Episode 79: Dr. Terry Wahls on how The Wahls Protocol came to be, and How to Launch Your Own Clinical Research Trial

We are all familiar with the Wahls Protocol. But how about the story behind the protocol? Did you know, for instance, that her director at U of Iowa (Terry is a clinician-researcher) told her to write up herself as a case report? That was the first step. Her “N of 1”; then she wrote up a case series. Then she received a small grant and product for a slightly larger study. Then a million dollars. And now she’s heading into her largest study to date (yes, you will be able to refer patients). Listen to our New Frontiers conversation on how YOU as a FxMed clinician can contribute to the body of research demonstrating that: What. We. Do. Works.

Terry and I also talk about behavioral change as THE MOST Important piece of the change journey. Hear how she supports it. This was by FAR one of my most treasured convos this year, and I appreciate you listening, commenting, giving us a 5-star review pretty please, and sharing with your colleagues! ~DrKF

Dr. Terry Wahls is a clinical professor of medicine at the University of Iowa where she conducts clinical trials. She is also a patient with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles (paperback), and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions.

She conducts clinical trials that test the effect of nutrition and lifestyle interventions to treat MS and other progressive health problems.  She also teaches the public and medical community about the healing power of the Paleo diet and therapeutic lifestyle changes that restore health and vitality to our citizens. She hosts a Wahls Protocol Seminar every August where anyone can learn how to implement the Protocol with ease and success. 

In this podcast, Dr. Wahls and Dr. Fitzgerald talk about how to secure funding and resources for clinical trials and how to foster behavior change in patients. Dr. Wahls offers clinical pearls on working with patients with advanced, aggressive disease and tailoring food and supplement programs for individual patient needs.

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Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and a clinical professor of medicine at the University of Iowa where she conducts clinical trials.  In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care and patient advocacy. She is also a patient with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day. She is the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, Learn more about her MS clinical trials by reaching out to her team: MSDietStudy@healthcare.uiowa.edu. Pick up a copies of her research papers at https://terrywahls.com/researchpapers/ and a one-page handout for the Wahls™ Diet at https://terrywahls.com/diet/

Dr. Terry Wahls contact info:
website | facebook | twitter | instagram | email | uiowa profile

• Wahls Protocol – The Book
• Wahls Protocol Seminar & Retreat
• Wahls Protocol Certification
• Wahls Protocol
• Cooking for Life
• Terry Wahls Research
• Follow-up: Dr. Wahls thoughts on movement towards higher lectin, plant-based diets

Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine and today is certainly no exception. I am so excited to once again be with Dr. Terry Wahls. She’s an inspiration to me. She’s a mentor, a colleague, a friend.

Anyway, let me give you her background. I know you know who she is, but let me just give you a little bit of her background and then we’re going to just jump right in. She’s clinical professor at University of Iowa, where she conducts clinical trials, testing the efficacy of therapeutic lifestyles to treat multiple sclerosis related symptoms. 

In addition, she’s the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, as well as the cookbook, The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. She’s got lots of research in the works that we’re going to talk about, she’s been conducting research for the entirety of her career. 

And she herself obviously has MS and has recovered from that. And she’s got some new publications coming out, so we’re going to… Terry, welcome to New Frontiers, I’m looking forward to jumping in here and picking your brain for the next hour or so.

Dr. Terry Wahls: Thank you so much. Always so glad to be with you.

Dr. Kara Fitzgerald: Yeah, absolutely. So as I was reading your notes and just thinking about our conversation today, the first thing that came up for me was just how grateful I am. I’m a clinician, a naturopathic physician by training and a clinician, and have just finished my first research study using a therapeutic lifestyle intervention, a diet and lifestyle program. 

And you were one of the first people we reached out to, to help us on this journey of how the heck do I as a clinician conduct research? And now we’re actually, we’re done with the study and we’re writing up our findings, and it’s incredibly exciting. It’s a little overwhelming, but I just have you to, you know you’re one of the key people to thank and I appreciate you making time for us. 

Dr. Terry Wahls: I so want to have more of the functional medicine community comfortable doing research, comfortable contributing to the body of published peer reviewed literature that we could all use for grant applications, to grow the confidence that what we’re offering meets therapeutic rigor.

Dr. Kara Fitzgerald: Yeah. It works. What we say we’re doing, we’re actually doing. We’re getting people better and here’s how. Give me… So, just from what we were talking about a few minutes ago, like some advice. So there’s a lot of clinicians listening to this.

Dr. Terry Wahls: Oh, yeah.

Dr. Kara Fitzgerald: And we all want to participate. I know we all do, especially those of us in functional medicine. We’re sort of geeky at heart and want to. So tell us, how do we do it?

Dr. Terry Wahls: So, here’s the sequence that innovations really occur. You have a clinician who makes an interesting observation and writes up the single case report. And then you have the clinician who makes the observation and has a little case series. And so, you have your clinical vignette. And then, in the report of the case series, you put it the context of that disease state, describe your case and then you have a discussion. And some really vital observations have been discovered that way. Thalidomide, the reason we’re able to understand that thalidomide was teratogenic, were some astute clinicians wrote case reports. 

Dr. Kara Fitzgerald: Wow. 

Dr. Terry Wahls: And that had a profound public health consequence. And I had been doing research for decades in diagnostic error, using secondary data analysis. It was my chair of medicine who, when he saw me recover said, “Terry, you have to get a case report written.” I said like, “On me?” He said, “Yes, on you. You’ll work with your treating medical team, your physical therapist, and get that written up. That’s your assignment for this year.” 

Dr. Kara Fitzgerald: Wow.

Dr. Terry Wahls: It’s like, well… Okay, I guess I have to do that. And so that was sort of a complicated task. As I’m working on it, he calls me back and says, “And here’s another assignment. I want you to write up a protocol and do a little safety study, see if anyone else can do what you did.” 

Dr. Kara Fitzgerald: Wow.

Dr. Terry Wahls: And so that takes about a year to get that done. In the meantime, we had a little case series that my treating physical therapist did in his cases. So, we had a case report, did a case series, the protocol. That all got written up, that took me about a year. And then I had to go find about $100,000 to do the study. 

Dr. Kara Fitzgerald: No big deal…..

Dr. Terry Wahls: That was a little trickier. But the one thing I do have is persistence and you just keep working at the problem. And I was able to get an in-kind donation for electro-therapy devices. And I reached out to the Canadian who had inspired me to utilize the Paleo diet the first time, Ashton Embry, and he had me come up to speak in Calgary. And I told my team… so we were working on getting approval for the study. We didn’t have approval yet. We didn’t have money. It was like how on Earth was I going to get this done. When I go to Canada, I’ll come back with money.

Dr. Kara Fitzgerald: So, you set some intention, too.

Dr. Terry Wahls: Yup. I said, when I go up to Canada, somehow that’s going to result…

Dr. Kara Fitzgerald: … in getting some dollars.

Dr. Terry Wahls: In getting money. And so, I got $50,000. And so then the university… I found a PhD student who, and then undergraduate students who wanted to work in our lab. And then my chair of medicine and chief of staff said, “Terry, we’ll give you two days a week unfunded time. You won’t have to be in clinic, they’ll be working on your study to do this.”

So, the university, gave me time, resources, which is the most valuable. The university gave me a way to access undergraduates to volunteer in the lab, and a PhD student to help run the study. And so we did this landmark study with $50,000 of in-kind supplies from the electro therapy device and $50,000 pilot funding from the MS group, Ashton Emory’s group directing MS charity.

Dr. Kara Fitzgerald: What is the device? What is the brand? 

Dr. Terry Wahls: The company was MP which was bought out by DGO and then DGO decided to get out of electrotherapy devices. And so, now there are other devices that we use and talk about. And so, it does take a lot of resourcefulness to figure out. I mean, intervention studies are really expensive. A survey-based study, that’s fairly inexpensive. Case report, case series are very inexpensive. That’s…

Dr. Kara Fitzgerald: …just your time. 

Dr. Terry Wahls: It’s just your time. And finding someone, an academic person like me to be a potential collaborator that’s like, “You know what, Terry? I’ve got 20 cases where we used the Wahl’s protocol that I’d like to write up, could you or your post-doc put it in context and I’ll give you the summaries?” Okay. So there are ways of finding a IFM collaborator who can provide some of the context if you provide here the little vignettes in the case stories to write these up. 

Dr. Kara Fitzgerald: We will all help folks. I mean, I know Terry, you made yourself very available to us early on and gave us a lot of tips, and really honestly, too, just the confidence, just the shout out. This is really cool idea you guys go. Just that alone meant a lot. 

Dr. Terry Wahls: And to know, yes, I should do this. I’ll give it a whirl. 

Dr. Kara Fitzgerald: The other thing I just want to point out because I’m not, you’re in an academic setting, so you’ve got some benefit but me, just as a clinician, I just want to tell the folks who are interested that other functional medicine clinicians reached out to IFM as well. And we all, everyone, all the faculty, that IFM as a whole is really committed to putting evidence behind what it is we’re doing big time. I mean, we know that from the Cleveland Clinic landmark, JAMA Network study that was just published, we’re all completely chuffed about that. And so, do that, reach out and all of us will help you as much as we possibly can. 

I’m thinking about me, and as a clinician having the support of well Romilly, who’s my nutrition director, great writer. And I have some nutrition interns in my practice, actually, we’ve got a nutrition residency program, so they’re not post docs, but we’ve reached out to some of the universities nationally who are training CNS’s, and there are people that you can bring on into your clinic practice who might also be able to help you. So if you’re not in an academic setting like Terry is, there’s a way that we can still do this. And if you’re not a science writer, and you want to do this, and you can pull together the time, also, again, reaching out to us will, we’re going to need to put together some sort of a clearinghouse of support to get IFM clinicians.

Dr. Terry Wahls: What we want to do is collect relative case series, case reports or case series, that in having a conversation about how we construct a case report case series, and that might be an interesting little series of lectures or podcasts to get people who’ve done case reports and case series to talk through that. So, I encourage you think about that, Kara. 

Dr. Kara Fitzgerald: Yeah, absolutely. I published a book of case… Where is it? Where is my book kicking around? Anyway, back in 2011, I can’t remember, case studies integrative and functional medicine, I published a book on it and so I’m very much in support of it. I absolutely agree with you just collecting our n of ones and mingling them together and starting it. 

Dr. Terry Wahls: And for me, as a grant writer, getting case series that are disease specific, because most of us have to write grants that are disease specific because that’s how the funding is. And so, although I like studying based on the intervention, I have to write grants based on the disease state so if you collect your case studies as “here’s my cure series of integrative approaches in clinically isolated syndrome, what happened” or “optic neuritis, here’s what happened” or uveitis, here’s what happened.” It’s more helpful to me. It makes it easier for us to build the quality of evidence that says we should change the standard of care for that disease state. So I’d encourage your listeners to focus on a disease state and collect case series around that particular disease state. 

Dr. Kara Fitzgerald: Perfect. Okay. And again, anybody who has questions just ping us, and I’ll reach out to Terry for responses. And we can circle in IFM for anybody who wants that. The other thing that I wanted to just point out too is Terry talked about getting funding from the electrical device company. We are generally working with supplement companies. We all have reps. We’re working with different specialty labs. We’ve got reps there as well. By all means, if you’re using a particular product and seeing a nice outcome with it, tap the company, tap the rep, see if you can get their support at any level. Even if it’s just a product donation, or do they have any tech staff that can help you with writing? They’re going to be really excited about contributing to this as well. 

Dr. Terry Wahls: In-kind donations is incredibly helpful to make it easier for your participants to- 

Dr. Kara Fitzgerald: What does that mean? 

Dr. Terry Wahls: In-kind donation means instead of giving you dollars, they’re giving you a product. So my electrical therapy company gave us 20 devices, and the lead wires and the electrical pads. So, every participant had supplies for a year. Then they had to give us the device. At the end, we ended up having to ship all the devices back, but that saved me $50,000. 

And the $50,000 that we got from direct MS Charity meant that I could pay for the supplements, reimburse people for cost for their supplements, charted supplements, and let me pay for the safety labs as required to obtain so I could run the study. And the other thing that people may not realize is, for a number of the studies I paid out of pocket many thousands of dollars to do this, do my studies, because I believe that much. Now, keep in mind, my first study, that was $100,000 between in-kind and my safety labs and supplement costs. The study that I just ran is a million dollars. The next one I’d like to run is $2 million. Because as the studies get larger, and you have a bigger end, it’s a whole lot more money. 

Dr. Kara Fitzgerald: We’re going to, and everybody wants to hear about all of your studies. I’m going to get there in a second. In fact, we’re almost there when I look at my question list here. We talked when your cookbook came out. It was after the Wahls protocol sort of rocked our world. And the Wahls protocol, you published that five years ago? 

Dr. Terry Wahls: 2014, yes. March 17th.

Dr. Kara Fitzgerald: That’s amazing. All right. So, what have you learned? Just update us from that and what you’re doing.

Dr. Terry Wahls: So, that book came out just as I was finally getting data from my first study published, and it was enormously difficult for me to get data from my first study published. We had many, many rejections. And that is absolutely typical for brilliant new innovations. Many of your people have heard of Barry Marshal, the guy who said h.pylori is the root cause of gastric ulcers, who couldn’t get his stuff published at first. And he got published in two really low impact, almost zero impact journals. Tiny, tiny regional journals. He credits getting acceptance because this very reputable journal put an article in that was buried in, I think, the January 10th edition of The National Inquirer. And the headline was “Doctor experiments on self, finds miraculous cure for stomach ulcers”. And that generated a fair amount of lay interest which then ultimately led to more acceptance and interest in scientific community. And twenty-five years later, he gets a Nobel Prize in medicine, and he finally gets a little more rigor and a little more money and is successful in his research domain.

Dr. Kara Fitzgerald: That’s such a great anecdote. From National Inquirer to Nobel.

Dr. Terry Wahls: And absolutely, this is the trajectory of medicine. We have a very hard time accepting anything that falls outside of our current construct of how we understand the world. And that’s just as true of you and I as it is of our conventional colleagues. We understand the world, and so anything that doesn’t fit into that we have a hard time seeing. Or we’ll discount it. Or it’s just invisible to us. And that’s how we all manage everyday aspects of our life. It’s incredibly hard to see new stuff.

Dr. Kara Fitzgerald: Is there anything that comes… So those of us in functional medicine, is there anything you can think of off the top of your head that we’re too myopic on that you’d like to see us expand on? I’m curious if you’ve pondered that.

Dr. Terry Wahls: It’s really hard to see what you don’t expect to see. So, we’ll always have to remember that when your patient doesn’t do well, or you have an unexpected result, thinking deeply about why did it happen that way, what is there, why is that happening. And particularly if you see that happening a couple of times, there is a tremendous insight there that will be incredibly hard for you to figure out because it’s not expected.

Dr. Kara Fitzgerald: So, David Jones used to talk about hitting the wall with patients. You know, someone’s not getting better.

Dr. Terry Wahls: They’re not getting better, not getting better, and thinking about why is that, what am I missing because I am really good at seeing what I expect to see. I am terrible at seeing what I don’t expect to see. So, over time, some of the things that I have learned to appreciate more and more is the reason people don’t do well, in my experience, has very little to do with did I get the right test, did I get the right supplement, did I do the right workup. It has far more to do with did I connect with the patient, did I resonate with them so that they understood the disconnect between diet, lifestyle that they’re having and the health they want to achieve so that they are actually willing to do the experiment of embracing a therapeutic diet and lifestyle. Because when I started doing a gluten test in the urine and stool for my failures, nearly always there’s gluten in the urine and stool. And so the person is not as thorough as they think they are in getting their diet clean.

That was such phenomenal breakthrough. I used to think I was missing something, and what I was missing was the person was not as thorough as they had thought. I go to the restaurant and I think I order a gluten-free meal, and so I’m confident that it’s labeled gluten-free in the menu and it should be. Forty percent of the time it is not. And you’re buying gluten-free products, and it’s labeled gluten-free on the label. And, depending on the product, twenty to eighty percent of the time there’s gluten in the product.

Dr. Kara Fitzgerald: All right. So then, that begs the question, and then I’m going to circle you back to updating us, but this begs the question. In your studies, when you’ve got somebody on a therapeutic diet and lifestyle program, are you simply having them cook at home for the duration and not buy processed foods or eat out? How are you controlling that?

Dr. Terry Wahls: In the study, we educate them on the diet, we give them support, and up until now, we have no measure of… because we have self-reported food questionnaires, self-reported data on either 24-hour dietary recall or weighed food record. And so people can still manufacture information. I don’t have biomarkers. I now have poop in the freezer, so I can go back and look. That’s more money that I don’t have yet, so that would be a future study to go back. I could go back and look was there poop in their stool or not. 

In my next study, we’ll be collecting urine and blood and stool, and we’ll be freezing it so we can go back and look.

Dr. Kara Fitzgerald: That’s going to be great to have the money. I was just talking to Helen Messiea, actually just personally chatting with her before. And Steve Horvath who came up with the epigenetic, the DNA methylation biological clock on the map, he was noticing that diet, a healthy diet actually lowers biological age. No great surprise. But he also observed that those doing recall, there was no significant reduction only when he looked at actual blood levels. So blood carotenoids, for instance, as the surrogate marker of vegetable intake. In that population, those with the highest carotenoids actually did have a slight but significant reduction in biological age. So I think it’s great you’ve got those specimen. And it’s actually also really amazing that you’ve gotten significance even prior to having those specimen.

Dr. Terry Wahls: Well, we did look at carotenoids in the freezer from all the studies that we’ve done so far. And we can certainly show that at baseline and after the intervention period the serum carotenoid radically changes. And of course that’s no surprise. If you implement the diet, your carotenoid has radically changed. I have not yet gone back to look at gluten intake. I don’t have urine all the way through, unfortunately. I don’t have stool in all of the previous studies. My current study, we have stool so we’ll be able to go back and look at that. 

And I think that there will be a time that we can look at metabolites in the urine, blood, and stool because what I think is the driver for the mechanism as to why health has improved, it’s the bacteria, it’s the microbiome in our gut that’s taking the food that we’re eating, metabolizing it, and those byproducts are getting into our bloodstream. That’s what’s changing our health status. And so, it’s probably a mix of what I’m eating, the genes I have, the microbes I have that creates the metabolites in my bloodstream that leads to the health I have. 

So, the more we can analyze the metabolites and how the metabolites change, then I’ll have a better idea of knowing did people change their diet or not. Because I could get metabolites at baseline, metabolites at the end, and then we’ll know did I change the metabolites and how well did they actually adhere to the dietary recommendations. And I’ve learned to spend much more time on helping people understand the behavior of change, food addictions, making sure that I relate the mechanism of…

So that whole behavior change process, we have the science of behavior change, pre-contemplative, contemplative, decision making, actions, and they can you sustain it. I’ve created a much more detailed behavior analysis map that is the process I’ve used in my clinics and my clinical trials that takes people through the inspiration, teaching them the mechanisms, engaging their purpose, their meaning. So, I break it down in a much more granular way so I can teach that to the clinicians that I am now training. Because the reason people succeed or not is right there. It’s that whole process of behavior change.

Dr. Kara Fitzgerald: So, if people want to learn this, because my first inclination is to say, “Do you have a PDF download I can out on our show notes?” But I suspect it’s…

Dr. Terry Wahls: No. You’ve got to come work with me.

Dr. Kara Fitzgerald: I know. I get it. I can hear sort of the gravitas, the experience behind that statement. It’s huge. So, if people want, if clinicians listening want to really learn the secret, this pivotal piece, you have a training program and that we can link to on the show.

Dr. Terry Wahls: We have a training program, and I keep getting more and more impressed that this is the critical step. It’s how we help people understand why to make the change and how. Because our brains are wired such that I’m very attuned to the pleasures I have today. It’s very hard to give up pleasures today for a future theoretic benefit tomorrow. It’s just not going to happen. That’s not how we had reproductive success as a species. We have reproductive success because we eat food because it tastes good, and we have sex because it feels good. 

Dr. Kara Fitzgerald: So, actually going against our evolutionary urges…

Dr. Terry Wahls: So, if you don’t attend to those two things, you won’t have reproductive success. So, immediate pleasures will always outweigh future benefit. Therefore, this is an extraordinary tasks we’re asking people to do. So, I have more and more appreciation for it, more and more attention to how it’s used, evolutionary biology, behavior change psychology, food addiction, positive psychology, to make that a very granular process to teach people how to do that as clinicians, that teach people how to do that as patients.

Dr. Kara Fitzgerald: Wow. Gosh, Terry. That’s awesome. Are you going to write about-

Dr. Terry Wahls: I talk about that in my new book.

Dr. Kara Fitzgerald: I was going to say.

Dr. Terry Wahls: I do talk about that a lot in my new book, and we talk about it and practice it a lot at my seminar.

Dr. Kara Fitzgerald: Okay. I want to know a little bit. Can you give me a little something on this? Can you give me a little bit of a pearl?

Dr. Terry Wahls: So, the big thing is, and we probably sort of know this, part of it is I have to have inspiration. I have to be able to see the possibility that recovery might be possible. I have to have metaphors that can be culturally appropriate. So, I’m talking to my farmers, I do a lot of agricultural metaphors. I’m talking to plumbers, then I’m using plumbing metaphors. I’m talking to a homemaker, I’m using homemaker metaphor. So you really have to understand the audience or the person you’re dealing with to have metaphors that can relate to them.

Dr. Kara Fitzgerald: They’re inspired because they see you’re healing. 

Dr. Terry Wahls: They hear about healing from their colleagues. I use metaphors that resonate for them. I also learned from the VA groups behavior change is not a solo sport, it’s a team sport.

Dr. Kara Fitzgerald: So, are your study populations connected? Do they become a community? Are they helping each other? How are you doing that?

Dr. Terry Wahls: My previous studies, we tried to figure out how to do it as a team, I couldn’t get anything through the IRB that worked, and the current study that I have in front of the the IRB right now, we’ve proposed a team model and a monthly team support interaction. Now, I am waiting. The IRB has met. They have their list of required actions that I’ll have to do. I haven’t yet gotten my minutes so I don’t know yet what they are. I’m hoping to get those, they told me I’d have them this week. They didn’t show up. So, I’m hoping next week. And then we can begin doing whatever it is we need to do. So anyway, I’m hopeful that I’ll be in a position to begin recruiting for the study in January. We’ll see if I can be ready to do that. I’m hopeful.

Dr. Kara Fitzgerald: Good. That’s exciting. Well, you can update us at the AIC. We’ll see you in May.

Dr. Terry Wahls: Hopefully at AIC I’ll be talking about the study and asking people to help me recruit.

Dr. Kara Fitzgerald: Awesome. Actually, I’ll be talking about our one that we just completed. I have a little bit of time.

Dr. Terry Wahls: I’ll be talking right after you.

Dr. Kara Fitzgerald: Oh, you are? Oh, sweet.

Dr. Terry Wahls: We’re in the same breakout.

Dr. Kara Fitzgerald: We’ll see each other. We are, fabulous. 

So, what else do I want to ask you? Just continuing on this behavior conversation, first of all thank you for underscoring how exquisitely important it is, not just in your research and as a clinician. How motivating is pain? How motivating is-

Dr. Terry Wahls: Actually, I talk a lot about this as part of the sequence. We really need to teach people how to embrace their biosensors. Hopefully, people have a biosensor that might relate to pain or vision or mood or something they can see in their skin that when the biosensor is turning on, there’s a symptom that they can detect. So now, they’re getting feedback like, “Okay. Things are not going well. I have to improve. I’m going to have to improve either my diet, my lifestyle, going to get meds. I’ve got to do something. Because my biosensor is turned on.”

In educating people about identifying a biosensor that they could monitor, what is the intervention that they could use when their biosensor is turning on. And I relate this back to my story that I had 27 years of my biosensors, my trigeminal neuralgia train on, getting relentlessly worse, but I didn’t know what that meant or what I could do when it starts turning on. Once I finally learned that there are things I could do when it’s beginning to turn on, and what’s the earliest signal that I could get, completely transformative.

Dr. Kara Fitzgerald: It’s amazing.

Dr. Terry Wahls: So helping people, that’s a very powerful part of the behavior change sequence that I use is educating people about biosensors, helping them identify their biosensor, helping them identify what’s the earliest signal that they could pick up, and then helping them identify when my biosensor is turning on, what are the tools I have in my tool kit to address that biosensor. So again, this is all highly individualized, and we want people to learn. And again, I talk about how I’ve learned over time so my biosensor is very clear. I’m getting better at detecting it earlier. And I’m learning how to expand my tool kit of what to do. 

And I’m getting more mature, and so I’m recognizing that my detox pathways are slowly getting to be a little more decrepit as my mother would say. Old and decrepit so you have to take better care of myself. So now I have to be very careful to always make sure my detox pathways are good. And I have to manage how many hours of flight time I have in a month. If I have too many hours of flight time, my biosensor turns on. And how many saunas I have to get in each week. So again, that’s a very nuanced conversation.

Dr. Kara Fitzgerald: Yeah. Very nuanced.

Dr. Terry Wahls: But if you can get your patients tuned on to their biosensors, now they’re much more willing to do whatever therapeutic interventions you’ve outlined which might include, in fact, prescription drugs. Or might not. But we as a species, we don’t give up today’s pleasures for future benefits lightly. We can give up today’s pleasures for avoidance of pain in the very near future. So if I can link to your biosensor why you want to do the stuff we’ve agreed that you want to do, I have dramatically made it more likely that you can succeed.

Dr. Kara Fitzgerald: So extraordinary.

Dr. Terry Wahls: But if I just told you, “I want you to do all this for future benefit.” I’ve made it dramatically harder.

Dr. Kara Fitzgerald: And in fact, I think when we set the bar too high without the adequate support, let alone the kind of granular fine-tooth archeological dig that you’re doing, we can lose them. And we can lose them to this whole model that has the power to actually make a difference.

Dr. Terry Wahls: Correct. And you will lose them. And we need to own the fact that biologically we are wired that way. That’s how we had reproductive success. Because sex feels good, food feels good, we have reproductive success. If you had a genetic mutation that made sex less attractive and food less attractive, those genetic variances disappear. 

Dr. Kara Fitzgerald: I’m think about the biosensor idea, and I have a patient with anterior Uveitis. And we did discover it’s like a prodrome. She would feel sort of like sand in her eye. And so she would hop on a protocol. And if she did it soon enough we could stop that, which is incredible. And then, we actually discovered that dusting could actually trigger this prodrome that would ultimately kick into a flare. Is that kind of what you’re talking about? Is that an example?

Dr. Terry Wahls: This is exactly what we’re talking about.

Dr. Kara Fitzgerald: And so, hubby needed to take over the dusting or…

Dr. Terry Wahls: And the more people can really dial in and learn and pay attention to this, they’ll keep getting better and better and better and better.

Dr. Kara Fitzgerald: Yeah. She just went back and back. Okay. This is the sensation. Okay. So what triggers the sensation. And of course for her it was extremely surprising that dusting could result in this flare. I mean, it was quite a dot and a connection. But it made a huge difference.

Dr. Terry Wahls: It’s a huge ah-hah. And to go from being helpless and hopeless to feeling confident and powerful and purposefully driven. And now, yes, I can do this. And things that seemed really hard become much easier.

Dr. Kara Fitzgerald: And it’s pretty extraordinary that you’re actually noticing with flying that you’re having that. And noticing the benefits as quickly and connecting the dots around sauna and doing detox. I know in the abstract it’s good. And I know in the abstract that flying a whole lot is bad. But you’ve tuned your biosensors to it, and I think that really…

Dr. Terry Wahls: Well, and this is sort of interesting, Kara. So, of 27 years of relentless worsening of trigeminal neuralgia. That’s a difficult history. But now, interestingly enough, I’m actually very grateful for my trigeminal neuralgia because I have learned so much. I have this incredibly sensitive biosensor of the inflammation level in my microglia. And the other things that’s sort of interesting is so I follow my telomeres and I know that… So you sort of think that with progressive MS my telomeres should probably be 10-15 years older than my standard age because that’s progressive MS. That’s just what you expect, but I’m twelve years younger than biologic age or chronologic age. And that’s because I got so tuned in to my biosensors and still taking care of my microglia. 

Dr. Kara Fitzgerald: That’s awesome. Well, listen-

Dr. Terry Wahls: And I’m going to continue to pay very close attention to my trigeminal neuralgia. So actually, now I am now immensely grateful that I have that biosensor.

Dr. Kara Fitzgerald: Good. It’s extraordinary. And just listening to, so you’re working with patients primarily who have MS or a neuro… I don’t know if you’ve extended beyond and you’re working with other neurodegenerative conditions at this point.

Dr. Terry Wahls: So, in my clinic, serious autoimmune issues and neurologic issues are really the people that I see. In my clinical trials, I will be seeing people with MS and clinically isolated syndrome.

Dr. Kara Fitzgerald: I’m wondering about for, I’m relatively healthy, tapping into my biosensors as a preventative. I guess I’m just throwing that out there as sort of a thought that I’m pondering. Because what you’re saying is…

Dr. Terry Wahls: You’ll certainly want to have something, and so you might think about that. Your biosensor might be if you’re doing workouts you might discover my workouts are easier or they’re harder. Or that my morning energy is better or not. Or that my husband is less annoying or more annoying. So that maybe these sort of subtle things that you can see in your task of daily life. And it may be that your spouse is the one that says, “Kara, I can tell that you’re bags under your eyes are more bluish now versus last week. Or that you seem to be a little sharper today as opposed to last week.” So it can be a little conversation with your spouse as to what they’re noticing.

Dr. Kara Fitzgerald: That make absolute sense. I get that. In fact, actually, I did notice today I was out on my bike, and I was a little bit moodier. And so I was doing some kind of self-introspection around what was actually going on.

Dr. Terry Wahls: My daughter was admitting that my mood definitely tracks my greens intake. 

Dr. Kara Fitzgerald: Isn’t that fascinating? Wow.

Dr. Terry Wahls: And I think it’s pretty cool that a 25-year-old is… We’ve been talking about all this stuff and she was just volunteering for me to like, “Yep. It’s definitely true. I can see it.” And of course if I, Jackie and I have noticed that for quite some time, but it would never be impactful for us to make that kind of observation. So it was very impactful for her to say, “You know what? I have noticed this.” And so I’m making a much more exerted effort to be sure that I’m getting all those greens in.

Dr. Kara Fitzgerald: I want to just say, this has been just a delightful, unexpected conversation that we took today, but one of the things we did in our study that was really helpful is we have this nutrition residency program here, so we’ve got a lot of nutritionists who are very eager to learn. And they jumped in and then they coached our participants in our study. And it was pretty rigorous diet and lifestyle program. And those touch points that were happening at least weekly and in a variety of different mediums, whatever the participants wanted. We had an app or the phone or a zoom meeting or email, just whatever worked was huge in the success I think. 

So, we did it through Healthy Gut Institute. They were our CRC and our Co-PI. Ryan Bradley said, “This is such a tough program you’re prescribing. We’re going to actually…” I don’t know that he was this direct but basically we’re going to watch and see if you succeed because the undertones seemed to be like we weren’t because it was too challenging. And a big piece of this I think was the constant touch point of our coaching, our nutritionists. So any thoughts on that?

Dr. Terry Wahls: Well, I think it has to be mindful of what the person wants. And so, if people want that frequent phone call or frequent zoom or text or do they just want social media because it may feel burdensome, and it’s at a level that they don’t desire. So, what we’re proposing, and I don’t know yet if my IRB has agreed with this plan, what we’re proposing is a monthly conference call and then a access to the social media page where we would basically Monday through Friday would have somebody from my team getting on, answering questions, providing… And again, I don’t know that my IRB is going to let us do that. We encourage people to follow me on Instagram so they see what I’m eating and getting that kind of relationship as well. We don’t know. I don’t know what the IRB’s going to be okay with or not. So, you’ll have to have me come back, and I’ll update you.

Dr. Kara Fitzgerald: Well, I’m going to see you in May also. So, I’ll be able to learn.

Dr. Terry Wahls: We’ll find out.

Dr. Kara Fitzgerald: Whether you speak before me or after me, but yeah. Of course I want to have you come back. I’m so excited about this. So, in addition to the behavior, well I have two more questions for you. One, I know folks are going to be asking me, what kind of protocol are you following these day? And when you do you’re quote detox what does that look like? What are some of working supplements that you’re doing? And then I want to circle back to that first. And then I want to circle back to some of the other big things that you’ve learned over the course of these last years.

Dr. Terry Wahls: The big things that I’ve learned is you want to keep your insulin down, you want to keep your glucose down. And ketosis is great.

Dr. Kara Fitzgerald: And what is that? What are those numbers?

Dr. Terry Wahls: So, ideally, you’d have your fasting glucose below 95, ideally below 90. And you want to have your A1C ideally below 5.2, if you can below 5.

Dr. Kara Fitzgerald: That’s realistic, I think.

Dr. Terry Wahls: Well, again, it depends on your genetics and your microbiome. And also depends on your obesogens that you’ve got stored in your fat. Now, ketosis, as much as I love ketosis, when you’re in ketosis, that’s sending a signal to the rest of your body that you’re starving. And so you’re thyroid hormones and your sex hormones will be suppressed to put you in sort of a quasi hibernation state and to keep you from reproducing. Although it is not reliable birth control, folks. So, don’t count on that.

Dr. Kara Fitzgerald: We’ll pull that out as a social media quote. “Ketosis. Not a reliable birth control.” Okay. Keep going.

Dr. Terry Wahls: But there is no society that will voluntarily be in ketosis. We’ll always eat more protein or eat more carbs if we get the opportunity. We will. That’s just human. However, our genetics have been such that if you can survive ketosis for a while, starvation, winter, famine, you will have greater reproductive success. So my interpretation of the evolutionary biology, ancestral health functional medicine, in the basic science is intermittent ketosis is really good for us. Long term ketosis for more than a season is probably not. So, what I do is I do periodic fasts. So a week a month, I’m doing my fast.

Dr. Kara Fitzgerald: For a full week?

Dr. Terry Wahls: For a full week. Five to seven days.

Dr. Kara Fitzgerald: And what is that?

Dr. Terry Wahls: So, you can either do that as a water fast, and that you would need to have medical supervision, or you can do it as a calorie restricted diet, and you can do that without medical supervision. Or with less medical supervision. You probably want to have some level of supervision either way. And the other thing I like to do is just in general eat just one meal a day so that there is a four hour window where I’m eating my calories. So, I’m in ketosis part of most days, and I’m in a lot more ketosis for a week most months.

Dr. Kara Fitzgerald: All right. So, when you say you’re into ketosis, not 24/7 but…

Dr. Terry Wahls: It’s really good anti-aging. It’s good for your mitochondria. I think the high fat, high dairy fat diet, I don’t recommend for a variety of reasons. I’d rather people do olive oil, or if you tolerate it MCT oil or coconut oil. You’re going to have to follow your lipids to know which one of those two fats are better. And that intermittently having more carbs is good for you. Intermittently having more protein is good for you.

Dr. Kara Fitzgerald: And what were those carbs? What would be your favorite carbs when you need to bump them up a smidge?

Dr. Terry Wahls: Well, I do this thing known as eat more vegetables. Eat more greens, more cabbage, more broccoli. If you’re going to have starchy vegetables, have them raw because your microbiome will like them more. I don’t really eat that many cooked starchy vegetables. I’ll have them raw. I’ll have berries. And very occasionally… It’s my wife’s birthday tonight so we made an apple crisp, and I’ll have that with her. That’ll be quite lovely. So, I will have occasional treats. Having a seven day fast, five day fast, or calorie restriction boosts your stem cells. If you make it five days, you get stem cells. And so, that’s really potent anti-aging.

Dr. Kara Fitzgerald: What are you looking at for protein? Are you leaning towards plant-based or an animal? A balance?

Dr. Terry Wahls: I need to know what your spiritual practices are. And if you’re committed to being a vegetarian or a vegan, then we’ll go down that path. If you’re not committed to vegetarian or vegan, then I would go down the meat path. If you’re doing the vegetarian path, then I’m going to want you to use and instant pot, a high pressure cooker, to reduce the lectin load. 

Dr. Kara Fitzgerald: So, you would be leaning on lectins, beans and so on.

Dr. Terry Wahls: Correct. And we’ll talk about ways to manage the lectins. There’s soaking, sprouting or high pressure cooking. But if spiritually, that’s important to you and you don’t want to eat meat. There are ways of doing that. So I think you really want to look at the person’s spiritual point of view, and you want to look at their health issues, and then design a program that will work for that individual.

Dr. Kara Fitzgerald: Now, when you say meat, you’re not doing a meat-centric diet. This is meat almost as an accessory.

Dr. Terry Wahls: So, the carnivore diet, there are people that are carnivore only. And they will identify that we have a few societies that are carnivores only. However, what they forget are these societies are eating their meat raw, and the meat is wild, and the meat is grass-fed. And so most of the carnivores that are existing now are eating factory farmed meat. They might be getting organic, grass-fed, wild-caught, but they’re probably not eating the meat raw. And of course you can’t really recommend raw meat because of the infectious disease risk and the parasite risk.

Dr. Kara Fitzgerald: Supplements. What are you taking? What are some of the fundamental things?

Dr. Terry Wahls: So, I never answer the question, what am I taking because I don’t want people to copy that. You need to do what’s appropriate for you.

Dr. Kara Fitzgerald: Fair enough.

Dr. Terry Wahls: I want you to know your vitamin D level. I want you to know your homocysteine level. I want you to do a nutritional exam on yourself. Look at your mouth, tongue, nails and address B vitamin and mineral deficiencies based on what you see there. And then I want you to do further evaluation based on your clinical scenarios. The thing that I have immense respect for is when you get nutrients out of the biologic ratios. That’s when we create toxicities with nutrients. That is you use synthetic forms of the vitamins, that’s when you create toxicities. If you get your nutrients from food, they’re in the biologic ratios you anticipate. You correct deficiencies, and you don’t become toxic.

So, in general, food is vastly safer and targeted supplementation based on clinical needs and/or laboratory assessment is the way to go. I personally have issues with B-12 based on my genetics. Since I work inside and wear clothes, I will have issues with vitamin D so I have to of course measure my vitamin D. And I measure my homocysteine, and I adjust my supplements based on that. And then I have a variety of other supplements that I talk about in my book that I use based on my risk profile that I have.

Dr. Kara Fitzgerald: Okay. What else do I want to ask you? So, you’re going to be recruiting for this new trial once you have IRB approval.

Dr. Terry Wahls: So, we’ll be recruiting for the new trial. I’m hoping that we can start in January. Certainly by March I expect that we’ll be starting. And we’ll be looking for people newly diagnosed with multiple sclerosis or clinically isolated syndrome.

Dr. Kara Fitzgerald: Do they need to be in Iowa? Or can they be remote and travel to you?

Dr. Terry Wahls: Anywhere in the 48 states. And in the 48, they will have to come to Iowa twice. At the beginning and at twelve months. And we need to get you in within twelve months of your initial diagnosis. I do have a handful of patients that I see. And so, we do that. And the big number of people that I see are in the seminar where we do this group functional medicine thing. 

Dr. Kara Fitzgerald: So, you have a patient seminar, and you have a clinician training.

Dr. Terry Wahls: We have a patient seminar, and the clinicians can either come to the patient seminar and stay for the practice day or they can get all the videos virtually and just stay for the practice day. And a lot of my practitioners love to come to see how I run a group functional medicine consult because it’s a pretty interesting experience to watch how I teach behavior change to hundreds of people at a time.

Dr. Kara Fitzgerald: Wow. I’m sure it is. That’s just great.

Dr. Terry Wahls: Plus, we sing and dance together. It’s pretty fun. 

Dr. Kara Fitzgerald: I’ve seen you talk. Actually, I’ve gotten to talk with you before. I know. It’s pretty fun being in your midst. Well, Listen, I just want to say, this has been just a pleasure of a conversation, and I’m just so grateful you’re on our side and doing all your good work and just to know you and support you.

Dr. Terry Wahls: Thank you so much. I’m grateful. It’s very clear to me had I not discovered functional medicine in the summer of ’07, I’d be demented. I would be bedridden. I would probably have developed intractable pain. And I would have stopped eating, drinking and refused a feeding tube. That was twelve years ago. And I would have probably starved to death because that was how grim things were for me in ’07. I was clearly on a path to bedridden. I was beginning to have brain fogs. Like, okay, dementia. My face pain was more and more difficult. It was so clear that was likely to get to the point of being permanently on. And when that happens like, “okay. There’s no feeding tube. And since I can’t swallow. That’s going to be how that ends.”

Dr. Kara Fitzgerald: And now you’re leading seminars across the country, probably the world, where you’re singing and dancing.

Dr. Terry Wahls: And so, I have this moral obligation, Kara, to teach the public because I know how grim my future was. And my neurology colleagues were so upset, and actually some of my medicine colleagues were too, that I’m talking about this stuff before my randomized double blind control trials. And I’m like, “You know what? This is what I’m morally obligated to do.” I will disclose where I’m at in my research, when it was just a theory, oh we just have pilot data. I’m happy to disclose all that and let people decide how dangerous vegetables feel, how dangerous meditation feels, and how dangerous physical therapy directed exercise feels. And if that feels too dangerous that you want to just do conventional medicines, that’s fine. That’s appropriate. But if it feels like that’s something you could do with your primary care doc, of course I want you to know how to do that.

Dr. Kara Fitzgerald: Yeah. Amen. Beautiful.

Dr. Terry Wahls: And now my neurology colleagues are in their peer reviewed scientific papers saying, “We have to protect your brain. And to do that you ought to be following a therapeutic diet. You ought to be meditating. You ought to be exercising.” And it sure sounds like now they are now saying you ought to be doing the Wahls protocol.

Dr. Kara Fitzgerald: Right. Wow. Indeed. Yeah. They are. Are they saying your name? I’m sure some of them are.

Dr. Terry Wahls: Some of them are. And so, we’re having a debate. Should you be doing the Wahls protocol with drugs or without drugs? That’s what the next study will answer because we’ll be doing the Wahls protocol without drugs to standard of care.

Dr. Kara Fitzgerald: Let me ask you, I know we have to come to a close here, but what about stem cell therapy? Where are you at with that?

Dr. Terry Wahls: Well, I get stem cells every month with my week long fast. I think we should all be getting stem cells. Get your own. Fast. I talk about that in my book. Do that. And then I discuss the role of stem cell therapy for aggressive disease that’s not resetting. However, I’m also stressing if you do stem cells without functional medicine it’s very temporary.

Dr. Kara Fitzgerald: And it’s so expensive.

Dr. Terry Wahls: And it’s so risky. So, there is a role for stem cells. I think we should all be doing our own stem cells. That’s why I think I talk a lot about fasts now. I think there’s a role for therapeutic stem cells. You for sure want to do functional medicine if you have to go down that route. It’s expensive. It’s high risk. It’s costly. But for some people it may be necessary. 

Dr. Kara Fitzgerald: Yep. Okay. Got it. We’re going to link, folks, to the show notes with all of these things. Terry’s book, the study she’s working on, just everything. The training that she has and we’ll just continue to keep you posted. 

Thanks so much for your good work, and I’m excited to see the new book.

Dr. Terry Wahls: Thanks, Kara.

Dr. Kara Fitzgerald: And this wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible through the years, without our generous, wonderful sponsors, including my friends at Integrative Therapeutics, Metagenics, and Biotics. These are companies I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them I sent you and thank them for making New Frontiers in Functional Medicine possible.

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