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The Melanie Avalon Biohacking Podcast Episode #97 - Dr. Terry Wahls

Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and a clinical professor of medicine at the University of Iowa where she conducts clinical trials. In addition, she has secondary appointments in the departments of neurology and epidemiology. In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care and patient advocacy. She is also a patient with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles (paperback), and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. 


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2:00 - IF Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group For A Weekly Episode GIVEAWAY, And To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

2:15 - Follow Melanie On Instagram To See The Latest Moments, Products, And #AllTheThings! @MelanieAvalon

3:15 - BEAUTYCOUNTER: Non-Toxic Beauty Products Tested For Heavy Metals, Which Support Skin Health And Look Amazing! Shop At Beautycounter.Com/MelanieAvalon For Something Magical! For Exclusive Offers And Discounts, And More On The Science Of Skincare, Get On Melanie's Private Beautycounter Email List At MelanieAvalon.Com/CleanBeauty! Find Your Perfect Beautycounter Products With Melanie's Quiz: Melanieavalon.Com/Beautycounterquiz
Join Melanie's Facebook Group Clean Beauty And Safe Skincare With Melanie Avalon To Discuss And Learn About All The Things Clean Beauty, Beautycounter And Safe Skincare!

2:35 - FOOD SENSE GUIDE: Get Melanie's App To Tackle Your Food Sensitivities! Food Sense Includes A Searchable Catalogue of 300+ Foods, Revealing Their Gluten, FODMAP, Lectin, histamine, Amine, glutamate, oxalate, salicylate, sulfite, and thiol Status. Food Sense Also Includes Compound Overviews, reactions To Look For, lists of foods high and low in them, the ability to create your own personal lists, And More!

7:30 - Dr. Wahls' Story

11:30 - Multiple Sclerosis

14:15 - Myelin and Mitochondria

15:05 - Myelin Dysfunction

15:50 - Mitochondrial Strain In Autoimmune Diseases

17:35 - Supplement Support

18:10 - DRY FARM WINES: Low Sugar, Low Alcohol, Toxin-Free, Mold- Free, Pesticide-Free , Hang-Over Free Natural Wine! Use The Link dryfarmwines.com/melanieavalon To Get A Bottle For A Penny!

20:30 - Electrical Stimulation for Muscle Growth

23:40 - Muscle Atrophy in MS

The Melanie Avalon biohacking Podcast Episode #74 - Benjamin Bikman, Ph.D.

24:05 - the shift of metabolism 

24:50  - diseases of insulin in MS patients

27:20 - insulin sensitivity in astronauts

29:20 - Neuromuscular electrical  Stimulation Devices

30:05 - e-stim in athletes

The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles

31:45 - e-stim in bed ridden patients

32:50 - recovery with the paleo diet and lifestyle

39:10 - SUNLIGHTEN: Get Up To $200 Off AND $99 Shipping (Regularly $598) With The Code MelanieAvalon At MelanieAvalon.Com/Sunlighten. Forward Your Proof Of Purchase To Podcast@MelanieAvalon.com, To Receive A Signed Copy Of What When Wine!
The Melanie Avalon Biohacking Podcast Episode #38 - Connie Zack
The Science Of Sauna: Heat Shock Proteins, Heart Health, Chronic Pain, Detox, Weight Loss, Immunity, Traditional Vs. Infrared, And More!

40:25 - Clinical Trials On The Diet Protocol

47:05 - healing the myelin

49:40 - remineralizing teeth

52:00 - the timeline of accepting new concepts in science

55:15 - proving the wahls protocol

56:50 - the early adopters 

57:45 - the importance of being strict for the first 100 days

59:10 - Accidently triggering new autoimmune disease

1:02:40 - working as a family

1:03:00 - Terry's current Protocol

1:05:05 - longevity Genes


Melanie Avalon: Hi friends, welcome back to the show. I am so, so incredibly excited about the conversation that I am about to have. It is with honestly a legend in the whole health diet world. That is the absolutely amazing Terry Wahls. I've been a follower of Dr. Wahls’ work for quite a long time ever since I saw her TED Talk, which came out quite a while ago. Since then, she's been the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. She also has an incredible bio. She is an Institute for Functional Medicine Certified Practitioner. She's a Clinical Professor of Medicine at the University of Iowa where she conducts clinical trials that I'm really hoping that we can talk about some of those today. She was even awarded in 2018, the Institute for Functional Medicine’s Linus Pauling Award for contributions to research, clinical care, patient advocacy. Really, she's just one of the most respected figures in this movement. Dr. Wahls, thank you so much for being here.
Terry Wahls: Thank you for having me.
Melanie Avalon: To start things off, I am pretty sure that most of my listeners are probably very familiar with your work, but for those who are not and even for those who are, could you tell us a little bit about your personal story? You have the most beautiful, incredible, encouraging story and I'm so excited I get to hear from you in this moment. Yes, could you tell listeners?
Terry Wahls: I'm going to take you back 20 years. I'm out walking with my wife, Jackie, a half mile from home. My left leg becomes weak, dragging it, I hobble home. At night laying in bed next to Jackie, I think about my zingers, the jolts of electrical face pain, they've been growing relentlessly worse for 20 years. Now not wanting to become a burden. I am secretly praying for a fatal diagnosis. I go to see my neurologist, and he says, “Terry, this could be bad, or really, really bad.” As I said, I'm thinking about those zingers, so I'm praying for that fatal diagnosis. It takes three years. I take the mitoxantrone infusions, [unintelligible [00:02:19] wheelchair, I take Tysabri, I take CellCept, but nothing helps. I am too weak to sit up at my desk. I order a zero-gravity chair so I can recline back with my knees higher than my nose, and I let go of my future. Instead, I learned to take each day as it unfolds. When my zingers turn on, those jolts of logical face pain, my 10-year-old daughter hugs me, [groans] triggering more pain. But I'm a physician, night after night, I go to PubMed to read the basic science. And I begin experiments on myself. The speed of my decline slows, I discover a study using electrical stimulation of muscles. I ask my physical therapist, “Can I try that?” It's called e-stim. My test session hurts bad, but when it's over, I feel great. I begin doing e-stim to as much pain as I can tolerate.
Now, I know I cannot recover. But is there more that I could do to slow my decline? I began meditating. I redesigned my paleo diet based on all the science that I've been studying. Just one month later, I can sit up at my desk. Three months later, those horrible zingers of 27 years are gone. And five months later, I walk without even a cane. Then, for the first time in six years, with my son, Zach, jogging alongside on the left, my daughter, Zeb, on the right, I get back on my bike. It wobbles, but I catch my balance, and I am biking. My family is crying, and so am I.
Then 10 years later, I received the Linus Pauling Award for my groundbreaking clinical research and patient care protocol. I am Terry Wahls, and I am now transforming the lives of millions, restoring their hope for a better future.
Melanie Avalon: Wow. That was one of the most beautiful things I have ever heard. Thank you so much. We haven't actually said yet what you were diagnosed with. Were you anticipating multiple sclerosis as the diagnosis?
Terry Wahls: Interestingly enough, I had not, and maybe it was just denial. The fact that I had 20 years of relentless sensory problem, I didn't know when my neurologist said, “It's going to be bad or really, really bad,” I'm thinking ALS or MS. I knew since I had a sensory problem, it probably wasn't ALS, but I didn't want to be disabled, so I was like, “You know what? I'll vote for ALS.” But, of course, that wasn't what happened.
Melanie Avalon: If a person just briefly googles MS, for example, the first thing Google tells you is that some people go their whole lives without symptoms. What actually is MS?
Terry Wahls: There appear to be periods of intermittent worsening. These are called relapses. Clinically, you have more symptoms, whether it's a sensory disturbance or a motor disturbance. If you did an MRI, you'd see an enhancing lesion on MRI. Then, over the next several months, the brain accommodates, it adds sodium channels, and it can send impulses albeit more slowly, and you have a reduction in symptoms, and that's called the remission. For about 80% of those who are first diagnosed, they have this relapsing and remitting phase.
But behind all of that is this progressive accumulation of permanent loss, either permanent destruction disturbance of the sensory function, or permanent disturbance of motor function. We also now know there's a progressive decline in cognition as well. Within 10 years of diagnosis, a third of folks will have really very severe gait disability, severe fatigue disability. Most will be unable to work due to severe fatigue.
Melanie Avalon: Basically, the nerves are deteriorating, the body adds these sodium channels to keep things functioning, but then you just reach a point where--
Terry Wahls: Where you can't cope. Structurally, we know that the myelin, that's the wiring insulation, is breaking down. We know now that the brain volume and the spinal cord volume is decreasing. When I was first diagnosed, nobody was talking about mitochondria, because I was reading the basic science. I thought, “No, no, there's too much parallel between that and Parkinson's and Alzheimer's, ALS, Huntington's disease, and mitochondrial problem all of those diseases,” I was sure mitochondria was a problem in MS as well. My original things that I was doing, was all focused on supplements to support my mitochondria. Originally, it was slowing down the speed of my decline, which had been very, very fast, almost like an ALS fast, but I was still declining. It wasn't until my deeper dive and redesigned my diet, and then attacked every aspect of my self-care routine that I stopped my decline and then had this stunning recovery.
Melanie Avalon: This is a very naive question, but just to get a big picture and there are two M words, the myelin and the mitochondria. Do the nerves in the myelin have mitochondria, where's the mitochondria on the myelin?
Terry Wahls: No, it's sort of interesting. Again, when I was reading all this stuff, originally in 2004-2005, nobody was saying that the myelin had any mitochondria. Now, we're beginning to think that in fact, there may be mitochondrial function in the myelin as well. The picture is not completely understood yet, but the myelin certainly requires a lot of energy. There is more thinking that the myelin does have mitochondria in it as well.
Melanie Avalon: With the mitochondria dysfunction throughout the body, that any way would not be providing enough energy to the myelin?
Terry Wahls: The brain and the retina are really the energy hogs for the organism. The number of mitochondria in a brain cell is huge, and in the number of mitochondria the retinal cells are huge, and in the heart cells. Those are the most mitochondrial death cells. Now, there's some evidence that's emerging suggesting that mitochondria is in the myelin as well. That answer is not fully in yet, but we'll see.
Melanie Avalon: It's so, so fascinating. Yeah, I was reading how when you got the diagnosis, you were reading studies about fish oil, CoQ10, and creatine in rats, or was it mice?
Terry Wahls: It was in mice. Actually, those were Parkinson's studies. Remember [unintelligible [00:10:08] Parkinson's, Alzheimer's, Huntington's, ALS, these are all mouse models. As I'm reading those studies, the common theme is mitochondrial dysfunction sending early signals for a photolysis to the nucleus. I get this idea that it's mitochondrial strain. I want to improve the efficiency of the mitochondria. Then, I'm trying to read basic science for mitochondrial studies. The NIH funds studies one molecular pathway at a time, one molecule at a time. So, I'm gradually adding supplements one molecule at a time to this cocktail. I think it was about six months into it, I get disgusted, because I'm not getting any better. I'm still feeling exhausted, and I quit. I quit all my supplements. [unintelligible [00:11:09].
I go to work the next day, like usual, I'm pretty exhausted by 10, I'm in my zero-gravity chair, I come back home. The next morning, I just cannot go to work. 36 hours, I am just really nonfunctional. The next day, I'm even more nonfunctional. Then the day after that, my wife says, “Honey, you didn’t take your supplements. Why didn’t you take them?” I take them that evening. The next morning, I can sit up and I go to work. I think, “Wow, that's really interesting.” I wait two weeks, and I stopped my supplements again, and 36 hours later, I just cannot function. I wait, again, on the third day, in the evening, I take my supplements again. The next morning, I can get up, I can go back to work. I think, “Wow, I am so excited. I am so excited.” I am really excited about reading the basic science, reading more, thinking more about what can I find for mitochondrial function. I'm really trying to look for what are the various supplements that would be helpful for mitochondria. Gradually, I get a more complicated supplement cocktail. That's what happens for the next three years where I'm gradually getting a more nuanced supplement cocktail.
Yeah, I've been doing the paleo diet for seven years by then, and the supplement cocktail for about three and a half years by then. Then, I discovered that study of using electrical stimulation of muscles. I convinced my physical therapist, “Let me have a test session.” That was quite a conversation. He treated athletes, so he was quite familiar with that. He used it on a bunch of US athletes, and he says, “Terry, I can grow bigger muscles for you. There's no question about that, but we don't know that your brain can talk to these muscles. So, I could be making your legs heavier, and you might not be able to use the muscle I grow, and so I could be making things even worse than they are. Plus, it's painful, and you have all of this pain from your MS. I don't know that you can tolerate it.”
We had a vigorous debate. Fortunately for me, he said, “Okay, we'll give you a test session,” yet hurt bad. But when it was over, I felt the best I had felt in years. They said it's probably the endorphins because I had just gotten a big set of endorphins because my muscles had worked, and it had a lot of pain. Pain releases endorphins. I went to clinic three times a week for my e-stim sessions. After two weeks, said, “Okay, it looks like you can do this.” He was able to demonstrate that I could put on the electrodes and he ordered a home-going device. I was able to demonstrate I could do that. He told me that, “Okay.”
He gave me a little program and I started working on my back muscles, which were so weak, which is why I could not sit up. I worked on my tibialis anterior muscle, which is the muscle that flexes your ankles upward. The goal was to get at least 15 minutes a day because that's what you do to prevent muscle atrophy. If I could get 45 minutes a day to the muscles that were weak, then I could be growing bigger muscles. So, 45 minutes a day, that would be three hours a day if I was going to do the back muscles, the abdominal muscles and the leg muscles he wanted me to do. I was like, “Well, that's a lot of time to try and figure out in my day, because I'm still working full time.” So, I had to figure out how to do my e-stim while I was working, but I did. I’d put my electrodes on, I'd dial up the current, and so you'd have 10 seconds of current, which inducing a strong muscle contraction, and I’d dial up to as much current as I could tolerate. I'm in a sweat from pain, and then I have 20 seconds of no current, no pain, and then I could do my work. If I'm seeing patients, my current at that intensely that I'm sweaty from pain, on my clinic days, it was just somewhat uncomfortable. On my non-clinic days, I was doing pain, absolutely as much pain as I could tolerate.
Melanie Avalon: The reason the muscles originally atrophy, is it because the nerves are not sending the signal to use the muscles, and so then they atrophy?
Terry Wahls: Correct. The atrophy, the mitochondria are being stimulated, the mitochondria shrink, they decrease in number, they decrease in size. The muscle cells actually look very ill, because the muscle cells have decreased, you get a shift in the cytokine profile, you get a shift in lipid metabolism, you get a shift in blood sugar metabolism, which really ramps drives you towards insulin resistance, metabolic syndrome, prediabetes, overt diabetes on the basis of this severe inactivity.
Melanie Avalon: Yeah, I was just thinking because I recently interviewed Dr. Benjamin Bikman about insulin resistance. We were talking about how the muscle is likely the largest thing for glucose, and it's usually the first thing that becomes insulin resistant. If you're losing your muscle, that must just be a train straight to metabolic issues.
Terry Wahls: Yes. If we look at the literature for MS patients, they have higher rates of central obesity, higher rates of insulin resistance, higher rates of polycystic ovarian disease, power rates of prediabetes, type 2 diabetes, and of course, cognitive decline. All of that is fundamentally linked, if I march it all the way back to that inactivity, decreased utilization of those muscle cells, decreased mitochondrial health, in the muscle cell, using the muscles. Then, we know there's some very interesting work done, and people were paralyzed. Actually, if I go back to that first study that inspired me to do all this, I read that study, because I was on the institutional review board for the university. So, we review all the clinical research for safety. I'd said, “Give me the cases to review related to the brain and the nervous system.”
I was reviewing a study that used electrical stimulation of muscles in people who had been paralyzed from a traumatic brain injury. The investigator wanted to extend the study for another five years, because the patients found it so valuable, they didn't want to stop doing the e-stim. These folks would come in, they'd get hooked up to the machines that would drive them to do squats and presses for their quads and the hamstrings, driven by electricity. They're paralyzed, they'll never walk, they're not going to walk. That's just not going to happen. But because they were now doing the e-stim, they were maintaining their muscle mass in their quads and their glutes. Their calves were getting pretty weak, because they weren't being stimulated. The quads and the glutes were strong. They maintained their bone density. They maintained their muscles in their quads, they maintained their insulin sensitivity. They maintained normal lipid profiles, they maintained a better mood. The folks who didn't get stimulated, had all these metabolic dysfunctions, add more depression and anxiety and lower quality of life. Isn't that interesting?
Melanie Avalon: Yeah, it's incredible. Do you know if they've done research on astronauts and insulin sensitivity?
Terry Wahls: That I don't know. I do know that we had pitched to NASA doing e-stim for the astronauts while they're on these extended space travel.
Melanie Avalon: That was my second question, could they do it in space? [laughs]
Terry Wahls: Yes, yes, yes. I think that would be a very useful strategy. When I first started doing this e-stim-- and my kids are thrilled to see me doing all of this stuff. If you want to think some of the sci-fi movies that were out at that time, if you remember the Matrix, and one of the scenes in the Matrix, Neo, he comes out, he's weak, he really can't do anything, and they hook him up to these needles that they put into his muscles to regrow his muscles. I'd be doing my e-stim, Zach, my son and his buddies would be over. My son would be explaining to his friends. “You know, it's just like Neo, she's hooking up to regrow all those muscles.” That was entirely accurate. Entirely accurate. Part of part of why I recovered so quickly, so remarkably, was that my physical therapist treated me like his athletes, yet, I was willing to train at a level that we can't do in any of my clinical trials, and I can't ask my patients to do because athletes will do things that you can't ask patients to do and you wouldn’t have FDA approval to do the kind of training program that I did.
Melanie Avalon: Did NASA respond favorably to your proposal?
Terry Wahls: I'm not at liberty to say.
Melanie Avalon: Oh, man, [laughs] dying to know. Okay, we'll have to see. One other question about the muscle stim, is this at all related to-- I know cosmetically people can do-- it's not for health reasons, but they have things now called like cool toning, or EMSculpt, where it's to grow muscle cosmetically.
Terry Wahls: I don't know those devices, so I can't comment on them. I know there are quite a number of electrical-- neuromuscular electrical stimulation devices that are out there. The over-the-counter devices have a lower amount of current that they can deliver than a prescription device. It's about a third the amount of current that can be delivered, to be sure that it's safe. A number of the athletes first started using these types of devices in Russia and in East Germany. This was a way as my physical therapist said to grow more muscles because you're putting intermittent, moderate severe stress on the muscle with the e-current without the use of testosterone or growth hormone, which are banned. So, many athletes will do electrical stimulation as part of their strength training program. Those sports that require strength, particularly high-velocity strength, explosive strength, the use of electrostimulation is quite common. Or if the athlete has had an injury and has to immobilize a joint, so you're immobilizing the joint, but you don't want to have the muscle mass decrease. You'll have the joint immobilized, but you may continue to do e-stim to the muscles across that joint, so you don't lose muscle mass.
Melanie Avalon: Wow. I wonder if way in the future, for hospital patients on bed rest, if it'll just be common practice to have something like this.
Terry Wahls: Yeah, I just updated my book, The Wahls Protocol. We re-published it last spring. I reviewed the literature for e-stim and what's being done because a lot has happened in the last seven years. We now have a number of very interesting clinical trials where you have ICU patients, so intensive care, in bed, going to be in bed for a while. They're coming in and hooking them up to electrodes, in their quads, in their hamstrings, plus/minus the glutes, but quads and hamstrings are pretty easy to get to. So, they give them exercise every day. Some folks are also doing the calves both for the exercise, but also as DVT prophylaxis. Clinical trials have been very positive. That's not become the standard of care, but I could certainly see that being an alternative to the balloon [unintelligible [00:24:47] on legs for a deep venous prophylaxis, and as an alternative to anticoagulation prophylaxis. Plus, it's physiologically much, much better for us because you're decreasing the inflammatory cytokine profile by having the muscles actually work.
Melanie Avalon: Yeah, this is so incredible. I will keep my fingers crossed for the future of all of this. Switching gears a little bit, but still on the same sphere. You spoke about the things that made a big difference in your recovery, the supplements, the e-stim. The redesigning of your paleo diet, what did that look like?
Terry Wahls: I mean, I like the paleo diet a whole lot. I want to remind your listeners that in my story, so I'm diagnosed in 2000, it's clear that I'm relentlessly going downhill. In 2002, my neurologist mentions the work of Loren Cordain, I read his books. It's a big deal. I read his books, his papers, and I decided to go back to eating meat because I had been a vegetarian for about 20 years for ethical reasons. I continued to decline for the next five years, but I stayed with it because at least I felt like okay, I'm doing something, I'm adding supplements. I'm still declining albeit more slowly. What is really interesting, I add the e-stim, I've discovered functional medicine, I get a longer list of supplements, which I add, and I'm doing e-stim, accelerating my dose of e-stim, for the next two months, not a lot has happened, maybe just not quite as weak in terms of my torso. And then, I get this aha, like, “What if I redesigned my paleo diet based on all the science?” that I've been reading everything I'm taking the supplement form. By now, I take 19 different things.
I consult with my registered dietitian friends, and they're like, “Well, we'd need an intern to figure this out.” They couldn't really tell me what the food sources were. I go back to the library. They can't really help me too much in terms of references. I do some more searching. I find the Linus Pauling Micronutrient Center. Using them, I redesigned my paleo diet in a really very specific way, emphasizing at first a list of foodstuffs that I would add to my diet. I do that, and it's startling. In a month's time, my fatigue is gone, my pain, the trigeminal neuralgia, which had been getting worse for 27 years, I'm pain free. Like, “Oh, my God, I'm pain free.” That is just stunning. My physical therapist is saying, “Terry, you're definitely stronger,” and he starts having me lift weights.
Then when this changes how I think about clinical practice, and I start trying to teach my patients to do what I'm doing, I can't give them these long lists of food. It's just not a practical way to change people's behaviors. You have to give them a structure, where that's a simple way of teaching the concepts. Now, I'm spending more time thinking about how can I organize some fairly simple rules that will get the big picture of what I'm doing? Maybe not the fine details, but the big picture that would really help people along. That's where I end up creating The Wahls Protocol. I have level one, level two, level three. Now, really, it's four levels to the diet. That's increasingly complex, as people move along in the journey in terms of how far they're willing to go with making this kind of big dietary change.
I also in the journey decided that I would create systems that could work for people who are vegetarian for their spiritual beliefs and for people who would really benefit from a ketogenic, even from being in ketosis because of their underlying neurologic conditions. It's nuanced, but I have an entry point for people that is really very, very basic. For many of my patients at the VA, even my very basic entry-level point if we’re thinking about this led to stunning health changes.
The other thing that I that I observed was because I had this stunning health change, I was actually remarkably effective, talking to my vets saying, “You've been suffering with--" I could insert-- It's most often is very helpful with pain. Suffering with severe pain due to their particular medical condition for years. I'd ask them, “Would you be interested in doing a little experiment to see what diet and lifestyle could do, because what you're doing isn't working? I invite you, if you're ready, I'll give you some simple diet instruction to try, and let's come back and see where things are at with your next visit.” I could do this pretty effectively, my residents would be stunned. I could have this conversation five minutes and get these guys fired up to do these radical things known as, get rid of sugar, I'd asked them to go gluten-free, and ramp up the vegetables, particularly non-starchy ones, and then have protein every day. Then, of course, sort out if they're a meat-eater or a not meat-eater, so I would recognize that and we would accommodate accordingly. Also, in the meat-eaters, I encourage them to have liver once a week.
If I said, “Look, we’ll just do this as an experiment. Take the gluten out, at least go gluten free, preferably for a month and see what you think.” Ideally, that they'd go gluten-free today, they would see me next in clinic. What stunned the residents was easily-- when I first started doing this, I could convince half of these vets to make these really big changes in their diet, with that five-minute conversation. By the time I retired from the VA, I was probably having 90% of my vets go on that journey with me, which is stunning.
Melanie Avalon: When did you first conduct your clinical trials on the diet?
Terry Wahls: This is another fun story. I'm remarkably better. I'm walking around the hospital at the VA. It's time for my every-two-year review with my chair of medicine at the university. He hasn't seen me in about a year. It's a quarter mile down the hill up the hill at the university, I think that's probably too far for me. By this time, I'd swapped out my wheelchair for a little scooter, but I hadn't used it the long time. I take the scooter over to the university. Going up the hill, it's dying. I get out and I walk next to it and I can get a few more feet and that dies entirely, so I disengage it, push it the rest of the way up the hill. I park it by the entrance and the attendant there, offers to call the patient mobile. Okay, that sounds good. I'd have to wait. Oh, I think he said half an hour, I thought, “Oh my goodness, I was already late to my appointment with the chair.” I couldn't do that. I walked slowly to my appointment. By the time I get there, I'm a half hour late, secretary choose me out, ushers me into the office. I'm very apologetic about being late, I explained that my scooter died. He goes, “Oh, so you had to wait for the patient mobile.” “No, actually, I decided I leave it and I walk up.” He goes, “You walk?” He hasn’t seen me walking probably four years.
I explained what I done, my diet, I showed him my e-stim device. He was intrigued. He was a rheumatologist. He certainly understood that serious autoimmune diseases, even MS don't reverse when you were as advanced as my case was. He told me first to get a case report written up. Once we had that written up, he then gave me the job of getting a clinical trial going. I explained that wasn't the area that I researched because I researched diagnostic error. He said, “Terry, we’ll get you the mentors. This is too important, you need to do this.” I saluted, like, “Okay.”
In 2010, we enrolled our first patient. It’s what we call a safety and feasibility study, where everyone gets the intervention. You are measuring, “Can people do it? Will they actually do everything?” It is a big question, because what I was doing was very complicated. It was diet, it was supplements, it was meditation, it was exercise, it was electrical stimulation of muscles. It was very complicated. The question was, could people do it? And then if they did, did they have any serious adverse events? Then, the third question is, what was the effect size on patient-reported outcomes of fatigue, quality of life, and on measurable motor functions, walking and working memory.
What is remarkable is that people gave up the sugar, gave up the processed foods, really dramatically ramped up their vegetables from one and a half servings a day to nearly eight servings a day. That's quite remarkable. They exercised. People who were profoundly exhausted were actually exercising every day. In fact, they did the e-stim. We're able to show that they were remarkably successful at implementing this very complicated regimen that we asked them to implement.
The side effects-- as a matter of fact, I had such serious side effects. I had to report them to Safety and Monitoring Board every three months. My serious side effect was people who are overweight or obese, lost weight and lost weight rapidly. To get back into a healthy body weight, I had to show that no one became underweight. Fortunately, that was good. Then, we were able to enroll 10 to show that nobody got hurt, no one got hurt, and that the trend for improvement was in the correct direction.
If you have only 10 people, no one expects you to have any statistical significance to any of your findings. Of course, we would not expect that to happen, but we did. The change with reduction in fatigue was really quite remarkable. It's a seven-point scale, seven being more severe fatigue, and one being no fatigue in any aspect of your life. The clinical, meaningful reduction is 0.45. We had a reduction of 2.38. That is the largest reduction fatigue severity that had been reported to date, and the p-value is 0.0008. That was just remarkable.
We were given permission to enroll the next 10. Again, I had to keep reporting in my safety stuff, because people kept losing weight quickly, no one became underweight. We continued to see remarkable reductions in fatigue severity, improvements in quality of life. Quality of life improvements, if you get a 5-point improvement that's clinically meaningful, and we got 16-point improvements in quality of life.
In terms of motor function, that takes longer to see. We had a couple folks got big changes in motor function early at three months, a couple others got them at nine months. I think it makes sense that it takes a while to build the muscles. Because these folks, when you have progressive MS and are in the progressive phase, you've had your disease, probably from 15 to 25 years, the level of atrophy, the level of dysfunction in those muscle cells is really quite severe. It will take a long time to recover. We were not pushing people, like athletes, the way my physical therapist allowed me to push myself, that would not have been approved by our IRB, so we certainly were not going to ask them to go beyond what would have been compatible with FDA guidance at that point. So, of course, they're going to come back much more slowly.
Melanie Avalon: Also related to that, because you spoke about how quickly you improved, and then I was reading in your book about the-- I don't know if it's the half-life or the turnover of different cells in the body and you're saying that the myelin, I think 7 to 10 years to be completely replaced. I was wondering what role that plays in healing?
Terry Wahls: I think it's really helpful for us to think about the fact that our immune cells chaperone the repair and replacement of all of our cellular structures within the cell. Your cell will do that, but the cellular structures as a whole will get digested and replaced when a cell has been identified is damaged by the immune cells. Your cell, if it's only mildly damaged, can repair the constituent damages through something called autophagy. If there's more extensive damage, the cell has to be completely dissolved and then replaced. Then, you end up replacing the entire cell. Again, depending on what cell it is, your lining of your mouth to your anus, that gets replaced about every 10 days. In my book, I go through all the various cell types. Your bone is about 20 years, your nervous tissue is 7 to 10 years.
If we think from my nadir, I would be about 10 years out. Clearly, I'm doing very well, I continue to get stronger and stronger, and in some capacities when I see my neurologist, he says, “Well, in many ways my neurologic function looks better than other women my same chronologic age.” In some capacity, I still have some fixed damage. If I go to my neuro ophthalmologist, there's still evidence of the old optic neuritis that I've had. But he also says like, “It's remarkable that you still see as remarkably well as you do, given the severity of damage that you've had.” We can do a lot of repair, but you may not be able to get it all back. The fact you can get any back-- when I went to medical school, we were clearly taught, if you damage your nervous system, it was not coming back. The fact that we can get anything back now is, was a radical concept. The fact that we can get anything back, I think, offers immense amount of hope for anyone with a progressive neurologic disorder.
Melanie Avalon: It's like what they say, and I still don't know if this is true about your teeth, that once you lose your teeth, you can never get them back. I don't know if that's a completely different structure.
Terry Wahls: Once the tooth is pulled, you'd have to have another tooth bud. There are a few people that have three tooth buds, so they can in fact get another tooth back, the vast majority cannot. Although who knows, that may change. Salamanders, for example, if you cut a limb off, they do have the capability of regrowing that limb. So, there may be a possibility that we will understand that and have that capability in the future. It's not understood well enough yet, but will it someday? Perhaps.
Melanie Avalon: I wasn't even thinking like teeth pulled, I was thinking they lose the mineralization.
Terry Wahls: Oh, yes, that you can repair.
Melanie Avalon: And grow back?
Terry Wahls: Yeah.
Melanie Avalon: That's what they say, once you lose the enamel, it's gone.
Terry Wahls: Actually, there are some dentists who are pretty effective with that. You're going to clean up your diet, obviously, you will also need to increase your vitamin K2 MK-4 intake, that will be immensely helpful. That really directs the remineralization of your teeth and of your bones. You also want to reduce the internal pH. It's a more alkaline diet, a less acidic diet. Certainly, yes, we have seen people improve their mineralization and heal their cavities. I would keep in mind for all your listeners is, scientific concepts-- let me come back, humans, we have an immense confirmation bias. We understand the world, and we will reject information that doesn't comport with our understanding of the world for a long time. That's because we can't deal with the volume of information coming to us, so we have to simplify everything. It's absolutely necessary for us to function. What that means though, is we ignore a lot of important information.
In the scientific world, it means that new concepts, I'll reject, reject, reject, reject until there's finally enough evidence like, “Okay, I guess we have to accept this new concept.” The ways to think about that is, scurvy used to be the major killer of sailors. We had two scientific discoveries, sauerkraut and citrus could prevent scurvy, as two different captains that made that observation. It took the naval industry 200 years to accept that observation. Then, we have hand washing in germ theory, and that was roundly ridiculed. I don't recall how many years it took us to accept hand washing, I think maybe 50. Then more recently, Helicobacter pylori as a driver of gastric ulcers and duodenal ulcers. When Barry Marshall promoted that theory, people rejected him. The first places he tried to get his findings published were basically throwaway journals, very regional. His scientific theories were soundly rejected. He basically paid a journal to publish his findings. He then had a publicist get his papers talked about in The National Enquirer and Reader's Digest.
Melanie Avalon: Oh, wow.
Terry Wahls: Isn't that wild?
Melanie Avalon: Wow. Yeah.
Terry Wahls: And the 25 years later, the guy gets a Nobel Prize in Medicine, because the public drove the interest, and then he got more funding for his science, he got published in more rigorous journals, and now his science-- and he had more money to get higher more PhDs to help them design better studies. Yes, all of that is true. When people come to me and say like-- they're mad at scientists for rejecting me, I'm like, “You're mad at them for being human. You do the same thing, I do the same thing, we all do the same thing.” It's part of how biology survives the fact that our brain has to cope with more information that we can possibly cope with. It's a very normal part of biological life. It's part of why we're in such trouble with now in politics and in our social media, that we have difficulty discerning that huge amount of volume information, that it makes it difficult for us to sort out what's real, what's not real. There's all sorts of challenges that way.
I guess where I was going with all of that is, when I look at the trajectory of the level of rejection that I face in the conventional world and with my colleagues, with my concepts of this very integrative approach towards improving the health of my patients, in my approach to treating MS and autoimmunity, in 2009, I'm called into the chair of medicine, the chief of staff's office, and warned that people are complaining and that I need to stop what I'm doing.
Now fortunately, because I had prepared for this, I brought in all my scientific papers, well, actually just a handful of them and explained what I was doing and why, and won them over. I started doing the science, which people hated at first, but I had a little-- every year at the research week, I would present our data, which was startlingly positive. Then, I had to publish my papers in little throwaway, terrible low impact journals at first. Then, I get into a little higher impact journal. We have just finished our fourth study, very fun, exciting results. We've analyzed it, we are getting our manuscript ready. We'll be submitting that off to much higher impact journals, and we'll get funded. We'll find the right home for it. We have our fifth study going. I'm writing grants for a sixth and our seven study. The fact that I'm presenting now at national, international meetings all over the world, and I'm not this crackpot anymore. Now, here at the university and around the world, I'm being seen more as this brilliant visionary. And that's 11 years, it's really very fast.
Melanie Avalon: That's absolutely incredible. I love all of that about how our brain perceives information, and it makes me feel even better about things like you coming on podcasts like this, because you're speaking to the-- it's not the Reader's Digest and National Enquirer, but just the importance of having cultural--
Terry Wahls: It's the early adopters. You're the early adopters. Although I want to remind the listeners that we're early adopters in some aspect of our life and I assure you, you are a denier in other aspects of your life. None of us can tolerate being early adopter in every aspect of our life.
Melanie Avalon: Oh, wow. That’s so mind blowing.
Terry Wahls: It's disheartening when you realize that, of course.
Melanie Avalon: Yeah. After this call, I'm going to be analyzing my life for where I'm the early and late adapter. I want to be super respectful of your time. For listeners, you have to get The Wahls Protocol for all of the details on everything to have a complete understanding. There's so much in there. I want to ask you one really quick question that really haunted me after reading your book. It was, you spoke about the importance, at least for patients, I believe, with MS, doing 100%, no cheating for 100 days, and you spoke about something called like epitope spreading and how things could possibly get worse. I just know so many of my listeners whether or not they have something like MS, there's often this idea of cheating on diets when you're addressing health issues. I was just wondering what your thoughts are about that.
Terry Wahls: Well, we go for a while thinking, I can get exposed to gluten, dairy, or eggs, it'll trigger my pain and then I clean everything up carefully and I get pain free. The unfortunate reality is that I can't always be certain that you can ever get back completely to baseline. If we keep challenging myself, so that I get exposed to-- I will say gluten is the problem, and so now I have created a molecular mimicry. We know it messes with some internal brain structures for me. Let's say I keep getting exposed occasionally. Now, in addition to going after my brain structure, it's begun to go after my liver, because of molecular mimicry and the sequencing in my unique genetics. So, I caution people that if we don't get to the root cause, every 5 to 10 years, you'll pick up another autoimmune disease. You might start out with asthma, go to endometriosis, go to psoriasis, go to MS, go to primary biliary cirrhosis, go to another autoimmune process that maybe we have classified as an autoimmune diagnosis or just as a possible autoimmune diagnosis, or simply as an autoimmune process. The best you can hope then is that I can slow my primary biliary cirrhosis, but I'm not able to really stop it because I've triggered the process. There's some evidence that ALS may have an autoimmune process in it as well. If I trigger ALS, then that's likely to be a fatal disease process.
What I caution people is that better to not cheat. Once you figure out that there is a sensitive problem, stay off it. Although I will also tell people that even if you're not ready to go gluten free-- and we tell people in my clinics at the VA, that in my lifestyle clinic, people could get referred into us and we'd give them the initial spiel, my story, and the concepts of functional medicine and would lay out three choices. One is that this is not the right time for you to take on doing diet and lifestyle changes because you have other major issues that you're facing with perhaps a severe financial strain or health challenge with some other member of your family, just can't take it on now. Or that it feels like too big of an ask, but you want to work on improving your diet. So, we send you to the dietitian to work on improving your diet, and most often these folks start on a Mediterranean diet. Or, if you're ready to be all in, 100%, at least 100% gluten free and eating more vegetables, or at least 100% gluten free and no junk food, if you're 100% all in, you can come to my lifestyle clinic and we'll work closely with you. But I want people to do this as a family, because if you can't do it as a family, and let's say just the patient is going to make these diet and lifestyle changes, but all around them, the rest of the family is still with the old way of eating and thinking about life, they will struggle and it will be very, very hard for them to be successful. But if we do whatever the change is as a family, the whole family will experience benefit and they will be much more successful. Then, they'll come at the pace of change that is sustainable for them.
Melanie Avalon: Yeah, I think that is such a key factor that the social aspect a lot of people deal with, especially when they're trying to follow diets that they perceive as often in the beginning at least, potentially restrictive, though I feel like a lot of people grow to love the freedom they get from the foods they're eating and the health experiences, but focus on the other people is often quite a hurdle for people.
Terry Wahls: Correct. In my lifestyle clinics, in my clinics, in my programs, we stress doing this all as a family and we bring families in, so that they can all understand why we do things the way we do them and we can help break down how to do things in a way that is successful.
Melanie Avalon: In your family, out of the four, the Wahls, the paleo plus, the elimination, what do you guys all do in your family?
Terry Wahls: Everyone in my house is probably Wahls paleo. I am doing a ketogenic version of my diet. The olive oil ketogenic version, and I eat every other day. Periodically, I will do a periodic fast, in addition for the benefits to the stem cells and the antiaging capacity as well.
Melanie Avalon: No eating every other day?
Terry Wahls: Correct.
Melanie Avalon: Oh, wow.
Terry Wahls: When you first start doing that, you're pretty hungry. I talk about you ease into time-restricted feeding, intermittent fasting, periodic fast at the pace that you are curious and your interest in doing. There is no need to go into any more advanced eating strategy than you are curious for, or that you wish to experiment with.
Melanie Avalon: I love that. It is a beautiful mindset. I might steal some of that, I’ll attribute it to you, but on the Intermittent Fasting Podcast, we get a lot of questions about finding the right protocol for them, and that's just a really, really great way of looking at it.
Terry Wahls: If your health is superb at level one of the Wahls diet or at the Mediterranean diet, then that's the diet to stay at. If your health is superb eating the standard American diet, you're not likely to want to make any changes, because we get so much pleasure out of the sugar and the processed foods, so likely-- They may have great health their whole life, and that's fine. They're likely to not want to make a change until someone in their family has a health change, and now there's a reason for them to want to give up that pleasure.
Melanie Avalon: Yeah, I'm so jealous of-- it seems like in the working super centenarians, that they basically just have genes that--
Terry Wahls: We all have those genes. They've created a culture that has the ability to live to 90 and 100 very well, and that culture has not yet been thoroughly contaminated. In those societies, when those cultures are contaminated with the westernized diet of sugar and processed foods, the lifespan dramatically falls and comes back to westernized lifespans.
Melanie Avalon: I was interviewing James Clement, have you met James? He's done a lot of work in super centenarians. They found that some people are the outliers. Even if the culture changed and the food was processed and terrible, that they have some genes that basically stay activated similar to what we would have to do with calorie restriction or fasting. So, they're sort of protected, regardless of what diet they have. So, it's not the entire culture, but those outlier people.
Terry Wahls: Well, there are a couple folks who have-- I think it's an Ecuador. They also have a very short stature and slowed aging as well.
Melanie Avalon: Yeah. Well, this has been absolutely wonderful. Thank you so much for your time. Thank you for all of your work that you're doing.
Terry Wahls: And do you have the links to all of my websites?
Melanie Avalon: Yeah, we'll put it all in the show notes, but what is the best way for listeners to follow your work?
Terry Wahls: Follow me on Instagram @drterrywahls, on Facebook and Twitter, @terrywahls. My website, terrywahls.com. If you want to get a one-page summary of my diet, that's at terrywahlsl.com/diet, you’ll get a link to our research study, so people can send people, particularly recruiting folks newly diagnosed with MS, or clinically isolated syndrome. Some of the listeners may have family members who've been recently diagnosed, and we'd love to get them in our study.
Melanie Avalon: Perfect. Well, so for listeners, again, there'll be a full transcript, all of those links in the show notes, which will be at melanieavalon.com/wahls. Thank you so much. The last question, it's very short, it's what I ask every single guest on this podcast and it's just because I realize more and more each day how important mindset is surrounding everything. What is something that you're grateful for?
Terry Wahls: Oh, I'm grateful I became ill. Had I not developed MS, I would not have developed all of these insights, so I'm grateful for that. I'm also grateful for the trigeminal neuralgia because without that-- I have this really amazing biosensor that tells me moment to moment, just how many inflammatory cytokines I have in my brain. So, I have a very exquisite sensor of my environment.
Melanie Avalon: That is incredible. Well, thank you so much, Dr. Wahls, this has been amazing. It's been a dream of mine to interview you for years and years, so thank you. I'm sure my listeners just learned so much and I look forward to your future work.
Terry Wahls: Sounds wonderful.
Melanie Avalon: Thank you. Bye.
Terry Wahls: Bye-bye.

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