056: How Dr. Terry Wahls Diet Can Boost Your Immune System & Help With Chronic Pain w/ Dr. Terry Wahls

November 2, 2018 Dr. Anna Cabeca

I'm really thrilled to have a renowned author, clinical professor and functional medicine physician, Dr. Terry Wahls, on Couch Talk this week to share her incredible story with you.

Dr. Wahls is a clinical professor of medicine at the University of Iowa and 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.

min. 0:02–06:00 The Discovery Of Dr. Terry Wahls’ Diet Plan

min. 6:00–9:17 Finding Joy And Meaning When You’re In Pain

min. 14:24–22:20 A Day In The Life Of The Wahls’ Diet

min. 22:20–25:25 Maintaining Self-Care During Travel

min 42:35–43:59 Three Things You Can Do Now To Make A Difference In Your Life

Transcript

The Discovery Of Dr. Terry Wahls’ Diet Plan

Today we're going to talk about boosting our immune system, and I want to introduce to you a really special superstar in the space — Dr. Terry Wahls. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, and the awesome cookbook called The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions.

Dr. Wahls is a clinical professor of medicine at the University of Iowa. She is just an impactful woman and someone that I have admired from afar for years.

She’s published over 60 peer-reviewed scientific abstracts, posters, and papers on Multiple Sclerosis; driven by her own personal journey of struggling with relapsing-remitting multiple sclerosis and being in a tilt-recline wheelchair; to walking again and even completing an 18-mile bicycle tour in just a year!

I'm so pleased to be interviewing you here, Dr. Wahls, thank you for joining us today. Tell us about your story.

Thank you so much for having me. It has been an amazing journey and such a wild exciting ride.

I'm an academic internal medicine doctor. Like many academic internal medicine doctors, I really believed in the newest drugs and the latest technology. I was very skeptical of vitamins, supplements, and special diets. I thought it was all a bunch of foo-foo, and didn't understand why patients wasted billions and billions of dollars every year on them.

But God works in mysterious ways. In 2000, I was diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS). I decided to go to the best MS Center in the country — the Cleveland Clinic, and see their best people and take the newest drugs.

In the next three years, I only had one episode of weakness involving my right arm. That would have been considered a huge success but the problem was I was going steadily downhill. By the end of the three years, I needed a tilt-recline wheelchair, and my condition had converted to Progressive MS that I had to start chemotherapy.

But my neurology physicians at the Cleveland Clinic had also told me about the paleo diet and the work of Loren Cordain. So I read his papers, read his books, and — after a lot of prayer and meditation, and after 20 years of having been a vegetarian — I went back to eating meat.

Still, I continued to decline, get worse, need the wheelchair, and need the chemotherapy. The best conventional medicine didn’t seem to be stopping this march towards becoming bedridden, potentially becoming demented, and having more and more refractory MS-related pain.

So I started reading the basic science about the animal models of MS, Parkinson's, Lou Gehrig's disease, Alzheimer's, and Huntington's; and started using vitamin supplements, which slowed my decline but didn’t stop it.

By the summer of 2007, I could not sit up longer than 10 minutes as I'd be completely exhausted. It was a struggle to walk 10 feet using two walking sticks. I was beginning to have brain fog, and the pain was getting more and more difficult to manage.

That's how I discovered The Institute for Functional Medicine and took their course on neuroprotection. This was in the midst of my brain fog, so it was really challenging. I had a longer list of vitamins and supplements yet not a lot was changing yet.

But then I had a really big aha moment: I should take this list of nutrients and redesign my diet to stress those nutrients. Thanks to the Linus Pauling Institute, I was able to do that. It's still a paleo diet — no grains, no legumes, no dairy — but very, very structured.

And it was stunning — in three months my fatigue was gone, and my brain fog was gone. In six months I was out of the wheelchair and walking around with a cane. In nine months I could get on my bike and pedal around the block. I cried, and my wife cried because, with progressive MS, the neurologists had said, “functions once lost are gone forever.” I had had no hope of recovery yet here I was, biking again. At 1 year — I did a 20-mile bike ride.

So this really transformed how I practice medicine and how I think. My chair of medicine called me and said — “This is just so phenomenal, can you get a case report written?”, which we did, with my treating team. Then he called me back and said, “I need you to shift your research program.” He helped me get the mentors on board so we got that published, and that launched a new focus.

It's just been a dramatic and totally unexpected direction that my life has taken.

That is a beautiful story, and to see you now, it's hard to believe — I've seen pictures of you in a wheelchair, and it looked like you were in chronic pain and just losing out.

It was very difficult. You know, there are very few pictures of me in the wheelchair because I (apparently) did not like being photographed; so I only have about five (photographs), and they’re precious.

Finding Joy And Meaning When You’re In Pain

One thing that you talk about is boosting the “internal will”. What got your internal will committed you to this?

There's a book that I read that I really love called Man's Search for Meaning by Viktor Frankl. He was a psychiatrist and neurologist who survived Auschwitz during the Holocaust, and in the book, he wrote about having seen tremendous acts of cruelty through the war.

But he also saw these tremendous acts of love and devotion. His premise was that all sorts of bad things happen in our life yet there’s always this phase between what happens to you and what your choice is; what it is that you will (choose to) do.

I had two young kids (aged) eight and five . My mantra every day, as I continued to work out and as I kept getting littler and littler, was — “Your kids are watching. Are you going to model giving up? Or are you going to model getting up, going on no matter how difficult life is?”

And so I modeled that: you do the best you can no matter what happens and you stay positive no matter what happens. Because that's the only thing I could control: the choice in my attitude, and that I could find joy in my life no matter how difficult it was.

As I got more and more disabled, I still could find joy. Snuggling in bed with my daughter, helping her memorize her lines for the next play that she was in, or drawing with my kids, or sitting out there in the garden and helping my family decide how we're going to organize what was being planted that year.

So there were still things that I could enjoy; still, things that I could do. I had to make sure I was trying everything that I could to slow my decline. I knew I couldn't get better but I could perhaps slow the decline. And so I did all of that. Not to get better, because I knew that was impossible but I thought maybe I could slow the speed of my decline.

Wow — that really is so touching. I love what you've said and then to find joy and wherever you are. I like that you're that concept I think too and in whatever we're facing in our life like, what are we modeling? Are we modeling joy? Are we modeling struggle and worry? Are we modeling giving up? Are we modeling, “No matter what, persevere, be patient, persist, keep looking for answers,”? And you modeled all of that and that is tremendous.

You can still find joy and pleasure whatever your circumstance is. You can still model the fact that there is stuff to be joyful about in your life whatever your circumstances are.

A Day In The Life Of The Wahls’ Diet

Tell us what you're doing in your world now as a result of your revive. What's your clinic like now?

I kept writing grants. I kept doing little pilot studies. These grants would go off to get reviewed, and they'd get ripped to shreds. People would say that I had no idea what the pathophysiology of MS was. But I kept writing my grants, I kept doing my pilot studies, and we had more and more impressive pilot data.

And ultimately, we got funded. We got funded by the National Multiple Sclerosis Society with the largest award that they've ever given to a clinical trial, I believe. They test our study and compare it to the Swank diet, and compare both to an observation period. And we have over a hundred patients in that.

So that's a very exciting study. It also means that we had to go through peer review and had enough compelling data that even my skeptic physician-scientist colleague said, “This study will probably work and therefore we should invest sizable resources behind it.”

The other thing that I do is that I present our research and give lectures around the University. Last year, the Department of Neurology gave me a secondary appointment. The College of Public Health has also given me a secondary appointment. The department that teaches physical therapists is asking me if I’d be willing to take a secondary appointment for them as well.

The fun thing about this is that when I first started having these conversations about diet and lifestyle being so powerful for neurodegeneration, people didn't know what to make of it. I received intense criticism. That was 10 years ago. Now, 10 years later, I have international recognition, we’re funded a research by the National MS Society, and more departments and colleges are asking me to lecture their students and accept secondary appointments.

So, wonderful things are happening. It’s lots of fun to watch and do my research. We also have public outreach in the very small private practice that I do, because I want to continue to have a private practice as well.

Wow! Your world has become so expansive as well as your influence. I'd love for you to share with us some of the pearls of your dietary plan, like the reason behind taking no grains and no legumes at all.

This has to do with lectins. Lectins are proteins that have a sugar side-chain to them. They're very common in parts of the plant world, and a little of the animal world as well.

You might think of this as the poison that the organism creates to kill off other organisms that are trying to eat it. So in the plant world, that means they'll be in nuts and seeds — so grains and legumes have a lot of these lectins. Depending on your genetic vulnerability, these lectins can be just a little bit annoying to you — or very, very annoying to your immune cells and cause an aggressive response.

So if you have an autoimmune condition, you're more likely to have this aggressive response; particularly to wheat and gluten-containing grains. That's why I really stress on being gluten-free in our research because I want people to have the best chance to do well on our diet. Be grain free, legume free, and dairy free. I do allow people to have clarified butter but all that is reduced lectin exposure.

In addition, I recommend taking out nightshades (Solanaceae plants) such as potatoes, tomatoes, peppers, and eggplants, because they also have a lot of lectins in them. In my book, I do this in a staged fashion with four variations of my diet where you steadily reduce the number of lectins. I also provide a ketogenic option as well, because there's a lot of benefit for ketosis.

In general, you can't just leap into this very restrictive diet without a lot of support and guidance. This is why I have much more of the public health perspective in my book, and why I give people guidance on how to gradually reduce their lectins and ease into this nutrient-dense diet.

That sounds good. Can you give us a day a day in your life; a day in the life of like that key transition with your best dietary nutrition?

I’m going to give you two (variations of) days.

Day 1: Getting Started With The Wahls Diet

The first day is sort of a level one, for those that just got started with the program. For this, you're going to get rid of gluten grains, and we ramp the day up.

You could have a big green smoothie in the morning, and add some protein or perhaps collagen in that smoothie.
If you’re busy, you can make a bigger batch so that you can have half of it as a midday snack.
You could take some sprouted nuts or a meat bar to work as a fast easy go-to meal for breakfast or for lunch.
At home, you could have a humongous salad with your complete protein. If you're a meat-eater, that's meat. If you’re a vegetarian, then I also provide some guidance.
You should also have a lot of greens — sulfur-containing vegetables in the cabbage, onion, and mushroom family; and brightly colored vegetables such as beets, carrots, and berries.
If you want to have dessert, I suggest something like a coconut milk chia seed pudding; you want to soak (the chia seeds) for at least six hours so you can germinate them, which will decrease the lectins. You can add some berries, fruit or dark chocolate with the pudding, or use cocoa and cinnamon to turn the pudding it into a sort of a chocolate mousse.

Level 2: A Day In My Life

The second day would be my day. I've been working on my diet lifestyle for 17 years. What does my day look like today?

I get up between 4:00 and 5:00 and meditate.
I do some mat exercises, inversion exercises (while doing some positive affirmations), strength training exercises and balance training exercises.
I make my green tea and have a few vitamins and supplements.
I swim and do my aquatic exercises for maybe 10-15 minutes.
I get into my (infrared) sauna and read for 20 minutes. Right now I'm reading Thieves of State, which is a very compelling book.
After 20 minutes I continue my sauna for another hour and do a range of isometric and motion exercises. And then I shower.
I do my cognitive training for 10-30 minutes, depending on what I have going on that day.

Then I go off to work and drink filtered water during the day.
In the evening I'll make dinner at home. We'd have a huge salad or cooked greens with sulfur-containing vegetables. Right now, we have a lot of brussels sprouts and cranberries and bacon, and we add black fermented garlic; my family loves that. We also have some broths that our local butcher makes.
For dessert, I’d blend phosphatidylcholine with omega-3 and omega-6 fats, inulin powder, aronia (chokeberries), cocoa, and cinnamon to make a little chocolate mousse. And then I put some frozen blackberries or raspberries or cherries or blueberries on top of all of that and leave it in the refrigerator.

All this is probably 40 to 50 grams of carbohydrates, so it's the ketogenic diet that I'm following, which I do during the winter. During the summer, it would be moderate carbohydrate; so I’ll go slightly out of ketosis but still very low on the glycemic index.

I spend 2-4 hours in my morning self-care every day. I sleep much better and I'm much more productive at work. I had my meeting with my division chief, and he was talking about how productive I've been with all the manuscripts we've published, the lectures I'm doing around the world, and the research.

“And you're only working halftime. I know you’ve got your private practice in your summer. How do you do it all?” He asked.

I said, “Well since I figured out that in order to do well, I have to spend all this time taking care of myself, what I discovered is that I'm vastly more effective. If I attend to all this meditation and exercise, I’m happier and more effective.”

That's huge, self-care. That's just such a message for our listeners; the right self-care and the right empowerment. I love that what you do — this is so in line with what I call a keto- alkaline style. You've got the blend of everything, especially all those good cruciferous vegetables and the nutrients. Disciplining your mind and taking care of your body, giving it what it needs and not relinquish on that.

Maintaining Self-Care During Travel

When you are so busy and you're traveling, how do you maintain self-care?

When I was flying a lot, I was having more problems with pain. I was like, “You know, maybe I'm going to have to cut out this traveling.”

Fortunately, I see my own personal functional medicine doc, and I was talking to her about this. And she said, “I bet it's the jet fuel and the increased radiation from all the altitude. So let's revisit some of your detox strategies.” So I did that, which is also why I'm very committed to the hour of infrared sauna that I do every day. That really made a phenomenal difference.

I have a little different detox regimen that I do when I travel and when I'm home. I may not get my usual 3-hour ritual in, but I still wake up early between and 5 am. Now it can be a little bit of a time issue if I'm going to the west coast or the east coast, I have to sort of deal with that. And then I'll do my mat exercises etc, and I'll do it salts bath instead of the sauna. And I have a more intensive detox regimen that I do when flying is involved.

Very cool! I was big on iodine and vitamin C when we fly but just keeping that extra care that so, you know, adding into phase 2 detoxifier support, what are the things that you’re adding?

I eat a lot of cabbage, take more algae and N-acetylcysteine when I fly. I also monitor my iodine status and make sure that I keep my iodine-replete because I swim a lot.

Those are big factors that make a difference in the long haul. You had suffered from multiple sclerosis but the Wahls protocol is good for all of us.

The Importance Of Vitamin D

I would love to touch on vitamin D supplementation and estriol.

Let’s first talk about vitamin D. I think vitamin D is so helpful in terms of epigenetic influence, activating antimicrobial peptides, and absorbing more calcium.

But you also have to be very careful about getting enough vitamin k2, so that when you absorb that calcium, it gets into your teeth and bones, and not ectopic calcium, which will go into your heart valves, blood vessels and breast tissue.

So where do you get k2? Tons and tons of greens; your bacteria will convert it to k2 and you'll absorb it. You can also get k2 from organic clarified butter, and grass-fed animal liver. K2 is vital and you have to get lots of it. Whether you should take k2 supplements with your vitamin D is a conversation you need to have with your practitioner.

It's also really, really important to monitor your vitamin D levels. Some research would say that giving supplemental vitamin D has not been helpful. Of course, most of those reports never bothered to monitor the levels. They didn't know if 400 units or 800 units or 1000 units was enough. In the studies that actually monitor the levels, you get favorable outcomes.

A lot of the vitamin D research also didn't know how to monitor vitamin k2 intake or vitamin k2 levels. In our study, we monitor vitamin D, k2 levels, and vitamin K intake so that we’re able to report on all that stuff.

How about Estriol?

In the MS world, we're certainly aware that the hormonal shifts during pregnancy appear to shift our immune response and decrease in the pro-inflammatory state in quiet MS and many (quiet) autoimmune conditions.

There have been a couple of very interesting studies using estriol at doses ranging from 2mg to 8mg when used as an add-on to conventional disease-modifying drugs. They saw that using the estriol as an add-on led to fewer relapses.

In Europe, there's more use for estriol. Certainly, some of the functional medicine doctors and anti-aging doctors will be very keen on using estriol either as a cream that you can absorb through the skin or the vaginal mucosa or as a troche that you can hold in your mouth and let dissolve.

I also use estriol personally. Has it made a difference for me? No — I turned off my disease very effectively using the Wahls protocol.

Eliminating and Being Assertive About Foods That Are Dangerous

If I go to your house and then you accidentally serve me gluten, I will have incapacitating face pain, usually in 6 to 24 hours, that I will have to take high-dose steroids or solu-medrol to turn off.

So I have learned, over the years, to be very, very assertive and clear that I can't have any gluten and I can’t have any dairy. And that if I accidentally serve that, I'll be in the hospital with refractory pain. Now I even offer to bring food to make it easier. And I can also just have coconut milk and tea while I watch everyone else eat, rather than risk having my pain turned on.

Wow. It would be so nice to say, “Okay, well, we can do this for a certain amount of time and then we're back to incorporating other things.” But it's a hard, “No.” it's a hard line. That's it — you can't cross it.

Correct. If you made some hummus for me, which I don't normally eat but because it's gluten-free, yes, these are foods that I will occasionally have. One of my Jordanian friends made a very delicious eggplant meal, and I love eggplant. I can have a small amount of it and do that on occasion. I can't have eggplant every day; that'll turn on my pain. But if I have a small amount, very sporadically, I do fine.

A tiny amount of gluten, however and I'll be incapacitated. I'm really quite grateful that I have that marker now. My pain, which had been so horrific for so long, has now become my friend because it tells me that “Something's not right. You have to think deeply, figure out what it was, and get it fixed.”

That’s said so beautifully because it's so interesting what we can and can’t eat. Dairy is a huge sensitivity for me.

We can live our life eating gluten and dairy and just slowly be numb to the effects until there a disease or a diagnosis. With my patients, we detox them, and then they go back to eating something that they used to love (and eat all the time), and they’d say “It never bothered me before, now it bothers me. What did you do to me?”

Your body is alerting you that this is a problem, it's going to cause devastation, and it's creating this huge inflammatory cascade.

How would you explain it?

Well, I explain that when they were dying slowly, they had accommodated to that dying slowly, and had just thought that was part of life.

Now that the inflammatory cascade is going off, and they realize all this damage that's happening in their brain and in their cells, and how this is jarring to their system, they can decide, “Do you want to go back to that and go back to that slowly dying? Or do you want to have your cells functioning as optimally as possible?”

And I train everyone that — “You know, this is a choice. You can choose what you're going to eat, and how are you going to deal with this. It's not up to me, it's entirely up to you.”

I love it — working to eliminate it completely and then be able to see what works, what doesn't work back with you.

Sugar, Gluten, And Dairy: A Slow Death For Many

The other thing I remind people is — we’re so addicted to these sweet foods, the gluten, and the dairy that the longer we are away from them and we begin to forget how sick we were, the world will still try to convince you that an occasional extravagance or an occasional thing will be okay.

Depending on your physiology in your genetics, they might be right; that occasional thing will be okay. But for the vast majority of folks, it will not be. And what you'll be setting up is this slow death again. If you're fortunate, you'll have acute symptoms that make you miserable and know, “I can't do that because it's making me miserable.”

With my two kids, one child has acute problems with severe headaches. She doesn’t have problems with dairy but has severe headaches if she does any gluten. So she's figured out how to be completely gluten-free through college, after college, living with roommates... and she stays gluten-free.

My son was gluten-free for a while. His acne went away, his asthma went away, and his migraines went away. He remained gluten-free and dairy-free for a couple years and then put things back in. And you could see the acne come up a little bit on his forehead, asthma come a little bit; but he doesn't have headaches. So these things are relatively mild and he can titrate on and off.

They have the same genes that are making different decisions, so we'll see how it works out for the long-term. My son commented that it'd be far easier if he had an acute symptom. He made the comment to his sister that, “You know, I know you don't like having the migraines but in the end, you're probably better served than I am.” Because he's not as diligent on his dietary choices.

Using The Elimination Diet To Determine Your Lectin Tolerance

With genetic testing, is there a way to find out if you can have lectins or not have lectins other than the elimination approach?

The gold standard is doing the elimination diet and having the lectin-rich food out for six months, and then reintroduce one ingredient at a time, one ingredient per a week.

There are no blood tests that tell you about lectins. There are some blood tests for specific food proteins but the problem with these tests is there's no national standard and they’re not, so you don't really know what they will mean. You can get tests for IgG or adaptive antibodies. You can get the test for an innate immune response that is cell lysis. But nothing that combines both. And because we don't have a national standard on the antigens, it can be very difficult to know what they mean.

So, yes, (the test) could be helpful and, yes, I did use these tests convince my kids that “I think you do have both some gluten sensitivity issues,” and it was helpful for that.

In my clinical practice, I use zero blood tests. I use the elimination diet and explain that's the gold standard. If you want to work with me, that's what I use. If you’re not ready to do that, that's fine; you can go work with someone else.

I like that because that’s discipline and practice and nothing beats being off it completely and then reintroducing it. And then you're like, “Oh, heck no! I can never have that again!”. It's so shocking.

The Wahls Protocol And Your Gut (Microbiomes)

The microbiome is a huge topic right now. How does the Wahls protocol influence the microbiome? I’d love to touch on that.

I am so excited about that. There's more and more evidence that our microbes in our gut are a huge impact and help us run the chemistry of life.

If thousands of generations ago, a genetic mutation came up that I couldn't do a biochemical process XYZ but my microbes could, we’d still have reproductive success at that moment, that the genes that manage the biochemical process for XYZ got passed on from my genes to my microbes.

So microbes are critical for how our brains work, our immune cells work, and how our hormonal balancing works. We are increasingly recognizing that the food we eat will determine which microbes are there. And we may be missing some key biochemical steps if we don't have a diverse enough microbial population.

Now you can go to pubmed.gov, type in the name of your disease that you're worried about and the microbiome, and probably get a lot of hits. There is a lot of recognition that the microbes are different between healthy people and people with your disease. We don't quite know what to make of that, other than to say that they're really, really important.

I think there are six studies now that document that, in the setting of MS, the microbes are very, very different. I’m incredibly excited because we've recruited one of the scientists to work on our study. And because I have some internal funding from philanthropists, we've been able to collect microbiome specimens in our clinical trial during the observation period.

We'll be able to see how the microbes change and we'll also be able to see the metabolic function of those microbes. So stay tuned. We will be able to do that!

That is cool! I would just imagine, back in 2000 during your worst disease state, that from what your microbiome was then to what it is now, there must’ve been a tremendous shift. It's so cool to be able to test that now and have studies that are going to show you these changes.

We're not just doing this for the setting of MS. I have another basic science collaborator who is studying this in healthy controls. I'm also meeting with our basic side collaborators here at the University, and we're developing a mouse model to study the effect of diet on MS — the low saturated fat diet, the conventional American diet, and the Wahl’s steady diet. So we'll be running those experiments this summer.

This is how practice standards change — the clinical trials. And because I'm so persistent, the basic scientists here at the University of Iowa are asking for meetings with me to talk about how we’re doing basic science studies to understand the mechanisms by which diet and lifestyle are so impactful.

It's a very exciting time. It's hard to sleep at night. I have to really work it, you know —, meditating, getting everything turned off and quiet. But I'm excited because now I ’ve figured out that it's so important to do all those things. I spend a lot more time with self-care in the morning and in the evening.

How can people see you? Where can they find your stuff?

I know that your book is available on Amazon. I love The Wahls Protocol: Cooking for Life. I 'm always looking at new recipes and great ideas.

They can go to www.terrywahls.com. On the resource pages, you can find information about who has been certified as a health professional. You’ll also see that we have a seminar that we do every summer for patients, and we also invite [unclear] to come and spend an extra session with us to go through case-based learning and take the exam so we can get them certified.

We also have a page where you can register to be on the waiting list to get into the private practice, and I certainly want everyone to sign up for the emails so they can hear announcements on our webinars.

Three Things You Can Do Now To Make A Difference In Your Life

Let's conclude with telling our viewers what are three things they can do right now that would make a difference in their life.

Replace the sugar and grains with more non-starchy vegetables.
Practice gratitude and take some time to reflect on what you are grateful every day.
Do some movement; whether it is stretching, strength training, or balance training, every day. Even if it's just 60 seconds of leaning your back against a wall and balancing on one leg with your eyes closed — it will be invaluable.

Great tips. I feel I've met a kindred spirit in you and I thank you for spending your time with me today and for sharing your wisdom with us; thank you.

Thank you so much, it's always such a pleasure.

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