Episode 145: Wahls Protocol Research Update

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Medical Research Into the Power of Diet and Lifestyle on Autoimmune Health

Dr. Terry Wahls is a physician with secondary progressive multiple sclerosis and creator of The Wahls Protocol. When diet and lifestyle changes made a dramatic difference in her own health, she was inspired to teach her protocol to others. She published her first book in 2010 and her Ted Talk went viral in 2011. But she didn’t stop there. She also began clinical trials to prove the efficacy of her protocol. Her first study was published in 2014, and there have been multiple studies since then. In this episode, we catch up on all the research.

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Show Notes

  • Intro (0:00)
  • Thank You to Our Podcast Sponsor: Paleo on the Go (1:51)
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  • Meet Dr. Wahls (3:01)
    • Dr. Terry Wahls is a physician with secondary progressive multiple sclerosis and creator of The Wahls Protocol. She is also a professor of medicine at the University of Iowa where she conducts clinical research. In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care and patient advocacy.
    • Her personal story: She was diagnosed with relapsing remitting MS. In spite of receiving the best medicine available, she developed secondary progressive MS 3 years later. No longer having the strength to sit up, she needed a tilt-recline wheelchair. She also experienced frequent trigeminal neuralgia (electrical face pain) as well as brain fog. She implemented the paleo diet alongside supplements, but continued to decline. It wasn’t until she developed a specific, nutrient-dense version of the paleo diet that her symptoms started to improve  Her pain reduced dramatically, her mental clarity returned, and her strength and mobility increased as well. She saw a physical therapist for exercise and electrical stimulation, and within 12 months, she no longer needed the wheelchair and was able to ride a bicycle.
  • What Is the Wahls Protocol? (5:22)
  • First Research Steps (7:27)
    • Step 1 was a Case Report, which described Dr. Terry’s story of decline, and her recovery through the Wahls Protocol.
    • Step 2 was a Case Series completed by her physical therapist. He implemented the same exercise and e-stim protocols with other patients with progressive MS and recorded the results.
    • Step 3 was a Single Arm Feasibility Study. The goal was to establish that the protocol is safe, that patients can do it, and if there are any changes in health, that they are positive. This study also focused on patients with progressive MS, but implemented the full Wahls Protocol (not just the PT component). All three goals of the study were met, and there were significant improvements in fatigue – far greater than expected – with a P value of <0.0008. Most of the patients at baseline were experiencing severe fatigue, and by the end of the study had moved into the moderate or mild range. For people with MS, fatigue is the leading cause of disability and loss of employment.
  • What Is a P Value? (9:35)
    • It’s a number that indicates the likelihood that the improvements shown in a study are due to chance. Scientists like to see a P value of <.05, which means there’s a only a 5% likelihood that the improvements were due to chance and a 95% likelihood that they were due to the interventions used in the study. In Dr. Wahls’ study referenced above, the P value was <0.0008, which means there was less than 1% chance the improvements in fatigue were due to chance, and a 99.92% likelihood they were due to the intervention.
    • Resource: Ep. 107 – Research: The Truth Behind the Headlines.
  • 2015 Pilot Study (12:24)
    • Since the feasibility study went well, the next study implemented the Wahls Protocol with a slightly larger group of people with progressive MS (20 patients this time).
    • The reason Dr. Wahls chose patients with progressive MS for these studies is two-fold. (1) With relapsing-remitting MS, periods of remission are expected. Critics could dismiss any improvements made. (2) With progressive MS, the expectation is that patients will decline an average of 20% each year. There is no expectation of improvement. If you are able to halt or slow the decline, that’s considered a success. If you can reverse the decline and show improvements, that’s remarkable. Dr. Wahls showed improvements in both studies. And the P value for this one was even better: <0.0005%.
    • The only “adverse event” that showed up in these studies was rapid weight loss in the patients who were most overweight. The research team tracked the weight loss and referred them to their primary care physicians. The result was usually a reduction in medication no longer needed (often blood pressure and blood sugar medications). Note: The Wahls Protocol has suggestions for people who need to gain weight as well as lose weight. No one became underweight in these studies.
  • 2017 Study Which Focused on Mood & Cognitive Improvements (17:00)
    • In this study, the Wahls Protocol was implemented with 19 patients with progressive MS. At the end of just 3 months, there were significant reductions in depression and anxiety. Cognitive improvements took longer, but at the end of 12 months, significant improvements were shown in both verbal and spatial reasoning.
    • There’s a reason the cognitive improvements take longer. Microglia are the immune cells in our brain, and when they’re inflamed, they do two things: they emit inflammatory compounds that cause mood disturbances, and they also overprune synaptic connections between neurons in our brain. When inflammation is reduced, the mood stabilizes more quickly, but it takes time for the brain to regrow the synapses again.
    • Dr. Wahls also looked at different aspects of the protocol to see if one had a stronger impact than the rest. In this small sample, diet was the most powerful, with the removal of inflammatory foods being most important, and adding nutrient-dense foods second important.
    • Resource: Ep. 140: Autoimmunity & the Brain.
  • 2017 Study Which Focused on Balance & Gait (24:15)
    • This study analyzed data from the pilot study with a new focus on balance and gait. Dr. Wahls tracks a lot of data in every study, and analyzes it as funding becomes available to do so.
    • 50% of patients experienced improvements, and 50% of patients had the normal decline expected of someone with progressive MS. However, the common medical belief is that no one with progressive MS can improve. So the fact that 50% of patients improved is remarkable.
    • The longer the disease duration and the lower the exercise capability, the less likely the patient would improve their balance and mobility. However, most did experience improvements in other areas (fatigue, mood, cognitive function). The two patients that didn’t improve at all had gone off the protocol.
  • Setting Yourself Up for Success (27:52)
  • Thank You to Our Podcast Sponsor: ShopAIP (30:09)
    • If you’re curious about the difference between the Wahls Protocol and the Paleo Autoimmune Protocol (AIP), there’s a lot of overlap. They’re both nutrient-dense, anti-inflammatory diets designed to reverse autoimmune disease. The AIP is an elimination diet, so it’s more restrictive than the Wahls Protocol for a short time, and then people personalize their diet through the reintroduction process. ShopAIP is a great resource for both diets. Visit their website to browse the full selection.
    • ShopAIP is an online store dedicated to the Paleo Autoimmune Protocol. With hundreds of items for the elimination phase of the AIP, and new products labeled by reintroduction category as well. You can find protein bars, sauces and condiments, AIP-friendly spices, cooking and baking ingredients, delicious snacks, non-toxic skincare, and more.
    • If you’re a first-time customer, use the code PHOENIX for 10% off your order. Purchase here.
  • The First Randomized Control Trial for the Wahls Protocol (31:22)
    • This study was also published in 2017, but this time the patients had relapsing-remitting MS. And instead of implementing the entire Wahls Protocol, they implemented the diet only. (The Wahls Protocol offers 3 levels of dietary options. All research studies have used level 2: Wahls Paleo.) This study was also shorter – just 12 weeks instead of a year. These changes were at the funder’s request. Dr. Terry prefers studies that implement the entire Wahls Protocol, but research is expensive, and many funders prefer a simpler intervention.
    • A randomized control trial is the gold standard for clinical research. The treatment group is compared to a control group of patients who don’t receive the intervention. In this trial, they used a waitlist control. People were randomized into one of the groups, and those who didn’t get into the Wahls group were supposed to wait 12 weeks and then they would be trained on the diet, too. The problem was that people didn’t want to wait, so many dropped out the study and bought Terry’s book so they could implement the diet on their own. This resulted in a smaller study than intended: 17 people total (8 in the treatment group and 9 in the control group).
    • The results of the study were remarkable. In just 12 weeks of implementing the diet-only, patients experienced significant improvements: reduced fatigue, improved quality of life, and even some improvements in walking speed and distance, as well as hand coordination. Dr. Terry does notice that people with relapsing-remitting MS respond faster than people with progressive MS, because they don’t have as much damage to the brain and spinal cord.
  • 2019 Nutrition Studies (37:10)
    • Anytime a diet removes food groups, the concern is that nutrient deficiencies will develop which worsen health over time. Dr. Wahls agrees that nutrient deficiencies need to be avoided, but she also knew that her diet was nutrient-dense. So, she did two studies. The first study compared the Wahls Paleo Diet to the RDA (dietary guidelines for Americans.) The second study compared The Swank Diet to the RDA. The Swank Diet is a low-fat diet often recommended for people with MS. The Swank Diet matched US dietary guidelines. Wahls Paleo was given a warning for removing food groups (which was expected). But when nutrients were compared, Wahls Paleo came out on top for most vitamins and minerals. See Table 5 of the study for details. The only exceptions were calcium and choline. (To increase your intake of these vitamins, eat liver for choline, and sardines and greens for calcium.) Even when the diet was modeled at only 60% compliance, it still met most of the nutrient guidelines of the RDA.
    • She also did a study looking at lipid profiles. After 12 months on the Wahls Paleo diet, total cholesterol of MS patients decreased, triglycerides also decreased, and good cholesterol (HDL) increased on the diet. Prior research has found a correlation between high HDL and better MS outcomes. Dr. Wahls’ study found the same – higher HDL was associated with better improvements in fatigue.
  • Current Study Comparing the Wahls Paleo & Swank Diets (44:14)
    • Funded by a $1 million grant from the National MS Society, this is the largest Wahls study to-date. It includes 100 patients with relapsing-remitting MS (50 following the Wahls Paleo Diet and 50 following the Swank Diet).
    • It’s a blind, randomized trial. Dr. Terry doesn’t know which participant is doing which diet. A statistician will be analyzing the data, and they won’t know the dietary assignments either. The results will go directly to the National MS Society, and then the MS Society will share the results.
    • Update 2021: The results are now available. Both diets ended up improving symptoms by reducing fatigue and improving physical quality of life. While quite different from each other, both diets reduce processed foods and increase fresh fruits and vegetables, showing that those basic changes can lead to improved health. BUT the Wahls Protocol was the only one that also improved mental health symptoms (both mood and cognition). Link to the study. Link to a summary by the National MS Society.
  • Future Research (48:32)
    • The Wahls Research Fund recently received a $2 million gift to fund a clinical trial comparing the Wahls Protocol to standard drug treatment for newly diagnosed patients with relapsing remitting MS.
  • Donate to the Wahls Research Fund (49:43)
    • If you would like to support this work, you can donate here.
  • What’s New in the Revised Expanded Edition of the Book? (50:11)
    • She just published the 5th Anniversary Edition of the Wahls Protocol.
    • 1/3 of the material is new, including research updates on the Wahls Protocol and also the fields of epigenetics, the microbiome, neuroplasticity, fasting, and ketosis. There’s also a larger section on behavior change and setting yourself up for success.
    • Buy your copy here.
  • Outro (52:07)
    • You can connect with Dr. Terry Wahls through her website. Sign up for her newsletter to receive a weekly summary of what’s happening worldwide in the field of autoimmune research.
    • Eileen (your podcast host) is the author of multiple books, written to help people thrive with autoimmune disease. Learn more on the Books Page.
    • If you like this podcast, follow or subscribe through your favorite podcast app. You can also subscribe to Eileen’s biweekly newsletter.
    • Check out the entire archive of podcast episodes.

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