Episode 62: The Wahls Diet and Autoimmune Disorders

Dr. Robert Rountree:

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Rountree, chief medical advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.

Dr. Robert Rountree:

Hi everyone, and welcome to The Thorne Podcast. Joining me this week, we have a wonderful, and I should say very special, guest, the esteemed Dr. Terry Wahls, who is a researcher and clinical professor of medicine at the University of Iowa Carver School of Medicine. She's been doing some incredible work and has an incredible personal story behind all of that that we're going to get into today. But first of all, I want to thank you, Dr. Wahls, for being on the podcast. Why don't you tell us more about yourself. I know you well and I've had the privilege of being on your show and actually interviewing you and publishing your interviews, so tell everybody else what I already know.

Dr. Terry Wahls:

I'm going to take the whole audience back 20 years ago. I'm out walking with my wife, Jackie. My left leg gets weak. I drag it home. I see the neurologist who says, "Terry, this could be bad or really, really bad." I go through the workup. Three days later, I see the neurologist. Three weeks later, I hear "multiple sclerosis." Take the newest drugs, see the best people, three years later, I hear "tilt recline wheelchair." I escalate my therapy. I'm taking chemotherapy, I continue to decline. I take Tysabri, I continue to decline, and that's when I'm like, "I got to go back to reading the basic science," and I begin experimenting on supplements.

Dr. Terry Wahls:

I've already adopted the paleo diet. I'm still declining, although it's slowed. Then I discover a study using electrical stimulation. I add that. My test session hurts really bad, by the way, but I feel great when it's done, so I add the electrical stimulation to my regimen, my physical therapy. I've also had trigeminal neuralgia that's been getting relentlessly worse for 27 years, and it's clear that I'm heading towards becoming bedridden, demented, having to live with intractable pain.

Dr. Robert Rountree:

And you were in a wheelchair at that point.

Dr. Terry Wahls:

I'm in a tilt recline wheelchair. I cannot sit up, that's how weak I am. Fortunately, the university and the VA has redesigned my job multiple times. I'm exhausted by 10:00, I'm beginning to have brain fog, I know I'm going to be forced into medical retirement because I'm beginning to have brain fog.

Dr. Robert Rountree:

But you were still seeing patients. You were able to see patients?

Dr. Terry Wahls:

I'm still seeing patients because I'm able to do it from a zero-gravity chair at the university and at the VA. Now, that summer, I discover electrical stimulation of muscles. I add that. I discover the Institute for Functional Medicine. I take the course on neuroprotection. I have a longer list of supplements, and I feel like, "Okay, there's more I can be doing."

Dr. Terry Wahls:

And then I have this really big aha moment that's is the big question, "Am I really doing everything that I can to slow my decline?" My physicians have always said, "Functions once lost will never come back because you have secondary progressive MS." But I'm like, "Okay. I'll go back to meditating. I am going to redesign my paleo diet very specifically based on everything I learned from functional medicine and from my review of the basic science." I'm already doing my electrical stimulation and physical therapy, and it's stunning. Within three months, my trigeminal neuralgia is gone. My fatigue is markedly reduced. My mental clarity, markedly improved.

Dr. Terry Wahls:

In another month, I'm walking with a cane, and then without a can. And then, Mother's Day, we had this emergency family meeting because I want to try riding my bike, which I've not done in six years. And so Jackie says that my son should jog alongside on the left, my daughter on the right, and she'll follow. I push off and I bike around the block. My son's crying, my daughter's crying, Jackie's crying, I'm crying. If you see my eyes now, I cry when I tell that story because that was when I understood that who knew how much recovery might be possible.

Dr. Terry Wahls:

That would change how I think about medicine, it would change the way I practice medicine. And then, interestingly enough, my chair of medicine at the university, when he saw me walk into his office for the first time in years and I told him my story, he gave me the clinical job of writing up the case report, which I did.

Dr. Robert Rountree:

Your case.

Dr. Terry Wahls:

My case. I said-

Dr. Robert Rountree:

Yeah. Your own case report.

Dr. Terry Wahls:

My own case report. I said, "Do you want me to do this?" And [inaudible 00:05:34] "Yes, you do, and you're doing that with your treating medical team and that's your assignment." So I saluted and said, "Okay, I'll do that." Once we had that written up, he called me back and said, "Now that we have a protocol, you're going to do a safety and feasibility study and you're going to change the focus of your research. I'll get you the mentors. You're going to now do clinical trials." And so we began the first clinical trial in 2010.

Dr. Robert Rountree:

Trials using your protocol that you used on yourself.

Dr. Terry Wahls:

Basically using my protocol. And we consented people with secondary and primary progressive MS. We had 20 folks. Everyone got the intervention. The question was, could people who were pretty disabled ... Because if you have secondary progressive MS, you're far enough along, there's usually gait disability, cane, walkers. Could they implement everything that I was doing? The meditation, the exercise, the stim, the targeted supplements, if they would hurt anyone, and then what was the effect size?

Dr. Robert Rountree:

And did you have to do a lot of convincing to get this protocol together, or did your treating physicians say, "Hey, you're a miracle and we want to reproduce this in everybody that we treat"?

Dr. Terry Wahls:

Interestingly enough, when I changed the way I practiced and I'm focusing more and more on diet and lifestyle and a few targeted supplements, my clinical partners complained. I had to go meet with the chief of staff and he said, "Terry, what's going on? People are complaining about you."

Dr. Robert Rountree:

Complaining. But not the patients.

Dr. Terry Wahls:

Not the patients, not at all.

Dr. Robert Rountree:

The patient weren't complaining.

Dr. Terry Wahls:

The patients were thrilled, because we were having great results. Now, actually, in retrospect, I'm very grateful that they complained. And my chief of staff ... I brought my scientific papers and went over them with him. He said, "Okay, Terry, but what you need to do is learn how to talk about this in the medical record, because I see you're giving talks in public now so you've got to learn how to talk about it in public. Because if there's an anonymous complaint that you're not practicing the standard of care, you'll go through a medical audit. I don't want you to lose your license."

Dr. Terry Wahls:

So then I get sent to meet with the head of the complimentary alternative medicine clinic at the university and I became much more mindful in my clinical notes to say, "I'm not doing FDA-approved treatments. I am working on improving the health and physiology of your cells, and then I'm monitoring your blood pressure and your blood sugar and your medications so you don't accidentally become overmedicated." And soon as I started constructing my medical notes that way, my partners were happy.

Dr. Robert Rountree:

As long as you were covering ... You were basically covering your A, as we say.

Dr. Terry Wahls:

Absolutely. A couple years later, the VA chief of staff and the chief of medicine pulled me out of primary care and had me create my own clinic. So I got a few people at first, had great results, then I got a few more, and then the flood came.

Dr. Robert Rountree:

Suddenly, people were standing in line.

Dr. Terry Wahls:

Yeah, people were standing in line. Then I'm giving quarterly reports first to the chief of medicine and chief of the pain service, chief of specialty medicine. And the VA has an electronic medical record, so we could show that blood pressures were improving, blood sugars were improving, and medication use was declining, including narcotics.

Dr. Robert Rountree:

So you realized all of this is basically challenging the fundamental paradigm of how medicine is practiced, which is the notion that once you get a chronic illness of any kind, whether it's MS or rheumatoid arthritis or diabetes, that inevitably, there's going to be a decline and the best you can do is slow it down. I mean, that's the primary functioning premise of medicine, isn't it?

Dr. Terry Wahls:

That is. And I'll tell you, the other thing that was really interesting. When I first had my recovery and I'm thinking very differently about disease and health, and I'm getting people convinced to eat these radical things known as vegetables and to walk-

Dr. Robert Rountree:

Vegetables.

Dr. Terry Wahls:

... and take vitamin D. My chief of staff said, "Now, Terry, people are telling me that you're using the same protocol for everyone. You can't do that. You cannot do that." And so I had my arm full of papers and I said to John, "Now, John, I know all of our cells have mitochondria, they all have cell membranes. That's what I'm focusing on."

Dr. Robert Rountree:

So you're really treating the person. You're treating the person. You're not treating the disease. You're not saying, "Well, MS is a disease and it's an autoimmune disease and here's the pathway that's abnormal, here's the cytokine that's a problem, or B-cells, or whatever." You're just getting the person healthier.

Dr. Terry Wahls:

Correct. We have to work on the wellness, the self care, the nutrition. It's a clinical decision, do people need to go immediately on very potent disease-modifying drugs to get their disease under control? And how long should they stay on their disease-modifying drugs? How do we get them off their disease-modifying drugs? Because we know as people age, the side effects from the disease-modifying drugs increase and the benefits decrease, over the age of 45 in particular.

Dr. Robert Rountree:

I think an important take-home message for people is that you're not just what we call an N-of-1, right?

Dr. Terry Wahls:

Yeah.

Dr. Robert Rountree:

It isn't like, "Wow, this is a miracle, but you just got lucky." You're saying these principles are applicable to a much larger population.

Dr. Terry Wahls:

Yeah. And furthermore, we've done clinical trials. We've done four clinical trials. The first one was everybody got the intervention. With progressive MS, you expect no one to improve, and we had a remarkable reduction in fatigue, improvement in quality of life, improvement in cognition, and half those folks had significant improvement in motor function. Then we started doing randomized trials, and again, in all of our randomized trials, people were able to implement the diet. And we did simplify things. We went down to just studying just the diet, but they could implement the diet and have significant improvement in quality of life, reduction of fatigue, and improvement in motor function.

Dr. Robert Rountree:

So this is something that can be applied anywhere in the world. I mean, it's not like, well, people have to come to you in Iowa and take their secret sauce. This is something you're saying, "Hey, it's not that complicated." There's some principles involved, correct?

Dr. Terry Wahls:

Correct. When I first started doing ... and I figured out the foods that were aligned with the nutrients I was taking in supplement form, I had food lists. But then when I started teaching my vets, I needed to come up with principles to teach the concepts that could be easily understood. I want to be sure that my vets are not getting hungry, and so I'm telling them, the goal is nine cups of vegetables a day and non-starchy fruits, so things like berries. And we're stressing green leafy vegetables, cabbage family, onion family, mushroom family vegetables, and things that are deeply colored like beets, carrots, peppers, tomatoes. Then I sort out, are they vegetarian, are they meat eaters. If they're meat eaters, I want them to have meat, fish, poultry, preferably organ meat such as liver once a week. But we also have people who are vegetarian for their deeply held spiritual beliefs, and so we created vegetarian options as well.

Dr. Robert Rountree:

So here's kind of a core question for you. As you know, Tecfidera, one of the more popular drugs for MS, supposedly works by activating the Nrf2 pathway, which I sometimes call that the broccoli pathway. Why not just tell people to eat broccoli or broccoli sprouts or take a supplement like broccoli seeds?

Dr. Terry Wahls:

I'm working fast and furiously on a grant proposal right now, Bob, that will investigate weaning people over the age of 45 off first-line drugs, which include Tecfidera, so we'll see. We'll see if I'm able to get that study funded or not.

Dr. Robert Rountree:

And what about omega-3 fatty acids? Do they play a big role in all this?

Dr. Terry Wahls:

That was certainly a very big role in my recovery. That's essential nutrient that we've included in all of our clinical trials, because it plays a key role in the nerves being able to repair themselves. It will play a key role in the neurite or the axon development. It's going to play a key role and in synapse, and of course, myelination.

Dr. Robert Rountree:

Are there any other nutrients that you'd say are really key that you could either take in a supplement or take from food that-

Dr. Terry Wahls:

I think it's also key to get plenty of vitamin D. Now, our ancestors were outside 24/7, so they got plenty of vitamin D from their skin, but most of us are inside. We work inside, we do a lot of recreation inside, so nearly everyone in my clinics, in my therapeutic lifestyle clinic, were severely vitamin D deficient. In my clinical trials, now the neurologists are getting more on board with checking vitamin D and treating vitamin D insufficiencies. If people are-

Dr. Robert Rountree:

So if-

Dr. Terry Wahls:

But I want to follow up one more, Bob. I think it's important if you're taking vitamin D, take vitamin K2. Because as your vitamin D goes up, I'll be able to absorb more calcium, and if I don't have enough vitamin K2, that extra calcium may deposit on my heart valves and blood vessels. So if I'm giving people vitamin D, I also like to see them take vitamin K. Now, if you have lots and lots of greens, the bacteria in your bowels will help make more vitamin K.

Dr. Robert Rountree:

So important point here, you don't think the vitamin D is just useful for prevention. You think even after somebody's been diagnosed, it's important to get your levels up.

Dr. Terry Wahls:

Oh, absolutely.

Dr. Robert Rountree:

Because I know some neurologists say, "Well, it may be involved in keeping you from getting MS, but once you have it, who cares?"

Dr. Terry Wahls:

The studies that I've looked at have been pretty consistent that if your level's at the top half of the reference range, your risk of relapse is significantly lower. And so in terms of relapse risk, definitely I'd want to have my vitamin D in the top half of the reference range. Now, in terms of clinical worsening, people have not looked at that data nearly well enough, so I can't specify. But my preference for all of my patients is to get your vitamin D up. And in my therapeutic lifestyle clinic, we're taking care of people with autoimmune issues, not just MS, and then the comorbid problems of anxiety, depression, high blood pressure, diabetes, obesity. We're working to get their vitamin D levels up to the top half of the reference range for all of them. And I was talking to all of those people about the importance of making sure they had plenty of vitamin K.

Dr. Robert Rountree:

I want to touch on something that's in the news right now and a lot of people are talking about it, and it may have some impact on management, which is this new study that was published from data from the military showing that Epstein-Barr virus is the "cause of MS." So I'm wondering if maybe you could tell our listeners ...

Dr. Terry Wahls:

Yeah, let's talk about that.

Dr. Robert Rountree:

... a little bit about the study. Yeah.

Dr. Terry Wahls:

Yeah. The military is uniquely qualified because they get blood from people when they come into the military, and while they're in the military, they keep getting blood from the service members. So they've been able to monitor using frozen blood the impact of what's changing over time. There appear to be 16 different microbes that are associated with a higher risk of developing MS, and the Epstein-Barr virus, we've know about for a very long time. Now, this paper saw that there was only one person who did not have a prior episode of Epstein-Barr virus who developed MS. Everyone else had.

Dr. Robert Rountree:

One person out of what? I can't remember the number. Was it like 600 people, 700 people?

Dr. Terry Wahls:

I think it was 800.

Dr. Robert Rountree:

800 people.

Dr. Terry Wahls:

800 or 801. And they also note that 95% of the individuals have been exposed to Epstein-Barr virus. So nearly all of us have, but not all of us are getting multiple sclerosis or other autoimmune disease. And so the researchers said, "There's clearly other genetic and environmental factors that play a very important role." So you have a genetic vulnerability. You're going to get one of these 16 different microbes, and most of us get Epstein-Barr virus and cytomegalovirus and coronavirus, and many of these different 16 microbes that increase our risk.

Dr. Robert Rountree:

So does that mean if a teenager gets infectious mononucleosis that they should be worried? Or what would you say to a parent ...

Dr. Terry Wahls:

Well-

Dr. Robert Rountree:

... who said, "My kid's got mono and ..."

Dr. Terry Wahls:

It's the same advice I would give to all parents of your kids. You want your kids to have long and healthy lives, so teach your kids to cook, eat vegetables, teach them a mindfulness meditation practice, encourage physical activity so that they will be more resilient. And that will decrease the likelihood of that Epstein-Barr virus reactivating and then contributing to the development of a autoimmune process.

Dr. Robert Rountree:

In other words, there is evidence that we can ward off autoimmunity. We can keep it from happening, even if "the cause" is Epstein-Barr virus. Obviously, millions of people get Epstein-Barr virus and not that many people get MS.

Dr. Terry Wahls:

We've known for a long time that you have a genetic predisposition, an infectious exposure, plus "unknown genetic environmental factors," equals autoimmunity. We've known that for over a decade. And the evidence keeps getting stronger that Epstein-Barr virus is a very strong player. But it's not the only player in this. And just because you have Epstein-Barr virus does not mean you're going to develop autoimmunity. Most of us have had one or more of these 16 microbes present.

Dr. Terry Wahls:

And the other thing I want to remind your listeners, Bob, is that when I went to medical school, probably when you went to medical school, we were taught that our bodies were sterile, that the urine was sterile, the blood was sterile, the brain was sterile, the lungs were sterile, and that our immune cells were very effective that way. We now know that we're not sterile, that our immune cells are keeping all those microbes we've been exposed to in check. So if we don't keep them effectively in check, they're much more likely to lead to a autoimmune type of diagnosis.

Dr. Robert Rountree:

In other words, you want a healthy gut microbiome.

Dr. Terry Wahls:

You want a healthy gut microbiome.

Dr. Robert Rountree:

Among other things.

Dr. Terry Wahls:

Yeah. You want a healthy amount of exercise, sleep, appropriate cortisol in the morning, resolution in the evening, appropriate melatonin in the evening, good sleep. There are all these lifestyle factors that my partners used to be beside themselves that I'd be talking about this multimodal lifestyle approach to treating complex chronic disease. But that is what you have to do to maintain your immune cell competence so they can keep all the microbes in check so I do not develop autoimmune processes that lead to an autoimmune diagnosis.

Dr. Robert Rountree:

Why don't we take a little break right now. When we come back, we can answer some questions from the audience that I think will explore some of the concepts you're bringing up in even more detail. So hold on, everybody. We'll be right back.

Dr. Robert Rountree:

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Dr. Robert Rountree:

And we're back. Now it's time to answer some questions that have come in from the community. Our first question this week for Dr. Wahls comes from a listener who asked, "What are the warning signs for MS?"

Dr. Terry Wahls:

Bob, typically, there is a prodrome for autoimmunity, MS, inflammatory bowel disease, rheumatoid arthritis, that goes from 2 to 10 years. Fatigue, pain, migraines, for women, infertility, endometriosis. So people will have that, and then they may have a sensory disturbance, numbness, tingling. That's very common. Some stumbling, also very common. 20% optic neuritis or sudden blurriness of the vision, or very dim, gray vision in one or both eyes.

Dr. Robert Rountree:

And this can go one. This can happen for years before they get a formal diagnosis.

Dr. Terry Wahls:

Typically, people are having symptoms that have been going on for 5, 10, even 15 years prior to getting a diagnosis.

Dr. Robert Rountree:

Doesn't that kind of imply that if the process that leads to MS is going on, it's kind of smoldering for a long time, there's time for intervention, too? In other words, don't wait until you've got a full-blown diagnosis.

Dr. Terry Wahls:

I'm trying to get the word out. If you have chronic fatigue, pain, chronic migraines, pelvic pain, infertility, that is the time to begin the Wahls protocol, because you could probably stabilize and reverse many of those processes and completely resolve them.

Dr. Robert Rountree:

So here's a kind of segue to that, which is how does your protocol differ from a basic paleo diet?

Dr. Terry Wahls:

I want to remind everyone, I went paleo in 2002. I hit the wheelchair in 2003 and I was meticulously gluten free, dairy free, very careful paleo eater, but continued to decline for another four years. It wasn't until I redesigned my nutrition based on what I learned from, yes, reading the basic science, reading functional medicine, and then adding the lifestyle components, the meditation, the exercise, the stim. I do take some foods out, but I'm much more prescriptive on what to be sure that you are eating.

Dr. Robert Rountree:

And that is, what is it, nine a day?

Dr. Terry Wahls:

Yeah. The goal's nine cups a day.

Dr. Robert Rountree:

Nine cups. Nine cups.

Dr. Terry Wahls:

Now, if you're a petite lady ... We have some very petite people in our study, 4'10". They're not going to have nine cups of vegetables a day. The goal is, you have your protein source and then you have greens, cabbage family, onion family, mushroom family, deeply colored, according to what your appetite will allow.

Dr. Robert Rountree:

So here's a segue from that question, which is, should people without MS follow this diet? Is it useful for anybody else?

Dr. Terry Wahls:

Yes. Yes. We use this clinically for people with all sorts of autoimmune issues. Inflammatory bowel disease, rheumatoid arthritis, systemic lupus, psoriasis, and any of the hundreds of autoimmune issues. And many of these people with autoimmune issues will have comorbid anxiety, depression, high blood pressure, insulin resistance. And if you want to have healthy aging, absolutely follow the diet.

Dr. Robert Rountree:

It's not just an MS diet. It's-

Dr. Terry Wahls:

It's not just an MS diet, absolutely not.

Dr. Robert Rountree:

And I see we have some other questions. Can people have coffee on your protocol? What about tomatoes? Potatoes? I assume nightshade ... What about nightshades, things like that?

Dr. Terry Wahls:

Okay. Well, let's talk about coffee first. Coffee, yes, you can have coffee. What I ask my patients is when you have coffee or tea or yerba mate, all of which have caffeine in them, does it keep you up at night? Do you have good sleep? If it interferes with your sleep, you have to have less coffee and less tea earlier in the day, and you may have to limit it because the caffeine and its impact on your sleep.

Dr. Terry Wahls:

Now, for the question about tomatoes and potatoes. I've designed the Wahls diet to give people a lot of flexibility according to their clinical circumstances and to what they and their family can successfully implement. So we have basically four levels of the diet. Levels one, two, and three, and elimination diet. The nightshades ... so that's tomatoes, potatoes, eggplants, and peppers ... are taken out if you're doing the elimination diet. And the people who will likely benefit from elimination diet are folks that have joint involvement, so rheumatoid arthritis, psoriatic arthritis, systemic lupus, or inflammatory bowel disease, or they have been doing the Wahls diet and haven't gotten the level of response that they're looking for. Then I'd go ahead and take the nightshades out for three months and see what kind of impact we have, because that is the most therapeutic, but it's also the hardest.

Dr. Terry Wahls:

Therefore, in my clinical practice, I usually have people start at level one, which is gluten free, dairy free, nine cups of vegetables, and we either have a vegetarian option or a meat-eating option, depending on the person's spiritual beliefs.

Dr. Robert Rountree:

So you're not automatically of the mind that nightshades are bad for everybody. You just think for certain individuals-

Dr. Terry Wahls:

Oh, no, no. For the vast majority, nightshades are great foods. I can have tomatoes, I can have eggplant, I can have peppers as long as I do it on an occasional basis. If I did it every day, I'm more likely to have my face pain turn on.

Dr. Robert Rountree:

How bad is cheating on this diet, if people, say they go out to restaurants and they're with their family, they feel kind of guilty if they're doing your program? I mean, my guess is that you're not telling people, "Don't, don't, don't. Avoid, avoid, avoid."

Dr. Terry Wahls:

How I approach this is, I try to teach people how to use the biosensor that they have built in. For me, it's very easy. I have trigeminal neuralgia, so if I get exposed to foods that are a problem, my face pain will turn on. Therefore, I've learned to be very, very careful on my diet. And some people have visual problems. Others have a sensory disturbance in their hands or feet, and so my advice is, start the diet that you can 100% do, level one. Or for some it's like, "You know what? All I can do is I will do the Mediterranean diet." Okay, that's fine. Do that at 100%.

Dr. Terry Wahls:

But whatever diet you're going to do, do it 100% and watch how your body's responding. If you go off your diet for whatever reason, whichever dietary plan that you've chosen, how did your body respond? Did you have a flare of visual problems so you couldn't see out of your right eye? That's a big signal. Did you have hand numbness? I get a huge signal when my trigeminal neuralgia turns on. So over 15 years now, I've developed a lot of nuances with what I will do based on paying attention to how my body responds.

Dr. Robert Rountree:

So people shouldn't feel guilty if they happen to cheat for some reason, but they should pay attention to ...

Dr. Terry Wahls:

Correct.

Dr. Robert Rountree:

... their biosensors as you said.

Dr. Terry Wahls:

If-

Dr. Robert Rountree:

Like, "Okay, I cheated. What happened?"

Dr. Terry Wahls:

What happened? And the other thing I would tell people is, there's a huge difference between doing whatever dietary intervention that you've decided to do at 75% and at 100%. If I did a scientific experiment at 75%, I'm just going to get trash results. I'll have no idea. So to all the listeners, you are the principal investigator of the most important experiment, which is your life. You want to know if the interventions you are doing are going to help you or not. Therefore, if you've decided to do an intervention, whether a diet or a meditation, actually do it 100%. And my challenge to people is, try the diet, whichever diet plan that you want to do, 100% for 100 days and see how you feel. Don't cheat for that 100 days. Then you can experiment and decide how rigorously you need to follow it.

Dr. Robert Rountree:

So along with that is ... We've already talked about vitamin D and we talked about the omega-3 fatty acids in fish oil. Are there other vitamins that people really should be taking as part of this protocol if they're going to dive in?

Dr. Terry Wahls:

A couple things that I think are really useful. One is NAC, N-acetyl cysteine. That can really help. Many of us are low in our sulfur amino acids and your body can take N-acetyl cysteine to make a number of key neurotransmitters. Very, very helpful. I also think it's likely useful to take a good multivitamin. I would do that as well. I would take-

Dr. Robert Rountree:

So your B vitamin? Something with B vitamins and a few minerals and ...

Dr. Terry Wahls:

B vitamins, a few minerals. Ideally, in addition to getting your homocysteine, there are a few other key labs that I would encourage everyone to know. So your vitamin D level, get a homocysteine. I would also get a glucose and insulin so you can see if you are developing insulin resistance.

Dr. Robert Rountree:

So keep that sugar down.

Dr. Terry Wahls:

Keep that sugar down, and keep the insulin down. Some people can have a normal blood sugar and a normal hemoglobin A1C, but their insulin is very, very high and they are developing insulin resistance. They're on the way to metabolic syndrome. And if you develop metabolic syndrome, you will be much more likely to have a severe MS. You're more likely to have relapses, you're more likely to have early disability, more likely to be needing a cane, walker, wheelchair, and more likely to have early cognitive decline.

Dr. Robert Rountree:

So one of our listeners wants to know, how long is it going to take for all this to work if you dive in and you do the Wahls protocol, take the supplements?

Dr. Terry Wahls:

So let me give you the feedback that we saw in our therapeutic lifestyle clinic, and then I'll talk about my clinical trials. In the therapeutic lifestyle clinic, I'm seeing people with a wide variety of diagnoses. A lot of autoimmune problems, some mental health problems, high blood pressure, metabolic syndrome, prediabetes, diabetes. So lots of diagnoses. Main complaints were usually fatigue, pain, and poor mood, even though they had lots of those diagnoses. We get them on ... fix their vitamin D, add a B complex, add fish oil, and I would put them basically on level one as a vegetarian or level two if they were a meat eater. So Wahls or Wahls paleo. And I'd see them every month.

Dr. Terry Wahls:

At the first month, people would often say, "This is the first time I feel like maybe pain is letting up and it's a little easier to get along with my spouse and my kids." So they're a little less irritable. On the second month, they're very clear, like, "It's very clear I'm having less pain and I'm definitely less irritable." And on the third month, nearly everyone had less fatigue, less pain. It's also in the third month ... A lot of these guys were young men who had served in the Iraq war, Rountree. So they had lost erectile function and lost a lot of libido. So it was also common in the third month ... And that one might take three to six months. The guys would come in and say, "Doc, my love life is coming back." So they're pretty excited about that.

Dr. Robert Rountree:

That's pretty exciting.

Dr. Terry Wahls:

They're very excited. And they're also now losing a lot of weight. The ladies have been losing a lot of weight, and so they're excited about the fact they've lost weight. But if you ask the ladies, "How's your love life?" They're like, "Well, actually, I am more interested in sex now and I'm having a lot less pelvic pain." So that shows up between three and six months.

Dr. Terry Wahls:

In my clinical trials, consistently at three months, fatigue is down, quality of life is better, mood is better. And improvement in motor function begins to show up most often between 6 and 12 months. I think the reason it takes longer for the motor function to show up is that you have to build muscle mass, and that's a longer process. Decreasing the inflammation in the brain, decreasing the microglia reactivity can happen relatively quickly if we improve the gut microbiome and if we are doing the diet and lifestyle stuff.

Dr. Robert Rountree:

Now, I remember you telling me a while back that it's more important to go with how a person is feeling, how they're doing clinically than to look at those brain scans. Because the neurologists look at the brain scans and say, "Oh, you've still got white matter lesions and look, nothing's different," and yet the person is out of their wheelchair and walking around and feeling better. So the brain scan is not the be all and end all.

Dr. Terry Wahls:

I was talking to my neurology colleagues about this as we were designing our future trials and my more senior MS neurology expert said, "The most important clinical response, is the person have relapses? Are they stable clinically or are they getting more disabled?" Because if you change the disease-modifying drug treatment based solely on the scan when someone is doing well, you're going to run out of drugs because there's more activity in the scans that come and go. What really matters longterm is, are they having relapses and are they doing well or not?

Dr. Terry Wahls:

Now, he's not going to feel comfortable ignoring 20 new lesions. But would he feel comfortable ignoring two or three? The answer was yes, he would feel very comfortable ignoring two or three, but he would not feel comfortable ignoring 10 new lesions. But if you had 10 new lesions, you're probably going to have-

Dr. Robert Rountree:

You're going to have symptoms.

Dr. Terry Wahls:

You're going to have symptoms.

Dr. Robert Rountree:

One last question. Is there anything that you're really excited about researching? Any particular questions about the intervention that you want to ...

Dr. Terry Wahls:

Well-

Dr. Robert Rountree:

... do a study on? Anything that's burning in your mind?

Dr. Terry Wahls:

We're getting ready to start a new study comparing a ketogenic diet, the Wahls elimination diet, dietary guidelines. We'll have MRIs at the beginning and at two years. And then the next thing that I really want to investigate are, are there things that we can do to help people find a off ramp from DMTs who are willing to do diet and lifestyle? When I have this conversation with my neurology colleagues, they agree that that's a very important clinical question that they would like to have help answering. So I'm like, "Okay." That's exactly the kind of question I'd like to investigate further.

Dr. Robert Rountree:

Well, Terry, I have to say that every time I talk to you, I'm just blown away by how impressive your work is. And the main thing that I get from it is you're very clear there's cause for hope, that when people get diagnosed with something like MS, they think, "Oh, I'm stuck now. I have this chronic disease and there is no hope." And your whole message is about hope, and it's evidence-based hope. That's what we should call that, evidence-based hope.

Dr. Terry Wahls:

Evidence-based hope, and there's so much that is under your control that will change the course of your disease. You can make choices that will accelerate your disease, or you can make choices that will stabilize and very potentially remarkably regress your disease.

Dr. Robert Rountree:

So it's all in your hands, folks.

Dr. Terry Wahls:

And at the tip of your fork.

Dr. Robert Rountree:

At the tip of your folks. So folks, that's all we have time for this week. Again, Dr. Wahls, I want to thank you so much for being on the podcast. I hope that we can have you on again. Where can our listeners go to follow your work if they want to get in touch, if they want to see your or find out about your protocol? I know you have your book and website, I think?

Dr. Terry Wahls:

Yeah. If you go to terrywahls, that's T-E-R-R-Y, Wahls, W-A-H-L-S, .com, that's our website. And if you add in /diet, then you'll get a one-page handout that summarizes the diet that's perfect for your refrigerator.

Dr. Robert Rountree:

Wonderful. That was professor and researcher Dr. Terry Wahls. As always, thank you everyone for listening. If you like what you heard, tell a friend about our show, and until next time. Bye bye.

Dr. Robert Rountree:

Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thornehealth. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news, videos, and stories on Thorne's Take Five daily blog. Once again, thanks for tuning in, and don't forget to join us next time for another episode of The Thorne Podcast.