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What is the Swank Diet for Multiple Sclerosis?

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Updated December 01, 2012

There is no doubt that many of you have heard about the Swank Diet for multiple sclerosis (MS). It was one of the first things that I ran across when I started investigating alternative and complementary approaches to managing my disease.

After reading testimonials and case studies, I gave it a half-hearted shot. I failed to stick to it for 36 hours – I was unprepared to make a drastic lifestyle change and was trying to stick to this very low-fat dietary approach by just cutting things out of my usual graduate student menu of pizza and cafeteria fare.

I now am a pretty healthy eater, being gluten-free and mostly vegetarian. I can see the merits of the Swank Diet. It is a very healthy way of eating for pretty much anyone, MS or not.

For an overview of the particulars of the Swank Diet, see Basic Rules of the Swank Diet for Multiple Sclerosis.

Theory Behind the Swank Diet

Dr. Roy Swank was a neurologist who started considering that diet might play a role in MS after considering the geography and epidemiology of MS. MS is far more prevalent in the United States, Europe, Canada and Australia than in other parts of the world, such as Asia or Africa. In the places with high MS prevalence, the diet tended to be high in fat – over 100 grams of saturated fat per day. When Dr. Swank looked at Norway, people who lived in fishing communities (where fish is the main part of their diet) were 8 times less likely to develop MS than those who lived in the mountains (and primarily ate meat).

Looking at the effects in the body on high consumption of dietary fat, Dr. Swank noted that after eating a high-fat meal, the blood cells would clump together and be able to block circulation in capillaries. He hypothesized that these clumps were blocking the tiny blood vessels in the blood-brain barrier and leading to inflammation and lesions in the central nervous system.

Thus, the theory goes that if you cut out the fat, you eliminate the clumps of blood cells. No more clumps means no more blockages and no more inflammation. This should mean (theoretically) that MS lesions should stop occurring.

Dr. Swank started his research in the mid-1950s by putting 25 people with MS on a very low-fat diet. Six of these people dropped out of the study and five of them died. The 19 people who remained on the diet did not have any disability progression.

He repeated that research and followed a group of 144 people with MS for 34 years to find pretty much the same results. 95% of those who stayed on a diet of 20 or less grams of saturated fat a day did not experience disability progression. After 34 years, they had a death rate of 31%, compared to the group following a more typical high-fat diet, which had a death rate of over 80%. The diet was not only protecting people from MS progression and death from MS-related causes, it was preventing other lifestyle diseases, as well.

Bottom Line

I think there is some validity in the Swank Diet. Unfortunately, the whole idea of diet having an impact on MS has been largely disregarded by the neurology community, claiming that the study was flawed. When I asked my neurologist about diet, he cut me off mid-sentence, saying something to the effect of, "Do you want to hear about real medicine now? Eating a healthy diet might help other problems, but not MS."

I disagree. The better I eat, the better I feel. I have fewer MS symptoms. It's as simple as that. Does the Swank Diet stop progression of MS? I don't know for sure, but I bet it does have an impact. I'm not sure the mechanism is fully known. There is very interesting research being done on the role of gut bacteria in the MS disease process at this time that shows that a high-fat, meat laden Western diet promotes the growth of gut bacteria that contribute to inflammatory diseases, whereas people who eat a low-fat, plant-based diet have a completely different profile of gut bacteria, which is anti-inflammatory.

Clearly, there is still much to learn about the role of diet in MS. I am happy to see that there is a study being conducted at the University of Oregon, Low Fat Diet and Multiple Sclerosis that is looking at the effects of a low-fat vegetarian diet on MS relapse rates, fatigue, depression and quality of life, as well as serum markers of inflammation. The diet will also be assessed for safety and tolerability in those people following the diet.

One thing that I have heard from physicians (of all specialities, not just neurologists) is that changing a diet and adopting a new way of eating is "too hard." I think many doctors lose interest in dietary interventions because they are convinced that their patients cannot be adherent to such a plan, especially if the results are not immediate. I disagree. I think many people with MS are motivated and would willingly adopt a new way of eating if it was endorsed by the medical community.

Sources:

Swank R. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet. 1990 Jul 7;336(8706):37-9.

Swank, Roy Laver and Dugan, Barbara Brewer. The Multiple Sclerosis Diet Book: A Low-Fat Diet for the Treatment of MS. New York: Doubleday, 1987.

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