The Melanie Avalon Biohacking Podcast Episode #207 - Terry Wahls

TRANSCRIPT

Melanie Avalon: Hi, friends. Welcome back to the show. I am so incredibly excited and honored about the conversation that I am about to have. So, it is with a repeat guest. And I love repeat guests because that's how you know that I just really, really adore their work and that the audience loves them. And really today, I am here with a legend. So, I am back with Dr. Terry Wahls. She was actually on this show almost to the day about two years ago. So, we will put links in the show notes to that episode. In that episode, we heard all about her personal story with MS, all of the clinical research, and work she was doing, and the incredible things that she's found with her dietary approach to not only addressing MS, but autoimmune conditions as well. So, she is the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles and also The Wahls Protocol Cooking for Life cookbook.

She's an Institute for Functional Medicine certified practitioner and a Clinical Professor of Medicine at the University of Iowa, where she conducts a lot of clinical trials on MS. All you have to do is go to PubMed and google her and she has so much work. I was looking over all of it in preparation for this, all of the new things that she's published and worked on even since I last interviewed her. So, I have so many things I'd love to do in today's episode. The backstory is I've been wanting to have her back anyways. I wanted to ask her some follow up from our last episode. I wanted to get some specific listener questions that I had come in for her. And then her team actually reached out, because she is currently conducting an incredible clinical trial. It's called Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis. You guys are still recruiting people for that study, right? 

Terry Wahls: Correct. It'll be one of the largest, longest studies that have been done. So, we're looking for 156 people. We're at 96 right now. So, that's very exciting. We got 60 more. I'm thinking that we'll recruit through into 2024, and we will finish, I'm guessing, in the spring of 2024. We'll finish recruiting then. 

Melanie Avalon: Awesome. No, it's funny because I was emailing your assistant. I don't think she told me right at the beginning that it was that long and that large. So, I kept asking her questions like, "When will it be done? Can I get some information?" And finally, she was like, "Melanie, this is a long study. [laughs] This is going for a long time." Yeah, I am just so excited to dive into all of that. To start things off though. a lot of my listeners are probably very familiar with your work. I've been following you for years and years. Your TED Talk, was it in 2011, correct?

Terry Wahls: November 11, 2011. 

Melanie Avalon: Awesome. So, a long time. People are probably pretty familiar. But for those who are not, could you tell listeners, reintroduce yourselves to them about your personal story and why you're doing what you're doing today? 

Terry Wahls: I'm trained internal medicine doc, an academic physician. And then in 2000, I developed weakness in my left leg, and went to see my neurologist, and we started the workup. Now, at that time, I'd already had 20 years of worsening electrical face pain. And so, I'm like, "Oh, dear God, this is not good." Actually, I'm praying for a fatal diagnosis, because I don't want to become disabled. And three weeks later, I hear multiple sclerosis. I do my research, find the best MS center in the country, see their best physician, take the newest drugs. And two years later, I'm in a tilt recline wheelchair. I'm taking mitoxantrone. I continue to get worse. I take Tysabri, I continue to get worse. I'm switched to CellCept. My face pains are relentlessly worse. I've already been on the paleo diet for three years and I'm still going downhill. 

Then I ask myself, "Am I really doing all that I can?" That's when I start reading the basic science, animal models of MS, Parkinson's, Alzheimer's, ALS and I decide mitochondria dysfunction drive disability. I create a supplement cocktail for my mitochondria. It slowed my decline. I'm super grateful. I discover a study using electrical stimulation of muscles. I asked my physical therapist if I can try that. He says, it's for athletes, that, yes, you can grow bigger muscles, but he's not sure my brain can talk to the muscles that he grows. But he does give me a test session. It hurts bad, really bad. But when it's over, I feel great. He says, that's the endorphins. And so, we add e-stim to my exercise. I'm so weak, I can only do 10 minutes of really a very basic mat exercise. Yet, in my office, while I'm seeing patients with the residents, I'm in a zero-gravity chair with my knees higher than my nose. I have another one at home. I take my meals and I spend my time with my family like that. I can take a few steps using two walking sticks. 

I'm beginning to have some brain fog, and my face pain is getting relentlessly worse. It's very clear to me, because I've had 27 years of worsening neurologic problems that I'm on track to become bedridden by my illness, demented by my illness, and probably have my face pain turned permanently on. That's when I discover the Institute for Functional Medicine, I take their course on neuroprotection, more mitochondrial stuff, and a longer list of supplements, which I add, and then I have a really big, "Aha, what if I redesign the paleo diet that I've been on now for five years based on this list of supplements to figure out where they are in the food supply?" So, that's a couple more months of research. I start this new way of eating December 26. Now, at that time, I cannot sit up anymore more than 10 minutes. Otherwise, I'm in that zero grav chair. As I said, I'm having brain fog, I can take just a few steps. My face pain is much more difficult to get turned off. I'm on maximum doses of gabapentin. And when it turns on, I go in to take Solu-Medrol a gram every day for five days. 

So, I start this new way of eating. By the middle of January, I realize that my mental clarity is improving, energy is a little bit better. And at the end of January, I tell my family, I want to try sitting in a regular chair for supper. And we do that and it goes pretty well. That's really a big deal, because I'm sitting at the table with my family for the meal. And then next thing that happens is I decide to use my walking sticks and I'm walking in the hallway at the hospital to mail a letter which stuns my partners. I start walking then in February using two walking sticks and then one and then none, I decide on Mother's Day that I want to try riding my bike. So, we have an emergency family meeting.

Jackie tells my 16-year-old son who's 6'5", "Zach, you run alongside on the left." She tells my 13-year-old daughter, "Zeb, you run alongside on the right and she'll follow." I get on my bike, and I bike around the block. And that big 16-year-old boy, he's crying. The 13-year-old girl, she's crying. Jackie's crying, and of course, I'm crying. That really changes how I think about disease and health. It will ultimately change the way I practice medicine and it will ultimately change the focus of my research. I've made it my mission to teach others with progressive chronic diseases who've been told there's nothing they can do that there's always stuff that we can do that may improve our symptoms, may slow the decline, and may surprise everyone with how much function you get back, because, Melanie, I now hike in my neighborhood bike hours.  I jog in my neighborhood. I was recently out in Colorado. We went to the Rocky Mountain National Park and I'm hiking up above the tree line three hours. It's really extraordinary. I'm not normal yet. My kids laugh. They'll say, I'll never be normal, but I am dramatically better than I was in 2007. 

Melanie Avalon: So inspiring. I have so many questions. Okay. So, one question to start. So, you mentioned in your story just now, you listed out things, Parkinson's, Alzheimer's, ALS, your experience with MS. All of these different autoimmune conditions and degenerative diseases that people get, what determines why people get certain things? With an autoimmune approach, and like your protocol, and looking at the supplements, and food, and using all of that to address things, why or can it work for everything? Yeah, why do things manifest the way they do? 

Terry Wahls: Yes, it's wild. So, as I was getting more and more disabled, I've had two relapses in my entire course. I had a relapse affecting my right hand and my right leg was weak. In retrospect, I had an episode of dim vision in 1987. So, there's two relapses. Otherwise, it's really been this slow progressive decline. I thought, okay, as I'm reading the basic science, inflammation is not what's driving my disease. It's more neurodegeneration. So, I wanted to read about neurodegeneration, because that's what was driving my disability. It was a lot of work because I had to learn how to read all this basic science, all this biochemistry. But I always came back to mitochondrial dysfunction. It drives brain atrophy, spinal cord atrophy, and that probably what can I do to improve mitochondrial function. And so, gradually, I'm adding more and more supplements to help pathways in the mitochondria. 

Now as I get better at biochemistry and I'm looking at these great, big, beautiful biochemical pathway maps, one of the things that you see is that it's so deeply interconnected to keep all of the constituent parts within safety parameters, mostly our electrolytes. We have to keep that in a very relatively tight range, so we stay alive otherwise, we die. We have all these enzymes that facilitate this chemistry that is so deeply interconnected. What I want your listeners to know is, it's the health behaviors that we have, how we act every day, what we eat, what we do, what we think, our time in light, our time sitting, our time exercising that speak to those biochemical pathways. And all of our behaviors are either behavior by behavior nudging the pathways in a more disease promoting way or a more health promoting way of functioning, which is why-- 

I am just so super optimistic that always whatever patient I see that there are things that I can help you do to nudge some of your health behaviors into a little bit more health promoting, and it will percolate through all of that rich biochemistry, and let it work just a little bit more correctly. 

Melanie Avalon: Yeah, I love that. It gives people so much agency. I think we learn more and more every day the power of epigenetics, and the role of diet and lifestyle on everything. Are genetics, are they necessary but not sufficient? Can anybody get MS or do you still have to have a genetic piece? 

Terry Wahls: We'll talk about MS. Well, the sequence looks like this. You have genetics. There are probably 300 genes to 400 genes that we've identified that increase your risk for MS. Now, for the vast majority of these genes, the amount of risk is about a 0.5% to maybe a 1%, maybe 2%. There are a couple of genes that have a bigger impact, maybe a 10% or 15%. It's very tiny and the vast majority of people with that gene will not get MS. We have people who are identical twins and they were raised in the same household. One gets a disease, one does not. We have identical twins raised not in the same household, and then you have sibling studies and parent studies. So, we know siblings and parents do have a higher risk. So, genes are part of it. 

Then the next thing that needs to happen is an infection that you don't completely clear or clear correctly. And right now, we've identified 16 different viruses and bacteria that are associated with a higher risk of MS and other autoimmunity. The reality, Melanie, is nearly everyone has been exposed to at least one of these 16 and probably many of these 16 microbes. But still the vast majority don't get MS or an autoimmune problem. So, there's other factors involved. My colleagues in the MS world would say, "We don't know what they are." And my response was, "Okay, but we know what the factors are that are associated with good health. So, let's work on using those to improve the health of the individual." 

At the very least, you are addressing the comorbidities, and what we see is reduced fatigue, higher-quality of life, better motor function, better thinking function, better MRIs, and that people get closer and closer to normal functioning. 

Melanie Avalon: That infection concept.

Terry Wahls: Step one is the gene. Step two is the infection. Step three is all the environmental stuff. 

Melanie Avalon: Wow. Okay. I'm just very shocked because I feel like I don't hear people talking about that. Infection step, is that specific to MS or for other conditions as well? 

Terry Wahls: Yeah, it's probably true for every autoimmune condition that you have genetics, then you have an infection that you don't properly clear, and then the environmental factors, toxin exposures, diet, exercise, stress, sleep, hormone balance, microbiome, all of those interact. We have a progressively more severe disruption or worsening of our health behaviors. People are sleeping less, there's more stress, more conflict, more hormone disruption. We don't have enough light. The quality of our food is declining. So, we have all of those insults that accelerate the disease process. I was at the consortium of MS centers, which is the annual international meeting where the clinical people who take care of MS patients, the researchers who do clinical research. It's not about the mouse people. It's about the people who do clinical research on humans. We're all there, the drug companies are there, patient advocacy groups are there, and then some MS people are there. So, they have a couple thousand people there. 

What was so remarkable, I started going to this meeting five years ago, and I was the only one with a research poster talking about food. Just me. This year there were many more people with research about food, several oral presentations and symposium about diet, and researchers who were talking about clinical trials and [unintelligible [00:16:23] MS, molecular pathways, etc. These PhDs were all saying diet and lifestyle, particularly diet and exercise, are just so important that MS is a disease of accelerated aging. I've been talking about that actually for years. And they said, "We don't really have anything to fix that." That foments very interesting animal model studies. And then there was diet and exercise. And I'm like, "Yes." Lecture after lecture, people were talking about the molecular mechanisms, potentially some drugs and then saying, "And yes, there is diet and exercise." They might have thrown in stress reduction and sleep. So, super interesting. We are certainly making progress. Clinicians are being told that you got to talk to your patients about diet and exercise that that should be an adjunct to every treatment conversation that's happening. 

Melanie Avalon: Well, one more question about the infection, the step two in the process, is it the actual infection itself that is causing the continued problem or is it the infection's effect on the immune system and how it modulates the immune system? 

Terry Wahls: It's the infection's impact on the immune system. What I want your listeners to know is we had thought-- I'm in my 60s. So, when I went to medical school, I was taught that we're sterile. The urine is sterile, the blood is sterile, my bones are sterile, my brain is sterile, that we're sterile. We're not. Now that we have this more sophisticated looking at our tissues, including our bloodstream, our spinal fluid, our brain, our bones, it turns out we're packed with organisms even in the areas that I thought were sterile when I was young. Isn't that wild that--? I think there's a debate, is it a quarter or a third of our DNA is borrowed stuff from viruses? And that when we get infected with a virus, it's never completely gone. We keep it under control with our immune system. We keep those viruses in our brain under control with our immune system. We keep the bacteria load in our body, in our blood, in our bones, in our lungs under control with their immune system. 

As we age, it begins faltering around and men faltering around age 40 and women, once you go through menopause at whatever age that happens, our immune cells begin to age. They can't control the viruses, the bacteria as effectively, which is why pneumonia becomes a bigger problem when we're older, why bladder infections become, kidney infections become bloodstream infections when we're older, why we get demented as we get older and we may begin to have more confusion and that we may begin to have some encephalitis or activation of the brain infections when we're older. 

Melanie Avalon: I've heard oftentimes people will say that when you're really stressed, you get sick, and it's because it's something that's already inside of you?

Terry Wahls: Absolutely. When you are ill, you sleep more. I tell, folks, when you're ill, go to bed and sleep. Your immune cells are much more effective with good sleep. 

Melanie Avalon: That is so fascinating. I was wondering if there was an update, because when we talked over two years ago, we were talking about if there were mitochondria in the myelin, and you said they were doing research on that, are there any updates on that? 

Terry Wahls: It's super interesting. There are mitochondria in the myelin, which helps support the energetic needs of myelin in transmitting the information down the axon, which is the wiring between nerve cells, requires a lot of energy. And so, yes, mitochondria are there. As we get older, the brain will use glucose to make the ATP run the chemistry of life. Apparently, the brain gets gradually less effective at using that glucose as we get older. But we can continue to use ketone bodies, which are fats. It's one of the reasons why people who have cognitive decline, often do a little better and wake up when we put them on a ketogenic diet. 

Melanie Avalon: Actually, speaking to that, because I was looking at some of the studies, and there're a lot of studies looking at your dietary approach versus the Swank diet, which seems to be radically different. Why do you think those both have shown effects? 

Terry Wahls: Dr. [unintelligible [00:21:33] and her team did what's called a network meta-analysis, that it's a way of looking at-- So, a meta-analysis combines multiple studies, and it uses something called the standardized mean difference and the 95% confidence interval to show that something is helpful or harmful compared to control or compared to another randomized arm. In this study, they looked at, let's see, low fat diets, and it was either the Swank or McDougall, the Mediterranean diet, the paleolithic diet, and they were all our studies, so really, the Wahls diet, anti-inflammation diet that was out of Iran, fasting patterns, which were time-restricted eating and intermittent fasting, there was a fasting mimicking diet and a ketogenic diet. And then usual diet, which is just eat what you normally eat. 

There were 608 people in the study when you combine everything and the calorie restriction lowered. People did worse on calorie restriction. I'm not surprised because you're eating only 75% of your caloric requirement, and people generally have less energy on that. So, there was a little bit of improvement for anti-inflammation ketogenic diets. However, the confidence interval crossed over into favoring the control. For the low-fat diet, the Mediterranean diet, and the paleo diet, the confidence interval was clearly on the side favoring intervention. So, they were all good for reducing fatigue. And the paleo diet was 50% larger effect size than either Mediterranean or the low-fat diet. Then for improving quality of life as measured by physical health or mental health, the paleo diet and the Mediterranean diet improved quality of life. And the paleo diet was twice as effective as the Mediterranean diet. 

So, these are all pilot studies. We need to have longer studies that preferably go two years. Also include MRI data. So, we get to know can people sustain it for that long. And if you look at the MRI, that'll be really interesting. I think it'll be hard for any diet study to show a difference in relapse rate, because the drugs are so effective. When people take drugs, they do a really good job of stopping new-enhancing lesions and reducing relapses, but they don't do a very good job on brain volume. 

Melanie Avalon: Got you. Was this the 2021 review of 32 articles? I was reading one where you were talking about how they were excluding studies and also making assumptions about the patients, like, interpreting data.

Terry Wahls: So, this paper came out in 2023. There were a couple of other meta-analyses combining diet studies and consistently what the meta-analyses that look at food plans find that. If you adopt a diet and it could be a variety of diets, you have reduced fatigue, improved quality of life, and that the standard usual diet leads to worse fatigue and worse outcomes. Now, we did publish a study in 2021 that compared the Swank Diet and the Wahls diet. Is that what you're referring to? 

Melanie Avalon: I had two. I had one, a review. I think it was a review article of a meta-analysis, and you were talking about how they excluded certain studies and how they also made assumptions that patients couldn't really interpret the data or stick to the diets. And you were saying in it how MS patients are very interested in their health. It was very empowering that they are. Go ahead. 

Terry Wahls: It's super interesting. Study after study with MS patients have found that the vast majority are now taking vitamin D in a B vitamin and fish oil. And patients started doing vitamins, fish oil, and vitamin D before their neurologists routinely were telling them to do that, and the vast majority are making some dietary changes. And of course, there's a variety of opinions. You do the Swank diet, the Wahls diet, the Mediterranean diet. Some folks are pretty impassioned about doing some variation of a vegetarian or a vegan diet. People have strong feelings about which diet they want to explore. I think many, not all, but many MS patients are like, "So, what is it that I could be doing?" I want to be doing something, because this is a pretty terrible disease and I'd like to keep working. I'd like to keep playing with my kids. I want to be able to coach my daughter's volleyball team or my son's football team, and I got to be doing what I can to be able to stay engaged in my life.

Melanie Avalon: Actually, does that--? Because that's a big question I had about your study that you're working on now or your trial, because it says in the recruitment information that people need to be open to being assigned to any one of the three diets, and maybe you can talk about what those are. Is that hard to find people that are open to doing any one of the three?

Terry Wahls: Of course. So, part of that is because I'm being so successful in going on these podcasts telling everyone like, "Oh, my God, you have to fix your diet. You can't have a terrible diet, because the standard American diet will accelerate your disease." And that message is getting out. So, people want to do a diet. Every diet study that anyone ever does, I assure you, we all run into the same thing. People who are willing to do a diet study, because it's a lot of work to say, "Okay, I'm going to change what I eat. Give up familiar recipes, patterns. I'm going to start eating new foods, give up things that I like, so I can follow the pattern you want me to follow." That's a lot of work. 

So, if I'm willing to do that and I get randomized to control, I'll be like, "Well, I don't like that. I want to do the work." So, we're very careful to explain that all three groups have a really vital role to play that we need a control arm, because that makes the strongest evidence that diet matters, and that I know full well the control arm is going to do a better job than the Standard American diet. And that's okay. We're going to give them little tips based on what's available with dietary guidelines. We have little cooking videos, cooking recipes that we'll give every month to the controller. The two intervention arms, one will be the time-restricted olive oil ketogenic arm. The other is the modified paleo elimination diet, which is what we studied in that study that compared Swank versus Wahls. They will get sessions with the dietitians and they get access to a monthly support call. 

I assure everyone that, yes, I expect all three groups to improve, and that we will be looking at patient reported outcomes in terms of mood, fatigue, energy, and clinical outcomes, walking, hand, vision function. We're looking at brain volume. In that, I expect all three groups will have very few relapses, because the drugs are so effective and that we know if you improve your diet, you'll have fewer relapses. But that brain volume in people with MS declines every year at about 1% per year, which is why we have higher rates of frailty in nursing home care at earlier ages, and higher rates of earlier cognitive decline, and job loss, because we're having difficulty with our thinking. Healthy rates of brain aging is less than 0.3% per year. 

So, what I think-- it's not my primary outcome. My primary outcome is change in quality of life. But a really interesting secondary outcome is change in clinical function. But I think the most interesting question is, how many people can I get to healthy rates of aging? Because that, I think, is a great way for me to predict who's going to be at risk for early nursing home care, early frailty, early wheelchair dependence. Because if your brain is shrinking at 1% per year or 2% per year or 3% per year, you are definitely on track to become disabled far earlier.

Melanie Avalon: For the aging piece, are you doing any testing of biological age testing or genetics or telomeres? 

Terry Wahls: I wish we could. We don't have that in the budget. Although, I will tell you, we keep writing grants all the time. And now that I've settled on accelerated aging is another mechanism that drives disability. And that, I think, the fact that clinically, when I look at my patients at the VA, when I was still seeing patients there in my own practice, we see people youth by about 15 years. When I looked at my telomeres, I was 15 years biologically younger than my chronologic age. So, we're writing grants now that include a look at aging markers. I'm also now this winter or this summer, we are doing a freezer analysis. So, in every one of my clinical trials, I've been collecting blood and freezing it. And so, now we're using some money. We've gotten money from some donors that we can use to pay for the analysis of the molecules.

Melanie Avalon: Oh, wow, that's exciting. 

Terry Wahls: That'll be very exciting. 

Melanie Avalon: I know so little about the logistics and the protocols about all of this. So, are you able to partner, because there're so many commercial companies now doing biological age-type tests. Can you ever partner with them? 

Terry Wahls: When you do research, you have to get people willing to pay for it. So, when you're doing the trial, I have to be able to pay my staff, cover those expenses, and then we freeze stuff. And now to analyze the stuff in the freezer, I have to pay for it in some capacity. In finding commercial companies so far, they might give me a somewhat better price, but they want to give it to me for free, so I still have to find money to pay for it. So, if there are any listeners listening to this podcast who would really like me to investigate that aging piece and would be interested, you can reach out to us and you go to my website, terrywahls.com. There are places you can contact my team, and let us know that you have either a disease state you'd like me to investigate or a molecular pathway that you analyze, and you would like us to analyze some of our freezer specimens. We'd love to talk. 

Melanie Avalon: We'll put all this information in the show notes. Going back to what you were talking about with the three diets, just to help encourage people to sign up, because we just talked about-- I know people have concerns about being assigned to the standard American diet or the control aspect. 

Terry Wahls: If you're on the control diet, you get to eat what you want. 

Melanie Avalon: That's what I was going to ask. Can you eat whatever you want? 

Terry Wahls: You get to eat what you want. We have people who are following intermittent fasting already following a keto diet or a Mediterranean diet or one version of the Wahls diets, or they may be a vegetarian. We tell them, "Look, you have to be willing to eat meat or fish at least, if you get randomized into the paleolithic arm." If you are following a ketogenic diet, you can enroll, but you have to be willing. If you get randomized to the paleo diet that you will in fact follow the paleo diet. If you're following the paleo diet, you'll have to be willing to like, "Okay, if I'm randomized to keto, I will switch to the keto diet." If you're following the Mediterranean diet or the intermittent fasting diet, you can come in if you're following another diet as long as you're willing to be randomized. If you're assigned to one of the intervention diets that you all follow the diet to which you've been assigned, I explain that this is how you build the strongest evidence.

We have done other studies that are called quasi experimental, where people choose-- We just recently did a study that looked at people who have declined disease-modifying drug treatment, and we're going to teach them basically how to do the Wahls protocol. We taught them a diet, we taught a stress reduction technique, and an exercise program. We followed them for a year. We had people who were in the standard of care who were getting DMTs, they got to eat and do what they wanted. We were just ready to start that study when the pandemic came upon us. So, I had to quick reimagine the study as a virtual only. We did just questionnaires, and collected the medical records, and abstracted the medical records, and figured out how many people are having relapses or worsening during that time. We're analyzing that data and we're writing up that manuscript. 

Now, that's called a quasi-experimental and we were looking the original intent of the study was to say, the health behaviors without drugs would be not inferior to the standard of care, which is, you take drugs and you get to do whatever you want for your diet and self-care program. We have some very exciting results, which I can't really tell you about other than say, we're working on the manuscript. Hopefully, we'll get it from our editors. It's usually about a year from the time you have it written. You go through editing, you submit it, you go back and forth with the journals, and you finally find a home. So, hopefully, in about 12 months, we'll have a home for that manuscript. 

Melanie Avalon: So many exciting things. Is it a concern--? Well, I guess, it would be a good thing. But you'll hear about studies where one of the arms is so effective that it's morally they can't continue to study. Is that a concern for you?

Terry Wahls: So, this is called a data safety monitoring board, and we report out every six months. I meet with them and they look at the data. It's diet ABC. We look at the data for adverse events and for outcomes. If there are serious adverse events or dramatic differences in terms of improvement, then yes, you do stop early. I would be quite surprised. Thus far, we're a year into this. We don't have the adverse events that we're seeing are things that you anticipate from the natural history of the disease. And then there are adverse lab values that you see that are the things that you anticipate from taking the disease-modifying drug treatments that can cause suppression of the white blood cells, damage to kidneys and livers, so the enzymes get just a little bit elevated. And so, then when I'm filling out those adverse event forms, then I send them off to the neurologist who's the medical monitor, who says, "Oh yeah, it's what we expect." If it's not what he expects, then we would have to deal with that. But yes, you always have a safety board that keeps an eye on your clinical outcomes and your adverse events to be sure that patients are not being harmed. 

Melanie Avalon: On the flipside, not necessarily for this study, just hypothetically, if you were doing a study and one of the interventions was so effective that you had to stop it, how would you feel and what would you do?

Terry Wahls: That does happen. That has happened. That studies have been stopped early because there was so much benefit. They're like, "Okay, we don't have to go any longer because the level of benefit is so great. We don't want the control arm to be deprived." Those studies get published early, and they're a big splash in the news usually, and a big splash at the scientific meeting. That would be pretty wonderful. My postdoc that I would let present that would be thrilled. And of course, I would be thrilled as well.

Melanie Avalon: Putting that out to the universe that that moment happens. How do you account for--? If there're multiple factors, either in this study or other studies you've done where there's lifestyle intervention, maybe e-stim or supplements with diet, how do you account for knowing what to attribute to what? 

Terry Wahls: The very first study that we did-- Well, actually, my first paper was a case report on me with my treating medical team. Second paper was case series. And then the third and fourth papers were the multimodal intervention, which basically was to see could other people do this very complicated regimen that I use for my recovery. Diet, supplements, a mantra-based meditation, exercise, electrical stimulation of muscles. People were severely fatigued with progressive MS. It was a big question. Could they even do all this stuff? Would they be willing? The shocking thing was, yup, they were willing. They were very compliant with doing the diet, adding all those vegetables, taking away gluten, dairy, and eggs. They were compliant on 92% of the days. 

They were not quite as compliant on the mantra-based meditation, but still, 13 minutes a day was the average. They exercised, I think, 25 minutes a day was the average, and another 30 minutes a day of electrical stimulation. That's the feasibility part. The safety, we lost 1% out of 20 who had continued cognitive decline, so she was no longer competent to give consent. So, she was withdrawn at six months. So, that's the safety part. Then we look at the effect size. What we saw was that as a group, fatigue severity down to 2.38%, the clinical difference is 0.45%. So, that's a pretty substantial reduction in fatigue. Quality of Life Score in the Short-Form 36 went up by 17 points for general health, and I think 15 points for energy. And the clinical effect size, that's measurably different is 5. So, again, a large difference. 

For motor function, walking speed, so how fast you can walk 25-foot walk. What is remarkable here, Melanie, is that you anticipate a 10% to 15% worsening that is slowing of walking speed each year when you're in that progressive phase. As a group, walking speed was unchanged. In half of the individuals, walking speed was remarkably better. People hated that study. We got panned, we had a very hard time getting it reviewed and getting it published. It took me two years to find a journal, two and a half years. Then that was of the 10. And then it took another year to get the next paper out, which I had 20 in it. Part of the problem was people said, "We don't know what helped." And I'm like, "But we helped." We can then begin to break down that, yes, exercise is really helpful, e-stim is helpful, meditation is helpful, and diet is helpful. So, after that, I began studying just diet. I'm now back to writing grants that combine diet, plus exercise in progressive MS. There have been more studies showing that, yes, exercise is super helpful even for people with progressive MS, diet is super helpful. We think you can get an even bigger effect when you combine diet and exercise. Then what we'll do is in the grants we're writing now is that we'll look at the molecular markers of aging. 

Melanie Avalon: So, basically, try all of these things that work, and then next step, you can look closer and figure out what specifically might be contributing to what.

Terry Wahls: Part of this is that I think there's more embracing that lifestyle is a factor. We've done a whole lot of good in the NIH with understanding biochemistry by using worms, flies, bacteria, yeast, mice, rats, dogs, primates, because there's a tremendous amount of overlap in the biochemistry of life between all of those species. As I mentioned earlier, that biochemistry is deeply interconnected. I think the fact that this summer, we're going to be analyzing more of our freezer to get at the molecules that change and speak a little more clearly that in our grant proposals that, yes, we don't study mice and knock up mice to do one chemical pathway. We study the whole person. The chemical pathways are deeply interconnected. We're going to do diet and exercise together and see how aging, I think, is going to be a wonderful model for us to investigate. 

Now that we're really good at big data in artificial intelligence, we can begin to look at metabolomics that look at about 1,500 different metabolites to say. When we did intervention A and intervention B, the metabolites changed over the year or over two years in this way. And so, we finally are getting the big data in the artificial intelligence to be able to analyze the changes in that whole biochemical pathway matrix a little more effectively.

Melanie Avalon: With AI, I'm glad you brought that up. I actually just did a whole show on this. How do you feel about black box answers? So, basically, where AI gives an interpretation or a result, but we actually don't know how it came to that. 

Terry Wahls: Well, I don't know how this is all going to work its way out. My basic science colleagues and I are looking at some of our microbiome data, our clinical outcome data, and some metabolite data, and we're using artificial intelligence to analyze this stuff. I'm going to be able to speak more eloquently to it in the future. But even in our preliminary analysis, because we're looking at, can I have clues to know who would respond better to the Swank diet and who would respond better to the Wahls diet based on the metabolites that people had at baseline and the microbiome at baseline. Because I know who did really well on Swank and who did terrible on Swank and I know who did really well on Wahls and who did terrible on Wahls. 

A really interesting question to me is, because I think ultimately, while eventually be able to see you, Melanie, I'll get a little urine from you, some saliva from you, and some blood from you, because saliva would be a lot more convenient than having to make you go poop for me. But if you could poop, that would better. We analyze all that. And then you come back and I can say, "Based on your genes, on your metabolites, your microbiome, this diet, you'll probably actually do better on Swank or you'll do better on Mediterranean or you'll do better on ketogenic or you're going to do better on paleo." Because we're never going to have one diet that's perfect for everyone. There's never going to be one diet that is the best diet. I'll be able to tell you which diets that you would do the best on, but then I also have to ask you, given your family and your cultural preferences that this was the best diet, but is that a diet that you could do? If that's not the best diet, I'll probably in my report will be able to say okay, you could do really great on diet one. You could do okay on diets two and three, but you would get a lot worse on diets four and five. So, I could give you that information that you could go home with your family and have a big conversation like, "Okay, we're not quite ready to do diet one. We know now to avoid diets four and five, because they would be bad for me, and we have to think more about whether it's going to be diets two or three." I don't know how quickly that will come. I'm guessing probably in five years. But again, that's just a big guess. 

Melanie Avalon: Also, similar to that-- This is the direction I thought you were going, but you were talking about having the data and then recommending a diet to somebody based on what they might be appropriate for. Do you think they'll use AI to select patients more suitable for diets and studies in the first place? And if so, would that bias studies? I'm wondering if the drug companies will start using AI to find patients that will more likely respond to what they're trying to test. 

Terry Wahls: I think that's a fair question. Hopefully, our drugs, all of our pharmacologic people will use AI to help know which patients are more likely to have an adverse event taking their drugs so they can say, "No, you should not take this," and which drugs are best for that drug. Hopefully, we will be in a position for all the prescribers to know, for me to be able to know based on you, which drugs are best for you or not. So, yes. Will the people prescribing someday and will this be good or not? That we come in and we get genetically profiled, microbiome profiled, and my clinician would have that, and they would be able to make much more personalized recommendations. How comfortable would we feel about that? I don't know. Would I feel comfortable about that being genetically profiled and having my microbiome profiled? So, it's uniquely me in this system. How comfortable would we feel about that? 

Melanie Avalon: It's a really good question. It's something, especially with this audience with biohackers, I feel like they're at the forefront of people who are really looking at that type of data in themselves anyways. 

Terry Wahls: It could be a profoundly helpful tool for me to know what supplements would be really good for me, hot and cold be really good for me, what diets would be best. I could certainly jump my health further along. Does that make me more vulnerable in ways that I'm uneasy? I don't really know. I think people will have maybe very excited about that and will feel perfectly fine, and then there'll be others who will feel anxious and uneasy about other people, like, other people having your fingerprints. Do you want that? On the other hand, we all get on social media, post ourselves, get our face tagged, and we have become okay with our face as an ID. 

Melanie Avalon: I haven't set that up. Every time it asks, I'm like, "No." 

Terry Wahls: But as a society.

Melanie Avalon: But as a society. Yeah. No, completely. 

Terry Wahls: As a society, we have all been willing to get our faces tagged. 

Melanie Avalon: It's so true. You're tapping into just a visceral experience I've had through my own biohacking journey, because I do engage with all these platforms, and it's a ton of data collection. I have wondered about what you're talking about specifically, and then I wonder, in the future, will this data be used? 

Terry Wahls: You can think about the ovulation tracking. Wonderfully helpful in many ways, but I also know that there are women who've turned that off because they are now feeling like, "Oh, my God, I don't want any app tracking my periods." That makes them feel vulnerable now. And so, it was a helpful tool that suddenly got politicized, and some women are very uncomfortable about that. 

Melanie Avalon: It's an interesting time we're living in. I'll be very curious to see where this all leads. So, going back, another question about your study, the big one that we're talking about. So, if, for example, let's say with the results that you find that either the modified paleo elimination diet or the time-restricted olive oil keto diet is substantially more effective. I want to hone in on that time-restricted piece. 

Terry Wahls: Yeah. So, let me explain the ketogenic diet. Most ketogenic diets lean way into eggs, lean way into dairy, fat, a lot of cheese, a lot of whole milk, lots and lots of saturated fat, and may drive cholesterols very, very high as a result. And in fact, at the six-month mark in the keto studies, the cholesterols were quite high. I'm doing the study for two years. We know that I think dairy is for some a very pro-inflammatory food. So, I personally have reworked the ketogenic diet to stress olive oil. You could do a ketogenic diet with MCT oil. You get to have more carbs and you get more ketone bodies, but that can also drive your cholesterol through the roof. We've known for a long time that olive oil lowers the risk of heart disease, lower the risk of cognitive decline. So, instead of using two tablespoons to four tablespoons, actually, it's four tablespoons to six tablespoons of butter every day, we use four tablespoons to six tablespoons of olive oil every day, and we restrict the carbs to about 50 grams and about 100 grams of protein. 

That's what I do clinically in my practice. Their lipids don't go haywire. Some folks have to reduce their carbs lower than 50 in order to get into ketosis. Remember, I'm an internal medicine doc. That's a much more heart friendly way to do ketosis than the dairy way, because it's harder to get into ketosis with olive oil. We do time-restricted eating. So, there's a six hour to eight-hour eating window. You can do that by either having breakfast and moving your evening meal earlier into the afternoon, or what most of our participants have done is they skip breakfast and have lunch and an early supper. Then we just have them check their ketones before lunch and the vast majority get into ketosis. 

Melanie Avalon: I'm so surprised, because like I said, I'm also the host of The Intermittent Fasting Podcast. I don't think in the six years we've been doing that show, we've had a discussion about people having more issues getting into keto with olive oil versus the saturated fats. Why do you think that is? 

Terry Wahls: Well, because they don't think about it. They just like, "Okay, I don't worry about a cluster of 300 or 400. It's going to be okay. I love my butter. I love my cream." If you look at the ketogenic diets, they're all about eggs, they're about dairy fats. Probably, the only one that I'm aware of that says, you can do a ketogenic diet, lean into olive oil instead. 

Melanie Avalon: But you were saying that you find it's harder for people with olive oil to get into ketosis?

Terry Wahls: So, if you do MCT oil, then you can have a 70% fat. If you're doing ghee or olive oil or any other fat, now you don't have all the MCT oil, it's going to be harder to get into ketosis. So, the MCT makes it easier. You can probably get 80 grams of carbs and still have ketones. If you're doing butter, ghee, cream, or olive oil, it's going to be less than 50 grams, maybe you have to go less than 40 grams, you might even have to go less than 30 grams. That is really hard for people. It's much harder. And so, we made it easier to say, you know what, we'll combine it. We'll add in time-restricted feeding and we will add the olive oil. 

Melanie Avalon: So, the goal with the time-restricted feeding is to encourage the ketosis aspect. What about the potential other benefits from that time restriction that might not be due to ketosis? Would that be a situation where you might do a follow-up study? Are you interested in the other benefits of time-restricted feeding? 

Terry Wahls: Well, I think time-restricted eating, intermittent fasting are really great. These are all hormetic challenges. If some people wanted to do in our arm decide, you know what, it's just simpler for me to have one meal a day. That's fine. We don't prohibit that. And clinical trials with people were messy. We get to eat what we want. We get to have fights with our spouses. We get to have work crises or not, or have everything going well or not. It's always a little bit messier than doing a study with mice. 

Melanie Avalon: How do you help with that, with compliance? Is it going to be people just reporting compliance? 

Terry Wahls: So, the ideal approach to really understand the impact of nutrition is that you do a metabolic ward study. You put people in the inpatient, you control all of their food, and then you know precisely what happened. Those are very expensive and usually very short, maybe a week. If you're doing a study that's two years, then people are going to be free living and these are the limitations of the study. It also means that it's going to be more generalizable in terms of what people can really do. But then you still have to acknowledge the limitations of the study. And of course, one of the limitations is that we screen thousands of people to get the 96 that are already in my study. So, you're screening thousands of people to find out that they have MS or don't have MS, they're willing to do a study or not. They're willing to come to Iowa and be part of our study or not. So, our people are much more motivated than the person who's going to go in to see the neurologist in clinical practice. 

But that is the nature of clinical trials is, you work hard to get a study going, recruit people who are motivated, willing to do the work, willing to make these changes, and you're trying to change clinical practice, so that the neurologists when they're seeing people and they're saying, "Okay, you've got MS I want you on a DMT. We'll get that sorted out. I'm going to send you to a dietitian because we need to improve your diet. I'll send you to physical therapist, because exercise is really a friend. We got to figure out how to get that into your daily life. I'm going to send you to my licensed social worker who's going to teach you, work with you to find a meditation practice, and make sure your sleep is right," so that they have a whole plan of people who are going to help them get their modifiable lifestyle factors improved according to what they and their family can do, because the neurologist isn't going to know how to do any of that stuff. But I just want the neurologist to say, "This is really important and I'm going to send you to other professionals who will help you succeed at making this work for you." 

Melanie Avalon: Awesome. We talked about this in the last episode. So, this is for people with the specific type of MS where they're going into remission.

Terry Wahls: Yeah, relapse and remitting. 

Melanie Avalon: Yes. So, some people have MS and don't have symptoms, is that correct? 

Terry Wahls: Well, so, here's the evolution of MS. You start out with what are called prodrome symptoms. There's a collection of symptoms that we know that those people who have these symptoms are at much higher risk of developing MS or some autoimmune condition in the future, including RA, systemic lupus, inflammatory bowel disease. You might have those prodrome symptoms for 5 years to 10 years. Then if you got an MRI for an unrelated issue, perhaps you had a car accident, hit your head, and you get a scan of your brain, and they say, "Oh, you've got some demyelinating lesions, but you don't have any symptoms and you don't have any neurologic symptoms." So, they just say, they call that radiologically isolated syndrome. So, now I've got one spot on my head on the MRI, no neuro symptoms, and maybe in the next five years, I have my first episode of neurologic symptoms that match somewhere, and then that's called clinically isolated syndrome. And then the next 5 years to 10 years, then I may have a second episode of radiologic-- of neurologic symptoms that affect a different part of my brain, because you have to have two episodes separated by time and space. So, symptoms in two different locations, lesions at two different locations at different times. Now I have a diagnosis of MS, and that time span can be 5 years to 20 years. 

Melanie Avalon: Oh, wow. Long time. So, with the findings it relates to all of this with the different autoimmune conditions that can manifest. When you have the findings from your study, do you think they can "automatically apply" to other autoimmune conditions that people have, or does it really--? 

Terry Wahls: Well, my clinical conventional folks would say, it has to be disease specific. My functional medicine folks will say, of course, they overlap. Having said that, I also see more of my conventional folks, rheumatology, OB-GYN, psychiatry calling me and talking with me saying, "You know, I'm using your approach in my clinic and patients are doing better, we're getting more pregnancies, my rheumatologic patients are doing much better, the GI patients are doing better." So, 15 years ago, I was really considered pretty woo-woo, crazy, very eccentric here at the university. And now, many more people who were so mad at me for using the same thing for everything are now saying like, "Oh, my God, you are so brilliant."

Melanie Avalon: That's amazing. Like I said, I had listener questions. So, for example, when I was asking for questions for you, I got so many questions asking about specific advice for all of these different conditions. I'm not asking for any answer, but just in general, Teresa said, "Do you have a protocol for Parkinson's?" And then Lori said, "What are your suggestions for postmenopausal women with Crohn's disease and dietary changes?" And then, Aretta said, "What can I do for microscopic colitis that's not a result of NSAIDs?" So, when people do have different diseases, do you suggest people making tweaks? 

Terry Wahls: I think it comes down to a reminder for everyone that we are alive because of self-correcting biochemistry. My big aha was, "Okay, so we don't know what the real cause of MS is." I'm going to do everything that I possibly can that supports better health. When I started doing that, it was about slowing my decline because I wanted to walk as long as I could, I wanted to use my hands as long as I could, I wanted to be able to wipe my own butt as long as I could. What I discovered is, if we do that because life is self-correcting chemistry, our chemistry slowly self corrects. So, for the person with Parkinson's, with cognitive decline, with early Alzheimer's, with ALS, with Huntington's disease, my advice to you to all of them very different diseases is, look at your diet and lifestyle, work with whatever professionals you can find to help you exercise more effectively, manage your stress more effectively, sleep more effectively, have the highest quality diet that will work for you and your family. 

Yes, people know I love the paleo diet. I think it's the closest match to what our genes expect. Now, you may do well with getting a food sensitivity test, so we could really personalize it and have a temporary restriction for about six months and then we can gradually liberalize it again. And yes, I could test your blood to know that you're low on certain vitamins that I have to restore, get back into optimal range for a time, and that there may be microbiome things that I'm going to do, and address with a variety of diet changes. But we don't have to make a protocol for each individual condition. Instead, think of this as I'm looking at a variety of functional assessments of your nutrition, your microbiome, how your mitochondria are working, and then I'm going to help you get nudge things in a more correct biochemical pathways, and practically check on your functional labs. But the vast majority of work are pretty close to the same. It's getting your diet as optimized as you and your family can manage, getting your self-care routines optimized step by step. 

I need to do this at a pace that will work for you. I had to retire from the VA, because I want to spend more time in my research. What I discovered is, when I retired from the VA, I shifted my self-care routine. And so, now, pretty consistently, I have a two-hour routine that I can do every morning. But I was able to do that only because I retired from the VA and I rearranged my schedule with the university, so I could let that happen. 

Melanie Avalon: I'm glad you mentioned the testing bit. So, I got a really good question from Amanda, and she wants to know about, "What tests are the best to determine the root cause of autoimmune disease?" So, for her specifically, she said that she has rheumatoid arthritis. She said she's managed it with diet since being diagnosed in 2017, but she's recently started having bizarre symptoms like, stomach spasms, Morton's neuromas in her feet, swelling in the glands in her neck. And she says, "The doctors say the only thing related to RA are some cysts that she has in her hand." But she thinks it's all related. So, she was wondering, is it possible they're all related, and also, what should she do for testing? 

Terry Wahls: So, let's say she came to see me. I take people through a detailed look at the health events in their life, when the symptoms happened, when they showed up, what time. And then life events, what happened at what time, the good things, the bad things, the moves, where you lived, your exposures. That is incredibly revealing in terms of what were the triggers for your illness, what were the triggers for your flare. That's the number one diagnostic test that I do is this very careful look at your life events, your health events, and look at the triggers. Then, based on that, I will recommend some further investigations, and that's to guide how I might tweak the supplements, the conversations we're going to have about your diet and your lifestyle. 

I'll tell you it's striking in my clinical trials and also in my patients. The number of individuals when I have these conversations about early life stress and adverse childhood experiences, we have much, much higher rates of adverse childhood experiences. And so, getting people to acknowledge that and go back to that trauma with a trauma therapist has sometimes led to a really profound impact on their disease course and their quality of life. 

Melanie Avalon: So looking at everything, I wish we could make your mindset the approach of a lot of conventional doctors out there. Okay, one really quick rabbit hole tangent question, just rapid fire. I got so many questions. People wanted to know your thoughts on LDN. 

Terry Wahls: So, that is a fairly safe compound to take. There are many small pilot studies showing that it's helpful in autoimmune conditions, reducing pain, improving quality of life. If your prescriber is open to prescribing it, it's certainly a very safe compound to add to your regimen. And if it benefits you, terrific. If it doesn't benefit you after three-- certainly after six months, I think it's safe to discontinue and realize that you're one of the non-responders. I tried it. It had no impact for me. But it can be a safe, helpful compound. It's not going to be miraculous, but it may be helpful. And it's worth a try. 

Melanie Avalon: My really quick LDN story, because I've been taking it for years and years. Originally, it was prescribed for GI issues. I do benefit from it with my sleep and my mood and everything. This was just such a moment for me realizing how the complete opposite of what you're talking about, where you see the whole patient and really see them and look at everything they're doing. I had to be hospitalized for anemia. And so, I was talking with the doctors and LDN was on my chart. Later, I saw the paperwork written about me because I asked for it, and it said in the paperwork that-- basically it said that I, as the patient, had said, I wasn't drinking a lot, but that I was on naltrexone. I felt so judged and just not seen and not understood. It was empowering for me because I was like, "Okay, you really just have to have agency to know what you're taking and what you're doing and understand that doctors might not understand everything," because basically they thought I was lying about being an alcoholic or something. 

Terry Wahls: Yeah. It is a compound that's very helpful for people with substance abuse to manage their substance abuse issues. 

Melanie Avalon: Yeah. Naltrexone in it's full form. I just remember that story. Well, this has been amazing. So, I'm so excited about your trial. I just want to emphasize again, because when I was reading over it and promoting it to listeners, personally, I felt like the barrier for a lot of people was going to be an unwillingness to be randomized to the control diet. But now, talking with you, I'm so glad we had this conversation because it sounds like it's a win-win. 

Terry Wahls: Oh, yeah. If you're on a good diet, you get to stay on it. You just have to be [unintelligible [01:10:52]. If you're on a mediocre diet, you get to be on a better diet, and we'll give you tips to make your mediocre diet even better if you're in the control arm. 

Melanie Avalon: Awesome. Yeah, because when I was looking at the requirements and it said, must be willing to do the control diet. I'm going to make a note, but you can stay on your own diet and the control diet. So, how can people sign up? What is the process? 

Terry Wahls: Yup. Let's walk through that. We have a great little website, terrywahls.com/msstudy and that will take you to a page. There's a cute little video with me telling you about this study, and a link to take the survey. In the survey, you're going to put in your name, and demographic information, and how we contact you. We then contact and you'll be on our patient registry for future studies, because we keep writing new protocols, new grants, and some of those studies will just be survey only. So, they'd be great to have. And then we'll contact you and get your consent, so we can get your neurologist to verify that you've had been diagnosed with relapsing-remitting MS, and that you are safe to follow either the keto diet, paleo diet, or usual diet, because it usually works better if we contact your neurologist on your behalf, get the neurology verification form. And then my team will contact you, go over the consent, go over all the study procedures, explain what happens, and confirm once again that you're good with coming to Iowa, you're good with being randomized to one of the three diets. And then hopefully you say, "Of course, yes, I want to do this." And then you get scheduled for a visit to Iowa. 

Sometimes, we have the good fortune that I pop in and I could say, "Hi, how are you? We'd like to have a selfie together. We give a hug. You get to take a picture." It's super fun. You'll see my team at month zero, month 3, month 24, and you'll know that you are on a sacred mission together, because I can't change the standard of care without research. I can't do research without people like all of you who are listening to this podcast, who are willing to say, "You know what, I'll come." And as long as you're willing to be in one of the three diets, it's okay. If you have a good diet and you're in the control arm, that's A, okay, because what I think will be the most interesting is, can I get people to healthy rates of aging? If I've inspired everyone to fix their diet, because you'll do some diet questionnaires along the way, so we'll know if you have a great diet or not. And so, if what I show is that I managed to get all three arms to really have a great diet, even the control arm, and that in fact, they all got to healthy rates of aging, that is the result that I'm hoping for. 

Melanie Avalon: Awesome. Well, this is amazing. If you're open to it, I'd actually love to have you on The Intermittent Fasting Podcast as well and share all of this with them, reach an even broader audience. Well, thank you so much. This was absolutely incredible. I'm so grateful for everything that you're doing. The last question I ask every single guest on this show. I asked you this last time. I don't remember what you said, it's just because I realize more and more each day how important mindset is. Oh, I do remember what you said. What is something that you're grateful for? 

Terry Wahls: I'm grateful that I have my disease. I'm grateful that I have trigeminal neuralgia, which is, when it's turned on, it's the most horrific pain I ever experienced. Worse than childbirth, worse than surgical pain, worse than broken bones, and I've broken several. Because one, it taught me a lot, taught me everything. I have basically a continuous monitor of the inflammation in my brain. If my face sensation is a little bit off and my pain starts, I know that my brain is inflamed, the microglia are reactive, and bad things are happening. If I have no pain and my sensation is completely normal, I know my brain's in great shape. So, I am so grateful for my trigeminal neuralgia, for having MS, because it's given me the gift of purpose, of meaning, and of the opportunity to change the world. 

Melanie Avalon: Wonderful, and you really are doing that. I am just, again, so, so grateful for your time. Everything that you're doing, it's just really beautiful and empowering, and it really is changing the world. So, thank you so much. I'm excited. We'll get you on IF Podcast. I really look forward to everything you find with your study. So, thank you. 

Terry Wahls: And thank you for all the wonderful work you are doing as well. 

Melanie Avalon: Thank you, Terry. Have a good rest of your day. 

Terry Wahls: Thanks. Bye-bye now. 

Melanie Avalon: Bye.

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