The relationship between autoimmune disease and metabolic health (Dr. Terry Wahls & Dr. Casey Means)

Dr. Terry Wahls’ journey into autoimmune research was a personal one. Diagnosed with multiple sclerosis over 20 years ago, she found herself in a wheelchair and on a path towards being bedridden. She took her health into her own hands. She scoured the literature to understand if there were any possible treatments for MS and ultimately developed the Wahls Protocol which is a nutrition and lifestyle program to treat all chronic autoimmune diseases, which reversed her disease process, restored her health and allowed her to get out of her wheelchair and back on her feet. Today Dr. Wahls is a clinical professor of medicine at University of Iowa, and also maintains a prolific research career. In this episode, she shares her journey and her findings on the connection between autoimmune disease and holistic health.

03:46 – A new framework for thinking about autoimmune disease

Most autoimmune diseases are treated via immune suppression. Dr. Terry Wahls likes to focus on modifying lifestyle.

When I was in medical school a few years ago, we’re taught that autoimmune diseases are the immune cells attacking self. We don’t really know why. For reasons entirely unknown, must be genetic. At that point, we didn’t even link infections. And all we had was prednisone. And then, we started adding some other immune-suppressing drugs. And scenes got a little bit more sophisticated. But we appreciate that there are hundreds of genes that increase the risk. And there’s still this long list of unknown environmental factors. And the conventional approach still focuses entirely on immune suppression. And, of course, that’s not the approach that I take, nor is it the approach that I teach. I focus on what are all the modifiable lifestyle factors that we can address. So we focus on creating health. And as a byproduct, you may discover that your chronic diseases begin to get under better control and then begin to regress.

06:52 – A supplement cocktail

Dr. Terry Wahls’ has struggled with an immune issue of her own. One day, she found a turning point.

It appeared to me that the root problem was mitochondria, that they couldn’t make enough energy. So my supplement cocktail was focused on mitochondrial nutraceuticals. And after six months, I was no better. So I was pissed off, and I stopped. And I couldn’t get up, couldn’t go to work. And on the third day, my wife Jackie says, “Honey, why don’t you take the supplements again? I mean, what’s it going to hurt?” So I take them. And the next day, I can get up and I can go to work. Now, mind you, I’m still struggling with fatigue. But I’m like, “Oh my God, that was really cool.” So two weeks later, I do the same thing. I stopped my supplements. Wait, three days, start them up to the third day. And I can pop back up and go to work. Now, mind you, popping up is hardly popping that much. But I could at least go to work. And I was like, “This was empowering. Oh my God. There is something to this.”

13:27 – The creation of health

Focusing on pathology will not allow us to correct health.

I always stayed on the exercise bandwagon. So I continue to very work very hard with my physical therapist. But it’s the creation of health. When we focus on treating disease, we get it wrong. Even when we focus on those mouse model preclinical studies, we’re still going to get those wrong because they’re focused on understanding pathology. One, molecular pathway and health and life are deeply interconnected. All of that metabolic pathways are so richly interconnected with checks and balances that when we focus on pathology, we will not be able to correct health. When we focus on health, on what are all the things that underpin health and add them incremental by incremental step, that’s when the magic happens for me. And that’s when the magic happens, and the patients I take care of.

15:56 – Humans are metabolically complex

Our modern bodies are part of a long chain of evolution. We can’t assume there are simple solutions and quick fixes.

If we think about our ancestral beginnings, whether we go back as Homo sapiens 250,000 years, or we diverge from the primates six million years, or when they became mammals 200 million years, when we were unicellular which are now billions of years, we had this very long history of metabolic complexity that means that the solutions aren’t going to be a single molecule drug-based solution. We have to be able to honor that complexity of our biochemical path.

17:50 What is mitochondrial dysfunction?

Dr. Terry Wahls explained the link between mitochondrial dysfunction and autoimmune disease.

The mitochondrial dysfunction is really an accelerant. This is a not enough energy that puts all of these tissues in strain. And it will accelerate the disease process. In addition, because of the cell danger response, we now know the mitochondria are deeply involved in recognizing cell danger that when in the inner contents spill out into extracellular space, those molecules particularly ATP are recognized by the cell membranes. And that activates the innate immune system. And then, that will address the pathogen, the infection, or as in when I broke my wrist, the fracture and cleans up the debris. The second step is the mitochondria involved in that second step. They’ll call in the stem cells to do the repair work. And then, the third step which is reintegrating the repaired tissues back into the surrounding tissues so they can function normally and complete healing and resolve the inflammation. And the mitochondria is involved in all three of those steps. So, it’s both an accelerant and it’s intimately involved in immune function. And either accelerating immune function or failing to resolve the immune dysfunction. So it has dual roles. And I think it’s a very big player in auto-immunity. But it’s also a very big player in most of our non-infectious chronic disease states.

28:46 – The connection between type-1 diabetes and mitochondrial dysfunction

The mitochondrial dysfunction and microbiome effects on autoimmune propensity that can be applied to type-1 diabetes.

When we look at the dramatic uptick of autoimmunity since World War II, they talk about inflammatory bowel disease, MS, and type-1 diabetes, that there are environmental factors that are tied in probably to the change in the food supply, the dramatic increase of fructose, the dramatic increase of sugar processed foods, the increase of synthetic chemicals in our diet, and the dramatic shift in our microbiome because of all of the antibiotics. All of those are a factor in why those three autoimmune diseases have increased. So, yes, it’s not just the infection that triggered the destruction of the pancreatic islet cells. It is the environment that set that cascade up. I’ll also tell you that we’ve had certainly many, many patients with type-2 diabetes tell us that they’ve reversed their diabetes using the Wahls Protocol. But I’ve also had many people with type-1 diabetes tell me that they’ve had dramatic improvement of their blood sugars in their management of their disease using the Wahls protocol.

37:30 – Addressing the root cause of autoimmune issues

Autoimmune diseases manifest in different ways. When your body keeps being forced to generate antibodies, it can have negative effects.

It’s really interesting. So we have disordered immune function. We have weakened mitochondria. We have toxin overload. We have hormone imbalance. We have difficulty eliminating in our toxins. And I have different sets of microbes in my gut. And then, I have different genetic vulnerability. And so depending on the microbes and my genes, when my immune system gets revved up and I begin making auto-antibodies that will begin clearing out that infectious problem or that food protein that I think is an infection. If that protein has a similar amino acid sequence to another structure in my body, in my brain, in my joints, in my lungs, in my skin, that part of my body is going to get damaged as I clear out that problem protein, whether it’s an infection or a food protein. And my vulnerability is a reflection of my genetics and my microbiome and the foods, and the similar immune-acid sequence between my structures and those various proteins. And then, I’ll add to that. So I had an autoimmune process involving my brain. I have asthma, autoimmune process involving my lungs. I have an autoimmune process involving the endometriosis. And I have very mild psoriasis. If you don’t address the root causes, you keep developing more auto antibodies, more autoimmune processes, and more parts of your body will become casualties in the autoimmune process development.

43:35 – How to support mitochondrial health

The best way to support mitochondrial health is through diet and lifestyle.

Number one, ditch all the sugar, sweeteners, and beverages. Number two, ditch all the fructose, all of those Paleo-friendly sugar substitutes that are all fructose. Get rid of those. Number three, replace grain-based products with vegetables. Number four, I’m a tall lady, six-foot tall. So it’s pretty easy for me to have nine cups of vegetables a day, three cups of greens, three cups of sulfur, three cups of color…And then, if you’re a meat eater, six to 12 ounces of meat. If you’re not a meat eater, gluten-free grains and legumes for your protein.

45:01 – Improving metabolic health can improve autoimmune disease

Improving metabolic health can be part of a journey in moving towards health and happiness.

I think everybody with an autoimmune disease really should go investigate their metabolic health. I told everyone we should know your glucose, your insulin levels, your A1C. And does answer that question? Do you have developing insulin resistance? And if you do, then, we need to have a strategy for dealing with that. So yes, if you have an autoimmune disease, I very strongly urge you to investigate: do you have insulin resistance?

Dr. Terry Wahls (00:06):

As part of the adaptation to living with a progressive neurodegenerative diseases, you let go of the future. You take each day as it unfolds. And so even though I was remarkably better walking around the neighborhood, I was still taking each day as it unfolded. And all of my physicians for seven years, it said, “You’ve got secondary progressive MS. Functions once lost will never come back.

Dr. Terry Wahls (00:29):

So I didn’t know what was happening. I just knew that day by day. But the day I rode my bike, I knew that the current understanding of MS was incomplete. So that really transformed how I thought about disease and health that transformed the way I practiced medicine. And it would transform my mission of life, and the way I conduct my research.

Ben Grynol (01:04):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And this is your front row seat to everything we do. This is a whole new level.

Dr. Casey Means (01:17):

Hello, everyone. Welcome to a whole new level. This is Dr. Casey Means, co-founder and chief medical officer of Levels. I am so excited for today’s conversation. Dr. Terry Wahls needs no introduction. But I am so excited to do one because I have been a huge follower of her work for over 10 years. And it has had a profound impact on my life professionally and personally as one of the first entry points and first exposure in the functional medicine for me. So I am incredibly grateful.

Dr. Casey Means (02:09):

Dr. Wahls is a clinical professor of medicine at University of Iowa, and also maintains a prolific research career. She’s had over 60 peer reviewed scientific abstracts, posters, and papers. And her personal story is incredible. She has experience as a patient being diagnosed with multiple sclerosis over 20 years ago in autoimmune disease that left her in a wheelchair and on a path towards being bedridden. And she took her health into her own hands.

Dr. Casey Means (02:37):

She scoured the literature to understand if there were any possible treatments for MS and ultimately developed the Wahls Protocol which is a nutrition and lifestyle program to treat all chronic autoimmune diseases, which reversed her disease process, restored her health and allowed her to get out of her wheelchair and back on her feet.

Dr. Casey Means (02:54):

Her learnings turned into an incredible book called the Wahls Protocol, and she gave a TEDx talk that has over 3.5 million views on YouTube called Minding Your Mitochondria, which everyone should go out and watch after listening to this podcast. She’s inspired countless individuals to make the choices to support their health and vitality. And I am so excited to welcome you, Dr. Wahls, to the podcast, and to dig in typically to the relationship between blood sugar, metabolic health, and autoimmune disease. Welcome to a whole new level.

Dr. Terry Wahls (03:26):

Hey, thank you so much, Dr. Means.

Dr. Casey Means (03:28):

So for those who may not be familiar, can you define for people what an autoimmune disease is a framework for thinking about this process in the body, and how autoimmune diseases may be similar from a root cause perspective?

Dr. Terry Wahls (03:45):

Okay. So when I was in medical school a few years ago, we’re taught that autoimmune diseases are the immune cells attacking self. We don’t really know why. They, for reasons entirely unknown, must be genetic. At that point, we didn’t even link infections. And all we had was prednisone.

Dr. Terry Wahls (04:05):

And then, we started adding some other immune-suppressing drugs. And scenes got a little bit more sophisticated. But we appreciate that there are hundreds of genes that increase the risk. And there’s still this long list of unknown environmental factors. And the conventional approach still focuses entirely on immune suppression. And, of course, that’s not the approach that I take, nor is it the approach that I teach. I focus on what are all the modifiable lifestyle factors that we can address. So we focus on creating health. And as a byproduct, you may discover that your chronic diseases begin to get under better control and then begin to regress.

Dr. Terry Wahls (04:50):

I’m going to take you back to my health journey here for a little bit. So 40 years ago during medical school, I started having these electrical face pains. And they’d been old over a period of the next seven years. I had an episode of visual dimming, see a neurologist. Can’t explain that. Fortunately, they don’t connect my face pain and visual dimming because they could have diagnosed MS then. Fortunately for me, they did not.

Dr. Terry Wahls (05:16):

13 years later after it had my two kids, then, I developed leg weakness, see the best people, take the newest drugs. And so within three years, I’m in a tilt-recline wheelchair. And that’s when I decide like, “You know what? It’s pretty clear I’m going to become bedridden demented.” And the trajectory in my face pain is such that it’s more frequent, more severe, far more difficult to turn off. I’m already on maximum dose of meds. I’m already going to the pain clinic. I’ve already gone to multiple pain centers. I am likely to have my face pain turned permanently on.

Dr. Terry Wahls (05:50):

And at that point, light, sound triggers my pain. Speaking triggers my pain. Swallowing triggers my pain. And I’m taking high dose Solu-Medrol when these episodes turn up. So I’m like, “Okay. I’ve got young kids. I have to do a thing that I possibly can.” So I can still read. I went to PubMed, and I started reading the basic science. You know what? At first, I was looking for drug development studies. Then, I had this big aha, like, “I can’t get these drugs.”

Dr. Terry Wahls (06:21):

So I switched over to start reading nutraceutical studies and started with a supplement cocktail. And so, I created this supplement cocktail. I was focusing in on cognitive decline, Alzheimer’s, [inaudible 00:06:36] disease, ALS because the nature by disease had been a slow progression, looked much more like a progressive MS even though I’d had two relapses at that point 27-year history of my disease.

Dr. Terry Wahls (06:52):

And it appeared to me that the root problem was mitochondria, that they couldn’t make enough energy. So my supplement cocktail was focused on mitochondrial nutraceuticals. And after six months, I was no better. So I was pissed off, and I stopped at [inaudible 00:07:08]. And I couldn’t get up, couldn’t go to work.

Dr. Terry Wahls (07:10):

And on the third day, my wife, Jackie says, “Honey, why’d you take the supplements again? I mean, what’s it going to hurt?” So I take them. And the next day, I can get up when I can go to work. Now, mind you, I’m still struggling with fatigue. But I’m like, “Oh my God, that was really cool.”

Dr. Terry Wahls (07:30):

So two weeks later, I do the same thing. I stopped my supplements. Wait, three days, start them up to the third day. And I can pop back up and go to work. Now, mind you, popping up is hardly popping that much. But I could at least go to work. And I was like, “This was empowering. Oh my God. There is something to this.”

Dr. Terry Wahls (07:54):

So now, I am really excited about reading the literature. So every day, I’m scanning and reading a paper or two, after my family’s gone to bed. I’m still okay with thinking that I can get by with four to five hours of sleep a night so I can spend my time reading, realizing that was probably not a very smart thing to be doing.

Dr. Terry Wahls (08:15):

And for years, I’m really focused on fixing my mitochondria with supplements. And so, I get a gradually more complicated supplement cocktail. And I [inaudible 00:08:25] IFM, take their course on functional medicine, have a little deeper understanding at a longer list of supplements.

Dr. Terry Wahls (08:32):

And then a couple months later, I had this really big aha because I had already switched from being vegetarian to a Paleo diet based on Lauren Cordain’s work and his papers. But I had this idea like, “What if I took this long list of supplements and said, where are they in the food supply?” And I got them from the food.

Dr. Terry Wahls (08:53):

So it was the first decision that I said, “I’m going to focus on creating help.” And so, that was more research that I had to do in the Linus Pauling Institute of Micronutrient was very helpful. They helped me identify the food sources.

Dr. Terry Wahls (09:10):

And so, in the early days, I had these long list of foods that was stressing on my diet. And this new focus started on December 26th. And within a month, I was not as exhausted. And my physical therapist said, “Now, Terry, you’re getting stronger.” And he began to advance my exercises. And within three months, I do this really radical thing. I get out of my wheelchair. And I walked down the hall and mail a letter. And my colleagues are like, “Oh my God, Dr. Wahls. You’re walking. You’re walking.”

Dr. Terry Wahls (09:46):

And that’s stunning. And then three months after that… Well, maybe it was about four months after that, I decided I want to try bike riding again. And we have this emergency family meeting. It’s on Mother’s Day. And we decided that I can try riding my bike. My son’s going to job alongside on the left. My daughter, Zeb’s going to jog alongside of the right. And Jack’s going to follow on her bike. And I push off the wobbles a little bit. But I catch my balance. And I’m biking, and my kids are crying. Jackie’s crying. I’m crying. If you look at my eyes closely, you see I’m crying, reliving that moment because that’s when I figured out, because up until then, as part of the adaptation to living with a progressive, neurodegenerative diseases, you’re let go of the future. You take each day as it unfolds.

Dr. Terry Wahls (10:39):

And so even though I was remarkably better walking around the neighborhood, I was still taking each day as it unfolded. And all of my physicians for seven years had said, “You’ve got secondary progressive MS. Functions once lost will never come back.”

Dr. Terry Wahls (10:55):

So I didn’t know what was happening. I just knew that day by day. But the day I rode my bike, I knew that the current understanding of MS was incomplete. And that who knew how much recovery might be possible? Four months after that, I do an 18.5 mile bike ride with my family.

Dr. Terry Wahls (11:17):

Once again, we’re all crying. My kids are crying. My wife’s crying. And I’m crying when I finish that bike ride. And so, that really transformed how I thought about disease and health that transformed the way I practice medicine. And it would transform my mission in life and the way I conduct my research.

Dr. Casey Means (11:39):

I’m bold over. And I am just so grateful to you for the work that you put in to dig deeper and to challenge the convention and go to some of the preclinical research, the mouse research, and actually put together a whole new framework for thinking about health that was really based on systems biology and around giving the cells what they need to function properly.

Dr. Terry Wahls (12:07):

This was all about thinking about the cells. Once I zero down, okay, the mitochondria. I’ve got the nutrition right for the mitochondria. Of course, I was thinking supplements. What were all the supplement cocktails, which we got complicated. And the AIM course was helpful. So still nobody was talking about the microbiome yet because we didn’t know about that.

Dr. Terry Wahls (12:29):

And it’s sort of embarrassing now to realize how long it took me think, “Okay. I have made some dietary changes that were important.” But what if I structured instead of thinking about what to avoid, what I should be eating, and I could use all these things that I should report from mitochondria, figure out where they were, the food supply and probably other really important molecules would come all long as well.”

Dr. Terry Wahls (12:55):

I want everyone to know that I did not get better from that supplement cocktail. People have heard about my use of electrical simulation muscles. I did not recover. As much as I love e-stim, I did not recover.

Dr. Terry Wahls (13:07):

The magic was when I shifted my thinking to creating health. Am I doing everything that I can? Have I maximized my nutrition using food to the very best that I possibly can? Have I got back to meditation? We did that.

Dr. Terry Wahls (13:27):

And I always stayed on the exercise bandwagon. So I continue to very work very hard with my physical therapist. But it’s the creation of health. When we focus on treating disease, we get it wrong. Even when we focus on those mouse model preclinical studies, we’re still going to get those wrong because they’re focused on understanding pathology, one molecular pathway, and health and life are deeply interconnected.

Dr. Terry Wahls (13:57):

All of that metabolic pathways are so richly interconnected with checks and balances that when we focus on pathology, we will not be able to correct health. When we focus on health, on what are all the things that underpin health and add them incremental by incremental step, that’s when the magic happens for me. And that’s when the magic happens, and the patients I take care of.

Dr. Casey Means (14:27):

I love that so much. And something that I think in a lot of ways, you really got me started to think about, which now is the dominant way I view health and medicine is that we have to focus on the cell.

Dr. Casey Means (14:39):

All health and disease comes from either cellular function or cellular dysfunction. This is the basic one of the building blocks of our bodies. Obviously, there’s the atomic level as well. But these are these beautiful machines that are working so hard. But they need specific things to function properly. And they need the avoidance of other things to function properly.

Dr. Casey Means (15:02):

And that’s where that really beautiful relationship between food and the cell comes into play because, like you said, supplements may have a few of these things that the cell needs. But food has thousands of chemicals that we don’t even know about what some of these are, that give this beautiful machine what it needs to generate health for us.

Dr. Casey Means (15:23):

And so, I think a point that you make that is so important is that when we focus on real whole cleanly grown foods, we’re fighting most of the battle here. We’re getting those thousands and thousands of chemicals in plants that are going to do such good work for ourselves.

Dr. Terry Wahls (15:41):

And I believe that number’s actually about 80,000 constituents. [crosstalk 00:15:46] Yeah. And that’s in plants. And then if we go into the animal protein and to the fungi as well, then, that number becomes even larger.

Dr. Terry Wahls (15:56):

If we think about our ancestral beginnings, whether we go back as Homo sapiens 250,000 years, or we diverge from the primates six million years, or when they became mammals 200 million years, when we were unicellular which are now billions of years, we had this very long history of metabolic complexity that means that the solutions aren’t going to be a single molecule drug-based solution. We have to be able to honor that complexity of our biochemical path.

Dr. Casey Means (16:35):

So what I’d love to pick your brain about here is focusing on the mitochondria. Your TED Talk is called Minding the Mitochondria. This clearly became something that came up in the research for you showing that mitochondria and mitochondrial dysfunction may be a centralizing factor in many of the different diseases we’re seeing.

Dr. Casey Means (16:54):

And mitochondria really a core part of our metabolism. And so, I’d love to hear this link between why mitochondrial dysfunction can then lead to the body attacking itself in autoimmune disease. What’s that pathway between problems with our mitochondria, and unfortunately at Western and modern lifestyle in many ways are hijacking the mitochondria and making it dysfunctional. And we can talk about some of the reasons for that.

Dr. Casey Means (17:20):

But then, how that translates to being a feature that links all autoimmune diseases and the body then essentially turning on itself and creating immune response against the body.

Dr. Terry Wahls (17:31):

And I might be incorrect here. But I see it more as an accelerant that if your mitochondria cannot generate energy efficiently, then, whatever disease processes you have will be accelerated.

Dr. Terry Wahls (17:50):

So I think the mitochondrial dysfunction is really an accelerant. This is a not enough energy that puts all of these tissues in strain. And it will accelerate the disease process. In addition, because of the cell danger response, we now know the mitochondria are deeply involved in recognizing cell danger that when in the inner contents spill out into extracellular space, those molecules particularly ATP are recognized by the cell membranes. And that activates the innate immune system. And then, that will address the pathogen, the infection, or as in when I broke my wrist, the fracture and cleans up the debris.

Dr. Terry Wahls (18:39):

The second step is the mitochondria involved in that second step. They’ll call in the stem cells to do the repair work. And then, the third step which is reintegrating the repaired tissues back into the surrounding tissues so they can function normally and complete healing and resolve the inflammation.

Dr. Terry Wahls (18:57):

And the mitochondria is involved in all three of those steps. So, it’s both an accelerant. And it’s intimately involved in immune function. And either accelerating immune function or failing to resolve the immune dysfunction. So it has dual roles. And I think it’s a very big player in auto-immunity.

Dr. Terry Wahls (19:23):

But it’s also a very big player in most of our non-infectious chronic disease states, whether it’s a mental health problem, obesity, diabetes, cardiovascular disease.

Dr. Casey Means (19:34):

And you’ve done quite a bit of clinical research in the MS population and have looked at several biomarkers in your research of metabolic health in this population. And what do you see in your own dataset in terms of rates of increased blood sugar or insulin resistance or metabolic dysfunction in a population with MS versus a non-autoimmune control population?

Dr. Terry Wahls (20:01):

That’s a very consistent finding across most autoimmune disease states, whether it’s MS, lupus, RA, probably true for psoriasis although I don’t know that. I certainly predict that of the hundreds of autoimmune diseases that they’ll probably have one-half to two and a half times the rate of the general population of insulin resistance and metabolic syndrome.

Dr. Casey Means (20:25):

What do you think is going on here in terms of the mechanisms in terms of chicken and the egg? Is it that hyperglycemia induces mitochondrial dysfunction through increased reactive oxygen species, and then that leads to this dysfunction that may lead to immune reactivity, or is there something else going on where maybe something else is causing mitochondrial dysfunction? And then, that’s leading to both metabolic disease and autoimmune disease, or what’s the model that we can think about this relationship?

Dr. Terry Wahls (20:57):

We have wandered so far from evolutionary roots. The diet we eat is so radically different. We eat continuously. We eat a lot of sugar. We eat a lot of fructose. We eat a lot of high glycemic index foods. We are continuously forcing the release of insulin. We have disrupted our microbiome. We are eating so many synthetic compounds in our diet, putting them on our skin.

Dr. Terry Wahls (21:26):

So all of those factors will drive insulin resistance. All of those factors increase our vulnerability to autoimmunity. All of those factors increase our vulnerability to serious mental health problems in chronic disease states.

Dr. Terry Wahls (21:44):

So I think the root cause is that we have terrible diets. We have toxic exposures. We have a lot of adverse childhood events and early trauma for our children. We have a lot of chronic stress as adults, and we don’t have enough hormetic stress followed by sufficient recovery time.

Dr. Casey Means (22:08):

That summary alone of all the different things that are impacting our core fundamental cellular biology from working. If we could just like print out that list and just focus on so many different aspects of our modern living that are ultimately feeding into this common denominator, which is mitochondrial dysfunction and poor cellular health.

Dr. Casey Means (22:28):

And while I feel like it can be overwhelming for people to think of all those things that need to be right, it can almost seem hopeless, I think it’s actually really an opportunity because there’s so many different areas that you can focus on to do right by yourselves.

Dr. Terry Wahls (22:41):

And what I want people to do is to start small. When I talk about behavior change, I invite them to think about some aspect of their health behaviors that they could begin to improve.

Dr. Terry Wahls (22:54):

So we get curious. We’re going to talk about diet. We’re going to talk about meditation, exercise, sleep. And in some of my studies, we make you do everything all at once. And in some ways, that’s easier. In my clinical practice, well, that’s going to be a very kind conversation like, “Okay. So here are the domains. Where do you want to start? Let’s come up with a goal that you’re confident you can really do because I want you to have a change that you can actually do as opposed to a change that you only do 50%.” And then we build on that success.

Dr. Casey Means (23:28):

Such a wise approach, giving people the manageable entry points to start, and maybe start seeing that success. And then using that as a way to really fuel and catalyze continued behavior change.

Dr. Terry Wahls (23:41):

And just do insist that people do the Wahls Diet first. And I actually have become a little more mellow about that now realizing that for some, they have to meditate first and get their stress down more manageable. And then, they can begin addressing food choices.

Dr. Casey Means (24:02):

Well, shifting things into getting into some of the hard science here, because a lot of our listeners really love the mechanistic aspects, you and I had a conversation recently about a really interesting chemical mediator in the body called osteopontin. You’ve undercovered some really interesting work about how this chemical that is secreted in the adipose tissue when it’s high can have really negative and toxic effects on the brain.

Dr. Casey Means (24:26):

And so, this is sort of one of these links between metabolic disease, high levels of visceral fat and visceral adiposity, this cytokine, and then the neurodegeneration and neurologic disease. Can you describe for people what this relationship is and what we’ve learned about it?

Dr. Terry Wahls (24:44):

So, it’s also involved in bone health. So it’s an important compound there. We know that it is involved in immune regulation. And people who have rheumatoid arthritis, a systemic lupus, MS have been seen to have elevated levels of osteopontin.

Dr. Terry Wahls (25:02):

And then again, when I was at one of my MS research meetings, I was listening to researchers talk about osteopontin’s effect on the microglia. And the microglia are the monitors of the brain environment. And depending if the microglia see the brain environment as hostile, they will begin attacking the invaders and killing brain cells and killing myelin and killing synapsis and leading to rapid atrophy of the affected parts of the brain or the microglia can see like this is a great environment. Everything looks good. But I see a few strained synapses in parts of the brain that need nurturing support. So I’m going to go there, secrete all of these nurturing compounds. And I’ll repair the myelin. I’ll repair the synapses. And so microglia can be restorative or destructive.

Dr. Terry Wahls (26:07):

And what intrigued me was they were discussing how high osteopontin accelerates the microglia to be very destructive, which then got me into reading. And so this has been known for some time. This has been reproduced that osteopontin can shift the microglia to be more destructive in what drives high osteopontin insulin resistance, too much central obesity.

Dr. Terry Wahls (26:36):

And so, I have a freezer full of specimens. And so, we’ve been writing grants. We just submitted a grant to look at our freezer. And osteopontin was one of the biomarkers that we proposed to analyze. So I’ll be able to tell you, hopefully, in funding cycle will run three years. So it’ll be three years before I’ll know this answer. But hopefully in three to four years, we can have this conversation. And we’ll be able to tell what we saw.

Dr. Casey Means (27:04):

Very, very interesting. Osteopontin I think is a word that most people have is not on their radar yet. And so, it’s really exciting to hear from you that this might be an area of strong interest and also actionable interest because-

Dr. Terry Wahls (27:14):

Actionable interest.

Dr. Casey Means (27:17):

From what it sounds like, if people can improve their insulin resistance, their central obesity, visceral adiposity, that you might be able to actually reduce your levels of osteopontin, and this could have then a downstream positive effect on our microglia and-

Dr. Terry Wahls (27:34):

Correct. And this might be one of the mechanisms how it’s through the microglia that while high blood sugars accelerate cognitive decline and worsen Alzheimer’s, it’s probably through the microglia. That’s part of the mechanism. It would be my conjecture. And we’d have to have some experiments to investigate that. But it certainly seems plausible.

Dr. Casey Means (27:57):

So another autoimmune disease that I think is of great interest to the people listening to this podcast is type-1 diabetes because mostly we focus on type-2 diabetes in the spectrum of really acquired insulin resistance and hyperglycemia that comes from that.

Dr. Casey Means (28:13):

But, of course, there’s this whole other branch of type-1 diabetes that is autoimmune destruction of our pancreatic beta cells, which produce our insulin. So it’s less an issue of insulin resistance and more an issue of not having enough in insulin around. So I’m curious if this disease state also fits within the walls protocol framework. And is there anything from the framework and what we know about mitochondrial dysfunction and microbiome effects on autoimmune propensity that can be applied to type-1 diabetes?

Dr. Terry Wahls (28:45):

Yes. When we look at the dramatic uptick of autoimmunity since World War II, they talk about inflammatory bowel disease, MS and type-1 diabetes, that there are environmental factors that are tied in probably to the change in the food supply, the dramatic increase of fructose, the dramatic increase of sugar processed foods, the increase of synthetic chemicals in our diet, and the dramatic shift in our microbiome because of all of the antibiotics.

Dr. Terry Wahls (29:17):

All of those are a factor in why those three autoimmune diseases have increased. So, yes, it’s not just the infection that triggered the destruction of the pancreatic islet cells. It is the environment that set that cascade up.

Dr. Terry Wahls (29:40):

I’ll also tell you that we’ve had certainly many, many patients with type-2 diabetes tell us that they’ve reversed their diabetes using the Wahls Protocol. But I’ve also had many people with type-1 diabetes tell me that they’ve had dramatic improvement of their blood sugars in their management of their disease using the Wahls protocol.

Dr. Terry Wahls (30:03):

There was one lady who has a fairly remarkable story. She had pulmonary sarcoidosis in addition to type-1 diabetes and was in ICU because of her severe psychosis on very high dose prednisone to control her sarcoid. And while she’s in ICU, one of her neighbors, here’s my very first lecture that I gave here in Iowa City. And so the neighbor went to see Julie and her husband to say, “When you get out of the hospital, we’re going to cook for you because I know how life is just so difficult.”

Dr. Terry Wahls (30:40):

And the food they cooked was based on the principles that laid out in that very first lecture, which looks very much like the principles that I teach in my TED Talk. And her sarcoidosis melted away, stunned her physicians. So she was able to get off her prednisone. Her insulin control became much, much better.

Dr. Terry Wahls (31:04):

Her renal disease had been very severe. She was on the brink of needing dialysis. And her renal function improved remarkably, was no longer a immediate threat for needed dialysis. And then, I finally met her about five years after the fact at another conference.

Dr. Terry Wahls (31:24):

She told me that story. So part of why I’m sharing that whole story for you, Dr. Means, is that… And of course, I had no idea of, of the impact that I had for Julie that you don’t know the ripple effect of these podcasts, or do I know the ripple effect of that TED Talk or my books or the practitioners that I teach.

Dr. Terry Wahls (31:50):

But the work we are doing is transforming the lives of millions and millions of people. So I so appreciate that you’re taking the time to do these podcasts. I appreciate that you had the brilliant insight to create levels, to give people the tools, to get their insulin resistance under better control. It will have this ripple effect of millions and millions of lives.

Dr. Casey Means (32:16):

Well, thank you. And I think that is so powerful. I mean, like I mentioned in the beginning, the ripple effect of your work, even in my own life, has been profound. And I’m just so grateful to you. And many of the authors in this space who have really put themselves out there by challenging the convention and digging deeper and asking the question why over and over and over again.

Dr. Terry Wahls (32:36):

When I first started having these public conversations, let me tell you neurology community was very upset and severely condemned over and over again. Fortunately, I stuck with it. I kept doing my little research, getting our papers published, writing our grants.

Dr. Terry Wahls (32:51):

And I now have a joint appointment in neurology. And my neurology colleagues are co-investigators on my grants. And I just got comments today from the chief of neurology on my current proposal. And he’s like, “Oh my gosh. Terry, this is very compelling, very exciting.” And so I’ve come a long way in these 11 years from being condemned as intolerably dangerous, being seen as having these really interesting, innovative ideas that now my very conventional chief of neurology, who is the chief of the MS clinic, thinks are brilliant and visionary.

Dr. Casey Means (33:38):

It takes a lot of brave to be one of those first voices.

Dr. Terry Wahls (33:41):

When I first started changing how I practiced medicine, people were complaining. My chief of medicine, chief of staff at the VA called me in. I explained myself. And then, I had to go have the same conversation with the chief of medicine at the university who said, “Terry, you’re going to lose your license because all we need is somebody to file anonymous complaint. You’ll get inspected. You’ll be inspected by people who don’t believe in functional medicine, integrative medicine. So you need to learn how to talk about this.”

Dr. Terry Wahls (34:12):

So they sent me to work with the chief of the complimentary alternative medicine clinic. And actually, I was very grateful that they did. So it became very clear with my patients and with the public that I’m focused on creating health. We’re going to really focus on modifiable lifestyle factors. And we’ll see what your body can do with that. I’ll have to watch you closely for your blood pressure, your blood sugar, and your current medication use so you don’t become over medicated. But we’re going to focus on creating health using these basic lifestyle principles.

Dr. Terry Wahls (34:46):

And when I shifted how I spoke to my patients that way and the residents, I quit getting complaints. And when I focused my clinical notes that way, I quit getting complaints. And my chief of staff and my chief of medicine said, “Atta girl. We appreciate that you’re doing that. That’ll be fine. You’ll be able to pass peer review because we need you to pass peer review, Terry.”

Dr. Terry Wahls (35:10):

And so that’s my caution when I train practitioners, is that we have to teach you how to talk about this because you and I get so excited. It’s so clear, like, “Oh my God. This is treating and reversing so many disease states.”

Dr. Terry Wahls (35:25):

But we have to be very careful that what we’re doing is we’re focused on creating health and monitoring current medication use and adjusting them so people aren’t over-medicated because that language will feel very comfortable to our conventional colleagues and very respectful. As soon as I say, “I’m treating MS with diet and lifestyle,” that’s not FDA approved. And that can be sanctioned. And that will not pass peer review.

Dr. Terry Wahls (35:51):

But if I say I’m focused on creating health by treating diet and lifestyle, and we’re going to watch your medications and adjust them so your blood pressure doesn’t become too low. Your blood sugar doesn’t become too low. And then, you can talk with your neurologist about what makes clinical sense to you.

Dr. Terry Wahls (36:07):

Everyone is very happy with that. My neurologist colleagues are happy with that. My chief of medicine is happy with that. My chief of neurology is happy with that. And so, we have to be careful that we teach our functional medicine practitioners how to talk about this in a way that respects conventional medicine, respects the patients, respects the healing process because what we’re doing is we’re creating health. And as a side effect, sometimes not always, but sometimes, you regress a considerable amount of pathology as a side effect of creating health.

Dr. Casey Means (36:44):

Before we conclude there’s one question that is lingering in my mind that I really want to take an opportunity to ask you, which is something that I think other people might also wonder, which is we’ve got all these different autoimmune diseases that look very, very different from type-1 diabetes to rheumatoid arthritis, to lupus, to MS.

Dr. Casey Means (37:05):

They all have very different clinical faces. And what you talk about in the book is that there’s really… It’s just a handful of core physiologic features that have kind of gone awry that can lead to all of these things. How does that happen in the body where in one person, it might look like lupus? In one person, it might look like rheumatoid arthritis. And another person, it’s MS. How do they show up at these different faces?

Dr. Terry Wahls (37:28):

Yeah. It’s that really interesting. So we have disordered immune function. We have weakened mitochondria. We have toxin overload. We have hormone imbalance. We have difficulty eliminating in our toxins. And I have different sets of microbes in my gut.

Dr. Terry Wahls (37:44):

And then, I have different genetic vulnerability. And so depending on the microbes and my genes, when my immune system gets revved up and I begin making auto-antibodies that will begin clearing out that infectious problem or that food protein that I think is an infection. If that protein has a similar amino acid sequence to another structure in my body, in my brain, in my joints, in my lungs, in my skin, that part of my body is going to get damaged as I clear out that problem protein, whether it’s an infection or a food protein.

Dr. Terry Wahls (38:28):

And my vulnerability is a reflection of my genetics and my microbiome and the foods, and the similar immune-acid sequence between my structures and those various proteins. And then, I’ll add to that. And we can use my myself as a case in point. So as a youngster, I have migraines. That’s an early prodrome. I have really heavy periods.

Dr. Terry Wahls (38:59):

And I think that’s just sort of a lot of women have miserable, heavy, heavy, heavy periods. And then, when I decided I want to have kids, I discover I have severe, severe endometriosis and going through IVF. And by then, I’ve already had 10 years of my trigeminal neurology, which was the autoimmune process involving my brain.

Dr. Terry Wahls (39:22):

So I had an autoimmune process involving my brain. I have asthma, autoimmune process involving my lungs. I have an autoimmune process involving the endometriosis. And I have very mild psoriasis. If you don’t address the root causes, you keep developing more auto antibodies, more autoimmune processes, and more parts of your body will become casualties in the autoimmune process development.

Dr. Terry Wahls (39:53):

So it’s one of my messages to people is, yeah, you may need disease modifying-drug treatment for your autoimmune disease that you have. But if you don’t address the underlying root causes, you will continue to develop other autoimmune processes through this molecular mimicry. And you will pick up another body part casualty whether it’s asthma or psoriasis or endometriosis, or autoimmune and thyroid disease, or Behcet’s. And besides, you want to have healthy aging and healthy brain and all that stuff.

Dr. Terry Wahls (40:27):

So everyone, whatever you got, whatever chronic complex health problems you have, you want to be sure that you’re also doing everything you can step by step with your modifiable lifestyle factors.

Dr. Casey Means (40:40):

Yeah. And you touched on something there that I think is also important in this metabolic health blood sugar conversation, which is the concept of warped proteins and that these can be a trigger for the body to fight. And I think I’d love for you to just touch on the relationship between glucose and warped proteins and glycation and how hyperglycemia might lead to some of this dysfunction in the structures of our body that then lead to the body being like, “What is this?”

Dr. Terry Wahls (41:08):

I think we would be so far ahead in our healthy aging, if we would all check our glucose and check for the possibility of insulin resistance. Ideally, I’d like to see every… because you can be skinny and have insulin resistance. You can be skinny. You cannot have any central obesity, be thin on the outside and fat on the inside.

Dr. Terry Wahls (41:34):

And so if you have elevated blood sugars, you’re going to be at risk for this glycation, the sugar being attached to the proteins, and the proteins becoming oxidized nonfunctional, and that will be an accelerant for this autoimmune process. And it can be an accelerant for that cell danger response.

Dr. Terry Wahls (41:59):

If you aren’t looking for insulin resistance, you’re going to miss the thin on the outside fat on the inside because we have so deranged our diets. We have such terrible diets for so long that I don’t know what the number is, how many people, what the active percent would be that actually have insulin resistance.

Dr. Terry Wahls (42:23):

But it is probably far higher than the rate of obesity. I don’t know because I don’t know that anyone has done any kind of population basis to really look for that number.

Dr. Casey Means (42:37):

I would just love to see a big retrospective study looking at a large hospital system, triglycerides to HDL ratio, which is something we already have cholesterol panels on everyone. And that would give us at least a hint at insulin sensitivity, which could be really interesting. So anyone listening, that might be a good-

Dr. Terry Wahls (42:56):

That’s a good idea. I could mention that to my poster.

Dr. Casey Means (42:59):

Literally, every adult patient has that cholesterol panel. And it’d be fascinated to see like who’s over one of a ratio. Who’s over two? Who’s over three. Does it correlate with BMI? Does it correlate with bread pressure? Actually, this would be fun to work on.

Dr. Terry Wahls (43:14):

That could be a nice epi study for a large dataset, such as women’s health initiatives.

Dr. Casey Means (43:22):

Well, to wrap up just a sort of actionable takeaway, couple high yield things people can do to support their mitochondrial health through diet and lifestyle. What would be some of your top recommendations?

Dr. Terry Wahls (43:35):

So number one, ditch all the sugar, sweet and beverages. Number two, ditch all the fructose, all of those Paleo-friendly sugar substitutes that are all fructose. Get rid of those. Number three, replace grain-based products with vegetables. Number four, I’m a tall lady, six-foot tall. So it’s pretty easy for me to have nine cups of vegetables a day, three cups of green, three cups of sulfur, three cups of color. But I don’t know how tall you are.

Dr. Casey Means (44:04):

Six feet.

Dr. Terry Wahls (44:05):

Okay. So we can talk about nine cups, no problem. And then, if you’re a meat eater, six to 12 ounces of meat. If you’re not a meat eater, gluten-free grains and legumes for your protein.

Dr. Casey Means (44:18):

Perfect. Well, I hope that this conversation is very uplifting for anyone listening, who is on the spectrum of autoimmune disease. I think the key message that we’re talking about and that you’ve promoted in such a beautiful way over the last decade is that there is so much hope. There is a lot that we can do.

Dr. Casey Means (44:37):

But we do have to change the choices that we’re making every day. But these choices can be wonderful, like including more beautiful vegetables and they work. Would you say that it’s safe to say that focusing on improving metabolic health can be part of a journey in moving towards improvement of autoimmune disease? That is an area.

Dr. Terry Wahls (45:00):

Oh my god.

Dr. Casey Means (45:00):

Yeah.

Dr. Terry Wahls (45:01):

Let me be even stronger. I think everybody with an autoimmune disease really should go investigate their metabolic health. I told everyone we should know your glucose, your insulin levels, your A1C. And does answer that question? Do you have developing insulin resistance? And if you do, then, we need to have a strategy for dealing with that. So yes, if you have an autoimmune disease, I very strongly urge you to investigate. Do you have insulin resistance?

Dr. Casey Means (45:29):

Amazing. How can people find you, Dr. Wahls online?

Dr. Terry Wahls (45:42):

Terry Wahls, T-E-R-R-Y. Wahls, W-A-H-L-S.com. My Instagram handle is Dr. Terry Wahls and Facebook and Twitter is Terry Wahls.

Dr. Casey Means (45:54):

And I highly recommend following your Instagram because you often do a meal recap of what you’re having for supper. And very frequently, it inspires me to have a slightly healthier dinner, because I know what you’re eating. So very much recommend that.

Dr. Terry Wahls (46:08):

We will be recruiting for a new clinical trial in the very near future. This is for a dietary study, comparing a modified Paleo diet, a time-restricted olive oil ketogenic diet and dietary guidelines diet. We’ll follow folks for two years. We’ll get MRIs at the baseline.

Dr. Terry Wahls (46:27):

And at the end of the study, that will be one of the largest and longest dietary intervention studies that we’ll have been done today. So we are very excited about that. And the key is we need to have people with relapse remitting MS who live within 500 miles of Iowa City. And we’ll get the links so people can go look for that study in screen and look to see if they’re eligible for any of the other studies that we are conducting.

Dr. Casey Means (46:54):

Thank you so much for taking your time today to educate this audience and really appreciate you, you being here, Dr. Wahls.

Dr. Terry Wahls (47:02):

Thank you.