The Swank Diet

      The Swank Diet is a low-fat plan proposed in 1950 for MS treatment by Dr. Roy Swank, an academic neurologist at the University of Oregon1. Swank designed the diet to “slow progression of the disease as well as benefit overall health.” It was based on an observed link between the increasing incidence of MS with concurrently increasing consumption of saturated animal fats2. Swank theorized that saturated fats became lodged in the smallest of blood vessels of the nervous system, denying nerves the circulation and nourishment they need to function normally3.

Swank tested this connection over a 50-year period by placing MS patients in several countries on overall low-fat (up to 55 grams per day) and very low saturated fat (10-15 grams per day) diets and assessing the progression of disease. It was found that approximately 20% of the patients on the lowest fat diet showed little or no neurologic deterioration. While this might seem like a low number, it’s five times what could have been expected4.

The following are details of the Swank diet as it evolved over the period of research.

Overview

• Saturated fat: 15 or less grams per day (5 grams = 1 tsp)

• Unsaturated fat: 20-50 grams per day

• Grains: not restricted; should be whole

• Gluten: not restricted

• Additional supplements: multi-vitamin and mineral, vitamins A and D

Foods to Favor

• Commercially prepared/processed food: boxed or canned food without hydrogenated fat, shortening or butter, and without saturated fat exceeding 1 gram per serving 

• Omega-3 polyunsaturated fatty acids: encouraged from oily fish, flaxseed, cod liver oil fluid or tablets, and other supplements

• Vegetable oils high in unsaturated fatty acids: for example, olive, peanut, rapeseed (canola), safflower, sesame seed, soybean, and sunflower seed

• Fruits: The recommended daily amount of fruit servings is two. All naturally fat-free fruits are permissible in any amount. Fresh fruits are preferred since they contain the most nutrients, followed by frozen, and then canned. The following fruits contain unsaturated fatty acids and must be counted in the daily oil allotment (each suggested serving yields 5 grams of fat): avocados (⅛ = 2 gently rounded tablespoons mashed = ¼ cup cubes or slices) and olives (10 medium or 5 jumbo = ¼ sliced).

• Vegetables: The recommended daily number of servings is two (1 cup raw or ½ cup cooked = 1 serving). Vegetables provide vitamins, minerals, antioxidant phytonutrients, and fiber. A variety of vegetables is encouraged.

• Grains & Cereals: All breads, pastas, and rice are permissible, and whole-grain products are encouraged. Refined, unenriched products are allowed, but not preferred. Cold and hot cereals with the least amount of saturated fat are favored, as are crackers containing no shortening, butter, margarine, or processed oils. Chips made without fat are permissible. For dessert, angel food cake is noted as acceptable, as it does not contain egg yolks or shortening.

• Nuts and seeds: These are encouraged as good sources of essential fatty acids, either as is or as butters that are free from hydrogenated oils.

• Eggs: Egg whites are naturally fat-free, and so can be used without limits. Each yolk contains 5 grams of fat, most of which is saturated. Three eggs per week are allowed in this plan, but only one at a sitting.

• Red meat: none for the first year; after the first year, 3 oz (85 g) or less (cooked weight) per week, depending on the degree of fattiness – the leaner the meat, the more is allowed. Lean meats according to Swank’s guidance include lamb leg, liver (chicken, turkey, beef, calf, pork), kidney (pork, veal, lamb), the lean portion of heart (calf, beef), tongue (calf only), gizzard (chicken), and wild game like rabbit, venison, and elk.

• Poultry: The recommended portion is four oz (114 g). Skinned, trimmed white chicken or turkey meat is permissible. Avoid processed meat products such as ground turkey and chicken, which may contain dark meat, skin, and fat; luncheon meats made from pressed turkey and chicken; and canned turkey and chicken products.

• Seafood: All white fish are permissible in any amount (e.g., cod, abalone, halibut, snapper, smelt, flounder, sole, sturgeon, tuna canned in water, shark, mahi, haddock, perch, pollock). All shellfish are permissible in any amount (e.g., clams, crab, lobster, oysters, scallops, shrimp – for those patients with elevated cholesterol levels, shellfish is recommended to be eaten infrequently). Fatty fish are encouraged, but specified that they must be counted in the daily oil allowance of 50 grams (10 tsp.) per day; a serving is 1-2 ounces depending on the degree of fattiness (fatty fish include tuna, salmon, trout, sardines, and herring).

• Condiments: With the exception of mayonnaise, condiments such as mustard, catsup, relish, barbeque sauces, taco sauces, sweet and sour sauces, herbs and spices are permissible in any amount. Mayonnaise contains unsaturated fatty acids (oil) and must be counted in the daily oil allotment.

Foods to Forgo

• Commercially prepared/processed food: any boxed or canned food containing hydrogenated oil, shortening, or butter and exceeding 1 gram of saturated fat per serving.

• Imitation dairy products: Note that those that were discouraged when the diet was composed were very different from those of today, and now provide much less trans fat. However, most still contain more than the 1% fat favored by Swank.

• Oils and spreads: Those high in saturated and artificial trans fats are discouraged on this plan. Examples include butter, cocoa butter, coconut oil, hydrogenated oil, lard, margarine, palm oil, shortening.

• Grains and cereals: Baked goods containing an undesirable oil, including hydrogenated, palm, or coconut oil, lard, butter, margarine, or shortening; commercially prepared chips and fancy crackers; granola, which is usually high in fat; commercially prepared pastry usually contains shortening, butter, margarine and/or processed oil

Beverages

• Caffeine-containing products increase nervousness and insomnia, as well as frequency and urgency to urinate. Therefore, it is necessary to limit these beverages to a maximum of 3 cups daily (can be combined). If an increase in symptoms occurs, do not consume caffeine.

• Alcohol: Swank noted that most MS patients tend to be sensitive to alcoholic beverages, but permits a glass of wine or a cocktail with the evening meal.

Supplements

The following daily supplements are recommended:

• 1 tsp. cod liver oil or 4 capsules (to be counted in the daily fat allotment). Because it is high in vitamins A and D, additional supplemental sources of these are recommended be restricted to only one therapeutic multiple vitamin and mineral capsule per day (not mega doses).

• 1 multiple vitamin with minerals (see #1 above).

• 1,000 mg vitamin C

• 400 IU vitamin E

References

1. Parks NE, Jackson-Tarlton CS, Vacchi L, Merdad R, Johnston BC. Dietary interventions for multiple sclerosis-related outcomes. Cochrane Database Syst Rev. May 19 2020;5:CD004192. doi:10.1002/14651858.CD004192.pub4

2. Swank RL. Multiple sclerosis: fat-oil relationship. Nutrition. Sep-Oct 1991;7(5):368-76. 

3. Swank RL, Goodwin JW. How saturated fats may be a causative factor in multiple sclerosis and other diseases. Nutrition. May 2003;19(5):478. doi:10.1016/s0899-9007(02)01099-7

4. Swank RL, Goodwin J. Review of MS patient survival on a Swank low saturated fat diet. Nutrition. Feb 2003;19(2):161-2. doi:10.1016/s0899-9007(02)00851-