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Dr. Terry Wahls is a clinical professor of medicine at the University of Iowa Carver College of Medicine, in Iowa City. In addition to teaching internal medicine residents in their primary care clinics, she conducts clinical trials that test the effect of nutrition and lifestyle interventions to treat multiple sclerosis and other progressive health problems. Dr. Wahls has published over 60 peer-reviewed abstracts, posters, and papers, as well as several books, including the bestselling The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine and her just-released cookbook, The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Diagnosed with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years, Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain. She now teaches the public and the medical community about the healing power of her protocol. To learn more about her work, visit www.terrywahls.com.
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Zachary Taylor: You have an incredible story of beating multiple sclerosis – a type of reversal that was almost unheard of previously. So, let’s start off with a snapshot of what multiple sclerosis is, how it usually progresses, and what you were told about your specific case.
Terry Wahls: Multiple sclerosis (MS) is a neurodegenerative disease in which the immune cells attack the brain and spinal cord. Most people with MS are diagnosed with the relapsing/remitting type and have acute attacks of worsening symptoms followed by periods of improvement. Over time, the vast majority will slowly decline. Within ten years of diagnosis, half the people with MS will be unable to work due to severe fatigue, a third will have some kind of gait disability, and most will develop secondary progressive MS.
When I was first diagnosed with relapsing/remitting MS in 2000, I was very optimistic. I had been an athlete – very physically active – and thought I’d do really well with treatment. I believed in medicine, so I took the newest drugs. However, within three years, my disease had converted into secondary progressive MS, and I needed a tilt-recline wheelchair. When you reach that phase, you take drugs simply to slow your decline. There’s no expectation of recovering function. My doctors were very clear that functions once lost are gone forever, and they encouraged me to treat my disease as aggressively as possible.
ZT: How in the world did you turn that around? Where did you start in that reversal process?
TW: When I ended up in the wheelchair, I knew I was headed towards becoming bedridden, and that’s when I decided I needed to take responsibility for my own health. I started reading the medical literature on MS, and I began to experiment based on what I was reading. I discovered functional medicine, ancestral health principles, and electrical stimulation of muscles (e-stim), and I synthesized and combined these to create a very intensive diet and lifestyle program.
I did all of that in an attempt to slow my decline, because I had fully accepted the conventional wisdom, which is that when you have progressive MS, there’s no more spontaneous recovery. There’s no more improvement. This was all just to slow the disease progression – but, of course, that’s not what happened. Within a year of starting my protocol, I was able to walk through the hospital without even a cane, and I completed an 18-mile bicycle tour.
ZT: Do you still have colleagues at the university who really don’t believe that you used nutrition to reverse your condition?
TW: In 2008, when I first reversed things, people thought, “That’s really quite remarkable.” I did a grand rounds on targeted nutrition for the brain, and my medical colleagues were fascinated by that. Then I started using the protocol in my clinical practice, and there were a lot of complaints from some of them because I was doing something that was so unorthodox – teaching patients how to care for themselves using diet and health-promoting behaviors. I met with the chief of staff and showed him the science behind what I was doing, and he has actually become a huge fan. Then I designed a clinical trial to prove that my protocol didn’t just work for me; it would work for others with similar afflictions. My success in clinical research grew, and now, instead of being an oddity, I’m heralded as a visionary, both within the Veterans Affairs system, in which I worked for many years as a staff physician, and at the university.
ZT: Does your protocol help with any other autoimmune or non-autoimmune conditions, in addition to MS?
TW: Back in 2007, I was assigned to head the polytrauma unit at the Iowa City Veterans Affairs Hospital, treating veterans with head injuries. That was probably done to force me to come to terms with the fact that I couldn’t do my job anymore and would have to take medical disability. However, that clinic turned out to be the perfect place for me. We had folks with traumatic brain injuries and psychiatric problems, and this diet and lifestyle program was very helpful for them. In my primary care clinics, it was very helpful for people with diabetes, heart disease, and other autoimmune conditions.
My chief of medicine saw what was going on and asked me if I’d be willing to leave primary care to create a special clinic that I could run the way I wanted. We called it a therapeutic lifestyle clinic, and I ran it for about four years. I found this protocol to be very effective for chronic pain, fibromyalgia, and autoimmune conditions, including inflammatory bowel disease, rheumatoid arthritis, psoriasis, and psoriatic arthritis. It’s also very helpful for mental health issues – depression, anxiety, obsessive-compulsive disorder, early cognitive decline, and Parkinson’s disease. To follow this protocol, you simply have to be alive – that’s the key thing – and be willing to use diet and lifestyle to create as much health-promoting behavior as you can. As your cells improve their function, your organs improve their function. Then we wait and see just how much recovery is possible.
ZT: I know you can’t really talk about your protocol without discussing mitochondria. Would you give our readers an idea of what mitochondria are and why they were a critical factor in developing your protocol?
TW: About one and a half billion years ago, we had a rise in oxygen levels on Earth, and there was a die-off of about 90 percent of all the bacteria, the only life forms existing at that time. But there was a mutation that allowed a subset of bacteria to handle oxygen much more efficiently and generate adenosine triphosphate (ATP), which stores energy in the bonds between its molecules. These ancient bacteria were engulfed by larger bacteria and developed a cooperative relationship, so that the larger bacteria could thrive and become the forerunners of multicellular organisms and, eventually, humans. The smaller ancient bacteria became the mitochondria within our cells, which help our cells generate energy efficiently. That’s particularly critical in high energy-using parts of the body, such as the brain, retina, heart, and liver.
When I was sitting in a wheelchair, reading, back in 2004, I saw that in diseases such as MS, where the brain or spinal cord is shrinking, there is a signal from the mitochondria to the nuclei of the cells, causing programmed cell death (apoptosis) to take place too early. I concluded that was happening because the mitochondria were not able to function very well. So, my next focus was on what I could do nutritionally to help my mitochondria function optimally. I kept tinkering with my vitamin and supplement regimen, and then I redesigned my food intake around how to feed my mitochondria – and, more specifically, how to feed my brain cells so they would have all the building blocks on hand to do everything correctly. That’s really when the magic began.
ZT: Do you believe it was feeding your mitochondria and your brain that helped you get out of your wheelchair? Was that what made this protocol work?
TW: Biology is a very complicated web of all sorts of processes and chemical reactions, but the basis of our health is our nutrition. The food we eat is incredibly powerful. Of course, meditation, social interactions, movement, and detoxification are also important. But we need to start with getting the food right, and then we build on that, adding lifestyle factors as we acquire new skills. If we try to do everythingall at once, it’s too overwhelming a task. We have to get the food basis correct first.
ZT: Another thing I think is important for our readers to understand before we get into your nutritional protocol is myelin. Would you tell us a little bit about what myelin is and why it was an important consideration in designing this protocol?
TW: Myelin is the insulation around the nerve cells in the brain. It’s one of the most important structures needed for proper brain functioning, and it’s the very thing that the immune system attacks in people with MS. Myelin is actually an extended and modified cell membrane that wraps around the axons of brain cells in a spiral fashion. Like other cell membranes, it is made mostly out of fat, which is one of the reasons my dietary protocol contains a lot of fat. I talk a lot about having the right kinds of fat, the omega-3 and omega-6 fats. You need them in proper proportion to one another. It’s not that omega-6s are bad and omega-3s are good; they’re both good. In fact, they’re both vital for the repair and maintenance of myelin. But they should be in an appropriate ratio, and I believe the best ratio of omega-6 to omega-3 is approximately 3:1.
ZT: That’s a nice segue into the nutritional part of your protocol. There are three levels of your protocol: the Wahls Diet, Wahls Paleo, and Wahls Paleo Plus. Would you introduce our readers to those three levels?
TW: I made the very intentional decision to lead people stepwise through this process. The most basic level, the Wahls Diet, infuses the body with intense nutrition and eliminates dietary elements that could be contributing to a person’s decline. Here, I emphasize eating a lot of vegetables, having high-quality protein, and getting rid of sugar, gluten, and dairy. If someone is a vegetarian or a vegan, they can avoid eating meat at this level – I give some guidance on how to do that safely, and I talk about its health risks.
At the next level, Wahls Paleo, I provide a little more structured guidance to help people further eliminate substances that can compromise gut health. I talk about the benefits of eating grassfed meats or wild fish daily, according to your financial means. I also explain what a powerful superfood organ meats are. Historically, they were a vital part of our diet for a very long time, and I recommend that they be eaten several times a week. Then I talk about the benefits of seaweed, which provides us with critical nutrients. I explain that nuts and seeds are also a vital part of our diet but can be very inflammatory. If you soak them – that is, begin the process of germination – you make them more digestible. You reduce the activity of the pro-inflammatory lectins and the phytates, which can interfere with mineral absorption. At this level of the protocol, I also further reduce carbohydrate intake and limit gluten-free grains to two servings, twice a week. For example, that’s a half cup of brown rice or wild rice twice a week. And I recommend adding fermented foods – such as lacto-fermented sauerkraut, pickles, kimchi, and kombucha tea – to the diet, as well as more raw foods, including some raw animal protein.
The next level is the ketogenic diet, Wahls Paleo Plus. This is the most challenging level of the diet, but it is the most therapeutic for people with autoimmune conditions and is particularly beneficial for anyone with neurological or psychological issues or a history of cancer. Here, we ramp up the fats, cut the carbs even further, and get rid of the starches. I want you to use medium-chain triglycerides or coconut oil, so you can have nonstarchy vegetables and a small amount of berries and still be in ketosis. Following the ketogenic diet using coconut oil or coconut milk as the fat source allows you to have enough fiber in your diet to keep your microbiome healthy. At this level, only six cups of vegetables a day are required, and we eat only twice a day.
If you’re still having problems, you might need to do an elimination diet, cut out the nightshades, and work with a nutritionist. Get some food sensitivity testing and really zero in on what foods are going to work for you and what needs to be removed from your diet.
ZT: How, specifically, do you recommend people incorporate more vegetables into their diet? Are there particular types they should eat?
TW: I’m very particular as to what vegetables and fruits I want people to eat, and I want a total of nine cups a day. We need lots of diversity. First, I want three cups of leafy greens, such as kale, collards, chard, Asian greens, and lettuces (the darker the better). If you are having them as salad, that would be two big dinner plates of raw greens. If you are cooking them, measure them first or go by the rule that two cups of raw greens equals one of cooked greens.
Then I want three cups of sulfur-rich vegetables from the cabbage, onion, and mushroom families. I’m very specific about those three family groups because the cabbage and onion families do specific things to improve your detoxification pathways, increase production of glutathione, and boost the brain’s ability to make gamma-aminobutyric acid. Mushrooms are high in B vitamins as well as sulfur, and they are protective against autoimmune disease. Sulfur-rich vegetables include broccoli, cabbage, asparagus, Brussels sprouts, turnips, radishes, onion, and garlic.
I also want three cups of deeply pigmented vegetables and fruits, preferably of three different colors – from the blue/purple/black category, the yellow/orange category, the red category, and the green category – so that you’re getting a variety of polyphenols. There’s a lot of great literature showing that the blue/purple/black family, in particular, is neuroprotective. Some examples of deeply colored foods are berries, carrots, winter squash, tomatoes, beets, and avocados.
To count as deeply colored, a plant has to have a pigment other than white all the way through. So, an apple or banana is not deeply colored. However, you can eat an apple or a banana after you’ve had your nine cups of vegetables and fruits, if you’re still hungry.
I’d also say, you don’t have to stuff yourself. Eat vegetables and fruit, along with some protein, according to your appetite. I’m six feet tall, so I might have twelve to fifteen cups of vegetables a day. My daughter, who’s five foot six, would be lucky to have six cups of vegetables in a day. And we have some people in our study who are very petite – about four foot nine – and, of course, they couldn’t possibly eat that amount.
ZT: You say our protein should preferably come from meats and organ meats. Could you elaborate on that a little bit?
TW: Organic, grassfed meat, wild-caught game, and fish are the highest-quality protein sources for humans. I strongly recommend them. Muscle meat is high in the amino acid methionine, but people also need a lot of glycine, which is found in skin, bone, and cartilage, as well as in organ meats. So, bone broths are good. And, yes, you should eat the skin on your chicken to get that glycine. We can eat legumes and grains, but they contain a lot of lectins and can be very inflammatory. However, if money is an issue, and if you soak them, that’s certainly an acceptable option.
You don’t need to eat a lot of protein. I think six to twelve ounces per day is generally sufficient. Of course, if you are an athlete or bodybuilder, that’s going to be different.
ZT: What, specifically, is the problem with gluten and casein, particularly for those with autoimmune conditions?
TW: There’s increasing recognition that autoimmune conditions all begin with a leaky gut, in which the intestinal barrier is too permeable, and incompletely digested proteins, including gluten, can get into the bloodstream. Depending on your genetics, your immune cells may react to that gluten, and you can have a huge revving up of the inflammatory response. That will make whatever health problems you have much worse, and, if you are genetically predisposed, you may develop an autoimmune disorder. In my case, I have asthma, mild psoriasis, and MS. It’s actually quite common that anyone with an autoimmune condition will start adding additional autoimmune diseases every decade or so, if they have not addressed their root causes.
As we have hybridized wheat over the 12,000 years of its cultivation, we’ve been changing the shape of gluten, making it less and less digestible and more inflammatory. I believe that about 35 percent of Africans and Europeans have the genetics that promote a severe immune response to gluten if we get sensitized to it.
The problem with casein is that the amino acid sequences of gluten and casein are similar enough that our immune cells, if they’re reactive to one of these, will probably also be reactive to the other. For that reason, I ask people in our clinics to completely eliminate gluten and all dairy products other than clarified butter for a hundred days. In the United States, the third most common food sensitivity, after gluten grains and dairy, is eggs, so I ask people to consider taking eggs out of their diet for a hundred days as well. Then they can retest and see how they do.
ZT: You mentioned the importance of fats, specifically for the brain and myelin. Is there anything else, in particular, that readers should know about fats?
TW: In order to make our cell membranes, we need omega-3 fats, which ideally you’re getting from grassfed meat and wild fish. You might also be eating chia seeds or flax seeds. As I mentioned, we also need omega-6s in order to make myelin. You can get your omega-6 fats from nuts, seeds, and avocados. It’s best if you have soaked and sprouted the nuts you eat.
Let’s also discuss cooking with fats. Olive oil is a great fat with many valuable polyphenols, including hydroxytyrosol, but please stop cooking with it. When you cook with it, you damage those polyphenols, and you lose many of its wonderful health benefits. Instead, take that olive oil and mix it with your favorite garden herbs and a little apple cider vinegar or lemon juice. Make a lovely sauce, and put that over your food after it’s been cooked. If you’re going to cook, I want you to use solid fats, such as duck fat, lard, ghee, and coconut oil.
ZT: At any point during your protocol, do you typically recommend supplements, and if so, what kinds of things are you recommending?
TW: I think getting our nutrients from food is always the safer option because with supplements, we have to worry about the ratios of our vitamins and minerals and our various amino acids. So, in my eyes, food is preferable. However, I do measure vitamin D and homocysteine levels, and I treat accordingly. In my book, I give people some guidance on what basic lab tests to ask their primary care doctors for. These include vitamin D, B12, folate, homocysteine, fasting lipids, and hemoglobin A1C. Then I give some suggestions as to supplements they can take to get their levels tuned up.
Just using those basic tests, we’ve seen quite remarkable results. I don’t think we always need to do the full complement of functional medicine tests that are available. Of course, that can be very revealing and educational, if you have the money for it. It can help you know precisely what’s wrong with you. But it’s not required. You can do wonderful things without it.
The most common things I end up supplementing are vitamin D, methyl folate, and methyl B12. I might give a person vitamin B complex, and we might talk about algae supplements and cod liver oil. I make my recommendations based on the exam and those basic lab tests, knowing that if we give the body the necessary building blocks and let it take care of itself, it will begin to heal and repair.
ZT: Do you have any tricks for getting people to eat organ meats, and are some of the desiccated products, such as desiccated liver, good replacements?
TW: I think they’re fine, as long as you know their source. We’ve used products that come from New Zealand. Generally, I think hiding organ meats in your meals is the way to go. We have recipes in my new cookbook that will help you do that. You can grind up some liver in your food processor, then add hamburger, grind it up, and make little patties. If you put in a small amount of liver, gradually increasing it each time you serve the dish, it becomes easier to introduce. I also grind up liver with water in my Vitamix and make a slurry. Then I make a chili – I like it hot with a lot of zip – and when it’s ready, I pour in my slurry of liver and stir, and the liver disappears. Nobody has any idea they just got some liver in their meal.
That also works with liver paté. I’ll take a kale leaf and put some guacamole in the bottom, then put in some liver paté. Then I add a lot of sriracha sauce. The more zip you give it, the more you hide the liver flavor. Even my daughter and her friends like that a lot. She has made a wonderful bacon-wrapped chicken liver that she broils and serves to our family and her friends. They say, “Wow, this is really good,” and then she tells them what they just ate. Just be careful to not overcook the liver. If you leave it medium-rare, so it sort of melts in your mouth, it’s quite tasty.
ZT: Let’s talk about some of the supportive therapies you recommend. How critical is exercise, and what kind of physical activity should people do to help reverse autoimmune conditions?
TW: When we look at the analyses of our various interventions, it’s no surprise that we find the most powerful one was adding all those vegetables. The next most powerful was removing the excluded foods. Doing both of these was vitally important. I thought the next most important would be exercise and electrical stimulation, but it was actually stress reduction. I was quite surprised. After that came exercise and then e-stim. But if your goal is to improve motor function, exercise is really important.
In people with MS, the depth of disability can be quite profound, and they may be essentially paralyzed and bedridden. In that case, it’s unrealistic to expect to get much motor function back. However, you can probably still get a lot of improvement in cognition and mood, as well as reduction of pain and fatigue. That we can do with diet and stress reduction. I would have those people do isometrics, according to their ability, and e-stim.
When we fire our muscles, we fire our mitochondria and generate nerve growth factor in our brains. That’s vital for protecting our brain cells and neural connections. So, exercise is certainly a very helpful thing for people with autoimmune conditions, mood disorders, and traumatic brain injuries, as well as anyone who wants their brain to still be alert when they’re in their nineties or a hundred – which I plan on. I want to play Scrabble with my children, my grandchildren, and my great-grandchildren when I’m a hundred, and I’d like to win sometimes. So, I care a lot about how my mitochondria are firing and whether or not I have enough nerve growth factor.
ZT: In terms of firing our muscles, which would you say is more helpful – interval training, weight training, or straight cardio workouts?
TW: The most helpful thing is the activity you’re willing to do. That’s probably number one. If I measure what makes the most nerve growth factor, it’s high-intensity interval training followed by strength training. But if you can’t do that kind of exercise because of your medical issues, we have to start where you’re at and begin to increase your physical activity. I treat twenty-year-olds with traumatic brain injuries who are very athletic and for whom high-intensity interval training is exactly right. I also have seventy-year-olds whom I just want to have walk to the mailbox and back as their first step.
ZT: You have pioneered electrical stimulation in the reversal of MS. How important is that in your protocol?
TW: It’s certainly a very useful adjunct to exercise. If you’re going to have it replace exercise – and it will for people with spinal cord injury, nabling them to maintain some muscle and bone mass – that’s a different kind of protocol. For people who still have some volitional use of their muscles, you use it to get more out of the exercises that they do. It hurts, however, so its use depends on how well the person can tolerate it.
ZT: How do you work with people in terms of detoxification?
TW: In my clinics, I ask each person a simple question: What are your exposures? I also ask them about specific things, such as solvents and agricultural or industrial chemicals. Then we discuss what kinds of foods they eat and what toxins from those foods are likely stored in their body, as well as some strategies that we can use to help their liver and kidneys remove more toxins than are absorbed every day.
I’d also like to mention the mercury in our mouths. Most people of my generation have silver, or amalgam, fillings, and they may wonder if they should have them taken out. I’m not a big proponent of removing them, because you can end up trading a slow daily release for a whopping release in one day. If you choose to remove them, you have to be very careful to go to a dentist who can do it without making you far more ill.
In addition, we are often exposed to fluoride and chlorine in our water and bromine in our food. These are all halogens, and they interfere with the iodine receptors in our body, which can lead to thyroid disease. So, I like to have people use iodized sea salt, eat some Brazil nuts, and add seaweed into their diet to replace minerals they may be deficient in. If we have our nutrient minerals in place, they will displace the toxic minerals. Consuming enough iodine can help get rid of mercury, but you have to be careful not to overdo it. The normal upper limit for iodine intake is 1100 mcg per day.
ZT: I know you have some very interesting new research underway. What’s next in this journey toward helping people prevent and reverse autoimmune conditions?
TW: We have some papers that are under review. One looks at the changes in mood and cognition that take place on our protocol. Others show the changes in brain structure that we have seen on MRIs. Also, I’m recruiting subjects for a new study comparing a low saturated fat diet, the Swank Diet, to a modified Paleolithic diet, the Wahls Elimination Diet, for people with relapsing-remitting MS and fatigue. We arerecruiting a hundred people who have relapsing-remitting MS and fatigue. You can reach my team at [email protected]. You can learn more about the study at now.uiowa.edu/2016/09/another-step-forward-ms-research.
It’s exciting that, because of the results from our initial pilot studies, we’ve been funded for larger trials. Having the National MS Society fund our work makes it much easier for people to tell their neurologists that they want to try adopting either the Wahls Diet or the Swank Diet in an attempt to reduce their MS symptoms.
ZT: Do you eventually see your protocols being instituted in patient settings across the country and around the world?
TW: Absolutely. The patients will demand it. More and more people are coming to my seminars, and clinicians are coming to get certified, so we’ll have increasing numbers of people able to implement, teach, and supervise the protocol. And, of course, I’ll keep doing research and fine-tuning our guidance based on our scientific findings.
But remember, we’re all in this together. The drug companies can’t make us well, the government can’t make us well, and the insurance companies can’t make us well, but we can make ourselves well – if we simply change what we eat and what we do.
About the Author
Zachary R. Taylor, MA, LPC, is a licensed professional counselor, nutritional therapist, and clinical herbalist specializing in integrative mental health therapies. He lives and practices in Lexington, Virginia. He can be contacted at [email protected].
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Published in the Price-Pottenger Journal of Health and Healing
Spring 2017 | Volume 41, Number 1
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