WTH?!? Episode 113: The Microenvironment in relation to Neurodegeneration with Dr. Terry Wahls

Welcome to what the Health an independent approach to your health span. Have you noticed how our healthcare system may not have your best interest in mind? Join Dr. Eckel in this fun and sometimes disturbing exploration of the state of healthcare and what it means for you. Now, here's your host, Dr. Eckel.

Welcome back, everybody. I'm Dr. Greg Eckel, and this is what THE Health We've got a great riveting topic today, the role of the microenvironment on microglial mitochondria and myelination and how it all relates to neurodegeneration and healthy aging with my guest and esteemed colleague, Dr. Terry Wahls. She's an Institute for Functional Medicine certified Practitioner clinical professor of medicine at the University of Iowa, where she conducts clinical trials in the setting of multiple sclerosis, which we're going to hear about. Some updates today. 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. Dr. Terry Wahls, welcome to what the Health.

Hey, thank you so much for having me.

It is so good to have you back on. And I love all of the alliterations of the microglial, the mitochondria and the myelination. And our topic today, for folks that haven't met you or have seen your work, you suffered from multiple sclerosis and severe pain due to trigeminal neuralgia. I'm wondering if you could just give us that overview and kind of your story as to what's happening there.

So we'll tell it as it happened. You know, 20 years ago, out walking with my wife a half mile from home, my left leg comes week dragging it a hobble home. The next day I see the neurologist who says, terry, this could be bad or really, really bad. So at night I'm thinking like, okay, bad or really, really bad. And I think about the 20 years of worsening electrical face pain that I've already endured. So I'm actually, I'm not wanting to become disabled. So I'm mentally praying for a fatal diagnosis. Three weeks later, I hear multiple sclerosis. See the best people take the most drugs. Three years later, I hear tilt, recline, wheelchair. I'm continuing to get worse. The trigeminal neuralgia is on yet again. Tears stream down my face as my 10 year old daughter hugs me. But you know, I'm a doc. So I go to PubMed and like, okay, I know how bad it is. I'll start reading the basic science and I begin experimenting on myself. I think mitochondria are key. And I work on a supplement cocktail slows my decline. Then I discover a study using electrostimulation of muscles. I asked my physical therapist, can I add that? He says, well, you know, Terry, this is called E sim. It's for athletes. I can grow bigger muscles. I don't know if your brain can talk to them. But he does agree to let me have a test session because by that time I'm too weak to sit up. So I'm a pretty weak kid. The test session hurts bad, really, really bad. But when it's over, I feel great. He says, it's the endorphins. We add the E stim to my physical therapy. All of my physicians have said, terry, you have secondary progressive Ms. Functions once lost will never come back. I'd taken, you know, the latest drugs. I'd taken mitozanterone. I had taken Tysabri. Nothing had helped. I just had this relentless decline. But I'm like, you know, am I really doing all that I can to slow my decline? Because I know I can't recover. I'd already been on the paleo diet for five years, the autoimmune intervention protocol, the IP diet. I redesign my paleo diet based on all the science and functional medicine course that I've taken. I go back to meditation. I'm adding more E stem and I can do 10 minutes of a little bit of MAT exercise. And two months after changing my diet, my zingers are gone, my fatigue is less, and I can sit up at the table with my family. Three months after this new diet, in my estim, I am walking with a cane in the VA hospital. Six months we have this emergency family meeting because I asked my wife, I want to try riding my bike, which I have not done in six years. So we have this emergency family meeting and she decides that she'll let me try. My son's going to jog alongside on the left, my daughter will jog on the right, she'll follow and I push off and I bike around the block. My son is crying, my daughter's crying, Jackie's crying. I'm crying. When I talk about it. Even now, I still get choked up because it was then that how I understood disease and health really was transformed. Because it was at that point I'd already Been walking around the block. But when you have a progressive neurologic disorder and you know you can't recover from it, you learn to take each day as it unfolds. So I didn't know what was happening. I didn't know what might be possible. But after I rode my bike that day, I understood that the current understanding of multiple sclerosis was incomplete. That who knew how much recovery might be possible? And what is stunning is about. So that's in May, in October. So, you know, six months, seven months later, I do an 18.5 mile bike ride with my family. And once again, everybody's crying. You know, my kids are crying, my wife's crying, I'm crying. And this really changes how I think about disease and health. It will change the way I practice medicine, and it will ultimately change the focus of my research and my mission in life.

For sure. I mean, that's super inspiring for all of us. And I can only imagine, really, I mean, your back literally was against the wall in the wheelchair.

Yeah. You know, so in 2007, I'm 52, I can't sit up anymore, can't sit in chair like this anymore. I have a zero gravity chair where I recline back with my knees higher than my nose. Fortunately, I'm still mentally clear. So the university and the VA had redesigned my job multiple times. So I was staffing residents, I was staffing the research committee called the irb, and my pain was clearly getting worse. I was clearly headed towards being bedridden, and I was beginning to have some brain fog. So the Future I saw in 07 was bedridden, demented, intractable pain. And I had my wife and I had changed my living well power of attorney, durable power of attorney such that because when my pain turns on in 2007, a breeze would trigger the pain, light sound would trigger the pain. Talking triggers the pain, swallowing triggers the pain. So I start drooling and I go in, get IV infusions of Silumidrol and get topical injections. And it would take five days of solubedrol to get things turned off. So I thought it, you know, from my, at that point, 27 year history of relentless worsening of the trigeminal neuralgia, it's like, okay, eventually it will be permanently on. And I took great comfort in that I could change my medical power of attorneys such that when I stopped swallowing, there'd be no IV fluids or feeding tubes. And until you have that level of pain, I mean, I don't think people can appreciate what what that was like.

For sure, for sure. And so how. I mean, what. Why you, like, what made you think, like, well, let's look at the diet. Like, you saw research on that or.

Well, you know, it's an interesting process. When I was first diagnosed, I started reading. Like many physicians, I go to pubmed, I start reading and I saw Ms. Is progressive. I was just getting really upset. And Jackie said, terry, you got to stop reading. It's just getting you upset. We'll find the best people. Let them take care of you. So I did that for the first three years, and then when I got in the tilt recline wheelchair and I was clear I had converted to secondary progressive, I said, okay, we now know how bad it's going to be. Really bad. I'm going to go back to reading the basic science. So at first I was looking for drug studies because, you know, I'm a professor of medicine. I believe in drugs, I believe in science. And then I finally realized, you know, that's a long pipeline. Maybe I should begin looking for some supplement studies. And so as I was reading these interesting supplement studies in neurodegeneration, I'm now on the irb, and I said, give me all the brain studies. So I was getting more and more comfortable reading clinical trials on brain stuff. I decided that mitochondria were the driver of disability, whether it was Huntington's, Alzheimer's, Parkinson's, or progressive Ms. Then for the next four years, I was really focused on the supplement cocktail for my mitochondria. Interestingly enough, this is why I was still walking. I hadn't been in the wheelchair yet. My neurologist had mentioned the work of Ashton Embry, whose son had remarkably improved on a Paleo diet. So I read Loren Cardan's work, followed what he was doing. I did the AIP diet. I had been a vegetarian the following year. I'm in a certain wheelchair. I'm definitely going downhill, but I feel like, well, it probably takes a few years for a diet to make a difference. At least I'm doing something. And so I stayed on the Paleo diet. No grain, no. No legumes, no dairy, but was continuing to decline. And then you add supplements. And after about six months of my mitochondrial supplement cocktail, I thought, you know, I'm just wasting my money. Nothing's happening. So I stopped them all. Yeah, and I went to work the next day. Nothing changed. But the following morning, I was even more exhausted than usual, couldn't go to work. And then on the third day, Jackie came in, said you know, honey, maybe you should try these again. So I took the supplements. The next morning I could, yeah, no, you know, I was still exhausted, but at least I could get up and go to work. And I thought, wow, that was really interesting. So two weeks later, I'm like, okay, we got to try this again. So I stop all the supplements. 24 hours later, I am just even more exhausted than usual. I wait three days, then I start them up, and I'm back to my usual level of exhaustion. So now I am so excited. I am figuring stuff out that my neurologist doesn't talk, isn't talking to me about that my primary care doc is not talking to me about. And so now I am working at scanning the research, looking for neurodegeneration, looking for nutraceuticals. And, you know, I began sort of tinkering with myself. And so gradually, you know, I get more. I get a more robust regiment and the speed of my decline is slower. So I'm very, very grateful, but I'm still declining. So, you know, in 07, I could do a little tiny 10 minute strengthening workout. Mat workout that because I had sent myself to physical therapy, and so I would practically have them tune up what I was doing if I did more than 10 minutes, if I did 12 minutes, I couldn't go to work. I saw in one of the research studies that I was reviewing for the IRB for the university, they were using electrical stimulation muscles in people who had spinal cord injuries. And people, they wanted to extend the study because patients want to stop because they found it so helpful. So I thought, well, that's really interesting. So I did a quick search. There's only 212 papers. And so it didn't take long to scan those 212 abstracts. And that led to the conversation with my physical therapist who said, well, I might be making you worse because if I can grow more muscles on your legs that you can't use, yeah, we could be making things a whole lot worse. There's a really big debate between the two of us. And that first Test session, I did 10 minutes on the paraspinous on the right side, then on the left side, then on my quads. I'd done 30 minutes of exercise, kept dialing up the current. Anytime it got tall, I said, okay, then, we want to get as much current in you as we can. And so it was. It hurt a lot. But when it's over, I just felt amazing. And he said, terry, that's the endorphins. I bet your brain has not had endorphins in years.

Wow.

Yeah. And so I went to clinic then three times a week for E STEM sessions. I could exercise more with the E stim. Then we eventually got me a homegoing device and I gradually was able to exercise more with the support of the E stem.

That's awesome. Again, super inspirational. I mean, I think a lot of folks with Ms. Diagnosis, I mean, you go online and it's downright depressing. Right.

I mean, it's just. It's a progressive disease.

Right. You're going to either slowly or quickly decline, but you're going to decline.

You know, these, these really expensive drugs that are very, very effective at turning off inflammation. And the new high efficacy drugs are very effective at that. So you have fewer relapses, fewer enhancing lesions. And the time from diagnosis to wheelchair to bedridden diagnosis to wheelchair is 20 years now instead of 10. So that's very positive.

Yeah, yeah.

But they don't stop the atrophy, they don't stop the disability. They slow it down. And of course, you and I are not surprised because inflammation is part of the problem, neurodegeneration is part of the problem, and new degeneration is probably driven by mitochondria. And the drugs will do nothing for the mitochondria.

Yeah. So this has led into your clinical research, which you put together the Wahls protocol, and you've been sitting on the. The institutional review board is what IRB stands for, which is a component in universities that oversee the research department.

Right.

Allowing studies. So what are you seeing now in your clinical research? Because I think the last time we talked, you were just launching on some of that. Yeah.

Oh, my goodness. So we are. I'll run through this sequence. First you write up a case report, which my chief of medicine had me do it myself. Then we did a case series. Then he called me back and said, okay, now we do what's called the safety and feasibility trial to see can others implement what you did and what happens to them? Do we hurt them and is the trend in the right direction? So we enrolled 20 folks with secondary and primary progressive Ms. It took me about a year to write out the protocol for what I had done. Then I also had to raise the money to do the study. We could show that, yes, they could implement this complicated regimen, change their diet, add in the exercise, the E stem, and that half had clinically meaningful improvement in hand function and walking function, which is truly remarkable with progressive Ms. In that we had a remarkable improvement in quality of life. Reduction in fatigue severity. So that's the first clinical trial. Then the next two clinical trials are small randomized pilot studies where you either get at this time we did relapse, remitted ms, you got the, the modified Paleo diet, which I've designed to be very specifically structured for the brain, or you had to wait 12 weeks and then we'd train you on the diet. We call that a weightless control. And we again show that people could make big changes in their diet, have big changes in quality of life and in mood. And we had is a short time, only 12 weeks, but we could still see changes in motor function then. So now we're up to the next study. So this was funded by the Ms. Society. It was a parallel group comparing a low saturated fat diet, the Swank diet, to the modified Paleo diet, which is the Wahls diet. We had baseline assessments, we watched people for 12 weeks, said, don't change your diet, just keep doing what you're doing, come back. We measure all the assessments again, quality of life, mood and motor function. Then we randomize them to the Swank diet or the Wahls diet. Bring them back in 12 weeks, repeat the measures, bring them back in 24 weeks, repeat the measures. So the first thing we show is no surprise in 12 weeks if you don't change your diet, your fatigue levels, quality of life and clinical function doesn't change. Then we randomize them and we either gave them the low fat diet or the Wahls diet. We actually improved the low fat diet because we said four servings of whole grains, four servings of vegetables. The standard instruction was just go low fat. But that was a big debate. We, we, we improved it. So it's probably not surprising that compared to the standard American diet and we did publish that the diet quality in both arms improved remarkably. Walls more so swing but diet certainly improved. The primary outcome was would fatigue severity reduce more in the Wahls group than the Swank group? Actually they reduced an equivalent amount in both groups, Swank and Wahls. On the more sensitive fatigue measure, Modified Fatigue Impact Scale, Wahls had a greater reduction at 24 weeks than swank. And on quality of life, Quality of life improved for both, but Wahls was significantly greater. Improvements on mental health and physical health. Quality of life in walking endurance. Wahls had a clinically larger improvement in Swank on walking endurance. I think the message that I want everyone to hear is the standard American diet is not going to help your Ms. The Swank diet or the Wahls diet will help your Ms. If Going low fat speaks to you clinically because you're very worried about your cholesterol. By all means, do the Swank diet. If the modified Paleo diet speaks to you, do that. Do what you can as a family, you'll be more effective. The effect size was larger on the modified Paleo diet, the Wahls diet. However, what I think is, to me the most important is work on your diet. If what you can do is the Mediterranean diet, do that. If what you can do is the dietary guidelines, do that. If ideally what you can do is the Wahls diet, because I think it has the largest effect size that's been published today, do that. But whatever diet you're going to do, actually do the diet. You know that diet is not doing the diet.

You actually have to do it.

Terry? Yeah, you actually do the diet. A 50% diet isn't really a diet. That's just sort of a, a going out to eat restaurant experience.

Right.

So have a conversation with your family, have a conversation with your primary care doc. We, we do research and we actually do, in addition to the clinical outcomes, we analyze the food and the quality of the diet so we can talk about the nutritional outcomes for all the diets that we've studied, whether it's the ketogenic diet, the low fat diet or the Paleo diet. So that's also why we improve the low fat diet. Because I couldn't in good conscience put people on a diet that I was concerned it would be nutritionally inadequate.

Yeah, that's pretty ethical of you there. Thank you for that. And what do you know, how long, I mean, what would be the minimum somebody is going to set out? I think it's easier to think in terms of, well, what do I start with? 6 weeks, 2 months? What would be a good trial just to see if you start feeling different on the diet.

So, Dr. Eckle, a couple ways we can think about this. One is if you were in my clinics at the va, we took all comers, all sorts of autoimmune, mental health, neurologic problems and we get them started and I see them every month. And I would say the majority of folks when they come back in a month will say, I'm beginning to feel a little better. Within three months, easily 80% are feeling better. The family agrees. They're definitely have more energy, better mood. Usually we can see better blood pressure, better blood sugar. Also in my primary care clinics, that was the therapeutic lifestyle clinic. And if you're going to come to that clinic, you'd have to already have committed. I'm going to be all in to do this 100%. For 100 days in my primary care clinic with the vets and with my residents, I would have conversations with patients with all sorts of medical problems and would talk about improving their diet. And yes, I might recommend a Mediterranean diet or the paleo diet, which would usually be my first choice or at least a trial no sugar. We talk about, here's your problem. Do you want to know the most therapeutic diet or do we need to have a small step that you can achieve? I let the veteran guide. People in a lot of pain and suffering are like, I'm ready. Give me the most potent. I'm ready. And others are like, this is going to be hard for me. I need small steps. And so you have to take the person where they're at. So it might be small steps that what we're going to do is how many diet. How many liquid sugar drinks are you having every day? You're having five. Okay, what we need to decrease that. What's the number that you could pick that you could decrease in the next week? Or it might be, you know what, I'll give your diet a try for a week. Okay, let's do it for a week and then I'll see you next week and we'll check in.

Yeah.

So it's really a negotiation. Dr. Bill Bean, who was my professor when I was a third year medical student, taught me that at the end of every medical encounter, there are two questions you want to be sure that always ask. That is, what did you learn today? Well, actually it's three. What did you learn today and what are you going to do? Because if they aren't going to do what I think they're going to do, it's better that I know that before they leave the room.

Yeah.

So I just like to find out that also taught me to speak in metaphor, that I could tailor to the person's profession, educational background, and their interests. And then so if they, if they didn't learn anything, like, okay, I gotta start over because I was not a good teacher and what are they going to do? And it's like, well, get a new doctor because I'm not doing any of that stuff that you just told me to do, Doc. Okay, we got to start over again, right?

Totally. Well, yeah, that's awesome because I think, you know, when we start talking about diet, you know, people get immediately overwhelmed with all of the misinformation. But I love the component that you are doing, the research. I mean, Number one from you, your own personal journey and showing that it is possible. Right. I mean, before that, I am guessing just conventionally you thought, well, diet is related to diabetes and really not a lot of other health conditions. Right. Is the predominant thought process out there. Maybe not you specifically, but in general.

There'S more acceptance that diet should have an impact on obesity, high blood pressure, metabolic syndrome. Finally, there's more agreement in the neurology community that the microbiome, immune are really important and that diet has something to do with Ms. There are many more dietary intervention studies out there. Yeah, I was one of the first, but now I'm not the only one. So there are a lot of us out there and there's a growing body of research that diet impacts fatigue, quality of life. We've not done studies long enough to show how it impacts disease activity in terms of enhancing lesions. Although I am very pleased to tell you that we are now recruiting for a two year study that includes MRIs at the beginning and at the end we'll be able to talk about how diet influenced the development of enhancing lesions and relapse risk.

Nice. Do you see a clinical correlation between the imaging on amount of lesions and severity of illness?

Well, certainly the conventional approach is the more lesions you have in number, the shorter the time to wheelchair.

Got it.

To disability, the more lesions in the spinal cord, the shorter the time to wheelchair.

Got it.

And the bigger the volume and whether it's in the brain or the spinal cord, the shorter the time to wheelchair.

Got it. Yeah, I just have seen it where our patients will come in and they get concerned with like, okay, I have more lesions, but there, I haven't seen it to correlate entirely to prognosis or clinical outcome.

Well, yeah, so in research, it's looking at what's happening to the population, to the whole study. It doesn't always tell you what's going to happen to the individual.

Right, right.

And my more senior neurologist in the Ms. Clinic will tell you that the most important outcome is patient clinical activity. What is their function, how functional, what limitations they have with their vision, their sensation, their mobility. And that is more important than what's going on in their mri.

Yeah, yeah, agreed. Yeah. That is, I mean, I think I just like to bring it up because sometimes folks are, whether they're following antibodies in their blood for autoimmune conditions or imaging with ms, we tend to put more emphasis on these objective findings. But ultimately it's, how are you living? What's your quality of life? What's your functioning. And really, you're the true guide. We can't place the power outside of us because I've seen it go both ways where somebody doesn't have a lot of lesions and they're very debilitated versus somebody has a lot of lesions and they're not debilitated. So. But I know in the numbers game of when you get a big cohort of folks that maybe there's that trend that way.

Oh, it certainly, it's very helpful if you're seeking FDA approval for drugs we use lesion volume, number of lesions to. You have to show that volume goes down. Number of lesions go down to get your drugs approved.

Yeah, got it. Well, so let's talk. Let's talk about that. On, you know, expectations of, you know, possibly drugs in the pipeline or growing in particular or multiple sclerosis and along those lines.

So I've been watching that. I have some collaborators who are basic scientists that are growing myelin very effectively in mice. And, you know, the discussion that we have is that in humans so far, nearly all of the studies that have taken drugs from that are effective in mice, they just don't work very well in humans. They work very, very, very poorly. Now there's a lot of excitement like, okay, it's the microglia, because the microglia again, for your audience, these are the immune cells that monitor my brain. And if there's a threat, so if they see that there are damaged brain cells or infected brain cells, they'll call the innate immune machinery to come in and attack that part of my brain to attack. Clean up the damage or to attack the infection. When they're in the attack mode, my myelin's being eaten up and my synapses are being eaten up and my neurons are being eaten up, and I have brain fog and headaches and my trigeminal neuralgia is probably going on, and. And it's a very inflamed brain, and we call that reactive microglia. And then there's another version of the microglia that is neuroprotective, that is calming down that innate immune system. And we know that if you look at Parkinson's, ALS, Alzheimer's, Ms. That you have abnormal levels of reactivity in abnormal levels of this neuroprotective phase. But it's not as simple as just saying we're going to dial back the reactive and dial up the neuro protective, because which is excess and which is inadequate depends on what phase you are in the disease. If you're in the neuroprotective phase, your microglia are making more blood vessels and they are interfering with your ability to clear amyloid. So some of the consequences and there is, you know, a lot of money being spent on drugs that will shift your microgliation one way or the other. And they're all trying to get you to the neuroprotective state. Let's sort of think through what some of those complications I anticipate.

Yeah.

So if we can't clear amyloid very well. And we know that people with progressive Ms. The longer I have ms, the more likely I am to have buildup of the amyloid and get confused and get demented, have difficulty with memory, with word finding, with speech. These drugs that we think are going to protect me may actually accelerate my cognitive decline.

Yeah.

And then, you know, I think seeing is a really handy thing. I like my eyes. I like being able to see the world.

Yeah. I would agree with you. I okay.

So if I make more blood vessels in the brain, I have to worry a little bit about brain cancer because we always have these spontaneous transformations that are occurring all the time in my immune cells going in and prevent blood vessel development to grow that cancer. But there's another area that you have to worry about, and that's my retina, which are also governed by the microglia. If I get more blood vessels in my retina now, I cannot see very well. I'm much more likely to have age related macular degeneration which. Which affects many more millions of people that have Ms.

Uh huh. So because of that overactive component of their growth.

Correct. So. So I think finding a drug that will nod to the microglia safely will be very challenging in the drugs that have been so effective in mice are not very effective in people. Because while I can give you precursors for myelin, I can make sure you're eating all the right stuff. I can give you a drug that might support a step in making myelin. But if I haven't helped your microglia be in the correct frame of mind, they will still be eating up my myelin.

Sure.

And that's where what my approach is so unique.

I really agree because when you look at the innate intelligence of the body and its healing abilities, when we think we can just throw this one switch on almost like the tip of the iceberg of we're treating a symptom and not the underlying causes or imbalances. And that's where your approach. So how do you then framework in the Dr. Terry Wahl's brain thought process.

So what you want to do is you want to nudge the whole system towards a healthier self care pattern. And so in my clinics, I work with my patients and we've worked out the science of behavior change to help people make sustainable behavior change at the rate and pace that they can manage in the domains that they can manage. And teach clinicians how to do that, we teach patients how to do that and to help them understand that, you know, biology is incredibly complicated. So we have to just gradually make these changes. So your microgliation will go from being pissed off, eating up your brain to being happy gardeners.

Yeah.

And you have to help help them find metaphors that they can relate to, that they can understand, that they can visualize. And then we work out. Okay, so in all the self care domains, you know, we can talk diet, we can talk sleep, we can talk meditation, we can talk exercise, we can talk relationship, forgiveness, gratitude. Where would you like to start? You can pick the domain and we'll start, we'll start there. You know, and I used to be very emphatic that you got to start on debt because that's where the money is. Well, my, you know, my veterans taught me to listen to them because I have to start where their heart is.

Yeah. And for some you meet your patients where they're at. Doctor.

Yeah. You know, and so what I learned was for some of these guys, you know, for them it was working on forgiving themselves for having survived the war. For some it was a stress reduction. And so when they got that under control, they said, okay, you know what, I want to work in that diet now. And it makes sense to me that you may have to have your cortisol level in a little better control before you can put yourself to the stress of a big dietary change.

Yeah.

I've gotten to be much more mellow with my patients over. We're going to address the whole self care routine so we can help the whole network. But together we're going to figure out where we're going to start on this network.

Love it. I love it. So what, in that vein, what are some beginning steps for folks that you've seen? I mean I, you're meeting everybody where they're at, but in general, I bet you have some recommendations on a broad.

One that has really resonated with me more recently is that forgiveness. Many of us, this is so common in my veterans and it's even common in my private practice when I talk with them like, and I tell my own story like, you know, as a young person I made some really poor decisions, and I deeply regretted some early decisions in my life. I engaged in a lot of self loathing for about 10 years, and I was still deeply committed to that. And I'm sure I was accelerating my autoimmune disease. It was when I had my first child, Zach, that I finally realized all the terrible things that I'd done in my life, I had to do in order to get to have him. And I forgave myself. And so when I have that question with my patients, I was like, do you have anything that you have to forgive in yourself or someone else? And I'll tell you what's compelling is how often, you know, they just. Spontaneous tears come.

Yeah. Wow.

And so we sit and we talk about that and ask them if they get them into talk therapy, to work through this more. And I invite them to do a little free writing about it, have a little gratitude journal to write one or two things that they're grateful for that day. And it could be as simple as the sunshine. The sun was shining today, or I planted my peas today, or, you know, I had bowel movement today.

Yeah.

And so that gratitude and forgiveness practice, beautiful place to start. Now, people come in agony from the rheumatoid arthritis. And like, well, I want to do the elimination diet. It's really hard. Do you want to go there or do we need to do something earlier? Like, I'm ready and I can be surprised people who I think are. Who are not likely to be ready to take on a very vigorous dietary change. The spouse and the patient are like, nope, we've suffered enough. We're ready. And it'll be really helpful for that person to have weekly visits with my health coach to work through all of that change.

There is, I'm guessing you see some patterns come up for folks. I mean, diet discussions are loaded, right? Because it's not just sustenance. There's emotional component, there's memories associated with, and there was, you know, possibly some rewards given for. Then, you know, the dopamine component happens. And, you know, as you start unmasking some of these things for folks where they were, you know, eating their emotions or avoiding.

And they probably have biologic dependence and addiction to if they're eating a lot of processed food, sugar, so. And they may have dependence on the gluten on the casein, so they can be definite real biologic symptoms as they try to reduce and then eliminate some of these foods. Plus, people don't know how to cook, don't know how to shop don't know how to meal plan. Yep.

Huge.

So I really, we have to deal with that as well.

Yeah. And I like you do offer that support with the cookbook and some of your online programming as well, which I'm going to put a lot of your links because you are, I mean you really embrace the dose area, the teacher component. You're teaching patients, you're teaching providers. You've got, you know, a lot of support for people to make these changes which I really commend you for because it is, you know, it's one thing to hear, well, you need to do, you know, the modified Paleo diet, but there's another to actually provide the support to make those changes.

Right. You know, to have the recipes, some meal planning tips.

Yeah.

Resources to learn how to do that. And for people who want and have the means who would really like to interact with my team or interact with me, we have that capability as well.

I love it. Yeah, we're going to mention for sure. You know, you have this challenge coming up, a five day challenge of conquer your immune autoimmune condition, creating your healing journey. A live free five day challenge that is conducted coming up here. So it's terrywalls.com five day challenge and I will have that in the show notes for folks. Please take advantage of it because it's a really generous gift to, to go through this with Dr. Walls and her team and, and just see, I mean it's like it is just getting into action is you got to do something different to make change and or you can choose to, you know, continue doing what you're doing but you're going to get the same result.

Yeah, yeah. You know, when you're ready, the teacher will appear. And I remind people that we aren't asking you to throw up your whole life. We're just asking you to identify you're ready to begin making a change. We'll talk about some small, easy, actionable next steps that you can do to make you a little further along in your healing journey.

I love it. I love it.

Well.

Kind of coming down the home stretch here of the, of our interview, is there anything else that you would like to share here?

Well, yeah, if you live within 500 miles of Iowa City, we're recruiting for a new clinical trial and so I'll make sure that you have that link as well. Dr. Eckel. So relapsing, remitting Ms. Between the ages of 18 and 70 living within 500 miles of Iowa City. We have three diets. We expect that all three diets will be helpful. What we're excited about is we get to follow you prospectively for two years. It will be just really quite exhilarating.

How many folks are you recruiting for that study?

156. So we need some help.

Yes, indeed. Yes, indeed. Yeah. So we will definitely help get the word out on that. And anybody listening to the show, please share this with folks, because this is how we get the information out. It is why I created the platform. I wanted to bring you the world's experts in different topics for your health, for your family's health, for the community's health. And this, you know, is. It's so inspiring. And we need to get the word out because not everybody with an Ms. Diagnosis, their neurologists are not potentially prescribing diet.

Or they may say, yeah, diet matters, but they haven't been trained on any dietary intervention, so they don't know how to tell you. So they might tell you, you know, go, go, go look for a book. At least more neurologists are beginning to say, yes, diet matters. You can't be eating all that sugar. At least we're finally getting that message.

Yeah, indeed. Right? The white death is what I call that in my practice. And, you know, let's explain that. But I also want you to answer, how do you respond to your patients or perspectives that are saying, well, why didn't my doctor tell me about that on the diet question?

You know, it's very hard for physicians to stay current on the latest research. And so I'm not current in all of the research either. Neither is our esteemed Dr. Eckell. So we were trained excellent at the time. And so when that physician was trained, he or she was certainly very excellent. It's a lot of work to stay current now, so let your physician have some grace, realize that they're doing the best they can. They're probably working too hard and take advantage of the resources that I have that Dr. Eckel has so you can be empowered to do a better job of feeding yourself and your family.

Nice, nice. And then let's talk on the sugar front. So we're starting to agree on maybe sugar isn't the best ingredient in our diets. How do you talk about it with your patient base around? What does it do to the body?

Well, it hijacks your pleasure center. It wrecks your microbiome. It's more addicting than cocaine, heroin, alcohol. It is so pervasive. So when you reduce and eliminate it, you will often experience craving, headaches. You may have a die off of yeast or herxheimer with fatigue and malaise. So I have to help people through that. But it is a huge, huge help to get that out of your diet even if you don't, if you're not ready to go gluten free or dairy free, which I think would be helpful if we get you to go sugar free. That is helpful. And then I have to help people who say, you know, I'm really good, I have, I have no gluten, no casein, but I'm still eating tons and tons of sugar and highly processed gluten free products. So then I have to educate them that you're, you still have. There's still ways to go for you, right? Yeah.

The component of why I'm gluten and dairy free and. But I've replaced all of those products with, you know, process.

Right. I'm still having six servings a day of gluten free products.

Yeah. What, where are the hidden sources of sugar that people may not be aware of?

Well, really all of your processed foods have sugar and other additives added to them to create more craving. Ketchup, for example. Many of our condiments, salad dressings, mayonnaise, will have, sauces, will have sugars added to them. And then of course, flour based products will also raise your blood sugar almost as fast as straight table sugar as well. So. And I'm really looking at how rapidly does your blood sugar spike from the food you ate?

Yeah. So do you follow? Are you doing, you know, one hour postprandial, two hours postprandial of sugar?

Well, so what I really want people to have at the very least is a fasting glucose, fasting insulin and lipids. So I have a, we can get all that in one blood draw while they're there in the clinic and I can give them some feedback on their metabolic health that things looking good or you're headed towards metabolic syndrome and we should begin to intervene because with and mental health issues are at greater risk to have insulin resistance, metabolic syndrome and those complications which of course accelerate the decline due to mental health issues or your autoimmune issues.

Got it? Yeah. So those are really underpinnings for everyone that is listening to this show here.

Yes, everyone listening, you should know your fasting insulin and your fasting glucose and presumably also fasting lipids as well.

Great, great. Well, doctor, I really appreciate you coming on the show and sharing your wisdom with us and I really want to help get this message out to as many people as possible. So folks, if you like this show, give us a five star review and actually put down one or two things that you're going to do. I love those questions for clinicians after the visit of what did you learn and what are you going to do? I am posing that to my listeners and viewers of this fine show. I wouldn't be doing it without you. Dr. Terry Wahls, any last final parting words?

Eat more greens. They are really good for you.

I love it. Much love to you. Thank you for coming on, everybody. This has been what the health. We are here on the contact talk radio Tuesdays from 2 to 3 Pacific time. We will see you next week.