It is estimated that Multiple Sclerosis (MS) affects up to 2.5 million people, making it one of the most widespread, disabling neurological conditions affecting young adults in the world. In the U.S alone, up to 200 new cases of MS are diagnosed each week.
Dr Terry Wahls became one of those statistics, facing a diagnosis of multiple sclerosis early into her medical career. Her journey is a story of triumph over adversity, after being confined to a wheelchair for nearly four years, Dr Wahls turned her life around dramatically and now cycles to work each day and leads an active lifestyle. Using her own experience, she now inspires MS sufferers all over the world to follow her lead and incorporate the best functional medicine has to offer into their medical regime using The Wahls Protocol.
She joins us today ahead of her visit to Australia in April 2018 to present at the 6th BioCeuticals Research Symposium in Melbourne.
Covered in this episode
[01:30] Welcoming Dr Terry Wahls
[02:45] Dr Wahls career, pre-diagnosis.
[04:10] The doctor becomes the patient
[05:13] Initial symptoms
[07:29] What is MS?
[08:45] Looking for answers and reimagining life
[14:15] Diet: a crucial catalyst in recovery
[17:16] Creating lasting change in behaviour and lifestyle
[21:57] Addressing the question of safety
[24:29] Creating open dialog with specialists
[25:46] How MS impacts overall quality of life
[27:16] Dr Wahls at the 6th BioCeuticals Research Symposium in 2018
Andrew: This is FX Medicine I’m Andrew Whitfield-Cook. Joining us on the line today is Dr Terry Wahls. She's actually Clinical Professor of Medicine at the Carver College of Medicine, University of Iowa, in Iowa City. There, she teaches internal medicine to residents in their primary care clinics. She also does research and has published over 60 peer-reviewed scientific abstracts, posters, and papers.
In addition to being a doctor, though, she's also a patient with a chronic progressive disease. She was diagnosed with relapsing-remitting multiple sclerosis in 2000, around the time she began working at the university. Suffice it to say that Professor Wahls has probably the most inspirational story of how integrative medicine can work when a dedicated patient takes control of their condition. You can find out more about "The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles."
Welcome to FX Medicine, Professor Terry Wahls. How are you?
Terry: Andy, I am excellent. And I'm so glad to have the chance to chat with you and your tribe.
Andrew: Look, I've got to say, I am so excited that you're coming out to Australia in April 2018 to speak at the BioCeuticals Symposium. First, I want to go through your career up until your diagnosis. Did you always have this interest in integrative medicine, or were you a ‘standard doctor’?
Terry: Oh, no, I was a standard doctor. I couldn't figure out why people were wasting their money. I thought it was all a bunch of hooey. And, you know, when I was diagnosed with MS, being a conventional doc, professor of medicine, I first went to drug therapy. I sought out the best center that I could find, which was the Cleveland Clinic, which has an international reputation. Saw the best people, took the newest drugs, and still steadily declined so that, within three years, I'd converted to the progressive form of MS, needed a reclining wheelchair. And, you know, I was switched to CellCept, Mitoxanthrone, and then Tysabri, that very potent new biologic drug, and continued to decline.
That's when I said, "Gosh, you know, things are looking really grim. The best medicine couldn't stop all of this." And so I started reading, and I began experimenting upon myself. And that's how I discovered integrative medicine and functional medicine.
Terry: Well, you know, as I was going through this, I actually was wanting to have a rapidly fatal disease. I did not want to become disabled. And so I was rooting for ALS. Because I knew that would be rapidly fatal. I didn't want to have MS and be chronically disabled. But, of course, you know, I was diagnosed with MS, and so I was going to treat my disease aggressively.
At first, you know, I was very agitated because reading the literature, I saw the progressive nature of the illness, the high probability of being fatigued, unable to work, and the risk of becoming demented by my illness. And all of that was very distressing to read about.
Andrew: I could imagine. But being a patient...or, in fact, can I just ask about the initial symptoms that you felt? Was it this, you know, quite an acute onset, or was it a gradual, insidious increase in symptoms?
Terry: Well, during medical school, I developed episodes of electrical pain involving my face. These episodes would come on sort of randomly. They were more likely to occur if I was sleep-deprived, under high levels of stress. And, you know, I ignored them for a while. I eventually saw a neurologist. No clear diagnosis. I was treated with a variety of drugs and developed drug rashes. None of them worked. And so I was like, "Okay, I'll just have to tough out these episodes of increasingly horrific pain." Then I, four years later, had an episode of dim vision in my left eye. Again, a big workup, no clear etiology. And my episodes of pain became more and more frequent, more severe.
13 years later, I had problems with my left leg and weakness. And my athletic stamina had been steadily declining. So I was just thinking, like, "I'm just getting old and apparently not training hard enough." And that's when I was diagnosed with MS. And actually, I was sort of relieved, like, "Okay, so I guess I wasn't a slug after all," that my maturity and athletic performance had nothing to do with my lack of training.
Andrew: Unfortunately, I have nothing to blame but myself. But I'm intrigued with that dimming of vision with the paresthesias, the neurological symptoms that you had. Were the doctors suspecting MS back then?
Terry: Well, they didn't tell me. And, you know, clearly, in retrospect, there was enough there that I could've made the diagnosis of MS. And I'm so grateful that they did not because I might not have had my kids. I would've been much more reluctant to have children. And so, you know, I'm incredibly grateful that my docs did not tell me that MS was even a possibility.
Terry: So MS right now is classified as an autoimmune condition where our immune cells are attacking brain structures and particularly causing damage to the myelin, which is the insulation on the wiring between brain cells.
We now know that in addition to that, these episodes of inflammation causing the acute symptoms, there's this progressive damage to the wirings themselves and the brain cells, so that the brain shrinks, the spinal cord shrinks. And there's this progressive loss of function, increased risk for cognitive decline, as well.
And though we have drugs that turn off the inflammation, we don't have drugs that stop the neurodegeneration. And that's, you know, part of why I think diet, lifestyle, integrative medicine is so incredibly powerful. Because that's what you need to do to stop the neurodegeneration, to restore mitochondrial health. And that's the stuff I'll be discussing when at the conference.
Andrew: In your mind, what was that moment where you thought, "Ah, to hell with it, I'll research this and I'll try something that, you know, has no proven benefit like a drug?" What was the mind, the decision?
Terry: Well, you know, what had happened, I was in the wheelchair and getting steadily worse by taking the best drugs. And I'm like, "I've got to start reading the science because I know how bad it is. I can't be any more depressed." So, at first, I read the basic science, I'm looking at drug studies. And then I have aha moment, like, "Well, this is crazy. I can't access these drugs for 10 to 20 years. I should read about things that I could access."
And so that got me down the path of vitamins, supplements, lifestyle kinds of things. And I would begin experimenting on myself and, you know, gradually I would figure out that the vitamins and supplements were improving my energy ever so slightly. They weren't necessarily stopping my decline, but I could tell if I didn't take them, my fatigue and brain fog and was much worse.
So I was very energized, like, "Okay, I'm figuring stuff out that my conventional primary care neurology docs are not telling me." You know, and that was 2004.
Andrew: I have to go back to your diagnosis, your progression of symptoms. You were still doing medicine. You used to be in a reclining wheelchair.
Terry: I never went on disability, never went on retirement. I never left the university. I kept redesigning my job so I was able to continue working. I had an administrative position. I also was doing work on the institutional review board, the committee that reviews research.
Terry: And I asked to review the cases related to neurology and psychiatry research, which got me more comfortable reading about clinical trials, the basic science, and clinical studies involving the brain-related issues. And that made me more comfortable with experimenting on myself.
Andrew: That must have taken an incredible amount of fortitude to be able to carry on in the face of adversity not just within yourself, but also how your medical colleagues would've viewed you. You know, this "Are you a colleague or a patient?" How was that treatment? What were you viewed like?
Terry: Well, you know, what really made it possible for me to get through all this was that, you know, I had two children, two very young kids. And while I had originally thought to teach them strength and resilience through athletic endeavors and, you know, out mountaineering and kayaking and backpacking, that wasn't going to happen. But they were still watching me, and so I could either model resilience that, okay, get up and keep cheering on, no matter how difficult life became. Or I could model giving up when things got hard.
And so I would give myself little pep talks about, you know, "Your kids are watching. You just get up, you've got to go to work. You got to do your little small workout every day that you can. Because this is what is going to be required."
Terry: And I would then teach the medical students about being evaluated for MS and coming to terms with progressive disease and reimagining your life. And what that informed me as a physician is that function is really incredibly important, not just diagnosis. That we need to be sending our patients to physical therapy, occupational therapy, everything that we can to maintain their function to the highest possibility.
Andrew: I would imagine that that would've made a huge impact on their medical lives as well.
Terry: You know, actually, those lectures have been the highest-rated lectures in the medical school history. Even still.
When I made the decision to give those lectures, a very intimate look at going to the workup, being diagnosed, being treated, and reimagining my life. My chief of staff at the time and my chairman, they both called me into their office, more or less told me I should never do this, it was completely unprofessional. You don't discuss your personal life. It's like taking your clothes off in front of the medical students. You just don't do this.
But obviously, in the end, I decided this was really important to do. I did it anyway. And that was incredibly popular. I ended up having a few more clinicians do some more lectures. And so I ended up breaking some big taboos here about that.
Andrew: But I think those taboos need to be broken because there's nothing like a medico treating a medical student about that intimate relationship with the disease.
Terry: Yes, yes. That's very powerful.
Andrew: When you started experimenting with things...I mean, this is a massive section, and you're going to be discussing this at length and in detail at the BioCeuticals Symposium. But what were the standout things that you learned? And indeed, did you learn anything that thought, "Oh, this isn't of any value at all?"
Terry: Well, you know, so the sequence is I was told about the paleo diet. And so, after 20 years of being vegetarian, I switched to a paleo diet 2 years after my diagnosis. Continued to decline anyway. But I said, "Okay, at least I'm doing something because that low-saturated fat vegetarian diet clearly had not been helpful."
And then I started doing vitamins and supplements, and those improved my cognition a little bit and certainly improved my energy, but I was still declining. And then, I discovered functional medicine had a longer list of supplements. It sort of flattened out the decline.
And then I had this really big aha that I should reorganise my paleo diet to stress the nutrients I was taking in pill form. And when I did that, the state of my recovery was stunning.
Andrew: Did you say "to stress the nutrients?"
Terry: Yeah. So I designed the paleo diet in a very structured way, which I'll talk a lot about when I'm there. To maximize vitamins and minerals, antioxidants, essential fatty acids, you know, and the phytonutrients that would boost my detoxification pathways and intracellular antioxidant production.
When I did all of that, it was way more powerful than supplements. I mean, targeted supplements can be very helpful, absolutely.
Andrew: But not with a McDonald's diet.
Terry: That's right. You can't supplement your way out of a bad diet and lifestyle. You can supplement your way to accelerate the impact of healthful eating and lifestyle. But it won't fix, you know, a fast food, sedentary lifestyle.
I also want to point out, you know, I really love the paleo diet. But that was not enough to fix me. We really have to be very thoughtful about how we structure a diet, whether it is a low-saturated-fat diet, vegan diet, vegetarian diet, paleo diet, ketogenic diet. And a lot of these diets are put together with a philosophical point of view, but they don't necessarily understand the nutritional requirements, nutritional density or how to design those diets to maximise nutrition for your brain cells and your mitochondria.
So once I made that change, the speed of my recovery really was stretching. So in a year, I went from the reclining wheelchair to biking 20 miles.
Andrew: Now Terry, obviously having a medical knowledge empowers you to ask questions and to choose or even direct therapy. But how does this translate to laypeople who are diagnosed with MS or naturopaths who have a patient coming in with a diagnosis of MS? What can they get, say from, for instance, your book?
Terry: Actually, you know, I've written my book in a very lay-friendly way. To let them know what are the diet and lifestyle things that science says are associated with improved quality of life, improved energy, improved mental clarity, reduced inflammation. That they could do working with their family and their primary care doc. They don't need their specialist's assistance to eat more vegetables. They don't need their specialist's assistance to get motivated to want to do stress reduction. Or to begin an exercise program. It's helpful to work with their primary care doc.
And so I really wrote this as a guide for the layperson to begin using diet and lifestyle to create more health and vitality in their lives. Which, as a side effect, will likely reduce their symptoms, likely reduce the need for prescription medications, and likely normalise blood pressure, likely normalise blood sugar.
And in our clinics, certainly what we see is many people are able to reduce/ eliminate many prescription drugs, including disease-modifying therapies because their autoimmune disease becomes dormant.
Andrew: When you're talking about a patient's embarking on this journey of recovery, especially given that many patients will be already on drug therapy, and especially given that many of them will have bad lifestyle habits, how do you change that? Like, what's the key, do you think, that you can impart?
Terry: We create attraction. We create hope. We see the possibilities. And for some, it'll be like they can't imagine it. They're too contemplative, and you can't do a thing about it.
The ability to change must come from within, and in order to change, that person has to see that it's possible, have meaning in their lives, have a purpose, understand what they want their health for, and be willing to begin the journey one step at a time. And obviously is easier if the whole family does it together than have one person begin these habits in the midst of everyone else continuing to eat a poor diet and have a very unhealthy lifestyle.
Andrew: Do you, then, include the family in visitations to show them what you're going to be embarking on?
Terry: Yeah, absolutely. We include the family both in our clinical trials, when we do the clinical trials, and we include the family in the clinic visits as well.
Andrew: I love the fact that you talk about attraction versus avoidance. Dr Lise Alschuler, she's got a beautiful way of looking at that fear of death. And she talks about, "Well, if you're scared of dying, doesn't that mean that you love living?" So how powerful do you find this attraction to something that you want but you might be fearful of the opposite? How powerful do you find that?
Terry: Creating change always requires attraction. Most parents realise that we have to let kids run their own lives, so you have to create incentives for them to want to do those things that you want otherwise life is miserable. So you reward and create rewards and attraction to get the behaviors that you want.
And when we are in clinics, I will do my introductory lecture to the public. People who are ready and interested in going on this journey can then sign up for a series of group classes and group visits where we take them on that journey. And we have, I'd say 75% to 90% of the folks who come to an introductory lecture are inspired enough, willing to go on the journey, do the work, and begin the group classes with us.
But there will some that say, like, "I'm not ready, it's not the right time," and we don't work with them. They'll have to come back when they're ready.
Andrew: What about safety? What about the issue that orthodox medical practitioners will have regarding the purported safety issues of supplements maybe interfering with their drug therapy and worsening the prognosis for MS patients? Do you see any real issues?
Terry: So, yeah, the big question's that the specialists want people on their disease-modifying drugs. My neurologists here are really very clear that for the vast majority of folks newly diagnosed with MS, you can give them steroids acutely to get them recovered from their initial episodes. And then, over the next three months, you have three months' worth of time to think through what treatments that you want. What disease-modifying treatments you want.
So you could start with aggressive diet lifestyle intervention for three months and see how effective you are, and then decide do you want to just stay with that lifestyle or add in the drug therapy. Some people decide they want to go to drug therapy right away. They add diet and lifestyle to drug therapy. They could certainly do that. One of the things that I'll talk about when I'm at the BioCeuticals seminar is what the research says about when you could reasonably stop disease-modifying drugs and not increase your risk of relapse or disease progression. What are those criteria? And how you could use diet and lifestyle to make it much more likely you can get to that criteria that would let you reasonably discontinue the disease-modifying treatments.
We don't want to get into it an adversarial relationship with the specialist. That's not helpful for anyone. I want the person to feel comfortable taking drugs, not taking drugs, understanding what the science says about what are the criteria that you could meet and then you have no greater risk if you stop your drug therapy or continue the drug therapy in terms of relapse rate.
And that's the big question both that the conventional docs want to know and the public wants to know. When could it be reasonable to stop the drug without increasing my risk?
Andrew: You're obviously going to detail this at the Symposium, but what advice can you give to practitioners when engaging in dialog with neurologists regarding diet and lifestyle interventions and drug therapy?
Terry: Well, the key thing is the specialist doesn't need to be an expert on diet and lifestyle. And you could tell them, "Look, we're going to address overall health and quality of life by improving the quality of the diet, addressing stress, addressing sleep, addressing physical activity." As a primary care provider, that's my area of expertise. I'll take care of that for this patient. They can deal with you for the MS or autoimmune-related drugs and symptoms.
And by optimizing diet and lifestyle, improving the quality of life, reducing the risk of obesity and other comorbidities. That improves the probability that the disease will be quiet and they can more quickly reach criteria to get off disease-modifying drugs. And again, I'll talk about this is more detail and review some of those papers.
Andrew: I think this is going to be a key part of what practitioners can take away from the Symposium. Can I ask...you know, we always talk about MS being a neurological issue, but it impacts on every tissue that the nerve innervates. So what, sort of, other areas does any practitioner need to be aware of when dealing with patients with MS, like sensations, burns, wounds, exercise, even toileting and things like that?
Terry: Early on, there's going to be a higher rate of becoming overweight, obese. As the person becomes overweight and obese, then all of the other medical comorbidities will develop. Fatty liver disease, high blood pressure, atherosclerosis. If they become increasingly inactive, then you can have acceleration of all of those chronic disease states. If you become completely inactive, then you have to worry about wounds. You'll have issues related to urinary function, urinary incontinence, higher risks for infections.
If they're on disease-modifying treatments, now you have to deal with the side effects from the various disease-modifying treatment drugs. Depression is very, very common. Very, very common.
Andrew: I mean, it truly is a multifactorial disease. It seems obvious now that we mention it, but people tend to compartmentalise things. And speaking with an expert, coming from your personal experience with your disease and really taking charge of adversity and almost thumbing up, you're just saying, "Well, I'm not accepting of that prognosis," you are truly inspirational. I cannot wait to meet you at the 6th BioCeuticals Research Symposium in April 2018, in Melbourne.
Terry: Well, I'm looking forward to coming to Australia. I'm looking forward to the presentation, a chance to meet you, and interact with all of the participants as well. It should be very, very interesting, very engaging.
Andrew: Yeah. Professor Terry Wahls, thank you so much for joining us on FX Medicine today.
Terry: Thank you.
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.
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