Exactly How To Follow a Low Salicylate Diet (And Who It’s Right For)

The low salicylate diet is not for everyone. But if you’re here, you probably have reason to think that you might have a salicylate intolerance, and could benefit from restricting salicylates at least over the short term. 

Today, I’m going to break down how to know if the low salicylate diet is a good fit for you, and how to follow it—including not only what to eat and avoid but what you can do before, during, and after to heal your system and feel better. 

What Are Salicylates? 

Let’s start with some quick background on salicylates. Salicylates are naturally occurring compounds found in many fruits, vegetables, herbs, and other foods. Synthetic forms are found in aspirin and several other medications. 

Plants use salicylates to help protect themselves against disease, insects, and other threats. They may actually be beneficial for human health in most cases, but for those with a salicylate intolerance, they can trigger symptoms including hives, headaches, brain fog, gastrointestinal inflammation, nasal polyps, and asthma. 

What Causes Salicylate Sensitivity? 

Salicylate intolerance generally occurs because of a combination of genetic and environmental factors. Here are a few possible causes—important to know, because an important part of healing salicylate intolerance (or any condition) is addressing the root cause. 

Impaired Detoxification and Enzyme Function

The liver breaks down salicylates using specific detoxification enzymes. These enzymes help convert salicylates into harmless substances before eliminating them from the body. 

But if this detox pathway is sluggish or enzymes are insufficient (this can happen because of genetic differences, nutrient deficiencies, high levels of toxins, or chronic inflammation), salicylates can accumulate and trigger reactions. 

COX Enzyme Inhibition and Overproduction of Leukotrienes 

Salicylates and salicylic acid are known to inhibit cyclooxygenase (COX) enzymes, which regulate the production of prostaglandins (inflammatory messengers). This is how aspirin and NSAIDs like ibuprofen work to reduce pain and inflammation. 

But for some people, COX inhibition causes an overproduction of a different kind of inflammatory mediator called leukotrienes, which triggers symptoms. 

Genetic Factors 

Your ability to metabolize salicylates is determined in part by your genes. Variants in specific genes related to detoxification can reduce enzyme activity and make it harder for your body to process salicylates (especially in combination with environmental factors like compromised gut health). 

Gut Issues and Absorption 

As with pretty well any chronic condition I can think of, impaired gut health is often part of the problem. Gastrointestinal inflammation, dysbiosis, and/or leaky gut can both impair your detox pathways and cause you to absorb more salicylates than you should. 

Is the Low Salicylate Diet Right For You? 

A lot of functional medicine is about pattern recognition. And the pattern of salicylate sensitivity can be hard to identify. 

Symptoms overlap with many other intolerances and conditions, they may come and go at different times even when you’re eating the same foods, and most of us don’t intuitively know to link specific healthy foods in our diet (like berries, tomatoes, and avocado) to salicylates even if they’re causing problems. 

To figure out if you have a salicylate intolerance and might benefit from a low salicylate diet, we can start by looking at a few different levels of signs. 

First, common symptoms of salicylate intolerance may include: 

• Nasal polyps
• Skin rashes, hives, or eczema
• Chronic sinus congestion
• Asthma or respiratory symptoms
• Digestive issues including bloating, abdominal pain, or diarrhea
• Tinnitus
• Brain fog
• Anxiety or mood changes
• Headaches

Again, this still leaves us with a lot of possible intolerances or conditions. Here are a few more specific signs that, combined with symptoms, may point to a salicylate intolerance: 

• You react poorly to aspirin and/or non-steroidal anti-inflammatory drugs (NSAIDs) 
• You have mast cell activation syndrome (MCAS) 
• You have AERD (aspirin-exacerbated respiratory disease) 
• You have one or more chronic inflammatory conditions 
• You already eat a clean, anti-inflammatory diet, but still have symptoms (especially if you’ve tried more general elimination diets and they haven’t worked) 

Does the Low Salicylate Diet Work? 

A low salicylate diet, especially over the short term, can be very helpful for some people—with “some” being the operative word. 

I want to address that there is some debate and even controversy around the low salicylate diet in the medical community due to limited research and the fact that a low salicylate diet may limit some nutrients. I know concerns are highest for children, who may develop food aversions or nutritional deficiencies. 

Again, we come back to the low salicylate diet not being for everyone. It’s not the first diet I would recommend for most patients, and if done properly, the goal should be to identify the intolerance and restrict foods over the short term, while working to resolve underlying imbalances. It’s very important to make sure you’re still getting enough nutrients when following this diet (we’ll cover more of this below). 

Ultimately it’s a conversation to be had between individuals or families and their trusted practitioners. 

With that said, we are starting to see some more studies on the benefits of a low salicylate diet in certain populations. For example, a 2021 study published in Nutrients found that a personalized low salicylate diet significantly reduced symptoms of asthma, rhinosinusitis, and chronic urticaria (hives) in people with NSAID sensitivity. (1) 

A more recent (2024) study also showed that patients with NSAID-exacerbated respiratory disease who followed a low salicylate diet for 12 weeks experienced a notable improvement in nasal polyps, obstruction, and overall symptoms. (2) 

How To Follow a Low Salicylate Diet 

The low salicylate diet should be approached like any elimination diet: we’re starting with a temporary elimination and reintroduction process, used to assess your individual tolerance, and then personalizing a more long-term eating plan that limits reactivity. 

Temporarily Eliminate High-Salicylate Foods

The first step is to eliminate high salicylate foods from your diet. This step should last at least 3-4 weeks. If your symptoms have persisted for a long time, you may need to spend longer in this phase. After 4 weeks, you’ll want to continue as long as symptoms are improving, until you reach a plateau. 

During this phase, you’ll also eliminate products and over-the-counter medications containing synthetic salicylates (speak with your practitioner first about any medications your doctor has recommended or prescribed).

What To Avoid: 

During your elimination phase, avoid the following: 

• Blueberries, cherries, grapes, cranberries, plums, raspberries, apricots, blackberries, currants, kiwi fruit, nectarines, watermelon, grapefruit, prunes, and dried fruits
• Tomatoes, peppers, sweet potatoes, zucchini, cucumbers, and radishes
• Olives
• Almost all spices and herbs, including turmeric, cinnamon, curry, coriander, cumin, chili, nutmeg, paprika, aniseed, mint, thyme, and rosemary
• Almonds, peanuts
• Honey
• Olive oil, coconut oil
• Coffee and tea
• Wine, beer, and cider (though I would suggest avoiding all alcohol during this phase even if low salicylate) 
• Chewing gum
• Aspirin (acetylsalicylic acid) and any over-the-counter medications containing salicylates (look for terms including salicylic acid, bismuth subsalicylate, and methyl salicylate) 
• Any mouthwash, cosmetics, or other products containing salicylates 

Note that this is not a complete list. 

Also keep in mind that salicylate content in foods is hard to reliably measure (the amount of salicylates may vary from tomato to tomato, for example) and it’s next to impossible to be completely salicylate-free.Still, you want to do what you can reasonably do within this phase to avoid salicylates. 

Eat Nutritious Low-Salicylate Foods

The thing about salicylates is that they’re found in a lot of really nutritious foods… and they’re also not found in a number of potentially inflammatory foods (for example, dairy products are low salicylate, but problematic for a lot of people, and sugar is also low salicylate).

One mistake I’ve seen some people make is getting so focused on avoiding salicylates that they’re no longer eating in a balanced, nutrient-dense way. The low salicylate diet IS restrictive (remember, short term) but there are still plenty of healthy low salicylate foods you can enjoy. 

Foods to enjoy include: 

• Papaya, rhubarb, peeled pears, bananas, golden delicious and red delicious apples, mango, pomegranate
• Cabbage, celery, peeled white potatoes, green beans, leek, brussels sprouts, asparagus
• Chives
• Eggs
• Unprocessed meat (including beef and lamb) and poultry 
• Fish 
• Cashews
• Lentils (if you tolerate them) 

Again, this is not a complete list. I encourage you to seek out as many diverse, nutritious, low salicylate foods as you can! 

Reintroduce Gradually

Once you’ve reached a plateau with symptom improvement, start reintroducing one high-salicylate food every 3-5 days, observing any change in how you feel or return of symptoms. 

I highly recommend using a food journal to track how you feel. You don’t have to be obsessive, but my patients and I find that this really helps to get a hold of patterns. 

As you reintroduce foods, you may find that some seem to cause a reaction. Remove them again for now, but you can always try reintroducing them again later—especially as you work on healing any underlying imbalances, which I’ll get to in a minute. 

Find Your Salicylate Threshold 

Part of why salicylate intolerance is so hard to identify is because, unlike a food allergy, you don’t necessarily react quickly every time you eat a high salicylate food. Like with histamine intolerance, this can largely be explained using the bucket concept. 

Every time you eat something containing salicylates (or take a medication or use a product that contains them), they’re filling up your “bucket”. At some point, if your body isn’t clearing the bucket faster than it’s filling up, the bucket becomes full, and then it overflows—this is what causes symptoms. 

So, you might be eating all kinds of berries and tomatoes for days with no issues, and then you eat a couple of olives and suddenly you break out into a rash and have a terrible headache. 

This is why personal experimentation is so important. You’ll start to learn what your threshold is—how much you can and can’t tolerate. In most cases, you won’t have to restrict all salicylates forever, but just be mindful of when your intake is on the higher side. 

Heal Underlying Imbalances

As you go through the low salicylate elimination diet process (and likely afterwards), work on identifying imbalances like leaky gut or chronic inflammation that may be causing impaired detoxification of salicylates. 

Healing these underlying issues will not only improve your tolerance of salicylates but improve your overall health. 

What If You Don’t See Improvement? 

If you don’t notice any symptom improvement after 3-4 weeks of avoiding salicylates, you probably don’t have a salicylate intolerance. The next step would be to investigate other potential intolerances and/or imbalances. I highly recommend working with a functional medicine practitioner who can help you figure out where to turn next. 

If you notice some improvement, but not enough, there are a few possibilities to consider. One, many people with salicylate intolerance also have another co-occurring intolerance—most commonly to histamine or oxalates. You can see if a combined elimination diet brings more resolution. 

The other piece to keep in mind is that you may need more time to work on underlying imbalances that are causing salicylate intolerance, as they may be causing other issues as well, keeping you from feeling better. Again, a functional medicine practitioner can help you with specialized testing and a personalized plan. 

Other Considerations and Tips 

Here are a few other things to keep in mind and tips for success as you follow a low salicylate diet. 

• You may not need to reintroduce synthetic salicylates. While foods that naturally contain salicylates are generally nutritious and therefore we want to reintroduce them, if you can find alternatives to salicylate-containing medications and personal care products that work for you, you don’t actually have to bring them back. This will help keep your bucket from filling up.
  
• Consider select supplements. Fish oil may help to reduce inflammation and improve symptoms for those with salicylate intolerance. (3) Other supplements that may help with reactivity and reducing inflammation include vitamin C and quercetin.
  
• Prioritize gut health. As mentioned above, an important component of healing a salicylate sensitivity is addressing underlying imbalances. In general, salicylate sensitivity often coexists with leaky gut and/or gut dysbiosis. Supporting gut healing may help to improve your tolerance over time.
  
• Keep an eye on packaged products. Packaged products often include salicylate-containing preservatives or additives. In general I always recommend avoiding packaged and processed foods as much as possible, focusing instead on whole foods. 

Personalizing Your Protocol

I hope this guide is helpful for you as you navigate salicylate sensitivity. I know there’s a lot to process and keep track of. If you are looking for more personalized guidance on exactly how to follow a low salicylate diet in your case, and a plan to heal underlying imbalances, that’s exactly what we can help you with at my functional medicine telehealth clinic. Learn more here. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

• Kęszycka, P. K., Lange, E., & Gajewska, D. (2021). Effectiveness of personalized low salicylate diet in the management of salicylates hypersensitive patients: interventional study. Nutrients, 13(3), 991.
• Jura-Szoltys, E., Rymarczyk, B., Gawlik, R., & Glück, J. (2025). Low-Salicylate Diet in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease: Personalization of Indications to Dietary Treatment. International Archives of Allergy and Immunology, 186(1), 67-74.
• Healy, E., Newell, L., Howarth, P., & Friedmann, P. S. (2008). Control of salicylate intolerance with fish oils. British Journal of Dermatology, 159(6), 1368-1369.