Episode 196: Troubleshooting with Dr. Terry Wahls

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Autoimmune Q&A with Dr. Terry Wahls

This podcast is all about autoimmune empowerment! Making choices in our daily lives that minimize symptoms and maximize our joy in living. That said, it’s not always easy. Sometimes the habits are hard to start and hard to keep. Other times, you’re doing everything right but not seeing the results you hoped to achieve. So, today, we’re doing a troubleshooting episode with an expert guest and one of my favorite people: Dr. Terry Wahls. She is a functional medicine physician, a clinical researcher, a professor of medicine, and a fellow autoimmune warrior. In this episode, she shares her best advice for thriving with autoimmune disease and troubleshooting the obstacles we encounter along the way. We talk about motivation, family dynamics, digestion, supplements, physical therapy, personalized diets, and more!

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Show Notes

  • Intro (0:00)
  • Meet Dr. Terry Wahls
  • Thank You To Our Podcast Sponsor – Luminance Skincare (3:02)
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  • What’s the Difference Between the Wahls Protocol and the AIP? (4:43)
    • No matter what diet you follow for your health, today’s episode will apply to you. We’re covering all aspects of healthy living. This episode isn’t only for Wahls Warriors.
    • That said, for those of you who are curious about the difference between the Wahls Protocol and The Paleo Autoimmune Protocol (AIP), they have a lot in common. They are both nutrient-dense, anti-inflammatory diet and lifestyle programs, designed to improve autoimmune health.
    • The Wahls Protocol Diet has 4 levels, to help people choose the diet that works best for their health and lifestyle. Every level focuses on nutrient-density first. Both the AIP and the Wahls Protocol stress that autoimmune health is about the foods we add, not just the foods we remove.
      • Level 1 is a gateway diet, to help people transition away from a westernized diet that includes a lot of processed foods, and introduce The Wahls prescription for 6-9 cups vegetables daily. It’s gluten-free, dairy-free, soy-free, and egg-free, but allows gluten-free grains and legumes. There’s also a vegetarian version of this diet.
      • Level 2 is a nutrient-dense paleo diet. This is the level most people choose, and it’s the one featured in most of her clinical trials.
      • Level 3 is a nutrient-dense ketogenic diet.
      • Level 4 is an elimination diet – this is the level that most closely matches the AIP.
      • Resource: The Wahls Protocol (expanded and revised edition of her book).
  • Getting Started with Diet & Lifestyle Changes (7:14)
    • Sometimes the barrier to getting started is motivation. Our brain is wired for routine, and making diet and lifestyle changes is a big disruption to that routine. For many people, change is hard.
    • The first step is believing improvement is possible. Terry’s story and other healing stories can be incredibly inspiring to people just getting started.
    • Step two is deciding it’s worth the effort. What is your meaning and purpose in life? What person or thing is so valuable to you, that you would risk your life to save it? If you improved your autoimmune health, would you be able to engage more deeply with that purpose? If yes, that becomes your “Big Why”. This is what motivates you to keep going when change is hard or uncomfortable, when you feel discouraged or you’re tempted to give up.
    • Once you have your motivation, your physical symptoms might be a barrier to getting started. Home cooking can feel overwhelming if you have severe pain, fatigue, or disability. Food is powerful medicine, but you don’t have to start with food. There are many entry points to a healing lifestyle.
  • Vegetable Intake Troubleshooting (15:30)
    • A cornerstone of the Wahls Protocol is 6-9 cups vegetables daily, and veggies are also the foundation of the AIP Food Pyramid.
    • However, some autoimmune diseases can interfere with digestion (like IBD), making high vegetable intake challenging. Other autoimmune diseases (like MS) can cause chewing fatigue, also making high vegetable intake challenging.
    • First, know that the Wahls Protocol is a dietary template which we can personalize to our own needs.
    • If you experience diarrhea as one of your autoimmune symptoms, you likely don’t tolerate fruit or raw vegetables well, and reducing fiber overall may be helpful. In that case, soups and stews are a wonderful option, including bone broth pureed with well-cooked vegetables that are easier to digest.
    • If you experience severe constipation, more fiber may be helpful, and in that case you may benefit from more cups of vegetables daily.
    • If you are on tube feeds only, the commercial nutrition products often contain high-fructose corn syrup and aren’t very healthy. You can use pureed soups in your tube feed instead, and Dr. Terry has seen patients’ health improve after making this switch.
    • If you experience chewing fatigue, pureed soups are also a wonderful option, but so are smoothies. However, smoothies can cause blood sugar swings if they’re too high in sugar. Here are Dr. Terry’s recommendations:
      • Avoid juicing. That removes all the fiber and can have a severe blood sugar impact.
      • Instead, use a high-speed blender so the fiber is preserved.
      • Include 2-3 servings of vegetables for every 1 serving of fruit, so that the sugar content isn’t too high.
      • Include a healthy fat like avocado, olive oil, or coconut milk. This helps stabilize the blood sugar impact.
      • Include some protein as well, like collagen powder (or nut butter if tolerated).
      • Resource: Dr. Terry’s cookbook has many smoothie recipes.
  • When Friends or Family Sabotage Our Efforts (21:40)
    • While ideally, our friends and family would support our efforts to improve our health, that’s not always the case.
    • At a recent Wahls Protocol Seminar, a family therapist spoke on this very topic. This was her advice:
      • Make an appointment with this person to discuss it.
      • First, validate how important this person and the relationship is to you.
      • Second, listen to their concerns and validate those concerns.
      • Third, share why you are making diet and lifestyle changes for your health, and how their behavior has become an obstacle. Ask them to listen.
      • Fourth, try to find a solution that validates both points of view. It might take more than one meeting to find a solution, but you’ve opened the conversation.
      • A family therapist might also be helpful to facilitate this conversation. Sometimes, when someone close to us sabotages our health efforts, it’s a sign of a deeper issue in the relationship.
      • If no solution is found, you may choose to spend less and less time with this person. However, often, people can become closer through conversations like these.
      • Resources: Ep. 117 – Eating AIP in a Non-Paleo Home and Ep. 51 – Marriage and Autoimmune Disease.
  • New Information About Ketogenic Diets (27:11)
    • The Wahls Protocol has four options on how to adapt the diet, and one of those options is a ketogenic diet. Recently, Dr. Terry released an expanded and revised edition of her book, and it included new information on ketosis.
    • Research shows that as we age, our brain is less effective at using sugar for fuel, but continues to use fats and ketone bodies very well for fuel. So, ketogenic diets may benefit people who are experiencing cognitive decline.
    • New research in MS shows that a ketogenic diet reduces serum neurofilaments in the blood. This is a marker of brain degeneration. Less neurofilaments means a healthier brain.
    • Ketogenic diets are also helpful for people prior to receiving radiation or chemotherapy as part of cancer treatment. Research shows that ketones make these therapies less toxic to the body and more toxic to the cancer cells.
    • The easiest way to get into ketosis is by prioritizing coconut-based fats. They make more ketones per gram of fat. However, depending on genetics, for some people, this will cause high cholesterol, high triglycerides, and increased cardiovascular risk. For this reason, it’s very important to have get your cholesterol checked regularly when following a ketogenic diet. (Resource: Ep. 173 – Cardiac Risk and Autoimmune Disease.)
    • For people who get high cholesterol with coconut oil, an alternative is a ketogenic diet that prioritizes extra-virgin olive oil instead. It doesn’t cause the same cholesterol spike. However, you have to work harder to get into ketosis. Dr. Terry recommends time-restricted feeding with a 6-8 hour eating window each day. You also need to limit vegetables (just 3-4 cups daily).
    • While a ketogenic diet is recommended in specific situations like those mentioned above, Dr. Terry doesn’t recommend it to most patients. It’s a very hard diet to follow and has some negative side effects. Hormone imbalances often develop because a ketogenic diet causes the body to conserve resources, lowering both sex and thyroid hormones. For most people, Wahls Paleo is the diet Dr. Terry recommends, and if necessary Wahls Elimination (AIP) temporarily to identify food intolerances. Her clinical trials focus on those two versions of the diet.
  • Thank You to Our Podcast Sponsor – Functional Nutrition Alliance (34:13)
    • Full Body Systems is their internationally acclaimed, 10-month online functional nutrition immersion training program.
    • It’s designed by world-renowned educator, Andrea Nakayama. Many of you know her as one of my most popular podcast guests. Her unique way of working with patients often leads to results where other practitioners hit dead ends. This program teaches you to do the same. She’s an excellent troubleshooter!
    • If you’re already trained as a health coach, nutritionist, or medical practitioner and want to more effectively help your clients break through healing plateaus, this class is for you!
    • And if you’re an aspiring practitioner just getting started, this might be the only training you need.
    • You’ll gain detailed knowledge of all the systems in the body, how they interact, how problems develop, and how to personalize diet and lifestyle recommendations for each unique client.
    • Enrollment is currently open. To learn more, visit FxNutrition.com/Eileen.
  • Supplement Experiments (35:40)
    • We are all scientists in charge of the experiment that is our life. Approach supplement experiments with that feeling of agency and curiosity. First, write down a baseline of your current symptoms. Then choose one supplement to try at a time and your goal for that supplement. Pay attention to how you feel when you begin to take that supplement, to monitor for any negative reactions. If you are tolerating the supplement well, continue to take that supplement and see if you experience any improvements. With some supplements, you may notice improvements quickly, while others may take a month or more. (Resource: Ep. 58 – Supplements.)
    • Every individual is different, but the supplements Dr. Terry recommends most frequently in her clinical practice are:
      • Vitamin D – ideally gotten through sunlight, but through supplement when sunlight isn’t an option. (Resource: Ep. 179 – Vitamin D & Autoimmune Disease.)
      • B Vitamins – Dr. Terry recommends getting homocysteine levels checked to see the efficiency of the B vitamin pathways. If the level is above 7, she’ll follow-up with a test of specific B vitamin levels to see which are deficient and supplement accordingly.
      • Omega-3 Fatty Acids –  Many research studies have shown fish oil supplementation to be beneficial for autoimmune disease. She tests omega 3:6 levels and personalizes dosage accordingly. (Resource: Ep. 184 – Anti-Inflammatory Supplements.)
      • Melatonin – As we age, we produce less melatonin which is a hormone that supports sleep. If people struggle with sleep, she addresses it through lifestyle first, but may recommend melatonin if that’s not enough. (Resource: Ep. 94 – Troubleshooting Sleep.)
  • When Diet Isn’t Enough: What Other Factors Matter? (40:57)
    • The Wahls Protocol is a holistic approach that incorporates many lifestyle interventions in addition to food: sleep, meditation, exercise, time in nature, etc.
    • For MS specifically, Dr. Terry recommends E-Stim – a form of physical therapy that helps rehabilitate muscles that have atrophied. It played a big part in her recovery. Note: the levels of E-stim she used in her own recovery were very high (above FDA limits) which she credits for the speed of her recovery. However, it was also a risk. It you develop the muscles too quickly, and your brain cannot control those muscles, it can make it harder to walk instead of easier. In her clinical trials, they stay within FDA limits, and it’s still an effective therapy, and safer. It just takes longer to progress. She has an online course available if you’d like to learn more.
    • It’s also important to realize that improvements can take time, especially for people with progressive MS. In Dr. Terry’s clinical trials, symptoms like fatigue improve quickly, but improvements in walking and motor function usually take longer – often 9-12 months.
    • If people don’t improve after a year, Dr. Terry recommends working with a functional medicine practitioner to identify underlying health issues that may be acting as barriers.
    • Part of personalized approach may also include pharmaceutical medications. Dr. Terry isn’t against them. Some of her patients are able to reduce or elimination medication. But for others, she recommends medication. Medication isn’t failure. (Resource: Ep. 48 – Medication Decisions.)
  • Clinical Trial Comparing the Wahls & Swank Diets for Multiple Sclerosis (49:03)
    • The version of the Wahls Diet used for this study was Wahls Elimination (the level most similar to the AIP).
    • The version of the Swank Diet used in the research recommended 4 cups vegetables daily, which the original Swank diet didn’t. It also recommended whole grains over processed grains.
    • The Swank Diet is a low-saturated fat diet based on research done by neurologist, Dr. Roy L. Swank. It allows no more than 15 grams of saturated fat daily (3 teaspoons). Foods like red meat and egg yolks are excluded, but sugar and processed foods are still allowed, so long as they aren’t high in saturated fat.
    • Interestingly, both diets showed improvements in MS symptoms, including reduction in fatigue and improved quality of life (both physically and mentally). However, Wahls improvements were higher on some measurements.
    • The study also showed that both diets contained more nutrition than the diets people were eating before entering the clinical trial, debunking criticisms that the Wahls and Swank diets are too nutrient-restrictive.
    • For people with heart disease who would benefit from less saturated fat, the Swank Diet is one option. You can also do a low-saturated fat version of the Wahls Protocol, choosing extra-virgin olive oil as your primary fat.
    • Resources:
  • Terry Wahls’ Online Courses 
    • Free 5-Day Challenge: Offered a few times each year, the goal is to inspire you to get started with healthy choices.
    • Autoimmune Intervention Mastery: This 5-week online course is designed specifically for autoimmune warriors by Dr. Terry Wahls. You also have the option to add 7 weeks of group coaching with Dr. Wahls herself.
    • Practitioner Certification: Designed for coaches, nutritionists, and healthcare practitioners, this program takes a deep dive into all aspects of the Wahls Protocol, including troubleshooting to help your clients succeed.
  • Outro (56:23)
    • You can connect with Dr. Terry Wahls through her website. She has a lot to offer: books, online classes for people with autoimmune disease, professional certification programs, clinical research, and more. Her newsletter will keep you updated on her latest program offerings, and you can sign up on her homepage. Also check out the Wahls Protocol Series for my past podcast interviews with Terry.
    • Eileen (your podcast host) is the author of multiple books, written to help people thrive with autoimmune disease. Learn more on the Books Page.
    • If you like this podcast, follow or subscribe through your favorite podcast app. You can also subscribe to Eileen’s biweekly newsletter.
    • Check out the entire archive of podcast episodes.

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