Assessing adherence to a rotary diversified diet, a treatment for 'environmental illness'

Objectives To develop and test a method to assess adher ence to a rotary di versified diet (RDD), a treatment for environmental illness, which is a put ative. disorder characterized by multiple sensitivities to foods, chemicals , or inhalants. The RDD requires the elimination of prohibited foods and ro tation of remaining nonprohibited foods and their "food families" within a 4- to 7-day cycle. The regimen has yet to be validated to the satisfaction of the scientific community. Design Details of the 2 components of the RDD prescription, elimination and rotation, were documented, and a food record method of assessing adherence was developed. Adherence to the RDD was then assessed in a cohort of women who were enrolled in a larger prospective study. Test-retest reliability o f the adherence assessment method was determined by calculating ratings twi ce on the same set of patient food records, with 1 week between trials. Subjects/setting All patients were contacted through a private environmenta l medicine clinic in Toronto, Canada. Eight patients provided the food reco rds needed for development of the method; adherence was then assessed in 22 women aged 25 to 67 years. Statistical analyses Means, standard deviations, and 95% confidence interva ls for adherence ratings were calculated. The reliability of the adherence assessment method was determined by calculating Pearson correlation coeffic ients for adherence ratings from each trial. A paired t test, was also used to determine if the mean differences in ratings between trials were signif icant;. Results Patients experienced difficulties following both components of the RDD: 37% tb 44% of foods consumed were either prohibited or allowed, but we re consumed on the incorrect day. The adherence assessment method was found to have high levels of reliability. Applications The adherence assessment method can be used in future evaluati ons of the RDD, although further testing of the method is recommended. Incr eased involvement of dietitians with patients diagnosed with environmental illness is recommended.