What is the RPAH Elimination Diet?

Did you know that food intolerance is different to food allergy?

Allergies are present in people who are born with an overactive immune system. You’ve probably heard about the IgE antibody allergy test that can determine whether or not you have allergies? Well that test isn’t going to work if you have food intolerance.

Our son Jack was tested for the standards; coeliac and lactose intolerance. Once these were ruled out, there wasn’t any mention of food intolerance again when exploring his diagnosis and symptoms. Which in retrospect is pretty crazy really!

Food intolerance is harder to diagnose (there are no skin or blood tests), symptoms are different in each individual and many people are intolerance to several things, not just the one.

Food intolerance is, most simply, your body reacting to natural food chemicals and/or additives. These chemicals can irritate the nerve endings in different parts of your body causing a range of symptoms both mild and severe.

Information from http://www.fedup.com.au based on a British study in 2007.


30 years ago, the food industry started adding preservatives and additives to food to improve shelf life and to mimic natural flavours at a fraction of the price.  Much of it is mislabeled and misleading and even many ‘healthy’ products contain concerning additives and preservatives.

I recently ate some bacon, regular bacon off the shelf in the supermarket and was left with numb lips and tongue for several hours. This happened again several times until I put two and two together and realised I was reacting to the preservative 250 or 251, also known as sulphates. Safe to say it didn’t leave a good taste in my mouth (pun intended) and I haven’t eaten it since. Which is sad, because I do love bacon.

The major (natural & synthetic) preservatives and additives that cause symptoms of food intolerance.

  • Salicylates (found in most fruit and vegetables)
  • Amines (found in aged meat, cheese, wine and chocolate)
  • Artificial colours
  • Synthetic antioxidants
  • MSG and natural glutamates

depending on severity or persistence of symptoms, it you may also need to avoid…

  • Dairy
  • Gluten
  • Soy
  • Legumes

This should be discussed with your GP or Dietician before cutting out major food groups.

What are typical food intolerance symptoms?

Symptoms differ from person to person so it’s best to talk to a GP or dietician before commencing the elimination diet.

Here are some of the common symptoms below…

Is Failsafe the same as the RPAH Elimination Diet?

Failsafe is Sue Dengate’s term to describe the RPAH Elimination diet: free from additives, low in salicylates, amines and flavour enhancers.

Sue Dengate’s books provide a wonderful resource alongside the RPAH Elimination Diet. She shares her own story of how the RPAH elimination diet made a difference to her family, specifically her children about 30 years ago. She and her husband Howard are pioneers in advocating for food intolerance and are involved in ground breaking research and lobbying ministers and food regulators to push for less additives in our food through the website The Food Intolerance Network.

It may be a bit confusing as the word failsafe is now used interchangeabley with the RPAH elimination diet on blogs and in many recipes.

The RPAH Elimination diet

The RPAH elimination diet, developed by the Allergy Unit at Royal Prince Alfred Hospital in Sydney, starts by REMOVING all possible triggers (naturally occurring food chemicals and synthetic additives) in common, everyday foods for a 4-6 week period, or until symptoms subside.

So basically the diet is SUPER plain and SUPER basic. It gives your body a break and a chance to recover and get back to baseline. Don’t get put off by basic and plain. Just keep reading…

Once the symptoms have stopped and you’re feeling great, like a brand new person, it’s time to reintroduce the trigger groups, carefully, one by one, to monitor reactions and find the cause of your symptoms. This part isn’t fun (hello old rashy/moody/migrainey/flatulenty self)…but this challenging step is CRITICAL to finding the ROOT of your symptoms. The dietician will help you with this one, don’t worry.

Do I have to eat brussel sprouts forever?

Not unless you particularly want to. Remember, the elimination phase is NOT meant to be long-term. It’s just a step towards finding the cause. Some people find they need to continue with a restricted diet, depending on their intolerances, but it is almost never as restrictive as the initial elimination phase. Some people for the first time, can start to enjoy a rich and diverse range of foods, but simply need to avoid certain known triggers (like sulphates or dairy etc).

Food intolerance is also often a threshold issue. Too much of one thing and you get symptoms (i.e. a flare up of eczema). A small to moderate amount and you are fine, or only have mild symptoms. It can be managed once you know what triggers you.

Knowledge is power, and freedom.

Don’t put it off

Also something helpful to understand is that food intolerance is more severe in young children, so it generally is more manageable into adulthood. But don’t put it off, thinking they’ll grow out of it.

I can’t imagine what Jack would have turned out like had we not addressed these food related issues now and helped him get back in control of his behaviours and emotions. He may have been labeled with some behavioural disorder or thought he wasn’t smart or studious because he couldn’t concentrate at school. Perhaps he may have been frequently absent from school, study or not been able to hold down a job because of his debilitating migraines. Now he gets a chance to tackle life, unaffected by these symptoms and face the hurdles without unnecessary hinderance. I can’t tell you how thankful we are to have discovered this diet and how much happier he is. He honestly isn’t bothered by not being able to eat whatever he wants, now that he feels better. He is happy, healthy and thriving.

Why is food chemical intolerance relevant to many, if not all?

With common issues of disrespect, irritability, restlessness, lack of concentration and aggression in classrooms these days, this is something that will likely become more prominently researched in the near future. How many children are being labeled with behavioural disorders like ADHD and ADD that could simply be aggravated by diet?

What can you do if you think you have a food intolerance/s?

If you think you may have a/several food intolerances, it’s recommended in the Elimination Diet Handbook by the Allergy Unit at RPAH to see a registered dietician to talk through your symptoms and diet more specifically. If you would like to commence the RPAH Elimination Diet, it is also highly recommended that you do so with the guidance of a dietician. The diet is very restrictive so it’s important to monitor nutritional intake, particularly in young children who are growing and changing.

Don’t despair. Short term pain for long term gain. The results we have seen in our son Jack since commencing the RPAH elimination diet have been phenomenal. To see him not only be migraine free for the first time since he was 6 months old, but also to be more in control of his emotions and behaviours. It has changed his life and ours too. Check out our story to read more about our son’s current journey to be migraine free.



The RPAH Elimination diet was developed at the Royal Prince Alfred Hospital in Sydney in 1977 by A. Swain, V. Soutter and R. Loblay.

Information in this document was taken from…

  1. The RPAH Elimination Diet Handbook which is available at http://www.allergy.net.au or from a elimination diet specialising Dietician.
  2. The Food Intolerance Network by Sue and Howard Dengate (www.fedup.com.au)


{DISCLAIMER: The Royal Prince Alfred Hospital Allergy Unit is not affiliated with this blog and does not endorse its content. Simply Failsafe is an independent blog sharing recipes and privately developed resources to help others as they stick to the RPAH Elimination Diet, recommended to be untaken with the supervision of a registered Dietician. The information on Simply Failsafe should not be used as medical advice and its affiliates will not be held responsible for any decisions or outcomes made by persons reading the blog. It is advised that each person should get professional medical advice with regards to symptoms and food intolerance enquiries from their GP or Dietician}.