McDougall Interview with Dr. Roy Swank, MD

Dr. Roy Swank, MD is the founder of the Low Fat Diet treatment for multiple sclerosis. Dr. Swank served as the head of the Division of Neurology of the University of Oregon Medical School (Oregon Health & Science University) for 22 years, and has published many papers in the most respected scientific journals on this subject. The following is a transcript of an interview with Dr. Swank conducted by John McDougall in 1998: John McDougall (JM): Dr. Swank, most of us have heard of MS; could you give us a rundown on what the life of a person with MS is like? Swank: These people are all energetic before they get the disease–they are driven people, always wanting to be busy. Once they get the disease they can’t be that active. So fatigue becomes a very important symptom. Then they begin to have neurologic symptoms, with repeated exacerbations, until they become quite disabled. They may have double vision or blindness at one time or another. They may lose control of their bladder, arm or leg. There is usually a partial recovery from these attacks, but they reoccur and become more severe. Soon patients have difficulty walking, they lose their balance and become clumsy; they have numbness and tingling, and sometimes burning. These things continue on and the course is steadily downhill. At about 10 to 15 years they often end up confined to a bed or wheelchair. Because of the disability and fatigue, they lead a very frustrated life. Patients go from a cane to a wheelchair to bedridden. Only about 5 to 10% of patients have a milder type of disease that does not result in this 0gloomy future. JM: Forty years ago you figured out that MS was caused by food. How did you reach this conclusion? Swank: At that time doctors thought MS had something to do with geography, because as you got further away from the equator the disease became more common. Scientists thought it might be due to magnetic fields, but I reasoned it could be a matter of food. The further north you go, the less vegetarian people become, and the more carnivorous they are. Looking at the literature and going over the United Nations food intake throughout the world after WW II, it was quite obvious that multiple sclerosis and heart disease both occurred in areas where large amounts of saturated (animal) fat were consumed. It was surprising to find that those populations with a high incidence of MS were those who consumed more than 100 grams of fat a day; where the disease was uncommon they consumed less than 50 grams of fat a day. For example, there was no MS in the Orient. I soon discovered that during World War II people in Western Europe, when food was scarce, had less MS and fewer attacks if they already had the disease. People living in prison camps during the war had no MS, but when they got out and returned to meats and dairy products they starting developing MS. At one point we did a survey in Norway, which showed a high incidence of the disease in the small dairy farming areas in the mountains where the fat intake was very, very high. Along the coastal fishing villages, the saturated fat intake was very low, and they had very few cases of multiple sclerosis. When you compared the two areas there were eight times as many MS cases in those mountainous, high-saturated-fat consuming areas than along the coast where they were primarily fishermen. JM: Some of your early work showed the effects of fat on circulation. Swank: We found a heavy-fat diet caused changes in circulation. After a typical, high-fat American meal red blood cells become very sticky and would bind to one another. About three hours after a meal they aggregated together to form clumps. And these clumps are large enough and tough enough so they can obstruct circulation in small capillaries throughout the body. We have also seen these changes in animals after feeding them a high-fat diet, and we also found a breakdown of the blood-brain barrier in these animals. I think this kind of injury results in the perivascular lesions (damage around blood vessels classically seen in MS) that are typical of MS. JM: How did you start treating patients with MS with a low-fat diet? Swank: We started treating patients at the Montreal Neurological Institute where we did studies comparing people on low-fat diets and high-fat diets. In our initial study of 25 patients, six did not go on the diet and, of these, five soon died, but of the 20 that went on the diet, only one died and the other 19 remained exactly the same as when they started, in other words no disability after 35 years (This was published in the Lancet1 in 1990). At the University of Oregon, we found that patients who adopted a very low-fat diet, following an early diagnosis of MS, had a 95% chance of remaining free from further disability. When we compared our patients, after 35 years; the group who strictly followed a low-fat diet had a death rate of 31%. They not only avoided death from MS, but also death from heart and other diseases. Those who followed a high-fat diet had a death rate of about 80%. But, they have to follow the diet strictly because even small amounts of fat make a big difference. In the study we published in the Lancet in 1990, we found that a difference of eight grams of saturated fat intake daily resulted in a threefold increased chance of dying from multiple sclerosis.1 (That means daily consumption of as little as one ounce of pork sausage at 10 grams, one medium cooked hamburger at 14 grams, an additional three ounces of porterhouse steak, or 2 ounces of cheddar cheese at 12 grams, significantly increases the risk for victims of MS.) JM: You must have had people charging your doorstep, scientists … Continue reading McDougall Interview with Dr. Roy Swank, MD