Latest Research Data on Diet & Other Interventions for Multiple Sclerosis with Dr. Terry Wahls

What a tour de force conversation with Dr. Terry Wahls, who is, with her groundbreaking research, changing both conventional and functional medicine’s approach to multiple sclerosis and ultimately patient care. I’m very excited to see the findings of her ongoing clinical trials, which evaluate the use of several popular dietary patterns, using MRIs to measure brain volume loss, microbiome data, metabolomics, and more. And folks, if you want to be a research participant there’s still time – register your interest on Dr. Wahls’ website here. In the podcast we also dive into long COVID, mental health challenges, autoimmunity, and explore treatments in the longevity and biohacking space, such as therapeutic plasma exchange, stem cells, and exosomes. Dr. Wahls has her finger on the pulse of what’s happening in the MS community, and you’re definitely going to want to listen to this one. Enjoy! ~DrKF

Latest Research Data on Diet & Other Interventions for Multiple Sclerosis with Dr. Terry Wahls

In this episode, Dr. Terry Wahls and Dr. Kara Fitzgerald embark on a journey through the latest advancements in multiple sclerosis (MS) management. Dr. Wahls illuminates the transformative effects of dietary interventions, emphasizing their role in symptom management and disease progression. From discussing the nuances of dietary fat choices to exploring the promises of plasma exchange and stem cell therapies, this conversation highlights innovative approaches in functional medicine. Dr. Wahls introduces the Octave test as a groundbreaking tool for assessing disease activity in MS, paving the way for personalized treatment strategies. Insights into clinical trial methodologies, the potential of rapamycin in longevity, and the impact of lifestyle interventions underscore the episode’s focus on optimizing patient outcomes. Tune in as we uncover the future of MS care through the lens of integrative and personalized medicine.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. If you’re with me on YouTube, you can see that I am sitting next to the brilliant, very inspirational Dr. Terry Wahls. Let me give you her background, and we will jump right into the latest work she’s doing. Dr. Wahls is an Institute for Functional Medicine certified practitioner, and she’s a clinical professor of medicine at the University of Iowa, where she conducts clinical trials. In 2018, she was awarded the Linus Pauling Award at IFM. I upvoted that award for you, Terry. Big time.

Dr. Terry Wahls: Oh, thank you, my friend.

Dr. Kara Fitzgerald: Yeah, absolutely. For her contributions in research, clinical care, and patient advocacy. She’s also a patient, as you probably know, with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. She restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day.

Dr. Kara Fitzgerald: This is incredibly inspirational and something that we’ve talked about on previous podcasts, and I will link all those podcasts so you can access them on the show notes page. Her backstory is interesting, so be sure to check it out. It was her boss at the University of Iowa who pushed her to research her transformation that he was observing. She continues to engage in extraordinary research, which we’ll talk about in a second. She’s got a bunch of books out, including cookbooks and the foundational Wahls Protocol. You’re probably familiar with it and might be working with it in practice, as we are. We’re going to talk about the latest and greatest in her research and just how she’s thinking about the state of the state on all things MS. Terry, once again, welcome to New Frontiers.

Dr. Terry Wahls: Hey, thanks for having me.

Dr. Kara Fitzgerald: Yeah, of course. It’s always great to circle back and catch up and just hang out with you. So we were going to talk about your research trial, which, amazingly, you’ve almost recruited a sufficient number of people. But I still want you to tell us about the research trial and the patient registry. Clinicians, refer your patients here. Patients go to these sites. All right, go, Terry.

Dr. Terry Wahls: Okay, so the trial that we’re doing will have 162 people in the study, comparing a time-restricted olive oil ketogenic diet, a modified paleo elimination diet, to usual diet. People will be randomized, come back at three months, and come back at 24 months. What’s really important is that they’re also getting an MRI at baseline and at 24 months, in addition to the clinical exams, measures of walking, hand function, working memory, fatigue, quality of life, and mood. And we’re collecting blood at months zero, three, and 24.

Dr. Terry Wahls: And we’re collecting salivary microbiome at zero, month three, and month 24. This will be the largest, longest dietary intervention study that’s been done to date that will also include MRIs and analysis of changes in the microbiome and changes in metabolites of the metabolome. So, in addition to seeing if people can sustain the diet, we’ll see what happens to quality of life, patient-reported symptoms, clinical measures, and brain structure. And we’ll see what happens with changes with the microbiome and the metabolome. Then, we’ll be able to use artificial intelligence machine learning to look at what we can learn about these changes and how they relate to the clinical outcomes and the patient-reported outcomes. We’re very excited. I think it will be remarkable. It’s also remarkable that we’ve been able to get 161 people to agree to be randomized in just over a two-year period.

Dr. Terry Wahls:  That means in 2026, we’ll have completed all our data collection, we’ll be cleaning the data, and then in 2027, I’ll be sending my postdocs around to present our study findings at major multiple sclerosis research meetings and the major clinical and research meetings. I would anticipate that the manuscripts will be coming out in 2028, and there will be many manuscripts that come out of this. In addition, although we will be done recruiting in the next month, we’ve got everyone scheduled, we’re still inviting people who are interested in being in our trials to go to my patient registry. The link for that is terrywahls.com/trials. We can take people from all over the world because some of our clinical trials will be observational and virtual, so we can allow people to participate in those types of studies. For example, we did a really interesting study looking at urban versus rural in terms of access to food and what impact that has on their MS symptoms. We looked at breastfeeding and what that experience looks like for women with MS. We do a variety of observational and interventional stuff virtually.

Dr. Terry Wahls: We’re writing grants. We’re looking at doing studies where we have virtual interventions related to exercise and dietary changes. If you’re in the patient registry, that means we can contact you about new studies that have been approved for which we’re recruiting. We’re looking to add people with multiple sclerosis, autoimmune conditions, mental health conditions, and other chronic disease states to the patient registry. We have studies that I’m recruiting for with fibromyalgia, and with long COVID, or post-acute sequelae of COVID. Those studies are open, and we have some proposals related to virtual interventions for exercise and diet.

Dr. Kara Fitzgerald: Awesome. Geez. Awesome, Terry. I cannot believe all that you’re up to. Wow. When we first started talking, when I first got to know you, I don’t want to say it was…

Dr. Kara Fitzgerald: I think the greater medical community would have described your work as fringe. Obviously, you were embraced by us immediately. You received the Linus Pauling Award relatively early on. We recognized the extraordinary work you were doing. But now you’re being embraced, perhaps begrudgingly by some, but the greater medical community is finally sitting up and paying attention. You’re doing really solid science.

Dr. Terry Wahls: You know, I tell my medical students and the postdocs that are in my lab that it takes about 30 years to change the standard of care. I’m 15 years into this journey. That means the early adopters are embracing my ideas. Of course, the functional medicine community, being early adopters, has embraced my work. When I go to the big international clinical meeting, called the Consortium of Multiple Sclerosis Centers, when I’m walking around there people stop me and say, “Dr. Wahls,” then they whip out their phones and ask, “Could I get a photo with you? My patients would really appreciate that.” So of course I stop and we have a quick conversation and take some photographs. And the PhDs are now also stopping me and saying, “Dr. Wahls…”

Dr. Terry Wahls: And then, when I went to the basic science lectures at the consortium meeting, this was really quite delightful, the last lecture I attended was about the diet’s impact on the microbiome. The very last person was talking about clinical trials, and she was saying the patients are ahead of us. The majority of patients with MS are reading the books and changing their diets, and she had a slide with the four most popular books. And of course, the Wahls Protocol was one of those four books. She talked about doing a qualitative investigation of what patients who are changing their diet are telling them.

Dr. Terry Wahls: That was super interesting. I went up and introduced myself afterward, and we had a lovely conversation, exchanged contact information, and are talking about ways to collaborate.

Dr. Kara Fitzgerald: Good for you.

Dr. Terry Wahls: It is happening. Our work is being cited more and more. We still have another 15 years. Will I be like Barry Marshall and get the Nobel Prize in Medicine? Who knows. But clearly more and more of the neurologists and specialists are agreeing that diet and lifestyle matter. Here at the university, more of my conventional colleagues are telling patients yes, diet and lifestyle matter. More of them, in fact, are sending people to go out and get my book. So, it is happening.

Dr. Kara Fitzgerald: It just makes me so proud. I’m just so thrilled. We support you and your work—it’s just incredible. But I want to give a shout-out also, and then I have a ton of questions. We need to get down to business here. But I want to give a shout-out to your boss, the director who pushed you to do this.

Dr. Terry Wahls: Yeah, that was Paul Rothman. So he was a rheumatologist, and he, of course, had seen me go from athletic to wheelchair-dependent, clearly getting worse and worse. His first direction was to get a case report written up. Then, when I did that, he said, “Now, get a safety and feasibility study going.” I said, “Well, you know, I don’t have any training in human clinical trials.” He said, “I’ll get you the mentors. I think this is really important, Terry. We need to see if others with progressive MS can implement this complicated regimen that you did. And then what happens?”

Dr. Terry Wahls: So we wrote up the protocol, and it was denied. It was disapproved by the IRB (Institutional Review Boards). Paul called the chair of the IRB and said, “I really want this to happen. We’ll get the mentors for her on her team to address all of the concerns you identified. We want it to be safe, but we need to help her figure out how to make this happen.” So he got me people who are still on my study team and who taught me how to do clinical trials. We ended up doing, I think we’re up to our 10th clinical trial. It’s super exciting, super fun. It ruins my sleep because I’m so excited about what I’m doing. I have to really work at meditating, getting myself to calm down, and so I can go to sleep at night.

Dr. Kara Fitzgerald: But you’re being bathed in all of the good energy of such deep inspiration. Well, God.

Dr. Terry Wahls: So it was my chair at the university, Paul Rothman, and then my chief of staff at the VA, who originally assigned me to the traumatic brain injury clinic for a job that I couldn’t possibly do physically, because he was trying to force my hand into medical retirement.

Dr. Terry Wahls: But John also became a huge fan and supported giving me protected time to do my research. So John and Paul talked to each other and agreed that it was really important to investigate this and were instrumental in getting those very first two studies going.

Dr. Kara Fitzgerald: Incredible. And because they were witnessing you, you know, they were witnessing you getting–

Dr. Terry Wahls: The transformation.

Dr. Kara Fitzgerald: Out of the wheelchair. More than that, you know, getting back on your bike. Incredible. Well, if you are awarded the Nobel at some point in your career–

Dr. Terry Wahls: Well you’ll have to come.

Dr. Kara Fitzgerald: For sure. But, you know, you’re standing on the shoulders of these people who displayed a lot of courage and pushed you out of your comfort zone. I personally have gratitude to both of them for that courage. Okay, so you’ve got this new study, and you’ve got two different dietary patterns that you’re looking at that we use in clinical practice quite a bit—the paleo elimination and then this olive oil-leaning keto. These diets are certainly overlapping.

Dr. Kara Fitzgerald: I want to understand what’s similar but also what’s different, why you’re using them, and what you expect to see. What’s your hypothesis on employing both?

Dr. Terry Wahls: If you look at the network meta-analysis that Dr. Snetselaar did, she looked at the published dietary intervention studies as of 2021. There were 12 studies, eight diets: paleo, Mediterranean, low fat, ketogenic, anti-inflammatory, fasting, calorie restriction, and usual diet. The three diets that were effective for fatigue were paleo, Mediterranean, and low fat. There were only two diets effective for quality of life: paleo and Mediterranean. The paleo diet was 50% more effective for fatigue and twice as effective for quality of life. Keto and the other diets, the 95% confidence interval flops over the midpoint, favoring the control, which is why they aren’t listed. However, the keto diet does reduce mood, reduce fatigue, and improve quality of life with a large effect size.

Dr. Terry Wahls: But the 95% confidence interval isn’t so great. Part of what I think can be a reason that the keto diet doesn’t do quite as well is that the traditional keto diet leans really heavily on eggs and dairy. And we can do better. In our ketogenic diet, I did not take dairy or eggs out because the keto diet is really tough for people to implement. So yes, we left those in but made them optional, and I stressed olive oil as opposed to dairy fat to make it a more heart-healthy version of the ketogenic diet. We made clear that dairy and eggs are optional; you do not have to have them if you don’t want to.

Dr. Kara Fitzgerald: So you might have a sub-cohort who is adhering to a dairy-free diet. You might get some data in there…

Dr. Terry Wahls: We probably won’t do a sub-analysis on that, but we certainly tell people that dairy and eggs are not a requirement.

Dr. Kara Fitzgerald: Are you going to do food frequency so you might be able to see…

Dr. Terry Wahls: Yes, we have a comprehensive food frequency at month zero, month 12, and month 24. We also do another questionnaire at the end to know what they were eating before the study began. Was there a diet they reported following? Because we know the majority of folks with a neuroimmune problem have changed their diet. So we want to know what diet they were following, how long they had been following it, and if they were in the usual diet group, what diet were they electing to follow because they aren’t going to be following the standard American diet. If people come to a dietary intervention study it’s because they are open to changing their diet and improving their diet. We give them monthly tips from the Dietary Guidelines for Americans on how to improve their diet. So I fully anticipate all three groups will improve. I don’t know if people in the usual diet group will adhere to the dietary guidelines.

Dr. Terry Wahls: We’ll be doing food frequency questionnaires, so we will be able to answer that question—did they follow the dietary guidelines or not? I know many of those folks may have already adopted the Mediterranean diet or a keto diet or be doing intermittent fasting, or they may have–

Dr. Kara Fitzgerald: This muddies the water, but go ahead.

Dr. Terry Wahls: Yes, it absolutely muddies the water. That is the nature of doing dietary intervention studies. The control group is always muddy because people who are willing to be in a diet intervention are willing to do a diet study because, “I made the decision to improve my diet. So they can look at the consent and say, “Well, here’s what the intervention diet looks like and I wanted to be in the intervention, so I’m going to follow the intervention diet on my own.”

Dr. Kara Fitzgerald: Right. Well, let me ask you, just thinking about some of the work that we’ve done. We run groups and do our methylation diet and lifestyle intervention and we’re looking at biological age and seeing if we’ve tweaked it. Recently, we had a cohort where some people, just looking at the lab data, we saw minimal response. And we’re using the (Dunedin) Pace of Aging Test now, so maybe there was an uptick in certain individuals. I had a group of people I was dialoguing with on their baseline and their follow-up labs and people are coming to us now, having already been on the methylation diet and lifestyle for a while, so we’re just looking at a cohort who has already adopted this. And you’re going to be doing the same thing.

Dr. Terry Wahls: We’ll have a lot of the same thing. Absolutely.

Dr. Kara Fitzgerald: How do you work with that?

Dr. Terry Wahls: This will continue to be an issue for everyone doing dietary studies in MS. As more practicing neurologists learn and agree that diet matters and they’re telling their patients that diet matters and you’ll greatly benefit from improving your diet, whether it’s a low fat diet, a Mediterranean diet, intermittent fasting, the Wahls Diet, keto diet… Work on fixing your diet.

Dr. Kara Fitzgerald: Some of your people are going to have quality of life measures or baseline MRIs that are already evolved because they’ve already adopted a better eating pattern. But you’re going to have that baseline food frequency questionnaire, so you’ll be able to tease those people out.

Dr. Terry Wahls: Well, we’ll know what they’re eating at their baseline. And we also know from MRI data the trajectory of volume loss that typically occurs, which is 0.7% to 0.9% volume loss per year. Healthy rates of volume loss are 0.3% per year. So if what we show is that the two intervention arms get to 0.3% per year, that is huge. That’s huge. We’ve got them to healthy rates of brain volume aging, which predicts that we have decreased the probability of future nursing home care, assisted living, or job loss.

Dr. Terry Wahls: Let’s say the two intervention arms are at 0.3%, and the usual diet arm is at 0.5%. Statistically, there’s not a difference between the two, but this is still remarkably better than what we see in the placebo arm of drug studies for MS.

Dr. Kara Fitzgerald: Got it. So you’re going to have a population that you can look at who’s probably more likely consuming a more standard diet.

Dr. Terry Wahls: That’s the beauty of having the MRIs and that’s one of our secondary outcomes: what happens to brain volume loss. Can we get people to healthy rates of aging? And what percentage of people got to healthy rates of aging compared to what we see in the placebo arms of drug trials?

Dr. Kara Fitzgerald: Awesome. So will you be able to collaborate with some of those scientists? Will they make their data available, or are you going to glean this just from their publications?

Dr. Terry Wahls: We’ll take it from their publications.

Dr. Kara Fitzgerald: This is going to be extremely interesting.

Dr. Terry Wahls: That will be super interesting. The cognitive issues will be super interesting. I certainly expect in most studies the first thing that improves is fatigue and quality of life. Motor changes take about nine months. Walking takes about nine months, but we’re following people for two years, so it’ll be super interesting to see what happens to walking. Even in our era of highly potent DMTs (Disease Modifying Therapies), where you can do a great job of stopping the relapses, of stopping the new enhancing lesions, we’re still having brain volume loss of 0.9% per year, which is why there’s cognitive decline, nursing home care, and frailty.

Dr. Kara Fitzgerald: Following standard of care?

Dr. Terry Wahls: Following standard of care.

Dr. Kara Fitzgerald: Following disease modifying treatment.

Dr. Terry Wahls: It’s super important to stop the enhancing lesions, to stop the relapses, and for many, that does require a DMT. You may not need to take the DMT indefinitely. Slowly, my colleagues are beginning to realize that the DMT is not enough. We have to be talking to people about diet. We need to be talking with them about sleep. We need to be talking with them about exercise and a stress management program.

Dr. Kara Fitzgerald: Because the pathophysiology, I mean, the disease progression is still happening even if they’ve cut–

Dr. Terry Wahls: That’s right. There’s the inflammation which the drugs do a nice job of turning off, but they don’t do a good job of turning off the degeneration. And of course, you and I are not surprised because that has to do with mitochondria. It has to do with toxins. It has to do with sleep. It has to do with diet quality. And that’s where all these environmental factors that we address in the functional medicine matrix are so impactful.

Dr. Kara Fitzgerald: Yeah. You can’t shut down a single pathway and expect Eureka, you know, as a drug model does. That’s right. You have to take a systems approach. This is going to be incredibly interesting. It’s so ridiculously interesting to explore your baseline people coming in and where they are in their health as compared to the control group over in the drug trials. It’s going to be incredible to see if you could take these people at a higher baseline and move them along further. And it’s just incredible that you’ll have this MRI data and that you’re going to be employing AI. I mean, I have developed–

Dr. Terry Wahls: We’ll have AI, and we’ll have microbiome data, and we’ll have metabolite data for the baseline and three-month visit across two studies. Across the first study that compared the low saturated fat or Swank diet and the modified paleo elimination diet or the Wahls diet. And then we have the data from the efficacy of diet and quality of life, comparing keto, paleo, and usual diet. So we’ll have a robust amount of data to look at.

Dr. Kara Fitzgerald: The AI lens, I have become a huge fan. As I learn more, I’m starting to develop my own body of experience in my own patient population looking at brain MRIs through the AI lens. And it’s extraordinary the level of information, the granular, profound, foundational information. It’s just so much. It’s blown up. So I’ll look forward to seeing what you guys learn. It’s just very exciting where we are right now.

Dr. Kara Fitzgerald: All right, so we were talking about the oral microbiome. I was excited to hear that you were taking salivary specimens in particular versus stool specimens. I think both are great, but to your point, it’s easier. Let me throw a couple thoughts out and then I’m going to turn it over and listen. Two thoughts that we were talking about– I’m doing oral microbiome testing routinely now in my clinic, and have come to deeply appreciate the kind of information we’re getting there. Because we can have what we think are incredibly healthy oral hygiene habits and go to our dentist and have pretty decent pockets with no sign of disease. But we are still harboring disease organisms that can prompt systemic disease, including MS, including influencing neurodegeneration, not to mention cardiovascular disease, and autoimmunity such as RA, and so forth. So that can be happening. That’s one question I wanted to hear from you. And I want to get your thoughts more broadly on the oral microbiome.

Dr. Kara Fitzgerald: But the other piece that you and I were talking about is that these dietary patterns you’re looking at and seeing efficacy around run the gamut from full tilt keto diet to modified vegan. Actually we were talking about the just published Ornish cognitive impairment study, which is really extraordinary, looking at his vegan approach, The Ornish Diet, and then putting that against Bredesen or Heather Sandison’s work in dementia, where they employ a ketogenic diet. We’re seeing that these wildly different dietary patterns have extraordinary outcomes, and your immediate thought was that it’s the microbiome and that you’re going to actually be able to actually provide information there. So throwing the ball over to you, Talk about all of that, Terry.

Dr. Terry Wahls: Well, let’s sort of think about our evolutionary history. We start out in equatorial Africa. We migrate north to Europe, have a 100,000-year war with the Neanderthals, we finally assimilate them, then spread to Europe, the Middle East, Asia, Australia, the Pacific Islands, North America, and South America. Humans were omnivores and ate a wide variety of diets and a wide variety of foodstuffs. So, the first thing I want to make very clear is that anyone who says there is one diet, or my diet, is wrong. Our evolutionary history makes it very clear we can eat a wide variety of foods.

Dr. Terry Wahls: We have a few societies that are carnivores, eating meat, blood, and milk, and that’s it. And they thrive and have reproductive success. Most of the evolutionary diet patterns have 80 grams of carbs or less and a wide variety of plants and animal products. That might be 80 grams, 50 grams, 30 grams, 20 grams, or the rare carnivore at zero grams. But we have very different foods. The thing that’s common is that we eat what’s seasonally available and it fluctuates. For most of our societies, there are 200 plus plants that you’re exposed to over the season. Therefore, we should not be at all surprised that we have studies saying that keto works. We have studies saying Mediterranean works. And we have studies saying that Dean Ornish’s vegan works.

Dr. Terry Wahls: Although I’ll say, Dean Ornish surely has to supplement because there are no vegan societies from an evolutionary standpoint. All of those societies are relatively recent and require supplements in order to be successful. But if it’s spiritually important to you, it certainly can be done. If we want to take someone who is ill who wants to recover from a chronic health problem, there will be a time where we could have them give us some saliva so we could do genetics and a microbiome. We could get blood to get nutrient markers and metabolites, urine to get more nutrient markers, metabolites, and send it off to the lab.

Dr. Terry Wahls: It might take a couple of months to get their report. They’ll come back, and there will be nutrient deficiencies that we should address, however it would be optimal, given that circumstance. Then, I would probably have a report based on their microbiome and their genetics that would tell me which dietary patterns they would most likely do really well with. I might even be able to rank order from most effective to less effective, and identify which dietary patterns would be not helpful or may make them worse. And there may be people who would do really well on Dean Ornish’s supplemented vegan diet, and there may be a very different cohort that’s going to do really well on the Mediterranean diet, or the paleo diet, or the ketogenic diet. Then the next question will be what diet would appeal to you and your family?

Dr. Terry Wahls: Because it has to be something actionable that the patient and the family can embrace together. So, my report might say yep, the Wahls Diet is definitely the best one, but if someone can’t eat meat for spiritual reasons, we need to say, okay, what can we do to make that work? Or we might say that yes, the Wahls diet is the best one, but they have type 2 diabetes and are 100 pounds overweight. So maybe a ketogenic diet is more appropriate, especially if they are enthusiastic about it because their cousin had done really well on a ketogenic diet. We have to think about what they’re excited about and what the family is excited about. And so this is a negotiation based on their evaluation and our recommendations, and then we need to listen and say okay, how does that sound to you and what are your thoughts about this?

Dr. Kara Fitzgerald: I have a couple questions. First of all, that makes total sense to me. There’s overlap between keto and the Wahls diet, so you can pull those Wahls principles into keto. We do that in our clinical practice, prescribing a keto-leaning Wahls approach. It’s definitely doable if you’re working with a good nutritionist, so that makes a lot of sense to me. I’m also wondering about the duration of these dietary patterns. A very aggressive keto – and this will actually jump into another thought that I have. I want to hear your thoughts around – A really aggressive keto may not be sustainable or appropriate for the long haul. Or it may be. And so I’m curious about your thoughts on that. Just thinking about the Ornish protocol which has some built-in nutrient insufficiencies unless you’re supplementing.

Dr. Terry Wahls: Well, I think whatever your plan is, you want to follow your patient. My preference clinically, depending on how ill the person is, I might see them more frequently, and at the very least I would see them every three months to assess their response and make adjustments. Even for those very enthusiastic about keto, I want to monitor their lipids closely. Whatever diet plan you use, whether it’s Dean Ornish’s vegan approach or another, we need to monitor them closely because as their nutrients improve, any prescription medications that they are taking, their needs for that medication may need to be adjusted. You don’t want them to become hypotensive. You don’t want them to become hypoglycemic. If they’re on a mood stabilizer and their mood is improving because you have improved their diet, you need to be careful they don’t become hypomanic or manic.

Dr. Kara Fitzgerald: How are you addressing this in your study?

Dr. Terry Wahls: Well, we have to follow them, and we certainly notify their primary care team. There’s also a symptoms questionnaire that we are following every three months.

Dr. Kara Fitzgerald: Okay. So you’ll be picking up on these and you’ll just have them–

Dr. Terry Wahls: Yes, we alert the primary care team and the neurologist that as their diet improves, their prescription medication needs may change.

Dr. Kara Fitzgerald: That’s absolutely true. We see it all the time, but in the clinic you’ve got somebody under a microscope basically, and in a research setting, you need to take that into consideration. That’s important. Certainly there are companies out there touting that they have data to prescribe the perfect dietary pattern for an individual these days. We have clues in functional medicine for sure, but I have not found anything that I would say is highly reliable right now.

Dr. Kara Fitzgerald: I’m curious about your thoughts because when we were talking earlier, I was excited about your idea. You’re doing these microbiome…

Dr. Terry Wahls: Well, we don’t know that yet. People who think they can do it based on your genetics are leaving out the microbiome and what your nutrient levels are right now. Will there be a time?

Dr. Kara Fitzgerald: What about the people who are making certain claims regarding the microbiome?

Dr. Terry Wahls: I’m surprised the FDA is not coming back. You have to be careful about what claims you can make.

Dr. Kara Fitzgerald: So you just don’t think we’re there yet?

Dr. Terry Wahls: I don’t think we’re there yet.

Dr. Kara Fitzgerald: Yeah. But you’re hopeful?

Dr. Terry Wahls: Will we be able to someday? Perhaps. Although the FDA will be very concerned about making claims. But will there be a time when we talk about, based on your microbiome, your nutrients, your genetics, that these are the diets we think you would do most effectively with? And these are the diets that would be least effective? It will be super interesting to see, because the FDA is very concerned that we don’t over promise beyond what has been validated with the literature and what the FDA will allow.

Dr. Kara Fitzgerald: It’s exciting for me to pay attention to this. I mean, anyone working with patients will see certain dietary patterns that seem to be beneficial, but there’s always outliers. There are always people who do very well with a different macronutrient structure, who need access to certain carbs, and others who don’t. We see this time and again.

Dr. Terry Wahls: That’s why I think it’s important when you’re seeing a patient that you have this conversation and based on your clinical judgment, what you think will be the best dietary pattern for them and then you have the conversation of which patterns they think that they and their family can get behind, and you pick one and you start.

Dr. Terry Wahls: Then you have to watch that you picked the right one for them and they’re feeling great and things are going well. Or you see that their cholesterol suddenly spikes to 330. Well, that’s not going to work. You don’t want to keep them on that. Or maybe their cholesterol is now 150. Well, I’m nervous about that. I think that’s too low and it’s going to create some problems. And so you’ll still want to have the close follow-up to know how people are doing.

Dr. Kara Fitzgerald: Absolutely. We’re leaning more and more on imaging. Clearly, the new technology, again through an AI lens, analyzing plaque, calcified plaque and soft plaque, etc, etc, I think we can nail down who are those hyper responders.Those people whose cholesterol goes a little wonky, we can do a little bit of a drill down in clinical practice to determine our index of concern with those.

Dr. Kara Fitzgerald:  But I will l say that I am not prescribing coconut oil in the same way that I once was. Are you still using coconut oil?

Dr. Terry Wahls: No, I’d much rather use olive oil.

Dr. Kara Fitzgerald: Yeah. That makes sense. What else do I want to say? I want to hear from you if you have any other thoughts on the dietary patterns that we’re talking about. But also, you’re paying attention for yourself, again, as somebody who continues to address MS in yourself. You’re trying new interventions, you’re trying new treatments, supplements, etc., all the time. You’ve really got your finger on the pulse of what’s happening in the community. So I’m curious about those. All of it, from supplements to drugs that are coming down the pike that you might have your eye towards with some sort of optimism.

Dr. Kara Fitzgerald: What about some of the more radical treatments that we’re using in the so-called longevity biohacking space? Therapeutic plasma exchange, actually I’ve seen wonders in some of my autoimmune cases. And then stem cells, exosomes, the whole lot. What are you thinking about?

Dr. Terry Wahls: In the biohacking longevity space, super interesting stuff that’s going on. There’s certainly a lot of excitement that plasma exchange and the removal of these proteins that are associated with accelerated aging, leads to a regression of symptoms, regression of disability, improvement in mental clarity, and improvement of vision. So this is certainly a very useful technology. And are billionaire folks going to get their plasma exchanges on a regular basis to stay young forever? Oh, I bet many of them are. Absolutely. And they’re the folks who are funding a lot of the longevity research.

Dr. Terry Wahls: And then in terms of stem cells, we know that after the age of 40, our stem cell populations decline. And if we have a standard American diet, high in sugar and high in flour-based products, stem cells decline more rapidly. If we are sedentary stem cells decline more rapidly. If we’re not exercising and doing strength training stem cells decline more rapidly. So yes, you could take stem cells, but you could also do a variety of lifestyle practices to boost your stem cells: fasting, a nutrient-rich diet, strength training, high-intensity interval training, cold plunges, and saunas. All of those things can be very helpful. Would taking stem cells or exosomes also be further helpful? Probably yes.

Dr. Kara Fitzgerald: Okay. Supplements or drug trials you’re paying attention to?

Dr. Terry Wahls: With supplements I’m thinking about what we can do for our mitochondria. There’s a lot of excitement about spermidine, which is derived from wheat germ. So that is not a compound that I’m going to consume, although your gut will make spermidine if you eat a lot of sauerkraut and legumes. Another compound that can be very helpful is Urolithin A, that your gut will make if you have the correct enzymes, the correct microbiome and you’re consuming pomegranates. Or you can take Urolithin A commercially as in Mitopure, and that turns out to be even more effective for mitophagy than spermidine. Then there’s the variety of senolytic compounds that can help take the cells that have begun to undergo senescence and are sort of stuck in that zombie phase that are creating misfolded proteins and accelerating aging. There are a variety of senolytic products that can help take out those senescent cells. If you take the senolytics once a month that may be very helpful.

Dr. Kara Fitzgerald: Okay. We actually have a blog on spermidine that we’ll pop into our show notes for anyone who wants to read a little bit about it. There’s a lot of people in the longevity space using rapamycin. Is that something you would consider for your population?

Dr. Terry Wahls: I have not looked into the rapamycin literature, so I really can’t speak to it intelligently.

Dr. Kara Fitzgerald: Yeah. And human data is just starting to emerge. It’s been in the animal space for a long time, but I think there are human clinical trials and so forth happening. What else do I want to ask you? Oh, drugs. Are there any drugs you think are worth thinking about?

Dr. Terry Wahls: There are over 20, maybe 24 different approved drugs, that reduce the number of new enhancing lesions for people with MS. And so basically there are about 20 different disease modifying treatments for a wide variety of autoimmune conditions and they are very effective at reducing new enhancing lesions and that’s how you get your FDA approval. They are also reducing the number of new relapses, with the goal being no new enhancing lesions and no relapses. The debate centers on how long to stay on these drugs and at what age should you come off. In the functional medicine space, our debate is, how long do you have to have no new lesions or relapses, and I could begin to transition you to a less potent drug or maybe off drugs with appropriate, close monitoring.

Dr. Terry Wahls: There is a company that I really like a lot called Octave, that has a test called the Multiple Sclerosis Disease Activity Test that looks at 18 proteins and then they use AI to analyze the proteins, and you get scores related to microglia, myelin biology, inflammation, and degeneration. You’ll get a score of low, medium or high, and if you’re low in all four areas, then I’m going to feel pretty good that your disease is quiet and I could consider moving you to a less potent disease modifying drug or potentially discontinuing the disease-modifying drug while continuing to follow you. This is important because, over the age of – and we don’t know – 50, 55, or 60, the risks of disease-modifying treatments is going up and their benefits are going down because now the increased risk of cancer and infections is climbing, and the benefits are declining because you’re not going to be getting new enhancing lesions as you get older.

Dr. Terry Wahls: So that Octave test is super helpful for people who are contemplating coming off the DMTs safely and how to monitor the disease because you would like to know before I have a new enhancing lesion and my brain is being damaged, that my disease activity scores are all low.

Dr. Kara Fitzgerald: Yes, yes, yes. And this is a blood specimen?

Dr. Terry Wahls: Yes, it’s a blood specimen. I’m very excited about that.

Dr. Kara Fitzgerald: Wow. This is the first I’m hearing about it. We’ll link to it, and it will be part of my own exploration. Would you use this sort of off-label, or is it very specific to MS? Could it be used more broadly?

Dr. Terry Wahls: Yes, they use it for MS, Parkinson’s, and Alzheimer’s. They have AI that gives people scores for the MS patients, the Parkinson’s patients, and Alzheimer’s patients.

Dr. Kara Fitzgerald: Would it be something that you might consider as a preventative investigation?

Dr. Terry Wahls: For healthy aging, I don’t know if they have that data. I’m having conversations with them. We keep writing grants because I want to do a stopping study.

Dr. Terry Wahls: What I would like to do is to have people come in who are over 55 and on a DMT, that we could put them on basically the Wahls Protocol, diet and lifestyle, for three months, then randomize half to stay on their DMT and half to go off. We would follow them for 18 months and see how they do. We would get the Octave test at baseline, at three months, and at the end of the study at 18 months, and probably every three to six months during the study so we could see what’s happening, not only with the MRI but also with disease activity as measured by these proteomics.

Dr. Kara Fitzgerald: Interesting. So they start the trial on the DMT. Would you take them off?

Dr. Terry Wahls: That’s how we write the grant. So far, we haven’t been able to get funding, but we keep trying. Ever the optimist, we keep writing our grants. I’m hopeful we will eventually get that kind of study funded.

Dr. Kara Fitzgerald: That’s great, Terry. I have a ton more questions for you. Let me ask you two more, and then we’re going to stop. We’re kind of heading over time. I neglected to ask you, in the time-restricted olive oil keto arm, what’s your time-restricted window?

Dr. Terry Wahls: It’s a six to eight-hour eating window.

Dr. Kara Fitzgerald: A six to eight-hour window, which is pretty restricted. That leads to my next question. What do you anticipate to see for adherence over the long haul?

Dr. Terry Wahls: We do have measures of adherence, and what we’ve been able to find in our previous studies is that adherence is actually quite high. If people perceive that their symptoms are reduced with the intervention and symptoms worsen when they don’t adhere, you’ll have great adherence. If they can’t perceive any difference in symptoms whether they adhere or not, adherence steadily declines. So, it will be super interesting for us to tell. In our WAVES study, I think our adherence rate was 80%. In our study comparing diet and lifestyle in people who declined drug therapy to people who were taking conventional therapy and doing drugs, we had self-reported diet adherence of 95%, exercise adherence of 90%, and meditation adherence of 70%. These figures were based on the app that we had people reporting every day and end-of-study surveys.

Dr. Kara Fitzgerald: That’s great. That is so terrific. We saw high adherence in our methylation diet and lifestyle study, because people were very excited about, and continue to be, about looking at biological age. But I want to say, also reflecting what you found, meditation was the most poorly adhered to intervention of all, although still not bad.

Dr. Terry Wahls: For people to adhere to an intervention long-term, it really works if they can link, I feel better when I’m doing this intervention versus worse if I’m not doing the intervention. If they can’t make that linkage, the intervention tends to extinguish over time.

Dr. Kara Fitzgerald: Yeah. And we’ve been working with healthy cohorts and our intervention is much, much shorter. Only eight weeks. I would imagine we might see that change, that fall off, because they’re starting baseline healthy. And yeah, to your point, they’re feeling better, so they’re adhering. That’s very interesting.

Dr. Terry Wahls: That’s part of what we teach. I use the Wahls Behavior Change Model, which we go through teaching people how to monitor their biomarkers, how to identify the facilitators and their barriers, and to create the environments that maximize their success.

Dr. Kara Fitzgerald: Will you be using that app with this group?

Dr. Terry Wahls: We do have a number of apps in the efficacy of data and quality of life that people are using, yes.

Dr. Kara Fitzgerald: And are they going to have access to coaches? Will they have support?

Dr. Terry Wahls: No. The intervention arms do have a monthly support call and they have the opportunity to submit questions that I answer in a video that’s hosted to the group. The usual care arm still gets a monthly message from me. All three arms have a diet-specific app. So they all get a monthly touch point to help them be more successful with the group to which they are assigned.

Dr. Kara Fitzgerald: Okay. In my observation that’s been pretty essential in our success, having some touch points. Anyway, Terry, just keep up the amazing work you’re doing. It’s always a pleasure to get to hang out with you, even if it’s in the virtual space.

Dr. Terry Wahls: Thank you. And I want to remind everyone listening to have your patients go terrywahls.com/trials and register to be part of our patient registry so they can be part of our future studies.

Dr. Kara Fitzgerald: Thanks again for joining me today.

Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and conducts clinical trials in the setting of Multiple Sclerosis. 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 the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, and the cookbook, The Wahls Protocol Cooking for Life. Learn more about the current study Efficacy of Diet on Quality of Life in Multiple Sclerosis at www.terrywahls.com/msstudy.

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Wahls^TM Diet Cheat Sheet: One page summary of the diet that Dr. Wahls is used in her clinics and clinical trials to restore cellular health. Great for the refrigerator.

The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician’s Guide

The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles,

Consortium of Multiple Sclerosis Centers

Study: Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systematic Review and Network Meta-analysis of Randomized Trials

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