Episode 4: Terry Wahls Protocol To Reverse MS and Autoimmunity – The Hero’s Journey

Transcript

Terry Wahls:
So in that group, we had this dramatic improvement in the quality of life, dramatic reduction of fatigue, reduction in anxiety and depression, improvement in verbal reasoning, non-verbal reasoning, and half of our folks got clinically meaningful improvements in days.

Jacob Gordon:
Hey guys, and welcome. You’re listening to The Rezilir Way with Jacob Gordon. I’m your host, Jacob, and I’m so excited to have you here today. In today’s episode, we have Dr. Terry Wahls, a leading researcher in multiple sclerosis. Not only has she suffered from MS herself, but she has also figured out how to improve MS and improve it for her patients.

Jacob Gordon:
In my interview with her and Dr. Craig Tanio, we discuss research with the VA, universities, and trying to get FDA approval. Her latest book, The Wahls Diet: Why 21st Century Medicine Hasn’t Caught on Yet, Root Causes and Stressors Relating to MS as Well as Resiliency Factors. So without further ado, let’s get started. Thank you, Dr. Wahls, for coming on the show today.

Terry Wahls:
Hey, you’re welcome. Glad to be here.

Jacob Gordon:
I’m excited to have you here. Your story is absolutely fascinating, from being an athlete and doing thedwindling downto your whole recovery. I’d love to hear more about that, would you be able to tell me a little bit about your story?

Terry Wahls:
So yeah, before I entered medical school, I competed in full-contact free sparring, actually in the Pan American Trials. So I was actually a very big-time athlete. I entered medical school, starting having some zingers in my electrical face pain. That would become progressively more troublesome. Then in 2000, my wife noticed while I was out walking, my left leg’s not working right. I agreed to go see a neurologist.

Terry Wahls:
He says, “This is going to be bad or really, really bad.” Being a physician, I know I’m looking at either ALS or MS, and I prefer an early death to a lingering disability. So secretly, I’m praying for ALS, but what I have is MS. That takes only three years, and I’m needing to get a tilt-recline wheelchair. I get my infusions, they don’t help. Then I try Tysabri infusion, that doesn’t help. Then, I am too weak to sit up at my desk. But fortunately, I can still read, I can still think. So I’m studying the basic science night after night, and I begin to experiment on myself, and the speed of my decline slows, and I am so grateful.

Terry Wahls:
But I’m still declining. My zingers are more frequent, more severe, more, really, awful. My daughter, who’s just 10, puts her arms around me, trying to comfort me, but it’s her touch, triggers more pain, more zingers. So I’m gritting my teeth as well to try and not scream as my family is touching me. The university redesigns my job so I can continue to work. They assign me to review clinical trials for safety, and I get better at reading the science. But I have a progressive disease and I’ve had four years in a wheelchair, unable to sit up.

Terry Wahls:
So I’ve learned to let go of my future, and I take each day as it unfolds. I review a research protocol that uses electrical stimulation of muscles. I ask my physical therapist, “Hey, could I try that?” And he says, “You know, Terry, this is for athletes. It’s really painful,” and I tell him, “No, no, no. I’m an athlete, I competed in full-contact free sparring and tae kwon do at the Pan American Trials. I can do this.” And he lets me. He hooks me up, dials up the current.

Terry Wahls:
It does really hurt a lot, but when I’m done, I feel great thanks to all those endorphins. So I began doing e-stim to as much pain as I can tolerate. I decide to add in daily meditation. I go back to my paleo diet, and I redesign that based on the science I’ve been studying. And now-

Jacob Gordon:
For the e-stim that you’re doing, what type of waves were it?

Terry Wahls:
Well, it would depend. If I was doing small muscles, it was an asymmetric wave. If it was large muscles, then it was a square wave that was symmetrical. And again, depending on small muscles or large muscles, it would have to do with the number of hertz that I would use at that time. And let me tell you, I was doing this to as much pain as I could tolerate, multiple times a day, and eventually, I would figure out how to take my portable device with me to work. And so I was stimming many, many hours each day. And what’s remarkable is just one month into this I can sit up again at my desk, and-

Jacob Gordon:
One month with the e-stim and the paleo diet?

Terry Wahls:
Well, I’d been doing the paleo diet for about five years. It wasn’t until I redesigned my paleo diet, based on the science, and I’m doing the e-stim, I’m back to meditation, one month into all of that, I can sit up again. Big deal, huge deal. Three months into that, those zingers that I’ve been having 27 years are gone. Five months into this, I can stand and I walk down the halls at the hospital, stunning everyone. And nine months into this, I convinced my family that I want a bike. And so we have this emergency family meeting.

Terry Wahls:
My wife says, “Okay.” We all get into position. My son’s going to run on the left, my daughter’s going to run aside on the right, my wife’s going to follow on her bike. And to give the signal, I push off, the bike wobbles, but I catch my balance, and I bike around the block. My son’s crying, my wife’s crying, I’m crying. If you could see me now, oh, I still cry talking about this, because that was such a miraculous day. Because remember, I had let go of my future, and even though I have remarkably improved, able to walk around, I didn’t know what any of that stuff meant. That was just taking each day as it unfolded. But once I biked around the block, I understood that the current understanding of MS was incomplete, and that-

Jacob Gordon:
Wow, that’s beautiful.

Terry Wahls:
Who knew how much recovery might be possible? And five months after that bike around the block, my wife sees the Courage Ride, which is an 18.5-mile ride, says, “Let’s sign you up.” At that point, so I could ride my bike eight miles, so this is going to be a big jump. And once again, my family’s with me, and as I cross that finish line, and once again, everybody’s crying, my kids are crying, my wife’s crying, I’m crying.

Terry Wahls:
And of course, I really am quite tired by this bit. Like, oh my God, so triumphant. And this, of course, really transforms how I think about disease and health, and it transforms the way I practice medicine, because now I’m talking to my patients about their diet…

Jacob Gordon:
So by this time, you knew you were on to something, something miraculous?

Terry Wahls:
Absolutely, absolutely, and I’m on to something miraculous, I’m on to something spectacular, how I’m thinking about disease and health has really been transformed. I’m talking more and more to my patients about what are they eating, what are they doing.

Terry Wahls:
And because I’ve transformed my approach to food, I feel very comfortable talking to people about food and their choices, and the residents of the clinic are so stunned to see how effective I am at convincing thesevets to make big changes in their eating habits and to make big changes in their daily habits, which leads then to steady improvements in blood pressure, in blood sugar. We’re able to reduce medications and take people off medications.

Craig Tanio:
Terry, what kind of approaches were you doing with the vets that made it that much more effective, let’s say, compared to a conventional physician might do?

Terry Wahls:
I’m asking them what they’re eating, what they’re doing, and I’m using metaphors that matter to them. So my farmers get that you can’t get a champion steer feeding them junk. My mechanics get that you can’t pour sugar into the gas line and expect the motor to work well. My teachers understand that the student who stays up all night doing alcohol and drugs is not going to perform well on their test. So I have to have metaphors that matter, engage them to try, and the other thing that I find effective to say is, “Let’s do this as an experiment. When you’re ready, let’s do this.”

Terry Wahls:
And I have encouraged 100 days, but if they could go at least two weeks, that would be enough to see the change. So you empower the vet, that they’re the ones to make the choice and decide when they’re going to do it. And the other questions I would ask a lot about what do they want their health for, and another big question was, “Is there something or someone you care so deeply about that if they were in a burning house, without even thinking, you would run in to go save them?”

Terry Wahls:
Once we got that identified, then we could begin the journey of what they could do that’s under their control. You know what, and I couldn’t convince everyone. At first, I was convincing half of my vets to make big changes, and by the time I retired from the VA, I’d say easily I was getting 90% of the vets to make these really big changes.

Jacob Gordon:
How long ago was that at the beginning?

Terry Wahls:
So I came to the university and the VA in 2000. I retired from the VA December, at the end of December of 2014. I made that decision because, well, two things: I’m really committed to continuing the research that I do, so I was going to stay with the university, and I’m also committed to teaching the public what I do, and I just had to spend more time supporting my mission of creating my teaching programs for other physicians and my teaching programs for the public. And my wife understands you can’t work all the time.

Terry Wahls:
You’re going to have to cut hours either at the VA or the university, and she knew I wasn’t going to cut hours from the university. So I retired from the VA, and that worked out beautifully. We hired other team members to continue the clinic that I was running, so they’re doing very well, and that clinic continues to grow. And the live events that I do for the public and the virtual events I do for the public and clinicians have just dramatically grown in these last four years. So it’s been a very good thing for everyone.

Jacob Gordon:
You’ve done a significant amount of research on this whole subject, through your whole experience, and with patients as well.

Terry Wahls:
Yes, you know-

Jacob Gordon:
I’m curious how-

Terry Wahls:
This all evolved?

Jacob Gordon:
A process like that all evolved because you don’t see clinical trials with diets and lifestyle changes.

Terry Wahls:
Correct. So the first thing that happens, I had this personal transformation. I start telling the public, the local organic grocer, ask the local churches, the local MS chapter wanted me to come to speak with them. I got interviewed, got banned by the MS Society because they thought my message was dangerous. Then I let it roll off my back. I do other speaking gigs, community colleges, regional meetings. I get a TED Talk that has millions of views. I have a bestselling book. Then the MS Society comes back and reverses their banning of me, has me come to their wellness conference.

Terry Wahls:
I’m part of that, I submit a grant to the MS Society and they now fund me. They give me $1 million, and that was in the fall of 2016, which actually was why I retired from the VA, so I could spend my time running that research setting. In the meantime, in 2010, so I recovered in 2008, my chair of medicine gave me the job assignment of getting what’s called a safety and feasibility trial going, that we take the same protocol that I used for my recovery, write that up into a rigid protocol.

Terry Wahls:
We ran 20 other patients with progressive MS through that protocol. And so it’s called the single-arm study. It was very exciting, we did very well. Published four papers out of that little study. We had two more, again, small pilot studies. Again, very positive results.

Jacob Gordon:
What were the results?

Terry Wahls:
So we have them published. From the first study of progressive MS, and keep in mind those progressive MS, you expect to decline 10 to 20%. So in that group, we had this dramatic improvement in quality of life, dramatic reduction in fatigue, reduction in anxiety and depression, improvement in verbal reasoning, non-verbal reasoning, and half of our folks had clinically meaningful improvement in gait. But limitations, that’s a single-arm study. Then, we do randomized studies. So the next randomized study was a comparison of the study diet to find your usual diet.

Terry Wahls:
And in that study, we again showed remarkable improvement in quality of life and reduction in fatigue, and we had moderate improvement in walking. But of course, it’s a much shorter study. That one was only 12 weeks. The next study, we compared a ketogenic diet, a paleo diet, my version of the paleo diet, to someone’s usual diet. And what we found was the Wahls diet was better than the keto diet and both were better than the weight loss control. So then we’re doing our fourth study, that’s the low-fat diet versus the Wahls diet. That study’s been completed, we’ve analyzed that data, and-

Jacob Gordon:
Was the low-fat diet the Swank diet?

Terry Wahls:
Yes, it was the Swank diet versus the Wahls elimination diet. So that data’s been analyzed, we’ve written it up, and it’s under review for publication. I’m very hopeful that we’ll find the right publisher and we’ll get all the reviewer comments, etc. taken care of, and hopefully it will get out in the press in 2021.

Terry Wahls:
And now we’re doing our fifth clinical trial, and in this trial, now, this is called quasi-experimental, so it’s non-randomized, we’re taking people who are newly diagnosed with either clinically isolated syndrome or newly-diagnosed relapsing-remitting MS who’ve been offered disease-modifying drug therapy and have declined it because they want to use diet and the lifestyle. And we’re training them on this steady diet, we’re teaching them a daily meditation, and putting them on a walking program.

Terry Wahls:
They get a monthly group support call and they can have unlimited text and email conversations with the dietician. The control group is getting MS care from an MS neurologist, and they are taking disease-modifying drugs, and they can follow whatever dietary plan they and their medical team think is appropriate. It’s a little disappointing, we had planned to be able to see them and get MRIs at baseline at the end, but because of the pandemic, we can’t do that.

Terry Wahls:
We’ll have the extract, the medical record to capture the results of what was found in the clinical exam by their physicians, and the MRI exam. We’re very excited, we have 29 folks involved in the intervention arm. We’re still enrolling in the control arm, and we will follow them for a year. So again, that will be a very, very exciting study.

Jacob Gordon:
What is the process especially for these studies to get FDA approved?

Terry Wahls:
Well, so the FDA does not approve the study. The study is reviewed by what’s called the Institutional Review Board. Each research organization has a review board that reviews the application for the research for safety, and if they have questions or concerns, they may tell the investigator, “You have to make these changes in order for us to feel that this is going to be appropriate and safe.”

Terry Wahls:
Then they review, every year, your progress. Typically, for an intervention study there is a safety board and a medical safety officer that reviews adverse events to ensure that there’s no serious harm or unexpected problems in that study. So for all of our studies, we’ve had the University of Iowa Institutional Review Board review our studies and safety monitoring boards, to make sure everything is safe and appropriate.

Craig Tanio:
In the documentary, I think at the end, there was a mention that there is a goal to try to get FDA approval of the protocol and the research itself?

Terry Wahls:
Yeah, so the goal is if you have two randomized controlled trials, then you can apply for FDA approval. That’s a big, expensive process. A randomized trial of this nature would probably be about $3 million. So you’re talking $6 million and an FDA application to get that kind of approval. Absolutely, that is my goal, but we’ll have to get more studies and we’ll need to get the NIH approval to be able to fund that kind of study.

Craig Tanio:
And if you could get that, or I should say not “if”, when you can get that, and let’s say those are positive trials showing a difference, do you think that leads the way then to better insurance coverage, or what do you think would be the impact of that?

Terry Wahls:
So, first thing, if you get two randomized control trials showing the Wahls diet or the low saturated fat diet is effective at improving quality of life or reducing fatigue, and I’m very confident in those kinds of outcomes, then this becomes the standard of care for treating neurologists, saying, “You know what, diet really matters. You absolutely should be following one of these two dietary plans.” Once you have those two big randomized control trials, even if the FDA has not approved it, it becomes the standard of care.

Terry Wahls:
So it’s sort of interesting. There’s a special, particular kind of application for an IMD or IEE that you have to go through to get approval for a drug intervention, or a device intervention. But keep in mind, like the diabetic diet or the American Heart Association diet, they never asked for FDA approval. But because there are studies showing that they’ve been effective, they became the standard of care, and they ultimately became something that insurance companies and Medicare will cover, because they became the standard of care.

Terry Wahls:
So I’m incredibly optimistic. 10 years ago … Well, yeah, 10 years ago, I’m banned as a speaker because my ideas were so dangerous. But because of my persistence with doing that clinical research, publishing the data, and then my skill at telling the story in the TED Talk and in my books, we’ve created this national interest which led to more funding for other pilot studies about dietary interventions.

Terry Wahls:
So now in the study of MS, there are actually quite a few small, little pilot studies about the impact of diet on many biomarkers and quality of life measures for MS. The MS Society created a working group on nutrition and invited me to be part of that working group. So I’m now in this group with a dozen other neurology and neuroscientists who investigate diet and care a lot about diet quality for the MS patients. So we’re changing practice, it’s very exciting.

Craig Tanio:
It really is, and I think what’s so impressive is that there’s certainly been a set of people who have gotten the public interested in changes in lifestyle and a functional and paleo approach. But there have been less people who have been really able to change the … Let’s call it the conventional medical practice, and medicine has always been a bit notorious for taking its time to incorporate new data. And I’ve just been so personally impressed how some of the local medical community and the practicing neurologists are starting to adapt. Just tell me, I’d be really interested in your approach to changing the medical community because I imagine that’s not been an easy set of conversations.

Terry Wahls:
Well, I can think about the process here at the university maybe where I practiced. When I first made these big changes in how I practice medicine, it made people very uncomfortable, because it was quite different. My chief of staff calls me in and he says, “Terry, what’s going on? People are upset, they’re complaining. I hear you’re banned as a speaker.” Now, I brought with me an armful of the scientific papers that underpinned my thinking in terms of what I was doing and why.

Terry Wahls:
I went through those papers with him and I won him over. And he said, “Look, if there’s ever an adverse outcome from one of Terry’s patients, she’ll go through peer review just like anyone, just like we would for anyone else. But in the meantime, her advice to eat more vegetables, and meditate, and move more is what we should all be doing. There’s nothing wrong with what she’s saying.” And then my chair of medicine, likewise, I had to go meet with him over at the university and have the same kind of conversation, and his response was, “This is so important, you’re going to do clinical research, and I’ll get you the mentors.”

Terry Wahls:
So he was visionary, he said, “Shift the research,” because I was in a different field of research. So we shifted my research focus into these early clinical trials, and he got me the mentors. Thanks to Paul Rothman, I went down this path of these very interesting clinical trials. Every year, the university and the VA have Research Week, so we’re presenting our data and showing these gait videos with these amazing restorations of function. I start going around various departments at the university and the VA talking about my research, my data.

Terry Wahls:
These videos that are so, so striking are publications, finally start getting into print, and as more of our studies get into print, that’s helpful. And the other thing that’s really helpful is my work is touching the lives of people, as more and more people in the public, and I’m doing this radical thing of telling the public what I’m doing and why. And let me tell you, I get a lot of criticism for that, a huge amount of criticism for doing the research, at the same time telling the public, “Eat more vegetables, meditate, go see a physical therapist, and start exercising.”

Craig Tanio:
And what was the criticism? Was it false hope or was it-

Terry Wahls:
False hope, “You should not be talking about this. You don’t have published research data yet, this is wrong.” I’ve worked very closely with my … Fortunately, the chair of medicine had seen my decline, my amazing recovery, had become the dean of medicine. I worked with my colleagues at the university to be very clear in my presentations, in my books that I was writing, in the lectures that I’m giving, that I’m disclosing, “This is my personal experience, this is the science behind why I do what I do, and this is the science behind why I’m doing clinical trials the way I’m doing them.”

Terry Wahls:
So I’m very, very transparent in all of that, and I’m also very public. I get this big following, my YouTube videos has three and a half million views on that. My bestselling book-

Craig Tanio:
Is that your TED Talk?

Terry Wahls:
That TED Talk, yeah.

Craig Tanio:
TEDx Talk? Okay.

Terry Wahls:
TEDx Talk and that, bestselling books. And then this next thing that happens, study, the university sets up a research account for me, which I’m using, raising a small amount of money to fund my very interesting, small pilot studies. The university gets a cold call from somebody in Hong Kong who makes a six-figure donation into my research fund. So that’s a big deal, and that lets us do another one of our little pilot studies.

Terry Wahls:
And then the university gets a second cold call with another person who wants to do a six-figure donation. So I’m getting to do these very interesting pilot studies, which is how those first three studies all got funded, and completely by wiped down philanthropic efforts. Then, I get a meeting on my schedule with the dean, and we have a new dean now, a dean of the medical school who wants me to come explain what’s going on with my lab, my research, my public persona, and visibility. Because now, the university’s really impressed because they’ve never had anyone get the kind of philanthropic support without a lot of support from the university foundation getting all of that to happen.

Terry Wahls:
And so it was the passion I have for the mission, the remarkable success that I have, in the fact that I’ve touched the lives of so many people around the globe, which led to this remarkable philanthropic support, which then allows me to do this very innovative research. So then we get the preliminary data to write these grants, which led to the larger grant with the MS Society, and we’re using that data to write for grants back to the NIH.

Craig Tanio:
And where do you think this criticism of false hope comes from? Because if I just break that down in terms of food, people need to eat food, so it’s not like a pharmaceutical where you say, “Oh, well, you don’t have to take a pharmaceutical.”

Terry Wahls:
So, the-

Craig Tanio:
So it’s like, healthy food or unhealthy food

Terry Wahls:
I was putting out the message to refuse drugs, do my protocol and refuse drugs, and they didn’t take the time to understand that my message was, “Talk to your neurologist, decide whatever you want to decide about the drugs, but you must address diet quality, smoking, meditation, and movement. This should be part of everyone’s self-care plan.” And once they began to realize that I’m not telling them to refuse drugs, I’m telling them, “You meet with your neurologists and you decide clinically what is right for you, but everyone will do much better if we deal with diet, deal with smoking, deal with meditation, and move.”

Terry Wahls:
And once they finally read my book, and but Craig, I think we have to be honest with ourselves: All of us, we reject information that doesn’t fit into our understanding of the world. We reject it over and over, over again until it’s overwhelming that we’ll finally admit like, “Okay, my previous understanding of the world was wrong. Two and two doesn’t really equal four. It does equal five now that I see the world in a new way.” None of us will accept new information very readily.

Craig Tanio:
And I do think that your approach, especially the nature of the multi-modal interventions, trying to get multiple things to work together to affect chronic disease, that does seem to be the new template that’s going to be necessary to address all types of chronic disease, and is going to really be a new way of structuring medicine.

Terry Wahls:
That is the way, the only way we can create health. When I first started doing my research, I got called into multiple meetings and was told that I had to pick just one of the intervention study, one molecular pathway at a time. And I kept saying, “No, no, no. We have to study everything.” And fortunately, the institution review board had seen me become profoundly disabled, saw me remarkably come back to health, and I think had I not been part of the IRB, I would’ve never gotten approval of this. The study question, my first study question, Craig, was, “Could other people do my protocol, yes or no? And if they did, what was the effect size?”

Terry Wahls:
Because remember, we’re asking people that had profound disability, severe fatigue, to radically change their diet. We had many, many things we’re asking them to do, and take a bunch of supplements, because we’d written out the protocol of what I had done, and so we’re trying to say, “Could anyone else do it?” And once we made it clear that we weren’t trying to change the disease course, we’re just trying to see, “Could people do it and was it safe? Did we hurt anyone?” And then, “What was the effect size to some of these folks?”

Terry Wahls:
No one expected, when you have only 20 people in the study, to have an effect size of any significance. You just want a trend in the right direction. As a matter of fact, people lost weight so rapidly, so consistently, I’m having to file reports back to the IRB every three months with everyone’s weight, what we’re seeing, and that we’re reporting the weight changes back to the person’s personal physicians. And then in terms of the reduction in fatigue and the improvement in quality of life, the P value for those changes …

Terry Wahls:
And by the way, the changes were dramatic, so reduction of fatigue was 2.38 on a scale of one to seven. And the clinically significant difference is 0.45. The improvement in quality of life was 16 points, and the clinical difference is five. So these are very large, favorable changes clinically, in these two groups. And the P value was less than point 0.0005.

Jacob Gordon:
Oh, my God.

Terry Wahls:
Yeah,

Craig Tanio:
This is-

Jacob Gordon:
Unbelievable.

Craig Tanio:
This is where you get it, you can see it across the room. You don’t need the statistician to tell you whether it’s …

Terry Wahls:
Right, and when I’m going around the university and around the world, showing the videos of what we could see, and again, I make it very clear, not everyone experienced these kinds of improvements, but in progressive MS, as I said, 10 to 20% worsening every year is what you expect, we have these dramatic improvements in walking. One lady, it took her 127 seconds to walk eight feet, turn around, and sit back down in her chair.

Terry Wahls:
At the end of the year, she was down to 43 seconds. She still needed her walker, but you can see, anybody can see a difference between something that takes 127 seconds, then comes down to 43 seconds.

Jacob Gordon:
Absolutely.

Craig Tanio:
And when you talk about patients that don’t improve, I think one of the hardest things I find in practicing lifestyle medicine is when patients are able to do, let’s say, 80% of the change, but you want to have a dialog with them about the potential benefit if they can get to 100%, and to see what that does. And I’m just curious, your experience of that, getting to the tipping point, and how you convince patients to get that kind of-

Terry Wahls:
To make these changes.

Craig Tanio:
Yeah.

Terry Wahls:
You know, I learned this from my veterans, and I learned this working with the Therapy lifestyle clinic, that groups are incredibly powerful for making behavior change, that I’m pretty good one on one with patients, but you put people in a group of 10 to 15 people, and you have them meet month after month, and so they get to know each other over six months to a year, that group dynamic is incredibly powerful. And as people in the group experience success, they celebrate as they experience challenges, they ask for help from one another.

Terry Wahls:
And I might offer the same suggestion, but it lands very differently to hearing it from another veteran, who explains how they dealt with a spouse who was not supportive, or how they dealt with extended family members who were less than supportive. That group dynamic is very powerful. Other things that are incredibly important is to have the conversation with the vet, what do they want their health for? And is there someone or something that they care so much that they would run into a burning room?

Terry Wahls:
And if there is nothing they want their health for, if they have no one for whom they would run into a burning building, that person will not be successful. And so that individual we refer to mental health services until they have clarity on those two issues. And then my advice is that they work with a mental health professional, and when they are ready they can come back to the group. So you get to be in my group by invitation, and by commitment that you’re willing to do this 100% for 100 days, and if it’s not the right time, because your family is having a crisis, because your spouse is dealing with breast cancer, then this is not the time to be working with me, but come back when it is the right time.

Terry Wahls:
And so it’s voluntary, you come when you are ready to do the work, and we may have you work with mental health counseling to understand your admission, your purpose, and why you want to do the work. I never, never, never argue with people. Ready to do the work, they’re ready to be part of the group, they’re ready for their hero’s journey, and we celebrate and struggle together. And if it’s not the right time, that’s okay. You can go work with mental health and then come back when it is the right time.

Jacob Gordon:
That’s great. I’m really curious, Dr. Wahls, about what the protocol specifically is. We’ve talked about it’s a diet approach, and meditation, and e-stim, but what specifically is going on with … What is happening in the diet that separates it from keto or from a Swank diet?

Terry Wahls:
So actually, this is very interesting: So people who have a clinical reason to be on a ketogenic diet, we could still have them be on a ketogenic diet, but I teach them how to do it in a way that is nutrient-dense, that makes sure that they’re less likely to have serious mineral deficiencies, vitamin deficiencies. A lot of keto diets are based on dairy and eggs, and will still be very, very inflammatory, and they will be relatively low in vitamin C, for example.

Terry Wahls:
We have people who need to be on a low saturated fat diet because they do have serious dyslipidemia, maybe they have diabetes, they have heart disease, and they can still be on a low saturated fat diet, but we teach them how to do that in a way that is nutrient-dense. So I understand the clinical needs. Then, we will tailor the dietary plan to meet that clinical need. In the big picture, I’m removing gluten, so gluten-contained grains: wheat, rye, barley, or removing dairy proteins, and also remove eggs.

Terry Wahls:
Those are the three most common inflammatory, inflammation-producing foods. Then, we ramp up the vegetables in a very specific way, we teach meditation, we talk about movement strategies, we talk about electrical stimulation of muscles. And then, we support that journey. This is not a diet, this is a way of moving and being, and how you approach life.

Jacob Gordon:
Is the meditation a specific type of meditation? Like you were saying before earlier, how you try to get people into a group so they have the support with one another. Is it a group type of meditation, or meditation on your own, visualization?

Terry Wahls:
So we talk about meditative practices. So in my veteran community, there’ll be a wide spectrum of beliefs and spiritual practices. Many of our veterans find that spiritual, meditative practice hunting, fishing, being out in their gardens. Some will do it with Epsom salts baths, some will do it with free writing about their time in military service. Others will do transcendental meditation, guided meditation, 4,7,8- breath work.

Jacob Gordon:
Is the overall goal to lower the stress response?

Terry Wahls:
Yes, the overall goal is to teach the veteran that they have, at their fingertip, many different tools to do that.

Jacob Gordon:
Since you’ve been working with veterans and MS, do you see a large percentage of those with, say, PTSD developing MS and that connection between stress?

Terry Wahls:
So I see, when I look at patients with autoimmune issues, whether it’s MS or inflammatory bowel disease, rheumatoid arthritis, and I’m working through the timeline of their health events, their life events, and when they had onset of symptoms or major worsening of symptoms, a flare of psychological stress is a very, very common theme. Another very common theme is adverse childhood experiences. In the veteran world, tox exposures occur more commonly than in the non-veteran world, and concussions will occur more commonly as well.

Jacob Gordon:
Absolutely, shell shock and everything.

Terry Wahls:
Yeah.

Jacob Gordon:
Why is it that stress makes it worse for MS?

Terry Wahls:
Well, stress makes it worse for MS and for autoimmunity, and I’ll also tell you, it makes it worse for insulin resistance, diabetes, as well as anxiety and depression. When you have the elevated stress that is relentless, so you don’t have any periods of relaxation, that chronic elevated stress, you alter the pituitary-adrenal response and you have insulin resistance, you have elevated glucose, you have pro-inflammatory cytokines, you have Microglia activation, you have worsening central obesity. You tend to have suppressed sex hormones and you tend to have disordered thyroid problems as well.

Terry Wahls:
So that’s a big cascade of poor metabolism, excessive, inappropriate inflammation, which, depending on your chronic health problems, that’s going to lead to more anxiety, more depression, more irritability. It will lead toward earlier development of autoantibodies, and progression of your autoimmune processes, which will lead to autoimmune diagnosis. And if you don’t get to the root cause, Craig, what’ll happen is you will get one autoimmune diagnosis, and then every decade you’ll begin to get another, and then another, and then another.

Jacob Gordon:
What are some of these root causes? So stress could be one of them, especially if you have autoimmunity, but what else could be causing …

Terry Wahls:
So there’s going to be many. I think adverse childhood experiences are part of it. I think the epigenetic changes that were experienced by your parents, your grandparents, your great grandparents, and now your great-great grandparents. We know epigenetic changes get passed on for generations, so you can think about the severe psychological stress that our ancestral mothers and fathers experienced, from their hardships, financial, physical, emotional, that never got resolved, got passed on epigenetically. And so that’s part of all of this.

Terry Wahls:
The stress of the birth experience and the prenatal, perinatal time period will increase the responsiveness or the excessiveness of the cortisol response, the stress, changes in the microbiome in terms of antibody exposure early, sugar, processed food exposure early, particularly things that happen before the age of three change the mix of the microbiome in my gut. And again, the research continues to explode, that the mix of microbes in my gut have a huge impact on the setpoints, so the inflammation markers in the inflammatory cytokines in my bloodstream, and the level of inflammation expressed by the Microglia in my brain.

Terry Wahls:
The balance of my sex hormones, thyroid hormones, and cortisol will also influence the risk of autoimmunity. The air and water quality, food quality in terms of tox exposures. If I’m a smoker, markedly increased my risk of autoimmunity. If I have air pollution I’m exposed to, that appears to increase my risk of autoimmunity. If my water is contaminated with lead or mercury, that will increase my risk.

Terry Wahls:
So, and am I sedentary? Do I have central obesity as a child? What is my vitamin D level? Am I telling myself that I’m a loser, I’m a failure all of this time? Do I have social connections? Am I struggling with chronic shame? All of these factors either create a more nurturing, healing environment for myself or a more dysfunctional environment for myself. That’s why-

Jacob Gordon:
So is the Wahls Protocol just creating an environment that is conducive for healing?

Terry Wahls:
Yes, and you know, I really focused on the cellular level and I focused on the microenvironment, what I was so severely criticized, it was so funny early on, in 2008, 2009, people are giving me a hard time, like, “Terry, you treat everybody the same way. This is just not right. You should have a different treatment for diabetes, a different treatment for high blood pressure, a different treatment for anxiety.”

Terry Wahls:
And I’d say like, “Well, I think we all have mitochondria, we all have cell membranes. I’m just trying to help the environment for those mitochondria and for those cell membranes, and then I’m watching my patients carefully to make sure that they’re not over medicated. That’s all I’m doing.” And that still is really all that I’m doing. I’m looking at how to create the best cellular microenvironment, by helping patients nudge their self-care routines into steadily more nurturing, healthier choices. We spent a lot of time discussing, “How do we create better health and a better self-care routine, step by step?”

Craig Tanio:
Well, it’s a little bit of a different paradigm, it’s not being disease-specific, but saying that there are optimal practices to just encourage overall health that can apply to 90%-plus of the population.

Terry Wahls:
Absolutely.

Craig Tanio:
And that that’s not a common paradigm-

Craig Tanio:
… in medicine.

Terry Wahls:
It is radical, and the other thing that I focus on is, “What is your self-care routine and how can we keep nudging it through doing a more effective job of caring for yourself?” One of the things that my vets taught me, again, is taking the time to discuss the hero’s journey, and discussing the great myths that inspire us so much. Part of that is there’s a lot at stake, you had no idea if the hero was going to make it, if they’re going to die trying, but you were really impressed with the fact they didn’t give up and they just kept at it.

Terry Wahls:
And so we laid that to their current struggle, is that, “Yeah, we don’t know if you’re going to succeed or not, but you can choose to be inspiring to your family, and to your children, and your grandchildren by staying in the game and keeping at it.” And when you do that in a group, when you have those conversations in a group and people are talking about their struggle and their fears, and like, “Oh my God, this is so hard.” And you do it in a group, that’s behavior change on steroids. Those people will stay at it and keep making favorable, incremental changes, and begin to experience improvement.

Terry Wahls:
And then you keep bringing in new people into the group, so now you have some seniors, and now I get to coach the other new person. It is such a wonderful thing to see. I had no idea that … I thought I was good at it, but let me tell you, when you put people in a group and you let people mentor newer folks, change is so much more effective in that environment.

Jacob Gordon:
That’s a great concept. It kind of takes the idea similar to Alcoholics Anonymous or those other-

Terry Wahls:
Exactly.

Jacob Gordon:
… supportive groups, and when you have a mentor like that it’s definitely going to keep you on track, make you more resilient.

Terry Wahls:
You have a mentor, you have a sponsor. Then, when you get to be the mentor and the sponsor, people are so energized, and they do amazing things, just like these vets would do amazing things for each other in times of war. And when they realize that now, they are in their very exciting hero’s journey, they’re helping other vets in their hero’s journey. I learned so much from my vets, they taught me how to do this.

Jacob Gordon:
Seeing other people having your issues definitely helps your progression. I could see how having a mentor or being a support for someone could help someone with their fatigue, even without starting the protocol.

Terry Wahls:
Yeah, you think of going through medical school, it’s sort of like you see one, do one, teach one, and then you really understand the process. And so going through this in a group, being supportive, becoming a mentor, a sponsor for someone, then you still want to have me in a group, helping shepherd the group to keep them headed on the right direction. But oh my goodness, it’s inspiring, it is such a fun way to practice medicine.

Jacob Gordon:
I bet. I want to know a little bit more about the resilience factors that you have to make people more resilient to MS and autoimmunity, what they can do. What are some ways that people with MS can, once they’ve already started the protocol, for example, help with Remyelination, or reduce their cytokines, or that kind of-

Terry Wahls:
So, now, there’s two different questions we’re asking here: The resilience factors that I talk about are the emotional resilience factors that allow you to be willing to do the work. And it is very uncomfortable thinking about the sugar, tobacco, alcohol, to give up these addictive compounds. That’s very uncomfortable. You’re going to go through withdrawal, craving, and so for people to have peer support, at least one other adult, for a living being for whom they are deeply connected, for that social connection, a religious or spiritual belief, the internal hero’s journey, all of that adds immensely to the resilience to be capable of doing the work.

Terry Wahls:
So that’s one thing. Now, for the other resilience factors, we need to stop doing the damage right away. So we got to get rid of the toxins, you want to be sure you have a nutrient-dense diet, you have all of the components, and you want to have a healthy microbiome. And you want to rebalance your hormonal parts and that comes down to enough cholesterol, enough minerals, stress reduction, strength training. Those are the key components.

Jacob Gordon:
Now, strength training over cardiovascular, why that? Why’s that-

Terry Wahls:
You’ll get a lot more growth factor, you’ll get better response to your sex hormones with strength training. If the person’s capable of high-intensity interval training, that is also a strategy. Strength training is preferable, but high-intensity interval training is another option.

Jacob Gordon:
Well, strength training does sound like it would be a little bit easier for someone who has more fatigue, because you have to have the endurance for it.

Terry Wahls:
Right, right, but they can’t do that, and in my population, they may start out with just doing one minute of strength training maybe that week. And you have to be very sensitive to, “Can they do their workout and still function the rest of the day, and can they function the next day?” So the key principle here is a workout that gives mild to moderate stress to the system, with enough recovery period for yourselves to go and repair all the damage from the exercise before you exercise again.

Jacob Gordon:
So we’re talking about hormesis here, adding a little bit of stress for it.

Terry Wahls:
We’re talking about hormesis, and that’s the principle for all exercise, is you have a little bit of stress, enough time to repair the damage, build stronger muscles, and then you have a little bit of stress again. In people with chronic disease and autoimmune disease, the most common problem is we train them too hard or they accidentally train too hard. They don’t have a long enough period to recover.

Jacob Gordon:
That makes sense, yeah. They’re overtraining, even if they are-

Terry Wahls:
Overtraining, yeah, because-

Jacob Gordon:
Even if it’s something that seems like the standard for someone who’s healthy, they’re overtraining.

Terry Wahls:
Right.

Jacob Gordon:
Yeah.

Terry Wahls:
They can easily be overtraining. So sometimes my people work out a minute, sometimes they work out three minutes, sometimes they work out five minutes. That can sometimes start out with a half-hour workout. So you have to have a very careful discussion and evaluation to know, “What is a reasonable starting point to try, then assess how they responded to the first workout?”

Jacob Gordon:
With working out, do you do e-stim around the same time?

Terry Wahls:
If some can do e-stim, they do e-stim during the workout.

Jacob Gordon:
Because I’ve seen that in a lot of physical therapy practices, but I wondered if that still applied?

Terry Wahls:
You do e-stim during the workout, you do a volitional contraction of the muscles while it’s being electrically contracted because you want to reinforce the connection between the brain and the muscle.

Craig Tanio:
Terry, I have a question about toxins. In your view, what are the toxins that are contributing the most to auto-immune?

Terry Wahls:
Well, it depends on where the person is living. So they may have contamination of lead, mercury in the environment because of local releases. And the person may have tobacco use, they may have had a personal exposure to heavy metals because of their art history, or soldering, or welding, or a lot of mercury in their mouth. Because of the plastics in emulsifiers, in processed foods, in food packaging, you may have a fair amount of hormonal disruptions.

Terry Wahls:
So there may be some local factors, and then you have to think about individual factors. A lot of my folks in the military told me that they had 30 vaccinations on the day that they were deployed. A lot of them went into theater and then had burn pits. They were bivowacked next to and said that they were basically downwind of the burn pits, and had daily exposure. And again, my patients have told me that their family was crop dusted routinely because of the crop dusting patterns, or that they were helping their dad with their crop dusting. Asked people what their thoughts are, what do they think their exposures were, and then having a deeper query about various toxins.

Craig Tanio:
And as you’re talking about, really, a paradigm change in how medicine should be practiced, I feel like this whole area of toxins is kind of one of the areas where there’s the most controversy, or you get the biggest immediate negative response within the conventional medicine world. Do you have any thoughts on why this whole area creates as much controversy as it does?

Terry Wahls:
Well, life is a whole lot easier because of the chemical revolution that has substituted chemistry for human labor, which has made life easier for how we manufacture stuff, how we grow things. And so we know that we’re exposed to more chemicals. It’s uncomfortable to think about, “Okay, if you give all that up, it’s going to be very expensive to live organically.” And so people feel like, “Okay, this is an elitist move.” I make the observation in my lifestyle clinic, the people I saw were living on food stamps in small towns in Iowa, Missouri, Illinois.

Terry Wahls:
They weren’t going to Whole Foods, they weren’t eating organic food. They were just doing the best that they could with their limited financial resources. And so they might still be eating conventional food. If they were still living in their community that maybe did not have the cleanest water, but teaching my folks how to eat, and meditate, and move their bodies, their blood pressure still improved, their blood sugar still improved.

Terry Wahls:
We still were able to reduce and simplify their meds. Now, true, if they had been able to go organic, I think they would’ve improved more rapidly. That’s true, but we work very carefully to respect everyone’s financial limits and means, and certainly not everyone went paleo, because many of my folks, at least some of them were still vegetarian or vegan for their spiritual beliefs, or they couldn’t afford meat because they were living on food stamps.

Jacob Gordon:
You say that some people are vegetarian or vegan, but the diet can … I know you talk in your book a lot about organ meats, can they also supplement with organ meat extracts instead?

Terry Wahls:
Sure. So people can do organ meat capsules, we teach them how to make liver that’s actually quite delicious. As a matter of fact, we had that last night. One of our family favorite meals, baked chicken liver. It’s really quite, quite, quite delicious. But I also had people who were vegetarian or vegan for their spiritual beliefs. We’re not going to ask them to drop their spiritual beliefs. I’ll assess their B12 and we’ll address that, we’ll assess their omega-3, omega-6 fatty acids. And so I may have to supplement them if there are some nutritional balances, but I’m not going to ask people to go against their spiritual belief.

Jacob Gordon:
Yeah, of course.

Terry Wahls:
Yeah, that creates that, in terms of those personal resilience factors, you would create dissonance, and that’s just not going to work for them.

Jacob Gordon:
Absolutely, yeah. You don’t want someone to be thrown off the protocol just because of a minor thing like that.

Terry Wahls:
Correct, and that’s why I’m very careful to say that, yes, you can do this in a ketogenic way. You could also do it in a low saturated fat way, or you could do it in a vegan way or a paleo way. So the key point is to design a diet that’s maximally nutrient-dense, that will fix your mitochondria, fix your cell membranes.

Jacob Gordon:
In terms of cell membranes, what’s the best thing that people can do?

Terry Wahls:
Well, so get rid of the sugar, so that’s going to be really important. We want to have the omega-3, omega-6 fatty acid radio ideally 4:1. So we’ll add fish oil, and again, the amount that I add depends in part are you a low saturated fat person or not? And if we can do it, I like to add phosphatidylcholine. That can be very helpful as well. That will depend in part on the person’s financial resources, phosphatidylcholine.

Jacob Gordon:
Do you see any adverse reactions to phosphatidylcholine in your patients with autoimmunity?

Terry Wahls:
I think in all the years I’ve had one person report an adverse problem, that they developed a skin rash.

Jacob Gordon:
Okay, so I don’t mean necessarily allergic reaction. A lot of the clients that I’ve worked with, as well as myself, because I have this issue with cholinergics, and it seems to drive up my autoimmunity, as well as theirs, so that they get this worsening reaction.

Terry Wahls:
So for any supplement, when people start supplements one at a time, and if you start the supplement you perceive there is a problem, then you stop that. So I’m not sure why I’ve had less problem than you’ve had. Perhaps I’ve just been extraordinarily fortunate that way.

Jacob Gordon:
I was just curious about if there’s a mechanism I’ve missed.

Terry Wahls:
Well, apparently I’ve missed it too.

Jacob Gordon:
All right, great. How can people learn more information, where they can get your book and see this documentary?

Terry Wahls:
Oh yeah, so if you go to terrywahls.com, T-E-R-R-Y, Wahls, W-A-H-L-S.com, you can see my website. And if you add /diet, you get a one-page summary of the Wahls diet. Again, remind everyone the diet is just the beginning to a whole new way of thinking about life. For the documentary, I would go to defyingallodds.com, and there’ll be links there where you can purchase access to that, and-

Jacob Gordon:
And if they want to contact you?

Terry Wahls:
So we have ways of contacting us on the website, terrywahls.com. We have many types of programs to help support people in this healing journey. We intermittently do five-day challenges to help people get started. Our next one’s going to be starting in early January, and that can be really quite transformative. People can access that anywhere in the world. You can learn more about that at terrywahls.com/5day.

Jacob Gordon:
Is the research also on your website or public? Where can people read it?

Terry Wahls:
Yeah, so to get the research, the research is very exciting, you go to terrywahls.com/researchpapers. You can get access to all of the research that we’ve done. Can also see some of those really amazing video changes that are just so inspiring to see, the level of change.

Jacob Gordon:
And if a practitioner wants to get involved and learn more, or if a patient wants to find a practitioner that’s practicing those protocols and learn more, where can they do that?

Terry Wahls:
So we do have practitioners, if you look on terrywahls.com, on the resource pages. There’s a link, and you can search according to geography. You can also search according towards specialty and the particular type of concern, and we do train practitioners. So we have a certification program that’s appropriate for physicians, health coaches, chiropractors, nutrition professionals, movement professionals, better health professionals.

Terry Wahls:
We have new terms starting every quarter, and people are able to do that virtually. I think we have 25 or 29 different countries represented. So it’s virtual, online modules you can take at your own pace, plus the combination of sessions you have with me leading case discussions. And then once you get certified, you can be part of a monthly Zoom meeting with me, where we go through cases, answer questions, and we’ll have a guest lecturer or speaker to give a presentation. So that’s really a phenomenal, phenomenal resource.

Jacob Gordon:
That sounds like an amazing resource, that is phenomenal. Thank you so much for being on the show today, it was great having you.

Craig Tanio:
Thank you, Terry.

Terry Wahls:
Well, thank you. I love getting this information out.

Jacob Gordon:
Thanks, guys, for listening, and to learn more information about her protocol, I’ve written up a breakdown of her latest book and current research, which can be found on rezilirhealth.com or mybiohack.com. Thanks, guys, for listening, and I’ll catch you in the next episode.