Listen to Ep 03 where Dr. Terry Wahls and I talk similarities between MS and CFS, food as medicine, her clinical trials, re-inventing yourself with a chronic illness, and more.
Full Text Transcript:
Dr. Craig: Welcome to Spoonie Radio. I’m your host Dr. Courtney Craig. My guest today is a Clinical Professor of Medicine at the University of Iowa where she teaches internal medicine residents, sees patients in a traumatic brain injury clinic and conducts clinical trials. She’s also a patient with secondary progressive multiple sclerosis which confined her to a tilt recline wheelchair for four years. Using diet and lifestyle changes she restored her health and now pedals her bike to work each day. She’s the author of the best seller “The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine” and teaches the public and medical community about the healing power of intensive nutrition. And she’s here today to do just that. I’d like to welcome to the show Dr. Terry Wahls.
Dr. Wahls: Hello! Thank you for having me.
Dr. Craig: Now, I first heard you speak and tell your story about 2 years ago at the Ancestral Health Symposium and that was the first time that I’d heard of you and heard about this wonderful story. I was immediately touched and moved because I heard so many similar things in your story as what I experienced with my own illness--because I too used functional medicine and paleo principles to basically beat a 15 year diagnosis of chronic fatigue syndrome. And I do want to talk a little bit today about the similarities between the two illnesses. But just to start if you could explain to our listeners, what is MS? What are the different subtypes of MS?
Dr. Wahls: Sure. So multiple sclerosis is an auto-immune disorder attacking the brain and spinal cord. Eight percent of people who are diagnosed initially with relapsing-remitting; which means you have an acute episode of worsen called the relapse. Your body is able to slowly adapt using sodium channels so it can work although somewhat less effectively and symptoms reduced--that’s all the remission. Ten percent are diagnosed with primary progressive who never have an acute worsening only a very gradual decline. And there is no FDA approved drug treatments that change the course of primary progressive. The longer you have relapsing-remitting, the more likely it is you’ll convert to the progressive form of the disease - secondary progressive or the decline continues despite treatment. After 10 – 15 days of diagnoses, the vast majority of those with relapsing-remitting have converted to secondary progressive multiple sclerosis.
Dr. Craig: I’ve always been intrigued between the similarities between these two illnesses: multiple sclerosis and CFS. Although CFS is not classically defined as an autoimmune condition we still see similar things in both: immune cell dysfunction, similar cytokine patterns, and similar symptom clusters clinically. These are more common in females, the debilitating fatigue, there’s pain, cognitive fog, all of these similar symptom clusters. It’s fun to intellectually think about these things but what I want to really get at is what do you think is going on here? What is the root cause of these things?
Dr. Wahls: Would that be a comment on the root cause of both?
Dr. Craig: These chronic illnesses and autoimmunity, these poorly defined conditions that we see?
Dr. Wahls: Well for generations, hundreds of generations, physicians have been classifying diseases based on the patient’s story, the physical findings and gradual we began to add more and more lab tests. Now scientists are able to look inside the cells to understand the molecular changes, such as cytokines, and we see the cellular changes with increased inappropriate inflammation, evidence of mitochondrial strain, and oxidative stress. We see that the presence of toxic load in the body worsens these symptoms. The presence of primary infections also worsens these symptoms. And part of what is surprising to scientists is that the cellular level, molecular level in these diseases look more and more alike. I’m talking about very common, excessive inappropriate inflammation, very common mitochondrial dysfunction, very common disease worsening by toxic exposure and body burden. From the neurological diseases, that includes bipolar, schizophrenia, mood disorders, obsessive compulsive disorders, anxiety, autism, and learning disabilities. On the medical side includes high blood pressure, obesity, diabetes, heart disease, autoimmune conditions, Parkinson’s… I think we need to begin to look at is look at the root causes of diseases: look at mitochondrial dysfunction, look at nutritional issues and look at toxic load issues and chronic infection issues and deal with all those root causes issues instead of only dealing with the main diagnosis through its symptoms and not uncovering the root causes that probably led to inflame disease-prone body.
Dr. Craig: Right, right, absolutely. And we’re seeing a shift, I think, in thinking; and in the way that medicine is practiced. It’s really a recent idea that chronic disease is inflammatory nature and I heard one of your interviews on another show you mentioned that we might be learning that a lot of chronic disease is autoimmune in nature. So what if you could speak more to that, what does that mean for those that do have an auto-immune illness, do we need a new definition of this term ‘autoimmunity’?
Dr. Wahls: Well, every year we’re adding more and more diseases to the possibly autoimmune and moving the “possible autoimmune” to the “probable, definite autoimmunity.” Let’s sorta step back for a moment and think about inflammation, which is the bodies’ response to traumatized tissue or tissue that has been damaged through infection. The immune cells will go in, dissolve the damaged tissue and assists in the rebuilding of those damaged tissues. So that’s normal healthy immune response that we all must have to do our ongoing repair that’s required to maintain our bodies. What is abnormal is where the tissues appear to be physiologically normal yet our immune cells go in and begin dissolving and replacing those seemingly normal tissues. That’s clearly a reflection of autoimmunity. For example, most of my colleagues do not think of high blood pressure or atherosclerosis as an autoimmune disease. Yet if you go to PubMed and you search for autoimmunity and atherosclerosis you will see that this a very hot and exciting area of research. In terms of understanding the atherosclerosis and blood pressure changes as an inflammatory response that is inappropriate; therefore an autoimmune response.
Dr. Craig: That’s really interesting and cutting edge, and outside-of-the-box thinking. I feel like your whole message is outside-of-the-box, you have this idea that food can affect everything on a cellular level. So let’s talk more about this: what is your Wahls’ Protocol? How does food fit into this picture?
Dr. Wahls: We’re alive because of chemistry. This wonderful self-correcting chemistry that can keep the concentration of calcium, sodium, potassium, magnesium in a very narrow range inside the cell or outside of the cell. When we get outside of those ranges we become very ill and die. Now that chemistry happens because of the food that we eat, and the food we don’t eat. It also includes the toxins we’re exposed to that can confuse our chemistry.
In 1700, humans ate less than 10lbs of sugar in a year. In 2008, 153lbs of sugar per person per year; our children ate even more than that and today we eat 109lbs of white flour a year. All of those calories are empty calories that our species would never have seen before 10,000 years ago. That really drives up inflammation, creates epigenetic changes on our DNA, and displaces from our diet the foods that would have provided the vitamins, minerals, antioxidants essential fats, amino acids that our cells need to conduct their biological lifecycle.
Dr. Craig: Now this is sounding a lot like a traditional paleo diet, nutrient-dense paleo diet. But you describe your dietary approach as a modified paleo diet and intensive nutrition. So how is your approach a little different than the typical paleo approach that we see?
Dr. Wahls: Many of the paleo authors send a lot of time explaining why you need to remove grain, legumes and dairy from the diet and then tell you to eat meat and vegetables. They don’t give people a lot of structure on how to organize these dietary choices. In fact one doctor, Jason Calton did a detailed nutritional analysis of modern diets: South Beach, Atkins, ADA, practical paleo is described by Sanfilippo in Practical Paleo, and Primal Blueprint as described by Mark Sisson. He found that the paleo diets were among the most nutrient-dense he analyzed. Great news, but it still missed 56% of the Recommended Daily Allowances (RDA’s), pardon, they only met 56% of the RDA’s, so they missed 40%. That’s really quite huge. What I’ve done that is different from all the other paleo authors is I went to the literature and through functional medicine, through my review of the basic science literature we identified basically 36 nutrients that I track a monitor that I know brain cells need. Then were created a food plan, menus, recipes--analyze how many nutrients were delivered and confirm that we met the needs for these 36 nutrients and so we exceed the RDA’s 1 ½ to 9 times, which looks very similar to a free living, traditional hunter gather society. I’ve confirmed my clients, no one else has done that, no one else has the research lab to validate what brain cells need and that there are eating plans that provide them.
Dr. Craig: Wow! Those are big differences. I wasn’t familiar with those numbers. One thing I know that you also stress is--that’s different I think from the traditional paleo--is your diet is much higher in fat. So what role does that high fat intake have on the cellular level?
Dr. Wahls: So what I do in my book is I help people transition from their current diet into an aggressively more health promoting, grain protecting diet. At the highest level I’ve created a ketogenic diet where I stress, and talk about the critical role of fat. You see every cell in my body has a fat wrapped around it of phospholipids. In that fat wrapper is 60 – 70% cholesterol, saturated fat, and 10% omega 6 and omega 3 fats. To have the healthiest membranes we want to have cholesterol, saturated fat, omega 6, and omega 3 fats. This fixation on a low fat diet has really been starving our cell membranes, putting ourselves at much higher risk for brain-related problems, earlier cognitive decline; earlier memory loss, neurodegenerative diseases like Parkinson’s, and chronic fatigue, and brain fog, that’s not been clearly diagnosed.
Dr. Craig: Right, right. Fat is so crucial. And thankfully we’re finally getting away from fat-phobia I think we’ve seen it in the media here in the recent weeks so hopefully that trend will be changing. What about animal fats and animal proteins here? Is this diet something that’s feasible for people who follow vegetarian diets?
Dr. Wahls: Well, I have several interesting perspective on that. So I had a 20 year vegetarian history and the way I practiced my vegetarian diet, I had plenty of grains, legumes. I didn’t eat much bread, it was whole grains, whole legumes, plenty of vegetables, not a lot of sugar, not a lot of white flour. But clearly the way I practice, I think I put myself at risk for low B12 and inappropriate omega 3, omega 6 ratios, and probably not enough protein. However I will also note that one of my research assistants is a vegetarian for religious reasons, and that really challenged me to reach out to those who I know are not going to go back to eating meat because of their spiritual beliefs.
So we did create a program that a vegetarian/vegan could follow. I also gave them some clear guidance on how to reduce the risk of lectins and phytates, address their B12 problems, and protein concerns. I did invite them that if they had a chronic health problem as a vegetarian, the way they were interpreting their vegetarian diet could very well be a large part of their illness. So I do think that eating meat as a complete protein particularly if grass-fed, wild game, and wild fish has many, many health benefits. But I will also agree that it is possible to be a vegetarian or vegan if done carefully and still have excellent health. Now, some people would agree that we have a lot more difficulty achieving that if they have food sensitivities to grains and legumes.
Dr. Craig: Another thing that you stress in your book and I think that’s kind of, one thing that most people are familiar with, is you recommend a ton of vegetables; something like 6 – 8 cups of vegetables a day. It’s hard enough to eat half of that, what are your tips for people to increase their vegetable intake?
Dr. Wahls: Well if you take out grains and starches, so you’re eating non-starchy vegetables, berries, and meat according to your appetite, and you’ll do pretty well. I tell people that 6 – 12 ounces of meat according to your size and gender and then eat non-starchy vegetables and berries according to your appetite. But the target, if you’re a tall lady or a man 9 cups of vegetables, or if you’re more petite lady, maybe 5-6 cups of vegetables, perhaps even 4, and it also depends on if you’re in the ketogenic phase of the diet, then of course we’d reduce the carbs further.
Dr. Craig: Another thing you stress is sulfur-rich foods. What’s the role of sulfur in all of this?
Dr. Wahls: The sulfur containing food groups I talk a lot about (the cabbage family, onion family, mushroom family) these 3 food groups have been medicinal foods across many cultures for many millennia. These sulfur compounds, thiols, are very important in the processing and eliminating of toxins. It’s very important for the generation of glutathione, antioxidants within the cell, and it’s very important for the generation of neurotransmitters. So it has many critical roles in the body, in terms of we run our chemistry, in addition these compounds will go speak to me my DNA through a epigenetic changes, turning some genes on, other genes off, which also has a profound impact on the way my cells will run the chemistry of life. It will greatly influence whether I’m tilted towards repair, or if I’m tilted towards inflammation and destruction.
Dr. Craig: Right. Food is biochemistry. I want to talk a little bit more about glutathione because that’s one nutrient that’s used clinically in chronic fatigue patients are given it intravenously, some take supplements. What is your opinion of supplemental glutathione? Is it something that you utilize for your own condition or recommend?
Dr. Wahls: Well, so if you eat this sulfur containing compounds one of the enzymes you boost is glutathione synthetase. So getting your 3 cups of sulphur in will greatly support your ability to generate more glutathione. You can take glutathione in a liposomal form and there are a variety of products out there that allow you to absorb some of that gluathione directly. If you take it in the tablet form, the stomach and intestine will digest it down to the component parts you will absorb that and have to reconstruct it, so it will be less effective. Using N-acetyl-cystiene (NAC) or taurine, or some of the sulfur amino acids, can directly boost that.
Dr. Craig: Now, are there any other supplements that you recommend for people dealing with autoimmunity and chronic illness? It seems like most of your protocol relies only on foods but do you think supplementation has a role in this as well?
Dr. Wahls: I think personalized supplementation can be very helpful. I think it’s extraordinarily challenging to make a public health recommendation that would be good for everyone. In my alternative medicine, supplement chapter I spend a fair amount of time talking about how to speak with your personal physician, how to request some basic labs that a primary care doc would feel comfortable ordering to follow your progress, to give people targets, and suggests inventions to get to that target, and when they would need to work with that functional medicine doc. I think that in my experience, people do far better if things are personalized based on either some lab testing and a history, understanding a person’s personal history and their family history to predict which enzymes are likely to be working less effectively and would benefit from taking supplements.
The challenge with supplements is that my cells see food mostly in ratios for the vitamins, minerals, antioxidants, and nutrients. The absolute level has less impact, the ratio has more impact. For example if you read that zinc, which is involved about 200 enzymatic steps in my brain, very important. So I read that zinc is critical. Ok, so I start taking zinc. I start taking 50mg of zinc every day. I will eventually make myself copper depleted, because zinc and copper are linked and it’s the ratio of zinc to copper that really drives all my chemistry that works through the zinc and copper functions. As soon as we begin taking a supplement, we run the risk of getting the ratios wrong. So you have to be thoughtful about supplement use. If you rely on food that’s going to be fine because the ratio will be correct. If you use history and exam and some lab testing to guide your supplements, and then monitor to know when you get the person replete so you can back off that would be more helpful.
Dr. Craig: That’s great advice, I agree with that. Some people just take so many supplements and I’m guilty of this too. I was taking 40 supplements a day at one point and eventually I had to evaluate and say, wait a second, what am I doing? Is this really making an impact? And then you look closer at the biochemistry and you can really create a personalized plan that is actually I think more effective.
Another thing that you mention as part of your protocol is the role of exercise. Now this an extremely controversial topic in the chronic fatigue community, because only a very, very small subset of these patients can tolerate exercise. With any sort of exertion we experience post-extertional malaise, flu-like symptoms, and could just go into severe relapse. So there’s a lot of fear surrounding exercise and a lot of uncertainty of what causes it. So, I’m wondering if we see this kind of thing going on in MS and what advice would you give to people who can’t exercise or have this fear of even trying to gradually exercise?
Dr. Wahls: So in our clinical trials, in the first trial that we did, we designed an exercise program based on where the person was at, and we added electrical stimulation of muscles to that exercise program. And then we’d gradually increase the electrical therapy time and the exercise time as recovery happened. We did see that we had to be very careful in personalizing, some of our folks were so disabled that a 5 minute exercise program was all they could do. We have everyone spend time stretching we count that stretching time as part of the exercise time and then we’d start the exercise. Again, we were very attentive, listening to our subjects asking how much exercise they could do and still function in that day. If we had too much exercise so we couldn’t function, we kept backing off the time and that’s how we got to people with severe disability--we’d start with only a 5 minute exercise program.
Dr. Craig: Now, talk more about this electrical muscle stimulation. I’m very interested in this, could this be replacement exercise?
Dr. Wahls: Well, there are devices called functional electrical stimulation devices that are used in people who have a traumatic spinal chord injury and are paralyzed. They will do cycling either with their arms or their legs using electrical current to the muscles entirely. In doing that they can maintain the health of the muscle, the health of the bone, and have more favorable cholesterol markers, inflammation markers, and better insulin sensitivity. It was actually in reviewing those studies that got me talking to my physical therapist about doing e-stim for myself. What I have learned is if you exercise and contract that muscle while you’re stimulating, you get much more improvement in muscle strength, muscle endurance. So our advice to patients was to do a voluntary muscle contraction at the same time as the electrical contraction. People who were more severely disabled we might have them do 10 voluntary contractions and then quit doing the voluntary contraction, and let the electrical therapy continue for the 5 minute duration. People do much better if they do a voluntary contraction during the electrical contraction.
Dr. Craig: This is very interesting from my chiropractic perspective and I’d like to explore this more and see maybe some people using this in clinical practice; especially for fibromyalgia patients that have small fiber neuropathy. Another effect of exercise is it’s stimulation of brain-derived neurotrophic factors (BDNF) or brain growth factors, and this is something that I think is very important for both MS and CFS patients. I’ve written about this recently because there’s a new study that came out just this last year looking at a group of CFS patients and a group of MS patients and they measured BDNF levels. BDNF was severely depleted in the CFS group compared to the MS group. So what is your opinion of this brain-derived neurotrophic factor and what are some ways that we can boost our levels.
Dr. Wahls: Well, from an evolutionary standpoint, physical activity particularly intervals where you’ve been running for your life is probably the most powerful stimulating factor. Strength training comes next. Mental learning would come next, aerobic training, low level activity comes next. From an evolutionary standpoint before agriculture, women travelled 2 – 3 miles a day, men 6 – 9 miles, and so there’s considerable physical activity. We certainly find, those who’d have less physical activity have markedly less nerve growth factors. In animal models, we can see that doing electrical therapy, electrical simulation of muscles will increase nerve growth factor locally and in the brain. There’ve been no human studies to look at that and I think it’s unlikely that we’ll have that because I don’t think people are not going to consent to get spinal taps before and after e-stim. That’s just not going to happen.
Dr. Craig: I don’t think so. So another important thing with the nerve growth factor is that it affects cognition and improves brain fog. Bringing up this whole idea of mind-body medicine that we’re still figuring out. So what role does mind-body medicine have in your protocol?
Dr. Wahls: Well, you know in, my book is in 3 parts and the first chapter, first couple chapters talk a lot about conventional medicine, functional medicine, and how the world view differs from disease to disease. Then the third chapter I talked about the internal motivation: that we need to really examine why we want to do this, what our higher purposes in life are, and I encourage developing a journal that you can keep as you go through this process. There is to my mind no question that stress-reducing practices are important—because high cortisol is going to lead to brain atrophy, inflammation, etc. Your purpose in understanding your internal motivation is also absolutely critical.
Dr. Craig: Yeah, I loved the example of the diary that you mention in your book. Not only because it encourages you to collect a lot of data on yourself and you can look at your symptoms each day and look back and see how you’re improving, but also you include things like a gratitude practice each day. I think that’s wonderful, in that we’re seeing there’s actually clinical research that shows that it increases things like growth factor and improves symptom outcomes.
Dr. Wahls: Yes, it helps improve parasympathetic outflow and also improves heart rate variability as well--the gratitude practice. So a lot of physiological parameters improve with that.
Dr. Craig: Absolutely, and it’s such a simple, free thing that someone can do every single day which is also excellent. As I’m reading through your book, the introduction, it tells the very moving story of your health decline and the impact it had on your family, your own mindset, and I related to this again. Although I never had the most severe form of chronic fatigue syndrome, I mean I grew up with it, it was extremely difficult for me to grow up with a chronic clearly defined illness that had no treatment approach. So it was devastating to all aspect of my life. So I’m wondering how did you cope with this diagnosis and what was the factor that made you say no, I’m not going to accept this. I’m going to do something about it?
Dr. Wahls: What certainly made it far easier to make it through by having a very supportive spouse and I had two kids; ages 6 and 9. So it was difficult to watch my involvement in their physical lives decline. I’d have to keep re-inventing myself--reimagined what my life would be like, what parenting was like. Now there are a couple of things that were very, very helpful to me. One was a book I read “Man's Search for Meaning” by Viktor Frankl. One of his concepts was that between every event in your life, and your response to it is a space and in that space the choice you make defines your character and your legacy. So my kids are watching and I’m thinking I want to teach them how to be resilient and thrive despite difficult times. This wasn’t the way I wanted to teach them resilience, and resourcefulness, but it was the hand I got dealt. As I was struggling with re-inventing who I was, I realized if you want to model resilience for your kids, you have to figure out what are the gifts in this circumstance and how are you going to still live a meaningful life. That got me through very tough times and of course having a very happy, committed spouse also makes all the difference in the world.
Dr. Craig: That’s wonderful. I definitely recommend listeners to read that book if they have not already. And one thing that’s so powerful about your story and all of your media talks that are available online, is you’re instilling hope. You’re sharing knowledge, this incredible knowledge that you can actually can get better from a chronic illness, but the bigger thing is, you’re instilling hope. So what is your goal here with all of this information, not only to educate but to spread this hope and awareness?
Dr. Wahls: Well, I want to create an epidemic of health. For many, many years now men understood that the root cause of nearly every chronic mental health problem, neurological problem, medical problem is diet and lifestyle; 70 – 95% of the reason why people became ill. If I can get them fired up about vegetables, positive practice, moving their bodies we can have a epidemic of health. People will need fewer drugs, they’ll have more energy, there’ll be less disability, and there’ll be a fall in cancer, fall in autoimmunity, fall in diabetes, and a fall in heart disease. We’ll save the country billions if not trillions of dollars and we’ll revitalize our economy. So yeah, I want to create an epidemic of health and it’s entirely within our grasp to do that.
Dr. Craig: It’s a very exciting time to be a part of this community--the paleo community, the functional medicine community--because I think you’re exactly right. Your niche is with multiple sclerosis, my niche is with chronic fatigue syndrome, but like you mention in your book, these are just names that we put on conditions. It doesn’t matter what we call it.
Dr. Wahls: What’s going wrong in the cell is the same in both diseases, so if we fix the root cause it dramatically improving nearly every chronic health problem by addressing, nutrition, stress, movement, sleep…it will have huge profound effects.
Dr. Craig: Absolutely, absolutely. And for those listening, I encourage you to think about this protocol, because it’s not just going to be helpful for MS, this is going to be helpful for a multitude of chronic illnesses.
Dr. Wahls: So I have many thousands of followers and you can go to my website terrywahls.com, go to the resource pages, look at success stories, you’ll see videos and stories we have a search bar so you can search through various diagnoses and symptoms. On my Facebook page we have thousands of followers who are chiming in talking about the improvement with their chronic fatigue, their fibromyalgia, Parkinson’s, mood disorders, diabetes, heart disease, obesity, and of course, frankly hundreds of disease I’ve never heard of before who’ve also been helped.
Dr. Craig: Ok, I guess we’ll wrap this up. I want to thank you so much for speaking with us today. So where can we find out more about your work, your clinical trials, and things that are going on
Dr. Wahls: So if you go to terrywahls.com, we have all that information. We have lots of info, videos, you can sign up there’s a great disease chart that you get when you sign up for the newsletter. Of course you can pick up the book, The Wahls’ Protocol, it’s a tremendous resource, lots of information to get you started in this journey.
Dr. Craig: I would agree. It’s a great book, it’s an easy read, it’s not too technical for the lay person and interspersed throughout the book you have success stories and really those speak louder than anything else. It’s amazing to hear your Wahls’ Warriors success stories. Thank you so much. Look forward to hearing more and seeing more of your interviews and appearances in the future.
Dr. Wahls: Well thank you very much for this opportunity.
Dr. Craig: Thank you. Until next time this is Spoonie Radio signing off.