Swank and Wahls Diets Show Positive Impact on Weight, Cholesterol in Relapsing MS

Tyler Titcomb, PhD, RDN, IFNCP

New 36-month findings from the WAVES randomized trial showed that individuals with relapsing-remitting multiple sclerosis (RRMS) had reductions in weight and cholesterol after utilizing either Swank or Wahls diets. Furthermore, these approaches may be even more beneficial for those with elevated weight or cholesterol.¹

Lead author Tyler Ticomb, PhD, RDN, IFMCP, post-doctoral scholar, Wahls UIHC Clinical Research Lab, University of Iowa, presented these findings at Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, held February 24-26, in West Palm Beach, Florida. This dataset presentation comes following presented data on the initial 12 weeks of the study at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28.

After patients underwent this 12-week run-in period, they were randomized 1:1 to either Swank (n = 44) or Wahls diets (n = 43) and evaluated at 4 study visits: run-in, baseline, 12-weeks, and 24-weeks. In total, 77 individuals completed 12 weeks and 73 completed 24-weeks follow-up.

Similar to what was previously observed, patients in both groups demonstrated statistically significant reductions in total cholesterol, low-density lipoprotein (LDL), body weight, and body mass index at the 12- and 24-week time points. In the Swank group, investigators recorded mean fasting insulin levels of 4.84 (±0.47) and 5.05 (±0.63) at those periods (P <.0001 for both), a significant decrease from 8.84 (±1.56) at baseline. As for those in the Wahls group, the insulin values did not change from 6.52 (±0.83) at baseline.

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The diets differ slightly. The Swank diet focuses on low saturated fat intake, with all participants encouraged to consume 4 servings of grains, fruits, vegetables each day, and to limit fat consumption to less than 15 g per day. On the other hand, the Wahls Elimination diet, is a modified version of a paleolithic diet, and encourages 6-9 servings of vegetables and berries each day, with total avoidance of gains, nightshades, dairy, and eggs.

Triglycerides significantly reduced from 105 mg/dL (±8.0) at baseline to 86.6 (±7.7) at 12 weeks and 79.9 mg/dL (±6.0) at 24 weeks among the Wahls group (P <.0001 for both); however, those in the Swank group did not see a change from 92.7 mg/dL (±8.6) at baseline. Significant reductions in high-density lipoprotein (HDL), from 63.0 mg/dL (±2.3) at baseline to 57.3 mg/dL (±2.1) and 59.6 mg/dL (±2.3) at weeks 12 and 24, respectively, were observed in the Swank group, whereas HDL values among those in the Wahls group did not change from 65.5 mg/dL (±2.7) at baseline.

There was also a significant reduction in diastolic blood among the Wahls group, from 77.3 mm Hg (±1.7) at baseline to 73.2 mm Hg (±1.5) at 12 weeks and 73.4 mm Hg (±1.9) at 24 weeks. Neither group demonstrated significant changes in serum glucose, hemoglobin A1c, or systolic blood pressure.

"Studies are ongoing right now to try and tackle this,” Titcomb said in his presentation at CMSC’s annual meeting. “Possible mechanisms of these [diets] include modulation of the microbiome, inflammation, the immune system, or micronutrient optimization. The key thing to note is about dietary intervention studies in multiple sclerosis is that we do not know if diet impacts disease activity or not."

Original 12-week data from WAVES showed that the Swank diet group (n = 38) reported total Perceived Deficits Questionnaire (PDQ) scores of 25.1 (±2.00), compared with 32.4 (±2.36) at baseline, while the Wahls group (n = 39) reported total scores of 29.1 (±2.71), compared with 35.9 (±2.16) at baseline, both being a significant improvement (P ≤.05). At 24 weeks, those scores remained significant at 26.1 (±2.14) and 25.1 (±3.03), respectively (P ≤.05).²

For more coverage of ACTRIMS Forum 2022, click here.

REFERENCES
1. Titcomb TJ, Eyck PT, Rubenstein L, Snetselaar LG, Wahls TL. Impact of Swank and Wahls diets on metabolic health among individuals with relapsing remitting MS: a secondary analysis of the WAVES trial. Presented at: ACTRIMS Forum 2022; February 24-26; West Palm Beach, Florida. Abstract P099.

2. Titcomb T, Eyck PT, Hoth KF, Snetselaar L, Wahls T. Effect of the Swank and Wahls elimination diets on perceived fatigue and cognitive dysfunction in relapsing-remitting multiple sclerosis: a randomized parallel-arm trial. Presented at: CMSC 2021; October 25-28; Paper 7210.