Salicylates challenge more than expected

After 31 days of a strict elimination diet, we've finally entered the discovery phase.  Our first challenge, salicylates, was harder than I thought it would be.  For the previous 31 days I had looked forward to indulging in strawberries, mangoes, cherries, pumpkin, and apples, and once again enjoying the flavor provided by curry and cinnamon.  I thought my son would too; he was absolutely fixated on pictures of strawberries.  But the food didn't taste as good as I expected, and I was surprised to discover that I didn't feel very well either.

We embarked on this diet to discover the cause of my son's eczema, which has been present since he was a month old.  It could be anything he has contact with, including the pervasive dust mite, but since food proteins and chemicals can be passed through breast milk, and are one of the few things we have much control over, we decided to do an exhaustive test of foods to determine if any of them were the cause.  Many food allergies can be diagnosed through skin prick tests or blood tests, but foods can also cause irritation without triggering an allergic reaction, and these sensitivities to food can only be determined by altering your diet.  To find a food sensitivity or allergy, you first eliminate all likely causes of irritation from your diet for a period of time.  This is the elimination phase of the diet.  The next stage is to challenge your body with possible irritants.  This is the discovery phase of the diet.  For some irritants, the reaction may be reduced by avoiding exposure to the irritant for a while, so there is a period of developing tolerance following the completion of the discovery phase, and then you should follow a maintenance diet that minimizes consumption of foods that cause a reaction for you.

It is worth noting, since many people I've spoken with about this whole process do not seem to understand this at first, that you are not meant to stay on the highly restricted elimination diet indefinitely.  Nor is it the theory of the diet developers that salicylates are inherently bad for everyone.  Once you have determined which classes of food do not cause a reaction for you through the challenge phase then those foods can be reintroduced into your diet.

The first challenge
Our first challenge was salicylates.  You may be asking yourself "What are salicylates?"  It's a fair question; it's not an everyday word.  Salicylates are a class of chemicals that occur naturally in fruits, vegetables, and nuts and are thought to function as natural pesticides.  According to the research of the Royal Prince Alfred Hospital Allergy Unit, a surprising number of people respond to salicylates, meaning that they will have some sort of reaction if they eat a large quantity.  Responses to salicylates vary dramatically, but can include migraines, rashes, irritability, restlessness, gastrointestinal problems, and asthma.  Salicylates occur in almost all fruits, many vegetables, and virtually anything derived from them, including artificial and natural flavors, most types of alcoholic drinks, and aspirin.

What was the salicylate challenge?
The challenge required eating six serves of salicylate laden foods a day for a week (or until we reacted, which ever happened first).  My own participation in the elimination diet was mandated by the fact that I was still breastfeeding my son, and anything I ate could be passed to him through the breast milk, so I anticipated participating in the challenge as long as my son did.  The foods we were required to eat comprised:

• mangoes
• Granny Smith apples
• cherries
• nectarines
• peaches
• apricots
• watermelon
• cantaloupe
• strawberries
• pumpkin
• sweet potato
• asparagus
• bell pepper
• carrots
• cucumber
• zucchini
• honey
• cinnamon
• curry powder
• tea

There was no shortage of choice, especially since it is stone fruit season.  On the first day, we ate strawberries on our breakfast, watermelon for morning tea, zucchini with lunch, mango and yogurt for afternoon tea, cherries before dinner, and a colorful stir fry for dinner.

Though we continued to stuff ourselves with red and orange fruits, both my son and I lost our appetite for the challenge foods pretty quickly.  On day one, I had a mild stomach ache most of the day, and by the afternoon I didn't feel like doing much of anything.  By day three, I was longing for cabbage, and my son wouldn't eat anything containing salicylates after lunch.  Over six days of the challenge (I didn't last all seven) I had a stomach ache of some sort nearly the entire time.  I was also irritable, emotional, and unmotivated.

Clearly I was responding to the salicylates, however, since my motivation for doing the diet was not to assess the cause of my own moods but to determine the cause of my son's skin problems, it took me five days before I finally clued in to the correlation between my mood and my diet.  Even then, I couldn't stand the thought of missing out on two more days of red and orange fruits and persisted eating them for almost another day before I realized that I was not only torturing myself, but increasing the likelihood of suffering withdrawal symptoms, and stopped the challenge.

It has taken six days for my son's skin to get back to what it was before the challenge and it is now clear that he also reacted to salicylates.

What next?
After the challenge we went back on to the elimination diet.  The first three days following a challenge are considered part of the challenge, as it is possible for reactions to be delayed, and also required to ensure there are no residual effects from the salicylates before the next challenge.  My mood improved almost immediately but both of us continued to show signs of reactions to salicylates over that period.  Since his skin has only just returned to its pre-challenge condition, we will wait a few more days before we go onto the next challenge, which for us will be amines.  Tune in next week for the results.

Elimination Diet: The Dietician's Judgement

A few nights ago I had a dream that I was eating miniature jelly beans.  The following night I dreamt that I was eating steak bathed in ketchup.  In both dreams, my immediate response was Why am I eating this?  It will ruin the diet.

I've never had this response to a diet before, but then this diet is different.  After 30 days, I can identify every item of food that my son and I have consumed.  For the past 23 days I can count on my thumbs every item of food my son or I ate that we weren't allowed.  And on day 30 a dietitian reviewed our progress.

The visit to the dietitian was the source of some trepidation.  The severity of my son's eczema has reduced dramatically, so we've obviously done something right.  We could be ready to start the challenge phase of the diet, which would mean indulging in fruits, vegetables, and spices.  But the eczema is not gone, so maybe we've done something wrong.  We could be about to face two of the hardest weeks yet, with no wheat or cow's milk.  As the appointment with the dietitian approached and the severity of my son's eczema bounced around I got more and more concerned.  It's no wonder I was dreaming about things going awry.

I met with the dietitian yesterday.  She greeted me with a smile and asked how things were going.  Then she examined the food log.  I sat for a few minutes listening to nothing but the occassional sound of a page turning.  She broke the silence by saying You're ready to start the challenges.  Ready to start the challenges?  I was ready to jump out of my seat.  I wanted to do a little victory dance.  Actually, I wanted to do a big victory dance.

Tomorrow I'll be having strawberries on my breakfast, watermelon at my picnic, taziki for my afternoon tea, and carrots and capsicum in my stir fry.  I'll make lentil curry and pumpkin soup.  I'll eat apricots, and cherries, and bake apple pie.  And I'll do it all in the name of science.

I'm so happy about this new food freedom that I need to remind myself of the sour note: if one of us reacts to salicylates then we'll have to stop eating all these wonderful foods, and when the discovery part of the diet ends we still won't be able to eat them.  But I'm not about to let that ruin my fantasizing now.

I still won't be allowed to eat miniature jelly beans or ketchup on my steak, but who'd want to when there are so many wonderful things to eat instead?

Elimination Diet: Weeks 3 and 4

The In-law Challenge

Weeks three and four of our elimination diet were marked by the arrival of my in-laws.  Prior to starting the diet I was so concerned about our ability to eat together harmoniously that I almost delayed the start of the diet until they left.  I was dreading having to listen to snide remarks.  I was afraid that I would have to prepare all of the food, rather than rely on mother-in-law to do some of the cooking, lest she undermine the diet by including forbidden ingredients.  And I was concerned that they would not be supportive of the diet, let alone eat it.  I underestimated my in-laws.

Perhaps it was not entirely fair to pin all these concerns on my in-laws.  After all, being helpful seems to be in their genes.  Many people have been curious about the diet, and very few people have made deprecatory remarks about the diet, but most people I explain the diet to can't shake the thought How could fruits and vegetables possibly cause a malady? and they only start to express an earnest interest in the diet when I reveal that my son's skin has definitively improved since starting the elimination diet.  Of course, I didn't have the luxury of this information when I spoke to my father just before D-day, who was very subtle but obviously doubtful.

In contrast, I was pleasantly surprised by my in-law's support; my mother-in-law baked cookies and scones, was an excellent sous-chef, and even took up the challenge of making two meals.  I did not hear one negative or unsupportive remark from either in-law during their two week visit.  They happily consumed our failsafe food, and even marveled at how many ways you could prepare a leek.  They graciously ate their forbidden foods (they arrived with a fruit cake, lemon butter, and pineapple poppers, and couldn't resist purchasing grapefruits for breakfast) out of site of the rest of the family.  In the two weeks they were here, there was not one diet mistake that could be attributed to their presence, and I am still eating my mother-in-law's cookies.  When they left, I was sad to see them go.