Link Between Cancer And Autoimmunity: What You Need To Know

Terry Wahls, MD

Thanks for having me.

Michael Karlfeldt, ND, PhD

For everyone out there, Dr. Terry Wahls is an Institute for Functional Medicine, Certified Practitioner, Board Certified Internal Medicine Physician, and conducts clinical trials, testing the efficacy of diet and lifestyle changes in the setting of autoimmunity. In 2018, she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care, and patient advocacy. In addition, Dr. Wahls has 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. Just amazing. 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, the revolutionary modern Paleo plan to treat all chronic autoimmune conditions.

Michael Karlfeldt, ND, PhD

I remember the first time I interviewed you a number of years ago on my radio show and hearing your story. It is just incredible.

Terry Wahls, MD

Thank you. It’s been a remarkable journey.

Michael Karlfeldt, ND, PhD

In regards to cancer, this is something that people without immunity and I have experienced heartbreakingly. I’ve had young, young people before they even turned 20, having been on autoimmune biologics or autoimmune medication. All of a sudden, they have a tumor in their head, or they have a tumor somewhere else. It is so heartbreaking , and that’s why I feel that this subject is so important that we discuss it in your mind. You are an expert in regards to autoimmunity. What is the link between autoimmunity and cancer?

Terry Wahls, MD

Well, a couple of things. I’m going to talk first about how we have these great immunotherapies for cancer that can activate our immune system to be much more effective against the cancer. People get into cancer remission. But then, secondarily, they get into problems with persistent fatigue in neuropathies as a result of the treatment, and they develop autoimmune diseases as a result of the treatment. I end up treating a lot of those folks to help them either with their neuropathy or their autoimmune disease that came as a result of the cancer treatment, even though they are now free of their cancer. In the autoimmune world, I take care of a lot of those folks, and then I have to be aware that the disease-modifying drugs that many of us with a serious autoimmune condition end up taking increase my vulnerability to developing secondary cancer. People may be doing well with their autoimmune disease, but then start developing more fatigue, perhaps some weight loss. I have to go look to see what the secondary cancer is. Certainly part of that is due to the effect of the drug, but it’s not been fully answered yet because, for people with autoimmunity, our immune systems are not functioning properly. Is that a defect? Increasing our vulnerability to cancer in addition to the problems we have from the drugs, quite possibly yes. But we don’t yet know that answer.

Michael Karlfeldt, ND, PhD

Yes. Obviously, with the drug, yes. The whole idea is to suppress the immune system, which means that now the immune system is not as efficient at patrolling and controlling the cancer cells that are moving about. That would be an issue.

Terry Wahls, MD

Every day, healthy people who are in great health have spontaneous dysplastic and spontaneous cancer cells that are present. A healthy immune system can recognize that dysplastic, that cancerous cell, and eliminate an unhealthy immune system that cannot do so in that cancer cell. Therefore, it can grow unchecked and then develop into an overt cancer.

Michael Karlfeldt, ND, PhD

You have that component with the medication being an issue, suppressing the immune system, and then making you more vulnerable. But then you are also dealing with an autoimmune condition in itself, and that means you have an X amount of resources with your immune system, and here it is, then it triggers to target a certain part of your body. Let’s say you have Hashimoto’s, where it’s attacking your thyroid, or you have colitis or Crohn’s, which is attacking the digestive system. but since the resources are going in that direction, it is also not intelligent enough. It’s like it becomes hyper-focused on not seeing other things as well, where cancer can then become an issue just based on that. Am I correct in that?

Terry Wahls, MD

Correct.  that the immune system is not functioning properly. It’s not adequately protecting you from infection. It’s not, so it can’t protect you from external threats, and it can’t adequately protect you from internal threats. We’re at greater risk for infection and greater risk for cancer just from the immune dysfunction. That is further heightened by the fact that we’re taking these drugs that further inhibit the appropriate function of our immune system.

Michael Karlfeldt, ND, PhD

The elegant way would be to describe what you are doing and the protocols that you are following. What can I do instead of getting on with these immunosuppressant drugs? Obviously, if you need it, you need it. There’s a certain point where you need it.

Terry Wahls, MD

I want to point out to everyone that it’s a very crucial decision and that it has to do with the severity of your autoimmune disease and the love of disability that it’s already imposed on you, and that informs you. Do I have time to give it six months with an aggressive functional medicine approach to see if I can get control of the disease, then have appropriate surveillance, and then I’ll know in six months that yes, I’m turning the tide and think we’re doing much better or that I’m not, and I still have considerable disease activity? Or I may decide that, due to the severity of a disability and the evidence of disease activity, I need to start taking disease-modifying drugs immediately. But whatever you decide about starting the drugs or waiting six months to start the drugs, everyone should be working on the root causes. addressing nutrition, addressing sleep, addressing toxin exposure, and adding exercise that’s gradual so that we aren’t overtraining. Everyone needs to be doing that because potent disease-modifying drugs won’t get to the root causes. If all you do is take the disease-modifying drugs, I can push the time to wheelchair out an additional five years. But I don’t stop the conversion to progressive at all. I don’t prevent the ultimate loss of a job. I don’t prevent needing wheelchairs. I don’t prevent the frailty from needing assisted living care in early nursing home care.

Michael Karlfeldt, ND, PhD

It’s like these disease-modifying drugs you are talking about. They are buying you a little bit of time.

Terry Wahls, MD

About five years, and the five years are great; that’s super helpful, but it’s not enough. It may be a very important part of the tool, but you still have to address diet and lifestyle. If you don’t address the root causes of diet and lifestyle, you’ll get another autoimmune disease every 5 to 10 years. If you start out with rheumatoid arthritis, then you pick up inflammatory bowel disease, or M.S. or Hashimoto’s, or perhaps a skin condition, psoriasis, or one of the blistering skin conditions. As you get additional systemic autoimmune diseases, you are going to be on additional medication. There are now multiple disease-modifying drugs, which further accelerate frailty.

Michael Karlfeldt, ND, PhD

To tell me a little bit about these drugs, are there ones that are safer than others, or are they all pretty much in the same category?

Terry Wahls, MD

You can think of these drugs as highly effective because they are very effective at turning off some aspects of my immune cells. Maybe it’s the B cells; maybe it’s a particular pathway. The more highly effective drugs have a much more severe impact on my immune system and, therefore, have a higher risk of secondary cancers or secondary infections. But they do a very good job of turning off disease activity. They do a great job of telling me about turning off the new enhancing lesions. and then the less effective drugs, and probably they may be more convenient; they are oral; they may impact; we think through the nerve to pathway. They may be things like Copaxone, which is a decoy protein that is not as effective at reducing the number of enhancing lesions, but they also have fewer side effects. I know a number of integrative neurologists lean very heavily on my work on diet and lifestyle, and they are much more inclined to use Copaxone, which is a much less efficacious drug but has a much safer profile.

Michael Karlfeldt, ND, PhD

Because it seems that if you can use a decoy protein rather than a direct immunosuppressant and that you are kind of altering your brain, you are not having the same suppression of the immune system.

Terry Wahls, MD

The pressure of the immune system you have is generally very well tolerated. For some people, there are a few who will not tolerate Copaxone, but it’s generally a very well-tolerated medication.

Michael Karlfeldt, ND, PhD

For an individual, let’s say they are dealing with an autoimmune disease. Obviously, you’ve been in that situation, and we know then that you are at risk for cancer. If you are staying, then on the disease, modifying drugs, and these immunosuppressants, what should be the strategy? You mentioned that it’s a personal choice, but let’s say that you would have the optimum direction for an individual. You would counsel them and say that this is what you should do.

Terry Wahls, MD

The first thing I want people to do is understand why and what they want their health for. They are willing to do the work of improving their diet, working on the domains of diet, sleep, stress, and exercise in general. I asked people, Which domain do you want to work on first? We start with small, achievable next steps so people can be successful and steadily improve their diet, their stress, their sleep, and their exercise. We talk about my desire to have surveillance of their disease activity for their autoimmune disease. We talk about the fact that, yes, you are going to have increased vulnerability for infections and for cancer. How do we pay attention to that risk, monitor it, and let them know about it? Certainly, what we see is that the vast majority of folks who enter into this lifestyle program, if they are on chronic medication for other complex health issues, whether it be high blood pressure, blood sugar issues, or mental health issues, their medication needs will likely change, and we will likely be decreasing their medication doses and simplifying them. I have to watch them fairly closely so that their blood pressure doesn’t become too low and they don’t faint.

Their blood sugar becomes too low, they get hypoglycemic, and they faint. We do that in conjunction with the rest of their medical team. Their primary care team knows what’s going on as we’re making these adjustments. Then I have to clarify, and I’m much more aggressive at this now because as people do this, often, many of their diseases melt away, their autoimmune symptoms melt away, and they are feeling like, yes, I’m feeling great. I’ve been feeling great now for several years. I can’t believe that I have M.S. or inflammatory bowel disease, or rheumatoid arthritis. It becomes tempting to go back to my previous diet and lifestyle. I used to enjoy pizza and beer with my buddy. I’m going to go do that. They go have their pizza and beer with their buddies, and they wake up and they can’t see because the optic neuritis slurred, and the rheumatologist will say, See, I told you that it was protocol; diet and lifestyle don’t work. What I need to stress is that your diet and lifestyle are now your very potent disease-modifying drugs. It’s your very potent disease-modifying treatment. If you stop it, you are going to get a severe rebound in flare. That is true. If you stop a potent disease-modifying drug such as Tysabri, you get a severe rebound in flare. If you abandon your diet—the diet that has been so helpful for you—expect a severe rebound in flare. If you stop exercising, expect a rebound and flare. If you were doing a great job on sleep but suddenly your spouse told you that they were having an affair and that they were dumping you for someone else, you have this huge internal stress. Yes. You’re probably going to get a flare, and it’s because something happened to your diet and lifestyle. It’s so important that people understand that this is now your potent disease-modifying treatment. If you abandon it, expect a flare. When your specialist says, See, that lifestyle didn’t work, I want to be on your shoulder, saying, If you abandon your diet and lifestyle, expect a flare. You have to go back to doing a better job.

Michael Karlfeldt, ND, PhD

Yes. I’ve seen that in so many cases, both for autoimmune disease and for cancer, they go back to the lifestyle that, in reality, created the disease. They have a flare. The tumor all of a sudden flares up, and the autoimmune condition flares up. The point that you are making, I think, is important for people to understand. Let’s say you are dealing with Hashimoto’s, you are on thyroid medication, and you are changing your lifestyle. You are following, like, the Wahls protocol, and all of a sudden you are noticing that your heart is racing and you are having a hard time sleeping. You’re agitated. It doesn’t mean that lifestyle changes are bad for you. It means that you are being overmedicated now because the body is doing what it’s supposed to do and doesn’t need that level of medication anymore. That is an important point to understand, so that the doctor does not go after whatever else you are doing because they may be saying that it’s interfering with the pharmaceuticals you are taking.

Terry Wahls, MD

That’s important to know. Very commonly, blood sugar improves. People often have insulin resistance. They may have diabetes or pre-diabetes. As they are improving their diet, the blood sugars are falling. Whoever is managing their diabetes may tell them, “Oh my God, you have to eat more carbs because your sugars are falling.” I’m like, “Well, maybe you need less anti-hypertensive, a lower dose of metformin, or a lower dose of insulin because we’ve been improving your diet.” I try to work very closely with the treating medical team and the patient so that as people recover because their cells are doing the chemistry of life, the first thing we can look at is: can we begin to reduce some of these medicines as opposed to the crazy idea like, “No, no, your diet’s too good, you have to go back to eating?” That is not what we’re going to be telling our patients to do.

Michael Karlfeldt, ND, PhD

You’re having it. You’re having a donut deficiency right now. 

Terry Wahls, MD

I’ve learned to warn my patients about that. If your blood sugar doctors are telling you that you have to increase your carbs because your blood sugar is improving, call me right away because there’s another way to think about this.

Michael Karlfeldt, ND, PhD

How does it work? For people out there. It’s such a strange notion in a way that here you are dealing with an autoimmune condition like M.S. , for you being in a wheelchair and now you are changing your diet, how can diet change your autumn, your autoimmune condition? That’s a big deal.

Terry Wahls, MD

Yes.  It’s hard for people to understand how that can happen. But we now know what I eat. Fertilizers, bacteria, viruses, parasites, yeast—all the stuff living in my gut. As I eat more of these radical things known as non-starchy vegetables, we’re fertilizing different bacteria that we now know actually stimulate regulatory cells and shift the expression of the innate immune system. We also know now that the foods that I’m eating will shift the expression of the microglia cells in my brain, how reactive the microglia are, and whether or not that is promoting the development of enhancing lesions. This is getting better, and we know this very well from the animal models. We’re beginning to tease this out in the human models of the disease. We’re also looking at how the food we eat changes the microbial metabolites that then diffuse into our bloodstream, influencing the activity of the innate and adaptive immune systems and the activity of microglia in my brain. Now, I realize that for many clinicians and scientists, if I can’t describe the molecules that are changing the mechanisms, it didn’t happen.

That is why basic science studies are so important. That is why we’re now partnering with basic scientists who are beginning to analyze the molecules in the blood specimens that we have frozen in our lab. From all those studies we’ve been doing over the last decade, that is very important. However, it’s also why I’ve done all these clinical trials, and we’re doing our eight clinical trials. As a matter of fact, from our perspective, we’ve shown that, yes, we improve quality of life, we reduce fatigue, we improve hand function, and we improve cognitive function. It takes a little longer to improve walking. That is about a year-long process. You have to have a much longer study to build a measure like that. But that’s why clinical trials are so important. You can design your protocol, randomize people to get it or not, and then see what happens over time. What we also do is freeze blood, poop, and saliva. We can go back and analyze it later. You have to get it; research is expensive. It’s expensive to conduct the study, and then we freeze a lot of stuff, raise some more money, and then we conduct those analyses.

Michael Karlfeldt, ND, PhD

That is fascinating. I know obviously that MS is of strong personal interest to you, but for you. But in regards to autoimmune, what you are saying translates to all autoimmune conditions, correct?

Terry Wahls, MD

In my clinical practice, certainly what I see are the protocols. I may have to personalize them for the individual. Yes, but this approach works well for inflammatory bowel disease, rheumatoid arthritis, systemic lupus, and autoimmune skin disorders. We also know that people with all these systemic autoimmune diseases have higher rates of co-morbid problems like anxiety, depression, pelvic pain, infertility, and cognitive decline. All of those issues are remarkably helped by our diet and lifestyle program. It’s interesting. I have a modification for my current study that I had to go into because people were getting pregnant, and we tell people, please don’t get pregnant during the study because we don’t want to have that complication. We asked them, If you are trying to get pregnant, you can’t be in the study. If you are in the study, please use birth control. Well, a lot of people with MS are infertile and have been told they are infertile. They can’t have kids. They’ve been trying to have kids. They quit using birth control because they knew they were infertile. They get into my study, we fix their diet, and they get pregnant. Now I have to add this risk of increased fertility. We’re sending letters out to everyone saying, Even if you’ve been told you are infertile, please go back to using birth control. We’ve observed that people are getting pregnant. If you are the female spouse of the male person and we’ve told the whole family to improve your diet, keep in mind that your spouse may be more fertile and your children, by the way, may be more fertile. Be sure everyone who’s having sex is using birth control. This is a while to tell them that your spouse and your children may be more fertile.

Michael Karlfeldt, ND, PhD

This is one of the severe side effects of the Wahls Protocol as far as pregnancy is concerned.

Terry Wahls, MD

In the minds of the couple of people who’ve gotten pregnant, they seem to be overjoyed that they are pregnant. Now, unfortunately, I have to tell them you can’t follow the study and that you have to follow it every day. Your medical team wants you to follow. If you are going to breastfeed, we go through all that so that it complicates the analysis of having to do that. Then I have to fill out all these adverse event forms and report them. but I’m thrilled for them because I know, having been infertile myself, that it’s very exciting to discover you get to have kids. It also gave me a lot of joy to have the opportunity now to send letters to everyone, saying increased fertility is one of the side effects. Use contraception when you are done with the study; if you want to get pregnant, stop using the contraception, and good luck.

Michael Karlfeldt, ND, PhD

That’s so cool. Like you are saying, there is so much joy. That’s beautiful. Here, for an individual, it’s kind of going back to the subject, and so for the individual and dealing with autoimmune conditions in order to reduce the risk of cancer, the best is to follow. like the Wahls protocol or doing some kind of modification of principles, and then, at the same time, work with whatever pharmaceuticals they are on, working with their medical team to then adjust dosages depending on where they are in their disease journey.

Terry Wahls, MD

I should probably also add toxin reduction because certainly many people with autoimmune issues have, as one of the root causes, increased toxin exposure, whether it’s heavy metals, industrial solvents, or agricultural chemicals that increase the risk for autoimmunity and will also, of course, increase the risk for cancer. I do want to stress that this was my understanding, and I’m sure I know this more thoroughly than I do on a high-glycemic diet. Lots of sugar and lots of simple carbs feed and accelerate cancer cells. Cancer cells are not very good at utilizing ketones, which are fats. People who are on a low-carb diet are much less likely to get cancer and much less likely to have side effects from cancer chemotherapy. They generally tolerate cancer treatment. Cancer cells are generally more vulnerable if someone’s on a ketogenic diet. If I have patients with autoimmunity who have had a history of cancer, I want them to be on a ketogenic diet. If they have a striking family history, that tells me that they have some of the genetics that increase their vulnerability to cancer. I encourage a ketogenic diet.

Michael Karlfeldt, ND, PhD

What’s fascinating about ketones is that, in addition to supporting energy production within normal cells, cancer cells, like you mentioned, have a hard time using ketones as an energy source. It also functions; the ketones also function as signaling molecules to control inflammation and control a lot of these different tumor and cancer drivers. They are powerful signals over and above. Just an energy source.

Terry Wahls, MD

We’re doing a study comparing paleo diets, which have a very high or large effect size for improving quality of life for people with M.S. to an olive oil-based ketogenic diet. I’m very keen on a ketogenic diet. I think they have a lot of great benefits. I pair it with extra olive oil for all the great things that olive oil does to your usual diet. We’ll follow those folks for two years, and I don’t know which diet groups are going to be better. But I love the idea that we’re trying to help people understand that, yes, there are several diets that you can consider, and there are reasons that a ketogenic diet may be superior. There are reasons why a paleo diet may be superior. In 2027, I can come back, and we’ll tell you which one turned out to be the better diet.

Michael Karlfeldt, ND, PhD

It’s so exciting that you are doing these studies. If something works, it works. But when I tell my patients, they ask and say, “Why? How does it work? I say,” Well, I’ve done it for 30 years, and somehow this works. I tell them that, if the apple falls from the tree, we may not understand all the forces at play, but it’s still false. It still happens. I’m so yes; we can see the impact, like you saw in your own life. But it is fascinating to go back and then understand the mechanisms. Why did it happen? Why, what molecules, and what systems are involved? It’s so amazing and cool that you are doing all these studies.

Terry Wahls, MD

It will help bring my colleagues along. What I can describe about the molecule is that the terms of this are what’s happening, and I do think that is important to understanding and moving the principles forward. But at the same time, after I should come back, my basic science colleagues tell me, part of the reason that people are so crazy and have resisted my work for so long is that most of modern medicine is built on the mouse, the rat, and 10% of the time it works in humans. You develop molecules, then you are finally tested on people, and then finally you have drug development. It is very rare that you have a protocol that works. You’re like, “I don’t know how?” We’re going to go back into the mouse, rats, and freezer to figure out what molecules were involved. But now I have some basic scientists who are pretty excited to be doing this, and we’re talking about how to develop mouse chow. That reflects what I’m doing, so we can better understand the molecules behind it. It’s more complicated because if you are doing the whole protocol, you have the mouse chow, you have the sleep pattern, and you have the running wheels. It’s a complicated intervention.

Michael Karlfeldt, ND, PhD

That’s fascinating. I want to go back to what you mentioned earlier in our chat in regards to the fact that you have patients dealing with cancer. They’ve gone through the therapy, whatever chemo, radiation, whatever it is that they’ve been doing. They are dealing with effects from that, like autoimmune-like conditions, fatigue, or neuropathy. You alluded to the fact that there is some powerful intervention you can do to reverse some of that.

Terry Wahls, MD

The neuropathies, the damage from chemotherapy or radiation therapy can lead to severe pain. It’s a similar approach. We help them detox because a lot of these agents have left some residual toxins stored in the fat. We deal with detox; we deal with addressing nutrition, because unfortunately, often they were not taught that nutrition needed to be a key part of their cancer treatment. I’ll do a nutritional assessment, and there may be some targeted supplements that we’ll use. People find that their pain remarkably diminishes. Fatigue is the easiest for me to treat. That resolves very nicely. I’m very excited. I am. Now we’re adding other disease states that we’re investigating, so we’ve added fibromyalgia, added long COVID, and we’re just in the process of adding cancer-related fatigue. people in camp cancer remission who are free of their cancer but are left with this severe fatigue, and we’ve added those are the groups of folks that we’re studying. I’d like to also add the cancer neuropathies because, in my clinical practice, I see a bunch of those people as well.

Michael Karlfeldt, ND, PhD

That is amazing. Where can people go to learn more about these studies? Where can they learn more? Because I know you have an amazing team, and that’s available.

Terry Wahls, MD

To learn more about my clinical trials, go to TerryWahls.com/MSStudy. That’s terrywahls.com/msstudy. To learn just more about me, I invite you to come follow me on Instagram: drterrywahls, you get to see what I’m eating and what I’m doing. It’s lots of fun. My website is terrywahls.com.

Michael Karlfeldt, ND, PhD

I urge all the listeners to listen to Dr. Wahls amazing recovery story. That is just fascinating. I didn’t want to go through it today, but I know that it is available on my website. the radio show interview I did with you. People can go just to my website and type in Wahls, and it pops up. Such an incredible story. Well, Dr. Terry Wahls, a dear friend, you are amazing at what you are doing. I marvel at your abilities and the impact you have on the world.

Terry Wahls, MD

Thank you so much.