To the Editor: I am concerned that the recent articles on salicylate diets, 17 June, 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. On the one hand one meta-analysis cited implicates artificial food additives, and, while another also implicates additives, it supports a few foods diet.12
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 for a trial, challenged with exclusions and an individual diet developed.
I have followed the research using variations on the low chemical and/or the “few foods” diets with interest and summarised much in a review article. 3 4. Families will continue to continue to use elimination diets while they see some benefit in their children’s symptoms or behaviour.
Grey et al are critical of the low salicylate diet but have not identified whether the nutritional risks they describe are inherent in the low salicylate aspect of the diet, or due to poor diet supervision. They did not clarify whether patients had instruction or support by 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 can be managed.
1 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.
2 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 Adol Psych 2012; 31:1 86-106.
3 Breakey J Review Article The role of diet and behaviour in childhood J Paediatr Child Health. 1997 Jun;33(3):190-4.
4 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. A J Nutr & Diet 1991;48:3 89-94.