Reversing Irreversible Neurodegenerative Diseases

Terry Wahls, MD

Thank you for having me.

Heather Sandison, ND

So let’s dive right in, you are an expert in brain health, and a lot of this is through the lens of multiple sclerosis, which you personally have experienced. I’m curious, how does that overlap at all with dementia?

Terry Wahls, MD

When I was diagnosed with multiple sclerosis way back in 2000, my neurologist said, “You know, Terry, do not worry, cognitive decline is not part of multiple sclerosis”. The thinking has since evolved, and we understand that cognitive decline is a very common occurrence and that somewhere between 40 and 70% of those diagnosed with multiple sclerosis experienced cognitive decline. In the vast majority will end up losing gainful employment within 10 years due to either cognitive decline or fatigue disability. And so yes, this commonly occurs and I think the root causes are probably very similar in terms of mitochondrial dysfunction, hormonal imbalance, and increased toxin burden, but I’m sure we will get into that.

Heather Sandison, ND

Yeah, I would love to also just the anatomy. Both multiple sclerosis and dementia are neurodegenerative disorders. We might put them in the.

Terry Wahls, MD

There was a lot of emphasis early on for the acute inflammatory components of multiple sclerosis and not enough emphasis on the neurodegenerative component. Now we have drugs that are very effective at reducing the risk of gadolinium-enhancing lesions. They may slow the decline of brain atrophy but they do not prevent it. They may slow the decline of early-onset disability but they do not prevent it.

Heather Sandison, ND

This is so fascinating because the story is so similar in dementia, especially in Alzheimer’s, where we have focused on beta-amyloid plaques. And yet we see when the drugs target just beta-amyloid plaques, they do not slow or prevent cognitive decline. And so there are lots of parallels here that, yes, perhaps we need to take this step back and say what is actually causing cell dysfunction. So let’s jump into the cells. Astrocytes, microglia, neurons, oligodendrocytes. What are the roles of these?

Terry Wahls, MD

Well, one of the things that I focused on before I was really tuned in to astrocytes, some microglia or the microbiome was when I thought, I should focus on creating health. I should focus on what science tells me or the scientifically validated ways that can improve health. I, and so that inspired me to go back to meditating and I would already be since I was a  former athlete. I had ignored my neurologist’s advice and said, “Do not exercise so much.” said, “Oh, that is wrong”. I know I need to exercise as much as I can to maintain my strength as well as I can. And then focused on, I had already been doing the paleo diet for many, many years, which was really focused on what not to eat. And, but then when I had this big aha, like all these things I have taken a supplement form for my mitochondria, where are these nutrients in the food supply? And what if I focus more on what foods I should be emphasizing? And that is when the magic really began.

Heather Sandison, ND

That is so much of your magic is that focus on what to eat. And these nine cups, the different, the three cups of different types of vegetables every day. It is so easy for me to communicate to a patient. It is easy for them to see in their minds. Now, of course, there are steps between imagining eating nine cups of vegetables, of three cups of leafy greens, your three cups of and please jump in, because clearly, you are the expert who created this. But from what I understand and what I tell patients, it is three cups of leafy greens, three cups of those really colorful veggies like carrots and beets and all of the mushrooms. I think I’m putting that in the right category.

Terry Wahls, MD

Well, so it is three cups and focused on beets, carrots, berries, and tomatoes. Things that when you slice through them there is pigment all the way through. And then I have three cups of the sulfur-rich vegetables, cabbage family, onion family, mushroom family. And then as people get more advanced, we can talk about fermented foods. If you are a meat eater, the benefits of eating organ meat, the benefits of bone broth. And then we talk about why you might want to consider a ketogenic diet and how to do that. The complexities around ketogenic eating are we doing a medium chain triglycerides which is handy because you get to eat more carbs. Or you are gonna do an olive oil-based ketogenic diet which I have become much more impressed with lately.

Heather Sandison, ND

Terry, tell us why?

Terry Wahls, MD

Well, medium chain triglycerides and coconut oil can cause an elevation of triglycerides, it can cause an elevation of LDL cholesterol, total cholesterol. And I think that is very deleterious. I do not, I have ketogenic eaters who think they are fine with cholesterols of 300, 350. And I do not think they are fine. Much rather they do go on a ketogenic diet if that speaks to you, check your lipids and if your lipids are still great, that is fine. If your lipids are not great. So your cholesterol is over 220, then I would take away the saturated fats and go on a olive oil ketogenic diet. Now, if you do that, it may be important to add in time restricted feeding. So you can get more ketones even though you are gonna have a lower-carb diet.

Heather Sandison, ND

Wow, so there are different ways to individualize the ketogenic diet. I’m sure you saw this study, a feasibility trial, a small nine person feasibility trial out of Florida that showed that in just six weeks, the majority of well, eight out of the nine participants were reversing their cognitive decline with just the intervention of a ketogenic diet. So we see a lot of movement here in the scientific space, supporting the ketogenic diet is really good for the brain and getting into that can be a little scary for people.

Terry Wahls, MD

Yeah, and part of that is as our brains age it becomes less effective at metabolizing glucose. But we maintain our ability to metabolize ketones really very well. So I think that is one of the reasons why as you age, a lower-carb diet with more ketones or a ketogenic diet can be really very helpful.

Heather Sandison, ND

And then there are these fears around, well, my cardiologist is telling me, I now need a statin because my cholesterol is going up on the ketogenic diet or what if I do not have a gallbladder? And so there are, it sounds like what you are saying is there are ways to individualize this diet, keep it really a veggie focused.

Terry Wahls, MD

Well, I certainly agree. You wanna, if you are going on a ketogenic diet it is really important to monitor your lipids and assess how that is doing. I also want to remind people that our ancestors were in ketosis primarily through physical activity. So our hominid ancestors had tremendous  endurance and we literally ran down big games. It might take all day or a couple days of continued light jogging to finally exhaust the great mammal that literally keeled over from exhaustion. But during that all day or two day track, you used up all of your glycogen. So you were in ketosis in part because maybe you were not eating a whole lot during that time but mostly because of the physical activity. So, we would fluctuate between a bean and ketosis and then we have the root feed higher in meat, a lot of green vegetables, plants, maybe some roots, a fair amount of dirt on my diet. And then when food was scarce, we are back out on the hunt again. And so the concept of a high fat ketogenic diet is only about a hundred years old, but humans have been on a ketogenic diet through exercise probably for thousands and tens of thousands of generations. And it was relatively recently when we became farmers that we started having a much higher carb diet. And then when we got into the industrial and information age, when we started having less and less activity and food that was designed, that was so high in sugar and processed foods that we really got into this very military diet and lifestyle pattern.

Heather Sandison, ND

And so what does this do to ourselves?

Terry Wahls, MD

Well, it accelerates aging. We do not have as much autophagy where our cells will clear the misfolded proteins that leads to shortened telomeres more rapid, aging of the cells. And we have a much shorter health span where we have the onset of high blood pressure, obesity, metabolic syndrome at early and earlier ages. We now see that even in our children and we have the onset of cognitive decline. So being sedentary, deadly accelerates aging, having a high sugar, high carbohydrate diet, deadly, accelerates aging, accelerates metabolic syndrome and being sedentary, accelerates mental health issues, anxiety, depression, irritability, rage.

Heather Sandison, ND

So toxicity is another piece here. The microglia and astrocytes are special in this way. Can you speak to that?

Terry Wahls, MD

Well, it is sort of interesting. The neurons, which is the thinking part of the brain that communicates down through the axons to the next neuron and so forth. Out to our sensory organs and to our muscles is 10% of the brain, 90%, there the 90% are the glial cells. So the microglia, those are the immune cells, the astrocytes, which cover the capillaries and help transport oxygen and nutrients to the neurons. And then the oligodendrocytes, which are repairing myelin, making new myelin. And of course there are subtypes in each of those big categories. It is the astrocytes and the microglia that are really responsible for monitoring the environment for pathogens, for evidence of damage. So if they perceive that there are pathogens or cellular debris damage, they will activate the innate immune system, which will call in more cytokines, chemokines, and begin dissolving the debris, begin dissolving synapsis, begin dissolving the oligodendrocytes, begin damaging the axons and the neurons until they have cleared out the damage cells, cleared out the pathogens. And so it is the health of the astrocytes, the microglia that determine the health of the brain, whether it is neurotoxic or neuro repaired off. 

And there is certainly a whole lot of interest in drug development to see like can we devise drugs that will shift these microglia to a more pro-repetitive phase. Because when we look at Parkinson’s, Alzheimer’s, multiple sclerosis that we see there is abnormal activation of the microglia to either the M1 phase, the reactive, hyperinflammatory, neurotoxic phase, or the M2 phase, which is the more pro-repetitive phase. The challenge is that, which is excessively high, whether it is M1 neurotoxic or M2 neuro repetitive, depends on which phase of the disease you are in. And if you shift away from M1 to M2, one of the consequences, if you are in the M2 phase, you are making more VEGF, you are making more blood vessels. So, if you are worried about the risk of macular degeneration, I have just increased the risk of macular degeneration and early blindness. If you are worried about the risk of cancer, I have just increased the risk of cancer of the brain and probably everywhere else, because I have added more blood vessels. 

And also when you are in the M2 phase, you can not clear debris as well. Well, if I’m not clearing debris and pathogens as well, now those latent infections that I have in my brain, herpes virus, Lyme, chlamydia, strep. We used to think the brain was sterile. Now we know that when I can do these RNA, DNA probes, my brain’s not sterile, but my immune cells, meaning microglia and the amyloid are keeping everything out of control. If I suppress my ability to clear the amyloid too, I’m worried that in fact, I’m going to be increasing activation of those latent infections. So I predict that drugs will not be very effective because they are going to have unacceptable risks of cancer, blindness of activating late infections. What I do predict will be effective is getting our lifestyles to be better aligned with our evolutionary history of physical activity, of sleep, of diverse diets, with 200 plant species, with meditation, with meaningful  relationships, the kinds of things that I have been taught talking about now for a over decade and the kinds of activities that I have been researching now for over a decade, that is more work, but ultimately will be much more effective for MS. And for anyone who wants to have healthy aging for their brain, or wants to have decreased risks of cognitive decline.

Heather Sandison, ND

It is more work and society is not really set up to make it easy to do that work that supports health. Do you have tips for anyone about how to approach that somewhat overwhelming or daunting task of shifting your diet, shifting your daily routine so that you are incorporating exercise?

Terry Wahls, MD

Well, the very first step that goes back to my work with veterans in the therapeutic lifestyle clinic, was that we would have this big intake in, then we’d have group visits. And one of the things that we would have were group visits, where we would do skill building class. And the skills class that was the most treasured by our vets. And they taught me, it was actually the most important was what is your why? We are gonna be ask you to do things that are difficult. Creating new habits is work, extinguishing unhealthy habits is work. And we do hard things when there is a compelling reason. And so, as we realized that these vets, they went into war, they would do enormously risky things for their fellow soldiers because they cared deeply for them. 

I began asking all of my patients now, what is your why? What would you do with your health, if it would moderately improve? Another question that we like to ask is, is there someone or something that you care so deeply about, that you would run into a burning building without hesitation, without question, because who you love is at risk? And once we identify that and we identify what they’d like to do with this person with somewhat better health, now they have a reason to begin doing things that are hard. And I’m very upfront. This is hard, it is hard work, creating new habits, it is hard work, extinguishing harmful habits. And then we work on strategies, how to make bitter vegetables taste really quite delicious, how to create foods that are wonderful and we certainly found them. And I think this is probably true for way too many people here in the United States. They have forgotten how to cook, or they never learned how to cook. They never learned how to meal plan, how to shop, how to plan for leftovers so that they are not throwing food away. So we would have cooking classes, we’d have meal planning classes, would  have shopping classes, would have classes on how to bulk prepare your food. So you cook one meal and either freeze it or can it, so now you have meals that will take me just five minutes to warm up. We wanna make it easier for them to be successful. But certainly, the very first step is to get into deep touch with what is your, why? Why do you wanna do this work?

Heather Sandison, ND

Do you find that some people decide this is not for me?

Terry Wahls, MD

You know, I make it very, very easy for people to say, nope, this is too hard, I do not wanna do it. And so the way to come see me at the VA was you could get a consult from your primary care doc, especially specialists. You would come to a big group class, keep having you get larger and larger rooms to have my initial consult with everyone. I would tell my story, we’d review some cases. We’d review the concepts of our functional medicine approach. And would say, okay, now you have a choice to make. One choice is you’ll be all on doing the diet. Gluten-free, dairy-free, lots of vegetables, 100%, 400 days. And we will talk about how you can get your group intake and your support with me and my team for six months. Or you could say that is too hard, but I would like to work on my diet, sort of, and we will give you a consult to the dietician, or you could say I’m not ready to diet, but I would really like to learn a stress reaction. 

Mindfulness meditation technique, would send you to our health psychologist. Or you could say, what really speaks to me as an exercise problem and we’d send it to physical therapy. Or you could say, this is not the right time. I can not do that because my wife’s going through breast cancer, I have to be all in for her. I just can not do this at this time. And that is okay too. Just come back when you are ready. We never argue with our patients. Here’s the possibilities, here are the ways you could work with me if you are ready. And if you wanna be all in, we have got this group plan. It is a great time. If you wanna just sort of start a little bit, you could work one on one with my dietician, with our health psychologist, with our physical therapist and that is okay. Or you could say, I can not do it, I’m not ready. And that is fine. Come back when you are. People aren’t committed. It is a waste of my time and their time.

Heather Sandison, ND

Yeah, 100%. Tell us a bit about your personal share, your personal story.

Terry Wahls, MD

Well, I will tell you in real time. 20 years ago, I’m out walking with my wife. My left leg grows weak, dragging it, I hobbled home. I see the neurologist the next day, who says, Terry, this could be bad or really, really bad. So at night in bed, next to Jackie, I’m thinking about really bad. And I’m thinking about the 20 years of worsening face pain, jolts of pain. And I’m like, I think I would rather this be fatal than disabling. So, I’m praying for a fatal diagnosis. Three weeks later, I hear multiple sclerosis. I am a professor of medicine. Of course, I go do some research. See the best people in the country. Take the nose drugs. Three years later, I hear tilt recline wheelchair. I get take even more aggressive drugs, neoadjuvant, chemotherapy, then Tysabri. I continue to go down, go downhill. Trigeminal neuralgia is relentlessly worse, but now I know how terrible it is. So I decided I’m gonna go back and start reading basic science. I develop theories that mitochondria are involved. I started on supplements. 

I slow my decline. I discovered electrical stimulation muscles. I get my physical therapist to let me try that, it hurts like hell, but when it is over, I feel great. So I go to clinic three times a week, I do e-stim. And then it says, it’ll get me a home going device. I start adding e-stim to my physical therapy and mind you, I can only do about 10 minutes of exercise because I’m so weak. I cannot sit up in a regular chair. I’m beginning to have brain fog. My electrical pain is more frequent, more severe, much more difficult to turn off. In 2007, the future I see is bed in demented and trigeminal neuralgia turned permanently on so that breathing, talking, swallowing triggers electrical pain. And that is when I have this big aha. And I should say I had already been a paleo eater for five years doing the AIP diet. And I had been declining the supplements maybe slowed my decline but it was that fall. I had this big aha. 

Like what if I redesign my paleo diet? And am I doing everything that I can. So I do some more research where these nutrients are in the food supply. Go back to meditation. And December 26th, I started this new way of eating, which originally was just a list of foods that I was stressing by the way. And at the end of the next month of January, my brain fog is less. My energy’s a little bit better in February. So in the second month, my physical therapist says you are getting stronger. He advances my exercises. I begin lifting little weights, mind you, little weights. In March, I am walking with a cane originally, two walking sticks, then with one. And then in May with my, I asked my wife, Jackie, said: “You know, could I try biking because well, you know, maybe in the fall things keep going well.” A week later we have an emergency family meeting because that I’m determined, I’m gonna try riding my bike. And my son says, tells my son, Zach, to  jog along the side and the left, my daughters Zebby will jog alongside in the right and Zach will follow. And I bike around the block. My kids are crying, Jackie’s crying, I’m crying. And three months later, I biked 18.5 miles with my family. 

And of course, we are all crying again and this really transforms how I think about disease and health that will transform the way I practice medicine. And it will transform the focus of my clinical research, my chair of medicine. And actually my Chief of Staff at the VA became a huge supporter of me. And I began doing clinical trials, testing the intervention I had used. First, it was a single arm safety and feasibility study showing could others with progressive multiple sclerosis, do this very complicated regimen that I had just done? And so could they do it? Do we hear anyone in our trends in the right direction, because no one expects anything to be statistically significant when you do just 20 people. So they could do it. We radically changed their diet. They began meditating, they began exercise. They did the e-stim. The biggest side effect was if you are overweight, you lost weight, got back into a healthy weight. And I had to do reports, safety reports every three months because people lost weight so rapidly. No one became underweight. And so remember we only expected to see a trend in the right direction. Well, the severity of fatigue went down and the clinically meaningful reduction fatigue severity is 4.5 it went down 2.38. So P value 0.0005 and the short form 36.

Heather Sandison, ND

This is for everyone listening, this means very significant, even in a very small sample size. You were demonstrating that not only was this feasible. Not only was it possible, but the significance of this intervention was well beyond placebo, well beyond other drugs, well beyond what was available.

Terry Wahls, MD

And we measured quality of life, the clinical significance there, you have to get to a five point scale and we were able to show 14 and 17 point improvements. So, again, P value of 0.0005. We also had improved verbal and non-verbal reasoning. And half of our folks had clinically meaningful improvement in either walking function or hand function. As a group, they stayed flat. And with progressive MS, you anticipate a 10 to 20% worsening every year. So the fact that the group stayed flat that is stunning and that half had clinically meaningful improvement is remarkable. We had one lady who went from cane to short distance walker, long distances, who is now jogging. And as I go around the state doing updated presentations, when I’m recruiting new patients, I see some of my former state participants and it is sort of like, I’m at a revival meeting because these ladies will. So I give my presentation and invite people to  the next study and these folks stand up and say, I was in Dr. Wahls first study. And let me tell you, this stuff really works. And if I quit doing the thing she asked me to do, if I stop eating that way, my fatigue is back. My balance is off, I can not walk nearly as well. I go back to a program. Without it, I would be in a nursing home now. So we have restored hope and lives to millions of people all over the globe.

Heather Sandison, ND

That is incredible. And thank you for the work that you are doing. There is quite a few parallels with this story around dementia, right? That progressive MS is supposed to be irreversible. This is not the relapsing remitting type of MS. This is the progressive MS that you are talking about. And so this is, you are somewhat casually reversing an irreversible disease. And with the Bredesen approach, we see something similar. And I feel very fortunate that I do not have a story similar to yours where I have experienced dementia and had to come back from it. But we have lots of study participants as well as Dr. Bredesen, the first survivor of Alzheimer’s who can describe these stories. And what’s incredible about this, is that what your intervention is so similar to his, right? What we are creating is health at a cellular level, optimizing the function of each cell. So that then the organ and then the entire body can function better into our seventh, eighth, and ninth decades. Exciting stuff.

Terry Wahls, MD

We are focused on health span. And what we discovered in the therapeutic lifestyle clinic at the VA is that by focusing on health and telling my referral physicians, I’m not gonna be prescribing drugs. I want you to keep monitoring their blood pressure, their blood sugar, and you may have to reduce meds. And occasionally I have to call them and say, look, the blood sugars are too low. You gotta back off on all that insulin. They do not need it anymore.

Heather Sandison, ND

And the blood pressure as well, right.

Terry Wahls, MD

And blood pressure. Yeah, then as far as telling my folks, so if you are getting lightheaded cut back on your blood pressure meds, if your sugars are getting low, you gotta cut back on your diabetic meds and then call your prescribing physicians. Because as health improves, this is the most effective treatment for chronic disease. It is not drugs and drugs may be necessary for time to control symptoms. It is not that we are anti-drug, we are ProHealth and pro-careful monitoring of medication use. And reducing it as is clinically appropriate.

Heather Sandison, ND

So instead of getting into the cycle of like adding the drug and then adding another one to take care of the side effects from that medication, and then another one to take care of the side effects from that medication and expecting people to kind of increase their polypharmacy as they age. What you are describing is this virtuous cycle where yes, we go in with our why and our motivation to either eliminate the MS or reverse the MS or the dementia. And what we end up doing as a side effect is optimizing weight, optimizing blood sugar, optimizing blood pressure, and actually getting rid of a lot of those expensive things.

Terry Wahls, MD

Producing, simplifying and getting off medication. Because again, I was working at the VA at this time and we had electronic medical records. I was able to give reports to the Chief of Medicine, Chief of Pain in terms of what was happening with our patient cohort in terms of their blood pressures, blood sugars, woman A1Cs, diabetic meds, hypertensive meds, and pain meds. And to know what’s  happening to their lipids and were able to show that our approach was leading to improvements in weight, improvements in blood pressure, blood sugar, and laboratory values. And so, and that certainly was the beauty and the wonder of being at the VA was the electronic medical record. That would let us see what was happening to our patients.

Heather Sandison, ND

So clearly points to the data that there was this really big impact. And when we put it, when we start to think about applying this at a societal scale, this changes the numbers in a big way. We can reduce the cost of spending in healthcare. We can reduce the amount of time that people are spending going to their doctor’s offices and interfacing, sitting in lines and waiting and doing labs and all of these things. So over the course of a lifetime, if we can improve health, we can really change how people spend their time and money.

Terry Wahls, MD

We can have a huge impact.

Heather Sandison, ND

Huge impact.

Terry Wahls, MD

Huge impact. In much of this, I wanna remind everyone. So in the VA system, I could not do fancy functional medicine testing. I could do some pretty, when I first started doing this, I was doing this in the brain injury clinic where I could see people twice a year and no labs. So people with traumatic brain injury who were told, well, there is nothing we can do. You are either gonna get better or not. And I came and said, oh, there is a whole lot we can do. And so I got people fired up to take care of everything that they could do. And you could tell very quickly who I saw and who didn’t get to see me, because the people I saw were getting better, that they kept their jobs. They still had their family and they were thriving. Their headaches were gone, their photophobia was gone, their fatigue was gone. 

And then in primary care with the residents, I could get a few basic primary care labs. And I got people inspired to eat these radical things, known as vegetables and to start walking. And my residents saw like they could tell the people, they were staffed with me, they were getting better and their blood pressures were getting better. Their blood sugars were getting better and they were simplifying their drugs. People they staffed with other folks, they were adding more drugs. And then the VA, the Chief of Medicine called me in and said, okay, we are gonna pull you out of primary care and we are gonna create your own new clinic. And so now I could decide the way I wanted. And I was able to have a dietician to work with, the health psychologist, physical therapist that we could refer to. 

And now I could order some labs. I was thrilled because now I could order really very basic primary care kinds of labs, an A1C, a lipid, and vitamin D. I got homocysteine that was a little bit controversial. I got insulin that was a little bit controversial. And occasionally I might get zinc level and a B vitamin level based on the exam. And with those very simple labs and getting people inspired to work on their diet and walking. Again, we saw fatigue go down, blood pressures go down, blood sugars go down. And many of these young men from the Iraq war, Afghanistan war had developed weight gain, pain and severe erectile dysfunction, loss of libido. And they come back and usually somewhere between months, three and months six, the erectile dysfunction is resolved. And these guys of course are really quite thrilled. And you part of that, their love life’s coming back. 

No doubt being less irritable, probably made it a whole lot easier to have romantic relations with their spouse. That would no doubt help. The ladies who were in the clinic. We didn’t have as many women as men, but we certainly had some they are thrilled because they are losing weight without being hungry. But when we talk to them, they are admitting that well, as a matter of fact, they are more interested in having a little romance with their partner now that their pelvic pain and severe menstrual cramps have gone away or their severe hot flashes have gone away. And, what they are most excited about is that they have lost weight without being hungry. And the men also lost weight without being hungry, but, and I’m gonna be a little, sex determined roles. The men are much more interested in performance and the women are much more interested in appearance, but they both had similar effects. They both were losing weight and they were both having enhanced romantic relationships with their romantic partner.

Heather Sandison, ND

Getting more joy and vitality out of life, more connection, right?

Terry Wahls, MD

More connection, more meaning and probably better hormonal balance. Their cortisol levels are probably down. They probably had less cortisol still. So the men were probably making more testosterone. And the fact that they are exercising more, they are making more testosterone. The women probably had less dysfunctional estrogen metabolism.

Heather Sandison, ND

So you are probably saying no, I hope that with all this success, with this wild success that you are showing that somebody has funded it so that you task this, so that you can so that you can measure it.

Terry Wahls, MD

Well, so we have a number of clinical trials going on. We are starting a new clinical trial. That is gonna be looking at the olive oil ketogenic diet, the modified paleo diet and dietary guidelines over two years. And so I’m just now recruiting for that. So Heather, I should make sure you have the links so you can send people to that. You have to live within 500 miles.

Heather Sandison, ND

What is the population?

Terry Wahls, MD

So it is relapsing-remitting MS. And you need to live within 500 miles of Iowa city. We also keep writing grants. We have a grant that is under review and hopefully, they will hear the results in the next month to analyze the metabolome of the last study that we just completed, and that we have a freezer full of vials. And we’d like to know what happened to the microbiome? What happened to serum neurofilaments? What happened to a number of biomarkers and how that changed over time? And so ever the optimists will get funded and we will be able to investigate that.

Heather Sandison, ND

Amazing, how exciting. And so the last time I talked to you, you had a very different background. You actually had little poopy guys.

Terry Wahls, MD

Oh, my little poops. Yes, that is on the other wall. Some people did not like all my poops in the background, so I flipped it. And so I have got this wall that does not have the poops, but yes we have lots of poops in the background.

Heather Sandison, ND

So for me personally, I am missing them today because I think this gut-brain connection is just absolutely critical to understanding health, right? Not just of the brain, but of the entire body. 

We’ve all heard the adage, that health starts in the gut. So just, I mean, the poopy guys are great because they spark that conversation, but I do not wanna miss the opportunity to have it with you. So would you describe what you’ve seen clinically? What have you learned from the science about the gut-brain connection?

Terry Wahls, MD

Well, when we became multicellular billions of years ago, at that moment we brought some of those single cellular organisms into our digestive tract and they have been helping us digest our food, and absorb our food through millions and trillions of generations. We also have come to learn that as the digester food, they speak to our immune cells and make our immune cells more reactive or calm, helping us develop tolerance to the food proteins that we are digesting. And that again, sort of think of it from an evolutionary standpoint when our ancestral mothers would develop spontaneous mutation and could not do a particular enzymatic step, but for microbes it could. It is no big deal. You just exported the genes for that step to the microbes. And so having millions of microbes to fill in the gaps, we are fine. And so over millions of generations, we trimmed our DNA to only those steps that our microbes could not do for us. If we lack diversity in our microbes, we are going to be lacking some of the metabolic pathways that we need for optimal health. And we have certainly, have seen that the less diverse your microbiome is, the more like you are to have obesity, chronic disease, mental health problems, cancers, and autoimmunity.

Heather Sandison, ND

Wow, so you mentioned that it kind of, as you work through your diet, at some point you are adding fermented foods. What are some of your favorite fermented foods?

Terry Wahls, MD

Well, we know that fermented cabbage really rich in lactobacillus, Enterobacter species in that those societies that have a lot of sauerkraut or kimchi have better health overall, less rate of influenza, less rate of COVID hospitalizations, deaths, ICU care. And so for my weekend chores, I’m making sauerkraut and kimchi, usually one or the other every weekend. And I have probably a couple cups or more of sauerkraut or kimchi every day, either on top of my salad, straight into my soups, straight into my casseroles, or just as a side. And for your listeners, if your family doesn’t know how to enjoy sauerkraut or kimchi, what you do is you prepare your evening meal and the transition between the stove top and your dinner plate before you put it on the table for your family, you stir in some sauerkraut or kimchi, it disappears into your casserole. It disappears into your soup, they will have no idea. You’ll let the food cool a little bit. So you are not killing off your probiotics. And it really adds a lovely flavor. You can gradually increase the ferments as your family gets used to it. And again, speak to the benefit of having these probiotic foods for maintaining your gut garden.

Heather Sandison, ND

And if you can get everybody to eat kimchi, then you do not have to worry about your breath being the only stinky breath.

Terry Wahls, MD

Well, if you stir into your casserole on your soup, it will be very mild.

Heather Sandison, ND

And then what about miso? And kombuchas are very popular.

Terry Wahls, MD

Okay, so kombucha are some of the hazards, if you make your own kombucha, or if you get commercial kombucha, read how much sugar there is. So commercial kombucha has way too much added sugar, so you’ll need to let it ferment further down. I think picamas has less sugar. So my preference is for the picamas. And what was the other?

Heather Sandison, ND

Miso like the fermented?

Terry Wahls, MD

So if you are looking for miso, be sure to read the ingredients, some miso is made from wheat and barley. So for me, that would be disastrous and that would trigger my face pain. But miso is made from soybean. Again, it will depend if you have an intolerance to soybeans. So read the ingredients to be sure that you are tolerating that miso or tempeh. Another fermented food, natto, which I have just discovered. And I have started making a great source of vitamin K2. It is a Japanese health food. So I will mix natto again in with sauerkraut and some olive oil. And that has become really very delicious snack for me.

Heather Sandison, ND

And then yogurt? A lot of my patients will say, I ask , are you taking a probiotic? Or do you get fermented foods? Oh yeah, I have yogurt every day, dairy.

Terry Wahls, MD

So, again for yogurt, you wanna be sure that you are reading the ingredient label. So what all of the ingredients are and then you have to sort them out. Are you tolerant of dairy? And there are reasons that I personally avoid dairy. You can get yogurts and kefirs from plant or nut-based milks or coconut milk as another option.

Heather Sandison, ND

Yeah, wonderful. What great options, it is making me hungry to have this conversation with you. Dr. Wahls, I could not be more grateful for your time. This is just an incredible opportunity for all of us to learn from your wisdom and experience. It is both going through this personally and then having dedicated your career to helping people understand the science and how this can really be amplified by getting more people access to the medicine that you provide. I am just so, so grateful again, that you have shown up on our summit, the Reverse Alzheimer’s Summit. Let everyone know where they can find out more about your clinical trials as well as your clinical practice.

Terry Wahls, MD

So if you go to terrywahls.com TERRYWAHLS.com. I will have a lot of information there. Follow me on Instagram at Dr. Terry Wahls, Dr. Terry Wahls. Follow me on Facebook at Terry Wahls and Twitter at Terry Wahls. And then if you search for the Wahls Lab, you’ll get access to our various papers. And you will hear about the various studies that we have, and I will send you the links so people could screen for our research studies as well.

Heather Sandison, ND

Fantastic, we will make sure those are on the show notes. Thank you again, it is been an absolute pleasure.