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

Unproved diagnostic and therapeutic approaches to food allergy and intolerance

PURPOSE OF REVIEW

Alternative and complementary medicine approaches to allergic disorders are commonly used by patients. Not all have been subjected to experimental analysis to support or refute their validity in the armamentarium of a practitioner. This review covers some of the most common unproved alternative or complementary approaches to diagnosis and therapy that we see in use by patients. These include the use of specific IgG to foods accompanied by rotary diets, provocation-neutralization testing and therapy, applied kinesiology followed by acupressure or acupuncture, and changes in cell size upon in-vitro exposure of leukocytes to food extract (using automated assays going under various trade names) followed by elimination diets or rotary diets.

RECENT FINDINGS

There continues to be a dearth of well performed studies investigating these approaches in the literature, but many testimonials have been posted on websites of practitioners using these methods attesting to their effectiveness. Several recent studies have refuted the use of applied kinesiology and provocation-neutralization in diagnosis. The placebo effect must not be overlooked as a potentially important factor in some approaches.

SUMMARY

There have been no studies supporting the use of these techniques, and several have refuted their utility. A beneficial placebo effect may be responsible for the perceived clinical effectiveness in many cases of food intolerance.

Dietary adequacy of the rotary diversified diet as a treatment for "Environmental Illness"

The rotary diversified diet, used in the management of environmental illness, consists of eliminating prohibited foods from the diet and rotating remaining non-prohibited foods and their "food families" within a regular cycle. We assessed the adequacy of nutrient intakes in 22 women prescribed the diet, described the nature of supplement use, and assessed the relationship between adherence and nutrient intake levels. Except for calcium and folacin intakes, mean nutrient intakes met or exceeded recommended levels. No subjects had calcium intakes above the adequate intake for calcium; 72.7% had folate intakes below the estimated average requirement. Intakes of other nutrients, except thiamin and magnesium, were below the estimated average requirement in less than 25% of the sample; 31.8% and 45.5% of subjects, respectively, had thiamin and magnesium intakes at this level. Those who adhered more closely to the rotary diversified diet had higher intakes of vitamin C, vitamin B6, folate, and fibre than did those who followed the diet less closely. Supplements conferred some nutritional benefits; however, supplemental niacin and magnesium intakes exceeded tolerable upper intake levels. Those prescribed the rotary diversified diet require nutrition counselling from dietitians to cope with the complexity and restrictiveness of the diet.