Episode 344: Special Guest: Dr. Terry Wahls, The Wahls Protocol, Multiple Sclerosis & Other Autoimmune Diseases, Food Sensitivity Testing, Muscle Electrostimulation, Fasting, Trauma, And More!

Intermittent Fasting


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Nov 19

Welcome to Episode 344 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine and Vanessa Spina, author of Keto Essentials: 150 Ketogenic Recipes to Revitalize, Heal, and Shed Weight.

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

The Melanie Avalon Biohacking Podcast Episode #207 - Terry Wahls

Listener Feedback: Brooke - My mother passed away about 5 years ago from MS...

Terry's Personal Story

Listener Q&A: Brittani - How to find the trigger [of MS]?


Listener Q&A:  Nisha - Are there certain genes that are associated with autoimmune disorders? 

Listener Q&A: Lorena - I had been under the impression that olive oil is very healthy but I received an email claiming it isn’t...

Wahls’ Research Papers And Gait Videos

Listener Q&A: Marina - Can she explain why she doesn’t feel being vegan/vegetarian is conducive to drastically improving autoimmune conditions?

food sensitivity testing

Listener Q&A: Jackie - Is Carnivore the best way to overcome auto immune disease?

Listener Q&A: Bethany - How can a low income person living on his own improve - what’s the first couple steps.

Listener Q&A: Claire - How Much Is Related To Unresolved Emotional Trauma?

The Melanie Avalon Biohacking Podcast #191 - Gabor Mate, MD

Learn more about her MS clinical trials here: Research Opportunity for Individuals Diagnosed with Relapsing-Remitting Multiple Sclerosis!

Follow Terry on Instagram @drterrywahls

Our content does not constitute an attempt to practice medicine and does not establish a doctor-patient relationship. Please consult a qualified healthcare provider for medical advice and answers to personal health questions.


Melanie Avalon: Welcome to Episode 344 of The Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat not what you eat with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker, author of What When Wine, and creator of the supplement line AvalonX. And I'm here with my cohost, Vanessa Spina, sports nutrition specialist, author of Keto Essentials, and creator of the Tone breath ketone analyzer and Tone LUX red light therapy panels. For more on us, check out ifpodcast.com, melanieavalon.com, and ketogenicgirl.com. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment. To be featured on the show, email us your questions to questions@ifpodcast.com. We would love to hear from you. So, pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time and get ready for The Intermittent Fasting Podcast.

Hi, friends. Welcome back to the show. We have a very special guest today here on The Intermittent Fasting Podcast. So, I am here with Dr. Terry Wahls and I've actually interviewed Dr. Wahls twice on the Melanie Avalon Biohacking Podcast, so I will put links to that in the show notes. But Dr. Wahls is honestly just a legend in the functional health world, the world of autoimmune disease and MS and she's doing really, really incredible things. She almost needs no introduction, but she is an institute for Functional Medicine Certified Practitioner, a clinical professor of medicine at the University of Iowa, where she conducts clinical trials in the setting of multiple sclerosis. She actually, right now, is doing a study that I'm really excited to talk about with you guys.

We'll dive into it in today's episode, but it has to do with the effects of different diet protocols on MS. And one of those arms in the study does include fasting, so that's very, very exciting. And she's also the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, as well as the cookbook, The Wahls Protocol Cooking for Life. I actually asked the audience for questions for Dr. Wahls for all things related to what she's working on and her studies. So, I have a lot of questions from you listeners. I thought I would start off.

I got some feedback from the last show when I aired it on the Melanie Avalon Biohacking Podcast. So, Brooke actually just wanted to share with you, Dr. Wahls. She said, “My mother passed away about five years ago from MS. Unfortunately, back then, I thought it was just a medical diagnosis and there wasn't anything that could be done to help. This episode was full of great information. I wish I could go back in time. Maybe, I could have helped my mother with her MS with the knowledge I have gained since then. I am so thankful to Dr. Wahls that she's out there making a difference for those struggling with MS and other autoimmune conditions. Thank you, Melanie, for helping her spread the word.” And that's just one of many. I got so much good feedback after listening to the interviews with you, so we're all just so grateful for your work and I have a lot of questions for you. So, Dr. Wahls, thank you so much for being here. 

Terry Wahls: Thank you for the work that you do.

Melanie Avalon:  Thank you. To start things off, like I said, I will put links to the other episodes, but because this is the first time on this show, can you tell listeners a little bit about your personal story? It's very haunting. What led to what you're doing today?

Terry Wahls: Sure. During medical school, I started having electrical face pain and nothing would help it. It would get progressively more troublesome. Seven years later, I had an episode of dim vision while out rollerblading on a hot August day, saw a neurology eye, no clear explanation, and I let it go. Then I continued to have worsening face pain. I would see back neurology many times to the pain clinic multiple times. 13 years after the episode of dim vision, I developed weakness in my left leg, saw the neurologist, began a workup that would take about three weeks. And during that three-week time, I thought about the already 20 years of worsening electrical face pain. I knew that I had a progressive disease. I did not want to become disabled. And so, actually, I was secretly hoping for a rapidly fatal diagnosis. I heard multiple sclerosis.

I did my research. I found the very best MS Center in the United States, saw their best physician, took the newest drugs. At 45 had diagnosis. Three years later, at age 48, I'm in a tilt reclined wheelchair. I take mitoxantrone in a form of chemotherapy. Then I take Tysabri, the new biologic that we're also excited about. That doesn't help either. Then I'm switched to CellCept, another form of immune suppression. And then it's very clear how terrible things are going to be. And that's when I decided to start reading the basic science to see am I really doing all that I can? I decide that mitochondrial dysfunction is what drives disability in the progressive phase of the illness. So, I end up creating a supplement cocktail for my mitochondria.

After six months, because I'm no better, I quit all my supplements, and I discover that I really can't function at all without my supplements. So, three days later, I start the supplements again. My energy gets back to my usual level, I can get back to work, and I'm thrilled. So, I start reading more and more. I'm adding more supplements, but I'm still declining. By 2007, I cannot sit up in a regular chair. I'm in a zero-gravity chair with my knees higher than my nose. I can take just a few steps with two walking sticks. I'm beginning to have brain fog. My electrical face pain is more relentless, far more difficult to turn off. That's why I discovered the Institute for Functional Medicine. I have a longer list of supplements which I add.

I discover electrical stimulation of muscles as another tool to add to my rehab. I convinced my physical therapist to let me try that. We add it now. At this time, I can do 10 minutes of very simple mat exercises. I'm now doing electrical stimulation of muscles while I do that. And then I had the SAHA and Melanie I really laugh at myself, like how long it took to have the SAHA. I'd been doing a paleo diet, basically the autoimmune protocol, for five years. And I thought, well, what if I redesign my paleo diet based on the list of supplements that I was taking and figure out where they are in the food supply. They'd probably get more really important good stuff. So, there're a few more months of research and I start this new way of eating December 26, 2007.

Now, at that time, I can only sit up about 10 minutes which, by the way, is the definition of being bedridden and beginning to have brain fog. My electrical face pain is far more difficult to turn off. So, it's clear to me I'm going on a track to become bedridden, demented, and probably die with intractable pain. And then I start this new focused way of eating. I'm still doing my supplements. I'm still doing the electrical stimulation of muscles. But by the end of January, four weeks later, it's clear that my pain is less, my mental clarity's improved, and I feel like I can sit up better. In fact, I tell Jackie, my wife, that I want to try sitting in a regular chair for supper and I can do that. First time in many years I've sat with my family at supper huge, huge.

Then in February, I begin walking with walking sticks in the VA Hospital, stunning my colleagues. And then by March, I'm walking with one walking stick. And then April, no walking sticks. And then on Mother's Day, I tell my family, “I really want to try riding my bike,” which I've not done in six years. So, we have an emergency family meeting. Jackie tells my 16-year-old son, who's 6’5”. “Zach, you run alongside on the left.” And she tells my daughter, “Zeb, who's 13, that she should run along on the right,” and she'll follow. And we all get in a position, and she tells me “I can push off” and I bike around the block. And that 16-year-old boy, he's crying. The 13-year-old girl, she's crying. Jackie's crying.

When I relive that moment, even now, I still cry, because that was the moment that who knows how much recovery might be possible? Because I had accepted that when you have secondary progressive MS, functions once lost are gone forever and that it would never come back. But who knew how much recovery might be possible? And so, I'd bike a little bit more every day. And then in October, Jackie says, “Well, I've signed you up for the courage ride. It's 18.5 miles. However far you go will be a triumph.” And when I cross that finish line, we're all crying. My kids are crying. Jackie's crying. I'm crying. And I still cry now, reliving that moment, it really changed how I practice medicine. It will change the focus of my research.

And I've made it my mission to change the standard of care so that when people are diagnosed with MS or any neuroimmune condition, any autoimmune condition that has neurologic or psychiatric symptoms that they may be told, “Yep, we have good disease modifying drug treatments.” But just as important as the DMTs is addressing diet and lifestyle. So, here I am.

Melanie Avalon: Wow. It's so powerful. I'm just thinking about how when I opened that question with Brooke, she was saying the exact same thing about how, at the time, she thought there was nothing that can be done. This is just so incredibly empowering. So, going to the cause of all of this, because Brittany says, “For example, how do you find the trigger?” She says that, “Regular medicine says, we're just not sure why some bodies start acting on themselves, but obviously, something causes the shift.” And then people were really interested when I interviewed last about, you were talking about the role of uncleared infections as a potential creation here. Sandy wanted to know, “Are they usually triggered by pathogens?” Leslie said, “She was shocked when she learned about uncleared infections contributing to the disease.” So, just in general, what is actually leading to these conditions. And do the conditions of MS apply to most autoimmune conditions? 

Terry Wahls: Well, hundreds of years ago, it was a revolutionary idea that germs cause disease. And there's a thing called Koch's postulates that you had four steps you had to go through. A [unintelligible 00:11:13] had to culture the bacteria, then you inoculate a healthy person, cause a disease, culture the bacteria again, it has to be the same as the original bacteria, and then you could say that bacteria caused that particular disease. It was a revolutionary concept that, unfortunately, let us begin to think that we'd find a precise cause for all chronic complex diseases, and that's not the case. And because we can't find that one bacterial cause, we keep saying we don't know what causes autoimmunity. I and those of us in the functional medicine world will come back and say, “Well, okay, so what do we know?”

We know that you have to have the genes that put you at risk. And for each autoimmune disease, there are about 300 genes that we know increase the risk a little bit. It's usually one-half percent, a percent, occasionally as much as a 10% increase for that particular gene. Step two is infections. And we know for MS, there are 16 different microbes, bacteria, and viruses that increase the risk. And literally, it's the rare person that hasn't had at least one, and probably multiple infections with those microbes. And once you get those microbes, they're never completely gone. Our immune system just controls them. And then the third step is all these environmental factors that my conventional colleagues say, “Well, we have no idea what they are.” I say, “We know all these factors that influence the health we have or don't have.”

So, my approach and my practice is, I'm going to take all the environmental factors and help you point them towards health-promoting behaviors away from disease-promoting behaviors. And in so doing, we often discover the person becomes steadily healthier. Blood pressures improve, blood sugars improve, pain reduces, anxiety reduces, depression reduces. The need for prescription medication declines. And when you go see your specialist they say, “Well, whatever you're doing, keep it up,” because everything's stable. So, I focus on creating health. I let the specialist treat disease. I warn them that you have to watch any prescription medication that you're using closely so you don't overmedicate your patients. And I focus on teaching people how to create steadily healthier microenvironments for their cells.

Melanie Avalon: I love this. And actually, speaking of the medications, because you mentioned being on the biologics earlier, and Lori wanted to know “How does being on a biologic medication long term affect your body?” So even the meds that you are on, is there a lingering effect from those? 

Terry Wahls: Oh, sure. So, I took Novantrone, several rounds of Novantrone. Each time you take Novantrone, there's a 2% risk of acute leukemia. Fortunately, that did not happen. There's also cumulative damage to your heart. So, I probably have a less effective cardiac reserve than I might have had if I'd never taken Novantrone. So, I have that residual. All of the immune suppressing drugs that you take for any autoimmune condition interfere with some aspect of my immune system. So, I have fewer numbers of new enhancing lesions on an MRI, which is how you get approval for that drug for MS. And you have to have, if it's a disease-modifying drug for other disease states, it would be approved according to some concrete biologic indicator of that disease state.

However, what I want to point out to everyone is over the age of 40, our immune cells are gradually less effective and that's part of the aging process. Over the age of 50, again, another step down, over the age of 60, markedly less effective which is why over the age of 60, there's a much higher rate of infections. Pneumonia begins to be much more lethal and a much higher rate of cancers, because my immune cells can't protect me as well from cancers and infections, which means these drugs that suppress my immune system under the age of 40 are very helpful at reducing the severity of MS in terms of the number of new lesions, the severity of autoimmune diseases, but they'll increase the risk of infections and cancers over the age of 50, 55, and 60.

And there's a lot of debate at what age do these immune suppressing drugs create more harm than benefit? In the MS world, there are a number of stopping studies where people are being randomized to stay on their DMT or go off their DMT, being at age 50, 55, 60, and 65. And those studies are beginning to come in to try and give the neurologists some view when they should stop their drug. What is so disappointing is that none of these studies have utilized the creation of health, improving the diet, the meditation, the exercise, the selfcare routine as part of the way to make it safer to stop the disease-modifying drug treatments. We've written multiple grants trying to get funding for a safer way to do stopping studies. Unfortunately, our grant proposals were never funded.

Melanie Avalon: One last drug question, what about rapamycin which some people actually take for life extension benefits in, like, the biohacking world? 

Terry Wahls: Yeah, that's an interesting question. I can't comment as to that I have any research that says what it's going to do for MS or autoimmunity in general. When I look at the strategies that we use for longevity, I think those are strategies that will likely be very beneficial for people with an autoimmune condition and MS. And certainly, I've been working on my biohacking because my goal is to still be doing research at 120, still having medical students, postdoc students in my lab doing the interesting research that we'll be doing in another 60 years.

Melanie Avalon: I'm just so fascinated by rapamycin. I'm always researching it and listening to podcasts about it. Two questions about what you just went through with the genes, the infections, and the other factors. So, with the genes. So, you answered Nisha's question. She said, “Are there certain genes that are associated with autoimmune diseases?” So, do you recommend people do any genetic testing for autoimmune conditions? Or is that more just data for us looking for solutions?

Terry Wahls: If you have an autoimmune condition, you've got probably several of these genes that increase your risk. If you're curious, you certainly can do genetic testing. However, most important is address all of your environmental factors. I think it can be helpful. I do like to have my folks understand some of their genetic risks. For example, ApoE4. If you are ApoE4 positive, if you elect to do a ketogenic diet, which I think is still fine, the diet I want you to do is the olive oil-based ketogenic diet, the diet that we use in our clinical trial. And in fact, I've been moving more and more into the olive oil-based ketogenic diet for all of my patients because I think it's more heart friendly.

And I just think olive oil is a really wonderful, health-promoting Omega-9 oil that the research is very strong, that the more olive oil you have, particularly if you have it cold, that it lowers the risk of cognitive decline of dementia, heart disease, all-cause mortality. Those are all great things.

Melanie Avalon: To that point. Lorena, she said, “I've been under the impression that olive oil is very healthy, but I received an email claiming it isn't.” This is me talking I feel like there's always some email saying something. She was curious about the comparison between olive oil and coconut oil. And actually, maybe this will be a good time to talk about the setup of the study that you're doing and how you came up with those diets. 

Terry Wahls: Okay, so olive oil, particularly if you have it cold, we have just so much research about the health benefits of olive oil from observational studies and interventional studies. The coconut oil is a medium chain triglyceride. It's fully saturated, there's no double bonds. It is heat stable. It is delicious. If you are in a medium chain triglyceride ketogenic diet, you get to have more carbs, more like 80 g of carbs, and you're still in ketosis. If you are using either butter, cream, or olive oil then you have to have 30 g of carbs. That's pretty hard. We chose olive oil over butter because I think butter, eggs, cream have at least a significant risk of unrecognized food sensitivities that can still happen with olive and olive oil, but it's much less frequent than with butter and eggs.

And if you combine the olive oil with time-restricted eating so that you have like a six to eight-hour eating window, we find that we can get people into ketosis with about 50 g of carbs. Occasionally you have to take it down to 45 or 40 g, but the vast majority, they can be in ketosis with 50 g of carbs. And that's a much easier diet. It also lets people have, I think, a healthier microbiome.

Melanie Avalon: So, the inclusion of fasting in the olive oil arm, was it more to look at the role of fasting, or was it more because you wanted to create that ketogenic state?

Terry Wahls: I wanted to get the ketogenic state. 

Melanie Avalon: Okay, that's really interesting. 

Terry Wahls: I'll talk a little bit more about the study. So, it is a study comparing the time restricted olive oil ketogenic diet and a modified paleo elimination diet, which is the diet that people know and love as basically the Wahls diet, the paleo version without night shades and grains to usual diet. People come in at month zero, month three, and month 24, the control arm, people follow the usual diet. We give them monthly tips on things they could do to improve their diet that they could follow or ignore. The reason that people do not get to choose which diet they're in is that we're having a randomized, controlled study design. And in diet studies, the controlled diet is either the government dietary guidelines or usual diet.

We knew for sure that people coming to my study would prefer to follow the usual diet to the government guidelines diet. Therefore, we have the paleo diet, the keto diet, the usual diet. You have to be willing to be randomized such that whatever you're eating now, whether it's keto, paleo, mediterranean, vegetarian, vegan, intermittent fasting, that if you get randomized to one of the intervention arms, you will follow that diet and you'll follow it for two years. And if you're randomized to the control arm, the usual diet, you get to keep eating what you want to be eating for the two years. We'll have patient reported outcomes on fatigue, quality of life, mood. We'll have clinical outcomes on walking, hand, vision function, and we will have MRI data at baseline in 24 months. So, these are research MRIs, no contrast. 

That will let us know, can we get people to healthy rates of brain aging over this two-year period? Because people with MS, as a group, our brains are shrinking at about 1% per year, which is why, as a group, we have higher rates of cognitive decline, anxiety, depression, job loss, frailty, needing assisted living, and nursing home care.

Melanie Avalon: So, people who are randomly assigned to the control diet, they can still eat what they were eating. They don't have to eat the standard American diet.

Terry Wahls: Oh, no, no. That people who enters dietary studies, they do that because they want to improve their diet. They never follow the standard American diet. Their diets are always better than the average usual American diet. What? It simply means that they can make whatever dietary changes they feel like making.

Melanie Avalon: Just hearing the timeline of this. So, two questions. What are you most testing here? Because those three diet arms, like I said, one has fasting and olive oil, and then like what are you isolating? 

Terry Wahls: The primary outcome is, can we improve quality of life by changing what people eat? We're comparing baseline to six-month quality-of-life changes. We follow people for two years to see, can they keep this diet up for two years? Do the gains that we see at six months continue? Do they continue to improve further over two years? We don't know. There are reasons to think that the ketogenic diet may be superior to the paleo diet. But there are also reasons to think the paleo diet may be superior to the keto diet. We know full well. In my consent, I have to describe both diets that people in the usual care arm may say, like, “I got a bad disease, I'm going to change my diet.”

And they're going to start reading, making their own decisions about how they can improve their diet as well. That's part of why we do several dietary assessments throughout the study to know what people are eating. We'll also ask them at the end of the study to describe how they would describe their diet? Do they describe their diet as a keto diet, a paleo diet, a fasting diet, mediterranean diet? We'll give them quite a number of options for them to describe how they would self-describe the diet they're eating. We're doing this diet assessment, so we'll know according to their dietary assessment, were they adherent to a keto diet, a paleo diet, or some other dietary plan? 

Melanie Avalon: Is it powered to detect within the individual groups? Is it possible that some people might do better one version but not the other? 

Terry Wahls: We have 156 people that we will have in the study. So, it's powered to detect changes at six months between the keto diet and the paleo diet and the usual diet. It'll be one of the largest, longest diet studies that will have been done to date.

Melanie Avalon: That's cool. That's awesome. 

Terry Wahls: And we're super excited that we have MRIs and that we are running it two years so we can see change in brain volume. Again, I think this will be the longest diet intervention study that has change in brain volume as one of the outcomes.

Melanie Avalon: That is so cool. And just a comment on the MRI piece, because I had an MRI recently and I felt so silly because I was associating MRIs with x-ray machines and CAT scans. So, I was really concerned about radiation. I didn't realize with MRI that's not a concern. So, I just want to put that out there for people. 

Terry Wahls: Right. There's no radiation and there's no gadolinium, so there's no contrast. It's a more powerful magnet that the research MRI uses as compared to the magnets that clinical studies use.

Melanie Avalon: I just felt so silly because I just assumed that. And so that was good for me to know. So, what would have to-- I'm really curious because you talked in the past about one of your studies where it was a small trial with only 10 people or so, but you got statistically significant results because it was so profound. 

Terry Wahls: Yeah. Our very first study, which is a safety and feasibility study in people with progressive MS, secondary progressive, primary progressive and we basically did the same protocol I'd use for myself, diet, supplements, meditation, exercise, and electrical stimulation of muscles. So, the big question is, could people do this complicated regimen who were actually quite disabled there? The average disability was between cane and walker, and then what was the effect size? If they did. So, it was quite striking. 90% of the days they were following the diet, there was an average of 13 minutes a day of meditation and 20 minutes a day of exercise and an hour of electrical stimulation of muscles, really quite remarkable. And the drop in fatigue severity was 2.38 on a 7-point scale, the clinical significant change is 0.45, and the p-value is 0.0008.

Melanie Avalon: And so, for listeners-- [laughs] the implications, what does that mean for listeners?

Terry Wahls: If they have p-value of less than 0.05 and we call that statistically significant. And then if it's less than 0.01, that's really quite significant. If it's less than 0.001, very significant. But we were 0.0008.

Melanie Avalon: Wow. 

Terry Wahls: It's really quite remarkable. And every study that we've done, then we powered up to 20 and the p-value was still 0.0005. So, a little more powerful. Then we started doing randomized controlled studies with a weightless control. And consistently, we could see that fatigue goes down, quality of life goes up, mood improves, and hand function improves. Hand function improves at about three months to six months, walking function takes longer that’s about a year to improve. We are in the process of publishing a paper about measured disability, which is a sum of walking function, hand function, and working memory from our study that compared the Swank diet and the Wahls diet. That was very exciting. That paper has been accepted and it will be available soon.

So, if people will want to come to my webpage, terrywahls.com/researchpapers, so you could get copies of the various papers that we've published. And when that is finally over the line and published probably in the next couple of weeks, we'll add that paper to our library of papers that you can get at the research paper.

Melanie Avalon: Well, we will definitely put links to that in the show notes. And the Swank diet. It's a low-fat diet. 

Terry Wahls: Yeah, it's a low-fat diet. When we studied that, we actually improved that diet because we wanted people to stress whole grains and to have at least four servings of vegetables every day. The original Swank diet just said less than 15 g of saturated fat. Eat the sugar that you want. He didn't stress the whole grains nor did he stress vegetables.

Melanie Avalon: We do have,actually some more questions about diet in general with all of this. But before that, the reason I was curious about the 10 studies with the statistical significance with this study, because it's such a long study, like you were saying, could there be a situation where you realize earlier that the effects are so dramatic that you'd have to stop the study?

Terry Wahls: Well, you do have a data safety monitoring board that we as a matter of fact, I'm meeting with them in two weeks. They review our progress, our recruiting progress, outcome, data thus far. And the most common issue is that they just want to be sure we aren't hurting people. And if we're hurting people, then study gets stopped. Very occasionally, studies are stopped early because you've already answered the question, people are being helped. I think that's unlikely and if they try to stop it because the six months study is met before everyone's finished the two years, I will try very hard to let them-- to convince them to let us finish the study so we could answer the questions about what's happening with the MRI. 

Melanie Avalon: I'm just thinking of like the PREDIMED study, which was olive oil.

Terry Wahls: Again, olive oil. There are so many wonderful studies about the benefits of olive oil. If we had only an olive oil intervention without MRIs, that certainly could happen that we'd be stopped early and say, “Okay,” they're clearly being superior and that could happen. But I would certainly try to convince them the benefits of letting us get to the MRI outcomes would be huge for society.

Melanie Avalon: Okay, that makes sense. So, basically, since this is all hypothetical, but because you have these other questions you're looking to answer, that would require longer time,

Terry Wahls: That would require longer time and the DSMB looks at the benefits to society for continuing the study to answer these additional questions. 

Melanie Avalon: Oh, I didn't know that. Okay, I'm learning so much. Okay. So, yeah, as I mentioned there were more diet-related questions. Marina wanted to know, do you feel being vegetarian or vegan puts you at a greater risk of developing an autoimmune condition? If so, why? And can you explain why you don't feel vegan or vegetarian is conducive to drastically improving autoimmune conditions. She says you can be vegetarian at her level 1 protocol, but not the more advanced levels. 

Terry Wahls: So, absolutely, we recognize that there are people who are vegetarian or vegan for their deeply held ethical and spiritual beliefs. And in my clinical practice, I work with those folks to be sure that they are nutritionally sound and that we address any food sensitivity issues. To understand that, you can do a food sensitivity screen and identify do they have food sensitivity to grain or legumes and address that. In general, I prefer that people have a higher protein diet. The protein needs 0.7 g/kg of body weight. If you're over the age of 60, that goes up to 1.2 g of protein per body weight. And then I want you to have the green sulfur in color proportionately after you've had sufficient protein, and ideally, if you'll tolerate fermented foods, because of the tremendous benefits to your microbiome.

When I've created the Wahls diet plans, we have people who can enter in and make changes at a pace that they and their family can implement. So, we start at level 1, then we go on to a more paleo diet with higher protein and adding some fermented foods, organ meats, and then for people who have cancers, seizure disorders, cognitive decline, then I want a lower carb diet and a more ketogenic diet. However, I also make clear from our evolutionary history, for millions of years, humans were in ketosis on the basis of how much physical work it took to gather our food. We would have a successful hunt or forage. We would have a higher protein refeed. And then when we ran out of food, we had to go back out and work hard to get our food again. 

So, we would go back and forth between being in ketosis and a higher protein refed state. So long term for the rest of your life, I feel best about putting people in a ketogenic, high protein, then ketogenic, higher protein, going back and forth with metabolic switching.

Melanie Avalon: We are all about protein on this show and my co-host, Vanessa Spina, she's interviewed you. I think she's also the host of the Optimal Protein Podcast. So, we're all about this. How about on the-- actually really quick comment on the food sensitivity piece? I just met a company recently, and they do food sensitivity testing, and they actually test IgE, IgG, IgG-4, and C3d. Have you heard of this more extensive testing for food sensitivities?

Terry Wahls: I have not. So, I don't know that last term, so I can't comment to that. I want your audience to know that in my practice at the VA, I had no access to any of the functional medicine testing. I could just do basic primary care stuff, lipids, glucose, A1c, insulin, homocysteine, vitamin D. And I was thrilled to finally get to do that. So, since I couldn't do any food sensitivity testing, what I could do was an elimination diet. Start people on level 1, level 2. If they didn't get the results that we were hoping for, then we'd put them on an elimination diet and take out night shades, grains, legumes, nuts and seeds, and then reintroduce them. Things that we were being missed one at a time. It's a longer, slower process to figure out to what you are sensitive.

But we couldn't do food sensitivity testing. And what I saw was the vast majority of folks did really great at Wahls level 1 or level 2 and did not need to go to food sensitivity testing. People who had joint involvement or gut involvement, so like rheumatoid arthritis, inflammatory bowel disease, I would try and convince them to do an elimination diet right away, because they almost certainly were going to have problems with grains, legumes, and night shades. And they'd do better if they would do the elimination diet for three to six months and then we would gradually liberalize it, and they would do very well. Again, all of that without food sensitivity testing. 

Melanie Avalon: Well, actually to that point, on the carnivore sphere, Jackie wanted to know, “Is carnivore the best way to overcome autoimmune disease?” I'm wondering, for carnivore, do you think its benefits are elimination?

Terry Wahls: So, the carnivore is probably another version of an elimination diet. The downside of the carnivore is they have yet to publish in a peer-reviewed journal, a case report, a case series, or a single arm study, which means there is no published research that tells us who the right patient is, what you need to follow, what are the risks, what are the hazards, how you get people on this, and I certainly have people who've been on the carnivore diet who have not done well and are [unintelligible 00:38:36] reintroduce plants, and it's a long and slow process. I've chatted multiple times with the carnivore people offering to help write a case report, a case series, or help with a clinical trial. So far, that's not worked out. I hope that sometime they will, so that we could understand how it fits in.

And, in fact, there may be people for whom a carnivore diet may be helpful, but without published peer-reviewed research, we don't know how to use it.

Melanie Avalon: Wow, that would be amazing. I have some ideas for that. [laughs] I'll circle back. So, the fasting, because we talked about the role of fasting in the trial and its purpose in creating that ketogenic state. This is The intermittent Fasting Podcast. Nicole wanted to know, “Is fasting helpful for MS.” Amanda wanted to know specifics about how fasting may help. So, fasting as a therapeutic tool. 

Terry Wahls: This is the concept of hormesis, where we give our cells mild to moderate stress for a period from which they can fully recover and then we stress them again. And the way to think about this is when you put someone in space where they're weightless and there's no stress on the bones or joints or you put them in bed rest because they were sick, they rapidly decondition, and it's really terrible for their health, for their bones, density, you’ve ever had a cast, your muscles shrink very rapidly. Huge problem. And air conditioning, central heating huge problem for us in terms of our ability to regulate our temperature carefully. It's like being on bed rest. Eating all the time is the same thing, like being in space, terrible for us. It reduces our flexibility with controlling our blood sugars. 

So intermittent fasting, not having food for a period, helps improve our ability to shift between burning fat or burning amino acids or burning sugar in our mitochondria. Really good for you. You want to have a little stress from which your cells can fully recover. In my clinical practice, I ask people to adapt time restrictive eating and intermittent fasting at a pace that is comfortable for them with the concept a little stress from which you can fully recover. And then as you get older, you can go on to a 24-hour water fast, a 36-hour water fast, a 48-hour water fast. I don't want people to go longer than that because then you're going to start using your muscles to run everything and that's pretty terrible.

What is probably preferable in my mind is reduced calories so that an intermittent calorie restriction or 5:2 intermittent fast gets you the benefit of that hormetic stress without using up your proteins to continue to run the biology of life.

Melanie Avalon: Awesome. Okay. I think listeners will love hearing that and going back to the implementation because you were talking earlier about doing it with a family and all of that. And Bethany had a specific question, but I think it can relate to a broader question as well. She said, talking about the episode that you're on my other show. She said, “This episode gives so much hope. We have a friend who is going downhill, but he won't do too much about his diet due to cost and trying to cook when he's not doing well. We're trying to figure out how to help him one step at a time. How can a low-income person living on his own improve? What's the first couple steps? So, people who are struggling with the income issue or actually implementing this.

Terry Wahls: I want to remind everyone that I ran a clinic, the VI Therapeutic Lifestyle Clinic, our patients were disabled living on food stamps. We taught them these concepts and they learned how to implement these concepts living on food stamps, helping them learn how to cook, to meal plan, make soups and stews in a slow cooker can be very, very helpful. Here in the Midwest, there are many communities have far too many deer and have controlled deer hunts, so there's free venison. Many communities have hunters who have lots of venison that they're happy to share that helps with getting sufficient protein. We did teach people how to have vegetarian meals with legumes and gluten-free grains, again to make it more affordable. Doing intermittent fasting, doing meditation, mindfulness, gratitude practice, exercise. These are things that you can begin doing that don't cost more than your time and attention.

Melanie Avalon: Actually, to that last point, so many people wanted to know the role of potential unresolved trauma in these conditions. Claire said, “She wanted to know how much is related to unresolved emotional trauma.” Carly says, “She 1000% believes her husband's autoimmune disease was triggered by stress when he was overseas.” And then Katie says, “She was diagnosed with Graves’ disease immediately following the unexpected death of her mother.” So, is trauma a role? 

Terry Wahls: Trauma is huge. We do know that people with MS, and I saw this in my clinical trials, have a much higher rate of adverse childhood experiences than the general public. Premature births, early life stress make it more likely that your parasympathetic system will be inadequately activated, in that we'll have the continued perceived threat, either physical threat or emotional threat that keeps our cortisol levels elevated and increases the risk for autoimmunity. It actually was only relatively recently when I recognized the high level of ACEs in my study populations that I thought about my own childhood. My sister died when I was 8. It was very traumatic. My mom had severe postpartum depression. It led to serious dysfunction for our family for the rest of my childhood. And when I started adding up the number of severe ACEs that I had, “I'm like, oh, my god.” That was probably a major, major factor in why I developed my serious autoimmune conditions. 

Melanie Avalon: Wow. For listeners who would like to learn more. On my other show, I interviewed Gabor Mate and we did a deep dive into trauma and how it affects so many things. So, I'll put a link to that in the show notes. One question I know listeners are probably begging for me to ask you, because I talk all the time on this show about how I do-- It's not the same thing, it is e-stim, but how I do EMSculpt, which is muscle stimulation that you can do just, I guess, not for, like, a health condition, but just to build muscle. So, do you think something like that is healthy for people? 

Terry Wahls: So, the athletes have been using electrical stimulation of muscles to grow more muscle mass. It's very helpful for bodybuilders, for strength-based athletes, they've been doing that for many decades, and they do it more recently to recover from injuries more quickly. I was the first one to begin advocating this in people with chronic progressive medical problems and the spinal cord injury folks do this to reduce the harm of inactivity in people who will never be walking again. I think it's very helpful. Is it a requirement? No, if you have access to it, this is a way to improve your motor function and have gains come more quickly. But you can make do with physical exercise training, working with a physical therapist. 

Melanie Avalon: Yeah, I remember, I think in our first episode, probably over two years ago, we were talking about NASA doing some experiments with this, which was cool to hear. So, something perhaps to end on. So, for people to get involved with your studies and your work. So, Stephanie said, “My uncle was recently diagnosed with MS. She was very informative with the studies. I wish I had a million dollars to help fund her. How can people best support?” So, how can people become involved support? What can they do? 

Terry Wahls: Well, the first thing is, please, if you have multiple sclerosis, go to terrywahls.com/msstudy and screen so you can be part of our database for future studies. And if you're eligible for the current study, that's people with relapse or remitting MS between the ages of 18 and 70 who live in the United States, Mexico, or Canada and are willing to be randomized, I would love to get you involved. If you want to help contribute to our research, you can go to terrywahls.com and you'll see an about page about the research.

I have a freezer full of blood from my previous studies and I'm beginning to analyze the frozen blood for some biomarkers in terms of the molecules that we think will change as a result of the intervention. Because the basic scientists and many of my scientific colleagues feel like if the molecules don't change, then they don't really believe the research. But if the molecules change and the molecules that change are strongly correlated with the clinical changes, then suddenly the research is validated. So, we're very excited that this year we will be analyzing the biomarkers. 

Melanie Avalon: Awesome. Well, we will put links to all of this in the show notes. So again, the show notes will be @ifpodcast.com/episode344. So, I cannot encourage people enough to check all those resources out, sign up for the things if applicable, get Dr. Wahls' book, check out all of her other podcasts. And Dr. Wahls, thank you so much for your time and everything that you're doing. I am just overwhelmingly filled with gratitude for what you're doing. You're providing not only so much hope and inspiration from your own story. But the work you're doing is just so, so profound, and I can't wait to see the results. Hopefully, we can have you back on with the results of the study in the future. 

Terry Wahls: Oh, and we keep publishing papers about 5 to 10 a year, so keep bringing me back so I'll have more research to talk about. 

Melanie Avalon: Oh, awesome. Yeah. Especially since this was the first one on this show. So, listeners definitely send us more questions. Thank you so much. This was amazing. Again, I so appreciate it, and I look forward to all of your future work. 

Terry Wahls: One last request. Follow me on Instagram. You get to see what I'm eating and doing. That's lots of fun. That's Instagram @drterrywahls. 

Melanie Avalon: Oh, perfect. Yeah, we'll put that in the show notes. I love your Instagram. I love that you post the reels and the videos and you're better than me. I get so drained by doing reels [laughs]. I'm always like, “Wow, she's impressive. She's like, got it together.” So, thank you so much. 

Terry Wahls: Thank you. 

Melanie Avalon: Bye. 

Thank you so much for listening to The Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice, and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing a review on iTunes. We couldn't do this without our amazing team. Administration by Sharon Merriman, editing by Podcast Doctors, show notes and artwork by Brianna Joyner, transcripts by SpeechDocs, and original theme composed by Leland Cox and recomposed by Steve Saunders. See you next week.

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