"The Wahls Protocol" - A Book Review

Terry Wahls, M.D., is a clinical professor of medicine at the University of Iowa Career College of Medicine, and is an internal medicine specialist. She was diagnosed with multiple sclerosis (an autoimmune disease in which the immune system attacks myelin, which is the protective covering of the nerves) in her mid 40s, and within a few years was confined to a wheelchair. Because Dr. Wahls is a conventionally trained physician, she naturally used traditional treatments and drug therapies; these slowed her symptoms for a while, but her physical decline became more evident. This is a woman who had been athletic and active her entire life, and at that point she needed a wheelchair just to function every day. Dr. Wahls was determined to try anything that she could, even if it meant working outside of mainstream medical parameters, in order to restore function and regain control of her life. Through dietary and lifestyle changes, Dr. Wahls was able to miraculously reverse her condition and resume a normal life. The forward-thinking strategies that she used are what became known as The Wahls Protocol.

Although Dr. Wahls suffers from multiple sclerosis, she believes that all autoimmune conditions (such as rheumatoid arthritis and lupus) and other chronic diseases exhibit the same characteristics. According to Dr. Wahls, "The truth is that diagnoses are simply names that we put on conditions, based on the parts we can actually quantify, like symptoms, test results, and which medications improve or worsen symptoms, as well as through process of elimination." All of these conditions are the result of mitochondrial dysfunction; mitochondria are the part of the human cell where energy is produced for cell function. If your cells are not functioning properly, you will not function properly. Conventional medicine and functional medicine have different viewpoints on autoimmune diseases. Dr. Wahls says, "The conventional medicine view of autoimmune disease says that the body has lost the ability to recognize its own internal protein components as native components of itself, but that we don't know why." Treatments usually involve prescription of immune-suppressing drugs, which treat symptoms but do not fix the underlying problem. Worse yet, these drugs can have nasty side effects. On the other hand, functional medicine, "...Looks more deeply at the reasons why the body has lost its tolerance to its own proteins in the first place." The functional medicine treatment approach involves implementing lifestyle changes, such as diet, exercise and stress management, and also addresses things like food intolerances, exposure to toxins, hormone levels, and the ratio of omega-3 and omega-6 fatty acids in the body. Prescription medications can be used in conjunction with the functional medicine approach and are not eliminated before cellular healing has taken place, but they are often greatly reduced over time.

The main thrust of the Wahls Protocol is dietary modification. As Dr. Wahls points out, "It is the one most influential element about your environment that you can control." I still find it utterly incomprehensible that most medical schools offer very little in the way of nutritional instruction; in fact, you can get a degree from Harvard Medical School and not take a single course on nutrition. Even Dr. Wahls had to educate herself about proper nutrition in order to develop her protocol. She recommends following a Paleolithic diet consisting of single-ingredient and nutrient-dense foods, along with a high level of fat consumption. The reasoning behind this is that, "The brain is 60 to 70 percent fat. We need healthy fats to make the myelin insulation for the wiring in your brain." The author's dietary recommendations have three levels: The Wahls Diet, Wahls Paleo, and Wahls Paleo Plus. The first level stipulates that you should consume nine cups of fruits and vegetables per day, avoid dairy and gluten, and to eat organic, grass-fed, and wild-caught sources of meat. Gluten is the protein found in wheat, rye, and barley, and casein is the protein found in dairy products like milk. Those with autoimmune disorders are likely to have a leaky gut that can be further aggravated by these proteins, so she recommends that they be avoided. The Wahls Paleo diet follows all the same guidelines of the Wahls Diet, but encourages a reduction of grains, legumes, and potatoes to two servings per week. In addition, more seeds, nuts, and raw fruits and vegetables can be incorporated. Finally, the Wahls Paleo Plus ups the ante by eliminating all grains, legumes, and potatoes, while still consuming at least six cups of vegetables (especially those rich in sulfur) each day, and adding in coconut oil and full-fat coconut milk to the menu. This is more akin to a ketogenic diet, which has been proven to be effective for patients with traumatic brain injuries, epilepsy, and those suffering from migraines. Further, she recommends eating just two times per day and practicing intermittent fasting for 12-16 hours per night. Dr. Wahls recommends starting with the Wahls Diet and progressing to the other two as needed, or depending on your personal circumstance.

The author believes it is important for those suffering from autoimmune/chronic diseases to incorporate stress management techniques on a regular basis. Our brains need stress periodically in order to learn and adapt so that we can change and grow, but chronic stress is not healthy. According to Dr. Wahls, "Stress, however, is meant to be acute, not chronic. Chronic high stress without that important recovery period is maladaptive, damaging the body and the brain." In order to relieve stress and recharge one's batteries, she recommends spending time outdoors (a good way to get Vitamin D), meditation, journaling, and periodically getting a massage. The good doctor also highlights how crucial it is to incorporate regular movement, especially when one is orthopedically impaired. Find some type of movement to do; even if it doesn't seem like you are doing much, it is better than doing nothing. To quote Dr. Wahls, "Lack of mobility only leads to immobility." She correctly points out that strength training works to build muscles and has the greatest impact on nerve growth factors. While she does not talk about muscular failure or specify a level of intensity while weight training, she does mention working to exhaustion, which I found refreshing.

I only have a few points of contention with Dr. Wahls's recommendations in this book. The first is with her lack of understanding of recovery as it pertains to strength training. She is under the impression that the body can adapt and recover within a 24 hour period, and recommends strength training every other day. This is incorrect, and would lead to an overuse injury, illness, and/or overtraining in fairly short order. Exercise has a narrow therapeutic window, and the dosage and frequency of exercise should be treated as you would with administering any medication: the minimum dose necessary to elicit the adaptive response. I mildly disagree with some of what she says in regard to intermittent fasting. She states that it is controversial; however, humans have been practicing fasting in some fashion for thousands of years. The author doesn't recommend long fasting periods, but doesn't specify what constitutes a "long" period. 16 hours seems to be the longest period she recommends, but my experience has been that you can fast for longer than that without harm, and certainly reap tremendous metabolic and hormonal benefits. In general, however, Dr. Wahls and I agree on the importance of regular fasting and how it can really improve mitochondrial function. Finally, Dr. Wahls does not recommend the consumption of eggs in any of the three levels of her diet. While it makes sense to avoid eggs if you have an allergy or a significant sensitivity to them, it cannot be denied that organic eggs from free-range chickens contain all the essential amino acids that the body requires. They are a tremendous source of fat, protein, and cholesterol, and I believe they should be incorporated whenever possible.

The miraculous return to health that Dr. Wahls made after being diagnosed with multiple sclerosis and confined to a wheelchair is an amazing story from which everyone can learn. Better still, her recovery was due to the strategies practiced in this book, and she has done a public service by sharing them with us. Whether you suffer from an autoimmune condition, another form of chronic disease, or you simply want to have more energy and be healthier, "The Wahls Protocol" can provide encouragement and guidance to help you take control of your life.