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

0:00What does it actually mean for your mitochondria to be dysfunctional? Mitochondria make ATP the energy currency of ourselves. If our mitochondria are not working as efficiently as they should, they can't make as much ATP. And because our brain, our retina, and our heart have the highest energy demands, that's where you'll have symptoms first. Either some sort of brain-related symptom, a vision problem, or a heart-related problem. Dr. Terry Walls is a physician, researcher, and pioneer in functional medicine who turned her own diagnosis of progressive multiple sclerosis into a breakthrough approach to healing.

0:38After being confined to a wheelchair, she restored her health and now leads groundbreaking research while biking to work every day. Are there steps we can take to protect our mitochondria knowing that we've got that level exposure? I want your listeners to know that obviously the first thing I want you to do is... So good, so good, so good. New summer arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60 % off brands like Rag & Bone, Levi's, Adidas, and Free People. Join the Nordiclub to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free.

1:18Great brands, great prices. That's why you rack. Good sleep is everything. That's why OLLI's Science Back Support is made with a blend of melatonin and L-theanine for both kiddos and grownups. So when your mind won't switch off, you've got something that can help. Erasing thoughts and restless nights won't stand a chance. Find OLLI Sleep Solutions for the whole family at OLLI.com. That's O-L-L-Y dot com. What is the most dangerous misconception doctors have about autoimmune disease? Just taking a disease-modifying treatment is sufficient. that there's no role for addressing modifiable lifestyle factors.

2:00What was the turning point for you when you decided that you needed more than just what doctors were offering? When I hit the wheelchair, 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, here, you have to stop reading. We're going to find you the best center to go see and let them take care of you. So I did that. I stopped reading. Three years later, when I was in the wheelchair, I was like, I think it's time to go back to reading. And so I started reading.

2:34And then I would eventually decide that mitochondrial dysfunction is what's driving disability. And I would focus on finding supplements to support my mitochondria. 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? So our mitochondria, our ancient bacteria that about, oh, 2 billion years ago were engulfed by bigger bacteria, and those mitochondria make ATP the energy currency of our cells. If our mitochondria are not working as efficiently as they should, they can't make as much ATP.

3:17And then whatever task that's been assigned to that cell is being less and less and less effective. And because our brain, our retina, and our heart have the highest energy demands, that's where you'll have symptoms first. Either some sort of brain-related symptom, a vision problem, or a heart-related problem. When we view this through the lens of autoimmune disease, how does the mitochondria relate to the immune system dysfunction? When we're young, healthy, and vibrant, our immune cells are really quite active. We will have flares where we have more symptoms. There's an acute relapse if you have MS.

3:59If you have psoriasis, an acute flare of your skin plaques. If you have RA, swollen joints. If you have inflammatory bowel disease, worse diarrhea. So you have a flare of your autoimmune symptoms. And then things begin to quiet down 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 cells aren't working as well. We have what's known as immunosenescence, the aging of the immune cells. That's when the mitochondria are getting old. They're not making as much ATP. We don't have as many relapses or flares of our autoimmune disease.

4:41In its place, we have this relentless worsening, so worsening fatigue, worsening brain fog. If you have a neurologic problem, you'll have probably more difficulty walking, more difficulty with your memory, more difficulty with your mood, more anxiety and depression. For you specifically, so you had multiple sclerosis. Oh, I still have. Well, you still have it. Yes. But my question was going to be, what were the first signs that you wish doctors would have recognized? Well, that's a wonderful question. In retrospect, my very first brain-like symptoms began as an adolescent when I was having troubles with depression.

5:22I also had some migraines and classical migraines, visual symptoms, followed by, you know, severe headache. That would sort of come and go throughout high school, throughout undergraduate. Then in medical school, I started having these jolts of discomfort at my temple, getting a little more electrical down to my jaw. Suddenly, I realized I couldn't see out of my left eye. Fortunately for me, no one said, I think this might be optic neuritis. 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. Oh, and why is that? Well, because I was like, you know, single parent, having kids with MS, that would probably be very challenging.

6:08Mm-hmm. Yeah, I think a lot of people can relate to that. I think there's a lot of people who have developed chronic illness, and 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. To the listeners, I want to reassure you that don't feel like just because you have an autoimmune condition that you're passing that on to your kids. You have a slightly increased risk, yes, maybe 2 % to 3 % probability. the vast lion's share like 90 % is going to be due to your modifiable lifestyle factors, your toxins, your diet, your exercise, your stress, your sleep.

6:59So if you want to be a parent, that's still quite possible. Now I will want your listeners to know that obviously the first thing I want you to do is optimize all of your environmental factors as thoroughly as we can so we can get your autoimmune condition, quiet, stabilized, then regressed, and hopefully completely stabilized, regressed, and so that you no longer need active treatment. What are the top environmental contributors to autoimmune disease and neurological deficits or neurodegenerative disease? Observational studies will tell us smoking, air pollution, vitamin D, your distance from the equator, so did you get a tan or not, a childhood obesity.

7:45Those are all factors. In addition, we know that people with autoimmunity have higher rates of gluten sensitivity and non-celiac gluten sensitivity. So I tell all my autoimmune patients, have a trial of a very carefully gluten-free, dairy-free diet to see if that is you. It may not be, but it's certainly worth exploring that possibility. If you're a tobacco user or a vapor, stop that. That would be very helpful. If you can manage to have an organic diet, filter your air, have an air cleaner in your room or in your home, have a water filter for your kitchen or your home so you can have the highest quality environment that's possible.

8:34What does this science say in terms of the correlation between gluten and autoimmunity? It depends on which autoimmune condition that we're talking about. But there's a two to five fold jump in the rates of celiac disease and autoimmunity for people with an autoimmune diagnosis compared to somebody without an autoimmune diagnosis. It's not that everyone with MS has gluten 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 100 % excluded during that trial period. And I recommend at least 12 weeks.

9:20If you go 24 weeks, the memory cells are gone. And then you could reintroduce the dairy, see if you tolerate that, and then reintroduce gluten and see what happens. What do you think about people with autoimmune disease who will say, if I'm in the U.S., 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, I eat gluten and I don't have the same effect. So a couple factors here. One is that wheat grown in the United States will have a lot of glyphosate and other herbicides placed on the wheat to mature all the wheat at the same rate.

10:06So that the wheat, you get about 10 % more wheat harvested from the field. So that's very helpful for the farmer. But it means you have a much higher toxin exposure. Then Europe doesn't have glyphosate, has lower 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. What do we know about glyphosate's impact on mitochondrial health? Well, you know, basically all herbicides, pesticides, insecticides have a negative impact on our mitochondrial function.

10:50And by the way, antibiotics as well. Yeah. And so is it a small impact or a huge impact? That will depend on the individual. 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? Well, according to your financial means, have organic foods as well as you can. You can also use environmental working group. They have consumer guides for food, for cleaning products, personal care products. So you could use that to prioritize. You could 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 lettuce for 15 minutes, you know, gently swirl it around, then drain, and that will decrease the surface pesticide considerably.

11:53If you could do organic, you'll probably recover more quickly. But again, I want people to know, do less of the harmful stuff, less of the sugar, less of the white flour, more of the good stuff, protein. And if money is really tight, maybe the protein is beans and rice and vegetables, and maybe it's frozen vegetables, canned vegetables. You just do the best you can given your financial reality. 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. B vitamins, creatine, coenzyme Q.

12:37Those are the first things that I relied on. Then I discovered the work of Bruce Ames. He also talked about vitamin D, vitamin K, multivitamin, multimineral. And so, you know, gradually over time, I was adding more supplements. I had, I think, eight or nine supplements I was taking, You know, and I got sort of annoyed. I thought, I'm taking these supplements. None of the damn things happening. And I quit them. 36 hours later, I just crashed. I couldn't go to work. I was completely exhausted. After the third day, my spouse came in and said, you know, honey, why don't you take these again? I took them.

13:15And the next morning, I was back to my usual energy level. I was able to go back to work. And I thought, wow, that was super interesting. And so gradually I would develop a more comprehensive supplement protocol for my mitochondria. What if I take my long list of supplements and look at where these nutrients are in the food supply? If I was following a Paleolithic-style eating, what should I stress? And that's how I ended up creating this very structured Paleolithic diet that I basically call the WALS protocol. For listeners, can you explain what goes into the WALS protocol, the principles that you developed?

13:53Well, so I made it sort of a phased program. So the first level you could do as a vegetarian or as a meat eater. And we're taking out gluten, dairy, and eggs because those are the three most inflammatory foods. We're encouraging people to get rid of the sugar in the added white flours. and have six to nine cups of vegetables, 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 want to 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.

14:37At the second level, now this is more of a paeolithic diet, We're talking about seaweed, organ meat. We're talking about fermented vegetables, sauerkraut, kimchi, algae, prurina, 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-chain triglyceride version. And then I have a elimination diet, which takes out nuts, seeds, and nightshade vegetables. And what do people typically experience, like if they go into level one, and how do they know if they need to go into level two or three? So what I tell people is additions are easier than subtractions.

15:21Absolutely. Have a family conversation and negotiate what you're willing to do. Talk about what you want to add and what you're going to reduce. And then discuss the principles of the six to nine cups of green leafy vegetables. sulfur-rich vegetables, deeply colored vegetables, and taking out gluten and dairy, and preferably also eggs. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy.

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16:56If that's too hard, then talk about a Mediterranean diet. 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 at the VA, 80 % of folks really had tremendous success doing level one, and they didn't need to go any further. It really depends. I tell people to give it 12 to 24 weeks and then evaluate. it. 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.

17:41I 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? Do you have a high hemoglobin A1C greater than 5.8 % or higher? Is your belly bigger than your butt? Is your HDL low? Is your triglyceride greater than 150? Those are all indications that a lower carbohydrate diet may be helpful. A ketogenic diet may be helpful. And how long do you typically recommend being on a ketogenic or a low-carbohydrate diet?

18:21It depends on what it is that you're addressing. If I'm doing this because I have severe obesity and type 2 diabetes, you're going to stay on that until you have fully regressed your type 2 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 helping you. If you are already skinny and underweight. You don't do a ketogenic diet. Is there a point where in doing this protocol you ever consider leveraging supplements with people? Well, I think supplements can be super helpful.

18:59The reality is people with obesity, with chronic disease, with autoimmune disease, we have a very deep nutritional hole that has contributing to our health problems. So again, when I look at Dr. Beal's work, Dr. Bruce Aime's work, they were very consistent that, yes, improve your nutrition, but add also the vitamin D, the vitamin K, a multivitamin, multimineral. Think about creatine. Think about a multivitamin, multimineral, B vitamin, coenzyme Q. What do you say to doctors who say all those supplements are just expensive urine? They don't do anything? Are you talking to your patients about nutrition?

19:43Are you talking to your patients about meditation? Are you talking to your patients about sleep? I don't want to have people spending$1 ,000 a month on supplements. Food is the most important. A vitamin D plus vitamin K and a multivitamin, multimineral, you could do fine with just those two. Yeah. And for people listening, I think the question comes up of like, why vitamin K if we're going to do nutrition? Can you speak to where we actually get vitamin K and vitamin D and why those are so important? Vitamin K does not have an upper value. So you can take a higher dose of vitamin K. When you take vitamin D, it increases the absorption of calcium from the gut into the bloodstream.

20:30And it helps get the calcium into your teeth and bones. Really great. It can also, we know, help impact having calcium into your heart valves and 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. 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 the blood vessel wall. And what do we know specifically about the research with vitamin D, autoimmunity, proximity to the equator?

21:12Well, we know that the societies that live close to the equator have the lowest incidence of MS and other autoimmune disease. The further you get from the equator, the higher the rate. We also know from observational studies, if we measure blood values, low 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. We've tried a variety of supplement studies. Supplement studies have been disappointing, but those supplement studies don't generally measure the blood values. And most of our vitamins don't work in isolation.

21:54It's a complicated interaction, vitamin D, vitamin A, magnesium. And so what I want people to do is get their vitamin D to the top half of the reference range, get vitamin K with it, and get a tan. And get a tan, everyone. So you 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're fine. What would you want people to know about the vitamin D reference range? So the reference range is usually 20 to 80. And the research will tell us if your vitamin D is above 40, you have a lower risk of relapse, lower risk of progression, lower risk of anxiety, depression.

22:44I don't know the risk for cancers. I don't know the risk for premature labor, but probably the same. Which is why my advice to your listeners are you want your vitamin D in the top half of the reference range. So that way, if you're in the European reference range, the Canadian reference range, or the American reference range, if you just look, am I in the top half or not? That will tell you that you're at the appropriate dosing. Mm-hmm. And, you know, I made a, you know, laughed about you saying, oh, and get a tan, but I realized maybe not everyone knows why you're speaking to getting a tan. So what do we know?

23:25It appears that our skin will make vitamin D in response to the ultraviolet light, in that the vitamin D made by our skin and the interaction of ultraviolet light with our skin also has additional changes to our immune cell modulation. It is different than the vitamin D we get from taking D3 that's absorbed through our gut. I think it's just get outside. It's good for you to get some fresh air. I don't want to get a sunburn, but I do think getting outside every day and maintaining a tan is very helpful. Why do women get autoimmune disease at such an alarming rate compared to men? We have a different immune tolerance that is required so we can get pregnant and maintain the pregnancy, which appears to also increase our vulnerability to autoimmunity.

24:21Now, it's super interesting in that if you have an autoimmune disease and you're female, during the pregnancy, the severity of the autoimmune disease declines. After delivery, there is a flare with a more severe 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. And so we've done some research with that as well. So, you know, more of the autoimmune specialists are finally, you know, talking to the women. Yes, there are some drugs that are approved for DMT use while pregnant, while breastfeeding.

25:12And they are encouraging women to breastfeed after delivery. How long does breastfeeding help protect you? Is it something like as long as you breastfeed for six months or? Well, you're probably going to have to wean the child before they go to college at age 18. I would imagine. Unfortunately, I guess. So it would have to stop then. Can you breastfeed for a year, for 18 months? And yeah, I think that would be fine. The child would be eating more solid food and the milk production would be gradually declining. So I don't have clear guidance from the research. when the woman breastfeeds to that 18-month and 24-month, how that transition will go.

25:56But I certainly see the autoimmune specialists encouraging women to breastfeed to 12 months to 24 months. So you've identified postpartum. That is a very vulnerable window. And then earlier on, you spoke to that, age 45, the immune system is 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? Age 45 to 55, we're beginning to have declining estrogen, declining progesterone, more problems with sleep disruption, more aging of the immune cells.

26:40And if we have an autoimmune disease, we're much more likely to go from these episodes of disease flares to progressive disability. And unfortunately, many physicians are not asking about symptoms of menopause, not asking about sleep, their intimate relationships, not asking about moods, not asking if there's been a gradual worsening of their autoimmune-related symptoms. So those kinds of conversations would be very helpful. If we're wondering, is premenopause, menopause part of this, measure the estrogen, progesterone, FSH, LH. Understand, and also measure the thyroid hormones and maybe the prolactin.

27:27And then treat with bioidentical hormones. So saying treat with bioidentical 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. Hormones are a vital support for mitochondria as well. And this is part of the programmed cell death that begins to happen. Fourth ventricle 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 thyroid, the ovaries, the testicles, to make our hormones.

28:15When the fourth ventricle stem cells are not making as much signaling molecules, the pituitary is not making as many signaling molecules to our endocrine organs. That is part of why we have immune senescence. That's part of why we age. That is part of why we develop menopause. That is part of why we become vulnerable to infections increasingly after the age of 50, more so after the age of 60 and 65. If we use bioidentical hormones, we can prevent that. I'd love to hear your perspective and what you could share with listeners about what are the things that you'd recommend. Let's say you're 45 now.

29:01You'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 substantially. A really basic question is, what do you want your health for? It's really hard to create new habits if we don't have a why? Because it takes effort, it takes work. Now we've got some goals. And then my next question is, okay, so if we're going to be working on modifiable lifestyle factors, which domain do you want to start with? And we want it to be a small enough domain so you can be successful.