Failsafe (free of additives, low in salicylates, amines and flavor enhancers) trial
Our initial reason for starting all these food trials was because I suspected there was something my spouse was sensitive to. And food chemical intolerance seemed like another possibility, as it didn’t seem like he had a clear reaction to any single food. Unlike an allergy where a tiny amount of a single food can trigger a reaction, food chemicals behave more like drugs and the reaction depends on the accumulated amount in one’s diet. We had been writing down everything we ate for more than a month by this time so I tried putting them all into a spreadsheet and weighted each food with the approximate amount of salicylates, amines, or free glutamates it contained. My symptoms seemed random when plotted against the approximate sum of food chemicals but in my partner’s case the two curves’ peaks and valleys had a very similar shape with less than a day’s phase delay. I tried other plots and mine matched up rather eerily with the sum of gluten and dairy, the latter of which I was still in denial of at this point in time. Based on this data, it seemed highly likely there was some food chemical my partner was reacting to, which made it worth the multiple week hassle of wading through a complex challenge.
Salicylates, amines, and free glutamates all occur naturally in food. At high enough concentrations everyone can start showing symptoms but most of us tolerate typical levels found in food. Salicylates are mostly found in fruit, nuts, and some vegetables. They are part of the plant’s natural defense against disease and predators. Highest concentrations tend to be in the peels and unripe fruit. Man made versions of salicylates include many medications, perfumes, and preservatives. Biogenic amines can appear in all foods containing protein or free amino acids and increase with the age of the food. Glutamate is the building block of protein and is ubiquitous. But here we are talking about the tiny portion that exists as free glutamates, recognizable as the flavor (umami) component in food, that can be rapidly absorbed and spike blood plasma levels unlike the bound form in protein. The artificial form is MSG (monosodium glutamate) but there are plenty of naturally occurring sources of free glutamates as well.
Finding out if one has a sensitivity to these naturally occurring food chemicals turned out to be a fairly complex and involved process. First, we went on a baseline diet low in salicylates, amines, and free glutamates, and of course free of any other additives, for at least a week. Then we did a salicylates challenge, intentionally eating high salicylates for up to a week unless symptoms became intolerable. Then we came back to the baseline diet for at least a few days while symptoms cleared up then challenged high amines for up to a week. Then repeat the process for high free glutamates. You could continue coming back to the low baseline diet and challenge individual food additives as well but we stopped at the naturally occurring food chemicals.
Allowed items on the low baseline diet include: all grains except corn, fresh meats, fish, eggs, and dairy (excluding cheese), sugar, soy (excluding any fermented forms), beans (except fava), some vegetables (potatoes, lettuce, cabbage, brussels sprouts, celery, chives, leek, shallot, mung bean sprouts, bamboo shoots, chayote, swede), cashews, peeled ripe pear, garlic, salt, pepper, vegetable oil, butter, or fresh animal fats.
Obviously if there is something you already know you have a problem with, for example in my case gluten and dairy, they should not be included in the baseline diet.
– Salicylates challenge
For the challenge we ate six high salicylate items a day. The clearest thing that happened for me was frequent nighttime urination (nocturia). The first night it was twice, the second six times, and I stopped the challenge midday on the third day. That night it was three times, the next night just once, and then it was back to normal. I also had swelling in my hands and face, and slight constipation, which seems somewhat counterintuitive when you are having more fruit. Another thing I noticed was a delay in stopping bleeding. I happened to be at what would usually be my last day of menstrual flow but it continued on with fairly heavy bleeding for about four more days than usual. Later I realized aspirin (acetylsalicylic acid) is used in low doses in the elderly population specifically for this anti-clotting property.
Going against our expectation my partner did not have any trouble with salicylates until we got to the last day of the challenge. Only at that point he also started to have nighttime toilet visits. Other than that he actually seemed in a really good condition the whole week he ate high salicylates.
– Amines challenge
Most foods high in amines are also high in salicylates or free glutamates or both. So the challenge came down to eating a lot of chocolate and bananas for a week. This is when I started to recognize there are some pitfalls in the set up of this elimination diet.
Anyway, to start with what we experienced, all my reactions were fairly subtle this time. A dull headache, slight heart palpitation, low appetite, swelling in hands and face, and a somewhat foul mood where I really didn’t want to move or do anything.
My partner had a slightly flushed face and seemed a bit distant the first day. As the days passed the symptoms added on. He seemed slow, spaced out, increased word choice errors, restless legs, sleep disturbance (waking early or late or napping, all highly unusual for him), gassy, headaches, darker watery bowel movements, then leaking and bleeding with bowel movement, and becoming increasingly angry and needy. He did not seem to be clearly aware of these changes so I made the decision to stop the challenge at this point. The next day he started to feel as if a cold is coming and the second day he had body aches and fever and a runny nose, which took a couple more days to recover from.
So what are the pitfalls? What if you mainly react to amines that are not well represented in chocolate or banana, like tyramine or histamine? What if your reactions are not to amines at all but to some other component of chocolate or banana? What if you had an actual allergy to banana?
So even with this elimination diet, there are no clear answers right away, especially regarding amines. It served more like a few good data points and to get to more concrete answers we had to continue to track food and symptoms. Ongoing observation made it clear we don’t have any problems with banana. My slight symptoms were likely not due to amines but something else in chocolate.
– Free Glutamates challenge
This was done by adding 1 Tablespoon of soy sauce each to our food as I wanted to test a more naturally occurring source. In hindsight the results might have been clearer if we just used monosodium glutamate (MSG) as at least there would have been no other confounding factors (amines, soy, or mold content). The soy sauce was traditionally brewed unlike most commercial brands, so it may have been higher in both amines and free glutamates. As we both started having some kind of reaction right away the challenge was stopped after this first meal.
I felt as if my whole body was buzzing and pulsing and my legs felt especially weird. I had ringing in my ears and stopped bowel movement for two days. But the oddest part was I couldn’t get a wink of sleep the first night. The second night I slept for a couple of hours and on the third about four hours and finally on the fourth night about six hours.
My partner got a severe headache with facial pressure lasting almost three days. But again, this might be a reaction to the amines (tyramine?) in the soy sauce.
The following are some links if you are considering trying out the diet for yourself and would like to explore further.