Terry Wahls, MD: Curative Food-based Nutrition

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Dr. Terry Wahls is a clinical professor of medicine at the University of Iowa. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. You can learn more about her work from her website, http://www.terrywahls.com/. She hosts the Wahls Protocol Seminar every August where anyone can learn how to implement the Protocol with ease and success. Follow her on Facebook (Terry Wahls MD) and on Twitter at @TerryWahls.

Facilitated by InnoVision Professional Media?s Inflammation Conference, to be held September 22 to 23, 2017, in Minneapolis, Minnesota. For more information, please visit http://www.inflammation2017.com/.

Alternative Therapies in Health and Medicine (ATHM):??? Basically, we want to touch base. Well, first of all, I want to ask you: Have you determined what your presentation is going to be at the seminar?

Dr Wahls:????????????????? I?ve got ?Dietary Focus: Reducing MS and Other Autoimmune-Related Symptoms.?

ATHM:?????????????????????? Online and in your book,1,2 you have documented your progression through multiple sclerosis, or MS, diagnosis and recovery from some of the disability you experienced. When you decided to take matters into your own hands, what drew you toward nutrition?

Dr Wahls:????????????????? The journey started with a food recommendation from my neurologist at the Cleveland Clinic who introduced me to the work of Ashton Embry, PhD, and Loren Cordain, PhD. After reading all of that, I adopted Dr Cordain?s paleo diet, giving up all grain, all legumes, and all dairy, and going back to eating meat after having been a vegetarian for about 20 years. My condition still declined. In fact, I needed a reclining wheelchair the following year, but I stayed with the diet because at least I was doing something and I felt the science made sense. I realized that it could take many years to repair my brain, so I should definitely give this several years before deciding it wasn?t helpful.

The next part of my journey was when I was confined to a wheelchair. I decided to start reading basic-science animal studies, mouse and rat studies, for multiple sclerosis, Parkinson?s, Alzheimer?s, and Lou Gehrig?s disease, looking for vitamins and supplements that were helpful. I started experimenting on myself and discovered things that certainly seemed to help my fatigue. In 2007, I discovered the Institute for Functional Medicine and took its course on neuroprotection. That was very helpful, and I now had a longer list of effective supplements.

In December of 2007, I had a major ?ah-hah? moment. I decided that I should redesign my paleo diet to maximize the intake of the nutrients that I was taking in supplement form. That?s really when the magic began and when I experienced this dramatic change in health status.

ATHM:?????????????????????? At what point did you make the connection that mitochondrial dysfunction was likely the root cause of this whole progression?

Dr Wahls:????????????????? In 2004, when I started reading the basic science myself?reading through mouse studies?there really wasn?t much in MS literature about mitochondria, but there was a lot in the Parkinson?s research, the Alzheimer?s research, and the ALS research, as well as for some of the other neurodegenerative diseases. What I was reading is that the mitochondria were signaling that it was time to die too early for these brain cells. That was the big driver in the shrinkage and atrophy in the neurodegeneration. Even though no one was talking about that with MS, it just seemed logical to me that mitochondria were going to be key in describing why there was progression with MS. It was going to be much more about the mitochondria than it was about inflammation.

I started focusing on discovering all the things that I could do to improve the efficiency and effectiveness of my mitochondria. That was my focus for research and reading beginning in 2004. Now, of course, I find great joy in seeing that MS researchers are now finally recognizing that progression and worsening of disability is likely strongly tied to the deteriorating function of the mitochondria. Of course, none of the drugs for any of the autoimmune conditions restore the vitality of mitochondria.

ATHM:?????????????????????? Is there any evidence that those drugs are mitochondrial toxins?

Dr Wahls:????????????????? Well, certainly many of them are. Because drugs are usually developed to interfere or act in one molecular pathway, it would be difficult to find a drug that restores mitochondrial function in MS, any of the neuroinflammatory diseases, or the neurodegenerative diseases. They would need a much more comprehensive program to support mitochondria than what the drugs currently in use and currently in the pipeline of development provide.

ATHM:?????????????????????? Would that be because mitochondrial health is much more multifactorial in nature?

Dr Wahls:????????????????? Right. There are many steps in the mitochondrial processes and all of our cellular processes that can become deranged or inefficient. If we have a more holistic, whole-systems approach to that cellular function and mitochondrial function, we are much more likely to restore the efficiency of those mitochondria and, therefore, restore the efficiency of the tissues, and then of the organs, and then, of course, of the whole human.

ATHM:?????????????????????? Is there a particular activity in the mitochondria that tends to become dysfunctional or a particular weakness that mitochondria are susceptible to that is influenced more by diet or environment?

Dr Wahls:????????????????? Sure, several things. One, many of us take antibiotics very frequently for a wide variety of indications, some of which are really viral and so the antibiotics will not be helpful. Sometimes, the antibiotics are very helpful?someone may develop a bacterial urinary infection, which is quite common in the setting of MS. We often forget, however, that antibiotics are going after the bacteria, and mitochondria are actually ancient bacteria, and so antibiotics?particularly in prolonged use?can be harmful to these bacteria.

Many of our foods are grown with herbicides and pesticides. These can interfere with several of the enzymatic steps that are involved in mitochondrial metabolism, so that can be a problem. Then we have several more problems: that our diets are so poor that we lack the necessary building blocks to make the fats and the membranes that are important for the mitochondria, or that we don?t provide the minerals that are important cofactors or the vitamins that are cofactors for many of these enzymatic steps. You can also poison the mitochondria.

ATHM:?????????????????????? As you did this research, what nutrients showed evidence as supportive of mitochondrial health?

Dr Wahls:????????????????? The first set of nutrients to think about is most of these enzymes and molecular processes occur in the membranes. Membranes are phospholipids, so they are fats, essential fats, cholesterol, or saturated fat. When America embraced the low-fat diet, for a large part of our population, we didn?t provide enough of the fats that we need to have healthy membranes. So the health of our cell membranes declined. That is problem number one.

The next problem that has come up is that as we relied more and more on chemical fertilizers and less on crop rotation and organic fertilizers in green tilling, the mineral content of our soil has steadily declined here in the United States?and I would say across the world. That becomes a problem because we have many more people who have nutrient deficiencies. Thirdly, as we are nutrient deficient, our bodies will try and use these toxic materials as substitutes and that makes us more vulnerable to heavy-metal poisoning than if we had a sufficient supply of our nutrient minerals.

ATHM:?????????????????????? In your book, when you talk about this, you mention the work of Bruce Ames, PhD. How does that tie in?

Dr Wahls:????????????????? Bruce Ames is a brilliant biochemist. One of his very important observations is called triage theory, where our bodies use nutrients that are in limited supply for the most acute needs. For example, vitamin K: We will make sure we have necessary clotting protein, so if I get cut, I don?t bleed to death. That is very, very important for survival. Vitamin K, however, is an important part of maintaining flexibility in the heart valve, in the blood vessel, and in repairing and maintaining myelin?the wiring insulation in the brain. We may use all our vitamin K to not bleed to death today, if we don?t have enough, and meanwhile, our blood vessels stiffen and our myelin deteriorates. This theory is very important because we will do that for all of our nutrients. We will triage for the most immediate, lifesaving need.

If you are insufficient, you are not doing the functions that would be required for optimal health 10 years down the road. I make the observation that modern science does not really know what the recommended daily allowance for our various vitamins, antioxidants, and essential fats are for optimal health. We can do those experiments in animals and we have a good sense of what the optimal range is, but we certainly do not have a good sense of that in humans. We have some idea of what is essential to be alive, but we do not know what is essential for optimal health 20 years down the road.

ATHM:?????????????????????? Did you have another thought about nutrient deficiency that you would like to finish?

Dr Wahls:????????????????? Yes. Look at the nutrient density of what we are eating?the recommended daily allowance, based on our various governmental dietary recommendations?then look at the nutrient density of foods consumed by people who follow traditional diets in the various hunter-gatherer societies from all over the globe. The nutrient density of the hunter-gatherer diet can be, depending on the nutrient, 2 to 5 times more dense than our Western diets. My simplistic way of thinking about this is that the traditional societies, if allowed to eat according to their traditional traditions probably have, over time, evolved the most nutrient-dense diet for their locale. It is probably a better indication of what is required for optimal health than our governmental guidelines at this point as nobody really knows yet what these optimal nutrient values should be.

ATHM:?????????????????????? As far as these nutrients go, there are plenty of companies willing to step up and supply supplements as capsules or drops, but you made the leap to believing that food was the best source of essential nutrients. Why?

Dr Wahls:????????????????? I want to remind everyone that the paleo diet did not fix me. I continued to get worse. Nutrients and vitamins did not fix me. I continued to decline, although I could tell when taking all my mitochondrial supplements that I certainly had more energy and it slowed my decline. So they were very helpful. Even though I had the more comprehensive list of nutrients from the Institute of Functional Medicine, I was still declining. When I redesigned my diet to maximize the intake of these nutrients through foods, the restoration of my health was dramatic and stunningly fast.

For example, take folates. When scientists first discovered and were identifying folate, trying to decide what the chemical structure that they should identify was, there were several related compounds?all with folic activity?found in folate from food. When you synthesize a folic acid compound, you do not get all of those related compounds.

Consider a superfood, two of them?two that I love?one is kale and the other, liver. They are complex foods that will, of course, vary depending on the quality of the soil that that kale is grown in or the quality of the food that that animal was able to consume. They have thousands of molecular compounds within them. We certainly do not understand all those compounds yet, but all of those compounds will speak to my microbiome and speak to my cells in ways that we do not yet fully understand?but clearly in ways that are beneficial to the overall metabolic functions.

That is very hard for us to replicate, such as in a diet for someone who has lost the function of their gut and must have total parenteral nutrition. We can keep them alive for a while with total parenteral nutrition, but we do not fully understand how to give them maximum health and vitality yet. We do know that people are always better served when they are fed through their gut and even better served when they are given food as opposed to tube feedings into the gut or total parenteral nutrition intravenously. That is because food is a much more complex set of molecules and the nutrient density of that food will depend on the quality of the soil the food was grown in and the quality of the food the animal ate. It is far more complicated than we realize. Trying to get the healthiest, most robust nutrient density in the food you eat is our best shot at having robust vitality ourselves.

ATHM:?????????????????????? Might that explain some of the contradictory results that researchers have experienced when researching nutrients?

Dr Wahls:????????????????? Yes. It is very easy to do a supplement study, and uniformly you do not get very good results when you give just a specific B vitamin or just C or just E. Every study that I am aware of?and there are hundreds, if not thousands?that looked at food had, in general, a much more favorable outcome than the studies looking at a specific vitamin or specific supplement because we are complex. It is much easier to get into trouble if you use a single nutrient to disrupt the nutrient ratios in ways that are not favorable. If you give food, we are more likely to maintain the favorable nutrient ratios and address the complex needs of that person.

ATHM:?????????????????????? As you made the decision to go with a food-based nutrition plan and reduce your reliance on the supplements, you came upon a significant gap in our knowledge. Could you describe that gap and how you went about trying to solve that?

Dr Wahls:????????????????? I had this list of nutrients that scientists had said were really important to brain and mitochondrial function?20 different nutrients I was chasing in the beginning. Now, we monitor 36 nutrients. I understood that I needed to do this through food. My first round of research was to identify what foods are rich in these nutrients. I had a list of foods to be eating. Then as I taught the public, I realized that I can?t just give people these long lists of foods. That is going to be confusing and difficult. It is really not very teachable. I needed to find a way to teach these concepts that could reliably help people achieve the nutrient intakes that I had identified were important to the brain.

ATHM:?????????????????????? Stepping back a little further, in your book you mentioned that there was a lack of information on how to get these nutrients from which foods.

Dr Wahls:????????????????? The US dietary advice committee is much more about promoting food products and taking care of agricultural interests and industrial food-supply interests. They do not value the opinion of the dietary scientists. I would also say regarding the dietary research, there are a lot of gaps in that knowledge. There has not been a clear recommendation in the United States on how to design a diet for maximal health. In countries where you can have no conflict of interest with either agriculture or the food industry, their dietary recommendations look different from ours in that they are much more likely to stress vegetables, berries, a limited amount of whole grains, no sugar, and no white flours. They do not stress as much meat or poultry. They are much more explicit about problems with sugar and white flour, and of the need to eat a lot more vegetables and a lot more berries. We simply do not go there because we have a strong tie to promoting dairy and a strong tie to promoting the wheat-based products.

ATHM:?????????????????????? And corn?

Dr Wahls:????????????????? ? And corn and soybeans. Remember the dietary guidelines are developed by the Department of Agriculture. The food guidelines were originally and are still promoting the needs of the Department of Agriculture. In the United States we are not obligated to make sure that the dietary guidelines are not being developed by scientists and lobbyists who have ties to agriculture or the food industry. I think that is a big part of our problem. I also say it is very expensive to do good dietary studies and see what the health outcomes are. It is much more expensive to do that than a food-based study or than a supplement-based study or a drug-based study.

Now fortunately, the dietary scientists are getting much more interested in looking at eating plans and looking at family and community interventions. Basically, the shift in all of these goals is to get people to eat more vegetables. That is overwhelmingly the consistent finding across the dietary studies that I looked at across the globe. The more vegetables people eat, the better the health outcomes. You can have a variety of opinions about whole grains, legumes, and dairy. Depending on the disease state, that might be helpful or negative but, uniformly, the more vegetables, the more berries you eat, the better the outcome for the brain, the heart, mental health, and autoimmunity. Vegetables rock.

ATHM:?????????????????????? They do, but is there a point of extremism you can reach with your pursuit of vegetables in the diet that maybe delivers diminishing returns?

Dr Wahls:????????????????? Oh, sure. If you do not have enough protein, that becomes a problem. If you do not have enough fat, that becomes a problem. Now fortunately our mitochondria can burn sugar, they can burn fat, and they can burn protein. In the short term, we could survive on a vegetable-only diet. It is a great diet for detox. Long term, if you do not have enough fats, and if you do not have enough protein, you will be back into health problems. The ketogenic diet, acutely, can also be very helpful depending on your condition but, long term, if you do not have enough vegetables to maintain your microbiome, you will get into trouble. If you do not have enough protein to maintain your protein needs for maintenance and repair, you will get into trouble.

ATHM:?????????????????????? So you advocate more moderation, balance, and getting back to traditional diets, rather than demanding vegan, paleo, or ketogenic diets?

Dr Wahls:????????????????? Correct. Each of those diets has some great healthful benefits, but you can make yourself quite ill in each of those diets inadvertently. I am very fond of certain aspects of each of those diets.

ATHM:?????????????????????? As you accumulated this research and came up with your eating plan, what form did that take? Where did you end up?

Dr Wahls:????????????????? I have created several versions of my diet so I could adapt it for those who are vegetarian or vegans because of their deeply held spiritual belief. The version that I personally really like the best is the paleo version, but unlike many of my paleo friends, there is nowhere near as much meat and there are a lot more vegetables in my version. Then I have the ketogenic version, and I followed that for several years. I go back into ketosis during the winter. Now that it is summer, I am back into my usual paleo diet. I also have an elimination diet that is a bit more restricted for people with more refractory autoimmune problems. I try to provide tailored guidance in my book, and hopefully I provided enough information so people can identify which of those 4 plans would be best for their own circumstances.

ATHM:?????????????????????? When you talk about serving sizes and the quantities of the vegetables that were required, it seems to be quite a lot, correct?

Dr Wahls:????????????????? It is a huge amount. People are stunned. They tell me, ?Oh, my god. I couldn?t possibly eat that many vegetables.? Part of the reason people get stunned is that they are still thinking about eating 4 to 5 servings of grain and, of course, they don?t want to give that up. So, they cannot imagine eating 9 cups of vegetables on top of everything else. If you take away the grain and eat so you have sufficient protein and then vegetables in the green, sulfur, and color categories, according to your appetite, you can do it. I am a tall lady, 6 feet tall. In my clinical practice?since I was at the VA with mostly men?I would push people to have 9 cups of vegetables every day. That cut out a lot of bad food for them. Now, if you are really petite, maybe only 4 to 6 cups of vegetables are necessary. Measure raw, so it will be a bit less when cooked. There is no need to stuff yourself or overconsume, but by giving people these larger numbers, I am cutting out a lot of harmful food.

ATHM:?????????????????????? You mention measuring raw versus cooked. Do you find that there is a better way to consume the vegetables, as far as a salad versus spinach that has been wilted?

Dr Wahls:????????????????? If you cook something, you break up the cell walls in the cooking process and we can absorb more of the nutrients. If you have them raw, you get more enzyme activity and there is more fiber for your microbiome. There are pros and cons about raw versus cooked. I encourage having about half and half but, again, we personalize this ratio. If someone is having GI issues, irritable bowel, or inflammatory bowel disease, they will need to have everything cooked until things have quieted down for them.

ATHM:?????????????????????? When you give this presentation at InnoVision?s Inflammation Conference this fall, what more will clinicians learn?

Dr Wahls:????????????????? They will learn more about my thinking about neurodegeneration in general, so we will talk about the mitochondria. I will talk more specifically about the nutrients. I am going to talk a little bit about Parkinson?s, of course, and multiple sclerosis, and I will talk about traumatic brain injury, because we have millions of Americans with traumatic brain injuries who have chronic long-term problems that could be resolved with the types of interventions I?m talking about. Then people will get a chance to see my research. They?ll see some wonderful videos of people walking when they enrolled in my study and where they were at 12 months later. I think it will be quite inspiring to see some of the gait changes that we are able to achieve.

ATHM:?????????????????????? When did your study start?

Dr Wahls:????????????????? We started it in 2010 and it went on through 2014.

ATHM:?????????????????????? So it?s completed at this point?

Dr Wahls:????????????????? We have several completed studies that I will be talking about and we have some studies that I am recruiting for now. If there are people practicing within 500 miles of Iowa City and they have patients with MS who are willing to use a dietary approach, they could contact my study team at [email protected]/.

Interview by Craig Gustafson

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