Supplements & vitamins
FOOD INTOLERANCE NETWORK FACTSHEET
Vitamins and other supplements
This factsheet covers vitamins and other supplements that are suitable for use on a diet free of additives and low in salicylates, amines and natural flavour enhancers (failsafe).
Products can change without warning. Always check ingredients.
Multivitamin and mineral supplements
Vitamins (C, B, folic acid)
Ingredients to avoid
How to check ingredients in pharmaceuticals – because reading the label isn’t enough!
How to get vitamins (and other pharmaceuticals) into kids
For the very sensitive
Fish oil supplements, essential fatty acids and the omega ratio
Psyllium (flea-seed) husks
Keywords: supplements, vitamins, unlisted additives
Daily vitamin supplements are one of the commonest causes of failure on the elimination diet. You have to avoid artificial colours, flavours, chewable tablets, bioflavonoids and herbs such as rose hips. These ingredients are not necessarily listed on pharmaceutical products.
Use only recommended supplements, one per day for adults, half per day for children under 12.
- Amcal One-A-Day dietary supplement tablets (multivitamin and mineral formula) are expected to be back in pharmacies by the end of May 2009.
- Elevit pregnancy supplements are recommended by some dietitians for use during the RPA elimination diet (whether pregnant or not, half dose for children). Online orders can be placed through the home pharmacy website or at many pharmacies.
- Orthoplex Children's Formula (I expect you could take 2 per day for an adult if not thrilled about taking the Elevit).
- Macro Multi M multivitamins - previously recommended - are no longer available.
Mega vitamins are usually not recommended during the strict elimination diet
Vitamin C (not needed on the elimination diet if eating permitted vegetables) Avoid colours, flavours, chewable tablets, bioflavonoids and herbs such as rose hips.
- Melrose Vitamin C plain white powder: Ascorbic Acid in the red pack, Calcium Ascorbate in the green pack (NOT the orange pack with added bioflavonoid and orange) http://www.aussievitamin.com/shop/aussievitamin/search.html
- Ester C (Calcium Ascorbate powder or Vit C tabs) http://www.myshopping.com.au/PT--209_Vitamins_Nutrition_Ester_C__fs_3987_e__
Megafol folic acid supplement by Alphapharm, available from Home Pharmacy as above
It is best to stick to RPA-recommended supplements. If you must try different brands, avoid: artificial colours, artificial and natural flavourings, preservatives (sorbates, sulphites including sodium metabisulphite, benzoates including sodium benzoate, hydroxybenzoates, parabens and PABA), herbs, bioflavonoids, fruit and vegetable extracts, and natural colour annatto (160b). Titanium dioxide (white, 171) and iron oxide colours (yellow or red, 172) are acceptable.
- pharmaceuticals are not required to list all ingredients on the label. Even if they claim 'no artificial colours and preservatives, yeast, sugar, gluten etc', they are not necessarily failsafe.
- all chewable or fizzy supplements contain flavours that are not failsafe.
- bioflavonoids and other natural sources of vitamins (eg rosehips) are often used in health food-type vitamin supplements, but are likely to contain salicylates.
- vitamin supplements from naturopaths or chiropractors are likely to contain such natural sources of vitamins that can be high in salicylates.
Note that children's chewable vitamins and similar supplements usually contain bioflavonoids and natural fruit extracts or flavours that are likely to be very high in salicylates and/or amines. You can use them only if your children pass the salicylate and amine challenges.
Reader story: Children’s flavoured vitamins
After four weeks on the elimination diet, I gave my kids one children's chewable vitamin pill each. All four kids reacted for a week, like "silly cats" - silly, jumping around, wouldn't listen, couldn't concentrate, fighting with each other. The little ones were the worst. I couldn't believe it, how could one tiny little pill be so bad?
Reader story: Adult multivitamin supplement
I am a 68 year-old with no health problems except the beginning of muscular stiffness. I’d like to know if [a certain multivitamin supplement with bioflavonoids] contains any additives not noted on the labels. I honestly cannot note any difference except that my sleep pattern has changed. Previously a 'go to bed and drop off' person I now find myself either lying awake half the night or going to sleep and waking in the small hours of the morning. [This is a typical reaction to bioflavonoids]
Manufacturers are not required to list all ingredients on pharmaceutical labels. You need to read the CMI (Consumer Medicine Information) sheet.
Where can you get Consumer Medicine Information?
Sometimes you can find Consumer Medicine Information inside the packet or box, or:
- Ask your pharmacist or doctor and they will print it from their computer.
- Telephone the National Prescribing Service Medicines Line on 1300 888 763 for the cost of a local call and talk to a pharmacist. You can ring Mon – Fri, 9 am – 6 pm, Australian Eastern Standard Time.
- Search the name of your medicine on the NPS website http://www.nps.org.au
- Or, contact the Medical Information Department of the pharmaceutical company that made your medicine. Find their number in the phone book.
Always be careful of any supplement taken daily. Keep a food and symptom diary for at least the first two weeks and be aware that any new symptoms could be due to the supplements.
Q. My son seems to react to the vitamins he is taking, even though they are hypo-allergenic and contain no preservatives or colours. I suspect they are loaded with salicylates. The ingredients include pineapple, apple, lemon bioflavonoid, PABA (para-amino benzoic acid), choline, inositol, natural grape flavour, spirulina, rosehip, brown rice, broccoli, spinach, mango fruit, carrot, West Indian Cherry, papaya, fructose, citric acid and guar gum. A few days after starting them he became fidgety, unfocussed and began regressing in his reading and writing (reversing and confusing letters and numbers which he has not done for a while), and having trouble with simple math computation.
A. Choline, inositol, brown rice, citric acid and guar gum are okay. Pineapple, apple, lemon bioflavonoid, natural grape flavour, rosehip, broccoli, spinach, mango, carrot, West Indian Cherry, and papaya extracts probably contain salicylates and/or amines. Spirulina hasn’t been tested. PABA (para-amino benzoic acid) is preservative (210) and has the same effects as sodium benzoate (211) that we have to avoid in soft drinks. It was one of the additives shown to affect children’s behaviour in the well-known 2007 Southampton University study. If you can't find safe vitamins in your local pharmacy, you can buy online, see above.
Always check ingredients on CMIs as formulations can change at any time.
For children's half doses, you can cut a tablet in half, crush it and mix into a spoonful of golden syrup, pear jam, or icecream. Or dissolve tablets in a small quantity water and add to magic cordial icypoles (half a tablet per icypole, 1 icypole per day). Frozen mixtures are particularly successful because they numb the taste buds. Parents say their children love the colour of failsafe vitamin icypoles. B vitamins have a natural orange appearance and Vitamin B2 (riboflavin) is actually approved as food colour (101).
Very sensitive people may react even to vitamins. Some dietitians advise starting with one-eighth of a tablet every day. After two weeks, double the dose, after another two weeks, double the dose again.
- Caltrate 600 mg, plain white unflavoured tablets. Avoid coloured, fizzy or flavoured versions with other ingredients such as “Caltrate 600 mg +D” (many failsafers have reported reactions to these). Plain Caltrate are usually available in any pharmacy, or http://www.homepharmacy.com.au/products/products_list.cfm?keywords=Caltrate
- In New Zealand, Caltrate are only available on prescription. NZ failsafers use the Healtheries Calcium supplements from health food stores, the 600mg plain white tablets only (not the coloured ones).
- Herron Calcium Plus with magnesium http://www.herron.com.au/Products/Osteoporosis/Calcium-Plus
It may be possible to buy calcium carbonate powder from pharmacies. Calcium should be taken with food to aid absorption. It is best taken in divided doses throughout the day, so you might want to consider using calcium fortified ricemilk or soymilk instead (not suitable for infant feeding, consult your dietitian).
Dose: as recommended by your dietitian. The recommended limit per day for adults is 2000 mg. For more information see http://courses.washington.edu/bonephys/opcalcium.html
Calcium carbonate also works as an antacid similar to Eno antacid powder, see below. Some failsafers have reported temporary relief (by slowly chewing a calcium tablet) from reflux and other food intolerance symptoms such as difficulty falling asleep or irritability.
Avoid fruit and especially mint flavours that contain salicylates
- ENO antacid powder, regular (not lemon) flavour.Available in supermarkets and pharmacies. For information http://www.gsk.com.au/products_consumer-healthcare-products_product-listing.aspx?view=38
- FGF Iron from Abbotts. RPAH recommended. Each tablet contains 80 mg of elemental iron but contains lactose and gluten http://www.homepharmacy.com.au/products/products_view.cfm?ProductID=3449
- FAB Iron & Vitamin B Complex. RPAH recommended. (5 mg elemental iron)
Warning: You can't trust labels on pharmaceutical products, because there is no requirement to list ingredients such as artificial colours or flavours, see the following reader reports.
I found out today that I'm anaemic and also have low calcium levels, so bought some FGF iron supplement, as recommended on the vitamins & supplements factsheet, but realized after taking the first tablet that it has lactose: (The label states, "Also contains lactose, sucrose.") I plan to take Ferro-Grad C for the time being, also by Abbott. I have had the Ferro-Grad C before going failsafe and did not notice any ill effects, so I hope it will be ok. The bottle says each tablet contains 325 mg Dried ferrous sulfate equivalent to 105 mg of elemental iron and 562.4 mg sodium ascorbate equivalent to 500 mg ascorbic acid (Vitamin C). Gluten, lactose and sucrose free.... LATER ... I rang up Abbott today and Ferro-Grad C has artificial colour in it (124, brilliant scarlet). (They could only tell me the name - they didn't even know whether it was artificial.) I am very unhappy about this. I took these tablets for most of my pregnancy with my daughter, plus some breastfeeding, at 2 per day. Maybe it has contributed to her problems.
Q. Our pediatrician recommended Fergon elixir iron supplement. I was wondering if my daughter can take this while on the elimination diet? This supplement contains Glucose liquid, Ethanol and Saccharin Sodium.
A. Fergon iron elixir is NOT suitable for an elimination diet. Remember that only a few ingredients have to be listed on pharmaceutical products. The actual contents of Fergon are in the CMI (Consumer Medication Information sheet) published Feb 2004, available from your pharmacist or do an itnernet search e.g. http://www.appgonline.com.au/drug.asp?drug_id=00098580&t=cmi Other Ingredients include : Glucose Liquid, Glycerol, Ethanol (alcohol), Saccharin Sodium, Gluconolactone, Apricot Superarome (Strong apricot flavour, NOT failsafe - all strong fruit flavours are high in salicylates and may contain amines).
- Zinc supplements are not part of the RPA elimination diet. The following have been recommended by a supportive dietitian: Zinc Caps (nothing but zinc in a gelatin capsule, 30 mgs). http://www.allegromedical.com/dietary-supplements-c522/zinc-caps-30-mg-100-capsules-p196301.html
- Zinc supplement update: Twin Laboratories failsafe zinc you recommended - an alternative supplier - iHerb - who ship to Australia at a reasonable price. – thanks to Kerri
Commercial medications and supplements are generally a minefield for people with food intolerance, because they can contain so many ingredients that may cause adverse effects.
If you can’t find a preparation to suit you, you can ask a compounding pharmacist to make a preparation to your specifications, see stories below.
How to find a compounding pharmacist: search the online Yellow Pages under <Compounding>
Reader story: An additive-free iron supplement with Vitamin C for a 6 year-old
I spoke to our compounding chemist - a very useful person, I think everyone with dietary issues should have one! He went through everything and came up with three alternatives - two were the ones listed on your web site, the third was to put his skills to work and make it up in the necessary dose for my child with a combination of iron and Vitamin C. I think I need to get a tattoo on my eyelids, which says "if child requires medicine - speak to Compounding Chemist" - they just seem better at getting to the bottom of what is in each medicine.
Reader story: Preservative free, flavour free antibiotic for a 3 month old baby
I went into a local pharmacy and explained what I wanted. The pharmacist had absolutely no idea what was in antibiotics other than the active ingredient, and conceded that I knew more about it than he did. He told me only a compounding pharmacist would be able to do that, so he gave me a contact within his group of chemists. They have made me up a liquid that is just the antibiotic with nothing else added. They made it more concentrated so that I could give her less at one time. It has just arrived and she took it with no problems.
Polycose by Abbott Laboratories http://www.homepharmacy.com.au/products/products_list.cfm?keywords=Polycose
- Polycal by Nutricia from selected pharmacies
- Polyjoule by Sharpe from selected pharmacies
These are glucose supplements for increasing caloric intake in people who are losing weight without wanting to, also used by some athletes for high energy. Available from pharmacies, ask your dietitian for more information.
Not for failsafers who are dairy free:
- Ensure from Abbott Laboratories, lactose free but contains milk proteins (www.Ensure.com)
- Sustagen from Mead Johnson, contains milk (www.sustagen.com.au)
Many failsafers who are sensitive to salicylates and/or amines have reported that they suffer from salicylate or amine reactions when using certain fish oil supplements. This applies even if the supplements claim to be free of salicylates and/or amines. In our experience, many people who have found fish oil supplements helpful before they try failsafe eating, may notice that that failsafe eating is more effective for symptom control than fish oil supplements and that adverse side effects of fish oils can outweigh the benefits. See factsheet on fish oil
You cannot take fish oil supplements during your strict elimination diet.
- If you pass your salicylate and amine challenges, you can then take any brand of fish oil supplement.
- If you pass your amine challenge, you can take tuna oil capsules and eat oily fish such as sardines. The latest thinking is that small fish such as sardines may be safer than large fish because of environmental pollutants.
- If you fail both salicylate and amine challenges, you might like to do a fish oil challenge.
A fish oil challenge:
- wait until you have a few days free of symptoms (and at least 3 weeks on the elimination diet)
- stick strictly to failsafe eating
- take the recommended dose of your fish oil capsules every day for two weeks
- keep a diary and record symptoms or improvements
- at the end of two weeks, decide whether the capsules caused overall improvement or worsening of symptoms.
Fish oil - reader reports
 'Wanted to warn others' about fish oil capsules (August 2006)
Previous to the diet, on the recommendation of our pediatrician we tried fish oil capsules for 4 weeks with good results for concentration. We stopped using the fish oil supplement when we started the diet as we wanted a clear reading of what it would do. (We were very much non-believers at this stage). The difference on the diet was amazing and we did the diet very successfully for over three months. We were into our second challenge when I reintroduced the fish oil thinking nothing of it as it was recommended along with diet by the pediatrician. We never got back to where we started even after four weeks of strict diet. We came off it thinking it was possibly a one-off and his body had adjusted to the diet. We have paid heavily for it, forgetting what life was like before the diet. My son is unhappy and we even began Ritalin trials feeling that we had exhausted all avenues. Then a friend who is also a failsafer was told by a doctor at the Allergy Clinic that there is a problem with fish oil and I just wanted to warn others who may fall into the same trap. We have begun the diet again today and my son is happy to go back on it even though he knows it means no McDonald parties and fruit and pizza which are his favourites. Thank you for giving us another option, and this fabulous website which makes the daunting task much easier.
 "My son had an horrific reaction to fish oil" (August 2006)
I complained to the Adverse Medications Events hotline (thru your website) about the fact that the label on a particular brand of fish oil supplements says free of salicylates and amines and they were most sympathetic and helpful. They asked the Queensland Nutrition Council to investigate and discovered that not only does the lemon and lime flavouring contain salicylates and amines, but so does the tuna, and how high depends on whether the tuna is fresh or canned. My son had an horrific adverse reaction to it, and was waking up through the night on it - in fact, he asked me if he could stop taking it. I tried lowering the dose to a teaspoon in the morning only (two teaspoons recommended morning and night), and it made no difference, so I stopped it. - father of a six year-old
 "Migraines due to amines including fish oil" (August 2006)
My daughter has had migraines since she was about three years old. We had no idea what they were for several years. She usually gets a fever with her migraines and because of the fever the doctor would always put it down to 'a virus', prescribing painkillers. I would often give her panadol for four days straight just to keep the headaches at bay. She goes limp and listless, her eyes droop, she lies there and sleeps for hours until the panadol wears off and then the pain and fever return. Most times she will scream and cry at me grabbing her forehead, pleading with me to take the pain away. “Mummmy Mummy my heads hurts, please stop it.”
A year after she started getting the migraines, we were referred to a paediatrician who could find no medical reason for them. He thought it may have been an attention grabber or perhaps the start of a cold. He was at a loss too. He asked me to diarise her migraines. The migraines continued on and off with no regular pattern that I could work out. Once a week, then maybe another in 6 weeks times, then two months. It varied greatly. Two years later we started taking a fish oil supplement [not the same brand as the one mentioned in the two stories above]. The migraines became more frequent and she started throwing up with them. She would go to sleep with a migraine, wake at 3 am and throw up in bed. This time her paediatrician ordered a CAT scan which was clear. He offered my 6 year old a daily dose of Betablockers or a trial using Riboflavins. He also suggested diet manipulation ... Guess which one we chose? ...
On the second day of the amine challenge, my daughter got a migraine, fever, droopy eyes and became listless. School rang and asked me to collect her, again. She stayed unwell for several days with the headache. Since the end of the amine challenge three months ago we haven’t had one migraine! So, no more amines for my daughter. It turns out that the fish oil supplement has amines in it which is why her migraines would have become so frequent and regular. I was giving her six capsules per day for three months as per instructions. - mother of a seven year-old
 Insomniac due to fish oils (March 2008)
My daughter was taking fish oil capsules prescribed by our homeopath (and yes, I have taken notice of your comments in the Checklist of Common Mistakes about homeopathics possibly causing more problems, just what I didn't need to hear) and within days she became an insomniac! It took us several weeks to come up with the connection and as soon as we stopped them, sleep returned to normal.
 Fish oil recommendation from Jen (March 2008)
I have done an extensive amount of research about the various fish oils available and found Xtend-Life from New Zealand to be very forthcoming with information about their product when emailed queries. We have tried it with the three children and myself (all amine, salicylate, lactose, and everything artificial responders) and found it to be fine (although I can’t say I noticed any benefits, I certainly didn’t notice any deterioration either). It is only available directly from them, not through stores. The website is as follows: http://health.xtend-life.com/product/Omega_3_~_DHA_Esters.aspx. [we welcome feedback]
Alternatives to fish oils
For people who cannot take fish oils, here are some food sources of essential fatty acids:
- flaxseed (linseed) oil is an excellent source of EFAs but seems to contain small amounts of salicylates and amines so needs to be approached with caution, see box.
Reader story: “We recently introduced Melrose flaxseed oil which appears to have helped our son in the attention span/concentration area. We were told to give 5ml per day, however I have only been giving him approx 3 - 3.5 ml - I did bump it up to 5ml and we started to see some problems so dropped it back and he's been good.” – from a failsafe mother
- fresh white fish, fresh scallops, fresh oysters (seafood is an excellent source of EFAs, but large fish especially are also a source of industrial pollution, sardines are better)
- lean lamb, lean beef (grassfed is better than grainfed), eggs (smaller amounts than seafood)
- canola oil - a source of balanced EFAs, see below
- brussels sprouts, lettuce, green beans, cabbage, leeks (smaller amounts than seafood)
- soybeans, tofu, other beans and peas, cooked or canned (smaller amounts than seafood)
The omega-6 to omega-3 ratio
Omega-3 and omega-6 fatty acids are essential to human health but it is best if they are consumed in balance, that is, close to a ratio of 1:1. Instead, Western diets are typically much higher in omega-6s, with ratios of omega-6s to omega-3s generally in the range 10:1 to 30:1. It is thought that traditional subsistence diets were much more in balance.
The ratios of omega-6 to omega-3 fatty acids in oils includes: cottonseed oil (commonly used in fried takeaways such as fish and chips) 258:1; sunflower seed oil 156:1; palm oil (in many processed foods, often listed as vegetable oil) 46:1; soy oil 7:1; butter 3:1, canola 2:1; fish oil 1:1; flaxseed oil 1:3.
So you can see that when you switch to failsafe eating, changing from fast foods fried in cottonseed oil to home-prepared meals cooked in canola oil will improve your omega ratio.
For a clear explanation of saturated, poly-unsaturated, mono-unsaturated and trans fats, see the Dietitians Association: http://www.daa.asn.au/index.asp?PageID=2145834401.
When reading information about oils on the internet, remember that glowing positive information may come from product manufacturers and dire negative information may come from manufacturers of a competing product.
Psyllium is considered to be the safest and gentlest water soluble fibre. It can be mixed into cereals, yoghurt, soups or stews or stirred into a glass of water and consumed immediately or cooked into foods.
Doses: Some suppliers suggest starting with one tsp per day and building up slowly to 5 grams (approx 2 metric tsp) once or twice a day mixed with a glass of water; for children 8–12 years 2.5 grams (1 metric tsp) once a day; under 8, consult your dietitian or pharmacist. As treatment for constipation, allow 2–3 days for effects. Cautions: Because it works by absorbing fluid from the bowel to form a kind of gel, each dose must be taken with the equivalent of a glass (150 ml) of water to prevent severe and life-threatening intestinal blockage. Do not take if you have problems swallowing. Flavoured or coloured psyllium supplements (e.g. orange flavoured Metamucil) is not failsafe. There have been some reports of allergies in people frequently exposed to powdered psyllium (e.g. nurses, factory workers).
See also our Psyllium and constipation factsheet.
Probiotics are living bacteria that may improve health by altering the balance of good and bad bacteria in the body. It is thought that in the gut alone there is a mixture of more than ten billion bacteria from more than one hundred species. Probiotics occur naturally in traditional fermented foods such as yoghurt and are sold as supplements in their dried form. Scientists have only recently started to study the beneficial effects of probiotics for a variety of disorders from irritable bowel symptoms to prevention of allergy. There are over a thousand strains and sub-strains of beneficial lactic acid bacteria that occur naturally in traditional fermented milk products. A single batch of traditional Indian dahi (yoghurt) or kefir from Eastern Europe may contain many more strains than found in Australian yoghurts. Consumption of such fermented milk products during a meal can prevent the flatulence normally associated with bean dishes, which may explain why yoghurt is traditionally served as a side dish or drink with meals in India.
It seems that some strains of probiotics may be more useful than others and that combinations of probiotics as found in traditional products may be more effective than a single strain. Of the few probiotics studied so far, Lactobacillus GG taken in late pregnancy by the mother and given to the baby in the first six months of life was found to protect against the development of eczema, but Lactobacillus Acidophilus did not. Another study showed that kefir, traditionally used as a weaning food, reduced specific IgE antibodies (involved in allergy) in mice, leading researchers to hope that it may help to reduce food allergies in babies. Not all probiotic supplements suit all people. People who are dairy free need to find a dairy-free source of probiotics, e.g. Inner Health Plus Dairy Free. If the probiotic you are taking causes adverse effects or does appear to help after one month or two, consider switching to another brand. See also the probiotic factsheet on www.fedup.com.au.
For shopping lists in countries other than Australia , see Shopping List
© Sue Dengate update March 2012