Healing Autoimmune Diseases With Functional Medicine - An Interview With Dr. Terry Wahls

Healing Autoimmune Diseases With Functional Medicine - An Interview With Dr. Terry Wahls

What follows is a transcript for the podcast How to Live a Healthy Lifestyle: From Gut Health to Life Purpose.

Topics within the interview include:

  • The Wahls Nutrition and Lifestyle Protocol
  • Foods that Combat Cognitive Decline
  • Dr. Wahls’ Study of Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis
  • Multiple Sclerosis and the Gut Microbiome
  • The Link Between Multiple Sclerosis and Mitochondrial Function

Heather Sandison, ND: So welcome to Collective Insights. My name is Dr. Heather Sandison. I am a contributor here at Collective Insights and at Neurohacker Collective, as well as the founder and medical director of my own clinic, North County Natural Medicine, here in San Diego. And everyone at Neurohacker is so excited and delighted, all morning they've been saying how excited they are to listen to our conversation with Dr. Terry Wahls who's joining me today. Welcome, Dr. Wahls.

Terry Wahls, MD: Gee, thank you so much for having me.

Heather Sandison, ND: You are welcome. So let me quickly introduce you. Dr. Terry Wahls is a clinical professor at the University of Iowa, where she conducts clinical trials, testing the efficacy of therapeutic lifestyle to treat multiple sclerosis related symptoms. In addition, she is the author of The Wahls Protocol, how to beat progressive MS using paleo principles and functional medicine and the cookbook that goes with it, The Wahls protocol, cooking for life, the revolutionary modern paleo plan to treat all chronic autoimmune conditions.

You can learn more about her work from her website, www.terrywahls.com and she hosts the walls protocol seminar every summer, where anyone can learn how to implement the protocol with ease and success. So Dr. Wells let's get into it. I'm so excited. You have a cookbook that goes with your protocol and the diet. I, as a clinician, recommend your diet all day long. I love it. So break it down for me. How does it work?

The Wahls Nutrition and Lifestyle Protocol

Terry Wahls, MD: Oh, so the first thing is I have several levels so people can transition gradually because I think it's important to give people tools they can be successful with. So the first level as the Wahls Diet and the key elements there are that we exclude the most inflammatory foods, gluten, the protein in wheat, dry barley. Casein, the protein and dairy and eggs. And that's because those three foods are the most common unrecognized food allergens.

And then we ramp up the vegetables. In particular, green, leafy vegetables, sulfur contained vegetables in the cabbage, onion, mushroom family. And then deeply pigmented vegetables like beets, carrots, peppers, and berries, fruits. People can still have the white colored fruits like pairs, apples bananas, but that's after they've had nine cups of the green sulfur and other deeply pigmented. So for most folks, they aren't eating that many apples and bananas anymore because they're filling up on these other, even more nutrient dense foods.

Heather Sandison, ND: So let's get into the why, why these foods and why some foods and not others?

Terry Wahls, MD: Okay. So I remove foods that people are more likely to have unrecognized food sensitivity because gluten sensitivity is a root cause for problems, for many people with neuro and psychiatric, psychological issues. People with schizophrenia Parkinson's and MS have higher rates of antibodies against casein and or gluten.

So for those simple reasons, I would take gluten and dairy out. Eggs are the third most common food sensitivity, inflammatory bowel disease, allergy, asthma. And for myself, I have a severe egg allergy as well. So remove those foods, then we have to ramp up these other foods. Greens, great source of vitamin K1. And there's more and more evidence that vitamin K1, which is metabolized by our bacteria to vitamin K2 and K7, which get absorbed by our ileum, transported to our liver. And then further metabolized to K2 and K4.

So that vitamin's great for minimizing your teeth and your bones, but it's also very important because it's an activator for neural stem cells, the progenitor cells that will make the cells that help nurture and support myelin. So this is a great way to support the brain's ability to repair itself. Having more greens. In addition, the greens will have a lot of magnesium. They'll have a lot of antioxidants that are key for retinal health and our brain overall. So lot's of greens.

So when you think about lots of leafy greens, how much? Part of what I love about your diet is that you're really specific about how much, so these nine cups, how many of those-

Terry Wahls, MD: Nine cups. So you think of this as a dinner plate covered with vegetables and you want to have three dinner plates covered with vegetables. And so it's a dinner plate covered with greens. You can have them raw or cooked. If they're cooked of course, when you cook three cups of greens that shrinks down to not a whole lot, maybe three fourths of a cup of greens, and then the-

Heather Sandison, ND: But that still counts, right? That still counts as your three cups?

Terry Wahls, MD: Still counts. Still counts.

Heather Sandison, ND: Okay. So it's three cups raw, is how you measure it.

Terry Wahls, MD: Three cups raw.

Heather Sandison, ND: Okay.

Terry Wahls, MD: Yeah. And then the sulfur containing cabbage family, onion family, mushroom family sulfur is very important to our metabolism in terms of our ability to detoxify compounds. It will also boost the enzymes involved in glutathione production, which is a very potent antioxidants for our cells. And it boosts the enzymes involved in making gamma-aminobutyric acid, which is a very important calming neurotransmitter for the brain. It reduces neuro excitotoxicity from too much glutamate. So very helpful. And again, I'm looking for a plate full of cabbage containing onion, mushroom containing vegetables. Now garlics are so potent that two cloves of garlic is equivalent to one cup of cabbage.

Heather Sandison, ND: Oh wow. Okay. There's a little shortcut for those days.

Terry Wahls, MD: Right. And black fermented garlic, particularly yummy, delicious. I love that. And so, I mean, I didn't munch on those. It sort of like a candy to me. It's just so, so yummy. And then mushrooms have a long history for medicinal use. Mushrooms stimulate natural killer cells, which will help prime your adaptive and innate immune immunity. And we have increasing recognition now that we're looking at our body tissues form of the DNA and RNA, we are not as sterile as we thought. That is shocking. Our blood and our brain is not as sterile as we thought. We keep everything in control by our immune cells.

Heather Sandison, ND: So with the mushrooms, there's a little bit of a nuance there. What is your opinion about people who maybe have been told they have candida or fungal overgrowth? Do you still recommend mushrooms?

Terry Wahls, MD: I still do. I suggest that they try cooking with them. They probably won't tolerate the fermented foods, but they will likely tolerate cooked mushrooms. However, I do tell my patients, you do have to work with your primary care doc because we're all individual and so it's a matter of your genetics, your microbiomes genetics, and you may discover that you can't metabolize greens as well.

And so instead of having three cups of greens, maybe you need to have just one cup of greens. Or that you can't metabolize sulfur as efficiently. And so you can't handle three cups of sulfur or you can't handle the onion family very well, but you do great with mushrooms. So this is the public health message, but I want people to work with their personal physician and to observe their own individual response.

Heather Sandison, ND: Okay. And individualize it for themselves. Yeah.

Terry Wahls, MD: Absolutely. Absolutely.

Heather Sandison, ND: And then the other thing... Go ahead.

Terry Wahls, MD: And then the pigmented, again, I have a very simple message. You cut your food item in half and you'll look at it. Is it pigmented all the way through if it is then that's in the pigmented category because those pigments are a great marker for polyphenols in the antioxidants. And we have many, many studies that tell us the more color you have, the lower the rate of obesity, of diabetes, of mental health problems, of cancer, of heart disease, lower all cause mortality. And we have multiple studies showing, particularly the blue purple black pigments are cognitive protective. That you have improvements in cognitive function in people who have early Alzheimer's in cognitive decline. With just a couple of blueberries.

Foods that Combat Cognitive Decline

Heather Sandison, ND: Yeah. Some good examples, blueberries, beets, carrots. What else is on that list?

Terry Wahls, MD: So beets, carrots, squash, the colored squash. Watermelon, great source of lycopene, tomatoes, peppers. The stone fruits, cherries, peaches, plums. The citrus fruits, oranges, lemons, limes, grapefruits. So all of those would be... Pawpaws, which is one of my favorite fruits here in the Midwest. It's a avocado that has mutated and can grow in the north. It is just like incredibly delicious. It is orange, like a peach, but has this rich fat like an avocado. And it is one of the best things about having late September in Iowa is you get to go have pawpaws.

Heather Sandison, ND: You're making me hungry.

Terry Wahls, MD: I have three trees in my yard because we love them so much.

Heather Sandison, ND: Yum, yum. And I've never tried that. So I'm going to have to get one of those.

Terry Wahls, MD: Yes. You'll have to come visit me in late September and then we can have some fresh off the tree.

Multiple Sclerosis and the Gut Microbiome

Heather Sandison, ND: Be careful because I'll show up. So tell me there... I have to tell our listeners that you are surrounded by stuffed poop emojis. So tell me about... We've talked about what goes in. This is also one of my favorite topics is elimination because I focus clinically so much on toxins. So tell me the significance for you of the poop emojis that surround you?

Terry Wahls, MD: So when I was a resident, we made a lot of fun of our patients who were so focused on their bowels. We just thought that was crazy and now, of course, I am so apologizing to those wise elders that I had. Our microbiome digests our food. And so all those microbial metabolites that are small will get into our bloodstream and they help us run the chemistry of life.

Now, if you go back thousands of generations and you had a spontaneous mutation, and so you didn't have the enzymatic step to make compound XYZ in your ancestral mother, but if her microbes did and that XYZ still got made in your gut and diffused back in your bloodstream, she had reproductive success. And at that moment, that important enzyme got exported from my genome into my bacterial genome. It was passed down through our ancestral vaginal vaults as they gave birth to their children.

And that's why we have about 25,000 genes instead of the hundred thousand genes that scientists predicted based on the number of proteins that we have to make. We therefore need our microbiome to have lots of diversity. So we can have those five million to nine million different genes that can make all those microbial metabolites that can get into our bloodstream to help us run the chemistry of life more effectively and more healthfully. And as our microbiome gets more and more narrowed with less diversity, instead of having five million genes, I have two million genes and a hundred thousand genes, then I'm not making stuff. The efficiency and vibrancy of my health steadily declines. So we could spend a lot of money getting our poop analyzed. But when I talk to my microbiome scientist, the truth is that we don't really know how to interpret that data because the microbes are swapping genes all the time.

What really matters is the metabolites. And we aren't sure which metabolites we really need to thrive. So again, I think about all this stuff incredibly simply. I tell my patients when you have a bowel movement, stand up, turn around and look. Are they rocks? Are they sort of dry logs? Are they soft snakes? Is it pudding or tea? If it's pudding or tea, you have too much inflammation. And either you have an inflammatory bowel disease, a chronic parasite, chronic infection that we need to investigate.

If you have snakes, perfect. If you have rocks, you need more fibers. So more fermented food, more vegetables, maybe chia seed pudding, flax seed pudding. If you have logs that are passed easily, that's probably okay. If the snakes... And many people with a neurologic problem, we have difficulty controlling our sphincter and the snakes get into our pants. And so even though that's sort of the perfect poop, if it's getting into your pants, that's not going to work. And so people have to back off on their fiber so they can have soft, easily passed stool that they can appropriately control.

Heather Sandison, ND: So you've said something in here that I really want to highlight because I think it's unique and not everyone is taking this step. So you certainly give credence to the people who are testing poop and seeing what's in there. But it's not as important as maybe the fact that something we didn't realize that the microbes that are in the poop are actually getting into the bloodstream and potentially into the brain and influencing our biochemistry. Is that what I heard you say?

Terry Wahls, MD: Not quite, but close. So it's the microbes making metabolites and they digest our food and they make these smaller molecules and metabolites. Those metabolites get into our bloodstream and we rely on those metabolites. Now it's true, some of the microbes get into our bloodstream and are there, and some of the microbes and viruses get into our brain and they're there.

But what I think is vital is the metabolites. That's how the microbes digest our food in each other's byproducts, those we depend on for our health. And we do not yet know what metabolites are most optimal. There's a lot of work being done now looking at the microbiome and the metabolome and our lab is doing some of that. So I'm really very excited to have a microbiologist as part of our research team. And now I've got more nutrition scientists on our research team. And so in my current study, we'll be analyzing the poop. Yay. Poop. We'll be analyzing the metabolome, which is very exciting.

Heather Sandison, ND: That's great. Okay. So yeah, you do a lot of research and that sort of sets you apart from a lot of other clinicians. Tell me, what gets you most excited about research and what do you see the role of research in modern medicine being?

Dr. Wahls’ Study of Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis

Terry Wahls, MD: Well, research... If we're going to change clinical practice, we need to have published peer reviewed research that can be replicated. And so the typical role is you have an alert clinician that sees an unexpected finding, writes a case report and maybe a case series. And then that inspires an early feasibility study to say like, "Okay, can other people do this? Is it safe?" And then you begin to have larger trials.

And so that's the path I've gone down, case report case series, multiple pilot studies and now larger clinical trials. And because our results are so remarkably positive, now my peers who at first thought I was a little eccentric, now think well, maybe I am onto something. And now in the MS world, our studies are being analyzed as part of those meta-analysis. And so now people are talking about, "Well, it's very interesting work that Wahls is doing with these very exciting, preliminary results yet..." And so we're being validated, but science is a very slow methodical process as it should be.

In my role in life is that I'm teaching the public at the same time about what I'm doing and why, I then conduct the clinical science to build the peer reviewed validated science that says, here's the mechanisms of why this works, it's safe and here are the consequences. And then I run around the world, teaching clinicians who want to use these concepts in the clinical practice as well.

Heather Sandison, ND: Sounds like you stay busy.

Terry Wahls, MD: It's very exciting.

Heather Sandison, ND: So tell me, how does the research that you do where it's more of a lifestyle approach, how does that fit into this hierarchy of double blinded placebo controlled trials?

Terry Wahls, MD: Oh sure. So it's really easy to do a double blind placebo controlled trial when you have pills that look alike and the researcher and the patient do not know. And so drug development is much easier to do. When we're doing a diet, people know what they're eating and when we're doing a lifestyle, they know if they're meditating or they're exercising. So you can't blind the participant, you can't really blind the researcher. You can blind the data analyst and you can blind the person doing the assessment.

And so that's what we do and that's what diets and lifestyle researchers do. And so it's a different kind of research, different kind of analysis than is done with the drug development folks. So it's important to have rigorous design. And so you can control things as thoroughly as you can. And it's very exciting, we're writing and publishing all the time. And one of my most recent papers, the reviewer asked us to put some comments in about the other diet and lifestyle studies being done in MS.

So we did, we added that and there are about 12 dietary intervention studies being done now. What is exciting is when I look back, when I started doing this in 2009, I was it, no one else was doing it. Then we had one other person do a low saturated fat study, very exciting. And that got published, and we're publishing our little pilot datas coming out.

And then the MS society started funding dietary intervention studies because the public pressure that they had as a result of my work, and it's very exciting that they were willing to do that. And now because of the early work that the MS society's funding and the NIH, there are 12 studies going on. Low saturated fat, low glycemic index, ketogenic diets, several lots of ketogenic diets, fasting diets. Then of course my work in the modified paleo diet, incredibly exciting stuff.

Heather Sandison, ND: That is fantastic.

Terry Wahls, MD: And that's happening, I think largely because the public is demanding it. We are pushing for diet and lifestyle research, and that's very exciting.

Heather Sandison, ND: It's such a testament to your persistence. And then also the snowball effect and the public asking for it. And really just going back and not giving up and not saying, "Oh, that this research model doesn't fit." But more asking like, "How can you get the research model to fit what we're doing and what we're showing works?"

Terry Wahls, MD: We really have to thank the chair of medicine who watched my decline and my recovery. He called me in and gave me the job of getting a case report. And then the case series written up and I was like, "What? On myself? Said, "Yes, yes, this is so important, Terry, this is what you have to do this year." So I did that. And then he called me back and said, "Now this is so important. I want you to do a safety and feasibility study." And I'm like, "I don't know how to do that. That's not the kind of research I know how to do." He goes, "I'll get you mentors. This is your assignment."

Heather Sandison, ND: Oh wow.

Terry Wahls, MD: And so I saluted and I said, "Okay." And he is a rheumatologist, he's a rheumatologist who studied autoimmune disease. And he understood how remarkable it was that progressive MS had this dramatic recovery.

Heather Sandison, ND: So those of our listeners who don't know your story, we didn't really... We started with your diet because I get so excited about it, but tell our listeners what happened to you.

Terry Wahls, MD: Oh sure. So I'm a academic control medicine doc, very skeptical of special diets and supplements, complimentary alternative medicine. I taught my residents to be skeptical, but God has a mysterious way about him or her. And so in 2000, I developed a weakness in my left leg, got evaluated and was ultimately diagnosed with relapsing, remitting, multiple sclerosis. Being an academic person, I wanted to get the best care possible.

And so I did some research. The Cleveland Clinic was very active in MS research. So I saw their best people, took the newest drugs. Over the next two years, I had one episode of weakness in my right hand, had I been in a clinical trial that would've been like a phenomenal success, but the problem was I was getting slowly, steadily worse. My Cleveland Clinic doctors told me about the work of Ashton Embry and Loren Cordain.

And so I read their papers, got Loren Cordain's book. And after 20 years of being a vegetarian, I went back to eating meat, big deal. I continued to decline the next year I needed a wheelchair. Then I took Mitoxantrone and I continued to decline. Then the next year I took Tysabri, I continued to decline. Then I was placed on CellCept and at that point it's very clear that the best conventional medicine it's not stopping the decline towards a bedridden, possibly demented life.

I have trigeminal neuralgia, my pain was getting more frequent, more severe, more difficult to control. And so I'm like, "Well, I'm going to go back to reading the basic science because I am screwed. I got to do everything I can to try and slow this decline." And I decide mitochondria are the big drivers. I ultimately create a mitochondrial supplement cocktail, based on papers I was reading about Parkinson's, Alzheimer's, [inaudible 00:22:42] disease.

The Link Between Multiple Sclerosis and Mitochondrial Function

Terry Wahls, MD: Nobody in the MS world was talking about mitochondria by the way. But I thought, "What the hell. That's probably similar enough." And so my supplement cocktail slowed my fatigue and slowed the speed of my decline. Very grateful. By the summer of 2007, I cannot sit up in a regular chair more than 10 minutes. I can walk about 10 feet using two walking sticks. I have severe fatigue by 10 in the morning. I'm beginning to have problems with brain fog. My chief of staff... And the VA and the university have redesigned my job multiple times to let me keep working.

I've been on the institutional review board, reviewing research for a period of four years, which by the way, had gotten me more and more comfortable reading science and experimenting on myself. But that summer of '07, my chief of staff calls me to say, "I'm going to assign you to the traumatic brain injury clinic come January. There won't be any residents. And you'll be seeing patients as part of a multidisciplinary team." Now I knew full well, that was a job physically I was unlikely to be able to do, because I'm going to have to stand up doing these exams and just like, man... It was difficult. And it's like, my wife and I talked about this it's okay. So in January, I'll go do that job. And either I can do it or I can't, in which case I will have to apply for disability.

So that was difficult. The following month I was reviewing an IRB protocol that used electrical stimulation of muscles. And I thought, "Well, that's pretty interesting." It's for people that had a spinal cord injury and they wanted to extend the study because the patients liked it a lot and they didn't want to stop. So then I did a quick search, there was 212 articles. That's not so many to read. So I went through those. Most of them were about athletes. There were a few about cerebral palsy and a few about stroke. I convinced my physical therapist to give me a test session, hurt like hell, but I also still felt energized by it. And so I did it in clinic for several weeks and then we got a home unit and I added that to my very simple exercise program.

At that same time, I discovered The Institute for Functional Medicine and they had a course on neuroprotection. I ordered that and I took that. In the midst of my brain fog, was a little tricky, but I got through that. I had a longer list of supplements, which I added. And then I had this big aha, it's about November. I should redesign my paleo diet, sort of around this list of supplements I'm taking, figure out where they're on the food supply and I'll probably get more nutrients that we haven't even described yet if I get them from the food. So that's more research to figure out what my diet should look like, but I get that sorted out in November and December. And so December 26th, I have now created this differently structured paleo eating plant because I have to remind everyone supplements did not stop my decline.

The ancestral health movement did not stop my decline, but when I redesigned my paleo diet in a very specific way, it had these additional supplements that I got from my functional medicine. So I'm starting that at the end of December. In January, I go off to my new clinic, but the middle of January I went and the first week you just watch. So like, I should be able to watch, that's not too hard. And then the third week of January, I'm starting to see patients myself as part of the team. And at the end of the week, I thought, "Well that didn't go too badly." And then the next week's like, "Well, no, that seemed to go okay. Maybe I can do this." And then, the next week I'm thinking now in the month of February. So I mean, my second month of this new way of eating, I'm thinking, "My energy is better and my mental clarity's improving." And the third month, I have a letter to go mail and I decide that's about 200 yards.

I use my cane and I walk down and I mail my letter. And so people are seeing me in the hall with a cane for the first time in years, they're like, "Oh my God, Dr. Wahls, what happened? You're walking." And then six months, I have to go see the chair of medicine and I decide... By this time, I've been walking all over the VA hospital, but going to the university, that's quite a bit further. I have to go up a hill, it's like, "Oh, that's too far. Better take my scooter." And it dies on the way up. So I end up having to unhook the drive shaft and push it up the hill, leave it by the entrance and I walk to my chairman's office. Of course, by then, I am late and he sees me and he's stunned.

That's where the whole conversation begins. He gives me an assignment of, "Well, this is such a big deal. You're writing a case report up." And then at nine months I get on my bike and I ride my bicycle around the block. I'm crying. My two children are crying. My wife is crying. And then at 12 months, I do a 20 mile bike ride with my family.

So clearly I am transformed in terms of how I think about disease and health. I have transformed how I'm practicing primary care. I'm spending a lot more time talking about diet and lifestyle, the traumatic brain injury clinic. I'm seeing these patients and I'm going, "Wait, there's a lot we can do. We can adjust your diet. We can meditate. We can add more exercise." And it's becoming apparent that people can tell the people I see in the traumatic brain injury clinic are doing remarkably better.

Then my chairman of medicine calls me back and I have to do that case series, we get that done. Then he calls me back and says, "Got to get a feasibility study going and got to raise money." So somehow I manage to get all that done and we get our little clinical trial going. And every year at the research week for the university and the VA. I'm presenting our progress and people are seeing that I'm getting people to adapt this very intense regimen and that we're getting these remarkable results in quality of life and fatigue. And then we start showing the videos, the remarkable videos of how much people improve. And people are beginning to think like, God, maybe I am onto something.

And then the chief of medicine at the VA calls me to say, "We've got to pull you out of primary care clinic and we want you to have your own clinic. So you can run things the way you would like to run them." And actually I tell them, "No." That I can't do that because this is going to be too controversial. "But if you can get the chair, the chief of staff and the hospital director to sign off on this, then I would do it."

And so I went back to clinic and two weeks later, I'm back with the chief of medicine. He goes, "Yep. They've signed off." I was like, "Oh." So we started the process of setting up a new clinic and we got the lifestyle clinic going. And we had such success that we went from individual appointments to group appointments. Then the VA central office heard about our success. They came out to see what I was doing. We were able to write a grant, add more staff. And then, so we had tremendous success, but then in 2016, I made the big decision to retire from the VA so I could spend more time traveling the world, teaching all this stuff and have more time for my research part. So that's my story in a quick summary for you.

Wow. What a story. You have been incredibly busy publishing research, seeing patients, raising a family and recover... And doing this all in the face of being quite ill yourself, although better and better and better over time. So you mentioned that you were quite skeptical at first. Can you summarize just sort of how your perspective on medicine has changed from when you initially thought about becoming a doctor to now?

When I became a doc, I was probably a little bit different because my undergraduate degree is in art, in painting. But still as I went through basic science and got fully indoctrinated, I got fully indoctrinated. I embraced the scientific method because I do in fact, love science and I developed that very skeptical approach to complimentary alternative medicine.

And besides, the drugs are very powerful, very effective and do a great job of controlling symptoms. But in practice, people kept needing more drugs, additional drugs, higher doses. And despite treating people aggressively, they kept developing additional diagnoses the longer we took care of them. That's what I learned and so I wanted the newest drugs, best technology. And then I became a patient and like most patients who are physicians, I go read the science as soon as I'm diagnosed.

I'm like, "Holy shit. This is really terrible." When I see it's a progressive disease, rapidly disabling, that was very, very sobering, but I want the best conventional drugs. So I head down that path. And then when those fail, that's when I start realizing if I want to do everything that I can on behalf of my family, because like many women, I'm much more willing to work harder for my kids and my family than for me.

So I was like, "Well man, I owe it to my family to do everything that I possibly can to figure out how to slow my disease." And so that's how I rationalize for myself the intensity of the effort that I was putting into all of this. And then as I recover, I'm like, "Whoa, this is really pretty interesting." Now in that journey, I mentioned that I discovered the ancestral health movement, the paleo community.

Using Functional Medicine to Heal Multiple Sclerosis

Terry Wahls, MD: And now I read through that. I thought the science made sense and it intuitively makes a certain amount of sense that over the thousands of generations, that when we were hunter gatherers, that that environment was what our genes evolved on and is probably more aligned with better health outcomes. So I was a little frustrated that I wasn't getting better, but I accepted that. I was terribly ill and who knew how long it would take to rebuild me.

And then when I discovered functional medicine, I really appreciated the science, the rigor and the use of peer reviewed literature to guide what it was that we were doing. So I appreciated that it, but when I synthesized the two and I used functional medicine principles in what I learned from the ancestral health community, that is when I was able to create this very intensive diet and lifestyle program. I think taking the best of both worlds that in a stunningly rapid period of time, I went from still profoundly disabled, having nearly incapacitating pain, severely disabled because of fatigue and severe gate disability to walking, biking, having plenty of energy, mental clarity, lecturing, and then ultimately writing books and doing research.

But I have to remind everyone, the supplements didn't fix me, ancestral health didn't fix me. It was more complicated than all of that. It was the synthesis of both communities that led to my recovery.

Heather Sandison, ND: So I think this is a common theme that with complex chronic disease, whether it's MS or Alzheimer's or even something like diabetes, that it doesn't come down to just not even just one pill for one symptom or for one diagnosis, but it's not one supplement either. It's not just exercise. It's sort of this whole lifestyle approach. So what are other components when you see someone with complex chronic disease, maybe it's MS or something else, what are all of the components that you want to consider?

Terry Wahls, MD: I talk about this in my book. So the diet hugely foundational, you have to stop the destruction and you want to give the building blocks you need to do the repair work. You want to rebalance the hormones as well as you can. And so stress reduction because it's when we perceive safety and our parasympathetics are elevated and our sympathetic are suppressed, that our cells get the signals to do the maintenance and repair work, to make our hormones, to do our detox and to do the rebuilding that happens. So we have to have that sense of safety.

We also have to sleep at night. When we are sleeping is when we do a lot of the detox work. When we are sleeping, our brain clears out the amyloid. And amyloid is not a bad thing, folks. Amyloid is the last offense against toxins and microbes that enter our brain. So the amyloid gums that stuff up, and as you sleep at night, your brain clear the amyloid out. So we need the amyloid to protect us, but we also need to be able to clear it. You got to sleep to do that.

And for the hormonal signaling, our bodies have been used to having the mitochondria in our muscles, fully engaged to cause the shortening of the muscle fibers. And that process is very inflammatory. It makes a lot of changes in the cytokines that lower inflammation. It makes changes in the hormonal signaling molecules that build muscle strength, tendon strength. It will also include the signals that add to the mineral content of your bones. It will make nerve growth factors that nourish the nerves in the periphery and that nourish the brain tissue and the spinal cord tissue. It will also make endorphins in the brain very anti-inflammatory. Our toxin exposures.

Now we do in fact benefit from the plants we eat, are a mixture of things that are incredibly good for us. And a few things that are sort of bad for us, that we have to metabolize and get rid of very quickly. But doing that work revs up the enzymes in our livers and kidneys, in sweat glands, to handle those compounds very well.

So encouraging people to have this huge diversity of plants helps with that detox process, but encouraging them to take care of their bowel movement. So they're pooping easily, because about 25% of your detoxification is in your gut. And if they can tolerate sweating, doing activities that will be associated with a big sweat, whether it's doing a sauna or in Iowa, this is really easy, just be outside in July and sit outside and sweat a lot.

It's really good for you. And then social bonding. We're a social species and for the vast majority of us, if we are not connected to others and we have loneliness that drives our inflammation and that's actually associated with disease acceleration that is more damaging than smoking cigarettes, for example. So having social bonding, meaningful relationships, and also talk about what is it that you want your health for? What is the journey? What is your hero's journey? What was the stuff you had to learn internalize and you can bring back to your community to help them in their journeys? How do you have a good life in your current health circumstances? How can you have a pleasant life in your current health circumstances? How can you contribute to your family in your current health circumstances? And how could you contribute to your society in your current health circumstances?

So you have a more meaningful life. And in my VA clinics, we would work through those exercises in our skills classes and what the vets taught me was addressing what I call... These are those resilience factors are some of the most profound work that we do because that's how people are willing to do all the other hard things I ask to do. Give up foods they love, eat foods that don't taste good to them at first, begin a meditative practice, begin exercising. But to do that work, because it is work, helping them work through their resilience factors, their why, their hero's journey, is very empowering.

Heather Sandison, ND: That's incredible. So tell me how MS is what you were diagnosed with, that this is a neurodegenerative disease that was progressive for you. So there's a couple types of relapsing remitting MS. And then this very progressive MS that usually leads to death relatively quickly and certainly lots of disability in between diagnosis and death. You phenomenally reverse that just in a very inspirational way. So some people are diagnosed with MS, but there's a lot of other neurodegenerative diseases. Things like ALS, Alzheimer's dementia. There's a whole... Parkinson's, a whole host of them.

Terry Wahls, MD: Yes.

Heather Sandison, ND: And there's a lot of similarities and then some differences. Can you go into that?

Terry Wahls, MD: Sure. So MS, we got very intrigued with the level of inflammation that people see and you do these MRIs, you see these enhancing lesions showing active inflammation. But over time you also see in MS a lot of atrophy of the brain and the spinal cord. And the number of inflammatory lesions tends to diminish. If you look at some other diseases such as Parkinson's and Alzheimer's, there's not so many enhancing lesions and you see the steady progression or steady level of atrophy.

If you look microscopically, however, you'll see, even in Alzheimer's, there is a lot of inflammation. And in Parkinson's, there is a lot of inflammation. If you look at mental health issues, you may see some level of atrophy. There's certainly evidence for oxidative stress. And again, microscopically, there is evidence for inflammation. So in one sense, at a molecular level, in terms of cytokines indicate inflammation, in terms of the mitochondria level, oxidative stress, in terms of the higher levels of pollutants, solvents, heavy metals, we see that in all these diseases.

Parkinson's, Alzheimer's, mental health problems, the new inflammatory diseases, whether it's new inflammation because of MS, because of RA, because of Behcet's, because of inflammatory bowel disease. Those molecular things are happening in all those diseases. The target systemically across the body may be a little different, which is one of the reasons why. And I talk about this in my book that we're treating the same disease. I'm treating the cells, I'm trying to create a healthy environment for the cells.

And as we do that because life is a series of self-correcting biochemical reactions, often these cells get steadily healthier, leading to healthier tissues, leading to healthier organs, leading to decreased symptom burden, leading to decreased need for medications. Then we have to start backing off on blood pressure meds, on blood sugar meds and gives us the opportunity to decrease mental health meds and the opportunity to think about and evaluate can we decrease these anti-inflammation meds? And so these disease modifying immune suppressing drugs.

So it always has to be interpreted very carefully in the context of that individual person. But certainly in my clinics at the VA and in my own private clinic, we see people with a wide variety of health challenges. We personalize a protocol, but the basis is very similar across all these disease states. And we monitor their progress and we're often able to steadily reduce meds, get people off meds, simplify their medication list, and occasionally get people off medications entirely.

Heather Sandison, ND: So in your opinion, does the diagnosis matter?

Terry Wahls, MD: Well, the diagnosis does matter in that yes, say someone's got Huntington's disease, they'll probably still die from their Huntington's. I can probably improve their quality of life and slow down the speed of the decline. With ALS, occasionally we've been able to stop the decline and occasionally I have significant improvement, but for everyone, regardless of what your disease is, the goal is still the same. Reduce inappropriate inflammation, reduce oxidative stress, reduce toxin exposure, improve the hormonal milieu and then see what level of self-correcting biochemistry can happen and what the impact is on overall symptom burden. So it does matter, but addressing cellular dysfunction is what matters most.

Heather Sandison, ND: So it sounds like the diagnosis is important in terms of prognosis and in terms of individualizing, but really most chronic inflammatory diseases will benefit from applying your type of protocol?

Terry Wahls, MD: Yeah. The key thing is you have to be alive.

Heather Sandison, ND: Be able to fog a mirror.

Terry Wahls, MD: Yeah.

Heather Sandison, ND: So tell me about the role of mitochondria. I listened to your Ted talk recently, and that talks significantly about the role of mitochondria in these diseases. Can you speak to that more?

Terry Wahls, MD: Yeah. About a billion and a half years ago, the mitochondria or ancestral mitochondria was the first organism that developed the enzymes to handle oxygen more effectively. And that gave it a competitive advantage. It was engulfed by a larger bacteria and they developed a very happy cooperative relationship that would evolve into multicellular organisms, into animals and of course, eventually into us.

It does mean that we depend on those mitochondria to generate energy for our cells that have since specialized into nerves, bone, gut, endocrine glands. When the mitochondria are working well, that tissue, that organ works really well. But when the mitochondria have been poisoned by toxins, such as mercury, cadmium or solvents or insecticides, then the mitochondria doesn't work well. It develops a lot of oxidative stress, can't make as much energy and that organ becomes dysfunctional.

And so you may develop brain fog or chronic pain or heart failure or visual dimming or worsening of your diabetes. Trying to help that mitochondria function better can lead to more effective tissues, more effective organs. So mitochondrial supplements can be very helpful, but often, if you keep feeding yourself a terrible diet, keep yourself surrounded with toxic chemicals. Those mitochondrial supplements will not do very much for you. So you've got to stop poisoning the mitochondria. So that's where a very targeted diet and paying attention to your toxic exposures has such a profound impact. And then yes, there are times where adding mitochondrial supplements can be a very nice adjunct.

Heather Sandison, ND: Got it. So you've talked about your research, seeing patients, your travels around the world, teaching about this, what do you see the future of Terry Wahls being? What are you still seeing patients if somebody has been diagnosed with MS and they want to make and appointment with you, is that possible? Or do they go to one of your seminars? How do people learn from you?

Terry Wahls, MD: So if they go to my website, terrywahls.com/diet, you can get a one page handout. It's very nice. It's a quick summary of the concepts.

Heather Sandison, ND: I will second that. I use it all the time in my practice. I email it, I hand it out to my patients and it is very digestible, practical, fantastic information about what to eat.

Terry Wahls, MD: It's a great start. The book gives you more information, a lot of inspiration, very helpful. We have a seminar every summer where we have hundreds of people come, patients, clinicians and their families to learn from me and my team for three days. And a lot of skill building, phenomenal life changing experience. And we do basically a group functional medicine consult. So people learn a huge amount about their illness, their why, and develop some very specific goals and standards of what they can do.

I also have, again, a small private practice, and you can learn more about that again at tertywahls.com about who would be appropriate and what kind of services that you could get from that. We have a menu program for people who would like to have more support with implementing, whether it's a level one level two, or level three diet with menus, recipes and shopping list.

Folks love that as well. We are working on... We'll soon have our exercise and E-Stim course. I'm very excited about that. So if you sign up for our newsletter, you'll hear when that's going to be released and available. So that will be exciting.

Now the future, what's happening in the future. So we're writing more grants. The next really big grant proposal we're trying to do is a newly diagnosed MS patient or clinically isolated syndrome who has been offered drugs, has declined drugs. What we are trying to raise funds so we could run a cohort study where these folks come in and we basically do the Wahls protocol, diet and lifestyle. Get MRIs and ocular coherence tomography, so detailed vision test at baseline.

And then we support them with the protocol, see them at 12 months, repeat all the measures, including the MRI and the ocular coherence tomography vision function testing. And we also have a cohort of newly diagnosed MS patients who are doing the usual care, and then we'll do a statistical analysis to see does diet lifestyle... Is that inferior to disease modifying drug therapy? And this would is a hugely big deal study. It'll cost us about a half million dollars. We're halfway there in our fundraising. So we're hoping we can find another philanthropist who could close the gap in that. Ideally, I'd like to launch that study at the end of this year.

Heather Sandison, ND: So I had two questions for you, and it sounds like you answered both of them. One was, if you could do any research that you wanted to without funding or time or anything being an obstacle in your way, what would it be? And it kind of sounds like you just described it.

Terry Wahls, MD: I just described it because what people would really would like to know, can I decline these toxic drugs? I have a high risk. And if I just do diet and lifestyle, am I hurting myself? And the way to really answer that is at least to do a parallel cohort study, where you have people doing the best drug therapy. And we have people doing the best lifestyle therapy and what happens at their brain volume? What happens with the number of acute lesions? What happens with their function?

This would be a huge study, basically for every systemic autoimmune issues, because that's the question where all the functional medicine docs are wrestling with this. People want to come to us, is a functional medicine approach, just as effective as these drugs that cost 50 to a 100,000 dollars a year. And you and I, our perspective is, "Yeah, that's what we see." Our peers need to see someone do a rigorous study, where you have blinded assessors, assessing the outcomes of both studies and get that published. That's how we change clinical practice and that's what we're going to do.

Heather Sandison, ND: So my other question was, what do you see the role of drug therapies being in the treatment of neurodegenerative diseases? And it sounds like perhaps that study would answer that question, but do you have a sense as a clinician? What's the role?

Terry Wahls, MD: My advice to patients right now is regardless of what you decide about drug therapy, you want to do a therapeutic diet lifestyle to protect your brain as well as you can. And then my neurology colleagues who here are part of my clinical trial, they know that they have patients, some of whom they recommend drugs to everyone. They also recommend diet and lifestyle to everyone.

And in this area, they have plenty of new patients say, "I don't want the drugs. I just want to do the Wahls thing." And so what they work out is, "Come see me every three months. And as long as you're doing great, the Wahls thing will be fine. And we'll do an MRI every six months. And as long as you're doing well, then it really is safe."

And so I think that is a very reasonable option with a systemic autoimmune thing is before you start the drugs, do aggressive diet and lifestyle, but have close follow up to confirm that you are continuing to do well. Once you've started drugs, now it's a more complicated question because when you stop these drugs, there is a risk of rebound. And so there's really no research that can guide. So how long do you have to be on your good diet and lifestyle before we know that it's safe to take you off these drugs? And that's a question that we'll talk about at the seminar, we'll be reviewing the research and discussing the nuances behind that question.

Heather Sandison, ND: Do you think that the drugs contribute to the toxicity?

Terry Wahls, MD: Yes.

Heather Sandison, ND: Yeah.

Terry Wahls, MD: And they also accelerate aging because we rely on our immune cells to maintain and repair us and we block immune cell function. They can't repair us and maintain us as well. So we're going to age more rapidly and we already know that you have higher rates of infection, higher rates of cancer on these drugs. But untreated, these major systemic autoimmune diseases lead to rapid declines in severe disability. So that trade off makes sense to them. And unfortunately, a pharmaceutical industry hires PhDs and health economics to figure out how to price most aggressively for maximal profit, which is very understandable from a business perspective. We need researchers like myself who are willing to go out there to study this question and try and answer, is a therapeutic lifestyle just as good as these biologic drugs at protecting brain volume in treating off disease activity? $250,000 is what we need.

Heather Sandison, ND: Yeah. It sounds like the other component you need is a philanthropist or two or three.

Terry Wahls, MD: Yes.

Heather Sandison, ND: Got it.

Terry Wahls, MD: But I'm very hopeful because we're halfway there.

Heather Sandison, ND: Right and you're getting out and spreading the word and telling people how effective this has been. Do you see any medication... So you're in the research world, you work closely with neurologists. Do you see any medications that are maybe coming up through the research tract that might be beneficial, that you would be excited about?

Terry Wahls, MD: Actually I don't follow the medications at all. I do follow... There's some very interesting studies, say lipoic acid, turmeric. So there's some interesting supplement studies showing neuroprotection, reduced oxidative stress, protection of brain volume. And of course it is always way easier to do supplement studies, one at a time, blah, blah, blah. And so yeah, again, in our seminar, we talk about these supplement studies and I have some comment as to what supplements are most exciting and maybe something that people may want to think about adding.

Heather Sandison, ND: Which ones do you think are most exciting? Do you mind sharing?

Terry Wahls, MD: Lipoic, turmeric and of course the omega-3s.

Heather Sandison, ND: And then what else would you want someone to know? So if they've either been diagnosed with one of these diseases or they're trying to prevent a neurodegenerative disease, or maybe even someone looking to optimize, is there anything else you'd want to share that would be important to have in their lifestyle to be thinking about?

Terry Wahls, MD: Pick up the Wahls protocol, read it thoroughly and implement what you can. I would also invite you to think deeply about what you want your health for. And yeah, I think it can be really helpful to have some big goals. So for some of our folks, the big goal is that I want to walk my son or my daughter into church for their wedding, or the big goal is I would like to ride in the great bike ride across Iowa, or the big goal is that I would like to walk a 5k. So I encourage people to have a big goal that involves using their body. And for some reason that is an incredibly powerful motivator to help people decide that it's worth making better choices about their diet and making better choice, more reliable choices about their physical workouts.

Heather Sandison, ND: How inspiring. Dr. Wahls, thank you so, so, so much for your time. Again, we know how busy you stay teaching everyone about your experience and doing the research and seeing the patients. Thank you for your contributions. Your why has certainly been powerful and I'm grateful for it as part of this community. So we're going to wrap up now and move over to Facebook. So again, thank you Dr. Wahls for being here and I will see you on another social network.

Terry Wahls, MD: Okay. Sounds good. Thank you so much.

Heather Sandison, ND: Thank you.

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