S7E06 Research on lifestyle and MS with Dr Terry Wahls

Dr. Terry Wahls  00:00

But for most of us, it’s a small little next step. And if the small next step is you’re going to learn how to make green smoothies, that’s a great step. If the small first step is I’m going to take the moment to have a gratitude statement before my meals, that’s a great first step. But the other suggestion I have for all of you is think about being the principal investigator of this most important experiment, which is your life.

 

Overcoming MS  00:30

Welcome to Living Well with MS. This show comes to you from Overcoming MS, the world’s leading multiple sclerosis, healthy lifestyle charity which helps people live a full and healthy life through the Overcoming MS program. We interview a range of experts and people with multiple sclerosis. Please remember all opinions expressed are their own. Don’t forget to subscribe to Living Well with MS on your favorite podcast platform so you never miss an episode. And now, let’s meet our guest.

 

Geoff Allix  01:05

Welcome to Living well with MS podcast. And today I have the great pleasure of being joined by Dr. Terry Wahls. Dr. Terry Wahls is a functional medicine certified practitioner and researcher in lifestyle interventions for multiple sclerosis. She was diagnosed with primary progressive MS and was able to improve her symptoms through diet and lifestyle. So, welcome to the show, Dr. Terry Wahls.

 

Dr. Terry Wahls  01:30

Hey. Thanks, Geoff. I’ll make a mild correction. I was first diagnosed with relapsing remitting MS in 2000 by 2003 it was revised to secondary progressive MS. And then I’m in the wheelchair for four years. And then, you know, we managed to get out of the wheelchair through some intensive diet and lifestyle.

 

Geoff Allix  01:52

Okay, sorry, secondary progressive, but you’re still in a situation similar to myself, actually, where we are somewhat left behind by the pharmaceutical industry compared to relapsing remitting. I’ll mention it now and I mention it later as well, but we’ll put in the show notes links to your website because it’s a fascinating story, and really is quite inspiring where you’ve where you were, where you are, from wheelchair to doing all these cycling events and things. But I’ll let you introduce yourself. So could you share your story, your MS diagnosis, and how you doing today?

 

Dr. Terry Wahls  02:27

In retrospect, my first neurologic symptoms begin during medical school in 1980 with episodes of electrical face pain that would be later diagnosed as trigeminal neuralgia. Twenty years later, actually 13 years later, I have an episode of dim vision in my left eye that’s evaluated. And then 13 years later, I have a weakness in my left leg and I’m diagnosed with relapsing remitting multiple sclerosis. At that point, I take Copaxone and my physicians introduced me to the work of Loren Cordain in the Paleo diet. So after 20 years of being a very low fat vegetarian, I go back to eating meat, become a Paleo Diet person. I continue to decline. I read the basic science animal models of multiple sclerosis, Parkinson’s, Alzheimer’s, and decide that mitochondria dysfunction drives disability. And so I create a supplement cocktail for my mitochondria, and actually it’s helpful for my fatigue a little bit. Super grateful.  I discover a study using electrical stimulation of muscles. I talk to my physical therapist. We add that. And then I discovered the Institute for Functional Medicine. They have a course on neuroprotection, which I take. I have a longer list of supplements which I had. And then I had this big aha Geoff, which is, what if I redesign the Paleolithic diet that I’ve already been following for five years based on the nutrients that have identified as important for the mitochondria? So that’s a few more months of research. And I start this new way of eating December 26, 2007. At that point, I have brain fog. I have difficulty sitting up. I’m in a zero gravity chair for my meals at home, and for my work. I could take a couple steps with two walking sticks. And my electrical face pain is much, much more severe. So it’s very clear to me, I’m on track to become bedridden by my illness, possibly demented by my illness, and possibly dying with intractable trigeminal neuralgia. But I, you know, I am doing the best that I can. I start this new way of eating. January comes. I have to start this new job that I’ve been assigned to, the Traumatic Brain Injury Clinic. The first two weeks, I just watch my new partners. The third week, I start having to examine the patient’s eye and write my notes and at the end of the week, I tell my family, “You know, actually, I think I can do this.” And by the end of the month, my when I’m seeing my physical therapist, he says, “You know, Terry, you’re definitely stronger.” And he begins advancing my little, tiny workout that I’m doing, which was 10 minutes. Now it’s 10 minutes, twice a day, then 15, twice a day. You know, 20 minutes twice a day, 30 minutes twice a day. And then I began walking with my walking sticks at the hospital. You know, everyone’s quite stunned by that. And then on Mother’s Day, which is the second Sunday in May, I went to try riding my bike. We have this emergency family meeting. And my wife Jackie, tells my 16 year old son, Zach, you run alongside in the left, and my 13 year old daughter, Zeb, you run alongside in the right, and she’ll follow. So I get on my bike, you know, I bike around the block. I and, of course, you know, that big 16 year old boy, he’s crying. My daughter’s crying, Jackie’s crying. I’m crying. after that every day, you know, I bike a little bit more. and then in October, Jackie comes home and says, “Honey, I signed us up for the Courage Ride.” It’s 18.5 miles. And I finished that. I crossed the line And once again, we’re all crying. And this, you know, this really changes how I think about disease and health. It will ultimately change the focus of my research. Both Chief of Staff at the Veteran Affairs Hospital and the Chief of Medicine at the University of Iowa want me to start doing clinical trials testing can others with progressive multiple sclerosis implement this complicated regimen that I had? Was it safe? And what’s the effect on quality of life, walking, etc.? They get me the mentors, and I begin doing clinical trials. Now we’ve done, I think we’re in our 10th trial. I’ve published over 100 posters, abstracts, oral presentations and manuscripts about our research. And we’ve studied, you know, the Paleolithic diet, the ketogenic diet, the Swank diet which is a low saturated fat diet. And we’ve done a wide variety of observational, interventional, and mechanistic studies. Diet matters. It’s super exciting.

 

Geoff Allix  02:27

Because obviously Overcoming MS, that’s a sort of modified Swank diet. And one thing about Overcoming MS, it’s just one of the pillars, but I think we’ll come on to that as well later on, that it’s not just diet. There’s a lot of other factors as well. From your clinical research, what conclusions have you drawn about lifestyle and the outcomes of someone with MS?

 

Dr. Terry Wahls  07:35

So a couple of things I want your listeners to know is, I think we all have to decide where disease modifying treatments fit into your treatment plan. Adopting diet and lifestyle is not in conflict with taking disease modifying treatments. Whatever decisions you make about the drugs, I want everyone to do the best they can with their diet and lifestyle because that addresses many more of the cellular factors involved in our health. What we’ve seen from the observational studies: diets high in added sugar; flour-based breads, pastas, cereal; processed foods that have more—here in the United States—food-like chemicals added to the foods increase the risk of MS; more severe disease; more severe mental health problems; more severe metabolic health—so insulin resistance, metabolic syndrome, diabetes, high blood pressure, high cholesterol. And the food supply is designed to tempt you to eat a lot of sugar, a lot of processed foods. The more you can replace those foods with these radical things known as vegetables, it’s a really good thing. It’s a really, really good thing. That’s a really basic first step is eating more green leafy salads, learning how to make cooked greens or green smoothies. It really can be quite delicious. Having more berries, more deeply colored vegetables, red cabbage, tomatoes, peppers, beets, carrots. These are all really, really good things for you. So you could start with the adds. Then you could do the reductions. Get rid of the sugar sweetened beverages. Instead of the flour based bread, cereals, pastas, have potatoes, have yams, have squashes, have turnips, rutabagas. All of those things would be really, really good for you.

 

Geoff Allix  07:35

Is rice ok? You didn’t mention rice there.

 

Dr. Terry Wahls  08:26

Rice is fine. If you’re going to have a grain, have it be whole grain. Whether it’s wheat berries, buckwheat, rice, quinoa…so that would be my recommendation there. And then there are several authors, and we’re one of them, who have done what’s called a meta-analysis, where you combine other clinical trials and you use statistical means to look at the measures. There are diet intervention studies that had a fatigue outcome or quality of life outcome. We did that analysis in ’21 and so there were 12 studies, eight diets. I don’t know if we can list them all; low saturated fat, Mediterranean, anti-inflammatory, ketogenic, Paleolithic, fasting, calorie restriction in usual diet. For fatigue, there were three diet patterns that were helpful; paleo, Mediterranean, low fat. The Paleo was about 40% more effective than low fat and Mediterranean. But you know, these three diets are very, very helpful. And then for improving physical quality of life or mental quality of life, then it was paleo and Mediterranean, and paleo was twice as effective. But these are all small, relatively small studies, relatively short duration. What you’d like to really have are studies that are one and two years long, to know that people can keep it up and what happens over time, and to have studies that include brain structure or MRIs as well.

 

Geoff Allix  11:06

I think what I find really interesting is, is because Overcoming MS has a slightly different diet to the Wahls protocol, slightly different diet to the best bet. It’s like, you know, the each of these are slightly different, but there’s a lot of overlaps as well. and I find that interesting. So you’ve mentioned, like eating a whole food diet. Don’t you know, things that our parents would have recognized, or grandparents to maybe younger, younger generation would have recognized as food.

 

Dr. Terry Wahls  11:33

Absolutely.

 

Geoff Allix  11:35

And the other thing that you haven’t mentioned, actually, what are your thoughts on dairy? I think dairy is the one that quite a lot.

 

Dr. Terry Wahls  11:41

So our ancestors, for 200 million years, we’ve been raising our young because we’re mammals with breast milk. And then when our offspring are weaned, they don’t get milk again. Only in the last eight to 10,000 years, some of our cultures have had dairy in the food supply. So it’s a very recent food. It has a lot of growth factors. So it’s really great for growing infants, growing children. When your bone plates fuse, those growth factors can help you grow horizontally. That is, make us fat. Or they can help us develop dysplasia and higher rates of cancer, pre cancer, colon polyps, etc. That’s one of the reasons why I’m not too keen on dairy. I’d rather get my calcium from a lot of leafy greens, which actually turns out to be good source of calcium and magnesium.

 

Geoff Allix  12:33

Yeah, the things I’ve learned, I found really interesting and that similar experts have said to me, one was about dairy. No one, no animal on earth has evolved to have breast milk as an adult.

 

Dr. Terry Wahls  12:46

As an adult, absolutely.

 

Geoff Allix  12:47

And as another species that’s even weirder. And then don’t even go around the cheese route, because then it’s gone, gone bad.

 

Dr. Terry Wahls  12:54

Right, so biologically, if we just look at our evolutionary history, it doesn’t, to me, make sense. That’s not a requirement. Because osteoporosis is so prevalent here in the US, we keep increasing the amount of calcium you’re supposed to eat. And so people take calcium supplements; which, by the way, seem to increase the risk for stroke, heart disease with and calcification of your heart valves and your blood vessels. The problem was we aren’t doing enough strength training, enough impact training, don’t have enough vitamin D. That’s the bigger problem for osteoporosis. Our evolutionary history; we’re eating tons of green leafy plants for millions of years. And what we separate from primates, we’re still eating tons of green leafy plants. And that turns out to be a very important nutrient for your retina, for your lens, and for your brain cells; a ll of those carotenoids in those green leafy plants.

 

Geoff Allix  12:54

And so you’ve mentioned about studies. Are there studies, any current or upcoming studies that people could get involved in if they’re interested?

 

Dr. Terry Wahls  13:22

Well, so if you go to Terry Wahls dot com forward slash trials (terrywahls.com/trials); I want all of the listeners to please sign up to be part of our patient database, including the international folks. We will be doing some very interesting survey based nutritional studies, where people can answer some questions about quality of life, fatigue, and the foods that they’re eating – a fairly short survey. So my junior faculty, Dr Chitcombe; he and I are talking about study design. And I’m very hopeful we’ll have that together within the next several months. So again, everybody sign up to be on the registry so you can get notified about that super interesting study. We have some virtual studies for fibromyalgia patients, long COVID. Those studies are limited to here, being here in the United States. But the patient registry, we do a number of survey based studies practically throughout the year. Those studies are available to the international audience as well.

 

Geoff Allix  15:10

With diet studies, what are some of the limitations on longitudinal diet studies?

 

Dr. Terry Wahls  15:17

There are other ways of doing diet studies. One is simply an observational study where I ask what you’re eating, and then some patient reported outcomes, and I keep checking with you over time, And so I might follow you for one year or two years or five years. Those are super interesting. Those kinds of studies will give you associations. But they don’t tell you causations. So it’s to generate a an idea or a hypothesis that I can then test with a prospective study. And then, so if I’m going to do a prospective study where now I’m going to do some kind of intervention, say with a supplement or with a food or a diet pattern, then, typically we have randomized. You can either do parallel comparing two interventions, like we did with the SWANK and the Wahls diet. Or a randomized controlled where one set gets the intervention, another set gets a control diet such as the government guidelines diet or their usual diet, and you follow them over a defined period. So the study that I’m doing right now is comparing a ketogenic diet, the modified paleo diet, and usual diet. We follow people over two years, and it includes MRI structures, patient reported outcomes and clinical outcomes. We will have our last study visit in July of 2026 and we’ll be cleaning the data, analyzing it, and then presenting it in scientific meetings in 2027. It’s really quite extraordinary. So we enrolled 162 people. The primary outcome was changes at six months. And we lost just four people. So we have a 97.5% retention rate. That’s really quite extraordinary. You know, as we’re going through we’ll see how high our retention is. In a diet study, because it’s getting people to change their diet and stay on the diet; and then, of course, life happens, you know, difficulties arise. And so you power your study to accommodate a 30% drop off. if you can keep 80% of your participants, that’s considered extraordinary. And of course, the longer the study, the more like it is stuff happens and people have difficulty staying in the study for a variety of reasons. So we’ll see how well we’re doing. The fact that we we kept 97.5% to six months is very, very exciting.

 

Geoff Allix  15:25

So do you think that there’s a point where every MS patient will be recommended an anti-inflammatory whole food diet as part of their treatment?

 

Dr. Terry Wahls  18:10

You know, it takes, uh, let’s look at Barry Marshall, who was the GI doc, who said, you know, h pylori is the cause of stomach ulcers. It he went from being considered sort of crazy, and 25 years later he gets a Nobel Prize in medicine. So I tell my students, it takes about 30 years in that really, I’m just 15 years into my journey. When we did our first study in 2010, we had results in 2011. It took until 2014 for me to get this first paper published because it was such a radical idea that this multimodal diet and lifestyle for progressive MS, even though we had, you know, spectacular results, And then, you know, the next paper, it wasn’t quite as hard to get published. And we’ve been able to get our papers into more prestigious journals, including Neurology, which is the most prestigious journal of all. So it takes time. It takes perseverance. You do trials, if you’re on to a important positive finding, then you validate that with the next trial, the next trial, and other people start quoting your work, citing your work. You know my ideas, which were absolutely condemned in 2009 when I first started talking that diet mattered, and then, as I started presenting our research at the MS scientific meetings my ideas have gone from crazy to accepted to being recognized as one of the early pioneers for diet research.

 

Geoff Allix  19:59

So, there’s a lot of skepticism about any form of lifestyle change, which I find frustrating. I see a lot of people with multiple sclerosis. What successes have you seen, both personally and with your patients to encourage them?

 

Dr. Terry Wahls  20:16

Well, first we’ll talk about my clinical trials. Every one of our clinical trials, like I said, I think we’re in our 10th clinical trial, we’re able to show that as people improve their nutrition, fatigue decreases, quality of life improves. And that’s about 70 to 80% of folks in a clinical trial have measurable reduction fatigue, improvement in quality of life. And that’s true whether they’re following the ketogenic diet, a low fat diet, or a paleo diet. And is that because we just have a more nutritionally sound diet, there’s less junk in the diet? You know, absolutely, that is big part of it. When in my clinical practice and in my tribes that I follow where I can use targeted supplements, meditation, exercise, we talk about sleep. We may include electrical stimulation muscles. And it’s a longer follow up. We have some really wonderful stories, Geoff. You know, I’m thinking of Josie, who was in her 50s, was even more disabled than I was. She was wheelchair, bed bound. She was struggling to transfer independently from her wheelchair to the toilet, from a wheelchair back and forth to bed. She could stand maybe 10 – 15 seconds. You know, really, you know, very severely disabled. She interestingly, she signed up to attend every free webinar that I did, took every little online course where she could have to be part of the Q and A. And then, you know, it’s very excited. She was so excited to report, I could stand for 60 seconds. I could stand for a minute. I started walking with a walker. I took just a few steps, I took 10 steps, I took I walked 100 yards. I’m walking with walking sticks now, instead of my walker, I’m walking without walking sticks. And now my new goal is I want to walk on the beach with my doggy. So that’s a three year journey for her. And she is a huge cheerleader of stay with it. It takes time. We’ve had other folks, and I think it’s interesting the people I see are who are the most successful were an athlete at some point in their life. That might have been in high school or in elementary school. They sort of had the idea about training, about a long term goal in that there’s life has sort of ups and downs and I just stay with it. If you have an integrative health practitioner who can help, you know, do a little bit of testing, give you more specific recommendations, yes, that is helpful. But even, you know, Josie, she was in a system where she couldn’t get access to any of that. But she could get access to community support, some Q and A, and she hung in there. She has a very impressive return. We’ve seen other folks who are wheelchair dependent over a period of a couple years get out of the wheelchair, get walking. One woman, her big goal was she wanted to walk her son down the aisle at his wedding. And she was able to do that. And she was able to do the mother-son dance. So for the listeners, absolutely it is possible. It may take time, but absolutely it is possible to have major improvement in your function.

 

Geoff Allix  24:10

So I think we’ve, we’ve touched on a lot of the core pillars of Overcoming MS. So there’s diet, there’s exercise, stress reduction, the drug side of it is certainly a part of it as well. One of the other ones actually is now one of the pillars of MS, of Overcoming MS, sorry, is family health, because we know that our children will have an increased risk of getting MS. My father had MS, and it’s so so particularly my children really do so I think they really see it  because they’re like, right grandfather, father.

 

Dr. Terry Wahls  24:43

Right, there are about 300 genes that have been identified that increase the risk for having MS. And for most of these genes, maybe 1 to 2% risk. They’re just a handful of genes where the risk is much higher, 10 to 15%. Or as we know that the you know, the quality of your nutrition, physical activity, vitamin D levels, stress, sleep, have a very large and important role. I hear from many people in the community like, “That diet is too hard. I’m not going to deprive my children of all those treats, of the candy cakes and yummy stuff.” And unfortunately, the research continues to grow that the more sugar we feed our children, the worse their future health. The more white flour we feed our children early, the worse their future health. The more vegetables we feed them, the better their health will be. The more sauerkraut and kimchi we teach them to enjoy fermented pickles, we teach them to enjoy, the better their health. And then, you know, if you’re into yogurt, kefirs, cheeses, that’s better than liquid milk. And you can make your decision what you’re going to do about about dairy, but you know sauerkraut, kimchi and vegetables, we all agree, those are really good things.

 

Geoff Allix  26:10

So you can reduce the risk for your children…

 

Dr. Terry Wahls  26:14

Absolutely.

 

Geoff Allix  26:15

…by bringing them up with us with a better diet and lifestyle as well.

 

Dr. Terry Wahls  26:20

And teaching them, you know, to have a family meditation in the evening. Having a family gratitude practice before your meals. I think that’s a lovely tradition. We started that during the pandemic. What was one tiny thing we could be grateful for?

 

Geoff Allix  26:36

You end up…yes, it is more, it takes more time to cook food from scratch. But people say to me, but your food’s delicious. It’s like, well, yeah, because it’s made from fresh fruit and vegetables.

 

Dr. Terry Wahls  26:49

You know, and you can learn how, you know, my spouse works full time. I’m working, so I cook everything from scratch. I do a lot of slow cooker meals. If you follow me on Instagram, you see that I’ll do skillet meals. And we have pretty simple things with ingredients that we can get here in the Midwest, I’m not looking to spend two hours to make a meal. I’m looking for like 15 minutes.

 

Geoff Allix  27:27

We touched on pharmaceuticals. So people who’ve got progressive MS, because there is not as much. There are some things coming online now, but there’s certainly less medication. So what would be your message to those people who are diagnosed with primary or secondary progressive MS in relation to lifestyle.

 

Dr. Terry Wahls  27:46

If we have relapsing-remitting MS, our immune cells are active. You get a new lesion, new relapse, things quiet down. Between age 45 and 55 your immune cells get old, sort of decrepit. You quit having new lesions, new relapses. Instead, there’s this relentless decline. And it’s probably tied into the mitochondrial aging and decline. So fixing your mitochondria, it’s reducing toxic exposure, plenty of B vitamins, really great nutrition, hormetic stress. That’s where, if you could have a little exercise, rest, exercise, rest, alternating cycles. If you can do little temperature stress; that would be something that’s a little bit warm for you, a little cooler for you, gradually increasing your the temperature range that you can tolerate. Then you could do hormetic stress with spices; having a variety of spices that that stresses the cellular chemistry a little bit. You could do hormetic stress by intermittent fasting; having one or two days a week where you have fewer calories, or having time restricted eating where there’s a smaller area of eating window. Or some people will do three to five days of what’s called intermittent calorie restriction where I have a reduced calories, you know, 500, 800 calories for three to five days, then go back to my usual diet. So there are many ways to give your little mitochondria a little workout. We call that hormetic stress. And so those are very helpful strategies. It will also help you youthen, help you have healthier aging, better longevity.

 

Geoff Allix  29:48

Yeah, I think that, and that actually, a lot of other guests have said similar things, so…

 

Dr. Terry Wahls  29:52

You know if you have a total of 200 different plant species in a year, and you get to include the herbs and spices, it makes it way easier to get to 200 different plant species in a year.

 

Geoff Allix  30:05

You’re also hosting the DrTalks Multiple Sclerosis and Autoimmune Summit, which I think…

 

Dr. Terry Wahls  30:11

Yes, yes.

 

Geoff Allix  30:12

…in April and May. So how tell us about it, and how can people can come along.

 

Dr. Terry Wahls  30:17

I will have interviewed 50 different people talking about the diet, self care practices that can be very helpful. I’ll also talk some people about some new, interesting technologies that may help support better mitochondria. It is free. It is online. If you are on my email list, and for that you can go to Terry Wahls dot com (terrywhals.com), We’ll send out an announcement, and the announcement for it will go on about April 15, because it starts April 29th and it’s five days. It’s free. It’s online. You get access to the interviews for that day. And I have a little summary of what each interview is about, so you can pick the ones that sound the most interesting to you. It’s lots of fun. I always learn a lot as I talk to people in terms of what are the things that they’re doing, how that applies to people with MS or a systemic autoimmune disease that has neurologic or psychiatric symptoms.

 

Geoff Allix  31:26

Okay, that’s been very interesting. Is there any final point that you’d have?

 

Dr. Terry Wahls  31:33

Well, I want people to be hopeful. There is so much that you can do that is under your control. And for some people, we’re ready to make a big, wholesale change. But for most of us, it’s a small, little next step. And if the small next step is you’re going to learn how to make green smoothies, that’s a great step. If the small first step is, I’m going to take the moment to have a gratitude statement before my meals, that’s a great first step. But the other suggestion I have for all of you is think about being the principal investigator of this most important experiment, which is your life. So have an idea about some intervention that I’m going to try that I think will be helpful. You could write down on your notebook, I’m going to try the intervention. I’m going to sort of rate my symptom that’s bothering; whether it’s fatigue, headache, pain. And then I’m going to check in, in at maybe in a month, or at least, not longer than three months, to see how that symptom is and decide that that intervention was helpful or not. And then go on to the next intervention. And I predict, over time, you will gradually add in things that will help you take a better and better care of you and your family.

 

Geoff Allix  32:57

Okay. And with that, thank you very much for joining us, Dr. Terry Whals.

 

Overcoming MS  33:02

Thank you for listening to this episode of Living Well with MS. Please check out this episode’s show notes at Overcoming MS dot org (overcoming ms.org/podcast). You’ll find useful links and bonus information there. Don’t forget to subscribe to the podcast so you never miss an episode. And please rate and review the show to help others find us. This show is made possible by the Overcoming MS community. Our theme music is by Claire and Nev Dean. Our host is Geoff Allix. Our videos are edited by Lorna Greenwood and I’m the producer Regina Beach. Have questions or ideas to share? Email us at podcast, at Overcoming MS dot org (overcomingms.org). We’d love to hear from you. The Living Well with MS podcast is for private, non-commercial use and exists to educate and inspire our community of listeners. We do not offer medical advice. For medical advice, please contact your doctor or other licensed healthcare professional.

 

Dr. Terry Wahls  33:02

Thank you, Geoff.