Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic.

Nutrients. 2019;11(2)
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Multiple Sclerosis (MS) is an inflammatory, immune-mediated condition of the nervous system. The causes are unknown but are believed to be a complex interaction between genetics and environmental exposures, including diet. Although a number of dietary regimes have been advocated for people with MS, there is insufficient evidence to support any particular diet at present. A randomised clinical trial is currently being conducted to compare the effect of two diets, the low saturated fat Swank and the modified Paleolithic Wahls Elimination Diet (WahlsElim), on MS-related fatigue. The aim of this review is to provide an overview of the published research on the use of the Swank and Wahls™ diets. Both diets and their rationales are also described in detail. Evidence in favour of the Swank diet, which was developed in 1948 by Dr Swank, comes from a long-term cohort study which showed that MS exacerbations were less frequent and less severe in those who followed the low saturated fat diet strictly, although patients with more advanced disability and in the progressive phase of the illness continued to decline even when they were following the Swank diet. The WahlsElim diet was originally developed in 2008 by Dr. Terry Wahls. Two small intervention studies found benefits of this protocol in terms of decreased fatigue and disability. All three studies mentioned above had a number of limitations, including lack of control group. The authors conclude that more research into dietary approaches to MS is needed.


The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two diets promoted for MS, low saturated fat Swank and modified Paleolithic Wahls Elimination (WahlsElim), are currently being investigated for their effect on MS-related fatigue and quality of life (NCT02914964). Dr. Swank theorized restriction of saturated fat would reduce vascular dysfunction in the central nervous system (CNS). Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet). Dr. Wahls further theorized restriction of lectins would reduce intestinal permeability and CNS inflammation (WahlsElim version). The purpose of this paper is to review the published research of the low saturated fat (Swank) and the modified Paleolithic (Wahls™) diets and the rationale for the structure of the Swank diet and low lectin version of the Wahls™ diet (WahlsElim) being investigated in the clinical trial.

Lifestyle medicine

Fundamental Clinical Imbalances : Immune and inflammation
Patient Centred Factors : Mediators/Diet type/multiple sclerosis
Environmental Inputs : Diet ; Nutrients
Personal Lifestyle Factors : Nutrition
Functional Laboratory Testing : Not applicable

Methodological quality

Allocation concealment : Not applicable
Publication Type : Journal Article ; Review