Autoimmune Disease Management with Dr. Terry Wahls: Nutrition, Mitochondria, and Women’s Hormone Transitions

What is the most dangerous misconception doctors have about autoimmune disease?

Terry Wahls: Well, the, uh, just taking a disease modifying treatment is sufficient. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: That there's no role for addressing modifiable lifestyle factors. 

Dr. Brighten: Mm-hmm. What was the turning point for you when you decided that you needed more than just what doctors were offering? 

Terry Wahls: Well, um. When I hit the wheelchair, uh, you know, when I was first diagnosed, I went to read the basic science and saw that it's a progressive disease.

It was very upsetting. I was getting agitated. Jackie sat me down and said, Terry, you have to stop reading. We're gonna find you the best, uh, center to go see and let them take care of you. Mm-hmm. So I did that. I stopped reading. Three years later when I was in the wheelchair. I was like. I think it's [00:02:00] time to go back to reading.

Dr. Brighten: Yeah. 

Terry Wahls: And so I started reading, uh, and then I, I would, uh, eventually decide that mitochondrial dysfunction is what's driving disability, and I would focus on finding supplements to support my mitochondria. 

Dr. Brighten: Mm-hmm. When you say mitochondria dysfunction, I think everybody immediately goes back to like sixth grade and they're like powerhouse of the cell.

What does it actually mean for your mitochondria to be dysfunctional? 

Terry Wahls: So our mitochondria are ancient bacteria that about oh 2 billion years ago were engulfed by bigger bacteria in those, uh, mitochondria make a TP the energy currency of our cells. If our mitochondria are not wor working as efficiently as, um, they should, they can't make as much a TP and then whatever task that's been assigned to that cell is being less and less and less effective.

Dr. Brighten: Mm-hmm. 

Terry Wahls: And because our, uh, brain. Uh, our retina and our [00:03:00] heart have the highest energy demands. That's where you'll have symptoms first. Either, uh, some sort of brain related symptom, uh, a vision problem, or a heart related problem. 

Dr. Brighten: And when we view this through the lens of autoimmune disease, how does the mitochondria relate to the immune system dysfunction.

Terry Wahls: Yeah. So when we're young, healthy, and vibrant, uh, our immune, uh, cells are really quite active. We will have flares where we have more symptoms. There's a acute relapse if you have ms, if you have psoriasis, a acute flare of your, uh, skin plaques, if you have, uh, ra uh, swollen joints. If you have inflammatory bowel disease, you have worse diarrhea, so you have a flare of your autoimmune symptoms.

And then things begin to quiet down, uh, on their own. Or you go see your physician and they give you a steroid medication to quiet it down more quickly. But beginning around age 45, our immune [00:04:00] cells aren't working as well. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: We have what's known as immunosenescence, the age of the immune cells.

That's when the mitochondria. Are getting old, they're not making as much, uh, a TP. Uh, we don't have as many relapses or flares of our autoimmune disease in its place. We have this relentless worsening, so worsening fatigue, worsening brain fog. Uh, if you have a neurologic problem, you'll have, uh, probably more difficulty walking, uh, more difficulty with your memory, more difficulty with your mood, more anxiety and depression.

Dr. Brighten: For you specifically, so you had multiple sclerosis. 

Terry Wahls: Oh, I still have. 

Dr. Brighten: Well, you still have it. 

Terry Wahls: Yes. 

Dr. Brighten: But my question was going to be what were like the first signs that you wish doctors would've recognized? 

Terry Wahls: Well, that's a wonderful question. In retrospect, my very first. Um, Brainly symptoms began as adolescent when I was having troubles with depression.

Mm-hmm. I also had some migraines, [00:05:00] uh, and, uh, classical migraines, visual, uh, symptoms followed by, you know, severe headache. Uh, and, uh. That would sort of come and go, uh, throughout high school, throughout undergraduate. Uh, then in medical school I started having these, uh, uh, jolts of discomfort at my temple, uh, getting a little more electrical down to my jaw.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and suddenly. I realized I couldn't see outta my left eye. 

Terry Wahls: Fortunately for me, no one said. I think this might be optic neuritis and, and I'm just so grateful.

Had I known that I was probably at risk for ms, I probably would not have elected to have children. 

Dr. Brighten: Oh, and why is that? 

Terry Wahls: Well, because I was like, you know, single parents, uh, having kids, uh, with ms, that would probably be very challenging. 

Dr. Brighten: Mm-hmm. Yeah, I think a lot of [00:07:00] people can relate to that. I think there's a lot of people who have developed chronic illness and they, this one has in some instances robbed them of motherhood.

But there's also been people that have said. I wish that I hadn't had children because now I'm passing on potentially this genetic condition. 

Terry Wahls: Well, um, and to the listeners, I want to reassure you that, uh, don't feel like, uh, just because you have an autoimmune condition, that you're passing that on to your kids.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, you're, you have a slightly increased risk. Yes. Maybe two to 3%, uh, uh, probability. The, the vast. Uh, lion's share, like 90% is gonna be due to your modifiable lifestyle factors. Mm-hmm. Your, your toxins, your diet, your exercise, your stress, your sleep. So if you want to be a parent, I, I, I, that's still quite possible.

Now, I will want your listeners to know [00:08:00] that obviously the first thing I want you to do is optimize all of your environmental factors as thorough as we can so we can. Get your autoimmune condition quiet, stabilized, then regressed, and hopefully, uh, it completely, you know, stabilized, regressed, and so that you no longer need, uh, active treatment.

Dr. Brighten: What are the top environmental contributors to autoimmune disease and neurological deficits or neurodegenerative disease? 

Terry Wahls: Well, from the research, the um, uh, observational studies will, will tell us smoking, air pollution, uh, um, vitamin D uh, your distance from the equator. So did you get a tan or not a childhood?

Obesity. Those are all factors. In addition. We know that people with autoimmunity have higher rates of gluten sensitivity and non CLIA gluten sensitivity. So I, I tell all my autoimmune patients have a trial of a very carefully [00:09:00] gluten-free, dairy-free diet to see if that is you. It may not be, but it's certainly worth exploring that possibility.

Uh, if you're, uh, a tobacco user or, uh, a vapor, uh, stop that, that would be very helpful. Um, if you. Can manage to have an organic, uh, diet, uh, have filter your air, have an air cleaner in your room or in your home, have a water filter for your, uh, uh, kitchen or your home. Uh, so you can have the highest quality environment that's possible.

Dr. Brighten: What does the science say in terms of the correlation between gluten and autoimmunity? 

Terry Wahls: Well, uh, it, it depends on which autoimmune condition that we're talking about. Uh, but there's a two to fivefold jump in the rates of celiac disease and autoimmunity for people with an autoimmune diagnosis compared to somebody without an autoimmune diagnosis.

Dr. Brighten: Mm-hmm. 

Terry Wahls: It's not that everyone with MS has gluten [00:10:00] sensitivity. But it's certainly worth exploring that. And what I want to remind the listeners, if you're going to have a trial of a gluten-free, dairy-free diet, it needs to be a hundred percent excluded during that trial period. And I recommend, uh, at least, uh, 12 weeks, uh, if you go 24 weeks, the memory cells are gone.

Uh, and then you could. Reintroduce the dairy. See if you tolerate that, and then we introduce gluten and see what happens. 

Dr. Brighten: Mm-hmm. What do you think about people with autoimmune disease who will say. If I am in the US I eat gluten, I feel awful, I have joint pain, I have migraines, I have all of my symptoms start flaring if I'm in another country.

You know, some people, Italy, France. Yeah. I eat gluten and I don't have the same effect. 

Well, 

Terry Wahls: so part the couple factors here. One is that, uh, wheat grown in the United States will [00:11:00] have a lot of glyphosate in other herbicides placed on the wheat to, um. Mature all the wheat at the same rate. Mm-hmm. So that the, uh, wheat, you get about 10% more.

Um. Wheat harvested from the field. So that's very helpful for the farmer, but it means you have a much higher toxin, uh, exposure. Then, uh, Europe doesn't have glyphosate has, uh, lower, uh, pesticide use and they also have a different strains of wheat that they use. So. It may not be the gluten, it may be the other wheat proteins that are affected, and it may be the pesticide exposures.

Dr. Brighten: What do we know about glyphosates impact on mitochondrial health? 

Terry Wahls: Well, you know, basically all of, uh, herbicides, pesticides, insecticides are, are, have a negative impact on our mitochondrial function. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and by the way, antibiotics as well. 

Dr. Brighten: Yeah. 

Terry Wahls: Uh, and so, uh, is it a small [00:12:00] impact or a huge impact that will depend on the individual.

Dr. Brighten: And so if someone's listening to this right now and they're like, great, there's glyphosate everywhere on everything. Are there steps we can take to protect our mitochondria knowing that we've got that level exposure? 

Terry Wahls: Well, uh, according to your financial means, uh, have organic foods, uh, as well as you can.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, you can also use environmental working group. Uh, they have, uh, consumer guides for food, for cleaning products, uh, uh, personal care products. So you could use that to prioritize. You could use, um, get conventional food and then take baking soda. A heaping tablespoon in two quarts of water.

Dissolve the baking soda in the water. Soak your uh, lettuce, your pro for 15 minutes, you know, gently swirl it around. Then drain, uh, and that will decrease the surface, uh, pesticide considerably.

Dr. Brighten: Mm-hmm. 

Terry Wahls: if you could do organic, you'll probably recover more quickly. But again, I want people to know you [00:14:00] do less of the harmful stuff, less of the sugar, less of the white flour, more of the good stuff, protein. And if money money's really tight, maybe the protein is, uh, beans and rice. Uh, in vegetables and maybe it's frozen vegetables, canned vegetables.

You just do the best you can given your financial reality. 

Dr. Brighten: Mm-hmm. You mentioned supplements when we started talking here and you said that you turned to leveraging supplements. I think a lot of people would be interested to know, which you found most helpful. 

Terry Wahls: B vitamins, uh, creatine, uh, kine q. Those are the first things, uh, that I relied on. Uh, then I, uh, discovered the work of Bruce Ames. Uh, he also talked about vitamin D, vitamin K, uh, multivitamin, [00:15:00] multi mineral.

Uh, and so, you know. Gradually over time, I was adding more supplements. I had, uh, I think eight or nine supplements I was taking, you know, uh, and I got sort of annoyed. I thought, I'm taking these supplements, not a damn thing's happening, and I quit them. Uh, and it was pretty entertaining. Three, six hours later, I, I, I just crashed.

I, I couldn't go to work. I was completely exhausted. Uh, after the third day, my spouse came in and said, you know, honey, uh, why don't you, why don't you take these again? Uh, I, I took them and the next morning. I was back to my usual en energy level. I was able to go back to work and I thought, wow, that was super interesting.

and so, you know, gradually I would develop. A [00:16:00] more comprehensive, uh, supplement protocol for my mitochondria.

What if I take my long list of supplements? And look at where these nutrients are and the food supply. If I was following a para lithic style, eating, what should I stress? And that's how I ended up creating this very structured para lithic diet, uh, that I, you know, basically call the walls protocol.

Dr. Brighten: Mm-hmm. For listeners, can you explain what goes into the walls? Protocol? Yeah. The principles that you developed. 

Terry Wahls: Well, so I, I made it, uh, uh, sort of a phased program. Um, so the first level you could do as a vegetarian or as a meat eater. Uh, and we're taking out gluten, dairy, and eggs. Uh, 'cause those are the three most inflammatory foods.

Uh, we're, uh, encouraging people to get rid of sugar, uh, in the added white flowers and have six to nine [00:17:00] cups of. Vegetables. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, two to three cups of green leafy vegetables, two to three cups of deeply colored vegetables and berries. Two to three cups of the cabbage, onion, mushroom, family vegetables.

And then we wanna have protein, either the legume and rice if you're a vegetarian, or six to 12 ounces of meat if you're a meat eater. At the second level, uh, now this is more of a paleolithic diet. Um, we're talking about seaweed, uh, organ meat. We're talking about fermented vegetables, uh, uh, sauerkraut, uh, Kim cheese, uh, uh, algae.

Uh, uh. Uh, spirulina, uh, chlorella. And then at the third level, we're talking about a ketogenic diet. And I have an olive oil based version, or a MCT oil, medium change triglyceride version. And then I have a elimination diet, which takes out nuts, seeds, and nightshade vegetables. 

Dr. Brighten: And what do people typically [00:18:00] experience, like if they go into level one and how do they know if they need to go into level two or three?

Terry Wahls: So what I tell people is. Additions are easier than subtractions. 

Dr. Brighten: Absolutely 

Terry Wahls: agreed. And have a family conversation, uh, and negotiate what you're willing to do. Mm-hmm. Talk about what you want to add, uh, and what you're going to reduce. And then discuss the principles of the six to nine cups of, uh, green, green, leafy vegetables, sulfur rich vegetables, deeply colored vegetables, and taking out gluten and dairy, and preferably also eggs.

Uh, if that's too hard. Then talk about a Mediterranean diet. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, uh, and talk about just working on the additions and gradually winding down the sugar and the white flour. If you do things as a family, they'll be much more successful in my clinics, uh, at the va, 80% of folks. Really had [00:19:00] tremendous success doing level one.

Dr. Brighten: Mm-hmm. 

Terry Wahls: And they didn't need to go any further. It, it really depends. I tell people to give it 12 to 24 weeks and then evaluate. Are you happy with your response? If you are, you can stay there. If you feel like, you know, I'm still having some trouble with joint pain, I'm still having trouble with headaches, I'm still don't have the amount of energy that I want.

So you feel like there's more health. That I want to achieve, then yes, you go to the next level. Now the question of who should think about a ketogenic diet? Now that question comes down to do you have insulin resistance? 

Dr. Brighten: Mm. 

Terry Wahls: Do you have a high hemoglobin A1C greater than, you know, a 5.8% or higher? Is your belly bigger than your butt?

Uh, is your HDL low? Is your triglyceride greater than one 50? Those are all indications that. A lower carbohydrate diet may be helpful. A ketogenic diet may be helpful. 

Dr. Brighten: And how long do [00:20:00] you typically recommend being on a ketogenic or a low carbohydrate diet? 

Terry Wahls: Well, it depends on what it is that you are addressing.

If I'm doing this because I have severe obesity and type two diabetes. You gonna stay on that until you have fully regressed your type two diabetes or your obesity with some caveats. If you're pregnant or breastfeeding, you don't do a ketogenic diet. If you're a child. You don't do a ketogenic diet without the pediatrician, uh, helping you.

Dr. Brighten: Mm-hmm. 

Terry Wahls: If you are already skinny and underweight. You don't do a ketogenic diet 'cause you'll lose too much weight. 

Dr. Brighten: Mm-hmm. And is there a point where in doing this protocol you ever consider leveraging supplements with people? 

Terry Wahls: Well, I, I think supplements, uh, can be super helpful. Uh. The reality is people with obesity, with chronic disease, autoimmune disease, we have a very deep nutritional hole 

Dr. Brighten: mm-hmm.

Terry Wahls: Uh, that has contributing to our health problems. Uh, so again, when I look at, [00:21:00] uh, Dr. Beal's work, uh, Dr. Bruce Amess work, they were very, um. Uh, uh, consistent that yes, improve your nutrition, but add also the vitamin D, the vitamin K, uh, a multivitamin, multimineral. Uh, think about creatine. Uh, think about, uh, a multivitamin, multimineral, uh, B vitamin, uh, uh, coenzyme q mq.

Dr. Brighten: What do you say to doctors who say all those supplements are just expensive urine, they don't do anything 

Terry Wahls: Well. I, uh, tell 'em

are you talking to your patients about nutrition? Are you talking to your patients about meditation? Are you talking to, uh, your patients about sleep? Uh, and. I, I don't want to have people spending a thousand dollars a month on supplements. Food is the most important, uh, a vitamin D plus vitamin K and a multivitamin, uh, [00:22:00] multi mineral.

You could do fine with just those two. 

Dr. Brighten: Mm-hmm. Yeah. And you know, for people listening, I think the question comes up of like, why, why vitamin K? If we're gonna do nutrition, can you speak to where we actually get vitamin K and vitamin D and why those are so important. 

Terry Wahls: Vitamin K does not have an upper value. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: So you can take a higher dose of vitamin K when you take vitamin D. It increases the absorption of calcium, uh, from the gut into the bloodstream, and it helps get the calcium [00:23:00] into your teeth and bones really great.

It can also, we know. Help, um, impact, uh, having calcium into your heart valves in your blood vessel walls, that's a problem. Having additional vitamin K prevents the deposition of calcium on your heart valve or your blood vessel walls. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: So I prefer that people have, you know, a moderate amount of vitamin D and well above the upper limit for vitamin K to reduce the risk of calcium on their heart valve or their blood vessel wall.

Dr. Brighten: And what do we know specifically about the research with vitamin D autoimmunity, proximity to the equator? 

Terry Wahls: Well, we know that, uh, the, um. Societies that live close to the equator have the lowest incidence of, uh, MS and other autoimmune disease. The further you get from the equator, uh, the higher the rate.

We also know for observational studies, if we measure blood values, low [00:24:00] vitamin D, you're more likely to have all sorts of bad health outcomes, more autoimmunity, more anxiety, more depression, premature labor cancer. It's really bad for you. Uh, we've tried a variety of supplement studies. Uh, supplement studies have been disappointing, but we've ne those supplement studies don't generally measure the blood values.

Dr. Brighten: Mm. 

Terry Wahls: And most of our vitamins don't work, uh, in isolation. It's a complicated interaction. Vitamin D, uh, vitamin A, uh, uh, magnesium, uh, and, and so. What I want people to do is get their vitamin D to the top half the reference range, get vitamin K with it, and get a tan. 

Dr. Brighten: Mm-hmm. And get a tan, everyone. So, uh, you, you've mentioned when vitamin D is too low, we will see providers who will use a reference range of like, let's say 20, some say 20, some say 30.

And if you're at 21 they say you are fine. What would you want people to know about the vitamin D reference range? 

Terry Wahls: So the reference [00:25:00] range, uh, is uh, usually 20 to 80. Uh, uh, and the research will tell us if your vitamin D is about 40, you have a lower, uh, risk of relapse, lower risk of progression, lower risk of anxiety, depression.

Uh, I don't, I don't know the risk for, uh, cancers, uh, and I don't know the risk for premature labor, but probably the same. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Which is why my advice to your listeners are. You want your vitamin D in the top half of the reference range. Uh, it so that way, uh, if you're in the European, uh, reference range, the Canadian reference range or the American reference range, if you just like, am I in the top half or not, that will tell you that you're, you're at the appropriate dosing.

Dr. Brighten: Mm-hmm. And, you know, I made a, you know, laughed about you saying, oh, and get its tan. But I realize maybe not everyone knows why you're speaking to getting a tan. So what do we know? Yeah. 

Terry Wahls: Well, it, it appears that our skin will make vitamin [00:26:00] D in response to the ultraviolet light, uh, in that the vitamin D made by our skin.

Uh, and the interaction of ultraviolet light with our skin also has additional changes to our immune cell modulation. And it is different than the vitamin D we get from taking D three that's absorbed the word gut. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Um. I think it's just get outside, it's good for you. Get some fresh air, uh, get, I don't want to get a sunburn, but I do think getting outside every day and maintaining a tan is very helpful. 

Dr. Brighten: Mm-hmm. Why do women get autoimmune disease at such an alarming rate compared to men? 

Terry Wahls: We have a different immune tolerance, uh, that is [00:27:00] required, uh, by, so we can get pregnant.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and maintain the pregnancy, uh, which appears to also increase our vulnerability to autoimmunity. Now, it's super interesting in that if you have an autoimmune disease and you're female. During the pregnancy, the, uh, severity of the autoimmune disease declines. After delivery, there is a flare with a more severe.

Uh, um, rebound of disease activity, whether it's MS or psoriasis or Hashimoto's or inflammatory bowel disease. We also know that if that woman breastfeeds, she is much more likely to not have that flare. Uh, and so, uh, and we've done some research with that as well, so. You know, more of the autoimmune specialists are, are finally, you know, talking to the women.

Yes. There are some drugs that are approved for, uh, DMT use [00:28:00] while pregnant, while breastfeeding. Uh, and, uh, they're encouraging women to, uh, breastfeed, uh, after delivery. 

Dr. Brighten: How long does breastfeeding help protect you? Is it something like, as long as you breastfeed for six months or? 

Terry Wahls: Well. Uh, you're probably gonna have to, uh, wean the child before they, uh, go to college at age 18, 

Dr. Brighten: I would imagine.

Yeah, unfortunately. I guess 

Terry Wahls: so. So it would have to stop then. Uh, can you breastfeed for a year, for 18 months and Yeah, I think that would be fine. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and then, uh, the child would be, uh, eating more solid food and the milk production will be gradually declining. So I, I don't have, uh, clear guidance from, uh, the research.

When, uh, the woman breastfeeds, uh, to that 18 month and 24 month, uh, uh, how that transition will go. Mm-hmm. But I, I certainly, uh, see. The autoimmune specialist encouraging women to breastfeed, uh, to 12 months, to 24 months. 

Dr. Brighten: Mm-hmm. So you've [00:29:00] identified postpartum that is a very vulnerable window. And then earlier on you spoke to that age 45, the immune system shifting.

We know that perimenopause is another window of vulnerability for developing autoimmune disease. What do you think doctors are not saying to women as they enter into perimenopause that they should be so. 

Terry Wahls: As women are, uh, age 45 to 55, we're beginning to have, uh, declining, uh, estrogen, declining progesterone, more problems with sleep disruption, more, uh, aging of the immune cells.

And if we have an autoimmune disease, we're much more likely to go from these episodes of disease flares to, uh, progressive disability. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and unfortunately many physicians are not asking about symptoms of menopause, not asking about sleep, not asking, uh, about, um, uh, their intimate [00:30:00] relationships, not asking, uh, about moods, uh, not asking if there's been a gradual worsening of their autoimmune related symptoms.

Uh, so those kinds of conversations would be very helpful and if. We're, we're, we're wondering, is perimenopause menopause part of this? Measured the estrogen, progesterone, FSH, lh, understand and also measure the thyroid hormones and maybe the prolactin, and then treat with bioidentical hormones. Mm-hmm. 

Dr. Brighten: So saying, treat with biodentical hormones has only recently become conventionally accepted.

I'd love to hear your perspective on how this could be leveraged, not just in the autoimmune conversation, but also in the mitochondrial conversation. 

Terry Wahls: Well, the, uh, hormones are, um, a vital support for mitochondria as well. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, uh, [00:31:00] and so it. And this is part of the program cell death that that begins to happen.

Uh, our, let's see, fourth ventricle, uh, should be making stem cells that go to the hypothalamus, that stimulate the hypothalamus to send signals to the pituitary to send signals to all of our organs, the, uh, thyroid, the um, ovary statistical to make our hormones. When the fourth ventricle stem cells are not being making, uh, as much singling molecules, the pituitary is not making as many singling molecules to our endocrine organs.

Mm-hmm. That is part of why we have immune senescence. That's part of why we age. That is part of why, um, we develop menopause. That is part of why we become vulnerable to infections. Uh, increasingly after the age of 50, more so after the age of 1665. [00:32:00] If we use bioidentical hormones, we can prevent that.

Dr. Brighten: Mm-hmm. I had love to hear your perspective and what you could share with listeners about what are the things that you'd recommend. Like let's say you're 45, now you're listening to this podcast. What things should you start to prioritize about your health? Because unfortunately, we haven't gotten to a point where it's like there's a drug and it can reverse aging or slow these things down, you know, substantially.

Terry Wahls: Well, uh, you know, I think, um, a, a really basic question is. What do you want your health for? 

Now we've got some goals, and then my next question is, okay, so we're going to be working on modifiable lifestyle factors. Which domain do you wanna start with? And we want it to be a small enough domain so you can be successful. So this could be something with nutrition, something with sleep, something with stress management, something with movement.

So pick one. Uh, and so they're like, okay, sleep is really a problem. Okay, so we'll work on sleep. What's small action? You could start for your sleep? And maybe that small action is, I'm going to take my phone outta my bedroom. I'll put it in the bathroom and I will turn it off. Uh uh, and I won't look at it after eight o'clock or nine o'clock, whatever time it is.[00:35:00] 

Dr. Brighten: Mm-hmm. 

Terry Wahls: So you wanna have a reason and small, achievable next steps. 

Dr. Brighten: You mentioned in your walls protocol, this [00:37:00] variety of vegetables you had, these categories of vegetables.

If we had a wide variety of plants, we will do very, very well.

Dr. Brighten: Mm-hmm. 

Terry Wahls: So. For the listenersƒ. Look at the variety of plants that grow in your [00:38:00] area. So in the big categories, look for the green leafy vegetables in herbs that are native to your area.

The, uh, cabbage family, onion family, garlic family, and mushrooms again, that are native into your area and the deeply colored vegetables native to your area. And then I, I want everyone to do a little international travel, uh, with your culinary habits. Uh, have spices from all over the world have herbs, uh, in tea from all over the world, with the goal of 200 different kinds of plant compounds.

Mm-hmm. They're exposed to. Um, uh, over the year, this becomes a wonderful family activity. Um, uh, kids will be, uh, engaged, intrigued, and interested. You can keep track of how many new different plants that you ate as a [00:39:00] family that week or that month. 

Dr. Brighten: When it comes to spices, herbs, and teas, I think those kind of get neglected in terms of nutrition and how beneficial they can be.

Can you explain why people want to start looking at variety in those areas as well? 

Terry Wahls: Um, so when we're at our conference this week, uh, people are talking about. The benefits of polyphenols. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Polyphenols are, uh, compounds that have multiple rings in them. Uh, uh, the phenols, uh, and they're large compounds.

We can't absorb them. Uh, from our gut into our bloodstream, but our bacteria will eat them, digest them, and those metabolites will get into our bloodstream and they will talk to our immune cells. They'll modulate the microbiome, they'll modulate, uh, our immune system. And that appears to be a, uh, again, one of the molecular mechanisms that our billionaire friends are identifying through their research 

Dr. Brighten: mm-hmm.

Terry Wahls: As, uh, part, uh, potent to [00:40:00] anti-aging strategies. 

Dr. Brighten: Mm-hmm. When it comes to gut health, what role is this playing in the development of neurological diseases? 

Terry Wahls: Well, uh, Alessio Fasano, uh, a, uh, pediatric, uh, GI specialist who also said he Clic disease. He made the observation that, uh, a leaky gut were increased.

Intestinal permeability is one of the very first steps of developing an overactive immune system. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: And overactive, uh, innate immune system and overactive, uh, autoimmunity. We know that if you have, uh, an overgrowth of yeast, if you have, um, uh, some of the pathogenic, uh, bacteria, uh, protozoa, uh, that can increase the, uh, leakiness of the gut, increase the activation of the innate immune system, and make it more likely that you'll have the autoimmune.

Uh, reaction. 

Dr. Brighten: Mm-hmm. So when we look at gut health, there's [00:41:00] the immune component. There's also the absorption of our foods and actually getting those nutrients in. I'm curious, are there nutrients that you've seen in the research that if you're deficient in these, this is almost a done deal that you're going to develop neurodegenerative disease?

Terry Wahls: Well, certainly if you are, uh, low in B12. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Low and folate, um, uh, uh, that. That will lead to neurodegeneration, uh, low and zinc. That will be a problem. Low and magnesium, that will be a problem. Uh, I worry about, um, you know, we have some dear family friends that are a vegetarian, vegan for their spiritual beliefs, um, which I certainly honor.

Uh, but I'm concerned that the vegetarian and vegans are. I have a much greater risk of having the low B12, uh, a low folate, and without the folate. And B12, the noted generation is, uh, greatly, greatly increased. 

Dr. Brighten: Mm-hmm. Often, whenever that's [00:42:00] presented on the podcast, there will be a vegan that says it's not that hard to get B12, but the reality is, is that.

While that person may be educated to seek out the food sources or to be supplementing, it's not true for everyone. 

Terry Wahls: Correct? It, it's not that hard. You can certainly take a, uh, B complex. You could take B12 drops if you're eating, uh, a lot of milk and dairy. Uh, you can get some B12 that way. Um, there are vegetarian vegans who are vegetarian, vegan for they're deeply held, uh.

Religious views, spiritual views in may not have learned about folate in B12. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, in zinc and magnesium. 

Dr. Brighten: Talk to us about magnesium, because there's been interesting research coming out showing that higher magnesium levels are associated with healthier brains. 

Terry Wahls: Um, yes. So, uh, magnesium, uh, and calcium are really important for, um, uh, conduction of nervous impulses, uh, conduction, uh, uh, of a contraction of muscles, [00:43:00] uh, and magnesium.

Is the central ion of chlorophyll. Mm-hmm. Much like iron is the central ion of hemoglobin. So if you eat lots and lots of green leafy vegetables, you'll have, uh, a more robust, uh, magnesium intake. Unfortunately, many of us are not eating lots and lots of green leafy vegetables. Uh, and there's, uh, I think about 60% of Americans have insufficient magnesium intake.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, which increases the prob, uh, and magnesium. Well, and I should step back for everyone. Our, um, our cells have about 2 billion chemical reactions every second. Uh, and we have enzymes that coordinate those chemical reactions to keep us alive, keep our electrolytes all in the narrow range that are optimal for, uh, life, uh, in living.

Uh, and the enzymes require vitamins and [00:44:00] mineral cofactors. So. Uh, in our diets, unfortunately, uh, over half of us have diets inadequate for magnesium, about 15 to 30% inadequate in zinc. Uh, about, uh, 30% inadequate in vitamin C. Uh, and I can't quite remember, uh, the frequencies for inadequates in our various B vitamins.

Dr. Brighten: Mm-hmm. 

Terry Wahls: It is not uncommon that we're gonna be inadequate for. One or more minerals and one or more vitamins, and particularly if you're eating a diet high in sugar added sugars and high in white flour, you're gonna be far more likely to be insufficient for your magnesium, your minerals, and your vitamins.

Dr. Brighten: Mm-hmm. You mentioned six to nine servings of vegetables a day. 

Terry Wahls: Yes. 

Dr. Brighten: How many people you think are meeting that target? 

Terry Wahls: The average intake is, uh, 1.5 servings. 

Dr. Brighten: 1.5. 

Terry Wahls: Yes. So 80% do not. 

Dr. Brighten: Mm-hmm. How do you recommend if [00:45:00] somebody right now is like, okay, I am getting one serving of vegetables a day. How do they get to that?

Six to nine? 

Terry Wahls: Um, well have a family conversation. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Start with a family conversation. What are the vegetables that you like? Uh, and begin adding those. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Um, so. Green leafy vegetables are so powerful. Um, so we talk about a, a really easy, uh, uh, we had, uh, little cooking classes for our vets. Um, so one of the things that I loved doing was passing around a kale leaf and we'd all p pull, uh, pull off a little bit, and then as a group we would start eating the kale and they'd say like, oh my God, that's bitter.

That's terrible. There's no way. No way I could eat it. No way. My kids are gonna eat it. And we say, yep, we agree. Then we take, uh, that kale leaf add. Green grapes, olive oil, ice, uh, and water. Put in a blender and we pass it around. Now that's actually a very tasty smoothie. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: And [00:46:00] they're like, well, no, I can have that.

And they agree that their spouse and kids could have it. Uh, then the next question we ask is, uh, are people eating bacon or not? If they eat bacon, then we'd wrap some bacon and we would, uh, take out the bacon at the desired level of doneness, or we would use ghee and add, uh. The kale, stir it until it's wilted.

So it's about 16 to 90 seconds. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Add the chopped bacon back and pass that around. And the vets would say, well actually that's really quite good. And I explained that. Uh, when we went low, fat vegetables became bitter. If you add fat back to the vegetables, if they still feel a little bit bitter, add little acid as in, uh, some vinegar or a citrus, uh, to bring the pH down.

Uh, they'll get rid of the bitterness. 'cause you have to have these demonstrations so that people understand how to make bitter ugh. Vegetables. 

Yeah. 

Terry Wahls: Taste [00:47:00] delicious. Yeah. 

Dr. Brighten: What do you think has been the most damaging diet trend over your lifetime that you've seen? Low 

Terry Wahls: fat. 

Dr. Brighten: Low fat. Tell us why. 

Terry Wahls: Uh, because it made vegetables bitter.

Dr. Brighten: Mm-hmm. 

Terry Wahls: And the way we compensated was we used added sugar. 

Dr. Brighten: Ah. 

Terry Wahls: So we went, yeah. Very high sugar. Uh, and, uh, we, uh, increased our white flower intake to the 70% for our kids, 60% for us. Incredibly damaging. 

Dr. Brighten: Mm-hmm. So how do we start to dig our way out of that as a culture as a whole? 

Terry Wahls: Um, well, and I should step back for people who have active heart disease and we're looking at should I have a triple bypass versus going on a low fat vegan diet to try and bring my very high cholesterol down, that's the person for whom a low fat vegan diet may be therapeutic.

For people with an autoimmune disease, with a neurologic disease, with an autoimmune disease, a very low [00:48:00] fat, uh, diet that brings your cho below one 70 increases the risk of suicide, homicide, uh, uh, impulsivity and, and serious mental health problems. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, for those folks, what I want them to do is to either embrace a Mediterranean diet or a para lithic diet.

Dr. Brighten: Okay. And for people listening, when you say a paleo diet, I feel like that has gotten its own spin online where people are like, it's just super restrictive eating. What do you mean when you say a paleo diet? 

Terry Wahls: So, um. Uh, I, I wanted to define all of this, uh, the standard American diet. High in added sugar, high and white flour.

70% of calories for kids. 60% of the calories for adults are processed foods, uh, sodas, artificial sweeteners, uh, bread, cereal, pasta. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: One and a half seres of vegetables. Uh, maybe half Serena fruit, uh, in whatever, uh, meat, uh, that you're having. A para lithic diet. Uh, now we're looking at meat and [00:49:00] vegetables.

That you can get in your region. You're not having added sugar, you're not having grain-based products. I'd rather you have vegetables.

Pumpkins, squashes, yams, potatoes, uh, instead of these, uh, starch based bread, cereal, pasta. 

Terry Wahls: I am not recommending any gluten-free, uh, processed foods. Mm-hmm. I recommend foods that are naturally gluten-free.

By that I mean vegetables. Fruit, meat, fish, poultry. Uh, I do recommend people take eggs out at least briefly 'cause uh, there may be unrecognized egg sensitivity, but at least gluten and dairy for a while. 

Dr. Brighten: Yeah. And why emphasizing these food groups, so the meat, the vegetables, the fruits, what benefit is that offering people?

Terry Wahls: Well, um, again, when I, uh, was reading, uh, uh, Dr. Bill, uh, Dr. Uh Ames, we had this long and there were actually 20 nutrients that are really good for the [00:51:00] nervous system. And I wanted to design a, uh, diet plan consistent with Paleolithic eating. That would make sure I, I had those 19 nutrients. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Uh, and so that's how I came up with, uh, you know, the green leafies, uh, the cabbage, onion, mushroom family, the deeply colored the, uh, cro, these fermented vegetables, uh, and the meats.

I did create level one. From a vegetarian and vegan friends. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: So we could, we can have a way for them to begin to have some of these health benefits as well. 

Dr. Brighten: Mm-hmm. And I think for people listening, it's important to also understand, as you were saying, it's easier to add things in. It is very difficult to reach six servings of vegetables a day when you're having one to two cups of grains at every single meal.

And so what you designed was to help people with. Disease states that frankly, medicine calls incurable. The only thing we can do is give you [00:52:00] immunosuppressants. Yeah. Wait until it's bad enough for the next drug. And they're run really offering much. 

Terry Wahls: And when I was, um, using this, my clinical practice at the Iowa City Veteran Affairs Clinics, um, my clinics were predominantly men, although I did have some women, uh, and I didn't want them to be hungry.

So my response is. Here are the food categories. You know, we're talking about meat, you know, poultry, fish, vegetables, six to nine cups. If you're still hungry, eat more, you know, meat and vegetables until you're, until you're full, you're, you're not to be hungry. This is not intended to be a weight loss diet.

Dr. Brighten: Mm-hmm. 

Terry Wahls: Now you may find that your weight drifts down to the weight you ha were at in your early twenties without being hungry. 

Dr. Brighten: Mm-hmm. I am curious for people listening to this right now. They're like, okay, I'm going to make dietary shifts. I'm going to shift my lifestyle. What's a realistic timeline to start feeling better 

Terry Wahls: [00:53:00] in?

Uh, my clinics, uh, at the va, we'd see people, uh, every month, uh, and. I had say, pretty typically within three months people are coming back. They're, uh, they have more energy, uh, they have less pain. Uh, their blood pressure's improving, uh, and we are watching, uh, their blood pressure, their blood sugar, and we might.

Be at a point where I'm beginning to nudge some of their medications down. That's probably more commonly, uh, at six months if they're on, uh, prescription meds. In my clinical trials again, uh, pretty commonly 60 to 70% will be, uh, reporting, uh, reduced fatigue, improved quality of life within 12 weeks. Uh, and that goes up to 80 to 90% within 24 weeks.

Mm-hmm. 

Dr. Brighten: So within three months, within three months 

Terry Wahls: can start to see improvements, you know, um, and I I, if you aren't experiencing that, hang in there, it may take, uh, 24 weeks. Uh, [00:54:00] and it may be that. We need to do further investigation. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: Are there other factors? Are there, uh, other toxins that we need to investigate?

Uh, might you need, uh, a elimination diet? Might you need to go to the next level? Might you have, uh, evidence of insulin resistance? And we should think about a ketogenic diet? 

Dr. Brighten: Mm-hmm. If someone's listening to this right now, they have autoimmune disease. They're feeling scared, maybe hopeless, given their conversations with their provider.

What message would you have for them? 

Terry Wahls: Well, uh, come to my website, terry walls.com. Look at some of the videos that we have, uh, um, because, you know, again, if I can come back from profound disability where I could not sit up to where, you know, I can bike for hours, I can jog in my treadmill and that we've seen.

Uh, remarkable recovery in others. There's absolutely hope for you as well. We don't know how rapidly these changes will happen, [00:55:00] but we know that if we don't do anything with your modifiable lifestyle factors, autoimmune diseases are progressive. 

Dr. Brighten: Mm-hmm. 

Terry Wahls: If you optimize your environment, if you optimize the modifiable lifestyle factors, there is a real possibility that we can stabilize your symptoms.

Regress disease activity, and we may be able to step by step, begin simplifying and your prescription medications, reducing some of the doses, and perhaps even eliminating some of these, uh, prescription meds. 

Dr. Brighten: Hmm. That is such a beautiful message. Thank you so much for taking the time to sit down with me today.

Terry Wahls: Okay.