The Wahls Protocol by Terry Wahls, M.D.
I first heard of Dr Terry Wahls from the excellent Ted talk* she gave in 2011 called Minding Your Mitochondria. The talk caused quite a stir as Dr Wahls, who was diagnosed with Multiple Sclerosis in 2000, explained how nutrition and lifestyle changes helped her to radically transform her life. Her return to walking and even biking after being confined to a tilt-recline wheelchair is at once inspirational and fascinating. I had stumbled across the video shortly after starting Paleo in April 2012 as I was looking for every available resource on the lifestyle. Dr Wahls’ story was particularly relevant to me as I had suffered with ongoing gut issues for over 20 years, followed by neurological symptoms such as Trigeminal Neuralgia and Facial Palsy. My consultant had warned about keeping a look-out for symptoms of MS, so I was intrigued by Dr Wahls’ story. I had also read the brilliant Grain Brain by Dr Perlmutter and the link between the gut, neurological problems and auto-immune disease is a topic that I find fascinating. When I learned of Dr Wahls new book The Wahls Protocol, I ordered it immediately.
The book begins with Dr Wahls’ story of diagnosis and decline. A clinical professor of medicine and a previously active marathon runner, mountain climber and tae kwon do black belt, Dr Wahls was seemingly fit and healthy individual with a full (although at times stressful) career and loving family. She writes very movingly of her diagnosis and the realisation in hindsight that something was wrong many years ago; the clues that appeared but were not investigated, the warning signs, the niggling problems… Post-diagnosis, and as her condition declined, Dr Wahls discovered the work of Ashton Embry and Loren Cordain. She began to adopt a nutritional strategy based around the Paleo diet but sadly her decline continued. Undaunted and with a thirst to find out everything that she could about her disease, Dr Wahls went on to study MS in more detail – in particular the relevance of healthy mitochondrial function – and eventually devised a treatment plan that incorporates food as the core component, along with electrical-stimulation, targeted supplements, exercise and stress management. The Wahls Protocol outlines this plan in an easy to read, incredibly practical way.
‘When chronic disease is the result of a deficiency, drugs aren’t going to solve the problem.’
The importance of food and other lifestyle factors in the treatment and prevention of disease lies at the heart of this wonderful book. However, Dr Wahls’ message is bigger than this. There is a power that lies within each of us to overcome symptoms and to improve our condition, if we adopt the right methods. The Wahls Protocol is about reinstating that power to individuals. It is about giving control back. It is not about throwing away medication, or ignoring your doctor. It is about working gradually to reclaim health; seeing how things improve, how you feel, monitoring symptoms. It is about ensuring that your illness no longer controls your life. A reduction in medication may be part of this – or it may be not – and Dr Wahls makes it very clear to discuss this carefully with your doctor. Testimonies from ‘Wahls Warriors’ – people who have adopted the Protocol with excellent results – are placed throughout the book. These moving accounts stand as a reminder that things can improve, even when hope has been lost.
‘A genetic propensity may never come to anything if the body stays healthy and fully nourished nourished.’
Dr Wahls stresses that tackling MS or any other major disease starts with the realisation that ‘Genes are not your destiny’ p.25. The importance of environmental factors in switching on genes for disease is huge. Although Dr Wahls discovered that she had a genetic vulnerability for MS, she reminds us that ‘scientists believe that environment determines 70-95% of the risk of developing autoimmune problems’ p.24. In the same way that environmental factors can ‘switch on’ these genes, so they can influence whether they remain ‘switched off’. The lifestyle choices we make can mitigate our genetic propensity for disease and merely possessing the gene for a particular illness is not an automatic route to that disease.
‘Cellular nutrition is everything’
So how do we ensure that we make the correct choices that enhance our genetic make-up? Dr Wahls argues that healthy cellular activity should be at the root of all such choices. ‘Cellular nutrition is everything. It is the very basis of all health.’ p.26. Healthy cellular function is dependent upon the correct workings of our mitochondria, the energy power-houses within cells that also regulate cell signalling, cell death and cell growth. Their optimal function is of critical importance to cell health and mitochondrial breakdown leads to chronic disease. I was fascinated to read that the ‘the cells that do not die when their time is up will continually grow at the expense of all other cells, becoming cancerous tumours.’ p.29. Making sure that we do everything we can to look after our mitochondria – particularly when it comes to neurological conditions – will ensure that cells function properly. One of the most important ways we can achieve this is through our diet and Dr Wahls urges us to remember this vitally important piece of information: Our cells are ultimately fuelled by what we eat.
‘The highest bioconcentration of toxins are in your fat, and remember that your brain is 60-70% fat’
Recognising that we can target our nutrition for brain health is one of the first steps in successfully applying the Protocol. Dr Wahls goes on to describe how MS is caused by a faulty immune system which attacks the myelin sheath (the fatty insulation that surrounds the nerve cells), resulting in damage to the nervous system. Dr Wahls looks at micronutrients that are essential for making myelin and for healthy neurotransmitter function, both of which contribute to brain health. Her exhaustive work in compiling this range of nutrients and her years of research, first upon herself and her own condition, then followed by her patients and Wahls Warriors, are brought together in an extremely detailed and easy-to-follow plan.
‘In a very real sense, we all have the same disease’
One of the most memorable passages of this book is when Dr Wahls explains the problem with naming and treating diseases based on symptoms. In reality, we are experiencing the same disease with different symptoms. Auto-immune diseases, along with the major diseases of Western societies are the result of ‘mitochondrial dysfunction, excessive inflammation, high cortisol levels and other markers of broken biochemistry. In a very real sense, we all have the same disease…’ p.47. I found this way of thinking about disease very interesting. By treating the various symptoms, conventional medicine names and classifies the disease yet fails to address the underlying cause. It treats auto-immune diseases by prescribing drugs which – in many cases – undermine the natural functioning of the body, and as a consequence inhibits the very immune system that needs help. An alternative, functional medicine approach which treats the whole person rather than the symptom, involves ‘optimizing the body’s environment to minimize immune hyperactivity’ p.55.
Just as we cannot separate ourselves from the world we live in, so we cannot isolate a disease from the functioning state of the whole person. If the environment we live in is polluted and sick, we cannot survive. If our bodies are sick, then disease takes hold. Our bodies are a microcosm of the world. We talk about environmental pollution and yet we find it so hard to look after our own bodies and give them what they need. If we cannot help ourselves, is it any wonder that we cannot help the world we live in? Symptom-based management will never solve the problem of our major Western diseases. At best it prevents a bad situation getting worse. Only through the optimization of health for the person as a whole can we begin to prevent some of these diseases taking hold in the first place. As you read The Wahls Protocol, there is a realisation that our whole medical system is based upon treating disease from completely the wrong angle – damage limitation rather than prevention. It’s depressing to think about, but maybe we can begin to turn things around.
‘Medications for autoimmune disease do not cure the disease. Their only purpose is to make you feel a little better, which might work, and possibly slow the progression, which also might work. Or not.’
The Wahls Protocol gives an excellent breakdown of the causes and characteristics of autoimmune disease, as well as explaining the conventional vs functional medicine approach. I found this to be an extremely fascinating part of the book. Dr Wahls explains the different types of MS and very interestingly looks at the CCSVI theory of Dr Paolo Zamboni, which suggests that MS is caused by a narrowing of the veins supplying blood to the brain. As Dr Wahls argues, if this is true then surely we need to examine the root cause of this narrowing. The inflammation that narrows the veins (don’t forget that inflammation is the body’s natural response to a problem) is triggered by things such as toxins, chronic infections, insufficient nutrients, food allergies/sensitivities, hormonal imbalance and sleep disruption. Dealing with these inflammatory triggers rather than operating to correct the narrowed veins (angioplasty or bypass) makes much more sense. The link between inflammation and disease is explored and we learn that ‘excessive inflammation is a factor in many if not all psychiatric disorders.’ P.65. Dealing with inflammation is at the heart of the Wahls Protocol and addressing this important issue is a must if we are to tackle diseases such as MS.
‘The root of optimal health begins with taking away the things that harm and confuse our cells while providing the body with the right environment in which to thrive.’
There are three levels of diet to the Wahls Protocol, increasing in strictness: the Wahls Diet, Wahls Paleo and Wahls Paleo Plus. Paleo diet principles underlie all of these and Dr Wahls gives an excellent background to Paleo nutrition with thorough explanations of issues such as leaky gut: a potential disaster for health. However, the Wahls Protocol is specifically tailored to address chronic disease and to maximise nutrients for mitochondrial function – taking Paleo principles to a whole new level. At all 3 stages, the diet centres around a diverse range of vegetables, together with pasture-raised meat, and wild-caught fish and eliminates gluten, dairy and eggs. I could write that the Protocol increases in strictness, but instead I like to think of it as becoming increasingly liberating. Depending on which stage you choose to follow, additional foods (such as all forms of grains) are eliminated and others increased (coconut fats). I was happy to see that those who experience difficulty digesting large amounts of raw vegetables can also scale the quantities down to suit and as the gut heals, reintroduce them.
At the Paleo Plus level, smaller quantities of vegetables are desirable. The highest stage of the Protocol takes the basics of a ketogenic diet but modifies it to include a slightly higher carbohydrate content from non-starchy vegetables. Staying in mild ketosis is possible due to the liberal use of ketone-producing MCTs from coconut products which are essential at the Paleo Plus stage. Some measurement of blood ketones may be desirable to track progress. At this stage of the Protocol, meals are also reduced to two per day (something that many Paleo followers find happens naturally), fat is increased, carbohydrates are decreased and protein limited.
As a Paleo devotee, I naturally slotted in to the Wahls Protocol. I had already eliminated all grains and dairy. After reading the book I cut eggs out too and I have got to say that I feel so much better for doing that. Eggs always made me feel slightly sickly – I can’t quite describe it – and I had read that they can provoke an immune reaction in some people. I hesitated for ages about eliminating them from my diet but when I read Dr Wahls’ book, I did it immediately and didn’t flinch. Likewise with dairy. We learn that ‘gluten and casein molecules have a similar amino acid sequence, and so to our immune cells they are often equivalent.’ P.129. I had cut dairy out completely before reading the book but the difference is that where I once found it hard to have it in the house or felt like I was missing it (definite opioid receptor response for me!), after reading The Wahls Protocol I am so completely resolved never to touch it again.
‘It provides more structure and guidance to help you maximise your nutrition, which is critical for those with any chronic disease.’
I have never found that following a Paleo eating template is hard, restrictive or unenjoyable. It is the complete opposite. However, sometimes I feel like I need help with structuring my food choices in a more systematic way to ensure I receive the full benefits of a wide range of foods. I have to say that this is one of the many things I found invaluable when reading The Wahls Protocol. Dr Wahls gives a very detailed explanation of the importance of foods such as seaweed, bone broth, organ meats and fermented foods and gives practical steps for integrating them into your diet on a regular basis. There are fantastically comprehensive lists of nutrients too. There are also full lists of the three vegetable groups that form an essential part of the Protocol (greens, sulphur-rich, colour), making it easy to plan shopping lists etc. as well as lists of foods permitted for each stage of the Protocol. There is even a handy recipe section. In addition, the book is filled with tips and advice for ensuring you get the full range and correct amounts of various foods. I have found this so helpful as I begin to implement changes. The Wahls Protocol is bursting at the seams with helpful information and the whole book is geared towards making your transition as easy as possible.
‘Brains depend on exercise for growth and maintenance.’
Of course the Wahls Protocol is about more than food. We are encouraged to keep a Wahls Diary in order to monitor progress, feelings, symptoms, etc. and to help us focus on the changes that we need to make. Dr Wahls also urges us to look at the toxins that surround us – in our home, even in our mouth – and look at ways to eliminate them. Natural detoxification through sweating and skin brushing is also encouraged. Exercise is a major part of the Protocol, in particular stretching, strength training (interestingly Dr Wahls explains that ‘strength training generates the largest gains in nerve growth factors’ p.234) and gentle cardiovascular. There are also many helpful illustrations of stretching exercises to supplement the text. Electrical stimulation is advised for MS sufferers to improve mobility and Dr Wahls also discusses when – and if – to reduce medication.
‘Vitamins and minerals act together to facilitate the chemistry of cells and must be kept in balance, but it is far better (if not easier) to achieve this balance through food.’
The Protocol provides extensive information on supplements but Dr Wahls always maintains that the majority of nutrients should come from food first and foremost, listing the various food sources to increase. If supplementation other than the basics (Vitamin D, Magnesium etc.) is desirable, there is a wealth of information here regarding the research and recommended doses, but Dr Wahls stresses that supplementation should be carefully individualised.
I found the section on alternative therapies extremely interesting and as someone who was previously rather sceptical of such things; Dr Wahls takes a measured and considered viewpoint on some of the treatments available. She provides a helpful list of questions to ask before embarking on such therapies but always stresses the underlying importance of healthy cellular function; maximise this first through food choices and lifestyle changes and then consider some alternative therapies as a helpful addition.
There are some great tips on stress management and the connection between stress and insulin resistance is explored. Reading this section made me realise how I was caught in a cycle of carbohydrate dependence that was inextricably linked to stress, with each feeding off the other and leading to all sorts of health problems over the years. Quality sleep is also a vital component of the Protocol and Dr Wahls explains the effect of sleep deprivation on stress levels and general health.
‘I believe the public will soon be far ahead of the medical community when it comes to understanding the power of food to reclaim and maintain health.’
The depth of detail and the sheer amount of information contained in this book is fantastic. It really is a bible for brain health. I read it once and then went back and read it again. Everything is so clearly and comprehensively explained and you will find yourself referencing it time after time. In my opinion it is not only a ‘must read’ for anyone who suffers from MS or other auto-immune conditions, this book is for anyone who wants to do as much as they possibly can to avoid these conditions and live a healthy life (that’s everyone right?).
The Wahls Protocol is also a testament to one woman’s determination to fight and transcend her disease and to help others do the same. Dr Wahls’ story, along with the story of her many Wahls Warriors, is inspirational and gives hope not only to those with MS, but to all of us. Taking control over our health and recovery begins with the Protocol set out in this book. Let’s pray that Dr Wahls gets the funding that she needs to expand her research even further and I look forward to reading more about her work in the future.
*This Ted talk now contains a warning: ‘This talk, which features health advice based on a personal narrative, has been flagged as potentially outside of TED’s curatorial guidelines. Viewer discretion advised.’ Hear Dr Wahls talk about this in this excellent inetrview with Robb Wolf here.
