Recognize and Manage Salicylate Intolerance

Nutri-IQ recommends to Wellness Practitioners the Salicylate Intolerance Assessment Tool to check salicylate intolerance as a possible cause of client’s complaints. Salicylate intolerance is often misdiagnosed. Unfortunately, there’s no variety of possible remedies. This article looks at the evidence-based ways to recognize and manage salicylate intolerance.

Take a minute to review and find your vitamins deficiencies – they may be a root cause of your symptoms and intolerances!

Abstract

The world is undergoing an epidemic of mysterious intolerances. In the western world, adverse reactions to ingested foods affect up to 20% of the population1 – cumulatively, this number is equal to the whole USA population2. We already spoke about histamine intolerance. In this article, we’ll discuss another popular topic: salicylate intolerance, associated health problems, and ways to ease the problem.

What is Salicylate Intolerance?

A salicylate allergy (also called salicylate intolerance or salicylate sensitivity) is a reaction that happens from the ingestion or contact with even small doses of salicylic acid, or salicylate3. Salicylate intolerance has been known for more than 100 years. Many substances contain different amounts of salicylate:

  • foods,
  • plants,
  • medications: COX-inhibitors i.e. acetilic salicylic acid (aspirin), NSAIDs, or related chemicals,
  • cosmetic products

Salicylate intolerance affects up to 0.6-2.5% of the general population, and about 10-20% of asthmatics4, but is not as common as as gluten or lactose intolerance. The normal Western diet has 10-100 mg of naturally occurring salicylates going from fruits, vegetables, nuts, herbs and spices, jams, honey, tea, coffee, wines, and other plant-derived foods and drinks.

Root Causes of Salicylate Intolerance

Salicylate sensitivity stems from decreased ability to properly metabolize and excrete salicylates from the body.

There is a theory that Phenol Sulfur-Transferase enzyme is responsible for the break down and detoxification of salicylates from foods5. With deficiency of this enzyme, salicylate intolerance is very possible.

Another possible root cause is that salicylate sensitivity is caused by an overproduction of leukotrienes (inflammatory mediators that have been linked to a variety of conditions, including asthma, rheumatoid arthritis and inflammatory bowel disease)6. This overproduction is caused by the inhibition of cyclooxygenase, an enzyme that regulates the production of leukotrienes. The buildup of leukotrienes in the body leads to symptoms related to salicylate intolerance7.

Health Effects of Salicylates

Bioactivity of salicylate-containing foods and medications definitely plays beneficial roles. As with other xenobiotics (ingested substances that are foreign to human body and in excess can harm it) salycilates can harm those who lacks ability to process and excrete them properly.

Consider dual effect of aspirin, the commercially available salicylate. It plays beneficial roles in cardiovascular health (this is being questioned now) and colon cancer, but also may also cause anaphylaxis, severe asthma, urticaria (hives), angioedema (swelling of the deeper layers of the skin), and gastrointestinal symptoms in salicylate‐sensitive individuals8.

Physiological Role of Salicylates

In plants, salicylates regulate various responses, like resistance to pathogens, flowering, thermogenesis, senescence, and abiotic stress. The leaves and barks of the willow tree, which were later on used to extract salicylates, were used by ancient Romans, Chinese, and native Americans to treat pain and fever. 1763, Edward Stone was able to cure malaria patients with a pulverized preparation of willow bark9.

Salicylates are anti-inflammatory. Today, the major roles of synthetically-derived salicylate aspirin include reducing risk of cardiovascular disease and also risks of some cancers (colorectal, prostrate, oesophageal, laryngeal, and gastric cancer), as well as reduction of inflammation and even – in vitro – DNA repair10.

Symptoms of Salicylates Harmful Effects

Multiple adverse reactions to salicylates have been reported. Salicylate reactions can be quite severe and include anaphylaxis. Salicylate reactions often blend with other conditions and if not addressed, can be quite harmful. Salicylate toxicity symptoms can be severe and even include anaphylactic reactions and even death: 11.

It’s not completely clear exactly what causes salicylate allergy, but it is confirmed that those reactions lead to inflammation and other symptoms. As we mentioned, the classic Samter triad of salicylate intolerance includes:

  • Bronchial asthma, wheezing and trouble breathing;
  • Nasal and sinus polyps;
  • Sensitivity to aspirin or NSAIDs.

These symptoms can be sometimes mistaken for general allergies.

The major negative respiratory and circulatory effects of salicylates were described 70 years ago in 12:

  • Respiratory acidosis, that is, inability to lungs to remove CO2 (asthma attack)
  • Drop in blood pressure.

Multiple other symptoms can be present too, along with urticaria, angioedema, and recurrent rhinitis.

High doses of sodium salicylate have long been known to be neurotoxic and induce temporary hearing loss and tinnitus 13

Reye’s syndrome is a rare but serious condition that causes swelling in the liver and brain. May be linked to salicylate hypersensitivity 14.

Chronic salicylate intoxication is deemed as a common morbidity among older population 15.

Recognize Salicylate Intolerance

To confirm salicylate intolerance diagnosis, consider signs and symptoms present in familial history too. Unfortunately, there are no laboratory tests to diagnose salicylate intolerance.

  • The standard test for salicylate intolerance to medications is exposure or provocation, which involves administering a small amount of salicylic acid and monitoring for symptoms. This test is only administered by medical professionals, and should be out of scope for a Wellness Practice. In this case, serum salicylate concentrations can be measured to confirm toxicological diagnosis16.
  • Increase of methylhistamine in urine can also signify salicylate intolerance17.
  • Deficiency of Phenol Sulfur-Transferase enzyme leads to impaired salicylate metabolism18. It can be tested from a biopsy specimen of the liver, by a medical professional. Urine test kits are available for phenol detection, but a blood test is not known.

Unfortunately, in many cases, these tests are deemed to be not feasible, or are not available.

For Wellness Practitioners, the quick test option is Nutri-IQ Salicylate Intolerance Assessment. It is the best option for the cases when salicylate intolerance is suspected as a root cause of client’s health problems. The probability of salicylate intolerance is established when at least conditions of Samter triad 19 are met. Please note the importance of a food & symptom journal to establish the link between salicylate type and dose, and the occurrence of the symptoms.

Management of Salicylate Intolerance

To reduce salicylate intolerance, we can apply at least one of the tactics depicted in the diagram. Application of more than one will improve results dramatically!

Cooking and Preparation Methods

Tips for cooking to reduce salicylate sensitivity:

  • Thickly peel fruit and vegetables. 
  • Eat fruit and vegetables as ripe as possible.
  • Discard the outer leaves.

Avoiding Salicylates

In general, there is no reason to completely avoid salicylates as a strict low-salicylate diet can be restrictive. Cutting out nutritious foods causes malnourishment and may provoke other diseases.

However, sometimes after consuming salicylate-rich foods or using products, symptoms of salicylate intolerance are bothersome and persistent. We recommend to confirm suspected offenders with tests and/or food & symptom journal. In those cases, avoiding these specific foods and products is feasible.

If any dietary restrictions are imposed, nutritional state needs to be monitored via Nutri-IQ Nutritional Balance Assessment Tool.

Salicylate Content in Foods

Below, we provide a list of foods sorted by approximate salicylate content per 100 grams of food or beverage 20, 21.

Please note that the intolerance does not necessarily involve the entire spectrum of salicylate-containing products, and salicylate content may vary dramatically from batch to batch.

Negligible Salicylate Content
FruitsBanana, Pear (peeled)
VegetablesBamboo shoots, Brussels sprouts, Cabbage, Celery, Chives, Choko, Beans, Peas (dried), Leeks, Lentils, Iceberg lettuce, Mungbean (and spouts), Potato (peeled white), Eschallots, Swedes, Soybeans, Beansprouts
Nuts, seeds, snacks & grainsCashews, Poppy seeds, All grains (except maize) 
Herbs, spices, seasonings & condimentsGarlic (fresh), Parsley,  Chives, Coriander,  Salt, Vinegar (malt)
Sweets & sugarsGolden syrup, Maple syrup, White sugar
BeveragesCocoa powder, Carob powder, Coffee ( De-caf), Milo, Ovaltine,
Low Salicylate Content: 0.1 – 0.25mg 
FruitsApple (golden and red delicious), Custard apple, Fig, Cherries (sour canned, morello), Grapes (green), Lemon (fresh), Mango, Pawpaw, Passion fruit, Persimmon, Pineapple juice, Pomegranate, Rhubarb, Tamarillo
VegetablesAsparagus (fresh), Beetroot (fresh), Carrot (fresh), Cauliflower, Corn (fresh), French beans , Horseradish (canned), Mushroom (fresh), Onion, Potato (unpeeled white), Peas (fresh), Pimiento (canned), Pumpkin, Spinach (frozen), Tomato (fresh), Turnip 
Nuts, seeds, snacks & grainsPecans, Peanut butter, Sesame seeds, Hazelnuts, Sunflower seeds, Potato chips (plain)
Herbs, spices, seasonings & condimentsVinegar , Soy sauce, Saffron, Tandoori spice powder, Horseradish (canned), Vanilla
Sweets & sugarsMolasses, Brown sugar
BeveragesChamomile tea, Vodka , Whiskey, Gin
Moderate Salicylate Content
0.25 – 0.49mg 
FruitsApple (Jonathon), Apple (canned), Grapefruit juice, Kiwi fruit, Lychee, Loquat, Nectarine (fresh), Pear (with peel), Plum (fresh), Watermelon
VegetablesAsparagus (canned), Beetroot (canned), Corn (canned), Bok choy, Choy sum, Lettuce (other than iceberg), Maize , Olives (black ), Parsley, Parsnip, Potato (red), Pumpkin, Snow peas (and sprouts), Sweet corn, Sweet potato (yellow)
Nuts, seeds, snacks & grainsCoconut (desiccated), Brazil nuts, Corn chips, Popcorn, Pumpkin seeds, Taco shells, Walnuts
Herbs, spices, seasonings & condimentsFennel
Sweets & sugarsNone
BeveragesCoffee (instant), Rosehip tea, Fruit herbal tea , Brandy, Vermouth, Beer, Cider
High Salicylate Content
0.5 – 1mg 
FruitsApple (granny smith), Avocado (fresh), Cherries (sweet), Fig (dried), Grapes (red), Grape juice, Grapefruit , Mandarin, Mulberry, Peach (fresh and canned), Tangelo
VegetablesAlfalfa, Artichoke, Broad beans, Broccoli, Chili (green and yellow), Corn (creamed), Cucumber, Eggplant, Fava beans, Okra, Spinach (fresh), Squash, Sweet potato (white), Tomato (canned), Water chestnut, Watercress
Nuts, seeds, snacks & grainsPine nuts, Macadamia nuts, Pistachio nuts
Herbs, spices, seasonings & condimentsVegemite, Vinegars (red and white wine, cider and others)
Sweets & sugarsNone
BeveragesSherry, Cointreau, Tia Maria, Fruit juices
Very High Salicylate Content
>1mg
FruitsApricot, Blackberries, Blueberries, Boysenberries, Cantaloupe Rockmelon, Cherries (canned sweet), Cranberry (sauce and canned), Currants, Dates, Grapes (fresh), Guava, Loganberries, Orange, Pineapple, Plum (canned), Prunes, Raisons, Raspberry, Redcurrants , Strawberries, Sultanas, Youngberry
VegetablesCapsicum (green), Champignon (canned), Chili (red), Chicory, Courgette , Endive, Gherkin, Mushroom (canned), Olives (green), Pepper (sweet), Radish, Tomato (paste and sauce), Zucchini
Nuts, seeds, snacks & grainsAlmonds, Peanuts, Chips and crackers (savory flavored)
Herbs, spices, seasonings & condimentsAll spice, Anise seed, Cayenne, Celery, Cinnamon, Cumin, Curry powder, Dill , Fenugreek, Five spice, Garam masala, Ginger, Honey , Jam , Mace, Mint, Mixed herbs, Mustard, Oregano, Paprika (hot), Paprika (sweet), Pepper, Rosemary, Sage, Tarragon, Turmeric, Thyme, Worcestershire sauce
Sweets & sugarsLicorice, Mints and Peppermints, Chewing gum, Fruit flavorings
BeveragesTea (all varieties), Liqueur, Peppermint tea , Port , Rum, Champagne, Wines , Cordials

Personal Care Products with Salicylates

Some products may cause topical salicylate reactions22 and should be avoided if in doubt. The problem is that salicylates on the labels are not explicitly marked. Instead, manufacturers can use one of the following names:

Acetylsalicylic acid
Coal tar derived dye
Artificial flavorings
Artificial colorings
Azo dyes
Benzyl salicylate
Beta hydroxy acid
BHA
BHT
Choline salicylate
Ethyl salicylate
Eucalyptus oils
Isoamyl salicylate
Magnesium salicylate
Menthol
Methyl salicylate
Mint
Octylsalicylate
Oil of wintergreen
Peppermint
Phenylethyl salicylate
Red dye (#40)
Salicylaldehyde
Salicylamide
Salicylate
Salicylic acid
Sodium salicylate
Spearmint
Yellow dye (#5 and #6)

Therefore, consumers have to carefully inspect the labels of the following products, in order to avoid topical reactions:

Acne products
Air fresheners
Alka seltzer
Breath mints
Bubble baths
Cleaning products
Cosmetics
Detergents
Essential oils
Fabric conditioners
Fragrances and perfumes
Hair sprays, gels and mouse
Lotions and creams
Lozenges
Mouthwash
Muscle and joint pain creams
Razor’s with aloe strips next to the blade
Shampoo and conditioners
Shaving cream
Cleansers and exfoliants
Soaps
Sunscreen and tanning lotion 
After sun lotions
Toothpaste
Warts and callus removers

Managing Salicylate Sensitivity with Supplementation

Salicylate intolerance can be reduced with improved metabolism and excretion of salicylates.

Essential nutrients Vitamin B6 and Magnesium regulate levels of Phenol Sulfur-Transferase enzyme metabolizing salicylates: Vitamin B6 can deplete this enzyme and downregulates of Sulfation pathways, and Magnesium upregulates this pathway23. 1:1 ratio of Magnesium and Vitamin B6 allows for adequate absorption without depletion.

There is an evidence that amino acid Glycine helps conjugate salicylates, and binds with salicylates, thus improving its excretion. Adding it with meals is a great way to offset salicylate absorption, and get salicylates excreted by the kidneys24.

Conclusion

In this article, we defined salicylate intolerance, determined its physiological functions and dangers, and identified sources of excess salicylates. Nutri-IQ Salicylate Intolerance Assessment tool brings “quick wins” in identification of salicylate intolerance and helps bringing clients back to health and wellness. We also suggested ways to address existing salicylate problems using awareness of external and internal factors affecting the condition.

References

  1. Schnedl WJ, Enko D. Considering histamine in functional gastrointestinal disorders. Crit Rev Food Sci Nutr. 2020 Jul 9:1-8. doi: 10.1080/10408398.2020.1791049.
  2. Western Countries 2020. Downloaded on January 6, 2021
  3. Salicylate Allergy. Downloaded from Webmd on Jan. 29, 2021
  4. Baenkler H. W. (2008). Salicylate intolerance: pathophysiology, clinical spectrum, diagnosis and treatment. Deutsches Arzteblatt international, 105(8), 137–142. https://doi.org/10.3238/arztebl.2008.0137
  5. Priyadarsini KI. The Chemistry of Curcumin: From Extraction to Therapeutic Agent. Molecules. 2014; 19(12):20091-20112. https://doi.org/10.3390/molecules191220091
  6. Sharma JN, Mohammed LA. The role of leukotrienes in the pathophysiology of inflammatory disorders: is there a case for revisiting leukotrienes as therapeutic targets? Inflammopharmacology. 2006 Mar;14(1-2):10-6. doi: 10.1007/s10787-006-1496-6. PMID: 16835707.
  7. Downloaded from Healthline on Jan. 28, 2021
  8. Malakar, S. (2017)  Bioactive food chemicals and gastrointestinal symptoms: a focus of salicylates. Journal of Gastroenterology and Hepatology,  32:  73– 77. doi: 10.1111/jgh.13702
  9. The Controversial Story of Aspirin. Downloaded from World Neurology Newsletter on Jan. 30, 2021
  10. Goel A, Chang DK, Ricciardiello L, Gasche C, Boland CR. A novel mechanism for aspirin‐mediated growth inhibition of human colon cancer cells. Clin. Cancer Res. 2003; 9: 383–390.
  11. Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2020 Jul 13]. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  12. S.M. Tenney, R.M. Miller,The respiratory and circulatory actions of salicylate, The American Journal of Medicine, 19(4), 1955, 498-508, ISSN 0002-9343, https://doi.org/10.1016/0002-9343(55)90342-9.
  13. Guang-Di Chen, Daniel Stolzberg, Edward Lobarinas, Wei Sun, Dalian Ding, Richard Salvi, Salicylate-induced cochlear impairments, cortical hyperactivity and re-tuning, and tinnitus, Hearing Research,
    295, 2013,100-113, ISSN 0378-5955, https://doi.org/10.1016/j.heares.2012.11.016.
  14. Downloaded from Mayo Clinic on Jan. 28, 2021
  15. Bailey, R.B. and Jones, S.R. (1989), Chronic Salicylate Intoxication. Journal of the American Geriatrics Society, 37: 556-561. https://doi.org/10.1111/j.1532-5415.1989.tb05689.x
  16. Jacqueline S. Partin, William K. Schubert, John C. Partin, Jeanne G. Hammond, Serum Salicylate Concentrations In Reye’s Disease: A Study of 130 Biopsy-proven Cases, The Lancet, 319(8265). 1982, 191-194, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(82)90759-0.
  17. M. Raithel, H. W. Baenkler, A. Naegel, F. Buchwald, H. W. Schultis, B. Backhaus, S. Kimpel, H. Koch, K. Mach, E.G.Hahn, P.C. Konturek, Significance of salicylate intolerance in diseases of the lower gastrointestinal tract. Journal Of Physiology And Pharmacology 2005, 56, Supp 5, 89-102
  18. Priyadarsini KI. The Chemistry of Curcumin: From Extraction to Therapeutic Agent. Molecules. 2014; 19(12):20091-20112. https://doi.org/10.3390/molecules191220091
  19. Samter M, Beers RF: Concerning the nature of intolerance to Aspirin. J Allergy 1967; 40: 281–93
  20. Cunningham E. Are there foods that should be avoided if a patient is sensitive to salicylates? J Am Diet Assoc. 2010 Jun;110(6):976. doi: 10.1016/j.jada.2010.04.020. PMID: 20497789
  21. Romilly E. Hodges and Deanna M. Minich: Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application J Nutr Metab. 2015; 2015: 760689. Published online 2015 Jun 16. doi: 10.1155/2015/760689
  22. What is a topical salicylate and where is it found? Downloaded on Jan. 29, 2021 from DermNet NZ
  23. Salicylate Foods – Sensitivity, Intolerances And Food List. Downloaded from ATP Science on Jan. 29, 2021
  24. Mawal YR, Qureshi IA. Purification to homogeneity of mitochondrial acyl coa:glycine n-acyltransferase from human liver. Biochem Biophys Res Commun. 1994 Dec 15;205(2):1373-9. doi: 10.1006/bbrc.1994.2817
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