Instructions for doing the FAILSAFE elimination diet

The FAILSAFE diet is the Simplified Elimination Diet from the Royal Prince Alfred Hospital (RPAH) Allergy Clinic in Sydney, Australia. FAILSAFE stands for Free of Additives, Low in Salicylates, Amines and Flavour Enhancers (easier to say!).

The FAILSAFE diet here is exclusively taken from Sue Dengate’s information available on fedup.com.au – an amazing resource. Use it, often. Sue’s website is full of personal stories and real-life information and really brings home the impact of some food chemicals – even the natural ones – on our bodies.

First we eliminate all the suspect food chemicals, then we add them back in one by one in food challenges. You’ll go 3-4 weeks on the full elimination diet, then spend 3-7 days eating a challenge food with great gusto, and recording your results. There needs to be 3 symptom-free days between challenges.

Not all additives, colours and preservatives cause reactions and not all of these cause reactions in everyone. We’re working out what your body doesn’t like.

We’re zeroing in on:

1. Salicylates
2. Amines
3. Artificial additives
4. Artificial and some natural food colourings
5. Preservatives
6. Glutamates
7. Dairy
8. Wheat/gluten

Note on dairy, wheat and gluten: if you already know you can’t eat these foods, don’t bother challenging them.

Note on salicylates: if you are already sensitive or allergic to aspirin, then you know you are salicylate sensitive, but it may pay to find out just how sensitive.

For a little while, you will not be eating:

• Take-aways/fast food
• Restaurant food
• TV dinners and prepackaged/packet meals
• Pies, sausage rolls, hot dogs, mini pizza, nuggets, doughnuts, instant noodle meals, flavoured chips/crisps, flavoured corn chips, Cheetos, ramen noodles with flavour sachets and other packet snack foods
• ALL snack biscuits and dippers
• Coloured, flavoured candy, sweets and lollies
• Coloured, flavoured ice cream
• Coloured, flavoured or preserved tubes, icypoles or slushies
• Sports drinks such as Powerade, Gatorade
• Soft drinks/soda/fizzy drinks
• Cordial
• Caffeine enhanced drinks/energy drinks
• Commercial BBQ chicken (generally coated with flavour enhancers)
• Bread with 282, whey powder or vinegar
• Cup-a-soups, stock cubes, canned soup

Instead, you’ll be eating…

Check recipes

See searchable full allowed foods list

BREAKFAST

• Rolled oats, porridge
• Egg (boiled, scrambled, poached, toad in the hole, French toast)
• Toast with e.g. butter only; or homemade cashew spread, golden syrup, homemade pear jam
• Pancakes with pure maple syrup
• Pear smoothie

LUNCH

• Additive-free sandwiches, rolls or wraps e.g. chicken, egg and lettuce
• HFC (Halliwell Fried Chicken) chicken nuggets
• Fried rice
• Hard-boiled egg, omelette, vegetable frittata
• Failsafe salad
• Baked potato with cream cheese and chives
• Chicken pasta
• Home-made pie or sausage roll
• Chicken, lamb and/or vegetable soup/stew

DINNER

• Home-made chicken nuggets and chips
• Failsafe burger/pizza/frittata
• Spaghetti with garlic mince topping
• Ten-minute stir fry (chicken, beef, lamb, egg, vegetables)
• Home-made fish fingers or panfried fresh fish
• Grilled lamb/steak/ chicken/failsafe sausages with vegetables
• Roast chicken/beef/lamb with vegetables
• Chicken, lamb and/or vegetable soup/stew

DRINKS

• Water – filtered, bottled, spring, mineral, soda, tap (if no nasty taste); decaf coffee; unflavored milk, A2 milk, soymilk, rice milk, magic cordial

SNACKS

• Fresh ripe peeled pear or canned in syrup (limit 2 per day)
• Home-made muffins
• Buttered plain wheat crackers
• Brumby’s white iced finger buns
• Plain (not flavoured) rice
• Cakes with pure butter or Nuttelex, home-made pear jam and Failsafe hummus
• Trail mix made from unsulphited pears, Chic Nuts and raw cashews
• Home-made icy poles, see recipe
• Home-made chicken noodle soup
• Homemade scones or pikelets
• Home-made potato wedges or hot chips
• Sandwiches
• Kidney beans or butter beans on toast
• Anything from the lunch or main meals menu, e.g. pasta
• Plain or vanilla yoghurt
• Plate of crunchy failsafe salad vegetables e.g. celery sticks filled with cream cheese, failsafe hummus or red bean paste, see recipes
• Home-made rolled oat bars or other biscuits
• Toast and homemade pear jam or other spreads
• Unflavoured, preservative and antioxidant free plain hot chips (potatoes, oil, salt)
• Treats, sweets, desserts – see recipes

Stages of going FAILSAFE

There are two stages: I and II. Stage one is the elimination phase, while the second stage is the challenges phase. Phase II goes for longer than stage I, as you slowly, one by one, test each food chemical and see if you react.

Stage I of FAILSAFE – Elimination Phase

The goal of the first stage of going FAILSAFE is to clear your system completely of these food chemicals and to provide a clear, stable platform from which to challenge foods. If you eat non-FAILSAFE foods during the elimination phase, you need to wait until you’re back to a clean slate without symptoms for at least three days before embarking on the challenge phase.

Here are some hot tips for the elimination phase.

A. Establish the foods you can and can’t eat. Check all ingredients in food in your cupboards, fridge and freezer and compartmentalise as necessary for your future ease of diet. Start becoming food label literate.

B. Choose the start date. Be mindful of special occasions that you are going to encounter, and how you will manage those. You may make mistakes, but plan ahead to avoid the diet taking way too long to finish.

C. Find recipes and sample menus, and do a week plan for yourself, including snacks. Don’t worry about variety at this stage – eat whatever is easy and tasty for you. Trial recipes before you start the diet. Consider freezing some meals you’ve already prepared, so you have food quickly later on.

D. Go shopping with your prepared list of foods to buy and your list of ingredients to avoid. Check all ingredients on the labels. If it’s unclear, avoid. Remember this shop will be longer, so leave enough time to browse, and be aware that the supermarket will never look the same again.

E. List and rate your symptoms out of 10, as your starting point. Every symptom, big or small, add to the list. Moods, energy levels, sleep, bowel motions, digestive upsets, heart palpitations, concentration, memory, bad thoughts, add it all.

F. Start the diet on your chosen date. For support, join the Failsafe Facebook group.

G. Keep a diary and symptom diary, which matches your initial symptom list and adds any new things that appear. List any issues you’ve been facing.

H. Expect withdrawal symptoms, typically kicking off on days 4 and 5. You might feel emotional, overwhelmed, or have strong food cravings. Physical effects of withdrawal might include ulcers, flu-like symptoms or other physical symptoms. To minimise these withdawals, you can start eliminating additives a few weeks before your diet starts to wean yourself off a little. Avoid bingeing on forbidden foods to ‘get it out of your system’ right before the diet.

I. Check the common mistakes checklist, especially if after two weeks, you’ve not seen any improvements. Improvements may be slow or fast, so you may only come good in the third week. If you’re still having symptoms in the third week, you may be making a mistake and need to extend it another week.

J. Be kind to yourself! You’re doing a hard thing. Don’t worry if you make a mistake – if you accidentally (or on purpose!) eat the wrong thing, you can try to arrest any side-effects by using the baking soda drink to minimise absorption (by neutralising stomach acid), then wait until the reaction has fully passed before moving on to the next stage.

K. After three weeks, do another symptom check before challenges start. If you need an extra week to settle into the diet, take it. You’re not even close to being finished. If you still have skin rashes or fatigue, take another week. You need to be symptom-free for a week before you start on challenges.

Stage II of FAILSAFE – Challenge Phase

Duration: 7 days eating challenge foods then at least 3 days symptom-free before next challenge

The goal of the challenges phase is to test each food chemical and see if you react to it. To properly challenge each chemical, you need to have a clean slate and no symptoms at all for at least three days.

You can choose which foods you challenge in any order you like, however, it is smart to choose the largest food groups first: salicylates and amines. That way, if you pass the challenge (meaning you don’t react to that chemical), you can reintroduce some foods to your diet. This immediately makes the diet less difficult to stick to as time goes by.

Hot tips for the challenges phase…

Choose one food chemical at a time and eat lots of it! Six serves minimum must be eaten each day for a successful challenge. A serving is one cup unless otherwise specified (for example you may not need six cups of food colouring to get a reaction!).

When challenging artificial additives, you only need 3 days to see a reaction. For natural chemicals like salicylates and amines, you’ll need to eat the food for 7 days, as they are slower to build up and cause a reaction. Bread preservative 282 may require 5-7 days or more and milk requires 10 days.

You must have at least 3 days without symptoms before you start each food challenge.

The diet must be followed strictly. If you make a mistake, start again after 3 days without symptoms.

Only eat specified foods in challenges. For example, don’t eat oranges, tomatoes or avocados in salicylate or amine challenges, as these foods contain both salicylates and amines.

Keep eating the food at the recommended servings until you get a reaction – up to 7 days. If you clearly have a reaction, keep going, because other reactions may emerge as well, but if the cost is too high, i.e. depression or arthritis, stop the challenge and consider yourself sensitive to that substance.

Do not do mini challenges i.e. only eating one or two serves of a food then making a decision. Mini challenges do not work, because chemicals take time and repeated ingestion to build up to a level that will cause a reaction.

Start your challenge diary, and record symptoms on each of your 7 challenge days.

Wait until you’ve been completely symptom-free for at least three days before starting a new food chemical. Don’t rush this process! We need a definitive result.

If you pass the challenge, then it’s best to continue with your diet as you were until you’ve completed other relevant challenges. For example, broccolli contains salicylates and amines, so you can’t reintroduce it until you’ve completed both the salicylate and amine challenges, and passed them both.

Additives to avoid

Food colours to avoid

• 102 tartrazine
• 104 quinoline yellow
• 110 sunset yellow
• 122 azorubine
• 123 amaranth
• 124 ponceau red
• 127 erythrosine
• 129 allura red
• 132 indigotine
• 133 brilliant blue
• 142 green S
• 143 fast green FCF
• 151 brilliant black
• 155 chocolate brown
• Natural colour 160b annatto (160a is a safe alternative)

Preservatives to avoid

• 200-203 sorbates
• 210-213 benzoates (including in medications)
• 220-228 sulphites
• 280-283 propionates (also called ‘cultured’ XYZ in the ingredients list, i.e. ‘cultured dextrose’)
• 249-252 nitrates, nitrites

Synthetic antioxidants to avoid

• 310-312 Gallates
• 319-320 TBHQ, BHA, BHT (306-309 are safe alternatives)

Flavour enhancers to avoid during FAILSAFE eating

• 621 MSG, hydrolysed vegetable protein, yeast extract, also goes by 129 other names!
• 627, 631, 635 disodium inosinate, disodium guanylate, ribonucleotides
• Strong flavours in foods and medicines (vanilla is safest)

Challenging salicylates – 7 days

Eat only high salicylate foods! (Moderate salicylate foods aren’t enough.) At least six serves per day of high salicylate foods. One serve is one cup.

• Capsicum/bell peppers
• Corn
• Cucumber
• Zucchini/courgettes
• Japanese pumpkin (grey outside, orange inside)
• Granny Smith apples
• Apricots
• Guavas
• Peaches
• Nectarines
• Cherries
• Rockmelon/Cantaloupe
• Watermelons
• Turmeric
• Cardamom
• Coriander
• Cumin
• Garam marsala
• Ginger
• Paprika
• Pepper

1 serve = 1 cup

Eat as much as you can all day long – salicylates build up in your system, so you need to hit threshold to get a reaction, usually over several days, not immediately.

Fed-up Fact Sheet

Challenging amines – 7 days

• 6 serves/cups per day
• Bananas
• Dark chocolate
• Canned tuna, salmon, sardines
• Frozen fish
• Seafood (except prawns)
• Pork chops and roast pork (but not bacon and ham)
• Homemade gravy

Amine reactions are usually delayed up to several days or more.

Challenging wheat and dairy – 10 days

You can do the wheat and dairy challenges together.

• 1 cup of milk per day for 10 days
• Challenge A1 and A2 milk separately, since A2 milk may be ok
• 1 cup/serve of plain uncoloured pasta plus plain 4 wheat crackers (check for hidden antioxidants) every day for 7 days
• Bread is not suitable for the wheat challenge as it contains other ingredients

Challenging bread preservative 282 – 7 days

This preservative is a mould inhibitor for the machines that process bread, not for the bread itself. The dose can vary, but the impacts can be big, so it’s worth testing.

• Eat at least 4 slices of bread/crumpets/muffins containing this preservative per day
• Challenge for 7 days
• Several names – E280 Propionic acid, E281 Sodium propionate, E282 Calcium propionate, E283 Potassium propionate
• E stands for Europe, not used in some places
• Fed-up Fact Sheet

Challenging natural colour annatto 160b – 3 days

• Yellow food colouring in vanilla and banana flavoured yoghurts, ice creams, biscuits, etc.
• Eat 3 products containing annatto for 3 consecutive days
• If dairy-free, look for soy yoghurt, non-dairy ice cream flavours or custard powder

Challenging sulphites 220-228 – 3 days

• Try sulphite-containing food six serves per day for three days
• Most likely to affect asthmatics, so ensure access to medical care and ventolin/medication during this challenge even if you think your asthma is mild – reactions can be swift and instense
• People can be sensitive to even tiny amounts of sulphites
• Most sulphite foods contain both salicylates or amines, so do those challenges first

Challenging benzoates 210-213 – 3 days

• Eat 3-4 serves of benzoate-containing foods for 3 consecutive days
• In many medications for babies and children
• Some lemonade may contain benzoates (but not much else) which can be suitable

Challenging antioxidants – gallates 310-312, TBHQ, BHA, BHT 319-321 – 4 days

• Eat 3-4 servings per day for 3 days
• Often unlisted in cooking oils and margarine, and can change in your regular products (check labels regularly)
• May be in McDonalds fries (BHA 320) (check website)

Challenging sorbates 200-203 – 3 or 7 days

• Normal serves i.e. in cream cheese for 7 days
• OR very high doses i.e. in home-made cheesecake for 3 days

Challenging flavour enhancers – MSG and natural glutamates – 3 days

• Soy sauce with meals
• MSG powder from an Asian grocer
• Add 3-4 serves in each day for 3 days
• Do green pea challenge separately – eat green peas twice daily for three days, if no reaction, add green peas back into the diet
• MSG (monosodium glutamate) is may be listed as flavour enhancer 621, hydrolysed vegetable protein (HVP), hydrolysed plant protein (HPP), ‘yeast extract’ or ‘natural flavour’
• ‘No added MSG’ labelling may contain natural glutamates
• Fed-up Fact Sheet

Challenging flavour enhancers – 635, 627 and 631

• Challenges not recommended – side effects can be serious
• Also called ribonucleotides, disodium guanylate and disodium inosinate
• Can result in ‘ribo rash’, an itchy rash
• ‘No added MSG’ labelling may contain ribonucleotides
• Don’t overdo these foods or avoid copletely
• Fed-up Fact Sheet

Challenging nitrates 249-252 – 3 days

• Eat 3-4 normal servings per day for 3 days (3-4 slices of ham, 3-4 rashers of bacon)
• Eat processed meats such as ham and bacon as long as you don’t react to amines
• Ensure meat contains ONLY nitrates, not sulphites or flavour enhancers as well
• Nitrates are a known carcinogen, so limit foods even if you don’t react

Challenging fish oils, supplements and other foods – up to you!

You can challenge anything you want, including herbal medicines and supplements, following the rules of challenges.

What to do if you react to a food chemical

If you react to a food chemical, then you know to limit that food. It is best to immediately go back to your clean slate after you react to a food chemical, and don’t eat even small amounts of that food until you’ve completed the rest of your challenges. We don’t want any interference. You can experiment later with how much of that food you can and can’t eat, but for now, we’ve got other challenges to complete.

If you react to both salicylates and amines can stop challenges now, as you’re very likely to react to additives as well, though it can pay to do some of the challenges. This is particularly true if you have asthma or a specific condition since it’s good to know what you do react to.

The Antidote

The antidote to a food reaction is a temporary neutralising of stomach acid to help prevent further absorption into the bloodstream of the problem food chemical. It’s only a temporary measure (1-2 hours) and shouldn’t be used unless necessary.

For example, don’t eat problem foods and then use the antidote for sport. It neutralises stomach acid, which is a required element of your digestion. If you continually neutralise stomach acid, expect digestive problems to follow.

What to do if you pass a challenge

If you go 7 days eating the food chemical as directed, and have no symptoms at all, then congratulations! You can now move on to the other challenges and reintroduce extra foods.

Slowly reintroducing foods

After your challenges where you reacted slowly, you can later on very carefully and gradually reintroduce foods. You may be able to tolerate small amounts.

An example is a half-cup or less of moderate salicylate foods (carrot, butternut pumpkin for salicylates) every 2-3 days for several weeks, then every day for a few weeks, then increase your dose. Keep track! If you start reacting to a food chemical, go back a level.

Things that might trip you up

• Soy and lentils can be an issue for some people
• Check personal/home care products (toothpaste, cleaning products)
• Avoid taking probiotics during this experiment – likely to contain biogenic amines
• Salicylates can be inhaled and absorbed through the skin (lotions, strong scents from plants, pesticides, scented deodorant or disinfectant)
• Avoid strong smells where possible – perfume or perfumed products, essential oils, strong-smelling flowers and trees, incense, potpourri, new mattress and cars, home renovations, new carpet, etc.
• Avoid perfumed shampoo, conditioner, deodorant, cosmetics, haircare, body lotion
• Some medications contain salicylates – Deep Heat, Vicks Vaporub, Dencorub, aspirin
• Household cleaners often contain salicylates – avoid perfumed laundry detergent, fabric conditioners, iron spray
• Avoid garden pesticides, pet pesticides and weedkiller where possible
• Alcohol –  choose whisky, gin or vodka (straight, or with ice, water, soda or tonic)