Volume 199 - Issue 7
Salicylate elimination diets in children: is food restriction supported by the evidence?
Author: Joan C Breakey
Med J Aust 2013; 199 (7): 459-460. || doi: 10.5694/mja13.10896
Published online: 7 October 2013
Published online: 7 October 2013
To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because ...
To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because diet has no role, but because the issue is complex. One meta-analysis cited by both Gray and colleagues and Loblay and colleagues implicates artificial food additives;3 another meta-analysis also implicates additives, but also supports a few-foods diet.4
The low-chemical diet is unusual in that it is not based on a known defect in digestion or metabolism, where testing may help show who may benefit. The mechanism is not known. It is also unusual as the diet can be implemented as a trial and challenged with exclusions, and an individual diet developed.
I have summarised much of the research about variations on the low-chemical and few-foods diets in a review article.5 In a trial of the low-chemical and few-foods diet in 516 children referred to child mental health clinics, 54.5% shifted into the normal range.6 Families will continue to use elimination diets as long as they see some benefit in their children’s symptoms or behaviour.
Gray et al are critical of the low salicylate diet,1 but have not identified whether the nutritional risks they describe are inherent in the low salicylate aspect of the diet, or the result of poor diet supervision. They did not clarify whether patients had instruction or support from dietitians. The recommendation should have been that wherever any elimination diet is being used, doctors should ensure dietetic input. This way, the value of the diet can be determined and adequate nutrition managed.
Competing interests
No relevant disclosures.
References
- Gray PEA, Mehr S, Katelaris CH, et al. Salicylate elimination diets in children: is food restriction supported by the evidence? Med J Aust 2013; 198: 600-602. 0_BABEBBGH
- Loblay RH, Soutter VL, Swain AR. Salicylate elimination diets in children. Med J Aust 2013; 198: 603. 0_CBBIIDIH
- Schab DW, Trinh NH. Do artificial colours promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr 2004; 25: 423-434. 0_CBBFGDGG
- Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diets, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry 2012; 51: 86-97.e8. 0_i1142876
- Breakey J. The role of diet and behaviour in childhood. J Paediatr Child Health 1997; 33: 190-194. 0_CBBDIBBA
- Breakey J, Hill M, Reilly C, Connell H. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. Aust J Nutr Diet 1991; 48: 89-94. 0_CBBJGFGI