Multiple Sclerosis is a chronic progressive neurologic disease which develops between the ages of twenty and fifty, and is characterized by recurrent attacks on the nervous system. After 10 years of disease with the best treatment modern medicine can offer, half of its victims are dead, bedridden, or wheelchair bound. Worldwide, the incidence of multiple sclerosis crosses all racial barriers and geographical boundaries. Multiple sclerosis is common in Canada, the United States, Northern Europe; it is rare in Japan, elsewhere in Asia, and in Africa. One important theory proposes that cow's milk consumed in infancy lays the foundation for injuries to the nervous system that appear later in life. Cow's milk contains one fifth as much of an essential fat, called linoleic acid, as does human mother's milk. Children raised on a linoleic acid-deficient, high-animal fat diet, as are most kids in our modern affluent society, quite possibly starting life with a damaged nervous system, susceptible to insults and injuries in later life. The possible sources of injury that can precipitate the attacks of multiple sclerosis in mid-life are suspected to be viruses, or allergic reactions, and/or disturbances of the flow of blood to the brain caused by a high fat diet.

"Gluttony and chronic degenerative diseases have been linked in the minds of both layman and scientists for many years. The saying "to dig your grave with your teeth" probably has its origins in antiquity, but in the prosperous areas of the Western world during the past few decades the maxim has taken on real and tragic meaning."

From "low-fat diet" 1959, by Dr. Roy Swank, MD, Professor and Head of Division of Neurology, University of Oregon Medical School. He served as the head of the Division of Neurology for 22 years. Now call the Swank Clinic at 503 520-1050.

The multiple sclerosis diet book, a low fat diet for the treatment of MS, was published the last time in 1987 by Double Day. It can be ordered at any book store.

Dr. McDougall: Dr Swank, most of us have heard of MS, could you give us a run down on what the life of a person with MS is like?

Dr 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 that 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. There is usually a partial recovery from these attacks, but they reoccur and they become more severe. Soon they 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 down hill. At about 10 to 15 years they end up confined to a bed or wheel chair. Because of the disability and fatigue they lead a very frustrated life. They go from a cane to a wheel chair to bedridden.

Not more than 5 to 10% of patients have a milder type of disease that does not result in this gloomy future.

 Dr. McDougall: How did you figure this out disease was caused by food more than four decades ago?

Dr Swank: At that time they 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 this 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 very much saturated fat was consumed. It was surprising to find that those with a high incidence of MS were those that 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 had less MS and fewer attacks if they already had the disease. People living in prison camps 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 high incidence of the disease in the small farming areas in the mountains, where the fat intake there was very, very high. Along the coast the fat intake was very low, and they had very few cases of multiple sclerosis. When you compared the two areas it was eight times as many MS cases in those mountainous, high fat consuming, areas than along the coast.

 Dr McDougall: Some of your early work showed the effects of fat on circulation.

Dr Swank: We found a heavy fat diet caused changes in circulation. After a meal typically eaten by Americans, very slowly red cells become very sticky and stuck 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, and that goes on throughout the body. We could see those changes in animals after feeding a high fat diet and also found a breakdown of the blood-brain barrier in these animals. I think this kind of injury results in the perivascular lesions that are typical of MS.

Dr. McDougall: How did you start treating patient with MS with a low-fat diet?

Dr. 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 five soon died, but 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. (Lancet 336:37, 1990).

Eventually we moved our work to the University of Oregon. We found if patients started early, before they had disability, and we placed them on the diet at that point, and they followed the low fat diet very carefully, they had a 95% of a good result--in other words they remain free from further disability. When we compared our patients, those strictly on the diet, the death rate was something like 31%. In all the others who were off the diet, the death rate was about 80% after 35 years. They not only avoided death from MS, but also from heart and other diseases.

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 a difference of eight grams of saturated fat intake daily resulted in three times the chance of dying for victims of multiple sclerosis. That means as little as one ounce of pork sausage at 10 grams, one medium cooked hamburger at 14 grams, or an additional three ounces of porter house steak, which is 13 grams.

Dr. McDougall: You must have people charging your door step, scientists from all over the world wanting to know about this wonderful low fat diet. The MS Society must be bending over backwards to tell people about your miraculous treatment.

Dr. Swank: Not really. You know, most people in this country expect to be cured by a pill and have a cure that is almost instantaneous. With the low fat diet, the person actually has to work and has to cure themselves. And as far as the MS Society, John, they don’t mention it because they didn't discover it. It wasn’t their research dollars that found this treatment. So they’re not going to tell anybody. I discovered it in my small office here, in the basement of the University of Oregon Medical School.

Dr. McDougall: Was there any interest at all in diet back in the 1940s and 50s?

Dr. Swank: No, I was more or less considered as a quack. I wondered why doctors felt this way. I think one of the reasons was economics. It doesn’t cost much to eat well and take care of yourself with a highly vegetarian diet. I was originally brought on board at the University of Oregon because of my interest in fats. The cardiologists felt there was some value in this.

Dr. McDougall: What does the Swank Diet consist of?

Dr. Swank: Most importantly it is a very low fat diet. We use a little bit of animal protein in the form of skim milk, egg whites, fish, and the white meat of turkey and chicken. Otherwise, it is a low-fat vegetarian. We have found over the years the vegetable oils can be added from 10 to 30 grams a day, unless they are overweight.

Dr. McDougall: Dr. Swank, what do you think about adding vegetable oils to your diet.

Dr. Swank: Well, I think it's worth while. We have looked at this over a number of years, and have found that the skin and the hair seem better in women. There is also some reserve of calories for energy. Best of all, however, is the fact that the patient can follow the diet more easily if they can have some oil. It makes it more palatable for them.

Dr. McDougall: But would you get upset at them if they decided they wanted to avoid the oil because they were too fat.

Dr. Swank: No. I vary the oil for that particular reason. If they are too heavy I cut back on the oil, and we absolutely cut out all saturated fats. We allow about 10 grams of saturated fats. That is about as low as we can get it.

Dr. McDougall: Drug therapy has gotten a lot of press these days with beta interferon for multiple sclerosis. As I understand it, in addition to the cost, which is $10,000.00 a year, the benefits would be 30% reduction in MS attacks, but no slowing in the progression of the disease.

Dr. Swank: We have gone to the trouble to do a statistical study of the results and we have come to the conclusion from this that there is no benefit to be derived from beta interferon. Our experience with this drug has been very grim.

Are three other things an MD patient should do?

Dr. Swank: Exercise, but don't exercise to the point where you tire yourself out, and take a nap midday, one hour at least around the middle of the day. That is very helpful. The fatigue is sometimes so great that it is more disabling than the neurological problems. We see this fatigue get better on a low fat diet. Every month patients will be able to increase the amount of exercise they can do.

Dr McDougall: You are now 90 years, what are you going to do for the next 15 to 20 years.