Some of the original studies on MS and dietary fat were done by Dr. Roy Swank. Because of the apparent association of dietary fat with MS, in 1948, he began treating people with MS with a specific diet. The diet involves a very low intake of saturated fat and a high intake of polyunsaturated fatty acids. Saturated fat is decreased to 15 grams per day. No red meat is allowed in the first year. Thereafter, 3 ounces of red meat per week are permitted. The diet does not allow high-fat dairy products or processed foods that contain saturated fats. A high intake of polyunsaturated fatty acids, cod liver oil supplements, frequent meals with fish, and a multivitamin also is recommended.
In 1970, Dr. Swank reported the results of his diet in people with MS (1). On average, he observed patients over a 17-year period. People on the diet had less frequent and less severe attacks, less worsening of their overall neurologic condition, and a decreased death rate. The diet was reported to be most beneficial when it was started in people who were early in the disease course or who had mild disability. Some of the results were dramatic. For example, he described a 95 percent reduction in the frequency of MS attacks.
A follow-up report was published in 1990 (2). In this report, 144 patients were monitored over 34 years. Once again, the diet produced significant benefits and appeared to be especially effective when started in people who were mildly affected or were early in the disease course.
In 2003, Dr. Swank published another follow-up to his initial clinical trial (3). This report described people who had been on his diet for 50 years. Of the 15 people who were examined, only two had significant disability. The other 13 people had done well neurologically, had "joyful laughter," and "appeared youthful." Although these findings are impressive, no description of standard neurologic test results was given, and the examined group represented only a small subgroup of the 144 people who were originally enrolled in the study.
As noted, this diet is strict. Saturated fat intake is very low and polyun-saturated fat intake is high. Because of the decreased intake of meat, people who follow this diet should be certain that protein intake is adequate.
Most physicians and other health care professionals have a reserved approach to the Swank diet because the study was not carried out by guidelines that are now traditionally used in trials of new medical therapies. In particular, patients were not randomly given a specific therapy (randomization), the clinician who examined the patients was aware of their treatment (in other words, the clinician was not "blinded"), and no placebo-treated group was used.
The Swank diet is a fairly extreme dietary approach without strong clinical studies to support its use. More details and specific recipes are provided in a book by Dr. Swank and Barbara Dugan, The Multiple Sclerosis Diet Book.
Other low-fat diets are more conservative than the Swank diet. It is not clear that the Swank diet is superior to these other low-fat diets; no clinical studies have compared the Swank diet with a less strict low-fat diet. General dietary guidelines that decrease saturated fats, increase fiber and polyunsaturated fatty acids, and maintain a well-balanced diet are outlined in Table 18.1. These guidelines are relatively easy to follow, are practical, and may produce beneficial effects.
TABLE 18.1. General Diet Guidelines That May Be of Benefit for MS and General Health
■ Choose whole grain cereals and breads.
■ Eat several daily servings of fruits and vegetables.
■ Decrease total fat in diet to 30 percent or less of calories.
■ Limit saturated fat intake.
■ Eat fish two to three times per week.
■ Choose a diet moderate in salt, sugar, and alcoholic beverages.
■ Drink plenty of fluids and water.
The dietary recommendations in Table 18.1 have not been tested clinically. However, it could be beneficial for people with MS and may improve general health by decreasing the risk of heart disease, stroke, and possibly other conditions.
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