, or you are not aware of them. Consider seeking the advice of a professional who is already well-versed in the RPAH elimination diet, or at least asking questions on some of the online failsafe discussion groups. Furthermore, do not trust the advice of professionals who have not heard of the diet or are unfamiliar with it, as they will tend to dismiss it or make as many mistakes as you would do alone.

Trying The Diet

This table contains a comprehensive positive list of the allowed food items on the diet. If a food is not in the table below, you should not eat it on the trial diet. You must also avoid the additives listed separately at the end of this page, and use caution with processed foods that may contain unlabelled additives. Eat only the amount specified in the maximum allowed column. Remember to read the common pitfalls column carefully so that you don't make mistakes with foods you thought were safe. The food chemicals column gives information on any very small amounts of food chemicals that are in these foods and may be useful if you are very sensitive to food chemicals. The other problems column gives insight into other reactions that people can experience to the food. Don't worry about this column to start with, though it might help you to understand any idiosyncratic or quirky reactions you cannot explain in the future.

If The Elimination Diet Fails

If you do not see a significant improvement in your symptoms or they continue to persist whilst on the elimination diet, consider the following possibilities:

• You are "cheating" too often
• You are not following the diet correctly - go through the foods you have eaten and check they all match the criteria above
• You have not been on the diet long enough to make a difference (at least four weeks)
• You are still coming into contact with environmental chemicals, smells, toiletries or cosmetics - people often cheat with shampoos or perfumes because they do not think it will make a difference - it does
• Environmental or food allergies are interfering with your ability to progress
• You are taking pharmaceutical drugs, vitamin supplements, or herbs that are interfering with the diet (eliminate them all, no matter how harmless you think they are)
• You are reacting to foods on the elimination diet
• Because you have a wholefood allergy or intolerance that is contributing
• Because you have not sorted out a supply of meat/fish that is low enough in amines (a very common pitfall)
• Because you are not limiting your consumption of low-salicylate allowed fruits and vegetables
• Because you are very sensitive to salicylates and other aromatics and must further restrict fruits and vegetables
• Because you are very sensitive to sulphur and must further restrict sulphurous foods
• Because you have other contributing sensitivites such as oxalates, lectins, and the opioid peptides in casein and gluten
• Because there are contributing factors like an infection from which you must also recover
• You are not food chemical intolerant

If you have seen no improvement in your symptoms and you feel you have followed the diet correctly, consider doing a flood challenge by reintroducing all high chemical foods into your diet at once. If you feel worse, it may be that you are sensitive but the diet alone is not enough to get rid of your symptoms. Once you have considered these possibilities, you can move on.

If The Elimination Diet Makes You Worse

If in the unlikely event that you feel the diet is making your symptoms worse without showing any benefits, or if the diet has been successful in reducing your daily symptoms but you seem to be hypersensitive when you cheat, consider the following possibilities:

• Check for hidden additives and food chemicals in foods that you believe are safe - people usually make a number of mistakes to begin with
• Look back through your symptom diary from before you started the diet and assess whether you genuinely feel worse - some people focus on the negative symptoms they have when reacting instead of focussing on their state of health between reactions
• You are still going through a withdrawal period (this can last up to three months), during which you may become temporarily more vulnerable to pain, infections and overreactions
• You have started eating something which you are allergic to or intolerant of (wholefoods, oxalates, lectins, opioid-peptides) which you did not eat before, such as wheat, oats, beans, pulses, dairy, eggs or potatoes
• Despite improvement, you are genuinely more sensitive when challenged with food chemicals - some people do experience this
• You are unnecessarily restricting your nutrition for fear of reactions to foods, like: meat, eggs, dairy, legumes, pulses, or grains
• You are eating in an unbalanced way and have increased your intake of refined carbohydrates or vegetable oils
• You have a problem with a different set of chemicals (oxalates, lectins, goiterogens, opioid-peptides)
• There are contributing factors like dysbiosis which you may have exacerbated by increasing carbohydrate consumption (specific carbohydrate diet)
• Food chemical intolerance can get worse or better over time despite dietary intervention, due to hormonal influences beyond your control
• Your condition is not related to food chemical intolerance, but is progressive and requires medical investigation

You may feel that food chemicals make you feel good and you only feel bad when you withdraw them. This is because they can produce a happy-high feeling in some people - unfortunately this also produces a rebound low several hours later or the following day, which you may not have associated with food. In this case the answer is still to eliminate the food chemicals from your diet as they are producing moodswings (bipolar disorder).

If The Elimination Diet Helps

Most people are content to wait for a few weeks after starting the elimination diet in order to give their body a rest or enjoy their new sense of health. Once you are ready, and you have been on the elimination diet for at least two weeks with at least five days in a row without symptoms, you can begin the food challenges. The RPAH prefer to perform blind, placebo-controlled capsule challenges in order to produce a high level of proof, but for those who are unable to follow this route, food challenges can also be performed.

• Keep a daily diary noting how much of each food you ate, how you felt, and anything else that could have happened to upset you
• Wait for two weeks on the elimination diet, with five days in a row without symptoms
• Eat at least the recommended amount of food for each challenge, every day, spread out over the day
  • For wheat, milk, salicylates and amines, eat the foods for seven days
  • For additives, eat the foods for three days
• Stop if your symptoms come back or worsen
• Stop if you have completed a food chemical challenge without experiencing a reaction
• Continue if at the end of a challenge you are unsure if you are reacting, and continue until you are sure
• Repeat challenges two or three times if you are unsure whether you are reacting
• Leave in milk and wheat if you have not reacted to them after seven days
• Wait for at least three days after stopping a challenge to see if there is a reaction (doesn't apply to milk and wheat as withdrawal usually produces immediate effects)
• Don't start the next challenge until you have had three full days in a row free of symptoms and do not require any additional medication
• Be patient during challenges, reactions can take up to 48 hours to begin, if you hurry your challenges you are likely to get confused and will have to start again

Food Challenges

The RPAH recommend challenging foods in order of usefulness and nutritional content in the diet, and therefore recommend starting off with milk, wheat, and bread challenges, if you have had reason to exclude these foods. If you have not had reason to exclude these foods but do not feel on top form, you may find it useful to test them. This can be done by excluding each food for a week and then adding it back in to see if it makes a difference. Next challenge salicylates, followed by amines, then glutamates/MSG. Glutamates/MSG are usually found in the same foods as amines and are usually only worth testing separately if you do not react to amines. Additives should be tested last since the foods they are in are rarely nutritious or useful, and because people who react to salicylates and amines always react to additives as well. The most useful additives to test separately are propionates (E280-E283), the bread preservative, since if you tolerate them it is much easier to shop for bread.

Challenge Amounts Per Day

Problem Additives

Any number of additive trials can be performed. Some additives have specific effects to watch out for - such as ribonucleotides (E627, E631, E635) which tend to cause rashes ("ribo rash"), or aspartame (E951) which tends to have MSG-like effects and cause depression. Additives not on the problem list are less likely to be problematic, however some other additives not in this list have been shown to have adverse effects on people. Splenda (sucralose, E955) can cause rashes especially in the chlorine sensitive, and sugar alcohols or polyols (E420, E421, E953, E965-E968, E1100) tend to cause digestive distress.

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