Talk:Swank diet

Whether Reference 1 Indicates Swank's Work Methodologically Unsound
The current version of this article states that the reason reference 1, the paper "Dietary interventions for multiple sclerosis", could not confirm Swanks's results is that Swank's work was methodologically unsound. Here is what the paper says about why it did not include the Swank case series in this paper:

"With the present review we are not able to confirm the positive results claimed in a broad case-series study (Swank 1990) on a dietary treatment developed by Dr Roy Swank. Swank started a dietary approach for MS treatment in the 1940s, which is still widely recommended in the patient community. The main aim of the Swank diet is a drastic reduction of intake of saturated fat (< 15 g/day) and supplementation with vegetable oil and cod liver oil. The study design he used did not fit the inclusion criteria considered for this review and, as an observational study, a proper protocol and statistical tools will be necessary to analyse and discuss such a study."

The authors of the paper do not seem to be stating that Swank's methodology was unsound. I think they are simply saying that their own paper did not include observational studies and that their own paper is not going to go to the effort of writing a proper protocol and using statistics to analyze the data from Swank's case series.

It seems like the claim in this article about Swank's work being methodologically unsound is not supported by the reference. David H. Barr (talk) 08:14, 10 December 2015 (UTC)
 * ✅ Yup - fixed. Alexbrn (talk) 08:25, 10 December 2015 (UTC)

Possible Additional Topics
Current version of this article is sparse on information for an encyclopedia article. Seems like the following topics would be appropriate additions: - Origins of the theory of the diet. - Research done to test the theory: types of studies, scope of studies, and outcomes. - Types of research still needed before the theory can be considered proven. - Cost, side effects, and effectiveness compared to the standard treatments of interferon beta and mitoxanthrone based on studies to date. - Popularity in the MS community. - Similarity to other plant-based diets that are proven to reverse diseases that aggravate MS. - Compliance rate of patients in studies. - Whether or not the Tomato Effect may be affecting acceptance of the diet by the medical community. - The credentials of Dr. Swank. - The book about the diet: The Multiple Sclerosis Diet Book David H. Barr (talk) 08:29, 12 December 2015 (UTC)
 * We'd need some reliable secondary sources as a basis for this, and WP:MEDRS for anything that went into biomedical considerations. Do such sources exist? Alexbrn (talk) 08:42, 12 December 2015 (UTC)

Thanks for the guidance. I will look for secondary sources for the non-biomedical topics and WP:MEDRS sources for the biomedical topics.David H. Barr (talk) 05:29, 13 December 2015 (UTC)
 * To be clear, primary sources are okay to "fill in the gaps", but the basis of the article is better built out of secondary sources. Alexbrn (talk) 05:56, 13 December 2015 (UTC)

"No Good 'Medical Evidence'" Seems Binary
This article says “As of 2015 there is no good medical evidence supporting the use of the Swank diet.[2]” The referenced recommendation by the British Dietetic Association is a secondary source that in its brief section on the Swank diet does not identify which of its references its comments are based on. I looked at the first two references listed for the entire document and found that their recommendations are binary and do not appear to follow the multilevel approach of “medical evidence” referred to in medical evidence link above. Also one of the sources implied that the Swank diet is unhealthy with no supporting documentation and used that unsupported premise in its argument for not recommending it. David H. Barr (talk) 08:33, 12 December 2015 (UTC)
 * We're not spoilt for sources, and it's from a respectable organisation. It's conclusions seem uncontroverial given what we know from the sources we *do* have. Alexbrn (talk) 08:44, 12 December 2015 (UTC)

Source of Quotations and Journal References
A good source of quotations and references to journal articles for someone interested in expanding this article are the following articles and videos on www.nutritionfacts.org. One can pause the videos to read quotations and look at top of journal page to see which of the references the quotation comes from: Article: “Plant-Based Diets for Multiple Sclerosis” Video: “Treating Multiple Sclerosis With the Swank MS Diet” Article: “How to Treat Multiple Sclerosis With Diet” David H. Barr (talk) 08:29, 12 December 2015 (UTC)
 * That whole site looks dodgy. We should only use sources in line with our medical sourcing guidelines for discussions of treatment efficacy. Alexbrn (talk) 08:52, 12 December 2015 (UTC)

Am new to Wikipedia. Thanks for medical sourcing guidelines link. David H. Barr (talk) 04:15, 13 December 2015 (UTC)

Main Swank study published in The Lancet (one of the most important medical journal of the World) but is not cited
As this page is about “Swank Diet” we should cite the main study that conducted Swank to the development of his diet. It is a study plublished in one of the most important medical journals of the world, The Lancet (http://dx.doi.org/10.1016%2F0140-6736%2890%2991533-G). It does not mean this is the proof that Swank diet works or does not work; it rapresents a description of how Swank developed it.

I wrote: Swank enrolled 144 people with multiple sclerosis and started them to his diet. In 1990, after 34 years of follow-up, Swank published the results of his study in the international journal The Lancet [1]: those who had less than 20 grams of saturated fats per day (good dieters) had a significantly better physical and mental outcome compared with those who had more than 20 grams of saturated fats per day (poor dieters).

Of course we can modify it but we should cite this study.

--FarinaD (talk) 17:21, 4 June 2016 (UTC)
 * 'Work' for what?

Arguably, there are good, common-sense approaches to human diet, then there are medical-sounding claims of curative efficacy. A purely harmless and likely generally beneficial diet can lack evidence for its specifically-curative efficacy.

In human subjects research (HSR), we are concerned with BOTH safety and efficacy. Let me cite a somewhat well-known story about a medicine for which strong evidence had been gathered for its safety. Researchers were fully convinced that the pharmaceutical was truly safe, so massive marketing efforts were conducted to sell the product far and wide. This drug for x was truly a safe drug to take - contrasted with the previous treatment for the same condition, for which harmful 'downsides' had been observed. Lots and lots of folks bought and used the pharmaceutical, and truly, no one was noted as being harmed by the drug. However, doubts about its efficacy began to appear, the previous evidence for its efficacy was reviewed, and doubt was cast upon its efficacy. New efficacy research was done and the conclusion was that the truly safe drug indeed did absolutely nothing more than a harmless placebo.

So, let me ask you, is there ANY solid, strong evidence that any aspect of the 'Swank diet' is medically harmful either for persons diagnosed with MS or others? Does the cited discourse concern claims made BY some advocates for 'curative' benefits or about the general advisability of the seemingly 'good-sense' and 'evidence-based' diet (as standard practice), and as standard practice compared with what other standard practices (MAD? and SAD?)?

Apart from the doubts about ANY 'curative claims' advanced for ANY evidence-based diet (for maintaining general health - ADVICE: "keep your health, whatever good health you currently have!"), is this Swank diet 'advice' IN LINE with currently evidence-based advance for sustaining, maintaining generally good health, vitality, and productivity?

DISCLOSURE: My personal diet is consistent with this diet's general, underlying strategies but is NOT in line with several of its prescriptions (since I use NO dairy and NO meat or animal products, no saturated fat, few - and often no - processed foods, no added oils, and take omega 3s only from ground flaxseed). MaynardClark (talk) 19:54, 4 June 2016 (UTC)

I don’t want to open a scientific discussion about swank diet, wiki talks is not the place. In wiki we don’t have to judge information, I am saying that it makes no sense that in the page “Swank Diet” the main study that brought Swank to the development of his diet is not even cited, furthermore it is published on one of the most important medical journal of the World, The Lancet. I don’t care about your personal diet choices, our personal belief does not have to influence Wikipedia pages. I repeat, in the page “Swank Diet” we have to cite the study on which “Swank Diet” is based, otherwise the page “Swank Diet” has no sense. So I am still convinced that we should write this: “Swank enrolled 144 people with multiple sclerosis and started them to his diet. In 1990, after 34 years of follow-up, Swank published the results of his study in the international journal The Lancet : those who had less than 20 grams of saturated fats per day (good dieters) had a significantly better physical and mental outcome compared with those who had more than 20 grams of saturated fats per day (poor dieters).” --FarinaD (talk) 09:28, 6 June 2016 (UTC)
 * It's an unreliable source for a discredited fringe diet. It might be acceptable as WP:EL, but for the diet itself we must summarize accepted knowledge as appears in secondary publications, rather than try and research/sift the original material ourselves. Alexbrn (talk) 11:25, 6 June 2016 (UTC)

"It's an unreliable source": it represent your personal opinion. The Lancet is one of the most important medical journal of the world, you cannot say it is unreliable. We cannot arbitrary omit a paper published in a so important journal just because someone retain it is unreliable. Again, we have to add the reference to The Lancet article and a briefly description of what the article say, we cannot judge information if they come from a reliable sources as The Lancet is. I tried to write a neutral description of what the article say, it is possible to modify it but we have to cite it, I propose again this paragraph: “Swank enrolled 144 people with multiple sclerosis and started them to his diet. In 1990, after 34 years of follow-up, Swank published the results of his study in the international journal The Lancet : those who had less than 20 grams of saturated fats per day (good dieters) had a significantly better physical and mental outcome compared with those who had more than 20 grams of saturated fats per day (poor dieters).” --FarinaD (talk) 20:29, 6 June 2016 (UTC)
 * Primary sources are unreliable for biomedical content. That is not my opinion, but part of the WP:PAGs; see WP:MEDRS. Swank made a claim in his paper; it hasn't been substantiated. Any commentary on this needs to come from secondary sources. Alexbrn (talk) 02:00, 7 June 2016 (UTC)

It is not mandatory to not accept primary sources in wikipedia as I read in your link WP:MEDRS, even in the medicine field. I will do some examples, just to stay in the field of multiple sclerosis: - in the article Chronic cerebrospinal venous insufficiency are cited 2 articles that defined the CCSVI as deseas. They are 2 primary sources (n. 1-2). It makes sense, if we are describing ccsvi we cite primary sources about ccsvi - in the article Stem-cell therapy, where the article speak about multiple sclerosis, 1 primary sources is cited (n. 14). It makes sense, if we are talking about the possible role of stem cells in MS we cite primary sources about stem-cells and MS. Moreover, in the main article of Multiple Sclerosis: - it is cited ccsvi primary sources (n. 120) - in the part of Medication are cited several primary source: 110, 111 and 112 (this is not even a published study but just a press release) I am sure that if a I search more I will find a lot of other primary sources cited in medical wikipedia articles. So why we don't have to cite the primary source about Swank Diet? If our article speaks about Swank Diet it has sense to cite the primary source on which Swank Diet is based, moreover it is a source published in one of the most important medical journal of the world, The Lancet. So I am still convinced that we should write this: “Swank enrolled 144 people with multiple sclerosis and started them to his diet. In 1990, after 34 years of follow-up, Swank published the results of his study in the international journal The Lancet : those who had less than 20 grams of saturated fats per day (good dieters) had a significantly better physical and mental outcome compared with those who had more than 20 grams of saturated fats per day (poor dieters).” --FarinaD (talk) 20:20, 8 June 2016 (UTC)
 * I would want to tweak that editorially, grammatically, etc. MaynardClark (talk) 01:18, 9 June 2016 (UTC)
 * Exactly which editorially are you referring? --FarinaD (talk) 15:31, 14 June 2016 (UTC)

Did Dr. Roy Laver Swank change his mind over time?
Later interviews with Dr. Roy L. Swank (by various medical doctors) seem to suggest a morphing or adjustment of some of his earlier views, in ways that don't match this article's description of 'the Swank Diet'. However, The Multiple Sclerosis Diet by Roy Laver Swank and Barbara Brewer Dugan may be a reference which should be cited (as a definition). I would suggest that, if Dr. Swank introduced THE IDEA of a low fat diet as less stressful for those with chronic MS, then illustrated that diet with recipes and a further 'buildout' of his theories, maybe the relationship between dietary fat and chronic conditions (including MS) should be discussed. Are hs results challenged by later or other studies, or are they merely not substantiated?

Dr. Swank's work seems to have been observational. He had been head of the University of Oregon's neurology department and then became a practicing physician at the Oregon Health Sciences University, where he observed that MS patients improved on a low-fat diet which was monitored. Wasn't this a very long time ago, in the 1950s? By what standards should 1950s era clinical researchers be evaluated?

In 2016,, the National MS Society's page on Diet & Nutrition: Eating healthy to take charge of your health, presents some perspectives on dietary strategies in the management of MS. They also link to a two-page discussion on "Is there an MS diet?" and related articles in Momentum Magazine, mentioning Dr. Swank and Dr. John A. McDougall, who wants to modernize Swank's low-fat dietary prescription. MaynardClark (talk) 02:27, 7 June 2016 (UTC)

Hi MaynardClark, you say that we should cite the The Multiple Sclerosis Diet by Roy Laver Swank and Barbara Brewer Dugan. I agree but I think we should also cite the publication of Swank in The Lancet (http://www.sciencedirect.com/science/article/pii/014067369091533G), it has much more scientific value than a book. --FarinaD (talk) 15:29, 14 June 2016 (UTC)