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The Swank Diet
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[2008 updates are highlighted in red]
| Description: |
In the 1940s, Dr. Roy Swank developed a dietary approach that has been reported to be an effective treatment for MS. With this diet, saturated fat intake is decreased to 15 grams or less daily, high-fat dairy products are excluded, frequent fish meals are recommended, and 10–15 grams of fluid vegetable oil and five grams of cod-liver oil are added to the daily diet.
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| Rationale: |
This diet was developed due to the apparent association of dietary fat intake with MS. Specifically, early epidemiological studies indicated that MS is less common in populations that consume relatively low levels of saturated fats and relatively high levels of polyunsaturated fatty acids (PUFAs). Studies conducted subsequent to the development of the Swank diet have provided additional rationale for this type of dietary approach (see below under “Supplementation with Omega-6 Fatty Acids” and “Supplementation with Omega-3 Fatty Acids”). |
| Evaluation: |
There have been several reports of the initial group of people with MS who were treated with the Swank diet. In one of these reports, 134 people with MS were monitored for 34 years on the Swank diet. In the first year on the diet, the rate of MS attacks was decreased by 70 percent relative to the attack rate prior to entering the study. Unfortunately, there was no placebo-treated group in this study. As a result, the people in the study were compared to people with MS reported in the medical literature who did not receive any type of MS treatment (“natural history controls”). When this type of comparison was done, it was found that people on the diet had less frequent attacks, less progression of neurological disability, and decreased mortality. These beneficial effects were greatest in those who adhered strictly to the diet and those who were mildly affected or were early in the course of the disease. Although these findings are encouraging, this study has significant shortcomings. As noted, there was no placebo-treated group. In addition, people who were treated were not randomly selected for treatment (“randomised”) and the examining clinicians and the treated patients were not “blind” to whether they were being treated. Due to these and other shortcomings, this study is not rigorous enough to provide definitive conclusions about the effectiveness of this dietary approach. |
| Risks: |
This diet is usually well tolerated. Long-term adherence to the diet may not be possible because the recommended food is not appealing. Due to the decreased meat intake in the Swank diet, people who use this dietary approach should be certain that protein intake is adequate. Although cod-liver oil, one component of this diet, is generally safe, it may rarely cause adverse effects. Cod-liver oil may have a blood-thinning effect and should be used with caution by those who take aspirin or anticoagulant medication, are undergoing surgery, or have bleeding disorders. Diabetics should also use cod-liver oil with caution. Finally, cod-liver oil contains relatively high concentrations of vitamin A, which may be toxic in doses greater than 10,000 IU. |
| Costs: |
The Swank diet is inexpensive. |
| Committee opinion: |
In the opinion of the Committee, the Swank diet is an inexpensive and relatively safe dietary approach that has produced suggestive results in a limited MS clinical study. Due to the inadequacies of the Swank diet clinical trial, definitive conclusions cannot be made about the safety or effectiveness of this diet in people with MS. Further study of the Swank diet is needed. The safety and effectiveness of the Swank diet in combination with disease-modifying medications (interferons, glatiramer acetate, mitoxantrone, and natalizumab) has not been studied. |
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