Multiple sclerosis (MS) is an incurable degenerative disease that attacks the central nervous system. Many people with MS use nutrition as a form of complementary or alternative treatment. Nutrition may play a role in treating MS, and it can help maintain overall health.
The Swank Diet: A Historical Perspective
Dr. Roy Swank began studying multiple sclerosis (MS) in the 1940s. Beginning in 1948 neurologist Roy Swank, MD, PhD began investigating the epidemiology of MS and proposed a low saturated fat dietary treatment based on data suggesting that a higher intake of saturated animal fats were associated with higher incidence of MS. His research in Canada and Norway led him to conclude that MS was less common in coastal fishing towns, where people ate more fish than in the mountains, where there was a higher intake of meat.
Working with a dietitian, Aagot Grimsgard, Dr, Swank developed a low-fat diet. In 1987, he published a book on the diet. Swank published a book that summarized his findings and provided practical advice, recipes and seven-day menus to assist pwMS in following his diet. He died in 2008 but his diet continues to be promoted by the Swank MS Foundation.
Dr. Swank published several articles advocating the benefits of a low-fat diet for people with MS, and these included research based on the findings of his original studies.
Core Principles of the Swank Diet
A central feature of the diet is that it limits fat - especially saturated fat - and focuses on lean fish, non-fat dairy products, fruits, vegetables, and whole grains. The Swank diet gives guidance on how much of various food types a person should eat.
Read also: The Hoxsey Diet
Fat Intake
The diet recommends consuming:
- No more than 15 grams (g) of saturated fat per day
- No less than 20 g of unsaturated fat per day
- No more than 50 g of total fat per day
A person can consume plant oils, such as olive oil, canola oil, soybean oil, peanut oil, and flax oil on the Swank diet because they contain mostly unsaturated fat.
Oils to avoid include:
- Coconut and palm oils, as they are high in saturated fat
- Butter, lard, margarine, shortening, and hydrogenated oils, as they are high saturated or trans fat
A person can eat nuts, nut butter, and seeds as snacks, but they must count them in the daily fat total.
Fruits and Vegetables
The Swank diet encourages a person to consume at least 2 servings each of fruits and vegetables per day. A person can eat most fruits and vegetables on the Swank diet without restriction. However, if a fruit naturally contains fat, such as avocados and olives, the person must count this towards their daily fat total.
Read also: Walnut Keto Guide
Meats and Poultry
A person cannot consume red meat and pork during the first year of the diet. After that, they may eat 3 ounces (oz) of cooked red meat. However, people can eat 4 oz skinless white chicken and turkey meat but should avoid dark poultry meat and processed poultry products.
Fish
Whitefish and shellfish are suitable, and there is no limit to the portion size, but people with high cholesterol levels should limit their shellfish consumption. When eating fatty fish, such as salmon and tuna, people must include it in their daily fat total.
Dairy and Eggs
The Swank diet recommends 2 servings a day of non-fat or low-fat dairy products. There is no restriction on servings of some dairy products, such as non-fat milk, non-fat cottage cheese, and fat-free cheese. Egg yolks contain saturated fat, so a person should eat no more than one whole egg three times a week.
Grain Products
The Swank diet recommends consuming 4 servings of grain products a day. People can eat bread, low-fat cereals, rice, pasta, and certain crackers, preferably whole grain products. People should avoid cakes and other baked goods that contain a fat source, such as butter or lard.
Caffeine and Alcohol
A person should consume no more than three caffeinated beverages a day. They can also consume 1 serving per day of wine or liquor.
Read also: Weight Loss with Low-FODMAP
Supplements
The diet recommends specific vitamin and mineral supplements, including:
- Cod liver oil
- A multivitamin with minerals
- Vitamin C
- Vitamin E
Research on the Swank Diet and MS
In 1990, Dr. Swank published a 34-year follow-up study on 144 people with MS. He reported that those who ate less than 20 g of saturated fat per day had less disease progression and were less likely to die than those who ate more saturated fat.
However, the study had several weaknesses:
- There was no control group for comparison
- The study lacked strict inclusion criteria
- There was a high drop-out rate among participants
Expanding on Dr. Swank’s work, a 2016 study looked at how following another plan, the McDougall Program, for 1 year affected people with MS. The McDougall Program is another very low-fat diet, but it also excludes meat, fish, eggs, dairy, and vegetable oils.
Those who followed the program did not see improvements in their brain scans or the number of flares they experienced, compared with the control group. However, they did report improved energy levels and positive changes in their BMI. Interestingly, cholesterol and insulin levels were lower in the diet group after 6 months, but not when the study ended.
Drawbacks of the Swank Diet
There are some drawbacks to the Swank diet:
- It is very restrictive, and some people may find it challenging to follow over a long period.
- One study found that people who followed the diet did not get enough vitamin C, A, E, or folate.
- People on a very low-fat diet, such as the Swank diet, may also experience drier skin and hair and have lower energy levels than other people.
Alternative Dietary Approaches for MS
Paleo Diet
Some people advocate a version of the Paleolithic, or “paleo” diet. Terry Wahls is a doctor, author, published researcher, and a clinical professor of medicine who also has a progressive form of MS. She has developed the Wahls protocol, which emphasizes a Paleolithic-style diet and excludes grains and gluten. A 2017 study found that it might help as part of a complementary approach to the management of progressive MS. Research is ongoing.
Gluten-Free Diet
In 2009, researchers found higher levels of gluten antibodies in people with MS, compared with those without the condition. The authors suggested that a gluten-free diet might help in some cases. A 2012 review also found a genetic link between celiac disease and other autoimmune disorders, such as MS.
General Recommendations for a Healthful Diet
Whether or not grains, gluten, or fat play a role in MS, all people are likely to benefit from a healthful diet.
A healthful diet involves:
- A low intake of sugar and salt
- A low consumption of processed foods
- A high-fiber diet, including fresh fruits, vegetables, lean proteins, and healthful fats
Specific Nutrients and MS
Sodium and Salt
Scientists have looked at how dietary salt might impact be a factor in MS activity. Some researchers have found evidence of:
- A link between dietary salt, increased inflammation of the nervous system, and decreased immune system function in mice
- A higher dietary salt intake and a higher chance of brain scarring and more frequent symptom flares in people with MS
However, later studies have found no links between salt and MS symptoms. Researchers need to do further studies to confirm whether a high salt intake increases the frequency or severity of MS symptoms.
Fish Oil
Fish oil contains omega-3 oil, which may be beneficial for nerve function and thinking. Some researchers believe that fish oil can help treat MS. CHECA 2012 study found no difference in multiple outcome measures between people with MS who took fish oil and those who took a placebo. In 2016, however, another study, concluded that fish-based omega-3s might reduce the risk of an MS diagnosis over a year.
Vitamin D
People with MS are more likely to have lower levels of vitamin D than other people. A small study indicated that vitamin D might reduce the occurrence of MS attacks. Participants who took a vitamin D supplement also had fewer nervous system scars visible on imaging. A more extensive 2017 study found that high-dose vitamin D might reduce a specific antibody level present in relapsing-remitting MS (RRMS).
Nutritional Adequacy of the Swank Diet
Many people now consider the Swank diet outdated. This study assessed the nutritional adequacy of seven-day menus developed by Swank and their compliance with the DGA; menus were modeled for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for males and females 31-50 years. Swank recommended dietary supplements corrected menu shortfalls in vitamins D, E, calcium, folate and iron but not dietary fiber, potassium and choline. Healthy Eating Index-2015 score for Swank menus (93.2/100) indicated good compliance with the DGA. Nutritional adequacy of the Swank modeled diet was similar to HEP for 17 vitamins and minerals (Mean Adequacy Ratios ≥94%) with similar shortfall nutrients except magnesium (HEP males) and dietary fiber (Swank males). Alternate Healthy Eating Index-2010 scores for Swank male (90/110) and female (88/110) model diets were similar to HEP. Swank menus have similar nutritional adequacy as HEP.
McDougall Program Study
On Tuesday, January 16, 2008 the McDougall Program made first contact with the Department of Neurology at Oregon Health & Science University (OHSU, the medical school in Portland, Oregon) with a proposal to study the effects of a very low-fat diet on Multiple Sclerosis (MS). OHSU was chosen because of Roy Swank, MD, head of the Division of Neurology at OHSU from 1954 until 1974.
In an effort to support Dr. Swanks’ observational research, we took on the task of doing a study that fellow scientists might respect: a single-blind, randomized, controlled trial of one year’s duration. On January 15, 2009, we received approval from the ethics board of OHSU to conduct this study. Those in the intervention group were sent to the McDougall Program in Santa Rosa, CA for a 10-day education and then asked to follow the diet for a year. The raters (neurologists, radiologists, and other analysts) were “blinded” as to which patients were in the intervention (diet) group and which were in the control group (staying on the Western Diet). Over the next 4 years, 61 people were enrolled in the study.
Our small study has demonstrated the high compliance rate of participants with the McDougall Diet after attending the 10-day Program in Santa Rosa, CA. Total fat intake for the diet group fell to 15% of the calories consumed, and remained at this level for one year. The control group continued to consume 40% of their calories as fat.
The diet group lowered their bad “LDL” cholesterol by 17.4 mg/dL and total cholesterol by 19.0 mg/dL. (The control group showed a 6 mg/dL reduction in both lipid measurements.) These reductions in cholesterol hold important significance for people with Multiple Sclerosis. Disease activity, as reflected by “enhancing lesions” found on MRI brain tests, is positively associated with both LDL and total cholesterol levels. Furthermore, research shows that more rapid disease progression and worsening disability is found in patients with higher LDL and total cholesterol levels.
Another important finding from our study was that triglycerides did not rise when people switched to a diet high in carbohydrates. There was actually a small reduction in these lipids (95 to 91.7 mg/dL) in their blood.
Our Diet & Multiple Sclerosis Study showed immediate and permanent positive changes in feelings of “well being” of patients with MS. Benefits for fatigue measurements were observed within a month of beginning the intervention diet and were sustained at the same improved level throughout the year.