First published Spring 2019


 

When Dr Terry Wahls developed her protocol for multiple sclerosis (MS), a disease that causes signalling problems in the nervous system, one organisation initially banned her as a speaker for offering false hope. Now the same organisation is funding her research. Louise Wates writes

 

In 2014, a book called The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine landed on the Optimum Nutrition desk. Inside, Dr Terry Wahls, a clinical professor of medicine at the University of Iowa, USA, described how dietary changes reversed her MS symptoms. A bold claim indeed. Although there is a great deal of research into MS, treatments have typically focused on medical intervention with recent studies even looking at drastic treatment to knock out and reboot the immune system. A dietary and lifestyle protocol was nothing new, however; both the Swank Diet and the Jelinek Overcoming Multiple Sclerosis programme already existed. Yet in Wahls’ book there was something that seemed almost miraculous about her recovery. At her worst, she was in a wheelchair. Now she cycles every day. 

Yet despite Wahls’ seemingly fantastic recovery, it proved difficult to get somebody with MS to read the book — such a viewpoint would have been valuable. But in the words of one contact who had lived with MS for 30 years, she felt as though she had already tried “everything” and didn’t believe Wahls had anything new to say. Eventually we found a young woman with a recent diagnosis who was interested. She concluded that it wasn’t just a book for MS sufferers; it was a book for everyone. But she was not prepared to put Wahls’ protocol in place — yet. The thought of giving up grains, pasta and potatoes was so unappealing she would rather wait until her symptoms had worsened. 

When, by email, I ask Wahls to comment on this response to her book she is unsurprised. “Not everyone is ready,” she says. “People [are] at varying stages of interest in trying a therapeutic lifestyle. Think of how many people are addicted to tobacco, alcohol and will die earlier as a result of their addiction. They know the harms caused by their addiction, but they are unable to stop.” 

She acknowledges that lifestyle changes are not always easy — her followers have been dubbed “Wahls’ warriors”, she explains, because what they do is not easy.

“They implement a therapeutic lifestyle giving up sugar, processed foods [and] sedentary habits, and sustain new nutrient-dense diets and lifestyle habits,” she says. “Sustaining a therapeutic diet is very challenging — that is what behaviour scientists will tell you. 

“If it was easy, we would not have an epidemic of chronic disease.” 

Some who find it hard to change behaviours, she says, may have “learned helplessness” and might benefit from cognitive behaviour therapy to help them — if they wanted to change. 

And for anyone used to a standard western diet high in carbohydrates and processed foods, the Wahls protocol is not an easy option. There are different levels to follow; at its strictest — the level she herself follows — it involves staying in ketosis; so eliminating sugar and starchy carbs. At its very basic level, it involves eliminating gluten, dairy and eggs, and incorporating a wide range of vegetables and fruit, meat and organ meats. 

For Wahls, this is now her way of life. After being diagnosed in 2000 with relapsing remitting MS, and in 2003 with secondary progressive MS, conventional treatment was not enough. She underwent chemotherapy in an attempt to slow down the disease but was eventually forced to use a tilt-recline wheelchair, to which she was confined for four years. She believes that she had been facing the prospect of being bedridden.

According to the Multiple Sclerosis Trust in the UK, an estimated 2.5 million worldwide have the condition. Affecting the myelin sheath (protective covers) of nerve cells in the spinal cord and brain, MS leads to signalling problems in the nervous system, causing a range of symptoms that often lead to disability. Relapsing-remitting MS is the most common form, characterised by attacks during which symptoms worsen or new symptoms appear. Another form is primary progressive MS, which is characterised by slow onset and steadily worsening symptoms. Because MS is considered to be a degenerative disease for which there is no cure, Wahls’ book was startling in its claims — although she does not claim to have been cured of all illness. Her website says: “I am... a patient with a chronic, progressive disease.”

So, whilst she keeps busy with her work, she says she is committed to taking care of herself. 

Research

It was the question of how to take care of herself that led Wahls to search for ways to manage her condition. Just as any of us might turn to books, journals or the internet to cope with illness, Wahls immersed herself in the latest research; relearning biochemistry, cellular physiology and neuroimmunology to make sense of what she was reading. Yet she knew that what goes on in laboratories can take decades to impact human medicine, so began taking supplements of nutrients associated with brain health. But although her physical decline slowed down, it did not stop.

...one of the biggest changes for Wahls, however, was — as a vegetarian — incorporating meat and organ meats into her diet

Dietary changes

Gradually, Wahls’ diet radically changed. Many ordinary foods such as bread, sugar, pasta and potatoes were dropped, and a range of vegetables added in. Her protocol excludes gluten, dairy and eggs. Foods known as nightshades, which include peppers, chillies, tomatoes and aubergines, are also excluded for people with rheumatoid arthritis or who haven’t responded to the initial levels of the protocol.

Perhaps one of the biggest changes for Wahls, however, was — as a vegetarian — incorporating meat and organ meats into her diet. Having grown up on a farm in Iowa, she had given up meat because she believed that it was wrong to farm animals for food and that it was environmentally unsustainable. But after reading the work of Dr Ashton Embry who recommended a diet that included meat but excluded grain and dairy, she considered it for herself. It was not an easy decision. “It took a great deal of prayer, meditation, and a gradual process,” she says. In her blog she describes adding meat to soups, after which she began to feel stronger. Now, although her diet is commonly described as ‘paleo’, it is not focused on meat as that label seems to imply. Emphasis is given to a range of vegetables and fruit each day, with small amounts of good-quality meat.

Whilst what works for one person may not work for another, evidence supporting Wahls’ protocol is based on subsequent research and results from other MS sufferers; not just her own experience. Yet not everyone who takes up the protocol will need exactly the same dietary interventions. Asked whether it’s important for everyone following the protocol to be in ketosis, or whether an occasional baked potato or pizza is ok once in a while, Wahls says: “It depends on the health issues for the individual”.

I am doing clinical trials, writing grants and papers — and then let the findings [and]results speak for themselves

In her talks and blogs, Wahls says that because of the level of her disease progression, more extreme measures were necessary for her, but that others may not need the same approach. Patience and perseverance are also necessary. “In our studies, for some individuals it took 12 months for the change to become clinically significant,” she says. 

“At best eccentric”

Although the Wahls protocol is now accepted as an approach to help with MS, not everyone was initially positive about it and Wahls became a controversial figure within the medical community. Some accused her of giving false hope to people with MS, and the National MS Society, USA, initially banned her as a speaker. In her blog, she explains that colleagues — whilst thrilled at her recovery — were critical. She writes: “My colleagues thought I was at best very eccentric and at worst completely unprofessional and dangerous.” It was even suggested that her MS diagnosis must have been wrong because such an improvement was not possible. 

Yet speaking to Optimum Nutrition, Wahls appears pragmatic about this. “There is always great resistance to new ideas,” she says. “I do my research, write my grants, and write manuscripts and teach the public that is hungry for this information. I focus on those things.”

She says that as a lesbian, she often had to face criticism when she was younger and that this experience may have prepared her for dealing with criticism now. As recently as 2011, she and her partner were thrown into the spotlight after a video of their son Zach’s speech defending his two mothers went viral. Of her private life she says: “I simply went on with my life, and led by example, showing people that my family is concerned about the same family issues as every other family.” It’s an approach that she extends to her working life. “I am doing clinical trials, writing grants and papers — and then let the findings [and] results speak for themselves.” 

And in time, criticism did turn into praise as Wahls went on to be what she has described in her blog as “banned to brilliant”. In 2016, the National MS Society — having previously banned her — committed more than US$1 million to support a clinical trial led by Wahls to compare the Wahls Protocol with the Swank Diet — a programme that she herself followed for two years. Her work has also been increasingly recognised by her peers. Last October she spoke at the national scientific meeting for registered dietitians in Washington DC. She also speaks at integrative medicine conferences around the world — in addition to being a clinical professor of medicine, Wahls is an Institute for Functional Medicine certified practitioner. In 2018, she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contribution to research, clinical care and patient advocacy. 

Functional medicine, which focuses on the cause of disease rather than treating just the symptoms, is an approach that Wahls says is growing in popularity but largely because of public interest. “As the public demands this, more clinicians want to be educated,” she says. “The conferences are growing in size, and medical schools are responding.” But, she adds, it is the public rather than the medical profession that is driving demand. 

Cooking up a health epidemic

One criticism sometimes levied at the Wahls protocol is that because it focuses on fresh produce and eliminates cheap, processed foods, it is expensive and time consuming. Wahls says this does not have to be an obstacle, but that people need to be prepared to learn how to shop and cook.

“For 17 years I took care [of] people in the veteran affairs health care system where more people I saw had very limited financial resources. We taught them how to cook at home, using conventional food — not organic — and gave them cooking and lifestyle classes. We taught them how to do this with limited financial resources. Key is learning to cook using ingredients [and] not pre-packed foods. We saw tremendous success. But you must begin cooking at home with ingredients.” In the future she wants to spark a “health epidemic... [to]... teach the public, teach kids, conduct research. Create public demands for cooking at home.” 

Currently, she is heading the clinical trial to compare her protocol with the Swank protocol, which has raised questions of bias. But she says that safety guards are in place. “The University of Iowa has a conflict of interest in research committee which reviews all research protocols including mine. I work closely with that committee to disclose all potential conflicts to ensure that they have been reviewed by the committee and that I comply with the management plan. This is the process that is used by all major universities. It is the process used by people developing drugs, devices etc.” 

As for the results, we will have to wait and see. “No analyses will be completed until the study is finished,” she says. “It will be two statisticians that do the analyses and confirm the significance … and one of those will be blinded as to which study diet the person is assigned to.”   

Wahls believes that research into genetics and the microbiome is already changing how medicine will be practised in the future. “As we understand the basic science of how diet influences gene expression and the microbiome… the idea that diet matters is now embraced. More clinicians are embracing what I am teaching, studying and researching.” 

Indeed, one research paper has associated regular consumption of sugar-sweetened drinks with more severe MS symptoms and a higher level of disability.1 In another study, food allergies were associated with MS relapses (see page 5); and, more recently, a Canadian study has identified the intestine as the source of immune cells that reduce brain inflammation in people with MS;2 all indicating the importance of the gut.

Yet for the medical profession, using diet to treat or alleviate an illness is still a new approach. Wahls says her book is a resource for anyone who is interested in learning about the “various mechanisms by which diet, stress reduction, exercise, nutraceuticals can have favourable impact, and just how much is under their control”. But, she acknowledges: “Not everyone is ready.”

Dr Terry Wahls (www.terrywahls.com) is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, and The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions

 

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References

  1. www.aan.com
  2. Cell, 2019; DOI: 10.1016/j.cell.2018.11.035